Cerebrovascular Disease

Repair of the VA has evolved in the last decade. It began as an uncommon operation used in a minute percentage of patients with cerebrovascular disease. At that time many neurologists and vascular surgeons viewed these reconstructions with skepticism, doubting that they could influence the neurologic outcome of these patients or even if they were needed at all.

Aims: Examine whether one session of high frequency repetitive transcranial magnetic stimulation (rTMS) applied over the left dorsolateral prefrontal cortex (DLPFC) would induce any measurable cognitive changes in patients with cerebrovascular disease and mild cognitive deficits. Patients and method: Seven patients with cerebrovascular disease and mild executive dysfunction entered the randomised, controlled, blinded study with a crossover design. rTMS was applied either over the left DLPFC (an active stimulation site) or over the left motor cortex (MC; a control stimulation site) in one session. Each patient participated in both stimulation sessions (days 1 and 4) and the order of stimulation sites (DLPFC or MC) was randomised. A short battery of neuropsychological tests was performed by a blinded psychologist prior to and after each rTMS session. Psychomotor speed, executive function, and memory were evaluated. Results: The only mild but significant stimulation site-specific effect of rTMS was observed in the Stroop interference results (i.e. improvement) after the stimulation of DLPFC but not MC in comparison with the baseline scores (Wilcoxon, Z=À2.03, p=0.04). Patients improved in the digit symbols subtest of the Wechsler adult intelligence scale-revised after both rTMS sessions regardless of the stimulation site (DLPFC or MC; Z=À2.06, p=0.04 and Z=À2.06, p=0.04, respectively). There was no measurable effect of rTMS in any other neuropsychological test. Conclusion: Our pilot study results showed that one session of the high frequency rTMS applied over the left DLPFC was safe in patients with cerebrovascular disease and mild executive deficits, and may induce measurable positive effects on executive functioning. D

An association between hemorheological alterations (i.e., whole-blood and plasma hyperviscosity, reduced erythrocyte deformability, increased red cell aggregation, hyperfibrinogenemia and increased acute-phase protein levels) and the mild stage of senile dementia of the Alzheimer's type (DAT) was suggested in the present study. In particular, hyperfibrinogenemia and the increase of erytrhocyte aggregation were correlated with the increased generation and release of TNF-␣ and IFN-␥ (spontaneous release and IL-2-modulated release) from natural killer (NK) lymphocytes (CD16ϩ, CD56ϩ, CD3-cells) of patients with DAT; whereas a normal cytokine release from NK cells was found in healthy old subjects and in patients with vascular dementia (VaD). The in vitro and in vivo administration of the hemorheologic drug pentoxifylline (PTX) significantly reduced spontaneous and IL-2-modulated cytokine overproduction from NK cells (in vitro effects with 500 U/ml and 1000 U/ml/NK cells) and improved all the hemorheological parameters. Taken together, these data suggest that disturbances of cerebrovascular flow and of hemorheology could be considered a negative component related to the pathogenesis and progression of DAT neurodegeneration. The association between hemorheological changes and alterations of TNF-␣ and IFN-␥ release from NK may indicate a potential immunorheologic mechanism associated with cerebrovascular damage in DAT and could suggest the use of vascular protective drugs as support of the main pharmacological and non-pharmacological therapy of AD.

To evaluate the cost effectiveness of capecitabine + docetaxel combination versus docetaxel alone in the treatment of advanced and/or metastatic breast cancer in France. METHODS: This analysis was based on primary data from an open-label, randomized, multi-centre phase III clinical trial (SO14999). Unit costs reflecting the French economic context was attached to patients' use of resource, i.e. reference tariffs for consultations, daily treatment costs for drugs and mean cost per DRG for hospitalizations. Direct medical costs were analyzed from a "payer" perspective, including payments from the public health insurance, private supplementary health insurers, and patients' co-payment. Significant differences in costs were identified with a Student's t-test for the means. To calculate incremental cost-effectiveness, the additional cost in the capecitabine arm was divided by the additional years of life saved. The time horizon of the clinical trial was 15 months and cost and health effects were not discounted. RESULTS: Survival was longer in the combination arm (mean 442 days versus 352 days). The cost of capecitabine amounted to €1786, while the cost of docetaxel was significantly reduced in the combination group (€6089 versus €7856; p < 0.0001). None of the other cost components differed between treatment groups, and the overall direct medical cost was comparable in the combination group (€9888 ± 343) and in the monotherapy group (€9852 ± 378; p = 0.9436). The additional cost in the combination arm was €36 and the clinical benefit was 0.23 life-year saved. Thus, the cost per life-year saved ratio was estimated to €157. CONCLU-SIONS: Capecitabine/docetaxel combination appears as a highly cost-effective strategy in comparison to docetaxel monotherapy in the treatment of advanced or metastatic breast cancer in France, while these results derived from a randomized clinical trial need to be confirmed in current practice.

Perceptual musical functions were investigated in patients significance in the temporal conditions. Detailed analysis outlined a hierarchical organization, with an initial rightsuffering from unilateral cerebrovascular cortical lesions. hemisphere recognition of contour and metre followed by Using MIDI (Musical Instrument Digital Interface) identification of interval and rhythm via left-hemisphere technique, a standardized short test battery was subsystems. Patterns of dissociated and associated melodic established that covers local (analytical) as well as global and temporal deficits indicate autonomous, yet partially perceptual mechanisms. These represent the principal integrated neural subsystems underlying the processing cognitive strategies in melodic and temporal musical of melodic and temporal stimuli. In conclusion, these data information processing (local, interval and rhythm; contradict a strong hemispheric specificity for music global, contour and metre). Of the participating brainperception, but indicate cross-hemisphere, fragmented damaged patients, a total of 69% presented with postneural substrates underlying local and global musical lesional impairments in music perception. Leftinformation processing in the melodic and temporal hemisphere-damaged patients showed significant deficits dimensions. Due to the diverse profiles of neuroin the discrimination of local as well as global structures psychological deficits revealed in earlier investigations as in both melodic and temporal information processing. well as in this study, individual aspects of musicality and Right-hemisphere-damaged patients also revealed an musical behaviour very likely contribute to the definite formation of these widely distributed neural networks. overall impairment of music perception, reaching

The brain is a delicate organ, and nature has very efficiently protected it. The brain is shielded against potentially toxic substances by the presence of two barrier systems: the blood brain barrier (BBB) and the blood cerebrospinal fluid barrier (BCSFB). Unfortunately, the same mechanisms that protect it against intrusive chemicals can also frustrate therapeutic interventions. Despite aggressive research, patients suffering from fatal and/or debilitating central nervous system (CNS) diseases, such as brain tumours, HIV encephalopathy, epilepsy, cerebrovascular diseases and neurodegenerative disorders, far outnumber those dying of all types of systemic cancers or heart diseases. The abysmally low number of potential therapeutics reaching commercial success is primarily due to the complexity of the CNS drug development. The clinical failure of many probable candidates is often, ascribable to poor delivery methods which do not pervade the unyielding BBB. It restricts the passive diffusion of many drugs into the brain and constitutes a significant obstacle in the pharmacological treatment of central nervous system (CNS) disorders. General methods that can enhance drug delivery to the brain are, therefore, of great pharmaceutical interest. Various strategies like non-invasive methods, including drug manipulation encompassing transformation into lipophilic analogues, prodrugs, chemical drug delivery, carrier-mediated drug delivery, receptor/vector mediated drug delivery and intranasal drug delivery, which exploits the olfactory and trigeminal neuronal pathways to deliver drugs to the brain, are widely used. On the other hand the invasive methods which primarily rely on disruption of the BBB integrity by osmotic or biochemical means, or direct intracranial drug delivery by intracerebroventricular, intracerebral or intrathecal administration after creating reversible openings in the head, are recognised. Extensive review pertaining specifically, to the patents relating to drug delivery across the CNS is currently available. However, many patents e.g. US63722506, US2002183683 etc., have been mentioned in a few articles. It is the objective of this article to expansively review drug delivery systems for CNS by discussing the recent patents available.

Peripheral arterial disease (PAD) is a common manifestation of atherosclerosis that affects more than 10 million people in the United States. The risk factors associated with PAD are similar to those found in patients with coronary artery disease and cerebrovascular disease. Medical therapy of PAD must include modification of cardiovascular risk factors with application of strict secondary prevention guidelines. For improvement in quality of life, a structured exercise rehabilitation program remains the most effective noninterventional treatment strategy, but it is difficult to employ from economic and patient-compliance perspectives. Newer pharmacologic therapies have demonstrated efficacy in patients with intermittent claudication. Emerging strategies for management of these patients include revascularization and maximal medical therapy for improvement of physical function as well as reduction in risk for subsequent major cardiovascular events. This article will review the clinical data supporting aggressive medical interventions for patients with PAD.

The imaging of brain haemodynamics and its applications are generating growing interest. By providing quantitative measurements of cerebral blood flow (CBF) and cerebral blood volume (CBV), dynamic perfusion computed tomography (p-CT) allows visualisation of cerebral autoregulation mechanisms and represents a fast, available and reliable imaging option for assessing cerebral perfusion. Thanks to its feasibility in emergency settings, p-CT is considered most useful, in combination with CT angiography, in acute ischaemic patients, as it is able to provide a fast and noninvasive assessment of cerebral perfusion impairment. In addition, p-CT can play a diagnostic role in other types of cerebrovascular disease to assess functional reserve, and in intracranial neoplasms, where it has a role in diagnosis, grading, biopsy guidance, and follow-up during treatment. This article illustrates the principles, technique and clinical applications of p-CT cerebral perfusion studies. Key words Brain ischemia • Brain neoplasms • Brain injury • Hemodynamics • Perfusion • CT Riassunto Lo studio dell'emodinamica cerebrale, ottenuto con le metodiche di imaging, con le sue varie ed attuali applicazioni, genera interesse crescente. La TC perfusione dinamica (p-TC) permette una valutazione quantitativa del flusso cerebrale ematico (CBF) e del volume cerebrale ematico (CBV), offrendo così una visualizzazione diretta dei meccanismi di autoregolazione cerebrale, e si pone come una valida alternativa ad altre modalità di misurazione della perfusione cerebrale, rispetto alle quali ha il maggior vantaggio di essere una tecnica prontamente disponibile ed accessibile, in condizioni di emergenza, nella maggior parte dei centri medici. Per tale ragione la p-TC è utile soprattutto nell'ischemia cerebrale acuta, condizione in cui, associata all'angio-TC, offre in maniera rapida e non-invasiva, la valutazione eziologica dell'ipoperfusione, nonché delle sue ripercussioni emodinamiche e fisiopatologiche sul parenchima cerebrale. Inoltre la p-TC trova utile impiego in pazienti con altre patologie cerebro-vascolari e per la diagnosi, il grading, la guida alle procedure bioptiche, ed il controllo durante la terapia, dei tumori intra-cranici. Questo articolo si propone di riassumere i principi, la tecnica e le principali applicazioni cliniche degli studi di perfusione cerebrale basati sulla metodica TC.

Neurological disease presents a particular range of problems in pregnancy. The majority of these disorders are preexisting and may require a modification of therapy to ensure that a therapeutic effect is maintained while fetal and neonatal morbidity is avoided. The drug management of epilepsy presents particular challenges in pregnancy. Some neurological conditions occur more frequently in pregnant women, for example compression mononeuropathies, benign intracranial hypertension and cerebral venous and sinus thrombosis, whereas others, such as eclampsia, are unique to pregnancy. The investigation, diagnosis and appropriate management of neurological symptoms and signs in pregnancy require a knowledge of neuroanatomy, physiology of pregnancy and the appropriate application of neuroimaging and neurophysiological testing.

mRecent developments in minimally invasive approach to cerebrovascular diseases include the placement of stents in arteries for treatment of aneurysms. Preliminary clinical observations and experimental studies have shown that intravascular stents traversing the orifice may lead to thrombosis and subsequent occlusion of the aneurysm. The alterations in vessel local hemodynamics due to the introduction of a stent are not yet well understood. We investigated changes in local hemodynamics resulting from stent implantation. Pulsatile flow patterns in an experimental flow apparatus were visualized using laser-induced fluorescence of rhodamine dye. The test cells were constructed in a rectangular shape to facilitate an undisturbed longitudinal view of flow patterns in parent vessel and aneurysm models with and without porous stents. Woven nitinol stents of various porosities (76%, 80%, 82%, and 85%) were investigated. The selected fluid dynamic similarity parameters (Reynolds and Womersley numbers) represented conditions usually found in high-flow, larger arteries in humans (such as the carotid artery) and low-flow, smaller arteries (such as the vertebral artery). The mean Reynolds number for the larger arteries was 180, with maximum/ minimum values of 490/-30 and the Womersley number was 5.3. The mean Reynolds number for the smaller arteries was 90, with maximum/minimum values of 230/2, and the Womersley number was 2.7. For the larger arteries modeled, placement of a stent of the lowest porosity across the aneurysm orifice resulted in reduction of aneurysmal vortex speed and decreased interaction with parent vessel flow. For smaller arteries, a stent of the same porosity led to a substantial reduction of parent vessel/ aneurysmal flow interaction and the appearance of a nonrecirculating crescent of fluid rich in rhodamine dye in the aneurysm dome. Our results can help explain in vivo thrombus formation within an aneurysm after placement of a stent that is compatible with local hemodynamics.

Hypertension is associated with cerebrovascular remodeling and endothelial dysfunction, which may reduce cerebral vasomotor reactivity to CO2. Treatment combining blood pressure (BP) reduction with inhibition of vascular effects of angiotensin II may reverse these changes. However, the reduction in BP at the onset of treatment can compromise cerebral perfusion and exhaust vasomotor reserve, leading to impaired CO2 reactivity. Eleven patients (nine men, two women) with newly diagnosed, untreated mild-to-moderate hypertension aged (mean (s.d.)) 52 (9) years, and eight controls (seven men, one woman) aged 46 (10) years were studied. Patients received losartan/hydrochlorothiazide (50/12.5 or 100/25 mg) to reduce BP to &lt;140/&lt;90 mm Hg within 1-2 weeks. BP (Finapres), heart rate (HR), CBFV (cerebral blood flow velocity, transcranial Doppler), cerebrovascular resistance, and CO2 reactivity were measured at baseline, after the rapid BP reduction, and after long-term treatment (3-4 mont...

doi:10.3791/50887 (2014). Obtaining in vivo human brain tissue volumetrics from MRI is often complicated by various technical and biological issues. These challenges are exacerbated when significant brain atrophy and age-related white matter changes (e.g. Leukoaraiosis) are present. Lesion Explorer (LE) is an accurate and reliable neuroimaging pipeline specifically developed to address such issues commonly observed on MRI of Alzheimer&apos;s disease and normal elderly. The pipeline is a complex set of semi-automatic procedures which has been previously validated in a series of internal and external reliability tests1,2. However, LE&apos;s accuracy and reliability is highly dependent on properly trained manual operators to execute commands, identify distinct anatomical landmarks, and manually edit/verify various computer-generated segmentation outputs. LE can be divided into 3 main components, each requiring a set of commands and manual operations: 1) Brain-Sizer, 2) SABRE, and 3) Le...

RESUMO -Este texto apresenta a síntese das conclusões do Iº Consenso Brasileiro do Tratamento da Fase Aguda do Acidente Vascular Cerebral (AVC). Tratou-se de reunião patrocinada e coordenada pela Sociedade Brasileira de Doenças Cerebrovasculares, com neurologistas especializados nas doenças cerebrovasculares, que analisaram os principais itens da conduta dos AVC.

The brain is a delicate organ, and nature has very efficiently protected it. The brain is shielded against potentially toxic substances by the presence of two barrier systems: the blood brain barrier (BBB) and the blood cerebrospinal fluid barrier (BCSFB). Unfortunately, the same mechanisms that protect it against intrusive chemicals can also frustrate therapeutic interventions. Despite aggressive research, patients suffering from fatal and/or debilitating central nervous system (CNS) diseases, such as brain tumours, HIV encephalopathy, epilepsy, cerebrovascular diseases and neurodegenerative disorders, far outnumber those dying of all types of systemic cancers or heart diseases. The abysmally low number of potential therapeutics reaching commercial success is primarily due to the complexity of the CNS drug development. The clinical failure of many probable candidates is often, ascribable to poor delivery methods which do not pervade the unyielding BBB. It restricts the passive diffusion of many drugs into the brain and constitutes a significant obstacle in the pharmacological treatment of central nervous system (CNS) disorders. General methods that can enhance drug delivery to the brain are, therefore, of great pharmaceutical interest. Various strategies like non-invasive methods, including drug manipulation encompassing transformation into lipophilic analogues, prodrugs, chemical drug delivery, carrier-mediated drug delivery, receptor/vector mediated drug delivery and intranasal drug delivery, which exploits the olfactory and trigeminal neuronal pathways to deliver drugs to the brain, are widely used. On the other hand the invasive methods which primarily rely on disruption of the BBB integrity by osmotic or biochemical means, or direct intracranial drug delivery by intracerebroventricular, intracerebral or intrathecal administration after creating reversible openings in the head, are recognised. Extensive review pertaining specifically, to the patents relating to drug delivery across the CNS is currently available. However, many patents e.g. US63722506, US2002183683 etc., have been mentioned in a few articles. It is the objective of this article to expansively review drug delivery systems for CNS by discussing the recent patents available.

The imaging of brain haemodynamics and its applications are generating growing interest. By providing quantitative measurements of cerebral blood flow (CBF) and cerebral blood volume (CBV), dynamic perfusion computed tomography (p-CT) allows visualisation of cerebral autoregulation mechanisms and represents a fast, available and reliable imaging option for assessing cerebral perfusion. Thanks to its feasibility in emergency settings, p-CT is considered most useful, in combination with CT angiography, in acute ischaemic patients, as it is able to provide a fast and noninvasive assessment of cerebral perfusion impairment. In addition, p-CT can play a diagnostic role in other types of cerebrovascular disease to assess functional reserve, and in intracranial neoplasms, where it has a role in diagnosis, grading, biopsy guidance, and follow-up during treatment. This article illustrates the principles, technique and clinical applications of p-CT cerebral perfusion studies.

Peripheral arterial disease (PAD) affects about 27 million people in North America and Europe, accounting for up to 413,000 hospitalizations per year with 88,000 hospitalizations involving the lower extremities and 28,000 involving embolectomy or thrombectomy of lower limb arteries. Many patients are asymptomatic and, among symptomatic patients, atypical symptoms are more common than classic claudication. Peripheral arterial disease also correlates strongly with risk of major cardiovascular events, and patients with PAD have a high prevalence of coexistent coronary and cerebrovascular disease. Because the prevalence of PAD increases progressively with age, PAD is a growing clinical problem due to the increasingly aged population in the United States and other developed countries. Until recently, vascular surgical procedures were the only alternative to medical therapy in such patients. Today, endovascular practice, percutaneous transluminal angioplasty with or without stenting, is used far more frequently for all types of lower extremity occlusive lesions, reflecting the continuing advances in imaging techniques, angioplasty equipment, and endovascular expertise. The role of endovascular intervention in the treatment of limb-threatening ischemia is also expanding, and its promise of limb salvage and symptom relief with reduced morbidity and mortality makes percutaneous transluminal angioplasty/stenting an attractive alternative to sur-

Background: This study was undertaken to compare mitral valve repair and replacement as treatments for ischemic mitral regurgitation (IMR) with left ventricular dysfunction (LVD). Specifically, we sought to determine whether the choice of mitral valve procedure affected survival, and discover which patients were predicted to benefit from mitral valve repair and which from replacement. Methods: A total of 218 consecutive patients underwent either mitral valve repair (MVP, n = 112) or mitral valve replacement (MVR, n = 106). We retrospectively reviewed the clinical material, operation methods, echocardiography check during operation and follow-up. Patients details and follow-up outcomes were compared using multivariate and Kaplan-Meier analyses.

Bilateral thalamic infarction is a rare condition. It can appear with acute coma. Awakening disability and loss of motivation is seen after coma and it causes permanent cognitive deficiency. Usually ocular signs accompany. Vertical gaze paresis of which the mechanism is not completely figured out, is often seen. In some cases corticospinal tractus is not affected so loss of strength in the extremities doesn’t occur. Infarct is bilateral at paramedian thalamus and generally extends to mesencephalon. In this article 4 cases with bilateral thalamus infarcts are discussed by clinical course and neurological
and radiological findings.

Robbins JA, Kays SA, Gangnon RE, Hind JA, Hewitt AL, Gentry LR, Taylor AJ. The effects of lingual exercise in stroke patients with dysphagia. Arch Phys Med Rehabil 2007;88:150-8. Objective: To examine the effects of lingual exercise on swallowing recovery poststroke.

Resumen La evaluación semiológica apropiada es uno de los aspectos más importantes para realizar un ade- cuado diagnóstico neurológico. Presentamos una paciente colombiana de 60 años de edad, quien padeció un infarto de la arteria cerebral media izquierda, originándole hemiplejía derecha, afasia motora, pará- lisis facial &quot;central&quot; derecha y atrofia del músculo platisma derecho. Este último hallazgo, originalmente descrito por

With increasing emphasis on early diagnosis of Alzheimer disease (AD), clinical research has focused on the identification of risk factors that may be modified at a preclinical and early clinical stage of dementing disorders. Prevalence and incidence of different predementia syndromes vary as a result of different diagnostic criteria, as well as different sampling and assessment procedures. Particular interest in mild cognitive impairment (MCI) arises from the fact that MCI is thought to be a prodromal phase and therefore highly predictive of subsequent AD. Furthermore, many of the risk factors for cerebrovascular disease (CVD) and vascular dementia (VaD), including serum total cholesterol, hypertension, atherosclerosis, and apolipoprotein E (APOE) genotype have also been shown to increase the risk of AD. Both vascular factors and APOE 4 allele have been associated with higher risk of AD. Some recent studies suggested further that CVD or vascular factors increased the risk of conversion of MCI to dementia. This review will focus on the possible role of vascular risk factors in modulating the risk of age-related cognitive decline, and the progression of predementia syndrome such as MCI to dementia.

BACKGROUND AND PURPOSE: Perfusion imaging with dynamic susceptibility contrast MR imaging (DSC-MRI) has been used to evaluate hemodynamic status in patients with symp- tomatic occlusive cerebrovascular disease. The aim of the present study was to determine the hemodynamic changes occurring in asymptomatic patients with unilateral internal carotid ar- tery (ICA) occlusion by use of DSC-MRI with transcranial Doppler (TCD) measurement

Human-machine interaction is becoming widespread. So, with the introduction of new technologies the gap between machines and humans is being reduced to ease the standard of living. This paper deals with design and implementation of an accelerometer based hand gesture controlled robot controlled wirelessly using a small low cost, 3-axis accelerometer. A novel algorithm for gesture identification has been developed to replace the approach of conventional controlling mechanism of robots via buttons etc. by an innovative hand gesture based controlling. Using a microcontroller system the program has been written & executed. This Project represents a simple accelerometer controlled robotic arm using Atmega328 powered embedded system as the core of this robot. The robot does not require training because the robotic arm is fully controlled by the user. The gesture controlled robot is a basic 4 wheel drive robot with a motor driver and three servos motor which is used for moving the arm.

Delayed ischemic neurological deficit as a result of cerebral vasospasm is currently the most common cause of morbidity and mortality following acute subarachnoid hemorrhage (SAH) (1 -5) . Because vasospasm occurs in a delayed fashion and is often predictable, it is an obvious target for aggressive preventative and therapeutic strategies. Cerebral vasospasm usually develops 3-5 days after aneurysmal SAH; peaks at 5 -14 days postinsult with symptom onset, which can be gradual or precipitous; and resolves over a period of 2 -4 weeks (4,6,7) . Symptomatic vasospasm is generally characterized by a global deterioration of the level of consciousness, sometimes accompanied by focal neurological deficits corresponding to the arterial territories involved.

The purpose of this review is to summarize current knowledge about the link between sleepdisordered breathing (SDB) and cardiovascular and cerebrovascular diseases. Obstructive sleep apnoea (OSA) is a well-established risk factor for systemic arterial hypertension, and its treatment with continuous positive airway pressure leads to a decrease in daytime and night-time blood pressure profiles. Pulmonary arterial hypertension occurs in 20-30% of OSA patients and is usually mild. It is not yet clear if OSA per se leads to pulmonary hypertension or if the coexistence of chronic obstructive pulmonary disease with daytime and/or sleep-related hypoxaemia is required to provoke a persistent rise in pulmonary artery pressure. Furthermore, OSA is associated with nocturnal cardiac arrhythmias, especially cyclical fluctuations of the heart rate in response to recurrent apnoeas. Atrioventricular conduction blocks and ventricular premature beats are less often observed and seem to be confined to patients with severe OSA and those with accompanying ischaemic heart disease. The association between OSA and vaso-occlusive disease (i.e. atherosclerosis) is less clear. However, accumulating experimental and epidemiological data support such a link. Thus, OSA may lead to coronary artery disease (CAD) and stroke by promoting atherosclerosis. Correspondingly, patients with CAD or acute stroke show a high prevalence of SDB. Cheyne-Stokes respiration (CSR) is a specific pattern of central sleep apnoea occurring in patients with advanced congestive heart failure (CHF). If present, CSR clearly has a negative impact on the clinical course of CHF. Although the optimal treatment strategy for CSR is less well defined than that for OSA, the successful reversal of CSR might increase overall survival in affected patients.

Background and Purpose-A hypoxic-ischemic origin of transient global amnesia (TGA) has been suggested on the basis of the observation of infarctlike diffusion-weighted imaging (DWI) abnormalities in some affected individuals. We tested this hypothesis by comparing vascular risk factors, magnetic resonance imaging (MRI) markers of cerebral small-vessel disease, and other evidence of a cerebrovascular disorder between TGA patients with (DWIϩ) and without (DWIϪ) DWI lesions and normal community-based controls. Methods-We retrospectively identified 86 patients hospitalized for TGA (meanϮSD age, 65.9Ϯ10.9 years; 62% female).

KRIT1 is a gene responsible for Cerebral Cavernous Malformations (CCM), a major cerebrovascular disease characterized by abnormally enlarged and leaky capillaries that predispose to seizures, focal neurological deficits, and fatal intracerebral hemorrhage. Comprehensive analysis of the KRIT1 gene in CCM patients has suggested that KRIT1 functions need to be severely impaired for pathogenesis. However, the molecular and cellular functions of KRIT1 as well as CCM pathogenesis mechanisms are still research challenges. We found that KRIT1 plays an important role in molecular mechanisms involved in the maintenance of the intracellular Reactive Oxygen Species (ROS) homeostasis to prevent oxidative cellular damage. In particular, we demonstrate that KRIT1 loss/down-regulation is associated with a significant increase in intracellular ROS levels. Conversely, ROS levels in KRIT1 2/2 cells are significantly and dose-dependently reduced after restoration of KRIT1 expression. Moreover, we show that the modulation of intracellular ROS levels by KRIT1 loss/restoration is strictly correlated with the modulation of the expression of the antioxidant protein SOD2 as well as of the transcriptional factor FoxO1, a master regulator of cell responses to oxidative stress and a modulator of SOD2 levels. Furthermore, we show that the KRIT1dependent maintenance of low ROS levels facilitates the downregulation of cyclin D1 expression required for cell transition from proliferative growth to quiescence. Finally, we demonstrate that the enhanced ROS levels in KRIT1 2/2 cells are associated with an increased cell susceptibility to oxidative DNA damage and a marked induction of the DNA damage sensor and repair gene Gadd45a, as well as with a decline of mitochondrial energy metabolism. Taken together, our results point to a new model where KRIT1 limits the accumulation of intracellular oxidants and prevents oxidative stress-mediated cellular dysfunction and DNA damage by enhancing the cell capacity to scavenge intracellular ROS through an antioxidant pathway involving FoxO1 and SOD2, thus providing novel and useful insights into the understanding of KRIT1 molecular and cellular functions.

Swallowing disorder is common in Parkinson's disease (PD). We studied the swallowing disorder in PD, and tested the efficacy of Banxia Houpo Tang (BHT, a Chinese traditional medicine) in improving the swallowing reflex of PD patients. The Swallowing reflex test is a simple method used to detect swallowing disorders in patients with cerebrovascular disease. Because we observed previously that BHT significantly improved the swallowing reflex in cerebrovascular patients, we studied whether BHT was also effective in improving the swallowing disorder in patients with PD. 23 PD patients (13 males, 10 females, mean age 66.0 ± 9.3, Hoehn & Yahr (H-Y) mean score =2.8) were evaluated for swallowing reflex and the concentration of substance-P in their saliva before and after 4 weeks of BHT treatment. The swallowing reflex before treatment was significantly delayed, according to the H-Y score (Spearman's p =0.014, R2 =0.463). The swallowing reflex before BHT treatment was 3.66 ± 0.98 sec, and after BHT treatment, it improved significantly, to 2.27 ± 0.54 sec (p < 0.0001). Substance-P concentration in PD patients saliva before treatment was significantly lower than in healthy controls (p =0.007), but showed no significant change after BHT treatment. Our research shows that the swallowing reflex is an effective method to evaluate the swallowing disorder in PD. BHT can significantly improved the swallowing reflex in PD patients, and therefore can be a hopeful candidate for preventing aspiration pneumonia in PD.

Natural chemical compounds are a widely researched topic worldwide because of their potential activity against cerebrovascular diseases. Chemicals from Juniperus phoenicea berries are reported in this study. Lipids (11%) from seeds are mainly unsaturated (86%). Minerals are also quantified like Na (63.8 mg per 100 g DW) or K (373.9 mg per 100 g DW).

The results of Interventional Management of Stroke (IMS) III, Magnetic Resonance and REcanalization of Stroke Clots Using Embolectomy (MR RESCUE), and SYNTHESIS EXPANSION trials are expected to affect the practice of endovascular treatment for acute ischemic stroke. The purpose of this report is to review the components of the designs and methods of these trials and to describe the influence of those components on the interpretation of trial results.

The brain is a delicate organ, and nature has very efficiently protected it. The brain is shielded against potentially toxic substances by the presence of two barrier systems: the blood brain barrier (BBB) and the blood cerebrospinal fluid barrier (BCSFB). Unfortunately, the same mechanisms that protect it against intrusive chemicals can also frustrate therapeutic interventions. Despite aggressive research, patients suffering from fatal and/or debilitating central nervous system (CNS) diseases, such as brain tumours, HIV encephalopathy, epilepsy, cerebrovascular diseases and neurodegenerative disorders, far outnumber those dying of all types of systemic cancers or heart diseases. The abysmally low number of potential therapeutics reaching commercial success is primarily due to the complexity of the CNS drug development. The clinical failure of many probable candidates is often, ascribable to poor delivery methods which do not pervade the unyielding BBB. It restricts the passive diffusion of many drugs into the brain and constitutes a significant obstacle in the pharmacological treatment of central nervous system (CNS) disorders. General methods that can enhance drug delivery to the brain are, therefore, of great pharmaceutical interest. Various strategies like non-invasive methods, including drug manipulation encompassing transformation into lipophilic analogues, prodrugs, chemical drug delivery, carrier-mediated drug delivery, receptor/vector mediated drug delivery and intranasal drug delivery, which exploits the olfactory and trigeminal neuronal pathways to deliver drugs to the brain, are widely used. On the other hand the invasive methods which primarily rely on disruption of the BBB integrity by osmotic or biochemical means, or direct intracranial drug delivery by intracerebroventricular, intracerebral or intrathecal administration after creating reversible openings in the head, are recognised. Extensive review pertaining specifically, to the patents relating to drug delivery across the CNS is currently available. However, many patents e.g. US63722506, US2002183683 etc., have been mentioned in a few articles. It is the objective of this article to expansively review drug delivery systems for CNS by discussing the recent patents available.