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Dzirkale Z, Pilipenko V, Pijet B, Klimaviciusa L, Upite J, Protokowicz K, Kaczmarek L, Jansone B. Long-term behavioural alterations in mice following transient cerebral ischemia. Behav Brain Res 2023; 452:114589. [PMID: 37481076 DOI: 10.1016/j.bbr.2023.114589] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/05/2023] [Accepted: 07/17/2023] [Indexed: 07/24/2023]
Abstract
Ischemic stroke is one of the leading causes of disability and mortality worldwide. Acute and chronic post-stroke changes have variable effects on the functional outcomes of the disease. Therefore, it is imperative to identify what daily activities are altered after stroke and to what extent, keeping in mind that ischemic stroke patients often have long-term post-stroke complications. Translational studies in stroke have also been challenging due to inconsistent study design of animal experiments. The objective of this study was to clarify whether and to what extent mouse behaviour was altered during a 6 months period after cerebral stroke. Experimental stroke was induced in mice by intraluminal filament insertion into the middle cerebral artery (fMCAo). Neurological deficits, recovery rate, motor performance, and circadian activity were evaluated following ischemia. We observed severe neurological deficits, motor impairments, and delay in the recovery rate of mice during the first 14 days after fMCAo. Aberrant circadian activity and distorted space map were seen in fMCAo mice starting one month after ischemia, similarly to altered new and familiar cage activity and sucrose preference using the IntelliCage, and was still evident 60- and 180- days following stroke in the voluntary running wheel using the PhenoMaster system. A preference towards ipsilateral side turns was observed in fMCAo mice both acutely and chronically after the stroke induction. Overall, our study shows the importance of determining time-dependent differences in the long-term post-stroke recovery (over 180 days after fMCAo) using multiple behavioural assessments.
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Affiliation(s)
- Zane Dzirkale
- Department of Pharmacology, Faculty of Medicine, University of Latvia, 3 Jelgavas Street, LV-1004 Riga, Latvia.
| | - Vladimirs Pilipenko
- Department of Pharmacology, Faculty of Medicine, University of Latvia, 3 Jelgavas Street, LV-1004 Riga, Latvia
| | - Barbara Pijet
- Laboratory of Neurobiology, BRAINCITY - Centre of Excellence for Neural Plasticity and Brain Disorders, Nencki Institute of Experimental Biology, Polish Academy of Sciences, 3 Pasteur Street, 02-093 Warsaw, Poland
| | - Linda Klimaviciusa
- Department of Pharmacology, Faculty of Medicine, University of Latvia, 3 Jelgavas Street, LV-1004 Riga, Latvia
| | - Jolanta Upite
- Department of Pharmacology, Faculty of Medicine, University of Latvia, 3 Jelgavas Street, LV-1004 Riga, Latvia
| | - Karolina Protokowicz
- Laboratory of Neurobiology, BRAINCITY - Centre of Excellence for Neural Plasticity and Brain Disorders, Nencki Institute of Experimental Biology, Polish Academy of Sciences, 3 Pasteur Street, 02-093 Warsaw, Poland
| | - Leszek Kaczmarek
- Laboratory of Neurobiology, BRAINCITY - Centre of Excellence for Neural Plasticity and Brain Disorders, Nencki Institute of Experimental Biology, Polish Academy of Sciences, 3 Pasteur Street, 02-093 Warsaw, Poland
| | - Baiba Jansone
- Department of Pharmacology, Faculty of Medicine, University of Latvia, 3 Jelgavas Street, LV-1004 Riga, Latvia.
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Ceanga M, Dahab M, Witte OW, Keiner S. Adult Neurogenesis and Stroke: A Tale of Two Neurogenic Niches. Front Neurosci 2021; 15:700297. [PMID: 34447293 PMCID: PMC8382802 DOI: 10.3389/fnins.2021.700297] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 06/30/2021] [Indexed: 01/17/2023] Open
Abstract
In the aftermath of an acute stroke, numerous signaling cascades that reshape the brain both in the perilesional zone as well as in more distal regions are activated. Despite continuous improvement in the acute treatment of stroke and the sustained research efforts into the pathophysiology of stroke, we critically lag in our integrated understanding of the delayed and chronic responses to ischemic injury. As such, the beneficial or maladaptive effect of some stroke-induced cellular responses is unclear, restricting the advancement of therapeutic strategies to target long-term complications. A prominent delayed effect of stroke is the robust increase in adult neurogenesis, which raises hopes for a regenerative strategy to counter neurological deficits in stroke survivors. In the adult brain, two regions are known to generate new neurons from endogenous stem cells: the subventricular zone (SVZ) and the dentate subgranular zone (SGZ) of the hippocampus. While both niches respond with an increase in neurogenesis post-stroke, there are significant regional differences in the ensuing stages of survival, migration, and maturation, which may differently influence functional outcome. External interventions such as rehabilitative training add a further layer of complexity by independently modulating the process of adult neurogenesis. In this review we summarize the current knowledge regarding the effects of ischemic stroke on neurogenesis in the SVZ and in the SGZ, and the influence of exogenous stimuli such as motor activity or enriched environment (EE). In addition, we discuss the contribution of SVZ or SGZ post-stroke neurogenesis to sensory, motor and cognitive recovery.
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Affiliation(s)
- Mihai Ceanga
- Hans-Berger Department of Neurology, Jena University Hospital, Jena, Germany
- Section Translational Neuroimmunology, Department of Neurology, Jena University Hospital, Jena, Germany
| | - Mahmoud Dahab
- Hans-Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Otto W. Witte
- Hans-Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Silke Keiner
- Hans-Berger Department of Neurology, Jena University Hospital, Jena, Germany
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3
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Branco JP, Rocha F, Sargento-Freitas J, Santo GC, Freire A, Laíns J, Páscoa Pinheiro J. Impact of Post-Stroke Recanalization on General and Upper Limb Functioning: A Prospective, Observational Study. Neurol Int 2021; 13:46-58. [PMID: 33557006 PMCID: PMC7931094 DOI: 10.3390/neurolint13010005] [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: 12/12/2020] [Revised: 01/17/2021] [Accepted: 01/22/2021] [Indexed: 11/16/2022] Open
Abstract
The objective of this study is to assess the impact of recanalization (spontaneous and therapeutic) on upper limb functioning and general patient functioning after stroke. This is a prospective, observational study of patients hospitalized due to acute ischemic stroke in the territory of the middle cerebral artery (n = 98). Patients completed a comprehensive rehabilitation program and were followed-up for 24 weeks. The impact of recanalization on patient functioning was evaluated using the modified Rankin Scale (mRS) and Stroke Upper Limb Capacity Scale (SULCS). General and upper limb functioning improved markedly in the first three weeks after stroke. Age, gender, and National Institutes of Health Stroke Scale (NIHSS) score at admission were associated with general and upper limb functioning at 12 weeks. Successful recanalization was associated with better functioning. Among patients who underwent therapeutic recanalization, NIHSS scores ≥16.5 indicate lower general functioning at 12 weeks (sensibility = 72.4%; specificity = 78.6%) and NIHSS scores ≥13.5 indicate no hand functioning at 12 weeks (sensibility = 83.8%; specificity = 76.5%). Recanalization, either spontaneous or therapeutic, has a positive impact on patient functioning after acute ischemic stroke. Functional recovery occurs mostly within the first 12 weeks after stroke, with greater functional gains among patients with successful recanalization. Higher NIHSS scores at admission are associated with worse functional recovery.
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Affiliation(s)
- João Paulo Branco
- Physical and Rehabilitation Medicine Department, Centro Hospitalar Universitário de Coimbra, 3030-075 Coimbra, Portugal; (F.R.); (J.L.); (J.P.P.)
- Faculty of Medicine, University of Coimbra, 3030-075 Coimbra, Portugal; (J.S.-F.); (G.C.S.); (A.F.)
- Correspondence:
| | - Filipa Rocha
- Physical and Rehabilitation Medicine Department, Centro Hospitalar Universitário de Coimbra, 3030-075 Coimbra, Portugal; (F.R.); (J.L.); (J.P.P.)
| | - João Sargento-Freitas
- Faculty of Medicine, University of Coimbra, 3030-075 Coimbra, Portugal; (J.S.-F.); (G.C.S.); (A.F.)
- Neurology Department, Centro Hospitalar Universitário de Coimbra, 3030-075 Coimbra, Portugal
| | - Gustavo C. Santo
- Faculty of Medicine, University of Coimbra, 3030-075 Coimbra, Portugal; (J.S.-F.); (G.C.S.); (A.F.)
- Neurology Department, Centro Hospitalar Universitário de Coimbra, 3030-075 Coimbra, Portugal
| | - António Freire
- Faculty of Medicine, University of Coimbra, 3030-075 Coimbra, Portugal; (J.S.-F.); (G.C.S.); (A.F.)
- Neurology Department, Centro Hospitalar Universitário de Coimbra, 3030-075 Coimbra, Portugal
| | - Jorge Laíns
- Physical and Rehabilitation Medicine Department, Centro Hospitalar Universitário de Coimbra, 3030-075 Coimbra, Portugal; (F.R.); (J.L.); (J.P.P.)
| | - João Páscoa Pinheiro
- Physical and Rehabilitation Medicine Department, Centro Hospitalar Universitário de Coimbra, 3030-075 Coimbra, Portugal; (F.R.); (J.L.); (J.P.P.)
- Faculty of Medicine, University of Coimbra, 3030-075 Coimbra, Portugal; (J.S.-F.); (G.C.S.); (A.F.)
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Diermayr G, Schomberg M, Greisberger A, Elsner B, Gronwald M, Salbach NM. Task-Oriented Circuit Training for Mobility in Outpatient Stroke Rehabilitation in Germany and Austria: A Contextual Transferability Analysis. Phys Ther 2020; 100:1307-1322. [PMID: 32266383 DOI: 10.1093/ptj/pzaa053] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 10/11/2019] [Accepted: 12/20/2019] [Indexed: 11/13/2022]
Abstract
People with stroke cite mobility deficits as one of the most burdensome limitations. National and international stroke guidelines recommend physical therapy based on task-oriented practice, with high numbers of repetitions to improve mobility. In the outpatient setting in Germany and Austria, these principles have not yet been established. The purpose of this study was to identify an evidence-based intervention that could help reduce this research-practice gap. A stepwise approach proposed by Voigt-Radloff and colleagues and Cochrane Germany was used. First, the specific health service problem in the German and Austrian physical therapy outpatient context was identified. Second, a promising intervention was identified using a systematic search in the Cochrane Library and by grading the quality of the evidence using the Grading of Recommendations Assessment, Development and Evaluation. Finally, the transferability of the promising intervention into the local context was evaluated using predefined questions from the Cochrane guide and reports from health insurances, professional organizations, and national stroke guidelines. Task-oriented circuit training reviewed by English and colleagues was chosen. The review showed clinically important improvements in walking distance and speed. The quality of the evidence was graded high for these 2 outcomes. We identified contextual challenges for implementation at the setting level (eg, insufficient reimbursement for group therapy by insurance companies), the participant and therapist level (eg, unknown motivation for group therapy due to the established 1:1 patient-therapist ratio), and the outcome measure level (eg, lack of standardized, cross-culturally translated manuals). Although task-oriented circuit training is scientifically well established, barriers to implementation into routine care in Germany and Austria can be expected. In a next step, research using knowledge translation methodology will focus on the detailed evaluation of barriers and facilitators with relevant stakeholders.
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Affiliation(s)
- Gudrun Diermayr
- School for Therapeutic Sciences, SRH University Heidelberg, Maria-Probst-Strasse 3, 69123 Heidelberg, Germany
| | | | | | | | | | - Nancy M Salbach
- Department of Physical Therapy, University of Toronto; and, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
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Hamzei F, Erath G, Kücking U, Weiller C, Rijntjes M. Anatomy of brain lesions after stroke predicts effectiveness of mirror therapy. Eur J Neurosci 2020; 52:3628-3641. [PMID: 32031282 DOI: 10.1111/ejn.14698] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 01/16/2020] [Accepted: 01/31/2020] [Indexed: 11/27/2022]
Abstract
To improve clinical outcome, one longstanding goal in treating stroke patients has been an individual therapy based on functional and anatomical knowledge of the single patient. Therefore, in this study brain imaging of 36 chronic stroke patients was analyzed to identify parameters predicting clinical recovery. T1-weighted MRI was acquired to assess the lesion; functional MRI was used to visualize existing resources; DTI for the integrity of the corticospinal tract (CST) and long association tracts. These data were related to the clinical course. All patients were treated intensively with the mirror therapy (MT) only. After the training period, we analyzed which patient's feature would predict a beneficial course. Patients as a group improved after MT, but according to the fMRI activation of primary sensorimotor cortex (SMC), they could be divided in two groups with very diverging clinical outcome: those with ipsilesional SMC activation showed a noticeable increase of clinical scores, accompanied with ipsilesional activation in the frontal projection areas of the dorsal and ventral streams during action observation in fMRI. Those with contralesional SMC activation had lesions affecting both the dorsal and ventral stream and did not benefit from MT. The outcome for this therapy was not related to affection of CST. This study demonstrates that only in patients in which dorsal and ventral streams are not affected and therefore an interaction between these streams in post- and prerolandic regions is possible, MT can induce clinical improvement. Consequently, knowledge of the anatomical lesion can predict the beneficial course of MT.
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Affiliation(s)
- Farsin Hamzei
- Section of Neurological Rehabilitation, Hans Berger Clinic of Neurology, Department of Neurology, Jena University Hospital, Jena, Germany.,Department of Neurology, Moritz Klinik, Bad Klosterlausnitz, Germany
| | - Gabriele Erath
- Department of Neurology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ursula Kücking
- Department of Neurology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Cornelius Weiller
- Department of Neurology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michel Rijntjes
- Department of Neurology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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6
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Lin B, Ding C, Mei Y, Wang P, Ma F, Zhang ZX. Unmet care needs of community-dwelling stroke survivors: a protocol for systematic review and theme analysis of quantitative and qualitative studies. BMJ Open 2019; 9:e029160. [PMID: 31230030 PMCID: PMC6596939 DOI: 10.1136/bmjopen-2019-029160] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 04/30/2019] [Accepted: 05/28/2019] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Stroke is a leading cause of disability worldwide. The average hospital length of stay ranges from 3 to 28 days, and after discharge home the stroke survivors will live with physical, cognitive, even psychological disorders for the rest of their lives. It is essential to review the unmet needs of stroke survivors. METHODS AND ANALYSIS A systematic review of previous quantitative and qualitative studies reporting the unmet needs of stroke survivors in their homes will be conducted. The following six databases will be searched from inception to December 2018 for relevant articles: PubMed, EMBASE, CINAHL, PsycINFO, SCOPUS and China Biology Medicine. We will include studies limited to human and published in English or Chinese, and the patients with stroke should discharge home rather than any other professional organisations including nursing homes or community rehabilitation units and so on. Data of quantitative research will be standardised for comparison, thematic analysis will be used for qualitative data and a narrative synthesis and pooled analysis of the main outcomes will be reported. ETHICS AND DISSEMINATION This review will be submitted to an international professional journal, and the detailed search strategies and analysis flowchart will be openly included as supplements. This study does not require ethical approval as no patient's identifiable data will be used. Our findings will give a new look at the aspect of stroke survivors' unmet needs in their long-term recovery stage, especially the trajectories of unmet needs at different timepoints. What is more, this review will demonstrate the long-term unmet needs of stroke survivors from different countries, will compare any variations between high-income and low-income regions, and the geographical differences of needs will be mapped if necessary. We will endeavour to provide as much information as possible to healthcare professionals and public health policy makers in order to promote further medical reform. TRIAL REGISTRATION NUMBER CRD42018112181.
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Affiliation(s)
- Beilei Lin
- Clinical 1 Teaching and Research Office, Nursing School, Zhengzhou University, Zhengzhou, Henan, China
| | - Chunge Ding
- Clinical 1 Teaching and Research Office, Nursing School, Zhengzhou University, Zhengzhou, Henan, China
| | - Yongxia Mei
- Clinical 1 Teaching and Research Office, Nursing School, Zhengzhou University, Zhengzhou, Henan, China
| | - Panpan Wang
- Clinical 1 Teaching and Research Office, Nursing School, Zhengzhou University, Zhengzhou, Henan, China
| | - Fayang Ma
- China-US (Henan) Hormel Cancer Institute, Zhengzhou University, Zhengzhou, Henan, China
| | - Zhen-Xiang Zhang
- Clinical 1 Teaching and Research Office, Nursing School, Zhengzhou University, Zhengzhou, Henan, China
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7
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Modular Design and Decentralized Control of the Recupera Exoskeleton for Stroke Rehabilitation. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9040626] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Robot-assisted therapy has become increasingly popular and useful in post-stroke neurorehabilitation. This paper presents an overview of the design and control of the dual-arm Recupera exoskeleton to provide intense therapist-guided as well as self training for sensorimotor rehabilitation of the upper body. The exoskeleton features a lightweight design, high level of modularity, decentralized computing, and various levels of safety implementation. Due to its modularity, the system can be used as a wheel-chair mounted system or as a full-body system. Both systems enable a wide range of therapies while efficiently grounding the weight of the system and without compromising the patient’s mobility. Furthermore, two rehabilitation therapies implemented on the exoskeleton system, namely teach & replay therapy and mirror therapy, are presented along with experimental results.
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8
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Branco JP, Oliveira S, Sargento-Freitas J, Laíns J, Pinheiro J. Assessing functional recovery in the first six months after acute ischemic stroke: a prospective, observational study. Eur J Phys Rehabil Med 2018; 55:1-7. [PMID: 29764094 DOI: 10.23736/s1973-9087.18.05161-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Stroke is a major cause of short-term functional impairment, but the recovery timeframes are not well-established. AIM This study aims to evaluate the progression of functional recovery during the first 24 weeks after acute ischemic stroke, to determine the timeframes for motor, cognitive, and overall recovery. DESIGN Prospective observational study. SETTING Tertiary care center; 12-week inpatient period, followed by 12-week outpatient period. POPULATION A group of 131 patients with acute stroke in the territory of the middle cerebral artery with age 18-85 years-old. METHODS Patients received treatment according to routine clinical practice and underwent a closely-controlled rehabilitation program for 24 weeks. Functionality assessments were conducted at 48 hours, 3 weeks, 12 weeks, and 24 weeks after acute stroke and included the modified Rankin Scale (mRS), the Functional Independence Measure (FIM), and the Stroke Upper Limb Capacity Scale (SULCS). RESULTS Over the study period, patient functionality improved significantly (P<0.001) as measured by all scales. Assessment scores improved significantly from 48 hours to 3 weeks for all scales; the same occurred from 3 weeks to 12 weeks, except for C-FIM. From 12 weeks to 24 weeks, there were no statistically significant functional improvements for any scale. In comparative terms, cognitive impairment was less severe than motor disability in the acute phase. C-FIM scores at 48 hours were significantly higher than M-FIM and mRS scores. Upper limb functioning measured by SULCS, showed a intermediate degree of disability compared to the C-FIM, M-FIM, and mRS. CONCLUSIONS Functional recovery occurs at least until 24 weeks after acute stroke, but most of the functional gains tend to be achieved during the first 12 weeks. Cognitive function tends to improve earlier than motor function, with the most substantial gains occurring within the first three weeks. From 12 to 24 weeks there are observable numerical gains in patient functionality, highlighting the need to maintain an adequate rehabilitation program. CLINICAL REHABILITATION IMPACT This study provides insight into the recovery timeframe for stroke patients, which can support the development of more effective rehabilitation programs.
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Affiliation(s)
- João P Branco
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal - .,Department of Physical and Rehabilitation Medicine, University Hospital Center of Coimbra, Coimbra, Portugal - .,Department of Physical and Rehabilitation Medicine, Centro de Medicina de Reabilitação da Região Centro, Rovisco Pais, Tocha, Portugal -
| | - Sandra Oliveira
- Department of Physical and Rehabilitation Medicine, Centro de Medicina de Reabilitação da Região Centro, Rovisco Pais, Tocha, Portugal
| | - João Sargento-Freitas
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Department of Neurology, University Hospital Center of Coimbra, Coimbra, Portugal
| | - Jorge Laíns
- Department of Physical and Rehabilitation Medicine, Centro de Medicina de Reabilitação da Região Centro, Rovisco Pais, Tocha, Portugal
| | - João Pinheiro
- Department of Physical and Rehabilitation Medicine, University Hospital Center of Coimbra, Coimbra, Portugal.,Department of Neurology, University Hospital Center of Coimbra, Coimbra, Portugal
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9
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Branco JP, Oliveira S, Sargento-Freitas J, Santos Costa J, Cordeiro G, Cunha L, Freire Gonçalves A, Pinheiro J. S100β Protein as a Predictor of Poststroke Functional Outcome: A Prospective Study. J Stroke Cerebrovasc Dis 2018; 27:1890-1896. [PMID: 29571758 DOI: 10.1016/j.jstrokecerebrovasdis.2018.02.046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 01/26/2018] [Accepted: 02/15/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Stroke is one of the leading causes of disability worldwide. Early prediction of poststroke disability using clinical models is of great interest, especially in the rehabilitation field. Although some biomarkers and neuroimaging techniques have shown potential predictive value, there are still insufficient data to support their clinical utility in predicting poststroke functional recovery. We aimed to assess the value of serum biomarkers (C-reactive protein [CRP], D-dimer, fibrinogen, and S100β protein) in predicting medium-term (12 weeks) functional outcome in patients with acute ischemic stroke. METHODS This is an observational, prospective study in a sample of patients hospitalized for ischemic stroke (N = 131). Peripheral blood levels of biomarkers of interest were determined at admission (CRP, D-dimer, and fibrinogen) or at 48 hours poststroke (S100β protein). Functional status was accessed at 48 hours and 12 weeks poststroke using the modified Rankin Scale (mRS). RESULTS S100β protein levels measured at 48 hours were significantly associated with mRS scores at 12 weeks (odds ratio = 1.005, 95% confidence interval [CI] [1.005-1.007]; P <.001). This association was not seen for the remaining biomarkers of interest. The S100β cutoff for poor functionality at 12 weeks was 140.5 ng/L or more (sensibility 83.8%; specificity 71.4%; area under the curve = .80, 95% CI [.722, .879]). CONCLUSIONS S100β levels in peripheral blood at 48 hours poststroke reflect acute stroke severity and predict functional outcome at 12 weeks with a cutoff value of 140.5 ng/dL. The value of S100β as predictor of functional recovery after stroke should be emphasized in further clinical research and clinical practice.
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Affiliation(s)
- João Paulo Branco
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Physical and Rehabilitation Medicine Department, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal; Physical and Rehabilitation Medicine Department, Centro de Medicina de Reabilitação da Região Centro-Rovisco Pais, Tocha, Portugal.
| | - Sandra Oliveira
- Physical and Rehabilitation Medicine Department, Centro de Medicina de Reabilitação da Região Centro-Rovisco Pais, Tocha, Portugal
| | - João Sargento-Freitas
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Neurology Department, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Joana Santos Costa
- Physical and Rehabilitation Medicine Department, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Gustavo Cordeiro
- Neurology Department, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Luís Cunha
- Neurology Department, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - António Freire Gonçalves
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Neurology Department, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - João Pinheiro
- Physical and Rehabilitation Medicine Department, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal; Neurology Department, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
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10
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Hoebel J, Rommel A, Schröder SL, Fuchs J, Nowossadeck E, Lampert T. Socioeconomic Inequalities in Health and Perceived Unmet Needs for Healthcare among the Elderly in Germany. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E1127. [PMID: 28954436 PMCID: PMC5664628 DOI: 10.3390/ijerph14101127] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 09/18/2017] [Accepted: 09/21/2017] [Indexed: 11/24/2022]
Abstract
Research into health inequalities in the elderly population of Germany is relatively scarce. This study examines socioeconomic inequalities in health and perceived unmet needs for healthcare and explores the dynamics of health inequalities with age among elderly people in Germany. Data were derived from the Robert Koch Institute's cross-sectional German Health Update study. The sample was restricted to participants aged 50-85 years (n = 11,811). Socioeconomic status (SES) was measured based on education, (former) occupation, and income. Odds ratios and prevalence differences were estimated using logistic regression and linear probability models, respectively. Our results show that self-reported health problems were more prevalent among men and women with lower SES. The extent of SES-related health inequalities decreased at older ages, predominantly among men. Although the prevalence of perceived unmet needs for healthcare was low overall, low SES was associated with higher perceptions of unmet needs in both sexes and for several kinds of health services. In conclusion, socioeconomic inequalities in health exist in a late working age and early retirement but may narrow at older ages, particularly among men. Socially disadvantaged elderly people perceive greater barriers to accessing healthcare services than those who are better off.
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Affiliation(s)
- Jens Hoebel
- Division of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Straße 62-66, 12101 Berlin, Germany.
| | - Alexander Rommel
- Division of Health Reporting, Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Straße 62-66, 12101 Berlin, Germany.
| | - Sara Lena Schröder
- Institute of Medical Sociology, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112 Halle, Germany.
| | - Judith Fuchs
- Division of Physical Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Straße 62-66, 12101 Berlin, Germany.
| | - Enno Nowossadeck
- Division of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Straße 62-66, 12101 Berlin, Germany.
| | - Thomas Lampert
- Division of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Straße 62-66, 12101 Berlin, Germany.
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11
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Branco JP, Oliveira S, Páscoa Pinheiro J, L. Ferreira P. Assessing upper limb function: transcultural adaptation and validation of the Portuguese version of the Stroke Upper Limb Capacity Scale. BMC Sports Sci Med Rehabil 2017; 9:15. [PMID: 28785412 PMCID: PMC5543451 DOI: 10.1186/s13102-017-0078-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 07/23/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Brachial hemiparesis is one of the most frequent sequelae of stroke, leading to important functional disability given the role of the upper limb in executing activities of daily living (ADL). The Stroke Upper Limb Capacity Scale (SULCS) is a stroke-specific assessment instrument that evaluates functional capacity of the upper limb based on the execution of 10 tasks. The objective of this study is the transcultural adaptation and psychometric validation of the Portuguese version of the SULCS. METHODS A Portuguese version of the SULCS was developed, using the process of forward-backward translation, after authorisation from the author of the original scale. Then, a multicentre study was conducted in Portuguese stroke patients (n = 122) to validate the psychometric properties of the instrument. The relationship between sociodemographic and clinical characteristics was used to test construct validity. The relationship between SULCS scores and other instruments was used to test criterion validity. RESULTS Semantic and linguistic adaptation of the SULCS was executed without substantial issues and allowed the development of a Portuguese version. The application of this instrument suggested the existence of celling effect (19.7% of participants with maximum score). Reliability was demonstrated through the intraclass correlation coefficient of 0.98. As for construct validity, SULCS was sensible to muscle tonus and aphasia. SULCS classification impacted the scores of the Motor Evaluation Scale for Upper Extremity in Stroke (MESUPES) and the Stroke Impact Scale (SIS). CONCLUSIONS The present version of SULCS shows valid and reliable cultural adaptation, with good reliability and stability.
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Affiliation(s)
- João Paulo Branco
- Faculty of Medicine of the University of Coimbra, Coimbra, Portugal
- Physical and Rehabilitation Medicine Department, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
- Physical and Rehabilitation Medicine Department, Centro de Medicina de Reabilitação da Região Centro – Rovisco Pais, Tocha, Portugal
| | - Sandra Oliveira
- Physical and Rehabilitation Medicine Department, Centro de Medicina de Reabilitação da Região Centro – Rovisco Pais, Tocha, Portugal
| | - João Páscoa Pinheiro
- Faculty of Medicine of the University of Coimbra, Coimbra, Portugal
- Physical and Rehabilitation Medicine Department, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Pedro L. Ferreira
- Faculty of Economics, University of Coimbra, Coimbra, Portugal
- Centre for Health Studies and Research of the University of Coimbra, Coimbra, Portugal
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12
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Dewilde S, Annemans L, Peeters A, Hemelsoet D, Vandermeeren Y, Desfontaines P, Brouns R, Vanhooren G, Cras P, Michielsens B, Redondo P, Thijs V. Modified Rankin scale as a determinant of direct medical costs after stroke. Int J Stroke 2017; 12:392-400. [DOI: 10.1177/1747493017691984] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Resource use in the acute and subacute phases after stroke depends on the degree of disability. Aims To determine if direct costs after stroke also vary by level of disability as measured using the modified Rankin scale at the chronic stage after stroke. Methods In a multicentre study, we collected acute and chronic in- and outpatient resource use in survivors of ischemic stroke stratified by levels of disability according to the modified Rankin Scale. Statistical inference on costs at each level of the modified Rankin Scale was estimated using a general linear model for the first three months, the first year, and any subsequent year after ischemic stroke. Results A total of 569 survivors of ischemic stroke with a mean age of 71.7 years were enrolled (41% female) from 10 academic and nonacademic centers. Costs varied substantially over time and with each modified Rankin Scale level. The total average costs in the first year were estimated $33,147 per patient, ranging from $9,114 for modified Rankin Scale 0 to $83,236 for modified Rankin Scale 5. In the second year, medical costs were on average $14,039, varying from $2,921 to $39,723 for patients with modified Rankin Scale 0–5. The level of disability based on the modified Rankin Scale was a major determinant of resource use, irrespective of age, gender, atrial fibrillation, and vascular risk factors. Conclusion Long-term resource use after stroke is high and is mainly driven by degree of disability as measured by the modified Rankin scale.
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Affiliation(s)
- Sarah Dewilde
- Department of Public Health, Faculty of Medicine, UGent, Belgium
- Services in Health Economics, Brussels, Belgium
| | - Lieven Annemans
- Services in Health Economics, Brussels, Belgium
- Interuniversity Centre for Health Economics Research UGent, VUB, Belgium
| | - Andre Peeters
- Cliniques Universitaires Saint Luc, Service de Neurologie, Brussels, Belgium
| | | | - Yves Vandermeeren
- Neurology Department, Université catholique de Louvain (UcL), Yvoir, Belgium
| | | | - Raf Brouns
- Department of Neurology, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Geert Vanhooren
- Department of Neurology, AZ Sint-Jan Brugge-Oostende AV, Bruges, Belgium
| | - Patrick Cras
- Department of Neurology, Born Bunge Institute, University and University Hospital, Antwerp, Belgium
| | | | | | - Vincent Thijs
- Austin Health, Department of Neurology and Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia
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Abstract
Advancements in medical care over the last decades have contributed to a continuous decline in immediate post-stroke mortality. The flipside of this development is that patients surviving the initial stroke are forced to live with sometimes extreme functional motor and/or language limitations for the remaining life span. The following overview presents evidence-based neurorehabilitative interventions to promote motor and language recovery in the acute and chronic post-stroke stages. Therapeutic approaches comprise intensive training, neuropharmacological drugs and non-invasive brain stimulation techniques, such as transcranial magnetic stimulation (TMS) or direct current stimulation (tDCS). Additionally, an outlook on promising future interventions for stroke neurorehabilitation is provided.
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Hofheinz M, Mibs M, Elsner B. Dual task training for improving balance and gait in people with stroke. Hippokratia 2016. [DOI: 10.1002/14651858.cd012403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Martin Hofheinz
- IFEP-Dresden; Department of Physiotherapy; Dresden Germany 01219
| | | | - Bernhard Elsner
- Dresden Medical School, Technical University Dresden; Department of Public Health; Fetscherstr. 74 Dresden Sachsen Germany 01307
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Weltin A, Kieninger J, Urban GA. Microfabricated, amperometric, enzyme-based biosensors for in vivo applications. Anal Bioanal Chem 2016; 408:4503-21. [PMID: 26935934 PMCID: PMC4909808 DOI: 10.1007/s00216-016-9420-4] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 02/08/2016] [Accepted: 02/12/2016] [Indexed: 01/19/2023]
Abstract
Miniaturized electrochemical in vivo biosensors allow the measurement of fast extracellular dynamics of neurotransmitter and energy metabolism directly in the tissue. Enzyme-based amperometric biosensing is characterized by high specificity and precision as well as high spatial and temporal resolution. Aside from glucose monitoring, many systems have been introduced mainly for application in the central nervous system in animal models. We compare the microsensor principle with other methods applied in biomedical research to show advantages and drawbacks. Electrochemical sensor systems are easily miniaturized and fabricated by microtechnology processes. We review different microfabrication approaches for in vivo sensor platforms, ranging from simple modified wires and fibres to fully microfabricated systems on silicon, ceramic or polymer substrates. The various immobilization methods for the enzyme such as chemical cross-linking and entrapment in polymer membranes are discussed. The resulting sensor performance is compared in detail. We also examine different concepts to reject interfering substances by additional membranes, aspects of instrumentation and biocompatibility. Practical considerations are elaborated, and conclusions for future developments are presented. Graphical Abstract ᅟ.
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Affiliation(s)
- Andreas Weltin
- Laboratory for Sensors, Department of Microsystems Engineering – IMTEK, University of Freiburg, Georges-Köhler-Allee 103, 79110 Freiburg, Germany
| | - Jochen Kieninger
- Laboratory for Sensors, Department of Microsystems Engineering – IMTEK, University of Freiburg, Georges-Köhler-Allee 103, 79110 Freiburg, Germany
| | - Gerald A. Urban
- Laboratory for Sensors, Department of Microsystems Engineering – IMTEK, University of Freiburg, Georges-Köhler-Allee 103, 79110 Freiburg, Germany
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Reddy VY, Akehurst RL, Armstrong SO, Amorosi SL, Brereton N, Hertz DS, Holmes DR. Cost effectiveness of left atrial appendage closure with the Watchman device for atrial fibrillation patients with absolute contraindications to warfarin. Europace 2016; 18:979-86. [PMID: 26838691 PMCID: PMC4927063 DOI: 10.1093/europace/euv412] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 11/04/2015] [Indexed: 01/21/2023] Open
Abstract
Aims Atrial fibrillation (AF) patients with contraindications to oral anticoagulation have had few options for stroke prevention. Recently, a novel oral anticoagulant, apixaban, and percutaneous left atrial appendage closure (LAAC) have emerged as safe and effective therapies for stroke risk reduction in these patients. This analysis assessed the cost effectiveness of LAAC with the Watchman device relative to apixaban and aspirin therapy in patients with non-valvular AF and contraindications to warfarin therapy. Methods and results A cost-effectiveness model was constructed using data from three studies on stroke prevention in patients with contraindications: the ASAP study evaluating the Watchman device, the ACTIVE A trial of aspirin and clopidogrel, and the AVERROES trial evaluating apixaban. The cost-effectiveness analysis was conducted from a German healthcare payer perspective over a 20-year time horizon. Left atrial appendage closure yielded more quality-adjusted life years (QALYs) than aspirin and apixaban by 2 and 4 years, respectively. At 5 years, LAAC was cost effective compared with aspirin with an incremental cost-effectiveness ratio (ICER) of €16 971. Left atrial appendage closure was cost effective compared with apixaban at 7 years with an ICER of €9040. Left atrial appendage closure was cost saving and more effective than aspirin and apixaban at 8 years and remained so throughout the 20-year time horizon. Conclusions This analysis demonstrates that LAAC with the Watchman device is a cost-effective and cost-saving solution for stroke risk reduction in patients with non-valvular AF who are at risk for stroke but have contraindications to warfarin.
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Affiliation(s)
- Vivek Y Reddy
- Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1030, New York, NY 10029, USA
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17
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Ehlers MR, López Herrero C, Kastrup A, Hildebrandt H. The P300 in middle cerebral artery strokes or hemorrhages: Outcome predictions and source localization. Clin Neurophysiol 2015; 126:1532-8. [DOI: 10.1016/j.clinph.2014.10.151] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 09/23/2014] [Accepted: 10/26/2014] [Indexed: 10/24/2022]
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Gyrd-Hansen D, Olsen KR, Bollweg K, Kronborg C, Ebinger M, Audebert HJ. Cost-effectiveness estimate of prehospital thrombolysis: results of the PHANTOM-S study. Neurology 2015; 84:1090-7. [PMID: 25672925 DOI: 10.1212/wnl.0000000000001366] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To analyze the cost-effectiveness of shorter delays to treatment and increased thrombolysis rate as shown in the PHANTOM-S (Prehospital Acute Neurological Treatment and Optimization of Medical Care in Stroke) Study. METHODS In addition to intermediate outcomes (time to thrombolysis) and treatment rates, we registered all resource consequences of the intervention. The analyzed treatment effects of the intervention were restricted to distribution of IV thrombolysis (IVT) administrations according to time intervals. Intermediate outcomes were extrapolated to final outcomes according to numbers needed to treat derived from pooled IVT trials and translated to gains in quality-adjusted life-years (QALYs). RESULTS The net annual cost of the Stroke Emergency Mobile (STEMO) prehospital stroke concept was €963,954. The higher frequency of IVT administrations per year (310 vs 225) and higher proportions of patients treated in the early time interval (within 90 minutes: 48.1% vs 37.4%; 91-180 minutes: 37.4% vs 50%; 181-270 minutes: 14.5% vs 12.8%) resulted in an annual expected health gain of avoidance of 18 cases of disability equaling 29.7 QALYs. This produced an incremental cost-effectiveness ratio of €32,456 per QALY. CONCLUSIONS Depending on willingness-to-pay thresholds in societal perspectives, the STEMO prehospital stroke concept has the potential of providing a reasonable innovation even in health-economic dimensions.
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Affiliation(s)
- Dorte Gyrd-Hansen
- From IVØ Analysis, Department of Business and Economics (D.G.-H., K.R.O., C.K.), and Institute of Public Health (D.G.-H.), University of Southern Denmark; Department of Neurology (K.B., H.J.A.), Charité, Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin; Department of Neurology (M.E.), Charité, Universitätsmedizin Berlin, Campus Mitte, Berlin; and Center for Stroke Research Berlin (K.B., M.E., H.J.A.), Charité, Universitätsmedizin Berlin, Germany.
| | - Kim Rose Olsen
- From IVØ Analysis, Department of Business and Economics (D.G.-H., K.R.O., C.K.), and Institute of Public Health (D.G.-H.), University of Southern Denmark; Department of Neurology (K.B., H.J.A.), Charité, Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin; Department of Neurology (M.E.), Charité, Universitätsmedizin Berlin, Campus Mitte, Berlin; and Center for Stroke Research Berlin (K.B., M.E., H.J.A.), Charité, Universitätsmedizin Berlin, Germany
| | - Kerstin Bollweg
- From IVØ Analysis, Department of Business and Economics (D.G.-H., K.R.O., C.K.), and Institute of Public Health (D.G.-H.), University of Southern Denmark; Department of Neurology (K.B., H.J.A.), Charité, Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin; Department of Neurology (M.E.), Charité, Universitätsmedizin Berlin, Campus Mitte, Berlin; and Center for Stroke Research Berlin (K.B., M.E., H.J.A.), Charité, Universitätsmedizin Berlin, Germany
| | - Christian Kronborg
- From IVØ Analysis, Department of Business and Economics (D.G.-H., K.R.O., C.K.), and Institute of Public Health (D.G.-H.), University of Southern Denmark; Department of Neurology (K.B., H.J.A.), Charité, Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin; Department of Neurology (M.E.), Charité, Universitätsmedizin Berlin, Campus Mitte, Berlin; and Center for Stroke Research Berlin (K.B., M.E., H.J.A.), Charité, Universitätsmedizin Berlin, Germany
| | - Martin Ebinger
- From IVØ Analysis, Department of Business and Economics (D.G.-H., K.R.O., C.K.), and Institute of Public Health (D.G.-H.), University of Southern Denmark; Department of Neurology (K.B., H.J.A.), Charité, Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin; Department of Neurology (M.E.), Charité, Universitätsmedizin Berlin, Campus Mitte, Berlin; and Center for Stroke Research Berlin (K.B., M.E., H.J.A.), Charité, Universitätsmedizin Berlin, Germany
| | - Heinrich J Audebert
- From IVØ Analysis, Department of Business and Economics (D.G.-H., K.R.O., C.K.), and Institute of Public Health (D.G.-H.), University of Southern Denmark; Department of Neurology (K.B., H.J.A.), Charité, Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin; Department of Neurology (M.E.), Charité, Universitätsmedizin Berlin, Campus Mitte, Berlin; and Center for Stroke Research Berlin (K.B., M.E., H.J.A.), Charité, Universitätsmedizin Berlin, Germany
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The global impact of non-communicable diseases on healthcare spending and national income: a systematic review. Eur J Epidemiol 2015; 30:251-77. [DOI: 10.1007/s10654-014-9984-2] [Citation(s) in RCA: 151] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 12/23/2014] [Indexed: 12/11/2022]
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Unrath M, Wellmann J, Diederichs C, Binse L, Kalic M, Heuschmann PU, Berger K. The influence of neighborhood unemployment on mortality after stroke. J Stroke Cerebrovasc Dis 2014; 23:1529-36. [PMID: 24589035 DOI: 10.1016/j.jstrokecerebrovasdis.2013.12.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 12/17/2013] [Accepted: 12/20/2013] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Few studies have investigated the impact of neighborhood characteristics on mortality after stroke. Aim of our study was to analyze the influence of district unemployment as indicator of neighborhood socioeconomic status (SES-NH) on poststroke mortality, and to compare these results with the mortality in the underlying general population. METHODS Our analyses involve 2 prospective cohort studies from the city of Dortmund, Germany. In the Dortmund Stroke Register (DOST), consecutive stroke patients (N=1883) were recruited from acute care hospitals. In the Dortmund Health Study (DHS), a random general population sample was drawn (n=2291; response rate 66.9%). Vital status was ascertained in the city's registration office and information on district unemployment was obtained from the city's statistical office. We performed multilevel survival analyses to examine the association between district unemployment and mortality. RESULTS The association between neighborhood unemployment and mortality was weak and not statistically significant in the stroke cohort. Only stroke patients exposed to the highest district unemployment (fourth quartile) had slightly higher mortality risks. In the general population sample, higher district unemployment was significantly associated with higher mortality following a social gradient. After adjustment for education, health-related behavior and morbidity was made the strength of this association decreased. CONCLUSIONS The impact of SES-NH on mortality was different for stroke patients and the general population. Differences in the association between SES-NH and mortality may be partly explained by disease-related characteristics of the stroke cohort such as homogeneous lifestyles, similar morbidity profiles, medical factors, and old age.
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Affiliation(s)
- Michael Unrath
- Institute of Epidemiology and Social Medicine, University of Muenster, Muenster, Germany.
| | - Jürgen Wellmann
- Institute of Epidemiology and Social Medicine, University of Muenster, Muenster, Germany
| | - Claudia Diederichs
- Institute of Epidemiology and Social Medicine, University of Muenster, Muenster, Germany
| | - Lisa Binse
- German Stroke Foundation, Guetersloh, Germany
| | - Marianne Kalic
- Institute of Epidemiology and Social Medicine, University of Muenster, Muenster, Germany
| | - Peter Ulrich Heuschmann
- Institute of Clinical Epidemiology and Biometry, University of Wuerzburg, Wuerzburg, Germany; Comprehensive Heart Failure Center, University of Wuerzburg, Wuerzburg, Germany; Clinical Trial Center Wuerzburg, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Klaus Berger
- Institute of Epidemiology and Social Medicine, University of Muenster, Muenster, Germany
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Grube MM, Koennecke HC, Walter G, Meisel A, Sobesky J, Nolte CH, Wellwood I, Heuschmann PU. Influence of acute complications on outcome 3 months after ischemic stroke. PLoS One 2013; 8:e75719. [PMID: 24086621 PMCID: PMC3782455 DOI: 10.1371/journal.pone.0075719] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 08/16/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Early medical complications are potentially modifiable factors influencing in-hospital outcome. We investigated the influence of acute complications on mortality and poor outcome 3 months after ischemic stroke. METHODS Data were obtained from patients admitted to one of 13 stroke units of the Berlin Stroke Registry (BSR) who participated in a 3-months-follow up between June 2010 and September 2012. We examined the influence of the cumulative number of early in-hospital complications on mortality and poor outcome (death, disability or institutionalization) 3 months after stroke using multivariable logistic regression analyses and calculated attributable fractions to determine the impact of early complications on mortality and poor outcome. RESULTS A total of 2349 ischemic stroke patients alive at discharge from acute care were included in the analysis. Older age, stroke severity, pre-stroke dependency and early complications were independent predictors of mortality 3 months after stroke. Poor outcome was independently associated with older age, stroke severity, pre-stroke dependency, previous stroke and early complications. More than 60% of deaths and poor outcomes were attributed to age, pre-stroke dependency and stroke severity and in-hospital complications contributed to 12.3% of deaths and 9.1% of poor outcomes 3 months after stroke. CONCLUSION The majority of deaths and poor outcomes after stroke were attributed to non-modifiable factors. However, early in-hospital complications significantly affect outcome in patients who survived the acute phase after stroke, underlining the need to improve prevention and treatment of complications in hospital.
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Affiliation(s)
- Maike Miriam Grube
- Center for Stroke Research Berlin (CSB), Klinik für Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Division of Health and Social Care Research, King’s College London, London, United Kingdom
- * E-mail:
| | | | | | - Andreas Meisel
- Center for Stroke Research Berlin (CSB), Klinik für Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jan Sobesky
- Center for Stroke Research Berlin (CSB), Klinik für Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Hans Nolte
- Center for Stroke Research Berlin (CSB), Klinik für Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ian Wellwood
- Center for Stroke Research Berlin (CSB), Klinik für Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Peter Ulrich Heuschmann
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Center for Clinical Studies, University Hospital Würzburg, Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany
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22
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[Anesthesia in the angiography suite : More than dancing in the dark]. Anaesthesist 2013; 62:687-91. [PMID: 24030857 DOI: 10.1007/s00101-013-2228-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Wang G, Zhang Z, Ayala C, Dunet DO, Fang J, George MG. Costs of hospitalization for stroke patients aged 18-64 years in the United States. J Stroke Cerebrovasc Dis 2013; 23:861-8. [PMID: 23954598 DOI: 10.1016/j.jstrokecerebrovasdis.2013.07.017] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 05/21/2013] [Accepted: 07/08/2013] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Estimates for the average cost of stroke have varied 20-fold in the United States. To provide a robust cost estimate, we conducted a comprehensive analysis of the hospitalization costs for stroke patients by diagnosis status and event type. METHODS Using the 2006-2008 MarketScan inpatient database, we identified 97,374 hospitalizations with a primary or secondary diagnosis of stroke. We analyzed the costs after stratifying the hospitalizations by stroke type (hemorrhagic, ischemic, and other strokes) and diagnosis status (primary and secondary). We employed regressions to estimate the impact of event type and diagnosis status on costs while controlling for major potential confounders. RESULTS Among the 97,374 hospitalizations (average cost: $20,396 ± $23,256), the number with ischemic, hemorrhagic, or other strokes was 62,637, 16,331, and 48,208, respectively, with these types having average costs, in turn, of $18,963 ± $21,454, $32,035 ± $32,046, and $19,248 ± $21,703. A majority (62%) of the hospitalizations had stroke listed as a secondary diagnosis only. Regression analysis found that, overall, hemorrhagic stroke cost $14,499 more than ischemic stroke (P < .001). For hospitalizations with a primary diagnosis of ischemic stroke, those with a secondary diagnosis of ischemic heart disease (IHD) had costs that were $9836 higher (P < .001) than those without IHD. CONCLUSIONS The costs of hospitalizations involving stroke are high and vary greatly by type of stroke, diagnosis status, and comorbidities. These findings should be incorporated into cost-effective strategies to reduce the impact of stroke.
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Affiliation(s)
- Guijing Wang
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Zefeng Zhang
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carma Ayala
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Diane O Dunet
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jing Fang
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mary G George
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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Salter KL, Foley NC, Zhu L, Jutai JW, Teasell RW. Prevention of poststroke depression: does prophylactic pharmacotherapy work? J Stroke Cerebrovasc Dis 2012; 22:1243-51. [PMID: 22554569 DOI: 10.1016/j.jstrokecerebrovasdis.2012.03.013] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 03/20/2012] [Accepted: 03/25/2012] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Given the negative influence of poststroke depression (PSD) on functional recovery, cognition, social participation, quality of life, and risk for mortality, the early initiation of antidepressant therapy to prevent its development has been investigated; however, individual studies have offered conflicting evidence. The present systematic review and meta-analysis examined available evidence from published randomized controlled trials (RCTs) evaluating the effectiveness of pharmacotherapy for the prevention of PSD to provide updated pooled analyses. METHODS Literature searches of 6 databases were performed for the years 1990 to 2011. RCTs meeting study inclusion criteria were evaluated for methodologic quality. Data extracted included the antidepressant therapy used, treatment timing and duration, method(s) of assessment, and study results pertaining to the onset of PSD. Pooled analyses were conducted. RESULTS Eight RCTs were identified for inclusion. Pooled analyses demonstrated reduced odds for the development of PSD associated with pharmacologic treatment (odds ratio [OR] 0.34; 95% confidence interval [CI] 0.22-0.53; P<.001), a treatment duration of 1 year (OR 0.31; 95% CI 0.18-0.56; P<.001), and the use of a selective serotonin reuptake inhibitor (OR 0.37; 95% CI 0.22-0.61; P<.001). CONCLUSIONS The early initiation of antidepressant therapy, in nondepressed stroke patients, may reduce the odds for development of PSD. Optimum timing and duration for treatment and the identification of the most appropriate recipients for a program of indicated prevention require additional examination.
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Affiliation(s)
- Katherine L Salter
- Aging, Rehabilitation & Geriatric Care Program, Lawson Health Research Institute, Parkwood Hospital, London, Ontario, Canada.
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Hetze S, Römer C, Teufelhart C, Meisel A, Engel O. Gait analysis as a method for assessing neurological outcome in a mouse model of stroke. J Neurosci Methods 2012; 206:7-14. [PMID: 22343052 DOI: 10.1016/j.jneumeth.2012.02.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Revised: 01/02/2012] [Accepted: 02/01/2012] [Indexed: 10/14/2022]
Abstract
Ameliorating stroke induced neurological deficits is one of the most important goals of stroke therapy. In order to improve stroke outcome, novel treatment approaches as well as animal stroke models predictive for the clinical setting are of urgent need. One of the main obstacles in experimental stroke research is measuring long-term outcome, in particular in mouse models of stroke. On the other hand, assessing functional deficits in animal models of stroke is critical to improve the prediction of preclinical findings. Automated gait analysis provides a sensitive tool to examine locomotion and limb coordination in small rodents. Comparing mice before and 10 days after experimental stroke (60 min MCAo) we observed a significant decrease in maximum contact area, stride length and swing speed in the hind limbs, especially the contralateral one. Mice showed a disturbed interlimb coordination represented by changes in regularity index and phase dispersion. To assess whether gait analysis is applicable to assess improvements by neuroprotective compounds, we applied a model calculation and approached common statistical problems. In conclusion, gait analysis is a promising tool to assess mid- to long-term outcome in experimental stroke research.
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Affiliation(s)
- Susann Hetze
- Center of Stroke Research Berlin, Neurocure Clinical Research Center, Department for Experimental Neurology, Charité Universitaetsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
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[Development of mortality and morbidity of vascular diseases: variations between coronary heart disease and stroke]. DER NERVENARZT 2011; 82:145-6, 148-50, 152. [PMID: 21286677 DOI: 10.1007/s00115-010-3110-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Cardiovascular diseases represent a central challenge for our health care system because of their individual and societal consequences. The manuscript compares the current development of mortality and morbidity of coronary heart disease and stroke in Germany. RESULTS Coronary heart diseases are one of the leading causes of death and one of the major causes for adult disability. In Germany the average life expectancy has increased by more then 2 years per decade within recent years. The greatest contribution to the increase in life expectancy between 1980 and 2002 in Germany was attributed in previous studies to the decline in mortality rates of cardiovascular diseases; for example in Germany 134,648 persons died in 2008 from coronary heart disease (ICD-10 I20-I25) and 63,060 persons from stroke (ICD-10 I60-I64) compared to 178,759 persons and 90,241 persons in 1998, respectively. Statistical models from other countries estimated that the decrease in coronary heart disease mortality is attributed by about 40% to better treatment and by about 60% to changes in risk factors in the population. Comparable data for stroke are lacking. CONCLUSION Despite the substantial knowledge on cardiovascular diseases in Germany a continuous and timely documentation of their determinants, time trends of risk factors and impact regarding mortality and morbidity is compulsory to assess the effectiveness of initiated population health measures and to identify future options for improving prevention and treatment of cardiovascular diseases in Germany.
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Abstract
On the background of aging population an increase of patients suffering from stroke has to be expected during the next years and decades. Strokes are the 3rd leading cause of death and reason for disability in Germany and many other countries. An effective treatment of the modifiable risk factors hypertension, hyperlipidemia, diabetes mellitus, atrial fibrillation, smoking, alcohol consumption, and adipositas is of enormous impact. Due to the linear relationship between blood pressure and risk of stroke, the treatment of hypertension is the most important and effective one in primary as well as in secondary prevention. Treatment with platelet inhibitors plays an additional important role in secondary prevention. Patients with atrial fibrillation should receive an effective oral anticoagulatory therapy when there are certain risk factors.
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Affiliation(s)
- S Lüders
- St. Josefs-Hospital, Krankenhausstrasse 13, 49661, Cloppenburg, Deutschland.
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Luengo-Fernandez R, Gray AM, Rothwell PM. Costs of stroke using patient-level data: a critical review of the literature. Stroke 2008; 40:e18-23. [PMID: 19109540 DOI: 10.1161/strokeaha.108.529776] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE With decision-analytic models becoming more popular to assess the cost-effectiveness of health care interventions, the need for robust estimates on the costs of cerebrovascular disease is paramount. This study reports the results from a literature review of the costs of cerebrovascular diseases, and assesses the quality of the published evidence against a set of defined criteria. METHODS A broad literature search was conducted. Those studies reporting mean/median costs of cerebrovascular diseases derived from patient-level data in a developed country setting were included. Data were abstracted using standardized reporting forms and assessed against 4 predefined criteria: use of adequate methodologies, use of a population-based study, inclusion of premorbid resource use, and reporting of costs by different patient subgroups. RESULTS A total of 120 cost studies were identified. The cost estimates of stroke were compared by taking into account the effects of inflation and price differentials between countries. Average costs of stroke ranged from $468 to $146 149. Differences in costs were also found within country, with estimates in the USA varying 20-fold. Although the costing methodologies used were generally appropriate, only 5 studies were based on population-based studies, which are the gold standard study design when comparing incidence, outcome, and costs. CONCLUSIONS This review showed large variations in the costs of stroke, mainly attributable to differences in the populations studied, methods, and cost categories included. The wide range of cost estimates could lead to selection bias in secondary health economic analyses, with authors including those costs that are more likely to produce the desired results.
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Affiliation(s)
- Ramon Luengo-Fernandez
- Department of Public Health, Health Economics Research Centre, University of Oxford, Oxford, USA.
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Dawson J, Lees JS, Chang TP, Walters MR, Ali M, Davis SM, Diener HC, Lees KR. Association Between Disability Measures and Healthcare Costs After Initial Treatment for Acute Stroke. Stroke 2007; 38:1893-8. [PMID: 17446431 DOI: 10.1161/strokeaha.106.472381] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The distribution of 3-month modified Rankin scale (mRS) scores has been used as an outcome measure in acute stroke trials. We hypothesized that hospitalization and institutional care home stays within the first 90 days after stroke should be closely related to 90-day mRS, that each higher mRS category will reflect incremental cost, and that resource use may be less clearly linked to the National Institutes of Health Stroke Scale (NIHSS) or Barthel index. METHODS We examined resource use data from the GAIN International trial comparing 90-day mRS with total length of stay in hospital or other institutions during the first 90 days. We repeated analyses using NIHSS and Barthel index scores. Relationships were examined by analysis of variance (ANOVA) with Bonferroni contrasts of adjacent score categories. Estimated costs were based on published Scottish figures. RESULTS We had full data from 1717 patients. Length of stay was strongly associated with final mRS (P<0.0001). Each mRS increment from 0 to 1-2 to 3-4 was significant (mean length of stay: 17, 25, 44, 58, 79 days; P<0.0005). Ninety-five percent confidence limits for estimated costs ( pound) rose incrementally: 2493 to 3412, 3369 to 4479, 5784 to 7008, 7300 to 8512, 10 095 to 11 141, 11 772 to 13 560, and 2623 to 3321 for mRS 0 to 5 and dead, respectively. Weaker relationships existed with Barthel and NIHSS. CONCLUSIONS Each mRS category reflects different average length of hospital and institutional stay. Associated costs are meaningfully different across the full range of mRS outcomes. Analysis of the full distribution of mRS scores is appropriate for interpretation of treatment effects after acute stroke and more informative than Barthel or NIHSS end points.
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Affiliation(s)
- Jesse Dawson
- Department of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
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