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Biomedical subjects

C A Molina

Publications and source records attributed to C A Molina.

At least 19 recordsLinked to original sources
PubMed2007

C-reactive protein predicts further ischemic events in transient ischemic attack patients.

BACKGROUND AND PURPOSE: Although patients with transient ischemic attack (TIA) experience cardiovascular events frequently, strong clinical predictors of recurrence are lacking. High-sensitivity C-reactive protein (hs-CRP) has been shown to be a powerful predictor of future first-ever and recurrent coronary and cerebral ischemic events. We aimed to investigate the relationship between hs-CRP and the risk of further ischemic events in TIA patients. METHODS: High-sensitivity C-reactive protein level was determined <24 h after symptom onset among 135 consecutive TIA patients and stroke recurrence or any new vascular event was recorded during 1 year follow-up period. RESULTS: A total of 38 (28.1%) patients experienced an end point event: 28 (20.7%) cerebral ischemic events, six (4.4%) heart ischemic events, four (3%) peripheral arterial disease, and nine (6.7%) vascular deaths. Cox proportional hazards multivariate analyses identified age [hazard ratio (HR) 1.07, 95% confidence interval (CI) 1.01-1.12, P = 0.01], large-artery occlusive disease (HR 2.73, 95% CI 1.16 to 6.41, P = 0.02) and hs-CRP> 4.1 mg/l (HR 2.81, 95% CI 1.12-7.10, P = 0.03) as independent predictors of stroke. Moreover, age (HR 1.05, 95% CI 1.01-1.10, P = 0.02), large-artery occlusive disease (HR 3.12, 95% CI 1.48-6.58, P < 0.01), coronary disease (HR 2.39, 95% CI 1.11-5.16, P = 0.03), and hs-CRP> 4.1 mg/l (HR 2.71, 95% CI 1.16-6.30, P = 0.02) were also independent predictors of any vascular event. CONCLUSIONS: High-sensitivity C-reactive protein serum level predicts further ischemic events following TIA. Routine CRP measurement might be a useful tool for identifying high-risk TIA patients in order to plan aggressive diagnostic protocols and prevention therapies.

Age Factors↗
PubMed2006

Outcome in hyperglycemic stroke with ultrasound-augmented thrombolytic therapy.

Hyperglycemia independently predicts poor outcome after acute ischemic stroke. CLOTBUST (Combined Lysis Of Thrombus in Brain ischemia using transcranial Ultrasound and Systemic tPA) demonstrated that ultrasound-augmented thrombolysis improves recanalization and 24-hour outcome in patients with acute ischemic stroke. We hypothesized that ultrasound would preferentially benefit hyperglycemic patients, and reviewed CLOTBUST with respect to admission glucose and good outcome. We found that ultrasound's benefit on 90-day outcome was primarily apparent at higher glucose levels, suggesting that ultrasound therapy may improve outcome following hyperglycemic stroke.

Aged↗
PubMed2006

Plasma d-dimer predicts poor outcome after acute intracerebral hemorrhage.

OBJECTIVE: To investigate if systemic d-dimer activation occurs after acute intracerebral hemorrhage (ICH) and to study its influence on clinical outcome. METHODS: The authors determined plasma baseline d-dimer in 98 consecutive acute (<24 hours) ICH patients. Glasgow Coma Scale and NIH Stroke Scale scores were recorded to assess neurologic status on baseline and follow-up visits (24 hours, 48 hours, 7th day, and 3rd month). They also determined the d-dimer temporal profile at follow-up visits in a subgroup of 21 patients. ICH volume was measured on baseline and follow-up CT scans. Early neurologic deterioration (END) and mortality during the 1st week were recorded. RESULTS: ICH patients showed higher plasma d-dimer level than reference laboratory values at baseline (1,780 vs 360 ng/mL; p = 0.013) and 3 months after ICH onset (1,530 vs 470 ng/mL; p = 0.013). The d-dimer level was related to baseline ICH volume (r = 0.23, p = 0.049) and to the presence of intraventricular (2,370 vs 1,360 ng/mL; p = 0.019) or subarachnoid (4,180 vs 1,520 ng/mL; p = 0.001) extension. Nearly one-fourth of patients presented END, and 20% died as a result of ICH. As predictors of END, the authors identified d-dimer level >1,900 ng/mL (odds ratio [OR] 4.5, 95% CI 1.03 to 20.26, p = 0.045) and systolic blood pressure >182 mm Hg (OR 6.8, 95% CI 1.25 to 36.9, p = 0.026). Moreover, ICH volume >30 mL (OR 19.13, 95% CI 2.06 to 177, p = 0.009) and d-dimer levels >1,900 ng/mL (OR 8.75, 95% CI 1.41 to 54.16, p = 0.020) emerged as independent predictors of mortality. CONCLUSION: Increased plasma d-dimer level following acute intracerebral hemorrhage is associated with early neurologic deterioration and poor outcome.

Acute Disease↗
PubMed2006

[ApoE genotype influences on efficacy and safety of thrombolytic treatment for ischemic stroke].

INTRODUCTION: Apolipoprotein E has been associated with intracerebral hemorrhages and with neurological outcome of ischemic stroke patients treated with rt-PA. Therefore, we hypothesized that ApoE genotype might influence the appearance of post-tPA hemorrhagic transformation and that the favorable outcome of E2 patients might be due to better rates of recanalization. PATIENTS AND METHODS: We analyzed the ApoE genotype of 77 patients with ischemic stroke involving the territory of the middle cerebral artery who received rt- PA within 3 h of symptoms onset. The hemorrhagic events were evaluated by computed tomography and the arterial recanalization by transcraneal doppler. RESULTS: We did not observe any association between ApoE genotypes and the rates of hemorrhagic transformation following rt-PA treatment (E2 = 33.3 %, E3 = 32.7%, E4=11.8%; p=0.241). Rates of artery recanalization following thrombolysis were similar regarding ApoE genotypes at 1 hour post-tPA administration (E2=40%, E3+E4=45.9%; p=0.799), at 6 hours post-tPA (E2=80%, E3+E4=62.3 %; p=0.43) or at 24 hours post-tPA (E2= 100%, E3+E4=75%, p=0.203). No association was observed between ApoE genotypes and NIHSS scores at 48 hours (E2=8, E3+E4=12; p=0.811) nor with the modified ranking scale at 3 months (E2=1.5, E3+E4=4; p=0.350). CONCLUSIONS: In our group of stroke patients, ApoE genotypes are not related with the presence of hemorrhagic transformations neither with the rates of recanalization following thrombolytic treatment.

Aged↗
PubMed2005

Outcome in patients with basilar artery occlusion treated conventionally.

BACKGROUND: Most data on the outcome of basilar artery occlusion are from recent case series of patients treated with intra-arterial thrombolysis. The limited knowledge on the outcome after a conventional treatment approach comes from a few small case series of highly selected patients. OBJECTIVE: To provide more data on the outcome of conventional treatment. METHODS: Data were analysed on patients from three centres with symptomatic basilar artery occlusion treated conventionally. Conventional therapy was defined as treatment with antiplatelets, anticoagulation, or both. RESULTS: Data were available on 82 patients. The case fatality was 40%. Among survivors, 65% remained dependent (Rankin score 4-5). Patients younger than 60 years (odds ratio = 3.1 (95% confidence interval, 1.0 to 9.5)) and those with a minor stroke (OR = 3.1 (1.0 to 9.6)) were more likely to have a good outcome (Rankin score 0-3). Patients with a progressive stroke were less likely to have a good outcome (OR = 0.3 (0.08 to 1.2)) than patients with a maximum deficit at onset or fluctuating symptoms at presentation. CONCLUSIONS: Conventional treatment of symptomatic basilar artery occlusion is associated with a poor outcome in almost 80% of patients, which emphasises the importance of the search for a more effective treatment approach.

Age Factors↗
PubMed2004

High lipoprotein (a), diabetes, and the extent of symptomatic intracranial atherosclerosis.

BACKGROUND: Lipoprotein (a) (Lp[a]) has important atherothrombogenic properties, but its role in intracranial atherosclerosis remains unclear. OBJECTIVE: To investigate the relationship between Lp(a) level and the extent of intracranial large-artery occlusive disease. METHODS: Between June 2001 and August 2003, 166 consecutive first-ever TIA or stroke patients had intracranial stenoses on transcranial Doppler, of which 100 fulfilled all inclusion criteria. The extent of intracranial large-artery occlusive disease was assessed by the number of angiographically confirmed intracranial stenoses. Serum Lp(a) was determined a minimum of 3 months after stroke onset. RESULTS: Two hundred eighty-one intracranial stenoses were documented. Fifty-one (51%) patients had three or more stenoses (greater-extent group). Patients in the highest Lp(a) quartile had a higher adjusted odds ratio (OR) for a greater extent than those in the lowest quartile (OR 3.43, 95% CI 1.04 to 11.33, p = 0.04). A positive correlation was found between Lp(a) concentration and the number of stenoses (r = 0.310, p = 0.002). Moreover, Lp(a) level increased gradually with the number of stenoses (p = 0.02). A multiple logistic regression model identified diabetes (OR 2.4, 95% CI 1.04 to 5.57, p = 0.04) and high Lp(a) (OR 2.52, 95% CI 1.03 to 6.18, p = 0.043) as independent markers of a greater extent of intracranial large-artery occlusive disease. CONCLUSIONS: High Lp(a) level and diabetes mellitus are independent markers of a greater extent of intracranial large-artery occlusive disease. These findings support a role for Lp(a) in intracranial stenotic atherogenesis and might be useful for the selection of high-risk patients.

Aged↗
PubMed2003

[Avoidable mortality. The case of the North border of Mexico, 1980-1990].

When the death causes are understood as a result of morbility process that may have been avoided with different kinds of economic, social and welfare services policies and the advance of scientific and technologic knowledges, there is clearly a structural determinism so that many population social sectors can't reach the "modern epidemiological patterns". This study used annual data bases of register death 1979-1991 brought by INEGI/DGE-SSA from five Mexican federal border entities. It were adjusted by Preston-Coale method and Life Tables were generated in 1980 and 1990. The percentage contributions of avoidable causes' groups by sex and age of the increases in the Expectation of Life (Ex) were calculated in the same years following Pollard's method. As result of this research, limited increments of Ex were found because of the permanence of high contribution of deaths, that may have been avoided (50%). Contrary to popular beliefs, Ex male diminished the difference compared with Ex female. Highest male mortality is explained even for this kind of causes, where accidents and violence deaths are bringing high percentages of total mortality.

English Abstract↗
PubMed2002

Gabapentin in late-onset poststroke seizures.

Stroke is a frequent cause of epileptic seizures (ES) in adults. The authors evaluated the long-term efficacy and tolerability of gabapentin (900 to 1,800 mg/day) in 71 patients with a first poststroke late ES during a mean follow-up time of 30 months. ES recurred in 18.3% of the patients and side effects were noted in 27 cases (38%), but only two (2.8%) required discontinuation or early withdrawal. Gabapentin monotherapy was useful and safe for late poststroke ES.

Acetates↗
PubMed2001

Progression and clinical recurrence of symptomatic middle cerebral artery stenosis: a long-term follow-up transcranial Doppler ultrasound study.

BACKGROUND AND PURPOSE: Patients with symptomatic intracranial atherosclerotic stenosis have a high rate of recurrence. We conducted a prospective study to determine which factors are associated with the progression of symptomatic middle cerebral artery (MCA) stenosis and to evaluate the relationship between progression and clinical recurrence. METHODS: Between January 1996 and February 2000, of a total of 2564 consecutive first-ever transient ischemic attack (TIA) or stroke patients admitted to our cerebrovascular unit, 145 showed an MCA stenosis signal on transcranial Doppler (TCD) on admission, and 40 fulfilled all criteria to enter this study, including angiographic confirmation. Patients were prescribed antiplatelet or anticoagulant agents following the criteria of the neurologist in charge. TCD recordings and clinical interviews were performed regularly during follow-up. Progression of MCA stenosis was defined as an increase >30 cm/s in TCD-recorded maximum mean flow velocity. Logistic regression analyses were used to identify predictors of progression and clinical recurrence. RESULTS: With a median follow-up of 26.55 months, 13 (32.5%) MCA stenoses progressed, 3 (7.5%) regressed, and 24 (60%) remained stable. Absence of significant extracranial internal carotid artery (ICA) stenosis (P=0.049) and the use of oral anticoagulants (P=0.045) were significantly associated with a lower progression rate in univariate analysis, and anticoagulation remained an independent predictor when a logistic regression model was applied (OR 7.25, CI 1.1 to 48.1, P=0.019). A new ischemic event during follow-up in the territory supplied by the stenosed MCA occurred in 8 cases (20%), and 13 patients had a major vascular event. Progression of the MCA stenosis detected by TCD was independently associated with a new ipsilateral ischemic event (OR 2.89, CI 1.09 to 7.71, P=0.031) and with the occurrence of any major vascular event (OR 7.03, CI 1.6 to 30.9, P=0.0071). CONCLUSIONS: Progression of symptomatic MCA stenosis detected by means of TCD predicts clinical recurrence. Anticoagulation is independently associated with a lower progression rate of symptomatic MCA stenosis.

Administration, Oral↗
PubMed2001

Matrix metalloproteinase expression is related to hemorrhagic transformation after cardioembolic stroke.

BACKGROUND AND PURPOSE: In animal models of cerebral ischemia, matrix metalloproteinase (MMP) expression was significantly increased and related to blood-brain barrier disruption, edema formation, and hemorrhagic transformation (HT). MMP inhibitors reduce HT after embolic ischemia in tissue-type plasminogen activator-treated animals. We aimed to determine the relationship between MMPs and HT after human ischemic stroke. METHODS: Serial MMP-2 and MMP-9 determinations were performed by means of ELISA in 39 cardioembolic strokes in the middle cerebral artery territory. Hemorrhagic events were classified according to clinical and CT criteria (hemorrhagic infarction [HI] and parenchymal hematoma [PH]). HT was evaluated on CT at 48 hours (early HT) and again between day 5 and 7 (late HT). RESULTS: HT was present in 41% of the patients (43.75% early HI, 25% early PH and 31.25% late HI). MMP-2 values were within normal range and were unrelated to HT. Increased expression of MMP-9 (normal range <97 ng/mL) was found among patients with and without HT (159.3+/-82 versus 143.9+/-112.6 ng/mL; P=0.64). According to HT subtypes, the highest baseline MMP-9 levels corresponded to patients with late HI (240.4+/-111.2 versus 102.5+/-76.7 ng/mL for all other patients, P=0.002). Baseline MMP-9 was the only variable associated with late HI in the multiple logistic regression model (OR 9; CI 1.46, 55.24; P=0.010). Peak of MMP-9 at the 24-hour time point (250.6 ng/mL) was found before appearance of PH. CONCLUSIONS: MMPs are involved in some subtypes of HT after human cardioembolic stroke. Baseline MMP-9 level predicts late HI and a 24-hour peak precedes early PH.

Aged↗
PubMed2001

Time course of tissue plasminogen activator-induced recanalization in acute cardioembolic stroke: a case-control study.

BACKGROUND AND PURPOSE: The relationship between arterial recanalization, infarct size, and outcome in patients treated with intravenous thrombolytics remains unclear. Therefore, we aimed to determine the time course of recombinant tissue plasminogen activator (rtPA)-induced recanalization in patients with cardioembolic stroke treated <3 hours from symptom onset and to investigate the relationship between arterial recanalization, infarct volume, and outcome. METHODS: We prospectively studied 72 patients with an acute cardioembolic stroke in the middle cerebral artery territory: 24 treated with rtPA at <3 hours and 48 matched controls. Serial transcranial Doppler examinations were performed on admission and at 6,12, 24, and 48 hours. Infarct volume was measured by use of CT at day 5 to 7. Modified Rankin Scale score was used to assess outcome at 3 months. RESULTS: Rate of 6-hour recanalization was higher (P<0.001) in the rtPA group (66%) than in the control group (15%). Five (20.8%) rtPA patients and 15 (31.2%) controls recanalized between 6 and 12 hours, and 2 (8.3%) patients and 12 (25%) controls between 12 and 48 hours, respectively. At 48 hours, 75% of rtPA patients and 27% of controls had improved (P<0.001). Infarct volume was 50.2+/-40.3 cm(3) in rtPA patients and 124.8+/-81.6 cm(3) in controls (P<0.001). Moreover, infarct volume was associated strongly (P<0.001) with duration of middle cerebral artery occlusion. At 3 months, 14 (58%) rtPA patients and 11 (23%) controls (P=0.037) became functionally independent (modified Rankin Scale score </=2). A close relationship (P=0.002) existed between modified Rankin Scale score at 3 months and time to reperfusion. In addition, clinical outcome was associated strongly (P=0.001) with degree of 6-hour recanalization. Logistic regression analysis identified National Institutes of Health Stroke Scale score <17 (odds ratio 12.1, 95% confidence interval 2.8 to 68, P=0.001) and early recanalization (odds ratio 23.4, 95% confidence interval 5.4 to 96, P=0.001) as independent predictors of functional independence at 3 months. CONCLUSIONS: Intravenous rtPA is associated with early recanalization, which leads to lower infarct size and better clinical outcome. Early recanalization is a powerful independent predictor of functional independence at 3 months.

Acute Disease↗
PubMed2001

The expression of inducible cAMP early repressor (ICER) is altered in prostate cancer cells and reverses the transformed phenotype of the LNCaP prostate tumor cell line.

Inducible cAMP early repressor (ICER) has been shown to be an important mediator of cAMP antiproliferative activity. In this report, it was found that cAMP retards LNCaP cell growth; in contrast, cAMP inhibits the growth of PC-3 and DU-145 cells. ICER protein levels were markedly reduced in prostate cancer epithelial cells and undetectable and uninducible by cAMP in LNCaP and DU 145 cells. Forced expression of ICER in LNCaP cells caused inhibition of cell growth and thymidine incorporation and halted cells at the G(1) phase of the cell cycle. These ICER-bearing LNCaP cells were rendered unable to grow in soft agar and unable to form tumors in nude mice. These results suggest that deregulation of ICER expression may be related to carcinogenesis of the prostate gland.

8-Bromo Cyclic Adenosine Monophosphate↗
PubMed2001

Mitogen-activated protein kinase phosphorylates and targets inducible cAMP early repressor to ubiquitin-mediated destruction.

Inducible cAMP early repressor (ICER) is an important mediator of cAMP antiproliferative activity that acts as a putative tumor suppressor gene product. In this study, we examined the regulation of ICER protein by phosphorylation and ubiquitination in human choriocarcinoma JEG-3 and mouse pituitary AtT20 cells. We found that cAMP stabilized ICER protein by inhibiting the mitogen-activated protein kinase (MAPK) cascade. Activation of the MAPK pathway increased ICER phosphorylation. ICER phosphorylation was abrogated by inhibition of the MAPK pathway either by cAMP or directly by the MAPK inhibitor PD098059. The MAPKs extracellular signal-regulated kinases 1 and 2 physically interact with ICER and mediated the phosphorylation of ICER on a critical serine residue (Ser-41). A mutant form of ICER in which Ser-41 was substituted by alanine had a half-life 4-5 h longer than its wild-type counterpart. This alteration in stability was due to the inability of the Ser-41-mutant ICER to be efficiently ubiquitinated and degraded via the ubiquitin-proteasome pathway. These results present a novel cell signaling cross-talk mechanism at the cell nucleus between the MAPK and cAMP pathways, whereby MAPK targets a repressor of the cAMP-dependent gene expression for ubiquitination and proteasomal degradation.

Animals↗
PubMed2001

Timing of spontaneous recanalization and risk of hemorrhagic transformation in acute cardioembolic stroke.

BACKGROUND AND PURPOSE: The relationship between reperfusion and hemorrhagic transformation (HT) remains uncertain. Therefore, we aimed to clarify the relationship between the time course of recanalization and the risk of HT in patients with cardioembolic stroke studied within 6 hours of symptom onset. METHODS: Fifty-three patients with atrial fibrillation and nonlacunar stroke in the middle cerebral artery (MCA) territory admitted within the first 6 hours after symptom onset were prospectively studied. Serial TCD examinations were performed on admission and at 6, 12, 24, and 48 hours. CT was performed within 6 hours after stroke onset and again at 36 to 48 hours. RESULTS: Proximal and distal MCA occlusions were detected in 32 patients (60.4%) and 18 patients (34%), respectively. Early spontaneous recanalization occurring within 6 hours was identified in 10 patients (18.8%). Delayed recanalization (>6 hours) occurred in 28 patients (52.8%). HT on CT scan was detected in 17 patients (32%) within the first 48 hours. Only large parenchymal hemorrhage (PH2) was significantly associated with an increase (P=0.038, Kruskal-Wallis test) in the National Institutes of Health Stroke Scale (NIHSS) score compared with the other subtypes of HT. Univariate analysis revealed that an NIHSS score of >14 on baseline (P=0.001), proximal MCA occlusion (P=0.004), hypodensity >33% of the MCA territory (P=0.012), and delayed recanalization occurring >6 hours of stroke onset (P=0.003) were significantly associated with HT. With a multiple logistic regression model, delayed recanalization (OR 8.9; 95% CI 2.1 to 33.3) emerged as independent predictor of HT. CONCLUSIONS: Delayed recanalization occurring >6 hours after acute cardioembolic stroke is an independent predictor of HT.

Adult↗
PubMed2000

Cerebral microembolism in acute spontaneous internal carotid artery dissection.

The rate and risk factors for early ischemic recurrence in patients with internal carotid artery dissection (ICAD) are largely unknown. Serial transcranial Doppler (TCD) monitoring of microembolic signals (MES) was performed in 28 consecutive patients with acute ICAD. MES were identified in 13 patients, and early ischemic recurrence occurred in 7. Six of 13 patients with MES and 1 of 15 without MES experienced early ischemic recurrence (p = 0.029). MES detection on serial TCD monitoring may be associated with an increased risk of early ischemic recurrence in patients with acute ICAD.

Acute Disease↗