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Bösebeck F, Worthmann H, Möller C, Konrad C. The social, psychological, and physical impact of COVID-19 restrictions for institutionalized adults with intellectual and developmental disabilities. J Intellect Disabil 2024; 28:567-577. [PMID: 36999659 PMCID: PMC10067708 DOI: 10.1177/17446295231168293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
During the COVID-19 pandemic, drastic measures to interrupt SARS-CoV-2 infection chains were implemented. In our study we investigated the consequences of pandemic related restrictions on the social, psychological, and physical well-being of institutionalized adults with intellectual and developmental disabilities. Methods: Online survey among professional caregivers in 71 residential groups, caring for 848 residents. Findings: (i.) A lack of participation concerning infection protection measures of the residents, their relatives, and their caregivers; (ii.) A 20% increase in doctor contacts during the pandemic; (iii.) A considerable deterioration in at least one item of the subdomains mood (49%), everyday skills (51%), social interaction (29%), exercise and coordination skills (12%), behavior (11%) and cognition and communication (7%); (iv.) A deterioration of the overall condition in 41%; Summery: Intensive attempts should be made to find individual and less categorical contra-infectious measures without questioning the basic everyday needs of people with intellectual and developmental disabilities.
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Affiliation(s)
- F Bösebeck
- Medical Centre for Adults with Disabilities, Agaplesion Diakonieklinikum Rotenburg, Rotenburg, Germany
| | - H Worthmann
- Psychological Service, Rotenburger Werke, Rotenburg, Germany
| | - C Möller
- Department for Research, Development and Innovation Management, Agaplesion gAG, Frankfurt, Germany
| | - C Konrad
- Medical Centre for Adults with Disabilities, Agaplesion Diakonieklinikum Rotenburg, Rotenburg, Germany
- Psychiatric Department, Agaplesion Diakonieklinikum Rotenburg, Rotenburg, Germany
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Wiestler H, Zickler P, Erdur H, Abu-Mugheisib M, Kallmünzer B, Klingner C, Müller-Barna P, Hubert G, Gumbinger C, Worthmann H. Recommendations for the organization of the teleconsultation service in a telestroke network. Neurol Res Pract 2024; 6:24. [PMID: 38659040 PMCID: PMC11044278 DOI: 10.1186/s42466-024-00318-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/15/2024] [Indexed: 04/26/2024] Open
Abstract
Telestroke networks aim to improve acute stroke care within their catchment area. Through a teleconsultation service, the network centers provide support to network hospitals that lack continuous neurological expertise for acute stroke management decisions. Although the importance of telemedical treatment in stroke care is steadily increasing, so far no standards exist for the organization of the teleconsultation service in networks.To ensure a high-level of quality for all processes and measures concerning telemedical stroke treatment, the commission for telemedical stroke care of the German Stroke Society (Deutsche Schlaganfall-Gesellschaft, DSG) created the following recommendations on how to organize a teleconsultation service within a telestroke network. The recommendations are the result of an adjustment process between the authors and include guidance on requirements, qualifications, processes and quality management within the teleconsultation service.
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Affiliation(s)
- Hanni Wiestler
- Department of Neurology, Academic Teaching hospital of the Ludwig-Maximilians-University, München Klinik, Munich, Germany.
| | - Philipp Zickler
- Department of Neurology and Clinical Neurophysiology, University Augsburg, Augsburg, Germany
| | - Hebun Erdur
- Department of Neurology, Asklepios Fachklinikum Teupitz, Teupitz, Germany
- Department of Neurology, Charité University Hospital, Berlin, Germany
| | - Mazen Abu-Mugheisib
- Department of Neurology, Municipal Hospital Braunschweig, Braunschweig, Germany
| | - Bernd Kallmünzer
- Department of Neurology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen- Nürnberg, Erlangen, Germany
| | | | - Peter Müller-Barna
- Department of Neurology, Academic Teaching hospital of the Ludwig-Maximilians-University, München Klinik, Munich, Germany
| | - Gordian Hubert
- Department of Neurology, Academic Teaching hospital of the Ludwig-Maximilians-University, München Klinik, Munich, Germany
| | | | - Hans Worthmann
- Department of Neurology, Hannover Medical School, Hannover, Germany
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Schlake K, Teller J, Hinken L, Laser H, Lichtinghagen R, Schäfer A, Fegbeutel C, Weissenborn K, Jung C, Worthmann H, Gabriel MM. Butyrylcholinesterase activity in patients with postoperative delirium after cardiothoracic surgery or percutaneous valve replacement- an observational interdisciplinary cohort study. BMC Neurol 2024; 24:80. [PMID: 38424490 PMCID: PMC10905803 DOI: 10.1186/s12883-024-03580-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 02/23/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Postoperative delirium is a frequent and severe complication after cardiac surgery. Activity of butyrylcholinesterase (BChE) has been discussed controversially regarding a possible role in its development. This study aimed to investigate the relevance of BChE activity as a biomarker for postoperative delirium after cardiac surgery or percutaneous valve replacement. METHODS A total of 237 patients who received elective cardiothoracic surgery or percutaneous valve replacement at a tertiary care centre were admitted preoperatively. These patients were tested with the Montreal Cognitive Assessment investigating cognitive deficits, and assessed for postoperative delirium twice daily for three days via the 3D-CAM or the CAM-ICU, depending on their level of consciousness. BChE activity was measured at three defined time points before and after surgery. RESULTS Postoperative delirium occurred in 39.7% of patients (n = 94). Univariate analysis showed an association of pre- and postoperative BChE activity with its occurrence (p = 0.037, p = 0.001). There was no association of postoperative delirium and the decline in BChE activity (pre- to postoperative, p = 0.327). Multivariable analysis including either preoperative or postoperative BChE activity as well as age, MoCA, type 2 diabetes mellitus, coronary heart disease, type of surgery and intraoperative administration of red-cell concentrates was performed. Neither preoperative nor postoperative BChE activity was independently associated with the occurrence of postoperative delirium (p = 0.086, p = 0.484). Preoperative BChE activity was lower in older patients (B = -12.38 (95% CI: -21.94 to -2.83), p = 0.011), and in those with a history of stroke (B = -516.173 (95% CI: -893.927 to -138.420), p = 0.008) or alcohol abuse (B = -451.47 (95% CI: -868.38 to -34.55), p = 0.034). Lower postoperative BChE activity was independently associated with longer procedures (B = -461.90 (95% CI: -166.34 to -757.46), p = 0.002), use of cardiopulmonary bypass (B = -262.04 (95% CI: -485.68 to -38.39), p = 0.022), the number of administered red cell-concentrates (B = -40.99 (95% CI: -67.86 to -14.12), p = 0.003) and older age (B = -9.35 (95% CI: -16.04 to -2.66), p = 0.006). CONCLUSION BChE activity is not independently associated with the occurrence of postoperative delirium. Preoperative BChE values are related to patients' morbidity and vulnerability, while postoperative activities reflect the severity, length and complications of surgery.
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Affiliation(s)
- Konstantin Schlake
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Johannes Teller
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Lukas Hinken
- Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Hans Laser
- Department for Educational and Scientific IT Systems, Hannover Medical School, MHH Information Technology, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Ralf Lichtinghagen
- Institute of Clinical Chemistry, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Andreas Schäfer
- Cardiac Arrest Center, Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Christine Fegbeutel
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Karin Weissenborn
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Carolin Jung
- Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Hans Worthmann
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Maria Magdalena Gabriel
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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Worthmann H, Ernst J, Grosse GM. [What is confirmed in the treatment of ischemic stroke]. Inn Med (Heidelb) 2023; 64:1143-1153. [PMID: 37947809 DOI: 10.1007/s00108-023-01622-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/20/2023] [Indexed: 11/12/2023]
Abstract
Ischemic stroke is one of the leading causes of death worldwide and the most frequent cause of permanent disability in adulthood. The acute treatment of stroke is time-critical and, according to the time is brain principle, it is important to determine as soon as possible whether recanalization treatment that can save the penumbra is possible. Intravenous thrombolysis (IVT) and, if a large vessel occlusion is identified, endovascular treatment (EVT) possibly in combination with IVT, are recommended. Further treatment in a stroke unit is another important component of acute stroke treatment. The best secondary preventive treatment must already be initiated in the acute phase. The cause of stroke guides making decisions on the ideal secondary preventive strategy. The most important etiologies of stroke are cardiac embolism, atherosclerotic macroangiopathy and cerebral microangiopathy (small vessel disease). Less frequent causes are dissections of arteries supplying the brain or vasculitis. In up to 20-30% of all cases, however, no clear etiology can be determined despite intensive investigation of the cause. This means corresponding uncertainty in the optimal secondary prevention that consists in particular of an anticoagulant medication adapted to the etiology, treatment of cardiovascular risk factors and if necessary surgical or interventional desobliterative procedures. This article describes the diagnostic procedure and the evidence-based treatment of ischemic stroke.
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Affiliation(s)
- Hans Worthmann
- Neurologische Klinik mit Klinischer Neurophysiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30623, Hannover, Deutschland.
| | - Johanna Ernst
- Neurologische Klinik mit Klinischer Neurophysiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30623, Hannover, Deutschland
| | - Gerrit M Grosse
- Neurologische Klinik mit Klinischer Neurophysiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30623, Hannover, Deutschland
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Hupe J, Worthmann H, Ravenberg KK, Grosse GM, Ernst J, Haverich A, Bengel FM, Weissenborn K, Schmitto JD, Hanke JS, Derlin T, Gabriel MM. Interplay between driveline infection, vessel wall inflammation, cerebrovascular events and mortality in patients with left ventricular assist device. Sci Rep 2023; 13:18552. [PMID: 37899422 PMCID: PMC10613624 DOI: 10.1038/s41598-023-45110-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 10/16/2023] [Indexed: 10/31/2023] Open
Abstract
In patients with left ventricular assist device (LVAD), infections and thrombotic events represent severe complications. We investigated device-specific local and systemic inflammation and its impact on cerebrovascular events (CVE) and mortality. In 118 LVAD patients referred for 18F-FDG-PET/CT, metabolic activity of LVAD components, thoracic aortic wall, lymphoid and hematopoietic organs, was quantified and correlated with clinical characteristics, laboratory findings, and outcome. Driveline infection was detected in 92/118 (78%) patients by 18F-FDG-PET/CT. Activity at the driveline entry site was associated with increased signals in aortic wall (r = 0.32, p < 0.001), spleen (r = 0.20, p = 0.03) and bone marrow (r = 0.20, p = 0.03), indicating systemic interactions. Multivariable analysis revealed independent associations of aortic wall activity with activity of spleen (β = 0.43, 95% CI 0.18-0.68, p < 0.001) and driveline entry site (β = 0.04, 95% CI 0.01-0.06, p = 0.001). Twenty-two (19%) patients suffered CVE after PET/CT. In a binary logistic regression analysis metabolic activity at the driveline entry site missed the level of significance as an influencing factor for CVE after adjusting for anticoagulation (OR = 1.16, 95% CI 1-1.33, p = 0.05). Metabolic activity of the subcutaneous driveline (OR = 1.13, 95% CI 1.02-1.24, p = 0.016) emerged as independent risk factor for mortality. Molecular imaging revealed systemic inflammatory interplay between thoracic aorta, hematopoietic organs, and infected device components in LVAD patients, the latter predicting CVE and mortality.
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Affiliation(s)
- Juliane Hupe
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Hans Worthmann
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Kim K Ravenberg
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Gerrit M Grosse
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Johanna Ernst
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Axel Haverich
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Frank M Bengel
- Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany
| | - Karin Weissenborn
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Jan D Schmitto
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jasmin S Hanke
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Thorsten Derlin
- Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany
| | - Maria M Gabriel
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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Chen S, Martens-Lobenhoffer J, Weissenborn K, Kielstein JT, Lichtinghagen R, Deb-Chatterji M, Li N, Tryc AB, Goldbecker A, Dong Q, Bode-Böger SM, Worthmann H. Correction: Association of dimethylarginines and mediators of inflammation after acute ischemic stroke. J Neuroinflammation 2023; 20:103. [PMID: 37131264 PMCID: PMC10155337 DOI: 10.1186/s12974-023-02775-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Affiliation(s)
- Shufen Chen
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30623, Hannover, Germany
- Department of Neurology, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Jens Martens-Lobenhoffer
- Department of Clinical Pharmacology, Otto-Von-Guericke University of Magdeburg, University Hospital, Leipziger Strasse 44, 39120, Magdeburg, Germany
| | - Karin Weissenborn
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30623, Hannover, Germany
- Center for Systems Neuroscience (ZSN), Bünteweg 2, 30559, Hannover, Germany
| | - Jan T Kielstein
- Department of Nephrology and Hypertension, Hannover Medical School, Carl-Neuberg-Strasse 1, 30623, Hannover, Germany
| | - Ralf Lichtinghagen
- Department of Clinical Chemistry, Hannover Medical School, Carl-Neuberg-Strasse 1, 30623, Hannover, Germany
| | - Milani Deb-Chatterji
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30623, Hannover, Germany
| | - Na Li
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30623, Hannover, Germany
- Center for Systems Neuroscience (ZSN), Bünteweg 2, 30559, Hannover, Germany
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, 6, Tiantan Xili, Beijing, 100050, China
| | - Anita B Tryc
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30623, Hannover, Germany
| | - Annemarie Goldbecker
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30623, Hannover, Germany
| | - Qiang Dong
- Department of Neurology, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Stefanie M Bode-Böger
- Department of Clinical Pharmacology, Otto-Von-Guericke University of Magdeburg, University Hospital, Leipziger Strasse 44, 39120, Magdeburg, Germany
| | - Hans Worthmann
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30623, Hannover, Germany.
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Worthmann H, Winzer S, Schuppner R, Gumbinger C, Barlinn J. Telestroke networks for area-wide access to endovascular stroke treatment. Neurol Res Pract 2023; 5:9. [PMID: 36864498 PMCID: PMC9983226 DOI: 10.1186/s42466-023-00237-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/24/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Endovascular therapy (EVT) offers a highly effective therapy for patients with acute ischemic stroke due to large vessel occlusion. Comprehensive stroke centers (CSC) are required to provide permanent accessibility to EVT. However, when affected patients are not located in the immediate catchment area of a CSC, i.e. in rural or structurally weaker areas, access to EVT is not always ensured. MAIN BODY Telestroke networks play a crucial role in closing this healthcare coverage gap and thereby support specialized stroke treatment. The aim of this narrative review is to elaborate the concepts for the indication and transfer of EVT candidates via telestroke networks in acute stroke care. The targeted readership includes both comprehensive stroke centers and peripheral hospitals. The review is intended to identify ways to design care beyond those areas with narrow access to stroke unit care to provide the indicated highly effective acute therapies on a region-wide basis. Here, the two different models of care: "mothership" and "drip-and-ship" concerning rates of EVT and its complications as well as outcomes are compared. Decisively, forward-looking new model approaches such as a third model the "flying/driving interentionalists" are introduced and discussed, as far as few clinical trials have investigated these approaches. Diagnostic criteria used by the telestroke networks to enable appropriate patient selection for secondary intrahospital emergency transfers are displayed, which need to meet the criteria in terms of speed, quality and safety. CONCLUSION The few findings from the studies with telestroke networks are neutral for comparison in the drip-and-ship and mothership models. Supporting spoke centres through telestroke networks currently seems to be the best option for offering EVT to a population in structurally weaker regions without direct access to a CSC. Here, it is essential to map the individual reality of care depending on the regional circumstances.
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Affiliation(s)
- Hans Worthmann
- Klinik Für Neurologie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30623, Hannover, Germany.
| | - S. Winzer
- grid.412282.f0000 0001 1091 2917Klinik Für Neurologie, Universitätsklinikum Dresden, Dresden, Germany
| | - R. Schuppner
- grid.10423.340000 0000 9529 9877Klinik Für Neurologie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30623 Hannover, Germany
| | - C. Gumbinger
- grid.5253.10000 0001 0328 4908Klinik Für Neurologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - J. Barlinn
- grid.412282.f0000 0001 1091 2917Klinik Für Neurologie, Universitätsklinikum Dresden, Dresden, Germany
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Ravenberg KK, Gabriel MM, Leotescu A, Tran AT, Grosse GM, Schuppner R, Ernst J, Lichtinghagen R, Tiede A, Werwitzke S, Bara CL, Schmitto JD, Weissenborn K, Hanke JS, Worthmann H. Microembolic signal monitoring in patients with HeartMate 3 and HeartWare left ventricular assist devices: Association with antithrombotic treatment and cerebrovascular events. Artif Organs 2023; 47:370-379. [PMID: 36114791 DOI: 10.1111/aor.14409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 08/07/2022] [Accepted: 09/06/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND In patients with left ventricular assist devices (LVADs), ischemic and hemorrhagic stroke are dreaded complications. Predictive markers for these events are lacking. This study aimed to investigate the prevalence and predictive value of microembolic signals (MES) for stroke, detected by Transcranial Doppler sonography (TCD) in patients with HeartMate 3 (HM 3) or HeartWare (HW). METHODS A thirty-minute bilateral TCD monitoring of the middle cerebral artery (MCA) was performed in 62 outpatients with LVAD (HM 3 N = 31, HW N = 31) and 31 healthy controls. Prevalence and quantity of MES were investigated regarding clinical and laboratory parameters. Cerebrovascular events (CVE) were recorded on follow-up at 90 and 180 days. RESULTS MES were detected in six patients with HM 3, three patients with HW, and three controls. Within the LVAD groups, patients on monotherapy with vitamin-K-antagonist (VKA) without antiplatelet therapy were at risk for a higher count of MES (negative binomial regression: VKA: 1; VKA + ASA: Exp(B) = 0.005, 95%CI 0.001-0.044; VKA + clopidogrel: Exp(B) = 0.012, 95%CI 0.002-0.056). There was no association between the presence of MES and CVE or death on follow-up (p > 0.05). CONCLUSION For the first time, the prevalence of MES was prospectively investigated in a notable outpatient cohort of patients with HM 3 and HW. Despite optimized properties of the latest LVAD, MES remain detectable depending on antithrombotic therapy. No association between MES and CVE could be detected.
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Affiliation(s)
| | | | - Andrei Leotescu
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Anh Thu Tran
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | | | - Ramona Schuppner
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Johanna Ernst
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Ralf Lichtinghagen
- Institute of Clinical Chemistry, Hannover Medical School, Hannover, Germany
| | - Andreas Tiede
- Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Sonja Werwitzke
- Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Christoph Leon Bara
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jan Dieter Schmitto
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | | | - Jasmin Sarah Hanke
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Hans Worthmann
- Department of Neurology, Hannover Medical School, Hannover, Germany
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Hasse IMC, Grosse GM, Schuppner R, Van Gemmeren T, Gabriel MM, Weissenborn K, Lichtinghagen R, Worthmann H. Circulating Inflammatory Biomarkers in Early Prediction of Stroke-Associated Infections. Int J Mol Sci 2022; 23:ijms232213747. [PMID: 36430226 PMCID: PMC9694763 DOI: 10.3390/ijms232213747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 11/10/2022] Open
Abstract
(1) Background: Patients with acute ischaemic stroke (AIS) are at high risk for stroke-associated infections (SAIs). We hypothesised that increased concentrations of systemic inflammation markers predict SAIs and unfavourable outcomes; (2) Methods: In 223 patients with AIS, blood samples were taken at ≤24 h, 3 d and 7d after a stroke, to determine IL-6, IL-10, CRP and LBP. The outcome was assessed using the modified Rankin Scale at 90 d. Patients were thoroughly examined regarding the development of SAIs; (3) Results: 47 patients developed SAIs, including 15 lower respiratory tract infections (LRTIs). IL-6 and LBP at 24 h differed, between patients with and without SAIs (IL-6: p < 0.001; LBP: p = 0.042). However, these associations could not be confirmed after adjustment for age, white blood cell count, reduced consciousness and NIHSS. When considering the subgroup of LRTIs, in patients who presented early (≤12 h after stroke, n = 139), IL-6 was independently associated with LRTIs (OR: 1.073, 95% CI: 1.002−1.148). The ROC-analysis for prediction of LRTIs showed an AUC of 0.918 for the combination of IL-6 and clinical factors; (4) Conclusions: Blood biomarkers were not predictive for total SAIs. At early stages, IL-6 was independently associated with outcome-relevant LRTIs. Further studies need to clarify the use of biochemical markers to identify patients prone to SAIs.
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Affiliation(s)
- Isabel M. C. Hasse
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany
| | - Gerrit M. Grosse
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany
| | - Ramona Schuppner
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany
| | - Till Van Gemmeren
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany
| | - Maria M. Gabriel
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany
| | - Karin Weissenborn
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany
| | - Ralf Lichtinghagen
- Institute of Clinical Chemistry, Hannover Medical School, 30625 Hannover, Germany
| | - Hans Worthmann
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany
- Correspondence: ; Tel.: +49-511-532-3580; Fax: +49-511-532-18625
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10
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Teller J, Jung C, Wilke JB, Schimmelpfennig SD, Hindermann M, Hinken L, Gabriel MM, Fegbeutel C, Schäfer A, Laser H, Lichtinghagen R, Worthmann H, Weissenborn K, Ehrenreich H. Autoantibodies against NMDAR subunit NR1 disappear from blood upon anesthesia. Brain Behav Immun Health 2022; 24:100494. [PMID: 35965838 PMCID: PMC9372600 DOI: 10.1016/j.bbih.2022.100494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/22/2022] [Accepted: 07/27/2022] [Indexed: 11/24/2022] Open
Abstract
Anesthetics penetrate the blood-brain-barrier (BBB) and - as confirmed preclinically – transiently disrupt it. An analogous consequence in humans has remained unproven. In mice, we previously reported that upon BBB dysfunction, the brain acts as ‘immunoprecipitator’ of autoantibodies against N-methyl-D-aspartate-receptor subunit-NR1 (NMDAR1-AB). We thus hypothesized that during human anesthesia, pre-existing NMDAR1-AB will specifically bind to brain. Screening of N = 270 subjects undergoing general anesthesia during cardiac surgery for serum NMDAR1-AB revealed N = 25 NMDAR1-AB seropositives. Only N = 14 remained positive post-surgery. No changes in albumin, thyroglobulin or CRP were associated with reduction of serum NMDAR1-AB. Thus, upon anesthesia, BBB opening likely occurs also in humans. Whether the blood brain barrier opens on general anesthesia in humans is unclear. Serum NMDAR1-AB titers drop upon anesthesia during cardiac surgery. Drop of serum NMDAR1-AB after anesthesia indicates ‘immunoprecipitation’ by brain. Immunoprecipitation needs brain access of NMDAR1-AB, indicating barrier opening. Neither hemodilution nor inflammation explain this loss of NMDAR1-AB from serum.
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11
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Ernst J, Storch KF, Tran AT, Gabriel MM, Leotescu A, Boeck AL, Huber MK, Abu-Fares O, Bronzlik P, Götz F, Worthmann H, Schuppner R, Grosse GM, Weissenborn K. Advancement of door-to-needle times in acute stroke treatment after repetitive process analysis: never give up! Ther Adv Neurol Disord 2022; 15:17562864221122491. [PMID: 36147621 PMCID: PMC9486271 DOI: 10.1177/17562864221122491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/05/2022] [Indexed: 11/21/2022] Open
Abstract
Background: In acute ischemic stroke, timely treatment is of utmost relevance.
Identification of delaying factors and knowledge about challenges concerning
hospital structures are crucial for continuous improvement of process times
in stroke care. Objective: In this study, we report on our experience in optimizing the door-to-needle
time (DNT) at our tertiary care center by continuous quality
improvement. Methods: Five hundred forty patients with acute ischemic stroke receiving intravenous
thrombolysis (IVT) at Hannover Medical School were consecutively analyzed in
two phases. In study phase I, including 292 patients, process times and
delaying factors were collected prospectively from May 2015 until September
2017. In study phase II, process times of 248 patients were obtained from
January 2019 until February 2021. In each study phase, a new clinical
standard operation procedure (SOP) was implemented, considering previously
identified delaying factors. Pre- and post-SOP treatment times and delaying
factors were analyzed to evaluate the new protocols. Results: In study phase I, SOP I reduced the median DNT by 15 min. The probability to
receive treatment within 30 min after admission increased by factor 5.35
[95% confidence interval (CI): 2.46–11.66]. Further development of the SOP
with implementation of a mobile thrombolysis kit led to a further decrease
of DNT by 5 min in median in study phase II. The median DNT was 29
(25th–75th percentiles: 18–44) min, and the probability to undergo IVT
within 15 min after admission increased by factor 4.2 (95% CI: 1.63–10.83)
compared with study phase I. Conclusion: Continuous process analysis and subsequent development of targeted workflow
adjustments led to a substantial improvement of DNT. These results
illustrate that with appropriate vigilance, there is constantly an
opportunity for improvement in stroke care.
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Affiliation(s)
- Johanna Ernst
- Department of Neurology, Hannover Medical School, Carl-Neuberg Strasse 1, Hannover 30625, Lower Saxony, Germany
| | - Kai F Storch
- Department of Neurology, Hannover Medical School, Hannover, Germany.,Department of Anesthesiology, Hannover Medical School, Hannover, Germany
| | - Anh Thu Tran
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Maria M Gabriel
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Andrei Leotescu
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Anna-Lena Boeck
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Meret K Huber
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Omar Abu-Fares
- Department of Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Paul Bronzlik
- Department of Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Friedrich Götz
- Department of Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Hans Worthmann
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Ramona Schuppner
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Gerrit M Grosse
- Department of Neurology, Hannover Medical School, Hannover, Germany
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12
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Fricke CZ, Stevens FG, Worthmann H, Beneke J, Bott OJ, Boeck AL, Ernst J, Goetz F, Schiele S, Marschollek M, Schulze M. Implementation of a Mobile Application in Acute Stroke Care Documentation. Stud Health Technol Inform 2022; 295:320-323. [PMID: 35773873 DOI: 10.3233/shti220727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Acute stroke care is a time-critical process. Improving communication and documentation process may support a positive effect on medical outcome. To achieve this goal, a new system using a mobile application has been integrated into existing infrastructure at Hannover Medical School (MHH). Within a pilot project, this system has been brought into clinical daily routine in February 2022. Insights generated may support further applications in clinical use-cases.
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Affiliation(s)
| | | | | | - Jan Beneke
- Center of Information Management, Hannover Medical School
| | | | | | | | | | - Sibylle Schiele
- Inpatient Operations, Planning and Analytics, Hannover Medical School
| | - Michael Marschollek
- Peter L. Reichertz Institute for Medical Informatics, Hannover Medical School
| | - Mareike Schulze
- Peter L. Reichertz Institute for Medical Informatics, Hannover Medical School
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13
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de Buhr N, Baumann T, Werlein C, Fingerhut L, Imker R, Meurer M, Götz F, Bronzlik P, Kühnel MP, Jonigk DD, Ernst J, Leotescu A, Gabriel MM, Worthmann H, Lichtinghagen R, Tiede A, von Köckritz-Blickwede M, Falk CS, Weissenborn K, Schuppner R, Grosse GM. Insights Into Immunothrombotic Mechanisms in Acute Stroke due to Vaccine-Induced Immune Thrombotic Thrombocytopenia. Front Immunol 2022; 13:879157. [PMID: 35619694 PMCID: PMC9128407 DOI: 10.3389/fimmu.2022.879157] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/11/2022] [Indexed: 12/29/2022] Open
Abstract
During the COVID-19 pandemic, vaccination is the most important countermeasure. Pharmacovigilance concerns however emerged with very rare, but potentially disastrous thrombotic complications following vaccination with ChAdOx1. Platelet factor-4 antibody mediated vaccine-induced immune thrombotic thrombocytopenia (VITT) was described as an underlying mechanism of these thrombotic events. Recent work moreover suggests that mechanisms of immunothrombosis including neutrophil extracellular trap (NET) formation might be critical for thrombogenesis during VITT. In this study, we investigated blood and thrombus specimens of a female patient who suffered severe stroke due to VITT after vaccination with ChAdOx1 in comparison to 13 control stroke patients with similar clinical characteristics. We analyzed cerebral thrombi using histological examination, staining of complement factors, NET-markers, DNase and LL-37. In blood samples at the hyper-acute phase of stroke and 7 days later, we determined cell-free DNA, myeloperoxidase-histone complexes, DNase activity, myeloperoxidase activity, LL-37 and inflammatory cytokines. NET markers were identified in thrombi of all patients. Interestingly, the thrombus of the VITT-patient exclusively revealed complement factors and high amounts of DNase and LL-37. High DNase activity was also measured in blood, implying a disturbed NET-regulation. Furthermore, serum of the VITT-patient inhibited reactive oxygen species-dependent NET-release by phorbol-myristate-acetate to a lesser degree compared to controls, indicating either less efficient NET-inhibition or enhanced NET-induction in the blood of the VITT-patient. Additionally, the changes in specific cytokines over time were emphasized in the VITT-patient as well. In conclusion, insufficient resolution of NETs, e.g. by endogenous DNases or protection of NETs against degradation by embedded factors like the antimicrobial peptide LL-37 might thus be an important factor in the pathology of VITT besides increased NET-formation. On the basis of these findings, we discuss the potential implications of the mechanisms of disturbed NETs-degradation for diagnostic and therapeutic approaches in VITT-related thrombogenesis, other auto-immune disorders and beyond.
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Affiliation(s)
- Nicole de Buhr
- Department of Biochemistry, University of Veterinary Medicine Hannover, Hannover, Germany.,Research Center for Emerging Infections and Zoonoses (RIZ), University of Veterinary Medicine Hannover, Hannover, Germany
| | - Tristan Baumann
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | | | - Leonie Fingerhut
- Department of Biochemistry, University of Veterinary Medicine Hannover, Hannover, Germany.,Research Center for Emerging Infections and Zoonoses (RIZ), University of Veterinary Medicine Hannover, Hannover, Germany.,Clinic for Horses, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Rabea Imker
- Department of Biochemistry, University of Veterinary Medicine Hannover, Hannover, Germany.,Research Center for Emerging Infections and Zoonoses (RIZ), University of Veterinary Medicine Hannover, Hannover, Germany
| | - Marita Meurer
- Department of Biochemistry, University of Veterinary Medicine Hannover, Hannover, Germany.,Research Center for Emerging Infections and Zoonoses (RIZ), University of Veterinary Medicine Hannover, Hannover, Germany
| | - Friedrich Götz
- Institute of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Paul Bronzlik
- Institute of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Mark P Kühnel
- Institute of Pathology, Hannover Medical School, Hannover, Germany.,Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
| | - Danny D Jonigk
- Institute of Pathology, Hannover Medical School, Hannover, Germany.,Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
| | - Johanna Ernst
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Andrei Leotescu
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Maria M Gabriel
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Hans Worthmann
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Ralf Lichtinghagen
- Institute of Clinical Chemistry, Hannover Medical School, Hannover, Germany
| | - Andreas Tiede
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Maren von Köckritz-Blickwede
- Department of Biochemistry, University of Veterinary Medicine Hannover, Hannover, Germany.,Research Center for Emerging Infections and Zoonoses (RIZ), University of Veterinary Medicine Hannover, Hannover, Germany
| | - Christine S Falk
- Institute of Transplant Immunology, Hannover Medical School, Hannover, Germany
| | | | - Ramona Schuppner
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Gerrit M Grosse
- Department of Neurology, Hannover Medical School, Hannover, Germany
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14
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Khallieva V, Sinke C, Zedler M, Worthmann H, Bleich S, Szycik GR. Dreaming and lucidity in synesthesia. Dreaming 2022. [DOI: 10.1037/drm0000190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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15
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Grosse GM, Blume N, Abu-Fares O, Götz F, Ernst J, Leotescu A, Gabriel MM, van Gemmeren T, Worthmann H, Lichtinghagen R, Imker R, Falk CS, Weissenborn K, Schuppner R, de Buhr N. Endogenous Deoxyribonuclease Activity and Cell-Free Deoxyribonucleic Acid in Acute Ischemic Stroke: A Cohort Study. Stroke 2022; 53:1235-1244. [PMID: 34991335 DOI: 10.1161/strokeaha.121.036299] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE Cell-free DNA (cfDNA) and endogenous deoxyribonuclease activity are opposing mediators and might influence the inflammatory response following acute ischemic stroke. In this cohort study, we investigated the relation between these markers, circulating inflammatory mediators and clinical course including occurrence of stroke-associated infections (SAI) in patients with acute stroke. METHODS Ninety-two patients with stroke due to large vessel occlusion undergoing mechanical thrombectomy were prospectively recruited at Hannover Medical School from March 2018 to August 2019. Deoxyribonuclease activity, cfDNA, damage-associated molecular patterns, and circulating cytokines were measured in venous blood collected immediately before mechanical thrombectomy and 7 days later. Reperfusion status was categorized (sufficient/insufficient). Clinical outcome was evaluated using the modified Rankin Scale after 90 days, where a score of 3 to 6 was considered unfavorable. To validate findings regarding SAI, another stroke cohort (n=92) was considered with blood taken within 24 hours after stroke onset. RESULTS Patients with unfavorable clinical outcome had higher cfDNA concentrations. After adjustment for confounders (Essen Stroke Risk Score, National Institutes of Health Stroke Scale, and sex), 7-day cfDNA was independently associated with clinical outcome and especially mortality (adjusted odds ratio: 3.485 [95% CI, 1.001-12.134] and adjusted odds ratio: 9.585 [95% CI, 2.006-45.790]). No association was found between reperfusion status and cfDNA or deoxyribonuclease activity. While cfDNA concentrations correlated positively, deoxyribonuclease activity inversely correlated with distinct biomarkers. Baseline deoxyribonuclease activity was lower in patients who developed SAI compared with patients without SAI. This association was confirmed after adjustment for confounding factors (adjusted odds ratio: 0.447 [95% CI, 0.237-0.844]). In cohort 2, differences of deoxyribonuclease activity between patients with and without SAI tended to be higher with higher stroke severity. CONCLUSIONS The interplay of endogenous deoxyribonuclease activity and cfDNA in acute stroke entails interesting novel diagnostic and potential therapeutic approaches. We confirm an independent association of cfDNA with a detrimental clinical course after stroke due to large vessel occlusion. This study provides first evidence for lower endogenous deoxyribonuclease activity as risk factor for SAI after severe stroke.
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Affiliation(s)
- Gerrit M Grosse
- Department of Neurology, Hannover Medical School, Germany. (G.M.G., N.B., J.E., A.L., M.M.G., T.v.G., H.W., K.W., R.S.)
| | - Nicole Blume
- Department of Neurology, Hannover Medical School, Germany. (G.M.G., N.B., J.E., A.L., M.M.G., T.v.G., H.W., K.W., R.S.)
| | - Omar Abu-Fares
- Institute of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Germany. (O.A.-F., F.G.)
| | - Friedrich Götz
- Institute of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Germany. (O.A.-F., F.G.)
| | - Johanna Ernst
- Department of Neurology, Hannover Medical School, Germany. (G.M.G., N.B., J.E., A.L., M.M.G., T.v.G., H.W., K.W., R.S.)
| | - Andrei Leotescu
- Department of Neurology, Hannover Medical School, Germany. (G.M.G., N.B., J.E., A.L., M.M.G., T.v.G., H.W., K.W., R.S.)
| | - Maria M Gabriel
- Department of Neurology, Hannover Medical School, Germany. (G.M.G., N.B., J.E., A.L., M.M.G., T.v.G., H.W., K.W., R.S.)
| | - Till van Gemmeren
- Department of Neurology, Hannover Medical School, Germany. (G.M.G., N.B., J.E., A.L., M.M.G., T.v.G., H.W., K.W., R.S.)
| | - Hans Worthmann
- Department of Neurology, Hannover Medical School, Germany. (G.M.G., N.B., J.E., A.L., M.M.G., T.v.G., H.W., K.W., R.S.)
| | - Ralf Lichtinghagen
- nstitute of Clinical Chemistry, Hannover Medical School, Germany. (R.L.)
| | - Rabea Imker
- Department of Biochemistry, University of Veterinary Medicine Hannover, Germany. (R.I., N.d.B.).,Research Center for Emerging Infections and Zoonoses (RIZ), University of Veterinary Medicine Hannover, Germany. (R.I., N.d.B.)
| | - Christine S Falk
- Institute of Transplant Immunology, Hannover Medical School, Germany. (C.S.F.)
| | - Karin Weissenborn
- Department of Neurology, Hannover Medical School, Germany. (G.M.G., N.B., J.E., A.L., M.M.G., T.v.G., H.W., K.W., R.S.)
| | - Ramona Schuppner
- Department of Neurology, Hannover Medical School, Germany. (G.M.G., N.B., J.E., A.L., M.M.G., T.v.G., H.W., K.W., R.S.)
| | - Nicole de Buhr
- Department of Biochemistry, University of Veterinary Medicine Hannover, Germany. (R.I., N.d.B.).,Research Center for Emerging Infections and Zoonoses (RIZ), University of Veterinary Medicine Hannover, Germany. (R.I., N.d.B.)
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16
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Deutsch NR, Worthmann H, Steixner-Kumar AA, Schuppner R, Grosse GM, Pan H, Gabriel MM, Hasse I, van Gemmeren T, Lichtinghagen R, Ehrenreich H, Weissenborn K. Autoantibodies against the NMDAR subunit NR1 are associated with neuropsychiatric outcome after ischemic stroke. Brain Behav Immun 2021; 96:73-79. [PMID: 34010714 DOI: 10.1016/j.bbi.2021.05.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/12/2021] [Accepted: 05/14/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND AND PURPOSE Preexisting autoantibodies against N-methyl-D-aspartate-receptor subunit NR1 (NMDAR1-AB) in acute ischemic stroke patients with previously intact blood-brain-barrier were associated with smaller evolution of lesion size. Effects of chronic exposure to NMDAR1-AB long after stroke, however, have remained unclear. We investigated in a prospective follow-up study whether long-term neuropsychiatric outcome after stroke differs depending on NMDAR1-AB status. METHODS Blood samples for NMDAR1-AB analysis were collected within 24 h after ischemic stroke from n = 114 patients. Outcome was assessed 1-3 years later using NIHSS, modified Rankin-scale, Barthel-Index, RBANS (Repeatable Battery for the Assessment of Neuropsychological Status) subcategories (immediate/delayed memory, attention, visuoconstruction), anamnesis evaluating neuropsychiatric symptoms (e.g. hallucinations, psychomotor slowing, reduced alertness, depressiveness, fatigue) and questionnaires (Beck's Depression Inventory-BDI, Fatigue Impact Scale-FIS). Scores were generated to cover RBANS plus neuropsychiatric symptoms (Score A; n = 96) or only neuropsychiatric symptoms (Score B; n = 114, including patients unable to conduct RBANS). Depression/fatigue were measured in patients, capable to perform questionnaires (n = 86). RESULTS NMDAR1-AB (IgM, IgA, IgG) were detected in n = 27 patients (23.7%). NMDAR1-AB seropositive patients showed inferior results in Score A (p = 0.006), Score B (p = 0.004), BDI (p = 0.013) and FIS (p = 0.018), compared to seronegative patients. Multiple regression analysis including covariates age, NIHSS at day 7 post-stroke, and days from stroke to follow-up, showed NMDAR1-AB seropositivity associated with worse outcome in Scores A (b: 1.517, 95%CI: 0.505-2.529, p = 0.004) and B (b: 0.803, 95%CI: 0.233-1.373; p = 0.006). Also FIS was unfavorably associated with NMDAR1-AB seropositivity (binary logistic regression: OR: 3.904, 95%CI: 1.200-12.695; p = 0.024). CONCLUSIONS Even though the numbers of included patients are low, our data apparently indicate that NMDAR1-AB seropositivity at the time point of acute ischemic stroke is associated with neuropsychiatric symptoms including cognitive dysfunction and fatigue years after stroke. Preclinical proof of a causal relation provided, targeted immunosuppression may be a future prophylactic option to be clinically evaluated.
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Affiliation(s)
- Nadine R Deutsch
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Hans Worthmann
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Agnes A Steixner-Kumar
- Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Hermann-Rein-Str. 3, 37075 Göttingen, Germany
| | - Ramona Schuppner
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Gerrit M Grosse
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Hong Pan
- Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Hermann-Rein-Str. 3, 37075 Göttingen, Germany
| | - Maria M Gabriel
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Isabel Hasse
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Till van Gemmeren
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Ralf Lichtinghagen
- Department of Clinical Chemistry, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Hannelore Ehrenreich
- Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Hermann-Rein-Str. 3, 37075 Göttingen, Germany
| | - Karin Weissenborn
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
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17
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Grosse GM, Werlein C, Blume N, Abu-Fares O, Götz F, Gabriel MM, Ernst J, Leotescu A, Worthmann H, Kühnel MP, Jonigk DD, Falk CS, Weissenborn K, Schuppner R. Circulating Cytokines and Growth Factors in Acute Cerebral Large Vessel Occlusion-Association with Success of Endovascular Treatment. Thromb Haemost 2021; 122:623-632. [PMID: 34225367 PMCID: PMC9142215 DOI: 10.1055/a-1544-5431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Mechanical thrombectomy (MT) is a highly efficient treatment in patients with acute ischemic stroke due to large vessel occlusion (LVO). However, in a relevant proportion of LVO, no sufficient recanalization can be achieved. The composition of cerebral thrombi is highly heterogeneous and may constitute a relevant factor for insufficient reperfusion. We hypothesized that circulating cytokines and growth factors involved in thromboinflammation and platelet activation may be associated with reperfusion status and thrombus composition in patients undergoing MT. An according biomarker panel was measured in plasma specimens taken prior to MT and at a 7-day follow-up. The reperfusion status was categorized into sufficient or insufficient. The composition of retrieved thrombi was histologically analyzed. Differences of baseline biomarker concentrations between insufficient and sufficient reperfusions were highest for interferon (IFN)-γ, epidermal growth factor, platelet-derived growth factor (PDGF)-AB/BB, and IFN-γ-induced protein 10 (IP-10/CXCL10). After applying correction for multiple comparisons and logistic regression analysis adjusting for stroke etiology, intravenous thrombolysis, and vascular risk factors, PDGF-AB/BB was identified as an independent predictor of reperfusion status (odds ratio: 0.403; 95% confidence interval: 0.199-0.819). Histological analysis revealed that the majority of thrombi had a mixed composition. In conclusion, this study provides the first evidence that cytokines and growth factors are potential effectors in patients undergoing MT for the treatment of acute ischemic stroke.
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Affiliation(s)
- Gerrit M. Grosse
- Department of Neurology, Hannover Medical School, Hannover, Germany,Address for correspondence Gerrit M. Grosse, MD Department of Neurology, Hannover Medical SchoolCarl-Neuberg-Str. 1, 30625 HannoverGermany
| | | | - Nicole Blume
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Omar Abu-Fares
- Institute of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Friedrich Götz
- Institute of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Maria M. Gabriel
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Johanna Ernst
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Andrei Leotescu
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Hans Worthmann
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Mark P. Kühnel
- Institute of Pathology, Hannover Medical School, Hannover, Germany,Member of the German Center for Lung Research (DZL), Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
| | - Danny D. Jonigk
- Institute of Pathology, Hannover Medical School, Hannover, Germany,Member of the German Center for Lung Research (DZL), Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
| | - Christine S. Falk
- Institute of Transplant Immunology, Hannover Medical School, Hannover, Germany
| | | | - Ramona Schuppner
- Department of Neurology, Hannover Medical School, Hannover, Germany
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18
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Weissenborn K, Gruber S, Grosse GM, Gabriel M, Schuppner R, Worthmann H, Abu-Fares O, Götz F. Endovascular Treatment of Acute Ischemic Stroke in Clinical Practice: Analysis of Workflow and Outcome in a Tertiary Care Center. Front Neurol 2021; 12:657345. [PMID: 34163422 PMCID: PMC8215500 DOI: 10.3389/fneur.2021.657345] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/27/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose: Pre- and intra-hospital workflow in mechanical recanalization of large cervicocephalic arteries in patients with acute ischemic stroke still needs optimization. In this study, we analyze workflow and outcome in our routine care of stroke patients undergoing mechanical thrombectomy as a precondition for such optimization. Methods: Processes of pre- and intra-hospital management, causes of treatment delay, imaging results (Alberta Stroke Program Early Computed Tomography Score, localization of vessel occlusion), recanalization (modified thrombolysis in cerebral infarction score), and patient outcome (modified Rankin scale at discharge and at the end of inpatient rehabilitation) were analyzed for all patients who underwent mechanical thrombectomy between April 1, 2016, and September 30, 2018, at our site. Results: Finally, data of 282 patients were considered, of whom 150 (53%) had been referred from external hospitals. Recanalization success and patient outcome were similar to randomized controlled thrombectomy studies and registries. Delay in treatment occurred when medical treatment of a hypertensive crisis, epileptic fits, vomiting, or agitation was mandatory but also due to missing prenotification of the hospital emergency staff by the rescue service, multiple mode or repeated brain imaging, and transfer from another hospital. Even transfer from external hospitals located within a 10-km radius of our endovascular treatment center led to a median increase of the onset-to-groin time of ~60 min. Conclusion: The analysis revealed several starting points for an improvement in the workflow of thrombectomy in our center. Analyses of workflow and treatment results should be carried out regularly to identify the potential for optimization of operational procedures and selection criteria for patients who could benefit from endovascular treatment.
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Affiliation(s)
| | - Sam Gruber
- Clinic for Neurology, Hannover Medical School, Hannover, Germany
| | - Gerrit M Grosse
- Clinic for Neurology, Hannover Medical School, Hannover, Germany
| | - Maria Gabriel
- Clinic for Neurology, Hannover Medical School, Hannover, Germany
| | - Ramona Schuppner
- Clinic for Neurology, Hannover Medical School, Hannover, Germany
| | - Hans Worthmann
- Clinic for Neurology, Hannover Medical School, Hannover, Germany
| | - Omar Abu-Fares
- Hannover Medical School, Institute for Diagnostic and Interventional Neuroradiology, Hannover, Germany
| | - Friedrich Götz
- Hannover Medical School, Institute for Diagnostic and Interventional Neuroradiology, Hannover, Germany
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19
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Barlinn J, Winzer S, Worthmann H, Urbanek C, Häusler KG, Günther A, Erdur H, Görtler M, Busetto L, Wojciechowski C, Schmitt J, Shah Y, Büchele B, Sokolowski P, Kraya T, Merkelbach S, Rosengarten B, Stangenberg-Gliss K, Weber J, Schlachetzki F, Abu-Mugheisib M, Petersen M, Schwartz A, Palm F, Jowaed A, Volbers B, Zickler P, Remi J, Bardutzky J, Bösel J, Audebert HJ, Hubert GJ, Gumbinger C. [Telemedicine in stroke-pertinent to stroke care in Germany]. Nervenarzt 2021; 92:593-601. [PMID: 34046722 PMCID: PMC8184549 DOI: 10.1007/s00115-021-01137-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/24/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND OBJECTIVE Telemedical stroke networks improve stroke care and provide access to time-dependent acute stroke treatment in predominantly rural regions. The aim is a presentation of data on its utility and regional distribution. METHODS The working group on telemedical stroke care of the German Stroke Society performed a survey study among all telestroke networks. RESULTS Currently, 22 telemedical stroke networks including 43 centers (per network: median 1.5, interquartile range, IQR, 1-3) as well as 225 cooperating hospitals (per network: median 9, IQR 4-17) operate in Germany and contribute to acute stroke care delivery to 48 million people. In 2018, 38,211 teleconsultations (per network: median 1340, IQR 319-2758) were performed. The thrombolysis rate was 14.1% (95% confidence interval 13.6-14.7%) and transfer for thrombectomy was initiated in 7.9% (95% confidence interval 7.5-8.4%) of ischemic stroke patients. Financial reimbursement differs regionally with compensation for telemedical stroke care in only three federal states. CONCLUSION Telemedical stroke care is utilized in about 1 out of 10 stroke patients in Germany. Telemedical stroke networks achieve similar rates of thrombolysis and transfer for thrombectomy compared with neurological stroke units and contribute to stroke care in rural regions. Standardization of network structures, financial assurance and uniform quality measurements may further strengthen the importance of telestroke networks in the future.
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Affiliation(s)
- J Barlinn
- Klinik für Neurologie, Universitätsklinikum Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland.
| | - S Winzer
- Klinik für Neurologie, Universitätsklinikum Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - H Worthmann
- Klinik für Neurologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - C Urbanek
- Klinik für Neurologie, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Deutschland
| | - K G Häusler
- Neurologische Klinik und Poliklinik, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - A Günther
- Klinik für Neurologie, Universitätsklinikum Jena, Jena, Deutschland
| | - H Erdur
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - M Görtler
- Klinik für Neurologie, Universitätsklinikum Magdeburg, Magdeburg, Deutschland
| | - L Busetto
- Klinik für Neurologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - C Wojciechowski
- Klinik für Neurologie, Universitätsklinikum Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - J Schmitt
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum Dresden, Dresden, Deutschland
| | - Y Shah
- Klinik für Neurologie, Klinikum Kassel, Kassel, Deutschland
| | - B Büchele
- Klinik für Neurologie, Städtisches Klinikum Karlsruhe, Karlsruhe, Deutschland
| | - P Sokolowski
- Klinik für Neurologie und neurologische Intensivmedizin, Fachkrankenhaus Hubertusburg, Hubertusburg, Deutschland
| | - T Kraya
- Klinik für Neurologie, Klinikum St.Georg Leipzig, Leipzig, Deutschland
| | - S Merkelbach
- Klinik für Neurologie, Heinrich-Braun-Klinikum Zwickau, Zwickau, Deutschland
| | - B Rosengarten
- Klinik für Neurologie, Klinikum Chemnitz, Chemnitz, Deutschland
| | - K Stangenberg-Gliss
- Klinik für Neurologie, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Deutschland
| | - J Weber
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - F Schlachetzki
- Klinik für Neurologie, Universität Regensburg, Regensburg, Deutschland
| | - M Abu-Mugheisib
- Klinik für Neurologie, Städtisches Klinikum Braunschweig, Braunschweig, Deutschland
| | - M Petersen
- Klinik für Neurologie, Klinikum Osnabrück, Osnabrück, Deutschland
| | - A Schwartz
- Klinik für Neurologie, Klinikum Region Hannover, Hannover, Deutschland
| | - F Palm
- Klinik für Neurologie, Helios Klinikum Schleswig, Schleswig, Deutschland
| | - A Jowaed
- Klinik für Neurologie, Westküstenkliniken Heide, Heide, Deutschland
| | - B Volbers
- Klinik für Neurologie, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - P Zickler
- Klinik für Neurologie und Klinische Neurophysiologie, Universitätsklinikum Augsburg, Augsburg, Deutschland
| | - J Remi
- Klinik für Neurologie, Klinikum der LMU München-Großhadern, München, Deutschland
| | - J Bardutzky
- Klinik für Neurologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - J Bösel
- Klinik für Neurologie, Klinikum Kassel, Kassel, Deutschland
| | - H J Audebert
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland.,Centrum für Schlaganfallforschung Berlin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - G J Hubert
- Klinik für Neurologie, München-Klinik Harlaching, München, Deutschland
| | - C Gumbinger
- Klinik für Neurologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
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20
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Vollmuth C, Miljukov O, Abu-Mugheisib M, Angermaier A, Barlinn J, Busetto L, Grau AJ, Guenther A, Gumbinger C, Hubert N, Hüttemann K, Klingner C, Naumann M, Palm F, Remi J, Rücker V, Schessl J, Schlachetzki F, Schuppner R, Schwab S, Schwartz A, Trommer A, Urbanek C, Volbers B, Weber J, Wojciechowski C, Worthmann H, Zickler P, Heuschmann PU, Haeusler KG, Hubert GJ. Impact of the coronavirus disease 2019 pandemic on stroke teleconsultations in Germany in the first half of 2020. Eur J Neurol 2021; 28:3267-3278. [PMID: 33619788 PMCID: PMC8013200 DOI: 10.1111/ene.14787] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 11/28/2022]
Abstract
Background and purpose The effects of the coronavirus disease 2019 (COVID‐19) pandemic on telemedical care have not been described on a national level. Thus, we investigated the medical stroke treatment situation before, during, and after the first lockdown in Germany. Methods In this nationwide, multicenter study, data from 14 telemedical networks including 31 network centers and 155 spoke hospitals covering large parts of Germany were analyzed regarding patients' characteristics, stroke type/severity, and acute stroke treatment. A survey focusing on potential shortcomings of in‐hospital and (telemedical) stroke care during the pandemic was conducted. Results Between January 2018 and June 2020, 67,033 telemedical consultations and 38,895 telemedical stroke consultations were conducted. A significant decline of telemedical (p < 0.001) and telemedical stroke consultations (p < 0.001) during the lockdown in March/April 2020 and a reciprocal increase after relaxation of COVID‐19 measures in May/June 2020 were observed. Compared to 2018–2019, neither stroke patients' age (p = 0.38), gender (p = 0.44), nor severity of ischemic stroke (p = 0.32) differed in March/April 2020. Whereas the proportion of ischemic stroke patients for whom endovascular treatment (14.3% vs. 14.6%; p = 0.85) was recommended remained stable, there was a nonsignificant trend toward a lower proportion of recommendation of intravenous thrombolysis during the lockdown (19.0% vs. 22.1%; p = 0.052). Despite the majority of participating network centers treating patients with COVID‐19, there were no relevant shortcomings reported regarding in‐hospital stroke treatment or telemedical stroke care. Conclusions Telemedical stroke care in Germany was able to provide full service despite the COVID‐19 pandemic, but telemedical consultations declined abruptly during the lockdown period and normalized after relaxation of COVID‐19 measures in Germany.
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Affiliation(s)
- Christoph Vollmuth
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Olga Miljukov
- Institute of Clinical Epidemiology and Biometry, Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Mazen Abu-Mugheisib
- Department of Neurology, University Hospital Braunschweig, Braunschweig, Germany
| | - Anselm Angermaier
- Department of Neurology, University Hospital Greifswald, Greifswald, Germany
| | - Jessica Barlinn
- Department of Neurology, University Hospital Dresden, Dresden, Germany
| | - Loraine Busetto
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Armin J Grau
- Department of Neurology, Hospital Ludwigshafen, Ludwigshafen, Germany
| | - Albrecht Guenther
- Hans Berger Department of Neurology, University Hospital Jena, Jena, Germany
| | - Christoph Gumbinger
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Nikolai Hubert
- TEMPiS Telemedical Stroke Center, Department of Neurology, Munich Clinic Harlaching, Munich, Germany
| | - Katrin Hüttemann
- NEVAS Telemedical Stroke Network, Department of Neurology, University Hospital Munich, Munich, Germany
| | - Carsten Klingner
- Hans Berger Department of Neurology, University Hospital Jena, Jena, Germany
| | - Markus Naumann
- Department of Neurology, University Hospital Augsburg, Augsburg, Germany
| | - Frederick Palm
- Department of Neurology, Hospital Schleswig, Kiel, Germany
| | - Jan Remi
- NEVAS Telemedical Stroke Network, Department of Neurology, University Hospital Munich, Munich, Germany
| | - Viktoria Rücker
- Institute of Clinical Epidemiology and Biometry, Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Joachim Schessl
- Department of Neurology, Hospital Karlsruhe, Karlsruhe, Germany
| | - Felix Schlachetzki
- TEMPiS Telemedical Stroke Center, Department of Neurology, Center for Vascular Neurology and Intensive Care, Medbo District Hospital Regensburg, University of Regensburg, Regensburg, Germany
| | - Ramona Schuppner
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Stefan Schwab
- Department of Neurology, University Hospital Erlangen, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | | | - Adrian Trommer
- Department of Neurology, Hospital Hubertusburg, Wermsdorf, Germany
| | - Christian Urbanek
- Department of Neurology, Hospital Ludwigshafen, Ludwigshafen, Germany
| | - Bastian Volbers
- Department of Neurology, University Hospital Erlangen, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Joachim Weber
- Clinic and University Outpatient Clinic for Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | | | - Hans Worthmann
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Philipp Zickler
- Department of Neurology, University Hospital Augsburg, Augsburg, Germany
| | - Peter U Heuschmann
- Institute of Clinical Epidemiology and Biometry, Julius Maximilian University of Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center, Clinical Trial Center Würzburg, University Hospital Würzburg, Julius Maximillian University of Würzburg, Würzburg, Germany
| | | | - Gordian Jan Hubert
- TEMPiS Telemedical Stroke Center, Department of Neurology, Munich Clinic Harlaching, Munich, Germany
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21
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Pan H, Steixner-Kumar AA, Seelbach A, Deutsch N, Ronnenberg A, Tapken D, von Ahsen N, Mitjans M, Worthmann H, Trippe R, Klein-Schmidt C, Schopf N, Rentzsch K, Begemann M, Wienands J, Stöcker W, Weissenborn K, Hollmann M, Nave KA, Lühder F, Ehrenreich H. Multiple inducers and novel roles of autoantibodies against the obligatory NMDAR subunit NR1: a translational study from chronic life stress to brain injury. Mol Psychiatry 2021; 26:2471-2482. [PMID: 32089545 PMCID: PMC8440197 DOI: 10.1038/s41380-020-0672-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/13/2020] [Accepted: 01/23/2020] [Indexed: 12/03/2022]
Abstract
Circulating autoantibodies (AB) of different immunoglobulin classes (IgM, IgA, and IgG), directed against the obligatory N-methyl-D-aspartate-receptor subunit NR1 (NMDAR1-AB), belong to the mammalian autoimmune repertoire, and appear with age-dependently high seroprevalence across health and disease. Upon access to the brain, they can exert NMDAR-antagonistic/ketamine-like actions. Still unanswered key questions, addressed here, are conditions of NMDAR1-AB formation/boosting, intraindividual persistence/course in serum over time, and (patho)physiological significance of NMDAR1-AB in modulating neuropsychiatric phenotypes. We demonstrate in a translational fashion from mouse to human that (1) serum NMDAR1-AB fluctuate upon long-term observation, independent of blood-brain barrier (BBB) perturbation; (2) a standardized small brain lesion in juvenile mice leads to increased NMDAR1-AB seroprevalence (IgM + IgG), together with enhanced Ig-class diversity; (3) CTLA4 (immune-checkpoint) genotypes, previously found associated with autoimmune disease, predispose to serum NMDAR1-AB in humans; (4) finally, pursuing our prior findings of an early increase in NMDAR1-AB seroprevalence in human migrants, which implicated chronic life stress as inducer, we independently replicate these results with prospectively recruited refugee minors. Most importantly, we here provide the first experimental evidence in mice of chronic life stress promoting serum NMDAR1-AB (IgA). Strikingly, stress-induced depressive-like behavior in mice and depression/anxiety in humans are reduced in NMDAR1-AB carriers with compromised BBB where NMDAR1-AB can readily reach the brain. To conclude, NMDAR1-AB may have a role as endogenous NMDAR antagonists, formed or boosted under various circumstances, ranging from genetic predisposition to, e.g., tumors, infection, brain injury, and stress, altogether increasing over lifetime, and exerting a spectrum of possible effects, also including beneficial functions.
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Affiliation(s)
- Hong Pan
- grid.419522.90000 0001 0668 6902Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany
| | - Agnes A. Steixner-Kumar
- grid.419522.90000 0001 0668 6902Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany
| | - Anna Seelbach
- grid.419522.90000 0001 0668 6902Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany
| | - Nadine Deutsch
- grid.10423.340000 0000 9529 9877Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Anja Ronnenberg
- grid.419522.90000 0001 0668 6902Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany
| | - Daniel Tapken
- grid.5570.70000 0004 0490 981XDepartment of Biochemistry I–Receptor Biochemistry, Ruhr University, Bochum, Germany
| | - Nico von Ahsen
- grid.411984.10000 0001 0482 5331Institute of Clinical Chemistry, University Medical Center Göttingen, Göttingen, Germany
| | - Marina Mitjans
- grid.419522.90000 0001 0668 6902Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany
| | - Hans Worthmann
- grid.10423.340000 0000 9529 9877Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Ralf Trippe
- grid.5570.70000 0004 0490 981XDepartment of Biochemistry I–Receptor Biochemistry, Ruhr University, Bochum, Germany
| | - Christina Klein-Schmidt
- grid.5570.70000 0004 0490 981XDepartment of Biochemistry I–Receptor Biochemistry, Ruhr University, Bochum, Germany
| | - Nadine Schopf
- grid.419522.90000 0001 0668 6902Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany
| | - Kristin Rentzsch
- Institute for Experimental Immunology, Euroimmun, Lübeck, Germany
| | - Martin Begemann
- grid.419522.90000 0001 0668 6902Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany ,grid.411984.10000 0001 0482 5331Department of Psychiatry & Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
| | - Jürgen Wienands
- grid.7450.60000 0001 2364 4210Institute for Cellular and Molecular Immunology, Georg August University, Göttingen, Germany
| | - Winfried Stöcker
- Institute for Experimental Immunology, Euroimmun, Lübeck, Germany
| | - Karin Weissenborn
- grid.10423.340000 0000 9529 9877Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Michael Hollmann
- grid.5570.70000 0004 0490 981XDepartment of Biochemistry I–Receptor Biochemistry, Ruhr University, Bochum, Germany
| | - Klaus-Armin Nave
- grid.419522.90000 0001 0668 6902Neurogenetics, Max Planck Institute of Experimental Medicine, Göttingen, Germany
| | - Fred Lühder
- grid.411984.10000 0001 0482 5331Institute for Neuroimmunology and Multiple Sclerosis Research, University Medical Center Göttingen, Göttingen, Germany
| | - Hannelore Ehrenreich
- Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany.
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22
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Grosse GM, Sieweke JT, Biber S, Ziegler NL, Gabriel MM, Schuppner R, Worthmann H, Bavendiek U, Weissenborn K. Nonstenotic Carotid Plaque in Embolic Stroke of Undetermined Source: Interplay of Arterial and Atrial Disease. Stroke 2020; 51:3737-3741. [PMID: 33040704 DOI: 10.1161/strokeaha.120.030537] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Approximately one-sixth of all ischemic strokes are attributable to embolic stroke of undetermined source (ESUS). Recent analyses suggest that atrial cardiopathy and nonstenotic carotid plaque (nsCP) may represent 2 distinct underlying causes in patients with ESUS, although both diseases share common risk factors and are pathophysiologically intertwined. In this study, we, therefore, aimed to search for associations between nsCP and markers of atrial remodeling and function in patients with embolic stroke. METHODS Sixty-eight patients with ESUS or atrial fibrillation (AF)-related stroke proven by imaging who underwent comprehensive echocardiographic studies, including measurements of left atrial function and remodeling, were considered. Patients with ESUS underwent a follow-up of at least 1 year after index stroke. For 20 patients with ESUS, NT-proBNP (N-terminal pro-B-type natriuretic peptide) values were available. Presence of nsCP was evaluated considering Duplex sonography and computed tomography angiography and was further categorized in possibly or probably symptomatic nsCP. RESULTS ESUS patients with nsCP tended to have higher values of septal and lateral total atrial conduction times (P=0.071 and P=0.072, respectively), left atrial volume index (P=0.077), and revealed significantly higher strain rates during early diastole (P=0.013) as well as higher NT-proBNP values (P=0.010) than ESUS patients without nsCP. Moreover, septal total atrial conduction time was significantly longer in ESUS patients with possibly symptomatic nsCP compared with those without (P=0.015). Comparison of ESUS with AF patients revealed significantly higher proportions of nsCP (P=0.010), possibly symptomatic nsCP (P=0.037), and probably symptomatic nsCP (P=0.036) in patients with atrial fibrillation-related stroke. In the regression analysis adjusted for vascular risk factors probably symptomatic nsCP remained significantly associated with AF (P=0.048, odds ratio: 4.46 [95% CI, 1.02-19.56]). CONCLUSIONS Presence of nsCP is associated with AF and markers of left atrial disease in patients with embolic stroke. Therefore, a thorough evaluation regarding atrial cardiopathy and AF in patients with ESUS should not be restricted if nsCP are found, even if high-risk plaque characteristics are evident.
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Affiliation(s)
- Gerrit M Grosse
- Department of Neurology (G.M.G., S.B., N.L.Z., M.M.G., R.S., H.W., K.W.), Hannover Medical School, Germany
| | - Jan-Thorben Sieweke
- Department of Cardiology and Angiology (J.-T.S., S.B., U.B.), Hannover Medical School, Germany
| | - Saskia Biber
- Department of Neurology (G.M.G., S.B., N.L.Z., M.M.G., R.S., H.W., K.W.), Hannover Medical School, Germany.,Department of Cardiology and Angiology (J.-T.S., S.B., U.B.), Hannover Medical School, Germany
| | - Nora L Ziegler
- Department of Neurology (G.M.G., S.B., N.L.Z., M.M.G., R.S., H.W., K.W.), Hannover Medical School, Germany
| | - Maria M Gabriel
- Department of Neurology (G.M.G., S.B., N.L.Z., M.M.G., R.S., H.W., K.W.), Hannover Medical School, Germany
| | - Ramona Schuppner
- Department of Neurology (G.M.G., S.B., N.L.Z., M.M.G., R.S., H.W., K.W.), Hannover Medical School, Germany
| | - Hans Worthmann
- Department of Neurology (G.M.G., S.B., N.L.Z., M.M.G., R.S., H.W., K.W.), Hannover Medical School, Germany
| | - Udo Bavendiek
- Department of Cardiology and Angiology (J.-T.S., S.B., U.B.), Hannover Medical School, Germany
| | - Karin Weissenborn
- Department of Neurology (G.M.G., S.B., N.L.Z., M.M.G., R.S., H.W., K.W.), Hannover Medical School, Germany
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23
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Putzer AS, Worthmann H, Grosse GM, Goetz F, Martens-Lobenhoffer J, Dirks M, Kielstein JT, Lichtinghagen R, Budde U, Bode-Böger SM, Weissenborn K, Schuppner R. ADAMTS13 activity is associated with early neurological improvement in acute ischemic stroke patients treated with intravenous thrombolysis. J Thromb Thrombolysis 2020; 49:67-74. [PMID: 31482326 DOI: 10.1007/s11239-019-01941-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Although intravenous thrombolysis (IVT) with recombinant tissue-plasminogen-activator represents a highly effective treatment in acute ischemic stroke patients, not every patient benefits. We hypothesized that pretreatment levels of mediators of hemostasis (VWF and ADAMTS13) and dimethylarginines (ADMA and SDMA) are associated with early neurological improvement and outcome after IVT in ischemic stroke. Moreover we aimed to investigate the link between ADAMTS13 and markers of inflammation (CRP, IL-6, MMP-9 and MCP-1). In 43 patients with acute ischemic stroke treated with IVT blood samples for determination of the different markers were strictly taken before treatment, as well as at 24 h, 3, 7 and 90 days after symptom onset. Early neurological improvement was assessed using the shift between National Institutes of Health Stroke Scale (NIHSS) at baseline and at 24 h. Outcome at 90 days was assessed using the modified Rankin Scale. The lowest quartile of ADAMTS13 activity was independently associated with less improvement in NIHSS (baseline-24 h) (OR 1.298, p = 0.050). No independent association of ADMA or SDMA levels at baseline with outcome could be shown. Furthermore, IL-6, MCP-1 and CRP levels at 90 days significantly differed between patients with low and high ADAMTS13 activity. Thus, ADAMTS13 might indicate or even influence efficacy of IVT.
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Affiliation(s)
- Anne-Sophie Putzer
- Department of Neurology, Hannover Medical School, 30625, Hannover, Germany
| | - Hans Worthmann
- Department of Neurology, Hannover Medical School, 30625, Hannover, Germany
| | - Gerrit M Grosse
- Department of Neurology, Hannover Medical School, 30625, Hannover, Germany
| | - Friedrich Goetz
- Institute of Diagnostic and Interventional Neuroradiology, Hannover Medical School, 30625, Hannover, Germany
| | - Jens Martens-Lobenhoffer
- Department of Clinical Pharmacology, Otto-Guericke-University of Magdeburg, University Hospital, 39106, Magdeburg, Germany
| | - Meike Dirks
- Department of Neurology, Hannover Medical School, 30625, Hannover, Germany
| | - Jan T Kielstein
- Medical Clinic V, Academic Teaching Hospital Braunschweig, 38118, Brunswick, Germany
| | - Ralf Lichtinghagen
- Department of Clinical Chemistry, Hannover Medical School, 30625, Hannover, Germany
| | - Ulrich Budde
- Medilys Laboratory, Asklepios Klinik Altona, 22763, Hamburg, Germany
| | - Stefanie M Bode-Böger
- Department of Clinical Pharmacology, Otto-Guericke-University of Magdeburg, University Hospital, 39106, Magdeburg, Germany
| | - Karin Weissenborn
- Department of Neurology, Hannover Medical School, 30625, Hannover, Germany
| | - Ramona Schuppner
- Department of Neurology, Hannover Medical School, 30625, Hannover, Germany.
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24
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van Gemmeren T, Schuppner R, Grosse GM, Fering J, Gabriel MM, Huber R, Worthmann H, Lichtinghagen R, Weissenborn K. Early Post-Stroke Infections Are Associated with an Impaired Function of Neutrophil Granulocytes. J Clin Med 2020; 9:jcm9030872. [PMID: 32209993 PMCID: PMC7141520 DOI: 10.3390/jcm9030872] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/11/2020] [Accepted: 03/18/2020] [Indexed: 01/02/2023] Open
Abstract
To investigate whether neutrophil granulocytes’ function relates to post-stroke infections and clinical outcome after stroke, we prospectively recruited 95 patients after ischemic stroke and tested them for their microbiocidal neutrophil functions in this exploratory study. Additionally, 24 age-adjusted controls were examined regarding neutrophil function. Phagocytic capacity and the ability of the neutrophil granulocytes to produce reactive oxygen species (ROS) as well as CD11b and CD16 receptor expression profile were measured by flow cytometry at days 1, 3, 7, and 90 after symptom onset. Primary outcome was the development of an infection within the first week after stroke. Results of neutrophil functional measurements were compared between patients with and without infection as well as between all stroke patients and controls. Further risk factors for the development of infections were summarized in an infection-risk score for the purpose of multivariate statistical analysis. The ROS production in neutrophils after stimulation with formyl-methionyl-leucyl-phenylalanine (fMLP) was reduced at baseline in patients with post-stroke infections compared to those without (p = 0.013). This difference proved to be independent from the infection-risk score in the binary logistic regression (p = 0.011). Phagocytosis and oxidative bursts were not significantly reduced in the whole stroke patient group compared to controls. Dysfunction of neutrophil granulocytes seems to play a significant role in the development of post-stroke infections. Further studies are warranted to investigate neutrophil granulocytes´ function as a potential biomarker of post-stroke infections.
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Affiliation(s)
- Till van Gemmeren
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (T.v.G.); (G.M.G.); (J.F.); (M.M.G.); (H.W.); (K.W.)
| | - Ramona Schuppner
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (T.v.G.); (G.M.G.); (J.F.); (M.M.G.); (H.W.); (K.W.)
- Correspondence: ; Tel.: +49-511-532-3580; Fax: +49-511-532-18625
| | - Gerrit M. Grosse
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (T.v.G.); (G.M.G.); (J.F.); (M.M.G.); (H.W.); (K.W.)
| | - Jessica Fering
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (T.v.G.); (G.M.G.); (J.F.); (M.M.G.); (H.W.); (K.W.)
| | - Maria M. Gabriel
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (T.v.G.); (G.M.G.); (J.F.); (M.M.G.); (H.W.); (K.W.)
| | - René Huber
- Institute of Clinical Chemistry, Hannover Medical School, 30625 Hannover, Germany; (R.H.); (R.L.)
| | - Hans Worthmann
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (T.v.G.); (G.M.G.); (J.F.); (M.M.G.); (H.W.); (K.W.)
| | - Ralf Lichtinghagen
- Institute of Clinical Chemistry, Hannover Medical School, 30625 Hannover, Germany; (R.H.); (R.L.)
| | - Karin Weissenborn
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (T.v.G.); (G.M.G.); (J.F.); (M.M.G.); (H.W.); (K.W.)
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25
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Grosse GM, Schwedhelm E, Worthmann H, Choe CU. Arginine Derivatives in Cerebrovascular Diseases: Mechanisms and Clinical Implications. Int J Mol Sci 2020; 21:ijms21051798. [PMID: 32150996 PMCID: PMC7084464 DOI: 10.3390/ijms21051798] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 02/27/2020] [Accepted: 03/01/2020] [Indexed: 02/07/2023] Open
Abstract
The amino acid L-arginine serves as substrate for the nitric oxide synthase which is crucial in vascular function and disease. Derivatives of arginine, such as asymmetric (ADMA) and symmetric dimethylarginine (SDMA), are regarded as markers of endothelial dysfunction and have been implicated in vascular disorders. While there is a variety of studies consolidating ADMA as biomarker of cerebrovascular risk, morbidity and mortality, SDMA is currently emerging as an interesting metabolite with distinct characteristics in ischemic stroke. In contrast to dimethylarginines, homoarginine is inversely associated with adverse events and mortality in cerebrovascular diseases and might constitute a modifiable protective risk factor. This review aims to provide an overview of the current evidence for the pathophysiological role of arginine derivatives in cerebrovascular ischemic diseases. We discuss the complex mechanisms of arginine metabolism in health and disease and its potential clinical implications in diverse aspects of ischemic stroke.
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Affiliation(s)
- Gerrit M. Grosse
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany;
- Correspondence:
| | - Edzard Schwedhelm
- Institute of Clinical Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, 20249 Hamburg, Germany;
- DZHK (Deutsches Zentrum für Herz-Kreislauf-Forschung e.V.), partner site Hamburg/Kiel/Lübeck, 20249 Hamburg, Germany
| | - Hans Worthmann
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany;
| | - Chi-un Choe
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20249 Hamburg, Germany;
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26
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Ziegler NL, Sieweke JT, Biber S, Gabriel MM, Schuppner R, Worthmann H, Martens-Lobenhoffer J, Lichtinghagen R, Bode-Böger SM, Bavendiek U, Weissenborn K, Grosse GM. Markers of endothelial pathology to support detection of atrial fibrillation in embolic stroke of undetermined source. Sci Rep 2019; 9:19424. [PMID: 31857660 PMCID: PMC6923420 DOI: 10.1038/s41598-019-55943-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 12/04/2019] [Indexed: 12/17/2022] Open
Abstract
A relevant part of embolic strokes of undetermined source (ESUS) is assumed to be cardiogenic. As shown previously, certain biomarkers of endothelial pathology are related to atrial fibrillation (AF). In this long-term follow-up study, we aimed to investigate whether these biomarkers are associated with subsequently diagnosed AF and with atrial cardiopathy. In 98 patients who suffered ischemic stroke of known and unknown origin L-arginine, Asymmetric (ADMA) and Symmetric Dimethylarginine (SDMA) have been measured on follow-up at least one year after index stroke. Stroke-diagnostics were available for all patients, including carotid Intima-Media-Thickness (CIMT) and comprehensive echocardiography studies. CIMT was larger in AF- compared with ESUS-patients (P < 0.001), independently from CHA2DS2VASC in the regression analysis (P = 0.004). SDMA-values were stable over time (P < 0.001; r = 0.788), whereas for ADMA moderate correlation with the initial values could be found (P = 0.007; r = 0.356). According to Kaplan-Meier-analyses, AF-detection rates were associated with CIMT (P = 0.003) and SDMA (P < 0.001). SDMA correlated with left atrial volume-index within the whole collective (P = 0.003, r = 0.322) and within the ESUS-subgroup (P = 0.003; r = 0.446). These associations were independent from CHA2DS2VASC and renal function in the regression analysis (P = 0.02 and P = 0.005, respectively). In conclusion, these results highlight SDMA and CIMT as potential markers of atrial cardiopathy and AF in ESUS-patients.
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Affiliation(s)
- Nora L Ziegler
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Jan-Thorben Sieweke
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Saskia Biber
- Department of Neurology, Hannover Medical School, Hannover, Germany
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Maria M Gabriel
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Ramona Schuppner
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Hans Worthmann
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | | | - Ralf Lichtinghagen
- Institute of Clinical Chemistry, Hannover Medical School, Hannover, Germany
| | - Stefanie M Bode-Böger
- Institute of Clinical Pharmacology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Udo Bavendiek
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | | | - Gerrit M Grosse
- Department of Neurology, Hannover Medical School, Hannover, Germany.
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27
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Grosse GM, Bascuñana P, Schulz-Schaeffer WJ, Teebken OE, Wilhelmi M, Worthmann H, Ross TL, Wester HJ, Kropf S, Derlin T, Bengel FM, Bankstahl JP, Weissenborn K. Targeting Chemokine Receptor CXCR4 and Translocator Protein for Characterization of High-Risk Plaque in Carotid Stenosis Ex Vivo. Stroke 2019; 49:1988-1991. [PMID: 30002148 DOI: 10.1161/strokeaha.118.021070] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- This pilot study aims to demonstrate the feasibility of targeting molecular characteristics of high-risk atherosclerotic plaque in symptomatic and asymptomatic carotid stenosis (CS), that is, upregulation of the translocator protein (TSPO) and the chemokine receptor type 4 (CXCR4), by means of molecular imaging. Methods- In a translational setting, specimens of carotid plaques of patients with symptomatic and asymptomatic CS obtained by carotid endarterectomy were analyzed for the presence of TSPO and CXCR4 by autoradiography, using the positron emission tomography tracers 18F-GE180 and 68Ga-Pentixafor and evaluated by histopathology. In addition, 68Ga-Pentixafor positron emission tomography/computed tomography was performed in a patient with high-grade CS. Results- Distinct patterns of upregulation of TSPO (18F-GE180 uptake) and CXCR4 (68Ga-Pentixafor uptake) were identified in carotid plaque by autoradiography. The spatial distribution was associated with specific histological hallmarks that are established features of high-risk plaque: TSPO upregulation correlated with activated macrophages infiltration, whereas CXCR4 upregulation also corresponded to areas of intraplaque hemorrhage. 68Ga-Pentixafor uptake was significantly higher in plaques of symptomatic compared with asymptomatic CS. Clinical positron emission tomography revealed marked 68Ga-Pentixafor uptake in carotid plaque of a patient with high-grade CS. Conclusions- Clinical imaging of molecular signatures of high-risk atherosclerotic plaque is feasible and may become a promising diagnostic tool for comprehensive characterization of carotid disease. This methodology provides a platform for future studies targeting carotid plaque.
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Affiliation(s)
| | - Pablo Bascuñana
- Department of Nuclear Medicine (P.B., T.L.R., T.D., F.M.B., J.P.B.)
| | | | - Omke E Teebken
- Division of Vascular and Endovascular Surgery, Department of Cardiothoracic, Transplantation, and Vascular Surgery (O.E.T., M.W.), Hannover Medical School, Germany.,Department of Vascular and Endovascular Surgery, Klinikum Peine, Germany (O.E.T.)
| | - Mathias Wilhelmi
- Division of Vascular and Endovascular Surgery, Department of Cardiothoracic, Transplantation, and Vascular Surgery (O.E.T., M.W.), Hannover Medical School, Germany
| | | | - Tobias L Ross
- Department of Nuclear Medicine (P.B., T.L.R., T.D., F.M.B., J.P.B.)
| | - Hans-Jürgen Wester
- Pharmaceutical Radiochemistry, Technical University of Munich, Germany (H.-J.W.)
| | - Saskia Kropf
- Scintomics GmbH, Fuerstenfeldbruck, Germany (S.K.)
| | - Thorsten Derlin
- Department of Nuclear Medicine (P.B., T.L.R., T.D., F.M.B., J.P.B.)
| | - Frank M Bengel
- Department of Nuclear Medicine (P.B., T.L.R., T.D., F.M.B., J.P.B.)
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28
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Dirks M, Haag K, Pflugrad H, Tryc AB, Schuppner R, Wedemeyer H, Potthoff A, Tillmann HL, Sandorski K, Worthmann H, Ding X, Weissenborn K. Neuropsychiatric symptoms in hepatitis C patients resemble those of patients with autoimmune liver disease but are different from those in hepatitis B patients. J Viral Hepat 2019; 26:422-431. [PMID: 30120896 DOI: 10.1111/jvh.12979] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 08/03/2018] [Accepted: 08/07/2018] [Indexed: 12/14/2022]
Abstract
Chronic fatigue, mood alterations and cognitive impairment are frequent accessory symptoms of HCV infection. Fatigue and mood alterations have also been observed in autoimmune hepatitis (AIH) and primary biliary cholangitis (PBC), but not in hepatitis B virus (HBV)-infection, thus indicating an autoimmune response as possible cause of HCV infection-associated encephalopathy. Data, however, are sparse. This study aimed to prove that HCV patients feature similar to those with autoimmune liver disease but contrary to HBV patients regarding neuropsychiatric symptoms. A total of 132 noncirrhotic patients (HCV: 46, HBV: 22, AIH: 27, PBC: 29, AIH/PBC: 8) completed questionnaires addressing the domains mentioned above. Eighty-eight underwent a comprehensive neuropsychological assessment. Patient groups were compared among each other and to 33 healthy controls. Fatigue, anxiety and depression scores were significantly increased, and the SF-36 mental score significantly decreased in all patient groups compared to controls. Fatigue was significantly more pronounced in HCV than in HBV patients. HCV patients scored significantly worse than HBV patients but not AIH and PBC patients in the SF-36. HCV, AIH and PBC but not HBV patients did significantly worse than controls in word learning. Recognition of words was impaired in HCV, AIH and PBC patients and recognition of figures in HCV patients, exclusively (P ≤ 0.002). HCV patients did also worse than controls and HBV patients concerning alertness and working memory (P ≤ 0.001). The neuropsychiatric profiles of HCV patients are similar to those of AIH and PBC patients but differ from those of HBV patients, suggesting an autoimmune response as a possible cause for these differences.
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Affiliation(s)
- Meike Dirks
- Clinic for Neurology, Hannover Medical School, Hannover, Germany
| | - Kim Haag
- Clinic for Neurology, Hannover Medical School, Hannover, Germany
| | - Henning Pflugrad
- Clinic for Neurology, Hannover Medical School, Hannover, Germany
| | - Anita B Tryc
- Clinic for Neurology, Hannover Medical School, Hannover, Germany
| | - Ramona Schuppner
- Clinic for Neurology, Hannover Medical School, Hannover, Germany
| | - Heiner Wedemeyer
- Clinic for Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Andrej Potthoff
- Clinic for Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Hans L Tillmann
- Division of Gastroenterology, Hepatology & Nutrition, East Carolina University, Greenville, North Carolina
| | | | - Hans Worthmann
- Clinic for Neurology, Hannover Medical School, Hannover, Germany
| | - Xiaoqi Ding
- Institute for Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
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29
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Grosse GM, Biber S, Sieweke JT, Martens-Lobenhoffer J, Gabriel MM, Putzer AS, Hasse I, van Gemmeren T, Schuppner R, Worthmann H, Lichtinghagen R, Bode-Böger SM, Bavendiek U, Weissenborn K. Plasma Dimethylarginine Levels and Carotid Intima-Media Thickness are related to Atrial Fibrillation in Patients with Embolic Stroke. Int J Mol Sci 2019; 20:ijms20030730. [PMID: 30744089 PMCID: PMC6387438 DOI: 10.3390/ijms20030730] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/04/2019] [Accepted: 02/07/2019] [Indexed: 11/23/2022] Open
Abstract
A relevant part of embolic strokes of undetermined source (ESUS) is assumed to be due to non-detected atrial fibrillation (AF). In this study, we aimed to investigate if markers of endothelial dysfunction and damage may indicate AF risk in embolic stroke. Eighty-eight patients with ischemic stroke confirmed by imaging were assigned to one of three groups: ESUS, AF, or micro-/macroangiopathy. ESUS patients underwent prolonged Holter electrocardiography scheduled for three days. The National Institutes of Health Stroke Scale (NIHSS), the CHA2DS2VASC score, and the carotid intima–media thickness (CIMT) were obtained. Markers of endothelial (dys)function (L-arginine, asymmetric dimethylarginine (ADMA), symmetric dimethylarginine (SDMA)) were measured at day seven after stroke. ESUS patients were younger and had fewer cardiovascular risk factors than patients with determined stroke etiology. Compared with AF patients, ESUS patients showed significantly lower values of SDMA (p = 0.004) and higher values of L-arginine (p = 0.031), L-arginine/ADMA ratio (p = 0.006), L-arginine/SDMA ratio (p = 0.002), and ADMA/SDMA ratio (p = 0.013). Concordant differences could be observed comparing ESUS patients with those with newly diagnosed AF (p = 0.026; p = 0.03; p = 0.009; p = 0.004; and p = 0.046, respectively). CIMT was significantly larger in AF than in ESUS patients (p < 0.001), and was identified as an AF risk factor independent from CHA2DS2VASC in the regression analysis (p = 0.014). These findings may support future stratification for AF risk in patients who have suffered embolic stroke.
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Affiliation(s)
- Gerrit M Grosse
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany.
| | - Saskia Biber
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany.
- Department of Cardiology, Hannover Medical School, 30625 Hannover, Germany.
| | | | - Jens Martens-Lobenhoffer
- Institute of Clinical Pharmacology, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany.
| | - Maria M Gabriel
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany.
| | - Anne-Sophie Putzer
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany.
| | - Isabel Hasse
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany.
| | - Till van Gemmeren
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany.
| | - Ramona Schuppner
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany.
| | - Hans Worthmann
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany.
| | - Ralf Lichtinghagen
- Institute of Clinical Chemistry, Hannover Medical School, 30625 Hannover, Germany.
| | - Stefanie M Bode-Böger
- Institute of Clinical Pharmacology, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany.
| | - Udo Bavendiek
- Department of Cardiology, Hannover Medical School, 30625 Hannover, Germany.
| | - Karin Weissenborn
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany.
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30
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Dirks M, Grosse G, Böckmann M, Goetz F, Pasedag T, Bode-Böger S, Martens-Lobenhoffer J, Budde U, Lanfermann H, Lichtinghagen R, Weissenborn K, Worthmann H, Schuppner R. ADAMTS-13 Activity Predicts Outcome in Acute Ischaemic Stroke Patients Undergoing Endovascular Treatment. Thromb Haemost 2018; 118:758-767. [DOI: 10.1055/s-0038-1637732] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background Endovascular treatment improves outcome in patients with acute ischaemic stroke due to large vessel occlusion in general. But outcome in some of these patients is jeopardized by recanalization failure or bleeding.
Objectives This study aimed to determine a possible association of mediators of inflammation and haemostasis (C-reactive protein, interleukin-6, matrix metalloproteinase-9, monocyte chemoattractant protein-1, asymmetric dimethylarginine [ADMA], symmetric dimethylarginine, von Willebrand factor and a disintegrin and metalloproteinase with a thrombospondin type 1 motif 13 [ADAMTS-13]) with the post-intervention grade of reperfusion, complications and clinical outcome in patients who underwent endovascular treatment of ischaemic stroke.
Patients/Methods Forty-one patients with acute ischaemic stroke due to large vessel occlusion were prospectively enrolled into the study. Peripheral venous blood was taken prior to treatment and 24 hours and 3, 7 and 90 days after symptom onset. The post-intervention grade of reperfusion was determined using the modified Treatment in Cerebral Infarction (mTICI) score. Clinical outcome on day 90 was assessed using the modified Rankin's scale (mRS).
Results Low ADAMTS-13 activity (p = 0.009) and missing of statin therapy (p = 0.038) on admission were independently associated with unfavourable outcome (mRS: 5–6). Patients with unsuccessful reperfusion (mTICI: 0–1) showed higher ADMA levels on admission (p = 0.018). However, this association could not be confirmed in the binary logistic regression analysis.
Conclusion Low ADAMTS-13 activity is a predictor of unfavourable outcome in patients with ischaemic stroke undergoing endovascular therapy. Further studies are warranted to elucidate the clinical and potential therapeutic role of ADAMTS-13 in acute ischaemic stroke.
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Affiliation(s)
- Meike Dirks
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Gerrit Grosse
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | | | - Friedrich Goetz
- Department of Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Thomas Pasedag
- Department of Neurology, Hannover Medical School, Hannover, Germany
- Department of Psychiatry, Kliniken der Region Hannover, Langenhagen, Germany
| | - Stefanie Bode-Böger
- Department of Clinical Pharmacology, Otto-von-Guericke University, Magdeburg, Germany
| | | | - Ulrich Budde
- Medilys Laboratory, Asklepios Clinic Altona, Hamburg, Germany
| | | | - Ralf Lichtinghagen
- Department of Clinical Chemistry, Hannover Medical School, Hannover, Germany
| | | | - Hans Worthmann
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Ramona Schuppner
- Department of Neurology, Hannover Medical School, Hannover, Germany
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31
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Worthmann H, Li N, Martens-Lobenhoffer J, Dirks M, Schuppner R, Lichtinghagen R, Kielstein JT, Raab P, Lanfermann H, Bode-Böger SM, Weissenborn K. Dimethylarginines in patients with intracerebral hemorrhage: association with outcome, hematoma enlargement, and edema. J Neuroinflammation 2017; 14:247. [PMID: 29237474 PMCID: PMC5729507 DOI: 10.1186/s12974-017-1016-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 11/28/2017] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Asymmetric dimethylarginine (ADMA)--the most potent endogenous NO-synthase inhibitor, has been regarded as mediator of endothelial dysfunction and oxidative stress. Considering experimental data, levels of ADMA and its structural isomer symmetric dimethylarginine (SDMA) might be elevated after intracerebral hemorrhage (ICH) and associated with clinical outcome and secondary brain injury. METHODS Blood samples from 20 patients with acute ICH were taken at ≤ 24 h and 3 and 7 days after the event. Nine patients had favorable (modified Rankin Scale (mRS) at 90 days 0-2) outcome, and 11 patients unfavorable outcome (mRS 3-6). Patients' serum ADMA, SDMA, and L-arginine levels were determined by high-performance liquid chromatography-tandem mass spectrometry. Levels were compared to those of 30 control subjects without ICH. For further analysis, patients were grouped according to outcome, hematoma and perihematomal edema volumes, occurrence of hematoma enlargement, and cytotoxic edema as measured by computed tomography and serial magnetic resonance imaging. RESULTS Levels of ADMA--but not SDMA and L-arginine--were elevated in ICH patients compared to controls (binary logistic regression analysis: ADMA ≤ 24 h, p = 0.003; 3 days p = 0.005; 7 days p = 0.004). If patients were grouped according to outcome, dimethylarginines were increased in patients with unfavorable outcome. The binary logistic regression analysis confirmed an association of SDMA levels ≤ 24 h (p = 0.048) and at 3 days (p = 0.028) with unfavorable outcome. ADMA ≤ 24 h was increased in patients with hematoma enlargement (p = 0.003), while SDMA ≤ 24 h was increased in patients with large hematoma (p = 0.029) and perihematomal edema volume (p = 0.023). CONCLUSIONS Our data demonstrate an association between dimethylarginines and outcome of ICH. However, further studies are needed to confirm this relationship and elucidate the mechanisms behind.
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Affiliation(s)
- Hans Worthmann
- Department of Neurology, Hannover Medical School, 30623, Hannover, Germany.
| | - Na Li
- Department of Neurology, Hannover Medical School, 30623, Hannover, Germany.,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jens Martens-Lobenhoffer
- Department of Clinical Pharmacology, Otto-von-Guericke-University of Magdeburg, University Hospital, Magdeburg, Germany
| | - Meike Dirks
- Department of Neurology, Hannover Medical School, 30623, Hannover, Germany
| | - Ramona Schuppner
- Department of Neurology, Hannover Medical School, 30623, Hannover, Germany
| | - Ralf Lichtinghagen
- Department of Clinical Chemistry, Hannover Medical School, Hannover, Germany
| | - Jan T Kielstein
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany.,Medical Clinic V, Academic Teaching Hospital Braunschweig, Braunschweig, Germany
| | - Peter Raab
- Institute of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Heinrich Lanfermann
- Institute of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Stefanie M Bode-Böger
- Department of Clinical Pharmacology, Otto-von-Guericke-University of Magdeburg, University Hospital, Magdeburg, Germany
| | - Karin Weissenborn
- Department of Neurology, Hannover Medical School, 30623, Hannover, Germany
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32
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Armbrust M, Worthmann H, Dengler R, Schumacher H, Lichtinghagen R, Eschenfelder CC, Endres M, Ebinger M. Circulating Insulin-like Growth Factor-1 and Insulin-like Growth Factor Binding Protein-3 predict Three-months Outcome after Ischemic Stroke. Exp Clin Endocrinol Diabetes 2017; 125:485-491. [PMID: 28724170 DOI: 10.1055/s-0043-103965] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Reports on neuroprotective effects of Insulin-like growth factor-1 (IGF-1) and Insulin-like growth factor binding protein-3 (IGFBP-3) in ischemic brain tissue are inconsistent. The aim of this study was to determine if plasma levels of IGF-1 and IGFBP-3 in acute stroke patients are indicative of 3 months functional outcome. Plasma levels were measured via chemiluminescence immunoassay in heparin blood samples of patients included in the EARLY trial (NCT00562588). Plasma samples were drawn on admission and 8 days post-stroke. Neurological deficits were assessed via modified Rankin Scale (mRS) 3 months post-stroke, resulting in favorable (mRS=0-2) or unfavorable (mRS=3-6) outcome. A multiple binary logistic regression including IGF-1 and IGFBP-3 levels and confounders was conducted. Out of 404 included patients, 89 patients had an unfavorable outcome. Mean mRS on admission as well as 3 months post-stroke was 2 (±1). Low IGF-1 levels (day 8) were independently associated with a decreased risk of an unfavorable outcome (OR 0.61; 95%CI 0.37-0.99; p=0.044). Low IGFBP-3 levels (day 8) were independently associated with an unfavorable outcome (OR 2.75; 95%CI 1.56-4.84; p<0.001). Low IGFBP-3 levels and high IGF-1 levels in the subacute phase are predictive of unfavorable outcome 3 months after stroke.
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Affiliation(s)
- Moritz Armbrust
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, Germany
| | - Hans Worthmann
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Strasse 1, Hannover, Germany
| | - Reinhard Dengler
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Strasse 1, Hannover, Germany
| | | | - Ralf Lichtinghagen
- Institute for Clinical Chemistry, Hannover Medical School, Carl-Neuberg-Strasse 1, Hannover, Germany
| | | | - Matthias Endres
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, Germany.,Department of Neurology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, Germany
| | - Martin Ebinger
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, Germany.,Department of Neurology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, Germany
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33
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Dirks M, Pflugrad H, Haag K, Tillmann HL, Wedemeyer H, Arvanitis D, Hecker H, Tountopoulou A, Goldbecker A, Worthmann H, Weissenborn K. Persistent neuropsychiatric impairment in HCV patients despite clearance of the virus?! J Viral Hepat 2017; 24:541-550. [PMID: 28117537 DOI: 10.1111/jvh.12674] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 12/14/2016] [Indexed: 12/30/2022]
Abstract
One of the most disabling symptoms of hepatitis C virus (HCV) infection is chronic fatigue. While this is accepted for HCV polymerase chain reaction (PCR)-positive patients, a relationship between HCV infection and chronic fatigue is questioned after successful virus eradication. As fatigue is a subjective criterion, we aimed to evaluate in addition mood alterations and cognitive function in HCV-exposed patients with only mild liver disease and to assess a) possible interrelationships between these factors and health-related quality of life and b) the impact of viremia and former interferon treatment. One hundred and fifty-nine anti-HCV-positive individuals without advanced liver disease answered health-related quality of life (HRQoL), fatigue and depression questionnaires and underwent a battery of attention and memory tests. Accompanying diseases which could distort the results of the study such as HIV co-infection or drug addiction were exclusion criteria. The patients were subdivided into four groups according to their viremia status and interferon treatment history. Patients' data were evaluated with respect to norms given in the respective test manuals and in addition compared to those of 33 age-matched healthy controls. Eighty-five per cent of the patients had chronic fatigue, 50-60% mild depression or anxiety, 45% memory deficits and 30% attention deficits, irrespective of their HCV viremia status or treatment history. HRQoL correlated negatively with chronic fatigue (P<.001), while cognitive deficits-especially memory function-were independent from fatigue and depression. HCV infection may cause long-standing cerebral dysfunction that significantly impairs HRQoL and may even persist after clearance of the virus.
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Affiliation(s)
- M Dirks
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - H Pflugrad
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - K Haag
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - H L Tillmann
- Division of Gastroenterology, Hepatology & Nutrition, East Carolina University, Greenville, NC, USA
| | - H Wedemeyer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - D Arvanitis
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - H Hecker
- Department of Biometrics, Hannover Medical School, Hannover, Germany
| | - A Tountopoulou
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - A Goldbecker
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - H Worthmann
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - K Weissenborn
- Department of Neurology, Hannover Medical School, Hannover, Germany
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Bustamante A, Vilar-Bergua A, Guettier S, Sánchez-Poblet J, García-Berrocoso T, Giralt D, Fluri F, Topakian R, Worthmann H, Hug A, Molnar T, Waje-Andreassen U, Katan M, Smith CJ, Montaner J. C-reactive protein in the detection of post-stroke infections: systematic review and individual participant data analysis. J Neurochem 2017; 141:305-314. [PMID: 28171699 DOI: 10.1111/jnc.13973] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 01/26/2017] [Accepted: 01/31/2017] [Indexed: 11/28/2022]
Abstract
We conducted a systematic review and individual participant data meta-analysis to explore the role of C-reactive protein (CRP) in early detection or prediction of post-stroke infections. CRP, an acute-phase reactant binds to the phosphocholine expressed on the surface of dead or dying cells and some bacteria, thereby activating complement and promoting phagocytosis by macrophages. We searched PubMed up to May-2015 for studies measuring CRP in stroke and evaluating post-stroke infections. Individual participants' data were merged into a single database. CRP levels were standardized and divided into quartiles. Factors independently associated with post-stroke infections were determined by logistic regression analysis and the additional predictive value of CRP was assessed by comparing areas under receiver operating characteristic curves and integrated discrimination improvement index. Data from seven studies including 699 patients were obtained. Standardized CRP levels were higher in patients with post-stroke infections beyond 24 h. Standardized CRP levels in the fourth quartile were independently associated with infection in two different logistic regression models, model 1 [stroke severity and dysphagia, odds ratio = 9.70 (3.10-30.41)] and model 2 [age, sex, and stroke severity, odds ratio = 3.21 (1.93-5.32)]. Addition of CRP improved discrimination in both models [integrated discrimination improvement = 9.83% (0.89-18.77) and 5.31% (2.83-7.79), respectively], but accuracy was only improved for model 1 (area under the curve 0.806-0.874, p = 0.036). In this study, CRP was independently associated with development of post-stroke infections, with the optimal time-window for measurement at 24-48 h. However, its additional predictive value is moderate over clinical information. Combination with other biomarkers in a panel seems a promising strategy for future studies.
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Affiliation(s)
- Alejandro Bustamante
- Neurovascular Research Laboratory, Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Andrea Vilar-Bergua
- Neurovascular Research Laboratory, Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sophie Guettier
- Department of Neurology, Centre Hospitalo-Universitaire Côte de Nacre, Université Caen-Normandie, Caen, France
| | - Josep Sánchez-Poblet
- Neurovascular Research Laboratory, Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Teresa García-Berrocoso
- Neurovascular Research Laboratory, Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Dolors Giralt
- Neurovascular Research Laboratory, Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Felix Fluri
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Raffi Topakian
- Department of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria
| | - Hans Worthmann
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Andreas Hug
- Spinal Cord Injury Center Heidelberg, University Hospital Heidelberg, Heidelberg, Germany
| | - Tihamer Molnar
- Department of Anesthesiology and Intensive Care, University of Pecs, Pecs, Hungary
| | | | - Mira Katan
- Department of Neurology, University Hospital of Zurich, Switzerland
| | - Craig J Smith
- Greater Manchester Comprehensive Stroke Centre and Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK
| | - Joan Montaner
- Neurovascular Research Laboratory, Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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35
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Pflugrad H, Meyer GJ, Dirks M, Raab P, Tryc AB, Goldbecker A, Worthmann H, Wilke F, Boellaard R, Yaqub M, Berding G, Weissenborn K. Cerebral microglia activation in hepatitis C virus infection correlates to cognitive dysfunction. J Viral Hepat 2016; 23:348-57. [PMID: 26768955 DOI: 10.1111/jvh.12496] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 11/02/2015] [Indexed: 01/16/2023]
Abstract
Hepatitis C virus (HCV) infection may induce chronic fatigue and cognitive dysfunction. Virus replication was proven within the brain and HCV-positive cells were identified as microglia and astrocytes. We hypothesized that cerebral dysfunction in HCV-afflicted patients is associated with microglia activation. Microglia activation was assessed in vivo in 22 patients with chronic HCV infection compared to six healthy controls using [(11) C]-PK11195 Positron Emission Tomography (PET) combined with magnetic resonance tomography for anatomical localization. Patients were subdivided with regard to their PCR status, Fatigue Impact Scale score (FIS) and attention test sum score (ATS). A total of 12 patients (54.5%) were HCV PCR positive [of which 7 (58.3%) had an abnormal FIS and 7 (58.3%) an abnormal ATS], 10 patients (45.5%) were HCV PCR negative (5 (50%) each with an abnormal FIS or ATS). Patients without attention deficits showed a significantly higher accumulation of [(11) C]-PK11195 in the putamen (P = 0.05), caudate nucleus (P = 0.03) and thalamus (P = 0.04) compared to controls. Patients with and without fatigue did not differ significantly with regard to their specific tracer binding in positron emission tomography. Preserved cognitive function was associated with significantly increased microglia activation with predominance in the basal ganglia. This indicates a probably neuroprotective effect of microglia activation in HCV-infected patients.
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Affiliation(s)
- H Pflugrad
- Department of Neurology, Hannover Medical School, Hannover, Germany.,Integrated Research and Treatment Centre Transplantation, Hannover Medical School, Hannover, Germany
| | - G-J Meyer
- Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany
| | - M Dirks
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - P Raab
- Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - A B Tryc
- Department of Neurology, Hannover Medical School, Hannover, Germany.,Integrated Research and Treatment Centre Transplantation, Hannover Medical School, Hannover, Germany
| | - A Goldbecker
- Department of Neurology, Hannover Medical School, Hannover, Germany.,Integrated Research and Treatment Centre Transplantation, Hannover Medical School, Hannover, Germany
| | - H Worthmann
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - F Wilke
- Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany
| | - R Boellaard
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - M Yaqub
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - G Berding
- Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany
| | - K Weissenborn
- Department of Neurology, Hannover Medical School, Hannover, Germany.,Integrated Research and Treatment Centre Transplantation, Hannover Medical School, Hannover, Germany
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36
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Grosse GM, Schulz-Schaeffer WJ, Teebken OE, Schuppner R, Dirks M, Worthmann H, Lichtinghagen R, Maye G, Limbourg FP, Weissenborn K. Monocyte Subsets and Related Chemokines in Carotid Artery Stenosis and Ischemic Stroke. Int J Mol Sci 2016; 17:433. [PMID: 27023515 PMCID: PMC4848889 DOI: 10.3390/ijms17040433] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 03/08/2016] [Accepted: 03/17/2016] [Indexed: 01/01/2023] Open
Abstract
Carotid stenosis (CS) is an important cause of ischemic stroke. However, reliable markers for the purpose of identification of high-risk, so-called vulnerable carotid plaques, are still lacking. Monocyte subsets are crucial players in atherosclerosis and might also contribute to plaque rupture. In this study we, therefore, aimed to investigate the potential role of monocyte subsets and associated chemokines as clinical biomarkers for vulnerability of CS. Patients with symptomatic and asymptomatic CS (n = 21), patients with cardioembolic ischemic strokes (n = 11), and controls without any cardiovascular disorder (n = 11) were examined. Cardiovascular risk was quantified using the Essen Stroke Risk Score (ESRS). Monocyte subsets in peripheral blood were measured by quantitative flow cytometry. Plaque specimens were histologically analyzed. Furthermore, plasma levels of monocyte chemotactic protein 1 (MCP-1) and fractalkine were measured. Intermediate monocytes (Mon2) were significantly elevated in symptomatic and asymptomatic CS-patients compared to controls. Mon2 counts positively correlated with the ESRS. Moreover, stroke patients showed an elevation of Mon2 compared to controls, independent of the ESRS. MCP-1 levels were significantly higher in patients with symptomatic than in those with asymptomatic CS. Several histological criteria significantly differed between symptomatic and asymptomatic plaques. However, there was no association of monocyte subsets or chemokines with histological features of plaque vulnerability. Due to the multifactorial influence on monocyte subsets, the usability as clinical markers for plaque vulnerability seems to be limited. However, monocyte subsets may be critically involved in the pathology of CS.
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Affiliation(s)
- Gerrit M Grosse
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany.
| | | | - Omke E Teebken
- Department of Vascular Surgery, Klinikum Peine, 31226 Peine, Germany.
| | - Ramona Schuppner
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany.
| | - Meike Dirks
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany.
| | - Hans Worthmann
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany.
| | - Ralf Lichtinghagen
- Department of Clinical Chemistry, Hannover Medical School, 30625 Hannover, Germany.
| | - Gerrit Maye
- Department of Nephrology and Hypertension, Hannover Medical School, 30625 Hannover, Germany.
| | - Florian P Limbourg
- Department of Nephrology and Hypertension, Hannover Medical School, 30625 Hannover, Germany.
| | - Karin Weissenborn
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany.
- Center for Systems Neuroscience (ZSN), 30559 Hannover, Germany.
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37
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Schuppner R, Maehlmann J, Dirks M, Worthmann H, Tryc AB, Sandorski K, Bahlmann E, Kielstein JT, Giesemann AM, Lanfermann H, Weissenborn K. Neurological Sequelae in Adults After E coli O104: H4 Infection-Induced Hemolytic-Uremic Syndrome. Medicine (Baltimore) 2016; 95:e2337. [PMID: 26871766 PMCID: PMC4753860 DOI: 10.1097/md.0000000000002337] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
In an outbreak of shiga toxin-producing Escherichia coli infections and associated hemolytic-uremic syndrome (STEC O104:H4) in Germany in the year 2011 neurological complications in adult patients occurred unexpectedly frequent, ranging between 48% and 100% in different patient groups. Few is known about the long-term effects of such complications and so we performed follow-up exams on 44 of the patients treated for STEC-HUS at Hannover Medical Scool in this observational study. Standardized follow-up exams including neurological and neuropsychological assessments, laboratory testing, magnetic resonance imaging (MRI), and EEG were carried out. Subgroups were examined 2 (n = 34), 7 (n = 22), and 19 (n = 23) months after disease onset. Additionally, at the 19-month follow-up, quality of life, sleep quality, and possible fatigue were assessed.Nineteen months after disease onset 31 patients were reassessed, 22 of whom still suffered from symptoms such as fatigue, headache, and attention deficits. In the neuropsychological assessments only 39% of the patients performed normal, whereas 61% scored borderline pathological or lower. Upon reviewal, the follow-up data most prominently showed a secondary decline of cognitive function in about one-quarter of the patients. Outcome was not related to treatment or laboratory data in the acute phase of the disease nor length of hospitalization. Prognosis of STEC-HUS associated brain dysfunction in adults with regard to severity of symptoms is mostly good; some patients however still have not made a full recovery. Patients' caretakers have to be aware of possible secondary decline of brain function as was observed in this study.
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Affiliation(s)
- Ramona Schuppner
- From the Clinic for Neurology (RS, JM, MD, HW, ABT, KS, KW); Clinic for Nephrology (EB, JTK); and Institute for Interventional and Diagnostic Neuroradiology, Hannover Medical School, Hannover, Germany (AMG, HL)
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38
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Wozniak MA, Lugo Iparraguirre LM, Dirks M, Deb-Chatterji M, Pflugrad H, Goldbecker A, Tryc AB, Worthmann H, Gess M, Crossey MME, Forton DM, Taylor-Robinson SD, Itzhaki RF, Weissenborn K. Apolipoprotein E-ε4 deficiency and cognitive function in hepatitis C virus-infected patients. J Viral Hepat 2016; 23:39-46. [PMID: 26306786 DOI: 10.1111/jvh.12443] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 07/16/2015] [Indexed: 12/14/2022]
Abstract
Hepatitis C virus (HCV) causes not only liver damage in certain patients but can also lead to neuropsychiatric symptoms. Previous studies have shown that the type 4 allele of the gene for apolipoprotein E (APOE) is strongly protective against HCV-induced damage in liver. In this study, we have investigated the possibility that APOE genotype is involved in the action of HCV in brain. One hundred HCV-infected patients with mild liver disease underwent a neurological examination and a comprehensive psychometric testing of attention and memory function. In addition, patients completed questionnaires for the assessment of fatigue, health-related quality of life and mood disturbances. Apolipoprotein E gene genotyping was carried out on saliva using buccal swabs. The APOE-ε4 allele frequency was significantly lower in patients with an impairment of working memory, compared to those with a normal working memory test result (P = 0.003). A lower APOE-ε4 allele frequency was also observed in patients with definitely altered attention ability (P = 0.008), but here, the P-value missed the level of significance after application of the Bonferroni correction. Our data suggest that the APOE-ε4 allele is protective against attention deficit and especially against poor working memory in HCV-infected subjects with mild liver disease. Considering the role of apolipoprotein E in the life cycle of the virus, the findings shed interesting new light upon possible pathomechanisms behind the development of neuropsychiatric symptoms in hepatitis C infection.
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Affiliation(s)
- M A Wozniak
- Faculty of Life Sciences, University of Manchester, Manchester, UK
| | | | - M Dirks
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - M Deb-Chatterji
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - H Pflugrad
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - A Goldbecker
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - A B Tryc
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - H Worthmann
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - M Gess
- Department of Gastroenterology and Hepatology, St George's Hospital and Medical School, London, UK
| | - M M E Crossey
- Department of Medicine, St Mary's Hospital Campus, Imperial College London, London, UK
| | - D M Forton
- Department of Gastroenterology and Hepatology, St George's Hospital and Medical School, London, UK
| | - S D Taylor-Robinson
- Department of Medicine, St Mary's Hospital Campus, Imperial College London, London, UK
| | - R F Itzhaki
- Faculty of Life Sciences, University of Manchester, Manchester, UK
| | - K Weissenborn
- Department of Neurology, Hannover Medical School, Hannover, Germany
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39
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Zerche M, Weissenborn K, Ott C, Dere E, Asif AR, Worthmann H, Hassouna I, Rentzsch K, Tryc AB, Dahm L, Steiner J, Binder L, Wiltfang J, Sirén AL, Stöcker W, Ehrenreich H. Preexisting Serum Autoantibodies Against the NMDAR Subunit NR1 Modulate Evolution of Lesion Size in Acute Ischemic Stroke. Stroke 2015; 46:1180-6. [PMID: 25765725 DOI: 10.1161/strokeaha.114.008323] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 02/17/2015] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND PURPOSE Recently, we reported high seroprevalence (age-dependent up to >19%) of N-methyl-d-aspartate-receptor subunit NR1 (NMDAR1) autoantibodies in both healthy and neuropsychiatrically ill subjects (N=4236). Neuropsychiatric syndrome relevance was restricted to individuals with compromised blood-brain barrier, for example, apolipoprotein E4 (APOE4) carrier status, both clinically and experimentally. We now hypothesized that these autoantibodies may upon stroke be protective in individuals with hitherto intact blood-brain barrier, but harmful for subjects with chronically compromised blood-brain barrier. METHODS Of 464 patients admitted with acute ischemic stroke in the middle cerebral artery territory, blood for NMDAR1 autoantibody measurements and APOE4 carrier status as indicator of a preexisting leaky blood-brain barrier was collected within 3 to 5 hours after stroke. Evolution of lesion size (delta day 7-1) in diffusion-weighted magnetic resonance imaging was primary outcome parameter. In subgroups, NMDAR1 autoantibody measurements were repeated on days 2 and 7. RESULTS Of all 464 patients, 21.6% were NMDAR1 autoantibody-positive (immunoglobulin M, A, or G) and 21% were APOE4 carriers. Patients with magnetic resonance imaging data available on days 1 and 7 (N=384) were divided into 4 groups according to NMDAR1 autoantibody and APOE4 status. Groups were comparable in all stroke-relevant presenting characteristics. The autoantibody+/APOE4- group had a smaller mean delta lesion size compared with the autoantibody-/APOE4- group, suggesting a protective effect of circulating NMDAR1 autoantibodies. In contrast, the autoantibody+/APOE4+ group had the largest mean delta lesion area. NMDAR1 autoantibody serum titers dropped on day 2 and remounted by day 7. CONCLUSIONS Dependent on blood-brain barrier integrity before an acute ischemic brain injury, preexisting NMDAR1 autoantibodies seem to be beneficial or detrimental.
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Affiliation(s)
- Maria Zerche
- From the Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany (M.Z., C.O., E.D., I.H., L.D., H.E.); Department of Neurology, Hannover Medical School, Hannover, Germany (K.W., H.W., A.B.T.); DFG Center for Nanoscale Microscopy and Molecular Physiology of the Brain, Göttingen, Germany (J.W.); Institute of Clinical Chemistry, University Medical Center, Göttingen, Germany (A.R.A., L.B.); Institute for Experimental Immunology, affiliated to Euroimmun, Lübeck, Germany (K.R., W.S.); Department of Psychiatry, University of Magdeburg, Magdeburg, Germany (J.S.); Department of Psychiatry and Psychotherapy, University of Göttingen, Germany (J.W.); and Department of Neurosurgery, University of Würzburg, Germany (A.-L.S.)
| | - Karin Weissenborn
- From the Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany (M.Z., C.O., E.D., I.H., L.D., H.E.); Department of Neurology, Hannover Medical School, Hannover, Germany (K.W., H.W., A.B.T.); DFG Center for Nanoscale Microscopy and Molecular Physiology of the Brain, Göttingen, Germany (J.W.); Institute of Clinical Chemistry, University Medical Center, Göttingen, Germany (A.R.A., L.B.); Institute for Experimental Immunology, affiliated to Euroimmun, Lübeck, Germany (K.R., W.S.); Department of Psychiatry, University of Magdeburg, Magdeburg, Germany (J.S.); Department of Psychiatry and Psychotherapy, University of Göttingen, Germany (J.W.); and Department of Neurosurgery, University of Würzburg, Germany (A.-L.S.)
| | - Christoph Ott
- From the Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany (M.Z., C.O., E.D., I.H., L.D., H.E.); Department of Neurology, Hannover Medical School, Hannover, Germany (K.W., H.W., A.B.T.); DFG Center for Nanoscale Microscopy and Molecular Physiology of the Brain, Göttingen, Germany (J.W.); Institute of Clinical Chemistry, University Medical Center, Göttingen, Germany (A.R.A., L.B.); Institute for Experimental Immunology, affiliated to Euroimmun, Lübeck, Germany (K.R., W.S.); Department of Psychiatry, University of Magdeburg, Magdeburg, Germany (J.S.); Department of Psychiatry and Psychotherapy, University of Göttingen, Germany (J.W.); and Department of Neurosurgery, University of Würzburg, Germany (A.-L.S.)
| | - Ekrem Dere
- From the Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany (M.Z., C.O., E.D., I.H., L.D., H.E.); Department of Neurology, Hannover Medical School, Hannover, Germany (K.W., H.W., A.B.T.); DFG Center for Nanoscale Microscopy and Molecular Physiology of the Brain, Göttingen, Germany (J.W.); Institute of Clinical Chemistry, University Medical Center, Göttingen, Germany (A.R.A., L.B.); Institute for Experimental Immunology, affiliated to Euroimmun, Lübeck, Germany (K.R., W.S.); Department of Psychiatry, University of Magdeburg, Magdeburg, Germany (J.S.); Department of Psychiatry and Psychotherapy, University of Göttingen, Germany (J.W.); and Department of Neurosurgery, University of Würzburg, Germany (A.-L.S.)
| | - Abdul R Asif
- From the Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany (M.Z., C.O., E.D., I.H., L.D., H.E.); Department of Neurology, Hannover Medical School, Hannover, Germany (K.W., H.W., A.B.T.); DFG Center for Nanoscale Microscopy and Molecular Physiology of the Brain, Göttingen, Germany (J.W.); Institute of Clinical Chemistry, University Medical Center, Göttingen, Germany (A.R.A., L.B.); Institute for Experimental Immunology, affiliated to Euroimmun, Lübeck, Germany (K.R., W.S.); Department of Psychiatry, University of Magdeburg, Magdeburg, Germany (J.S.); Department of Psychiatry and Psychotherapy, University of Göttingen, Germany (J.W.); and Department of Neurosurgery, University of Würzburg, Germany (A.-L.S.)
| | - Hans Worthmann
- From the Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany (M.Z., C.O., E.D., I.H., L.D., H.E.); Department of Neurology, Hannover Medical School, Hannover, Germany (K.W., H.W., A.B.T.); DFG Center for Nanoscale Microscopy and Molecular Physiology of the Brain, Göttingen, Germany (J.W.); Institute of Clinical Chemistry, University Medical Center, Göttingen, Germany (A.R.A., L.B.); Institute for Experimental Immunology, affiliated to Euroimmun, Lübeck, Germany (K.R., W.S.); Department of Psychiatry, University of Magdeburg, Magdeburg, Germany (J.S.); Department of Psychiatry and Psychotherapy, University of Göttingen, Germany (J.W.); and Department of Neurosurgery, University of Würzburg, Germany (A.-L.S.)
| | - Imam Hassouna
- From the Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany (M.Z., C.O., E.D., I.H., L.D., H.E.); Department of Neurology, Hannover Medical School, Hannover, Germany (K.W., H.W., A.B.T.); DFG Center for Nanoscale Microscopy and Molecular Physiology of the Brain, Göttingen, Germany (J.W.); Institute of Clinical Chemistry, University Medical Center, Göttingen, Germany (A.R.A., L.B.); Institute for Experimental Immunology, affiliated to Euroimmun, Lübeck, Germany (K.R., W.S.); Department of Psychiatry, University of Magdeburg, Magdeburg, Germany (J.S.); Department of Psychiatry and Psychotherapy, University of Göttingen, Germany (J.W.); and Department of Neurosurgery, University of Würzburg, Germany (A.-L.S.)
| | - Kristin Rentzsch
- From the Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany (M.Z., C.O., E.D., I.H., L.D., H.E.); Department of Neurology, Hannover Medical School, Hannover, Germany (K.W., H.W., A.B.T.); DFG Center for Nanoscale Microscopy and Molecular Physiology of the Brain, Göttingen, Germany (J.W.); Institute of Clinical Chemistry, University Medical Center, Göttingen, Germany (A.R.A., L.B.); Institute for Experimental Immunology, affiliated to Euroimmun, Lübeck, Germany (K.R., W.S.); Department of Psychiatry, University of Magdeburg, Magdeburg, Germany (J.S.); Department of Psychiatry and Psychotherapy, University of Göttingen, Germany (J.W.); and Department of Neurosurgery, University of Würzburg, Germany (A.-L.S.)
| | - Anita B Tryc
- From the Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany (M.Z., C.O., E.D., I.H., L.D., H.E.); Department of Neurology, Hannover Medical School, Hannover, Germany (K.W., H.W., A.B.T.); DFG Center for Nanoscale Microscopy and Molecular Physiology of the Brain, Göttingen, Germany (J.W.); Institute of Clinical Chemistry, University Medical Center, Göttingen, Germany (A.R.A., L.B.); Institute for Experimental Immunology, affiliated to Euroimmun, Lübeck, Germany (K.R., W.S.); Department of Psychiatry, University of Magdeburg, Magdeburg, Germany (J.S.); Department of Psychiatry and Psychotherapy, University of Göttingen, Germany (J.W.); and Department of Neurosurgery, University of Würzburg, Germany (A.-L.S.)
| | - Liane Dahm
- From the Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany (M.Z., C.O., E.D., I.H., L.D., H.E.); Department of Neurology, Hannover Medical School, Hannover, Germany (K.W., H.W., A.B.T.); DFG Center for Nanoscale Microscopy and Molecular Physiology of the Brain, Göttingen, Germany (J.W.); Institute of Clinical Chemistry, University Medical Center, Göttingen, Germany (A.R.A., L.B.); Institute for Experimental Immunology, affiliated to Euroimmun, Lübeck, Germany (K.R., W.S.); Department of Psychiatry, University of Magdeburg, Magdeburg, Germany (J.S.); Department of Psychiatry and Psychotherapy, University of Göttingen, Germany (J.W.); and Department of Neurosurgery, University of Würzburg, Germany (A.-L.S.)
| | - Johann Steiner
- From the Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany (M.Z., C.O., E.D., I.H., L.D., H.E.); Department of Neurology, Hannover Medical School, Hannover, Germany (K.W., H.W., A.B.T.); DFG Center for Nanoscale Microscopy and Molecular Physiology of the Brain, Göttingen, Germany (J.W.); Institute of Clinical Chemistry, University Medical Center, Göttingen, Germany (A.R.A., L.B.); Institute for Experimental Immunology, affiliated to Euroimmun, Lübeck, Germany (K.R., W.S.); Department of Psychiatry, University of Magdeburg, Magdeburg, Germany (J.S.); Department of Psychiatry and Psychotherapy, University of Göttingen, Germany (J.W.); and Department of Neurosurgery, University of Würzburg, Germany (A.-L.S.)
| | - Lutz Binder
- From the Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany (M.Z., C.O., E.D., I.H., L.D., H.E.); Department of Neurology, Hannover Medical School, Hannover, Germany (K.W., H.W., A.B.T.); DFG Center for Nanoscale Microscopy and Molecular Physiology of the Brain, Göttingen, Germany (J.W.); Institute of Clinical Chemistry, University Medical Center, Göttingen, Germany (A.R.A., L.B.); Institute for Experimental Immunology, affiliated to Euroimmun, Lübeck, Germany (K.R., W.S.); Department of Psychiatry, University of Magdeburg, Magdeburg, Germany (J.S.); Department of Psychiatry and Psychotherapy, University of Göttingen, Germany (J.W.); and Department of Neurosurgery, University of Würzburg, Germany (A.-L.S.)
| | - Jens Wiltfang
- From the Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany (M.Z., C.O., E.D., I.H., L.D., H.E.); Department of Neurology, Hannover Medical School, Hannover, Germany (K.W., H.W., A.B.T.); DFG Center for Nanoscale Microscopy and Molecular Physiology of the Brain, Göttingen, Germany (J.W.); Institute of Clinical Chemistry, University Medical Center, Göttingen, Germany (A.R.A., L.B.); Institute for Experimental Immunology, affiliated to Euroimmun, Lübeck, Germany (K.R., W.S.); Department of Psychiatry, University of Magdeburg, Magdeburg, Germany (J.S.); Department of Psychiatry and Psychotherapy, University of Göttingen, Germany (J.W.); and Department of Neurosurgery, University of Würzburg, Germany (A.-L.S.)
| | - Anna-Leena Sirén
- From the Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany (M.Z., C.O., E.D., I.H., L.D., H.E.); Department of Neurology, Hannover Medical School, Hannover, Germany (K.W., H.W., A.B.T.); DFG Center for Nanoscale Microscopy and Molecular Physiology of the Brain, Göttingen, Germany (J.W.); Institute of Clinical Chemistry, University Medical Center, Göttingen, Germany (A.R.A., L.B.); Institute for Experimental Immunology, affiliated to Euroimmun, Lübeck, Germany (K.R., W.S.); Department of Psychiatry, University of Magdeburg, Magdeburg, Germany (J.S.); Department of Psychiatry and Psychotherapy, University of Göttingen, Germany (J.W.); and Department of Neurosurgery, University of Würzburg, Germany (A.-L.S.)
| | - Winfried Stöcker
- From the Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany (M.Z., C.O., E.D., I.H., L.D., H.E.); Department of Neurology, Hannover Medical School, Hannover, Germany (K.W., H.W., A.B.T.); DFG Center for Nanoscale Microscopy and Molecular Physiology of the Brain, Göttingen, Germany (J.W.); Institute of Clinical Chemistry, University Medical Center, Göttingen, Germany (A.R.A., L.B.); Institute for Experimental Immunology, affiliated to Euroimmun, Lübeck, Germany (K.R., W.S.); Department of Psychiatry, University of Magdeburg, Magdeburg, Germany (J.S.); Department of Psychiatry and Psychotherapy, University of Göttingen, Germany (J.W.); and Department of Neurosurgery, University of Würzburg, Germany (A.-L.S.)
| | - Hannelore Ehrenreich
- From the Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany (M.Z., C.O., E.D., I.H., L.D., H.E.); Department of Neurology, Hannover Medical School, Hannover, Germany (K.W., H.W., A.B.T.); DFG Center for Nanoscale Microscopy and Molecular Physiology of the Brain, Göttingen, Germany (J.W.); Institute of Clinical Chemistry, University Medical Center, Göttingen, Germany (A.R.A., L.B.); Institute for Experimental Immunology, affiliated to Euroimmun, Lübeck, Germany (K.R., W.S.); Department of Psychiatry, University of Magdeburg, Magdeburg, Germany (J.S.); Department of Psychiatry and Psychotherapy, University of Göttingen, Germany (J.W.); and Department of Neurosurgery, University of Würzburg, Germany (A.-L.S.).
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Worthmann H, Tryc AB, Dirks M, Schuppner R, Brand K, Klawonn F, Lichtinghagen R, Weissenborn K. Lipopolysaccharide binding protein, interleukin-10, interleukin-6 and C-reactive protein blood levels in acute ischemic stroke patients with post-stroke infection. J Neuroinflammation 2015; 12:13. [PMID: 25613713 PMCID: PMC4307994 DOI: 10.1186/s12974-014-0231-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 12/21/2014] [Indexed: 11/10/2022] Open
Abstract
Background Ischemic stroke patients are prone to infection by stroke-induced immunodepression. We hypothesized that levels of lipopolysaccharide binding protein (LBP), interleukin-10 (IL-10), IL-6 and C-reactive protein (CRP) are early predictors for the development of stroke-associated infection. Methods Fifty-six patients with ischemic stroke (n = 51) and transient ischemic attack (TIA) (n = 5) who presented within 6 hours after symptom onset and who were free of detectable infection on admission were included in the study. Of these, 20 developed early infections during the first week. Blood samples were taken at 6, 12, and 24 hours and at 3 and 7 days after stroke onset. Levels of LBP, Il-10, IL-6 and CRP, as well as S100B, were measured as markers of inflammation and brain damage by commercially available immunometric tests. Results In the univariate analysis, levels of LBP, IL-10, IL-6 and CRP significantly differed between patients who developed an infection and those who did not. In the binary logistic regression analysis, which was adjusted for National Institutes of Health Stroke Scale (NIHSS) on admission, stroke subtype and S100B peak levels, as indicator of the extent of brain damage, IL-10 at 6 hours, CRP at 6 hours and NIHSS on admission were identified as independent predictors of infection (IL-10: P = 0.009; CRP: P = 0.018; NIHSS: P = 0.041). The area under the curve (AUC) of the receiver operating characteristic (ROC) curves in relation to the dichotomized status of the infection (infection versus no infection) was 0.74 (95% confidence interval: 0.59 to 0.88) for CRP at 6 hours, 0.76 (0.61 to 0.9) for IL-10 at 6 hours, 0.83 (0.71 to 0.94) for NIHSS on admission and 0.94 (0.88 to 1) for the combination of CRP, IL-10 and NIHSS. In a subanalysis, 16 patients with early infections were matched with 16 patients without infection according to S100B peak levels. Here, the temporal pattern of LBP, IL-10, IL-6 and CRP significantly differed between the patient groups. Conclusions Our data show that blood levels of inflammation markers may be used as early predictors of stroke-associated infection. We propose prospective studies to investigate if the calculated cut-offs of CRP, IL-10 and NIHSS might help to identify patients who should receive early preventive antibiotic treatment.
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Affiliation(s)
- Hans Worthmann
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30623, Hannover, Germany.
| | - Anita B Tryc
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30623, Hannover, Germany.
| | - Meike Dirks
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30623, Hannover, Germany.
| | - Ramona Schuppner
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30623, Hannover, Germany.
| | - Korbinian Brand
- Department of Clinical Chemistry, Hannover Medical School, Carl-Neuberg-Str. 1, 30623, Hannover, Germany.
| | - Frank Klawonn
- Department of Computer Science, Ostfalia University of Applied Sciences, Am Exer 2, 38302, Wolfenbuettel, Germany. .,Biostatistics, Helmholtz Centre for Infection Research, Inhoffenstr. 7, 38124, Braunschweig, Germany.
| | - Ralf Lichtinghagen
- Department of Clinical Chemistry, Hannover Medical School, Carl-Neuberg-Str. 1, 30623, Hannover, Germany.
| | - Karin Weissenborn
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30623, Hannover, Germany. .,Center for Systems Neuroscience (ZSN), Buenteweg 2, 30559, Hannover, Germany.
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Diener HC, Stanford S, Abdul-Rahim A, Christensen L, Hougaard KD, Bakhai A, Veltkamp R, Worthmann H. Anti-thrombotic therapy in patients with atrial fibrillation and intracranial hemorrhage. Expert Rev Neurother 2014; 14:1019-28. [DOI: 10.1586/14737175.2014.945435] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Bustamante A, Sobrino T, Giralt D, García-Berrocoso T, Llombart V, Ugarriza I, Espadaler M, Rodríguez N, Sudlow C, Castellanos M, Smith CJ, Rodríguez-Yánez M, Waje-Andreassen U, Tanne D, Oto J, Barber M, Worthmann H, Wartenberg KE, Becker KJ, Chakraborty B, Oh SH, Whiteley WN, Castillo J, Montaner J. Prognostic value of blood interleukin-6 in the prediction of functional outcome after stroke: a systematic review and meta-analysis. J Neuroimmunol 2014; 274:215-24. [PMID: 25091431 DOI: 10.1016/j.jneuroim.2014.07.015] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 07/16/2014] [Accepted: 07/17/2014] [Indexed: 11/24/2022]
Abstract
We aimed to quantify the association of blood interleukin-6 (IL-6) concentrations with poor outcome after stroke and its added predictive value over clinical information. Meta-analysis of 24 studies confirmed this association with a weighted mean difference of 3.443 (1.592-5.294) pg/mL, despite high heterogeneity and publication bias. Individual participant data including 4112 stroke patients showed standardized IL-6 levels in the 4th quartile were independently associated with poor outcome (OR=2.346 (1.814-3.033), p<0.0001). However, the additional predictive value of IL-6 was moderate (IDI=1.5%, NRI=5.35%). Overall these results indicate an unlikely translation of IL-6 into clinical practice for this purpose.
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Affiliation(s)
- Alejandro Bustamante
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona, Spain; Neurology Department, Hospital Vall d'Hebron, Barcelona, Spain
| | - Tomás Sobrino
- Department of Neurology, Clinical Neurosciences Research Laboratory, University Clinical Hospital, Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Dolors Giralt
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona, Spain
| | - Teresa García-Berrocoso
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona, Spain
| | - Victor Llombart
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona, Spain
| | | | - Marc Espadaler
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona, Spain
| | | | - Cathie Sudlow
- Centre for Clinical Brain Sciences, University of Edinburgh, UK
| | - Mar Castellanos
- Department of Neurology, Hospital Universitario Dr. Josep Trueta of Girona, Biomedical Research Institute of Girona, Spain
| | - Craig J Smith
- Stroke and Vascular Research Centre, University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, UK
| | - Manuel Rodríguez-Yánez
- Department of Neurology, Clinical Neurosciences Research Laboratory, University Clinical Hospital, Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
| | | | - David Tanne
- Sagol Neuroscience Center, Chaim Sheba Medical Center and Tel Aviv University, Israel
| | - Jun Oto
- University of Tokushima Graduate School, Japan
| | - Mark Barber
- Stroke Managed Clinical Network, NHS Lanarkshire, UK
| | - Hans Worthmann
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Katja E Wartenberg
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Germany
| | - Kyra J Becker
- Department of Neurology and Neurological Surgery, University of Washington School of Medicine, Seattle, WA, United States
| | | | - Seung-Hun Oh
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | | | - José Castillo
- Department of Neurology, Clinical Neurosciences Research Laboratory, University Clinical Hospital, Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Joan Montaner
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona, Spain; Neurology Department, Hospital Vall d'Hebron, Barcelona, Spain.
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Grosse GM, Tryc AB, Dirks M, Schuppner R, Pflugrad H, Lichtinghagen R, Weissenborn K, Worthmann H. The temporal dynamics of plasma fractalkine levels in ischemic stroke: association with clinical severity and outcome. J Neuroinflammation 2014; 11:74. [PMID: 24722201 PMCID: PMC4022085 DOI: 10.1186/1742-2094-11-74] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 03/28/2014] [Indexed: 01/18/2023] Open
Abstract
Background The chemokine fractalkine (CX3CL1, FKN) is involved in neural-microglial interactions and is regarded as neuroprotective according to several in vivo studies of inflammatory and degenerative states of the brain. Recently, an association with outcome in human ischemic stroke has been proposed. In this study, we aimed to investigate the temporal pattern of FKN levels in acute ischemic stroke in relation to stroke severity and outcome. Methods FKN levels were measured in plasma specimens of fifty-five patients with acute ischemic stroke. Blood was available for time points 6 hours (h), 12 h, 3 days (d), 7 d and 90 d after stroke onset. Clinical outcome was evaluated using the modified Rankin Scale (mRS) at 7 d and 90 d. Results The time course of FKN significantly differs depending on stroke severity, with higher FKN levels linked to a lower severity. FKN levels in patients with moderate to severe strokes differ significantly from controls. In outcome analysis, we found an association of dynamics of FKN with clinical outcome. Decrease of FKN is pronounced in patients with worse outcome. Multivariate analysis including stroke severity and stroke etiology revealed that deltaFKN between 6 h and 3 d is independently associated with mRS at 90 d. In addition deltaFKN is inversely correlated with the extent of brain damage, as measured by S100B. Conclusions FKN dynamics are independently associated with stroke outcome. Further studies might give insight on whether FKN is actively involved in the inflammatory cascade after acute ischemic stroke.
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Affiliation(s)
| | | | | | | | | | | | | | - Hans Worthmann
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str, 1, 30625 Hannover, Germany.
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Heeren M, Sojref F, Schuppner R, Worthmann H, Pflugrad H, Tryc AB, Pasedag T, Weissenborn K. Active at night, sleepy all day--sleep disturbances in patients with hepatitis C virus infection. J Hepatol 2014; 60:732-40. [PMID: 24308991 DOI: 10.1016/j.jhep.2013.11.030] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 11/23/2013] [Accepted: 11/26/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS More than 50% of patients with chronic hepatitis C with only mild liver disease complain about chronic fatigue, daytime sleepiness and poor sleep quality. The aim of the present study was to characterize and objectify the sleep disturbances in hepatitis C virus-infected patients. METHODS Twenty-five women who had been infected with hepatitis C virus contaminated anti-D immunoglobulin in 1978/79 and 22 age-matched female healthy controls underwent actigraphy over a period of 5 days to measure motor activity and thereby sleep-wake-rhythm and in addition completed questionnaires for depression, health-related quality of life, fatigue and sleep, and a sleep diary. Liver cirrhosis, a history of neurological or psychiatric disease, history of intravenous drug abuse, shift work, or current medication with effect upon the central nervous system were exclusion criteria. RESULTS The patients achieved higher scores for depression, fatigue and sleep disturbances and lower quality of life scores than the healthy controls. Actigraphy showed higher nocturnal activity and worse sleep efficiency in the patients, while the 24-h activity level did not differ between groups. Fatigue and quality of life scores correlated with bad sleep quality and daytime sleepiness. CONCLUSIONS Our data indicate that chronic fatigue is associated with bad sleep quality and increased nocturnal activity in HCV-infected patients suggesting an alteration of sleep architecture behind fatigue in HCV-associated encephalopathy.
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Affiliation(s)
- Meike Heeren
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Faina Sojref
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Ramona Schuppner
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Hans Worthmann
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Henning Pflugrad
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Anita B Tryc
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Thomas Pasedag
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Karin Weissenborn
- Department of Neurology, Hannover Medical School, Hannover, Germany.
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Worthmann H, Kielstein JT, Weissenborn K. Response to letter regarding article, "Asymmetric dimethylarginine in response to recombinant tissue-type plasminogen activator and erythropoietin in acute stroke". Stroke 2013; 44:e230. [PMID: 24130135 DOI: 10.1161/strokeaha.113.003259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Hans Worthmann
- Department of Neurology, Hannover Medical School, Hannover, Germany
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Deb-Chatterji M, Gerdes S, Heeren M, Lambrecht J, Worthmann H, Goldbecker A, Tryc AB, Lovric S, Schulz-Schaeffer W, Brandis A, Dengler R, Weissenborn K, Haubitz M. Circulating endothelial cells as potential diagnostic biomarkers in primary central nervous system vasculitis. J Neurol Neurosurg Psychiatry 2013; 84:732-4. [PMID: 23243263 DOI: 10.1136/jnnp-2012-303335] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Histological evidence is considered the only proof of primary central nervous system vasculitis (PCNSV). However, brain biopsy is often omitted or delayed because of the invasiveness and possible complications of the procedure. Circulating endothelial cells (CEC) were shown to be elevated in patients with active antineutrophil cytoplasmic antibody-associated vasculitis. We hypothesise that CEC are also elevated in patients with active PCNSV and may contribute to the diagnosis. METHODS CEC were assessed in 18 patients, 3 of whom had biopsy-proven PCNSV and 15 clinical, cerebrospinal fluid and imaging data, highly suggestive of PCNSV. In 3 of these 15 patients CEC assessment was performed after initiation of successful immunosuppressive therapy. CEC numbers of all patients were compared to those of 16 healthy volunteers and 123 subjects with cerebrovascular risk factors and/or ischaemic stroke, who had been studied in our group before. CEC were assessed by immunomagnetic isolation from peripheral blood. RESULTS In patients with proven and suspected active PCNSV, CEC were extremely elevated (>400 cells/ml in most of the patients) and significantly higher than in healthy and disease controls (p≤0.01 for each group). CEC significantly decreased with immunosuppressive treatment. CONCLUSIONS For the first time it is shown that CEC are significantly elevated in patients with active PCNSV in contrast to other pathologies associated with brain infarction and correlate with disease activity. Sensitivity and specificity of the method for diagnosing PCNSV and the use of the method for treatment monitoring should be addressed in future prospective studies with a larger patient group.
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Affiliation(s)
- Milani Deb-Chatterji
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover D-30625, Germany.
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Worthmann H, Martens-Lobenhoffer J, Joumaah M, Li N, Lichtinghagen R, Hecker H, Kielstein JT, Ehrenreich H, Bode-Böger SM, Weissenborn K. Asymmetric dimethylarginine in response to recombinant tissue-type plasminogen activator and erythropoietin in acute stroke. Stroke 2013; 44:2128-33. [PMID: 23788583 DOI: 10.1161/strokeaha.113.001145] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE In the German Multicenter Erythropoietin (EPO) Stroke Trial, patients not receiving thrombolysis most likely benefited from EPO on clinical recovery, whereas a combination of rtPA and EPO was associated with increased mortality. We investigated whether the combination of rtPA and EPO increased release of the endogenous NO synthase inhibitor asymmetric dimethylarginine (ADMA), and thereby potentially deteriorated ischemic stroke outcome, as suggested from experimental data. METHODS ADMA was determined in serum samples from 90 patients of the German Multicenter EPO Stroke Trial taken at days 1 (within 6 hours after symptom onset), 2, 3, 4, and 7 after stroke using high-performance liquid chromatography-tandem mass spectrometry. ADMA was analyzed for the different treatment groups (EPO, n=25; placebo, n=30; rtPA+placebo, n=18; EPO+rtPA, n=17). Clinical outcome was expressed as difference between National Institutes of Health Stroke Scale at baseline and 90 days. RESULTS ADMA levels significantly increased during the observation time in EPO, EPO+rtPA, and placebo groups (P<0.05). A treatment effect on ADMA levels was revealed by repeated measures ANOVA only in the rtPA+placebo group (P=0.027). Here, ADMA levels were decreased compared with the placebo group (P<0.05). Both the EPO and the rtPA+placebo groups in the Hannover subgroup of the EPO trial had better outcome than the placebo group (P<0.05). CONCLUSIONS Our data underscore the potential benefit of EPO in ischemic stroke. The hypothesis from experimental data, that EPO treatment increases ADMA in stroke patients, was disproved. Further studies are needed to clarify whether decreased ADMA might contribute to therapeutic rtPA effects.
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Affiliation(s)
- Hans Worthmann
- Department of Neurology, Hannover Medical School, Hannover, Germany
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Li N, Liu YF, Ma L, Worthmann H, Wang YL, Wang YJ, Gao YP, Raab P, Dengler R, Weissenborn K, Zhao XQ. Association of Molecular Markers With Perihematomal Edema and Clinical Outcome in Intracerebral Hemorrhage. Stroke 2013; 44:658-63. [DOI: 10.1161/strokeaha.112.673590] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Na Li
- From the Departments of Neurology (N.L., Y.F.L., Y.L.W., Y.J.W., X.Q.Z.) and Neuroradiology (L.M., Y.P.G.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; the Departments of Neurology (N.L., H.W., R.D., K.W.) and Interventional and Diagnostic Neuroradiology (P.R.), Hannover Medical School, Hannover, Germany; and the Center for Systems Neuroscience (ZSN), Hannover, Germany (N.L., R.D., K.W.)
| | - Yan Fang Liu
- From the Departments of Neurology (N.L., Y.F.L., Y.L.W., Y.J.W., X.Q.Z.) and Neuroradiology (L.M., Y.P.G.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; the Departments of Neurology (N.L., H.W., R.D., K.W.) and Interventional and Diagnostic Neuroradiology (P.R.), Hannover Medical School, Hannover, Germany; and the Center for Systems Neuroscience (ZSN), Hannover, Germany (N.L., R.D., K.W.)
| | - Li Ma
- From the Departments of Neurology (N.L., Y.F.L., Y.L.W., Y.J.W., X.Q.Z.) and Neuroradiology (L.M., Y.P.G.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; the Departments of Neurology (N.L., H.W., R.D., K.W.) and Interventional and Diagnostic Neuroradiology (P.R.), Hannover Medical School, Hannover, Germany; and the Center for Systems Neuroscience (ZSN), Hannover, Germany (N.L., R.D., K.W.)
| | - Hans Worthmann
- From the Departments of Neurology (N.L., Y.F.L., Y.L.W., Y.J.W., X.Q.Z.) and Neuroradiology (L.M., Y.P.G.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; the Departments of Neurology (N.L., H.W., R.D., K.W.) and Interventional and Diagnostic Neuroradiology (P.R.), Hannover Medical School, Hannover, Germany; and the Center for Systems Neuroscience (ZSN), Hannover, Germany (N.L., R.D., K.W.)
| | - Yi Long Wang
- From the Departments of Neurology (N.L., Y.F.L., Y.L.W., Y.J.W., X.Q.Z.) and Neuroradiology (L.M., Y.P.G.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; the Departments of Neurology (N.L., H.W., R.D., K.W.) and Interventional and Diagnostic Neuroradiology (P.R.), Hannover Medical School, Hannover, Germany; and the Center for Systems Neuroscience (ZSN), Hannover, Germany (N.L., R.D., K.W.)
| | - Yong Jun Wang
- From the Departments of Neurology (N.L., Y.F.L., Y.L.W., Y.J.W., X.Q.Z.) and Neuroradiology (L.M., Y.P.G.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; the Departments of Neurology (N.L., H.W., R.D., K.W.) and Interventional and Diagnostic Neuroradiology (P.R.), Hannover Medical School, Hannover, Germany; and the Center for Systems Neuroscience (ZSN), Hannover, Germany (N.L., R.D., K.W.)
| | - Yi Pei Gao
- From the Departments of Neurology (N.L., Y.F.L., Y.L.W., Y.J.W., X.Q.Z.) and Neuroradiology (L.M., Y.P.G.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; the Departments of Neurology (N.L., H.W., R.D., K.W.) and Interventional and Diagnostic Neuroradiology (P.R.), Hannover Medical School, Hannover, Germany; and the Center for Systems Neuroscience (ZSN), Hannover, Germany (N.L., R.D., K.W.)
| | - Peter Raab
- From the Departments of Neurology (N.L., Y.F.L., Y.L.W., Y.J.W., X.Q.Z.) and Neuroradiology (L.M., Y.P.G.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; the Departments of Neurology (N.L., H.W., R.D., K.W.) and Interventional and Diagnostic Neuroradiology (P.R.), Hannover Medical School, Hannover, Germany; and the Center for Systems Neuroscience (ZSN), Hannover, Germany (N.L., R.D., K.W.)
| | - Reinhard Dengler
- From the Departments of Neurology (N.L., Y.F.L., Y.L.W., Y.J.W., X.Q.Z.) and Neuroradiology (L.M., Y.P.G.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; the Departments of Neurology (N.L., H.W., R.D., K.W.) and Interventional and Diagnostic Neuroradiology (P.R.), Hannover Medical School, Hannover, Germany; and the Center for Systems Neuroscience (ZSN), Hannover, Germany (N.L., R.D., K.W.)
| | - Karin Weissenborn
- From the Departments of Neurology (N.L., Y.F.L., Y.L.W., Y.J.W., X.Q.Z.) and Neuroradiology (L.M., Y.P.G.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; the Departments of Neurology (N.L., H.W., R.D., K.W.) and Interventional and Diagnostic Neuroradiology (P.R.), Hannover Medical School, Hannover, Germany; and the Center for Systems Neuroscience (ZSN), Hannover, Germany (N.L., R.D., K.W.)
| | - Xing Quan Zhao
- From the Departments of Neurology (N.L., Y.F.L., Y.L.W., Y.J.W., X.Q.Z.) and Neuroradiology (L.M., Y.P.G.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; the Departments of Neurology (N.L., H.W., R.D., K.W.) and Interventional and Diagnostic Neuroradiology (P.R.), Hannover Medical School, Hannover, Germany; and the Center for Systems Neuroscience (ZSN), Hannover, Germany (N.L., R.D., K.W.)
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Skripuletz T, Wurster U, Worthmann H, Heeren M, Schuppner R, Trebst C, Kielstein JT, Weissenborn K, Stangel M. Blood-cerebrospinal fluid barrier dysfunction in patients with neurological symptoms during the 2011 Northern German E. coli serotype O104:H4 outbreak. ACTA ACUST UNITED AC 2013; 136:e241. [PMID: 23404332 DOI: 10.1093/brain/aws361] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Li N, Worthmann H, Heeren M, Schuppner R, Deb M, Tryc AB, Bueltmann E, Lanfermann H, Donnerstag F, Weissenborn K, Raab P. Temporal pattern of cytotoxic edema in the perihematomal region after intracerebral hemorrhage: a serial magnetic resonance imaging study. Stroke 2013; 44:1144-6. [PMID: 23391767 DOI: 10.1161/strokeaha.111.000056] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Knowledge about cytotoxic edema (CE) in intracerebral hemorrhage is still limited. We aimed to analyze its presence, temporal pattern, and prognostic meaning. METHODS Twenty-one patients with primary intracerebral hemorrhage underwent magnetic resonance imaging at days 1, 3, and 7 after symptom onset. CE was identified using diffusion-weighted imaging. Hematoma and perihematomal edema volumes were measured on fluid-attenuated inversion recovery images. National Institutes of Health Stroke Scale score was assessed at admission and with each magnetic resonance imaging. Clinical outcome was assessed by modified Rankin scale at 90 days. RESULTS CE appeared in half of the patients within the first 24 hours. The apparent diffusion coefficient values decreased until day 3 and were significantly reversed from days 3 through 7 (P<0.01). Patients with CE showed significantly faster perihematomal edema growth from day 0 to 1 (P=0.036) than those without. Larger 3-day perihematomal edema volume (P=0.02) and presence of CE on day 3 (P=0.07) were associated with poor clinical outcome. CONCLUSIONS CE is associated with stroke severity, perihematomal edema volume, and poor outcome. It is considered to indicate ongoing neuronal injury and, thus, might emerge as new treatment target.
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Affiliation(s)
- Na Li
- Department of Neurology, Hannover Medical School, Hannover, Germany.
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