Elevated trimethylamine N-oxide related to ischemic brain lesions after carotid artery stenting

Neurology ◽  
2018 ◽  
Vol 90 (15) ◽  
pp. e1283-e1290 ◽  
Author(s):  
Chuanjie Wu ◽  
Chuanhui Li ◽  
Wenbo Zhao ◽  
Nanchang Xie ◽  
Feng Yan ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Confidence Interval ◽  
Predictive Value ◽  
Carotid Artery Stenting ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Characteristic Curve ◽  
Brain Lesions ◽  
Ischemic Brain ◽  
Increased Risk

ObjectivesTo investigate whether the plasma level of trimethylamine N-oxide (TMAO), a proatherosclerotic intestinal microbiota metabolite, can be a predictor of ischemic brain injury secondary to carotid artery stenting (CAS).MethodsIn this multicenter, prospective cohort study, we enrolled patients with severe carotid artery stenosis (>70%) who were prepared for CAS. Plasma TMAO level was measured within 3 days before CAS, and MRI was performed 1 to 3 days after CAS.ResultsThe mean age of the 268 eligible patients was 64.4 years. New lesions on diffusion-weighted imaging (DWI) were detected in 117 patients (43.7%). TMAO level was higher in patients with new (DWI) lesions than in patients without new lesions (median 5.2 vs 3.2 µmol/L; p < 0.001). Increased plasma TMAO levels were associated with an increased risk of having new lesions on DWI after CAS (adjusted odds ratio for the highest vs lowest quartile, 3.85; 95% confidence interval, 1.37–7.56, p < 0.001; adjusted odds ratio for the third vs lowest quartile, 1.86; 95% confidence interval, 1.09–4.66, p = 0.02). The area under the receiver operating characteristic curve of TMAO was 0.706 for new lesions on DWI, and the optimal cutoff value was 4.29 µmol/L. The sensitivity, specificity, positive predictive value, and negative predictive value of TMAO levels ≥4.29 µmol/L for predicting new lesions on DWI were 61.5%, 74.8%, 65.5%, and 65.5%, respectively.ConclusionsIncreased TMAO levels are associated with an increased risk of new ischemic brain lesions on post-CAS MRI scans.

scholarly journals Tissue Protrusion With Attenuation Is Associated With Ischemic Brain Lesions After Carotid Artery Stenting

Stroke ◽  
2020 ◽  
Vol 51 (1) ◽  
pp. 327-330 ◽  
Author(s):  
Naoko Funatsu ◽  
Yukiko Enomoto ◽  
Yusuke Egashira ◽  
Keita Yamauchi ◽  
Noriyuki Nakayama ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Brain Lesions ◽  
Ischemic Brain

scholarly journals The association of gout with an increased risk of hypertension and diabetes mellitus among stroke survivors in New Zealand: A cross-sectional study using routinely collected electronic health data

2019 ◽  
Vol 8 ◽  
pp. 204800401986323 ◽  
Author(s):  
Dina Eufemia D San Gabriel ◽  
Julia Slark
Keyword(s):  
Diabetes Mellitus ◽  
New Zealand ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Cross Sectional Study ◽  
Stroke Survivors ◽  
Sectional Study ◽  
Cross Sectional ◽  
Increased Risk

Background There is a paucity of data relating to the association of gout with the occurrence of hypertension and diabetes mellitus in patients with stroke. This study aimed to determine the association of gout with the risk of hypertension and diabetes mellitus in a cohort of stroke patients from Auckland, Aotearoa New Zealand. Methods A cross-sectional study was conducted among stroke survivors in South and East Auckland, New Zealand from the years 2010 to 2014. Electronic health record data were collected and analysed using Statistical Package for Social Science version 23. Multivariate logistic regression modelling adjusted for age, gender, and ethnicity was conducted to determine the association of gout with the risk of hypertension and diabetes mellitus in patients discharged with a diagnosis of stroke. Results The age-, gender-, and ethnicity-adjusted odds ratio for having hypertension and diabetes mellitus among stroke survivors with gout history were 3.25 (95% confidence interval 1.32–8.03) and 1.94 (95% confidence interval 1.12–3.36), respectively. Māori stroke survivors with gout history had the highest risk of having diabetes mellitus with age- and gender-adjusted odds ratio of 5.10 (95% confidence interval 1.90–18.93). Conclusion The findings from this study suggest gout may be independently associated with an increased risk of hypertension and diabetes mellitus in patients with stroke. Māori who are the indigenous population of New Zealand show a greater risk of diabetes mellitus associated with a gout diagnosis compared to other populations. This finding highlights the importance of the need for further research with Māori stroke survivors and other indigenous populations.

scholarly journals Association between hydroxocobalamin administration and acute kidney injury after smoke inhalation: a multicenter retrospective study

Critical Care ◽  
2019 ◽  
Vol 23 (1) ◽  
Author(s):  
François Dépret ◽  
Clément Hoffmann ◽  
Laura Daoud ◽  
Camille Thieffry ◽  
Laure Monplaisir ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Retrospective Study ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Kidney Injury ◽  
Smoke Inhalation ◽  
Logistic Regression Models ◽  
Increased Risk ◽  
The Impact

Abstract Background The use of hydroxocobalamin has long been advocated for treating suspected cyanide poisoning after smoke inhalation. Intravenous hydroxocobalamin has however been shown to cause oxalate nephropathy in a single-center study. The impact of hydroxocobalamin on the risk of acute kidney injury (AKI) and survival after smoke inhalation in a multicenter setting remains unexplored. Methods We conducted a multicenter retrospective study in 21 intensive care units (ICUs) in France. We included patients admitted to an ICU for smoke inhalation between January 2011 and December 2017. We excluded patients discharged at home alive within 24 h of admission. We assessed the risk of AKI (primary endpoint), severe AKI, major adverse kidney (MAKE) events, and survival (secondary endpoints) after administration of hydroxocobalamin using logistic regression models. Results Among 854 patients screened, 739 patients were included. Three hundred six and 386 (55.2%) patients received hydroxocobalamin. Mortality in ICU was 32.9% (n = 243). Two hundred eighty-eight (39%) patients developed AKI, including 186 (25.2%) who developed severe AKI during the first week. Patients who received hydroxocobalamin were more severe and had higher mortality (38.1% vs 27.2%, p = 0.0022). The adjusted odds ratio (95% confidence interval) of AKI after intravenous hydroxocobalamin was 1.597 (1.055, 2.419) and 1.772 (1.137, 2.762) for severe AKI; intravenous hydroxocobalamin was not associated with survival or MAKE with an adjusted odds ratio (95% confidence interval) of 1.114 (0.691, 1.797) and 0.784 (0.456, 1.349) respectively. Conclusion Hydroxocobalamin was associated with an increased risk of AKI and severe AKI but was not associated with survival after smoke inhalation. Trial registration ClinicalTrials.gov, NCT03558646

scholarly journals Association of dietary patterns and endoscopic gastric mucosal atrophy in an adult Chinese population

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Song Lin ◽  
Tao Gao ◽  
Chongxiu Sun ◽  
Mengru Jia ◽  
Chengxia Liu ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Dietary Patterns ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Dietary Intakes ◽  
Mucosal Atrophy ◽  
Gastric Mucosal Atrophy ◽  
Increased Risk ◽  
Group Frequency ◽  
H Pylori

Abstract Atrophy gastritis harbor a high risk for the development of dysplasia and gastric cancer. The study investigated the relationships of specific dietary patterns and endoscopic gastric mucosal atrophy. In this cross-sectional study, we enrolled 574 consecutive outpatients who were diagnosed as chronic gastritis according to endoscopic examination. Dietary intakes of study individuals was assessed using the semi-quantitative food group frequency questionnaire. Logistic regression analyses were used to evaluate the relationship between dietary patterns and endoscopic gastric mucosal atrophy adjusted for potential confounders. A total of 574 participants were included, 286 with endoscopic gastric mucosal atrophy. Three dietary patterns were identified by factor analysis. “Alcohol and fish” (tertile 1 vs. tertile 3: adjusted odds ratio = 1.85, 95% confidence interval: 1.06–3.22) and “coarse cereals” (tertile 1 vs. tertile 3: adjusted odds ratio = 2.05, 95% confidence interval: 1.24–3.39) were associated with an increased risk for endoscopic gastric mucosal atrophy but a “traditional” pattern was not. Dietary pattern was not associated with gastric mucosal atrophy in women or in participants with H. pylori infection. A high adherence to both “Alcohol and Fish” and “Coarse cereals” dietary patterns seem to be associated with higher odds of endoscopic gastric mucosal atrophy in men and in patients without H. pylori infection. Further prospective cohort studies needed to confirm these findings.

scholarly journals HHV-6 reactivation and its effect on delirium and cognitive functioning in hematopoietic cell transplantation recipients

Blood ◽  
2011 ◽  
Vol 117 (19) ◽  
pp. 5243-5249 ◽  
Author(s):  
Danielle M. Zerr ◽  
Jesse R. Fann ◽  
David Breiger ◽  
Michael Boeckh ◽  
Amanda L. Adler ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Confidence Interval ◽  
Cell Transplantation ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Hematopoietic Cell Transplantation ◽  
Hematopoietic Cell ◽  
Central Nervous System Dysfunction ◽  
Increased Risk

AbstractHuman herpesvirus 6 (HHV-6) is detected in the plasma of approximately 40% of patients undergoing hematopoietic cell transplantation (HCT) and sporadically causes encephalitis in this population. The effect of HHV-6 reactivation on central nervous system function has not been fully characterized. This prospective study aimed to evaluate associations between HHV-6 reactivation and central nervous system dysfunction after allogeneic HCT. Patients were enrolled before HCT. Plasma samples were tested for HHV-6 at baseline and twice weekly after transplantation until day 84. Delirium was assessed at baseline, 3 times weekly until day 56, and weekly on days 56 to 84 using a validated instrument. Neurocognitive testing was performed at baseline and at approximately day 84. HHV-6 was detected in 111 (35%) of the 315 included patients. Patients with HHV-6 were more likely to develop delirium (adjusted odds ratio = 2.5; 95% confidence interval, 1.2-5.3) and demonstrate neurocognitive decline (adjusted odds ratio = 2.6; 95% confidence interval, 1.1-6.2) in the first 84 days after HCT. Cord blood and unrelated transplantation increased risk of HHV-6 reactivation. These data provide the basis to conduct a randomized clinical trial to determine whether prevention of HHV-6 reactivation will reduce neurocognitive morbidity in HCT recipients.

scholarly journals Trimethoprim Use prior to Pregnancy and the Risk of Congenital Malformation: A Register-Based Nationwide Cohort Study

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Jon Trærup Andersen ◽  
Morten Petersen ◽  
Espen Jimenez-Solem ◽  
Jeppe Nørgaard Rasmussen ◽  
Nadia Lyhne Andersen ◽  
...  
Keyword(s):  
Cohort Study ◽  
Confidence Interval ◽  
Congenital Malformation ◽  
Odds Ratio ◽  
Congenital Malformations ◽  
Adjusted Odds Ratio ◽  
Limb Defects ◽  
Major Congenital Malformation ◽  
Increased Risk

Objectives. The aim of the study was to investigate whether the use of the antifolate antibiotic trimethoprim during the 12 weeks before conception was associated with congenital malformations.Methods. We conducted a nationwide register-based cohort study including all Danish women giving birth from 1997 to 2004. All women with at least one prescription of trimethoprim dispensed during the 12 weeks before conception were identified.Results. There was a doubling of congenital malformations in offspring to women exposed to trimethoprim in the 12 weeks before conception. The adjusted odds ratio (OR) of major congenital malformation was 1.87, 95% confidence interval (CI) 1.25–2.81. There was a significant increase in major malformations of the heart (OR=2.49; 1.18–5.26) and limbs (OR=2.18; 1.13–4.23).Conclusions. In this study, we found an association between exposure to trimethoprim during the 12 weeks before conception and an increased risk of heart and limb defects.

scholarly journals Ischemic Brain Lesions After Carotid Artery Stenting Increase Future Cerebrovascular Risk

2015 ◽  
Vol 65 (6) ◽  
pp. 521-529 ◽  
Author(s):  
Henrik Gensicke ◽  
H. Bart van der Worp ◽  
Paul J. Nederkoorn ◽  
Sumaira Macdonald ◽  
Peter A. Gaines ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Brain Lesions ◽  
Ischemic Brain ◽  
Cerebrovascular Risk

scholarly journals The dynamics of blood pressure within 12 months after carotid artery stenting in patients with stenotic carotid lesions

2019 ◽  
pp. 17-21 ◽  
Author(s):  
F. B. Shukurov ◽  
E. S. Bulgakova ◽  
A. N. Shapieva ◽  
B. А. Rudenko ◽  
T. V. Tvorogova ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Carotid Artery ◽  
Confidence Interval ◽  
Carotid Artery Stenting ◽  
Odds Ratio ◽  
Diastolic Pressure ◽  
Hypotensive Effect ◽  
Postoperative Management ◽  
Circle Of Willis ◽  
Daily Monitoring

Aim. To assess the dynamics of blood pressure (BP) and determine the predictors of the hypotensive effect after carotid artery stenting (CAS).Material and methods. The analysis included 99 patients who underwent CAS in a period of March 2014 and May 2016. Inclusion criteria: (1) the presence of 50% symptomatic or 70% asymptomatic stenosis of the carotid artery (according to NASCET criteria), (2) follow-up for at least 1 year, (3) measurement and recording of BP at four points: 24 hours before surgery, 1 hour, 24 hours and 12 months after surgery. Results. According to office measurement of BP, the average systolic/diastolic pressure was 117,11/60,75, 119,73/60,75, 134,75/70,48 mm Hg after 1 hour, one day and 12 months after the intervention, respectively. In comparison with the average numbers of BP before the intervention, 148,13/89,52 mm Hg there was a significantly significant decrease in BP levels after CAS (p<0,01). According to the results of daily monitoring of blood pressure, a statistically important decrease in blood pressure was observed after 1 year of observation (p<0,01) (136,52/76,84 compared with 145,91/87,63 before the intervention). Dissociated circle of Willis (odds ratio=10,37, 95% confidence interval, from 3,64 to 29,52; p<0,001) and the occurrence of intraoperative hypotension (odds ratio =3,62, 95% confidence interval, from 1,16 to 11,28; p<0,027) were predictors of a persistent decrease in BP after CAS. Conclusion. The obtained results indicated the need for more thorough conservative postoperative management, especially for patients with a dissociated circle of Willis. It is also necessary to achieve the target blood pressure values by individualized correction of antihypertensive therapy.

scholarly journals The association between migraine and hospital readmission due to pain after surgery: A hospital registry study

Cephalalgia ◽  
2018 ◽  
Vol 39 (2) ◽  
pp. 286-295 ◽  
Author(s):  
Katharina Platzbecker ◽  
Megan Behua Zhang ◽  
Tobias Kurth ◽  
Maira Isabella Rudolph ◽  
Katharina Eikermann-Haerter ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Hospital Readmission ◽  
Odds Ratio ◽  
Migraine Without Aura ◽  
Adjusted Odds Ratio ◽  
Surgical Patients ◽  
Day Hospital ◽  
Registry Study ◽  
Increased Risk ◽  
Hospital Registry

Background Migraine has been identified as a risk factor of 30-day hospital readmission after surgery. We aimed to further characterize this association examining pain as a potentially migraine-associated, preventable reason for readmission. Hypothesis Compared to patients with no migraine, surgical patients with migraine are at increased risk of 30-day hospital readmission with an admitting diagnosis specifying pain. Methods This hospital registry study examined 150,710 patients aged 18 years and above, who underwent surgery with general anesthesia and mechanical ventilation between 2007 and 2015 at a tertiary care center and two affiliated community hospitals in Massachusetts, USA. Results Migraine was associated with an increased risk of 30-day pain-related readmission after surgery (adjusted odds ratio 1.42 [95% confidence interval 1.15–1.75]). The association was stronger for migraine with aura (compared to migraine without aura: Adjusted odds ratio 1.69 [95% confidence interval 1.06–2.70]; compared to no migraine: Adjusted odds ratio 2.20 [95% confidence interval 1.44–3.37]). The predicted adjusted risk of pain-related 30-day readmissions was 9.1 [95% confidence interval 5.3–13.0] in 1000 surgical patients with migraine with aura and 5.4 [95% confidence interval 4.2–6.6] in 1000 patients with migraine without aura, compared to 4.2 [95% confidence interval 3.8–4.5] in 1000 patients with no migraine. Furthermore, migraine was associated with an increased risk of postsurgical 30-day readmission due to a priori defined migraine-related pain (headache or abdominal pain) (adjusted odds ratio 1.55 [95% confidence interval 1.20–2.00]). Conclusion Patients with migraine undergoing surgery are at increased risk of 30-day hospital readmission due to pain.

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