Prototype development of bilateral arm mirror-like-robotic rehabilitation device for acute stroke patients

During the early six months after the onset of a stroke, patients usually remain disabled with limbs weakness and need intensive rehabilitation. An increased number of stroke patients is countered with a reduced number of physical therapists. The development of medical robots to substitute therapists' work should be helpful. We developed a prototype of bilateral arm mirror-like-robotic rehabilitation device covering the shoulder to the elbow as a 4-degrees of freedom (DOF). The device was operated by gripping the patient's arm or forearm. The motor for arm movement and point of force was calculated from static and dynamic. A developed microcontroller drove the assistive control system to regulate the movement of a robotic arm by getting the position of the normal arm's movement to control the weak arm's movement position. The prototype was built with operation control system and tested in the acute stroke patients. The effectiveness of rehabilitation using developed robot was assessed and compared with the conventional training group. Patients with either left or right arm paresis can practice with the device. They can safely train the weakened arm by using the normal arm as a working model. A bilateral robot was designed to be easy to use, lightweight, and compact size. Patients can use the device regularly for rehabilitation training, even at home.&#xD.

The Role of Transcranial Doppler in Detecting Patent Foramen Ovale

Air embolic signals detected in the intracranial arteries using transcranial Doppler after intravenous injection of agitated saline bubbles indicate right-to-left cardiac shunting. They prove that emboli from venous sites can bypass the lungs and flow to the intracranial arteries. The Valsalva maneuver immediately after an intravenous injection of agitated saline bubbles helps the air bubbles pass through the shunt. If the air embolic signal appears in the intracranial arteries without the Valsalva maneuver, the shunting is highly significant to the etiology of embolism. Transcranial Doppler to detect air embolic signals after intravenous injection of agitated saline bubbles may not be mandatory to diagnose and treat patent foramen ovale; however, as with echocardiography, transcranial Doppler is considered a noninvasive, convenient, and low-cost investigation. The test should be helpful to confirm the significance of the corresponding patent foramen ovale.

Comparison of ANN and ANFIS Models for AF Diagnosis Using RR Irregularities

Classification of normal sinus rhythm (NSR), paroxysmal atrial fibrillation (PAF), and persistent atrial fibrillation (AF) is crucial in order to diagnose and effectively plan treatment for patients. Current classification models were primarily developed by electrocardiogram (ECG) signal databases, which may be unsuitable for local patients. Therefore, this research collected ECG signals from 60 local Thai patients (age 52.53 ± 23.92) to create a classification model. The coefficient of variance (CV), the median absolute deviation (MAD), and the root mean square of the successive differences (RMSSD) are ordinary feature variables of RR irregularities used by existing models. The square of average variation (SAV) is a newly proposed feature that extracts from the irregularity of RR intervals. All variables were found to be statistically different using ANOVA tests and Tukey’s method with a p-value less than 0.05. The methods of artificial neural network (ANN) and adaptive neuro-fuzzy inference system (ANFIS) were also tested and compared to find the best classification model. Finally, SAV showed the best performance using the ANFIS model with trapezoidal membership function, having the highest system accuracy (ACC) at 89.33%, sensitivity (SE), specificity (SP), and positive predictivity (PPR) for NSR at 100.00%, 94.00%, and 89.29%, PAF at 88.00%, 90.57%, and 81.48%, and AF at 80.00%, 96.00%, and 90.91%, respectively.

The Effects of Foot Reflexology for Smoking Cessation on Brain Activities with Functional Magnetic Resonance Imaging (fMRI): A Pilot Study

Background. Foot reflexology is a treatment with the hypothesis that such massage stimulation on the feet may cause a therapeutic effect which should be helpful for smoking cessation. However, its mechanism of action in the brain of smoking people remains unknown. Functional magnetic resonance imaging (fMRI) is helpful for real-time brain activity detection. We aim to compare the brain activity effects of foot reflexology with fMRI between smoking and nonsmoking subjects. Materials and Methods. We divided participants into experimental (smokers) and control groups (nonsmokers). Both groups received similar foot reflexology under the fMRI examination. Then, we compared the mean response score in each brain area before and after foot stimulation among groups and between groups. Results. Five nonsmokers and fifteen smokers had completed the study. All participants were right-handed males, with a mean age of 38.6 years. The fMRI brain response in the areas correlated with foot stimulation, including the precentral gyrus of the frontal lobe and the postcentral gyrus of the parietal lobe, was present for all participants. The fMRI response outside the correlated area, including other parts of the frontal and parietal lobes, the temporal and occipital cortices, and the thalamus, was also found in all participants, but was not consistent. Conclusions. The fMRI of the brain is feasible and safe for demonstrating foot reflexology reactions. The response signal outside the correlated motor-sensory cortical area with foot reflexology may have clinical significance and may be helpful for smoking cessation. We suggest conducting a large-scale, randomized controlled trial to confirm these findings.

The differences in clinical characteristics and natural history between essential tremor and essential tremor plus

The diverse clinical manifestation of essential tremor (ET) has led to the question whether the different phenotypes may affect the clinical outcome and progression. This study aimed to estimate the clinical characteristics and natural history of ET and ET-plus. A total of 221 patients with ET were included, 117 (52.9%) reclassified as ET and 104 (47.1%) as ET-plus. Patients with ET-plus were significantly older in age at onset (P < 0.001); had a higher frequency of cranial tremors (P < 0.001), neurological comorbidities (P < 0.001) and psychiatric comorbidities (P = 0.025); more tremor progression (P < 0.001); and poorer response to medical treatment (P < 0.001) compared to ET patients. Regression analysis revealed that late-onset tremor (OR 11.02, 95% CI 2.79–43.53), neurological comorbidities (OR 3.38, 95% CI 1.56–7.31), psychiatric comorbidities (OR 4.29, 95% CI 1.48–12.44), cranial tremors (OR 2.10, 95% CI 1.02–4.30), and poor response to medical treatment (OR 3.67, 95% CI 1.87–7.19) were associated with ET-plus diagnosis. ET and ET-plus differ in the age of onset, tremor distribution, comorbidities, treatment response rate, and progression. Identifying the ET phenotypes may increase the clinical value in therapeutic strategies and clinical research in the future.

Development of a DIY rehabilitation device for lower limb weakness in acute to subacute ischemic stroke

Many patients have significantly lower limb weakness after getting a stroke. Continuous regular physical therapy is essential to promote the improvement of the weakness and overall outcomes. Home rehabilitation provides motivation and enhances regular rehabilitation in stroke patients. The Do-It-Yourself (DIY) medical device is developed to fill the gap of unmet medical management needs and becomes increasingly applied in rehabilitation. The DIY device should support the concept of home rehabilitation in stroke patients. We designed and developed a low-cost, easy-to-use, DIY rehabilitation device to promote regular physical therapy in stroke patients with lower limb weakness. The methods and rationale of device development were described. The feasibility and safety of the device were also evaluated.•The DIY rehabilitation device for the lower limb is convenient and easy to assembly.•Regular home rehabilitation is enhanced with the DIY rehabilitation device.•The device is feasible and safe for physical therapy in stroke patients with lower limb weakness.

Accuracy of laboratory tests drawn by pull-push method from central venous catheterization after routine flushing with 10 ml normal saline in patients with sepsis at the emergency department

Central venous catheterization (CVC) remains a common practice in the emergency setting. Routine flushing 10-20 ml of normal saline to maintain the patency of CVC could affect the accuracy of laboratory tests. Typically, physicians require peripheral vein phlebotomy when more blood sampling is needed. One alternative method, the Pull-push method, could avoid the trauma associated with venipuncture and unnecessary peripheral vein phlebotomy. However, there has been no recent study analyzing the accuracy of blood sampling using this technique. We evaluate laboratory tests' accuracy between blood samples drawn by the Pull-push method from CVC after routine flushing with 10 ml of normal saline versus control. We conducted a diagnostic accuracy study from May to September 2019. After exclusion, 72 patients were eligible for analysis. Promptly after central venous catheterization, we drew blood samples, stored them in blood collecting tubes, and labeled them for the gold standard group. We flushed with 10 ml of normal saline before blood sampling using the Pull-push method's completed three times; then, we drew blood samples again, labeled Pull-push group. We compared the laboratory results between two groups by paired t-test. The accuracies were analyzed based on an allowable error by Clinical Laboratory Improvement Amendments (CLIA) and presented by a modified Bland-Altman plot. The 72 patients were primarily male (n = 47, 65.3%), had a mean age 60.1 ± 14.0 years, and were diagnosed with sepsis (n = 4, 5.6%) or septic shock (n = 65, 90.3%). For almost all the laboratory values, including hemoglobin, hematocrit, white blood cell count, platelet count, blood urea nitrogen, creatinine, sodium, potassium, chloride, bicarbonate, prothrombin time, international normalized ratio, and blood sugar, the accuracy was more than 90% (92.8-98.6%), except aPTT (85.5%) and aPTT ratio (86.7%). Laboratory tests drawn by the Pull-push method could replace peripheral vein phlebotomy to avoid the trauma associated with venipuncture and infection risk.

The Effectiveness of Mirror Therapy to Upper Extremity Rehabilitation in Acute Stroke Patients

Rehabilitation is a crucial part of stroke recovery to help them regain use of their limb. The aim of this article was to compare the effectiveness of long-term training of mirror therapy with conventional rehabilitation therapy on neurological and recovery of upper limb in acute stroke patients. In this randomized and assessor-blinded control study, 20 acute stroke patients were analyzed in this study and allocated to a case (n = 10, 50.6 ± 17.90 years) and control group (n = 10, 55.9 ± 11.25 years). All the participants performed daily home exercise during 12 weeks. The patients in the control group were treated with conventional therapy (CT) and a group of cases were treated with mirror therapy (MT) alone program. The outcome measurements were assessed by a therapist blinded assessor using Fugl-Meyer Assessment (FMA) upper extremity score, Brunnstrom recovery stages (BRS), Modified Ashworth Scale (MAS) and Muscle Strength to evaluate upper limb motor function and motor recovery. Data were analyzed using Wilcoxon and Mann-Whitney U tests to compare within-groups and between-group differences. The results revealed that, after 12 weeks of treatment, patients of both groups presented statistically significant improvements in all the variables measured (p < 0.05). Compared with the control group, the patients of the MT group had greater improvement in the proximal movement portion of the FMA upper extremity mean score change (15.8 ± 3.2 versus 10.0 ± 2.7, p = 0.002) while there were no differences in other variables (p > 0.05). There were also no adverse events. It suggests that 12 weeks training of mirror therapy alone was likely to improve the motor recovery of the upper limb and activity of daily living in acute stroke patients than conventional therapy, if treated early.

Mirror Therapy Rehabilitation for Lower Limb of Acute Stroke Patients

This paper aims to study the effectiveness of mirror therapy (MT) having treated to acute stroke patients. The subjects of 20 acute stroke patients, who possessed the ability to respond to verbal instructions were randomly blinded and allocated to a control group (n = 10, 59.2 ± 2.28 years) and a mirror group (n = 10, 53.8 ± 6.14 years). Both groups were treated by intervention of traditional rehabilitation therapy comparing with mirror therapy. Intervention of mirror therapy was taken 60 minutes per day, 5 days per week for 12 weeks. Measures of intervention effectiveness were taken before treatment and after treatment by therapist using Brunnstrom stages, Fugl-Meyer Assessment (FMA) lower extremity score and Brunnel Balance Assessment (BBA) balance. Data were analyzed using independent sample t-test. The results revealed that, after 12 weeks of treatment, subjects of both groups gained statistically significant improvements in all variables measure (p < 0.05). Having compared with the control group, the participants of the MT group had greater improvement on the FMA score (31.0 ± 1.20 versus 28.7 ± 0.58). MT is inexpensive and easily applicable in conjunction with traditional physiotherapy for home care program. Consequently, MT proves to be an effective approach for rehabilitation of patients with post-acute stroke.

An Implementation Framework for Telemedicine to Address Noncommunicable Diseases in Thailand

To maintain the continuity of noncommunicable disease (NCD) services and ascertain the health outcomes of patients with NCDs during the COVID-19 (coronavirus disease 2019) outbreak in Thailand, various telemedicine services have been developed. To achieve this determination, the implementation framework has been constructed based on recommendations from multidisciplinary experts (Thai NCD Collaboration Group). Within the framework, all key elements are illustrated with their priority and expected collaborations. Ultimately, active collaborations from multi-stakeholders are vitally important to ensure that telemedicine services for NCDs will finally become practical, successful, and sustainable.

Clinical approach to coma patients: tips and tricks

The reticular activating system (RAS) is responsible for wakefulness. The RAS projects activation to either side of the hemisphere. The dysfunction of the RAS or insufficiency of its activation results in impairment of consciousness. Physicians classify levels of awareness into four levels, from normal status to most severe unconsciousness, these being alert, drowsy, stupor, and coma, respectively. While the causes of unconsciousness are varied, physicians generally divide them into structural and metabolic etiologies upon the dominant approach. Surgical management is the primary treatment for the structural coma, while the metabolic coma requires predominantly medical treatment. The diagnosis and management of unconscious patients require extensive clinical assessment, consisting of a careful approach to history-taking and general medical and neurological examinations. Following immediate resuscitation by the ABCDE approach and proper management protocols, physicians should look for causes of loss of consciousness through clinical evidence and investigations. Appropriate management will help to avoid secondary complications related to the impairment of consciousness. The prognostication of a coma is also varied and primarily depends on its etiology. The algorithm for prognostication in a coma is helpful for poor outcome determinants.

Effectiveness of press needle treatment and electroacupuncture in patients with postherpetic neuralgia: A matched propensity score analysis

BACKGROUND AND PURPOSE

Postherpetic neuralgia (PHN) is a well-known painful syndrome. Acupuncture is a treatment for PHN. We aimed to compare the effectiveness of pain control between press needle and electroacupuncture (EA) in PHN patients.

MATERIALS AND METHODS

We conducted a retrospective cohort study by a review of PHN patients treated with the press needle and the EA and compared the Pain visual analogue scale (VAS) before and after treatment. Propensity score matching was applied to adjust the confounding.

RESULTS

48 patients in each group had a matched propensity score. The absolute reduction of VAS in the press needle and the EA groups were not different (5.4±2.8 vs. 5.4±2.9, p=0.971). The VAS score improvement was not statistically different between groups.

CONCLUSION

The Press needle and the EA are equally effective in the treatment of PHN.

Outcomes of Perilla Seed Oil as an Additional Neuroprotective Therapy in Patients with Mild to Moderate Dementia: A Randomized Control Trial

BACKGROUND

Dementia is a common medical disorder in the elderly. Oxidative stress plays a major role in the process of cognitive decline in dementia. Perilla seed oil demonstrates its neuroprotective effects via anti-oxidative mechanisms against dementia. We investigate neuroprotective effects of perilla seed oil as an additional treatment in patients with mild to moderate dementia.

METHOD

A double-blind, randomized-control trial (perilla seed oil versus placebo) in patients with mild to moderate dementia was conducted. Perilla seed oil or placebo was added on with standard treatment for six months. Cognitive function was compared at nine months after enrollment.

RESULT

182 patients, with 94 in the experimental group and 88 in the placebo group, were able to complete the study. Cognitive function is not significantly different compared between groups. However, the total cholesterol and LDL cholesterol were significantly lower in the experimental group. Perilla seed oil had no adverse effect to kidney, liver, blood components or glucose metabolism.

CONCLUSION

Perilla seed oil as additional neuroprotective therapy in patients with mild to moderate dementia does not improve cognitive function. Perilla seed oil significantly reduced total cholesterol and LDL cholesterol. A clinical trial is needed to prove the benefit of cholesterol-lowering effects with perilla seed oil in human.

Accuracy of laboratory tests collected at referring hospitals versus tertiary care hospitals for acute stroke patients

BACKGROUND

The standard treatment of acute ischemic stroke patients is thrombolytic therapy within 60 minutes of a patient's arrival in stroke center hospitals. Based on the policy of the Lampang Referral System Committee, blood samples of suspected stroke patients need to be collected before transfer to the stroke center (Lampang Hospital). It was still questionable as to whether these blood samples are valid for clinical use and the present study aimed to confirm or deny their validity.

METHODS

A diagnostic study was conducted from June 2015 to May 2016. After exclusion, 340 patients were deemed eligible for analysis. Blood samples were collected just before normal saline infusion at referring hospitals and stored in blood collecting tube boxes set during transportation. At the stroke center, informed consents was requested, blood samples were re-collected to serve as a 'gold standard'. Prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (aPTT), platelet count, hemoglobin (Hb), hematocrit (Hct), blood urea nitrogen (BUN), and creatinine (Cr) were compared using paired t-tests. Binary regression was used to analyze for accuracy (%) to adjust for extraneous influences and was presented by modified Bland-Altman plots.

RESULTS

The laboratory results of referring hospitals vs. the stroke center were: PT, 12.4±3.2 vs. 12.5±3.0 sec; INR: 1.0±0.3 vs. 1.0±0.3; and platelet count: 239.8±77.1 vs. 239.8±74.8 (x103/μL). The adjusted accuracy of the PT, INR, and platelet counts were 96.8%, 96.8%, and 95.3% respectively.

CONCLUSION

Laboratory tests from referring hospital were determined to be valid. Blood samples should thus be collected at referring hospitals in order to avoid unnecessary blood collection at the stroke center.

Implementation of multiphase computed tomography angiography in management of patients with acute ischemic stroke in clinical practice

Multiphase computed tomography angiography (CTA) provides information on the status of major cranial arteries and extent of brain collateralization. The purpose of the study was to determine whether implementation of multiphase CTA in routine clinical practice was feasible, safe and useful. Patients with acute ischemic stroke (NIHSS ≥ 6) were included. Multiphase CTA was performed. Duration of performing multiphase CTA, inter-rater correlation and incidence of contrast-induced nephropathy (CIN) were studied. Infarct volume, incidence of hemorrhagic transformation, the rates of favorable outcome and death were compared between those with poor and intermediate-good collateralization. Multiphase CTA was performed in 108 patients. Mean duration on each multiphase CTA study was 4.8 min. Inter-rater reliability was intermediate-good (weighted kappa 0.7569, p < 0.001). CIN occurred in 3 patients (2.8%). There were no major intracranial/extracranial artery occlusion in 31 patients (29%) and there were severe stenosis or occlusions in 77 patients (71%). In the subgroup of patients with major artery severe stenosis or occlusion, 36 patients (36/77, 47%) had poor collateralization. Despite non-significant difference in acute treatment, the patients with poor collateralization had larger infarct (123 vs 35 cc, p < 0.001) and poorer outcomes (mean modified Rankin scale 3.86 vs 2.73, p = 0.011), while the differences in symptomatic hemorrhagic transformation (2.6 vs 7%, p = 0.385) and death rate (14 vs 12%, p = 0.825) were non-significant, as compared to those with intermediate-good collateralization. Multiphase CTA was feasible and safe. Besides the status of major arteries, multiphase CTA provided information on collateralization, which was associated with the size of infarct and clinical outcomes.

Microembolic signal detection by transcranial Doppler: Old method with a new indication

Transcranial Doppler (TCD) is useful for investigation of intracranial arterial blood flow and can be used to detect a real-time embolic signal. Unfortunately, artefacts can mimic the embolic signal, complicating interpretation and necessitating expert-level opinion to distinguish the two. Resolving this situation is critical to achieve improved accuracy and utility of TCD for patients with disrupted intracranial arterial blood flow, such as stroke victims. A common type of stroke encountered in the clinic is cryptogenic stroke (or stroke with undetermined etiology), and patent foramen ovale (PFO) has been associated with the condition. An early clinical trial of PFO closure effect on secondary stroke prevention failed to demonstrate any benefit for the therapy, and research into the PFO therapy generally diminished. However, the recent publication of large randomized control trials with demonstrated benefit of PFO closure for recurrent stroke prevention has rekindled the interest in PFO in patients with cryptogenic stroke. To confirm that emboli across the PFO can reach the brain, TCD should be applied to detect the air embolic signal after injection of agitated saline bubbles at the antecubital vein. In addition, the automated embolic signal detection method should further facilitate use of TCD for air embolic signal detection after the agitated saline bubbles injection in patients with cryptogenic stroke and PFO.

Effect of Combined Treatment with MLC601 (NeuroAiDTM) and Rehabilitation on Post-Stroke Recovery: The CHIMES and CHIMES-E Studies

BACKGROUND AND PURPOSE

MLC601 has been shown in preclinical studies to enhance neurorestorative mechanisms after stroke. The aim of this post hoc analysis was to assess whether combining MLC601 and rehabilitation has an effect on improving functional outcomes after stroke.

METHODS

Data from the CHInese Medicine NeuroAiD Efficacy on Stroke (CHIMES) and CHIMES-Extension (CHIMES-E) studies were analyzed. CHIMES-E was a 24-month follow-up study of subjects included in CHIMES, a multi-centre, double-blind placebo-controlled trial which randomized subjects with acute ischemic stroke, to either MLC601 or placebo for 3 months in addition to standard stroke treatment and rehabilitation. Subjects were stratified according to whether they received or did not receive persistent rehabilitation up to month (M)3 (non- randomized allocation) and by treatment group. The modified Rankin Scale (mRS) and Barthel Index were assessed at month (M) 3, M6, M12, M18, and M24.

RESULTS

Of 880 subjects in CHIMES-E, data on rehabilitation at M3 were available in 807 (91.7%, mean age 61.8 ± 11.3 years, 36% female). After adjusting for prognostic factors of poor outcome (age, sex, pre-stroke mRS, baseline National Institute of Health Stroke Scale, and stroke onset-to-study-treatment time), subjects who received persistent rehabilitation showed consistently higher treatment effect in favor of MLC601 for all time points on mRS 0-1 dichotomy analysis (ORs 1.85 at M3, 2.18 at M6, 2.42 at M12, 1.94 at M18, 1.87 at M24), mRS ordinal analysis (ORs 1.37 at M3, 1.40 at M6, 1.53 at M12, 1.50 at M18, 1.38 at M24), and BI ≥95 dichotomy analysis (ORs 1.39 at M3, 1.95 at M6, 1.56 at M12, 1.56 at M18, 1.46 at M24) compared to those who did not receive persistent rehabilitation.

CONCLUSIONS

More subjects on MLC601 improved to functional independence compared to placebo among subjects receiving persistent rehabilitation up to M3. The larger treatment effect of MLC601 was sustained over 2 years which supports the hypothesis that MLC601 combined with rehabilitation might have beneficial and sustained effects on neuro-repair processes after stroke. There is a need for more data on the effect of combining rehabilitation programs with stroke recovery treatments.

Automated embolic signal detection using Deep Convolutional Neural Network

This work investigated the potential of Deep Neural Network in detection of cerebral embolic signal (ES) from transcranial Doppler ultrasound (TCD). The resulting system is aimed to couple with TCD devices in diagnosing a risk of stroke in real-time with high accuracy. The Adaptive Gain Control (AGC) approach developed in our previous study is employed to capture suspected ESs in real-time. By using spectrograms of the same TCD signal dataset as that of our previous work as inputs and the same experimental setup, Deep Convolutional Neural Network (CNN), which can learn features while training, was investigated for its ability to bypass the traditional handcrafted feature extraction and selection process. Extracted feature vectors from the suspected ESs are later determined whether they are of an ES, artifact (AF) or normal (NR) interval. The effectiveness of the developed system was evaluated over 19 subjects going under procedures generating emboli. The CNN-based system could achieve in average of 83.0% sensitivity, 80.1% specificity, and 81.4% accuracy, with considerably much less time consumption in development. The certainly growing set of training samples and computational resources will contribute to high performance. Besides having potential use in various clinical ES monitoring settings, continuation of this promising study will benefit developments of wearable applications by leveraging learnable features to serve demographic differentials.

XANAP: A real-world, prospective, observational study of patients treated with rivaroxaban for stroke prevention in atrial fibrillation in Asia

BACKGROUND

ROCKET AF and its East Asian subanalysis demonstrated that rivaroxaban was non-inferior to warfarin for stroke/systemic embolism (SE) prevention in patients with non-valvular atrial fibrillation (NVAF), with a favorable benefit-risk profile. XANAP investigated the safety and effectiveness of rivaroxaban in routine care in Asia-Pacific.

METHODS

XANAP was a prospective, real-world, observational study in patients with NVAF newly starting rivaroxaban. Patients were followed at ~3-month intervals for 1 year, or for ≥30 days after permanent discontinuation. Primary outcomes were major bleeding events, adverse events (AEs), serious AEs and all-cause mortality; secondary outcomes included stroke/SE. Major outcomes were adjudicated centrally.

RESULTS

XANAP enrolled 2273 patients from 10 countries: mean age was 70.5 years and 58.1% were male. 49.8% of patients received rivaroxaban 20 mg once daily (od), 43.8% 15 mg od and 5.9% 10 mg od. Mean treatment duration was 296 days, and 72.8% of patients had received prior anticoagulation therapy. Co-morbidities included heart failure (20.1%), hypertension (73.6%), diabetes mellitus (26.6%), prior stroke/non-central nervous system SE/transient ischemic attack (32.8%) and myocardial infarction (3.8%). Mean CHADS2, CHA2DS2-VASc and HAS-BLED scores were 2.3, 3.7 and 2.1, respectively. The rates (events/100 patient-years [95% confidence interval]) of treatment-emergent major bleeding, stroke and all-cause mortality were 1.5 (1.0-2.1), 1.7 (1.2-2.5) and 2.0 (1.4-2.7), respectively. Persistence was 66.2% at the study end.

CONCLUSIONS

The real-world XANAP study demonstrated low rates of stroke and bleeding in rivaroxaban-treated patients with NVAF from Asia-Pacific. The results were consistent with the real-world XANTUS study and ROCKET AF.

Feasibility and Safety of Perilla Seed Oil as an Additional Antioxidative Therapy in Patients with Mild to Moderate Dementia

Dementia is a broad-spectrum terminology for a degenerate in cognitive function severe enough to intervene in activities of daily living. Oxidative stress plays a major role in the neurodegenerative cascade, leading to the irreversible mechanism in dementia. Perilla seed oil is extracted from its seeds and contains a high source of antioxidative substances such as omega-3 fatty acid. With its prominent antioxidative property, perilla seed oil demonstrates neuroprotective effects against dementia in preclinical studies. We aim to prove the feasibility and safety of perilla seed oil as an additional antioxidative therapy in patients with dementia. This single-centered, double-blinded, placebo-controlled trial randomized 239 patients with clinical diagnosis of mild to moderate dementia according to the Thai Mini-Mental State Examination (TMSE) score of 10 to 23 or the Thai Montreal Cognitive Assessment score of 12 to 25. Either two capsules containing 500 milligrams of perilla seed oil or similarly appearing two capsules containing 500 milligrams of olive oil (placebo) four times daily was added to conventional standard treatment of dementia for six months. Clinical side effects and routine laboratory results at baseline and after treatment were compared between both groups. Nausea and vomiting were the most common clinical side effects (3%) found equally in both groups. Three patients in the placebo group prematurely discontinued the medication, while only one patient in the treatment group quit the medication early. However, about 5% of patients in both groups could not comply with the regimen of the treatment. The routine laboratory results, including complete blood counts, kidney function tests, and liver function panels, at baseline and after treatment, were not significantly different in both groups. In conclusion, perilla seed oil was feasible and safe to add on with standard treatment in patients with mild to moderate dementia. Further study is needed to confirm its benefit to use as additional antioxidative therapy in patients with dementia.