Biomedical subjects

Jan Willem Elting

Publications and source records attributed to Jan Willem Elting.

5 recordsLinked to original sources

PubMed2006

Intravenous tissue plasminogen activator in patients with stroke increases the bioavailability of insulin-like growth factor-1.

BACKGROUND AND PURPOSE: Insulin-like growth factor (IGF)-1 has potent neuroprotective properties. We investigated the effects of intravenous administration of tissue plasminogen activator (tPA) on serum levels of IGF-1 and IGF-binding protein (IGFBP)-3 in patients with acute ischemic stroke. METHODS: Serum levels of total IGF-1, free IGF-1, and IGFBP-3 were measured by radioimmunoassay in 10 patients with ischemic stroke treated with intravenous tPA (0.9 mg/kg body weight) and 10 untreated controls. RESULTS: During tPA treatment, total IGF-1 and IGFBP-3 serum levels did not change, but there was an &70% increase in free IGF-1 serum levels from 0.98+/-0.25 at baseline to 1.69+/-0.18 nmol/L at the end of the 1-hour infusion (P=0.01). CONCLUSIONS: Intravenous therapy with tPA enhances the bioavailability of IGF-1.

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PubMed2005

P300 component identification in auditory oddball and novel paradigms using source analysis techniques: reduced latency variability in the elderly.

P300 latency variability in normal subjects limits its diagnostic applicability as a test for cognitive function. One of the causes of variation is the overlap in P300 (P3A and P3B) components resulting in inaccurate latency determination. Recently, we have shown that identification of P3A and P3B components using source analysis techniques significantly reduces P300 latency variability in healthy younger subjects. Here, we included a novel paradigm to enhance sensitivity and investigated the efficiency of the source analysis technique in reducing the P300 latency variability in healthy older subjects. Data were recorded with a 128-channel EEG system in 28 healthy subjects (aged 53-82 years, 12 males). We used a standard two-tone and a novel three-tone auditory oddball paradigm and an established source analysis technique, and compared the latencies to those obtained with conventional P300 analysis. The source analysis method identified both P3A and P3B components in a substantially larger percentage of subjects (93% versus 32%) than the conventional method. Both for the standard and novel paradigm, the source analysis method yielded a later mean P3B latency (361.4 versus 344.2 milliseconds, P = 0.017, and 374.4 milliseconds versus 354.3 milliseconds, P = 0.014, respectively) with a smaller standard deviation (15.8 versus 26.2 milliseconds, P = 0.013, and 18.9 versus 30.0 milliseconds, P = 0.052, borderline significant, respectively) than the conventional P300 method, for subjects aged 50 to 70 years. When applying the source analysis technique, as in young healthy subjects, a considerable reduction of P300 latency variability was thus found in healthy older subjects aged 50 to 70 years for both paradigms. This may have important consequences for applications of clinical event-related potential research in the early diagnosis of dementia, because the first signs of this disease are mostly observed in this age category.

Acoustic Stimulation↗

PubMed2005

Neuroprotection in acute ischemic stroke.

Neuroprotection of patients with acute ischemic stroke should start at the scene and continue in the ambulance with the assessment and treatment of the airway, breathing, circulation, body temperature, and blood glucose. The key goal in eligible patients should be fast vessel recanalization with intravenous recombinant tissue-type plasminogen activator Results from a meta-analysis suggest that systemic thrombolysis is effective when given within 4.5 hours after stroke onset. The time window extends to 6 hours for patients undergoing intravascular thrombolysis. Acute stroke patients should be admitted to stroke care units. A crucial component of neuroprotection is the prevention of secondary brain damage, which can be caused by hypoxemia, hypotension, hyperthermia and hyperglycemia. This can be achieved by avoiding complications, e.g. aspiration, and intensive control of oxygenation, hydration and blood pressure, body temperature, blood glucose, and cardiac monitoring. Neuroprotective agents are designed to try to salvage brain tissue within the penumbra. Thus far, despite promising preclinical studies, clinical trials with neuroprotective drugs in acute ischemic stroke have been disappointing. However, we have been able to identify many of the factors that were responsible for these failures, and better-designed clinical trials with neuroprotective drugs should look more promising. Mild induced hypothermia is another form of neuroprotective treatment that is currently being investigated in acute stroke.

Animals↗

PubMed2003

Acetylsalicylic acid and acetaminophen to combat elevated body temperature in acute ischemic stroke.

BACKGROUND: Because elevated body temperature (BT) in acute ischemic stroke is associated with poor outcome, it is currently recommended to maintain normothermia with antipyretics. Whether this can be achieved by the administration of acetylsalicylic acid (ASA) or acetaminophen is uncertain. METHODS: Over a period of 9 months, patients admitted with acute hemiparetic ischemic stroke were monitored for BT in the first 48 h. When BT rose >37.5 degrees C, patients were treated with either ASA 500 mg intravenously or acetaminophen suppository 1,000 mg. When 6 h later the BT was still or again >37.5 degrees C, patients were further treated with acetaminophen suppository 1,000 mg up to 4 times a day. Primary outcome measure was normothermia (BT </=37.5 degrees C) within respectively 1 and 3 h after intervention. Secondary outcome parameters were any decrease in BT and the mean decrease in BT. RESULTS: Of a total of 132 patients, 63 (48%) developed a BT >37.5 degrees C. The effects of 43 injections of ASA and 89 administrations of acetaminophen were studied. After 1 h, treatment with acetaminophen produced both significantly more reductions in BT and normothermia (respectively in 60 and 20%) than treatment with ASA (respectively in 37 and 5%). At 3 h, both interventions had a similar effect, with normothermia being achieved in only 37-38%. Fever (>38.0 degrees C) and evidence of an infection were related to unresponsiveness to treatment. CONCLUSIONS: In the majority of patients with acute ischemic stroke, ASA and acetaminophen are insufficient for reducing an elevated BT to a state of normothermia.

Acetaminophen↗

PubMed2003

Admitting acute ischemic stroke patients to a stroke care monitoring unit versus a conventional stroke unit: a randomized pilot study.

BACKGROUND AND PURPOSE: Pathophysiological considerations and observational studies indicate that elevated body temperature, hypoxia, hypotension, and cardiac arrhythmias in the acute phase of ischemic stroke may aggravate brain damage and worsen outcome. METHODS: Both units were organized with the same standard care and multidisciplinary approach to nursing and rehabilitation. A blinded observer assessed functional outcome at 3 months with the modified Rankin scale (mRS) and Barthel Index (BI). End points were (1) poor outcome, defined as either mRS > or =4 or BI <60 or the need for institutional care and (2) mortality. RESULTS: Fifty-four patients meeting the inclusion criteria were randomized. The groups were well matched for baseline characteristics, stroke subtype, stroke severity, vascular risk factors, and prognostic factors. Poor outcome was seen in 7 (25.9%) patients in the SCMU group and in 13 (48.1%) in the SU group (P=0.16). Mortality was lower in the SCMU group than in the SU group (1 [3.7%] vs 7 [25.9%]; odds ratio, 0.11 [95% CI, 0.02 to 0.96], P=0.05). CONCLUSIONS: This pilot study suggests that admission of acute stroke patients to an SCMU may reduce mortality and poor outcome. A larger trial is required to confirm these findings.

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