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Wang S, He Q, Qu Y, Yin W, Zhao R, Wang X, Yang Y, Guo ZN. Emerging strategies for nerve repair and regeneration in ischemic stroke: neural stem cell therapy. Neural Regen Res 2024; 19:2430-2443. [PMID: 38526280 PMCID: PMC11090435 DOI: 10.4103/1673-5374.391313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/26/2023] [Accepted: 11/10/2023] [Indexed: 03/26/2024] Open
Abstract
Ischemic stroke is a major cause of mortality and disability worldwide, with limited treatment options available in clinical practice. The emergence of stem cell therapy has provided new hope to the field of stroke treatment via the restoration of brain neuron function. Exogenous neural stem cells are beneficial not only in cell replacement but also through the bystander effect. Neural stem cells regulate multiple physiological responses, including nerve repair, endogenous regeneration, immune function, and blood-brain barrier permeability, through the secretion of bioactive substances, including extracellular vesicles/exosomes. However, due to the complex microenvironment of ischemic cerebrovascular events and the low survival rate of neural stem cells following transplantation, limitations in the treatment effect remain unresolved. In this paper, we provide a detailed summary of the potential mechanisms of neural stem cell therapy for the treatment of ischemic stroke, review current neural stem cell therapeutic strategies and clinical trial results, and summarize the latest advancements in neural stem cell engineering to improve the survival rate of neural stem cells. We hope that this review could help provide insight into the therapeutic potential of neural stem cells and guide future scientific endeavors on neural stem cells.
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Affiliation(s)
- Siji Wang
- Stroke Center, Department of Neurology, the First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Qianyan He
- Stroke Center, Department of Neurology, the First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Yang Qu
- Stroke Center, Department of Neurology, the First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Wenjing Yin
- Stroke Center, Department of Neurology, the First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Ruoyu Zhao
- Stroke Center, Department of Neurology, the First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Xuyutian Wang
- Department of Breast Surgery, General Surgery Center, the First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Yi Yang
- Stroke Center, Department of Neurology, the First Hospital of Jilin University, Changchun, Jilin Province, China
- Neuroscience Research Center, Department of Neurology, the First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Zhen-Ni Guo
- Stroke Center, Department of Neurology, the First Hospital of Jilin University, Changchun, Jilin Province, China
- Neuroscience Research Center, Department of Neurology, the First Hospital of Jilin University, Changchun, Jilin Province, China
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Liu C, Cai Q, Gou Y, Liu Y, Kang M, Hui J, Zhou R, Shi P, Wang B, Zhang F. Association of accelerated biological aging with brain volumes: A cross-sectional study. J Affect Disord 2024; 364:188-193. [PMID: 39147148 DOI: 10.1016/j.jad.2024.08.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 07/10/2024] [Accepted: 08/12/2024] [Indexed: 08/17/2024]
Abstract
BACKGROUND Multiple epidemiological studies have observed the connection between aging and brain volumes. The concept of accelerated biological aging (BA) is more powerful for observing the degree of aging of an individual than chronologic age (CA). The objective of this study is to explore the relationship between BA and brain volumes. METHODS BA was measured from clinical traits using two blood-chemistry algorithms, the Klemera-Doubal method (KDM) and the PhenoAge. The two age acceleration biomarkers were calculated by the residuals from regressing CA, termed "KDM-acceleration" and "PhenoAge-acceleration". Brain volumes were from brain magnetic resonance imaging (MRI) data. After adjustment for confounding factors, general linear regression models were used to examine associations between KDM-acceleration and PhenoAge-acceleration and brain volumes, respectively. Additionally, we stratified participants by sex, age, and the four quartiles of the Townsend Deprivation Index (TDI) for extra subgroup analysis. RESULTS 14,725 participants with available information were enrolled. After full adjustment, we observed negative associations between KDM-acceleration and brain volumes, such as gray matter (β = -0.029), white matter (β = -0.021), gray and white matter (β = -0.026), and hippocampus (β = -0.011 for left and β = -0.014 for right). There were also negative associations between PhenoAge-acceleration and brain volumes, such as white matter (β = -0.008), gray and white matter (β = -0.010), thalamus (β = -0.012 for left and β = -0.012 for right). In the subgroup analysis stratified by sex, age, and the four quartiles of TDI, the association between KDM-acceleration and PhenoAge-acceleration and brain volumes still existed. In subgroup analyses, the variation in associations suggests that socioeconomic and biological factors may differentially influence brain aging. CONCLUSIONS Our research indicated that more advanced BA was associated with less brain tissue.
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Affiliation(s)
- Chen Liu
- Key Laboratory of Environment and Endemic Diseases of National Health Commission of China, Key Laboratory of Environment and Genes Related to Diseases of Ministry of Education of China, Key Laboratory for Prevention and Control and Health Promotion of Shaanxi Province, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Qingqing Cai
- Key Laboratory of Environment and Endemic Diseases of National Health Commission of China, Key Laboratory of Environment and Genes Related to Diseases of Ministry of Education of China, Key Laboratory for Prevention and Control and Health Promotion of Shaanxi Province, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Yifan Gou
- Key Laboratory of Environment and Endemic Diseases of National Health Commission of China, Key Laboratory of Environment and Genes Related to Diseases of Ministry of Education of China, Key Laboratory for Prevention and Control and Health Promotion of Shaanxi Province, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Ye Liu
- Key Laboratory of Environment and Endemic Diseases of National Health Commission of China, Key Laboratory of Environment and Genes Related to Diseases of Ministry of Education of China, Key Laboratory for Prevention and Control and Health Promotion of Shaanxi Province, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Meijuan Kang
- Key Laboratory of Environment and Endemic Diseases of National Health Commission of China, Key Laboratory of Environment and Genes Related to Diseases of Ministry of Education of China, Key Laboratory for Prevention and Control and Health Promotion of Shaanxi Province, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Jingni Hui
- Key Laboratory of Environment and Endemic Diseases of National Health Commission of China, Key Laboratory of Environment and Genes Related to Diseases of Ministry of Education of China, Key Laboratory for Prevention and Control and Health Promotion of Shaanxi Province, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Ruixue Zhou
- Key Laboratory of Environment and Endemic Diseases of National Health Commission of China, Key Laboratory of Environment and Genes Related to Diseases of Ministry of Education of China, Key Laboratory for Prevention and Control and Health Promotion of Shaanxi Province, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Panxing Shi
- Key Laboratory of Environment and Endemic Diseases of National Health Commission of China, Key Laboratory of Environment and Genes Related to Diseases of Ministry of Education of China, Key Laboratory for Prevention and Control and Health Promotion of Shaanxi Province, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Bingyi Wang
- Key Laboratory of Environment and Endemic Diseases of National Health Commission of China, Key Laboratory of Environment and Genes Related to Diseases of Ministry of Education of China, Key Laboratory for Prevention and Control and Health Promotion of Shaanxi Province, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Feng Zhang
- Key Laboratory of Environment and Endemic Diseases of National Health Commission of China, Key Laboratory of Environment and Genes Related to Diseases of Ministry of Education of China, Key Laboratory for Prevention and Control and Health Promotion of Shaanxi Province, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China.
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Montes-Narváez O, García-Juárez M, Beltrán-Pérez G, Espinosa-García C, González-Flores O, Delgado-Macuil RJ. ATR-FTIR spectroscopy to evaluate serum protein expression in a murine cerebral ischemia model. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2024; 326:125261. [PMID: 39395276 DOI: 10.1016/j.saa.2024.125261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 09/22/2024] [Accepted: 10/05/2024] [Indexed: 10/14/2024]
Abstract
Stroke is a prevalent vascular disease that causes disability and death worldwide. Molecular techniques have been developed to assess serum concentrations of biomarkers associated with this disease, such as some proteins. ATR-FTIR was proposed as an alternative technique to determine protein expression during the early stages of stroke. Serum samples from sham, ischemic, and ischemic treated with estradiol benzoate (EB; as a neuroprotective agent) male rats were evaluated at 0, 2-, 4-, 6-, 12-, and 24-hours post-ischemia. The analysis was developed in the mid-infrared region but mainly focused on the protein region (1500-1700 cm-1), where it was possible to observe the modulation in the absorbance intensity. The peaks at 1545, 1645, 1635, and 1650 cm-1 associated with amide II, amide I, β-sheets, and α-helixes, respectively, were prominent peaks where protein modulation was observed. The results demonstrate that infrared spectroscopy could be a good alternative technique to determine the modulation of protein expression during stroke events.
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Affiliation(s)
- Omar Montes-Narváez
- Centro de Investigación en Reproducción Animal, Universidad Autónoma de Tlaxcala-CINVESTAV, Plaza Hidalgo S/N. San Nicolas Panotla, C.P. 90140 Tlaxcala, Mexico; Doctorado en Ciencias Biológicas, Universidad Autónoma de Tlaxcala, Tlaxcala 90000, Mexico
| | - Marcos García-Juárez
- Centro de Investigación en Reproducción Animal, Universidad Autónoma de Tlaxcala-CINVESTAV, Plaza Hidalgo S/N. San Nicolas Panotla, C.P. 90140 Tlaxcala, Mexico.
| | - Georgina Beltrán-Pérez
- Facultad de Ciencias Físico-Matemáticas, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - Claudia Espinosa-García
- Department of Neurology, Emory University School of Medicine, Atlanta, GA 30322, USA; Department of Neurology, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Oscar González-Flores
- Centro de Investigación en Reproducción Animal, Universidad Autónoma de Tlaxcala-CINVESTAV, Plaza Hidalgo S/N. San Nicolas Panotla, C.P. 90140 Tlaxcala, Mexico
| | - Raúl Jacobo Delgado-Macuil
- Instituto Politécnico Nacional, Centro de investigación en Biotecnología Aplicada, Tepetitla, Tlaxcala 90700, Mexico
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Niles J, Bhasin G, Ganti L. Large right middle cerebral artery stroke with hemorrhagic transformation. Int J Emerg Med 2024; 17:138. [PMID: 39367308 PMCID: PMC11453048 DOI: 10.1186/s12245-024-00739-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2024] [Accepted: 09/28/2024] [Indexed: 10/06/2024] Open
Abstract
The authors present a case of an acute right middle cerebral artery infarct in a 65-year-old male with a history of diabetes, hypertension, and cardiovascular disease. The timeline of treatment and the evolution of the stroke is described. This case highlights the significant burden of right-sided cerebral artery stroke, even when intervention is swift.
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Affiliation(s)
- Jack Niles
- Trinity Preparatory School, Winter Park, FL, USA
| | - Garv Bhasin
- Brown University, Providence, Rhode Island, USA
| | - Latha Ganti
- Orlando College of Osteopathic Medicine, Winter Garden, FL, 34787, USA.
- Warren Alpert Medical School of Brown University, Providence, RI, 02903, USA.
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Rust R, Nih LR, Liberale L, Yin H, El Amki M, Ong LK, Zlokovic BV. Brain repair mechanisms after cell therapy for stroke. Brain 2024; 147:3286-3305. [PMID: 38916992 PMCID: PMC11449145 DOI: 10.1093/brain/awae204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 06/04/2024] [Accepted: 06/08/2024] [Indexed: 06/27/2024] Open
Abstract
Cell-based therapies hold great promise for brain repair after stroke. While accumulating evidence confirms the preclinical and clinical benefits of cell therapies, the underlying mechanisms by which they promote brain repair remain unclear. Here, we briefly review endogenous mechanisms of brain repair after ischaemic stroke and then focus on how different stem and progenitor cell sources can promote brain repair. Specifically, we examine how transplanted cell grafts contribute to improved functional recovery either through direct cell replacement or by stimulating endogenous repair pathways. Additionally, we discuss recently implemented preclinical refinement methods, such as preconditioning, microcarriers, genetic safety switches and universal (immune evasive) cell transplants, as well as the therapeutic potential of these pharmacologic and genetic manipulations to further enhance the efficacy and safety of cell therapies. By gaining a deeper understanding of post-ischaemic repair mechanisms, prospective clinical trials may be further refined to advance post-stroke cell therapy to the clinic.
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Affiliation(s)
- Ruslan Rust
- Department of Physiology and Neuroscience, University of Southern California, Los Angeles, CA 90033, USA
- Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
- Institute for Regenerative Medicine, University of Zurich, 8952 Schlieren, Switzerland
| | - Lina R Nih
- Department of Brain Health, University of Nevada, Las Vegas, NV 89154, USA
| | - Luca Liberale
- Department of Internal Medicine, University of Genoa, 16132 Genova, Italy
- IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Hao Yin
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 3K7, Canada
| | - Mohamad El Amki
- Department of Neurology, University Hospital and University of Zurich, 8091 Zurich, Switzerland
| | - Lin Kooi Ong
- School of Health and Medical Sciences & Centre for Health Research, University of Southern Queensland, Toowoomba, QLD 4350, Australia
| | - Berislav V Zlokovic
- Department of Physiology and Neuroscience, University of Southern California, Los Angeles, CA 90033, USA
- Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
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Udoh U, Seeger R, Dewar B, Cummings E, Gocan S, Nicholls S, Fedyk M, Shepherd V, Perry J, Fahed R, Ramsay T, Brehaut J, Hill MD, Poppe AY, Menon BK, Swartz RH, Dowlatshahi D, Shamy M. Advance Consent for participation in Acute Stroke Trials (ACTION): protocol for a feasibility study. Stroke Vasc Neurol 2024:svn-2023-003029. [PMID: 39357897 DOI: 10.1136/svn-2023-003029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 06/21/2024] [Indexed: 10/04/2024] Open
Abstract
INTRODUCTION Obtaining informed consent for research from patients in medical emergencies remains a challenge, particularly in acute stroke care as treatment must be administered quickly and patients often arrive in the hospital in a state of incapacitation. Adaptations to standard consenting approaches-such as the use of surrogate consent or deferral of consent-have significant limitations. This feasibility study aims to test a new consenting approach in acute stroke care that we call advance consent. Advance consent has the potential to render emergency trial enrolment faster, fairer and more transparent, leading to more generalisable results. METHODS AND DESIGN We will conduct a five-part study at The Ottawa Hospital, a quaternary care stroke centre: (1) administering questionnaires in the Ottawa Hospital Stroke Prevention Clinic that will examine patients' perspectives on research participation and advance consent; (2) inviting participants to consent in advance to any or both currently enrolling acute stroke trials; (3) tracking patient enrolment into these trials over 1 year; (4) administering a follow up questionnaire to participants at 1 year and (5) administering a questionnaire to participating hospital staff in order to interrogate their experiences with advance consent. Outcomes include but are not limited to eligibility rate, recruitment rate, withdrawal rate and the proportion of patients whose advance consent results in trial enrolment. CONCLUSION This study will test the feasibility of enrolling patients at risk of stroke into acute stroke trials using advance consent.
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Affiliation(s)
- Ubong Udoh
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Rena Seeger
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Brian Dewar
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Emma Cummings
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Sophia Gocan
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Mark Fedyk
- School of Medicine, University of California, Davis, Sacramento, California, USA
| | | | - Jeff Perry
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Robert Fahed
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Tim Ramsay
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Jamie Brehaut
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Michael D Hill
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | | | - Bijoy K Menon
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Richard H Swartz
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Dar Dowlatshahi
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Michel Shamy
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Chen H, Lee JS, Michel P, Yan B, Chaturvedi S. Endovascular Stroke Thrombectomy for Patients With Large Ischemic Core: A Review. JAMA Neurol 2024; 81:1085-1093. [PMID: 39133467 DOI: 10.1001/jamaneurol.2024.2500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
Importance Recently, 6 randomized clinical trials-RESCUE-Japan-LIMIT (Recovery by Endovascular Salvage for Cerebral Ultra-Acute Embolism-Japan Large Ischemic Core Trial), ANGEL-ASPECT (Trial of Endovascular Therapy for Acute Ischemic Stroke With Large Infarct), SELECT2 (Trial of Endovascular Thrombectomy for Large Ischemic Strokes), TESLA (Thrombectomy for Emergent Salvage of Large Anterior Circulation Ischemic Stroke), TENSION (Endovascular Thrombectomy for Acute Ischemic Stroke With Established Large Infarct), and LASTE (Large Stroke Therapy Evaluation)-have concluded their investigations on the efficacy and safety of endovascular thrombectomy (EVT) for the treatment of patients with ischemic stroke, anterior-circulation large vessel occlusions, and large areas of ischemic changes defined as an Alberta Stroke Program Early Computed Tomography Score (ASPECTS) of 5 or less. Overall, the results appeared to be positive, with 5 of the 6 trials meeting their primary efficacy end point, and 1 trial that was a near miss. However, questions remain regarding how these trial results should be interpreted and incorporated into routine clinical practice. Observations In this narrative review and analysis of published trials, important nuances of the available clinical data were identified, and important areas of lingering uncertainty were highlighted, including the efficacy and safety of EVT for patients with a low ASPECTS score in late treatment windows and those with large core volumes. Also emphasized was the possibly important role of advanced neuroimaging modalities such as perfusion and magnetic resonance imaging when making EVT treatment decisions for select patients with low ASPECTS scores. Conclusions and Relevance Recent trial data provide strong evidence that EVT is safe and effective for patients with anterior, large vessel-occlusion stroke and low ASPECTS scores who present within 6 hours from stroke onset. However, patient outcomes often remain poor despite EVT treatment. The efficacy and safety of EVT for patients with low ASPECTS scores who present beyond 6 hours of stroke onset remain uncertain, and the current trial data seem too scarce to justify forgoing advanced stroke imaging during this extended time window. Furthermore, the efficacy and safety of EVT for patients with large core volumes (100 mL or greater) or M2 occlusions (ie, occlusions of the second segment of the middle cerebral artery) remain uncertain. Future research to better identify patients likely to meaningfully respond to EVT is needed to further optimize the stroke triage process and health care resource utilization.
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Affiliation(s)
- Huanwen Chen
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
- Department of Neurology, MedStar Georgetown University Hospital, Washington, DC
| | - Jin Soo Lee
- Department of Neurology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Republic of Korea
| | - Patrik Michel
- Stroke Center, Neurology Service, University Hospital of Lausanne, Lausanne, Switzerland
| | - Bernard Yan
- Melbourne Braine Center at Royal Melbourne Hospital, Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Seemant Chaturvedi
- Department of Neurology, University of Maryland School of Medicine, Baltimore
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Peng YJ, Kuo CY, Chang SW, Lin CP, Tsai YH. Acceleration of brain aging after small-volume infarcts. Front Aging Neurosci 2024; 16:1409166. [PMID: 39391585 PMCID: PMC11464776 DOI: 10.3389/fnagi.2024.1409166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 08/27/2024] [Indexed: 10/12/2024] Open
Abstract
Introduction Previous studies have shown that stroke patients exhibit greater neuroimaging-derived biological "brain age" than control subjects. This difference, known as the brain age gap (BAG), is calculated by comparing the chronological age with predicted brain age and is used as an indicator of brain health and aging. However, whether stroke accelerates the process of brain aging in patients with small-volume infarcts has not been established. By utilizing longitudinal data, we aimed to investigate whether small-volume infarctions can significantly increase the BAG, indicating accelerated brain aging. Methods A total of 123 stroke patients presenting with small-volume infarcts were included in this retrospective study. The brain age model was trained via established protocols within the field of machine learning and the structural features of the brain from our previous study. We used t-tests and regression analyses to assess longitudinal brain age changes after stroke and the associations between brain age, acute stroke severity, and poststroke outcome factors. Results Significant brain aging occurred between the initial and 6-month follow-ups, with a mean increase in brain age of 1.04 years (t = 3.066, p < 0.05). Patients under 50 years of age experienced less aging after stroke than those over 50 years of age (p = 0.245). Additionally, patients with a National Institute of Health Stroke Scale score >3 at admission presented more pronounced adverse effects on brain aging, even after adjusting for confounders such as chronological age, sex, and total intracranial volume (F 1,117 = 7.339, p = 0.008, η 2 = 0.059). There were significant differences in the proportional brain age difference at 6 months among the different functional outcome groups defined by the Barthel Index (F 2,118 = 4.637, p = 0.012, η 2 = 0.073). Conclusion Stroke accelerates the brain aging process, even in patients with relatively small-volume infarcts. This phenomenon is particularly accentuated in elderly patients, and both stroke severity and poststroke functional outcomes are closely associated with accelerated brain aging. Further studies are needed to explore the mechanisms underlying the accelerated brain aging observed in stroke patients, with a particular focus on the structural alterations and plasticity of the brain following minor strokes.
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Affiliation(s)
- Ying-Ju Peng
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Department of Diagnostic Radiology, Chang Gung University, Taoyuan, Taiwan
| | - Chen-Yuan Kuo
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Neuroscience, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Sheng-Wei Chang
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Department of Diagnostic Radiology, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Po Lin
- Institute of Neuroscience, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
| | - Yuan-Hsiung Tsai
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Department of Diagnostic Radiology, Chang Gung University, Taoyuan, Taiwan
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Zuo CY, Hao XY, Li MJ, Guo MN, Ma DR, Li SJ, Liang YY, Hao CW, Wang ZY, Feng YM, Sun YM, Xu YM, Shi CH. Anemia, blood cell indices, genetic correlations, and brain structures: A comprehensive analysis of roles in Parkinson's disease risk. Parkinsonism Relat Disord 2024; 128:107153. [PMID: 39316934 DOI: 10.1016/j.parkreldis.2024.107153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 09/11/2024] [Accepted: 09/15/2024] [Indexed: 09/26/2024]
Abstract
INTRODUCTION Anemia may contribute significantly to the onset of Parkinson's disease (PD). Current research on the association between anemia and PD risk is inconclusive, and the relationships between anemia-related blood cell indices and PD incidence require further clarification. This study aims to investigate the relationships between anemia, blood cell indicators, and PD risk using a thorough prospective cohort study. METHODS We used data from the UK Biobank, a prospective cohort study of 502,649 participants, and ultimately, 365,982 participants were included in the analysis. Cox proportional hazards models were utilized to adjust for confounding factors, aiming to thoroughly explore the associations between anemia and blood cell indices with the risk of incident PD. The interaction between anemia and Polygenic Risk Score (PRS) for PD was also examined. Linear regression and mediation analyses assessed potential mechanisms driven by brain structures, including grey matter volume. RESULTS During a median follow-up of 14.24 years, 2513 participants were diagnosed with PD. Anemia considerably increased PD risk (hazard ratio [HR] 1.98, 95 % confidence interval [CI]: 1.81-2.18, P < 0.001) after adjustments. Those with high PRS for anemia had an 83 % higher PD incidence compared to low PRS participants. Sensitivity analyses confirmed result robustness. Linear regression showed that anemia correlated with grey matter volumes and most white matter tracts. Furthermore, mediation analyses identified that the volume of grey matter in Thalamus mediates the relationship between anemia and PD risk. CONCLUSION In summary, we consider there to be a substantial correlation between anemia and increased PD risk.
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Affiliation(s)
- Chun-Yan Zuo
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, 450000, Henan, China
| | - Xiao-Yan Hao
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, 450000, Henan, China; Academy of Medical Sciences of Zhengzhou University, Zhengzhou, 450000, Henan, China
| | - Meng-Jie Li
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, 450000, Henan, China; Academy of Medical Sciences of Zhengzhou University, Zhengzhou, 450000, Henan, China
| | - Meng-Nan Guo
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, 450000, Henan, China
| | - Dong-Rui Ma
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, 450000, Henan, China
| | - Shuang-Jie Li
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, 450000, Henan, China
| | - Yuan-Yuan Liang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, 450000, Henan, China
| | - Chen-Wei Hao
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, 450000, Henan, China
| | - Zhi-Yun Wang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, 450000, Henan, China
| | - Yan-Mei Feng
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, 450000, Henan, China
| | - Yue-Meng Sun
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, 450000, Henan, China
| | - Yu-Ming Xu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, 450000, Henan, China; NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Diseases, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, 450000, Henan, China; Henan Key Laboratory of Cerebrovascular Diseases, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, 450000, Henan, China; Institute of Neuroscience, Zhengzhou University, Zhengzhou, 450000, Henan, China
| | - Chang-He Shi
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, 450000, Henan, China; NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Diseases, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, 450000, Henan, China; Henan Key Laboratory of Cerebrovascular Diseases, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, 450000, Henan, China; Institute of Neuroscience, Zhengzhou University, Zhengzhou, 450000, Henan, China.
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10
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Li X, Lu Z, Li S, Zhu L, Jiang T, Sun H, Pan Y, Zhou J, Deng Q. Effect of MR-guided perfusion imaging mismatch profiles within 6 h on endovascular thrombectomy outcomes. Neurol Sci 2024:10.1007/s10072-024-07751-x. [PMID: 39242369 DOI: 10.1007/s10072-024-07751-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 08/26/2024] [Indexed: 09/09/2024]
Abstract
BACKGROUND The treatment of acute ischemic stroke (AIS) aims to achieve early vascular recanalization and reperfusion of the penumbra. However, the effect of early penumbral imaging within 6 h on clinical outcomes remains unclear. The objective of this study was to determine the effect of magnetic resonance-guided (MR-guided) perfusion imaging within 6 h after symptom onset on endovascular thrombectomy outcomes in AIS patients. METHODS We prospectively collected the clinical information of consecutive AIS patients undergoing endovascular thrombectomy based on MR-guided perfusion imaging within 6 h after symptom onset from AISRNA and EVTRNA studies. The primary outcome was defined as the poor outcome (mRS > 2 within 90 days). The perfusion-weighted imaging/diffusion-weighted imaging (PWI/DWI) mismatch was assessed by an automated software. RESULTS We enrolled 84 patients (25 in the mismatch ≤ 1.8 group and 59 in the mismatch > 1.8 group). Significant difference was found between the mismatch > 1.8 group and the mismatch ≤ 1.8 group for the incidence of disabling stroke (mRS > 2) within 90 days (40.7% vs. 68.0%, OR: 3.099, 95% CI: 1.154-8.323, P = 0.025). Intracranial hemorrhage occurred in 8 patients (13.6%) in the mismatch > 1.8 group and 10 patients in the mismatch ≤ 1.8 group (40.0%) (P = 0.010). The risk of severe cerebral edema was 2/59 (3.4%) vs. 7/25 (28.0%) (P = 0.004). These findings remained stable after adjustment. CONCLUSIONS MR-guided perfusion imaging mismatch profiles within 6 h after symptom onset may be feasible to predictclinical outcomes and reduce clinically ineffective reperfusion after endovascular thrombectomy.
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Affiliation(s)
- Xiaohui Li
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China
| | - Zhaomin Lu
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China
| | - Shuo Li
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China
| | - Lin Zhu
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China
| | - Teng Jiang
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China
| | - Huiling Sun
- General Clinical Research Center, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China
| | - Yuqin Pan
- General Clinical Research Center, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China.
| | - Junshan Zhou
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China.
| | - Qiwen Deng
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China.
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
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11
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Hedayati E, Safari F, Verghese G, Ciancia VR, Sodickson DK, Dehkharghani S, Alon L. An experimental system for detection and localization of hemorrhage using ultra-wideband microwaves with deep learning. COMMUNICATIONS ENGINEERING 2024; 3:126. [PMID: 39242634 PMCID: PMC11379885 DOI: 10.1038/s44172-024-00259-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 08/05/2024] [Indexed: 09/09/2024]
Abstract
Stroke is a leading cause of mortality and disability. Emergent diagnosis and intervention are critical, and predicated upon initial brain imaging; however, existing clinical imaging modalities are generally costly, immobile, and demand highly specialized operation and interpretation. Low-energy microwaves have been explored as a low-cost, small form factor, fast, and safe probe for tissue dielectric properties measurements, with both imaging and diagnostic potential. Nevertheless, challenges inherent to microwave reconstruction have impeded progress, hence conduction of microwave imaging remains an elusive scientific aim. Herein, we introduce a dedicated experimental framework comprising a robotic navigation system to translate blood-mimicking phantoms within a human head model. An 8-element ultra-wideband array of modified antipodal Vivaldi antennas was developed and driven by a two-port vector network analyzer spanning 0.6-9.0 GHz at an operating power of 1 mW. Complex scattering parameters were measured, and dielectric signatures of hemorrhage were learned using a dedicated deep neural network for prediction of hemorrhage classes and localization. An overall sensitivity and specificity for detection >0.99 was observed, with Rayleigh mean localization error of 1.65 mm. The study establishes the feasibility of a robust experimental model and deep learning solution for ultra-wideband microwave stroke detection.
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Affiliation(s)
- Eisa Hedayati
- Center for Advanced Imaging Innovation and Research (CAI2R), New Yorsity School of Medicine, New York, NY, USA
- Center for Biomedical Imaging, New York University School of Medicine, New York, NY, USA
| | - Fatemeh Safari
- Center for Advanced Imaging Innovation and Research (CAI2R), New Yorsity School of Medicine, New York, NY, USA
- Center for Biomedical Imaging, New York University School of Medicine, New York, NY, USA
| | - George Verghese
- Center for Advanced Imaging Innovation and Research (CAI2R), New Yorsity School of Medicine, New York, NY, USA
- Center for Biomedical Imaging, New York University School of Medicine, New York, NY, USA
| | - Vito R Ciancia
- LaGuardia Studios, New York University, New York, NY, USA
| | - Daniel K Sodickson
- Center for Advanced Imaging Innovation and Research (CAI2R), New Yorsity School of Medicine, New York, NY, USA
- Center for Biomedical Imaging, New York University School of Medicine, New York, NY, USA
| | - Seena Dehkharghani
- Center for Advanced Imaging Innovation and Research (CAI2R), New Yorsity School of Medicine, New York, NY, USA.
- Center for Biomedical Imaging, New York University School of Medicine, New York, NY, USA.
- Department of Neurology, New York University Langone Medical Center, New York, NY, USA.
| | - Leeor Alon
- Center for Advanced Imaging Innovation and Research (CAI2R), New Yorsity School of Medicine, New York, NY, USA.
- Center for Biomedical Imaging, New York University School of Medicine, New York, NY, USA.
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12
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Chen S, Fang S, Zhou Y, Huang Z, Yu S, Chen D, Wang Z, Xu Y, Liu P, Li Y, Lin W, Jiang L, Yuan C, Huang M. A low bleeding risk thrombolytic agent: citPA5. Cardiovasc Res 2024; 120:1191-1201. [PMID: 38546342 DOI: 10.1093/cvr/cvae060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 12/26/2023] [Accepted: 01/11/2024] [Indexed: 06/07/2024] Open
Abstract
AIMS Alteplase is a cornerstone thrombolytic agent in clinical practice but presents a potential bleeding risk. Stroke patients need pre-screening to exclude haemorrhagic stroke before using alteplase. In this study, we develop a new thrombolytic agent citPA5, characterized by an enhanced safety profile and minimal bleeding tendency. METHODS AND RESULTS A clot lysis agent, named citPA5, is developed based on rtPA with point mutations to completely suppress its proteolytic activity in the absence of fibrin. In the presence of fibrin, citPA5 exhibited significantly higher fibrinolytic activity (a 15.8-fold increase of kcat/Km). Furthermore, citPA5 showed resistance to endogenous fibrinolysis inhibitor, PAI-1, resulting in enhanced potency. In a series of safety evaluation experiments, including thrombelastography assay, mice tail bleeding assay, and a murine intracerebral haemorrhage (ICH) model, citPA5 did not cause systemic bleeding or worsen ICH compared with alteplase. This highlights the low risk of bleeding associated with citPA5. Finally, we found that citPA5 effectively improved cerebral blood flow and reduced infarct volume in a carotid embolism-induced stroke model. CONCLUSION This clot lysis agent, citPA5, not only exhibits a low risk of bleeding but also demonstrates highly effective thrombolysis capabilities. As a result, citPA5 shows great potential for administration prior to the classification of stroke types, making it possible for use in ambulances at the onset of stroke when symptoms are identified. The findings presented in this study also suggest that this strategy could be applied to develop a new generation of fibrinolytic drugs that offer greater safety and specificity in targeting fibrin.
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Affiliation(s)
- Shanli Chen
- College of Chemistry, Fuzhou University, No.2 Wulongjiang North Avenue, Fuzhou 350108, China
| | - Sudan Fang
- College of Chemistry, Fuzhou University, No.2 Wulongjiang North Avenue, Fuzhou 350108, China
| | - Yang Zhou
- College of Chemistry, Fuzhou University, No.2 Wulongjiang North Avenue, Fuzhou 350108, China
| | - Zhiwei Huang
- College of Chemistry, Fuzhou University, No.2 Wulongjiang North Avenue, Fuzhou 350108, China
| | - Shujuan Yu
- College of Chemistry, Fuzhou University, No.2 Wulongjiang North Avenue, Fuzhou 350108, China
| | - Dan Chen
- College of Chemistry, Fuzhou University, No.2 Wulongjiang North Avenue, Fuzhou 350108, China
| | - Zhiyou Wang
- College of Chemistry, Fuzhou University, No.2 Wulongjiang North Avenue, Fuzhou 350108, China
| | - Yanyan Xu
- College of Chemical Engineering, Fuzhou University, Fuzhou, China
| | - Peiwen Liu
- College of Chemistry, Fuzhou University, No.2 Wulongjiang North Avenue, Fuzhou 350108, China
| | - Yongkun Li
- Department of Neurology, Provincial Hospital Affiliated to Fujian Medical University, Fuzhou, China
| | - Wei Lin
- Fujian Institute of Integrated Traditional Chinese and Western Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Longguang Jiang
- College of Chemistry, Fuzhou University, No.2 Wulongjiang North Avenue, Fuzhou 350108, China
| | - Cai Yuan
- College of Biological Science and Engineering, Fuzhou University, No.2 Xueyuan Road, New District, Fuzhou 350108, China
| | - Mingdong Huang
- College of Chemistry, Fuzhou University, No.2 Wulongjiang North Avenue, Fuzhou 350108, China
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13
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Brissette V, Roy DC, Jamal M, Fahmy M, Guenego A, Fahed J, Shamy M, Dowlatshahi D, Fahed R. Benefits of First Pass Recanalization in Basilar Strokes Based on Initial Clinical Severity. Clin Neuroradiol 2024; 34:555-562. [PMID: 38386052 DOI: 10.1007/s00062-024-01392-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/24/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE Randomized trials demonstrating the benefits of thrombectomy for basilar artery occlusions have enrolled an insufficient number of patients with a National Institutes for Health Stroke Scale (NIHSS) score < 10 and shown discrepant results for patients with an NIHSS > 20. Achieving a first pass recanalization (FPR) improves clinical outcomes in stroke. We aimed to evaluate the effect of the FPR on outcomes among basilar artery occlusion patients, characterized by prethrombectomy initial NIHSS score. METHODS We retrospectively analyzed the Endovascular Treatment in Ischemic Stroke (ETIS) registry of 279 basilar artery occlusion patients treated with thrombectomy from 6 participating centers. We compared the 90-day clinical outcomes of achieving a FPR versus no FPR, categorized by initial clinical severity: mild (NIHSS < 10), moderate (NIHSS 10-20) and severe (NIHSS > 20). We used Poisson regression with robust error variance to determine the effect of the NIHSS score on the association between FPR and outcomes. RESULTS The FPR patients with NIHSS < 10 or NIHSS 10-20 were more likely to have a favorable clinical outcome (modified Rankin scale, mRS 0-3) than non-FPR patients (relative risk, RR = 1.32, 95% confidence interval, CI: 1.04, 1.66, p-value = 0.0213, and RR = 1.79, 95% CI: 1.26, 2.53, p-value = 0.0011, respectively). A similar benefit was not found in patients with severe symptoms. We found a significantly lower risk of poor clinical outcome (mRS 4-6) in FPR patients with NIHSS 10-20, but not among patients with an NIHSS > 20. CONCLUSION Achieving a FPR in basilar artery occlusion patients with mild (NIHSS < 10) or moderate (NIHSS 10-20) symptoms is associated with better clinical outcomes, but not in patients with severe symptoms. These results support the importance of further clinical trials on the benefits of thrombectomy in severe strokes.
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Affiliation(s)
- Vincent Brissette
- Department of Medicine (Neurology), Department of Medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Danielle Carole Roy
- School of Epidemiology and Public Health, Faculty of Medicine, Ottawa, Ontario, Canada
| | - Mobin Jamal
- Department of Medicine (Neurology), Department of Medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Maria Fahmy
- Department of Medicine (Neurology), Department of Medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Adrien Guenego
- Interventional Neuroradiology, Erasme Hospital, Brussels, Belgium
| | - Joud Fahed
- Department of Medicine (Neurology), Department of Medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Michel Shamy
- Department of Medicine (Neurology), Department of Medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Dar Dowlatshahi
- Department of Medicine (Neurology), Department of Medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, Ottawa, Ontario, Canada
| | - Robert Fahed
- Department of Medicine (Neurology), Department of Medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
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14
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Montalvan V, Neves G, Shannon J, Clifford T, Curry J, Kahathuduwa C, Tan Y, Barnes R, Kopel J, Chintakayala L, Brister R, Hancock S, Baugham A, Hendley K, Bhatt N, Pollard R. The use of a pre-hospital questionnaire expedited the acute management of patients with ischemic stroke in a comprehensive stroke center. Clin Neurol Neurosurg 2024; 244:108442. [PMID: 39038420 DOI: 10.1016/j.clineuro.2024.108442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 06/28/2024] [Accepted: 07/07/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUND Delays in intravenous thrombolysis (IVT) treatment for acute ischemic stroke decrease the benefit of treatment. Difficulties determining a patient's clinical eligibility for IVT is a frequent cause of treatment delays. OBJECTIVE We aimed to assess the effectiveness of the "PROVIDENCE" datasheet, a pre- hospital assessment of contraindications for IVT use applied by emergency medical services personnel. METHODS We performed a single-center cohort study comparing IVT decision and treatment times between patients with PROVIDENCE datasheets and those without. Patients were eligible if they were over 18 years old and presented to our comprehensive stroke center from the field with stroke-like symptoms with onset within 4.5 hours. RESULTS We identified 465 records and included 166 records in our final analysis (54 in the study group and 112 in the control group). A subgroup of 85 patients received IVT (30 in the study group patients and 55 in the control group). The PROVIDENCE datasheet was associated with a faster median time by five minutes from the patient's initial presentation at the emergency department to the final decision regarding IVT eligibility (p = 0.032) and a faster time between the first encounter with a neurology provider and the decision regarding IVT administration by six minutes (p = 0.002) for the entire sample. In the subgroup that received IVT, the PROVIDENCE datasheet decreased the median decision time by seven minutes (p = 0.044) There was no significant difference in door-to-needle times between groups. CONCLUSION Using the PROVIDENCE datasheet, first responders can quickly identify potential contraindications for IVT treatment in patients with stroke-like symptoms. This tool expedited decision-making and led to faster IVT administration process at a comprehensive stroke center.
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Affiliation(s)
- V Montalvan
- Department of Neurology. Texas Tech University Health Science Center, Lubbock, TX, United States; Department of Neurology. Covenant Medical Center, Lubbock, TX, United States; Department of Neurology, Vascular Neurology Division, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
| | - G Neves
- Department of Neurology. Texas Tech University Health Science Center, Lubbock, TX, United States; Department of Neurology. Covenant Medical Center, Lubbock, TX, United States.
| | - J Shannon
- Department of Pulmonology and Critical Care Medicine. Covenant Medical Center, Lubbock, TX, United States.
| | - T Clifford
- Covenant Direct Regional Transfer Center, Covenant Medical Center, Lubbock, TX, United States.
| | - J Curry
- Emergency Medical Services, University Medical Center, Lubbock, TX, United States.
| | - C Kahathuduwa
- Department of Neurology. Texas Tech University Health Science Center, Lubbock, TX, United States; Department of Neurology. Covenant Medical Center, Lubbock, TX, United States.
| | - Y Tan
- Department of Neurology. Texas Tech University Health Science Center, Lubbock, TX, United States; Department of Neurology. Covenant Medical Center, Lubbock, TX, United States.
| | - R Barnes
- Texas Tech University School of Medicine, Lubbock, TX, United States.
| | - J Kopel
- Texas Tech University School of Medicine, Lubbock, TX, United States.
| | - Laxmi Chintakayala
- Neurology Department, Barrow Neurological Institute. Phoenix, AZ, United States.
| | - R Brister
- Texas Tech University School of Medicine, Lubbock, TX, United States.
| | - S Hancock
- Department of Neurology. Covenant Medical Center, Lubbock, TX, United States.
| | - A Baugham
- Department of Neurology. Covenant Medical Center, Lubbock, TX, United States.
| | - K Hendley
- Department of Neurology. Covenant Medical Center, Lubbock, TX, United States.
| | - N Bhatt
- Department of Neurology, Vascular Neurology Division, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
| | - R Pollard
- Department of Neurology, Vascular Neurology Division, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
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15
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Al-Ajlan FS, Alkhiri A, Alamri AF, Alghamdi BA, Almaghrabi AA, Alharbi AR, Alansari N, Almilibari AZ, Hussain MS, Audebert HJ, Grotta JC, Shuaib A, Saver JL, Alhazzani A. Golden Hour Intravenous Thrombolysis for Acute Ischemic Stroke: A Systematic Review and Meta-Analysis. Ann Neurol 2024; 96:582-590. [PMID: 38922985 DOI: 10.1002/ana.27007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 04/30/2024] [Accepted: 05/25/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVES The benefits of intravenous thrombolysis are time-dependent, with maximum efficacy when administered within the first "golden" hour after onset. Nevertheless, the impact of golden hour thrombolysis has not been well quantified. METHODS Medline, Embase, and Web of Science databases were systematically searched from inception to August 27, 2023. We included studies that reported safety and efficacy outcomes of ischemic stroke patients treated with intravenous thrombolysis in the golden hour versus later treatment window. The primary outcome was an excellent functional outcome, defined as a modified Rankin Scale score of 0-1 at 90 days. The secondary efficacy outcome was a good functional outcome (defined as modified Rankin Scale score of 0-2). The main safety outcome was symptomatic intracerebral hemorrhage. RESULTS Seven studies involving 78,826 patients met the selection criteria. Golden hour thrombolysis was associated with higher odds of 90-day excellent functional outcomes (OR 1.40, 95% CI 1.16-1.67) and 90-day good functional outcomes (OR 1.38, 95% CI 1.13-1.69) compared with thrombolysis outside the golden hour. The number needed to treat to benefit for golden hour thrombolysis to reduce disability by at least 1 level on the modified Rankin Scale per patient was 2.6. Rates of symptomatic intracerebral hemorrhage and mortality were similar between groups. INTERPRETATION Golden hour thrombolysis significantly improved acute ischemic stroke outcomes. The findings provide rationale for intensive efforts aimed at expediting thrombolytic therapy within the golden hour window following the onset of acute ischemic stroke. ANN NEUROL 2024;96:582-590.
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Affiliation(s)
- Fahad S Al-Ajlan
- Neuroscience Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Alfaisal University, Riyadh, Saudi Arabia
| | - Ahmed Alkhiri
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Aser F Alamri
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Basil A Alghamdi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Ahmed A Almaghrabi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Abdullah R Alharbi
- Department of Neurology, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Nayef Alansari
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Ahmed Z Almilibari
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - M Shazam Hussain
- Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Heinrich J Audebert
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - James C Grotta
- Memorial Hermann Hospital, Texas Medical Center, Houston, TX, USA
| | - Ashfaq Shuaib
- Neurology Division, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Jeffrey L Saver
- Department of Neurology, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Adel Alhazzani
- Neuroscience Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Alfaisal University, Riyadh, Saudi Arabia
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16
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Aytaç E, Gönen M, Tatli S, Balgetir F, Dogan S, Tuncer T. Large vessel occlusion detection by non-contrast CT using artificial ıntelligence. Neurol Sci 2024; 45:4391-4397. [PMID: 38622451 PMCID: PMC11306655 DOI: 10.1007/s10072-024-07522-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 04/06/2024] [Indexed: 04/17/2024]
Abstract
INTRODUCTION Computer vision models have been used to diagnose some disorders using computer tomography (CT) and magnetic resonance (MR) images. In this work, our objective is to detect large and small brain vessel occlusion using a deep feature engineering model in acute of ischemic stroke. METHODS We use our dataset. which contains 324 patient's CT images with two classes; these classes are large and small brain vessel occlusion. We divided the collected image into horizontal and vertical patches. Then, pretrained AlexNet was utilized to extract deep features. Here, fc6 and fc7 (sixth and seventh fully connected layers) layers have been used to extract deep features from the created patches. The generated features from patches have been concatenated/merged to generate the final feature vector. In order to select the best combination from the generated final feature vector, an iterative selector (iterative neighborhood component analysis-INCA) has been used, and this selector has chosen 43 features. These 43 features have been used for classification. In the last phase, we used a kNN classifier with tenfold cross-validation. RESULTS By using 43 features and a kNN classifier, our AlexNet-based deep feature engineering model surprisingly attained 100% classification accuracy. CONCLUSION The obtained perfect classification performance clearly demonstrated that our proposal could separate large and small brain vessel occlusion detection in non-contrast CT images. In this aspect, this model can assist neurology experts with the early recanalization chance.
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Affiliation(s)
- Emrah Aytaç
- Department of Neurology, Faculty of Medicine, Fırat University, Elazig, Turkey
| | - Murat Gönen
- Department of Neurology, Faculty of Medicine, Fırat University, Elazig, Turkey
| | - Sinan Tatli
- Department of Neurology, Faculty of Medicine, Fırat University, Elazig, Turkey
| | - Ferhat Balgetir
- Department of Neurology, Faculty of Medicine, Fırat University, Elazig, Turkey.
| | - Sengul Dogan
- Department of Digital Forensics Engineering, College of Technology, Fırat University, Elazig, Turkey
| | - Turker Tuncer
- Department of Digital Forensics Engineering, College of Technology, Fırat University, Elazig, Turkey
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17
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Yu S, Yin P, Li X, Xiao J, Zhang H, Zhou L, Tian Y. Association of high serum β2-microglobulin levels with poor functional outcomes in patients with acute ischemic stroke: A cohort study. Medicine (Baltimore) 2024; 103:e39525. [PMID: 39213200 PMCID: PMC11365628 DOI: 10.1097/md.0000000000039525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 07/21/2024] [Accepted: 08/09/2024] [Indexed: 09/04/2024] Open
Abstract
We evaluated the association between serum β2-microglobulin (β2M) levels and prognosis in patients with acute ischemic stroke (AIS) and determined whether the association was affected by any clinical variables. This prospective study included 533 patients with AIS who were admitted to the Hospital of Nanhua Affiliated with the University of South China for treatment from June 1, 2021, to July 31, 2022. Using multiple regression modeling, the association between serum β2M levels and poor functional outcomes-which were classified as being modified Rankin Scale scores of 3 to 6 (composite score of death and major disability), 3 to 5 (major disability), and 6 (death)-were assessed 3 months after stroke onset. At the 3-month follow-up assessment, 209 (47.39%) participants had poor functional outcomes: major disabilities in 150 (34.01%) cases and deaths in 59 (13.38%). After adjusting for important covariates, the group with serum β2M levels in the highest quartile had the highest proportion of individuals with modified Rankin Scale scores of 3 to 6 (odds ratio [OR], 3.54; 95% confidence interval [CI], 1.35-9.33), 3 to 5 (OR, 2.95; 95% CI, 1.21-7.16), or 6 (OR, 1.02; 95% CI, 0.29-3.64) compared with the group having serum β2M levels in the lowest quartiles. The risk prediction for the combined outcome of death and major disability improved after incorporating β2M levels into models that included conventional risk factors. Subgroup analysis revealed a significant impact on the association between serum β2M levels and poor functional outcomes only in patients with AIS whose time from onset to hospitalization was <12 hours (P for interaction < .05). Elevated serum β2M levels were associated with poor functional outcomes in patients with AIS, possibly affected by the time from onset to hospitalization.
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Affiliation(s)
- Shan Yu
- Department of Clinical Laboratory, The Affiliated Nanhua Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Peng Yin
- Department of Information Statistics, The Affiliated Nanhua Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Xiujuan Li
- Department of Clinical Laboratory, The Affiliated Nanhua Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Jian Xiao
- Department of Clinical Laboratory, The Affiliated Nanhua Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Hao Zhang
- Department of Neurology, The Affiliated Nanhua Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Liangqi Zhou
- Department of Neurology, The Affiliated Nanhua Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Ying Tian
- Department of Clinical Research, The Affiliated Nanhua Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
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Zaleski MH, Omo-Lamai S, Nong J, Chase LS, Myerson JW, Glassman PM, Lee F, Reyes-Esteves S, Wang Z, Patel MN, Peshkova AD, Komatsu H, Axelsen PH, Muzykantov VR, Marcos-Contreras OA, Brenner JS. Nanocarriers' repartitioning of drugs between blood subcompartments as a mechanism of improving pharmacokinetics, safety, and efficacy. J Control Release 2024; 374:425-440. [PMID: 39103056 DOI: 10.1016/j.jconrel.2024.07.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 07/25/2024] [Accepted: 07/29/2024] [Indexed: 08/07/2024]
Abstract
For medical emergencies, such as acute ischemic stroke, rapid drug delivery to the target site is essential. For many small molecule drugs, this goal is unachievable due to poor solubility that prevents intravenous administration, and less obviously, by extensive partitioning to plasma proteins and red blood cells (RBCs), which greatly slows delivery to the target. Here we study these effects and how they can be solved by loading into nanoscale drug carriers. We focus on fingolimod, a small molecule drug that is FDA-approved for treatment of multiple sclerosis, which has also shown promise in the treatment of stroke. Unfortunately, fingolimod has poor solubility and very extensive partitioning to plasma proteins and RBCs (in whole blood, 86% partitions to RBCs, 13.96% to plasma proteins, and 0.04% is free). We develop a liposomal formulation that slows the partitioning of fingolimod to RBCs and plasma proteins, enables intravenous delivery, and additionally prevents fingolimod toxicity to RBCs. The liposomal formulation nearly completely prevented fingolimod adsorption to plasma proteins (association with plasma proteins was 98.4 ± 0.4% for the free drug vs. 5.6 ± 0.4% for liposome-loaded drug). When incubated with whole blood in vitro, the liposomal formulation greatly slowed partitioning of fingolimod to RBCs and also eliminated deleterious effects of fingolimod on RBC rigidity, morphology, and hemolysis. In vivo, the liposomal formulation delayed fingolimod partitioning to RBCs for over 30 min, a critical time window for stroke. Fingolimod-loaded liposomes showed improved efficacy in a mouse model of post-stroke neuroinflammation, completely sealing the leaky blood-brain barrier (114 ± 11.5% reduction in albumin leak into the brain for targeted liposomes vs. 38 ± 16.5% reduction for free drug). This effect was only seen for liposomes modified with antibodies to enable targeted delivery to the site of action, and not in unmodified, long-circulating liposomes. Thus, loading fingolimod into liposomes prevented partitioning to RBCs and associated toxicities and enabled targeted delivery. This paradigm can be used for tuning the blood distribution of small molecule drugs for the treatment of acute illnesses requiring rapid pharmacologic intervention.
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Affiliation(s)
- Michael H Zaleski
- Department of Pharmacology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Serena Omo-Lamai
- Department of Bioengineering, School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, PA, USA
| | - Jia Nong
- Department of Pharmacology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Liam S Chase
- Department of Pharmacology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jacob W Myerson
- Department of Pharmacology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Patrick M Glassman
- Department of Pharmaceutical Sciences, School of Pharmacy, Temple University, Philadelphia, PA, USA
| | - Florence Lee
- Department of Pharmacology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Zhicheng Wang
- Department of Pharmacology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Manthan N Patel
- Department of Pharmacology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Alina D Peshkova
- Department of Pharmacology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Hiroaki Komatsu
- Department of Pharmacology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Paul H Axelsen
- Department of Pharmacology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Vladimir R Muzykantov
- Department of Pharmacology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Oscar A Marcos-Contreras
- Department of Pharmacology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Jacob S Brenner
- Department of Pharmacology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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19
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Azhari HF. Advancing stroke diagnosis and management through nuclear medicine: a systematic review of clinical trials. Front Med (Lausanne) 2024; 11:1425965. [PMID: 39224610 PMCID: PMC11368133 DOI: 10.3389/fmed.2024.1425965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 07/19/2024] [Indexed: 09/04/2024] Open
Abstract
Introduction Despite advancements in stroke care, challenges persist in timely triage and treatment initiation to prevent the burden of stroke-related disabilities. Although nuclear medicine has shown promise, no imaging technique has yet provided a sufficiently rapid, precise, and cost-effective approach to routine stroke management. This study aims to review the clinical application of nuclear medicine in stroke diagnosis and treatment. Methods A systematic search of the Cochrane, EU Clinical Trials Register, ISRCTN, the International Stroke Trial, and the ClinicalTrials.gov database was conducted to find all registered trials reporting nuclear medicine's clinical applications in stroke up to June 07, 2024. Results Among the 220 screened trials, 51 (36 interventional; 15 observational) met the eligibility criteria. Participants were older than 18 years old, with only six studies including pediatric under 17 years old, with a total of 11,262 stroke (9,232 ischemic; 2,030 haemorrhagic) participants. The bias risk varied across trials but remained mostly low to moderate. Discussion The review highlighted nuclear medicine's significant contributions to stroke diagnosis and management, notably through mobile stroke units, pre-hospital acute stroke magnetic resonance image (MRI) based biomarkers, and MRI-based stroke mechanisms for 4D flow nuclear imaging. These advancements have generally reduced treatment delays and enhance clinical outcomes post-stroke. Specifically, radiopharmaceutical radiotracers can effectively discriminate between strokes and mimics, particularly in high-risk patients. Integrating novel positron emission tomography (PET) radiotracer 18F glycoprotein 1 and radionuclide angiography may improve sensitivity and specificity in thrombi detection for decisions regarding stenting or carotid endarterectomy, and the single-photon emission computed tomography and PET integration with ferumoxytol radiotracer-enhanced MRI enables functional imaging for evaluating cerebral perfusion, metabolic activity, and neuroinflammatory markers post-stroke. Overall, the integration of nuclear medicine into multimodal imaging equipment like computed-tomography PET and MRI-PET offers a more comprehensive picture of the brain. Nevertheless, further research is needed on novel stroke imaging techniques and standardization across stroke centers for optimal performance. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024541680, identifier PROSPERO CRD(42024541680).
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Affiliation(s)
- Hala F. Azhari
- College of Medicine and Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
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20
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Black GB, Ramsay AIG, Simister R, Baim-Lance A, Eng J, Melnychuk M, Fulop NJ. Temporal structures that determine consistency and quality of care: a case study in hyperacute stroke services. BMJ Qual Saf 2024; 33:587-596. [PMID: 37336572 PMCID: PMC11347214 DOI: 10.1136/bmjqs-2022-015620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 05/20/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Temporal structuring is determined by practices and social norms and affects the quality and timing of care. In this case study of hyperacute stroke wards which provide initial stroke investigation, treatment and care, we explored temporal structuring patterns to explain how these may affect quality of care. METHODS This paper presents a thematic analysis of qualitative interviews with hyperacute stroke staff (n=76), non-participant observations (n=41, ~102 hours) and documentary analysis of the relevant service standards guidance. We used an inductive coding process to generate thematic findings around the concept of temporal structuring, with graphically illustrated examples. RESULTS Five temporal structures influence what-happens-when: (1) clinical priorities and quality assurance metrics motivate rapid activity for the initial life-prolonging assessments and interventions; (2) static features of ward organisation such as rotas and ward rounds impact consistency of care, determining timing and quality of care for patients; (3) some services experimented with staff rotas to try to meet peaks in demand, sometimes unsuccessfully; (4) implicit social norms or heuristics about perceived necessity affected staff motivation to make changes or improvements to consistency of care, particularly around weekend work; and (5) after-effects such as bottlenecks or backlogs affect quality of care, which are hard to measure effectively to drive service improvement. CONCLUSIONS Patients need temporally consistent high quality of care. Temporal consistency stems from the design of services, including staffing, targets and patient pathway design as well as cultural attitudes to working patterns. Improvements to consistency of care will be limited without changes to structures such as rotas and ward rounds, but also social norms around weekend work for certain professional groups.
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Affiliation(s)
- Georgia B Black
- Applied Health Research, University College London, London, UK
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | | | - Robert Simister
- Stroke Research Centre, Institute of Neurology, University College London, London, UK
| | - Abigail Baim-Lance
- Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, New York, New York, USA
- James J Peters VA Medical Center, US Department of Veterans Affairs, New York, New York, USA
| | - Jeannie Eng
- Stroke Research Centre, Institute of Neurology, University College London, London, UK
| | | | - Naomi J Fulop
- Applied Health Research, University College London, London, UK
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21
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Özdemir Z, Acar E. YouTube as a source of recognizing acute stroke; progress in 2 years. BMC Public Health 2024; 24:2208. [PMID: 39138572 PMCID: PMC11323591 DOI: 10.1186/s12889-024-19710-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 08/07/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND YouTube™ has a great role in providing information, which includes educational videos, to more than 2 billion users, making it the second most popular application in the world. BE-FAST is a modified version of the FAST mnemonic and is used to detect acute ischemic stroke by the patients or their relatives. The purpose of this study is to assess the overall usefulness of the information of YouTube in patients to realize an acute stroke attack. METHODS YouTube was searched for the following five terms: "stroke", ''stroke diagnosis", "stroke signs", "brain attack" and "what is stroke" in November 2021 and May 2023, separately. Two independent neurology specialists scored each video by using Global Quality Scale (GQS). RESULTS Among the total of 150 videos, the number that met inclusion criteria was 91 for the November 2021 search and 104 for the May 2023 search. For the 2021 search, in 30 videos (33%), the FAST mnemonic or its contents were noticed, whereas BE-FAST was mentioned in only four videos (4.4%). For the 2023 search, the FAST mnemonic or its contents were noticed in 36 videos (34.6%) and BE-FAST was mentioned in 11 videos (10.6%). Among the 2021 and 2023 searches, the mean GQS values were 3.09 and 2.96 points, 50 (54.8%) vs. 56 (53.8%) videos rated 3.5 points or higher (high quality), respectively. GQS scores of the videos mentioning balance, eyes, face, arms, speech, and time, the basic and advanced information about radiology and treatment, and mentioning FAST, BE-FAST, and TPA were significantly higher. CONCLUSION We conclude that YouTube is not yet a very useful tool for patients to realize that they may have acute ischemic stroke, though over the years; information available on social media for healthcare information and education has improved.
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Affiliation(s)
- Zeynep Özdemir
- Department of Neurology, Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatric, Neurologic and Neurosurgical Diseases, Istanbul Health Sciences University, Istanbul, Turkey.
| | - Erkan Acar
- Department of Neurology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
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22
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Scheldeman L, Sinnaeve P, Albers GW, Lemmens R, Van de Werf F. Acute myocardial infarction and ischaemic stroke: differences and similarities in reperfusion therapies-a review. Eur Heart J 2024; 45:2735-2747. [PMID: 38941344 DOI: 10.1093/eurheartj/ehae371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 04/16/2024] [Accepted: 05/28/2024] [Indexed: 06/30/2024] Open
Abstract
Acute ST-elevation myocardial infarction (STEMI) and acute ischaemic stroke (AIS) share a number of similarities. However, important differences in pathophysiology demand a disease-tailored approach. In both conditions, fast treatment plays a crucial role as ischaemia and eventually infarction develop rapidly. Furthermore, in both fields, the introduction of fibrinolytic treatments historically preceded the implementation of endovascular techniques. However, in contrast to STEMI, only a minority of AIS patients will eventually be considered eligible for reperfusion treatment. Non-invasive cerebral imaging always precedes cerebral angiography and thrombectomy, whereas coronary angiography is not routinely preceded by non-invasive cardiac imaging in patients with STEMI. In the late or unknown time window, the presence of specific patterns on brain imaging may help identify AIS patients who benefit most from reperfusion treatment. For STEMI, a uniform time window for reperfusion up to 12 h after symptom onset, based on old placebo-controlled trials, is still recommended in guidelines and generally applied. Bridging fibrinolysis preceding endovascular treatment still remains the mainstay of reperfusion treatment in AIS, while primary percutaneous coronary intervention is the strategy of choice in STEMI. Shortening ischaemic times by fine-tuning collaboration networks between ambulances, community hospitals, and tertiary care hospitals, optimizing bridging fibrinolysis, and reducing ischaemia-reperfusion injury are important topics for further research. The aim of this review is to provide insights into the common as well as diverging pathophysiology behind current reperfusion strategies and to explore new ways to enhance their clinical benefit.
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Affiliation(s)
- Lauranne Scheldeman
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
- Department of Neurosciences, Experimental Neurology KU Leuven - University of Leuven, Leuven, Belgium
| | - Peter Sinnaeve
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven, University of Leuven, Herestraat 49, B-3000 Leuven, Belgium
| | - Gregory W Albers
- Department of Neurology, Stanford University Medical Center, Palo Alto, USA
| | - Robin Lemmens
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
- Department of Neurosciences, Experimental Neurology KU Leuven - University of Leuven, Leuven, Belgium
| | - Frans Van de Werf
- Department of Cardiovascular Sciences, KU Leuven, University of Leuven, Herestraat 49, B-3000 Leuven, Belgium
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23
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Smith FS, Whisenant M, Johnson CM, Burnett J, Savitz SI, Beauchamp JES. Development of an Acute Stroke Care Seeking Framework. J Neurosci Nurs 2024:01376517-990000000-00100. [PMID: 39133535 DOI: 10.1097/jnn.0000000000000782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
ABSTRACT BACKGROUND: A multitude of variables influence an individual's decision to seek care in emergency situations. By recognizing these variables and their impact on the timeline of an individual seeking care for a stroke, nurses have an opportunity to positively affect the outcomes of stroke within the community. The purpose of this narrative review was to develop a research framework describing the variables involved in care seeking during an acute stroke. METHODS: Using a theory synthesis methodology that included variable identification and the establishment of relationships between variables based on existing literature, a framework describing variables relevant to acute stroke care seeking behavior was developed. RESULTS: Fourteen recently published studies reported significant variables related to seeking emergency medical care during the hyperacute phase of a stroke. Eight variables were identified and characterized as either promoters or distractors. Promoters led an individual to seek acute stroke care earlier, such as perceived symptom severity, stroke knowledge, and the presence of others. Distractors led an individual to delay seeking acute stroke care and resulted in later hospital arrival times, such as a lack of social network or resources, comorbid conditions, and incongruity with the local health system. CONCLUSION: Although individual decision making is exceedingly complex and varies by individual and situation, the developed acute stroke care seeking framework may provide a basis on which to develop stroke awareness programs and interventions targeted at individuals at risk for delayed acute stroke care.
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24
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Althaus O, ter Jung N, Stahlke S, Theiss C, Herzog-Niescery J, Vogelsang H, Weber T, Gude P, Matschke V. Region-specific protective effects of monomethyl fumarate in cerebellar and hippocampal organotypic slice cultures following oxygen-glucose deprivation. PLoS One 2024; 19:e0308635. [PMID: 39110748 PMCID: PMC11305562 DOI: 10.1371/journal.pone.0308635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 07/25/2024] [Indexed: 08/10/2024] Open
Abstract
To date, apart from moderate hypothermia, there are almost no adequate interventions available for neuroprotection in cases of brain damage due to cardiac arrest. Affected persons often have severe limitations in their quality of life. The aim of this study was to investigate protective properties of the active compound of dimethyl fumarate, monomethyl fumarate (MMF), on distinct regions of the central nervous system after ischemic events. Dimethyl fumarate is an already established drug in neurology with known anti-inflammatory and antioxidant properties. In this study, we chose organotypic slice cultures of rat cerebellum and hippocampus as an ex vivo model. To simulate cardiac arrest and return of spontaneous circulation we performed oxygen-glucose-deprivation (OGD) followed by treatments with different concentrations of MMF (1-30 μM in cerebellum and 5-30 μM in hippocampus). Immunofluorescence staining with propidium iodide (PI) and 4',6-diamidine-2-phenylindole (DAPI) was performed to analyze PI/DAPI ratio after imaging with a spinning disc confocal microscope. In the statistical analysis, the relative cell death of the different groups was compared. In both, the cerebellum and hippocampus, the MMF-treated group showed a significantly lower PI/DAPI ratio compared to the non-treated group after OGD. Thus, we showed for the first time that both cerebellar and hippocampal slice cultures treated with MMF after OGD are significantly less affected by cell death.
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Affiliation(s)
- Oliver Althaus
- Department of Cytology, Medical Faculty, Institute of Anatomy, Ruhr University Bochum, Bochum, Germany
| | - Nico ter Jung
- Department of Cytology, Medical Faculty, Institute of Anatomy, Ruhr University Bochum, Bochum, Germany
| | - Sarah Stahlke
- Department of Cytology, Medical Faculty, Institute of Anatomy, Ruhr University Bochum, Bochum, Germany
| | - Carsten Theiss
- Department of Cytology, Medical Faculty, Institute of Anatomy, Ruhr University Bochum, Bochum, Germany
| | - Jennifer Herzog-Niescery
- Department of Anesthesiology and Intensive Care Medicine, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Heike Vogelsang
- Department of Anesthesiology and Intensive Care Medicine, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Thomas Weber
- Department of Anesthesiology and Intensive Care Medicine, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Philipp Gude
- Department of Anesthesiology and Intensive Care Medicine, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Veronika Matschke
- Department of Cytology, Medical Faculty, Institute of Anatomy, Ruhr University Bochum, Bochum, Germany
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25
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Hamon G, Legrand L, Hmeydia G, Turc G, Hassen WB, Charron S, Debacker C, Naggara O, Thirion B, Chen B, Lapergue B, Oppenheim C, Benzakoun J. Multicenter validation of synthetic FLAIR as a substitute for FLAIR sequence in acute ischemic stroke. Eur Stroke J 2024:23969873241263418. [PMID: 39096195 DOI: 10.1177/23969873241263418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2024] Open
Abstract
PURPOSE To evaluate performance of synthetic and real FLAIR for identifying early stroke in a multicenter cohort. METHODS This retrospective study was conducted using DWI and FLAIR extracted from the Endovascular Treatment in Ischemic Stroke image registry (2017-2021). The database was partitioned into subsets according to MRI field strength and manufacturer, and randomly divided into training set (70%) used for model fine-tuning, validation set (15%), and test set (15%). In test set, five readers, blinded to FLAIR sequence type, assessed DWI-FLAIR mismatch using real and synthetic FLAIR. Interobserver agreement for DWI-FLAIR rating and concordance between synthetic and real FLAIR were evaluated with kappa statistics. Sensitivity and specificity for identification of ⩽4.5 h AIS were compared in patients with known onset-to-MRI delay using McNemar's test. RESULTS 1454 complete MRI sets (1172 patients, median (IQR) age: 73 years (62-82); 762 women) acquired on 125 MRI units were analyzed. In test set (207 MRI), interobserver reproducibility for DWI-FLAIR mismatch labeling was substantial for real and synthetic FLAIR (Fleiss κ = 0.79 (95%CI: 0.73-0.84) and 0.77 (95%CI: 0.71-0.82), respectively). After consensus, concordance between real and synthetic FLAIR was excellent (κ = 0.85 (95%CI: 0.78-0.92)). In 141 MRI sets with known onset-to-MRI delay, diagnostic performances for ⩽4.5 h AIS identification did not differ between real and synthetic FLAIR (sensitivity: 60/71 (85%) vs 59/71 (83%), p = .56; specificity: 65/70 (93%) vs 65/70 (93%), p > 0.99). CONCLUSION A deep-learning-based FLAIR fine-tuned on multicenter data can provide comparable performances to real FLAIR for early AIS identification. This approach may help reducing MR protocol duration and motion artifacts.
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Affiliation(s)
- Guillaume Hamon
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Paris, France
| | - Laurence Legrand
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Paris, France
- Department of Neuroradiology, GHU Paris Psychiatrie et Neurosciences, Paris, France
- Université Paris-Cité, FHU Neurovasc, Paris, France
| | - Ghazi Hmeydia
- Department of Neuroradiology, GHU Paris Psychiatrie et Neurosciences, Paris, France
| | - Guillaume Turc
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Paris, France
- Université Paris-Cité, FHU Neurovasc, Paris, France
- Department of Neurology, GHU Paris Psychiatrie et Neurosciences, Paris, France
| | - Wagih Ben Hassen
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Paris, France
- Department of Neuroradiology, GHU Paris Psychiatrie et Neurosciences, Paris, France
- Université Paris-Cité, FHU Neurovasc, Paris, France
| | - Sylvain Charron
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Paris, France
- Université Paris-Cité, FHU Neurovasc, Paris, France
| | - Clement Debacker
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Paris, France
- Department of Neuroradiology, GHU Paris Psychiatrie et Neurosciences, Paris, France
- Université Paris-Cité, FHU Neurovasc, Paris, France
| | - Olivier Naggara
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Paris, France
- Department of Neuroradiology, GHU Paris Psychiatrie et Neurosciences, Paris, France
- Université Paris-Cité, FHU Neurovasc, Paris, France
| | | | - Bailiang Chen
- CIC, Innovation Technologique, Université de Lorraine, INSERM 1433, Nancy, France
| | - Bertrand Lapergue
- Department of Neurology, Foch Hospital, Versailles Saint-Quentin-en-Yvelines University, Suresnes, France
| | - Catherine Oppenheim
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Paris, France
- Department of Neuroradiology, GHU Paris Psychiatrie et Neurosciences, Paris, France
- Université Paris-Cité, FHU Neurovasc, Paris, France
| | - Joseph Benzakoun
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Paris, France
- Department of Neuroradiology, GHU Paris Psychiatrie et Neurosciences, Paris, France
- Université Paris-Cité, FHU Neurovasc, Paris, France
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26
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Arnold N, Gough K, Patsalou A, Carrigan B, MacAskill W. Does on-site computed tomography matter? A cross-sectional study of stroke patients' door-to-scan-time in rural hospitals. Aust J Rural Health 2024; 32:834-839. [PMID: 38764424 DOI: 10.1111/ajr.13140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 05/02/2024] [Accepted: 05/07/2024] [Indexed: 05/21/2024] Open
Abstract
PURPOSE Many rural Australian hospitals lack on-site computed tomography (CT). These hospitals often refer patients to local off-site private radiology clinics or to central hospitals, challenging the achievement of time-sensitive scans. For stroke patients, timely access to CT affects treatment options. This study questions whether on-site CT matters in rural hospitals by investigating stroke patients' door-to-scan-time (DTST) and CT scan sequence referrals. METHOD A retrospective chart audit was completed across four rural hospitals; two with on-site CT and two without. Adult emergency stroke presentations were randomly sampled. Comparisons between on-site and off-site CT hospitals were made for DTST and CT sequence referrals using Mann-Whitney U-tests and Fisher's exact tests. RESULTS A total of 120 charts were audited (on-site CT, n = 60; off-site CT, n = 60). DTST was longer for off-site vs. on-site CT hospitals (median = 4.30 h vs. median = 0.70 h; U = 338, p < 0.001) regardless of whether presentations occurred in business hours or out of hours (p < 0.001). Off-site CT hospitals ordered less CT angiography or perfusion scanning (32% vs. 85%, p < 0.001). CONCLUSIONS Off-site CT hospital patients had longer DTST and received less angiography or perfusion scanning. These findings suggest that on-site CT matters to rural stroke patients by improving equitable access to CT and appropriate scan referrals.
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Affiliation(s)
- Nicholas Arnold
- Griffith University Rural Clinical School, Gold Coast, Queensland, Australia
| | - Kathryn Gough
- Griffith University Rural Clinical School, Gold Coast, Queensland, Australia
| | - Anthony Patsalou
- Griffith University Rural Clinical School, Gold Coast, Queensland, Australia
| | - Brendan Carrigan
- Griffith University Rural Clinical School, Gold Coast, Queensland, Australia
| | - William MacAskill
- Rural Medical Education Australia, East Toowoomba, Queensland, Australia
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27
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Chiramal JA, Johnson J, Webster J, Nag DR, Robert D, Ghosh T, Golla S, Pawar S, Krishnan P, Drain PK, Mooney SJ. Artificial Intelligence-based automated CT brain interpretation to accelerate treatment for acute stroke in rural India: An interrupted time series study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003351. [PMID: 39047001 PMCID: PMC11268585 DOI: 10.1371/journal.pgph.0003351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 06/19/2024] [Indexed: 07/27/2024]
Abstract
In resource-limited settings, timely treatment of acute stroke is dependent upon accurate diagnosis that draws on non-contrast computed tomography (NCCT) scans of the head. Artificial Intelligence (AI) based devices may be able to assist non-specialist physicians in NCCT interpretation, thereby enabling faster interventions for acute stroke patients in these settings. We evaluated the impact of an AI device by comparing the time to intervention (TTI) from NCCT imaging to significant intervention before (baseline) and after the deployment of AI, in patients diagnosed with stroke (ischemic or hemorrhagic) through a retrospective interrupted time series analysis at a rural hospital managed by non-specialists in India. Significant intervention was defined as thrombolysis or antiplatelet therapy in ischemic strokes, and mannitol for hemorrhagic strokes or mass effect. We also evaluated the diagnostic accuracy of the software using the teleradiologists' reports as ground truth. Impact analysis in a total of 174 stroke patients (72 in baseline and 102 after deployment) demonstrated a significant reduction of median TTI from 80 minutes (IQR: 56·8-139·5) during baseline to 58·50 (IQR: 30·3-118.2) minutes after AI deployment (Wilcoxon rank sum test-location shift: -21·0, 95% CI: -38·0, -7·0). Diagnostic accuracy evaluation in a total of 864 NCCT scans demonstrated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) in detecting intracranial hemorrhage to be 0·89 (95% CI: 0·83-0·93), 0·99 (0·98-1·00), 0·96 (0·91-0·98) and 0·97 (0·96-0·98) respectively, and for infarct these were 0·84 (0·79-0·89), 0·81 (0·77-0·84), 0·58 (0·52-0·63), and 0·94 (0·92-0·96), respectively. AI-based NCCT interpretation supported faster abnormality detection with high accuracy, resulting in persons with acute stroke receiving significantly earlier treatment. Our results suggest that AI-based NCCT interpretation can potentially improve uptake of lifesaving interventions for acute stroke in resource-limited settings.
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Affiliation(s)
- Justy Antony Chiramal
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, United States of America
| | - Jacob Johnson
- Department of Medicine, Baptist Christian Hospital, Mission Chariali, Tezpur, Assam, India
| | - Jemin Webster
- Department of Medicine, Baptist Christian Hospital, Mission Chariali, Tezpur, Assam, India
| | - D. Rachel Nag
- Department of Medicine, Baptist Christian Hospital, Mission Chariali, Tezpur, Assam, India
| | - Dennis Robert
- Qure.ai Technologies Pvt. Ltd. Raheja Platinum, Andheri East, Mumbai, India
| | - Tamaghna Ghosh
- Qure.ai Technologies Pvt. Ltd. Raheja Platinum, Andheri East, Mumbai, India
| | - Satish Golla
- Qure.ai Technologies Pvt. Ltd. Raheja Platinum, Andheri East, Mumbai, India
| | - Saniya Pawar
- Qure.ai Technologies Pvt. Ltd. Raheja Platinum, Andheri East, Mumbai, India
| | - Pranav Krishnan
- Qure.ai Technologies Pvt. Ltd. Raheja Platinum, Andheri East, Mumbai, India
| | - Paul K. Drain
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, United States of America
- Department of Global Health, University of Washington School of Public Health, Seattle, Washington, United States of America
| | - Stephen J. Mooney
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, United States of America
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Chapalain X, Morvan T, Gentric JC, Subileau A, Jacob C, Cadic A, Caillard A, Huet O. Continuous non-invasive vs. invasive arterial blood pressure monitoring during neuroradiological procedure: a comparative, prospective, monocentric, observational study. Perioper Med (Lond) 2024; 13:77. [PMID: 39034414 PMCID: PMC11265173 DOI: 10.1186/s13741-024-00442-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 07/16/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND In the perioperative setting, the most accurate way to continuously measure arterial blood pressure (ABP) is using an arterial catheter. Surrogate methods such as finger cuff have been developed to allow non-invasive measurements and are increasingly used, but need further evaluation. The aim of this study is to evaluate the accuracy and clinical concordance between two devices for the measurement of ABP during neuroradiological procedure. METHODS This is a prospective, monocentric, observational study. All consecutive patients undergoing a neuroradiological procedure were eligible. Patients who needed arterial catheter for blood pressure measurement were included. During neuroradiological procedure, ABP (systolic, mean and diatolic blood pressure) was measured with two different technologies: radial artery catheter and Nexfin. Bland-Altman and error grid analyses were performed to evaluate the accuracy and clinical concordance between devices. RESULTS From March 2022 to November 2022, we included 50 patients, mostly ASA 3 (60%) and required a cerebral embolization (94%) under general anaesthesia (96%). Error grid analysis showed that 99% of non-invasive ABP measures obtained with the Nexfin were located in the risk zone A or B. However, 65.7% of hypertension events and 41% of hypotensive events were respectively not detected by Nexfin. Compared to the artery catheter, a significant relationship was found for SAP (r2 = 0.78) and MAP (r2 = 0.80) with the Nexfin (p < 0.001). Bias and limits of agreement (LOA) were respectively 9.6 mmHg (- 15.6 to 34.8 mmHg) and - 0.8 mmHg (- 17.2 to 15.6 mmHg), for SAP and MAP. CONCLUSIONS Nexfin is not strictly interchangeable with artery catheter for ABP measuring. Further studies are needed to define its clinical use during neuroradiological procedure. TRIAL REGISTRATION Clinicaltrials.gov, registration number: NCT05283824.
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Affiliation(s)
- Xavier Chapalain
- Department of Anesthesiology and Surgical Intensive Care, University and Regional Hospital Centre Brest, Boulevard Tanguy Prigent, Brest, Cedex, 29609, France
- Laboratoire ORPHY, Université de Bretagne Occidentale, Brest, France
| | - Thomas Morvan
- Department of Anesthesiology and Surgical Intensive Care, University and Regional Hospital Centre Brest, Boulevard Tanguy Prigent, Brest, Cedex, 29609, France
| | - Jean-Christophe Gentric
- Department of Neuroradiology, University and Regional Hospital Centre Brest, Brest, France
- Laboratoire GETBO, UMR 1304, Université de Bretagne Occidentale, Brest, France
| | - Aurélie Subileau
- Department of Anesthesiology and Surgical Intensive Care, University and Regional Hospital Centre Brest, Boulevard Tanguy Prigent, Brest, Cedex, 29609, France
| | - Christophe Jacob
- Department of Anesthesiology and Surgical Intensive Care, University and Regional Hospital Centre Brest, Boulevard Tanguy Prigent, Brest, Cedex, 29609, France
| | - Anna Cadic
- Department of Anesthesiology and Surgical Intensive Care, University and Regional Hospital Centre Brest, Boulevard Tanguy Prigent, Brest, Cedex, 29609, France
| | - Anaïs Caillard
- Department of Anesthesiology and Surgical Intensive Care, University and Regional Hospital Centre Brest, Boulevard Tanguy Prigent, Brest, Cedex, 29609, France
| | - Olivier Huet
- Department of Anesthesiology and Surgical Intensive Care, University and Regional Hospital Centre Brest, Boulevard Tanguy Prigent, Brest, Cedex, 29609, France.
- Laboratoire ORPHY, Université de Bretagne Occidentale, Brest, France.
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Antunes R, Costeira C, Pereira Sousa J, Santos C. The Contribution of the Triage Nurse in the Optimisation of Door-to-Computed-Tomography Time in Stroke. NURSING REPORTS 2024; 14:1769-1780. [PMID: 39051367 PMCID: PMC11270310 DOI: 10.3390/nursrep14030131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 07/11/2024] [Accepted: 07/15/2024] [Indexed: 07/27/2024] Open
Abstract
A stroke is a time-sensitive emergency, so diagnosing and treating the victim promptly is extremely important. Therefore, the purpose of this study was to identify the influence of the Stroke Code Protocol's activation on the door-to-computed-tomography (door-to-CT) time and determine whether factors such as previous Modified Rankin Scale (mRS), age, and gender influence its activation. A retrospective study was conducted in a Medical-Surgical Emergency Department in the centre of Portugal from 1 January 2021 to 31 December 2022. The sample was selected according to the diagnosis assigned at the time of clinical discharge from the Emergency Department and the Stroke Code Protocol activation criteria. It was observed that 113 (50%) suspected stroke victims who met the activation criteria for the Stroke Code Protocol did not have the protocol activated, which had a highly significant influence (p < 0.001) on door-to-CT time. It was determined that activation at triage has an average door-to-CT time of 35 ± 18 min, post-triage activation has an average door-to-CT time of 38 ± 26 min, and non-activation has an average door-to-CT time of 1 h 04 ± 45 min. The need to implement an institutional protocol for activating the Stroke Code Protocol and provide specialised training for the multidisciplinary team is reiterated.
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Affiliation(s)
- Raquel Antunes
- Local Health Unit of Castelo Branco, 6000-085 Castelo Branco, Portugal;
| | - Cristina Costeira
- School of Health Sciences, Polytechnic of Leiria, Center for Innovative Care and Health Technology—ciTechCare, 2411-901 Leiria, Portugal; (C.C.); (J.P.S.)
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3004-011 Coimbra, Portugal
| | - Joana Pereira Sousa
- School of Health Sciences, Polytechnic of Leiria, Center for Innovative Care and Health Technology—ciTechCare, 2411-901 Leiria, Portugal; (C.C.); (J.P.S.)
| | - Cátia Santos
- School of Health Sciences, Polytechnic of Leiria, Center for Innovative Care and Health Technology—ciTechCare, 2411-901 Leiria, Portugal; (C.C.); (J.P.S.)
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Liu H, Jiang M, Chen Z, Li C, Yin X, Zhang X, Wu M. The Role of the Complement System in Synaptic Pruning after Stroke. Aging Dis 2024:AD.2024.0373. [PMID: 39012667 DOI: 10.14336/ad.2024.0373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 06/25/2024] [Indexed: 07/17/2024] Open
Abstract
Stroke is a serious disease that can lead to local neurological dysfunction and cause great harm to the patient's health due to blood cerebral circulation disorder. Synaptic pruning is critical for the normal development of the human brain, which makes the synaptic circuit completer and more efficient by removing redundant synapses. The complement system is considered a key player in synaptic loss and cognitive impairment in neurodegenerative disease. After stroke, the complement system is over-activated, and complement proteins can be labeled on synapses. Microglia and astrocytes can recognize and engulf synapses through corresponding complement receptors. Complement-mediated excessive synaptic pruning can cause post-stroke cognitive impairment (PSCI) and secondary brain damage. This review summarizes the latest progress of complement-mediated synaptic pruning after stroke and the potential mechanisms. Targeting complement-mediated synaptic pruning may be essential for exploring therapeutic strategies for secondary brain injury (SBI) and neurological dysfunction after stroke.
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Affiliation(s)
- Hongying Liu
- Department of Medical Laboratory, Affiliated Hospital of Jiujiang University, Jiujiang, 332000, China
| | - Min Jiang
- Jiujiang Clinical Precision Medicine Research Center, Jiujiang, 332000, China
| | - Zhiying Chen
- Department of Neurology, Affiliated Hospital of Jiujiang University, Jiujiang 332000, China
| | - Chuan Li
- Department of Medical Laboratory, Affiliated Hospital of Jiujiang University, Jiujiang, 332000, China
| | - Xiaoping Yin
- Department of Neurology, Affiliated Hospital of Jiujiang University, Jiujiang 332000, China
| | - Xiaorong Zhang
- Jiujiang Clinical Precision Medicine Research Center, Jiujiang, 332000, China
| | - Moxin Wu
- Department of Medical Laboratory, Affiliated Hospital of Jiujiang University, Jiujiang, 332000, China
- Jiujiang Clinical Precision Medicine Research Center, Jiujiang, 332000, China
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Bushnaq S, Hassan AE, Delora A, Kerro A, Datta A, Ezzeldin R, Ali Z, Anwoju T, Nejad L, Silva R, Abualnadi YD, Khalil ZM, Ezzeldin M. A Comparison of CT Perfusion Output of RapidAI and Viz.ai Software in the Evaluation of Acute Ischemic Stroke. AJNR Am J Neuroradiol 2024; 45:863-870. [PMID: 38346817 DOI: 10.3174/ajnr.a8196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 02/06/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND AND PURPOSE Automated CTP postprocessing packages have been developed for managing acute ischemic stroke. These packages use image processing techniques to identify the ischemic core and penumbra. This study aimed to investigate the agreement of decision-making rules and output derived from RapidAI and Viz.ai software packages in early and late time windows and to identify predictors of inadequate quality CTP studies. MATERIALS AND METHODS One hundred twenty-nine patients with acute ischemic stroke who had CTP performed on presentation were analyzed by RapidAI and Viz.ai. Volumetric outputs were compared between packages by performing Spearman rank-order correlation and Wilcoxon signed-rank tests with subanalysis performed at early (<6 hours) and extended (>6 hours) time windows. The concordance of selecting patients on the basis of DAWN and DEFUSE 3 eligibility criteria was assessed using the McNemar test. RESULTS One hundred eight of 129 patients were found to have adequate-quality studies. Spearman rank-order correlation coefficients were calculated on time-to-maximum >6-second volume, time-to-maximum >10-second volume, CBF <30% volume, mismatch volume, and mismatch ratio between both software packages with correlation coefficients of 0.82, 0.65, 0.77, 0.78, 0.59, respectively. The Wilcoxon signed-rank test was also performed on time-to-maximum >6-second volume, time-to-maximum >10-second volume, CBF <30% volume, mismatch volume, and mismatch ratio with P values of .30, .016, <.001, .03, <.001, respectively. In a 1-sided test, CBF <30% was greater in Viz.ai (P < .001). Although this finding resulted in statistically significant differences, it did not cause clinically significant differences when applied to the DAWN and DEFUSE 3 criteria. A lower ejection fraction predicted an inadequate study in both software packages (P = .018; 95% CI, 0.01-0.113) and (P = .024; 95% CI, 0.008-0.109) for RapidAI and Viz.ai, respectively. CONCLUSIONS Penumbra and infarct core predictions between Rapid and Viz.ai correlated but were statistically different and resulted in equivalent triage using DAWN and DEFUSE3 criteria. Viz.ai predicted higher ischemic core volumes than RapidAI. Viz.ai predicted lower combined core and penumbra values than RapidAI at lower volumes and higher estimates than RapidAI at higher volumes. Clinicians should be cautious when using different software packages for clinical decision-making.
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Affiliation(s)
- Saif Bushnaq
- From the Department of Neurology (S.B.), Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Ameer E Hassan
- Department of Neurology (A.E.H.), Valley Baptist Medical Center Harlingen (L.N., R.S., Y.D.A., Z.M.K.), Harlingten, Texas
| | - Adam Delora
- Department of Emergency Medicine (A. Delora, A. Datta), Clinical Sciences (Z.A., T.A.), and Neuroendovascular Surgery (M.E.), HCA Houston Healthcare Kingwood, Kingwood, Texas
| | - Ali Kerro
- Department of Neurology (A.K.), HCA Houston Healthcare Conroe, Conroe, Texas
| | - Anita Datta
- Department of Emergency Medicine (A. Delora, A. Datta), Clinical Sciences (Z.A., T.A.), and Neuroendovascular Surgery (M.E.), HCA Houston Healthcare Kingwood, Kingwood, Texas
| | - Rime Ezzeldin
- Jordan University of Science and Technology (R.E.), Irbid, Jordan
| | - Zuhair Ali
- Department of Emergency Medicine (A. Delora, A. Datta), Clinical Sciences (Z.A., T.A.), and Neuroendovascular Surgery (M.E.), HCA Houston Healthcare Kingwood, Kingwood, Texas
| | - Tunmi Anwoju
- Department of Emergency Medicine (A. Delora, A. Datta), Clinical Sciences (Z.A., T.A.), and Neuroendovascular Surgery (M.E.), HCA Houston Healthcare Kingwood, Kingwood, Texas
| | - Layla Nejad
- Department of Neurology (A.E.H.), Valley Baptist Medical Center Harlingen (L.N., R.S., Y.D.A., Z.M.K.), Harlingten, Texas
| | - Rene Silva
- Department of Neurology (A.E.H.), Valley Baptist Medical Center Harlingen (L.N., R.S., Y.D.A., Z.M.K.), Harlingten, Texas
| | - Yazan Diya Abualnadi
- Department of Neurology (A.E.H.), Valley Baptist Medical Center Harlingen (L.N., R.S., Y.D.A., Z.M.K.), Harlingten, Texas
| | - Zorain Mustafa Khalil
- Department of Neurology (A.E.H.), Valley Baptist Medical Center Harlingen (L.N., R.S., Y.D.A., Z.M.K.), Harlingten, Texas
| | - Mohamad Ezzeldin
- Department of Emergency Medicine (A. Delora, A. Datta), Clinical Sciences (Z.A., T.A.), and Neuroendovascular Surgery (M.E.), HCA Houston Healthcare Kingwood, Kingwood, Texas
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Henningsen M, Herrmann ML, Meier S, Bergmann U, Busch HJ, Taschner CA, Brich J. Parallel activation of helicopter and ground transportation after dispatcher identification of suspected anterior large vessel occlusion stroke in rural areas: a proof-of-concept case with modeling from the LESTOR trial. Scand J Trauma Resusc Emerg Med 2024; 32:62. [PMID: 38971748 PMCID: PMC11227698 DOI: 10.1186/s13049-024-01233-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 06/30/2024] [Indexed: 07/08/2024] Open
Abstract
BACKGROUND When stroke patients with suspected anterior large vessel occlusion (aLVO) happen to live in rural areas, two main options exist for prehospital transport: (i) the drip-and-ship (DnS) strategy, which ensures rapid access to intravenous thrombolysis (IVT) at the nearest primary stroke center but requires time-consuming interhospital transfer for endovascular thrombectomy (EVT) because the latter is only available at comprehensive stroke centers (CSC); and (ii) the mothership (MS) strategy, which entails direct transport to a CSC and allows for faster access to EVT but carries the risk of IVT being delayed or even the time window being missed completely. The use of a helicopter might shorten the transport time to the CSC in rural areas. However, if the aLVO stroke is only recognized by the emergency service on site, the helicopter must be requested in addition, which extends the prehospital time and partially negates the time advantage. We hypothesized that parallel activation of ground and helicopter transportation in case of aLVO suspicion by the dispatcher (aLVO-guided dispatch strategy) could shorten the prehospital time in rural areas and enable faster treatment with IVT and EVT. METHODS As a proof-of-concept, we report a case from the LESTOR trial where the dispatcher suspected an aLVO stroke during the emergency call and dispatched EMS and HEMS in parallel. Based on this case, we compare the provided aLVO-guided dispatch strategy to the DnS and MS strategies regarding the times to IVT and EVT using a highly realistic modeling approach. RESULTS With the aLVO-guided dispatch strategy, the patient received IVT and EVT faster than with the DnS or MS strategies. IVT was administered 6 min faster than in the DnS strategy and 22 min faster than in the MS strategy, and EVT was started 47 min earlier than in the DnS strategy and 22 min earlier than in the MS strategy. CONCLUSION In rural areas, parallel activation of ground and helicopter emergency services following dispatcher identification of stroke patients with suspected aLVO could provide rapid access to both IVT and EVT, thereby overcoming the limitations of the DnS and MS strategies.
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Affiliation(s)
- Max Henningsen
- Department of Neurology and Neuroscience, Faculty of Medicine and Medical Center, University of Freiburg, Breisacher Str. 64, Freiburg, Germany.
| | - Matthias L Herrmann
- Department of Neurology and Neuroscience, Faculty of Medicine and Medical Center, University of Freiburg, Breisacher Str. 64, Freiburg, Germany
| | - Simone Meier
- Department of Neurology and Neuroscience, Faculty of Medicine and Medical Center, University of Freiburg, Breisacher Str. 64, Freiburg, Germany
| | - Ulrike Bergmann
- Department of Neurology and Neuroscience, Faculty of Medicine and Medical Center, University of Freiburg, Breisacher Str. 64, Freiburg, Germany
| | - Hans-Jörg Busch
- Department of Emergency Medicine, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Christian A Taschner
- Department of Neuroradiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Jochen Brich
- Department of Neurology and Neuroscience, Faculty of Medicine and Medical Center, University of Freiburg, Breisacher Str. 64, Freiburg, Germany
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Mahajan C, Kapoor I, Prabhakar H. The Urban-Rural Divide in Neurocritical Care in Low-Income and Middle-Income Countries. Neurocrit Care 2024:10.1007/s12028-024-02040-z. [PMID: 38960992 DOI: 10.1007/s12028-024-02040-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 06/05/2024] [Indexed: 07/05/2024]
Abstract
The term "urban-rural divide" encompasses several dimensions and has remained an important concern for any country. The economic disparity; lack of infrastructure; dearth of medical specialists; limited opportunities to education, training, and health care; lower level of sanitation; and isolating effect of geographical location deepens this gap, especially in low-income and middle-income countries (LMICs). This article gives an overview of the rural-urban differences in terms of facilities related to neurocritical care (NCC) in LMICs. Issues related to common clinical conditions such as stroke, traumatic brain injury, myasthenia gravis, epilepsy, tubercular meningitis, and tracheostomy are also discussed. To facilitate delivery of NCC in resource-limited settings, proposed strategies include strengthening preventive measures, focusing on basics, having a multidisciplinary approach, promoting training and education, and conducting cost-effective research and collaborative efforts. The rural areas of LMICs bear the maximum impact because of their limited access to preventive health services, high incidence of acquired brain injury, inability to have timely management of neurological emergencies, and scarcity of specialist services in a resource-deprived health center. An increase in the health budget allocation for rural areas, NCC education and training of the workforce, and provision of telemedicine services for rapid diagnosis, management, and neurorehabilitation are some of the steps that can be quite helpful.
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Affiliation(s)
- Charu Mahajan
- Department of Neuroanaesthesiology and Critical Care, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Indu Kapoor
- Department of Neuroanaesthesiology and Critical Care, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Hemanshu Prabhakar
- Department of Neuroanaesthesiology and Critical Care, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, 110029, India.
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Tran QK, Ternovskaia A, Chen N, Faisal M, Yardi I, Emamian N, Kim A, Kowansky T, Niles E, Sahadzic I, Chasm R, Sjeklocha L, Haase DJ, Downing J. Air or Ground Transport to the Critical Care Resuscitation Unit: Does It Really Matter? Air Med J 2024; 43:295-302. [PMID: 38897691 DOI: 10.1016/j.amj.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 12/14/2023] [Accepted: 01/12/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVE Critically ill patients requiring urgent interventions or subspecialty care often require transport over significant distances to tertiary care centers. The optimal method of transportation (air vs. ground) is unknown. We investigated whether air transport was associated with lower mortality for patients being transferred to a specialized critical care resuscitation unit (CCRU). METHODS This was a retrospective study of all adult patients transferred to the CCRU at the University of Maryland Medical Center in 2018. Our primary outcome was hospital mortality. The secondary outcomes included the length of stay and the time to the operating room (OR) for patients undergoing urgent procedures. We performed optimal 1:2 propensity score matching for each patient's need for air transport. RESULTS We matched 198 patients transported by air to 382 patients transported by ground. There was no significant difference between demographics, the initial Sequential Organ Failure Assessment score, or hospital outcomes between groups. One hundred sixty-four (83%) of the patients transported via air survived to hospital discharge compared with 307 (80%) of those transported by ground (P = .46). Patients transported via air arrived at the CCRU more quickly (127 [100-178] vs. 223 [144-332] minutes, P < .001) and were more likely (60 patients, 30%) to undergo urgent surgical operation within 12 hours of CCRU arrival (30% vs. 17%, P < .001). For patients taken to the OR within 12 hours of arriving at the CCRU, patients transported by air were more likely to go to the OR after 200 minutes since the transfer request (P = .001). CONCLUSION The transportation mode used to facilitate interfacility transfer was not significantly associated with hospital mortality or the length of stay for critically ill patients.
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Affiliation(s)
- Quincy K Tran
- Program in Trauma, The R Adam Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD; The Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD; Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Anastasia Ternovskaia
- The Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Nelson Chen
- University of Maryland School of Medicine, Baltimore, MD
| | - Manal Faisal
- The Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Isha Yardi
- The Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Nikki Emamian
- The Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Abigail Kim
- The Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Taylor Kowansky
- The Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Erin Niles
- Program in Trauma, The R Adam Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD
| | - Iana Sahadzic
- The Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Rose Chasm
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Lucas Sjeklocha
- Program in Trauma, The R Adam Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD; Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Daniel J Haase
- Program in Trauma, The R Adam Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD; Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Jessica Downing
- Program in Trauma, The R Adam Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD; Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD.
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Horiguchi D, Shin S, Pepino JA, Peterson JT, Kehoe IE, Goldstein JN, Lee J, Kwon BK, Hahn JO, Reisner AT. Hypotension During Vasopressor Infusion Occurs in Predictable Clusters: A Multicenter Analysis. J Intensive Care Med 2024; 39:683-692. [PMID: 38282376 DOI: 10.1177/08850666241226893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
Background: Published evidence indicates that mean arterial pressure (MAP) below a goal range (hypotension) is associated with worse outcomes, though MAP management failures are common. We sought to characterize hypotension occurrences in ICUs and consider the implications for MAP management. Methods: Retrospective analysis of 3 hospitals' cohorts of adult ICU patients during continuous vasopressor infusion. Two cohorts were general, mixed ICU patients and one was exclusively acute spinal cord injury patients. "Hypotension-clusters" were defined where there were ≥10 min of cumulative hypotension over a 60-min period and "constant hypotension" was ≥10 continuous minutes. Trend analysis was performed (predicting future MAP using 14 min of preceding MAP data) to understand which hypotension-clusters could likely have been predicted by clinician awareness of MAP trends. Results: In cohorts of 155, 66, and 16 ICU stays, respectively, the majority of hypotension occurred within the hypotension-clusters. Failures to keep MAP above the hypotension threshold were notable in the bottom quartiles of each cohort, with hypotension durations of 436, 167, and 468 min, respectively, occurring within hypotension-clusters per day. Mean arterial pressure trend analysis identified most hypotension-clusters before any constant hypotension occurred (81.2%-93.6% sensitivity, range). The positive predictive value of hypotension predictions ranged from 51.4% to 72.9%. Conclusions: Across 3 cohorts, most hypotension occurred in temporal clusters of hypotension that were usually predictable from extrapolation of MAP trends.
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Affiliation(s)
- Daisuke Horiguchi
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
- Nihon Kohden Innovation Center, LLC, Cambridge, MA, USA
| | - Sungtae Shin
- Department of Mechanical Engineering, University of Maryland, College Park, MD, USA
| | - Jeremy A Pepino
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jeffrey T Peterson
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Iain E Kehoe
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Joshua N Goldstein
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jarone Lee
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Surgery, Massachusetts General Hospital, Boston MA, USA
| | - Brian K Kwon
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jin-Oh Hahn
- Department of Mechanical Engineering, University of Maryland, College Park, MD, USA
| | - Andrew T Reisner
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
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Dugan S, Patch M, Hoang T, Anderson JC. Anoxic Brain Injury: A Subtle and Often Overlooked Finding in Non-Fatal Intimate Partner Strangulation. J Emerg Med 2024:S0736-4679(24)00191-4. [PMID: 39304396 DOI: 10.1016/j.jemermed.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 05/24/2024] [Accepted: 06/03/2024] [Indexed: 09/22/2024]
Abstract
BACKGROUND A paucity of literature exists dedicated to the identification of anoxic brain injury in patients that survive non-fatal intimate partner strangulation (NF-IPS). While some individuals report experiencing symptoms of brain hypoxia followed by a loss of consciousness, other individuals report symptoms of brain hypoxia prior to amnesia, rendering some unable to recall loss of consciousness (LOC). OBJECTIVE Using a standardized clinical assessment tool, the purpose of this retrospective analysis is to describe anoxic brain injury symptom prevalence in a sample of patients reporting NF-IPS. METHODS One hundred and ninety-one unique patients, reporting a total of 267 strangulation events, were assessed by a member of the Shasta Community Forensic Care Team utilizing the Strangulation Hypoxia Anoxia Symptom TBI Assessment (SHASTA) tool. The sample is 98% female and includes adult patients ages 18-68. Examination records were categorized based on the presence or absence of hypoxia and anoxia symptoms. This manuscript utilizes the STROBE checklist. RESULTS Amnesia was reported in 145 of the 267 strangulations (54.3%). Of those, 74 reported LOC (51.0%) while 71 did not recall LOC (49.0%). CONCLUSIONS Within our sample, 49% of patients with amnesia did not recall losing consciousness, demonstrating that LOC is an imperfect measure of anoxia for patients following NF-IPS. Healthcare providers examining NF-IPS patients should inquire about additional symptoms of hypoxia and amnesia, which can be captured on the SHASTA tool.
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Affiliation(s)
- Sean Dugan
- Shasta Community Health Center, Redding, California.
| | - Michelle Patch
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Taman Hoang
- Shasta Community Health Center, Redding, California
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Zeng M, Smith L, Bird A, Trinh VQN, Bacchi S, Harvey J, Jenkinson M, Scroop R, Kleinig T, Jannes J, Palmer LJ. Predictions for functional outcome and mortality in acute ischaemic stroke following successful endovascular thrombectomy. BMJ Neurol Open 2024; 6:e000707. [PMID: 38932996 PMCID: PMC11202712 DOI: 10.1136/bmjno-2024-000707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024] Open
Abstract
Background Accurate outcome predictions for patients who had ischaemic stroke with successful reperfusion after endovascular thrombectomy (EVT) may improve patient treatment and care. Our study developed prediction models for key clinical outcomes in patients with successful reperfusion following EVT in an Australian population. Methods The study included all patients who had ischaemic stroke with occlusion in the proximal anterior cerebral circulation and successful reperfusion post-EVT over a 7-year period. Multivariable logistic regression and Cox regression models, incorporating bootstrap and multiple imputation techniques, were used to identify predictors and develop models for key clinical outcomes: 3-month poor functional status; 30-day, 1-year and 3-year mortality; survival time. Results A total of 978 patients were included in the analyses. Predictors associated with one or more poor outcomes include: older age (ORs for every 5-year increase: 1.22-1.40), higher premorbid functional modified Rankin Scale (ORs: 1.31-1.75), higher baseline National Institutes of Health Stroke Scale (ORs: 1.05-1.07) score, higher blood glucose (ORs: 1.08-1.19), larger core volume (ORs for every 10 mL increase: 1.10-1.22), pre-EVT thrombolytic therapy (ORs: 0.44-0.56), history of heart failure (outcome: 30-day mortality, OR=1.87), interhospital transfer (ORs: 1.42 to 1.53), non-rural/regional stroke onset (outcome: functional dependency, OR=0.64), longer onset-to-groin puncture time (outcome: 3-year mortality, OR=1.08) and atherosclerosis-caused stroke (outcome: functional dependency, OR=1.68). The models using these predictors demonstrated moderate predictive abilities (area under the receiver operating characteristic curve range: 0.752-0.796). Conclusion Our models using real-world predictors assessed at hospital admission showed satisfactory performance in predicting poor functional outcomes and short-term and long-term mortality for patients with successful reperfusion following EVT. These can be used to inform EVT treatment provision and consent.
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Affiliation(s)
- Minyan Zeng
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Australian Institute for Machine Learning, Adelaide, South Australia, Australia
| | - Luke Smith
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Australian Institute for Machine Learning, Adelaide, South Australia, Australia
| | - Alix Bird
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Australian Institute for Machine Learning, Adelaide, South Australia, Australia
| | - Vincent Quoc-Nam Trinh
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Australian Institute for Machine Learning, Adelaide, South Australia, Australia
| | - Stephen Bacchi
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Jackson Harvey
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Mark Jenkinson
- Australian Institute for Machine Learning, Adelaide, South Australia, Australia
- School of Computer and Mathematical Sciences, Faculty of Sciences, Engineering and Technology, The University of Adelaide, Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Rebecca Scroop
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Timothy Kleinig
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Jim Jannes
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Lyle J Palmer
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Australian Institute for Machine Learning, Adelaide, South Australia, Australia
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Vimalesvaran K, Robert D, Kumar S, Kumar A, Narbone M, Dharmadhikari R, Harrison M, Ather S, Novak A, Grzeda M, Gooch J, Woznitza N, Hall M, Shuaib H, Lowe DJ. Assessing the effectiveness of artificial intelligence (AI) in prioritising CT head interpretation: study protocol for a stepped-wedge cluster randomised trial (ACCEPT-AI). BMJ Open 2024; 14:e078227. [PMID: 38885990 PMCID: PMC11184206 DOI: 10.1136/bmjopen-2023-078227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 04/30/2024] [Indexed: 06/20/2024] Open
Abstract
INTRODUCTION Diagnostic imaging is vital in emergency departments (EDs). Accessibility and reporting impacts ED workflow and patient care. With radiology workforce shortages, reporting capacity is limited, leading to image interpretation delays. Turnaround times for image reporting are an ED bottleneck. Artificial intelligence (AI) algorithms can improve productivity, efficiency and accuracy in diagnostic radiology, contingent on their clinical efficacy. This includes positively impacting patient care and improving clinical workflow. The ACCEPT-AI study will evaluate Qure.ai's qER software in identifying and prioritising patients with critical findings from AI analysis of non-contrast head CT (NCCT) scans. METHODS AND ANALYSIS This is a multicentre trial, spanning four diverse sites, over 13 months. It will include all individuals above the age of 18 years who present to the ED, referred for an NCCT. The project will be divided into three consecutive phases (pre-implementation, implementation and post-implementation of the qER solution) in a stepped-wedge design to control for adoption bias and adjust for time-based changes in the background patient characteristics. Pre-implementation involves baseline data for standard care to support the primary and secondary outcomes. The implementation phase includes staff training and qER solution threshold adjustments in detecting target abnormalities adjusted, if necessary. The post-implementation phase will introduce a notification (prioritised flag) in the radiology information system. The radiologist can choose to agree with the qER findings or ignore it according to their clinical judgement before writing and signing off the report. Non-qER processed scans will be handled as per standard care. ETHICS AND DISSEMINATION The study will be conducted in accordance with the principles of Good Clinical Practice. The protocol was approved by the Research Ethics Committee of East Midlands (Leicester Central), in May 2023 (REC (Research Ethics Committee) 23/EM/0108). Results will be published in peer-reviewed journals and disseminated in scientific findings (ClinicalTrials.gov: NCT06027411) TRIAL REGISTRATION NUMBER: NCT06027411.
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Affiliation(s)
- Kavitha Vimalesvaran
- Clinical Scientific Computing, Guy's and St Thomas' NHS Foundation Trust, London, UK
- King's College London, London, UK
| | | | | | | | | | | | - Mark Harrison
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Sarim Ather
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Alex Novak
- Emergency Medicine Research Oxford (EMROx), Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | | | - Nicholas Woznitza
- Department of Radiology, Homerton University Hospital NHS Foundation Trust, London, UK
- School of Allied & Public Health, Canterbury Christ Church University, Canterbury, UK
| | - Mark Hall
- NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Haris Shuaib
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - David J Lowe
- Emergency Medicine, Queen Elizabeth University Hospital, Glasgow, UK
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Hundt B, Stevens S. Palliative Care of Stroke Patients. AACN Adv Crit Care 2024; 35:125-133. [PMID: 38848563 DOI: 10.4037/aacnacc2024489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
Critical care clinicians frequently care for patients with acute brain injury, such as stroke. Regardless of the severity of the neurologic insult, these patients have life-altering deficits that threaten their personal identity and quality of life. The sudden nature of the injury often means that there has been little discussion between patients and their families about life-sustaining treatments, and most patients are unable to speak for themselves because of impaired cognition and communication. Thus, individuals experiencing stroke and their families present clinicians with unique and complex care needs in the acute care setting. Key professional organizations have endorsed the early integration of palliative care into the treatment of patients with stroke and devastating neurologic injury. Implementing interdisciplinary primary or specialty palliative care helps clinicians adopt a patient-centered approach to care and aids in decision-making.
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Affiliation(s)
- Beth Hundt
- Beth Hundt is Stroke Program Supervisor, Centra Health, 3276 Hardware River Rd, Charlottesville, VA 22903
| | - Stacie Stevens
- Stacie Stevens is Stroke Program Manager, VCU Health, Richmond, Virginia
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40
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Ghamri RA. Knowledge of cardiovascular diseases and associated risk factors in the general adult population of Jeddah, Saudi Arabia: A cross-sectional study examining gender disparities. Medicine (Baltimore) 2024; 103:e38566. [PMID: 38875402 PMCID: PMC11175923 DOI: 10.1097/md.0000000000038566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/16/2024] Open
Abstract
To assess knowledge about cardiovascular diseases (CVD) among the general population, we emphasized gender-related disparities and other lifestyle and health-related factors. This cross-sectional study was conducted among 395 individuals from the general population of Jeddah, Saudi Arabia. An online questionnaire was administered to assess knowledge of CVD types, symptoms, and risk factors. The majority of participants identified coronary heart disease (73.7%) as having CVD, with no sex effect. Males had higher knowledge regarding cerebrovascular disease (44% vs 31.5%) and congenital heart diseases (60% vs 51.9%) as being part of CVD, while they had lower knowledge of peripheral arterial disease (44% vs 50.7%) than females, respectively (P < .05). Males exhibited better knowledge of heart attack and stroke symptoms than females. Knowledge was optimal for major CVD risk factors, such as smoking (90.6%) and high low-density lipoprotein cholesterol levels (85.1%); however, gaps were observed in recognizing diabetes (56.2%) and stress (69.4%) as factors for CVD. The mean overall knowledge score was 16.33 ± 5.72 25, with no difference between sexes (P = .239). Predictors of good CVD knowledge included university-level education, daily healthy food consumption, and perceived life as highly stressful; nonetheless, sex showed no significant effect. While the general population displayed a suboptimal understanding of CVD, notable sex disparities were observed, highlighting the need for tailored public health interventions. Emphasizing cognitive and behavioral aspects can foster better prevention and management strategies, given the evident gender disparities.
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Affiliation(s)
- Ranya Alawy Ghamri
- Family Medicine Department, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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41
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Banyas P, Jadhav A. Stroke and Transient Ischemic Attack. Prim Care 2024; 51:283-297. [PMID: 38692775 DOI: 10.1016/j.pop.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
Cerebrovascular disease is a common and potentially life-threatening illness if not triaged and/or treated appropriately. The diagnosis is made based on a combination of clinical history and neuroimaging studies. The majority of strokes can be prevented, and this process often begins in the primary care office through the careful assessment of vascular risk factors. Appropriate workup aims to pinpoint a pathogenic mechanism and guide therapy. Stroke treatment has rapidly advanced over the past several years, resulting in improved outcomes.
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Affiliation(s)
- Paige Banyas
- Department of Neurology, HonorHealth Neurology Bob Bove Neuroscience Institute, 7242 E Osborn Road, Suite 400, Scottsdale, AZ 85251, USA.
| | - Ashutosh Jadhav
- Department of Neurology and Neurosurgery, Barrow Brain and Spine, 2910 North Third Avenue, Suite 200, Phoenix, AZ 85013, USA
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Jay D, Wheatley R, Smith L, Davis KJ. Time is brain, so we must BEFAST: Improving stroke identification and triage in a rural emergency department. Emerg Med Australas 2024; 36:413-420. [PMID: 38168903 DOI: 10.1111/1742-6723.14369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 11/14/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVE Shoalhaven District Memorial Hospital is a rural (MM3) secondary hospital which is over an hour travel time from the nearest tertiary centre. The objective of the present study was to pilot the implementation of the BEFAST (Balance, Eyes, Face, Arms, Speech and Time) stroke screening tool at the ED, and determine whether its usage improved timely stroke detection. METHODS During initial implementation and training (October-December 2019), triage nurses consulted with senior medical officers before activating stroke calls. Data were collected for the subsequent 24 months (January 2020-2022), and retrospective records for confirmed strokes during a 24-month period prior to BEFAST implementation (October 2017-2019) were also collected. The main outcome measures were triage category, CT scan result time, discharge destination, length of stay (LOS) and Modified Rankin Score (MRS). RESULTS After BEFAST implementation, patients (n = 268) were three times more likely to be triaged at category 1 or 2, and door-to-CT scan time was reduced by 20.7 min on average. More patients were discharged to their usual residence and more quickly (LOS 7.9 vs 11.1 days). MRS 90 days after stroke was less, and patients were nearly twice as likely to experience an improvement in neurological symptoms. CONCLUSIONS Patient outcomes were improved after implementation of the BEFAST stroke triage tool. More stroke patients were identified upon presentation to the ED, and in a timely fashion. For those with a stroke diagnosis, time-critical interventions can take place earlier, allowing patients to return home sooner, and with less disability.
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Affiliation(s)
- Donna Jay
- Stroke Unit, Shoalhaven District Memorial Hospital, Illawarra Shoalhaven Local Health District, Nowra, New South Wales, Australia
| | - Richard Wheatley
- Emergency Department, Shoalhaven District Memorial Hospital, Illawarra Shoalhaven Local Health District, Nowra, New South Wales, Australia
- Emergency Department, Campbelltown Hospital, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Lhyriel Smith
- Emergency Department, Shoalhaven District Memorial Hospital, Illawarra Shoalhaven Local Health District, Nowra, New South Wales, Australia
| | - Kimberley J Davis
- Research Central, Illawarra Shoalhaven Local Health District, Nowra, New South Wales, Australia
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
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Alotaibi FF, Alshahrani A, Mohamed G, AlShamrani MA, Bin Amir H, Alsaeed A, Heji A, Alghanmi S, Alqurishi M, Alanazi A, Aldraye H, Asiri M, Alqahtani M, Alreshaid AA, AlKawi A, AlHazzani A, AlZawahmah M, Alokaili RN, Shuaib A, Al-Ajlan FS. Diagnostic accuracy of large and medium vessel occlusions in acute stroke imaging by neurology residents and stroke fellows: A comparison of CT angiography alone and CT angiography with CT perfusion. Eur Stroke J 2024; 9:356-365. [PMID: 37990504 PMCID: PMC11318430 DOI: 10.1177/23969873231214218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 10/30/2023] [Indexed: 11/23/2023] Open
Abstract
INTRODUCTION Neurology senior residents and stroke fellows are first to clinically assess and interpret imaging studies of patients presenting to the emergency department with acute stroke. The aim of this study was to compare the diagnostic accuracy of brain CT angiography (CTA) with and without CT perfusion (CTP) between neurology senior residents and stroke fellows. METHODS In this neuroimaging study, nine practitioners (four senior neurology residents (SNRs) and five stroke fellows (SFs)) clinically assessed and interpreted the imaging data of 50 cases (15 normal images, 21 large vessel occlusions (LVOs) and 14 medium vessel occlusions (MeVOs) in two sessions, 1 week apart in comparison to final diagnosis of experienced neuroradiologist and experienced stroke neurologist consensus. Interrater agreement of CTA alone and CTA with CTP was quantified using kappa statistics, sensitivity, specificity and overall accuracy. RESULTS Overall, arterial occlusions were correctly identified in 221/315 (70.1%) with CTA alone and in 266/315 (84.4%) with CTA and CTP (p < 0.001). The sensitivity of overall arterial occlusions detection with CTA alone was 94.2% (95% CI: 90.8%-96.6%) while with addition of CTP was 98% (95% CI: 95.6%-99.3%), The specificity of CTA alone was 74.7% (95% CI: 67.2%-81.3%) which increased with CTP to 84.4% (95% CI: 77.7%-89.8%). The likelihood of correct identification with CTA alone was 156/189 (82.54%) for LVOs and 65/126 (51.59%) for MeVOs. This increased to 169/189 (89.42%; p = 0.054) for LVOs and 97/126 (76.98%; p < 0.001) for MeVOs when the CTA images with CTP were viewed. There was good overall interrater agreement between readers when using CTA alone (k 0.71, 95% CI, 0.62-0.80) and almost perfect (k 0.85, 95% CI, 0.76-0.94) when CTP was added to the image for interpretation. CTA and CTP had a significantly lower median interquartile range (IQR) interpretation time than CTA alone (114 [IQR, 103-120] s vs 156 [IQR, 133-160] s, p < 0.001). DISCUSSION In cerebral arterial occlusions, the rate of LVO and MeVOs detections increases when adding CTP to CTA. The accuracy and time for diagnosing arterial occlusion can be significantly improved if CTP is added to CTA. As MeVOs are commonly missed by front-line neurology senior residents or stroke fellows, cases with significant deficits and no apparent arterial occlusions need to be reviewed with neuroradiological expertise.
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Affiliation(s)
- Fawaz F Alotaibi
- Neuroscience Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Asma Alshahrani
- Department of Biostatistics, Epidemiology, and Scientific Computing, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Gamal Mohamed
- Department of Biostatistics, Epidemiology, and Scientific Computing, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mohamed A AlShamrani
- Neuroscience Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Hussain Bin Amir
- Neuroscience Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Ali Alsaeed
- Neuroscience Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Alaa Heji
- Neuroscience Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Suwaidi Alghanmi
- Neuroscience Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mohammed Alqurishi
- Neuroscience Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Azhar Alanazi
- Neuroscience Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Hamad Aldraye
- Neuroscience Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Muhannad Asiri
- Neuroscience Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mohammed Alqahtani
- Neuroscience Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Abdulrahman A Alreshaid
- Neuroscience Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- Alfaisal University, Riyadh, Saudi Arabia
| | - Ammar AlKawi
- Neuroscience Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- Alfaisal University, Riyadh, Saudi Arabia
| | - Adel AlHazzani
- Neuroscience Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- Alfaisal University, Riyadh, Saudi Arabia
| | - Mohamed AlZawahmah
- Neuroscience Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Riyadh N Alokaili
- Department of Radiology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Ashfaq Shuaib
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Fahad S Al-Ajlan
- Neuroscience Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- Alfaisal University, Riyadh, Saudi Arabia
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Yanık T, Yanık B. Current neuroprotective agents in stroke. Turk J Phys Med Rehabil 2024; 70:157-163. [PMID: 38948647 PMCID: PMC11209336 DOI: 10.5606/tftrd.2024.15287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 05/13/2024] [Indexed: 07/02/2024] Open
Abstract
What is expected from neuroprotection is to inhibit neuronal death and halt or decelerate the neuronal loss to lower the mortality rates, decrease disability, and improve the quality of life following an acute ischemic stroke. Several agents were described as neuroprotective up to date; however, there is still debate which to use in the neurorehabilitation of stroke patients, in terms of both efficacy and also safety. In this review, we discuss the agents, citicoline, cerebrolysin and MLC901 (NeuroAiD II), the three agents which have started to be used frequently in neurorehabilitation clinics recently in the light of the current literature.
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Affiliation(s)
- Tuğra Yanık
- Department of Neurology, Güven Hospital, Ankara, Türkiye
| | - Burcu Yanık
- Department of Physical Medicine and Rehabilitation, Bilkent City Hospital, Ankara, Türkiye
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Pannell JS, Corey AS, Shih RY, Austin MJ, Chu S, Davis MA, Ducruet AF, Hunt CH, Ivanidze J, Kalnins A, Lacy ME, Lo BM, Setzen G, Shaines MD, Soares BP, Soderlund KA, Thaker AA, Wang LL, Burns J. ACR Appropriateness Criteria® Cerebrovascular Diseases-Stroke and Stroke-Related Conditions. J Am Coll Radiol 2024; 21:S21-S64. [PMID: 38823945 DOI: 10.1016/j.jacr.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 06/03/2024]
Abstract
Cerebrovascular disease encompasses a vast array of conditions. The imaging recommendations for stroke-related conditions involving noninflammatory steno-occlusive arterial and venous cerebrovascular disease including carotid stenosis, carotid dissection, intracranial large vessel occlusion, and cerebral venous sinus thrombosis are encompassed by this document. Additional imaging recommendations regarding complications of these conditions including intraparenchymal hemorrhage and completed ischemic strokes are also discussed. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | - Amanda S Corey
- Panel Chair, Atlanta VA Health Care System and Emory University, Atlanta, Georgia
| | - Robert Y Shih
- Panel Vice Chair, Uniformed Services University, Bethesda, Maryland
| | | | - Sammy Chu
- University of Washington, Seattle, Washington; University of British Columbia, Vancouver, British Columbia, Canada
| | - Melissa A Davis
- Yale University School of Medicine, New Haven, Connecticut; Committee on Emergency Radiology-GSER
| | - Andrew F Ducruet
- Barrow Neurological Institute, Phoenix, Arizona, Neurosurgery expert
| | - Christopher H Hunt
- Mayo Clinic, Rochester, Minnesota; Commission on Nuclear Medicine and Molecular Imaging
| | | | | | - Mary E Lacy
- Washington State University, Spokane, Washington; American College of Physicians
| | - Bruce M Lo
- Sentara Norfolk General Hospital/Eastern Virginia Medical School, Norfolk, Virginia; American College of Emergency Physicians
| | - Gavin Setzen
- Albany ENT & Allergy Services, Albany, New York; American Academy of Otolaryngology-Head and Neck Surgery
| | - Matthew D Shaines
- Albert Einstein College of Medicine Montefiore Medical Center, Bronx, New York, Primary care physician
| | - Bruno P Soares
- Stanford University School of Medicine, Stanford, California
| | - Karl A Soderlund
- Uniformed Services University of the Health Sciences, Bethesda, Maryland; Naval Medical Center Portsmouth, Portsmouth, Virginia
| | | | - Lily L Wang
- University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Judah Burns
- Specialty Chair, Montefiore Medical Center, Bronx, New York
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Łajczak PM, Jóźwik K, Nowakowski P, Nawrat Z. Machine Meets Brain: A Systematic Review of Effectiveness of Robotically Performed Cerebral Angiography Interventions. World Neurosurg 2024; 186:235-241.e1. [PMID: 38593910 DOI: 10.1016/j.wneu.2024.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Stroke is a leading cause of death in the United States, with significant economic and human costs. Early diagnosis and rapid treatment are critical for preventing stroke-related morbidity and mortality. However, accessibility to neurointerventional medical centers remains a challenge for many Americans, highlighting the need for innovative solutions to improve stroke management. METHODS This systematic review adhered to the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines and included 5 medical databases to identify relevant studies on robotically assisted cerebral angiography (RCA). Studies focusing on in-human robotic intracranial cerebral angiography were included. A bias assessment was conducted using appropriate tools for randomized controlled trials (RCTs) and non-RCTs. RESULTS A total of 7 studies met the inclusion criteria, with 1 RCT and 6 non-RCTs included in the analysis. Robotic systems such as CorPath GRX, Magellan robot, YDHB-NS01, VIR-2 (vascular interventional robot), and RobEnt were evaluated. The studies reported various success rates, procedure times, and complications associated with robotically assisted procedures. Overall, the robotic interventions demonstrated promising results in terms of safety and efficacy, with comparable outcomes to manual methods. Despite the promising findings, several limitations were identified, including technical issues with the robotic systems, the high costs, and limited long-term data. Future research should focus on standardizing protocols, conducting larger trials with longer follow-up periods, and assessing cost-effectiveness to determine the role of RCA in clinical practice. CONCLUSIONS RCA shows potential as a valuable tool in neuroendovascular interventions. Addressing the technical challenges and conducting further research will be crucial to fully realize the clinical benefits of this innovative technology and improve patient outcomes in stroke management.
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Affiliation(s)
- Paweł Marek Łajczak
- Department of Biophysics, Professor Zbigniew Religa Student Scientific Club, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland.
| | - Kamil Jóźwik
- Department of Biophysics, Professor Zbigniew Religa Student Scientific Club, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Przemysław Nowakowski
- Department of Biophysics, Professor Zbigniew Religa Student Scientific Club, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Zbigniew Nawrat
- Department of Biophysics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland; Foundation of Cardiac Surgery Development, Zabrze, Poland
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Bhatia S, Riccobono G, Lima NJ, Cruz JT, Prusener DW, Domingo R, Ghaith AK, Rios-Zermeno J, Kashyap S, Tawk RG. Percutaneous Closure Device for the Carotid artery: An integrated review and design analysis. J Neurointerv Surg 2024; 16:567-571. [PMID: 37739794 DOI: 10.1136/jnis-2023-020702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/11/2023] [Indexed: 09/24/2023]
Abstract
Endovascular thrombectomies (EVTs) are the current standard of care therapy for treating acute ischemic strokes. While access through the femoral or radial arteries is routine, up to 20% of EVTs through these sites are unable to access the cerebral vasculature on the first pass. These shortcomings are commonly due to tortuous vasculature, atherosclerotic arteries, and type III aortic arch, seen especially in the elderly population. Recent studies have shown the benefits of accessing the cerebral vasculature through a percutaneous direct carotid puncture (DCP), which can reduce the time of the procedure by half. However, current vascular closure devices (VCDs) designed for the femoral artery are not suited to close the carotid artery due to the anatomical differences. This unmet clinical need further limits a DCP approach. Thus, to foster safe adoption of this potential approach, a VCD designed specifically for the carotid artery is needed. In this review, we outline the major biomechanical properties and shortcomings of current VCDs and propose the requirements necessary to effectively design and develop a carotid closure device.
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Affiliation(s)
- Shovan Bhatia
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | | | - Nicholas J Lima
- Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Joshua T Cruz
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Derek W Prusener
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Ricardo Domingo
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - Jorge Rios-Zermeno
- Department of Neurosurgery, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Samir Kashyap
- Department of Neurosurgery, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Rabih G Tawk
- Department of Neurosurgery, Mayo Clinic Florida, Jacksonville, Florida, USA
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48
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Delora A, Hadjialiakbari C, Percenti E, Torres J, Alderazi YJ, Ezzeldin R, Hassan AE, Ezzeldin M. Viz LVO versus Rapid LVO in detection of large vessel occlusion on CT angiography for acute stroke. J Neurointerv Surg 2024; 16:599-602. [PMID: 37355255 DOI: 10.1136/jnis-2023-020445] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 06/10/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Endovascular thrombectomy improves outcomes and reduces mortality for large vessel occlusion (LVO) and is time-sensitive. Computer automation may aid in the early detection of LVOs, but false values may lead to alarm desensitization. We compared Viz LVO and Rapid LVO for automated LVO detection. METHODS Data were retrospectively extracted from Rapid LVO and Viz LVO running concurrently from January 2022 to January 2023 on CT angiography (CTA) images compared with a radiologist interpretation. We calculated diagnostic accuracy measures and performed a McNemar test to look for a difference between the algorithms' errors. We collected demographic data, comorbidities, ejection fraction (EF), and imaging features and performed a multiple logistic regression to determine if any of these variables predicted the incorrect classification of LVO on CTA. RESULTS 360 participants were included, with 47 large vessel occlusions. Viz LVO and Rapid LVO had a specificity of 0.96 and 0.85, a sensitivity of 0.87 and 0.87, a positive predictive value of 0.75 and 0.46, and a negative predictive value of 0.98 and 0.97, respectively. A McNemar test on correct and incorrect classifications showed a statistically significant difference between the two algorithms' errors (P=0.00000031). A multiple logistic regression showed that low EF (Viz P=0.00125, Rapid P=0.0286) and Modified Woodcock Score >1 (Viz P=0.000198, Rapid P=0.000000975) were significant predictors of incorrect classification. CONCLUSION Rapid LVO produced a significantly larger number of false positive values that may contribute to alarm desensitization, leading to missed alarms or delayed responses. EF and intracranial atherosclerosis were significant predictors of incorrect predictions.
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Affiliation(s)
- Adam Delora
- Emergency Medicine, HCA Houston, Kingwood, Texas, USA
| | | | - Eryn Percenti
- Internal Medicine, HCA Houston, Kingwood, Texas, USA
| | - Jordan Torres
- Internal Medicine, HCA Houston, Kingwood, Texas, USA
| | | | - Rime Ezzeldin
- Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Ameer E Hassan
- Department of Neurology, University of Texas Rio Grande Valley, Harlingen, Texas, USA
| | - Mohamad Ezzeldin
- Department of Clinical Sciences, College of Medicine, University of Houston, Houston, Texas, USA
- Neuroendovascular Surgery, HCA Houston, Houston, Texas, USA
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49
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Shapiro J, Reichard A, Muck PE. New Diagnostic Tools for Pulmonary Embolism Detection. Methodist Debakey Cardiovasc J 2024; 20:5-12. [PMID: 38765212 PMCID: PMC11100535 DOI: 10.14797/mdcvj.1342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 04/11/2024] [Indexed: 05/21/2024] Open
Abstract
The presentation of pulmonary embolism (PE) varies from asymptomatic to life-threatening, and management involves multiple specialists. Timely diagnosis of PE is based on clinical presentation, D-dimer testing, and computed tomography pulmonary angiogram (CTPA), and assessment by a Pulmonary Embolism Response Team (PERT) is critical to management. Artificial intelligence (AI) technology plays a key role in the PE workflow with automated detection and flagging of suspected PE in CTPA imaging. HIPAA-compliant communication features of mobile and web-based applications may facilitate PERT workflow with immediate access to imaging, team activation, and real-time information sharing and collaboration. In this review, we describe contemporary diagnostic tools, specifically AI, that are important in the triage and diagnosis of PE.
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Affiliation(s)
- Jacob Shapiro
- Good Samaritan Hospital, Cincinnati, Ohio, US
- Bethesda North Hospital, Cincinnati, Ohio, US
| | - Adam Reichard
- Good Samaritan Hospital, Cincinnati, Ohio, US
- Bethesda North Hospital, Cincinnati, Ohio, US
| | - Patrick E. Muck
- Good Samaritan Hospital, Cincinnati, Ohio, US
- Bethesda North Hospital, Cincinnati, Ohio, US
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50
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Wolcott ZC, English SW. Artificial intelligence to enhance prehospital stroke diagnosis and triage: a perspective. Front Neurol 2024; 15:1389056. [PMID: 38756217 PMCID: PMC11096539 DOI: 10.3389/fneur.2024.1389056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/22/2024] [Indexed: 05/18/2024] Open
Abstract
As health systems organize to deliver the highest quality stroke care to their patients, there is increasing emphasis being placed on prehospital stroke recognition, accurate diagnosis, and efficient triage to improve outcomes after stroke. Emergency medical services (EMS) personnel currently rely heavily on dispatch accuracy, stroke screening tools, bypass protocols and prehospital notification to care for patients with suspected stroke, but novel tools including mobile stroke units and telemedicine-enabled ambulances are already changing the landscape of prehospital stroke care. Herein, the authors provide our perspective on the current state of prehospital stroke diagnosis and triage including several of these emerging trends. Then, we provide commentary to highlight potential artificial intelligence (AI) applications to improve stroke detection, improve accurate and timely dispatch, enhance EMS training and performance, and develop novel stroke diagnostic tools for prehospital use.
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