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To measure changes in quantitative tortuosity descriptors of the internal carotid artery (ICA) after intracranial aneurysm embolization, and to determine possible factors associated with changes in tortuosity. An analysis of 52 patients with embolized intracranial aneurysms was performed. ICA tortuosity was assessed by digital subtraction angiograms obtained prior to the embolization and after the first follow-up examination. For each patient, tortuosity descriptors were calculated: relative length (RL), sum of angle metrics (SOAM), triangular index, product of angle distance (PAD), and inflection count metric (ICM). To represent changes in tortuosity for each descriptor, delta (Δ) value was defined as value of the descriptor prior to embolization minus value of the descriptor on follow-up examination. In a median follow-up of 14 months, no statistically significant changes in tortuosity were observed on the nonembolized side. On the embolized side, SOAM (2.89 [SD ± 0.92] vs 2.38 [SD ± 0.94]; P <.001), PAD (5.01 [SD ± 1.83] vs 3.95 [SD ± 1.72]; P <.001), and ICM (12.18 [SD ± 4.55] vs 9.76 [SD ± 4.04]; P =.006) were significantly higher after embolization than before embolization. Median ΔRL (−0.02 [−0.045 to 0.002] vs −0.01 [−0.02 to 0.003]; P =.003), ΔPAD (0.84 [0.30–1.82] vs 0.10 [−0.001 to 1.10]; P <.001), and ΔICM (2.05 [0.42–3.50] vs 0.27 [0.02–2.16]; P =.004) were significantly higher on the embolized side. Tortuosity correlated with elapsed time after embolization. Tortuosity of the ipsilateral ICA increased after intracranial aneurysm embolization. [Display omitted] [ABSTRACT FROM AUTHOR]

Abstract: Glucose handling impairment and oxidative stress are implicated in the overexpression of endothelin-1 (ET-1). The objective of the study was to assess possible interplay of the 2 systems in relation to ET-1 in clinical setting. In hypertensive outpatients, on top of typical clinical workup, we assessed ET-1 levels, glucose handling parameters (glycated hemoglobin [HbA1c], homeostasis model assessment [HOMA] index, and insulin level), and antioxidative protection (ferric reducing ability of plasma [FRAP], superoxide dismutase [SOD], and vitamin C). Average age of 68 patients (64% women, 50% diabetic, 40% smokers) was 67.7 (10.6) years. Serum ET-1 level averaged 1.09 (0.48) pg/mL and correlated positively with glucose handling–associated parameters (insulin, r = 0.22; HOMA, r = 0.21; HbA1c, r = 0.23; all Ps < .05) and negatively with constituents of antioxidative protection system (FRAP, r = −0.45; SOD, r = −0.47; both Ps < .0001; vitamin C, r = −0.27; P ≤ .01). In sex-, age-, blood pressure–, and creatinine-adjusted models, with interchangeable introduction of antioxidative parameters on top of interchangeable introduction of glucose handling–associated parameters, ET-1 levels were each time only significantly associated with FRAP in the context of HbA1c; FRAP, SOD, or vitamin C in the context of HOMA; and FRAP or SOD in the context of insulin concentration. In the stepwise regression with the above parameters offered, only FRAP and vitamin C were associated with ET-1 level. In treated hypertensive patients, impaired glucose handling is associated with higher ET-1 levels. This statistical relation is blunted in the context of parameters of antioxidative protection. The hypothesis that poor antioxidation is mediating the effect of impaired glucose handling on ET-1 levels needs further confirmation. [Copyright &y& Elsevier]

Tortuosity of intracranial arteries has been proven to be associated with the risk of intracranial aneurysm development. We decided to analyze which aspects of tortuosity are correlated with hemodynamics parameters promoting intracranial aneurysm development. We constructed 73 idealized models of tortuous artery (length: 25 mm, diameter: 2.5 mm) with single bifurcation. For each model, on the course of segment before bifurcation, we placed 1–3 angles with measures 15, 30, 45, 60, or 75 degrees and arc lengths 2, 5, 7, 10, or 15 mm. We performed computational fluid dynamics analysis. Blood was modeled as Newtonian fluid. We have set velocity wave of 2 cardiac cycles. After performing simulation we calculated following hemodynamic parameters at the bifurcation: time average wall shear stress (TAWSS), time average wall shear stress gradient (TAWSSG), oscillatory shear index (OSI), and relative residence time (RRT). We found a significant positive correlation with number of angles and TAWSS (R = 0.329; P < 0.01), TAWSSG (R = 0.317; P < 0.01), and negative with RRT (R = −0.335; P < 0.0.01). Similar results were obtained in terms of arcs lengths. On the other hand, mean angle measure was negatively correlated to TAWSS (R = −0.333; P < 0.01), TAWSSG (R = −0.473 P < 0.01), OSI (R = −0.463; P < 0.01), and positively to RRT (R = 0.332; P < 0.01). On the basis of the obtained results, we developed new tortuosity descriptor, which considered angle measures normalized to its arc length and distance from bifurcation. For such descriptor we found strong negative correlation with TAWSS (R = −0.701; P < 0.01), TAWSSG (R = 0.778; P < 0.01), OSI (R = −0.776; P < 0.01), and positive with RRT (R = 0.747; P < 0.01). Hemodynamic parameters promoting aneurysm development are correlated with larger number of smaller angles located on larger arcs. [ABSTRACT FROM AUTHOR]

Many researchers have found a correlation between tortuous arteries and development of aneurysms in cerebral arteries. We decided to determine whether tortuosity of the internal carotid artery can be related to its aneurysm rupture. We retrospectively analyzed the internal carotid artery anatomy of 149 patients with internal carotid artery aneurysms. For each patient, we calculated relative length (RL), sum of angle metrics (SOAM), triangular index (TI), product of angle distance (PAD), and inflection count metrics (ICM). A total of 33 patients (22.15%) had subarachnoid hemorrhage. These patients had significantly lower SOAM (0.31 ± 0.17 vs. 0.42 ± 0.21; P < 0.01), TI (0.27 ± 0.09 vs. 0.31 ± 0.11; P = 0.03) and ICM (0.25 ± 0.11 vs. 0.31 ± 0.17; P = 0.04). In multivariate logistic regression analysis, higher SOAM (odds ratio, 0.780; 95% confidence interval, 0.619–0.961; P = 0.025) remained independently associated with lower risk of internal carotid artery aneurysm rupture. In addition, we found significant positive correlation of aneurysm dome size with SOAM (R = 0.224; P = 0.013) and PAD (0.269; P < 0.01). Our study also showed that age (R = 0.252; P = 0.036), Glasgow Coma Scale score (R = –0.706; P < 0.01), and TI (R = –0.249; P = 0.042) were independently correlated with modified Rankin Scale score on discharge. Lower tortuosity might be a protective factor against internal carotid artery aneurysm rupture and poor outcome after subarachnoid hemorrhage. Higher tortuosity is correlated with internal carotid artery aneurysm growth. [ABSTRACT FROM AUTHOR]

Subarachnoid hemorrhage is (SAH) is a devastating neurologic emergency often associated with systemic inflammatory response. Many reports have demonstrated an association between elevated inflammatory markers and poor outcome. We performed an observational study and a meta-analysis of the impact of high leukocyte count on outcome after SAH. We initially retrospectively analyzed 147 patients with SAH through assessment of medical records database. Poor outcome was defined as modified Rankin Scale score >3. Then, we performed a systematic literature search of PubMed, EMBASE, and the Cochrane Library. Prospective and retrospective studies were included if they assessed impact of leukocytosis on outcome after aneurysmal SAH in adults. We used a random-effect model and quality-effect model, based on the study quality assessment tool, an adapted version of inventory to assess quality of intervention studies. Within our initial observational study, a total of 63 (42.86%) patients had poor treatment outcome. Those patients significantly more often had elevated white blood cell count upon admission (60.32 vs. 40.48%; P = 0.02). A literature search identified 10,119 articles, of which 13 were included into the meta-analysis. Pooled impact of high leukocyte count on outcome was odds ratio 1.42 (95% confidence interval 1.24–1.63) for random-effect model and OR 1.86 (95% confidence interval 1.46–2.36) for the quality-effect model. However, the studies were heterogenous (I = 54%). Elevated white blood cells is a marker of poor outcome after SAH. Despite the fact that it is unlikely to be causative, it may be treated as a useful risk predictor. [ABSTRACT FROM AUTHOR]

Background Many researchers have found a correlation between tortuous arteries and development of aneurysms in cerebral arteries. However, there are no studies analyzing the impact of tortuosity on risk of subarachnoid hemorrhage (SAH) occurrence. Therefore, we decided to determine whether tortuosity of the anterior cerebral artery can be related to the rupture of anterior communicating artery aneurysm and to severity and treatment outcome of SAH. Methods We retrospectively analyzed anterior cerebral artery anatomy of 121 patients with anterior communicating artery aneurysms. From patients' medical records, we obtained their history including previous and current diseases and medications. For each patient we calculated relative length, sum of angle metrics, triangular index, product of angle distance, and inflection count metrics. Results Patients with SAH had significantly higher relative length (0.70 ± 0.19 vs. 0.63 ± 0.22; P = 0.03) and significantly lower inflection count metrics (0.10 ± 0.08 vs. 0.16 ± 0.19; P < 0.01), respectively. In multivariate logistic regression analysis, after adjustment of all possible confounders, diabetes mellitus (odds ratio [OR], 0.154; 95% confidence interval [CI], 0.032–0.553; P < 0.01) and higher inflection count metrics (OR, 0.604; 95% CI, 0.357–0.909; P = 0.042) remained independently associated with lower risk of SAH. We also found an independent correlation between aneurysm dome size (R = −0.289; P = 0.02) and triangular index (R = 0.273; P = 0.03) and Glasgow Coma Scale score on admission. Conclusions Higher anterior cerebral artery tortuosity might be a protective factor against anterior communicating artery aneurysm rupture. [ABSTRACT FROM AUTHOR]

Background Shape and density of intracerebral hemorrhage (ICH) are associated with a higher risk of poor treatment outcome. However, methods of assessment for the features are still inconclusive. Therefore, we decided to measure ICH shape irregularity using shape factors to achieve objective results. Methods We retrospectively analyzed 48 patients with spontaneous ICH confirmed by head computed tomography (CT) scan. We obtained detailed medical history and blood test results from medical records. On admission patients were assessed using Glasgow Coma Scale score, and on discharge patients were assessed using Glasgow Outcome Scale (GOS) score. GOS score of less than 3 was defined as poor outcome. For each slice of CT scan with visible ICH, we extracted its contour and calculated the fractal dimension (FD), compactness (C), and Fourier factor (FF). We also calculated the circle factor (CF), which was defined as the contour perimeter/perimeter of the biggest circle that can be inscribed into the contour, and density heterogeneity, defined as the variance of pixel density. Results A total of 28 patients (58.33%) had poor treatment outcome. Those patients had significantly higher C (0.71 ± 0.09 vs. 0.59 ± 0.09; P < 0.01), FD (1.42 ± 0.12 vs. 1.27 ± 0.09; P < 0.01), and CF (3.59 ± 0.92 vs. 2.63 ± 0.63; P < 0.01). In multivariate logistic regression analysis, FD (odds ratio, 4.176; 95% confidence interval, 1.551–15.577; P = 0.012) remained independently associated with higher risk of poor treatment outcome. Conclusions Each of the shape descriptors, except FF, was associated with treatment outcome after ICH. FD can be used as an independent predictor of outcome. Highlights • Higher fractal dimension is an independent predictor of poor outcome after spontaneous ICH. • C, FF, CF, and DH are associated with poor outcome after spontaneous ICH in univariate analysis. • New descriptors of ICH are introduced. [ABSTRACT FROM AUTHOR]

Abstract: Falls are a geriatric syndrome which affects the physical and psychological well-being of the aged. So far, in Poland there have not been any population-based data on the prevalence of falls among the elderly. The aim of this analysis was to assess the prevalence of falls, their circumstances and consequences in the Polish population aged 65years and older in comparison to younger respondents aged 55–59years, and the relation of falls to visual and hearing deficits. Mean age of the 4920 elderly subjects (51.6% men) was 79.4±8.7years. Falls in the past year were reported by 10.4% of the younger and 19.1% of the older subjects. In both groups falls occurred more frequently in women (11.9% vs. 8.7%, p=0.03 in the younger and 22.7% vs. 13.2%, p<0.001 in the older group). In the group of older subjects falls occurred most often during walking (66.7% vs. 50.7% in the group of 55–59years old), p=0.005), while the younger more often fell while practicing sports (5.48% vs. 0.8% in the group 65+, p<0.001) and risky activities (respectively: 13.7% vs. 4.9%, p=0.002). A similar percentage of younger and older fallers reported one (44.0% and 46.1% respectively) or more falls (56.1% and 53.9%; p=0.6). The percentage of recurrent fallers grew with increasing age (Cc=0.177; p<0.001). The prevalence of injurious falls was similar in the younger and older groups (45.4% and 42.8%, p=0.53). In both genders fall-related injuries were more frequent in younger elderly (65–74years old) and in subjects 90years old and older. In the non-standardized analysis and after adjustment for age and gender visual and hearing impairments and its degree were associated with falls but both relations lost statistical significance after adjustment for a set of explanatory variables. Despite somewhat lower estimates, falls in older Poles are no less an important factor influencing overall health than in other populations. The higher prevalence of multiple falls should draw attention of the health-care policy makers. Sensory impairment may add to the risk of falls and should be adequately taken care of, however the priority in the future fall prevention initiative should be given to stronger factors, such as age, type of activity, overall health, cognitive function and functional status. [Copyright &y& Elsevier]

Frailty and cardiovascular disease share some of the pathophysiologic features. Our objective was to review and metaanalyse the available published evidence on the topic. We performed a comprehensive literature search for studies where pulse wave velocity (PWV) or carotid-ankle vascular index (CAVI) has been linked with frailty in older persons. Of the initial 362 abstracts, after the application of the PRISMA approach, 5 were analysed in detail. We calculated within-study and pooled standardised mean differences of aortic stiffness measures between frail and non-frail (0.62 [0.31–0.92], p < 0.0001, I2 = 88%), and pre-frail and non-frail (0.32 [0.14–0.51], p = 0.0006, I2 = 72%) groups. In two studies it was possible to extract directly or calculate based on published data the odds ratios for the concomitant frailty, associated in one case with CAVI greater by 1 m/s and in another with cfPWV >13 m/s, indicating greater probability of concomitant frailty given greater aortic stiffness. Across the studies, the prevalence of hypertension, diabetes mellitus, hyperlipidaemia, and smoking tended to increase from non-frail, to pre-frail, and frail groups, presenting a possibility of important confounding, but also a common pathophysiology. In conclusion, the pooled analysis of the published cross-sectional study results indicates a relation between aortic stiffness and frailty in older subjects. However, well designed prospective studies are needed to answer the questions of causality. • There is a relationship between cardiovascular risk factors and frailty. • The published studies are cross sectional. • In our metaanalysis, CAVI or cfPWV increase from non-frail to frail persons • Hypertension, diabetes, hyperlipidaemia or smoking may be important confounders. [ABSTRACT FROM AUTHOR]

Abstract: Frailty syndrome (FS) and cognitive impairment are associated with an increased risk of falls, disability, hospitalization and death. We investigated prognostic meaning of FS and cognitive impairment in persons ≥65 years, living in 2 nursing homes. Information about the health status of patients was gathered from history, medical documentation, test assessing FS, according to the Canadian Study of Health and Aging-Clinical Frailty Scale (CSHA-CFS) and the Mini-Mental State Examination (MMSE). The study group included 66 women and 20 men, between 66 and 101 years of age (mean±S.D.=83.8±8.3 years). The frequency of severe frailty (CSHA-CFS=7) among the elderly living in nursing homes was 34.9%, while severe cognitive impairment (MMSE<18) was present in 55.8%. Residents with severe FS and MMSE<18 consisted 33.7% of examined and 50.0% of those who died during 12-month follow-up, p <0.05. Individuals with severe FS and severe cognitive impairment (n =29) as compared to all other patients, were significantly less probable (59% vs. 79%, p =0.03) to survive one year. Neither frailty, nor dementia, nor severe FS or cognitive impairment when considered separately was associated with higher mortality rate. The risk assessment in severely disabled geriatric patients is best performed with measures of functional and cognitive function considered jointly, but not separately. [Copyright &y& Elsevier]

Background Blood pressure (BP) control in the elderly is often limited by poor compliance with prescribed regimen. Both can be influenced by clinical cognitive or mood impairments; however, the impact of subclinical alterations of cognition or mood remains unknown. Objectives To assess the relation between cognition, mood, and BP control in treated older hypertensive patients. Design Cross-sectional association study. Setting Predefined substudy to the POLFOKUS nationwide survey investigating the correlates of poor BP control in patients randomly drawn from primary and specialist practices across Poland. Participants 1988 outpatients ≥65 years of age treated for hypertension for at least 1 year. Measurements BP was mean of at least 2 office measurements. We assessed adherence to antihypertensive medications using a questionnaire and performed screening tests for cognitive deficits [Abbreviated Mental Test Score (AMTS)] and mood disorders [Geriatric Depression Scale (GDS)]. In all patients, we used a unified (BP <140/90 mm Hg) and in ≥80 years old a unified or age-specific (<150 mm Hg systolic BP) definition of BP control. We fitted logistic regression models to assess the probability of poor BP control in association with cognitive and mood disturbances. Results The mean [standard deviation (SD)] age of 1988 (65.6% women) patients was 73.9 (6.0) years (19.3% ≥80 years old). Cognitive and mood impairments were observed in 8.0% and 37.2%, respectively. Mean systolic and diastolic BP were 141.8 (16.4) and 83.6 (9.5) mm Hg, respectively. According to age-stratified and unified definition of proper BP control, goal BP was achieved in 65.4% and 38.5% patients ≥80 years of age, respectively. In younger patients, the control reached 46%. Globally, 66% patients adhered to antihypertensive medications. Poor compliance was related to cognitive and mood impairments. When unified goal was applied, there was a 15.0% higher risk of finding poor BP control per 1 score lost in AMTS and an 8.0% increase per 1 score gained in GDS (all P < .001). Conclusion Poorer BP control is related to subclinical worsening of cognition and mood, which supports widespread use of the Comprehensive Geriatric Assessment even in apparently self-dependent older patients with hypertension. [ABSTRACT FROM AUTHOR]