Hemolysis and Non-Hemorrhagic Stroke during Venoarterial Extracorporeal Membrane Oxygenation

We examined the association of low level hemolysis (LLH) and non-hemorrhagic stroke during venoarterial extracorporeal membrane oxygenation (VA ECMO) support.MethodsA single center retrospective review of all adult patients placed on VA ECMO from January 2012 to September 2017 was conducted. To determine the association between LLH and non-hemorrhagic stroke, patients were categorized as those with and without LLH. LLH was defined by 48-hour plasma free hemoglobin (PFHb) of 11-50 mg/dL after VA ECMO implantation.ResultsOf 201 patients who underwent VA ECMO placement, 150 (75%) met inclusion criteria and composed the study population. They were 55±14 years old and 50 (33%) were women. Sixty-two (41%) patients had LLH. Patients with LLH had a higher likelihood of incident non-hemorrhagic stroke during VA ECMO support (20[32%] vs. 4[5%]; aHR, 7.6; 95% CI, 2.2-25.9; P=0.001). The severity of LLH was associated with an incrementally higher likelihood of a non-hemorrhagic stroke (PFHb: 26-50 mg/dL, HR, 11.3; 95% CI, 3.6-35.1; P=0.001; PFHb: 11-25 mg/dL, HR, 4.4; 95% CI, 1.36-14.85, P=0.014), in comparison to no LLH. Those with LLH had a 2-fold greater increase in mean platelet volume after VA ECMO placement (0.98±1.1 vs. 0.49±0.96 fL, p=0.03). Patients with a non-hemorrhagic stroke had a higher operative mortality, (20[83%] vs. 57[45%]; adjusted hazard ratio, 3.1; 95% CI, 1.8-5.3; P
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research

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Publication date: Available online 9 December 2019Source: NeuroImage: ClinicalAuthor(s): Yunzhe Xue, Fadi G. Farhat, Olga Boukrina, A.M. Barrett, Jeffrey R. Binder, Usman W. Roshan, William W. GravesAbstractAutomatic identification of brain lesions from magnetic resonance imaging (MRI) scans of stroke survivors would be a useful aid in patient diagnosis and treatment planning. It would also greatly facilitate the study of brain-behavior relationships by eliminating the laborious step of having a human expert manually segment the lesion on each brain scan. We propose a multi-modal multi-path convolutional neural network sys...
Source: NeuroImage: Clinical - Category: Radiology Source Type: research
In this study, we aimed to investigate the safety and efficacy of endovascular treatment of acute strokes due to vertebrobasilar artery occlusion.MethodsWe did a multicentre, randomised, open-label trial, with blinded outcome assessment of thrombectomy in patients presenting within 8 h of vertebrobasilar occlusion at 28 centres in China. Patients were randomly assigned (1:1) to endovascular therapy plus standard medical therapy (intervention group) or standard medical therapy alone (control group). The randomisation sequence was computer-generated and stratified by participating centres. Allocation concealment was implemen...
Source: The Lancet Neurology - Category: Neurology Source Type: research
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Source: Journal of Cardiovascular Translational Research - Category: Cardiology Source Type: research
AbstractHereditary hemorrhagic telangiectasia (HHT) is an autosomal-dominant vascular disorder characterized by development of high-flow arteriovenous malformations (AVMs) that can lead to stroke or high-output heart failure. HHT2 is caused by heterozygous mutations inACVRL1, which encodes an endothelial cell bone morphogenetic protein (BMP) receptor, ALK1. BMP9 and BMP10 are established ALK1 ligands. However, the unique and overlapping roles of these ligands remain poorly understood. To define the physiologically relevant ALK1 ligand(s) required for vascular development and maintenance, we generated zebrafish harboring mu...
Source: Angiogenesis - Category: Molecular Biology Source Type: research
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Source: Neurological Sciences - Category: Neurology Source Type: research
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Source: Frontiers in Neurology - Category: Neurology Source Type: research
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Source: Clinical Neuroradiology - Category: Neurology Source Type: research
We present a contemporary analysis of risk of fatal stroke among more than 7.5 million cancer patients and report that stroke risk varies as a function of disease site, age, gender, marital status, and time after diagnosis. The risk of stroke among cancer patients is two times that of the general population and rises with longer follow-up time. The relative risk of fatal stroke, versus the general population, is highest in those with cancers of the brain and gastrointestinal tract. The plurality of strokes occurs in patients older than 40 years of age with cancers of the prostate, breast, and colorectum. Patients of any ag...
Source: Fight Aging! - Category: Research Authors: Tags: Medicine, Biotech, Research Source Type: blogs
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Source: Neurocritical Care - Category: Neurology Source Type: research
AbstractSpreading depolarization is observed as a large negative shift of the direct current potential, swelling of neuronal somas, and dendritic beading in the brain ’s gray matter and represents a state of a potentially reversible mass injury. Its hallmark is the abrupt, massive ion translocation between intraneuronal and extracellular compartment that causes water uptake (= cytotoxic edema) and massive glutamate release. Dependent on the tissue’s energy st atus, spreading depolarization can co-occur with different depression or silencing patterns of spontaneous activity. In adequately supplied tissue, spread...
Source: AGE - Category: Geriatrics Source Type: research
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