RATIONALE: Oxygen is essential for cellular energy metabolism. Neurons are particularly vulnerable to hypoxia. Increasing oxygen supply shortly after stroke onset could preserve the ischemic penumbra until revascularization occurs. AIMS: PROOF investigates the use of normobaric oxygen (NBO) therapy within 6 h of symptom onset/notice for brain-protective bridging until endovascular revascularization of acute intracranial anterior-circulation occlusion. METHODS AND DESIGN: Randomized (1:1), standard treatment-controlled, open-label, blinded endpoint, multicenter adaptive phase IIb trial. STUDY OUTCOMES: Primary outcome is ischemic core growth (mL) from baseline to 24 h (intention-to-treat analysis). Secondary efficacy outcomes include change in NIHSS from baseline to 24 h, mRS at 90 days, cognitive and emotional function, and quality of life. Safety outcomes include mortality, intracranial hemorrhage, and respiratory failure. Exploratory analyses of imaging and blood biomarkers will be conducted. SAMPLE SIZE: Using an adaptive design with interim analysis at 80 patients per arm, up to 456 participants (228 per arm) would be needed for 80% power (one-sided alpha 0.05) to detect a mean reduction of ischemic core growth by 6.68 mL, assuming 21.4 mL standard deviation. DISCUSSION: By enrolling endovascular thrombectomy candidates in an early time window, the trial replicates insights from preclinical studies in which NBO showed beneficial effects, namely early initiation of near 100% inspired oxygen during short temporary ischemia. Primary outcome assessment at 24 h on follow-up imaging reduces variability due to withdrawal of care and early clinical confounders such as delayed extubation and aspiration pneumonia. TRIAL REGISTRATIONS: ClinicalTrials.gov: NCT03500939; EudraCT: 2017-001355-31.

• MeSH
• endovaskulární výkony * metody   MeSH
• ischemická cévní mozková příhoda * komplikace   diagnóza   MeSH
• ischemie mozku * komplikace   MeSH
• klinické zkoušky, fáze II jako téma MeSH
• kvalita života MeSH
• kyslík terapeutické užití   MeSH
• lidé MeSH
• multicentrické studie jako téma MeSH
• trombektomie metody   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• protokol klinické studie MeSH

BACKGROUND AND OBJECTIVES: COVID-19-related inflammation, endothelial dysfunction, and coagulopathy may increase the bleeding risk and lower the efficacy of revascularization treatments in patients with acute ischemic stroke (AIS). We aimed to evaluate the safety and outcomes of revascularization treatments in patients with AIS and COVID-19. METHODS: This was a retrospective multicenter cohort study of consecutive patients with AIS receiving intravenous thrombolysis (IVT) and/or endovascular treatment (EVT) between March 2020 and June 2021 tested for severe acute respiratory syndrome coronavirus 2 infection. With a doubly robust model combining propensity score weighting and multivariate regression, we studied the association of COVID-19 with intracranial bleeding complications and clinical outcomes. Subgroup analyses were performed according to treatment groups (IVT-only and EVT). RESULTS: Of a total of 15,128 included patients from 105 centers, 853 (5.6%) were diagnosed with COVID-19; of those, 5,848 (38.7%) patients received IVT-only and 9,280 (61.3%) EVT (with or without IVT). Patients with COVID-19 had a higher rate of symptomatic intracerebral hemorrhage (SICH) (adjusted OR 1.53; 95% CI 1.16-2.01), symptomatic subarachnoid hemorrhage (SSAH) (OR 1.80; 95% CI 1.20-2.69), SICH and/or SSAH combined (OR 1.56; 95% CI 1.23-1.99), 24-hour mortality (OR 2.47; 95% CI 1.58-3.86), and 3-month mortality (OR 1.88; 95% CI 1.52-2.33). Patients with COVID-19 also had an unfavorable shift in the distribution of the modified Rankin score at 3 months (OR 1.42; 95% CI 1.26-1.60). DISCUSSION: Patients with AIS and COVID-19 showed higher rates of intracranial bleeding complications and worse clinical outcomes after revascularization treatments than contemporaneous non-COVID-19 patients receiving treatment. Current available data do not allow direct conclusions to be drawn on the effectiveness of revascularization treatments in patients with COVID-19 or to establish different treatment recommendations in this subgroup of patients with ischemic stroke. Our findings can be taken into consideration for treatment decisions, patient monitoring, and establishing prognosis. TRIAL REGISTRATION INFORMATION: The study was registered under ClinicalTrials.gov identifier NCT04895462.

• MeSH
• cerebrální krvácení komplikace   MeSH
• cévní mozková příhoda * epidemiologie   terapie   diagnóza   MeSH
• COVID-19 * komplikace   MeSH
• endovaskulární výkony * škodlivé účinky   MeSH
• fibrinolytika terapeutické užití   MeSH
• intrakraniální krvácení etiologie   MeSH
• ischemická cévní mozková příhoda * epidemiologie   chirurgie   MeSH
• ischemie mozku * komplikace   epidemiologie   chirurgie   MeSH
• kohortové studie MeSH
• lidé MeSH
• registrace MeSH
• trombolytická terapie škodlivé účinky   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH

BACKGROUND AND PURPOSE: Autonomic nervous system (ANS) seems to play an important role in the post-stroke immunosuppression syndrome with increased susceptibility to infections. The aim of this study was to investigate if ANS activity measured at admission is associated with post-stroke infections. METHODS: We prospectively analyzed patients with acute ischemic stroke. ANS was measured using the cross-correlational baroreflex sensitivity (BRS) at admission. The occurrence and cause of in-hospital infections was assessed based on the clinical and laboratory examination. Demographic and clinical variables including initial stroke severity, dysphagia, procedures as nasogastric tubes, central venous and urinary catheters and mechanical ventilation were included in the analysis. RESULTS: We included 161 patients with ischemic stroke, of those 49 (30.4%) developed a nosocomial infection during the first 7 days of hospital stay. Patients with infections had significantly lower BRS (median 3 vs 5 ms/mmHg, p < .001) higher initial NIHSS (median 15 vs 5, p < .001), had more often non-lacunar etiology and underwent more invasive procedures. In the multivariable regression model decreased BRS (adjusted OR 1.21, 95% CI 1.03-1.41, p = .02), admission NIHSS (adjusted OR 1.10, 95% CI 1.02-1.19, p = .02) and invasive procedures (adjusted OR 1.46, 95% CI 1.03-2.06, p = .03) were independently associated with infection after ischemic stroke. CONCLUSIONS: Decreased BRS was independently associated with infections after ischemic stroke. Autonomic shift may play an important role in increased susceptibility to infections after stroke. The possible diagnostic and therapeutic relevance of this finding deserves further research.

• MeSH
• baroreflex fyziologie   MeSH
• cévní mozková příhoda diagnóza   patofyziologie   MeSH
• dospělí MeSH
• infekce spojené se zdravotní péčí diagnóza   patofyziologie   MeSH
• ischemie mozku diagnóza   patofyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• prospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

DWI-FLAIR mismatch has been recently proven to identify patients with unknown onset stroke (UOS) eligible for thrombolysis. However, this concept may exclude patients from thrombolysis who may eventually benefit as well. We aimed to examine the feasibility, safety and potential efficacy of thrombolysis in wake-up stroke (WUS) and UOS patients using a modified DWI-FLAIR mismatch allowing for partial FLAIR positivity. WUS/UOS patients fulfilling the modified DWI-FLAIR mismatch and treated with intravenous thrombolysis (IVT) were compared to propensity score matched WUS/UOS patients excluded from IVT due to FLAIR positivity. The primary endpoint was a symptomatic intracranial hemorrhage (SICH), the secondary endpoints were improvement of ≥ 4 in NIHSS score and mRS score at 3 months. 64 IVT-treated patients (median NIHSS 9) and 64 controls (median NIHSS 8) entered the analysis (p = 0.2). No significant difference in SICH was found between the IVT group and the controls (3.1% vs. 1.6%, p = 0.9). An improvement of ≥ 4 NIHSS points was more frequent in IVT patients as compared to controls (40.6% vs. 18.8%, p = 0.01). 23.4% of IVT patients achieved a mRS score of 0-1 at 3 months as compared to 18.8% of the controls (p = 0.8). SICH, improvement of NIHSS ≥ 4 and mRS 0-1 at 3 months were comparable in thrombolyzed patients with negative FLAIR images versus those thrombolyzed with partial positive FLAIR images (3% vs. 3%, p = 0.9; 40% vs. 41%, p = 0.9; 19% vs. 22%, p = 0.8). Our study signalizes that thrombolysis may be feasible in selected WUS/UOS patients with partial FLAIR signal positivity.

• MeSH
• časové faktory MeSH
• cévní mozková příhoda diagnostické zobrazování   farmakoterapie   patofyziologie   MeSH
• difuzní magnetická rezonance * MeSH
• dospělí MeSH
• fibrinolytika aplikace a dávkování   škodlivé účinky   MeSH
• intrakraniální krvácení chemicky indukované   MeSH
• klinické rozhodování MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční angiografie MeSH
• mozková angiografie metody   MeSH
• mozkový krevní oběh MeSH
• obnova funkce MeSH
• posuzování pracovní neschopnosti MeSH
• prediktivní hodnota testů MeSH
• registrace MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• studie proveditelnosti MeSH
• trombolytická terapie škodlivé účinky   metody   MeSH
• výběr pacientů MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE: Autonomic imbalance as measured by heart rate variability (HRV) has been associated with poor outcome after stroke. Observations on HRV changes in intracerebral hemorrhage (ICH) are scarce. Here, we aimed to investigate HRV in ICH as compared to a control group and to explore associations with stroke severity, hemorrhage volume and outcome after ICH. METHODS: We examined the autonomic modulation using frequency domain analysis of HRV during the acute phase of the ICH and in a healthy age- and hypertension-matched control group. Hematoma volume, intraventricular extension, initial stroke severity and baseline demographic, clinical parameters as well as mortality and functional outcome were included in the analysis. RESULTS: 47 patients with ICH and 47 age- and hypertension matched controls were analyzed. ICH patients showed significantly lower total high frequency band (HF) and low frequency band (LF) powers (p = 0.01, p < 0.001), higher normalized HF power (p = 0.03), and lower LF/HF ratio (p < 0.001) as compared to the controls. Autonomic parameters showed associations with stroke severity (p = 0.004) and intraventricular involvement (p = 0.01) and predicted poor outcome independently (p = 0.02). CONCLUSIONS: Autonomic changes seems to be present in acute ICH and are associated with poor outcome independently. This may have future monitoring and therapeutic implications.

• MeSH
• autonomní nervový systém patofyziologie   MeSH
• cerebrální krvácení diagnóza   patofyziologie   MeSH
• cévní mozková příhoda patofyziologie   MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• prognóza MeSH
• senioři MeSH
• srdeční frekvence fyziologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• Publikační typ
• abstrakt z konference MeSH

Syndróm obštrukčného spánkového apnoe je formou poruchy dýchania viazanej na spánok. Dochádza pri ňom k opakovanej redukcii prietoku vzduchu v horných dýchacích cestách. Intermitentné striedanie desaturácie krvi kyslíkom a následnej resaturácie hrá v patofyziológii syndrómu spánkového apnoe významnú úlohu. Intermitentná hypoxia pri syndróme spánkového apnoe spôsobuje obmedzenie dostupnosti endoteliálneho oxidu dusnatého, následné zhoršenie cievnej dilatácie závislej od endotelu a má tým kľúčový význam pre vznik endoteliálnej dysfunkcie. Endoteliálna dysfunkcia predstavuje úvodný krok v procese aterogenézy, ktorej dôsledkom sú všeobecne známe klinické komplikácie, cerebrovaskulárne ochorenia nevynímajúc.

Obstructive sleep apnea syndrome is form of a sleep-related breathing disorder. It is characterised by repetitive upper airways obstruction. Intermittent changes of the oxygen desaturation of the blood and subsequent oxygen resaturation play a significant role in the pathophysiology of the obstructive sleep apnea syndrome. Intermittent hypoxia in sleep apnea syndrome restricts the availability of endothelial nitric oxide, causes consequent worsening of the vascular endothelium-dependent dilation and has thus a key importance for the development of the endothelial dysfunction. Endothelial dysfunction represents an initial step in the process of atherogenesis, which leads to the well-known clinical complications, including cerebrovascular diseases.

Vzhľadom k širokej variabilite kovových implantátov a implantovaných prístrojov je potrebné v záujme zachovania bezpečnosti zobrazovacích vyšetrení pomocou magnetickej rezonancie (MRI) neustále zvyšovať povedomie odbornej verejnosti o ich kompatibilite s magnetickým poľom. Kovové implantáty a materiály sa považujú často za kontraindikáciu vyšetrenia pre možné riziko vychýlenia alebo posunu, vzniku tepla, nadmerného zohrievania, indukcie elektrického prúdu a možnosť misinterpretácie artefaktu. Článok sa zaoberá jednotlivými typmi interakcií medzi arteficiálnymi materiálmi a magnetickým poľom MRI prístrojov a ich dopadom na živý organizmus resp. klinickú prax.

• MeSH
• bezpečnost normy   MeSH
• defibrilátory implantabilní kontraindikace   škodlivé účinky   MeSH
• elektrická stimulace škodlivé účinky   MeSH
• hluboká mozková stimulace kontraindikace   škodlivé účinky   MeSH
• magnetická rezonanční tomografie metody   škodlivé účinky   MeSH
• nervus vagus MeSH
• protézy a implantáty kontraindikace   škodlivé účinky   MeSH
• stenty kontraindikace   škodlivé účinky   MeSH

V prehľadnom článku autori popisujú špecifiká sclerosis multiplex v detskom veku. Uvádzajú jej diagnostické kritériá, klinický obraz, prognostické faktory a sumarizujú doterajšie poznatky o efektivite a znášanlivosti imunomodulačnej liečby v detskom veku. Výsledky štúdií svedčia o tom, že znášanlivosť a efektivita liečby kortikoidmi, interferónom a glatiramer acetátom sú podobné ako u dospelých, a preto by mali byť súčasťou liečby aj u detí. V závere autori uvádzajú súčasné doporučenia v liečbe SM u detí.

The review article describes the specificity of multiple sclerosis in childhood. Diagnostic criteria, clinical picture, prognostic factors are presented, as well as knowledge of effectiveness and tolerance of immunomodulatory therapy in childhood are summarized. The results of studies confirm that tolerance and effectiveness of therapy with corticoids, interferons and glatiramer acetate is the same as in adults and should be the part of the therapy in children. The authors present current suggestions in treatment of MS in children.