Early goal-directed mobilization in patients with acute type A aortic dissection: A randomized controlled trial

OBJECTIVE

To determine the safety and efficacy of early postoperative mobilization in patients who have undergone surgical repair of acute type A aortic dissection.

DESIGN

Randomized controlled trial.

SETTING

Heart Medical Center.

SUBJECTS

Seventy-seven patients with acute type A aortic dissection were assessed.

INTERVENTION

Patients were randomly allocated into: (1) the control group (usual care) (n  =  38) and (2) the intervention group (early goal-directed mobilization) (n  =  39).

MAIN MEASURES

The primary outcome was the patient's functional status. The secondary outcomes included vital signs, serious adverse events, muscle strength, intensive care unit-acquired weakness, grip strength, duration of mechanical ventilation, length of stay, readmission rate, and health-related quality of life after 3 months.

RESULTS

The vital signs of the patients were within the tolerable ranges during the entire intervention. No serious exercise-related adverse events were observed in the intervention group. The Barthel Index score (P  =  0.013), Medical Research Council score (P  =  0.001), grip strength (P  =  0.001), and health-related quality of life (P  =  0.001) were higher in the intervention group. Intensive care unit acquired weakness (P  =  0.019), duration of mechanical ventilation (P  =  0.002), intensive care unit stay (P  =  0.002), and total length of stay (P  =  0.010) were lower in the intervention group. Patients in the intervention group had a higher physical health-related quality of life (P  =  0.015) at 3 months post-surgery. There was no difference in readmission rates.

CONCLUSIONS

Delivery of early goal-directed mobilization in acute type A aortic dissection was safe and facilitated the recovery of daily living ability, shorter hospital stay, and improved quality of life after discharge.

[The Occurrence and Risk Factors of Stroke Complicated by Venous Thromboembolism]

Objective

To investigate the occurrence and the risk factors of stroke complicated by venous thromboembolism.

Methods

A total of 2709 stroke patients who received treatment at our hospital between January 2018 and June 2021 were selected. The incidence of stroke complicated by venous thromboembolism was analyzed and the risk factors of stroke complicated by venous thromboembolism were investigated by logistic regression.

Results

Among the 2709 stroke patients, 390 had venous thromboembolism, resulting in 14.39% incidence of venous thromboembolism. Among them, 383 patients (14.14%) had deep venous thrombosis (DVT), 4 patients (0.15%) had pulmonary thromboembolism (PTE), and 3 cases (0.11%) had DVT combined with PTE. According to the analysis of unconditional multivariate logistic regression model, age>60 years, concomitant hypertension, concomitant diabetes, bedrest time after admission≥3 days, D-dimer (D-D)≥0.95 mg/mL, triglyceride (TG)≥1.83 mmol/L, Barthel Index (BI) score≤9 points, and Padua score>4 points after admission were independent risk factors for stroke complicated by venous thromboembolism ( P<0.05), while anticoagulation therapy was a protective factor ( P<0.05).

Conclusion

Stroke complicated by venous thromboembolism is associated, to some degree, with age, concomitant hypertension, concomitant diabetes, bedrest time, D-D, TG, BI score, Padua score, and whether anticoagulant therapy is administered or not. Interventions in line with relevant risk factors should be strengthened to effectively reduce the risk of stroke complicated by venous thromboembolism.

Effects of early rehabilitation on functional outcomes in patients after coronary artery bypass graft surgery: a randomized controlled trial

Objective

This study evaluated the effectiveness, feasibility, and safety of early rehabilitation for patients after coronary artery bypass graft (CABG) surgery.

Methods

In a three-arm randomized controlled trial, patients who underwent CABG from January 2018 to June 2018 were randomly assigned to one of three groups: (i) usual care (UC group); (ii) UC + single general ward rehabilitation (SGR group); and (iii) UC + general ward rehabilitation and intensive care unit (ICU) rehabilitation (IGR group). The primary outcome was the Barthel Index scores.

Results

The Barthel Index score for UC (75.3 ± 12.1) was significantly lower than that of both SGR (86.2 ± 14.1) and IGR (89.1 ± 15.5). There was no significant difference in the Barthel Index scores between the SGR and IGR groups. Statistically significant differences were found in the length of ICU stay and post-operative hospital stay but not in post-operative pulmonary complications (PPC) or atrial fibrillation between the three groups.

Conclusion

Early rehabilitation implemented during ICU stay and on the general ward resulted in significant improvements in functional independence and could be a safe part of routine care post-CABG.

Evaluation of APOE Genotype and Ability to Perform Activities of Daily Living Following Aneurysmal Subarachnoid Hemorrhage

Survivors of aneurysmal subarachnoid hemorrhage (aSAH) often experience unfavorable functional outcomes that result in a reduced ability to independently perform activities of daily living. The apolipoprotein E gene ( APOE) encodes for a protein known to facilitate lipid transport and aid in neuronal repair within the central nervous system and to moderate the inflammatory response, making functional variations in this gene likely candidate biomarkers to predict outcomes following aSAH. In the present work, we examined the relationship between APOE genotype and the ability to perform activities of daily living as measured by the Barthel Index (BI) score at 3 months ( n = 298) and 12 months ( n = 288) following aSAH. APOE genotypes were determined using polymerase chain reaction followed by restriction digestion and gel electrophoresis and treated as binary variables depending on the presence or absence of alleles E4 and E2. Multiple logistic regression was used to determine whether APOE genotype accounted for variability in BI score after controlling for age, sex, and severity of clinical condition as measured by the Hunt and Hess classification. No significant association was found between the presence of allele E4 and BI score at 3 ( p = .20) or 12 months ( p = .29) or between the presence of allele E2 and BI score at 3 ( p = .23) or 12 months ( p = .86) after controlling for covariates. The results of this study do not support a relationship between APOE genotype and the ability to perform activities of daily living after aSAH.

Is aura around citicoline fading? A systemic review

Stroke and traumatic brain injury (TBI) are the critical public health and socioeconomic problems throughout the world. At present, citicoline is used as a coadjuvant for the management of acute ischemic stroke (AIS) and TBI in various countries. This systemic review analyzes the beneficial role of citicoline in AIS and TBI. This systemic review is based on "PubMed" and "Science Direct" search results for citicoline role in stroke and TBI. In this systemic review, we included 12 human trials. A meta-analysis was performed on the basis of neurological evaluation, functional evaluation and Glasgow outcome scale, domestic adaptation evaluation outcomes, and cognitive outcome individually. In neurological evaluation, domestic adaptation evaluation, and cognitive outcomes, there was no significant difference in both the citicoline and placebo groups (odds ratio [OR] = 1.04 [0.9-1.2, P = 0.583]; OR = 1.1 [0.94-1.27, P = 0.209]; OR = 0.953 [0.75-1.2, P = 0.691]). In evaluation of functional outcomes, there was significant difference in both groups and OR was 1.18 (1.04-1.34, P = 0.01). Functional outcomes were significantly improved by citicoline, but the positive role of this drug in neurological recovery, domestic adaptation, and cognitive outcomes is still a topic of discussion for future.