1851
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Hioki H, Miura T, Miyashita Y, Ebisawa S, Motoki H, Izawa A, Koyama J, Ikeda U. Circulating eicosapentaenoic acid to oleic acid ratio and risk for cardiovascular events in patients with coronary artery disease: A sub-analysis of the SHINANO registry. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.ijcme.2015.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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1852
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Zhou ZB, Meng L, Gelb AW, Lee R, Huang WQ. Cerebral ischemia during surgery: an overview. J Biomed Res 2016; 30:83-87. [PMID: 28276664 PMCID: PMC4820884 DOI: 10.7555/jbr.30.20150126] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 11/30/2015] [Indexed: 12/23/2022] Open
Abstract
Cerebral ischemia is the pathophysiological condition in which the oxygenated cerebral blood flow is less than what is needed to meet cerebral metabolic demand. It is one of the most debilitating complications in the perioperative period and has serious clinical sequelae. The monitoring and prevention of intraoperative cerebral ischemia are crucial because an anesthetized patient in the operating room cannot be neurologically assessed. In this paper, we provide an overview of the definition, etiology, risk factors, and prevention of cerebral ischemia during surgery.
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Affiliation(s)
- Zhi-Bin Zhou
- Department of Anesthesiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Lingzhong Meng
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA, USA
| | - Adrian W Gelb
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA, USA
| | - Roger Lee
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA, USA
| | - Wen-Qi Huang
- Department of Anesthesiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China;
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1853
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Incremental prognostic value of computed tomography in stroke: rationale and design of the IMPACTS study. Int J Cardiovasc Imaging 2016; 32 Suppl 1:83-9. [PMID: 26910046 DOI: 10.1007/s10554-016-0860-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 02/17/2016] [Indexed: 01/07/2023]
Abstract
This study was designed to determine the prognostic value of coronary computed tomography angiography (CCTA) in ischemic stroke patients and to identify any incremental risk stratification benefits of CCTA findings compared with coronary artery calcium scoring (CACS) and traditional Framingham risk scores (FRS) in ischemic stroke patients without chest pain. IMPACTS is a prospective, multicenter, observational cohort study in which at least seven centers in Korea will participate. All participants will be enrolled in this study after providing informed consent. Nine hundred total ischemic stroke patients without chest pain will be enrolled and will undergo CACS and CCTA. All participants will be followed-up for a minimum of 24 months to determine the endpoints. The primary endpoint will be occurrence of major adverse cardiovascular events (MACEs), defined as all-cause mortality, cardiovascular death, myocardial infarction, or cardiovascular events requiring hospitalization and revascularization either by percutaneous coronary intervention or by coronary artery bypass graft after 90 days of index testing during the follow-up period. Patient enrollment should be completed within 2.5 years. We plan to analyze and identify the CCTA predictors of MACEs. In addition, we will compare several models used to assess independent relationships between the variables and MACEs using a shared frailty model and therefore determine the incremental prognostic value of CCTA findings compared with either the CACS or FRS. The results of IMPACTS will provide valuable information for risk stratification with CCTA in ischemic stroke patients without chest pain.
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1854
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Effects of Oral Anticoagulant Therapy in Medical Inpatients ≥65 Years With Atrial Fibrillation. Am J Cardiol 2016; 117:590-595. [PMID: 26718230 DOI: 10.1016/j.amjcard.2015.11.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 11/10/2015] [Accepted: 11/10/2015] [Indexed: 11/21/2022]
Abstract
In this retrospective cohort observational study, we investigated mortality, ischemic, and hemorrhagic events in patients ≥65 years with atrial fibrillation consecutively discharged from an Acute Geriatric Ward in the period 2010 to 2013. Stroke and bleeding risk were evaluated using CHA2DS2-VASC (congestive heart failure/left ventricular dysfunction, hypertension, aged ≥75 years, diabetes mellitus, stroke/transient ischemic attack/systemic embolism, vascular disease, aged 65 to 74 years, gender category) and HAS-BLED (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly, drugs/alcohol concomitantly) scores. Co-morbidity, cognitive status, and functional autonomy were evaluated using standardized scales. Independent associations among clinical variables, including use of vitamin K antagonist-based oral anticoagulant therapy (OAT), all-cause mortality, and fatal and nonfatal ischemic and hemorrhagic events, were evaluated. Further clinical outcomes comparison between patients treated with OAT and those untreated was performed after adjustment for significant differences in patient baseline characteristics with propensity score matching. Of 980 patients discharged (mean age 83 years, 60% women, roughly 30% cognitively impaired or functionally dependent, mean CHA2DS2-VASC and HAS-BLED scores 4.8 and 2.1, respectively), 505 (51.5%) died during a mean follow-up period of 571 days; ischemic and hemorrhagic stroke occurred in 82 (12.3%) and 13 patients (1.3%), respectively, and major bleedings in 43 patients (4.4%). Vitamin K antagonists' use was independently associated with reduced mortality (odds ratio 0.524) and with a nonsignificant reduction in incidence of ischemic stroke, without excess in bleeding risk. Similar findings were observed in the 2 propensity score-matched cohorts of patients. In conclusion, among vulnerable patients with atrial fibrillation ≥65 years with high post-discharge death rate, OAT was associated, among other multiple factors, with reduced mortality.
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1855
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Kalaria RN, Akinyemi R, Ihara M. Stroke injury, cognitive impairment and vascular dementia. Biochim Biophys Acta Mol Basis Dis 2016; 1862:915-25. [PMID: 26806700 PMCID: PMC4827373 DOI: 10.1016/j.bbadis.2016.01.015] [Citation(s) in RCA: 314] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 01/18/2016] [Accepted: 01/20/2016] [Indexed: 12/13/2022]
Abstract
The global burden of ischaemic strokes is almost 4-fold greater than haemorrhagic strokes. Current evidence suggests that 25–30% of ischaemic stroke survivors develop immediate or delayed vascular cognitive impairment (VCI) or vascular dementia (VaD). Dementia after stroke injury may encompass all types of cognitive disorders. States of cognitive dysfunction before the index stroke are described under the umbrella of pre-stroke dementia, which may entail vascular changes as well as insidious neurodegenerative processes. Risk factors for cognitive impairment and dementia after stroke are multifactorial including older age, family history, genetic variants, low educational status, vascular comorbidities, prior transient ischaemic attack or recurrent stroke and depressive illness. Neuroimaging determinants of dementia after stroke comprise silent brain infarcts, white matter changes, lacunar infarcts and medial temporal lobe atrophy. Until recently, the neuropathology of dementia after stroke was poorly defined. Most of post-stroke dementia is consistent with VaD involving multiple substrates. Microinfarction, microvascular changes related to blood–brain barrier damage, focal neuronal atrophy and low burden of co-existing neurodegenerative pathology appear key substrates of dementia after stroke injury. The elucidation of mechanisms of dementia after stroke injury will enable establishment of effective strategy for symptomatic relief and prevention. Controlling vascular disease risk factors is essential to reduce the burden of cognitive dysfunction after stroke. This article is part of a Special Issue entitled: Vascular Contributions to Cognitive Impairment and Dementia edited by M. Paul Murphy, Roderick A. Corriveau and Donna M. Wilcock. Ischaemic injury is common among long-term stroke survivors About 25% stroke survivors develop dementia with a much greater proportion developing cognitive impairment Risk factors of dementia after stroke include older age, vascular comorbidities, prior stroke and pre-stroke impairment Current imaging and pathological studies suggest 70% of dementia after stroke is vascular dementia Severe white matter changes and medial temporal lobe atrophy as sequelae after ischaemic injury are substrates of dementia Controlling vascular risk factors and prevention strategies related to lifestyle factors would reduce dementia after stroke
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Affiliation(s)
- Raj N Kalaria
- Institute of Neuroscience, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne, NE4 5PL, United Kingdom; Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria; Department of Stroke and Cerebrovascular Diseases, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565, Japan.
| | - Rufus Akinyemi
- Institute of Neuroscience, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne, NE4 5PL, United Kingdom; Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria; Department of Stroke and Cerebrovascular Diseases, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565, Japan
| | - Masafumi Ihara
- Institute of Neuroscience, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne, NE4 5PL, United Kingdom; Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria; Department of Stroke and Cerebrovascular Diseases, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565, Japan
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1856
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Iwasaki M, Sato M, Yoshihara A, Ansai T, Miyazaki H. Association between tooth loss and medical costs related to stroke in healthy older adults aged over 75 years in Japan. Geriatr Gerontol Int 2016; 17:202-210. [PMID: 26799814 DOI: 10.1111/ggi.12687] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2015] [Indexed: 11/30/2022]
Abstract
AIM Growing evidence suggests that tooth loss is associated with increased risk of stroke. In the current study, we investigated cumulative medical costs related to stroke using data from the Advanced Elderly Medical Service System. We hypothesized that tooth loss was associated with an increase in medical costs related to stroke among older Japanese adults. METHODS A total of 273 Japanese adults aged 80 years were enrolled in the current study. Baseline medical and dental examinations were carried out in June 2008. Medical care use and costs were monitored by linkage with National Health Insurance claim files from baseline to the end of February 2011. Medical costs related to stroke per month were calculated and examined for any association with the baseline number of remaining teeth using a linear regression model with robust standard errors. RESULTS A total of 19 individuals were admitted to hospital for stroke during the follow-up period. A significant negative association was found between the number of teeth and medical costs related to stroke per month. The regression coefficients of the number of teeth in relation to medical costs related to stroke was -248 (95% CI -438 to -58, P = 0.011) in the crude model and -226 (95% CI -413 to -38, P = 0.018) after adjusting for other confounders. CONCLUSION Within the limitations of the present study, the reported findings suggest an independent relationship of tooth loss with increase in medical cost related to stroke among older Japanese adults. Further studies are necessary to substantiate these findings. Geriatr Gerontol Int 2017; 17: 202-210.
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Affiliation(s)
- Masanori Iwasaki
- Division of Preventive Dentistry, Department of Oral Health Science, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.,Division of Community Oral Health Development, Kyushu Dental University, Kitakyushu, Japan
| | - Misuzu Sato
- Division of Preventive Dentistry, Department of Oral Health Science, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Akihiro Yoshihara
- Division of Oral Science for Health Promotion, Department of Oral Health and Welfare, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Toshihiro Ansai
- Division of Community Oral Health Development, Kyushu Dental University, Kitakyushu, Japan
| | - Hideo Miyazaki
- Division of Preventive Dentistry, Department of Oral Health Science, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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1857
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Domingues R, Rossi C, Cordonnier C. Diagnostic evaluation for nontraumatic intracerebral hemorrhage. Neurol Clin 2016; 33:315-28. [PMID: 25907908 DOI: 10.1016/j.ncl.2014.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Intracerebral hemorrhage (ICH) is a devastating condition with multiple possible underlying causes. Early diagnosis of ICH associated with a precise diagnostic work-up is mandatory. Clinical signs may give clues to diagnosis but are not reliable enough and imaging remains the cornerstone of management. Noncontrast computed tomography and magnetic resonance imaging (MRI) are highly sensitive for ICH identification. Additionally, MRI may disclose brain parenchymal biomarkers that can contribute to the etiologic diagnosis. Vessel examination should be carried out whenever there is a clinical suspicion of underlying structural lesions, such as vascular malformations or tumors. To date, conventional angiography remains the gold standard to detect intracranial vascular malformations in patients with ICH.
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Affiliation(s)
- Renan Domingues
- Department of Neurology, University of Lille, UDSL, CHU Lille, Inserm U 1171, Lille 59000, France; CAPES Foundation, Ministry of Education, Quadra 2, Bloco L, Lote 06, Edifício Capes - CEP: 70.040-020 - Brasilia-DF, Brazil
| | - Costanza Rossi
- Department of Neurology, University of Lille, UDSL, CHU Lille, Inserm U 1171, Lille 59000, France
| | - Charlotte Cordonnier
- Department of Neurology, University of Lille, UDSL, CHU Lille, Inserm U 1171, Lille 59000, France.
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1858
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Lagogianni C, Thomas S, Lincoln N. Examining the relationship between fatigue and cognition after stroke: A systematic review. Neuropsychol Rehabil 2016; 28:57-116. [PMID: 26787096 DOI: 10.1080/09602011.2015.1127820] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Many stroke survivors experience fatigue, which is associated with a variety of factors including cognitive impairment. A few studies have examined the relationship between fatigue and cognition and have obtained conflicting results. The aim of the current study was to review the literature on the relationship between fatigue and cognition post-stroke. The following databases were searched: EMBASE (1980-February, 2014), PsycInfo (1806-February, 2014), CINAHL (1937-February, 2014), MEDLINE (1946-February, 2014), Ethos (1600-February, 2014) and DART (1999-February, 2014). Reference lists of relevant papers were screened and the citation indices of the included papers were searched using Web of Science. Studies were considered if they were on adult stroke patients and assessed the following: fatigue with quantitative measurements (≥ 3 response categories), cognition using objective measurements, and the relationship between fatigue and cognition. Overall, 413 papers were identified, of which 11 were included. Four studies found significant correlations between fatigue and memory, attention, speed of information processing and reading speed (r = -.36 to .46) whereas seven studies did not. Most studies had limitations; quality scores ranged from 9 to 14 on the Critical Appraisal Skills Programme Checklists. There was insufficient evidence to support or refute a relationship between fatigue and cognition post-stroke. More robust studies are needed.
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Affiliation(s)
- Christodouli Lagogianni
- a Division of Rehabilitation & Ageing, Medical School , University of Nottingham , Nottingham , UK.,b Queens Medical Centre , Nottingham , UK
| | - Shirley Thomas
- a Division of Rehabilitation & Ageing, Medical School , University of Nottingham , Nottingham , UK.,b Queens Medical Centre , Nottingham , UK
| | - Nadina Lincoln
- a Division of Rehabilitation & Ageing, Medical School , University of Nottingham , Nottingham , UK.,b Queens Medical Centre , Nottingham , UK
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1859
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Kumar D, Dutta A, Das A, Lahiri U. SmartEye: Developing a Novel Eye Tracking System for Quantitative Assessment of Oculomotor Abnormalities. IEEE Trans Neural Syst Rehabil Eng 2016; 24:1051-1059. [PMID: 26780816 DOI: 10.1109/tnsre.2016.2518222] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Eye movements are a continuous and ubiquitous part of sensory perception. To properly generate highly accurate and co-ordinate ocular movements, a vast network of brain areas are engaged, from low-level visual processing to motor control of gaze orientation. This renders oculomotor system vulnerable to various neurological disorders with unique clinical patterns. Therefore, oculomotor examination can serve as an early and sensitive indicator for various neurological conditions. A simple-to-use, clinically valid system for objectively assessing the oculomotor function can thus bring a paradigm shift in diagnosis and treatment of brain disorders. In principal accordance, this paper presents a gaze assessment tool, called SmartEye, which is based on eye fixation, smooth pursuit, and blinking in response to both static and dynamic visual stimuli. The gaze related indices were evaluated in real-time by SmartEye and these were mapped to the reported pathological state in chronic ( > 3 months) patients with stroke. Our preliminary feasibility study with eight pairs of chronic ( > 3 months) stroke survivors and healthy individuals revealed that gaze related indices in response to both static and dynamic visual stimuli may serve as potential quantitative biomarkers for stroke assessment.
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1860
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Rizos T, Horstmann S, Dittgen F, Täger T, Jenetzky E, Heuschmann P, Veltkamp R. Preexisting Heart Disease Underlies Newly Diagnosed Atrial Fibrillation After Acute Ischemic Stroke. Stroke 2016; 47:336-41. [PMID: 26742800 DOI: 10.1161/strokeaha.115.011465] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 12/01/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Whether newly diagnosed atrial fibrillation (nAF) after stroke reflects underlying heart disease and represents an increased risk of cardioembolic stroke, or whether it is triggered by neurogenic mechanisms remains uncertain. We investigated, whether cardiovascular risk factors and echocardiographic parameters in patients with nAF are similar to patients with known AF (kAF) and differ from patients without AF. METHODS Consecutive acute ischemic stroke patients were enrolled into a prospective stroke database. All patients with echocardiography were included and univariable and multivariable testing was applied to compare clinical characteristics and echocardiographic findings among patients with nAF, kAF, and no AF. RESULTS A total of 1397 patients were included (male, 62.3%; median age, 71 years). AF was present in 320 (22.9%) patients. Of those, nAF was present in 36.2% (116/320) and kAF in 63.8% (204/320). No clinical or echocardiographic factor was independently associated with detection of nAF compared with kAF but a trend toward larger left atrial diameters in patients with kAF was observed (P=0.070). In contrast, patients with nAF were more often female (P<0.001), older (P<0.001) and had a larger left atrial diameters (P<0.001) compared with patients without AF. While stroke severity in patients with nAF and kAF was similar, patients without AF had less severe strokes. CONCLUSIONS Stroke patients with nAF and with kAF share common cardiovascular risk factors, have similar echocardiographic findings and suffer equally severe strokes. We conclude that preexisting heart disease is the major cause of AF that is first diagnosed after stroke.
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Affiliation(s)
- Timolaos Rizos
- From the Departments of Neurology (T.R., S.H., F.D., R.V.) and Cardiology (T.T.), University of Heidelberg, Heidelberg, Germany; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany (E.J.); Department for Child and Adolescent Psychiatry, Johannes Gutenberg-University, Mainz, Germany (E.J.); Department of Clinical Epidemiology and Biometry and Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany (P.H.); and Department of Stroke Medicine, Imperial College London, London, United Kingdom (R.V.).
| | - Solveig Horstmann
- From the Departments of Neurology (T.R., S.H., F.D., R.V.) and Cardiology (T.T.), University of Heidelberg, Heidelberg, Germany; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany (E.J.); Department for Child and Adolescent Psychiatry, Johannes Gutenberg-University, Mainz, Germany (E.J.); Department of Clinical Epidemiology and Biometry and Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany (P.H.); and Department of Stroke Medicine, Imperial College London, London, United Kingdom (R.V.)
| | - Felix Dittgen
- From the Departments of Neurology (T.R., S.H., F.D., R.V.) and Cardiology (T.T.), University of Heidelberg, Heidelberg, Germany; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany (E.J.); Department for Child and Adolescent Psychiatry, Johannes Gutenberg-University, Mainz, Germany (E.J.); Department of Clinical Epidemiology and Biometry and Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany (P.H.); and Department of Stroke Medicine, Imperial College London, London, United Kingdom (R.V.)
| | - Tobias Täger
- From the Departments of Neurology (T.R., S.H., F.D., R.V.) and Cardiology (T.T.), University of Heidelberg, Heidelberg, Germany; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany (E.J.); Department for Child and Adolescent Psychiatry, Johannes Gutenberg-University, Mainz, Germany (E.J.); Department of Clinical Epidemiology and Biometry and Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany (P.H.); and Department of Stroke Medicine, Imperial College London, London, United Kingdom (R.V.)
| | - Ekkehart Jenetzky
- From the Departments of Neurology (T.R., S.H., F.D., R.V.) and Cardiology (T.T.), University of Heidelberg, Heidelberg, Germany; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany (E.J.); Department for Child and Adolescent Psychiatry, Johannes Gutenberg-University, Mainz, Germany (E.J.); Department of Clinical Epidemiology and Biometry and Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany (P.H.); and Department of Stroke Medicine, Imperial College London, London, United Kingdom (R.V.)
| | - Peter Heuschmann
- From the Departments of Neurology (T.R., S.H., F.D., R.V.) and Cardiology (T.T.), University of Heidelberg, Heidelberg, Germany; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany (E.J.); Department for Child and Adolescent Psychiatry, Johannes Gutenberg-University, Mainz, Germany (E.J.); Department of Clinical Epidemiology and Biometry and Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany (P.H.); and Department of Stroke Medicine, Imperial College London, London, United Kingdom (R.V.)
| | - Roland Veltkamp
- From the Departments of Neurology (T.R., S.H., F.D., R.V.) and Cardiology (T.T.), University of Heidelberg, Heidelberg, Germany; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany (E.J.); Department for Child and Adolescent Psychiatry, Johannes Gutenberg-University, Mainz, Germany (E.J.); Department of Clinical Epidemiology and Biometry and Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany (P.H.); and Department of Stroke Medicine, Imperial College London, London, United Kingdom (R.V.)
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1861
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1862
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Mugwano I, Kaddumukasa M, Mugenyi L, Kayima J, Ddumba E, Sajatovic M, Sila C, DeGeorgia M, Katabira E. Poor drug adherence and lack of awareness of hypertension among hypertensive stroke patients in Kampala, Uganda: a cross sectional study. BMC Res Notes 2016; 9:3. [PMID: 26725042 PMCID: PMC4698320 DOI: 10.1186/s13104-015-1830-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 12/21/2015] [Indexed: 12/12/2022] Open
Abstract
Background Raised blood pressure (BP) remains an important risk factor for cardiovascular diseases such as stroke. Adherence to therapeutic recommendations especially antihypertensive drugs is important in BP control. The aim of the study was to assess the stroke risk factors and levels of adherence among hypertensive patients with stroke in Kampala Uganda. Methods In a cross-sectional study we describe 112 hypertensive subjects with stroke from two Kampala city hospitals. A standardized pre-tested questionnaire was used to collect medical history, clinical details, radiological findings and laboratory data. Results A total of 112 hypertensive subjects with stroke were enrolled between May 2013 and April 2014. The median ages were 63.5 years (52.5–75.0) for the cases. Seventy percent (78/112) of the study participants had ischemic strokes. Only 17 % were adherent to anti-hypertensive medications. The main cause of non-adherence appears to be lack of knowledge. Conclusions Poor adherence of anti-hypertensive medications among hypertensive patients remains a big challenge in our setting. This has been attributed to lack of adequate knowledge and cost of the prescribed drugs. There is therefore an urgent need to promptly diagnose and educate hypertensive patients with emphasis on adherence to anti hypertensive drugs.
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Affiliation(s)
- Isaac Mugwano
- Mother Kevin Post Graduate Medical School, Nsambya Hospital, Uganda Martyr's University, P. O. Box 5498, Kampala, Uganda.
| | - Mark Kaddumukasa
- Department of Medicine, College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda.
| | - Levi Mugenyi
- Infectious Diseases Research Collaboration, Mulago Hill Road, MUJHU3 Building, P. O. Box 7475, Kampala, Uganda. .,I-Biostat, University of Hasselt, 3590, Diepenbeek, Belgium.
| | - James Kayima
- Department of Medicine, College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda.
| | - Edward Ddumba
- Mother Kevin Post Graduate Medical School, Nsambya Hospital, Uganda Martyr's University, P. O. Box 5498, Kampala, Uganda.
| | - Martha Sajatovic
- Neurological and Behavioral Outcomes Center, University Hospital Case Medical Center, Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH, 44106, USA.
| | - Cathy Sila
- Neurological and Behavioral Outcomes Center, University Hospital Case Medical Center, Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH, 44106, USA.
| | - Michael DeGeorgia
- Neurological and Behavioral Outcomes Center, University Hospital Case Medical Center, Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH, 44106, USA.
| | - Elly Katabira
- Department of Medicine, College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda.
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1863
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Abstract
Strokes, whether ischemic or hemorrhagic, are among the most common causes of secondary movement disorders in elderly patients. Stroke-related (vascular) movement disorders, however, are uncommon complications of this relatively common disease. The spectrum of post-stroke movement disorders is broad and includes both hypo- and hyperkinetic syndromes. Post-stroke dyskinesias are involuntary hyperkinetic movements arising from cerebrovascular insults and often present with mixed phenotypes of hyperkinesia which can sometimes be difficult to classify. Nevertheless, identification of the most relevant motor phenotype, whenever possible, allows for a more specific phenomenological categorization of the dyskinesia and thus helps guide its treatment. Fortunately, post-stroke dyskinesias are usually self-limiting and resolve within 6 to 12 months of onset, but a short-term pharmacotherapy might sometimes be required for symptom control. Functional neurosurgical interventions targeting the motor thalamus or globus pallidus interna might be considered for patients with severe, disabling, and persistent dyskinesias (arbitrarily defined as duration longer than 12 months).
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Affiliation(s)
- Mohammad Obadah Nakawah
- Stanely H. Appel, Department of Neurology, Houston Methodist Neurological Institute, Houston, TX, USA
| | - Eugene C Lai
- Stanely H. Appel, Department of Neurology, Houston Methodist Neurological Institute, Houston, TX, USA
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1864
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Lai M, Wang D, Lin Z, Zhang Y. Small Molecule Copper and Its Relative Metabolites in Serum of Cerebral Ischemic Stroke Patients. J Stroke Cerebrovasc Dis 2016; 25:214-9. [PMID: 26573522 DOI: 10.1016/j.jstrokecerebrovasdis.2015.09.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 09/11/2015] [Accepted: 09/16/2015] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Copper is a strong pro-oxidant. The most important pro-oxidative form in serum is small molecule copper (SMC), which is copper that is loosely bound to small molecules, such as amino acids and polypeptides. The association between copper and atherosclerotic diseases has been confirmed, but that between SMC and cerebral ischemic stroke (CIS), one of the most principal manifestations and causes of death of atherosclerotic disease, is not yet clear. METHODS We recruited 45 CIS patients and 25 age- and gender-matched healthy controls. We detected their serum levels of SMC, total copper, homocysteine (Hcy), and ceruloplasmin (CP), as well as urinary total copper, and analyzed the relationship of SMC with these aforementioned metabolites or compounds in CIS patients. RESULTS SMC was 4.2 ± .5 µg/L and 2.1 ± .9 µg/L; total copper in sera was 1345.5 ± 308.2 µg/L and 1180.3 ± 134.0 µg/L; and total copper in urine was 27.6 ± 9.3 µg/L and 18.8 ± 8.1 µg/L in patients and controls, respectively (all P < .05). Serum CP activity in CIS patients was 59.92 ± 12.11 U/L versus 37.76 ± 5.71 U/L in controls (P = .0001). The concentration of SMC was positively correlated with CP activity, Hcy concentration in sera, and urinary total copper. CONCLUSION The serum level of SMC and total copper is remarkably elevated, and SMC positively correlates with Hcy, CP activity, and urinary total copper in CIS patients.
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Affiliation(s)
- Minchao Lai
- Department of Neurology, First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Dian Wang
- Department of Forensic Medicine, Shantou University Medical College, Shantou, China
| | - Zhexuan Lin
- Analytical and Testing Center, Shantou University Medical College, Shantou, China
| | - Yuan Zhang
- Analytical and Testing Center, Shantou University Medical College, Shantou, China.
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1865
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Arnold R, Issar T, Krishnan AV, Pussell BA. Neurological complications in chronic kidney disease. JRSM Cardiovasc Dis 2016; 5:2048004016677687. [PMID: 27867500 PMCID: PMC5102165 DOI: 10.1177/2048004016677687] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 09/16/2016] [Accepted: 09/21/2016] [Indexed: 01/12/2023] Open
Abstract
Patients with chronic kidney disease (CKD) are frequently afflicted with neurological complications. These complications can potentially affect both the central and peripheral nervous systems. Common neurological complications in CKD include stroke, cognitive dysfunction, encephalopathy, peripheral and autonomic neuropathies. These conditions have significant impact not only on patient morbidity but also on mortality risk through a variety of mechanisms. Understanding the pathophysiological mechanisms of these conditions can provide insights into effective management strategies for neurological complications. This review describes clinical management of neurological complications in CKD with reference to the contributing physiological and pathological derangements. Stroke, cognitive dysfunction and dementia share several pathological mechanisms that may contribute to vascular impairment and neurodegeneration. Cognitive dysfunction and dementia may be differentiated from encephalopathy which has similar contributing factors but presents in an acute and rapidly progressive manner and may be accompanied by tremor and asterixis. Recent evidence suggests that dietary potassium restriction may be a useful preventative measure for peripheral neuropathy. Management of painful neuropathic symptoms can be achieved by pharmacological means with careful dosing and side effect considerations for reduced renal function. Patients with autonomic neuropathy may respond to sildenafil for impotence. Neurological complications often become clinically apparent at end-stage disease, however early detection and management of these conditions in mild CKD may reduce their impact at later stages.
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Affiliation(s)
- Ria Arnold
- School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Tushar Issar
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Arun V Krishnan
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Bruce A Pussell
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
- Bruce A Pussell, Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales 2052, Australia.
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1866
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Arnold J, Sims D, Ferro CJ. Modulation of stroke risk in chronic kidney disease. Clin Kidney J 2015; 9:29-38. [PMID: 26798458 PMCID: PMC4720212 DOI: 10.1093/ckj/sfv136] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 11/10/2015] [Indexed: 12/12/2022] Open
Abstract
Stroke is the second most common cause of death and the leading cause of neurological disability worldwide, with huge economic costs and tragic human consequences. Both chronic kidney disease (CKD) and end-stage kidney disease are associated with a significantly increased risk of stroke. However, to date this has generated far less interest compared with the better-recognized links between cardiac and renal disease. Common risk factors for stroke, such as hypertension, hypercholesterolaemia, smoking and atrial fibrillation, are shared with the general population but are more prevalent in renal patients. In addition, factors unique to these patients, such as disorders of mineral and bone metabolism, anaemia and its treatments as well as the process of dialysis itself, are all also postulated to further increase the risk of stroke. In the general population, advances in medical therapies mean that effective primary and secondary prevention therapies are available for many patients. The development of specialist stroke clinics and acute stroke units has also improved outcomes after a stroke. Emerging therapies such as thrombolysis and thrombectomy are showing increasingly beneficial results. However, patients with CKD and on dialysis have different risk profiles that must be taken into account when considering the potential benefits and risks of these treatments. Unfortunately, these patients are either not recruited or formally excluded from major clinical trials. There is still much work to be done to harness effective stroke treatments with an acceptable safety profile for patients with CKD and those on dialysis.
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Affiliation(s)
- Julia Arnold
- Department of Nephrology , Queen Elizabeth Hospital , Birmingham , UK
| | - Don Sims
- Department of Stroke Medicine , Queen Elizabeth Hospital , Birmingham , UK
| | - Charles J Ferro
- Department of Nephrology , Queen Elizabeth Hospital , Birmingham , UK
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1867
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Wirsching HG, Morel C, Gmür C, Neidert MC, Baumann CR, Valavanis A, Rushing EJ, Krayenbühl N, Weller M. Predicting outcome of epilepsy after meningioma resection. Neuro Oncol 2015; 18:1002-10. [PMID: 26683139 DOI: 10.1093/neuonc/nov303] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 11/09/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Surgical excision is the standard treatment for intracranial meningiomas. Epilepsy is a major cause of morbidity in meningioma patients, but postoperative control of epilepsy is not achieved in a substantial fraction of patients. The purpose of this study was to define risk factors for postoperative epilepsy. METHODS Patients treated for histologically confirmed intracranial meningioma at the University Hospital Zurich between 2000 and 2013 were retrospectively analyzed. Demographic, clinical, imaging, and electroencephalographic data were assessed. A binary regression model was applied to identify risk factors for postoperative epilepsy. RESULTS Of the 779 patients analyzed, epileptic seizures occurred in 244 (31.3%) patients before surgery and in 204 (26.6%) patients after surgery. Of the 244 patients with preoperative epilepsy, 144 (59.0%) became seizure-free after surgery; of the 535 patients without preoperative seizures, 104 (19.4%) suffered from epilepsy after surgery. Risk factors for postoperative epilepsy were preoperative epilepsy (odds ratio [OR]: 3.46 [95% confidence interval {CI}: 2.32-5.16]), major surgical complications including CNS infections (OR: 5.89 [95% CI: 1.53-22.61]), hydrocephalus (OR: 3.27 [95% CI: 1.35-7.95]), recraniotomy (OR: 2.91 [95% CI: 1.25-6.78]), and symptomatic intracranial hemorrhage (OR: 2.60 [95% CI: 1.17-5.76]) as well as epileptiform EEG potentials (OR: 2.52 [95% CI: 1.36-4.67]), younger age (OR: 1.74 [(95% CI: 1.18-2.58]), and tumor progression (OR: 1.92 [95% CI: 1.16-3.18]). Postoperative improvement or recovery from preoperative neurologic deficits was associated with improved seizure control (OR: 0.46 [95% CI: 0.25-0.85], P = .013). CONCLUSION We suggest prospective validation of a score ("STAMPE2") based on clinical findings, EEG, and brain-imaging measures to estimate postoperative seizure risk and guide anticonvulsant treatment in meningioma patients.
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Affiliation(s)
- Hans-Georg Wirsching
- Department of Neurology, University Hospital Zurich, Switzerland (H.-G.W., C.M., C.G., C.R.B., M.W.); Department of Neurosurgery, University Hospital Zurich, Switzerland (M.C.N., N.K.); Department of Neuroradiology, University Hospital Zurich, Switzerland (A.V.); Department of Neuropathology, University Hospital Zurich, Switzerland (E.J.R.)
| | - Corinne Morel
- Department of Neurology, University Hospital Zurich, Switzerland (H.-G.W., C.M., C.G., C.R.B., M.W.); Department of Neurosurgery, University Hospital Zurich, Switzerland (M.C.N., N.K.); Department of Neuroradiology, University Hospital Zurich, Switzerland (A.V.); Department of Neuropathology, University Hospital Zurich, Switzerland (E.J.R.)
| | - Corinne Gmür
- Department of Neurology, University Hospital Zurich, Switzerland (H.-G.W., C.M., C.G., C.R.B., M.W.); Department of Neurosurgery, University Hospital Zurich, Switzerland (M.C.N., N.K.); Department of Neuroradiology, University Hospital Zurich, Switzerland (A.V.); Department of Neuropathology, University Hospital Zurich, Switzerland (E.J.R.)
| | - Marian Christoph Neidert
- Department of Neurology, University Hospital Zurich, Switzerland (H.-G.W., C.M., C.G., C.R.B., M.W.); Department of Neurosurgery, University Hospital Zurich, Switzerland (M.C.N., N.K.); Department of Neuroradiology, University Hospital Zurich, Switzerland (A.V.); Department of Neuropathology, University Hospital Zurich, Switzerland (E.J.R.)
| | - Christian Richard Baumann
- Department of Neurology, University Hospital Zurich, Switzerland (H.-G.W., C.M., C.G., C.R.B., M.W.); Department of Neurosurgery, University Hospital Zurich, Switzerland (M.C.N., N.K.); Department of Neuroradiology, University Hospital Zurich, Switzerland (A.V.); Department of Neuropathology, University Hospital Zurich, Switzerland (E.J.R.)
| | - Antonios Valavanis
- Department of Neurology, University Hospital Zurich, Switzerland (H.-G.W., C.M., C.G., C.R.B., M.W.); Department of Neurosurgery, University Hospital Zurich, Switzerland (M.C.N., N.K.); Department of Neuroradiology, University Hospital Zurich, Switzerland (A.V.); Department of Neuropathology, University Hospital Zurich, Switzerland (E.J.R.)
| | - Elisabeth Jane Rushing
- Department of Neurology, University Hospital Zurich, Switzerland (H.-G.W., C.M., C.G., C.R.B., M.W.); Department of Neurosurgery, University Hospital Zurich, Switzerland (M.C.N., N.K.); Department of Neuroradiology, University Hospital Zurich, Switzerland (A.V.); Department of Neuropathology, University Hospital Zurich, Switzerland (E.J.R.)
| | - Niklaus Krayenbühl
- Department of Neurology, University Hospital Zurich, Switzerland (H.-G.W., C.M., C.G., C.R.B., M.W.); Department of Neurosurgery, University Hospital Zurich, Switzerland (M.C.N., N.K.); Department of Neuroradiology, University Hospital Zurich, Switzerland (A.V.); Department of Neuropathology, University Hospital Zurich, Switzerland (E.J.R.)
| | - Michael Weller
- Department of Neurology, University Hospital Zurich, Switzerland (H.-G.W., C.M., C.G., C.R.B., M.W.); Department of Neurosurgery, University Hospital Zurich, Switzerland (M.C.N., N.K.); Department of Neuroradiology, University Hospital Zurich, Switzerland (A.V.); Department of Neuropathology, University Hospital Zurich, Switzerland (E.J.R.)
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1868
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Monitoring cerebral tissue oxygen saturation at frontal and parietal regions during carotid artery stenting. J Anesth 2015; 30:340-4. [DOI: 10.1007/s00540-015-2117-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 11/29/2015] [Indexed: 10/22/2022]
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1869
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Diagnostic Yield of Universal Urine Toxicology Screening in an Unselected Cohort of Stroke Patients. PLoS One 2015; 10:e0144772. [PMID: 26675665 PMCID: PMC4686022 DOI: 10.1371/journal.pone.0144772] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 11/23/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Illicit drug use increases the risk of cerebrovascular events by a variety of mechanisms. A recent report suggested that universal urine toxicology (UTox) screening of patients with stroke may be warranted. We aimed to evaluate the diagnostic yield of urine drug screening among unselected patients admitted with acute stroke or transient ischemic attack (TIA). METHODS Using a single-center prospective study design, we evaluated consecutive patients with acute ischemic stroke, TIA, intracerebral hemorrhage (ICH), or subarachnoid hemorrhage (SAH) over one year. Urine samples were collected within 48 hours of admission and analyzed for common classes of abused drugs. Prevalence of positive UTox screening was determined. We evaluated whether baseline demographics and clinical factors were associated with UTox results. RESULTS Of 483 eligible patients (acute ischemic stroke 66.4%; TIA 18.8%; ICH 7.7%; SAH 7.0%), 414 (85.7%) completed UTox screening. The mean (standard deviation) age was 65.1 (15.6) years, 52.7% were male, and 64.3% were Caucasian. Twenty-two (4.6%) patients had positive screening-cannabinoids were detected in 13 cases (3.1%), cocaine in 5 cases (1.2%), amphetamines in 1 case, and phencyclidine in 1 case. The highest yield (14.1%) was observed in patients < 60 years old with history of tobacco use while it was < 5% in the remaining subgroups (p<0.01). CONCLUSIONS Consistent with current guidelines, a selective approach to UTox screening should be pursued in acute stroke evaluation. The highest diagnostic yield is likely to be for cannabinoids and cocaine testing in younger patients with a history of concurrent tobacco use.
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1870
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Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, Das SR, de Ferranti S, Després JP, Fullerton HJ, Howard VJ, Huffman MD, Isasi CR, Jiménez MC, Judd SE, Kissela BM, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Magid DJ, McGuire DK, Mohler ER, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Rosamond W, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Woo D, Yeh RW, Turner MB. Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. Circulation 2015; 133:e38-360. [PMID: 26673558 DOI: 10.1161/cir.0000000000000350] [Citation(s) in RCA: 3740] [Impact Index Per Article: 415.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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1871
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Paiva S, Magalhães R, Alves J, Sampaio A. Efficacy of cognitive intervention in stroke: A long road ahead. Restor Neurol Neurosci 2015; 34:139-52. [PMID: 26684266 DOI: 10.3233/rnn-150590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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1872
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Chukwuonye II, Ohagwu KA, Uche EO, Chuku A, Nwanke RI, Ohagwu CC, Ezeani IU, Nwabuko CO, Nnoli MA, Oviasu E, Ogah OS. Validation of Siriraj Stroke Score in southeast Nigeria. Int J Gen Med 2015; 8:349-53. [PMID: 26604813 PMCID: PMC4629972 DOI: 10.2147/ijgm.s87293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The aim of the study is to validate the use of Siriraj Stroke Score (SSS) in the diagnosis of acute hemorrhagic and acute ischemic stroke in southeast Nigeria. This was a prospective study on validity of SSS in the diagnosis of stroke types in southeast Nigeria. Subjects diagnosed with stroke for whom brain computerized tomography (CT) scan was performed on admission were recruited during the study period. SSS was calculated for each subject, and the SSS diagnosis was compared with brain CT scan-based diagnosis. A total of 2,307 patients were admitted in the hospital medical wards during the study period, of whom 360 (15.6%) were stroke patients and of these, 113 (31.4%) adult subjects met the inclusion criteria. The mean age of the subjects was 66.5±2.6 years. The mean interval between ictus and presentation was 2.5±0.4 days. Ischemic stroke was confirmed by CT in 74 subjects; however, SSS predicted 60 (81.1%) of these subjects correctly (P<0.05). Hemorrhagic stroke was confirmed by CT in 39 subjects, and SSS predicted 36 (92.3%) of them correctly (P<0.05). In acute ischemic stroke, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of SSS were 92%, 94%, 97%, 86%, and 93%, respectively, while in patients with hemorrhagic stroke, the corresponding percentages were 94%, 92%, 86%, 97%, and 93%, respectively. SSS is not reliable enough to clinically differentiate stroke types in southeast Nigeria to warrant interventions like thrombolysis in acute ischemic stroke.
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Affiliation(s)
| | - Kenneth Arinze Ohagwu
- Division of Neurology, Department of Internal Medicine, Federal Medical Centre, Umuahia, Nigeria
| | - Enoch Ogbonnaya Uche
- Division of Neurosurgery, Department of Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria ; Federal Medical Centre, Umuahia, Nigeria
| | - Abali Chuku
- Department of Ophthalmology, Federal Medical Centre, Umuahia, Nigeria
| | - Rowland Ihezuo Nwanke
- Division of Neurology, Department of Internal Medicine, Federal Medical Centre, Umuahia, Nigeria
| | | | - Ignatius U Ezeani
- Division of Endocrinology, Department of Internal Medicine, Federal Medical Centre, Umuahia, Nigeria
| | | | | | - Efosa Oviasu
- Federal Medical Centre, Umuahia, Nigeria ; Division of Nephrology, Department of Internal Medicine, University of Benin Teaching Hospital, Benin City, Nigeria
| | - Okechukwu Samuel Ogah
- Federal Medical Centre, Umuahia, Nigeria ; Division of Cardiology, University College Hospital Ibadan, Ibadan, Nigeria
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1873
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Bayar N, Üreyen ÇM, Erkal Z, Küçükseymen S, Çay S, Çağırcı G, Arslan Ş. Evaluation of the association between stroke/transient ischemic attack and atrial electromechanical delay in patients with paroxysmal atrial fibrillation. Anatol J Cardiol 2015; 16:572-578. [PMID: 27004705 PMCID: PMC5368512 DOI: 10.5152/anatoljcardiol.2015.6424] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: This study aimed to evaluate the association between the history of stroke/transient ischemic attack (TIA) and inter- and intra-atrial electromechanical delay (EMD) in patients with paroxysmal atrial fibrillation (PAF). Methods: Patients diagnosed with PAF were included in this retrospective study. Patients who had a history of stroke or TIA were defined as the symptomatic group, whereas those who did not have such a history were defined as the asymptomatic group. On the basis of the transthoracic echocardiographic records, atrial electromechanical coupling (time interval from the onset of the P wave on the surface electrocardiogram to the beginning of the A’ wave interval with tissue Doppler echocardiography) and intra- and interatrial EMD were measured. Results: In this study, 160 patients were included, 52 of whom were symptomatic. While the intra-left atrial EMD was 68.2±6.1 ms in the symptomatic group, it was found to be 50.8±6.5 ms in the asymptomatic group (p<0.001). Interatrial EMD was 91.3±5.0 ms in the symptomatic group, whereas it was 71.5±7.0 ms in the asymptomatic group (p<0.001). In multiple logistic regression analysis, intra-left atrial [odds ratio (OR): 1.417, 95% confidence interval (CI): 1.193–1.684, p<0.001] and interatrial EMDs (OR:1.398, 95% CI: 1.177–1.661, p<0.001) were found to be independently associated with the presence of stroke/TIA. Conclusion: Prolonged inter- and intra-left atrial EMDs in patients with PAF is associated with stroke/TIA. Evaluating this parameter in addition to the CHA2DS2-VASc score in patients with PAF may be helpful in identifying patients who are at a high risk of stroke/TIA. (Anatol J Cardiol 2016; 16: 572-8)
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Affiliation(s)
- Nermin Bayar
- Department of Cardiology, Antalya Education and Research Hospital, Antalya-Turkey.
| | - Çağın Mustafa Üreyen
- Department of Cardiology, Antalya Education and Research Hospital, Antalya-Turkey
| | - Zehra Erkal
- Department of Cardiology, Antalya Education and Research Hospital, Antalya-Turkey
| | - Selçuk Küçükseymen
- Department of Cardiology, Antalya Education and Research Hospital, Antalya-Turkey
| | - Serkan Çay
- Department of Cardiology, Yu¨ksek İhtisas Education and Research Hospital, Ankara-Turkey
| | - Göksel Çağırcı
- Department of Cardiology, Antalya Education and Research Hospital, Antalya-Turkey
| | - Şakir Arslan
- Department of Cardiology, Antalya Education and Research Hospital, Antalya-Turkey
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1874
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Yin B, Barrionuevo G, Weber SG. Optimized real-time monitoring of glutathione redox status in single pyramidal neurons in organotypic hippocampal slices during oxygen-glucose deprivation and reperfusion. ACS Chem Neurosci 2015; 6:1838-48. [PMID: 26291433 DOI: 10.1021/acschemneuro.5b00186] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
A redox-sensitive Grx1-roGFP2 fusion protein was introduced by transfection into single pyramidal neurons in the CA1 subfield of organotypic hippocampal slice cultures (OHSCs). We assessed changes in the GSH system in neuronal cytoplasm and mitochondria during oxygen-glucose deprivation and reperfusion (OGD/RP), an in vitro model of stroke. Pyramidal cells in a narrow range of depths below the surface of the OHSC were transfected by gene gun or single-cell electroporation with cyto- or mito-Grx1-roGFP2. To mimic the conditions of acute stroke, we developed an optimized superfusion system with the capability of rapid and reproducible exchange of the solution bathing the OHSCs. Measurements of pO2 as a function of tissue depth show that in the region containing the transfected cells, the pO2 is well-controlled. We also found that the pO2 changes on the same time scale as changes in intracranial pressure, cerebral blood flow, and pO2 during acute stroke. Determining the reduction potential, EGSH, from the ratiometric fluorescence signal requires an absolute intensity measurement during calibration of the Grx1-roGFP2. Using the signal from cotransfected tdTomato as an internal standard during calibration improves quantitative measurements of Grx1-roGFP2 redox status and allows EGSH to be determined. EGSH becomes more reducing during OGD and more oxidizing during RP in mitochondria while changes in cytoplasm are not significant compared with controls.
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Affiliation(s)
- Bocheng Yin
- Department
of Chemistry, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, United States
| | - Germán Barrionuevo
- Department
of Neuroscience, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, United States
| | - Stephen G. Weber
- Department
of Chemistry, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, United States
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1875
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Okorie CK, Ogbole GI, Owolabi MO, Ogun O, Adeyinka A, Ogunniyi A. Role of Diffusion-weighted Imaging in Acute Stroke Management using Low-field Magnetic Resonance Imaging in Resource-limited Settings. WEST AFRICAN JOURNAL OF RADIOLOGY 2015; 22:61-66. [PMID: 26709342 DOI: 10.4103/1115-3474.162168] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
A variety of imaging modalities exist for the diagnosis of stroke. Several studies have been carried out to ascertain their contribution to the management of acute stroke and to compare the benefits and limitations of each modality. Diffusion-weighted imaging (DWI) has been described as the optimal imaging technique for diagnosing acute ischemic stroke, yet limited evidence is available on the value of DWI in the management of ischemic stroke with low-field magnetic resonance (MR) systems. Although high-field MR imaging (MRI) is desirable for DWI, low-field scanners provide an acceptable clinical compromise which is of importance to developing countries posed with the challenge of limited availability of high-field units. The purpose of this paper was to systematically review the literature on the usefulness of DWI in acute stroke management with low-field MRI scanners and present the experience in Nigeria.
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Affiliation(s)
| | - Godwin I Ogbole
- Department of Radiology, University of Ibadan, Ibadan, Nigeria
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1876
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Lehman LL, Watson CG, Kapur K, Danehy AR, Rivkin MJ. Predictors of Stroke After Transient Ischemic Attack in Children. Stroke 2015; 47:88-93. [PMID: 26556823 DOI: 10.1161/strokeaha.115.009904] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 10/14/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Transient ischemic attack (TIA) in children has received far less attention compared with TIA in adults. The risk factors of stroke after TIA in children are relatively unknown. We aimed to determine the percentage of children who have stroke after TIA and the risk factors associated with stroke after TIA. METHODS We searched the medical records at Boston Children's Hospital for the year 2010 to find children who were evaluated for TIA to determine associated risk factors of stroke after TIA. We included children who were evaluated in 2009 through 2010 for TIA and had magnetic resonance imaging. We examined follow-up imaging through August 2014 for subsequent stroke. Logistic regression was used to calculate odds ratios for factors in our cohort who are associated with stroke after presentation with TIA. RESULTS We identified 63 children who experienced a TIA. The mean time of imaging follow-up was 4.5 years after TIA presentation. Of the 63 children, 10 (16%) developed radiological evidence of ischemic cerebral injury within the follow-up period. Four of the 10 (6%) demonstrated diffusion abnormalities on magnetic resonance imaging at TIA presentation, whereas 8 (13%) had a stroke after their TIA. Arteriopathy, female sex, and autoimmune disorders were significantly associated with stroke after TIA. CONCLUSIONS In our cohort of children, stroke occurred after TIA at a rate similar to that seen in adults, but the risk factors for stroke after TIA in children are different.
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Affiliation(s)
- Laura L Lehman
- From the Departments of Neurology (L.L.L., C.G.W., K.K., M.J.R.), Psychiatry (M.J.R.), and Radiology (A.R.D., M.J. R.), Boston Children's Hospital, MA; and Departments of Radiology (A.R.D.) and Neurology (L.L.L., M.J.R.), Harvard Medical School, Boston, MA.
| | - Christopher G Watson
- From the Departments of Neurology (L.L.L., C.G.W., K.K., M.J.R.), Psychiatry (M.J.R.), and Radiology (A.R.D., M.J. R.), Boston Children's Hospital, MA; and Departments of Radiology (A.R.D.) and Neurology (L.L.L., M.J.R.), Harvard Medical School, Boston, MA
| | - Kush Kapur
- From the Departments of Neurology (L.L.L., C.G.W., K.K., M.J.R.), Psychiatry (M.J.R.), and Radiology (A.R.D., M.J. R.), Boston Children's Hospital, MA; and Departments of Radiology (A.R.D.) and Neurology (L.L.L., M.J.R.), Harvard Medical School, Boston, MA
| | - Amy R Danehy
- From the Departments of Neurology (L.L.L., C.G.W., K.K., M.J.R.), Psychiatry (M.J.R.), and Radiology (A.R.D., M.J. R.), Boston Children's Hospital, MA; and Departments of Radiology (A.R.D.) and Neurology (L.L.L., M.J.R.), Harvard Medical School, Boston, MA
| | - Michael J Rivkin
- From the Departments of Neurology (L.L.L., C.G.W., K.K., M.J.R.), Psychiatry (M.J.R.), and Radiology (A.R.D., M.J. R.), Boston Children's Hospital, MA; and Departments of Radiology (A.R.D.) and Neurology (L.L.L., M.J.R.), Harvard Medical School, Boston, MA
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1877
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Sangha RS, Caprio FZ, Askew R, Corado C, Bernstein R, Curran Y, Ruff I, Cella D, Naidech AM, Prabhakaran S. Quality of life in patients with TIA and minor ischemic stroke. Neurology 2015; 85:1957-63. [PMID: 26537051 DOI: 10.1212/wnl.0000000000002164] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 06/29/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We investigated health-related quality of life (HRQOL) in patients with TIA and minor ischemic stroke (MIS) using Neuro-QOL, a validated, patient-reported outcome measurement system. METHODS Consecutive patients with TIA or MIS who had (1) modified Rankin Scale (mRS) score of 0 or 1 at baseline, (2) initial NIH Stroke Scale score of ≤5, (3) no acute reperfusion treatment, and (4) 3-month follow-up, were recruited. Recurrent stroke, disability by mRS and Barthel Index, and Neuro-QOL scores in 5 prespecified domains were prospectively recorded. We assessed the proportion of patients with impaired HRQOL, defined as T scores more than 0.5 SD worse than the general population average, and identified predictors of impaired HRQOL using logistic regression. RESULTS Among 332 patients who met study criteria (mean age 65.7 years, 52.4% male), 47 (14.2%) had recurrent stroke within 90 days and 41 (12.3%) were disabled (mRS >1 or Barthel Index <95) at 3 months. Any HRQOL impairment was noted in 119 patients (35.8%). In multivariate analysis, age (adjusted odds ratio [OR] 1.02, 95% confidence interval [CI] 1.01-1.04), initial NIH Stroke Scale score (adjusted OR 1.39, 95% CI 1.17-1.64), recurrent stroke (adjusted OR 2.10, 95% CI 1.06-4.13), and proxy reporting (adjusted OR 3.94, 95% CI 1.54-10.10) were independent predictors of impaired HRQOL at 3 months. CONCLUSIONS Impairment in HRQOL is common at 3 months after MIS and TIA. Predictors of impaired HRQOL include age, index stroke severity, and recurrent stroke. Future studies should include HRQOL measures in outcome assessment, as these may be more sensitive to mild deficits than traditional disability scales.
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Affiliation(s)
- Rajbeer S Sangha
- From the Departments of Neurology (R.S.S., F.Z.C., C.C., R.B., Y.C., I.R., A.M.N., S.P.) and Medical Social Sciences (R.A., D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Fan Z Caprio
- From the Departments of Neurology (R.S.S., F.Z.C., C.C., R.B., Y.C., I.R., A.M.N., S.P.) and Medical Social Sciences (R.A., D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Robert Askew
- From the Departments of Neurology (R.S.S., F.Z.C., C.C., R.B., Y.C., I.R., A.M.N., S.P.) and Medical Social Sciences (R.A., D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Carlos Corado
- From the Departments of Neurology (R.S.S., F.Z.C., C.C., R.B., Y.C., I.R., A.M.N., S.P.) and Medical Social Sciences (R.A., D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Richard Bernstein
- From the Departments of Neurology (R.S.S., F.Z.C., C.C., R.B., Y.C., I.R., A.M.N., S.P.) and Medical Social Sciences (R.A., D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Yvonne Curran
- From the Departments of Neurology (R.S.S., F.Z.C., C.C., R.B., Y.C., I.R., A.M.N., S.P.) and Medical Social Sciences (R.A., D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Ilana Ruff
- From the Departments of Neurology (R.S.S., F.Z.C., C.C., R.B., Y.C., I.R., A.M.N., S.P.) and Medical Social Sciences (R.A., D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - David Cella
- From the Departments of Neurology (R.S.S., F.Z.C., C.C., R.B., Y.C., I.R., A.M.N., S.P.) and Medical Social Sciences (R.A., D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Andrew M Naidech
- From the Departments of Neurology (R.S.S., F.Z.C., C.C., R.B., Y.C., I.R., A.M.N., S.P.) and Medical Social Sciences (R.A., D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Shyam Prabhakaran
- From the Departments of Neurology (R.S.S., F.Z.C., C.C., R.B., Y.C., I.R., A.M.N., S.P.) and Medical Social Sciences (R.A., D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL.
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1878
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Wojak JC, Abruzzo TA, Bello JA, Blackham KA, Hirsch JA, Jayaraman MV, Dariushnia SR, Meyers PM, Midia M, Russell EJ, Walker TG, Nikolic B. Quality Improvement Guidelines for Adult Diagnostic Cervicocerebral Angiography: Update Cooperative Study between the Society of Interventional Radiology (SIR), American Society of Neuroradiology (ASNR), and Society of NeuroInterventional Surgery (SNIS). J Vasc Interv Radiol 2015; 26:1596-608. [DOI: 10.1016/j.jvir.2015.07.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 07/07/2015] [Accepted: 07/07/2015] [Indexed: 12/19/2022] Open
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1879
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Abdul Rani AA, Ab Ghani RM, Shamsuddin S, Abdullah Z, Abdul Halim NH, Mustapha N, Muhamad NA. Massage therapy for improving functional activity after stroke. Hippokratia 2015. [DOI: 10.1002/14651858.cd011924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Aidatul Azura Abdul Rani
- Ministry of Health Malaysia; Division of Traditional and Complementary Medicine; Block E, Jalan Cenderasari Kuala Lumpur Malaysia 50590
| | - Rimah Melati Ab Ghani
- Ministry of Health Malaysia; Division of Traditional and Complementary Medicine; Block E, Jalan Cenderasari Kuala Lumpur Malaysia 50590
| | - Shamsaini Shamsuddin
- Ministry of Health Malaysia; Division of Traditional and Complementary Medicine; Block E, Jalan Cenderasari Kuala Lumpur Malaysia 50590
| | - Zalilah Abdullah
- Ministry of Health Malaysia; Institute Health Systems Research; Suites 55-1 55-4 Setia Avenue No.2 Jalan Setia Prima S U 13 Seksyen U13 Setia Alam Shah Alam Selangor Malaysia 40170
| | - Nur Hidayati Abdul Halim
- Institute for Health Systems Research; Health Economics Research; No 55-1 Setia Avenue No 2 Jalan Setia Prima S U13/S Seksyen U 13, Setia Alam Shah Alam Selangor Malaysia 40170
| | - Normi Mustapha
- Universiti Sains Malaysia; School of Medical Sciences; Unit of Biostatistics and Research Methodology Health Campus Kubang Kerian Kelantan Malaysia 16150
| | - Nor Asiah Muhamad
- Institute for Medical Research; Medical Research Resource Centre; Jalan Pahang Kuala Lumpur Malaysia 50588
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1880
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Autonomic symptoms in hypertensive patients with post-acute minor ischemic stroke. Clin Neurol Neurosurg 2015; 139:188-91. [PMID: 26513431 DOI: 10.1016/j.clineuro.2015.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 07/09/2015] [Accepted: 10/07/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Most studies regarding autonomic dysfunction in ischemic stroke are limited to heart rate and blood pressure changes during the acute phase. However, there are few data on quantitative assessment of autonomic symptoms. We sought to assess autonomic symptoms in hypertensive ischemic stroke patients. METHODS In 100 hypertensive patients (45 with symptomatic ischemic stroke (6 months after stroke onset) and 55 without stroke), we assessed autonomic symptoms using the Scale for Outcomes in Parkinson disease-Autonomic (SCOPA-AUT). RESULTS The age (mean ± standard deviation) for the stroke group was 66 ± 12 and 63 ± 15 for the without stroke group (P=0.8). Orthostatic hypotension occurred in 3.6% of the stroke group and 4.4% in the group without stroke. The total SCOPA-AUT score was higher in the stroke group compared with the group without stroke (P=0.001). Domain scores for gastrointestinal (P=0.001), urinary (P=0.005) and cardiovascular (P=0.001) were higher in the stroke group. No differences were found when comparing the total SCOPA-AUT scores for stroke subtypes (P=0.168) and for lateralization (P=0.6). SCOPA AUT scores were correlated with depression scores (P=0.001) but not with stroke severity (P=0.2). CONCLUSION Autonomic symptoms, especially, gastrointestinal, urinary and cardiovascular function, were significantly increased in hypertensive patients with minor ischemic stroke. Symptoms were associated with depression but not with the characteristic of the stroke.
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1881
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Hicks KA, Tcheng JE, Bozkurt B, Chaitman BR, Cutlip DE, Farb A, Fonarow GC, Jacobs JP, Jaff MR, Lichtman JH, Limacher MC, Mahaffey KW, Mehran R, Nissen SE, Smith EE, Targum SL. 2014 ACC/AHA Key Data Elements and Definitions for Cardiovascular Endpoint Events in Clinical Trials: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards (Writing Committee to Develop Cardiovascular Endpoints Data Standards). J Nucl Cardiol 2015; 22:1041-144. [PMID: 26204990 DOI: 10.1007/s12350-015-0209-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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1882
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Pöss J, Desch S, Eitel C, de Waha S, Thiele H, Eitel I. Left Ventricular Thrombus Formation After ST-Segment–Elevation Myocardial Infarction. Circ Cardiovasc Imaging 2015; 8:e003417. [DOI: 10.1161/circimaging.115.003417] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Janine Pöss
- From the Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Luebeck, Medical Clinic II, Luebeck, Germany
| | - Steffen Desch
- From the Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Luebeck, Medical Clinic II, Luebeck, Germany
| | - Charlotte Eitel
- From the Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Luebeck, Medical Clinic II, Luebeck, Germany
| | - Suzanne de Waha
- From the Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Luebeck, Medical Clinic II, Luebeck, Germany
| | - Holger Thiele
- From the Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Luebeck, Medical Clinic II, Luebeck, Germany
| | - Ingo Eitel
- From the Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Luebeck, Medical Clinic II, Luebeck, Germany
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1883
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POLENZ GUSTAVOFREB, LEIRIA TIAGOLUIZLUZ, ESSEBAG VIDAL, KRUSE MARCELOLAPA, PIRES LEONARDOMARTINS, NOGUEIRA THAIZEBRISOLARA, GUIMARÃES RAPHAELBOESCHE, SANTANNA ROBERTOTOFANI, DE LIMA GUSTAVOGLOTZ. CHA2DS2VASc Score as a Predictor of Cardiovascular Events in Ambulatory Patients without Atrial Fibrillation. Pacing Clin Electrophysiol 2015; 38:1412-7. [DOI: 10.1111/pace.12744] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 07/22/2015] [Accepted: 08/15/2015] [Indexed: 11/28/2022]
Affiliation(s)
- GUSTAVO FREB POLENZ
- Electrophysiology Department of the Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia; Porto Alegre Rio Grande do Sul Brazil
| | - TIAGO LUIZ LUZ LEIRIA
- Electrophysiology Department of the Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia; Porto Alegre Rio Grande do Sul Brazil
| | - VIDAL ESSEBAG
- Cardiac Electrophysiology; McGill University Health Centre; Montreal Québec Canada
| | - MARCELO LAPA KRUSE
- Electrophysiology Department of the Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia; Porto Alegre Rio Grande do Sul Brazil
| | - LEONARDO MARTINS PIRES
- Electrophysiology Department of the Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia; Porto Alegre Rio Grande do Sul Brazil
| | - THAIZE BRISOLARA NOGUEIRA
- Electrophysiology Department of the Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia; Porto Alegre Rio Grande do Sul Brazil
| | - RAPHAEL BOESCHE GUIMARÃES
- Electrophysiology Department of the Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia; Porto Alegre Rio Grande do Sul Brazil
| | - ROBERTO TOFANI SANTANNA
- Electrophysiology Department of the Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia; Porto Alegre Rio Grande do Sul Brazil
| | - GUSTAVO GLOTZ DE LIMA
- Electrophysiology Department of the Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia; Porto Alegre Rio Grande do Sul Brazil
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1884
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Abstract
The nonselective monovalent cation channel transient receptor potential melastatin 4 (Trpm4) is transcriptionally upregulated in neural and vascular cells in animal models of brain infarction. It associates with sulfonylurea receptor 1 (Sur1) to form Sur1-Trpm4 channels, which have critical roles in cytotoxic edema, cell death, blood-brain barrier breakdown, and vasogenic edema. We examined Trpm4 expression in postmortem brain specimens from 15 patients who died within the first 31 days of the onset of focal cerebral ischemia. We found increased Trpm4 protein expression in all cases using immunohistochemistry; transcriptional upregulation was confirmed using in situ hybridization of Trpm4 messenger RNA. Transient receptor potential melastatin 4 colocalized and coassociated with Sur1 within ischemic endothelial cells and neurons. Coexpression of Sur1 and Trpm4 in necrotic endothelial cells was also associated with vasogenic edema indicated by upregulated perivascular tumor necrosis factor, extravasation of serum immunoglobulin G, and associated inflammation. Upregulated Trpm4 protein was present up to 1 month after the onset of cerebral ischemia. In a rat model of middle cerebral artery occlusion stroke, pharmacologic channel blockade by glibenclamide, a selective inhibitor of sulfonylurea receptor, mitigated perivascular tumor necrosis factor labeling. Thus, upregulated Sur1-Trpm4 channels and associated blood-brain barrier disruption and cerebral edema suggest that pharmacologic targeting of this channel may represent a promising therapeutic strategy for the clinical management of patients with cerebral ischemia.
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1885
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Vlisides P, Mashour GA. Perioperative stroke. Can J Anaesth 2015; 63:193-204. [PMID: 26391795 DOI: 10.1007/s12630-015-0494-9] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 07/02/2015] [Accepted: 09/11/2015] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Perioperative stroke is associated with significant morbidity and mortality, with an incidence that may be underappreciated. In this review, we examine the significance, pathophysiology, risk factors, and evidence-based recommendations for the prevention and management of perioperative stroke. SOURCE This is a narrative review based on literature from the PubMed database regarding perioperative stroke across a broad surgical population. The Society for Neuroscience in Anesthesiology and Critical Care recently published evidence-based recommendations for perioperative management of patients at high risk for stroke; these recommendations were analyzed and incorporated into this review. PRINCIPAL FINDINGS The incidence of overt perioperative stroke is highest in patients presenting for cardiac and major vascular surgery, although preliminary data suggest that the incidence of covert stroke may be as high as 10% in non-cardiac surgery patients. The pathophysiology of perioperative stroke involves different pathways. Thrombotic stroke can result from increased inflammation and hypercoagulability; cardioembolic stroke can result from disease states such as atrial fibrillation, and tissue hypoxia from anemia can result from the combination of anemia and beta-blockade. Across large-scale database studies, common risk factors for perioperative stroke include advanced age, history of cerebrovascular disease, ischemic heart disease, congestive heart failure, atrial fibrillation, and renal disease. Recommendations for prevention and management of perioperative stroke are evolving, though further work is needed to clarify the role of proposed modifiable risk factors such as perioperative anticoagulation, antiplatelet therapy, appropriate transfusion thresholds, and perioperative beta-blockade. CONCLUSIONS Perioperative stroke carries a significant clinical burden. The incidence of perioperative stroke may be higher than previously recognized, and there are diverse pathophysiologic mechanisms. There are many opportunities for further investigation of the pathophysiology, prevention, and management of perioperative stroke.
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Affiliation(s)
- Phillip Vlisides
- Department of Anesthesiology, University of Michigan Health System, University Hospital 1H247, 1500 East Medical Center Drive, SPC 5048, Ann Arbor, MI, 48109, USA
| | - George A Mashour
- Department of Anesthesiology, University of Michigan Health System, University Hospital 1H247, 1500 East Medical Center Drive, SPC 5048, Ann Arbor, MI, 48109, USA.
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1886
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Park TH, Choi JC. Validation of Stroke and Thrombolytic Therapy in Korean National Health Insurance Claim Data. J Clin Neurol 2015; 12:42-8. [PMID: 26365022 PMCID: PMC4712285 DOI: 10.3988/jcn.2016.12.1.42] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 06/08/2015] [Accepted: 06/10/2015] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose The claims data of the Korean National Health Insurance (NHI) system can be useful in stroke research. The aim of this study was to validate the accuracy of hospital discharge data used for NHI claims in identifying acute stroke and use of thrombolytic therapy. Methods The hospital discharge data of 1,811 patients with stroke-related diagnosis codes were obtained from Jeju National University Hospital (JNUH) and Seoul Medical Center (SMC). Three algorithms were tested to identify discharges with acute stroke [ischemic stroke (IS), intracranial hemorrhage (ICH), or subarachnoid hemorrhage (SAH)]: 1) all diagnosis codes up to nine positions, 2) one primary diagnosis and one secondary diagnosis, and 3) only one primary diagnosis code. Reviews of medical records were considered the gold standards. Results Overall, the degree of agreement (κ) was higher for algorithms 1 and 2 than for algorithm 3, and the sensitivity and specificity of the first two algorithms for IS and SAH were both >90%, with almost perfect agreement (κ=0.83-0.84) in the JNUH data set. Regarding ICH, only algorithm 1 yielded an almost perfect agreement (κ=0.82). In the SMC data set, almost perfect agreement was found for both ICH and SAH in all three algorithms. In contrast, the three algorithms yielded a range of agreement levels, though all substantial, for IS. Almost perfect agreement was obtained for use of thrombolytic therapy in both data sets (κ=0.91-0.99). Conclusions Discharge with hemorrhagic stroke and use of thrombolytic therapy were identified with high reliability in administrative discharge data. A substantial level of agreement was also obtained for IS, despite variation between the algorithms and data sets.
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Affiliation(s)
- Tai Hwan Park
- Department of Neurology, Seoul Medical Center, Seoul, Korea
| | - Jay Chol Choi
- Department of Neurology, School of Medicine, Jeju National University, Jeju, Korea.
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1887
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Shah SV, Corado C, Bergman D, Curran Y, Bernstein RA, Naidech AM, Prabhakaran S. Impact of Poststroke Medical Complications on 30-Day Readmission Rate. J Stroke Cerebrovasc Dis 2015; 24:1969-77. [DOI: 10.1016/j.jstrokecerebrovasdis.2015.04.037] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 03/18/2015] [Accepted: 04/05/2015] [Indexed: 10/23/2022] Open
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1888
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Thijs V, Butcher K. Challenges and misconceptions in the aetiology and management of atrial fibrillation-related strokes. Eur J Intern Med 2015; 26:461-7. [PMID: 26164438 DOI: 10.1016/j.ejim.2015.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 06/15/2015] [Accepted: 06/16/2015] [Indexed: 11/17/2022]
Abstract
Strokes, whether ischaemic or haemorrhagic, are the most feared complications of atrial fibrillation (AF) and its treatment. Vitamin K antagonists have been the mainstay of stroke prevention. Recently, direct oral anticoagulants have been introduced. The advantages and disadvantages of these treatment strategies have been extensively discussed. In this narrative review, we discuss dilemmas faced by primary care clinicians in the context of stroke and transient ischaemic attack (TIA) in patients with AF. We discuss the classification of stroke, the different types of stroke seen with AF, the prognosis of AF-related strokes, the early management after AF-related stroke or TIA and the therapeutic options after anticoagulant-associated intracerebral haemorrhage. Most importantly, we aim to dispel common misconceptions on the part of non-stroke specialists that can lead to suboptimal stroke prevention and management.
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Affiliation(s)
- V Thijs
- Division of Experimental Neurology, Department of Neurosciences, KU Leuven, Leuven, Belgium; Laboratory of Neurobiology, VIB Vesalius Research Center, Leuven, Belgium; Department of Neurology, University Hospitals Leuven, Leuven, Belgium.
| | - K Butcher
- Division of Neurology, University of Alberta, Edmonton, Alberta, Canada
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1889
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Purrucker JC, Hametner C, Engelbrecht A, Bruckner T, Popp E, Poli S. Comparison of stroke recognition and stroke severity scores for stroke detection in a single cohort. J Neurol Neurosurg Psychiatry 2015; 86:1021-8. [PMID: 25466259 DOI: 10.1136/jnnp-2014-309260] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Accepted: 11/03/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVE First, to determine the sensitivity and specificity of six stroke recognition scores in a single cohort to improve interscore comparability. Second, to test four stroke severity scores repurposed to recognise stroke in parallel. METHODS Of 9154 emergency runs, 689 consecutive cases of preclinically 'suspected central nervous system disorder' admitted to the emergency room (ER) of the Heidelberg University Hospital were included in the validation cohort. Using data abstracted from the neurological ER medical reports, retrospective assessment of stroke recognition scores became possible for the Cincinnati Prehospital Stroke Scale (CPSS), Face Arm Speech Test (FAST), Los Angeles Prehospital Stroke Screen (LAPSS), Melbourne Ambulance Stroke Screen (MASS), Medic Prehospital Assessment for Code Stroke (Med PACS) and Recognition of Stroke in the Emergency Room score (ROSIER), and that of stroke severity scores became possible for the Kurashiki Prehospital Stroke Scale (KPSS), Los Angeles Motor Scale (LAMS) and shortened National Institutes of Health Stroke Scale (sNIHSS)-8/sNIHSS-5. Test characteristics were calculated using the hospital discharge diagnosis as the reference standard. RESULTS The CPSS and FAST had a sensitivity of 83% (95% CI 76 to 88) and 85% (78% to 90%) and a specificity of 69% (64% to 73%) and 68% (63% to 72%), respectively. The more complex LAPSS, MASS and Med PACS had a high specificity (92% to 98%) but low sensitivity (44% to 71%). In the ROSIER, sensitivity (80%, 73 to 85) and specificity (79%, 75 to 83) were similar. Test characteristics for KPSS, sNIHSS-8 and sNIHSS-5 were similar to the simple recognition scores (sensitivity 83% to 86%, specificity 60% to 69%). The LAMS offered only low sensitivity. CONCLUSIONS The simple CPSS and FAST scores provide good sensitivity for stroke recognition. More complex scores do not result in better diagnostic performance. Stroke severity scores can be repurposed to recognise stroke at the same time because test characteristics are comparable with pure stroke recognition scores. Particular shortcomings of the individual scores are discussed.
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Affiliation(s)
- Jan C Purrucker
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Christian Hametner
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas Engelbrecht
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Erik Popp
- Department of Anesthesiology, University of Heidelberg, Heidelberg, Germany
| | - Sven Poli
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany Department of Neurology & Stroke, Tübingen University, Tübingen, Germany
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1890
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Kalani R, Bernstein R, Passman R, Curran Y, Ruff I, Prabhakaran S. Low Yield of Mobile Cardiac Outpatient Telemetry after Cryptogenic Stroke in Patients with Extensive Cardiac Imaging. J Stroke Cerebrovasc Dis 2015; 24:2069-73. [DOI: 10.1016/j.jstrokecerebrovasdis.2015.05.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 04/04/2015] [Accepted: 05/01/2015] [Indexed: 11/16/2022] Open
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1891
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Hioki H, Miura T, Motoki H, Kobayashi H, Kobayashi M, Nakajima H, Kimura H, Mawatari E, Akanuma H, Sato T, Ebisawa S, Miyashita Y, Ikeda U, Hotta S, Kamiyoshi Y, Maruyama T, Watanabe N, Eisawa T, Aso S, Uchikawa S, Hashizume N, Sekimura N, Morita T. Lean body mass index prognostic value for cardiovascular events in patients with coronary artery disease. HEART ASIA 2015; 7:12-18. [PMID: 26345318 PMCID: PMC4559317 DOI: 10.1136/heartasia-2015-010644] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 06/28/2015] [Accepted: 07/05/2015] [Indexed: 01/05/2023]
Abstract
Objective Little is known about the relationship between body composition indicators, including body mass index (BMI), fat mass index (FMI) and lean BMI (LBMI), and adverse outcomes after percutaneous coronary intervention (PCI) in Asian populations. The aim of this study was to clarify this relationship. Methods The SHINANO registry is a prospective, observational, multicenter cohort registry that enrolled 1923 consecutive patients with coronary heart disease (CHD) from August 2012 to July 2013; 66 patients were excluded because of missing data. We evaluated 1857 patients with CHD who underwent PCI (aged 70±11 years; 23% women; BMI 23.8±3.5 kg/m2; LBMI 18.3±1.8 kg/m2; FMI 5.4±2.2 kg/m2). Patients were divided into three groups, based on BMI, LBMI and FMI tertiles, to assess the prognostic value of the three indicators. The primary endpoint was major adverse cardiac events (MACE), including all cause death, non-fatal myocardial infarction and ischaemic stroke at 1 year. Results Over a 1 year follow-up period (1776 patients, 95.6%), the cumulative MACE incidence was 8.7% (161 cases). Using Kaplan–Meier analysis, the MACE incidence was significantly higher in patients with lower BMI values (13.4–22.2 kg/m2) (p=0.002) and lower LBMI values (11.6–17.6 kg/m2) (p<0.001); this trend was not observed for FMI. Multivariate Cox regression analysis showed that lower LBMI but not lower BMI values were predictive of a higher MACE incidence (HR 1.55; 95% CI 1.05 to 2.30). Conclusions Lower LBMI values are associated with adverse outcomes in an Asian population with CHD undergoing PCI. LBMI is a better predictor of MACE than BMI or FMI. Clinical trial registration UMIN-ID; 000010070.
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Affiliation(s)
- Hirofumi Hioki
- Department of Cardiovascular Medicine , Shinshu University School of Medicine , Matsumoto , Japan
| | - Takashi Miura
- Department of Cardiovascular Medicine , Shinshu University School of Medicine , Matsumoto , Japan
| | - Hirohiko Motoki
- Department of Cardiovascular Medicine , Shinshu University School of Medicine , Matsumoto , Japan
| | - Hideki Kobayashi
- Department of Cardiology , Nagano Red Cross Hospital , Nagano , Japan
| | - Masanori Kobayashi
- Department of Cardiology , Matsumoto Kyoritsu Hospital , Matsumoto , Japan
| | - Hiroyuki Nakajima
- Department of Cardiology , Nagano Matsushiro General Hospital , Nagano , Japan
| | - Hikaru Kimura
- Department of Cardiology , Saku Central Hospital , Saku , Japan
| | | | - Hiroshi Akanuma
- Department of Cardiology , Iida Municipal Hospital , Iida , Japan
| | - Toshio Sato
- Department of Cardiology , Shinonoi General Hospital , Nagano , Japan
| | - Souichirou Ebisawa
- Department of Cardiovascular Medicine , Shinshu University School of Medicine , Matsumoto , Japan
| | - Yusuke Miyashita
- Department of Cardiovascular Medicine , Shinshu University School of Medicine , Matsumoto , Japan
| | - Uichi Ikeda
- Department of Cardiovascular Medicine , Shinshu University School of Medicine , Matsumoto , Japan
| | | | - Shoji Hotta
- Department of Cardiovascular Medicine , Shinshu University School of Medicine , Matsumoto , Japan
| | - Yuichi Kamiyoshi
- Department of Cardiovascular Medicine , Shinshu University School of Medicine , Matsumoto , Japan
| | - Takuya Maruyama
- Department of Cardiovascular Medicine , Shinshu University School of Medicine , Matsumoto , Japan
| | - Noboru Watanabe
- Department of Cardiovascular Medicine , Shinshu University School of Medicine , Matsumoto , Japan
| | - Takayuki Eisawa
- Department of Cardiovascular Medicine , Shinshu University School of Medicine , Matsumoto , Japan
| | - Shinichi Aso
- Department of Cardiovascular Medicine , Shinshu University School of Medicine , Matsumoto , Japan
| | - Shinichirou Uchikawa
- Department of Cardiovascular Medicine , Shinshu University School of Medicine , Matsumoto , Japan
| | - Naoto Hashizume
- Department of Cardiovascular Medicine , Shinshu University School of Medicine , Matsumoto , Japan
| | - Noriyuki Sekimura
- Department of Cardiovascular Medicine , Shinshu University School of Medicine , Matsumoto , Japan
| | - Takehiro Morita
- Department of Cardiovascular Medicine , Shinshu University School of Medicine , Matsumoto , Japan
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1892
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McCormick N, Bhole V, Lacaille D, Avina-Zubieta JA. Validity of Diagnostic Codes for Acute Stroke in Administrative Databases: A Systematic Review. PLoS One 2015; 10:e0135834. [PMID: 26292280 PMCID: PMC4546158 DOI: 10.1371/journal.pone.0135834] [Citation(s) in RCA: 287] [Impact Index Per Article: 31.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 07/27/2015] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To conduct a systematic review of studies reporting on the validity of International Classification of Diseases (ICD) codes for identifying stroke in administrative data. METHODS MEDLINE and EMBASE were searched (inception to February 2015) for studies: (a) Using administrative data to identify stroke; or (b) Evaluating the validity of stroke codes in administrative data; and (c) Reporting validation statistics (sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), or Kappa scores) for stroke, or data sufficient for their calculation. Additional articles were located by hand search (up to February 2015) of original papers. Studies solely evaluating codes for transient ischaemic attack were excluded. Data were extracted by two independent reviewers; article quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool. RESULTS Seventy-seven studies published from 1976-2015 were included. The sensitivity of ICD-9 430-438/ICD-10 I60-I69 for any cerebrovascular disease was ≥ 82% in most [≥ 50%] studies, and specificity and NPV were both ≥ 95%. The PPV of these codes for any cerebrovascular disease was ≥ 81% in most studies, while the PPV specifically for acute stroke was ≤ 68%. In at least 50% of studies, PPVs were ≥ 93% for subarachnoid haemorrhage (ICD-9 430/ICD-10 I60), 89% for intracerebral haemorrhage (ICD-9 431/ICD-10 I61), and 82% for ischaemic stroke (ICD-9 434/ICD-10 I63 or ICD-9 434&436). For in-hospital deaths, sensitivity was 55%. For cerebrovascular disease or acute stroke as a cause-of-death on death certificates, sensitivity was ≤ 71% in most studies while PPV was ≥ 87%. CONCLUSIONS While most cases of prevalent cerebrovascular disease can be detected using 430-438/I60-I69 collectively, acute stroke must be defined using more specific codes. Most in-hospital deaths and death certificates with stroke as a cause-of-death correspond to true stroke deaths. Linking vital statistics and hospitalization data may improve the ascertainment of fatal stroke.
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Affiliation(s)
- Natalie McCormick
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
- Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Vidula Bhole
- Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Diane Lacaille
- Arthritis Research Canada, Richmond, British Columbia, Canada
- Division of Rheumatology, Department of Medicine. University of British Columbia, Vancouver, British Columbia, Canada
- Cardiovascular Committee of the CANRAD Network, Richmond, British Columbia, Canada
| | - J. Antonio Avina-Zubieta
- Arthritis Research Canada, Richmond, British Columbia, Canada
- Division of Rheumatology, Department of Medicine. University of British Columbia, Vancouver, British Columbia, Canada
- Cardiovascular Committee of the CANRAD Network, Richmond, British Columbia, Canada
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1893
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Haussen DC, Rose DZ, Drazin D, Newsome SD, Gardener H, Edgell RC, Boulos A, Bernardini G, Rundek T, Yavagal DR. Ipsilateral Infarct in Newly Diagnosed Cervical Internal Carotid Artery Atherosclerotic Occlusion. INTERVENTIONAL NEUROLOGY 2015; 3:142-8. [PMID: 26279661 DOI: 10.1159/000382133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We aimed to determine factors associated with recent infarct (RI) in patients with newly identified atherosclerotic cervical internal carotid artery occlusion (CICAO). METHODS This was a retrospective review of consecutive patients who underwent cervical CT angiography from 2002 to 2006 at a single tertiary center. RI was defined by positive diffusion-weighted imaging/apparent diffusion coefficient magnetic resonance imaging (MRI) in the correspondent CICAO territory. Subjects were dichotomized into those with a RI versus patients with no RI (No-RI). RESULTS Of 2,459 patients with cervical CT angiograms in the study period, 108 (4.4%) had complete medical records and brain MRI and were included. The mean age was 64 ± 13 years, 58% were men, and 62 (57%) had a RI. The demographics of the RI and No-RI patients were comparable, with the exception that those with RI had a lower frequency of coronary artery disease (CAD, 13 vs. 54%; p < 0.01) and dyslipidemia (38 vs. 69%; p < 0.01). The use of antiplatelets was not statistically different between the groups (56 vs. 71%; p = 0.1). Subjects with RI were less likely on statins (21 vs. 56%; p < 0.01) and antihypertensives (9 vs. 71%; p < 0.01). Multivariate regression revealed that CAD, the use of statins, and the use of antihypertensives were associated with No-RI CICAO presentation. CONCLUSION The use of statins and antihypertensives is associated with a decreased risk of RI atherosclerotic CICAO.
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Affiliation(s)
- Diogo C Haussen
- Department of Neurology, Neurosurgery and Radiology, Emory University School of Medicine, Atlanta, Ga., USA
| | - David Z Rose
- Department of Neurology, University of South Florida, Tampa, Fla., USA
| | - Doniel Drazin
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, Calif., USA
| | - Scott D Newsome
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Md., USA
| | - Hannah Gardener
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Fla., USA
| | - Randall C Edgell
- Department of Neurology and Psychiatry, St. Louis University, St. Louis, Mo., USA
| | - Alan Boulos
- Department of Neurosurgery, Albany Medical Center, Albany, N.Y., USA
| | - Gary Bernardini
- Department of Neurology, Albany Medical Center, Albany, N.Y., USA
| | - Tatjana Rundek
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Fla., USA
| | - Dileep R Yavagal
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Fla., USA
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1894
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Agarwal R. Defining end-stage renal disease in clinical trials: a framework for adjudication: Table 1. Nephrol Dial Transplant 2015; 31:864-7. [DOI: 10.1093/ndt/gfv289] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 06/29/2015] [Indexed: 11/14/2022] Open
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1895
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Carbone F, Teixeira PC, Braunersreuther V, Mach F, Vuilleumier N, Montecucco F. Pathophysiology and Treatments of Oxidative Injury in Ischemic Stroke: Focus on the Phagocytic NADPH Oxidase 2. Antioxid Redox Signal 2015; 23:460-89. [PMID: 24635113 PMCID: PMC4545676 DOI: 10.1089/ars.2013.5778] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
SIGNIFICANCE Phagocytes play a key role in promoting the oxidative stress after ischemic stroke occurrence. The phagocytic NADPH oxidase (NOX) 2 is a membrane-bound enzyme complex involved in the antimicrobial respiratory burst and free radical production in these cells. RECENT ADVANCES Different oxidants have been shown to induce opposite effects on neuronal homeostasis after a stroke. However, several experimental models support the detrimental effects of NOX activity (especially the phagocytic isoform) on brain recovery after stroke. Therapeutic strategies selectively targeting the neurotoxic ROS and increasing neuroprotective oxidants have recently produced promising results. CRITICAL ISSUES NOX2 might promote carotid plaque rupture and stroke occurrence. In addition, NOX2-derived reactive oxygen species (ROS) released by resident and recruited phagocytes enhance cerebral ischemic injury, activating the inflammatory apoptotic pathways. The aim of this review is to update evidence on phagocyte-related oxidative stress, focusing on the role of NOX2 as a potential therapeutic target to reduce ROS-related cerebral injury after stroke. FUTURE DIRECTIONS Radical scavenger compounds (such as Ebselen and Edaravone) are under clinical investigation as a therapeutic approach against stroke. On the other hand, NOX inhibition might represent a promising strategy to prevent the stroke-related injury. Although selective NOX inhibitors are not yet available, nonselective compounds (such as apocynin and fasudil) provided encouraging results in preclinical studies. Whereas additional studies are needed to better evaluate this therapeutic potential in human beings, the development of specific NOX inhibitors (such as monoclonal antibodies, small-molecule inhibitors, or aptamers) might further improve brain recovery after stroke.
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Affiliation(s)
- Federico Carbone
- 1 Division of Cardiology, Foundation for Medical Researches, Department of Medical Specialties, University of Geneva , Geneva, Switzerland .,2 Department of Internal Medicine, University of Genoa School of Medicine , IRCCS Azienda Ospedaliera Universitaria San Martino-IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | - Priscila Camillo Teixeira
- 3 Division of Laboratory Medicine, Department of Genetics and Laboratory Medicine, Geneva University Hospitals , Geneva, Switzerland
| | - Vincent Braunersreuther
- 1 Division of Cardiology, Foundation for Medical Researches, Department of Medical Specialties, University of Geneva , Geneva, Switzerland
| | - François Mach
- 1 Division of Cardiology, Foundation for Medical Researches, Department of Medical Specialties, University of Geneva , Geneva, Switzerland
| | - Nicolas Vuilleumier
- 3 Division of Laboratory Medicine, Department of Genetics and Laboratory Medicine, Geneva University Hospitals , Geneva, Switzerland
| | - Fabrizio Montecucco
- 1 Division of Cardiology, Foundation for Medical Researches, Department of Medical Specialties, University of Geneva , Geneva, Switzerland .,2 Department of Internal Medicine, University of Genoa School of Medicine , IRCCS Azienda Ospedaliera Universitaria San Martino-IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy .,3 Division of Laboratory Medicine, Department of Genetics and Laboratory Medicine, Geneva University Hospitals , Geneva, Switzerland
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1896
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Monge-Fuentes V, Gomes FMM, Campos GAA, Silva JDC, Biolchi AM, Dos Anjos LC, Gonçalves JC, Lopes KS, Mortari MR. Neuroactive compounds obtained from arthropod venoms as new therapeutic platforms for the treatment of neurological disorders. J Venom Anim Toxins Incl Trop Dis 2015; 21:31. [PMID: 26257776 PMCID: PMC4529710 DOI: 10.1186/s40409-015-0031-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 07/28/2015] [Indexed: 01/25/2023] Open
Abstract
The impact of neurological disorders in society is growing with alarming estimations for an incidence increase in the next decades. These disorders are generally chronic and can affect individuals early during productive life, imposing real limitations on the performance of their social roles. Patients can have their independence, autonomy, freedom, self-image, and self-confidence affected. In spite of their availability, drugs for the treatment of these disorders are commonly associated with side effects, which can vary in frequency and severity. Currently, no effective cure is known. Nowadays, the biopharmaceutical research community widely recognizes arthropod venoms as a rich source of bioactive compounds, providing a plethora of possibilities for the discovery of new neuroactive compounds, opening up novel and attractive opportunities in this field. Several identified molecules with a neuropharmacological profile can act in the central nervous system on different neuronal targets, rendering them useful tools for the study of neurological disorders. In this context, this review aims to describe the current main compounds extracted from arthropod venoms for the treatment of five major existing neurological disorders: stroke, Alzheimer’s disease, epilepsy, Parkinson’s disease, and pathological anxiety.
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Affiliation(s)
- Victoria Monge-Fuentes
- Laboratory of Neuropharmacology, Department of Physiological Sciences, Institute of Biological Sciences, University of Brasília, DF CEP 70.910-900, Brasília, Brazil
| | - Flávia Maria Medeiros Gomes
- Laboratory of Neuropharmacology, Department of Physiological Sciences, Institute of Biological Sciences, University of Brasília, DF CEP 70.910-900, Brasília, Brazil
| | - Gabriel Avohay Alves Campos
- Laboratory of Neuropharmacology, Department of Physiological Sciences, Institute of Biological Sciences, University of Brasília, DF CEP 70.910-900, Brasília, Brazil
| | - Juliana de Castro Silva
- Laboratory of Neuropharmacology, Department of Physiological Sciences, Institute of Biological Sciences, University of Brasília, DF CEP 70.910-900, Brasília, Brazil
| | - Andréia Mayer Biolchi
- Laboratory of Neuropharmacology, Department of Physiological Sciences, Institute of Biological Sciences, University of Brasília, DF CEP 70.910-900, Brasília, Brazil
| | - Lilian Carneiro Dos Anjos
- Laboratory of Neuropharmacology, Department of Physiological Sciences, Institute of Biological Sciences, University of Brasília, DF CEP 70.910-900, Brasília, Brazil
| | - Jacqueline Coimbra Gonçalves
- Laboratory of Neuropharmacology, Department of Physiological Sciences, Institute of Biological Sciences, University of Brasília, DF CEP 70.910-900, Brasília, Brazil
| | - Kamila Soares Lopes
- Laboratory of Neuropharmacology, Department of Physiological Sciences, Institute of Biological Sciences, University of Brasília, DF CEP 70.910-900, Brasília, Brazil
| | - Márcia Renata Mortari
- Laboratory of Neuropharmacology, Department of Physiological Sciences, Institute of Biological Sciences, University of Brasília, DF CEP 70.910-900, Brasília, Brazil
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1897
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Abstract
Stroke is the leading cause of disability in the USA and a major cause of mortality worldwide. One out of four strokes is recurrent. Secondary stroke prevention starts with deciphering the most likely stroke mechanism. In general, one of the main goals in stroke reduction is to control vascular risk factors such as hypertension, diabetes, dyslipidemia, and smoking cessation. Changes in lifestyle like a healthy diet and aerobic exercise are also recommended strategies. In the case of cardioembolism due to atrial fibrillation, mechanical valves, or cardiac thrombus, anticoagulation is the mainstay of therapy. The role of anticoagulation is less evident in the case of bioprosthetic valves, patent foramen ovale, and dilated cardiomyopathy with low ejection fraction. Strokes due to larger artery atherosclerosis account for approximately a third of all strokes. In the case of symptomatic extracranial carotid stenosis, surgical intervention as close as possible in time to the index event seems highly beneficial. In the case of intracranial large artery atherosclerosis, the best medical therapy consists of antiplatelets, high-dose statins, aggressive controls of vascular risk factors, and lifestyle modifications, with no role for intracranial arterial stenting or angioplasty. For patients with small artery occlusion (ie, lacunar stroke), the therapy is similar to that used in patients with intracranial large artery atherosclerosis. Despite the constant new evidence on how to best treat patients who have suffered a stroke, the risk of stroke recurrence remains unacceptably high, thus evidencing the need for novel therapies.
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Affiliation(s)
- Charles Esenwa
- Department of Neurology, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - Jose Gutierrez
- Department of Neurology, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
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1898
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Metformin and sitAgliptin in patients with impAired glucose tolerance and a recent TIA or minor ischemic Stroke (MAAS): study protocol for a randomized controlled trial. Trials 2015; 16:332. [PMID: 26242578 PMCID: PMC4526305 DOI: 10.1186/s13063-015-0882-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 07/22/2015] [Indexed: 02/08/2023] Open
Abstract
Background Impaired glucose tolerance is present in one third of patients with a TIA or ischemic stroke and is associated with a two-fold risk of recurrent stroke. Metformin improves glucose tolerance, but often leads to side effects. The aim of this study is to explore the feasibility, safety, and effects on glucose metabolism of metformin and sitagliptin in patients with TIA or minor ischemic stroke and impaired glucose tolerance. We will also assess whether a slow increase in metformin dose and better support and information on this treatment will reduce the incidence of side effects in these patients. Methods/Design The Metformin and sitAgliptin in patients with impAired glucose tolerance and a recent TIA or minor ischemic Stroke trial (MAAS trial) is a phase II, multicenter, randomized, controlled, open-label trial with blinded outcome assessment. Non-diabetic patients (n = 100) with a recent (<6 months) TIA, amaurosis fugax or minor ischemic stroke (modified Rankin scale ≤ 3) and impaired glucose tolerance, defined as 2-hour post-load glucose levels between 7.8 and 11.0 mmol/L after repeated standard oral glucose tolerance test, will be included. Patients with renal or liver impairment, heart failure, chronic hypoxic lung disease stage III–IV, history of lactate acidosis or diabetic ketoacidosis, pregnancy or breastfeeding, pancreatitis and use of digoxin will be excluded. The patients will be randomly assigned in a 1:1:2 ratio to metformin, sitagliptin or “no treatment.” Patients allocated to metformin will start with 500 mg twice daily, which will be slowly increased during a 6-week period to a twice daily dose of 1000 mg. Patients allocated to sitagliptin will be treated with a daily fixed dose of 100 mg. The study has been registered as NTR 3196 in The Netherlands Trial Register. Primary outcomes include percentage still on treatment, percentage of (serious) adverse events, and the baseline adjusted difference in 2-hour post-load glucose levels at 6 months. Discussion This study will give more information about the feasibility and safety of metformin and sitagliptin as well as the effect on 2-hour post-load glucose levels at 6 months in patients with TIA or ischemic stroke and impaired glucose tolerance. Trial registration number NTR3196, Date of registration: 15 December 2011.
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1899
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Charidimou A, Wilson D, Shakeshaft C, Ambler G, White M, Cohen H, Yousry T, Al-Shahi Salman R, Lip G, Houlden H, Jäger HR, Brown MM, Werring DJ. The Clinical Relevance of Microbleeds in Stroke study (CROMIS-2): rationale, design, and methods. Int J Stroke 2015; 10 Suppl A100:155-61. [PMID: 26235450 DOI: 10.1111/ijs.12569] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 06/02/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND RATIONALE The increasing use of oral anticoagulants, mostly to prevent ischemic stroke due to atrial fibrillation in an ageing population, has been associated with a fivefold increased incidence of oral anticoagulant-associated intracerebral hemorrhage: a rare, serious, and unpredictable complication. We hypothesize that cerebral microbleeds and other markers of cerebral small vessel disease on magnetic resonance imaging, and genetic polymorphisms (e.g. influencing cerebral small vessel integrity or anticoagulation stability), are associated with an increased risk of oral anticoagulant-associated intracerebral hemorrhage, with potential to improve risk prediction. AIMS (1) To determine the incidence, clinical, radiological, and genetic associations of oral anticoagulant-associated intracerebral hemorrhage in a prospective, multicentre cohort study of patients with atrial fibrillation-related ischemic stroke or transient ischemic attack started on oral anticoagulants; (2) To investigate characteristics of oral anticoagulant-associated intracerebral hemorrhage compared with non-oral anticoagulants related intracerebral hemorrhage in a prospective study. DESIGN AND METHODS Study 1: Prospective, multicentre, inception cohort study of 1425 adults started on oral anticoagulants (including vitamin K antagonists and the nonvitamin K oral anticoagulants) after recent ischemic stroke and concurrent atrial fibrillation. Participants will have standardized brain magnetic resonance imaging (including a T2*-weighted gradient-recalled echo sequence) and DNA sample collection at baseline, with two-year follow-up by postal questionnaire and medical records surveillance for symptomatic intracranial hemorrhage, other serious vascular events, and death. We will compare the rates of symptomatic intracranial hemorrhage (primary outcome; subclassified as intracerebral, subdural, extradural, intraventricular), other vascular events, and death (secondary outcomes) in participants with one or more cerebral microbleeds to the rates in those without cerebral microbleeds. STUDY Prospective case-control study of oral anticoagulant-associated intracerebral hemorrhage compared with non-oral anticoagulant-associated intracerebral hemorrhage to investigate genetic, clinical, and radiological associations with oral anticoagulant-associated intracerebral hemorrhage. In participants with intracerebral hemorrhage (including at least 300 with oral anticoagulant-associated intracerebral hemorrhage), we will collect a DNA sample, standardized clinical data and routine brain imaging (magnetic resonance imaging or computed tomography), and information on functional outcome. EXPECTED OUTCOMES We will identify the factors associated with increased intracranial hemorrhage risk after oral anticoagulants for secondary prevention after ischemic stroke due to atrial fibrillation. We will determine clinical, radiological and genetic factors, and clinical outcomes associated with oral anticoagulant-associated intracerebral hemorrhage.
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Affiliation(s)
- Andreas Charidimou
- UCL Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
| | - Duncan Wilson
- UCL Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
| | - Clare Shakeshaft
- UCL Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
| | | | - Mark White
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Hannah Cohen
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Tarek Yousry
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK.,Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, London, UK
| | - Rustam Al-Shahi Salman
- Division of Clinical Neurosciences, Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh, Edinburgh, UK
| | - Gregory Lip
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK
| | - Henry Houlden
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
| | - Hans R Jäger
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK.,University College London Hospitals NHS Foundation Trust, London, UK
| | - Martin M Brown
- UCL Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
| | - David J Werring
- UCL Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
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1900
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Yang L, Zhang H, Jiang X, Song L, Qin F, Zou Y, Wu H, Bian J, Zhou X, Hui R, Zheng D. Clinical Features and Outcomes of Takayasu Arteritis with Neurological Symptoms in China: A Retrospective Study. J Rheumatol 2015; 42:1846-52. [DOI: 10.3899/jrheum.150097] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2015] [Indexed: 11/22/2022]
Abstract
Objective.To describe the clinical features and longterm outcomes of patients with Takayasu arteritis (TA) in China who experienced neurological symptoms.Methods.A retrospective study was undertaken of patients with TA who attended a single study center from 2002 to 2013, who also exhibited neurological symptoms (n = 274). Clinical and imaging features were analyzed, as well as longterm outcomes.Results.The mean age at disease onset was 28.2 ± 11.2 years, with a female-to-male ratio of 4.3:1. The most common neurological manifestation was dizziness (214, 78.1%), the most frequent type of TA was type III (112, 40.9%), and the most common affected artery was the left subclavian (147, 53.6%). Involvement of 3 or 4 branches of the aortic arch was observed in 28% of patients. Among 30 patients experiencing a stroke (10.9%), steno-occlusive lesions of the subclavian artery and common carotid artery were frequently observed in patients with ischemic stroke, while steno-occlusive lesions of the descending aorta, abdominal aorta, and/or renal arteries were more frequently observed with hemorrhagic stroke. Heart failure was the most common cardiovascular event in those who died (n = 6) and in surviving cohorts.Conclusion.Neurological features in patients with TA were variable, and correlated with the number of arteries and the site of artery involvement. Resistant hypertension was one of the most important risk factors for hemorrhagic stroke in patients with TA.
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