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Akaishi T, Asari M, Sekiguchi S, Muroya T, Hasebe M. A Case With Bilateral Hippocampal Infarction Resembling Transient Global Amnesia. J Med Cases 2024; 15:159-166. [PMID: 39091574 PMCID: PMC11287902 DOI: 10.14740/jmc4240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Accepted: 06/11/2024] [Indexed: 08/04/2024] Open
Abstract
Transient global amnesia (TGA) is a benign and transient condition with a sudden short-term amnesia. One of the conditions resembling TGA is hippocampal infarction, which requires relapse prevention treatments. In this report, we present a case with bilateral hippocampal infarction in whom distinguishing these two conditions was difficult for up to 1 week from the onset. A 60-year-old female visited our hospital with sudden onset retrograde and anterograde amnesia. Thin-slice magnetic resonance imaging (MRI) with 2-mm thickness revealed hyperintense signals on diffusion-weighted imaging (DWI) with signal loss on apparent diffusion coefficient (ADC) on both sides of the hippocampus. MRI with 5-mm thickness on day 7 revealed persistent restricted diffusion on both sides, one of which was still with decreased ADC values. Based on this finding, the diagnosis of bilateral hippocampal infarction was reached, and the relapse-preventive antiplatelet was continued. This case implied the potential difficulty of distinguishing cases with TGA and those with hippocampal infarction based on MRI findings within the first several days after onset. Thin-slice brain MRI, careful search of potential cardiovascular risks, and follow-up MRI ≥ 7 days after onset will be helpful to reach a correct diagnosis in cases with sudden amnesia.
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Affiliation(s)
- Tetsuya Akaishi
- Department of Education and Support for Regional Medicine, Tohoku University, Sendai, Japan
| | - Mami Asari
- Department of Neurology, Izumi Hospital, Sendai, Japan
| | | | - Tomoko Muroya
- Department of Neurology, Izumi Hospital, Sendai, Japan
| | - Makoto Hasebe
- Department of Neurology, Izumi Hospital, Sendai, Japan
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Wen J, Hao X, Pang J, Li X, Chen C, Sun M, Geng S, Wang B, Jiang C. Association of hydration status and in-hospital mortality in critically ill patients with ischemic stroke: Data from the MIMIC-IV database. Clin Neurol Neurosurg 2024; 244:108451. [PMID: 39018993 DOI: 10.1016/j.clineuro.2024.108451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 07/10/2024] [Accepted: 07/12/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND Hydration plays a critical role in the pathophysiological progression of ischemic stroke. However, the impact of extreme hydration on the mortality of critically ill patients with ischemic stroke remains unclear. Therefore, our objective was to evaluate the association between hydration, as indicated by the blood urea nitrogen to creatinine ratio (UCR), and in-hospital mortality in critically ill patients with ischemic stroke. METHODS Data from the Medical Information Mart for Intensive Care (MIMIC-IV) database were utilized. Patients with ischemic stroke admitted to the Intensive Care Unit (ICU) for the first time were identified. The exposure variable was the hydration state represented by the UCR. The study outcome measure was in-hospital mortality. The primary analytical approach involved multivariate Cox regression analysis. Kaplan-Meier curves were constructed, and subgroup analyses with interaction were performed. RESULTS A total of 1539 patients, with a mean age of 69.9 years, were included in the study. Kaplan-Meier curves illustrated that patients in higher UCR tertiles exhibited increased in-hospital mortality. Accordingly, the risk of in-hospital mortality significantly rose by 29 % with every 10 units increase in UCR. Subgroup analysis indicated a robust association between UCR and in-hospital mortality in each subgroup, with no statistically significant interactions observed. CONCLUSION Hydration status is significantly associated with in-hospital all-cause mortality in critically ill patients with ischemic stroke. This finding underscores the importance of closely monitoring critically ill patients for adequate hydration and implementing appropriate rehydration strategies.
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Affiliation(s)
- Jiaqi Wen
- Department of Neurology, Baotou Central Hospital, Baotou, China; Inner Mongolia Autonomous Region Clinical Medical Research Center for Neurological Diseases, Baotou, China.
| | - Xiwa Hao
- Department of Neurology, Baotou Central Hospital, Baotou, China; Inner Mongolia Autonomous Region Clinical Medical Research Center for Neurological Diseases, Baotou, China.
| | - Jiangxia Pang
- Department of Neurology, Baotou Central Hospital, Baotou, China; Inner Mongolia Autonomous Region Clinical Medical Research Center for Neurological Diseases, Baotou, China.
| | - Xia Li
- Department of Neurology, Baotou Central Hospital, Baotou, China.
| | - Chao Chen
- Department of Neurology, Baotou Central Hospital, Baotou, China.
| | - Mingying Sun
- Department of Neurology, Baotou Central Hospital, Baotou, China.
| | - Shangyong Geng
- Department of Neurology, Baotou Central Hospital, Baotou, China.
| | - Baojun Wang
- Department of Neurology, Baotou Central Hospital, Baotou, China; Inner Mongolia Autonomous Region Clinical Medical Research Center for Neurological Diseases, Baotou, China.
| | - Changchun Jiang
- Department of Neurology, Baotou Central Hospital, Baotou, China; Inner Mongolia Autonomous Region Clinical Medical Research Center for Neurological Diseases, Baotou, China.
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Abe Y, Okada M, Tanaka K, Toyama K, Miyamoto Y, Hato N. The Association Between Dehydration and the Prognosis of Sudden Sensorineural Hearing Loss. OTOLOGY & NEUROTOLOGY OPEN 2023; 3:e041. [PMID: 38516543 PMCID: PMC10950149 DOI: 10.1097/ono.0000000000000041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/09/2023] [Indexed: 03/23/2024]
Abstract
Background There is an urgent need to identify undetermined risk factors for sudden sensorineural hearing loss (SSNHL) for the development of effective treatment strategies. SSNHL is likely associated with vascular insufficiency; however, no study has evaluated the relationship between dehydration and SSNHL. Objective This study aimed to investigate the role of dehydration in the development and prognosis of sudden sensorineural hearing loss. Study Design Retrospective case-control study. Setting Secondary referral hospital. Patients and Interventions This was a comparative study that compared dehydration parameters between healthy subjects without SSNHL (n = 94) and patients with SSNHL (n = 94). The study also evaluated the effect of dehydrated conditions on the prognosis of SSNHL. Main Outcome Measures We compared dehydration parameters, such as the blood urea nitrogen-to-creatinine ratio (BUN/Cre) and plasma osmolality (Posm), between matched healthy subjects without SSNHL and patients with SSNHL. To evaluate the effect of dehydrated conditions on the SSNHL prognosis, the SSNHL patients were divided into 2 groups based on the cutoff value obtained from the receiver operating characteristic analysis: hydrated (n = 50; BUN/Cre <21.4) and dehydrated (n = 44; BUN/Cre ≥21.4) groups. Subsequently, the severity and prognosis of SSNHL were analyzed. Results The dehydration parameters, BUN/Cre and Posm, were significantly higher in patients with SSNHL than in healthy subjects. The initial hearing levels and SSNHL grades were worse in the dehydrated group than in the hydrated group. Moreover, a dehydrated condition (BUN/Cre ≥21.4) was associated with a poor SSNHL prognosis in all models of the multiple logistic regression analysis. Conclusions The dehydration parameters of BUN/Cre and Posm were higher in patients with SSNHL than in healthy subjects. Additionally, a dehydrated condition (BUN/Cre ≥21.4) was an independent prognostic factor for SSNHL. Level of evidence: Level 4.
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Affiliation(s)
- Yasunori Abe
- Department of Otolaryngology, Head and Neck Surgery, Ehime University School of Medicine, Toon, Japan
- Department of Otolaryngology, Jyuzen General Hospital, Niihama, Japan
| | - Masahiro Okada
- Department of Otolaryngology, Head and Neck Surgery, Ehime University School of Medicine, Toon, Japan
| | - Keiko Tanaka
- Department of Epidemiology and Public Health, Ehime University Graduate School of Medicine, Toon, Japan
- Integrated Medical and Agricultural School of Public Health, Ehime University, Matsuyama & Toon, Japan
| | - Kensuke Toyama
- Department of Pharmacology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Yoshito Miyamoto
- Department of Otolaryngology, Jyuzen General Hospital, Niihama, Japan
| | - Naohito Hato
- Department of Otolaryngology, Head and Neck Surgery, Ehime University School of Medicine, Toon, Japan
- Integrated Medical and Agricultural School of Public Health, Ehime University, Matsuyama & Toon, Japan
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Miller C, Mcloughlin AS, Benedetto V, Christian DL, Jones SP, Smith E, Watkins CL. Diagnosis and treatment of dehydration after stroke: A synthesis of existing evidence. BRITISH JOURNAL OF NEUROSCIENCE NURSING 2023; 19:S24-S32. [PMID: 38812878 PMCID: PMC7616033 DOI: 10.12968/bjnn.2023.19.sup5.s24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
Dehydration after stroke is associated with poor health outcomes, increased mortality, and poses a significant economic burden to health services. Yet research suggests that monitoring and assessment of hydration status is not routinely undertaken. In this commentary, we critically appraise a systematic review which aimed to synthesise the existing evidence regarding diagnosis and treatment of dehydration after stroke. The review discusses common measures of dehydration, describes studies evaluating rehydration treatments, and highlights the link between dehydration and poorer health outcomes in both human and animal studies. The reviewers suggest, future research should focus on determining a single, validated, objective measure to clinically diagnose dehydration in stroke patients. Research designs should include clearly defined patient characteristics, type and severity of stroke, and type and time point of dehydration measurement, to enable comparison between studies. Management of hydration status is a crucial element of acute stroke care which should be routinely practiced.
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Affiliation(s)
- Colette Miller
- IMPlementation and Capacity building Team (IMPaCT), Applied Health Research Hub, University of Central of Central Lancashire (UCLan), Preston
- Stroke Research Team, School of Nursing and Midwifery, UCLan, Preston
- NIHR Applied Research Collaboration North West Coast (ARC NWC), UCLan, Preston
| | - Alison S.R. Mcloughlin
- IMPlementation and Capacity building Team (IMPaCT), Applied Health Research Hub, University of Central of Central Lancashire (UCLan), Preston
- NIHR Applied Research Collaboration North West Coast (ARC NWC), UCLan, Preston
| | - Valerio Benedetto
- NIHR Applied Research Collaboration North West Coast (ARC NWC), UCLan, Preston
- Methodological Innovation, Development, Adaptation & Support Theme (MIDAS), Applied Health Research Hub, University of Central
| | - Danielle L. Christian
- IMPlementation and Capacity building Team (IMPaCT), Applied Health Research Hub, University of Central of Central Lancashire (UCLan), Preston
- NIHR Applied Research Collaboration North West Coast (ARC NWC), UCLan, Preston
| | | | - Eleanor Smith
- NIHR Applied Research Collaboration North West Coast (ARC NWC), UCLan, Preston
| | - Caroline L. Watkins
- IMPlementation and Capacity building Team (IMPaCT), Applied Health Research Hub, University of Central of Central Lancashire (UCLan), Preston
- Stroke Research Team, School of Nursing and Midwifery, UCLan, Preston
- NIHR Applied Research Collaboration North West Coast (ARC NWC), UCLan, Preston
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Liu Y, Wang H, Xu R, He L, Wu K, Xu Y, Wang J, Xu F. Serum uric acid to serum creatinine ratio predicts neurological deterioration in branch atheromatous disease. Front Neurol 2023; 14:1098141. [PMID: 36741280 PMCID: PMC9895829 DOI: 10.3389/fneur.2023.1098141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/02/2023] [Indexed: 01/22/2023] Open
Abstract
Background and objective Branch atheromatous disease (BAD) makes patients prone to early neurological deterioration (END), resulting in poor prognosis. The aim of this study was to investigate the association between SUA/SCr and END in BAD stroke patients. Methods We conducted a retrospective study that included 241 patients with BAD-stroke within 48 h of symptom onset. We divided the patients into the END group and the no END group. END was defined as an NIHSS score increase of more than 2 points within 1 week. SUA/SCr was calculated by the concentration of serum uric acid and creatine (serum uric acid/serum creatine) on admission. Univariate and multivariate analyses were used to identify independent predictors of END in BAD-stroke patients. Results END was observed in 24.1% (58/241) of the patients in our study. Multiple logistic regression analyses showed that SUA/SCr (aOR, 0.716; 95% CI, 0.538-0.952; P = 0.022) and female sex (aOR, 0.469; 95% CI, 0.245-0.898; P = 0.022) were associated with END after adjusting for confounding factors. The predicted value of SUA/Scr for END was a sensitivity of 79.3%, a specificity of 44.8%, and an AUC of 0.609 (95% CI, 0.527-0.691, P < 0.05). The optimal cut-off value was 4.76. Conclusion SUA/SCr was negatively associated with the risk of END in BAD stroke patients.
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Affiliation(s)
- Yinglin Liu
- Department of Neurology, Chengdu Second People's Hospital, Chengdu, Sichuan, China
| | - Honglei Wang
- Department of Neurology, Yibin Second People's Hospital, Yibin, Sichuan, China
| | - Ronghua Xu
- Department of Neurology, Chengdu Second People's Hospital, Chengdu, Sichuan, China
| | - Lanying He
- Department of Neurology, Chengdu Second People's Hospital, Chengdu, Sichuan, China
| | - Kun Wu
- Department of Laboratory, Yibin Sixth People's Hospital, Yibin, Sichuan, China
| | - Yao Xu
- Department of Radiology, Pingshan County People's Hospital, Chengdu, Sichuan, China
| | - Jian Wang
- Department of Neurology, Chengdu Second People's Hospital, Chengdu, Sichuan, China,*Correspondence: Jian Wang ✉
| | - Fan Xu
- Department of Public Health, School of Public Health, Chengdu Medical College, Chengdu, Sichuan, China,Fan Xu ✉
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Abstract
Background We hypothesized that stroke outcome is related to multiple baseline hydration-related factors including volume contracted state (VCS) and diuretic use. Methods and Results We analyzed a prospective cohort of subjects with ischemic stroke <24 hours of onset enrolled in acute treatment trials within VISTA (Virtual International Stroke Trials Archive). A VCS was defined based on blood urea nitrogen-to-creatinine ratio. The primary end point was modified Rankin Scale score at 90 days. Primary analysis used generalized ordinal logistic regression over the mRS range, adjusted for Totaled Health Risks in Vascular Events score, onset-to-enrollment time, and thrombolytic use. Of 5971 eligible patients with stroke, 42% were taking diuretics at the time of hospitalization, and 44% were in a VCS. Patients in a VCS were older, had more vascular risk factors, were more likely taking diuretics, and had more severe strokes. Diuretic use was associated with both reduced chance of achieving a good functional outcome (odds ratio [OR], 0.57 [95% CI, 0.52-0.63]) and increased mortality at 90 days (OR, 2.30 [95% CI, 2.04-2.61]). VCS was associated with greater mortality 90 days after stroke (OR, 1.53 [95% CI, 1.33-1.76]). There was no evidence of effect modification among the 3 exposures of VCS, diuretic use, or hypokalemia in relation to outcome. Conclusions A VCS at the time of hospitalization was associated with more severe stroke and odds of death but not associated with worse functional outcome when accounting for relevant characteristics. Diuretic use and low serum potassium at the time of stroke onset were associated with worse outcome and may be worthy of further investigation.
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Affiliation(s)
| | | | - Philip M. Bath
- Stroke Trials Unit, University of NottinghamNottinghamUnited Kingdom
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Chen Z, Wang J, Yang H, Li H, Chen R, Yu J. Relationship between the Blood Urea Nitrogen to Creatinine Ratio and In-Hospital Mortality in Non-Traumatic Subarachnoid Hemorrhage Patients: Based on Propensity Score Matching Method. J Clin Med 2022; 11:jcm11237031. [PMID: 36498609 PMCID: PMC9736588 DOI: 10.3390/jcm11237031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/23/2022] [Accepted: 11/25/2022] [Indexed: 11/30/2022] Open
Abstract
(1) Background: To explore the correlation between the blood urea nitrogen to creatinine ratio (UCR) and in-hospital mortality in non-traumatic subarachnoid hemorrhage patients. (2) Methods: Specific clinical information was collected from the Medical Information Mart for Intensive Ⅳ (MIMIC-Ⅳ) database. The optimal cut-off value of the UCR was calculated with ROC curve analysis conducted using the maximum Youden index for the prediction of survival status. Univariable and multivariable logistic regression analyses were also carried out to assess the prognostic significance of UCR, and the Kaplan−Meier (K−M) analysis was conducted to draw the survival curves. Then, the 1:1 propensity score matching (PSM) method was applied to improve the reliability of the research results while balancing the unintended influence of underlying confounders. (3) Results: This retrospective cohort study included 961 patients. The optimal cut-off value of the UCR for in-hospital mortality was 27.208. The PSM was performed to identify 92 pairs of score-matched patients, with balanced differences exhibited for nearly all variables. According to the K−M analysis, those patients with a UCR of more than 27.208 showed a significantly higher level of in-hospital mortality compared to the patients with a UCR of less than 27.208 (p < 0.05). After the adjustment for possible confounders, those patients whose UCR was more than 27.208 still had a significantly higher level of in-hospital mortality than the patients whose UCR was less than 27.208, as revealed by the multivariable logistic regression analysis (OR = 3.783, 95% CI: 1.959~7.305, p < 0.001). Similarly, the in-hospital mortality remained substantially higher for those patients in the higher UCR group than for the patients in the lower UCR group after PSM. (4) Conclusion: A higher level of the UCR was evidently associated with an increased risk of in-hospital mortality, which made the ratio useful as a prognostic predictor of clinical outcomes for those patients with non-traumatic subarachnoid hemorrhage.
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Meng YH, Lin PY, Wu YH, Hou PC, How CK, Chen CT. Prognostic significance of the blood urea nitrogen to creatinine ratio in in-hospital cardiac arrest after targeted temperature management. J Chin Med Assoc 2022; 85:987-992. [PMID: 35727104 DOI: 10.1097/jcma.0000000000000767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Targeted temperature management (TTM) has been reported to improve outcomes in in-hospital cardiac arrest (IHCA) patients but little has been investigated into the relationship between prognoses and the blood urea nitrogen to creatinine ratio (BCR). METHODS A retrospective analysis of data from IHCA survivors treated with TTM between 2011 and 2018 was conducted based on the Research Patient Database Registry of the Partners HealthCare system in Boston. Serum laboratory data were measured during IHCA and within 24 hours after TTM completion. Intra-arrest and post-TTM BCRs were calculated, respectively. The primary outcome was neurologic status at discharge. The secondary outcome was in-hospital mortality. RESULTS The study included 84 patients; 63 (75%) were discharged with a poor neurologic status and 40 (47.6%) died. Regarding poor neurological outcome at discharge, multivariate analysis revealed that post-TTM BCR was a significant predictor (adjusted OR, 1.081; 95% CI, 1.002-1.165; p = 0.043) and intra-arrest BCR was a marginal predictor (adjusted OR, 1.067; 95% CI, 1.000-1.138; p = 0.050). Post-TTM BCR had an acceptably predictive ability to discriminate neurological status at discharge, with an area under the receiver-operating characteristic curve of 0.644 (95% CI, 0.516-0.773) and a post-TTM BCR cutoff value of 16.7 had a sensitivity of 61.9% and a specificity of 70.0%. CONCLUSION Post-TTM BCR was a significant predictor of the neurologic outcome at discharge among IHCA patients receiving TTM. IHCA patients with elevated intra-arrest BCR also had a borderline poor neurological prognosis at discharge.
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Affiliation(s)
- Yu-Hsiang Meng
- Emergency Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Pei-Ying Lin
- Emergency Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yu-Hsuan Wu
- Nursing Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Peter Chuanyi Hou
- Division of Emergency Critical Care Medicine, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Chorng-Kuang How
- Emergency Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Kinmen Hospital, Ministry of Health and Welfare, Kinmen, Taiwan, ROC
| | - Chung-Ting Chen
- Emergency Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan, ROC
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Jiang WF, Deng ML. Prognostic impact of blood urea nitrogen/creatinine ratio changes in patients with acute ischemic stroke. Clin Neurol Neurosurg 2022; 215:107204. [DOI: 10.1016/j.clineuro.2022.107204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/14/2022] [Accepted: 03/07/2022] [Indexed: 12/01/2022]
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Effects of Early Rehydration on Brain Perfusion and Infarct Core after Middle Cerebral Artery Occlusion in Rats. Brain Sci 2021; 11:brainsci11040439. [PMID: 33805440 PMCID: PMC8066368 DOI: 10.3390/brainsci11040439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/23/2021] [Accepted: 03/25/2021] [Indexed: 12/05/2022] Open
Abstract
Imaging evidence for the effect of rehydration on cerebral perfusion and brain ischemia has never been proposed in the literature. This study aimed to test the hypothesis that early rehydration treatment can improve cerebral perfusion and decrease infarct volume, consequently reducing mortality of dehydrated stroke animals. Methods: Thirty dehydrated experimental rats were randomly assigned to either a rehydration or control group after middle cerebral artery occlusion (MCAO). Diffusion-weighted imaging and dynamic contrast enhancement perfusion imaging were performed at 30 min and 6 h after MCAO using a 9.4T MR imaging scanner to measure the infarct volume and brain perfusion. Results: The survival rates after the first MRI scan were 91.7% for the rehydration group and 58.3% for the control group (p = 0.059). The survival rates after the second MRI scan were 66.7% for the rehydration group, and 8.3% of the control group survived (p = 0.003). The infarct volume of the rehydration group was significantly smaller than control group at 30 min after MCAO (p = 0.007). The delay time and time to maximum were significantly shorter in the rehydration group at 30 min (p = 0.004 and 0.035, respectively). Conclusions: The findings suggest that early rehydration therapy can decrease the infarct volume, shorten the delay time of cerebral perfusion, and increase survival of dehydrated ischemic-stroke rats. This preliminary study provided imaging evidence that more intensive early hydration therapies and reperfusion strategies may be necessary for acute stroke patients with dehydrated status.
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Joachim MV, Ghantous Y, Zaaroura S, Alkeesh K, Zoabi T, Abu el-Na’aj I. Does fasting during Ramadan increase the risk of the development of sialadenitis? BMC Oral Health 2020; 20:156. [PMID: 32471399 PMCID: PMC7260764 DOI: 10.1186/s12903-020-01139-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 05/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ramadan is a month within the Islamic lunar calendar when Muslims are required to fast (abstain from food and drink) during the daytime (from sunrise to sunset) for the entire month. Due to the established connection between fasting and dehydration and acute sialadenitis, the aim of this study is to determine if there is a higher frequency of sialadenitis among the Muslim population during Ramadan than during other months of the year. METHODS We conducted a retrospective study using the medical records of 120 Muslim patients admitted to the emergency room (ER) and diagnosed with acute sialadenitis over a 5-year period at the Baruch Padeh Medical Center, Poriya, and St. Vincent de Paul (French) Hospital, Nazareth, both located in Israel. The study group were Muslim patients, with the aforementioned diagnosis, admitted during Ramadan, while the control group included patients diagnosed with sialadenitis during the rest of the year. We analyzed overall admission frequency as well as descriptive and diagnostic data, including age, sex, gland involved and several blood test results. RESULTS During the month of Ramadan, the admission of Muslims with a diagnosis of acute sialadenitis was more than double that during the other months of the year - a difference that was found to be statistically significant (p = 0.001). Additionally, we found that Ramadan sialadenitis patients had significantly higher leukocyte numbers at admission (p = 0.0085) and, importantly, a significantly higher level of dehydration (blood urea nitrogen (BUN)/creatinine ratio) than non-Ramadan sialadenitis patients (p = 0.0001). CONCLUSION There is evidence that fasting in Ramadan may increase the risk for the development of acute sialadenitis. Our results suggest that this may be the result of dehydration.
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Affiliation(s)
- Michael V. Joachim
- Department of Oral & Maxillofacial Surgery, Baruch Padeh Medical Center, Poriya, Israel and Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Yasmine Ghantous
- Department of Oral & Maxillofacial Surgery, Baruch Padeh Medical Center, MP Lower Galilee, Poriya, 1520800 Israel
| | - Suleiman Zaaroura
- Department of Otolaryngology, St. Vincent de Paul (French) Hospital, POB 50294, Nazareth, 1616102 Israel
| | - Kutaiba Alkeesh
- Department of Oral & Maxillofacial Surgery, Baruch Padeh Medical Center, MP Lower Galilee, Poriya, 1520800 Israel
| | - Tameem Zoabi
- Department of Otolaryngology, St. Vincent de Paul (French) Hospital, POB 50294, Nazareth, 1616102 Israel
| | - Imad Abu el-Na’aj
- Department of Oral & Maxillofacial Surgery, Baruch Padeh Medical Center, Poriya, Israel and Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
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Lacey J, Corbett J, Forni L, Hooper L, Hughes F, Minto G, Moss C, Price S, Whyte G, Woodcock T, Mythen M, Montgomery H. A multidisciplinary consensus on dehydration: definitions, diagnostic methods and clinical implications. Ann Med 2019; 51:232-251. [PMID: 31204514 PMCID: PMC7877883 DOI: 10.1080/07853890.2019.1628352] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/28/2019] [Accepted: 05/28/2019] [Indexed: 01/02/2023] Open
Abstract
Background: Dehydration appears prevalent, costly and associated with adverse outcomes. We sought to generate consensus on such key issues and elucidate need for further scientific enquiry. Materials and methods: A modified Delphi process combined expert opinion and evidence appraisal. Twelve relevant experts addressed dehydration's definition, objective markers and impact on physiology and outcome. Results: Fifteen consensus statements and seven research recommendations were generated. Key findings, evidenced in detail, were that there is no universally accepted definition for dehydration; hydration assessment is complex and requires combining physiological and laboratory variables; "dehydration" and "hypovolaemia" are incorrectly used interchangeably; abnormal hydration status includes relative and/or absolute abnormalities in body water and serum/plasma osmolality (pOsm); raised pOsm usually indicates dehydration; direct measurement of pOsm is the gold standard for determining dehydration; pOsm >300 and ≤280 mOsm/kg classifies a person as hyper or hypo-osmolar; outside extremes, signs of adult dehydration are subtle and unreliable; dehydration is common in hospitals and care homes and associated with poorer outcomes. Discussion: Dehydration poses risk to public health. Dehydration is under-recognized and poorly managed in hospital and community-based care. Further research is required to improve assessment and management of dehydration and the authors have made recommendations to focus academic endeavours. Key messages Dehydration assessment is a major clinical challenge due to a complex, varying pathophysiology, non-specific clinical presentations and the lack of international consensus on definition and diagnosis. Plasma osmolality represents a valuable, objective surrogate marker of hypertonic dehydration which is underutilized in clinical practice. Dehydration is prevalent within the healthcare setting and in the community, and appears associated with increased morbidity and mortality.
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Affiliation(s)
- Jonathan Lacey
- Institute of Sport Exercise & Health, University College London, London, UK
| | - Jo Corbett
- Department of Sport & Exercise Science, University of Portsmouth, Portsmouth, UK
| | - Lui Forni
- Intensive Care Unit, Royal Surrey County Hospital, Guildford, UK
| | - Lee Hooper
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Fintan Hughes
- Institute of Sport Exercise & Health, University College London, London, UK
| | - Gary Minto
- Department of Anaesthesia, University Hospitals Plymouth, Plymouth, UK
- Peninsula School of Medicine, Plymouth, UK
| | - Charlotte Moss
- Division of Surgery & Interventional Science, University College London, London, UK
| | - Susanna Price
- Intensive Care Unit, Royal Brompton Hospital, London, UK
| | - Greg Whyte
- Research Institute for Sport & Exercise Science, Liverpool John Moores University, UK
| | - Tom Woodcock
- Formerly Consultant University Hospitals Southampton NHS Trust, Southampton, UK
| | - Michael Mythen
- Institute of Sport Exercise & Health, University College London, London, UK
| | - Hugh Montgomery
- Centre for Human Health and Performance, University College London, London, UK
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14
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Buoite Stella A, Gaio M, Furlanis G, Douglas P, Naccarato M, Manganotti P. Fluid and energy intake in stroke patients during acute hospitalization in a stroke unit. J Clin Neurosci 2019; 62:27-32. [PMID: 30655231 DOI: 10.1016/j.jocn.2019.01.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 01/04/2019] [Indexed: 10/27/2022]
Abstract
Proper hydration and nutrition have been found to be contributing factors to a better recovery in patients after stroke. A better knowledge of factors influencing fluid and energy intake may contribute to a better care of the acute stroke patient. Aim of this study was to describe hydration status, fluid intake, and energy intake of stroke patients during acute hospitalization in a stroke unit. A retrospective descriptive study was conducted in stroke patients admitted to a stroke unit. All patients received neurological evaluation and urinary osmolality (uOsm) measure at admission and discharge. During stroke unit stay patients received a day-by-day diary to record data about beverages, food, and therapy. Water and energy content were then reported based on a national nutritional database. Ninety-five patients were included in the analysis. uOsm did not differ between patients with or without dysphagia, with uOsm > 500 mosm/kg in 58.1% at admission and 57.8% at discharge. Inadequate fluid intake was found in 41.2% of the sample with no difference between groups. Insufficient energy intake was found in 95.6% of the sample, with no patients with dysphagia reaching the minimum suggested amount. Our results suggest that a relevant proportion of stroke patients with and without dysphagia may not improve their hydration status during the first days after admission. Diet and therapy were insufficient to achieve recommended fluid intake and energy intake in a large proportion of patients, suggesting a more careful monitoring of hydration and nutrition needs.
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Affiliation(s)
- Alex Buoite Stella
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Trieste, Italy.
| | - Marina Gaio
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Trieste, Italy
| | - Giovanni Furlanis
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Trieste, Italy
| | - Pauline Douglas
- Nutrition Innovation Centre for Food and Health (NICHE), Ulster University, Coleraine BT52 1SA, Northern Ireland, United Kingdom
| | - Marcello Naccarato
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Trieste, Italy
| | - Paolo Manganotti
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Trieste, Italy
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15
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Izol V, Ardo IA, Tansu Z, Doran F, Eren Erdo& K, Mahir Kapl H, ingirik E, Ertu P, Pazarci P. Hypericum perforatum Extract Against Oxidative Stress, Apoptosis and Oedema in Kidney Induced by Gentamicin. INT J PHARMACOL 2018. [DOI: 10.3923/ijp.2019.66.73] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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16
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Liu K, Pei L, Gao Y, Zhao L, Fang H, Bunda B, Fisher L, Wang Y, Li S, Li Y, Guan S, Guo X, Xu H, Xu Y, Song B. Dehydration Status Predicts Short-Term and Long-Term Outcomes in Patients with Cerebral Venous Thrombosis. Neurocrit Care 2018; 30:478-483. [DOI: 10.1007/s12028-018-0628-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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17
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Lin J, Jiang A, Ling M, Mo Y, Li M, Zhao J. Prediction of neurologic deterioration based on support vector machine algorithms and serum osmolarity equations. Brain Behav 2018; 8:e01023. [PMID: 29888877 PMCID: PMC6043694 DOI: 10.1002/brb3.1023] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 04/22/2018] [Accepted: 04/30/2018] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Dehydration on admission is correlated with neurological deterioration (ND). The primary objective of our study was to use support vector machine (SVM) algorithms to identify an ND prognostic model, based on dehydration equations. METHODS This study included a total of 382 patients hospitalized with acute ischemic stroke. The following parameters were recorded: age, sex, laboratory values (serum sodium, potassium, chlorinum, glucose, and urea), and vascular risk factor data. Receiver operating characteristic (ROC) curve analysis was used to evaluate the discriminative performance of the BUN/Cr ratio as well as each of 38 equations for predicting ND. We used the Boruta algorithm for feature selection. After optimizing the SVM kernel parameters, we built an SVM model to predict ND and used the test set to obtain predictive values for assessing model accuracy. RESULTS In total, 102 of 382 patients (26.7%) with acute ischemic stroke developed ND. In all patients, the BUN/Cr ratio and each of 38 equations were significant predictors of ND. Equation 20 [1.86 × Na+ + glucose + urea + 9] yielded the maximum area under the ROC curve, and faired best in terms of prognostic performance (a cutoff value of 284.49 mM yielded a sensitivity of 94.12% and specificity of 61.43%). Equation 32 predicted ND poststroke across population groups, and worked well in older as well as young adults; (a cutoff value of 297.08 mM yielded a sensitivity of 93.14% and specificity of 60.00%). Feature selection by the Boruta algorithm was used to decrease the number of variables from 18 to 5 in the condition. The specificity of test samples for the SVM prediction model increased from 44.1% to 89.4%, and the AUC increased from 0.700 to 0.927. CONCLUSIONS SVM algorithms can be used to establish a prediction model for dehydration-associated ND, with good classification results.
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Affiliation(s)
- Jixian Lin
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, China
| | - Aihua Jiang
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, China
| | - Meirong Ling
- Emergency Department, Minhang Hospital, Fudan University, Shanghai, China
| | - Yanqing Mo
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, China.,Institute of Fudan-Minhang Academic Health System, Minhang Hospital, Fudan University, Shanghai, China
| | - Meiyi Li
- Institute of Fudan-Minhang Academic Health System, Minhang Hospital, Fudan University, Shanghai, China
| | - Jing Zhao
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, China
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18
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Lin J, Weng Y, Li M, Mo Y, Zhao J. Hydration prevents chronic hyperglycaemic patients from neurological deterioration post-ischaemic stroke. Acta Neurol Scand 2018; 137:557-565. [PMID: 29363095 DOI: 10.1111/ane.12900] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To determine whether chronic hyperglycaemia predisposes patients to dehydration, which may promote neurological deterioration, and to investigate whether dehydration control improves functional outcome. PATIENTS AND METHODS This study included 355 patients hospitalized with acute ischaemic stroke and diabetes mellitus who fulfilled the glycaemic gap ≤0. We used the following cut-offs: (i) no chronic hyperglycaemia (glycated haemoglobin A1c [HbA1c] < 7%) and (ii) chronic hyperglycaemia (HbA1c ≥ 7%). The chronic hyperglycaemic patients were randomly divided into the control group and the hydration group. Hydration therapy was only initiated in the hydration group. The blood urea nitrogen (BUN)/creatinine (Cr) ratio was used as an indicator of dehydration. Stroke severity on admission and discharge was assessed by means of National Institutes of Health Stroke Scale (NIHSS). RESULTS The mean baseline BUN/Cr ratios were higher in the control group and hydration group than in the no chronic hyperglycaemia group. The mean BUN/Cr ratio decreased from 91.22 ± 29.95 on the first day to 77.03 ± 18.23 on the third day (P < .001) in the hydration group. On the third day after admission, there was no significant difference in the BUN/Cr ratio between the hydration group and the no chronic hyperglycaemia group (P = .831). Moreover, neurological deterioration was highest in the control group (33.6%, 36/107), followed by the hydration group (10.5%, 11/105) and the no chronic hyperglycaemia group (5.6%, 8/143). CONCLUSIONS Chronic hyperglycaemia was associated with the admission NIHSS score and neurological deterioration after excluding the effect of stress hyperglycaemia. Furthermore, hydration therapy may help prevent neurological deterioration.
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Affiliation(s)
- J. Lin
- Department of Neurology; Minhang Branch; Zhongshan Hospital; Fudan University; Shanghai China
- Institute of Fudan-Minhang Academic Health System; Minhang Hospital; Fudan University; Shanghai China
| | - Y. Weng
- Department of Neurology; Minhang Branch; Zhongshan Hospital; Fudan University; Shanghai China
- Institute of Fudan-Minhang Academic Health System; Minhang Hospital; Fudan University; Shanghai China
| | - M. Li
- Department of Neurology; Minhang Branch; Zhongshan Hospital; Fudan University; Shanghai China
- Institute of Fudan-Minhang Academic Health System; Minhang Hospital; Fudan University; Shanghai China
| | - Y. Mo
- Department of Neurology; Minhang Branch; Zhongshan Hospital; Fudan University; Shanghai China
- Institute of Fudan-Minhang Academic Health System; Minhang Hospital; Fudan University; Shanghai China
| | - J. Zhao
- Department of Neurology; Minhang Branch; Zhongshan Hospital; Fudan University; Shanghai China
- Institute of Fudan-Minhang Academic Health System; Minhang Hospital; Fudan University; Shanghai China
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19
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Primary 'dehydration' and acute stroke: a systematic research review. J Neurol 2018; 265:2167-2181. [PMID: 29497817 DOI: 10.1007/s00415-018-8799-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 02/12/2018] [Accepted: 02/14/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND AND PURPOSE Hydration status at the time of stroke has been acknowledged as an important determinant in early stroke recovery. However, the diagnosis of dehydration, or more accurately, a volume-contracted state, at the time of stroke is challenging since there are currently no consensus diagnostic criteria. In this systematic review, we gather the available evidence about diagnosis and treatment of dehydration after stroke. METHODS Studies of hospitalized ischemic stroke patients that reported rates of dehydration from January 1997 to March 2017 were screened for inclusion via a systematic search of PubMed, CINAHL, Cochrane, and Scopus using keywords hydration, dehydration, hemodilution, viscosity, volume status, and thirst. RESULTS Twenty-five studies of 8699 acute stroke patients were included. Nineteen studies reported on the diagnostic approach to dehydration. Findings are synthesized into four main categories of available research including studies that specify: (1) biological mechanisms using animal models to investigate the relationship between dehydration and stroke; (2) measures of dehydration in the acute human stroke population; (3) rehydration therapies after stroke; and (4) outcomes after stroke in dehydrated patients. CONCLUSIONS We found considerable variation in terminology specific to hydration status, diagnostic approach to dehydration, and few prospective studies of treatment strategies with varying results. This review supports the need for consensus development of operational diagnostic criteria, standardization of language, and the opportunity for prospective study of rehydration strategies to impact outcome after stroke.
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20
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Bahouth MN, Gaddis A, Hillis AE, Gottesman RF. Pilot study of volume contracted state and hospital outcome after stroke. Neurol Clin Pract 2018; 8:21-26. [PMID: 29517060 PMCID: PMC5839680 DOI: 10.1212/cpj.0000000000000419] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 08/22/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND An increasing body of research suggests that acute stroke patients who are dehydrated may have worsened functional outcomes. We sought to explore the relationship between a volume contracted state (VCS) at the time of ischemic stroke and hospital outcomes as compared with euvolemic patients. METHODS We enrolled a consecutive series of ischemic stroke patients from a single academic stroke center within 12 hours from stroke onset. VCS was defined via surrogate markers (blood urea nitrogen/creatinine ratio >15 and urine specific gravity >1.010). The primary outcome was change in NIH Stroke Scale (NIHSS) score from admission to discharge. Multivariable analyses included adjustment for demographics and infarct size. RESULTS Over an 11-month study period, 168 patients were eligible for inclusion. Of the126 with complete laboratory and MRI data, 44% were in a VCS at the time of admission. Demographics were similar in both the VCS and euvolemic groups, as were baseline NIHSS scores (6.7 vs 7.3; p = 0.63) and infarct volumes (12 vs 16 mL; p = 0.48). However, 42% of patients in a VCS demonstrated early clinical worsening, compared with 17% of the euvolemic group (p = 0.02). A VCS remained a significant predictor of worsening NIHSS in adjusted models (odds ratio 4.34; 95% confidence interval 1.75-10.76). CONCLUSIONS Acute stroke patients in a VCS demonstrate worse short-term outcomes compared to euvolemic patients, independent of infarct size. Results suggest an opportunity to explore current hydration practices.
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Affiliation(s)
- Mona N Bahouth
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Andrew Gaddis
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Argye E Hillis
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Rebecca F Gottesman
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
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21
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A randomized controlled study of intravenous fluid in acute ischemic stroke. Clin Neurol Neurosurg 2017; 161:98-103. [PMID: 28866264 DOI: 10.1016/j.clineuro.2017.08.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 08/14/2017] [Accepted: 08/23/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare the outcome of patients with acute ischemic stroke who received or did not receive intravenous fluid. PATIENTS AND METHODS This study was a prospective, multicenter, randomized, open-label trial with blinded outcome assessment. We enrolled acute ischemic stroke patients without dehydration aged between 18 and 85 years with NIH Stroke Scale score (NIHSS) score from 1 to 18 who presented within 72h after onset. Patients were randomly assigned to receive 0.9% NaCl solution 100ml/h for 3days or no intravenous fluid. RESULTS On the interim unblinded analysis of the safety data, significant excess early neurological deterioration was observed among patients in the non-intravenous fluid group. Therefore, the study was prematurely discontinued after enrollment of 120 patients, mean age 60 years, 56.6% male. Early neurological deterioration (increased NIHSS ≥3 over 72h) not of metabolic or hemorrhagic origin was observed in 15% of the non-IV fluid group and 3.3% of the IV fluid group (p=0.02). Predictors of neurological deterioration were higher NIHSS score, higher plasma glucose, and increased pulse rate. There was no difference in the primary efficacy outcome, NIHSS≤4 at day 7, 83.3% vs 86.7%, p=0.61 or secondary efficacy outcomes. CONCLUSION Administration of 0.9% NaCl 100ml/h for 72h in patients with acute ischemic stroke is safe and may be associated with a reduced risk of neurological deterioration. These study findings support the use of intravenous fluid in acute ischemic stroke patients with NIHSS less than 18 who have no contraindications.
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22
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Gerdt AM, Shutov AM, Menzorov MV, Gubareva EA. [Causal relationships in stroke and kidney injury]. TERAPEVT ARKH 2017; 89:62-68. [PMID: 28745691 DOI: 10.17116/terarkh201789662-68] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
AIM To assess the frequency, severity, and causes of acute kidney injury (AKI) in patients with stroke. SUBJECTS AND METHODS 272 patients (143 men and 129 women) (mean age, 66.7±11.6 years) with stroke were examined. The 2008 European Stroke Organization (ESO) guidelines were used to diagnose stroke, to determine indications for and contraindications to thrombolytic therapy, and to evaluate its efficiency. Hemorrhagic and ischemic strokes (HS and IS) were diagnosed in 52 (19%) and 220 (81%) patients, respectively. AKI was diagnosed and classified according to the 2012 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. RESULTS AKI was diagnosed in 89 (33%) patients: 19 (36.5%) with HS and 70 (31.8%) with IS. The relative risk of death in patients with AKI-associated stroke was 2.6 (95% confidence interval (CI) 1.6-4.0). A poor outcome (the combined endpoint of death or Rankin scale scores of 4-5) was noted in 56 (62.9%) patients with AKI and in 70 (38.2 %) without AKI (χ2=14.6; p=0.0002). The relative risk of a poor outcome in patients with AKI-associated with stroke was 1.64 (95% CI 1.3-2.0). Forty-five (50.6%) patients with stroke developed AKI in the prehospital period. CONCLUSION AKI complicates stroke in every three patients and increases death rates. 50% of cases develop AKI in the prehospital period due to the common causes of stroke and AKI.
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Affiliation(s)
- A M Gerdt
- Ulyanovsk State University, Ulyanovsk, Russia; V.V. Banykin Tolyatti City Hospital Two, Tolyatti, Russia
| | - A M Shutov
- Ulyanovsk State University, Ulyanovsk, Russia
| | | | - E A Gubareva
- V.V. Banykin Tolyatti City Hospital Two, Tolyatti, Russia
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23
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Wu FF, Hung YC, Tsai YH, Yang JT, Lee TH, Liow CW, Lee JD, Lin CJ, Peng TI, Lin LC. The influence of dehydration on the prognosis of acute ischemic stroke for patients treated with tissue plasminogen activator. BMC Cardiovasc Disord 2017; 17:154. [PMID: 28610565 PMCID: PMC5470225 DOI: 10.1186/s12872-017-0590-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 06/05/2017] [Indexed: 02/06/2023] Open
Abstract
Background Many studies have determined that dehydration is an independent predictor of outcome after ischemic stroke (IS); however, none have determined if the use of thrombolytic therapy modifies the negative impact of poor hydration. To inform the stroke registry established at our institution, we conducted a retrospective study to determine if dehydration remains a negative prognostic factor after IS patients treated with tissue plasminogen activator (tPA). Methods Between 2007 and 2012, we recruited 382 subjects; 346 had data available and were divided into 2 groups on the basis of their blood urea nitrogen/creatinine (BUN/Cr) ratio. Dehydrated subjects had a BUN/Cr ratio ≥ 15; hydrated subjects had a BUN/Cr < 15. The primary outcome was impairment at discharge as graded by the Barthel Index (BI) and the modified Rankin Scale (mRS). Results The dehydration group had a greater mean age; more women; lower mean levels of hemoglobin, triglycerides, and sodium; and higher mean potassium and glucose levels. A favorable outcome as assessed by the mRS (≤2) was significantly less frequent among dehydrated subjects, but a favorable outcome by the BI (≥60) was not. Logistic regression and multivariate models confirmed that dehydration is an independent predictor of poor outcome by both the mRS and the BI; however, it was not predictive when patients were stratified by Trial of Org 10,172 in Acute Stroke Treatment subtype. Conclusions Our findings indicate that use of thrombolytic therapy does not eliminate the need to closely monitor hydration status in patients with IS.
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Affiliation(s)
- Fei-Fan Wu
- Department of Emergency Medicine, Chang Gung Memorial Hospital, No. 6, W. Sec., Jiapu Rd., Puzih City, Chiayi County, 613, Taiwan, ROC
| | - Yen-Chu Hung
- Department of Neurology, Chang Gung University, Taoyuan, Taiwan.,Department of Nursing, Chang Gung University of Science and Technology, Chiayi Campus, Chiayi, Taiwan
| | - Y H Tsai
- Department of Diagnostic Radiology, Chang Gung University, Taoyuan, Taiwan.,Department of Nursing, Chang Gung University of Science and Technology, Chiayi Campus, Chiayi, Taiwan
| | - Jen-Tsung Yang
- Division of Neurosurgery, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tsong-Hai Lee
- Stroke Center and Department of Neurology, Linkou Chang Gung Memorial Hospital, and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Wei Liow
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, and College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - Jiann-Der Lee
- Department of Neurology, Chang Gung University, Taoyuan, Taiwan
| | - Chung-Jen Lin
- Department of Emergency Medicine, Chang Gung Memorial Hospital, No. 6, W. Sec., Jiapu Rd., Puzih City, Chiayi County, 613, Taiwan, ROC
| | - Tsung-I Peng
- Department of Neurology, Keelung Chang Gung Memorial Hospital, and College of Medicine, Chang Gung University, Keelung, Taiwan
| | - Leng-Chieh Lin
- Department of Emergency Medicine, Chang Gung Memorial Hospital, No. 6, W. Sec., Jiapu Rd., Puzih City, Chiayi County, 613, Taiwan, ROC. .,Department of Nursing, Chang Gung University of Science and Technology, Chiayi Campus, Chiayi, Taiwan.
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24
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Lin CJ, Yang JT, Huang YC, Tsai YH, Lee MH, Lee M, Hsiao CT, Hsiao KY, Lin LC. Favorable outcome of blood urea nitrogen/creatinine-based hydration therapy 3 months after acute ischemic stroke. Am J Emerg Med 2016; 34:2414-2418. [PMID: 27717719 DOI: 10.1016/j.ajem.2016.09.033] [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] [Received: 07/15/2016] [Revised: 09/14/2016] [Accepted: 09/15/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Dehydration is associated with acute ischemic stroke. However, the relationship between hydration therapy given during acute ischemic stroke and clinical outcomes remains unclear. AIMS We determined whether hydration therapy in patients with a blood urea nitrogen/creatinine (BUN/Cr) ratio of at least 15 improved clinical outcome. METHODS We conducted a nonblinded, phase II, single-arm, prospective study of patients with acute ischemic stroke and BUN/Cr ratio of at least 15 with historical controls. The hydration group received intravenous bolus (300-500 mL) saline followed by maintenance saline infusion (40-80 mL/h for the first 72 hours), whereas the control group received maintenance saline infusion (40-60 mL/h for the first 24 hours and 0-60 mL/h for 24-72 hours after stroke). The study end point was the percentage of patients with a favorable outcome defined as modified Rankin scale score of 2 or lower at 3 months after stroke. RESULTS A total of 237 patients were enrolled (hydration, n = 134; control, n = 103). The mean volume of saline infused within the first 72 hours was significantly larger (P < .001), and the rate of favorable outcome at 3 months after stroke was significantly higher (P = .016) in the hydration group than in the controls. Further analysis revealed that the difference was significant in the lacunar stroke subtype (P = .020) but not in the nonlacunar subtype. CONCLUSIONS Blood urea nitrogen/Cr ratio-based saline hydration therapy in patients with acute ischemic stroke significantly increased the rate of favorable clinical outcome with functional independence at 3 months after stroke.
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Affiliation(s)
- Chung Jen Lin
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Puzih City, Chiayi County, Taiwan.
| | - Jen Tsung Yang
- Division of Neurosurgery, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Puzih City, Chiayi County, Taiwan.
| | - Yen Chu Huang
- Department of Neurology, Chang Gung Memorial Hospital, Puzih City, Chiayi County, Taiwan; Departments of Nursing and Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan.
| | - Yuan Hsiung Tsai
- Departments of Nursing and Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan; Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Puzih City, Chiayi County, Taiwan.
| | - Ming Hsueh Lee
- Division of Neurosurgery, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Puzih City, Chiayi County, Taiwan; Departments of Nursing and Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan.
| | - Meng Lee
- Department of Neurology, Chang Gung Memorial Hospital, Puzih City, Chiayi County, Taiwan; Departments of Nursing and Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan.
| | - Cheng Ting Hsiao
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Puzih City, Chiayi County, Taiwan; Departments of Nursing and Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan.
| | - Kuang Yu Hsiao
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Puzih City, Chiayi County, Taiwan; Departments of Nursing and Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan.
| | - Leng Chieh Lin
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Puzih City, Chiayi County, Taiwan; Departments of Nursing and Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan.
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25
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Lahiri S, Schlick K, Kavi T, Song S, Moheet AM, Yusufali T, Rosengart A, Alexander MJ, Lyden PD. Optimizing Outcomes for Mechanically Ventilated Patients in an Era of Endovascular Acute Ischemic Stroke Therapy. J Intensive Care Med 2016; 32:467-472. [PMID: 27543141 DOI: 10.1177/0885066616663168] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Endovascular mechanical thrombectomy is a new standard of care for acute ischemic stroke (AIS). The majority of these patients receive mechanical ventilation (MV), which has been associated with poor outcomes. The implication of this is significant, as most neurointerventionalists prefer general compared to local anesthesia during the procedure. Consequences of hemodynamic and respiratory perturbations during general anesthesia and MV are thought to contribute significantly to the poor outcomes that are encountered. In this review, we first describe the unique risks associated with MV in the specific context of AIS and then discuss evidence of brain goal-directed approaches that may mitigate these risks. These strategies include an individualized approach to hemodynamic parameters (eg, adherence to a minimum blood pressure goal and adequate volume resuscitation), respiratory parameters (eg, arterial carbon dioxide optimization), and the use of ventilator settings that optimize neurological outcomes (eg, arterial oxygen optimization).
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Affiliation(s)
- Shouri Lahiri
- 1 Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,2 Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Konrad Schlick
- 1 Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Tapan Kavi
- 1 Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Shlee Song
- 1 Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Asma M Moheet
- 1 Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,2 Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Taizoon Yusufali
- 3 Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Axel Rosengart
- 1 Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,2 Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Michael J Alexander
- 2 Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Patrick D Lyden
- 1 Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Chang SW, Huang YC, Lin LC, Yang JT, Weng HH, Tsai YH, Lee TH. Effect of dehydration on the development of collaterals in acute middle cerebral artery occlusion. Eur J Neurol 2016; 23:494-500. [PMID: 26801969 DOI: 10.1111/ene.12841] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 08/03/2015] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND PURPOSE Recent large series studies have demonstrated that dehydration is common amongst stroke subjects and is associated with poor outcome. However, the effects of hydration status on the development of collaterals have never been discussed. In this study, the hypothesis that hydration status is an important factor for developing collaterals after acute middle cerebral artery (MCA) infarction was tested. METHODS Eighty-seven patients with acute infarction due to occlusion of the MCA were enrolled. Two collateral markers, posterior cerebral artery (PCA) laterality and fluid-attenuated inversion recovery hyperintense vessels (HVs) were assessed from magnetic resonance imaging. Dehydration status was defined by a nitrogen to creatinine ratio ≧ of 15. The associations between dehydration status and the development of collaterals were estimated. RESULTS Sixty-one of 87 patients (70.1%) were identified as dehydrated. The development of PCA laterality and HVs shows a significant difference between dehydrated and euhydrated patients. A serum nitrogen to creatinine ratio <15, diastolic blood pressure and the presence of a dense MCA on computed tomography were significantly associated with the development of PCA laterality. A serum nitrogen to creatinine ratio <15, the initial National Institutes of Health Stroke Scale score, the presence of a dense MCA and calcifications of the internal carotid artery on computed tomography were significantly associated with the development of HVs. Dehydration remained an independent negative predictor for the development of PCA laterality and HVs in the multivariate analysis. CONCLUSIONS Hydration status is associated with the development of collateral flow after acute MCA occlusion. This preliminary study provides an imaging clue that hydration status and early hydration therapy could be important for acute stroke management.
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Affiliation(s)
- S-W Chang
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Y-C Huang
- Department of Neurology, Chang Gung Memorial Hospital, Chiayi, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - L-C Lin
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - J-T Yang
- Department of Neurosurgery, Chang Gung Memorial Hospital, Chiayi, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - H-H Weng
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Y-H Tsai
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - T-H Lee
- Stroke Center and Department of Neurology, Linkou Medical Center, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
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Preliminary Prospective Study to Assess the Effect of Early Blood Urea Nitrogen/Creatinine Ratio-Based Hydration Therapy on Poststroke Infection Rate and Length of Stay in Acute Ischemic Stroke. J Stroke Cerebrovasc Dis 2015; 24:2720-7. [PMID: 26338107 DOI: 10.1016/j.jstrokecerebrovasdis.2015.08.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 07/28/2015] [Accepted: 08/01/2015] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND This study aimed to determine whether blood urea nitrogen (BUN)/creatinine (Cr)-based hydration therapy can decrease the rate of poststroke infection and length of stay (LOS) in the neurology ward. METHODS This was a nonblinded, phase II single-arm prospective study with a historical control group of patients with acute ischemic stroke and a BUN/Cr ratio of 15 or higher. The study group (n = 134) received an intravenous saline bolus (300-500 mL) followed by maintenance saline (40-80 mL/hour) for the first 72 hours. The control group (n = 103) received maintenance saline infusions (40-60 mL/hour for the first 24 hours and 0-60 mL/hour for the next 24-72 hours). RESULTS The hydration group had a significantly lower poststroke infection rate than did the control group (7.5% versus 17.5%, P = .018) and significantly shorter LOS in the neurology ward (13.5 ± 11.6 versus 19.6 ± 14.6 days, P < .01). With regard to adverse events, two patients in each group had cerebral edema. CONCLUSIONS The findings suggest that the BUN/Cr ratio needs to be corrected in a timely manner in patients with acute ischemic stroke. Providing prompt saline hydration therapy based on the daily BUN/Cr ratio might decrease the poststroke infection rate and shorten LOS.
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Affiliation(s)
- Anne Rowat
- Lecturer, School of Nursing, Midwifery and Social Care, Edinburgh Napier University
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Ekka M, Lakra SB, Aggarwal P, Jamshed N. Hydration therapy: critical intervention in the ED to prevent stroke in evolution after acute ischemic stroke. Am J Emerg Med 2014; 32:1544. [DOI: 10.1016/j.ajem.2014.09.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 09/13/2014] [Indexed: 11/30/2022] Open
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