Yujiro Seike

Carotid Intima-Media Thickness and Risk of Cardiovascular Events in High-Risk Patients

Background and Purpose: There is epidemiological evidence that increased carotid intima-media thickness (IMT) is a predictor of cardiovascular disease (CVD) events. However, the significance of carotid IMT in high-risk patients in whom risk factors are managed clinically has not been adequately investigated. The purpose of this study was to determine the usefulness of carotid IMT measurement in such patients. Methods: The study comprised 900 outpatients with cardiovascular risk factors or established atherosclerosis. Carotid IMT was calculated as the mean bilateral IMT of the common carotid artery, bifurcation, and internal carotid artery. Baseline vascular risk factors, medications, and history of CVD were recorded at the time of enrollment. The incidence of CVD events was determined prospectively. Results: During a mean follow-up period of 2.6 years, there were 64 CVD events. The relative risk (RR) of a CVD event increased with increased IMT. Association between CVD events and carotid IMT was significant after adjustment for risk factors and history of CVD, showing an increased risk per IMT tertile from the middle tertile (RR, 2.5; 95% confidence interval [CI]: 1.0–6.3) to the highest (RR, 3.6; 95% CI: 1.4–9.0). When patients with a history of CVD were excluded (n = 574), the predictive value of IMT was significant even after adjustment for risk factors (hazard ratio per 1 SD IMT increase was 1.57 [95% CI: 1.11–2.20]). Conclusions: Carotid IMT is an independent predictor of vascular events in high-risk patients in whom risk factors are managed clinically.

Benefit of inpatient multidisciplinary rehabilitation up to 1 year after stroke

OBJECTIVE To analyze the benefit of inpatient multidisciplinary rehabilitation up to 1 year after stroke. DESIGN Retrospective cohort study. SETTING Inpatient rehabilitation hospital in Japan. PARTICIPANTS A total of 1056 patients with stroke were divided into 3 groups based on the interval between stroke onset and admission to the rehabilitation hospital: group I, within 90 days (n=507, 48%); group II, 91 to 180 days (n=377, 36%); and group III, more than 180 days (n=172, 16%). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Functional outcome (A to D; independent to totally dependent) in walking, affected upper extremity, and activities of daily living (ADLs) and discharge disposition. RESULTS Walking status improved in 70.9% of nonambulatory patients in group I, in 54.8% in group II, and in 43.9% in group III. Similarly, ADLs improved in 66.7% of the totally dependent patients in group I and in approximately 50% in groups II and III. Functional gain in those with a totally nonfunctional upper extremity at admission was poor (29.7%). Initial functional categories affected each outcome (P<.0001). On discharge, 73.8% in group I and approximately 60% in groups II and III went home. CONCLUSION Approximately half of all patients regained their abilities in walking and ADLs after inpatient multidisciplinary rehabilitation up to 1 year after stroke. However, there was considerable limitation in functional recovery of the affected upper extremity.

Evaluation of the use of a standard input function for compartment analysis of [123I]iomazenil data: factors influencing the quantitative results.

Adoption of standard input function (SIF) has been proposed for kinetic analysis of receptor binding potential (BP), instead of invasive frequent arterial samplings. The purpose of this study was to assess the SIF method in quantitative analysis of [123I]iomazenil (IMZ), a central benzodiazepine antagonist, for SPECT.SPECT studies were performed on 10 patients with cerebrovascular disease or Alzheimer disease. Intermittent dynamic SPECT scans were performed from 0 to 201 min after IMZ-injection. BPs calculated from SIFs obtained from normal volunteers (BPs) were compared with those of individual arterial samplings (BPo).Good correlations were shown between BPos and BPss in the 9 subjects, but maximum BPss were four times larger than the corresponding BPos in one case. There were no abnormal laboratory data in this patient, but the relative arterial input count in the late period was higher than the SIF. Simulation studies with modified input functions revealed that height in the late period can produce significant errors in estimated BPs.These results suggested that the simplified method with one-point arterial sampling and SIF can not be applied clinically. One additional arterial sampling in the late period may be useful.

Super-early Iodine-123 Iodoamphetamine SPECT imaging of human primary motor cortex.

UNLABELLED This study was designed to visualize the motor function area related to finger movements in normal human brain using super-early (first 640 sec of acquisition) [123l]iodoamphetamine ([123I]IMP) SPECT. METHODS Seven healthy male volunteers performed paired, isolated baseline and task sessions. The task was a right thumb-to-fingers opposition task, which was loaded for the initial 11 min of the session. A high-performance, four-head SPECT camera was used. At each session, administration of 222 MBq [123I]IMP was followed by 16 serial 160-sec dynamic SPECT acquisitions. To obtain matched brain anatomical images, MRI was also performed using the same slice formation as in the SPECT study. After image reconstruction, ROIs were set on bilateral sensorimotor hand areas (SMHA), the supplementary motor area (SMA), the frontal, temporal and occipital lobes and the cerebellar hemispheres. The percent increase of ROI activity (%INC) in the task session compared with that in the baseline session was calculated in each ROI after normalization to the global brain radioactivity. RESULTS There was significant activation of the left SMHA by the task, the amplitude of which was maximal in the initial phase of dynamic images (the super-early phase). This area was located in the left peri-central area identified on the analogous slice in the MR image. The left SMHA showed gradual and statistically significant decrease of %INC during the three phases. CONCLUSION Super-early [123I]IMP may be used to identify the primary motor cortex and to evaluate its function in some pathological conditions.

Motor-evoked potentials following transcranial magnetic stimulation during recovery after a stroke

Abstract In general, during the course of rehabilitation, it is essential to assess the physical state of the patients in terms of the functional disturbances and disabilities on the activities of daily living (ADL). However, the quality of motor recovery is difficult to predict on the basis of only having clinical data. While various degrees of motor improvement are frequently observed in the patients affected by a stroke, the mechanisms underlying the recovery processes have not yet been fully identified. This study investigated the reorganization of motor maps after a vascular mono-hemispheric lesion with transcranial magnetic stimulation (TMS) and applied TMS to diagnostic and prognostic use for the chronic stage of hemiparesis, as well as the acute stage after a stroke. The results demonstrated several specific patterns of motor-evoked potentials (MEP) in 19 stroke patients due to the excitability changes of motocortical areas that accompany the chronic recovery processes. Our results suggest that greater emphasis should be placed on handedness in determining the reorganization in the motocortical areas. Handedness may also prove useful when considering the specific training regimes during neuro-rehabilitation.