Background and Purpose: Whether patients with both lobar and deep cerebral microbleeds (mixed CMB) have advanced cerebral amyloid angiopathy (CAA), hypertensive angiopathy (HA) or both is uncertain. To get insight into the underlying small vessel disease (SVD) associated with mixed CMB, we explored its association with cortical superficial siderosis (cSS), a key marker of CAA and other MRI markers of SVD in patients with intracerebral hemorrhage (ICH).Methods: Of 425 consecutive patients with acute ICH who had received brain MRIs, 260 had ≥1 CMB and were included in the analysis. They were categorized as strictly lobar CMB (suggesting CAA), strictly deep CMB (suggesting HA) or mixed CMB. Clinical and imaging characteristics were compared (1) between the three CMB groups and (2) within mixed CMB patients according to the symptomatic ICH location.Results: Overall, 111 (26%) patients had mixed CMB. Compared to strictly lobar CMB (n = 111) and strictly deep CMB (n = 38), patients with mixed CMB had a more severe burden of lacune, white matter hyperintensities and CMB. cSS was observed in 24.3% of patients with mixed CMB compared to 44.1% in strictly lobar CMB and 10.5% in strictly deep CMB (p < 0.0001). Among patients with mixed CMB, 44 (39.6%) had a lobar symptomatic ICH and 67 (60.4%) had a non-lobar ICH. Patients with non-lobar ICH were more likely to have hypertension, whereas those with lobar ICH were more likely to have cSS and chronic lobar ICH and had higher ratio lobar CMB count/total CMB count.Conclusions: Mixed CMB is frequently encountered in patients with ICH and appears as a heterogeneous group, suggesting that both CAA and HA may be contributing to mixed CMB. Neuroimaging markers including ICH location, cSS, and CMB distribution may indicate the predominant underlying vasculopathy, with potential prognostic implications.
Background and aims: Cerebral small vessel disease (CSVD) is the main cause of intracerebral Hemorrhage (ICH) in older individuals but has not been systematically studied in younger people. We aimed to evaluate the prevalence and characteristics of CSVD in young adults with symptomatic ICH. Methods: We conducted a cohort study of consecutive adults aged 18–50 years with non-traumatic ICH. All patients were evaluated with brain and vascular imaging. Using validated imaging markers (cerebral microbleeds, white matter hyperintensities and/or lacunes), patients were categorized as having CSVD-related ICH or non-CSVD-related ICH. Factors associated with CSVD were evaluated using multivariable analyses. CSVD subtypes were characterized using pre-specified criteria. Results: Of 146 young adults with ICH (mean age 37.7), CSVD was present in 41 patients (28.1%; 95% CI 21.0–36.1). In multivariable analysis, older age, male sex and hypertension were independently associated with the presence of CSVD. Deep perforator arteriopathy (48.8%) and mixed CSVD (31.7%) were the most common CSVD subtypes. Conclusion: Our results suggest that CSVD is a frequent cause of ICH in young adults and provide new insights into the characterization of the disease. These findings may have important implications since the treatment and management differ from other causes of ICH.
Introduction:The development of antibiotic resistant bacteria has resulted in treatment failure for the current antibiotic regimen against many bacteria. A corresponding decrease in the development of new antibiotic therapies has highlighted the urgent need for the discovery of new antibiotics. An examination of 'superfoods' is an attractive option due to the high antioxidant capacities and beneficial secondary compounds reported in many 'superfoods'. This study was undertaken to test kale and spirulina extracts for the ability to inhibit the growth of a panel of bacterial pathogens of human importance. Methods: Commercially sourced kale and spirulina powders were extracted and tested for antimicrobial activity using modified disc diffusion and liquid dilution MIC methods. Toxicity was evaluated using an Artemia franciscana nauplii bioassay. Results: The methanolic and aqueous extracts of kale and spirulina displayed noteworthy growth inhibitory activity against P. mirabilis. The aqueous spirulina extract was a particularly good inhibitor of P. mirabilis, with MIC values as low as 220μg/mL. In contrast, all extracts were ineffective or of low inhibitory activity against all other bacteria tested. All extracts were non-toxic in the Artemia nauplii bioassay, confirming their suitability as natural antibacterial therapies. Conclusion: These studies indicate that aqueous kale and spirulina extracts are promising inhibitors of P. mirabilis growth and may be useful in the prevention and treatment of rheumatoid arthritis, as well as other diseases caused by that bacterium.
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