掲載種別：研究論文（学術雑誌）   出版者・発行元：Medical Association of Nippon Medical School  

DOI： 10.1272/jnms.jnms.2024_91-612

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Wiley  

ABSTRACT

Background

The efficacy of intravenous alteplase therapy for acute cerebral infarction is well established, regardless of the ischemic stroke subtype. However, its effectiveness in patients with mild cerebral infarction remains controversial, raising concerns about the significance of the treatment.

Aim

To retrospectively evaluate the efficacy of intravenous alteplase in patients with mild cerebral infarction and other factors affecting the outcome.

Methods

A total of 527 patients received intravenous alteplase (0.6 mg/kg) at our hospital between October 2012 and March 2023. Of these, 118 patients with mild cerebral infarction (National Institutes of Health Stroke Scale [NIHSS] ≤ 5) who were treated with intravenous alteplase without mechanical thrombectomy were retrospectively evaluated for treatment efficacy and the factors affecting the efficacy.

Results

The modified Rankin scale (mRS) outcome at 90 days was good (mRS: 0–1) in 85 (72%) patients and poor (mRS: 2–5) in 33 (28%) patients. Branch atheromatous disease (BAD) and proximal anterior circulation large vessel occlusion (proximal LVO: internal carotid artery and M1 segment of middle cerebral artery) were observed more frequently in the poor outcome group than in the good outcome group. Multivariate analysis, adjusted for age and sex, identified BAD and proximal LVO as factors associated with poor outcomes after intravenous alteplase treatment for mild cerebral infarction. Symptomatic intracranial hemorrhage was observed in one patient with BAD.

Conclusion

Most patients with mild cerebral infarction who were treated with intravenous alteplase alone had good outcomes. BAD and proximal LVO were other factors influencing poor outcomes.

DOI： 10.1111/ncn3.12868

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.2169/internalmedicine.4315-24

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.2169/internalmedicine.3940-24

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掲載種別：研究論文（学術雑誌）  

Background: Intracranial branch atheromatous disease (BAD)-type cerebral infarction is often associated with a progressive worsening of neurological symptoms in the acute phase. Aim: To investigate the factors influencing the occurrence of early neurological deterioration (END) in patients with BAD. Methods: We included and evaluated 198 consecutive patients (150 patients with lenticulostriate artery [LSA-BAD] and 48 patients with paramedian pontine artery [PPA-BAD]) with onset within 24 h and with a modified Rankin scale score of ≤1 before admission for END retrospectively out of 235 patients with BAD-type cerebral infarction admitted to our hospital from January 2019 to March 2023. Results: END was observed in 26 (17%) and 15 (31%) patients with LSA-BAD and PPA-BAD, respectively. Patients in the END group with LSA-BAD had significantly higher rates of diabetes mellitus and blood glucose (BG) levels on admission and lower rates of initial clopidogrel loading therapy than those in the non-END group. Patients in the END group with PPA-BAD had significantly higher BG levels on admission than those in the non-END group. In LSA-BAD multivariate analysis, the BG level on admission and initial clopidogrel loading were identified as factors influencing END (BG level [per 10 mg/dL], odds ratio [OR] 1.084, 95% confidence interval [CI] 1.008–1.166; initial clopidogrel loading, OR 0.302, 95% CI 0.101–0.901). Conclusions: Higher BG levels at stroke onset were associated with END in patients with LSA-BAD and PPA-BAD. Additionally, initial clopidogrel loading therapy suppressed END in patients with LSA-BAD.

DOI： 10.1111/ncn3.12800

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Essential thrombocythemia (ET) is a myeloproliferative neoplasm that is a rare cause of ischemic stroke. We herein report a 70-year-old man with JAK2 V617F mutation-positive ET who experienced ischemic stroke twice in 1 month due to transient stenosis. In both events, transient stenosis formed at the same curvature of the right middle cerebral artery, and the thrombus disappeared with the initiation of antiplatelet agents. The formation of in situ thrombus at the curvature of the intracranial vessels may be a unique characteristic of JAK2 V617F mutation-positive ET patients.

DOI： 10.2169/internalmedicine.3590-24

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Cardioembolic stroke accounts for over 20% of ischemic strokes and is associated with worse outcomes than other types of strokes. Atrial fibrillation (AF) is the most common risk factor for cardioembolic stroke. In this narrative review, we present an update about cardioembolic stroke mainly related to AF and atrial cardiopathy. Direct oral anticoagulants (DOACs) have revolutionized stroke prevention in patients with AF; however, their efficacy in preventing recurrent embolic stroke of unknown source remains uncertain. Various cardiac monitoring methods are used to detect AF, which is crucial for preventing stroke recurrence. DOACs are preferred over warfarin for AF-related stroke prevention; however, the timing of initiation after acute ischemic stroke is debated. Resuming anticoagulation after intracerebral hemorrhage in AF patients requires careful assessment of the risks. While catheter ablation may reduce the incidence of cardiovascular events, its effect on stroke prevention is unclear, especially in heart failure patients. Atrial cardiopathy is the emerging cause of embolic stroke of unknown source, which indicates atrial structural and functional disorders that can precede AF. Future research should focus on refining stroke risk prediction models, optimizing AF detection, understanding the roles of ablation and anticoagulation in stroke prevention, and establishing atrial cardiopathy as a therapeutic target, which could significantly reduce the burden of stroke.

DOI： 10.3390/ijms25115777

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We herein report a 47-year-old woman who developed migraine-like headache with aura and subsequent multiple cerebral infarcts, likely due to severe iron deficiency anemia (IDA) from menorrhagia. The progression from IDA to ischemic stroke involves several pathophysiological mechanisms, including reduction of erythrocyte deformability, reactive thrombocytosis, and anemic hypoxia. We speculate that a microembolus first caused cortical spreading depression without infarcts and that a larger thromboembolus then caused multiple infarcts. This case highlights the transition from migraine-like headache to ischemic stroke. New-onset migraine-like headache is a warning of impending ischemic stroke, and IDA may be a potential underlying cause.

DOI： 10.2169/internalmedicine.3842-24

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: Various variations in the head and neck vasculature have been reported. The purpose of this report is to describe an extremely rare case of thyrolinguofacial trunk (TLFT) arising from the common carotid artery (CCA). METHODS: A 66-year-old woman with vertigo, dizziness, and heaviness in the head underwent computed tomography (CT) angiography of the neck and head region for evaluation of cerebrovascular diseases. RESULTS: The TLFT originated from the anterior wall of the right CCA and was divided into the superior thyroid artery and linguofacial trunk (LFT). The LFT was divided into lingual and facial arteries. In addition, we observed fusiform dilatation of the intracranial right vertebral artery, which might have caused these symptoms. CONCLUSION: The presence of a common trunk of the external carotid artery (ECA) branches increases the risk of complications such as bleeding and ischemia during treatment of the head and neck region, including chemoradiotherapy for oral bleeding and tongue cancer. Therefore, this is an area of significant interest across various medical specialties, including surgery, otolaryngology, and radiology. Understanding the diverse variations in the neck vasculature is expected to lead to a reduction in complications associated with various procedures.

DOI： 10.1007/s00276-024-03313-0

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Brain natriuretic peptides (BNP) are an important diagnostic and prognostic marker in patients with heart failure. However, the relationship between BNP levels and stroke severity in patients with atrial fibrillation (AF) remains unelucidated. In this study, we aimed to investigate the association between stroke severity at admission and BNP levels. METHODS: In this prospective observational study, we used data from 513 patients with AF and acute ischemic stroke treated with oral anticoagulants (OAC) registered in the Multicenter Prospective Analysis of Stroke Patients Taking Oral Anticoagulants study. The patients were divided into two groups: high-BNP (≥200 pg/mL) and low-BNP level (<200 pg/mL) groups. We compared the clinical characteristics between the two groups and determined the effect of BNP levels on stroke severity on admission. RESULTS: Among the 513 enrolled patients, 248 (females, n = 30; median age, 82 years) and 265 (females, n = 76; median age, 71 years) were assigned to the high- and low-BNP level groups, respectively. The high-BNP level group had a higher proportion of patients with severe stroke (National Institutes of Health Stroke Scale score, ≥10) on admission (49.2% vs. 32.8%, p = 0.002) and major vessel occlusion (57.5% vs. 39.2%, p < 0.0001) than that had by the low-BNP level group. Multivariate analysis showed that high BNP level was independently associated with severe stroke on admission (odds ratio 1.07, 95% confidence interval 1.00-1.15; p = 0.0478). CONCLUSIONS: High BNP level compared with low BNP level was associated with severe stroke and major vessel occlusion, even before OAC treatment.

DOI： 10.1016/j.jns.2024.122935

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Antithrombotic therapy (AT) should generally be avoided within 24 hours after recombinant tissue-plasminogen activator (rt-PA) treatment but should be considered in patients with large-artery atherosclerosis (LAA) who undergo concomitant emergent endovascular treatment (EVT). The aim of the present study was to assess the safety of AT within 24 hours after rt-PA treatment in patients with hyperacute ischemic stroke due to LAA who received concomitant EVT. METHODS: From January 2013 through July 2019, consecutive patients with acute ischemic cerebrovascular disease due to LAA who were admitted within 6 hours from symptom onset were recruited. The patients were classified into six groups based on the reperfusion treatment and early (within 24 hours) AT from rt-PA treatment. Safety outcomes were compared among the groups. RESULTS: A total of 155 patients (35 women [23%], median age 74 [IQR 66-79] years; NIHSS score 3 [1-10]) were included in the present study. Of these, 73 (47%) received no reperfusion therapy, 24 (15%) received rt-PA treatment and early AT, seven (6%) received rt-PA without early AT, 26 (17%) received EVT only, six (4%) received both rt-PA and EVT without early AT, and 19 (12%) received rt-PA and EVT with early AT. AT was administered a median of 3.9 (1.6-8.0) hours after rt-PA in patients with rt-PA+EVT with early AT. AT within 24 hours after rt-PA and EVT treatment did not increase hemorrhagic complications (p > 0.05 for all). CONCLUSION: In this retrospective analyses, early AT administration for patients with hyperacute stroke due to LAA treated with rt-PA plus EVT did not increase hemorrhagic events.

DOI： 10.1272/jnms.JNMS.2024_91-309

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掲載種別：研究論文（学術雑誌）  

Background: Intravenous alteplase treatment is effective for acute cerebral infarction, irrespective of the stroke type. However, its value for branch atheromatous disease (BAD) remains unclear, and early neurological deterioration (END) can occur. Aim: To investigate factors affecting END after intravenous alteplase treatment in patients with acute BAD. Methods: This study included 40 consecutive patients diagnosed with cerebral infarction due to BAD in the lenticulostriate artery territory and treated with intravenous alteplase between April 2007 and March 2023. END was defined as an increase of ≥2 points in the total National Institutes of Health Stroke Scale score or ≥1 point in the motor items within 24 h post-alteplase administration compared to the score at admission. Factors affecting END were retrospectively evaluated. Results: END was observed in 17 of the 40 patients (43%). The median time from the start of alteplase administration to the worsening of neurologic symptoms was 5 h. After intravenous alteplase treatment, the END group had a significantly lower 24-h average systolic blood pressure (SBP, mean ± standard deviation mmHg) than the non-END group (142.0 ± 15.2 vs. 149.4 ± 12.0, p < 0.001). The SBP at each time point (immediately before alteplase administration and every 2 h up to 24 h after alteplase administration) was significantly lower in the END than in the non-END group at 2, 4, and 6 h after alteplase administration. Conclusions: When intravenous alteplase was administered for BAD, BP control after alteplase administration affected END. When alteplase is administered for BAD, it is important to control the blood pressure to maintain hemodynamics.

DOI： 10.1111/ncn3.12848

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The differences in the characteristics of ischemic stroke associated with a mobile versus nonmobile residual left atrial thrombus (LAT) are unclear. We investigated whether the mobility of an LAT detected by transthoracic echocardiography is associated with the clinical features of stroke. METHODS: This study included 20 consecutive patients with nonvalvular atrial fibrillation who were admitted to our hospital for treatment of acute ischemic stroke and then found to have an LAT on transthoracic echocardiography. The patients were divided into two groups: those with a mobile LAT (Group M) and those with a nonmobile LAT (Group N). The clinical, neuroradiological, and echocardiographic variables were assessed. RESULTS: The LAT was mobile in 11 patients (Group M) and nonmobile in nine patients (Group N). The median National Institutes of Health Stroke Scale score on admission was higher in Group M than N (17 vs. 7, respectively; p=0.196). Four patients in Group M and one in Group N developed in-hospital stroke recurrence (36% vs. 11%, respectively; p=0.319). The prevalence of large vessel occlusion (15 events in Group M and 10 events in Group N, including in-hospital recurrent events) was significantly higher in Group M than N (73% vs. 30%, respectively; p=0.049), which seemed to lead to poorer functional outcomes in Group M than N (ratio of modified Rankin scale score of 0-2 at discharge: 18% vs. 44%, respectively; p=0.336). CONCLUSIONS: The mobility of LAT may affect stroke severity in patients with nonvalvular atrial fibrillation.

DOI： 10.1272/jnms.JNMS.2024_91-311

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND AND PURPOSE: The impact of CHADS2 score on outcome in patients with stroke taking an oral anticoagulant (OAC) has not yet been fully elucidated. We investigated the association between pre-stroke CHADS2 score and outcome at discharge in patients with acute cardioembolic (CE) stroke due to atrial fibrillation (AF) who were prescribed OAC. METHODS: The data of 548 OAC-treated patients with AF and CE stroke who were registered in the multicenter Prospective Analysis of Stroke patients Taking oral Anticoagulants (PASTA) study were analyzed. High CHADS2 score was defined as a pre-stroke CHADS2 score ≥2. Unfavorable outcome was defined as a modified Rankin scale (mRS) of 3-6. The impacts of pre-stroke CHADS2 score on outcome at discharge were evaluated using multiple logistic regression analysis. RESULT: A high CHADS2 score was found in 472/548 patients and unfavorable outcome was found in 330/548 patients. In patients with unfavorable outcome, age, male sex, pre-stroke CHADS2 score, initial National Institute Health Stroke Scale (NIHSS) score, and glucose level on admission were significantly higher, whereas creatinine clearance and body weight were significantly lower, than those with favorable outcome (each p < 0.001). Multivariate logistic regression analysis indicated that high CHADS2 score (OR 2.18, 95 %CI 1.08-4.42, p = 0.031), pre-stroke mRS (OR 2.21, 95 %CI 1.69-2.67, p < 0.001), and initial NIHSS score (OR 1.19, 95 %CI 1.17-1.24, p < 0.001) were independently associated with unfavorable outcome. CONCLUSION: Pre-stroke CHADS2 score was associated with poor outcome in patients with cardioembolic stroke due to AF, even in those taking OAC.

DOI： 10.1016/j.jstrokecerebrovasdis.2023.107519

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Frailty in older individuals is an underappreciated condition that affects the incidence and/or prognosis of stroke. OBJECTIVES: We evaluated the prevalence of pre-onset frailty in patients with acute first-onset and recurrent strokes and association between pre-onset frailty and functional disability at hospital discharge. METHODS: This prospective cohort study included 210 acute stroke patients admitted to the Stroke Unit of Nippon Medical School Hospital during November 2021-June 2022. The mean participant age was 79.2 ± 7.4 years. Age, sex, pre-onset frailty, body mass index (BMI), stroke type, medical history, and National Institutes of Health Stroke Scale (NIHSS) score at admission were evaluated. Frailty was defined as a clinical frailty scale (CFS) score ≥ 5. Frailty prevalence was calculated for all patients, and scores of functional disabilities at discharge were evaluated using modified Rankin scale. RESULTS: Overall frailty prevalence was 31% in all stroke patients, with 24% and 47% of first-onset and recurrent strokes, respectively. Pre-onset frailty, NIHSS score at admission, age, stroke type, previous stroke, sex, BMI, dyslipidemia, and atrial fibrillation were significantly associated with functional disability at discharge. Logistic regression analysis revealed that CFS score, NIHSS score at admission, and previous stroke were independent predictors of functional disability at discharge. CONCLUSIONS: Approximately one-fourth of patients with first-onset stroke had pre-onset frailty; the rate doubled in recurrent stroke; these rates appear to be much larger than rate in healthy individuals. Pre-onset frailty, a negative independent factor affecting functional disability at discharge, is important for pre-onset frailty evaluation and rehabilitation intervention in acute stroke patients.

DOI： 10.1080/10749357.2023.2291898

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記述言語：日本語   出版者・発行元：(一社)日本神経学会  

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.jns.2023.120810

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Frontiers Media SA  

Background

Cryptogenic stroke (CS) are heterogeneous in origin; however, most CS are embolic mechanism. Paroxysmal atrial fibrillation (AF) is suspected to be a major type of CS that leads to severe cerebral infarction without anticoagulant use. Therefore, the identification of AF is vital in patients with CS. However, patients are often unaware of AF because they have no symptoms, and AF may not be detected on an electrocardiogram (ECG) or Holter ECG on admission. After patients with stroke are treated in the acute phase, they are promptly transferred to a rehabilitation hospital for functional recovery. Once the patient is transferred to a hospital, a few attempts are made to detect AF. In addition, rehabilitation therapists are considered to have insufficient awareness of the possibility of undiagnosed AF.

Objective

This study aimed to increase the understanding of the importance of AF detection in patients with ischemic stroke among therapists in rehabilitation hospitals and to investigate whether regular pulse screening can aid in the detection of AF. If AF was detected, we determined the rate and timing of AF detection and identified the patient characteristics.

Methods

This multicenter prospective observational study aimed to detect AF in patients with non-cardiac stroke at rehabilitation hospitals. Therapists performed pulse checks before, during, and after rehabilitation. If arrhythmia or tachycardia was detected, an ECG was performed, and the physician checked for AF. If the patient complained of chest symptoms, electrocardiography (ECG) was performed to check for AF. We investigated the characteristics, laboratory data, cognitive status, complications, such as stroke recurrence, and functional outcomes of patients with AF.

Results

The study is in the enrollment phase. Recruitment began in September 2022 and will end in August 2023. Patients have provided written informed consent. The main results have been submitted for publication in your journal.

Conclusion

The findings of this study will help identify patients with AF in rehabilitation hospitals and improve awareness among therapists.

DOI： 10.3389/fneur.2023.1247020

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Essential thrombocythemia is a myeloproliferative neoplasm. Ischemic stroke is frequently the first manifestation of essential thrombocythemia. We herein report a patient with JAK2V617 mutation-positive essential thrombocythemia who developed recurrent ischemic stroke with rapid development of intracranial artery stenosis and subsequently underwent successful mechanical thrombectomy. The high JAK2V617F allele burden in our patient (58.4%) may have affected the patient's condition. We discuss similar reports in the literature and the possible pathophysiologic mechanism of large artery involvement in these patients.

DOI： 10.2169/internalmedicine.2189-23

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.omtm.2023.07.005

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担当区分：筆頭著者,　責任著者   記述言語：日本語   掲載種別：研究論文（学術雑誌）  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Paroxysmal atrial fibrillation (AF) is a probable cause of cryptogenic stroke (CS), and its detection and treatment are important for the secondary prevention of stroke. Insertable cardiac monitors (ICMs) are clinically effective in screening for AF and are superior to conventional short-term cardiac monitoring. Japanese guidelines for determining clinical indications for ICMs in CS are stricter than those in Western countries. Differences between Japanese and Western guidelines may impact the detection rate and prediction of AF via ICMs in patients with CS. Available data on Japanese patients are limited to small retrospective studies. Furthermore, additional information about AF detection, including the number of episodes, cumulative episode duration, anticoagulation initiation (type and dose of regimen and time of initiation), rate of catheter ablation, role of atrial cardiomyopathy, and stroke recurrence (time of recurrence and cause of the recurrent event), was not provided in the vast majority of previously published studies. OBJECTIVE: In this study, we aim to identify the proportion and timing of AF detection and risk stratification criteria in patients with CS in real-world settings in Japan. METHODS: This is a multicenter, prospective, observational study that aims to use ICMs to evaluate the proportion, timing, and characteristics of AF detection in patients diagnosed with CS. We will investigate the first detection of AF within the initial 6, 12, and 24 months of follow-up after ICM implantation. Patient characteristics, laboratory data, atrial cardiomyopathy markers, serial magnetic resonance imaging findings at baseline, 6, 12, and 24 months after ICM implantation, electrocardiogram readings, transesophageal echocardiography findings, cognitive status, stroke recurrence, and functional outcomes will be compared between patients with AF and patients without AF. Furthermore, we will obtain additional information regarding the number of AF episodes, duration of cumulative AF episodes, and time of anticoagulation initiation. RESULTS: Study recruitment began in February 2020, and thus far, 213 patients have provided written informed consent and are currently in the follow-up phase. The last recruited participant (May 2021) will have completed the 24-month follow-up in May 2023. The main results are expected to be submitted for publication in 2023. CONCLUSIONS: The findings of this study will help identify AF markers and generate a risk scoring system with a novel and superior screening algorithm for occult AF detection while identifying candidates for ICM implantation and aiding the development of diagnostic criteria for CS in Japan. TRIAL REGISTRATION: UMIN Clinical Trial Registry UMIN000039809; https://tinyurl.com/3jaewe6a. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/39307.

DOI： 10.2196/39307

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND AND PURPOSE: Prior concomitant use of vitamin K antagonists (VKAs) and antiplatelet (AP) therapy increase the hematoma volume and mortality compared with VKA monotherapy in patients with intracranial hemorrhage (ICH). However, the prior concomitant use of non-vitamin K oral antagonists (NOACs) and AP has not been clarified. METHODS: We conducted a PASTA registry study, which was an observational, multicenter, registry of 1043 patients with stroke receiving oral anticoagulants (OACs) in Japan. In the present study, ICH from the PASTA registry was used to analyze the clinical characteristics including mortality among the four groups (NOAC, VKA, NOAC and AP, and VKA and AP) using univariate and multivariate analyses. RESULTS: Among the 216 patients with ICH, 118 (54.6%), 27 (12.5%), 55 (25.5%), 16 (7.4%) were taking NOAC monotherapy, NOAC and AP, VKA, and VKA and AP, respectively. In-hospital mortality rates were the highest in VKA and AP (31.3%) than in NOACs (11.9%), NOACs and AP (7.4%), and VKA (7.3%). Multivariate logistic regression analysis demonstrated that the concomitant use of VKA and AP (odds ratio [OR], 20.57; 95% confidence interval [CI], 1.75-241.75, p = 0.0162), initial National Institutes of Health Stroke Scale score (OR, 1.21; 95%CI, 1.10-1.37, p < 0.0001), hematoma volume (OR, 1.41; 95%CI, 1.10-1.90, p = 0.066), and systolic blood pressure (OR, 1.31; 95%CI, 1.00-1.75, p = 0.0422) were independently associated with in-hospital mortality. CONCLUSIONS: Although VKA in addition to AP therapy could increase the in-hospital mortality, NOAC and AP did not increase the hematoma volume, stroke severity, or mortality compared to NOAC monotherapy.

DOI： 10.1016/j.jns.2023.120643

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The safety of intravenous recombinant tissue plasminogen activator (rtPA) and mechanical thrombectomy (MT) in patients treated with direct oral anticoagulants (DOACs) before stroke has not been fully investigated. Therefore, we aimed to investigate the safety of recanalization therapy in patients receiving DOACs. METHODS: We assessed data from a prospective multicenter registry of patients with stroke, including those with acute ischemic stroke (AIS) treated with rtPA and/or MT who were administered DOACs. We evaluated the safety of recanalization considering the DOACs dosage and interval between the last DOAC intake and recanalization. RESULTS: The final analysis included 108 patients (women, n = 54; median age, 81 years; DOAC overdose, n = 7; appropriate dose, n = 74; and inappropriate low dose, n = 27). The rate of any ICH differed significantly among overdose-, appropriate dose-, and inappropriate-low dose DOACs groups (71.4, 23.0, and 33.3%, respectively; P = 0.0121), whereas no significant difference was observed in respect of symptomatic ICH (P = 0.6895). Multivariate analysis showed that the National Institutes of Health Stroke Scale score on admission (odds ratio [OR]: 1.06, 95% confidence interval [CI]: 1.01-1.11; P = 0.0267) and overdose-DOAC (OR: 8.40, 95% CI: 1.24-56.88; P = 0.0291) were independently associated with any ICH. No relationship was observed between the timing of the last DOAC intake and occurrence of ICH in patients treated with rtPA and/or MT (all P > 0.05). CONCLUSION: Recanalization therapy during DOAC treatment may be safe in selected patients with AIS, if it is performed >4 h after the last DOAC intake and the patient is not overdosed with DOACs. REGISTRATION: https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000034958.

DOI： 10.1016/j.jns.2023.120639

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Objective In recent decades, living conditions have changed drastically. However, there are few data regarding the interaction between living conditions and the risk of ischemic stroke (IS) in young adults. The present study explored the association between living conditions or marital status and the risk factors, etiology, and outcome of IS in young adults. Methods We prospectively enrolled patients with incident IS who were 20-49 years old from 37 clinical stroke centers. We collected the demographic data, living conditions, marital status, vascular risk factors, disease etiology, treatment, and outcomes at discharge. A comparison group was established using the official statistics of Japan. We categorized patients into the two groups based on living conditions: solitary group and cohabiting group. Clinical characteristics were then compared between living conditions. Results In total, 303 patients were enrolled (224 men; median age at the onset: 44 years old). Significant factors associated with the incidence of IS were as follows: solitary status, body mass index >30 kg/m2, current smoking, heavy alcohol consumption, hypertension, diabetes mellitus, and dyslipidemia. Furthermore, in the solitary group, the proportions of men, unmarried individuals, and current smokers were significantly higher than in the cohabiting group. In addition, poor outcomes (modified Ranking Scale ≥ 4) of IS were more common in the solitary group than in the cohabiting group. Conclusion Our study showed that not only conventional vascular risk factors but also living conditions, especially living alone while unmarried, were independent risk factors for IS in young adults.

DOI： 10.2169/internalmedicine.0912-22

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: JTR-161 is a novel allogeneic human cell product consisting of dental pulp stem cells isolated from the extracted teeth of healthy adults. It is currently under development as a cell-based therapy for ischaemic stroke. The aim of this study is to evaluate the safety and efficacy of JTR-161 in patients with acute ischaemic stroke when given as a single intravenous administration within 48 hours of symptom onset. METHODS AND ANALYSIS: This is a first-in-human, randomised, double-blind, placebo-controlled, multicentre, phase 1/2 clinical trial to be conducted in Japan (from January 2019 to July 2021). Patients with a clinical diagnosis of anterior circulation ischaemic stroke with a National Institutes of Health Stroke Scale (NIHSS）score of 5-20 at baseline were enrolled. Patients previously treated with recombinant tissue-type plasminogen activator and/or endovascular thrombectomy were allowed to be enrolled. The study consists of three cohorts: cohorts 1 and 2 (each eight patients) and cohort 3 (60 patients). Subjects were randomly assigned to receive either JTR-161 or placebo in a 3:1 ratio in cohorts 1 and 2, and in a 1:1 ratio in cohort 3. The number of cells administered was increased sequentially from 1×108 (cohort 1) to 3 x 108 (cohort 2). In cohort 3, the higher tolerated dose among the two cohorts was administered. The primary endpoint is the proportion of patients who achieve an excellent outcome as defined by all of the following criteria at day 91 in cohort 3: modified Rankin Scale ≤1, NIHSS ≤1 and Barthel Index ≥95. ETHICS AND DISSEMINATION: The protocol and informed consent form were approved by the institutional review board at each participating study site. A manuscript with the results of the primary study will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: NCT04608838; JapicCTI-194570 and Clinical Trials. gov.

DOI： 10.1136/bmjopen-2021-054269

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MDPI AG  

Regenerative medicine aims to restore human functions by regenerating organs and tissues using stem cells or living tissues for the treatment of organ and tissue defects or dysfunction. Clinical trials investigating the treatment of cerebral infarction using mesenchymal stem cells, a type of somatic stem cell therapy, are underway. The development and production of regenerative medicines using somatic stem cells is expected to contribute to the treatment of cerebral infarction, a central nervous system disease for which there is no effective treatment. Numerous experimental studies have shown that cellular therapy, including the use of human dental pulp stem cells, is an attractive strategy for patients with ischemic brain injury. This review describes the basic research, therapeutic mechanism, clinical trials, and future prospects for dental pulp stem cell therapy, which is being investigated in Japan in first-in-human clinical trials for the treatment of patients with acute cerebral ischemia.

DOI： 10.3390/biomedicines10040737

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

BACKGROUND AND PURPOSE: Prescribing under-dose direct oral anticoagulants (DOACs) for non-valvular atrial fibrillation (NVAF) is alerted to increase cardiovascular events or death. However, the association between dose selection of DOACs and the clinical course remains unclear. This study aimed to propose a novel criterion for selecting the DOAC dose and investigate clinical characteristics of ischemic stroke (IS) under this criterion. METHODS: We assessed the pooled prospective multicenter registry data of stroke patients taking anticoagulant agents, including IS patients with NVAF and prior DOAC usage. The recommended dose according to the reduction criteria of each DOAC and the selected dose were identified for each patient, and patients were categorized into four groups: no alternative low-dose, selecting low-dose appropriately with all DOACs applicable for reduction criteria; selected low-dose, selecting low-dose appropriately or inappropriately despite at least one DOAC inapplicable for reduction criteria; selected standard-dose, appropriate standard-dose use; and absolute over-dose, inappropriate standard-dose regardless of criteria. We investigated the effects of dose selection of DOACs on short-term poor functional outcomes. RESULTS: 322 patients were included in the analysis. The prevalence of no alternative low-dose, selected low-dose, selected standard-dose, and absolute over-dose was 74 (23%), 144 (45%), 89 (27%), and 15 (5%), respectively. Multivariable analysis found that the selected low-dose group showed significantly poorer functional outcomes than the selected standard-dose group only in patients without renal dysfunction (OR, 2.60; 95% CI, 1.17-6.00; P = 0.0186). CONCLUSIONS: Selecting a low dose DOAC might be associated with poor functional outcomes in patients without renal dysfunction.

DOI： 10.1016/j.jns.2022.120163

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記述言語：日本語   出版者・発行元：医歯薬出版(株)  

脳梗塞に対する抗凝固療法は、抗血小板療法と並ぶ抗血栓療法の要である。従来のワルファリンに加えて直接作用型経口抗凝固薬(DOAC)が登場して、脳梗塞の治療の選択肢は増えた。DOACでの非弁膜症性心房細動(NVAF)による脳梗塞に対しての一次予防、二次予防の有効性は確立されている。一方で、脳梗塞急性期に対するDOACの開始時期や出血リスクの高い超高齢者を対象とした使用など実臨床的な課題も多い。また、抗凝固療法中の最大の問題は出血合併症であるが、ダビガトランに対してイダルシズマブや、ワルファリンに対して静注用人プロトロンビン複合体製剤(4F-PCC)が使用可能となり、より安全に抗凝固薬を用いることができるようになってきている。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J00060&link_issn=&doc_id=20220308010015&doc_link_id=issn%3D0039-2359%26volume%3D280%26issue%3D10%26spage%3D1077&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0039-2359%26volume%3D280%26issue%3D10%26spage%3D1077&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

BACKGROUND: Atrial fibrillation (AF) includes paroxysmal and sustained (persistent or permanent) AF, and both forms are considered risk factors for ischemic stroke. This study aimed to investigate the differences in stroke severity at admission between patients with paroxysmal AF and sustained AF when treated with direct oral anticoagulants (DOACs). METHODS: Using data from DOAC-treated 300 nonvalvular patients with AF and acute anterior circulation stroke who were registered in the Multicenter Prospective Analysis of Stroke Patients Taking Oral Anticoagulants study, patients were divided into two groups, namely, paroxysmal AF and sustained AF. We compared the clinical characteristics between the two groups and determined the effect of these two types of AF on stroke severity on admission. RESULTS: Of 300 patients, 246 (males, n = 149; median age, 80 years) and 54 (males, n = 32; median age, 78 years) were assigned to the sustained AF and paroxysmal AF groups, respectively. The sustained AF group had a higher proportion of severe stroke (National Institutes of Health Stroke Scale score, >20) on admission (22.0% vs. 5.7%, p = 0.006) and internal carotid artery occlusion (11.4% vs. 1.9%, p = 0.03) compared to the paroxysmal AF group. Multivariate analysis showed that sustained AF was independently associated with severe stroke on admission (odds ratio 4.31, 95% confidence interval 1.24-15.0, p = 0.02). CONCLUSIONS: Sustained AF was associated with a higher severity of stroke accompanied with major vessel occlusion than paroxysmal AF, even prior to DOACs treatment. Registration https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000034958.

DOI： 10.1016/j.jns.2022.120172

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Objective Limited data exist regarding the comparative detailed clinical characteristics of patients with ischemic stroke (IS)/transient ischemic attack (TIA) and intracerebral hemorrhage (ICH) receiving oral anticoagulants (OACs). Methods The prospective analysis of stroke patients taking oral anticoagulants (PASTA) registry, a multicenter registry of 1,043 stroke patients receiving OACs (vitamin K antagonists [VKAs] or non-vitamin K oral antagonists [NOACs]) across 25 medical institutions throughout Japan, was used. Univariate and multivariable analyses were used to analyze differences in clinical characteristics between IS/TIA and ICH patients with atrial fibrillation (AF) who were registered in the PASTA registry. Results There was no significant differences in cardiovascular risk factors, such as hypertension, diabetes mellitus, dyslipidemia, smoking, or alcohol consumption (all p>0.05), between IS/TIA and ICH among both NOAC and VKA users. Cerebral microbleeds (CMBs) (odds ratio [OR], 4.77; p<0.0001) were independently associated with ICH, and high brain natriuretic peptide/N-terminal pro B-type natriuretic peptide levels (OR, 1.89; p=0.0390) were independently associated with IS/TIA among NOAC users. A history of ICH (OR, 13.59; p=0.0279) and the high prothrombin time-international normalized ratio (PT-INR) (OR, 1.17; p<0.0001) were independently associated with ICH, and a history of IS/TIA (OR, 3.37; 95% CI, 1.34-8.49; p=0.0101) and high D-dimer levels (OR, 2.47; 95% CI, 1.05-5.82; p=0.0377) were independently associated with IS/TIA among VKA users. Conclusion The presence of CMBs, a history of stroke, natriuretic peptide and D-dimer levels, and PT-INR may be useful for risk stratification of either IS/TIA or ICH development in patients with AF receiving OACs.

DOI： 10.2169/internalmedicine.8113-21

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND AND PURPOSE: We investigated whether the signal change on fluid-attenuated inversion recovery (FLAIR) can serve as a tissue clock that predicts the clinical outcome after endovascular thrombectomy (EVT), independently of the onset-to-admission time. METHODS: Consecutive patients with acute stroke treated with EVT between September 2014 and December 2018 were enrolled. Based on the parenchymal signal change on FLAIR, patients were classified into FLAIR-negative and FLAIR-positive groups. The clinical characteristics, imaging findings, EVT parameters, and the intracranial hemorrhage defined as Heidelberg Bleeding Classification ≥1c hemorrhage (parenchymal hemorrhage, intraventricular hemorrhage, subarachnoid hemorrhage, and/or subdural hemorrhage) were compared between the 2 groups. A modified Rankin Scale score 0 to 1 at 3 months was considered to represent a good outcome. RESULTS: Of the 227 patients with EVT during the study period, 140 patients (62%) were classified into the FLAIR-negative group and 87 (38%) were classified into the FLAIR-positive group. In the FLAIR-negative group, the patients were older (P=0.011), the onset-to-image time was shorter (P<0.001), the frequency of cardioembolic stroke was higher (P=0.006), and the rate of intravenous thrombolysis was higher (P<0.001) in comparison to the FLAIR-positive group. Although the rate of complete recanalization after EVT did not differ between the 2 groups (P=0.173), the frequency of both any-intracranial hemorrhage and Heidelberg Bleeding Classification ≥1c hemorrhage were higher in the FLAIR-positive group (P=0.004 and 0.011). At 3 months, the percentage of patients with a good outcome (FLAIR-negative, 41%; FLAIR-positive, 27%) was significantly related to the FLAIR signal change (P=0.047), while the onset-to-image time was not significant (P=0.271). A multivariate regression analysis showed that a FLAIR-negative status was independently associated with a good outcome (odds ratio, 2.10 [95% CI, 1.02-4.31], P=0.044). CONCLUSIONS: A FLAIR-negative status may predict the clinical outcome more accurately than the onset-to-admission time, which may support the role of FLAIR as a tissue clock.

DOI： 10.1161/STROKEAHA.120.033374

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: Intracerebral hemorrhage (ICH) is a devastating hemorrhagic event and is associated with high mortality or severe neurological sequelae. Age-associated differences in hematoma location for nonlobar ICH are not well known. The aims of the present study were to elucidate the relationship between age and hematoma location and to assess the differences in small-vessel disease (SVD) burden as a potential surrogate marker for longstanding hypertension among various hematoma locations. METHODS: From September 2014 through July 2019, consecutive patients with acute, spontaneous ICH were retrospectively enrolled from a prospective registry. Magnetic resonance imaging was performed during admission, and the total SVD burden score (including microbleeds, lacunes, enlarged perivascular spaces, and white matter hyperintensities) was calculated. The relationships of hematoma location with aging and SVD burden were assessed by using multivariate logistic regression analyses. RESULTS: A total of 444 patients (156 women [35%]; median age 69 [interquartile range 59-79] years; National Institutes of Health Stroke Scale score 9 [17][3-17]) were enrolled in the present study. Multivariate logistic regression analyses showed that advanced age was independently associated with thalamic (odds ratio [OR]: 1.48, 95% confidence interval [CI]: 1.19-1.84, p < 0.001 for 10-year increment) and lobar hemorrhage (OR: 1.58, 95% CI: 1.19-2.09, p = 0.002) and was independently and negatively related to putaminal hemorrhage (OR: 0.55, 95% CI: 0.44-0.68, p < 0.001). The total SVD burden score was independently and positively associated with thalamic hemorrhage (OR: 1.27, 95% CI: 1.01-1.59, p = 0.045) and negatively with lobar hemorrhage (OR: 0.74, 95% CI: 0.55-0.99, p = 0.042), even after adjusting by age, but not with putaminal hemorrhage (OR: 0.91, 95% CI: 0.73-1.14, p = 0.395). CONCLUSION: Putaminal, thalamic, and lobar hemorrhages are prone to occur in specific ages and SVD states: putaminal in young patients, thalamic in old and high SVD burden patients, and lobar hemorrhages in old and low SVD burden patients. Susceptibility to bleeding with aging or severe SVD accumulation seems to differ considerably among brain locations.

DOI： 10.1159/000515411

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: Several studies have investigated the predictors of functional outcome in patients with ischemic stroke after mechanical thrombectomy (MT). However, it is not clear whether pre-stroke cognitive (PSC) impairment is associated with the functional outcome of patients treated with MT. METHODS: We enrolled 113 patients treated with MT from December 2016 to November 2018. PSC was evaluated using the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Poor outcome was defined as a modified Rankin Scale score of 3-6. We compared the clinical characteristics between the groups with poor outcome (n = 61) and good outcome (n = 52) to determine if PSC could be a predictor of poor outcome. RESULTS: IQCODE was significantly higher in the group with poor outcome than good outcome (3.34 vs. 3.13, P = 0.017). Moreover, the following metrics differed between those two groups: age (75.9 vs. 71.6 years old, P = 0.010), the percentage of females (39.9% vs. 17.3%, P = 0.009), the percentage with hypertension (72.1% vs. 44.2%, P = 0.003), National Institutes of Health Stroke Scale (NIHSS) score on admission (20 vs. 11, P < 0.001), and no successful recanalization (24.5% vs. 7.7%; P = 0.025). Multivariable logistic regression analysis demonstrated that PSC (OR: 5.59; 95% CI: 1.55-23.47), history of hypertension (OR: 3.33; 95% CI: 1.29-9.11), no successful recanalization (OR: 5.51; 95% CI: 1.49-25.03), and NIHSS score on admission (OR: 1.14; 95% CI: 1.07-1.22) were associated with poor outcome 3 months after stroke onset. CONCLUSIONS: PSC was significantly and independently associated with poor functional outcome in patients treated with MT.

DOI： 10.1007/s10072-021-05158-6

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Objective Computed tomography (CT) can be used for visualizing acute intracerebral hemorrhages (ICHs) as distinct hyperdense areas and cerebral edema as perihematomal low-density areas (LDAs). We observed a perihematomal LDA on CT, which appeared to be part of a hemorrhage on magnetic resonance imaging (MRI) in acute ICH. We named this "CT perihematomal rim" and evaluated its characteristics and clinical significance. Methods We stratified patients with acute ICH according to the presence or absence of a CT perihematomal rim and then compared their radiologic findings. Logistic regression analyses were performed to assess whether the CT findings can predict the presence of a CT perihematomal rim. Patients Patients within 24 hours of ICH onset who were admitted between September 1, 2014, and October 31, 2018, were registered. Results Overall, 139 patients (91 men; mean age, 66 years) were investigated. CT perihematomal rims were observed in 40 patients (29%). ICH volumes on CT were 30% smaller than those on MRI in patients with CT perihematomal rims. On a multivariate analysis, the presence of a CT perihematomal rim was independently associated with the maximum diameter of the perihematomal LDA. According to a receiver operating characteristic analysis, the maximum LDA diameter threshold was 7.5 mm (sensitivity, 85%; specificity, 83%). Conclusion CT perihematomal rims were observed in 29% of the patients with acute ICH. A perihematomal LDA (>7.5 mm) in acute ICH cases should be considered a CT perihematomal rim. Clinicians should be aware that the ICH volume on CT may be underestimated by 30%.

DOI： 10.2169/internalmedicine.6653-20

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

PURPOSE: This study aimed to evaluate the risk factors, etiology, and outcomes of ischemic stroke (IS) in Japanese young adults. METHODS: This was a prospective multicenter study. We enrolled patients aged 16 to 55 years with IS within seven days of the onset of symptoms. We assessed the demographic data, risk factors, stroke etiology, and outcome at discharge. The clinical characteristics were compared between sexes and among age groups. RESULTS: We prospectively enrolled 519 patients (median age, 48 years: 139 females). The mean National Institute of Health Stroke Scale score was 3.6 ± 0.2. The most common risk factors were hypertension (HT) (55%), dyslipidemia (DL) (47%), and current smoking (42%). Body mass index, incidence of current smoking, and heavy alcohol consumption were higher in males. The prevalence of current smoking, HT, DL, and diabetes mellitus increased with aging. The most common etiologic subgroup of IS was small vessel disease (145/510, 28%). Intracranial arterial dissection (IAD) was the most common among the other determined causes (56/115, 49%). The outcome at discharge was relatively good (mRS 0-1, 71.7%); however, poor outcome (mRS ≥ 4) was observed at an incidence of 9.5%. CONCLUSIONS: Most young adults with IS had modifiable risk factors, of which prevalence increased with age. This emphasizes lifestyle improvement to prevent IS in the young population. Furthermore, we indicated that the incidence rate of IAD was high among the other determined causes.

DOI： 10.1016/j.jns.2020.117068

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Stroke is the most prevalent cardiovascular disease worldwide, and is still one of the leading causes of death and disability. Stem cell-based therapy is actively being investigated as a new potential treatment for certain neurological disorders, including stroke. Various types of cells, including bone marrow mononuclear cells, bone marrow mesenchymal stem cells, dental pulp stem cells, neural stem cells, inducible pluripotent stem cells, and genetically modified stem cells have been found to improve neurological outcomes in animal models of stroke, and there are some ongoing clinical trials assessing their efficacy in humans. In this review, we aim to summarize the recent advances in cell-based therapies to treat stroke.

DOI： 10.3390/ijms21186718

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Urinary liver-type fatty-acid binding protein (L-FABP), which is a biomarker of kidney tubule injury, has been studied extensively and established as a risk marker of acute kidney injury (AKI). However, no evidence has indicated whether kidney tubule injury is associated with the development of AKI and mortality in patients with acute ischemic stroke. METHODS: Acute ischemic stroke patients hospitalized in the stroke care unit (SCU) within 24 hours after symptom onset were prospectively investigated. AKI was defined on the basis of Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Baseline urinary L-FABP was measured upon admission. We evaluated the association among urinary L-FABP, the incidence of AKI, and 90-day mortality adjusted for renal function, albuminuria, and other potentially predictive variables using the multivariable analysis. RESULTS: In total, 527 acute ischemic stroke patients (342 males; median age 74 years) were enrolled to the study. Twenty-seven patients (5.1%) occurred AKI within 7 days after admission. In the univariate analysis, high urinary L-FABP level had positive associations with AKI (53.8 μg/g Cr vs. 3.9 μg/g Cr, P<0.001) and 90-day mortality (15.5 μg/g Cr vs. 4.0 μg/g Cr, P<0.001). In the multivariate analysis, elevated urinary L-FABP level (per 10 μg/g Cr increase) was independently associated with AKI (Odds ratio 1.225; 95% confidence interval (CI), 1.083-1.454, P=0.003) and 90-day mortality (Hazard ratio 1.091; 95% CI, 1.045-1.138, P<0.001). CONCLUSION: Urinary biomarker of kidney tubule injury is independently associated with the development of AKI and 90-day mortality in patients with acute ischemic stroke treated at the SCU.

DOI： 10.1111/ene.14448

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The long-term outcome in acute stroke patients with large vessel occlusion (LVO) treated with endovascular therapy (EVT) are unclear. We investigated functional outcomes one year after EVT in acute stroke patients with LVO. METHODS: We retrospectively enrolled 149 stroke patients with LVO who underwent EVT from our prospective stroke registry. We assessed modified Rankin Scale (mRS) scores at one year from onset. The degree of recanalization was evaluated using modified thrombolysis in cerebral infarction (mTICI) grades. Good recanalization and a favorable outcome were defined as an mTICI grade ≥ 2b and mRS score ≤ 2, respectively. RESULTS: Favorable outcomes were observed in 76 (51.0%) patients. The favorable outcome group was younger (median age: 72 [interquartile range, 63-79] years vs. 79 [70-84] years, P < .001) and had more male patients (79% vs. 60%, P = .013), lower National Institutes of Health Stroke Scale scores at admission (median 14 [7-18]) vs. 19 [15-25], P < .001), higher DWI-ASPECTS upon admission (median [6-9] vs. 6 [4-8], P = .022), more patients with mTICI ≥ 2b (93% vs. 64%, P < .001) and fewer post-therapy intracranial cerebral hemorrhages (13% vs. 29%, P = .019) than the poor outcome group. In our multivariate analysis, mTICI ≥ 2b were independently associated with favorable outcomes at one year from onset (odds ratio, 10.282; 95% confidence interval, 1.587-66.604; P = .015). CONCLUSIONS: Good recanalization was associated with favorable functional outcomes one year after EVT in acute stroke patients with LVO.

DOI： 10.1016/j.jns.2020.117009

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Myeloproliferative neoplasms (MPNs) including polycythemia vera (PV) and essential thrombocythemia (ET) have an increased risk of ischemic stroke. However, little is known about brain morphological changes and the cerebral vasculature in MPNs. The aim of the present study is to clarify the prevalence rates of brain infarcts (BIs) on magnetic resonance imaging (MRI) and to assess the detailed clinical and MRI characteristics in those patients. METHODS: We prospectively enrolled patients with MPNs who underwent brain MRI between September 2017 and June 2019. BI patterns were characterized by the numbers and locations of BIs on MRI. RESULTS: A total of 101 patients were included in the present study. BIs were observed in 23 patients (23%). Multiple logistic regression analysis showed that age > 60 years (odds ratio (OR) 7.34, 95% confidence interval (CI) 1.08-49.7, p = .041) and history of thrombosis (OR 40.6, 95% CI 7.97-207, p < .0001) were independently associated with BIs, but not the JAK2V617F mutation. Of the 23 patients with BIs, eight patients (35%) had multiple territorial infarcts, and large vessel involvement was identified in five patients (22%). Two patients had thrombus formation in large vessels. CONCLUSIONS: Among patients with MPNs who underwent MRI, BIs were observed in 23% of patients followed up in our center. Older age and thrombosis history were independently associated with BIs. Some patients with MPNs may present with distinctive MRI findings including multiple territorial infarcts and thrombus formation in large vessels.

DOI： 10.1016/j.jns.2020.116990

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: Some hyperacute stroke patients have unfavorable outcomes after endovascular thrombectomy (EVT) despite successful recanalization. We hypothesized that a cardiac parameter, moderate-to-severe mitral regurgitation (MR), might decrease the rate of favorable clinical outcome after EVT in patients with atrial fibrillation (AF). METHOD: From our prospective EVT registry, AF patients who underwent transthoracic echocardiography (TTE) were retrospectively analyzed. Based on the presence of moderate-to-severe MR, patients were assigned to either significant MR or nonsignificant MR group. The severity of MR was determined by the ratio of the color Doppler jet area to the left atrial area in mid-systole. Moderate-to-severe MR was estimated to be at a ratio of >20%. Favorable outcome was defined as having a modified Rankin Scale score of 0-1 at 3 months. RESULT: 127 patients with AF who underwent TTE were included in the study. TTE results found that 25 (20%) patients had significant MR. Patients with significant MR were older (p = 0.051) and had enlarged left (p = 0.015) and right (p = 0.002) atria. Tricuspid and aortic regurgitation (p = 0.007 and 0.043, respectively) were more severe in significant MR group. At 3 months, favorable outcomes were 11% in the significant MR group and 26% in the non-significant MR group (p = 0.031). Multivariate regression analysis reported that moderate-to-severe MR was a negative predictor of favorable outcome (odds ratio = 0.14; 95% confidence interval = 0.02, 0.84; p = 0.031). CONCLUSIONS: Significant MR might prevent the clinical recovery of AF patients.

DOI： 10.1080/01616412.2020.1773611

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND AND PURPOSE: We investigated the impact of complete recanalization beyond partial recanalization in distal (M2) middle cerebral artery (MCA) occlusion. METHODS: Data regarding M2 occlusion patients treated with endovascular thrombectomy (EVT) and/or intravenous thrombolysis (tPA) were reviewed from our prospective EVT registry and multicenter tPA (YAMATO study) data bank. Complete recanalization was modified thrombolysis with cerebral infarction score (TICI) of 3 at the end of EVT or similar appearances of both MCAs on magnetic resonance angiography (MRA) within 1.5 h after tPA. Partial recanalization was defined as TICI ≥2b or > 50% recanalization on MRA. At 3 months, favorable outcome was defined as a modified Rankin Scale score ≤ 2. RESULT: Data on 121 patients were analyzed. EVT-alone was in 38 patients; combined EVT and tPA in 28; and tPA-alone in 55. Complete recanalization was achieved in 27 (22%), partial recanalization in 48 (40%), and no-to-limited recanalization in 46 (38%). At 3 months, 51% of patients had favorable outcomes, and this rate was significantly higher in the complete recanalization group than in the partial and no-to-limited recanalization groups (75% vs. 41% vs. 49%, p = .043). Multivariate regression analysis showed that complete recanalization was an independent parameter related to favorable outcomes (odds ratio 4.78, 95% CI: 1.16-19.73, p = .030). However, combined complete and partial recanalization was not associated with favorable outcomes (odds ratio 1.49, 95% CI 0.53-4.22, p = .449). CONCLUSION: Complete recanalization, but not partial recanalization, at the end of EVT and tPA therapy is associated with favorable outcomes in patients with M2 occlusion.

DOI： 10.1016/j.jns.2020.116873

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: Evaluation of cognitive status is not performed routinely in the acute stroke setting. This study aimed to evaluate the frequency of early cognitive impairment in patients with minor ischemic stroke, analyze the factors associated with early cognitive impairment, and assess functional outcomes. METHODS: In this prospective study, 112 consecutive patients with acute minor ischemic stroke were enrolled. Neuroimages were assessed for semiquantitative evaluation of brain atrophy and small vessel disease (SVD) markers. Cognitive performance was measured within 5 days of onset using Montreal Cognitive Assessment (MoCA) scores. Functional outcome analyses were adjusted for demographic variables, premorbid cognitive status, education level, vascular risk factors, neuroimaging characteristics, stroke severity, and MoCA scores. RESULTS: The median MoCA score was 22, and 63% of patients had cognitive impairment. Factors independently associated with cognitive impairment were education (odds ratios [OR], .79; confidence intervals [CI], .63-.99), smoking (OR, .26; 95%CI, .073-.89), and temporal horn atrophy (OR, 4.73; 95% CI, 1.66-13.49). Factors independently associated with poor functional outcome were total MoCA score (OR, .78; 95%CI, .62-.95) and the sum of 4 MoCA subscores (visuospatial/executive, attention, language, and orientation; OR, .72; 95%CI, .53-.92). The cutoff value of the sum of 4 MoCA subscores for predicting poor outcome was 13 points with 76.5% sensitivity and 81.1% specificity. CONCLUSIONS: Early cognitive impairment was common after minor ischemic stroke and was associated with preexisting temporal horn atrophy but not SVD markers. The sum of 4 MoCA subscores was useful in predicting the functional outcome.

DOI： 10.1016/j.jstrokecerebrovasdis.2020.104749

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: Cognitive assessment is not performed routinely in the acute stroke setting. We investigated factors associated with cognitive impairment and the differences between the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores in patients with acute stroke. METHODS: In this prospective study, 881 consecutive patients (median age, 73 years) with acute stroke were enrolled. Clinical characteristics, such as education, vascular risk factors, premorbid cognitive status using the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), and stroke severity, were assessed. Cognitive performance was measured using MMSE and MoCA within 5 days of stroke onset. RESULTS: Both MMSE and MoCA were feasible in 621 (70.5%) patients. Factors independently associated with nonfeasibility were age (odds ratio [OR]: 1.05; 95% confidence interval [CI]: 1.02-1.08), IQCODE score (OR: 1.02; 95%CI: 1.00-1.04), and National Institutes of Health Stroke Scale (NIHSS) score (OR, 1.16; 95%CI, 1.12-1.20). Impaired MoCA (with a cut-off <26/30) performance was observed in 544 of 621 (87.6%) patients. Factors independently associated with cognitive impairment were age (OR: 1.06; 95%CI: 1.03-1.10) and NIHSS score (OR: 1.34; 95%CI: 1.14-1.57). Eighty percent of patients with normal MMSE scores had an impaired MoCA score (MMSE-MoCA mismatch). The differences were highest in the visuospatial (94.8% versus 65.3%; P < .0001), recall (76.6% versus 35.6%; P < .0001), abstraction (82.5% versus 49.8%; P < .0001), and language (72.3% versus 65.9%; P < .0001) domains between the normal MMSE and MoCA group and MMSE-MoCA mismatch group. CONCLUSIONS: The MoCA can be particularly useful in patients with cognitive deficits undetectable on the MMSE in the acute stroke phase.

DOI： 10.1016/j.jstrokecerebrovasdis.2020.104688

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The feasibility of performing MRI first for patients with suspected hyperacute stroke in real-world practice has not been fully examined. Moreover, most past studies of reducing door-to-reperfusion time (DRT) in endovascular treatment (EVT) were conducted using CT. The aim of this study was to evaluate the feasibility of an MRI-first policy and to examine the effects of a quality improvement (QI) process for reducing DRT using MRI. METHODS: From January 2013 to December 2018, consecutive patients with acute stroke who came to hospital directly and were treated with emergent EVT were prospectively enrolled into the present study. In principle, MRI was performed first for patients with suspected acute stroke. A step-by-step QI process for decreasing DRT was adopted during this period. Time metrics for EVT were compared between specific time periods. RESULTS: A total of 180 patients (71 women; median age 76 years (range 69-64); National Institutes of Health Stroke Scale score 17 (range 10-23)) were included in the present study. More patients in the late phase were managed with the MRI-first policy (p<0.001). DRT (199 min in Phase 1, 135 min in Phase 2, 129 min in Phase 3, and 121 min in Phase 4, p<0.001) was significantly reduced across the phases. The percentage of patients with DRT <120 min increased significantly across time periods (p<0.001). Symptomatic intracerebral hemorrhage did not increase across phases (p=0.575). CONCLUSION: An MRI-first policy was feasible, and DRT decreased considerably with a step-by-step QI process. This process may be applicable to other hospitals.

DOI： 10.1136/neurintsurg-2019-015625

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記述言語：英語  

DOI： 10.1016/j.jocn.2019.11.032

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記述言語：英語  

DOI： 10.1016/j.jstrokecerebrovasdis.2019.104482

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is a clinicoradiological syndrome characterized by transient mild encephalopathy and magnetic resonance imaging (MRI) findings of a reversible lesion in the splenium of the corpus callosum (SCC). Patients with MERS generally present with central nervous system symptoms such as consciousness disturbance, headache, and seizure; adult-onset MERS with cerebellar ataxia is rare. A 53-year-old man was admitted to our hospital with fever of 1 week's duration, headache, neck stiffness, and gait disturbance. Neurological examination revealed bilateral intention tremor (predominantly affecting the right hand) and gait ataxia. Diffusion-weighted brain MRI showed a focal hyperintense lesion in the SCC. Cerebrospinal fluid analysis revealed elevated levels of mononuclear cells and proteins. Brain imaging with 123I-iofetamine single-photon emission computed tomography showed reduced cerebral blood flow in the left thalamus and right cerebellum. Several diseases, including cerebellar stroke and acute cerebellitis, develop as comorbidities in patients with acute cerebellar ataxia. This case suggests that MERS should be suspected in adults with cerebellar ataxia.

DOI： 10.1272/jnms.JNMS.2020_87-305

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: The management of atrial fibrillation and deep venous thrombosis has evolved with the development of direct oral anticoagulants (DOAC), and oral anticoagulant (OAC) might influence the development or clinical course in both ischemic and hemorrhagic stroke. However, detailed data on the differences between the effects of the prior prescription of warfarin and DOAC on the clinical characteristics, neuroradiologic findings, and outcome of stroke are limited. DESIGN: The prospective analysis of stroke patients taking anticoagulants (PASTA) registry study is an observational, multicenter, prospective registry of stroke (ischemic stroke, transient ischemic attack, and intracerebral hemorrhage) patients receiving OAC in Japan. This study is designed to collect data on clinical background characteristics, drug adherence, drug dosage, neurological severity at admission and discharge, infarct or hematoma size, acute therapy including recanalization therapy or reverse drug therapy, and timing of OAC re-initiation. Patient enrollment started in April 2016 and the target patient number is 1000 patients. CONCLUSIONS: The PASTA prospective registry should identify the status of stroke patients taking OAC in the current clinical practice in Japan.

DOI： 10.1016/j.jstrokecerebrovasdis.2019.104456

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.4103/1673-5374.255964

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.jns.2019.06.033

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s12149-019-01367-4

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記述言語：英語  

We experimentally demonstrate a double-layer platform of silicon nitride and silicon for ultralow-crosstalk multiport optical switches. By using a silicon nitride overpass with a large gap of 1.5 µm, we achieve a crosstalk of less than -50 dB and -45 dB almost entirely in the C-band for 4 × 4 and 16 × 16 switches, respectively. To demonstrate the scalability of the platform, we also measured a 32 × 32 passive test device and show that a worst-case crosstalk of less than -50 dB is feasible with appropriate gate switches.

DOI： 10.1364/OE.27.021130

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.jns.2019.03.018

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.jns.2019.03.031

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.jstrokecerebrovasdis.2018.12.013

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1253/circj.CJ-18-0938

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Human neural stem cells (hNSCs) transplantation in several brain injury models has established their therapeutic potential. However, the feasibility of hNSCs transplantation is still not clear for acute subdural hematoma (ASDH) brain injury that needs external decompression. Thus, the aim of this pilot study was to test feasibility using a rat ASDH decompression model with two clinically relevant transplantation methods. Two different methods, in situ stereotactic injection and hNSC-embedded matrix seating on the brain surface, were attempted. Athymic rats were randomized to uninjured or ASDH groups (F344/NJcl-rnu/rnu, n = 7-10/group). Animals in injury group were subjected to ASDH, and received decompressive craniectomy and 1-week after decompression surgery were transplanted with green fluorescent protein (GFP)-transduced hNSCs using one of two approaches. Histopathological examinations at 4 and 8 weeks showed that the GFP-positive hNSCs survived in injured brain tissue, extended neurite-like projections resembling neural dendrites. The in situ transplantation group had greater engraftment of hNSCs than matrix embedding approach. Immunohistochemistry with doublecortin, NeuN, and GFAP at 8 weeks after transplantation showed that transplanted hNSCs remained as immature neurons and did not differentiate toward to glial cell lines. Motor function was assessed with rotarod, compared to control group (n = 10). The latency to fall from the rotarod in hNSC in situ transplanted rats was significantly higher than in control rats (median, 113 s in hNSC vs. 69 s in control, P = 0.02). This study first demonstrates the robust engraftment of in situ transplanted hNSCs in a clinically-relevant ASDH decompression rat model. Further preclinical studies with longer study duration are warranted to verify the effectiveness of hNSC transplantation in amelioration of TBI induced deficits.

DOI： 10.3389/fneur.2019.00082

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.biopha.2018.09.084

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.jstrokecerebrovasdis.2018.06.009

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1253/circj.CJ-18-0561

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.omtm.2018.07.009

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1161/JAHA.118.009507

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1161/STROKEAHA.118.022107

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

DOI： 10.5692/clinicalneurol.cn-001181

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Perampanel (PER), a noncompetitive α-amino-3-hydroxy-5-methyl-4-isoxazole propionate receptor antagonist, clinically used for seizure control, has been reported to exert neuroprotective effects in experimental models of neurodegenerative diseases. However, few studies have investigated the therapeutic effects of PER in brain injury including stroke. Our aim was to investigate the neuroprotective potential of PER using a rat transient middle cerebral artery occlusion (MCAO) model. Sprague-Dawley rats underwent 90-min MCAO followed by intraperitoneal PER administration at a dose of 1.5 mg/kg. Infarct volumes, neurological deficits, and immunological analyses were performed at 7 days after MCAO. PER significantly reduced infarct volumes (p < 0.05) and improved motor function (p < 0.05) compared with vehicle. Immunological analysis showed that PER significantly inhibited microglial activation, pro-inflammatory cytokine expression, and oxidative stress compared with vehicle. Moreover, PER suppressed neurodegeneration in the cortical ischemic boundary zone, via downregulation of Bcl-2-associated x and upregulation of Bcl-extra-large with Akt activation. In addition, post-stroke secondary neuronal damage and cognitive impairments, using the Y-maze test, were assessed 30 days after MCAO. PER significantly improved spatial working memory, which was accompanied by hippocampal CA1 neuronal loss and cortical thinning, compared with vehicle. These results indicate that PER attenuates infarct volumes and motor function deficits possibly through its anti-inflammatory, antioxidant, and anti-apoptotic activities, mediated via activation of phosphatidylinositol 3-kinase (PI3K)/Akt pathways in the acute ischemic phase, and further ameliorates post-stroke cognitive impairments via the suppression of secondary neuronal damage in the chronic ischemic phase.

DOI： 10.1016/j.neuroscience.2018.06.043

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：W.B. Saunders  

Background and Purpose: Anemia upon hospital admission is a known predictor of poor functional outcomes in patients with acute cerebral infarction. However, it remains unclear whether reductions in hemoglobin levels during hospitalization influence stroke outcomes. We investigated the association between in-hospital decline in hemoglobin and poor outcomes. Materials and Methods: We retrospectively analyzed data from 480 consecutive patients who had experienced acute cerebral infarction and presented without anemia between January 2012 and March 2015. Decline in hemoglobin was taken as the difference between hemoglobin levels upon admission and nadir hemoglobin. Poor outcome was defined as a modified Rankin Scale score 3-6. A multivariate analysis of the relationship between decline in hemoglobin and poor outcome at discharge was conducted for various patient characteristics. Results: The mean hemoglobin level at admission was 14.3 ± 1.3 g/dL, whereas the mean nadir hemoglobin value was 13.1 ± 1.9 g/dL, with a mean decline in hemoglobin of 1.3 ± 1.5 g/dL. In patients with poor outcomes, mean decline in hemoglobin was significantly reduced to 3.1 g/dL (P &lt
.001). The optimal cutoff decline in hemoglobin required to distinguish a poor outcome was 1.5 g/dL whereas the sensitivity and specificity were 62% and 82.3%, respectively, with an area under the curve of .77 (P &lt
.0001). A decline in hemoglobin below 1.5 g/dL was found to be an independent predictor of poor outcome (odds ratio: 2.10
confidence interval: 1.10-3.99
P = .023). Conclusion: Decline in hemoglobin in patients hospitalized with acute stroke may be associated with poor outcome.

DOI： 10.1016/j.jstrokecerebrovasdis.2018.01.026

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier B.V.  

Introduction: Magnetic resonance imaging (MRI) has recently emerged as a first-line tool for investigating acute stroke. However, MRI requires long scan times, which could be detrimental for severe stroke patients with a large intracerebral hemorrhage (ICH). MRI scout images, which are taken prior to a study to determine the range of subsequent images, can be used to rapidly screen the whole brain. We examined whether MRI scout imaging can detect ICHs observed by computed tomography (CT). Methods: Between September 2014 and March 2016, consecutive acute ICH patients who underwent both MRI scout and CT imaging in the acute setting were studied. ICHs on MRI scout images were defined as space-occupying lesions. Two neurologists independently assessed the scout images. We investigated whether ICHs on CT scans can be detected on MRI scout images and the characteristics of ICHs not detected by MRI scout images. Results: One hundred and forty-eight ICH patients (median age, 68 [interquartile range, 59–77] years
99 [67%] males
median National Institutes of Health Stroke Scale score, 11 [4–17]) were enrolled. Among these, 138 (93%) patients were diagnosed as having ICH by MRI scout imaging (positive group), and 10 (7%) patients were not (negative group). The bleeding volume was 9.3 [4.5–22.4] ml in the positive group and 1.0 [0.4–2.0] ml in the negative group (p &lt
.001). The cut-off value of bleeding volume calculated from the receiver operating characteristic curve was 2.0 ml. Regarding ICH lesions, 4 (44%) of the 9 pontine hemorrhages were detected on MRI scout images, whereas 134 (96%) of the 139 other hemorrhages were diagnosed (p &lt
.001). Conclusions: We diagnosed &gt
90% of ICHs using MRI scout images. Low levels of ICH and pontine hemorrhaging might be difficult to detect using MRI scout imaging.

DOI： 10.1016/j.jns.2018.01.041

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1161/STROKEAHA.117.019216

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Dr. Dietrich Steinkopff Verlag GmbH and Co. KG  

Stroke-associated infection (SAI) is a common and serious complication of stroke. This study aimed to assess the effects of SAI on patient mortality and functional outcome at 3 months after stroke onset. We retrospectively analyzed 809 consecutive patients with acute stroke (517 men and 292 women
median age, 72 years) who were admitted to our department between September 2014 and June 2016. SAI was defined as an infection diagnosed during the hospitalization period. Poor outcome was defined as a modified Rankin Scale (mRS) score of 3–5 or death (mRS score of 6). The effect of SAI on functional outcome was evaluated using a multivariate logistic regression analysis. SAI occurred in 169 patients (20.9%)
of these, 106 (62.7%) had pneumonia, 23 (13.6%) had a urinary-tract infection, and 40 (23.7%) had other types of infection. Patients with SAI were older, more likely to be female, had lower body mass indices, had higher stroke severity, and were more likely to have atrial fibrillation and a history of ischemic heart disease than patients without SAI. Poor functional outcome and mortality were more common in patients with SAI than in patients without SAI (poor functional outcome 41.8 vs. 4.8%, mortality 24.3 vs. 3.9%, respectively). After adjusting for age, sex, stroke severity, and various comorbidities, SAI was independently associated with poor functional outcome [odds ratio (OR) 6.88
95% confidence interval (CI) 3.72–12.73] and mortality (OR 4.45, 95% CI 2.27–8.72) at 3 months after stroke onset. Our results suggest that SAI during the hospitalization period is independently associated with 3-month poor functional outcome and mortality.

DOI： 10.1007/s00415-017-8714-6

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：W.B. Saunders  

Background: Poststroke infection (PSI) is common and is usually associated with a severe prognosis. We investigated the association between PSI and thyroid hormones, which are critical to immune regulation, in patients with acute stroke. Methods: We retrospectively enrolled 520 consecutive patients with acute ischemic stroke (326 men
age, 71.9 ± 13.2 years) admitted to our department between September 2014 and June 2016. The impact of serum thyroid hormone levels measured at admission (thyroid-stimulating hormone [TSH], free triiodothyronine [FT3], and free thyroxine [FT4]) on the PSI was evaluated using multivariate logistic regression analysis. Results: We diagnosed 107 patients (20.6%
pneumonia, 65
urinary tract infection, 19
others, 23) with PSIs. While age (P &lt
.001), body mass index (P =.0012), preadmission modified Rankin scale score (P =.0001), National Institutes of Health Stroke Scale score on admission (P &lt
.001), admission FT3 level (P &lt
.001), atrial fibrillation (P &lt
.001), and ischemic heart disease (P =.0451) were significantly associated with PSI, we found no relationship among TSH levels, FT4 levels, and PSI occurrence. After multivariate adjustment, patients with PSIs were more frequently in the Q1 quartile (≤2.25 pg/mL) than in the Q2 (2.26-2.55 pg/mL
P =.0251), Q3 (2.56-2.89 pg/mL
P =.0007), or Q4 (≥2.90 pg/mL
P =.0010) quartiles of FT3 levels. Moreover, low FT3 levels (&lt
2.29 pg/mL) were independently associated with PSI occurrence (P =.0013). Conclusions: Low FT3 levels at admission are independently associated with PSI occurrence.

DOI： 10.1016/j.jstrokecerebrovasdis.2017.09.012

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記述言語：英語  

DOI： 10.1016/j.jns.2016.06.063

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記述言語：英語  

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DOI： 10.1159/000490461

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Medical Association of Nippon Medical School  

Background and Purpose: It is clinically important to evaluate time course changes in symptomatic middle cerebral artery (MCA) stenotic plaques because of likely recurrence. The objective of this study is to determine whether contrast-enhanced high-resolution magnetic resonance imaging (MRI) is a feasible method for this purpose. Methods: Contrast-enhanced, high-resolution, 3D turbo spin-echo images with low refocusing flip angle control (3D LOWRAT) applied to 7 patients with symptomatic MCA stenosis were evaluated at the initial (1 month after stroke onset) and follow-up (7 months after stroke onset) stages, and statistical variables, including plaque-to-thalamus signal intensity ratio, degree of stenosis, and stroke recurrence obtained at the 2 stages, were compared. Stenotic change at the initial stage was compared to that at the follow-up stage using MR angiography. Results: In 4 of the 7 patients, the signal intensity ratio measured at the follow-up stage was lower than that measured at the initial stage and in 1 patient, the stenosis subsequently improved. We used a Chi-Square Test. In the other 3 patients, the signal intensity ratios did not differ between the 2 stages, and ischemic stroke occurred in 2 of these 3 patients. Conclusion: Gadolinium contrast enhancement was found to be useful for effective evaluation of time course changes in the stability of symptomatic MCA stenotic plaques.

DOI： 10.1272/jnms.2018_85-4

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Japanese Circulation Society  

Background: Insufficient anticoagulant intensity on admission is common in stroke patients with atrial fibrillation (AF) on vitamin K antagonist (VKA) therapy. Nevertheless, the effects of VKA under-treatment on stroke severity or arterial occlusion are not well known. The aim of the present study was to investigate the relationship between insufficient VKA therapy and stroke severity, or the site of arterial occlusion in patients with acute ischemic stroke (AIS) and AF. Methods and Results: From March 2011 through July 2016, 446 consecutive patients with AF and AIS were recruited. Of the 446 patients, 364 (167 women
median age, 79 years
IQR, 71–86 years) with anterior-circulation stroke were assessed to investigate the effects of insufficient VKA. Of these, 281 were on no anticoagulant, 53 were undertreated with a VKA, and 30 were sufficiently treated with VKA on admission (PT-INR ≥2.0 for patients &lt
70 years and PT-INR ≥1.6 for ≥70 years old). On multivariate analysis, insufficient VKA was independently associated with severe stroke (i.e., initial NIHSS score ≥10
OR, 2.70, P=0.022) and higher prevalence of proximal artery occlusion (OR, 1.91
P=0.039) compared with no anticoagulant therapy. Conclusions: Insufficient VKA therapy on admission was associated with higher severity of stroke and higher prevalence of proximal artery occlusion in patients with AF and acute anterior-circulation stroke compared with no anticoagulant medication.

DOI： 10.1253/circj.CJ-17-1110

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER HEIDELBERG  

Cortical superficial siderosis (cSS) is a pathologic and radiologic diagnosis of hemosiderin deposition in subpial brain layers. However, cSS has not been fully studied in patients with acute stroke. Here, we investigated the prevalence of cSS in patients with acute stroke and analyzed the relationship between cSS and different clinical and neuroimaging characteristics. From September 2014 through June 2016, consecutive patients with acute stroke who were admitted to our department were retrospectively investigated. We analyzed the prevalence of cSS and the associations between cSS and risk factors, the topographic distribution of cerebral microbleeds (CMBs), and the severity of white matter lesions (WMLs). In total, 739 patients (589 patients with ischemic stroke/transient ischemic stroke [IS/TIA] and 150 with intracerebral hemorrhage [ICH]; mean age, 71.4 years) were enrolled. We identified cSS in six (1.0%) patients with IS/TIA and seven (4.7%) patients with ICH. The presence of cSS was associated with ICH (P &lt; 0.0001), WMLs (P = 0.0105), and lobar and non-lobar CMBs (both P &lt; 0.0001); no associations between cSS and age, sex, cardiovascular risk factors, IS subtype classification, or antiplatelet and anticoagulant therapy were found. In a multivariable logistic regression analysis, high numbers of lobar CMBs (ae&lt;yen&gt; 2; odds ratio, 11.03; 95% confidence interval, 2.03-205.40; P = 0.0029) were independently associated with cSS. Furthermore, cSS was often located near lobar CMBs. Our results suggest that cSS is prevalent in ICH and is independently associated with lobar CMBs; however, no associations between cSS and other risk factors or comorbidities were observed.

DOI： 10.1007/s00415-017-8646-1

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY  

Background and purposeAnticoagulant treatment with a vitamin K antagonist (VKA) has been reported to reduce stroke severity when patients with atrial fibrillation (AF) suffer acute ischaemic stroke (AIS). Direct oral anticoagulant (DOAC) therapy also has the potential to reduce the initial severity of AIS. However, the effect of DOAC therapy on the severity of AIS is not well known. The aim of the present study was to investigate the effect of DOACs on initial stroke severity in patients with AIS and non-valvular AF.
MethodsFrom March 2011 to July 2016, consecutive patients with AIS having non-valvular AF were recruited. The effects of prior DOAC treatment on severity were assessed by multivariate logistic regression analyses.
ResultsA total of 484 patients [208 women; median age 79 (interquartile range, 71-85) years; National Institutes of Health Stroke Scale (NIHSS) score 9 (interquartile range, 3-20)] were enrolled. Of these, 352 (73%) were on no anticoagulant medication, 54 (11%) were undertreated with a VKA, 35 (7%) were sufficiently treated (admission prothrombin time-international normalized ratio: 2.0 for patients &lt;70 years old and 1.6 for 70 years old) with a VKA and 43 (9%) were on a DOAC. The initial NIHSS score (median 10 in patients with no anticoagulation, 13 in undertreated VKA, 7 in sufficient VKA and 6 in DOAC, P = 0.018) was different among the groups. Multivariate analysis showed that DOAC was independently and negatively associated with severe (initial NIHSS score 10) stroke (odds ratio, 0.39; P = 0.041), compared with no anticoagulant therapy.
ConclusionsDirect oral anticoagulant treatment prior to the event should reduce initial stroke severity in patients with AIS and non-valvular AF.

DOI： 10.1111/ene.13405

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：CELL PRESS  

Interleukin (IL)-10 is a contributing factor to neuroprotection of mesenchymal stem cell (MSC) transplantation after ischemic stroke. Our aim was to increase therapeutic effects by combining MSCs and ex vivo IL-10 gene transfer with an adeno-associated virus (AAV) vector using a rat transient middle cerebral artery occlusion (MCAO) model. SpragueDawley rats underwent 90 min MCAO followed by intravenous administration of MSCs alone or IL-10 gene-transferred MSCs (MSC/IL-10) at 0 or 3 hr after ischemia reperfusion. Infarct lesions, neurological deficits, and immunological analyses were performed within 7 days after MCAO. 0-hr transplantation of MSCs alone and MSC/IL-10 significantly reduced infarct volumes and improved motor function. Conversely, 3-hr transplantation of MSC/IL-10, but not MSCs alone, significantly reduced infarct volumes (p &lt; 0.01) and improved motor function (p &lt; 0.01) compared with vehicle groups at 72 hr and 7 days after MCAO. Immunological analysis showed that MSC/IL-10 transplantation significantly inhibits microglial activation and pro-inflammatory cytokine expression compared with MSCs alone. Moreover, overexpressing IL-10 suppressed neuronal degeneration and improved survival of engrafted MSCs in the ischemic hemisphere. These results suggest that overexpressing IL-10 enhances the neuroprotective effects of MSC transplantation by anti-inflammatory modulation and thereby supports neuronal survival during the acute ischemic phase.

DOI： 10.1016/j.omtm.2017.06.005

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE BV  

Background: The safety of intravenous thrombolysis (IVT) and endovascular therapy (EVT) in patients treated with DOAC is unclear. We investigated whether recanalization therapy in patients treated with DOAC is safe.
Methods: A nationwide, multicenter, retrospective cohort questionnaire survey was conducted to investigate the: (1) frequency of intracerebral hemorrhage (ICH) after recanalization therapy in patients treated with DOAC; (2) independent factors related to ICH; (3) relationship between last intake time of DOAC and ICH; and (4) comparison of ICH frequency between patients treated with DOAC, vitamin K antagonist (VKA), and no-anticoagulation (no-ACT) (control).
Results: One hundred eighteen stroke centers returned the questionnaire and 100 patients (56 IVT alone, 29 EVT alone, and 15 both IVT and EVT) on DOAC were registered. The frequency of asymptomatic and symptomatic (&gt;=. 4-point NIHSS score increase) ICH within 24 h in DOAC patients were 18% and 2%, and were not different compared with the VKA and no-ACT groups (p = 0.728; and p = 0.626). On multivariate analysis, systolic blood pressure (OR, 1.04; p&lt;0.001) and blood glucose (OR, 1.02; p = 0.019) were independent factors for ICH. Among the 52 patients with a known last intake time of DOAC, the rate of ICH was higher in patients 54 h from last intake than those &gt;4 h (38% vs. 10%, p = 0.033).
Conclusions: Risk of ICH after reperfusion therapy in patients treated with DOAC should be low. Systolic blood pressure, glucose level, and DOAC intake time appear to be factors for ICH. (C) 2017 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.jns.2017.06.004

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY  

Aim: Albuminuria and a low estimated glomerular filtration rate (eGFR) are widely recognized indices of kidney dysfunction and have been linked to cardiovascular events, including stroke. We evaluated albuminuria, measured using the urinary albumin/creatinine ratio (UACR), and the eGFR in the acute phase of ischaemic stroke, and investigated the clinical characteristics of ischaemic stroke patients with and those without kidney dysfunction.
Methods: The study included 422 consecutive patients admitted between June 2010 and May 2012. General blood and urine examinations were performed at admission. Kidney dysfunction was defined as a low eGFR (&lt; 60mL/min per 1.73m(2)), high albuminuria (30mg/g creatinine), or both. Neurological severity was evaluated using the National Institutes of Health Stroke Scale (NIHSS) at admission and the modified Rankin scale (mRS) at discharge. A poor outcome was defined as a mRS score of 3-5 or death. The impacts of the eGFR and UACR on outcomes at discharge were evaluated using multiple logistic regression analysis.
Results: Kidney dysfunction was diagnosed in 278 of the 422 patients (65.9%). The eGFR was significantly lower and UACR was significantly higher in patients with a poor outcome than in those with a good outcome. In multivariate analyses performed after adjusting for confounding factors, UACR &gt; 31.2mg/g creatinine (OR, 2.58; 95% CI, 1.52-4.43; P=0.0005) was independently associated with a poor outcome, while a low eGFR was not associated.
Conclusions: A high UACR at admission may predict a poor outcome at discharge in patients with acute ischaemic stroke.

DOI： 10.1111/nep.12745

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE BV  

Background: The presence of white matter lesions (WML) is an indicator of small vessel disease; however, the underlying pathological mechanisms are still unclear. We aimed to investigate the association of estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (UACR) with WML severity in first-ever stroke patients.
Methods: We retrospectively enrolled 284 consecutive patients (177 male; median age 72 years) admitted to our stroke center between May 2010 and January 2012. eGFR and UACR measurements were performed on admission. WML severity was assessed using the Fazekas classification. Severe WML was defined as a Fazekas grade of 2 or higher. The impact of eGFR and UACR on severe WML was evaluated using multiple logistic regression analysis.
Results: Age (P &lt; 0.0001), sex (P = 0.0094), eGFR (P = 0.0173), UACR (P = 0.0001), hypertension (P = 0.0436), and brain natriuretic peptide (P = 0.0354) were significantly associated with severe WML. On multivariable logistic regression analysis, high UACR (&gt;= 39.6 mg/g creatinine, P = 0.039), but not low eGFR (&lt;= 74 ml/min/1.73 m(2), P = 0.3672), was independently associated with severe WML. Comparisons between the UACR levels showed that severe WML was more frequent in the UACR mg/g creatinine group than in the UACR &lt;30.0 mg/g creatinine group after multivariate adjustment (OR, 225; 95% CI, 1.04-5.00; P = 0.039). However, there was no significant association between eGFR and severe WML.
Conclusions: Our data suggest that high UACR, but not eGFR, is independently associated with severe WML. (C) 2017 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.jns.2017.01.011

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記述言語：英語   掲載種別：論文集(書籍)内論文   出版者・発行元：Springer Japan  

Stem cell-based approaches have recently attracted much attention owing to their potential therapeutic effects in patients with stroke. Bone marrowderived mononuclear cells (MNCs), a source of stem cells, contain populations of lymphocytes, mesenchymal and hematopoietic stem cells, and hematopoietic and endothelial progenitor cells. They can be rapidly harvested from the bone marrow, separated, isolated, and then returned back into the animal or human. Experimental studies have demonstrated that the beneficial effects of MNCs may occur due to neuroprotection, modulation of inflammation and the immune response, endogenous neurogenesis, arteriogenesis, and angiogenesis. Several clinical studies have shown the safety and efficacy of MNCs in patients with ischemic stroke. Therefore, MNC treatment is a potentially attractive candidate to promote stroke recovery. Further studies are required to develop therapeutic strategies for improved protection against stroke and optimal transplantation protocols, such as cell dose, timing, delivery route, patient selection (age, gender, comorbidities, stroke subtype, and location), and combination therapy.

DOI： 10.1007/978-4-431-56059-3_1

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE BV  

Background: Reduced glomerular filtration rate (GFR) and albuminuria have been independently associated with an increased risk of stroke and unfavorable long-term outcomes. However, the association between GFR, albuminuria, and early neurological deterioration (END) in patients with ischemic stroke has not been well studied to date. We therefore investigated the ability of estimated GFR (eGFR) and albuminuria to predict END in patients with acute ischemic stroke.
Methods: We retrospectively enrolled 294 patients that were admitted to our stroke center with acute ischemic stroke between January 2011 and September 2012. General blood and urine examinations, including eGFR and urinary albumin/creatinine ratio (UACR) measurements, were performed on admission. Kidney dysfunction was defined by a low eGFR value (&lt;60 mL/min/1.73 m(2)) and/or increased albuminuria (&gt;= 30 mg/g creatinine). END was defined as a &gt;= 2-point increase in the National Institutes of Health Stroke Scale (NIHSS) score within 7 days after admission.
Results: Kidney dysfunction was diagnosed in 200 of the 294 patients (68.0%). END was observed in 60 patients (20.4%). Age, blood glucose level on admission, UACR on admission, and NIHSS score on admission were significantly associated with END, while no relationship between eGFR on admission and END was identified. A multivariable logistic regression analysis showed that END was positively associated with high UACR (&gt;= 39.6 mg/g creatinine) and a high NIHSS score (6 points).
Conclusions: Our data suggest that high UACR on admission may predict END in patients with acute ischemic stroke. Larger prospective studies are required to validate the correlation between albuminuria and END. (C) 2016 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.jns.2016.11.007

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：PERGAMON-ELSEVIER SCIENCE LTD  

Aims: Rats subjected to transient focal ischemia and cultured neuronal cells subjected to oxygen-glucose deprivation (OGD) were treated with clarithromycin (CAM) to evaluate the effects of CAM in protecting against neuronal damage.
Main methods: Sprague-Dawley rats were subjected to middle cerebral artery occlusion (MCAO) for 90 min and then reperfused. Each animal was given an oral dose clarithromycin (CAM, 100 mg/kg) or vehicle alone just after the ischemia was commenced. The infarct volume, edema index and neurological performance were assessed after 24 and 72 h of reperfusion. The cerebral blood flow (CBF) was measured with an MRI system at 90 min after MCAO. After 24 and 72 h, oxidative stress (4-HNE, 8-OHdG) and inflammation (lba-1,TNF-alpha) were assessed by immunohistochemical analyses and degenerative cells were assessed in the cortex by Fluoro-Jade C (FJC) labeling. The cultured neuronal cells were also used to examine the effects of CAM exposure on the viability of the cells after OGD.
Key findings: CBF was unchanged between the two groups. Significant reductions of the infarct volume and edema index, an improved neurological deficit score, a significant suppression of 4-HNE and 8-OHdG expression, marked reductions of lba-1 and TNF-alpha expression, and a significant reduction of FJC-positive cells were also observed in the CAM-treated animals at both time points. Treatment with 10 mu M and 100 mu M CAM in vitro significantly reduced cell death after OGD.
Significance: CAM appears to provide antioxidant and anti-inflammatory effects and protect against neuronal damage after cerebral ischemia and OGD. (C) 2016 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.ifs.2016.11.004

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN SOC INTERNAL MEDICINE  

Ataxic hemiparesis (AH) is a classic lacunar syndrome associated with localized damage to the pons, internal capsule, thalamus, or corona radiata. A depression of metabolic activity known as crossed cerebellar diaschisis (CCD) is frequently observed in the cerebellar hemisphere contralateral to the site of the lesion in patients with AH. Though small cortical or subcortical lesions may result in AH, such occurrences are rare. The current report details the case of a patient with AH resulting from acute infarction associated with localized lesions of the postcentral gyrus who presented without CCD.

DOI： 10.2169/internalmedicine.8806-17

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Societas Neurologica Japonica  

A 67-year-old woman developed weakness of the entire left side of the body and disturbance of consciousness, and was admitted to our hospital. She had atrial fibrillation (AF) on arrival at the hospital. Diffusion weighted magnetic resonance imaging showed high intensity area in the right basal ganglia, and magnetic resonance angiography showed occlusion of the right internal carotid artery (ICA). Thrombolytic therapy with intravenous tissue plasminogen activator (IV tPA) was administered 225 minutes after onset, and endovascular procedure also performed. After endovascular therapy, the patient had successful recanalization of the right ICA. Transesophageal echocardiography (TEE) showed a mass in the left atrium. Cardiac surgery for the excision of a left atrial mass and the maze procedure for atrial fibrillation were performed on the 29th hospital day. The mass was pathologically confirmed as thrombus. Follow up TEE after cardiac surgery revealed recurrence of thrombus at the both origin of pulmonary vein in the left atrium. Finally, the thrombus was disappeared at 6-month after onset with taking warfarin. She had no stroke events during the clinical course.

DOI： 10.5692/clinicalneurol.cn-001069

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：KARGER  

Background: Thrombus visualization in patients with acute ischemic stroke has been detected and reported using various imaging modalities. T1-weighted imaging (T1-WI) can depict thrombi as hyperintense signals within vessels. Moreover, in addition to thrombi, T1-WI hyperintensities in arteries may suggest arterial dissection. However, the frequency of and factors related to the T1-hyperintense vessel sign (T1-HVS) are not fully known. The aim of this study was to clarify the prevalence of and related factors for the T1-HVS in patients with acute ischemic stroke.
Methods: From September 2014 through December 2015, consecutive acute ischemic stroke patients who were admitted to our stroke unit within 7 days from symptom onset were retrospectively recruited from the prospective registry. A T1-HVS was defined as the presence of a hyperintense signal, with intensity higher than surrounding brain, within the vessel lumen. Moreover, T1-HVSs were separated into filled T1-HVSs (hyperintensity fills whole vessel lumen) and non-filled T1-HVSs. The frequency of the T1-HVS and the timing of emersion and the relationship between the presence of the T1-HVS and arterial occlusion were assessed. Results: A total of 399 patients (139 women; median age 73 years; National Institutes of Health Stroke Scale score 3) were enrolled in the present study. Of these, 327 (82%) patients had T1-WI on admission. Two hundred and sixty-seven (67%) subjects had at least one follow-up T1-WI (median 6 days after admission), and 134 (34%) cases had &gt;= 2 follow-up T1-WI examinations. The T1-HVS was observed in 18 patients during admission; therefore, the frequency of the T1-HVS in acute ischemic stroke patients was 4.5% (95% CI 2.5-6.5%). All but one (94%) of the T1-HVSs were first observed on follow-up imaging, and the median number of days from onset to T1-HVS appearance was 9. For patients having initial major artery occlusion and follow-up MRI (n = 95), sensitivity and specificity of the T1-HVS for persistent arterial occlusion on follow-up MR angiography were 22 and 100%, respectively. T1-HVS persisted for a few months and then normalized. Although there were no significant differences between filled and non-filled T1-HVS, more patients with non-filled T1-HVS had arterial dissection (43%) than those with filled T1-HVS (9%, p = 0.245). Conclusion: The T1-HVS was observed in 4.5% of acute ischemic stroke patients. T1-HVSs appeared in the subacute phase in arteries with persistent occlusion and remained for a few months. (C) 2017 S. Karger AG, Basel.

DOI： 10.1159/000479593

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE BV  

Objective: This study was performed to investigate whether the Penumbra 5MAX ACE is superior to other Penumbra systems. Materials and Methods: We performed a retrospective, single center analysis of patients with acute ischemic stroke with occlusion of the internal carotid artery or middle cerebral artery (M1 segment) who underwent endovascular therapy using a Penumbra system. The reperfusion success rate, puncture-to-revascularization time, and number of passes were assessed. Multivariate regression analysis was conducted to evaluate independent factors related to revascularization within 60 minutes. Successful revascularization was defined by a thrombolysis in cerebral infarction score &gt;= 2b. Results: The Penumbra 5MAX ACE was used in 24 of the 40 patients (60%). Although the revascularization success rate was similar between patient groups (P = .229), the number of passes was significantly lower (1.5 +/- .8 versus 2.6 +/- 1.3, P = .006) and the puncture-to-revascularization time was shorter (50 +/- 26 minutes versus 116 +/- 69 minutes, P = .002) in patients treated with the Penumbra 5MAX ACE. The Penumbra 5MAX ACE was identified as an independent factor for early revascularization (odds ratio, 5.80; P = .041). Among patients with a premorbid modified Rankin Scale score of 0-1, a modified Rankin Scale score of 0-2 at 3 months was observed in 15 of the 19 patients (79%) treated with the Penumbra 5MAX ACE and in 8 of the 16 (50%) who were not (P = .072). Conclusion: Acute revascularization therapy using the Penumbra 5MAX ACE can achieve rapid successful recanalization and tend to improve clinical outcomes.

DOI： 10.1016/j.jstrokecerebrovasdis.2016.08.016

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE BV  

Background and purpose: The aim of this study was to investigate the association of admission serum thyroid hormone concentration with clinical characteristics and functional outcomes in patients after acute ischemic stroke.
Methods: We retrospectively enrolled 398 consecutive patients admitted to our stroke center between July 2010 and April 2012. Serum thyroid stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4) were evaluated upon admission. Neurological severity was evaluated using the National Institutes of Health Stroke Scale (NIHSS) upon admission and the modified Rankin Scale (mRS) upon discharge. Poor outcome was defined as a mRS score of 3-5 or death (mRS score 6). Separate analyses were conducted according to outcome and quartile serum FT3 concentration.
Results: In total, 164 patients (41.2%) demonstrated a poor outcome. Age, male gender, blood glucose level, arterial fibrillation, dyslipidemia, smoking, NIHSS score, cardioembolic stroke type, and periventricular hyperintensities, but not FT4 or TSH, were significantly associated with poor functional outcome. Furthermore, poor functional outcome was independently associated with low FT3 (&lt;2.29 pg/mL). In comparisons between FT3 quartiles (Q1 [&lt;= 2.11 pg/mL], Q2 [2.12-2.45 pg/mL], Q3 [2.46-2.77 pg/mL], Q4 [&gt;= 2.78 pg/mL]), patients with poor outcomes were more frequent in Q1 than in Q4 after multivariate adjustment. Death was more frequent in Q1 than in Q4 after adjustment for risk factors and comorbidities, but this difference was non-significant after additional adjustment for age and NIHSS score.
Conclusions: Our data suggest that a lower FT3 value upon admission may predict a poor functional outcome in patients with acute ischemic stroke. Further large-scale prospective studies are required to clarify the role of thyroid hormone in the acute phase of ischemic stroke. (C) 2016 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.jns.2016.06.063

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE BV  

Background: Feasibility of performing MRI first for suspected hyperacute stroke patients in real-world practice has not been fully examined. Moreover, most past studies of reducing door-to-needle time (DNT) in intravenous thrombolysis were conducted using CT. The aim of this study was to evaluate the feasibility of an MRI-first policy and examine the effects of a quality improvement (QI) process for reducing DNT using MRI.
Methods: From January 2014 to August 2015, consecutive acute stroke patients who were treated with thrombolysis were prospectively enrolled into the present study. In principle, multimodal 1.5T-MRI was performed first for patients with suspected acute stroke. A step-by-step QI process for decreasing DNT, including prenotification by the emergency medical service, limiting the MRI sequence, and introduction of a rapid examination tool, was also implemented during this period. Time metrics for thrombolysis were compared between specific time periods.
Results: A total of 73 patients (27 women; median age 74 years) were included in the present study. More than 80% of the patients were screened with MRI. More patients were managed with the MRI-first policy in the late phase (p = 0.018). DNT (83 min in the early phase, 68 min in the middle phase, and 54 min in the late phase, p &lt; 0.001) was significantly reduced across phases. The percentage of patients with DNT &lt; 60 min increased significantly across time periods (p &lt; 0.001).
Conclusion: An MRI-first policy was feasible, and DNT was substantially reduced with a QI process. This process may be applicable to other hospitals. (C) 2016 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.jns.2016.07.011

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE BV  

Objective: Isolated deep subcortical infarcts develop as a result of occlusion of the penetrating arteries from the internal carotid artery (ICA) and the proximal (M1) and distal middle cerebral artery (MCA). However, the clinical and neuroimaging characteristics of infarcts due to the occlusion of the distal MCA penetrating artery are unclear.
Methods: Consecutive patients with ischemic stroke or transient ischemic attack with magnetic resonance imaging (MRI) performed within 2 days of onset were studied retrospectively. Using coronal MRI data, isolated deep subcortical infarcts were classified into two groups: 1) proximal group, described as being longer than they are wide, which were expected to be related to the occlusion of the ICA or M1 penetrating artery; and 2) distal group, described as oblong, which were expected to be associated with the occlusion of penetrating arteries from the distal MCA (M2/M3/M4).
Results: A total of 653 consecutive acute ischemic stroke patients (proximal group, 50 [7.7%]; distal group, 14 [2.1%]) were enrolled. Baseline clinical characteristics were not different between the 2 groups. Modified Rankin Scale scores were lower in the distal group than in the proximal group 3 months after stroke onset (1.43 +/- 0.36 vs. 226 +/- 1.35, p = 0.023). We measured the lengths of the infarcts in the X and Y directions using axial MRI. The X/Y ratio was larger in tile distal group than in the proximal group (1.3 +/- 0.6 vs. 0.7 +/- 02, p &lt; 0.01), which indicated that distal MCA penetrating artery infarcts appear more oblong on axial MRI.
Conclusions: One cause for deep subcortical infarction is the occlusion of the distal MCA penetrating arteries, which occurs in 22% of patients with deep subcortical infarctions. These patients had better clinical outcomes than those with ICA and M1 penetrating artery infarctions. Distal MCA penetrating artery infarctions appear oblong on axial MRI. (C) 2016 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.jns.2016.07.005

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記述言語：英語   出版者・発行元：WILEY-BLACKWELL  

DOI： 10.1111/ene.12977

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記述言語：日本語   出版者・発行元：(株)東京医学社  

脳卒中と慢性腎臓病は動脈硬化を共通の基盤としているが、慢性腎臓病に特有の非古典的危険因子も脳卒中発症の誘因となる。慢性腎臓病は、脳卒中発症後の死亡や転帰不良、血栓溶解療法後の頭蓋内出血にも関連する。重篤な腎障害患者における静注血栓溶解療法は、慎重投与であるが、禁忌ではなく、腎機能正常者と同量を使用する。慢性腎臓病患者における脳梗塞予防としての抗血小板薬は、脳梗塞発症リスクと出血性合併症のリスクを勘案して適応を決める。非弁膜症性心房細動における脳梗塞予防には、2011年からNOAC(non-vitamin K antagonist oral anticoagulants:新規抗凝固薬)が使用可能となった。しかし、慢性腎臓病のステージにより禁忌あるいは減量投与しなければならないことに留意する必要がある。脳腎連関を念頭に置いた包括的なリスク管理、治療が求められる。(著者抄録)

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その他リンク： http://search.jamas.or.jp/link/ui/2016225649

記述言語：英語   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

Limb-shaking associated with steno-occlusion of the internal carotid artery (ICA) was first reported by Miller Fisher(1) in 1962, and is characterized by brief, jerky, coarse, involuntary movements involving an arm or leg. Limb-shaking TIA is an under-recognized manifestation of an intracranial and extracranial carotid occlusion or severe stenosis. Although hemodynamic compromise has been suggested to be associated with shaking movements, the pathogenic nature of this symptom remains unclear. Neurophysiologic evaluation of this movement disorder would be useful, but the attack is rare and typically lasts less than 5 minutes.(2) Thus, few reports have investigated this hyperkinetic phenomenon under neurophysiologic assessment.(3&lt;/SUP)

DOI： 10.1212/WNL.0000000000002293

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記述言語：日本語   出版者・発行元：(株)南江堂  

心房細動患者において,その予後を規定する心原性脳塞栓を予防することはもっとも重要な課題である.warfarinは唯一無二の経口抗凝固薬として半世紀以上の歴史があり,心房細動患者の塞栓症予防に用いられてきたが,2011年からNOACと総称される新規抗凝固薬が登場した.NOACは食事の影響がなく,モニタリング不要で固定用量を用いること,効果発現が速やかなこと,脳梗塞予防効果はwarfarinと同等かそれ以上で頭蓋内出血は少ないことから,warfarinに代わるより使いやすい抗凝固薬として使用率が高まっている.本稿では,NOAC登場により,脳梗塞治療に起きつつあるパラダイムシフトについて概説する.(著者抄録)

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その他リンク： http://search.jamas.or.jp/link/ui/2016044802

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MARY ANN LIEBERT, INC  

Autologous bone marrow-derived mononuclear cells (MNCs) are a potential therapy for ischemic stroke. However, the effect of MNCs in intracerebral hemorrhage (ICH) has not been fully studied. In this study, we investigated the effects of autologous MNCs in experimental ICH. ICH was induced by infusion of autologous blood into the left striatum in young and aged male Long Evans rats. Twenty-four hours after ICH, rats were randomized to receive an intravenous administration of autologous MNCs (1x10(7) cells/kg) or saline. We examined brain water content, various markers related to the integrity of the neurovascular unit and inflammation, neurological deficit, neuroregeneration, and brain atrophy. We found that MNC-treated young rats showed a reduction in the neurotrophil infiltration, the number of inducible nitric oxide synthase-positive cells, and the expression of inflammatory-related signalings such as the high-mobility group protein box-1, S100 calcium binding protein B, matrix metalloproteinase-9, and aquaporin 4. Ultimately, MNCs reduced brain edema in the perihematomal area compared with saline-treated animals at 3 days after ICH. Moreover, MNCs increased vessel density and migration of doublecortin-positive cells, improved motor functional recovery, spatial learning, and memory impairment, and reduced brain atrophy compared with saline-treated animals at 28 days after ICH. We also found that MNCs reduced brain edema and brain atrophy and improved spatial learning and memory in aged rats after ICH. We conclude that autologous MNCs can be safely harvested and intravenously reinfused in rodent ICH and may improve long-term structural and functional recovery after ICH. The results of this study may be applicable when considering future clinical trials testing MNCs for ICH.

DOI： 10.1089/scd.2015.0107

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1364/OE.23.017599

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE BV  

Valproic acid (VPA) is widely used for the clinical treatment of epilepsy. Previous studies have demonstrated that VPA ameliorates brain injury following experimental stroke. However, the effect of VPA in stroke models featuring comorbid conditions has not been fully explored. In this study, we investigate the effects of VPA on permanent ischemic stroke with hyperglycemia. Hyperglycemia Was induced by streptozotocin (STZ) injection 3 days before. Test animals received a single injection of VPA immediately after induction of ischemia. Control animals received occlusion and physiological saline injection, or STZ, occlusion, and saline. Magnetic resonance imaging of cerebral blood flow (CBF) and apparent diffusion coefficient (ADC) was performed 60 min after ischemia. Infarct volume, neurological deficits, rotarod test performance, and immunohistological markers were assessed 3 days after ischemia. Hyperglycemia significantly expanded the area of decreased of CBF and ADC, and increased the number of myeloperoxidase-positive cells, ionized calcium binding adapter molecule 1-positive cells, inducible nitric oxide synthase-positive cells, von Willebrand factor-positive cells, and Fluoro-Jade C-positive cells in the ischemic boundary zone, which was accompanied by increased infarct volume and deteriorated neurological deficit and rotarod test compared with normoglycemia (P &lt;0.05). VPA significantly alleviated the aggravation of functional outcome accompanied by suppressing these inflammation, endothelial injury, and neuronal degeneration compared with saline-treated group (P&lt;0.05). A single injection of VPA following permanent ischemia in STZ-induced hyperglycemic rats ameliorates neurological deficits and reduces neuronal degeneration by inhibiting inflammation and endovascular injury. VPA may be promising as a candidate therapy for human stroke. (C) 2015 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.brainres.2015.02.013

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

A 33-year-old man presented with a lateral medullary infarction, vertigo, and nausea. At the time of hospital admission, he had Wallenberg syndrome. Although initial magnetic resonance imaging showed no abnormalities, subsequent diffusion-weighted magnetic resonance imaging showed a high-intensity area in the right lateral medulla oblongata. The right vertebral artery was shown to be dilated on basi-parallel anatomical scanning but to be stenosed on magnetic resonance angiography (MRA). Cerebral angiography 7 days after onset showed the "pearl and string sign" in the right vertebral artery. Followup MRA showed gradual improvement of the stenosis in the right vertebral artery Multiple neuroimaging studies, such as MRA, basi-parallel anatomical scanning, 3-dimensional computed tomographic angiography, and cerebral angiography, should be performed soon after onset in suspected cases of cerebral artery dissection. In addition, serial imaging examinations increase diagnostic accuracy, and the medical history and neurological examination are important.

DOI： 10.1272/jnms.82.68

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Society for Experimental Stroke  

Nicergoline has been widely used for various conditions, including cerebrovascular disorders and senile mental impairment. However, the precise mechanisms underlying this neuroprotection remain unknown. We investigated the neuroprotective properties of nicergoline on outcome after focal ischemia in rats. Sprague–Dawley rats were treated with nicergoline or vehicle through a gavage feeding needle for 7 days before the induction of ischemia. For ischemia, rats were subjected to transient middle cerebral artery occlusion (tMCAO) or permanent middle cerebral artery occlusion (pMCAO). Magnetic resonance imaging was used to obtain cerebral blood flow (CBF) measurements at 24 hours after tMCAO and pMCAO. Nicergoline significantly diminished infarct area and edema volume compared with the vehicle-treated group at 24 hours after tMCAO, but there was no significant reduction in behavioral dysfunction. Twenty-four hours after pMCAO, the nicergoline-treated group showed significantly reduced infarcts, edema, and neurological scores compared with the vehicle-treated group. Decreased areas of CBF were markedly smaller in the nicergoline-treated group compared with the vehicle-treated group 24 hours after occlusion in both models. This study shows that pretreatment with nicergoline prevents brain damage, and increased CBF levels may be involved in the neuroprotective mechanism of nicergoline after acute stroke.

DOI： 10.4172/1939-067x.1000144

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

Central alveolar hypoventilation syndrome (CAHS) is a rare and potentially fatal condition. However, respiratory care for patients with CAHS caused by lateral medullary infarction (CAHS-LMI) remains an important unsolved problem. We describe 2 patients with CAHS-LMI and review the case reports for 17 previously described patients. Patient 1 was a 78-year-old man who was referred to our hospital because of dizziness. After admission, Wallenberg syndrome developed. Magnetic resonance imaging showed left LMI. He had hypercapnia and respiratory acidosis the next afternoon and temporarily received mechanical ventilation. A tracheotomy was performed on the 12th hospital day, and the patient was weaned from the ventilator on the 18th hospital day. Patient 2 was 72-year-old man who was referred to our hospital because of dizziness and gait disturbance. Wallenberg syndrome was diagnosed after admission, and magnetic resonance imaging showed right LMI. His consciousness deteriorated, and hypercapnia developed on the ninth hospital day. The patient received ventilatory support, and a tracheotomy was performed on the 12th hospital day. He was weaned from the ventilator by the 16th hospital day. Consistent with our findings, most previously reported cases of CAHS-LMI were initially associated with mild symptoms, which subsequently worsened. Five of the 19 patients (26.3%) died within 1 month after onset, and 7 patients (36.8%) died within 1 year. Tracheotomy was performed in 12 patients, 2 of whom died 1 month after onset (16.7%); another patient died of chronic renal failure after 2 years. Tracheotomy seemed to be an effective procedure in patients with CAHS-LMI. We speculate that tracheotomy assists alveolar ventilation by reducing dead space ventilation. Closure of the tracheotomy should, therefore, be avoided in patients with CAHS-LMI, even if respiratory status is good.

DOI： 10.1272/jnms.81.276

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE BV  

Bone marrow derived mononuclear cell (MNC) transplantation is a potential therapy for ischemic stroke. Here, we hypothesized that valproic acid (VPA) would modulate transplantation effects of MNCs in a rat ischemic stroke model. Male Sprague-Dawley rats were subjected to transient 90 min middle cerebral artery occlusion. Infarct volume, neurological outcome, and immunohistological assessments were. performed 7 days after ischemia. MNCs injected 6 or 24 h but not 48 or 72 h after ischemia significantly reduced infarct volume and improved neurological deficits. We then tested whether the therapeutic window of MNC transplantation could be expanded through combination therapy with VPA. MNC transplantation at 48 h combined with VPA injection three times at 47, 53, and 72 h after ischemia significantly ameliorated infarct volume and neurological deficits compared to a vehicle group. Combination therapy reduced the number of myeloperoxidase-positive cells, ionized calcium binding adapter molecule 1-positive cells, tumor necrosis factor-a-positive cells, and von Willebrand factor-positive cells in the ischemic boundary zone. The number of engrafted MNCs that were fluorescently labeled with PKH 26, on day 7, was significantly higher after combination therapy than after that MNC transplantation alone. Our results demonstrated that combination therapy with VPA enhanced the anti-inflammatory and vasculo-protective effects against endothelial damage following ischemia, and increased the survival of transplanted cells, leading to expansion of the therapeutic time window for MNC transplantation. Together, these findings suggest that VPS may be an appropriate partner for cell-based treatment of ischemic stroke. (C) 2014 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.brainres.2014.04.011

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1159/000362434

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：PERGAMON-ELSEVIER SCIENCE LTD  

Aims: Transplantation of bone marrow mononuclear cells (BMMCs) exerts neuroprotection against cerebral ischemia. We examined the therapeutic timepoint of allogeneic BMMC transplantation in a rat model of focal cerebral ischemia, and determined the effects of repeated transplantation outside the therapeutic window.
Main methods: Male Sprague-Dawley rats were subjected to 90 minute focal cerebral ischemia, followed by intravenous administration of 1 x 10(7) allogeneic BMMCs or vehicle at 0,3 or 6 h after reperfusion or 2 x 10(7) BMMCs 6 h after reperfusion. Other rats administered 1 x 10(7) BMMCs at 6 h after reperfusion received additional BMMC transplantation or vehicle 9 h after reperfusion. Infarct volumes, neurological deficit scores and immunohistochemistry were evaluated 24 or 72 h after reperfusion.
Key findings: Infarct volumes at 24 h were significantly decreased in transplantation rats at 0 and 3 h, but not at 6 h, after reperfusion, compared to vehicle-treatment. Even high dose BMMC transplantation at 6 h after reperfusion was ineffective. Repeated BMMC transplantation at 6 and 9 h after reperfusion reduced infarct volumes and significantly improved neurological deficit scores at 24 and 72 h. Immunohistochemistry showed repeated BMMC transplantation reduced ionized calcium-binding adapter molecule 1, 4-hydroxy-2-nonenal and 8-hydroxydeoxyguanosine expression at 24 and 72 h after reperfusion.
Significance: Intravenous allogeneic BMMCs were neuroprotective following transient focal cerebral ischemia, and the therapeutic time window of BMMC transplantation was &gt;3 h and &lt;6 h after reperfusion in this model. Repeated transplantation at 6 and 9 h after reperfusion suppressed inflammation and oxidative stress in ischemic brains, resulting in improved neuroprotection. (C) 2013 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.lfs.2013.12.016

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE BV  

Thromboembolic complications, such as deep venous thrombosis and pulmonary embolism, are well described in patients with inflammatory bowel disease, but cerebral venous thrombosis (CVT) is a rare but potentially devastating complication. The authors describe the case of a 36-year-old Japanese man presenting with CVT associated with ulcerative colitis (UC) that was successfully treated with a combination of continuous anticoagulant and pulse steroid therapy. Our observations suggest that aggressive therapy for inducing acute UC remission is vitally important for CVT associated with UC.

DOI： 10.1016/j.jstrokecerebrovasdis.2013.07.023

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: Intra-arterial transplantation of bone marrow mononuclear cells (BMMCs) effectively improves neuronal function and limits the infarct size. We monitored the fate of BMMCs labeled with super paramagnetic iron oxide (SPIO) until 7 days after the transplantation using high-field magnetic resonance imaging (MRI). METHODS: Male Sprague-Dawley rats were subjected to 90-minute focal ischemia using the intraluminal suture technique followed by transplantation of 1 × 10(7) BMMCs or vehicle only via the ipsilateral carotid artery immediately after reperfusion. Autologous BMMCs were labeled with SPIO by electroporation prior to ischemia. MRI studies were performed at 1 hour, 24 hours, 3 days, and 7 days after reperfusion on each rat. The total infarct volume and the volume of negative dots were measured on T2-weighted images and T2*-weighted images, respectively. RESULTS: One hour after BMMC transplantation, we confirmed wide spread distribution of BMMCs in the ischemic hemisphere as a negative dot. The volume of negative dot normalized by hemispheric volume decreased rapidly and was seldom seen at the seventh day after transplantation. The infarct volume was significantly smaller in the transplanted group than the vehicle group at 24 hours and 7 days after reperfusion. DISCUSSION: The present study established In vivo monitoring of intra-arterial transplanted SPIO-labeled BMMCs immediately after reperfusion using MRI of a rat transient focal ischemia model. The accumulation of BMMCs in ischemic lesion at the acute stage of ischemia can be part of the conditions to limit the infarct size.

DOI： 10.1179/1743132813Y.0000000171

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE BV  

Valproic acid (VPA), widely used in clinical contexts for the treatment of seizures and bipolar mood disorder, has neuroprotective properties in cellular and animal models. However, the precise mechanisms underlying its neuroprotection against stroke remain unknown. In the present study, we explored the effect of VPA on experimental ischemic stroke. Male Sprague-Dawley rats were subjected to middle cerebral artery occlusion for 90 min, followed by reperfusion. The animals received a single injection of VPA (300 mg/kg) immediately, 90, or 270 min after the induction of ischemia. Vehicle-treated animals underwent the same procedure with physiological saline. Infarct volume and neurological symptoms were evaluated 24 h after reperfusion. Immunohistochemical staining for myeloperoxidase (MPO), microglia (Iba1), 4-hydroxy-2-nonenal (4-HNE), or 8-hydroxy-deoxyguanosine (8-OHdG) was performed. Ischemic boundary zone cell death was determined by TUNEL staining. VPA injected immediately or 90 min after ischemia induction significantly reduced infarct volume and improved neurological deficit compared with vehicle (P &lt; 0.05). VPA was ineffective when given 270 min after ischemia induction. VPA significantly reduced TUNEL-positive cells, MPO-positive cells, Iba1-positive cells, 4-HNE-positive cells, and 8-OHdG-positive cells compared with vehicle in the ischemic boundary zone (P &lt; 0.05). The therapeutic time window for single injection of VPA is between 0 and 90 min in this model. Our results demonstrate that single injection of VPA may have anti-inflammatory as well as antioxidative effects, leading to reduced cell death in ischemia-reperfusion injury. (C) 2013 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.ejphar.2013.03.020

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記述言語：英語   出版者・発行元：KARGER  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN SOC INTERNAL MEDICINE  

We herein report the case of a 75-year-old woman with a paradoxical cerebral air embolism (CAE). She developed a bilateral visual disturbance at the time of needle puncture during a computed tomography (CT)-guided percutaneous needle lung biopsy in the face down position. The air density within the descending aorta on chest CT suggested the presence of a cerebral air embolism. Brain MRI demonstrated increased signal intensity in the bilateral occipital lobes on diffusion-weighted images. Usually, CAE occurs predominantly in the right hemisphere for anatomical reasons. The face down position and the anatomical features of the right subclavian artery, which diverges backward from the brachiocephalic artery, might explain such a unique distribution of CAE in this patient.

DOI： 10.2169/internalmedicine.52.8760

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：KARGER  

Background: Epidemiological and clinical trials have shown that n-3 polyunsaturated fatty acids (PUFAs) reduce the incidence of coronary heart disease or stroke. However, the association between PUFAs and acute-phase stroke has not yet been thoroughly studied. We investigated the impact of serum PUFAs on early neurological deterioration (END) in patients with acute ischemic stroke. Methods: In this retrospective study, we enrolled 281 Japanese patients (mean age: 75 +/- 13 years; 165 males) with acute ischemic stroke diagnosed within 24 h of onset. General blood examinations, including PUFAs (n-3 PUFAs: eicosapentaenoic acid, EPA, and docosahexaenoic acid, DHA, and n-6 PUFAs: arachidonic acid, AA), were performed on admission. Other risk factors and comorbidities were also examined. END was defined as a &gt;= 2-point increase in the National Institutes of Health Stroke Scale (NIHSS) score within a 72-hour period. Statistical significance between the END and non-END group was assessed using Wilcoxon rank sum tests or Student's t tests for categorical variables. Multiple logistic regression analyses were performed to identify predictors of END. Results: END was observed in 75 patients (26.7%). Diabetes mellitus (p = 0.003), high-sensitivity C-reactive protein (hs-CRP) level (p &lt; 0.001), prior stroke (p = 0.035), ischemic heart disease (p = 0.029), EPA/AA ratio (p = 0.003), DHA/AA ratio (p = 0.002), EPA+ DHA/AA ratio (p = 0.002), diagnosis of small vessel disease (p = 0.004) and admission NIHSS score (p &lt; 0.001) were significantly associated with END. We used separate multiple logistic regression analyses for the EPA/AA, DHA/AA and EPA+ DHA/AA ratios, because EPA and DHA are considered covariant factors (r = 0.544; p &lt; 0.0001). Multiple logistic regression analyses showed that END was positively associated with diabetes mellitus, hs-CRP level and NIHSS score on admission, and negatively associated with the EPA/AA ratio (odds ratio, OR: 0.18; 95% confidence interval, CI: 0.05-0.58; p = 0.003), DHA/AA ratio (OR: 0.045; 95% CI: 0.006-0.30; p = 0.001), EPA+ DHA/AA ratio (OR: 0.45; 95% CI: 0.26-0.74; p = 0.002) and diagnosis of small vessel disease. Conclusions: Our data suggest that a low serum n-3 PUFA/n-6 PUFA ratio on admission may predict neurological deterioration in Japanese patients with acute ischemic stroke. Largescale prospective studies are further required to clarify the role of PUFAs in the acute phase of ischemic stroke. (C) 2013 S. Karger AG, Basel

DOI： 10.1159/000355683

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

A 35-year-old man presented with simultaneous occurrence of subarachnoid hemorrhage (SAH) and cerebral infarction (CI) caused by anterior cerebral artery (ACA) dissection. He complained of sudden onset of left frontal headache and his symptoms progressed to consciousness disturbance and right hemiparesis. Computed tomography and magnetic resonance imaging demonstrated SAH localized in the left interhemispheric fissure and CI in the territory of the left ACA. Right carotid angiography demonstrated a long double lumen sign at the left A2 to A4 segment of the left ACA, leading to a diagnosis of the combined type of CI and SAH caused by ACA dissection. Although many surgeons have previously tried to perform endovascular treatment, we selected only medication in this case, and his neurological findings gradually improved. Only 9 cases including the present case presented with simultaneous occurrence of SAH and CI caused by ACA dissection. Many of these patients showed stenosis with dilatation of ACA on carotid angiography. The prognoses of these patients were good. However, many SAH patients with dissecting aneurysm had poor prognoses. To improve the strategy for managing ACA dissection, we need to accumulate a greater number of such cases in the future. We also recommend that angiography should be performed in the patients with ACA dissection. (J Nippon Med Sch 2012: 79: 153-158)

DOI： 10.1272/jnms.79.153

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記述言語：英語   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

Many drugs for cerebral infarction that were shown to be effective in animal experiments have shown negative results in human clinical trials. For this reason, a completely new approach is needed to develop brain protection therapies against cerebral infarction. Brain protection therapies can be categorized into 3 types: 1) lengthening the therapeutic time window for thrombolytic therapy, 2) reducing the side effects of thrombolytic therapy, and 3) brain protection drug therapy for patients with contraindications for thrombolytic therapy (including combination therapy). Here, we show our recent results of brain protection therapy. First, combination therapy with 2 effective drugs was tried, and time-lag administration was performed. Combination therapy was effective and lengthened the therapeutic time window. Next, a completely new approach to improve cerebral ischemic damage, namely, H-2 gas inhalation therapy, was tried. This therapy was also effective, even in the ischemic core. (J Nippon Med Sch 2012; 79: 104-110)

DOI： 10.1272/jnms.79.104

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記述言語：英語   出版者・発行元：SPRINGER HEIDELBERG  

DOI： 10.1007/s00415-011-6127-5

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN SOC INTERNAL MEDICINE  

Venous congestive myelopathy associated with spinal dural arteriovenous fistulas (DAVFs) is a treatable disorder that can be controlled without sequelae if it is diagnosed at an early stage. It is important to consider spinal DAVFs in the differential diagnosis based on clinical history and neurologic examination. We report the unique case of a patient with DAVFs at the craniocervical junction presenting with occipital/neck pain associated with sleep.

DOI： 10.2169/internalmedicine.51.6607

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記述言語：英語   出版者・発行元：KARGER  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：PERGAMON-ELSEVIER SCIENCE LTD  

Aims: Transplantation of bone marrow stromal cells (MSCs) has been shown to ameliorate ischemic brain injury in animals. In the present study, we investigated whether the transplantation of MSCs combined with FK506, a clinically used immunosuppressant, enhanced neuroprotective effects in rat experimental stroke.
Main methods: Male Sprague-Dawley rats underwent transient 90 min middle cerebral artery occlusion (MCAO). Two or 6 h after ischemia onset, the rats were randomly assigned to receive intravenous administration of MSCs plus FK506, MSCs alone, FK506 alone, or vehicle. Infarct volume, and neurological and immunohistological assessments were performed to examine the effects of these therapies.
Key findings: In 2-hour post-ischemia treatment groups, significant improvement of infarct volume and neurological scores were observed 1 day after combination therapy compared with monotherapy, and this neuroprotection continued for 7 days. Combination therapy significantly reduced the number of TUNEL-positive apoptotic cells, increased Bcl-2 expression, decreased Bax expression, and suppressed neutrophil infiltration and microglia/macrophage activation compared to monotherapy. In 6-hour post-ischemia treatment groups, a significant reduction of infarct volume, edema index, and neurological score was observed only in the combination therapy group. Moreover, the number of engrafted MSCs on day 7 with combination therapy was significantly higher than with MSCs alone.
Significance: Combination therapy using FK506 enhanced the anti-apoptotic and anti-inflammatory effects of MSCs and increased the survival of transplanted cells, leading to expansion of the therapeutic time window for MSCs. (C) 2011 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.lfs.2011.05.001

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記述言語：英語   出版者・発行元：The Medical Association of Nippon Medical School  

DOI： 10.1272/jnms.78.410

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記述言語：英語   出版者・発行元：ELSEVIER SCI LTD  

DOI： 10.1016/j.jocn.2008.11.005

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記述言語：英語   出版者・発行元：ELSEVIER SCI LTD  

DOI： 10.1016/j.jocn.2007.10.006

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：PERGAMON-ELSEVIER SCIENCE LTD  

Aims: Transplantation of bone marrow cells has been reported to exert neuroprotection against cerebral ischemia. However, the effect of bone marrow mononuclear cells (BMMCs) administered immediately after reperfusion has rarely been investigated. The present study was designed to examine whether brain injury in response to transient focal ischemia can be ameliorated by BMMC administration immediately after reperfusion in rats, and to determine whether there are differences in the route of administration.
Main methods: Autologous BMMCs were obtained from each rat. Rats were then subjected to transient focal ischemia followed by BMMC administration via the ipsilateral carotid artery (IA group) or the femoral vein (IV group) immediately after reperfusion. Control rats underwent the same procedure but received vehicle injection. Infarct volume was compared among the groups 24 h and 7 days after reperfusion. BMMCs were fluorescently labeled with PKH26 prior to administration to track transplanted cells.
Key findings: Total infarct volume decreased in the IA group, but not in the IV group, when compared to the vehicle group. In the ipsilateral hemisphere, PKH26 positive cell count was greater in the IA group than in the IV group. Motor function, assessed with a rotarod test, improved in the IA group compared to the vehicle group.
Significance: These results show significant neuroprotection after transient focal ischemia by 1 X 107 autologous BMMCs administered intra-arterially, but not intravenously, immediately after reperfusion in rats. The larger number of transplanted BMMCs in the brain during the early stage of reperfusion may be responsible for the protective effect.(c) 2008 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.lfs.2008.07.018

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記述言語：英語   掲載種別：研究論文（国際会議プロシーディングス）  

Background and aims: Recently, it has been reported that rho-kinase that participates in the regulation of vascular tonus, spasm, and remodeling in response to smooth muscle constriction, is involved in the atherosclerosis, inflammation, and hypertention (1). Furthermore, rho-kinase is involved in nitric oxide (NO), free radical, resulting in the neuronal cell death (2). Nevertheless, the mechanism of rho-kinase on the ischemic brain have not been fully understood. The aim of this study is, therefore, to determine whether a newly rho-kinase inhibitor, fasudil, which is a myosin light chain kinase inhibitor and have strong inhibition of rho-kinase, would prevent neuronal cell death following transient focal ischemia in rats compared to a free radical scavenger, edaravone , which is the first clinical neuroprotective agent used in Japan for the treatment of acute stroke patients. Methods: Sprague-Dawley rats were subjected to MCAo using an intraluminal suture technique for 90 minutes (3). The rats were reperfused for 24 hours and decapitated for infarct and edema analysis (4). Animals were randomly divided into the following four groups. (I) vehicle-treated control group (II) low dose of fasudil (3.0 mg/kg)-treated group (III) high dose of fasudil (10.0 mg/kg)-treated group (IV) edaravone-treated group. A rho-kinase inhibitor-treated animals received a continuous injection of fasudil (3.0 or 10.0 mg/kg) intravenously for 60 minutes after the onset of ischemia, while vehicle-treated groups received same dose of vehicle. Edaravone-treated animals received twice injection of edaravone (3.0 mg/kg) intravenously immediately after the reperfusion and 30 minutes after reperfusion. During ischemia, temporal muscle and rectal temperatures were monitored and maintained at 37 degrees in the experimental animals. Neurological symptom evaluations (posture and hemiplegia) were performed immediately before infarct and edema analysis. Furthermore, cortical cerebral blood flow was measured during ischemia and reperfusion. Results: The cortical and striatal infarct volume in the edaravone-treated group was significantly less than those in the vehicle-treated control group I (p&lt
0.001, p&lt
0.01 respectively). Fasudil (group II, III) decreased the cortical or striatal infarct volume significantly compared with those of groups I (p&lt
0.001, p&lt
0.05 respectively). The cortical or striatal edema significantly was also improved in the low dose (3.0 mg/kg) fasudil-treated groups significantly, compared with those of groups I (p&lt
0.05, p&lt
0.05, respectively). Moreover, low dose or high dose (10.0 mg/kg) fasudil significantly improved neurological symptoms (p&lt
0.001, p&lt
0.01 respectively). Conclusions: These results demonstrate that a rho-kinase inhibitor, fasudil prevents neuronal cell death, compared to a free radical scavenger, edaravone. Furthermore, it is suggested that this rho-kinase inhibitor may be a candidate for new neuroprotectant for the treatment of acute stroke in future.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN NEUROSURGICAL SOC  

The anti-edema effect of edaravone, a free radical scavenger, was evaluated by magnetic resonance imaging in six patients with extensive hemispheric ischemic stroke. T-2 relaxation time in the infarct core, the boundary zone of the infarct, and the noninfarcted hemisphere were calculated, and T, mapping was performed before and after edaravone administration. Edaravone administration significantly decreased the mean T, relaxation time in the boundary zone of the infarct from 121.5 +/- 9.2 (mean +/- standard deviation) to 114.5 +/- 9.9 msec (p = 0.008), but not in the core from 142.3 +/- 13.4 to 142.2 +/- 18.5 msec (p = 0.97) or the noninfarcted hemisphere from 93.0 +/- 3.7 to 93.1 +/- 3.8 msec (p = 0.91). The T-2 subtraction map clearly demonstrated shortened T-2 relaxation time in the boundary zone of the infarct. The present results indicate that edaravone can salvage the boundary zone of the infarct and is a useful cytoprotective anti-edema agent.

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記述言語：英語   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

DOI： 10.1212/01.wnl.0000191329.34585.15

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著書種別：学術書

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担当ページ：136-137  

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記述言語：日本語   出版者・発行元：(一社)日本認知症学会  

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記述言語：日本語   出版者・発行元：(一社)日本認知症学会  

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記述言語：日本語   出版者・発行元：(一社)日本神経学会  

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記述言語：日本語   出版者・発行元：(一社)日本神経学会  

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記述言語：日本語   出版者・発行元：(一社)日本神経学会  

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記述言語：日本語   出版者・発行元：The Mt. Fuji Workshop on CVD事務局  

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記述言語：日本語   出版者・発行元：(株)へるす出版  

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記述言語：日本語   出版者・発行元：(株)へるす出版  

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記述言語：日本語   出版者・発行元：日本内科学会-関東地方会  

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記述言語：日本語   出版者・発行元：(一社)日本医療安全学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J04260&link_issn=&doc_id=20230208420003&doc_link_id=10.1272%2Fmanms.18.329&url=https%3A%2F%2Fdoi.org%2F10.1272%2Fmanms.18.329&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   出版者・発行元：(一社)日本神経学会  

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記述言語：日本語   出版者・発行元：(一社)日本脳循環代謝学会  

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記述言語：日本語   出版者・発行元：(一社)日本脳循環代謝学会  

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記述言語：日本語   出版者・発行元：(一社)日本神経学会  

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記述言語：日本語   出版者・発行元：(一社)日本神経学会  

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記述言語：日本語   出版者・発行元：(一社)日本神経学会  

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記述言語：日本語   出版者・発行元：(一社)日本神経学会  

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J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本脳循環代謝学会  

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記述言語：日本語   出版者・発行元：(一社)日本脳循環代謝学会  

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記述言語：日本語   出版者・発行元：(株)メディカル・サイエンス・インターナショナル  

＜文献概要＞筋萎縮性側索硬化症(ALS)患者の周術期管理は,エビデンスが乏しく不明点が多い。ALS患者の麻酔管理に関して,肺機能検査も含めた十分な術前評価および詳細なALSの病状把握が行える予定手術についての報告は散見されるが,緊急手術症例の周術期管理報告はほとんど見当たらない。今回は,詳細が不明なALS患者の絞扼性イレウスの緊急開腹手術である。時間的制約もあり,予定手術のように十分な術前検査が行えず,患者の現在のALSの病状も十分に把握できない状況で,麻酔管理,術後管理およびリハビリテーションまでのプランを立てることになった。「他院でフォロー中のALS患者が絞扼性イレウスで救急外来に来てるので,今から緊急開腹手術をお願いします!」と外科医から突然連絡が来たらどうするか?読者も考えてみてほしい。

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記述言語：日本語   出版者・発行元：(一社)日本脳卒中学会  

【背景と目的】動脈硬化性内頸動脈閉塞例では,閉塞部をガイドワイヤーで通過(lesion cross)することが求められる.頸動脈エコーはlesion cross部位を描出できる可能性がある.【方法】2015年4月から2019年5月までの血栓回収療法例中,内頸動脈起始部の動脈硬化性閉塞例を対象とした.再開通療法後に,術前に施行した頸動脈エコー所見を再評価した.【結果】8例のデータを解析でき,6例でlesion cross部位を頸動脈エコーで描出できていた.Lesion cross部位は,周囲の高輝度から等輝度のプラークと区別でき,低輝度を呈する血管腔として捉えられた.Color Doppler法では3例で血流が入り込む像を描出していた.5例のlesion cross部位は,内頸動脈の前面に位置していた.【結論】頸動脈エコーは,動脈硬化性内頸動脈の急性閉塞部の同定に有用な可能性がある.(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J01786&link_issn=&doc_id=20210802450004&doc_link_id=%2Fdh3strok%2F2021%2F004304%2F004%2F0320-0326%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdh3strok%2F2021%2F004304%2F004%2F0320-0326%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(有)科学評論社  

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記述言語：日本語   出版者・発行元：(公社)日本皮膚科学会  

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J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本脳循環代謝学会  

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記述言語：日本語   出版者・発行元：(一社)日本脳循環代謝学会  

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記述言語：日本語   出版者・発行元：(一社)日本神経学会  

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記述言語：日本語   出版者・発行元：(一社)日本神経治療学会  

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記述言語：日本語   出版者・発行元：(一社)日本認知症学会  

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掲載種別：書評論文，書評，文献紹介等  

t-PA therapy has been able to be performed based on RCT study results in the world from 25 years ago. However, the Japan government approved the use of t-PA 15 years ago. In the last 15 years, diagnostic imaging and treatment for acute stroke have been changed remarkably. The appearance of diffusion-weighted images as diagnostic imaging for acute stroke and mechanical thrombectomy as treatment for acute stroke can markedly improve patient outcome. We experienced many severe patients treated with such therapies discharged by walk. Therefore, we would like to emphasize that stoke treatment has been changed drastically. Unfortunately, at present, stroke patients who do not have benefit from t-PA therapy and mechanical thrombectomy therapies are not so many. In order to solve those problems, we should need to establish a stroke medical care system in Japan as soon as possible. In this presentation, we will outline the image of acute stroke, acute treatment, and stroke medical care system.

DOI： 10.1111/ncn3.12428

Scopus

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記述言語：日本語   出版者・発行元：(株)メディカ出版  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

Web of Science

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J-GLOBAL

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J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本神経学会  

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記述言語：日本語   出版者・発行元：(一社)日本神経学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本神経学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：日本脳循環代謝学会  

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記述言語：日本語   出版者・発行元：(一社)日本神経学会  

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記述言語：日本語   出版者・発行元：(一社)日本神経学会  

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記述言語：日本語   出版者・発行元：(一社)日本神経学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭痛学会  

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記述言語：日本語   出版者・発行元：(一社)日本神経学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：(一社)日本神経治療学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：(一社)日本認知症学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本神経学会  

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記述言語：日本語   出版者・発行元：(一社)日本神経学会  

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記述言語：日本語   出版者・発行元：(一社)日本神経学会  

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記述言語：日本語   出版者・発行元：(一社)日本神経学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本神経学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本神経学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本神経学会  

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記述言語：日本語   出版者・発行元：(一社)日本神経学会  

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記述言語：日本語   出版者・発行元：(一社)日本神経学会  

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記述言語：日本語   出版者・発行元：(一社)日本神経治療学会  

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記述言語：日本語   出版者・発行元：(一社)日本神経治療学会  

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記述言語：日本語   出版者・発行元：(一社)日本糖尿病学会  

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記述言語：日本語   出版者・発行元：日本脳循環代謝学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：日本脳循環代謝学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：日本脳循環代謝学会  

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記述言語：日本語   出版者・発行元：(一社)日本神経学会  

血栓回収療法例の転院受け入れをCT室とし、初療室を経ずに脳血管造影検査室へ移動する体制を検討した。転帰良好は転院群で11例(41%)、直接搬送群で15例(25%)と差はなかった(P=0.205)。発症から来院は転院群で長かったが(P=0.001)、来院から画像や、画像から穿刺までの時間は転院群で短く(共にP&lt;0.001)、発症から再灌流までの時間は両群で同等であった(P=0.183)。発症から再灌流は転帰良好に関連(オッズ比0.982、95% CI:0.967〜0.998、P=0.026)したが、発症から来院までの時間や転院の因子自体は関連していなかった(P=0.064、0.730)。院内プロトコールの迅速化は転帰を改善させるかもしれない。(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本脳神経超音波学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本脳神経超音波学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本脳神経超音波学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本脳神経超音波学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(公財)先進医薬研究振興財団  

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記述言語：日本語   出版者・発行元：(公財)大和証券ヘルス財団  

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記述言語：日本語   出版者・発行元：(公財)先進医薬研究振興財団  

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記述言語：日本語   出版者・発行元：(公財)大和証券ヘルス財団  

脳卒中後認知機能障害の発症率および予測因子について検討した。2016年12月1日から2017年9月14日迄に脳梗塞、脳出血、一過性脳虚血発作の診断で当科に入院した457例を対象とした。MMSE(Mini-Mental State Examination)、Moca(Montreal Cognitive Assessment)、FAB(Frontal Assessment Battery)の三つすべての認知機能検査が施行できたのは288例(63%)であった。施行できた群と施行できなかった群との比較では、日本語版Informant Questionnaire on Cognitive Decline in the Elderly、発症前modified Rankin Scale、入院時National Institute of Health Stroke Scale、既往歴では、脳卒中、心房細動で有意差を認めた。退院時転帰不良群は良好群に比べて、IQ codeおよびすべての認知機能検査において低値であった。急性期脳卒中患者の6割で認知機能検査が可能であり、検査不可能例では発症前の認知機能が低下しており、脳卒中の重症度が高い症例であった。また、退院時の転帰不良群は良好群に比較して、認知機能検査の得点が有意に低値であることが明らかになった。

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記述言語：日本語   出版者・発行元：(一社)日本神経学会  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

Web of Science

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J-GLOBAL

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J-GLOBAL

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記述言語：日本語  

J-GLOBAL

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記述言語：日本語   出版者・発行元：日本内科学会-関東地方会  

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記述言語：日本語   出版者・発行元：日本脳循環代謝学会  

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記述言語：日本語   出版者・発行元：日本脳循環代謝学会  

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記述言語：日本語   出版者・発行元：(一社)日本認知症学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：(一社)日本脳神経超音波学会  

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記述言語：日本語   出版者・発行元：日本内科学会-関東地方会  

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記述言語：日本語  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本神経学会  

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記述言語：日本語   出版者・発行元：(NPO)日本脳神経血管内治療学会  

【目的】2015年に脳梗塞の機械的血栓回収療法の有用性が示されたが,一方で頭蓋内/外の主幹動脈狭窄を有する脳梗塞例に対する血管形成術の有用性はいまだ明らかになっていない.われわれは急性期脳梗塞に対し血栓溶解療法,機械的血栓回収療法およびステントを用いた血管形成術を施行し奏功した症例を経験した.文献的考察と合わせて報告する.【症例】62歳の男性が前医で右内頸動脈閉塞に伴う脳梗塞と診断され,発症158分で当院に搬送された.Tissue plasminogen activator(tPA)静注療法後に血管内治療を行い,撮影で内頸動脈破裂孔部から海綿静脈洞部にかけて閉塞を認めた.内頸動脈に誘導した9Fr Optimoから用手吸引術を行うと内頸動脈破裂孔部に狭窄を確認できた.同部位にPercutaneous Transluminal Angioplasty(PTA)施行後,Penumbra 5MAX ACEを用いて右M1閉塞に対し機械的血栓回収療法を行い完全再開通が得られた.内頸動脈破裂孔部の残存狭窄に対し冠動脈ステントを留置し手技を終了した.翌日の頭部MRA検査では前方循環の描出は改善しており,臨床所見も著明な改善を認めた.【結語】頭蓋内内頸動脈内での用手吸引術,頭蓋内PTA,右M1での機械的血栓除去術,頭蓋内内頸動脈の残存狭窄に対する冠動脈ステント留置術によって良好な経過が得られた1例を報告した.(著者抄録)

DOI： 10.20626/nkc.cr.2016-0082

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

Web of Science

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

Web of Science

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

Web of Science

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

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記述言語：日本語  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本神経学会  

症例は67歳の女性。意識障害と左片麻痺で発症し、頭部MRI及びMRA所見から右内頸動脈閉塞症による脳梗塞と診断した。心電図で心房細動があり、発症225分で経静脈的血栓溶解療法を開始し、脳血管内治療を併用し発症から275分で再開通を得た。第3病日の経食道心臓超音波検査(transesophageal echocardiography;TEE)で左房内に腫瘤を認め、第29病日に左房内腫瘤摘出術と心房細動に対してメイズ手術を施行し、摘出した腫瘤は病理学的に血栓であった。術後のTEEで、メイズ手術で焼灼した左房内肺静脈起始部に血栓を認めた。ワルファリンによる抗凝固療法を6ヵ月間継続し、脳梗塞の再発はなく、最終的に血栓は消失した。(著者抄録)

DOI： 10.5692/clinicalneurol.cn-001069

Scopus

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本神経学会  

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記述言語：日本語   出版者・発行元：(一社)日本神経学会  

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記述言語：日本語   出版者・発行元：(一社)日本神経学会  

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記述言語：日本語   出版者・発行元：日本脳循環代謝学会  

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記述言語：日本語   出版者・発行元：日本脳循環代謝学会  

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記述言語：日本語   出版者・発行元：日本脳循環代謝学会  

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記述言語：日本語   出版者・発行元：日本脳循環代謝学会  

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記述言語：日本語   出版者・発行元：(NPO)日本脳神経血管内治療学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭痛学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本内科学会-関東地方会  

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記述言語：日本語   出版者・発行元：(一社)日本脳神経超音波学会  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

Web of Science

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

Web of Science

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

Web of Science

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記述言語：日本語   出版者・発行元：(一社)日本神経学会  

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記述言語：日本語   出版者・発行元：(一社)日本神経学会  

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記述言語：日本語   出版者・発行元：日本脳循環代謝学会  

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記述言語：日本語   出版者・発行元：日本脳循環代謝学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

DOI： 10.1272/manms.11.226

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記述言語：日本語   出版者・発行元：日本脳循環代謝学会  

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記述言語：日本語   出版者・発行元：日本脳循環代謝学会  

イブジラストは脳梗塞後遺症に伴う慢性脳循環障害に使用されている.今回,我々は中大脳動脈永久閉塞モデルを用いて,イブジラスト投与による脳保護効果について検討を行った.雄性SDラットに,イブジラスト30mg/kg/日を虚血7日前から経口胃管投与後,永久閉塞を行った.虚血後30分と24時間にMRIを撮像した.虚血後24時間後にMRIを用いて脳血流低下領域を測定し,神経徴候,梗塞体積,浮腫index(%)を評価すると共に,免疫組織化学的検討を行った.イブジラスト投与群はコントロール群と比較して脳血流低下領域が縮小し,神経徴候は改善し,梗塞体積および脳浮腫も縮小した.また,イブジラスト投与により,虚血周辺部の酸化ストレスマーカーや炎症マーカー発現の抑制を認めた.今回の結果から,イブジラストは脳虚血後の血流障害の改善や酸化ストレス軽減,虚血後炎症の抑制を介して脳保護作用を発揮することが示唆された.(著者抄録)

DOI： 10.16977/cbfm.26.2_19

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記述言語：日本語   出版者・発行元：(一財)博慈会老人病研究所  

バルプロ酸は抗てんかん薬として長年の臨床経験があり、最近の基礎的研究において、虚血性脳損傷に対する保護効果が報告されている。今回、我々は、1型糖尿病誘発ラットを用いて、永久脳虚血モデルでのバルプロ酸投与による脳保護効果について検討を行った。雄性SDラットを使用し、ストレプトゾトシン投与により、1型糖尿病を発症させた。中大脳動脈遠位部の永久虚血モデルを作成し、虚血と同時にバルプロ酸の腹腔内投与を行った。虚血3日後に梗塞体積、神経徴候、免疫組織化学的検討を行った。糖尿病誘発ラットでは、正常血糖ラットに比べて虚血3日後の梗塞体積は拡大すろと共に神経徴候は増悪した。バルプロ酸投与により、神経徴候は有意に改善し、好中球の浸潤、ミクログリアの活性化、inducible nitric oxide synthase産生亢進、血管内皮傷害が改善し、神経細胞変性が抑制された。今回の結果から、バルプロ酸は脳虚血後の2次的炎症反応および血管内皮傷害を抑制することにより、糖尿病誘発ラットを用いた永久脳虚血モデルによる重度の脳損傷も軽減できる可能性が示唆された。齧歯類と人ではバルプロ酸の体内動態が著しく異なるため、適正投与量、投与回数などの詳細な検討が必要であるが、今回の結果からバルプロ酸は急性期脳梗塞に対する治療薬として有望であることが示唆された。(著者抄録)

CiNii Books

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その他リンク： http://search.jamas.or.jp/link/ui/2015338037

記述言語：日本語   出版者・発行元：(一社)日本腎臓学会  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

Web of Science

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記述言語：日本語   出版者・発行元：(一社)日本神経学会  

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記述言語：日本語   出版者・発行元：日本脳循環代謝学会  

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記述言語：日本語   出版者・発行元：日本脳循環代謝学会  

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記述言語：日本語   出版者・発行元：日本脳循環代謝学会  

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記述言語：日本語   出版者・発行元：日本脳循環代謝学会  

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記述言語：日本語   出版者・発行元：日本神経治療学会  

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記述言語：日本語   出版者・発行元：(株)日本臨床社  

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記述言語：日本語   出版者・発行元：(一社)日本脳卒中学会  

近年、急性期血栓溶解療法、機械的血栓除去術などにより急性期再灌流療法の進歩は著しい。しかしながらその恩恵を受けられるのは限られた患者であり、依然としてより効果のある脳保護療法の登場がまたれている。我々が今回紹介するのは新しい観点からの脳保護療法の試みである。第一は治療効果が高い脳保護的な蛋白質に、蛋白細胞導入ドメインを融合させることにより、静脈内への1回投与で神経細胞にまで到達させ脳保護的に働かせる方法である。次に全く新しい方法として、低濃度の水素ガスを吸入させると、脳梗塞体積が減少する結果を報告してきた。水素ガスには軽微なフリーラジカルスカベンジ作用があり、最も毒性の強いhydroxyl radicalを選択的に消去することがわかってきている。さらに、すでに臨床で使用されている薬物を脳梗塞急性期治療に応用する方法として、抗てんかん薬であるバルプロ酸の急性期脳保護効果についても紹介する。(著者抄録)

DOI： 10.3995/jstroke.36.147

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記述言語：日本語   出版者・発行元：日本神経治療学会  

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記述言語：日本語   出版者・発行元：(一社)日本神経学会  

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記述言語：日本語   出版者・発行元：(株)先端医学社  

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記述言語：日本語   出版者・発行元：(一社)日本神経学会  

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記述言語：日本語   出版者・発行元：(一社)日本神経学会  

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記述言語：日本語   出版者・発行元：(一社)日本神経学会  

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記述言語：日本語   出版者・発行元：(一社)日本神経学会  

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記述言語：日本語   出版者・発行元：日本脳循環代謝学会  

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記述言語：日本語   出版者・発行元：日本脳循環代謝学会  

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記述言語：日本語   出版者・発行元：(株)先端医学社  

ラット一過性局所脳虚血モデル(90分間)における骨髄単核球細胞静脈内移植(1×10^7個)では、再灌流3時間後の移植で観察された脳梗塞縮小効果は再灌流6時間後の移植では失われ、同モデルにおける骨髄単核球細胞移植のtherapeutic time windowは、3〜6時間のあいだにあると考えられた。また再灌流6時間後の移植に加えて再灌流9時間後に同数の骨髄単核球細胞を移植しても梗塞体積が縮小し、複数回投与の有効性が示唆された。脳梗塞急性期の細胞治療は実現不可能な概念ではないと考えられる。(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本腎臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本内科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内科学会  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：KARGER  

Web of Science

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：KARGER  

Web of Science

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記述言語：日本語   出版者・発行元：(一社)日本神経学会  

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記述言語：日本語   出版者・発行元：(一社)日本神経学会  

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記述言語：日本語   出版者・発行元：(一社)日本神経学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭痛学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭痛学会  

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記述言語：日本語   出版者・発行元：日本脳循環代謝学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

Vertigo and nausea suddenly developed in a 33-year-old man without a relevant medical history. He reported that he had had throbbing headaches for 1 month. On admission, neurological examination revealed dysarthria, right Horner syndrome, and hypoesthesia of the left side of the face and of the left side of the body below the neck. Initial magnetic resonance imaging of the brain showed no areas of abnormal intensity on diffusion-weighted imaging, but magnetic resonance angiography showed a stringlike structure of the right vertebral artery. Acute infarction due to right vertebral artery dissection was diagnosed. Heparin sodium was immediately administered intravenously. Three days after symptom onset, magnetic resonance imaging-diffusion-weighted imaging of the brain clearly showed a high-intensity area in the right lateral medulla oblongata, a finding that confirmed the clinical diagnosis. This case emphasizes that vertebral artery dissection should be considered in patients with vertigo, especially young patients without risk factors for cerebrovascular disorders. The clinical history and neurological examination remain fundamental aspects of patient assessment in the era of advanced neuroimaging.<br>

DOI： 10.1272/manms.7.175

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本神経治療学会  

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記述言語：日本語   出版者・発行元：(一社)日本神経学会  

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記述言語：日本語   出版者・発行元：(一社)日本腎臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本神経学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭痛学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭痛学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭痛学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭痛学会  

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記述言語：日本語   出版者・発行元：日本神経治療学会  

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記述言語：日本語   出版者・発行元：(一社)日本神経学会  

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