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Chen S, Cai D, Lai Y, Zhang Y, He J, Zhou L, Sun H. Risk factors and outcomes for refeeding syndrome in acute ischaemic stroke patients. Nutr Diet 2024. [PMID: 38738826 DOI: 10.1111/1747-0080.12872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/24/2023] [Accepted: 03/04/2024] [Indexed: 05/14/2024]
Abstract
AIM Patients with acute ischaemic stroke are more likely to develop refeeding syndrome due to increased need for nutritional support when suffering alterations of consciousness and impairment of swallowing. This study aimed to evaluate the incidence, risk factors and outcomes of refeeding syndrome in stroke patients. METHODS This was a retrospective observational study, using the prospective stroke database from hospital, included all consecutive acute ischaemic stroke patients who received enteral nutrition for more than 72 h from 1 January 2020 and 31 December 2022. Refeeding syndrome was defined as occurrence of new-onset hypophosphataemia within 72 h after enteral feeding. Multiple logistic regression analysis was conducted to evaluate risk factors and relationships between refeeding syndrome and stroke outcomes. RESULTS 338 patients were included in the study. 50 patients (14.8%) developed refeeding syndrome. Higher scores on National Institutes of Health Stroke Scale and Nutritional Risk Screening 2002, albumin <30 g/L and BMI <18.5 kg/m2 were risk factors for refeeding syndrome. Moreover, refeeding syndrome was independently associated with a 3-month modified Rankin Scale score of >2 and 6-month mortality. CONCLUSIONS Refeeding syndrome was common in stroke patients and higher baseline National Institutes of Health Stroke Scale, higher Nutritional Risk Screening 2002, albumin <30 g/L and BMI <18.5 kg/m2 were independent risk factors of refeeding syndrome. Occurrence of refeeding syndrome was significantly associated with higher 3-month modified Rankin Scale and 6-month mortality.
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Affiliation(s)
- Shumin Chen
- Department of Neurology, Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Affiliated Hospital of Traditional Chinese University of Guangzhou, Foshan, China
| | - Dongchun Cai
- Department of Neurology, Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Affiliated Hospital of Traditional Chinese University of Guangzhou, Foshan, China
| | - Yuzheng Lai
- Department of Neurology, Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Affiliated Hospital of Traditional Chinese University of Guangzhou, Foshan, China
| | - Yongfang Zhang
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jianfeng He
- Department of Neurology, Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Affiliated Hospital of Traditional Chinese University of Guangzhou, Foshan, China
| | - Liang Zhou
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hao Sun
- Department of Neurology, Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Affiliated Hospital of Traditional Chinese University of Guangzhou, Foshan, China
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Huo S, Gao J, Lv Q, Xie M, Wang H, Zhang X, Xie Y, Wu M, Liu R, Liu X, Yuan K, Ye R. Trajectories of stroke severity and functional outcomes after endovascular treatment in ischemic stroke: A post hoc analysis of a randomized controlled trial. Clin Neurol Neurosurg 2024; 239:108248. [PMID: 38507987 DOI: 10.1016/j.clineuro.2024.108248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 02/26/2024] [Accepted: 03/15/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND The trajectory of early neurological changes in patients with acute ischemic stroke has been understudied. This study aimed to investigate the association between longitudinal trajectories of stroke severity and 90-day functional outcomes in patients with acute ischemic stroke receiving endovascular treatment. METHODS We enrolled patients from a prospective, multicenter, randomized controlled trial. The stroke severity was assessed with the National Institute of Health Stroke Scale at the pre-procedure, 24 hours, and seven days after the procedure. Group-based trajectory modeling (GBTM) was used to identify trajectories of stroke severity. Multivariable logistic regression was performed to explore the association between stroke severity markers and 90-day functional outcomes. RESULTS Of 218 enrolled patients, 127 (58.3%) had poor functional outcomes at 90 days. We identified three trajectories of stroke severity in the GBTM: stable symptom (38.1%), symptom deterioration (17.0%), and symptom improvement (44.9%). In multivariable analyses, trajectories of stroke severity were associated with an increased risk of poor functional outcomes (symptom improvement versus symptom deterioration: odds ratio, 0.007; 95% confidence interval, 0.001-0.040; P <0.001). Reclassification indexes revealed that trajectories of stroke severity would increase the predictive ability for poor functional outcomes at 90 days. CONCLUSION After endovascular treatment, patients would follow one of three distinct trajectories of stroke severity. Symptom deterioration trajectory was associated with an increased risk of poor functional outcomes at 90 days. TRIAL REGISTRATION NUMBER NCT04973332.
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Affiliation(s)
- Shuxian Huo
- Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210002, China
| | - Jie Gao
- Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210002, China
| | - Qiushi Lv
- Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210002, China
| | - Mengdi Xie
- Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing 210002, China
| | - Huaiming Wang
- Department of Neurology, The 80th Group Army Hospital of The People's Liberation Army, Weifang, Shandong 261021, China
| | - Xiaohao Zhang
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210000, China
| | - Yi Xie
- Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210002, China
| | - Min Wu
- Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing 210002, China
| | - Rui Liu
- Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210002, China; Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing 210002, China
| | - Xinfeng Liu
- Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210002, China; Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing 210002, China
| | - Kang Yuan
- Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210002, China.
| | - Ruidong Ye
- Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210002, China; Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing 210002, China
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Fernandes M, Westover MB, Singhal AB, Zafar SF. Automated Extraction of Stroke Severity from Unstructured Electronic Health Records using Natural Language Processing. medRxiv 2024:2024.03.08.24304011. [PMID: 38559062 PMCID: PMC10980121 DOI: 10.1101/2024.03.08.24304011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND Multi-center electronic health records (EHR) can support quality improvement initiatives and comparative effectiveness research in stroke care. However, limitations of EHR-based research include challenges in abstracting key clinical variables from non-structured data at scale. This is further compounded by missing data. Here we develop a natural language processing (NLP) model that automatically reads EHR notes to determine the NIH stroke scale (NIHSS) score of patients with acute stroke. METHODS The study included notes from acute stroke patients (>= 18 years) admitted to the Massachusetts General Hospital (MGH) (2015-2022). The MGH data were divided into training (70%) and hold-out test (30%) sets. A two-stage model was developed to predict the admission NIHSS. A linear model with the least absolute shrinkage and selection operator (LASSO) was trained within the training set. For notes in the test set where the NIHSS was documented, the scores were extracted using regular expressions (stage 1), for notes where NIHSS was not documented, LASSO was used for prediction (stage 2). The reference standard for NIHSS was obtained from Get With The Guidelines Stroke Registry. The two-stage model was tested on the hold-out test set and validated in the MIMIC-III dataset (Medical Information Mart for Intensive Care-MIMIC III 2001-2012) v1.4, using root mean squared error (RMSE) and Spearman correlation (SC). RESULTS We included 4,163 patients (MGH = 3,876; MIMIC = 287); average age of 69 [SD 15] years; 53% male, and 72% white. 90% patients had ischemic stroke and 10% hemorrhagic stroke. The two-stage model achieved a RMSE [95% CI] of 3.13 [2.86-3.41] (SC = 0.90 [0.88-0. 91]) in the MGH hold-out test set and 2.01 [1.58-2.38] (SC = 0.96 [0.94-0.97]) in the MIMIC validation set. CONCLUSIONS The automatic NLP-based model can enable large-scale stroke severity phenotyping from EHR and therefore support real-world quality improvement and comparative effectiveness studies in stroke.
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Affiliation(s)
- Marta Fernandes
- Department of Neurology, Massachusetts General Hospital (MGH), Boston, Massachusetts, United States
| | - M. Brandon Westover
- Department of Neurology, Beth Israel Deaconess Medical Center (BIDMC), Boston, Massachusetts, United States
| | - Aneesh B. Singhal
- Department of Neurology, Massachusetts General Hospital (MGH), Boston, Massachusetts, United States
| | - Sahar F. Zafar
- Department of Neurology, Massachusetts General Hospital (MGH), Boston, Massachusetts, United States
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Karn AK, Narayan S, Qavi A, Maurya PKK, Singh A, Kulshreshtha D. Sequential carotid Doppler study in acute stroke and its clinical correlation: A prospective study. J Neurosci Rural Pract 2024; 15:42-46. [PMID: 38476433 PMCID: PMC10927035 DOI: 10.25259/jnrp_342_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/31/2023] [Indexed: 03/14/2024] Open
Abstract
Objectives Resistive index (RI) and pulsatility index (PI) assessed on carotid Doppler assess the hemodynamic status of cranial vasculature. They are related to the severity of stroke and help determine the overall outcome. This study was done to compare the hospital stay and stroke severity with RI and PI of both internal carotid arteries. Materials and Methods Patients >18 years of age presenting within 48 h of anterior circulation stroke (either ischemic or hemorrhagic) were included. They were divided into two groups based on their length of stay (LOS). They were assessed clinically on days 1, 3, and 5, and underwent a carotid Doppler study on the same days. The Doppler parameters were correlated with the LOS and stroke severity for possible associations. Results One hundred and one patients were included. Forty-seven patients had a favorable outcome based on LOS. In this group, significant decrease in RI and PI scores was seen from days 1 to 3. In patients with unfavorable outcome, there was a significant increase in PI on days 1-3 and days 1-5. The National Institutes of Health Stroke Scale decreased significantly from days 1 to 5 in favorable group. Conclusion For those with an unfavorable outcome and prolonged LOS, PI continues to increase suggesting a failure of autoregulation. Carotid Doppler can be a simple bedside tool to predict outcome in patients with acute stroke.
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Affiliation(s)
- Ashutosh Kumar Karn
- Department of Neurology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Shamrendra Narayan
- Department of Radiodiagnosis, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Abdul Qavi
- Department of Neurology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Pradeep Kumar Kumar Maurya
- Department of Neurology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ajai Singh
- Department of Neurology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Dinkar Kulshreshtha
- Department of Neurology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Waddell KJ, Myers LJ, Perkins AJ, Sico JJ, Sexson A, Burrone L, Taylor S, Koo B, Daggy JK, Bravata DM. Development and validation of a model predicting mild stroke severity on admission using electronic health record data. J Stroke Cerebrovasc Dis 2023; 32:107255. [PMID: 37473533 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 07/10/2023] [Accepted: 07/13/2023] [Indexed: 07/22/2023] Open
Abstract
OBJECTIVE Initial stroke severity is a potent modifier of stroke outcomes but this information is difficult to obtain from electronic health record (EHR) data. This limits the ability to risk-adjust for evaluations of stroke care and outcomes at a population level. The purpose of this analysis was to develop and validate a predictive model of initial stroke severity using EHR data elements. METHODS This observational cohort included individuals admitted to a US Department of Veterans Affairs hospital with an ischemic stroke. We extracted 65 independent predictors from the EHR. The primary analysis modeled mild (NIHSS score 0-3) versus moderate/severe stroke (NIHSS score ≥4) using multiple logistic regression. Model validation included: (1) splitting the cohort into derivation (65%) and validation (35%) samples and (2) evaluating how the predicted stroke severity performed in regard to 30-day mortality risk stratification. RESULTS The sample comprised 15,346 individuals with ischemic stroke (n = 10,000 derivation; n = 5,346 validation). The final model included 15 variables and correctly classified 70.4% derivation sample patients and 69.4% validation sample patients. The areas under the curve (AUC) were 0.76 (derivation) and 0.76 (validation). In the validation sample, the model performed similarly to the observed NIHSS in terms of the association with 30-day mortality (AUC: 0.72 observed NIHSS, 0.70 predicted NIHSS). CONCLUSIONS EHR data can be used to construct a surrogate measure of initial stroke severity. Further research is needed to better differentiate moderate and severe strokes, enhance stroke severity classification, and how to incorporate these measures in evaluations of stroke care and outcomes.
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Affiliation(s)
- Kimberly J Waddell
- VA Center for Health Equity Research and Promotion (CHERP), Crescenz VA Medical Center; Philadelphia, PA, USA; Department of Physical Medicine and Rehabilitation, Perelman School of Medicine, University of Pennsylvania; Philadelphia, PA, USA; Leonard Davis Institute for Health Economics, University of Pennsylvania; Philadelphia, PA, USA.
| | - Laura J Myers
- VA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center; Indianapolis, IN, USA; Department of Medicine, Indiana University School of Medicine; Indianapolis, IN, USA; Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Expanding Expertise Through E-health Network Development (EXTEND) Quality Enhancement Research Initiative (QUERI), Indianapolis, IN, USA; Regenstrief Institute; Indianapolis, IN, USA
| | - Anthony J Perkins
- VA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center; Indianapolis, IN, USA; Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Expanding Expertise Through E-health Network Development (EXTEND) Quality Enhancement Research Initiative (QUERI), Indianapolis, IN, USA; Department of Biostatistics and Health Data Science, Indiana University School of Medicine & Fairbanks School of Public Health, Indianapolis, IN, USA
| | - Jason J Sico
- Neurology Service, VA Connecticut Healthcare System; West Haven, CT, USA; Departments of Neurology and Internal Medicine, Yale School of Medicine; New Haven, CT, USA; Pain Research, Informatics, and Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System; West Haven, CT, USA
| | - Ali Sexson
- VA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center; Indianapolis, IN, USA
| | - Laura Burrone
- Pain Research, Informatics, and Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System; West Haven, CT, USA
| | - Stanley Taylor
- VA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center; Indianapolis, IN, USA; Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Expanding Expertise Through E-health Network Development (EXTEND) Quality Enhancement Research Initiative (QUERI), Indianapolis, IN, USA
| | - Brian Koo
- Neurology Service, VA Connecticut Healthcare System; West Haven, CT, USA; Departments of Neurology and Internal Medicine, Yale School of Medicine; New Haven, CT, USA; Pain Research, Informatics, and Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System; West Haven, CT, USA
| | - Joanne K Daggy
- VA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center; Indianapolis, IN, USA; Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Expanding Expertise Through E-health Network Development (EXTEND) Quality Enhancement Research Initiative (QUERI), Indianapolis, IN, USA; Department of Biostatistics and Health Data Science, Indiana University School of Medicine & Fairbanks School of Public Health, Indianapolis, IN, USA
| | - Dawn M Bravata
- VA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center; Indianapolis, IN, USA; Department of Medicine, Indiana University School of Medicine; Indianapolis, IN, USA; Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Expanding Expertise Through E-health Network Development (EXTEND) Quality Enhancement Research Initiative (QUERI), Indianapolis, IN, USA; Department of Neurology, Indiana University School of Medicine; Indianapolis, IN, USA; Regenstrief Institute; Indianapolis, IN, USA
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Lim SH, Guek TY, Woon FP, Tay DD, Ho SS, Ng SC, De Silva DA. National Institutes of Health Stroke Scale: comparison of original and modified versions for Singapore culture. Singapore Med J 2023; 64:563-566. [PMID: 34600450 PMCID: PMC10564095 DOI: 10.11622/smedj.2021126] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 01/06/2021] [Indexed: 11/18/2022]
Abstract
Introduction The National Institutes of Health Stroke Scale (NIHSS), originally designed in the United States of America, contains items on dysphasia and dysarthria that are deemed culturally unsuitable for the Singapore context. We compared the error rates of dysphasia objects, dysphasia phrases and dysarthria words between the original and alternative items in a cohort of Singaporean subjects without dysphasia or dysarthria. Methods In this prospective study, 140 English-speaking Singaporean subjects without impairments of dysphasia or dysarthria had an assessment of NIHSS items 9 and 10 using the original and alternative items. Paired analyses were conducted for comparison of error rates. Results The error rates were high for four original dysphasia objects (Hammock: 62.9%, Cactus: 38.6%, Feather: 23.6%, Glove: 20.7%) and significantly lower for alternative items (Snail: 5%, Horse: 1.4%, Hanger: 1.4%, Car: 0%) (P < 0.001). For dysphasia phrases and dysarthria words, the error rates were low and there were no differences in error rates between the original and alternative items. Conclusion There are cultural issues with several dysphasia objects in the original NIHSS as evidenced by the high error rates, which were lowered with more culturally suitable alternatives. This study formed a basis to derive a more suitable version of the NIHSS for English-speaking subjects in Singapore.
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Affiliation(s)
- Shu Han Lim
- Duke-NUS Medical School, Singapore
- Department of Neurology, National Neuroscience Institute (SGH Campus), Singapore
| | - Tai Yan Guek
- Department of Neurology, National Neuroscience Institute (SGH Campus), Singapore
| | - Fung Peng Woon
- Department of Neurology, Singapore General Hospital, Singapore
| | | | - Shu Swen Ho
- Department of Neurology, National Neuroscience Institute (SGH Campus), Singapore
| | - Szu Chyi Ng
- Department of Neurology, Singapore General Hospital, Singapore
| | - Deidre Anne De Silva
- Department of Neurology, National Neuroscience Institute (SGH Campus), Singapore
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Senda J, Ito K, Kotake T, Mizuno M, Kishimoto H, Yasui K, Nakagawa-Senda H, Katsuno M, Nishida Y, Sobue G. Association between National Institutes of Health Stroke Scale and Functional Independence Measure scores in patients with ischemic stroke from convalescent rehabilitation outcomes. Nagoya J Med Sci 2023; 85:428-443. [PMID: 37829489 PMCID: PMC10565594 DOI: 10.18999/nagjms.85.3.428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 08/03/2022] [Indexed: 10/14/2023]
Abstract
We investigated the associations among neurological severity, activities of daily living (ADLs), and clinical factors in patients with ischemic stroke in convalescent rehabilitation outcome. The study sample included 723 patients with ischemic stroke (484 men and 239 women; mean age, 73.2 ± 8.5 years) for inpatient convalescent rehabilitation. National Institutes of Health Stroke Scale (NIHSS) was used to measure the neurological severity, and Functional Independence Measure (FIM) was used to assess ADLs at discharge. Leukoaraiosis was graded based on periventricular hyperintensity (PVH) and deep white matter hyperintensity (DWMH) on magnetic resonance imaging. The correlations between NIHSS scores and total FIM scores were significant but relatively mild (r = -0.684, P < 0.001). Multiple regression analysis revealed that age and PVH grade significantly decreased their total FIM scores and affected the discrepancies between NIHSS scores at discharge (P < 0.001), but DWMH scores did not affect these results. Factors such as positive history of heart disease (P = 0.008) and bilateral infarction (P = 0.038) additionally decreased their total FIM scores and affected the discrepancies between NIHSS scores. These findings suggest that age, PVH, history of heart disease positive, and bilateral infarction in patients with ischemic stroke affected their performance of ADLs and the discrepancies between their neurological severities in convalescent rehabilitation outcomes, probably because the pathophysiological background of leukoaraiosis and these factors strongly decrease their ADL performance in post-phase ischemic stroke.
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Affiliation(s)
- Joe Senda
- Department of Neurology and Rehabilitation, Komaki City Hospital, Komaki, Japan
- Division of Rehabilitation, Kami-iida Rehabilitation Hospital, Nagoya, Japan
| | - Keiichi Ito
- Division of Rehabilitation, Kami-iida Rehabilitation Hospital, Nagoya, Japan
| | - Tomomitsu Kotake
- Division of Rehabilitation, Kami-iida Rehabilitation Hospital, Nagoya, Japan
- Department of Physiology, Graduate School of Health Sciences, Toyohashi Sozo University, Toyohashi, Japan
| | - Masanori Mizuno
- Division of Rehabilitation, Kami-iida Rehabilitation Hospital, Nagoya, Japan
| | - Hideo Kishimoto
- Division of Rehabilitation, Kami-iida Rehabilitation Hospital, Nagoya, Japan
| | - Keizo Yasui
- Department of Neurology, Japanese Red Cross Aichi Medical Center Nagoya Second Hospital, Nagoya, Japan
| | - Hiroko Nakagawa-Senda
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Masahisa Katsuno
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshihiro Nishida
- Division of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Gen Sobue
- Graduate School of Medicine, Aichi Medical University, Nagakute, Japan
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Amini M, Eijkenaar F, Lingsma HF, den Hartog SJ, Olthuis SGH, Martens J, van der Worp B, van Zwam W, van der Hoorn A, Roosendaal SD, Roozenbeek B, Dippel D, van Leeuwen N. Validity of Early Outcomes as Indicators for Comparing Hospitals on Quality of Stroke Care. J Am Heart Assoc 2023; 12:e027647. [PMID: 37042276 DOI: 10.1161/jaha.122.027647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
Background Insight into outcome variation between hospitals could help to improve quality of care. We aimed to assess the validity of early outcomes as quality indicators for acute ischemic stroke care for patients treated with endovascular therapy (EVT). Methods and Results We used data from the MR CLEAN (Multicenter Randomized Controlled Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry, a large multicenter prospective cohort study including 3279 patients with acute ischemic stroke undergoing EVT. Random effect linear and proportional odds regression were used to analyze the effect of case mix on between-hospital differences in 2 early outcomes: the National Institutes of Health Stroke Scale (NIHSS) score at 24 to 48 hours and the expanded thrombolysis in cerebral infarction score. Between-hospital variation in outcomes was assessed using the variance of random hospital effects (tau2). In addition, we estimated the correlation between hospitals' EVT-patient volume and (case-mix-adjusted) outcomes. Both early outcomes and case-mix characteristics varied significantly across hospitals. Between-hospital variation in the expanded thrombolysis in cerebral infarction score was not influenced by case-mix adjustment (tau 2=0.17 in both models). In contrast, for the NIHSS score at 24 to 48 hours, case-mix adjustment led to a decrease in variation between hospitals (tau 2 decreases from 0.19 to 0.17). Hospitals' EVT-patient volume was strongly correlated with higher expanded thrombolysis in cerebral infarction scores (r=0.48) and weakly with lower NIHSS score at 24 to 48 hours (r=0.15). Conclusions Between-hospital variation in NIHSS score at 24 to 48 hours is significantly influenced by case-mix but not by patient volume. In contrast, between-hospital variation in expanded thrombolysis in cerebral infarction score is strongly influenced by EVT-patient volume but not by case-mix. Both outcomes may be suitable for comparing hospitals on quality of care, provided that adequate adjustment for case-mix is applied for NIHSS score.
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Affiliation(s)
- Marzyeh Amini
- Department of Public Health Erasmus University Medical Center Rotterdam The Netherlands
| | - Frank Eijkenaar
- Erasmus School of Health Policy and Management Erasmus University Rotterdam Rotterdam The Netherlands
| | - Hester F Lingsma
- Department of Public Health Erasmus University Medical Center Rotterdam The Netherlands
| | - Sanne J den Hartog
- Department of Public Health Erasmus University Medical Center Rotterdam The Netherlands
- Department of Radiology and Nuclear Medicine Erasmus University Medical Center Rotterdam The Netherlands
- Department of Neurology Erasmus University Medical Center Rotterdam The Netherlands
| | - Susanne G H Olthuis
- Department of Neurology Maastricht University Medical Center and School for Cardiovascular Diseases Maastricht The Netherlands
| | - Jasper Martens
- Department of Radiology Rijnstate Arnhem The Netherlands
| | - Bart van der Worp
- Department of Neurology and Neurosurgery, Brain Center University Medical Center Utrecht, Utrecht University Utrecht The Netherlands
| | - Wim van Zwam
- Department of Neurology Maastricht University Medical Center and School for Cardiovascular Diseases Maastricht The Netherlands
- Department of Radiology and Nuclear Medicine Maastricht University Medical Center, Cardiovascular Research Institute Maastricht Maastricht The Netherlands
| | - Anouk van der Hoorn
- Department of Radiology, Medical Imaging Center University Medical Center Groningen Groningen The Netherlands
| | - Stefan D Roosendaal
- Department of Radiology and Nuclear Medicine Amsterdam University Medical Center Amsterdam The Netherlands
| | - Bob Roozenbeek
- Department of Radiology and Nuclear Medicine Erasmus University Medical Center Rotterdam The Netherlands
- Department of Neurology Erasmus University Medical Center Rotterdam The Netherlands
| | - Diederik Dippel
- Department of Neurology Erasmus University Medical Center Rotterdam The Netherlands
| | - Nikki van Leeuwen
- Department of Public Health Erasmus University Medical Center Rotterdam The Netherlands
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Claus JJ, Berghout BBP, Ikram MK, Wolters FJ. Validity of stroke severity assessment using medical records in a population-based cohort. J Stroke Cerebrovasc Dis 2023; 32:106992. [PMID: 36801651 DOI: 10.1016/j.jstrokecerebrovasdis.2023.106992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 01/05/2023] [Accepted: 01/10/2023] [Indexed: 02/20/2023] Open
Abstract
OBJECTIVES Stroke severity is an important prognostic indicator of morbidity and mortality, but often not recorded outside of specialised stroke centres. We aimed to develop a scoring rule and validate standardised assessment of the National Institutes of Health Stroke Scale (NIHSS) from medical records. METHODS We developed a standardised assessment of the NIHSS from medical records. Four trained raters independently assessed the charts of 100 patients with first-ever stroke, randomly selected from the population-based Rotterdam Study cohort. Interrater agreement was determined using the intraclass correlation coefficient (ICC), and Fleiss' kappa for major versus minor stroke. We validated the scoring method against 29 prospective, clinical NIHSS ratings, using Kendall's tau and Cohen's kappa. RESULTS Of 100 included patients with stroke (mean age 80 years, 62% women), 71 (71%) were admitted to hospital and 9 (9%) were seen in outpatient clinic, whereas 20 (20%) were treated exclusively by their general practitioner or nursing home physician. Interrater agreement for retrospective, chart-based NIHSS ratings was excellent when assessed continuously (ICC: 0.90), and for minor versus major stroke (for NIHSS>3: κ=0.79, NIHSS>5: κ=0.78). Interrater agreement was good both for hospital-based and out-of-hospital settings (ICC: 0.97 and 0.75 respectively). Overall, assessment from medical records was in excellent agreement with prospective NIHSS ratings (τ=0.83; NIHSS>3: κ=0.93, and NIHSS>5: κ=0.93). However, for severe stroke (NIHSS>10) retrospective assessment tended to underestimate severity by 1-3 points on the NIHSS, which was accompanied by a somewhat lower interrater agreement for those more severe cases (NIHSS>10: κ=0.62). CONCLUSIONS Assessment of stroke severity according to the NIHSS on the basis of medical records is feasible and reliable in population-based cohorts of patients with stroke. These findings facilitate more individualised risk estimates in observational studies that lack prospective ascertainment of stroke severity.
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Affiliation(s)
- Jacqueline J Claus
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands; Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands; Department of Neurology, Erasmus MC, Rotterdam, the Netherlands
| | - Brian B P Berghout
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands; Department of Neurology, Erasmus MC, Rotterdam, the Netherlands
| | - M Kamran Ikram
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands; Department of Neurology, Erasmus MC, Rotterdam, the Netherlands
| | - Frank J Wolters
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands; Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands.
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10
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Tarvonen-Schröder S, Niemi T, Koivisto M. Inpatient Rehabilitation After Acute Severe Stroke: Predictive Value of the National Institutes of Health Stroke Scale Among Other Potential Predictors for Discharge Destination. Adv Rehabil Sci Pract 2023; 12:27536351231157966. [PMID: 37223636 PMCID: PMC10201155 DOI: 10.1177/27536351231157966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/25/2023] [Indexed: 05/25/2023]
Abstract
Background Research focusing on predictors for discharge destination after rehabilitation of inpatients recovering from severe stroke is scarce. The predictive value of rehabilitation admission NIHSS score among other potential predictors available on admission to rehabilitation has not been studied. Aim The aim of this retrospective interventional study was to determine the predictive accuracy of 24 hours and rehabilitation admission NIHSS scores among other potential socio-demographic, clinical and functional predictors for discharge destination routinely collected on admission to rehabilitation. Material and Methods On a university hospital specialized inpatient rehabilitation ward 156 consecutive rehabilitants with 24 hours NIHSS score ⩾15 were recruited. On admission to rehabilitation, routinely collected variables potentially associated with discharge destination (community vs institution) were analyzed using logistic regression. Results 70 (44.9%) of rehabilitants were discharged to community, and 86 (55.1%) were discharged to institutional care. Those discharged home were younger and more often still working, had less often dysphagia/tube feeding or DNR decision in the acute phase, shorter time from stroke onset to rehabilitation admission, less severe impairment (NIHSS score, paresis, neglect) and disability (FIM score, ambulatory ability) on admission, and faster and more significant functional improvement during the in-stay than those institutionalized. Conclusion The most influential independent predictors for community discharge on admission to rehabilitation were lower admission NIHSS score, ambulatory ability and younger age, NIHSS being the most powerful. The odds of being discharged to community decreased with 16.1% for every 1 point increase in NIHSS. The 3-factor model explained 65.7% of community discharge and 81.9% of institutional discharge, the overall predictive accuracy being 74.7%. The corresponding figures for admission NIHSS alone were 58.6%, 70.9% and 65.4%.
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Affiliation(s)
- Sinikka Tarvonen-Schröder
- Neurocenter, Turku University Hospital,
Turku, Finland
- Department of Clinical Neurosciences,
University of Turku, Turku, Finland
| | - Tuuli Niemi
- Neurocenter, Turku University Hospital,
Turku, Finland
- Department of Clinical Neurosciences,
University of Turku, Turku, Finland
- Department of Expert Services, Turku
University Hospital, Turku, Finland
| | - Mari Koivisto
- Neurocenter, Turku University Hospital,
Turku, Finland
- Department of Clinical Neurosciences,
University of Turku, Turku, Finland
- Department of Biostatistics, University
of Turku, Turku, Finland
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11
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Pawluk H, Kołodziejska R, Grześk G, Kozakiewicz M, Woźniak A, Pawluk M, Kosinska A, Grześk M, Wojtasik J, Kozera G. Selected Mediators of Inflammation in Patients with Acute Ischemic Stroke. Int J Mol Sci 2022; 23:ijms231810614. [PMID: 36142524 PMCID: PMC9500922 DOI: 10.3390/ijms231810614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/07/2022] [Accepted: 09/10/2022] [Indexed: 11/16/2022] Open
Abstract
During a stroke, a series of biochemical and metabolic changes occur which eventually lead to the death of cells by necrosis or apoptosis. This is a multi-stage process involving oxidative stress and an inflammatory response from the first signs of occlusion of a blood vessel until the late stages of regeneration and healing of ischemic tissues. The purpose of the research was to assess the concentration of pro-inflammatory cytokines IL-6 and TNF-α in the blood serum of patients with ischemic stroke (AIS) and to investigate their role as new markers in predicting functional prognosis after thrombolytic therapy. The researches have shown that the concentrations of the measured biomarkers were higher compared to the control group. Serum levels of IL-6 and THF-α before the initiation of intravenous thrombolysis were lower in the subgroup of patients with a favourable functional result (mRS: 0−2 pts) compared to the group of patients with an unfavourable functional result (mRS: 3−6 pts). A positive correlation was found between the concentration of IL-6 and TNF-α in patients with AIS during <4.5 h and on one day after the onset of stroke, which means that the concentration of IL-6 increases with the increase in TNF-α concentration. It has also been shown that higher levels of IL-6 in the acute phase of stroke and on the first and seventh days, and TNF-α during onset, were associated with poorer early and late prognosis in patients treated with intravenous thrombolysis. A relationship was found between the level of IL-6 and TNF-α in the subacute AIS and the severity of the neurological deficit. It has been shown that the investigated biomarkers may be a prognostic factor in the treatment of thrombolytic AIS.
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Affiliation(s)
- Hanna Pawluk
- Department of Medical Biology and Biochemistry, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Karłowicza 24, 85–092 Bydgoszcz, Poland
- Correspondence: (H.P.); (R.K.)
| | - Renata Kołodziejska
- Department of Medical Biology and Biochemistry, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Karłowicza 24, 85–092 Bydgoszcz, Poland
- Correspondence: (H.P.); (R.K.)
| | - Grzegorz Grześk
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Ujejskiego 75, 85-168 Bydgoszcz, Poland
| | - Mariusz Kozakiewicz
- Division of Biochemistry and Biogerontology, Department of Geriatrics, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Dębowa 3, 85-626 Bydgoszcz, Poland
| | - Alina Woźniak
- Department of Medical Biology and Biochemistry, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Karłowicza 24, 85–092 Bydgoszcz, Poland
| | - Mateusz Pawluk
- Department of Medical Biology and Biochemistry, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Karłowicza 24, 85–092 Bydgoszcz, Poland
| | - Agnieszka Kosinska
- Centre for Languages & International Education, University College London, 26 Bedford Way, London WC1H 0AP, UK
| | - Magdalena Grześk
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Ujejskiego 75, 85-168 Bydgoszcz, Poland
| | - Jakub Wojtasik
- Statistical Analysis Centre, Nicolaus Copernicus University in Toruń, Chopin 12/18, 87-100 Toruń, Poland
| | - Grzegorz Kozera
- Medical Stimulation Centre, Medical University of Gdańsk, Dębowa 25, 80-204 Gdańsk, Poland
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12
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Zhang WW, Xin J, Zhang GY, Zhai QJ, Zhang HM, Wu CS. Efficacy of Guhong injection versus Butylphthalide and Sodium Chloride Injection for mild ischemic stroke: A multicenter controlled study. World J Clin Cases 2022; 10:7265-7274. [PMID: 36157984 PMCID: PMC9353891 DOI: 10.12998/wjcc.v10.i21.7265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/07/2022] [Accepted: 05/28/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Most studies on Guhong injection have involved a single center with a small sample size, and the level of clinical evidence is low.
AIM To assess the safety and efficacy of Guhong injection for mild ischemic stroke (IS).
METHODS A total of 399 IS patients treated at six hospitals from August 2018 to August 2019 were retrospectively analyzed. The patients were given Guhong injection (experimental group) or Butylphthalide and Sodium Chloride Injection (control group). Changes in National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) scores were observed before treatment and at 1, 2, and 3 wk after treatment in each group. The efficacy and safety of Guhong injection for IS were assessed. Other medications taken by the patients were confounding factors for efficacy assessment. These factors were controlled by propensity score matching, and the results were further analyzed based on the matching.
RESULTS The marked response rates at three follow-up visits were 64.64%, 74.7%, and 66.7% in the experimental group, and 48.26%, 45.4%, and 22.2% in the control group. The marked response rates increased significantly in the experimental group compared with the control group (P < 0.05). The overall response rate at the first visit (days 7 ± 2) did not differ significantly between the two groups, but differed significantly at the second (days 14 ± 2) and third visits (days 21 ± 3) (P < 0.05). The proportion of patients without any symptoms in the experimental group was significant different at the first visit (P < 0.05), but not significantly different at the second visit. The two groups showed no significant difference in the baseline distribution of mRS scores. At the first and second visits, the change in mRS scores was -2 and -1 in the experimental and control groups, respectively, which were significantly different (P < 0.05). After propensity score matching, the overall response rate and marked response rate were 97.29% and 100% in the experimental group (P > 0.05) and 64.0% and 47.7% in the control group (P < 0.05) at the first visit, respectively. The decreased NIHSS scores in the two groups were significant different (P < 0.05). The overall response rate and marked response rate differed significantly between the two groups at the second visit (P < 0.05). There was no significant difference in the incidence of adverse events between the two groups. No severe adverse events occurred in either group.
CONCLUSION Guhong injection is safe and more effective than Butylphthalide and Sodium Chloride Injection for treatment of IS.
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Affiliation(s)
- Wei-Wei Zhang
- Department of Neurology, The Seventh Medical Center of PLA General Hospital, Beijing 100039, China
| | - Jiang Xin
- Department of Neurology, Liaoning Provincial People’s Hospital, Shenyang Liaoning Provincial People's Hospital, Shenyang 110016, Liaoning Province, China
| | - Guang-Yu Zhang
- Department of Neurology, Cangzhou City People’s Hospital, Cangzhou 061000, Hebei Province, China
| | - Qi-Jin Zhai
- Department of Neurology, Huai’an Second People’s Hospital, Huai’an 223002, Jiangsu Province, China
| | - Hua-Min Zhang
- Department of Neurology, Ganyu People’s Hospital of Lianyungang, Ganyu 222100, Jiangsu Province, China
| | - Cheng-Si Wu
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
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Chiu YC, Yang JL, Wang WC, Huang HY, Chen WL, Yen PS, Tseng YL, Chen HH, Tsai ST. Predictors of unfavorable outcome at 90 days in basilar artery occlusion patients. World J Clin Cases 2022; 10:3677-3685. [PMID: 35647155 PMCID: PMC9100731 DOI: 10.12998/wjcc.v10.i12.3677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 11/01/2021] [Accepted: 03/16/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In a previous study, basilar artery occlusion (BAO) was shown to lead to death or disability in 80% of the patients. The treatment for BAO patients in the acute stage includes thrombolysis and intra-arterial thrombectomy, but not all patients benefit from these treatments. Thus, understanding the predictors of outcome before initiating these treatments is of special interest.
AIM To determine the predictors related to the 90-d clinical outcome in patients with BAO in an Asian population.
METHODS We performed a retrospective case review of patients admitted to a tertiary stroke center between 2015 and 2019. We used the international classification of diseases-10 criteria to identify cases of posterior circulation stroke. A neurologist reviewed every case, and patients fulfilling the criteria defined in the Basilar Artery International Cooperation Study were included. We then analyzed the patients’ characteristics and factors related to the 90-d outcome.
RESULTS We identified a total of 99 patients as real BAO cases. Of these patients, 33 (33.3%) had a favorable outcome at 90 d (modified Rankin Scale: 0–3). Moreover, 72 patients received intra-arterial thrombectomy, while 13 patients received intravenous tissue-type plasminogen activator treatment. We observed a favorable outcome in 33.3% of the cases and an unfavorable outcome in 66.7% of the cases. We found that the initial National Institutes of Health Stroke Scale (NIHSS) score and several BAO symptoms, including impaired consciousness, tetraparesis, and pupillary abnormalities, were significantly associated with an unfavorable outcome (P < 0.05), while cerebellar symptoms were associated with a favorable outcome (P < 0.05). In the receiver operating characteristic (ROC) analysis, the areas under the ROC curve of initial NIHSS score, impaired consciousness, tetraparesis, cerebellar symptoms, and pupillary abnormalities were 0.836, 0.644, 0.727, 0.614, and 0.614, respectively. Initial NIHSS score showed a higher AUROC (0.836) compared to BAO symptoms.
CONCLUSION The most important predictor of an unfavorable outcome was the initial NIHSS score. BAO symptoms, including tetraparesis, impaired consciousness, and pupillary abnormality were also related to an unfavorable outcome.
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Affiliation(s)
- Yu-Chen Chiu
- Department of Neurology, An Nan Hospital, China Medical University, Tainan 709204, Taiwan
- College of Medicine, China Medical University, Taichung 404332, Taiwan
| | - Jia-Li Yang
- Department of Anesthesiology, China Medical University Hospital, Taichung 404332, Taiwan
| | - Wei-Chun Wang
- College of Medicine, China Medical University, Taichung 404332, Taiwan
- Department of Neurology, China Medical University Hospital, Taichung 404332, Taiwan
| | - Hung-Yu Huang
- College of Medicine, China Medical University, Taichung 404332, Taiwan
- Department of Neurology, China Medical University Hospital, Taichung 404332, Taiwan
| | - Wei-Liang Chen
- Department of Radiology, China Medical University Hospital, Taichung 404332, Taiwan
| | - Pao-Sheng Yen
- Department of Radiology, Kuang Tien General Hospital, Taichung 404332, Taiwan
| | - Ying-Lin Tseng
- Department of Radiology, China Medical University Hospital, Taichung 404332, Taiwan
| | - Hsiu-Hsueh Chen
- Stroke Center, China Medical University Hospital, Taichung 404332, Taiwan
| | - Sheng-Ta Tsai
- College of Medicine, China Medical University, Taichung 404332, Taiwan
- Department of Neurology, China Medical University Hospital, Taichung 404332, Taiwan
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Liu J, Yang Y, Liu H. Efficacy outcomes and safety measures of intravenous tirofiban or eptifibatide for patients with acute ischemic stroke: a systematic review and meta-analysis of prospective studies. J Thromb Thrombolysis 2021; 53:898-910. [PMID: 34780001 DOI: 10.1007/s11239-021-02584-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/03/2021] [Indexed: 12/12/2022]
Abstract
To review the literature for randomized control trials (RCTs) and prospective cohort studies investigating the safety and efficacy of tirofiban and eptifibatide in patients with acute ischemic stroke (AIS). PubMed, Embase, and the Cochrane library were searched for available papers published up to September 2021. The efficacy was evaluated based on the 3-month favorable outcome [modified Rankin scale (mRS) = 0-1], functional outcome (mRS = 0-2), and the last available National Institutes of Health Stroke Scale (NIHSS) score measured in each study. Twelve studies (two RCTs and 10 prospective cohorts) and 2926 patients were included. Treatment with tirofiban or eptifibatide had no effects on the favorable outcome (RR = 1.09, 95% CI 0.89-1.35, P = 0.411), functional outcome (RR = 1.12, 95% CI 0.98-1.28, P = 0.010), and last available NIHSS (WMD = - 2.32, 95% CI - 5.14 to 0.50, P = 0.106), but might increase mortality (RR = 0.84, 95% CI 0.71-0.99, P = 0.121). The sensitivity analyses showed that the meta-analyses were robust. There was no significant publication bias. Tirofiban did not increase the risk of ICH (P = 0. 423) and sICH (P = 0. 990) but increased the risk of fatal ICH (RR = 3.59, 95% CI 1.62-7.96, P = 0.002). Thrombolysis/thrombectomy did not influence any of the outcomes. Adding tirofiban or eptifibatide to thrombolysis/thrombectomy was not significantly associated with a favorable outcome (mRS = 0-1) nor functional outcome (mRS = 0-2) in patients with AIS at 3 months, but might be associated with mortality, possibly due to fatal ICH. The NIHSS was also not significantly different between the intervention and control groups after treatments.
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Affiliation(s)
- Jingting Liu
- Xiangya School of Medicine, Central South University, Changsha, 410013, China
| | - Yihong Yang
- Department of Emergency, Fuyang People's Hospital, Fuyang, 236000, China
| | - Hongbo Liu
- Department of Emergency, Fuyang People's Hospital, Fuyang, 236000, China.
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El Otmani H, Berrada M, Abdulhakeem Z, Bellakhdar S, El Moutawakil B, Abdoh Rafai M. Aspirin withdrawal: A risk factor for ischemic stroke severity. J Med Vasc 2021; 46:171-174. [PMID: 34238511 DOI: 10.1016/j.jdmv.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/09/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Acetylsalicylic acid (ASA) cessation, is suggestive of a rebound phenomenon laying the ground for ischemic stroke (IS) re-occurrence but nothing is known about its implication for IS severity (ISS). Thus, the aim of our study is to examine whether or not aspirin withdrawal is a risk factor for ISS. PATIENTS AND METHODS This study, recruited patients having presented an IS in the following 2 weeks of ASA withdrawal, matched with treatment free cases. ISS was evaluated in all patients at admission using the National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin scale (mRS) at 3 months' follow-up. FINDINGS Fifty cases were included in this study and fifty, manually matched, controls. ISS analysis found that the case group had a more severe stroke at admission (mean NIHSS: 12.76 (±7.319) in cases vs 10.04 (±5.562) in controls, P=0.039), with ASA discontinuation judged as a risk factor directly related to ISS regardless of the underlying cardiovascular risk factors (using the multivariate analysis). CONCLUSION Our study's findings suggest that aspirin interruption over a 15-days period could result in a more severe IS in the acute phase. To our knowledge, no study has ever discussed this outcome, shedding the light on the pressing need for larger studies with various withdrawal periods to support these data.
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Affiliation(s)
- H El Otmani
- Department of Neurology, Ibn Rochd Hospital, Hassan II University, Faculty of Medicine and Pharmacy, rue Tarik Ibn Ziad, 20360 Casablanca, Morocco; Laboratory of genetics and molecular pathology, Ibn Rochd Hospital, Hassan II University, Faculty of Medicine and Pharmacy, rue Tarik Ibn Ziad, 20360 Casablanca, Morocco.
| | - M Berrada
- Department of Neurology, Ibn Rochd Hospital, Hassan II University, Faculty of Medicine and Pharmacy, rue Tarik Ibn Ziad, 20360 Casablanca, Morocco
| | - Z Abdulhakeem
- Department of Neurology, Ibn Rochd Hospital, Hassan II University, Faculty of Medicine and Pharmacy, rue Tarik Ibn Ziad, 20360 Casablanca, Morocco
| | - S Bellakhdar
- Department of Neurology, Ibn Rochd Hospital, Hassan II University, Faculty of Medicine and Pharmacy, rue Tarik Ibn Ziad, 20360 Casablanca, Morocco
| | - B El Moutawakil
- Department of Neurology, Ibn Rochd Hospital, Hassan II University, Faculty of Medicine and Pharmacy, rue Tarik Ibn Ziad, 20360 Casablanca, Morocco; Laboratory of genetics and molecular pathology, Ibn Rochd Hospital, Hassan II University, Faculty of Medicine and Pharmacy, rue Tarik Ibn Ziad, 20360 Casablanca, Morocco
| | - M Abdoh Rafai
- Department of Neurology, Ibn Rochd Hospital, Hassan II University, Faculty of Medicine and Pharmacy, rue Tarik Ibn Ziad, 20360 Casablanca, Morocco; Research Laboratory on diseases of the nervous system, neurosensory and disability, Hassan II University, Faculty of Medicine and Pharmacy, rue Tarik Ibn Ziad, 20360 Casablanca, Morocco
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Grönberg A, Henriksson I, Lindgren A. Accuracy of NIH Stroke Scale for diagnosing aphasia. Acta Neurol Scand 2021; 143:375-382. [PMID: 33368189 PMCID: PMC7985870 DOI: 10.1111/ane.13388] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 11/10/2020] [Accepted: 11/26/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The National Institutes of Health Stroke Scale (NIHSS) has not been validated to diagnose aphasia in the stroke population. We therefore examined the diagnostic accuracy of NIHSS for detecting aphasia in acute ischemic stroke. METHODS Consecutive patients with acute first-ever ischemic stroke were included prospectively in Lund Stroke Register Study at Skåne University Hospital, Sweden. Exclusion criteria were: (a) non-native Swedish; (b) obtundation (c) dementia or psychiatric diagnosis. Patients were assessed with NIHSS item 9 (range 0-3, where 1-3 indicate aphasia) by a NIHSS certified research nurse in the acute phase after stroke onset (median 3 days). Within 24 h after this assessment, a speech therapist evaluated the patients' language function with the comprehensive language screening test (LAST, range 0-15 where 0-14 indicates aphasia). Data were analyzed using LAST as 'reference standard'. RESULTS We examined 221 patients. Among these, 23% (n = 50) had aphasia according to NIHSS (distribution of scores 0, 1, 2, 3 were n = 171, n = 29, n = 12, n = 9) compared to 26% (n = 58) with aphasia according to LAST (score ≤14; median = 11). Assuming LAST as reference standard, NIHSS gave 16 false negatives (NIHSS item 9 = 0) for aphasia (LAST scores range 8-14), and 8 false positives (NIHSS item 9 score = 1) for aphasia, yielding a sensitivity of 72% (0.59-0.83) and a specificity of 95% (0.91-0.98). CONCLUSIONS When using NIHSS for screening and diagnosing aphasia in adults with acute ischemic stroke, patients with severe aphasia can be detected, however, some mild aphasias might be misclassified. Given the 72% sensitivity, absence of aphasia on the NIHSS should not be used to guide stroke treatment.
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Affiliation(s)
- Angelina Grönberg
- Department of Clinical Sciences Lund Neurology Lund University Lund Sweden
- Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics Skåne University Hospital Lund Sweden
| | - Ingrid Henriksson
- Speech and Language Pathology Unit Institute of Neuroscience and Physiology Sahlgrenska AcademyUniversity of Gothenburg Gothenburg Sweden
| | - Arne Lindgren
- Department of Clinical Sciences Lund Neurology Lund University Lund Sweden
- Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics Skåne University Hospital Lund Sweden
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Esmael A, Elsherief M, Eltoukhy K. Prevalence of cognitive impairment in acute ischaemic stroke and use of Alberta Stroke Programme Early CT Score (ASPECTS) for early prediction of post-stroke cognitive impairment. Neurol Neurochir Pol 2021; 55:179-185. [PMID: 33507530 DOI: 10.5603/pjnns.a2021.0006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 12/11/2020] [Accepted: 12/14/2020] [Indexed: 11/25/2022]
Abstract
AIM OF THE STUDY This study aims to assess the prevalence of post-stroke cognitive impairment, and to evaluate the correlation of ASPECTS with impaired cognition. MATERIALS AND METHODS 150 patients presenting with acute middle cerebral artery territory ischaemic stroke were included in this study. Risk factors of ischaemic stroke and the initial NIHSS were determined. An initial and a follow-up non-contrast CT brain were carried out after seven days which were assessed by ASPECTS. The prevalence of cognitive impairment was determined by MoCA during the follow up of patients after three months. Correlations of ASPECTS, NIHSS and MoCA were done by Spearman correlation. Multivariate logistic regression analysis was carried out for the independent variables of cognitive impairment. RESULTS The prevalence of post-stroke cognitive impairment in this study, according to the threshold for cognitive impairment with a MoCA score of 25 or less, was 25.3% (38 patients). Significant positive correlations between ASPECTS and total MoCA test domains were found (r = 0.73 and P = 0.002). Logistic regression analysis demonstrated that the independent factors associated with cognitive impairment were older age, certain domains of the MoCA test like executive functions, memory, attention, language, NIHSS, HTN, and ASPECTS. CONCLUSIONS AND CLINICAL IMPLICATIONS There is a prevalence of cognitive impairment in about 25% of patients after three months of follow-up in cases with acute ischaemic stroke. ASPECTS is directly correlated with cognitive impairment, and may be considered as a biomarker of post-stroke cognitive impairment.
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Affiliation(s)
- Ahmed Esmael
- Neurology Department, Faculty of Medicine, Mansoura University, 35516 mansoura, Egypt.
| | - Mohammed Elsherief
- Neurology Department, Faculty of Medicine, Mansoura University, 35516 mansoura, Egypt
| | - Khaled Eltoukhy
- Neurology Department, Faculty of Medicine, Mansoura University, 35516 mansoura, Egypt
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18
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Hsu KC, Lin CH, Johnson KR, Fann YC, Hsu CY, Tsai CH, Chen PL, Chang WL, Yeh PY, Wei CY. Comparison of outcome prediction models post-stroke for a population-based registry with clinical variables collected at admission vs. discharge. Vessel Plus 2021; 5:2. [PMID: 35356047 PMCID: PMC8963213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
AIM The ability to predict outcomes can help clinicians to better triage and treat stroke patients. We aimed to build prediction models using clinical data at admission and discharge to assess predictors highly relevant to stroke outcomes. METHODS A total of 37,094 patients from the Taiwan Stroke Registry (TSR) were enrolled to ascertain clinical variables and predict their mRS outcomes at 90 days. The performances (i.e., the area under the curves (AUCs)) of these independent predictors identified by logistic regression (LR) based on clinical variables were compared. RESULTS Several outcome prediction models based on different patient subgroups were evaluated, and their AUCs based on all clinical variables at admission and discharge were 0.85-0.88 and 0.92-0.96, respectively. After feature selections, the input features decreased from 140 to 2-18 (including age of onset and NIHSS at admission) and from 262 to 2-8 (including NIHSS at discharge and mRS at discharge) at admission and discharge, respectively. With only a few selected key clinical features, our models can provide better performance than those previously reported in the literature. CONCLUSION This study proposed high performance prognostics outcome prediction models derived from a population-based nationwide stroke registry even with reduced LR-selected clinical features. These key clinical features can help physicians to better focus on stroke patients to triage for best outcome in acute settings.
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Affiliation(s)
- Kai-Cheng Hsu
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan,Artificial Intelligence Center for Medical Diagnosis, China Medical University Hospital, Taichung, Taiwan,Department of Neurology, China Medical University Hospital, Taichung, Taiwan
| | - Ching-Heng Lin
- Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kory R. Johnson
- Bioinformatics Section, National Institute of Neurological Disorder and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Yang C. Fann
- Bioinformatics Section, National Institute of Neurological Disorder and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Chung Y. Hsu
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| | - Chon-Haw Tsai
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan
| | - Po-Lin Chen
- Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wei-Lun Chang
- Department of Neurology, Show Chwan Memorial Hospital, Changhua County, Taiwan
| | - Po-Yen Yeh
- Department of Neurology, St. Martin De Porres Hospital, Chiayi, Taiwan
| | - Cheng-Yu Wei
- Department of Neurology, Chang Bing Show Chwan Memorial Hospital, Changhua County, Taiwan
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Huang JB, Chen NC, Chen CL, Fu MH, Pan HY, Hsu CY, Chen SD, Chuang YC. Serum Levels of Soluble Triggering Receptor Expressed on Myeloid Cells-1 Associated with the Severity and Outcome of Acute Ischemic Stroke. J Clin Med 2020; 10:E61. [PMID: 33375339 DOI: 10.3390/jcm10010061] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/14/2020] [Accepted: 12/22/2020] [Indexed: 12/15/2022] Open
Abstract
Stroke is a neurological emergency, where the mechanism of the blood supply to the brain is impaired, resulting in brain cell ischemia and death. Neuroinflammation is a key component in the ischemic cascade that results in cell damage and death after cerebral ischemia. The triggering receptor expressed on myeloid cells-1 (TREM-1) modulates neuroinflammation after acute ischemic stroke. In the present study, 60 patients with acute ischemic stroke, who had been subjected to neurological examinations and National Institutes of Health Stroke Scale (NIHSS) and brain magnetic resonance imaging studies, were enrolled in the emergency room of Kaohsiung Chang Gung Memorial Hospital. Twenty-four healthy volunteers were recruited as controls. The serum levels of soluble TREM-1 (sTREM-1), human S100 calcium-binding protein B (S100B), and proinflammatory cytokines and chemokines, including tumor necrosis α (TNF-α), interleukin 1β, interleukin 6 (IL-6), interleukin 8, and interferon-γ were measured immediately after acute ischemic stroke. The serum levels of sTREM-1, TNFα, IL-6, and S100B were correlated with the stroke volume and NIHSS, after acute ischemic stroke. Additionally, the serum levels of sTREM-1 were significantly positively correlated with S100B. The functional outcomes were evaluated 6 months after ischemic stroke by the Barthel index, which was correlated with the age and levels of sTREM-1 and S100B. We suggest that acute ischemic stroke induces neuroinflammation by the activation of the TREM-1 signaling pathway and the downstream inflammatory machinery that modulates the inflammatory response and ischemic neuronal cell death. From a translational perspective, our results may allow for the development of a new therapeutic strategy for acute ischemic stroke by targeting the TREM-1 signaling pathway.
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20
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Lin LC, Tsai YY, Yang JT, Chen YC, Wu YF, Huang YC, Tsai YH, Hsiao KY, Seak CJ. Do initially non-dehydrated patients with acute ischemic stroke need fluid supplement? INT J VITAM NUTR RES 2020; 91:10-15. [PMID: 33196400 DOI: 10.1024/0300-9831/a000686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: We previously found that dehydration is an independent predictor of early deterioration after acute ischemic stroke and rehydration helps to improve outcomes. There is limited evidence of how to treat patients who are initially non-dehydrated. In this study, we tested the hypothesis that rehydration therapy, based on the daily urine specific gravity, will improve the outcome of ischemic stroke patients who are initially non-dehydrated. Methods: We conducted a single-arm prospective study of patients with acute ischemic stroke with historical controls. For the first 5 days of study group, a daily urine specific gravity of > 1.020 g/ml was taken as indication for rehydration and patients were advised to drink water via oral or tubal feeding with a dose of 5 ml/kg body weight right away and after dinner. Control group patients were rehydrated without reference to urine specific gravity. An increase in National Institutes of Health Stroke Scale score of ≥ 4 within three days was defined as having stroke-in-evolution. Scores of ≤ 1 on the modified Rankin scale at 3 months were considered to indicate a favorable outcome. Results: A total of 125 patients were analyzed, 46 in the study group and 79 in the control group. The groups did not significantly differ in the stroke-in-evolution rate (4.3% vs. 8.2%, P = 0.474). The rate of favorable outcome at 3 months was significantly higher in the study group than in the control group (56.5% vs. 27.8%, P = 0.001). Conclusions: Urine specific gravity-based hydration might be a useful method to improve functional outcomes of patients with acute ischemic stroke who were non-dehydrated at admission.
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Affiliation(s)
- Leng Chieh Lin
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.,Shu-Zen Junior College of Medicine and Management, Taiwan
| | - Yen Yun Tsai
- Department of Dermatology, Changhua Christian Hospital, Changhua, Taiwan
| | - Jen Tsung Yang
- Division of Neurosurgery, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Taiwan
| | - Yi Chuan Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.,Departments of Nursing and Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Yi Fang Wu
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yen Chu Huang
- Departments of Nursing and Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan.,Department of Neurology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yuan Hsiung Tsai
- Departments of Nursing and Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan.,Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Kuang Yu Hsiao
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.,Shu-Zen Junior College of Medicine and Management, Taiwan
| | - Chen-June Seak
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Emergency Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan
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21
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Gudarzi S, Jafari M, Pirzad Jahromi G, Eshrati R, Asadollahi M, Nikdokht P. Evaluation of modulatory effects of saffron ( Crocus sativus L.) aqueous extract on oxidative stress in ischemic stroke patients: a randomized clinical trial. Nutr Neurosci 2020; 25:1137-1146. [PMID: 33151132 DOI: 10.1080/1028415x.2020.1840118] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Saffron (Crocus sativus L.) has been widely used in traditional medicine as a treatment of nervous disorders. Saffron as an antioxidant can be considered effective for treatment of oxidative stress in ischemia stroke. Therefore, the aim of the present study was to investigate the role of aqueous extract of saffron in reducing oxidative stress in ischemic strokes patients. METHODS Forty patients with acute ischemic stroke were randomly divided into two groups including control group and saffron group. During 4 days of experiment, control group received routine stroke care and saffron group received routine care plus capsule of saffron 400 mg/day (200 mg twice per day). Then, two groups were compared using the National Institute of Health Stoke Scale (NIHSS) and serum oxidative stress biomarkers, at the time of hospital admission and 4 days later as well. RESULTS On the fourth day after ischemic stroke onset, antioxidant enzymes activities and glutathione (GSH) and total antioxidant capacity (TAC) levels were higher in the saffron group compared to the control group, while malondialdehyde (MDA) level was lower. In addition, the severity of stroke, based on the NIHSS scores, was significantly reduced after 4 days in the saffron group. The severity of stroke was negatively correlated with the levels of GSH and TAC and positively correlated with MDA level. CONCLUSIONS Saffron has modulatory effects on ischemic-induced oxidative stress due to its free radical scavenging and antioxidant properties. Thus, saffron extract can be considered as a potential candidate therapy of the ischemic brain.
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Affiliation(s)
- Saeed Gudarzi
- Faculty of Medicine, Department of Biochemistry, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mahvash Jafari
- Faculty of Medicine, Department of Biochemistry, Baqiyatallah University of Medical Sciences, Tehran, Iran.,Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Gila Pirzad Jahromi
- Neuroscience Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Reza Eshrati
- Faculty of Medicine, Department of Biochemistry, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mostafa Asadollahi
- Neurology, Electrophysiology Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Parisa Nikdokht
- Department of Neurology, Shahid Beheshti University of Medical Science, Tehran, Iran
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Demir A, Öztürk Ş, Ekmekçi AH, Demir K, Avcı A, Eren F, Sivri M. Decrease in Pulse Wave Velocity is Associated with Clinical Improvement in Patients with Ischemic Stroke. J Stroke Cerebrovasc Dis 2020; 29:105206. [PMID: 33066902 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/22/2020] [Accepted: 07/23/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Arterial stiffness is an independent determinant of cardiovascular and cerebrovascular risks. The relationship between the increase in arterial stiffness parameters and the severity of stroke has been shown in previous studies. We aimed to investigate the association between clinical improvement and changes in arterial stiffness parameters in patients presenting acute ischemic stroke. METHODS A total of 107 patients were enrolled in this study. On the first and seventh day of the hospitalization, 24 h non-invasive blood pressure was monitored and arterial stiffness parameters were measured. The National Institutes of Health Stroke Scale (NIHSS) was used to determine the severity of stroke, and the Modified Rankin Scale was used to determine dependency and to evaluate functional improvements. RESULTS Arterial stiffness parameters of augmentation index (AIx@75) and pulse wave velocity (PWV) were significantly higher in patients who died during hospitalization than patients who were discharged (respectively p <0.001, p = 0.04). In the group with clinical improvement, PWV values measured on the seventh day were significantly lower than PWV values measured on the first day (p = 0.032). When the changes in PWV value measured on the first and seventh day for both groups were analyzed using mixed ANOVA test, p value were significant (p = 0.033). Multivariate binary logistic regression analyses showed that negatively change in PWV and CDBP independently predicts the clinical improvement. CONCLUSIONS Increased AIx@75 and PWV appear to be associated with higher in-hospital mortality rates in patients with acute ischemic stroke. Additionally, clinical improvement in patients with ischemic stroke is associated with a decrease in PWV .
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Affiliation(s)
- Ayşegül Demir
- Department of Neurology, Konya Education Research Hospital, 04240, Konya, Turkey
| | - Şerefnur Öztürk
- Department of Neurology, Selcuk University Faculty of Medicine, 04240, Konya, Turkey
| | - Ahmet Hakan Ekmekçi
- Department of Neurology, Selcuk University Faculty of Medicine, 04240, Konya, Turkey
| | - Kenan Demir
- Department of Cardiology, Selcuk University Faculty of Medicine, 04240, Konya, Turkey.
| | - Ahmet Avcı
- Department of Cardiology, Zonguldak Bülent Ecevit University Faculty of Medicine, 67100, Zonguldak, Turkey
| | - Fettah Eren
- Department of Neurology, Konya Education Research Hospital, 04240, Konya, Turkey
| | - Mesut Sivri
- Departmant of Radiology, Ankara City Hospital, 06800, Ankara, Turkey
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Abstract
Acute stroke assessment is classically supported by clinical localization whereby presenting disabilities are associated with key arterial territories in the brain. Clinical localization skills are rarely taught to nonneurologists; yet, these skills are essential to the provision of evidence-based nursing care of stroke, enabling rapid patient identification, diagnosis, and ultimately, the delivery of acute treatment. This article explores the process of clinical localization in relation to the physiology affected by stroke vascular insufficiency. Elements of the neurologic examination are described as they relate to discreet areas in the brain and the National Institutes of Health Stroke Scale.
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Affiliation(s)
- Wendy Dusenbury
- College of Nursing University of Tennessee Health Science Center, 920 Madison Avenue, Office Suite 568, Memphis, TN 38163.
| | - Anne W Alexandrov
- College of Nursing University of Tennessee Health Science Center, 920 Madison Avenue, Office Suite 568, Memphis, TN 38163
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24
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Qin W, Zhang X, Yang L, Li Y, Yang S, Li X, Hu W. Predictive value of the sequential organ failure assessment (SOFA) score for prognosis in patients with severe acute ischemic stroke: a retrospective study. J Int Med Res 2020; 48:300060520950103. [PMID: 32865055 PMCID: PMC7469749 DOI: 10.1177/0300060520950103] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/24/2020] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To identify the risk factors for early death and determine the predictive value of the sequential organ failure assessment (SOFA) score for prognosis of severe acute ischemic stroke (AIS). METHODS A total of 110 patients with severe AIS were enrolled and divided into the non-survivor (n = 34) and survivor groups (n = 76). Logistic regression analysis was conducted to identify risk factors for early death, while the receiver operator characteristic (ROC) curve was used to determine the predictive effect of the SOFA score on prognosis. RESULTS Logistic regression analysis showed that urinary tract infection (odds ratio [OR] = 17.364, 95% confidence interval [CI]: 1.903-158.427), mechanical ventilation (OR = 1.754, 95% CI: 1.648-2.219), and osmotic therapy (OR = 2.835, 95% CI: 1.871-5.102) were significantly correlated with early death of severe AIS. ROC curve analysis of the area under the curve after hospitalization showed that the maximum SOFA and ΔSOFA scores exceeded 0.7. CONCLUSION Our study shows that urinary tract infection, mechanical ventilation, and osmotic therapy are risk factors for early death of severe AIS. The SOFA score has good predictive value for prognosis of severe AIS. These findings may provide a guideline for improving clinical outcome.
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Affiliation(s)
- Wei Qin
- Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiaoyu Zhang
- Department of Neurology, Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Lei Yang
- Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yue Li
- Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Shuna Yang
- Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xuanting Li
- Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Wenli Hu
- Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Yang S, Zhan X, He M, Wang J, Qiu X. miR-135b levels in the peripheral blood serve as a marker associated with acute ischemic stroke. Exp Ther Med 2020; 19:3551-3558. [PMID: 32346417 PMCID: PMC7185079 DOI: 10.3892/etm.2020.8628] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 02/26/2020] [Indexed: 12/16/2022] Open
Abstract
The protective role of microRNA (miR)-135b in cerebral neurons has been previously identified. However, to the best of our knowledge, the involvement of miR-135b in acute ischemic stroke has yet to be elucidated. The present study aimed to investigate the expression profile of miR-135b in peripheral blood obtained from patients with acute ischemic stroke. A total of 76 patients with acute ischemic stroke were selected as the case group, which included 33 cases of aorta atheromatous plague, 19 cases of cardioembolism, 16 cases of small arterial occlusion and 8 cases with unknown causes. In addition, 60 healthy subjects were selected as the control group. Reverse transcription-quantitative PCR was used to measure the expression of miR-135b in the peripheral blood of the patients. The National Institutes of Health Stroke Scale (NIHSS) score was used to evaluate the severity of acute ischemic stroke. The relationship between miR-135b levels and acute stroke was subsequently analyzed. The expression of miR-135b in the peripheral blood of the case group was found to be significantly higher compared with that in the control group. By contrast, the expression levels of miR-135b in the case group did not differ significantly between the different etiology types of acute ischemic stroke. In addition, a significant positive correlation was observed between levels of miR-135b expression and NIHSS scores. Further analysis demonstrated that hypertension, hyperglycemia, platelet count, international normalized ratio and miR-135b were risk factors for acute ischemic stroke. Based on bioinformatics analysis, a conserved binding site for miR-135b was identified in the 3'-untranslated region of the transient receptor potential cation channel subfamily C member 6 (TRPC6). Dual luciferase reporter and western blot analysis showed that TRPC6 was a target gene of miR-135b. In conclusion, data from the present study suggest that elevated expression of miR-135b in the peripheral blood of patients with acute ischemic stroke is closely associated with disease severity.
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Affiliation(s)
- Sha Yang
- Department of Clinical Laboratory Medicine, Southwest Hospital, Third Military Medical University, Chongqing 400038, P.R. China
| | - Xinyu Zhan
- Department of Clinical Laboratory Medicine, Southwest Hospital, Third Military Medical University, Chongqing 400038, P.R. China
| | - Min He
- Department of Clinical Laboratory Medicine, Southwest Hospital, Third Military Medical University, Chongqing 400038, P.R. China
| | - Jingjing Wang
- Vasculocardiology Department, The 903rd Hospital of PLA, Hangzhou, Zhejiang 310013, P.R. China
| | - Xuemei Qiu
- Department of Clinical Laboratory Medicine, The 80th Army Hospital of PLA, Weifang, Shandong 261021, P.R. China
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Shimizu Y, Tsuchiya K, Fujisawa N. Risk factors of diffuse alveolar hemorrhage after acute ischemic stroke treated with tissue-type plasminogen activator. The effectiveness of activated recombinant factor VII treatment. Surg Neurol Int 2020; 11:129. [PMID: 32547816 PMCID: PMC7294161 DOI: 10.25259/sni_2_2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 05/07/2020] [Indexed: 11/25/2022] Open
Abstract
Background: Diffuse alveolar hemorrhage (DAH) is a rare and frequently life-threatening complication of a variety of conditions. DAH may result from coagulation disorders, inhaled toxins, or infections. We report a series of patients who developed DAH after receiving a tissue-type plasminogen activator (tPA) for acute cerebral infarction. We aimed to find risk factors of DAH in patients receiving tPA and the effectiveness of activated recombinant factor VII (rFVIIa) treatment for the same. Case Description: A total of 1023 acute ischemic stroke (AIS) patients who received tPA in our department from January 2006 to December 2018 were enrolled in this study. Four of the 1023 patients (0.39%) developed DAH. The modified Rankin scale was used to assess clinical severity. Infarction volume was assessed upon follow-up using DWI (diffusion-weighted imaging). Atherothrombotic brain infarction cases were excluded from the study. The age, sex, occlusion site, area of infarction, emphysema, intracranial hemorrhage, and neurological outcomes were analyzed. Patients who developed DAH were more likely to have a history of emphysema. We administered rFVIIa to three DAH patients with good prognosis. Conclusion: The inclusion/exclusion criteria of tPA were based on the AHA/ASA Guidelines for the early management of patients with AIS.These patients had no evidence of infections, bronchoscopy, autoimmune diseases, HIV, and transplantations. Our study suggests that systemic administration of rFVIIa for DAH is effective. Emphysema may be a risk factor for the development of DAH following tPA. When we use tPA for emphysema patients, we must be careful about DAH enough.
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Affiliation(s)
- Yu Shimizu
- Department of Neurosurgery, Kanazawa Medical Center, Shimoishibikimachi, Kanazawa, Ishikawa, Japan
| | - Katsuhiro Tsuchiya
- Department of Neurosurgery, Kanazawa Medical Center, Shimoishibikimachi, Kanazawa, Ishikawa, Japan
| | - Norihiro Fujisawa
- Department of Neurosurgery, Kanazawa Medical Center, Shimoishibikimachi, Kanazawa, Ishikawa, Japan
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Umemura T, Hachisuka K, Miyachi H, Nishizawa S, Yamamoto J. Clinical outcomes of cerebral infarction in nonagenarians compared among four age groups. Neurol Sci 2020; 41:2471-6. [PMID: 32212011 DOI: 10.1007/s10072-020-04348-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 03/16/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Average female life expectancy in Japan is approximately 90 years. Occasionally, we encounter stroke patients older than 90 years. AIMS To determine the clinical features and outcomes associated with cerebral infarction in patients aged ≥ 90 years. METHODS We examined 289 consecutive patients (163 males, 129 females; mean age 77.5 years) diagnosed with cerebral infarction. We divided them into four groups according to age in years: middle (< 65), pre-old (65-74), old (75-89), and super old (≥ 90). We divided the super old group into mild symptoms (NIHSS ≤ 5) and severe symptoms (NIHSS > 5) and examined outcomes. RESULTS Statistically significant associations were observed between female sex, cardiogenic infarction, and high complication rates and super old age. NIHSS and mRS scores at 30-day post-stroke were higher in the super old group. In some cases, complications led to poor prognoses. Eighty-seven percent of patients with mild symptoms (NIHSS ≤ 5) recovered to mRS 0-2 similar to the younger age group. None of the patients with severe symptoms (NIHSS > 5) recovered to mRS 0-2. DISCUSSION We investigated the clinical outcomes following cerebral infarction in patients aged 90 years or older and found that mild symptoms were consistently associated with good prognoses, regardless of patients' age. CONCLUSIONS Patients in the super old group had more severe symptoms and poorer outcomes than younger age groups. However, patients with mild symptoms tended to have better prognoses and returned to daily life similar to the younger age group.
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28
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Ferraz B, Reis R, Rocha ALC, Moreira G, Fonseca L, Parreira T, Azevedo E, Castro P. Prognostic yield of imaging before and after recanalization treatments in ischemic stroke. Acta Neurol Scand 2020; 141:226-235. [PMID: 31858586 DOI: 10.1111/ane.13208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/09/2019] [Accepted: 12/16/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The scores to predict outcome in ischemic stroke were validated prior to the approval of modern revascularization treatments. We evaluated the accuracy of pre and post-treatment models in a recent recanalization therapy cohort and whether radiological and ultrasound findings could improve their accuracy. MATERIAL & METHODS We included 375 anterior circulation ischemic stroke patients treated with intravenous thrombolysis or thrombectomy during 2017 and 2018. We collected demographic, clinical, and imaging data. We built pre and post-treatment logistic regression models to predict independence (modified Rankin Scale 0-2) at 3 months. The models included the Alberta Stroke Program Early CT Score (ASPECTS), infarct volume (ABC/2 method), and the Thrombolysis in Brain Ischemia (TIBI) ultrasonographic grade of recanalization. We compared areas under the receiver operating characteristic curve (AUC). RESULTS Our preintervention model, combining neurological deficit severity, age, and admission glycemia, was not improved by the inclusion of ASPECTS (AUC 0.80 vs 0.79, P = .28). Early neurological recovery at 24-hour significantly increased prognostic performance (AUC = 0.85, P < .01), which did not change by adding final infarct volume or the persistence of arterial occlusion of the affected territory (AUC = 0.86 and 0.85, P > .05). CONCLUSIONS Models that combine simple variables such as neurological deficit severity, age, and admission glycemia were the most useful for predicting functional outcome in ischemic stroke patients submitted to revascularization treatments. Pre and post-treatment imaging findings did not enhance prognostic accuracy when compared to the patient's clinical improvement.
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Affiliation(s)
- Beatriz Ferraz
- Department of Neurology Faculty of Medicine of University of Porto Centro Hospitalar Universitário São João Porto Portugal
| | - Ricardo Reis
- Department of Neurology Faculty of Medicine of University of Porto Centro Hospitalar Universitário São João Porto Portugal
| | - Ana Luísa Carvalho Rocha
- Department of Neurology Faculty of Medicine of University of Porto Centro Hospitalar Universitário São João Porto Portugal
| | - Goreti Moreira
- Department of Internal Medicine and Stroke Unit Centro Hospitalar Universitário São João Porto Portugal
| | - Luísa Fonseca
- Department of Internal Medicine and Stroke Unit Faculty of Medicine Centro Hospitalar Universitário São João Porto Portugal
| | - Tiago Parreira
- Department of Neuroradiology Centro Hospitalar Universitário São João Porto Portugal
| | - Elsa Azevedo
- Department of Neurology Faculty of Medicine of University of Porto Centro Hospitalar Universitário São João Porto Portugal
| | - Pedro Castro
- Department of Neurology and Stroke Unit Faculty of Medicine of University of Porto Centro Hospitalar Universitário São João Porto Portugal
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Zhang H, Li CL, Wan F, Wang SJ, Wei XE, Hao YL, Leng HL, Li JM, Yan ZR, Wang BJ, Xu RS, Yu TM, Zhou LC, Fan DS. Efficacy of cattle encephalon glycoside and ignotin in patients with acute cerebral infarction: a randomized, double-blind, parallel-group, placebo-controlled study. Neural Regen Res 2020; 15:1266-1273. [PMID: 31960812 PMCID: PMC7047806 DOI: 10.4103/1673-5374.272616] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Cattle encephalon glycoside and ignotin (CEGI) injection is a compound preparation formed by a combination of muscle extract from healthy rabbits and brain gangliosides from cattle, and it is generally used as a neuroprotectant in the treatment of central and peripheral nerve injuries. However, there is still a need for high-level clinical evidence from large samples to support the use of CEGI. We therefore carried out a prospective, multicenter, randomized, double-blind, parallel-group, placebo-controlled study in which we recruited 319 patients with acute cerebral infarction from 16 centers in China from October 2013 to May 2016. The patients were randomized at a 3:1 ratio into CEGI (n = 239; 155 male, 84 female; 61.2 ± 9.2 years old) and placebo (n = 80; 46 male, 34 female; 63.2 ± 8.28 years old) groups. All patients were given standard care once daily for 14 days, including a 200 mg aspirin enteric-coated tablet and 20 mg atorvastatin calcium, both taken orally, and intravenous infusion of 250–500 mL 0.9% sodium chloride containing 40 mg sodium tanshinone IIA sulfonate. Based on conventional treatment, patients in the CEGI and placebo groups were given 12 mL CEGI or 12 mL sterile water, respectively, in an intravenous drip of 250 mL 0.9% sodium chloride (2 mL/min) once daily for 14 days. According to baseline National Institutes of Health Stroke Scale scores, patients in the two groups were divided into mild and moderate subgroups. Based on the modified Rankin Scale results, the rate of patients with good outcomes in the CEGI group was higher than that in the placebo group, and the rate of disability in the CEGI group was lower than that in the placebo group on day 90 after treatment. In the CEGI group, neurological deficits were decreased on days 14 and 90 after treatment, as measured by the National Institutes of Health Stroke Scale and the Barthel Index. Subgroup analysis revealed that CEGI led to more significant improvements in moderate stroke patients. No drug-related adverse events occurred in the CEGI or placebo groups. In conclusion, CEGI may be a safe and effective treatment for acute cerebral infarction patients, especially for moderate stroke patients. This study was approved by the Ethical Committee of Peking University Third Hospital, China (approval No. 2013-068-2) on May 20, 2013, and registered in the Chinese Clinical Trial Registry (registration No. ChiCTR1800017937).
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Affiliation(s)
- Hui Zhang
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Chuan-Ling Li
- Department of Neurology, Xuzhou Central Hospital, Xuzhou, Jiangsu Province, China
| | - Feng Wan
- Department of Neurology, Huang Gang Central Hospital, Huanggang, Hubei Province, China
| | - Su-Juan Wang
- Department of Neurology, The First People's Hospital of Luoyang City, Luoyang, Henan Province, China
| | - Xiu-E Wei
- Department of Neurology, General Hospital of Xuzhou Mining Group, Xuzhou, Jiangsu Province, China
| | - Yan-Lei Hao
- Department of Neurology, Affiliated Hospital of Jining Medical University, Jining, Shandong Province, China
| | - Hui-Lin Leng
- Department of Neurology, People's Hospital of Yichun City, Yichun, Jiangxi Province, China
| | - Jia-Min Li
- Department of Neurology, The First Hospital of Shijiazhuang City, Shijiazhuang, Hebei Province, China
| | - Zhong-Rui Yan
- Department of Neurology, Jining No.1 People's Hospital, Jining, Shandong Province, China
| | - Bao-Jun Wang
- Department of Neurology, Baotou Central Hospital, Baotou, Inner Mongolia Autonomous Region, China
| | - Ren-Shi Xu
- Department of Neurology, Jiangxi Provincial People's Hospital, Affiliated People's Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Ting-Min Yu
- Department of Neurology, The Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Li-Chun Zhou
- Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Dong-Sheng Fan
- Department of Neurology, Peking University Third Hospital, Beijing, China
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Grewal P, Dobbs MR, Pennypacker K, Kryscio RJ, Kitzman P, Wolfe M, Elkins K, Bix GJ, Fraser JF. Evaluation of Patients with High National Institutes of Health Stroke Scale as Thrombectomy Candidates Using the Kentucky Appalachian Stroke Registry. Cerebrovasc Dis 2019; 48:251-256. [PMID: 31851968 DOI: 10.1159/000504834] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 11/18/2019] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Mechanical thrombectomy has become standard of care for emergent large vessel occlusive stroke. Estimates of incidence for thrombectomy eligibility vary significantly. National Institutes of Health Stroke Scale (NIHSS) of 10 or greater is highly predictive of large vessel occlusion. Using our Kentucky Appalachian Stroke Registry (KApSR), we evaluated temporal trends in stroke admissions with NIHSS ≥10 to determine patient characteristics among that group along with effects and needs in thrombectomy utilization. METHODS Using the KApSR database that captures patients throughout the Appalachian region in our stroke network, we evaluated patients admitted with ischemic stroke with NIHSS ≥10. We recorded demographics, comorbidities, treatment (thrombectomy, decompressive craniectomy), and county of origin. Change in NIHSS from admission to discharge was used as an indicator of inpatient outcome. RESULTS Between 2010 and 2016, 1,510 patients were admitted with NIHSS ≥10. 87.2% had high blood pressure, 69.6% had dyslipidemia, and 41.7% used tobacco. There were significant sex differences in the types of patients presenting with NIHSS ≥10 with females being older on average and having more atrial fibrillation and obesity. There was an increase in thrombectomy utilization from 2010 to 2016, but only 7.5% of the potentially eligible patients underwent the procedure. In comparison to the period 2010-2014, the 2015-2016 period had higher rates of obesity and tobacco abuse. CONCLUSION Among patients with significant burden of ischemic stroke, the most common coexisting medical condition was high blood pressure. Patients who underwent thrombectomy had significantly better inpatient clinical improvement. These data support the need to maximize utilization of thrombectomy along with need to devote increased resources on modifiable stroke risk factors.
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Affiliation(s)
- Parneet Grewal
- Department of Neurology, Rush University Medical Center, Chicago, Illinois, USA
| | - Michael R Dobbs
- Department of Neurology, University of Texas Rio Grande, Rio Grande, Texas, USA
| | - Keith Pennypacker
- Department of Neurology, Rush University Medical Center, Chicago, Illinois, USA
| | - Richard J Kryscio
- Department of Statistics, College of Arts and Sciences/University of Kentucky, Lexington, Kentucky, USA
| | - Patrick Kitzman
- Department of Neurology, University of Texas Rio Grande, Rio Grande, Texas, USA
| | - Marc Wolfe
- Department of Neurology, University of Texas Rio Grande, Rio Grande, Texas, USA.,Norton Healthcare/UK HealthCare Stroke Network, Lexington, Kentucky, USA
| | - Kelley Elkins
- Norton Healthcare/UK HealthCare Stroke Network, Lexington, Kentucky, USA
| | - Gregory J Bix
- Department of Neurosurgery, Tulane University, New Orleans, Louisiana, USA
| | - Justin F Fraser
- Department of Neurology, Rush University Medical Center, Chicago, Illinois, USA, .,Department of Neurological Surgery, College of Medicine/University of Kentucky, Lexington, Kentucky, USA, .,Department of Radiology, College of Medicine/University of Kentucky, Lexington, Kentucky, USA,
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Lin W, Xiong L, Yang Z, Deng X, Zhu J, Chen C, Huang S, Ma Y, Zhu F. Severe Periodontitis Is Associated with Early-Onset Poststroke Depression Status. J Stroke Cerebrovasc Dis 2019; 28:104413. [PMID: 31582272 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104413] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/01/2019] [Accepted: 09/10/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Poststroke depression (PSD) is one of the most common complications after ischemic stroke, and periodontitis is associated with depression. However, whether severe periodontitis is associated with early-onset PSD status remains unknown. In this study, we aimed to investigate whether there is an association between severe periodontitis and PSD status in acute ischemic stroke patients. MATERIAL AND METHODS We recruited 202 acute ischemic stroke patients within 7 days after stroke onset. Pocket depth and clinical attachment loss were assessed by oral examination to define the severe periodontitis. On the basis of diagnosis of PSD status according to DSM-5 criteria and a 24-item Hamilton Depression Rating Scale score greater than or equal to 8 within 2 weeks after stroke onset, we stratified patients into PSD status or non-PSD status groups and identified the independent predictors for the development of PSD status in multivariate logistic analysis. RESULTS 77 (38.1%) patients were diagnosed as early-onset PSD status. PSD status group showed more severe periodontitis, lower income, lower Barthel Index (BI) score and Montreal Cognitive Assessment score, higher National Institutes of Health Stroke Scale score and modified Rankin scale (mRS) score compared with non-PSD status group. Multivariate logistic regression showed that severe periodontitis (odds ratio 2.401) and NIHSS score (>4, odds ratio 2.130) were independent predictors for early-onset PSD status. CONCLUSIONS Severe periodontitis is found to be an important independent predictor of early-onset PSD status in patients with acute ischemic stroke, in addition to the well-known prognostic factors such as nonminor stroke assessed by NIHSS greater than 4.
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Affiliation(s)
- Weifeng Lin
- Department of Neurology, The Affiliated Yuebei People's Hospital of Shantou University Medical College, Shaoguan, Guangdong Province, China; Department of Psychiatry, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China
| | - Li Xiong
- BrainNow Research Institute, Shenzhen, Guangdong Province, China
| | - Zhi Yang
- Department of Neurology, The Affiliated Yuebei People's Hospital of Shantou University Medical College, Shaoguan, Guangdong Province, China
| | - Xuhui Deng
- Department of Neurology, The Affiliated Yuebei People's Hospital of Shantou University Medical College, Shaoguan, Guangdong Province, China
| | - Jinhua Zhu
- Department of Neurology, The Affiliated Yuebei People's Hospital of Shantou University Medical College, Shaoguan, Guangdong Province, China
| | - Chunchun Chen
- Cognitive Impairment Ward of Neurology Department, The Third Affiliated Hospital of Shenzhen University Medical College, Shenzhen, China
| | - Shuxuan Huang
- Department of Neurology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Ying Ma
- Department of Cardiology, The Third Affiliated Hospital of Shenzhen University Medical College, Shenzhen, China
| | - Feiqi Zhu
- Department of Neurology, The Affiliated Yuebei People's Hospital of Shantou University Medical College, Shaoguan, Guangdong Province, China; Cognitive Impairment Ward of Neurology Department, The Third Affiliated Hospital of Shenzhen University Medical College, Shenzhen, China.
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Han Y, Xu M, Zhao Y, Zhang Y. Long-term outcome and prognostic factors of posterior circulation ischemia patients: Results from a single center retrospective study. Vascular 2019; 28:25-30. [PMID: 31362596 DOI: 10.1177/1708538119866604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective This study was to assess the clinical features and prognostic factors of posterior circulation cerebral infarction (PCCI) patients. Methods A total of 165 PCCI patients who were admitted to the Department of Neurology, Beijing Friendship hospital, Capital Medical University between January 2016 and December 2016 were included. Patients had complete medical record and received 12-month follow-up. The demographics, risk factors, clinical manifestations, National Institutes of Health Stroke Scale (NIHSS) score and imaging findings were collected and factors affecting their prognosis were further analyzed. Results The mean age was 59.5 ± 10.8 years and the mean National Institutes of Health Stroke Scale (NIHSS) score on admission was 6.6 ± 2.8. The one-year recurrence rate of stroke was 6.7%; 84.8% of patients had good prognosis (modified Rankin Scale [mRS] score 0–3) and 15.2% had poor prognosis (mRS score >3). The one-year mortality was 3.0%. Patients with ≥50% stenosis in the basilar artery and higher NIHSS score were more likely to have poor outcome. Conclusion The majority of PCCI patients have a good prognosis and a low mortality. The prognosis is poor in patients with ≥50% stenosis in the basilar artery and higher NIHSS score on admission.
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Affiliation(s)
- Yanfei Han
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Man Xu
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yuan Zhao
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yongbo Zhang
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Huang L, Yao S. Carotid artery color Doppler ultrasonography and plasma levels of lipoprotein-associated phospholipase A2 and cystatin C in arteriosclerotic cerebral infarction. J Int Med Res 2019; 47:4389-4396. [PMID: 31342824 PMCID: PMC6753554 DOI: 10.1177/0300060519859141] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Objective This study was performed to evaluate the clinical application value of
carotid artery color Doppler ultrasonography and the plasma levels of
lipoprotein-associated phospholipase A2 (Lp-PLA2) and cystatin C (Cys C) in
the diagnosis and treatment of arteriosclerotic cerebral infarction. Methods Sixty patients with arteriosclerotic cerebral infarction and 60 matched
healthy participants were included. The patients were divided into mild,
moderate, and severe groups according to their National Institutes of Health
Stroke Scale (NIHSS) scores. Carotid artery intima plaque formation and the
intima–media thickness (IMT) were observed using carotid artery color
Doppler ultrasonography. The correlation between IMT and the Lp-PLA2 or Cys
C level was statistically analyzed. Results Patients with arteriosclerotic cerebral infarction had a higher detection
rate of carotid plaques, especially unstable plaques, than healthy
participants. The plasma levels of Lp-PLA2 and Cys C were elevated in
patients with arteriosclerotic cerebral infarction and increased with the
NIHSS scores. The plasma levels of Lp-PLA2 and Cys C in patients with
arteriosclerotic cerebral infarction were correlated with IMT. Conclusion The combination of carotid artery color Doppler ultrasonography with the
Lp-PLA2 and Cys C plasma levels is of great clinical value in the diagnosis
and treatment of arteriosclerotic cerebral infarction.
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Affiliation(s)
- Lei Huang
- Department of Ultrasonography, First Hospital of Zibo, Zibo City, P.R. China
| | - Shengguo Yao
- Department of Ultrasonography, First Hospital of Zibo, Zibo City, P.R. China
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Lee TH, Huang YH, Su TM, Chen CF, Lu CH, Lee HL, Tsai HP, Sung WW, Kwan AL. Predictive Factors of 2-Year Postoperative Outcomes in Patients with Spontaneous Cerebellar Hemorrhage. J Clin Med 2019; 8:E818. [PMID: 31181777 DOI: 10.3390/jcm8060818] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 05/28/2019] [Accepted: 06/06/2019] [Indexed: 11/30/2022] Open
Abstract
Spontaneous cerebellar hemorrhage (SCH) is associated with high patient mortality and morbidity, but the clinical and radiographic predictors of the postoperative outcome have not been widely addressed in the literature. The purpose of this study was to define the prognostic factors for the two-year postoperative outcome in patients with SCH. We conducted a retrospective study of 48 consecutive patients with SCH who underwent neurosurgical intervention. Correlation analysis was performed to examine the possible link between clinical and radiographic parameters, and the National Institutes of Health Stroke Scale (NIHSS) score at each patient’s discharge and the two-year postoperative outcome as defined according to the Glasgow outcome scale (GOS). A total of 48 patients with SCH underwent neurological surgery, which included suboccipital craniectomy and/or external ventricular drainage (EVD). The mean patient age was 63 years. Nine patients underwent suboccipital craniectomy only; 38 underwent both suboccipital craniectomy and EVD. The overall mortality rate was 35.4%. Fourteen patients (29.2%) had good outcomes. A good outcome on the GOS at 2 years after surgical treatment of SCH was associated with the NIHSS score at discharge. An increase of one point in a patient’s NIHSS score at discharge following neurological surgery will increase the probability of a poor two-year postoperative outcome by 28.5%.
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Abstract
Objective This study was performed to investigate the effect of acupuncture combined
with Buyang Huanwu decoction in patients with ischemic stroke. Methods In total, 115 patients with ischemic stroke were recruited and divided into 3
groups. The control group received normal treatment, the acupuncture group
received additional acupuncture treatment, and the combined group received
additional acupuncture combined with Buyang Huanwu decoction treatment. The
National Institutes of Health Stroke Scale (NIHSS) and Chinese Stroke Scale
(CSS) were used to evaluate the stroke condition, and the Barthel index (BI)
was used to measure life quality. Blood lipids and recurrence were also
analyzed. Results The CSS and NIHSS scores were significantly lower in the acupuncture group
and combined group than in the control group; however, the BI score was
significantly higher in the acupuncture group and combined group. Similarly,
the levels of cholesterol, triglycerides, and low-density lipoprotein were
all significantly increased, while the level of high-density lipoprotein
showed no significant difference in all groups. The recurrence rate was
significantly lower in the combined group than in the other two groups. Conclusion Acupuncture combined with Buyang Huanwu decoction could improve the clinical
outcomes and reduce the recurrence rates in patients with ischemic
stroke.
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Affiliation(s)
- Huili Sun
- 1 School of Basic Medical Sciences, Nanjing University of Traditional Chinese Medicine, Nanjing, Jiangsu, China.,2 TCM Physiotherapy, First People's Hospital of Xuzhou, Xuzhou, Jiangsu, China
| | - Chengyu Wu
- 1 School of Basic Medical Sciences, Nanjing University of Traditional Chinese Medicine, Nanjing, Jiangsu, China
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Ho TH, Yang FC, Lin RC, Chien WC, Chung CH, Chiang SL, Chou CH, Tsai CK, Tsai CL, Lin YK, Lee JT. Impact of virtual reality-based rehabilitation on functional outcomes in patients with acute stroke: a retrospective case-matched study. J Neurol 2019; 266:589-597. [PMID: 30610428 DOI: 10.1007/s00415-018-09171-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 12/22/2018] [Accepted: 12/25/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND OBJECTIVES To date, the efficacy of the virtual reality (VR) application for acute stroke compared with conventional therapy (CT) remains unclear. This retrospective study aims to assess the impact of adjuvant VR technology on multidimensional therapy for patients with acute-stage stroke. METHODS 100 acute ischemic stroke patients with onset within 7 days who underwent combined adjuvant VR-based rehabilitation program and CT (intervention group-VR + CT) were compared to an equal number of cross-matched patients who received CT alone. While the intervention group received 40-min CT plus 20-min VR program (seven times for 1 week), the comparison group received time-matched CT alone. The National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), medical cost-effectiveness, and shortening of hospital stay were used as outcome measures. RESULTS Posttreatment, the VR + CT group revealed significantly improved NIHSS and mRS (P < 0.001), whereas only the mRS improvement was remarkable in the CT group. In between-group comparisons, the intervention group had better improvements of symptom severity (NIHSS percentage improvement from the baseline; 20.18% vs. 4.59%, P < 0.005), functional outcomes (mRS improvement from the baseline; - 0.58 vs. - 0.23, P < 0.001), and reduced medical cost (Taiwan dollar; 49474 vs. 66306, P < 0.005). Furthermore, the VR + CT group reached markedly higher proportion of functional independence in activities of daily living (mRS, 0-2) at discharge compared with the CT group (68% vs. 60%, P < 0.001). CONCLUSIONS This study suggests that the combination of VR-based rehabilitation and traditional therapy could be more effective for neurorehabilitation than CT alone in the early improvement of symptom severity, functional outcomes, and lower medical expenditure in acute stroke patients.
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Affiliation(s)
- Tsung-Han Ho
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Fu-Chi Yang
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Ruei-Ching Lin
- Department of Nursing, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Chi-Hsiang Chung
- School of Public Health, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Shang-Lin Chiang
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Chung-Hsing Chou
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan.,Graduate Institute of Medical Sciences, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Chia-Kuang Tsai
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan.,Graduate Institute of Medical Sciences, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Chia-Lin Tsai
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan.,Graduate Institute of Medical Sciences, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Yu-Kai Lin
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Jiunn-Tay Lee
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan. .,Graduate Institute of Medical Sciences, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan.
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Chen CY, Wu RW, Tsai NW, Lee MS, Lin WC, Hsu MC, Huang CC, Lai YR, Kung CT, Wang HC, Su YJ, Su CM, Hsiao SY, Cheng BC, Chiang YF, Lu CH. Increased circulating endothelial progenitor cells and improved short-term outcomes in acute non-cardioembolic stroke after hyperbaric oxygen therapy. J Transl Med 2018; 16:255. [PMID: 30208940 PMCID: PMC6134692 DOI: 10.1186/s12967-018-1629-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 09/06/2018] [Indexed: 01/08/2023] Open
Abstract
Background Acute ischemic stroke is a leading cause of mortality and long-term disability, and profiles of endothelial progenitor cells (EPCs) reflect the degree of endothelial impairment. This study tested the hypothesis that hyperbaric oxygen therapy (HBOT) both improves the clinical short-term outcomes and increases the number of circulating EPCs and antioxidant capacity. Methods The numbers of circulating EPCs [CD133+/CD34+ (%), KDR+/CD34+ (%)], biomarkers for oxidative stress (thiols and thiobarbituric acid-reactive substances), and clinical scores (National Institutes of Health Stroke Scale [NIHSS], Barthel index [BI], and modified Rankin Scale [MRS]) were prospectively evaluated in 25 patients with acute non-cardioembolic stroke under HBOT at two time points (pre- and post-HBOT). The biomarkers and clinical scores were compared with those of 25 age- and sex-matched disease controls. Results The numbers of KDR+/CD34+ (%) in the HBOT group following HBOT increased significantly, whereas the numbers of CD133+/CD34+ (%) also showed a tendency to increase without statistical significance. The mean high-sensitivity C-reactive protein levels showed significant decrease post-HBOT follow-up in the HBOT group. The changes in KDR+/CD34+EPC (%) numbers were positively correlated with changes in clinical outcomes scores (BI, NIHSS, and MRS) in the HBOT group. Conclusions Based on the results of our study, HBOT can both improve short-term clinical outcomes and increase the number of circulating EPCs in patients with acute non-cardioembolic stroke.
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Affiliation(s)
- Chen-Yu Chen
- Department of Hyperbaric Oxygen Therapy Center, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Re-Wen Wu
- Department of Hyperbaric Oxygen Therapy Center, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Nai-Wen Tsai
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Mel S Lee
- Department of Hyperbaric Oxygen Therapy Center, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Che Lin
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Mei-Chi Hsu
- Department of Nursing, I-Shou University, Kaohsiung, Taiwan
| | - Chih-Cheng Huang
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yun-Ru Lai
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chia-Te Kung
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hung-Chen Wang
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Jih Su
- Department of Rheumatology, Allergy and Immunology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Min Su
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sheng-Yuan Hsiao
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ben-Chung Cheng
- Department of Nephrology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Yi-Fang Chiang
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-Hsien Lu
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan. .,Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan. .,Department of Neurology, Xiamen Chang Gung Memorial Hospital, Xiamen, Fujian, China.
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Li Y, Liang K, Zhang L, Hu Y, Ge Y, Zhao J. Upper Limb Ischemic Postconditioning as Adjunct Therapy in Acute Stroke Patients: A Randomized Pilot. J Stroke Cerebrovasc Dis 2018; 27:3328-3335. [PMID: 30201456 DOI: 10.1016/j.jstrokecerebrovasdis.2018.07.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 07/14/2018] [Accepted: 07/22/2018] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE This study aims to observe the clinical effect of upper limb ischemic postconditioning (LIPostC) as an adjunct to treatment with acute stroke patients, possibly due to increased cerebral perfusion. METHODS We perform a randomized blinded placebo controlled trial in nonthrombolysis patients with acute ischemic stroke, within 72hours of ictus, divided into the LIPostC group and control group. The LIPostC group is induced by 4 cycles of intermittent repeated limb ischemia: alternating 5 minutes inflation (20mm Hg above systolic blood pressure) and 5 minutes deflation performed manually using a standard upper arm blood pressure cuff in the nonparetic arm. The control group receives a sham procedure (cuff inflation to 30mm Hg). Patients underwent the intervention from the time of enrollment to Day 14. Comparison of National Institutes of Health Stroke Scale (NIHSS) score, cerebral infarction volume, relative Perfusion weighted imaging (PWI) parameters (regional relative cerebral blood flow, regional relative mean transit time; preintervention [day 0], day 14, day 90), modified Rankin Scale (mRS; the preintervention score [day 0], the curative ratio at day 90 [we define 0-1 score as close to recovery or full recovery]). RESULTS Sixty eligible patients with acute stroke (29 LIPostC and 31 control) are recruited age 65years (SD 12.22), blood pressure 156/74mm Hg (SD 14/10), and NIHSS score 5.98 (SD 3.35), mRS score 2.25 (SD .79). Only 1 in the LIPostC group is intolerant the first cycle to give up. All patients tolerate the sham procedure. Two patients experience recurrent stroke versus none in the LIPostC group. Day 90, compared with the control group, there is a significant decrease the NIHSS score, regional relative mean transit time (P < .05) and increase the curative ratio of mRS, regional relative cerebral blood flow(P < .05) in the LIPostC group, which infarct volume decreased by 31.3% (P < .05). CONCLUSIONS LIPostC after acute stroke is well tolerated and appears safe and feasible. LIPostC may improve neurological outcome, and protective mechanisms may be increased cerebral blood flow to improve cerebral perfusion. A larger trial is warranted.
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Affiliation(s)
- Yuejuan Li
- Departments of Neurology, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Keke Liang
- Departments of Neurology, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Long Zhang
- Departments of Neurology, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Yamei Hu
- Departments of Neurology, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Yunli Ge
- Departments of Neurology, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Jianhua Zhao
- Departments of Neurology, Zhengzhou University People's Hospital, Zhengzhou, China.
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Visser MM, Yassi N, Campbell BCV, Desmond PM, Davis SM, Spratt N, Parsons M, Bivard A. White Matter Degeneration after Ischemic Stroke: A Longitudinal Diffusion Tensor Imaging Study. J Neuroimaging 2018; 29:111-118. [PMID: 30160814 DOI: 10.1111/jon.12556] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 07/29/2018] [Accepted: 08/16/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND AND PURPOSE Degeneration of gray matter and subcortical structures after ischemic stroke has been well described. However, little is known about white matter degeneration after stroke. It is unclear whether white matter degeneration occurs throughout the whole brain, or whether patterns of degeneration occur more in specific brain areas. METHODS We prospectively collected National Institutes of Health Stroke Scale (NIHSS) scores and diffusion tensor imaging (DTI) in patients with acute ischemic stroke within the first week after onset (baseline), and at 1 and 3 months. DTI was processed to produce maps of fractional anisotropy, apparent diffusion coefficients, and axial and radial diffusivity. DTI parameters in specified regions-of-interest corresponding to items on the NIHSS were calculated and changes over time were assessed using linear mixed-effect modeling. RESULTS Seventeen patients were included in the study. Mean age (SD) was 71 (11.7) years, and median (IQR) baseline NIHSS 9 (5-13.3). Changes over time were observed in both visual cortices, contralesional primary motor cortex, premotor cortex, and superior temporal gyrus (P < .05). Changes in the ipsilesional motor cortex and inferior parietal lobule were only seen in patients with scores on the respective NIHSS-items (P < .05). No significant changes in global white matter diffusivity parameters were identified (P > .05). CONCLUSION White matter changes after stroke may be localized rather than a global phenomenon.
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Affiliation(s)
- Milanka M Visser
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia.,Priority Research Centre for Stroke and Brain Injury, Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Nawaf Yassi
- Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia.,Department of Neurology, The Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Bruce C V Campbell
- Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia.,Department of Neurology, The Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Patricia M Desmond
- Department of Radiology, The Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia.,Melbourne Brain Centre, The Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Stephen M Davis
- Melbourne Brain Centre, The Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Neil Spratt
- Priority Research Centre for Stroke and Brain Injury, Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,Department of Neurology, John Hunter Hospital, University of Newcastle, Callaghan, New South Wales, Australia
| | - Mark Parsons
- Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia.,Department of Neurology, The Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia.,Department of Neurology, John Hunter Hospital, University of Newcastle, Callaghan, New South Wales, Australia
| | - Andrew Bivard
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia.,Department of Neurology, The Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia.,Department of Neurology, John Hunter Hospital, University of Newcastle, Callaghan, New South Wales, Australia
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Wouters A, Nysten C, Thijs V, Lemmens R. Prediction of Outcome in Patients With Acute Ischemic Stroke Based on Initial Severity and Improvement in the First 24 h. Front Neurol 2018; 9:308. [PMID: 29867722 PMCID: PMC5950843 DOI: 10.3389/fneur.2018.00308] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 04/19/2018] [Indexed: 12/03/2022] Open
Abstract
Introduction Stroke severity measured by the baseline National Institutes of Health Stroke Scale (NIHSS) is a strong predictor of stroke outcome. Early change of baseline severity may be a better predictor of outcome. Here, we hypothesized that the change in NIHSS in the first 24 h after stroke improved stroke outcome prediction. Materials and methods Patients from the Leuven Stroke Genetics Study were included when the baseline NIHSS (B-NIHSS) was determined on admission in the hospital and NIHSS after 24 h could be obtained from patient files. The delta NIHSS, relative reduction NIHSS, and major neurological improvement (NIHSS of 0–1 or ≥8-point improvement at 24 h) were calculated. Good functional outcome (GFO) at 90 days was defined as a modified Rankin Scale of 0–2. Independent predictors of outcome were identified by multivariate logistic regression. We performed a secondary analysis after excluding patients presenting with a minor stroke (NIHSS 0–5) since the assessment of change in NIHSS might be more reliable in patients presenting with a moderate to severe deficit. Results We analyzed the outcome in 369 patients. B-NIHSS was associated with GFO (odds ratio: 0.82; 95% CI 0.77–0.86). In a multivariate model with B-NIHSS and age as predictors, the accuracy [area under the curve (AUC): 0.82] improved by including the delta NIHSS (AUC: 0.86; p < 0.01). In 131 patients with moderate to severe stroke, the predictive multivariate model was more accurate when including the RR NIHSS (AUC: 0.83) to the model which included B-NIHSS, age and ischemic heart disease (AUC: 0.77; p = 0.03). Conclusion B-NIHSS is a predictor of stroke outcome. In this cohort, the prediction of GFO was improved by adding change in stroke severity after 24 h to the model.
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Affiliation(s)
- Anke Wouters
- Department of Neurosciences, Experimental Neurology, KU Leuven - University of Leuven, Leuven, Belgium.,Laboratory of Neurobiology, Center for Brain and Disease Research, VIB, Leuven, Belgium.,Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Céline Nysten
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Vincent Thijs
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia.,Department of Neurology, Austin Health, Heidelberg, VIC, Australia
| | - Robin Lemmens
- Department of Neurosciences, Experimental Neurology, KU Leuven - University of Leuven, Leuven, Belgium.,Laboratory of Neurobiology, Center for Brain and Disease Research, VIB, Leuven, Belgium.,Department of Neurology, University Hospitals Leuven, Leuven, Belgium
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Okano Y, Ishimatsu K, Kato Y, Yamaga J, Kuwahara K, Okumoto K, Wada K. Clinical features of stroke mimics in the emergency department. Acute Med Surg 2018; 5:241-248. [PMID: 29988676 PMCID: PMC6028791 DOI: 10.1002/ams2.338] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 02/22/2018] [Indexed: 11/23/2022] Open
Abstract
Aim To clarify the features of stroke mimics. Methods We retrospectively investigated stroke mimic cases among the suspected stroke cases examined at our emergency department, over the past 9 years, during the tissue‐type plasminogen activator treatment time window. Results Of 1,557 suspected acute stroke cases examined at the emergency department, 137 (8.8%) were stroke mimics. The most common causes were symptomatic epilepsy (28 cases, 20.4%), neuropathy‐like symptoms (21 cases, 15.3%), and hypoglycemia (15 cases, 10.9%). Outcomes were survival to hospital discharge for 91.2% and death for 8.8% of the cases. Clinical results were significantly different between stroke mimics and the stroke group for low systolic blood pressure, low National Institutes of Health Stroke Scale score on initial treatment, history of diabetes, and no history of arrhythmia. On multivariate analysis, distinguishing factors for stroke mimics include systolic blood pressure ≤ 140 mmHg, National Institutes of Health Stroke Scale score ≤ 5 points, history of diabetes, and no history of arrhythmia. Conclusions Frequency of stroke mimics in cases of acute stroke suspected cases is 8.8%, and the most common cause is epilepsy. In order to distinguish stroke mimics, it is useful to understand common diseases presenting as stroke mimics and evaluate clinical features different from stroke by medical interview or nerve examination.
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Affiliation(s)
- Yuichi Okano
- Department of Emergency Medicine Kumamoto Red Cross Hospital Kumamoto Japan
| | - Kazuaki Ishimatsu
- Department of Emergency Medicine Kumamoto Red Cross Hospital Kumamoto Japan
| | - Yoichi Kato
- Department of Emergency Medicine Kumamoto Red Cross Hospital Kumamoto Japan
| | - Junichi Yamaga
- Department of Emergency Medicine Kumamoto Red Cross Hospital Kumamoto Japan
| | - Ken Kuwahara
- Department of Emergency Medicine Kumamoto Red Cross Hospital Kumamoto Japan
| | - Katsuki Okumoto
- Department of Emergency Medicine Kumamoto Red Cross Hospital Kumamoto Japan
| | - Kuniyasu Wada
- Department of Emergency Medicine Kumamoto Red Cross Hospital Kumamoto Japan
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Li CC, Hao XZ, Tian JQ, Yao ZW, Feng XY, Yang YM. Predictors of short-term outcome in patients with acute middle cerebral artery occlusion: unsuitability of fluid-attenuated inversion recovery vascular hyperintensity scores. Neural Regen Res 2018; 13:69-76. [PMID: 29451209 PMCID: PMC5840994 DOI: 10.4103/1673-5374.224375] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Fluid-attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH) is used to assess leptomeningeal collateral circulation, but clinical outcomes of patients with FVH can be very different. The aim of the present study was to assess a FVH score and explore its relationship with clinical outcomes. Patients with acute ischemic stroke due to middle cerebral artery M1 occlusion underwent magnetic resonance imaging and were followed up at 10 days (National Institutes of Health Stroke Scale) and 90 days (modified Rankin Scale) to determine short-term clinical outcomes. Effective collateral circulation indirectly improved recovery of neurological function and short-term clinical outcome by extending the size of the pial penumbra and reducing infarct lesions. FVH score showed no correlation with 90-day functional clinical outcome and was not sufficient as an independent predictor of short-term clinical outcome.
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Affiliation(s)
- Chan-Chan Li
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiao-Zhu Hao
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Jia-Qi Tian
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhen-Wei Yao
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiao-Yuan Feng
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yan-Mei Yang
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
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Zhang YY, Huang NN, Zhao YX, Li YS, Wang D, Fan YC, Li XH. Elevated Tumor Necrosis Factor-a-induced Protein 8-like 2 mRNA from Peripheral Blood Mononuclear Cells in Patients with Acute Ischemic Stroke. Int J Med Sci 2018; 15:1713-1722. [PMID: 30588195 PMCID: PMC6299423 DOI: 10.7150/ijms.27817] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 10/18/2018] [Indexed: 12/23/2022] Open
Abstract
Background: Tumor necrosis factor-a-induced protein 8-like 2 (TIPE2) is a novel regulator of immunity and protects against experimental stroke. However, the expression and function of TIPE2 in patients with acute ischemic stroke has not been well demonstrated. Methods: A total of 182 consecutive patients with acute ischemic stroke and 40 healthy controls were included during November 2015 to June 2016. The mRNA levels of TIPE2, interleukin(IL)-1β, IL-10, IL-6, nuclear factor(NF)-κβ, activator protein(AP)-1, interferon(IFN)-γ and tumor necrosis factor(TNF)-α from peripheral blood mononuclear cells were determined using real time quantitative reverse transcriptase polymerase chain reaction. The severity of stroke was assessed using the National Institutes of Health Stroke Scale (NIHSS) score. Results: The median mRNA levels of TIPE2, TNF-α, AP-1, IFN-γ and NF-κβ in patients with acute ischemic stroke were significantly higher than healthy controls (all P<0.001, respectively). Of note, TIPE2 mRNA showed an increasing trend on a time-dependent manner after the onset of stroke. Furthermore, TIPE2 mRNA was negatively associated with lesion volumes (r=-0.23, P<0.01), NIHSS(r=-0.15, P<0.05), TNF-α(r=-0.33,P<0.001), AP-1(r=-0.28,P<0.001), IFN-γ (r=-0.16, P<0.05) and NF-κβ (r=-0.13, P<0.05), but positively associated with IL-6(r=0.14, P<0.05) and IL-10(r=-0.31, P<0.001). Hierarchy cluster analysis showed that TIPE2 mRNA has nearest membership with TNF-α, followed by IL-6, NF-κβ, AP-1, IL-10, IL-1β and IFN-γ. In addition, TIPE2 mRNA in survivals (n=149) was significantly higher than nonsurvivals (n=33) (P<0.001), and showed a great odd ratio (0.52, 95% confidence interval: 0.349-0.760, P<0.001) on 3-month mortality. Conclusions: TIPE2 mRNA contributed to the immune response of stroke and might be a potential biomarker for the mortality of acute ischemic stroke.
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Affiliation(s)
- Yuan-Yuan Zhang
- Department of Neurology, Jinan Central Hospital affiliated to Shandong University, Jinan 250013, China
| | - Na-Na Huang
- Department of Neurology, Jinan Central Hospital affiliated to Shandong University, Jinan 250013, China
| | - Yan-Xin Zhao
- Department of Neurology, Jinan Central Hospital affiliated to Shandong University, Jinan 250013, China
| | - Yan-Shuang Li
- Department of Neurology, Jinan Central Hospital affiliated to Shandong University, Jinan 250013, China
| | - Dong Wang
- Department of Neurology, Jinan Central Hospital affiliated to Shandong University, Jinan 250013, China
| | - Yu-Chen Fan
- Department of Hepatology, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Xiao-Hong Li
- Department of Neurology, Jinan Central Hospital affiliated to Shandong University, Jinan 250013, China
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Fan L, Yeatts SD, Foster LD, Khatri P, Tomsick T, Broderick JP, Palesch YY. Endovascular Therapy Demonstrates Benefit over Intravenous Recombinant Tissue Plasminogen Activator Based on Repeatedly Measured National Institutes of Health Stroke Scale. Interv Neurol 2017; 6:25-30. [PMID: 28611830 DOI: 10.1159/000452137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND PURPOSE The Interventional Management of Stroke (IMS) III trial was a randomized controlled trial designed to compare the effect of endovascular therapy after intravenous recombinant tissue plasminogen activator (i.v. rt-PA) as compared to i.v. rt-PA alone. The primary outcome was modified Rankin Scale at 90 days. Secondary outcomes included National Institutes of Health Stroke Scale (NIHSS), which was assessed repeatedly through 90 days. The objective of this analysis is to evaluate the treatment effect of endovascular therapy over time on NIHSS. METHODS 656 subjects were enrolled in the IMS III trial, including 434 subjects randomized to endovascular therapy and 222 to i.v. rt-PA only. NIHSS scores evaluated at 40 min, 24 h, Day 5, and Day 90 were included in the analysis. A covariance structure model was used to investigate the treatment effect on NIHSS over time, adjusting for relevant covariates including baseline stroke severity. Model assumptions were valid. RESULTS Based on the covariance structure model, after adjusting for relevant baseline covariates, a significant time-by-treatment interaction effect (p = 0.0137) was observed. Only NIHSS at Day 90 showed a significant treatment effect (p = 0.0473), with subjects in the endovascular arm having a lower NIHSS (less neurologic deficit) compared to the i.v. rt-PA arm. CONCLUSIONS The IMS III trial demonstrated an endovascular treatment effect based on the secondary outcome of NIHSS. However, the magnitude of this treatment effect varied by the time of assessment. It was only at Day 90 that the endovascular arm had a significantly lower NIHSS compared to that in the i.v. rt-PA arm.
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Affiliation(s)
- Liqiong Fan
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, and Departments of, OH, USA
| | - Sharon D Yeatts
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, and Departments of, OH, USA
| | - Lydia D Foster
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, and Departments of, OH, USA
| | | | - Thomas Tomsick
- Radiology, University of Cincinnati, Cincinnati, OH, USA
| | | | - Yuko Y Palesch
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, and Departments of, OH, USA
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Isono N, Imamura Y, Ohmura K, Ueda N, Kawabata S, Furuse M, Kuroiwa T. Transthyretin Concentrations in Acute Stroke Patients Predict Convalescent Rehabilitation. J Stroke Cerebrovasc Dis 2017; 26:1375-1382. [PMID: 28314625 DOI: 10.1016/j.jstrokecerebrovasdis.2017.02.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 02/06/2017] [Accepted: 02/15/2017] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE For stroke patients, intensive nutritional management is an important and effective component of inpatient rehabilitation. Accordingly, acute care hospitals must detect and prevent malnutrition at an early stage. Blood transthyretin levels are widely used as a nutritional monitoring index in critically ill patients. Here, we had analyzed the relationship between the transthyretin levels during the acute phase and Functional Independence Measure in stroke patients undergoing convalescent rehabilitation. METHODS We investigated 117 patients who were admitted to our hospital with acute ischemic or hemorrhagic stroke from February 2013 to October 2015 and subsequently transferred to convalescent hospitals after receiving acute treatment. Transthyretin concentrations were evaluated at 3 time points as follows: at admission, and 5 and 10 days after admission. After categorizing patients into 3 groups according to the minimum transthyretin level, we analyzed the association between transthyretin and Functional Independence Measure. RESULTS In our patients, transthyretin levels decreased during the first 5 days after admission and recovered slightly during the subsequent 5 days. Notably, Functional Independence Measure efficiency was significantly associated with the decrease in transthyretin levels during the 5 days after admission. Patients with lower transthyretin levels had poorer Functional Independence Measure outcomes and tended not to be discharged to their own homes. DISCUSSION A minimal transthyretin concentration (<10 mg/dL) is predictive of a poor outcome in stroke patients undergoing convalescent rehabilitation. In particular, an early decrease in transthyretin levels suggests restricted rehabilitation efficiency. Accordingly, transthyretin levels should be monitored in acute stroke patients to indicate mid-term rehabilitation prospects.
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Affiliation(s)
- Naofumi Isono
- Department of Neurosurgery, Higashi-Sumiyoshi Morimoto Hospital, Osaka, Japan.
| | - Yuki Imamura
- Clinical Nutrition and Food Service, Higashi-Sumiyoshi Morimoto Hospital, Osaka, Japan
| | - Keiko Ohmura
- Clinical Nutrition and Food Service, Higashi-Sumiyoshi Morimoto Hospital, Osaka, Japan
| | - Norihide Ueda
- Clinical Nutrition and Food Service, Higashi-Sumiyoshi Morimoto Hospital, Osaka, Japan; Clinical Nutrition and Food Service, Kokuho Central Hospital, Shiki, Japan
| | - Shinji Kawabata
- Department of Neurosurgery, Osaka Medical College, Takatsuki, Japan
| | - Motomasa Furuse
- Department of Neurosurgery, Osaka Medical College, Takatsuki, Japan
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Maruyama K, Uchiyama S, Shiga T, Iijima M, Ishizuka K, Hoshino T, Kitagawa K. Brain Natriuretic Peptide Is a Powerful Predictor of Outcome in Stroke Patients with Atrial Fibrillation
. Cerebrovasc Dis Extra 2017; 7:35-43. [PMID: 28253498 PMCID: PMC5465753 DOI: 10.1159/000457808] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 01/10/2017] [Indexed: 01/25/2023] Open
Abstract
Background Since stroke patients with nonvalvular atrial fibrillation (NVAF) have poor outcomes in general, the prediction of outcomes following discharge is of utmost concern for these patients. We previously reported that brain natriuretic peptide (BNP) levels were significantly higher in NVAF patients with larger infarcts, higher modified Rankin Scale (mRS) score, and higher CHADS2 score. In the present study, we evaluated an array of variables, including BNP, in order to determine significant predictors for functional outcome in patients with NVAF after acute ischemic stroke (AIS). Methods A total of 615 consecutive patients with AIS within 48 h of symptom onset, admitted to our hospital between April 2010 and October 2015, were retrospectively searched. Among these patients, we enrolled consecutive patients with NVAF. We evaluated the mRS score 3 months after onset of stroke and investigated associations between mRS score and the following clinical and echocardiographic variables. Categorical variables included male sex, current smoking, alcohol intake, hypertension, diabetes mellitus, dyslipidemia, coronary artery disease, peripheral artery disease, use of antiplatelet drugs, anticoagulants, or tissue plasminogen activator (tPA), and infarct size. Continuous variables included age, systolic blood pressure (SBP), diastolic blood pressure, hemoglobin, creatinine, D-dimer, brain natriuretic peptide (BNP), left atrial diameter, left ventricular ejection fraction (EF), and early mitral inflow velocity/diastolic mitral annular velocity (E/e’). We also analyzed the association of prestroke CHADS2, CHA2DS2-VASc, and R2CHADS2 scores, and National Institutes of Health Stroke Scale (NIHSS) score on admission with mRS score 3 months after the onset of stroke. Patients were classified into 2 groups according to mRS score: an mRS score ≤2 was defined as good outcome, an mRS score ≥3 was defined as poor outcome. To clarify the correlations between categorical or continuous variables and mRS score, uni- and multivariate logistic regression models using the stepwise variable selection method were applied. Results Among 157 patients with NVAF after AIS, 63.7% were male and the mean age was 75.9 years. In univariate regression analysis, poor outcome (mRS score ≥3) was associated with use of tPA, infarct size, age, SBP, BNP, EF, and NIHSS score. In multivariate regression analysis, BNP levels (odds ratio [OR] 6.40; 95% confidence interval [CI] 1.26–32.43; p = 0.0235) and NIHSS score (OR 2.87; 95% CI 1.84–4.47; p < 0.001) were significantly associated with poor outcome (mRS score ≥3) after adjusting for use of tPA, infarct size, age, BNP, EF, and NIHSS score. Conclusions Apart from NIHSS score, BNP was a very useful predictor for long-term outcomes of patients with NVAF after AIS.
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Affiliation(s)
- Kenji Maruyama
- Department of Neurology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Shinichiro Uchiyama
- Department of Neurology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.,Clinical Research Center, International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo, Japan
| | - Tsuyoshi Shiga
- Department of Cardiology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Mutsumi Iijima
- Department of Neurology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Kentaro Ishizuka
- Department of Neurology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Takao Hoshino
- Department of Neurology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Kazuo Kitagawa
- Department of Neurology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
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Abstract
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.
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Affiliation(s)
- Saurabh Agarwal
- Department of Pharmacology, Nirma University, Ahmedabad, Gujarat, India
| | - Bhoomika M. Patel
- Department of Pharmacology, Nirma University, Ahmedabad, Gujarat, India
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Jurjāns K, Noviks I, Volčeka D, Zandersone L, Meilerte K, Miglāne E, Stepens A, Millers A. The adaption and evaluation of a Latvian version of the National Institutes of Health Stroke Scale. J Int Med Res 2016; 45:1861-1869. [PMID: 28703630 PMCID: PMC5805183 DOI: 10.1177/0300060516664636] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives To determine the validity and reliability of a Latvian version of the National Institutes of Health Stroke Scale (LV-NIHSS) for evaluating Latvian stroke patients. Methods The adaption of the LV-NIHSS followed standard methods used for the adaption and validation of clinical assessment tools. The scale validity was tested by comparison with the Glasgow Coma Scale (GCS) and the modified Rankin scale (mRs). The reliability of the LV-NIHSS was evaluated by intra-rater and inter-rater agreement using intra-class correlation coefficient (ICC) analysis. Results A total of 296 stroke patients and 101 control subjects were evaluated. The mean age of the overall study population was 73.6 years (range, 37 - 94 years; 227 [57.2%] were female). The mean LV-NIHSS score of the patients with stroke was 8.4 ± 6.2. In terms of construct validity of the LV-NIHSS, it correlated with the GCS ( r = -0.571) and mRs ( r = 0.755). In terms of the reliability of the LV-NIHSS, the inter-rater agreement had an ICC of 0.99 and the intra-rater agreement had an ICC of 0.99. Conclusion The adaption of LV-NIHSS was successful and the evaluation showed that the scale was valid and reliable for evaluating Latvian stroke patients.
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Affiliation(s)
- Kristaps Jurjāns
- 1 Department of Neurology and Neurosurgery, Riga Stradins University, Riga, Latvia.,2 Department of Neurology, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Iļja Noviks
- 1 Department of Neurology and Neurosurgery, Riga Stradins University, Riga, Latvia.,2 Department of Neurology, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Diāna Volčeka
- 1 Department of Neurology and Neurosurgery, Riga Stradins University, Riga, Latvia
| | - Linda Zandersone
- 1 Department of Neurology and Neurosurgery, Riga Stradins University, Riga, Latvia
| | - Kristīne Meilerte
- 1 Department of Neurology and Neurosurgery, Riga Stradins University, Riga, Latvia
| | - Evija Miglāne
- 1 Department of Neurology and Neurosurgery, Riga Stradins University, Riga, Latvia.,2 Department of Neurology, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Ainars Stepens
- 1 Department of Neurology and Neurosurgery, Riga Stradins University, Riga, Latvia
| | - Andrejs Millers
- 1 Department of Neurology and Neurosurgery, Riga Stradins University, Riga, Latvia.,2 Department of Neurology, Pauls Stradins Clinical University Hospital, Riga, Latvia
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Siegler JE. The Utility of Quantifiable Neurologic Assessments After Stroke: In response to Marsh et al, "The NIH Stroke Scale Has Limited Utility in Accurate Daily Monitoring of Neurologic Status". Neurohospitalist 2016; 6:95-6. [PMID: 27366290 PMCID: PMC4906560 DOI: 10.1177/1941874416641469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- James E. Siegler
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Ermis E, Demirelli S, Ceylan M, Firtina S, Ipek E, Yalcin A, Sahin BD, Yildirim E, Bayraktutan OF, Kalkan K. The evaluation of myocardial function of patients in the early stage of acute ischemic stroke by two-dimensional speckle tracking echocardiography. J Clin Ultrasound 2016; 44:305-311. [PMID: 26888734 DOI: 10.1002/jcu.22332] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 12/09/2015] [Accepted: 12/29/2015] [Indexed: 06/05/2023]
Abstract
PURPOSE To evaluate the myocardial dysfunction in the early stage of nonhemorrhagic stroke and its association with the National Institutes of Health Stroke Scale (NIHSS) score, by two-dimensional speckle tracking echocardiography. METHODS We included 29 patients with acute ischemic stroke, in whom NIHSS scores were calculated and stroke infarct volumes recorded. Within 48 hours of admission, cardiac evaluation with speckle tracking echocardiography was performed and left ventricular global longitudinal strain (GLS) and global longitudinal systolic strain rate were obtained. These measurements were repeated on the 10th day. RESULTS NIHSS score improved, but infarct volume increased (p = 0.011 and 0.065, respectively) from admission to day 10. Ejection fraction was 53.2% and 55.8%, respectively, at admission and day 10 (p = 0.482), while GLS improved from -16.41% to -18.76% (p = 0.003). CONCLUSIONS GLS and global longitudinal systolic strain rate showed significant improvement together with NIHSS score. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:305-311, 2016.
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Affiliation(s)
- Emrah Ermis
- Department of Cardiology, Erzurum Education and Research Hospital, Erzurum, Turkey
| | - Selami Demirelli
- Department of Cardiology, Erzurum Education and Research Hospital, Erzurum, Turkey
| | - Mustafa Ceylan
- Department of Neurology, Erzurum Education and Research Hospital, Erzurum, Turkey
| | - Serdar Firtina
- Department of Cardiology, Maresal Cakmak Military Hospital, Erzurum, Turkey
| | - Emrah Ipek
- Department of Cardiology, Erzurum Education and Research Hospital, Erzurum, Turkey
| | - Ahmet Yalcin
- Department of Radiology, Erzurum Education and Research Hospital, Erzurum, Turkey
| | - Bingul Dilekci Sahin
- Department of Cardiology, Erzurum Education and Research Hospital, Erzurum, Turkey
| | - Erkan Yildirim
- Department of Cardiology, Erzurum Education and Research Hospital, Erzurum, Turkey
| | | | - Kamuran Kalkan
- Department of Cardiology, Erzurum Education and Research Hospital, Erzurum, Turkey
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