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Hunter S, Vogel K, O’Leary S, Blennerhassett JM. Evaluating Feasibility of a Secondary Stroke Prevention Program. Healthcare (Basel) 2023; 11:2673. [PMID: 37830710 PMCID: PMC10573005 DOI: 10.3390/healthcare11192673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/25/2023] [Accepted: 09/28/2023] [Indexed: 10/14/2023] Open
Abstract
Healthy lifestyles including exercise and diet can reduce stroke risk, but stroke survivors often lack guidance to modify their lifestyles after hospital discharge. We evaluated the implementation of a new, secondary stroke prevention program involving supervised exercise, multidisciplinary education and coaching to address modifiable risk factors. The group-based program involved face-to-face and telehealth sessions. The primary outcomes were feasibility, examined via service information (referrals, uptake, participant demographics and costs), and participant acceptability (satisfaction and attendance). Secondary outcomes examined self-reported changes in lifestyle factors and pre-post scores on standardized clinical tests (e.g., waist circumference and 6-Minute Walk (6MWT)). We ran seven programs in 12 months, and 37 people participated. Attendance for education sessions was 79%, and 30/37 participants completed the full program. No adverse events occurred. Participant satisfaction was high for 'relevance' (100%), 'felt safe to exercise' (96%) and 'intend to continue' (96%). Most participants (88%) changed (on average) 2.5 lifestyle factors (diet, exercise, smoking and alcohol). Changes in clinical outcomes seemed promising, with some being statistically significant, e.g., 6MWT (MD 59 m, 95% CI 38 m to 80,159 m, p < 0.001) and waist circumference (MD -2.1 cm, 95%CI -3.9 cm to -1.4 cm, p < 0.001). The program was feasible to deliver, acceptable to participants and seemed beneficial for health. Access to similar programs may assist in secondary stroke prevention.
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Affiliation(s)
- Stephanie Hunter
- Austin Health, Health Independence Program, Community Rehabilitation Service, Melbourne, VIC 3084, Australia
| | - Kimberley Vogel
- Austin Health, Health Independence Program, Community Rehabilitation Service, Melbourne, VIC 3084, Australia
| | - Shane O’Leary
- Austin Health, Health Independence Program, Community Rehabilitation Service, Melbourne, VIC 3084, Australia
- Austin Health, Spinal Community Integration Service, Melbourne, VIC 3101, Australia
| | - Jannette Maree Blennerhassett
- Austin Health, Health Independence Program, Community Rehabilitation Service, Melbourne, VIC 3084, Australia
- Austin Health, Physiotherapy Department, Melbourne, VIC 3084, Australia
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Hsieh YH, Hsu JC, Lin C, Lin LY. X-RIM: Extreme Recurrent Independent Mechanisms for Noise-resistant and Interpretable Stroke Risk Prediction. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38083743 DOI: 10.1109/embc40787.2023.10339978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Stroke is a leading cause of mortality and long-term disability worldwide. An accurate stroke risk prediction is crucial for its early detection and prevention. Using deep learning to exploit patients' time-series electronic health records (EHRs) has been shown as a promising and efficient solution for such a prediction. Although time-series data could be more informative than a single cross-section in time, real-world time-series EHRs usually have a significantly high missing rate due to irregular patient visits. This could undermine sequential data's benefits unless a proper deep-learning model design is adopted. Furthermore, deep models have long been challenged for their interpretability, which is especially crucial for medical applications. In this study, we propose an extreme design based on the concept of recurrent independent mechanisms (RIM), termed extreme RIM (X-RIM). With no need for imputation, X-RIM utilizes the information of each input feature's temporal records through independent recurrent modules. Experiments on real-world data from the National Taiwan University Hospital showed that, in terms of the area under the precision-recall curve (AUPRC), the area under the receiver-operating characteristics curve (AUROC), and Youden Index, X-RIM (AUPRC: 0.210; AUROC: 0.764; Youden: 0.373) outperformed the classic risk score CHA2DS2-VASc (AUPRC: 0.103; AUROC: 0.650; Youden: 0.223) and other benchmarks in stroke risk prediction. Additional experiments also indicate that individual feature contributions to a prediction could be evaluated intuitively under X-RIM's independent structure to enhance interpretability.
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Ha JW, Heo J, Pyo JY, Ahn SS, Song JJ, Park YB, Lee SW. Acute Brain Infarction in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis: A Korean Single-Center Study. J Clin Rheumatol 2023:00124743-990000000-00118. [PMID: 37158752 DOI: 10.1097/rhu.0000000000001985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVES This study investigated the clinical and radiological features of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) patients with acute brain infarction, using a cohort of Korean patients with AAV. METHODS This study included 263 patients with AAV. Acute brain infarction was defined as infarction that occurred within 7 days or less. The brain territories affected by acute brain infarction were investigated. Active AAV was arbitrarily defined as the highest tertile of Birmingham Vasculitis Activity Score (BVAS). RESULTS The median age at diagnosis was 59.0 years, and 35.4% were male. Fourteen cases of acute brain infarction occurred in 12 patients (4.6%), which was calculated as 1332.2 per 100,000 patient-years and 10 times higher than the incidence rate in the Korean general population. Patients with AAV with acute brain infarction exhibited significantly older age, increased BVAS at diagnosis, and a more frequent history of prior brain infarction compared with those without. The brain territories affected in AAV patients were middle cerebral artery (50.0%), multiple territories (35.7%), and posterior cerebral artery (14.3%). Lacunar infarction and microhemorrhage were observed in 42.9% and 71.4% of cases, respectively. Prior brain infarction and BVAS at diagnosis were independently associated with acute brain infarction (hazard ratios, 7.037 and 1.089). Patients with AAV with prior brain infarction or BVAS for active AAV exhibited significantly lower cumulative acute brain infarction-free survival rates than those without. CONCLUSION Acute brain infarction was observed in 4.6% of AAV patients, and both prior brain infarction and BVAS at diagnosis were independently associated with acute brain infarction.
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Affiliation(s)
- Jang Woo Ha
- From the Division of Rheumatology, Department of Internal Medicine
| | | | - Jung Yoon Pyo
- From the Division of Rheumatology, Department of Internal Medicine
| | - Sung Soo Ahn
- From the Division of Rheumatology, Department of Internal Medicine
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BOLATTÜRK ÖF. Factors affecting the presentation time of patients with acute stroke to hospital and level of awareness of thrombolytic therapy. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2023. [DOI: 10.32322/jhsm.1177076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Introduction
In this study, it was aimed to reveal the factors affecting the time of presentation of patients with acute stroke to the hospital, determine the rates of benefiting from thrombolytic therapy and assess the thrombolytic therapy awareness of patients.
Materials and Methods
276 patients with acute stroke were included in our study. Standard structured questionnaire was administered to the patients. Patients were asked about the time of onset of stroke, age, place of residence, level of education, whether they received thrombolytic therapy, what was done as the first intervention, and whether they had information about thrombolytic therapy. Stroke severity was also evaluated by applying the National Institutes of Health Stroke Scale (NIHSS) to the patients.
Results
Of the patients included in the study, 218 (79%) had ischemic stroke, 26 (9.4%) had intracerebral hemorrhage and 32 (11.6%) had TIA. The mean NIHH score of the patients was 6.7±6.2. Stroke onset time was mainly between 18.00-24.00 with a rate of 28.3%. It was understood that 83.1% of the patients came to the emergency department by ambulance and 16.9% came by their own vehicle. When the groups of patients who received and did not receive thrombolytic therapy were compared, no significant difference was found between who the patient lived with at home and the groups of the level of education. Statistical significance was found with symptom onset time (p
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Sirisha S, Jala S, Vooturi S, Yada PK, Kaul S. Awareness, Recognition, and Response to Stroke among the General Public-An Observational Study. J Neurosci Rural Pract 2021; 12:704-710. [PMID: 34737504 PMCID: PMC8559085 DOI: 10.1055/s-0041-1735822] [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] [Indexed: 11/18/2022] Open
Abstract
Objective
To evaluate awareness and response to stroke among the general public.
Materials and Methods
In this prospective, observational study, self-reported stroke awareness questionnaire was administered in 2000 consecutive participants who visited outpatient clinic of a tertiary care hospital. For data analysis, comparison included for awareness of stroke and response in case of stroke.
Results
The average age of the study participants was 39.64 ± 15.55 (17–85), with 651(32.6%) women. Among the respondents, 786(39.3%) participants mentioned stroke as blood clot in the brain; 268(13.4%) stated it as brain hemorrhage. Awareness of stroke was higher in people in cities (71.0 vs. 8.5%;
p
< 0.001) and graduates (75.3 vs. 60.9%;
p
< 0.001) or knew a family member or friend who had stroke (42.7 vs. 30.4%;
p
< 0.001). Most commonly recognized risk factors included stress (1,152; 57.6%) and hypertension (1,148; 57.4%). Most identified warning sign was weakness of one side of body (807; 40.4%) and speech impairment (658; 32.9%). Participants who were aware of stroke knew a greater number of risk factors (3.75 ± 2.88 vs. 2.45 ± 2.66;
p
< 0.001) and warning signs (2.85 ± 2.25 vs. 1.49 ± 1.41;
p
<0.001). Among 1,138 participants who were aware of stroke, 166 (14.6%) participants knew one correct response in case of a stroke, either call a doctor (49.3 vs. 35.0%;
p
<0.001) or call an ambulance (41.1 vs. 34.9%;
p
= 0.055). Participants who knew one correct response to stroke had at least a family member/friend who had stroke (44.1 vs. 34.3%;
p
< 0.022).
Conclusion
We report that among 56.9% of the participants who were aware of stroke most could not name more than four risk factors or three warning signs of stroke. Only 14.6% of those aware of stroke knew appropriate response to stroke.
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Affiliation(s)
- Sai Sirisha
- School of Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Sireesha Jala
- Department of Neurology, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
| | - Sudhindra Vooturi
- Department of Neurology, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
| | - Praveen Kumar Yada
- Department of Neurology, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
| | - Subhash Kaul
- Department of Neurology, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
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Rana S, Luo W, Tran T, Venkatesh S, Talman P, Phan T, Phung D, Clissold B. Application of Machine Learning Techniques to Identify Data Reliability and Factors Affecting Outcome After Stroke Using Electronic Administrative Records. Front Neurol 2021; 12:670379. [PMID: 34646226 PMCID: PMC8503552 DOI: 10.3389/fneur.2021.670379] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 08/30/2021] [Indexed: 01/19/2023] Open
Abstract
Aim: To use available electronic administrative records to identify data reliability, predict discharge destination, and identify risk factors associated with specific outcomes following hospital admission with stroke, compared to stroke specific clinical factors, using machine learning techniques. Method: The study included 2,531 patients having at least one admission with a confirmed diagnosis of stroke, collected from a regional hospital in Australia within 2009-2013. Using machine learning (penalized regression with Lasso) techniques, patients having their index admission between June 2009 and July 2012 were used to derive predictive models, and patients having their index admission between July 2012 and June 2013 were used for validation. Three different stroke types [intracerebral hemorrhage (ICH), ischemic stroke, transient ischemic attack (TIA)] were considered and five different comparison outcome settings were considered. Our electronic administrative record based predictive model was compared with a predictive model composed of "baseline" clinical features, more specific for stroke, such as age, gender, smoking habits, co-morbidities (high cholesterol, hypertension, atrial fibrillation, and ischemic heart disease), types of imaging done (CT scan, MRI, etc.), and occurrence of in-hospital pneumonia. Risk factors associated with likelihood of negative outcomes were identified. Results: The data was highly reliable at predicting discharge to rehabilitation and all other outcomes vs. death for ICH (AUC 0.85 and 0.825, respectively), all discharge outcomes except home vs. rehabilitation for ischemic stroke, and discharge home vs. others and home vs. rehabilitation for TIA (AUC 0.948 and 0.873, respectively). Electronic health record data appeared to provide improved prediction of outcomes over stroke specific clinical factors from the machine learning models. Common risk factors associated with a negative impact on expected outcomes appeared clinically intuitive, and included older age groups, prior ventilatory support, urinary incontinence, need for imaging, and need for allied health input. Conclusion: Electronic administrative records from this cohort produced reliable outcome prediction and identified clinically appropriate factors negatively impacting most outcome variables following hospital admission with stroke. This presents a means of future identification of modifiable factors associated with patient discharge destination. This may potentially aid in patient selection for certain interventions and aid in better patient and clinician education regarding expected discharge outcomes.
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Affiliation(s)
- Santu Rana
- Applied Artificial Intelligence Institute (A2I2), Deakin University, Geelong, VIC, Australia
| | - Wei Luo
- School of Information Technology, Deakin University, Burwood, VIC, Australia
| | - Truyen Tran
- Applied Artificial Intelligence Institute (A2I2), Deakin University, Geelong, VIC, Australia
| | - Svetha Venkatesh
- Applied Artificial Intelligence Institute (A2I2), Deakin University, Geelong, VIC, Australia
| | - Paul Talman
- Neurosciences Department, University Hospital Geelong, Geelong, VIC, Australia
| | - Thanh Phan
- Stroke and Ageing Research Group, Department of Medicine, Monash University, Melbourne, VIC, Australia
| | - Dinh Phung
- Department of Science and AI, Monash University, Clayton, VIC, Australia
| | - Benjamin Clissold
- Neurosciences Department, University Hospital Geelong, Geelong, VIC, Australia.,Stroke and Ageing Research Group, Department of Medicine, Monash University, Melbourne, VIC, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Zuo ML, Li CM, Deng Y, Bhattacharyya S, Shuai P, Tse HF, Siu CW, Yin LX. The impact of cigarette smoking in predicting stroke using CHADS 2 and CHA 2DS 2-VASc schemas. Neurol Sci 2020; 42:159-166. [PMID: 32572660 PMCID: PMC7819918 DOI: 10.1007/s10072-020-04455-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 05/07/2020] [Indexed: 11/26/2022]
Abstract
Objective To determine the impact of smoking status in the prediction of stroke using CHADS2 and CHA2DS2-VASc schemes. Methods Five hundred twenty-eight consecutive patients with arrhythmic symptoms and without any documented arrhythmia from Queen Mary Hospital, Hong Kong, were followed up to determine the incidence of ischemic stroke, new-onset atrial fibrillation (AF), or all-cause mortality. Smoking status was classified into nonsmokers and smokers. The pairwise comparisons of C-statistics for outcomes were performed. Results During a median follow-up period of 6.2 years, 65 (12.3%) individuals developed ischemic stroke. Smokers experienced higher annual incidence of stroke, a new-onset AF, and all-cause death compare to nonsmokers, with corresponding hazard ratio (HR) of stroke, AF, and all-cause death being 2.51 (95% confidence intervals, CI 1.36als, CIse death bein 1.15a3.24), and 1.95 (95% CI 1.161.95 (95% CIath being 2.51 (95% confidence corr2 and CHA2DS2-VASc for stroke were 0.60 (95% CI 0.51 for stp = 0.09) and 0.59 (95% CI 0.50 (95%, p = 0.15) respectively, whereas the C-statistics of CHADS2 and CHA2DS2-VASc were 0.66 (95% CI 0.61 were 0p = 0.005), 0.75 (95% CI 0.7 CI 0.7p < 0.0001), respectively among nonsmokers. After incorporating smoking, both the CHADS2-smoking and CHA2DS2-VASc-smoking achieved better C-statistics for new-onset ischemic stroke prediction superior to baseline score systems in male groups. Conclusion Cigarette smoking status has impact on stroke stratification using CHADS2 and CHA2DS2-VASc scheme. The discrimination of the CHADS2 and CHA2DS2-VASc scheme for stroke can be significantly improved if smoking status is additionally considered.
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Affiliation(s)
- Ming-Liang Zuo
- Department of Cardiovascular Ultrasound and Non-invasive Cardiology, Health Management Center, Sichuan Provincial People’s Hospital, Affiliated Hospital of University of Electronic Science and Technology, 32# W. Sec 2, 1st Ring Rd, Chengdu, 610072 China
| | - Chun-Mei Li
- Department of Cardiovascular Ultrasound and Non-invasive Cardiology, Health Management Center, Sichuan Provincial People’s Hospital, Affiliated Hospital of University of Electronic Science and Technology, 32# W. Sec 2, 1st Ring Rd, Chengdu, 610072 China
| | - Yan Deng
- Department of Cardiovascular Ultrasound and Non-invasive Cardiology, Health Management Center, Sichuan Provincial People’s Hospital, Affiliated Hospital of University of Electronic Science and Technology, 32# W. Sec 2, 1st Ring Rd, Chengdu, 610072 China
| | - Sanjib Bhattacharyya
- College of Pharmaceutical Sciences, Southwest University, Beibei, Chongqing, 400715 China
| | - Ping Shuai
- Department of Cardiovascular Ultrasound and Non-invasive Cardiology, Health Management Center, Sichuan Provincial People’s Hospital, Affiliated Hospital of University of Electronic Science and Technology, 32# W. Sec 2, 1st Ring Rd, Chengdu, 610072 China
| | - Hung-Fat Tse
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Room 1928, Block K, 102 Pokfulam Road, Hong Kong SAR, 999077 China
| | - Chung-Wah Siu
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Room 1928, Block K, 102 Pokfulam Road, Hong Kong SAR, 999077 China
| | - Li-Xue Yin
- Department of Cardiovascular Ultrasound and Non-invasive Cardiology, Health Management Center, Sichuan Provincial People’s Hospital, Affiliated Hospital of University of Electronic Science and Technology, 32# W. Sec 2, 1st Ring Rd, Chengdu, 610072 China
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Wang HC, Su YC, Luk HN, Wang JH, Hsu CY, Lin SZ. Increased risk of strokes in patients with chronic low back pain (CLBP): A nationwide population-based cohort study. Clin Neurol Neurosurg 2020; 192:105725. [PMID: 32086183 DOI: 10.1016/j.clineuro.2020.105725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 02/05/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES There have not been any longitudinal studies reported that chronic low back pain (CLBP) patients are at risk for stroke. Thus, in this study, we explored the association between CLBP and strokes. PATIENTS AND METHODS Data (2000∼2010) from the Taiwan National Health Insurance database were analyzed. We matched 10,308 CLBP patients with 20,616 propensity score-matched non-low back pain (NLBP) patients according to age, gender, index year and comorbidities. Covariates of age, gender, comorbidities, and usage of non-steroidal anti-inflammatory drugs (NSAIDs) were adjusted and analyzed. RESULTS The mean follow-up duration was 8 years. CLBP patients had higher risks of all stroke, hemorrhagic stroke, and ischemic stroke. The adjusted hazard ratios (aHRs) were 2.35 (95 % confidence interval (CI): 2.14-2.57, p < 0.001), 1.55 (95 % CI: 1.16-2.06, p = 0.003), and 2.41 (95 % CI: 2.18-2.66, p < 0.001), respectively. After adjusting and analyzing the NSAIDs used for the varied duration in the CLBP patients, we did not observe any impacts of such NSAIDs used on the association of CLBP with strokes. The association between CLBP and ischemic stroke was most prominent in the patients less than 50 years old with aHR: 3.56 (CI: 2.74∼4.61, p < 0.001). CONCLUSION CLBP was associated with increased risk of strokes, especially ischemic stroke, and the association was most prominent in patients less than 50 years old. Further large prospective studies on detailed lifestyle-related factors and qualitative pain assessment are needed to clarify the causal relationship between CLBP and stroke.
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Affiliation(s)
- Hao-Chin Wang
- Department of Anesthesiology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan.
| | - Yuan-Chih Su
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.
| | - Hsiang-Ning Luk
- Department of Anesthesiology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan.
| | - Jen-Hung Wang
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan.
| | - Chung-Y Hsu
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.
| | - Shinn-Zong Lin
- Department of Neurosurgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan.
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Stroke Management: An Emerging Role of Nanotechnology. MICROMACHINES 2017; 8:mi8090262. [PMID: 30400452 PMCID: PMC6190436 DOI: 10.3390/mi8090262] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 08/07/2017] [Accepted: 08/09/2017] [Indexed: 12/21/2022]
Abstract
Stroke is among the leading causes of mortality and morbidity worldwide. Stroke incidences and associated mortality are expected to rise to 23 million and 7.8 million, respectively, by 2030. Further, the aging population, imbalanced lifestyles, and environmental factors continue to shift the rate of stroke incidence, particularly in developing countries. There is an urgent need to develop new therapeutic approaches for treating stroke. Nanotechnology is a growing field, offering an encouraging future prospect for medical research in the management of strokes. The world market for nanotechnology derived products is expected to rise manyfold in the coming decades. Different types of nanomaterials such as perfluorocarbon nanoparticles, iron oxide nanoparticles, gold nanoparticles, polymeric nanoparticles, quantum dots, nanospheres, etc. have been developed for the diagnosis as well as therapy of strokes. Today, nanotechnology has also been integrated with stem cell therapy for treating stroke. However several obstacles remain to be overcome when using such nanomaterials for treating stroke and other neurological diseases.
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Castilla-Guerra L, Fernández-Moreno MDC, de la Vega-Sánchez JM. Which antihypertensive drug should be used in patients with cerebrovascular disease to prevent a new stroke? Med Clin (Barc) 2017; 148:184-187. [PMID: 28069253 DOI: 10.1016/j.medcli.2016.11.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 11/23/2016] [Indexed: 01/28/2023]
Affiliation(s)
- Luis Castilla-Guerra
- Unidad de Riesgo Vascular, Servicio de Medicina Interna, Hospital Virgen Macarena, Sevilla, España.
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Sawalha A. Characterization of Hospitalized Ischemic Stroke Patients in Palestine. Libyan J Med 2016. [DOI: 10.3402/ljm.v4i1.4803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A.F. Sawalha
- Poison Control and Drug Information Center (PCDIC). An-Najah National University, Nablus, Palestine
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12
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Kumar P, Kathuria P, Nair P, Prasad K. Prediction of Upper Limb Motor Recovery after Subacute Ischemic Stroke Using Diffusion Tensor Imaging: A Systematic Review and Meta-Analysis. J Stroke 2016; 18:50-9. [PMID: 26846758 PMCID: PMC4747076 DOI: 10.5853/jos.2015.01186] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 12/10/2015] [Accepted: 12/10/2015] [Indexed: 10/30/2022] Open
Abstract
Early evaluation of the pyramidal tract using Diffusion Tensor Imaging (DTI) is a prerequisite to decide the optimal treatment or to assess appropriate rehabilitation. The early predictive value of DTI for assessing motor and functional recovery in ischemic stroke (IS) has yielded contradictory results. The purpose is to systematically review and summarize the current available literature on the value of Fractional Anisotropy (FA) parameter of the DTI in predicting upper limb motor recovery after sub-acute IS. MEDLINE, PubMed, EMBASE, Google Scholar and Cochrane CENTRAL searches were conducted from January 1, 1950, to July 31, 2015, which was supplemented with relevant articles identified in the references. Correlation between FA and upper limb motor recovery measure was done. Heterogeneity was examined using Higgins I-squared, Tau-squared. Summary of correlation coefficient was determined using Random Effects model. Out of 166 citations, only eleven studies met the criteria for inclusion in the systematic review and six studies were included in the meta-analysis. A random effects model revealed that DTI parameter FA is a significant predictor for upper limb motor recovery after sub-acute IS [Correlation Coefficient=0.82; 95% Confidence Interval-0.66 to 0.90, P value<0.001]. Moderate heterogeneity was observed (Tau-squared=0.12, I-squared=62.14). The studies reported so far on correlation between DTI and upper limb motor recovery are few with small sample sizes. This meta-analysis suggests strong correlation between DTI parameter FA and upper limb motor recovery. Well-designed prospective trials embedded with larger sample size are required to establish these findings.
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Affiliation(s)
- Pradeep Kumar
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Prachi Kathuria
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Pallavi Nair
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Kameshwar Prasad
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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13
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Bembenek JP, Karliński M, Kobayashi A, Członkowska A. The prestroke use of vitamin K antagonists for atrial fibrillation - trends over 15 years. Int J Clin Pract 2015; 69:180-5. [PMID: 25358816 DOI: 10.1111/ijcp.12486] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 06/02/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Effective anticoagulation with vitamin K antagonists (VKAs) is the standard of stroke prevention in patients with non-valvular atrial fibrillation (AF). Although, everyday practice is becoming increasingly guideline-driven, proper anticoagulation is still problematic. We aimed to investigate changes in the use of VKAs for stroke prevention in patients with AF admitted because of acute stroke over a period of 15 years. METHODS We analysed consecutive acute stroke patients admitted to our centre between June 1995 and December 2010. Data were prospectively collected in a detailed stroke registry. We distinguished between three periods: 1995-2000 (used as reference for comparisons), 2001-2005 and 2006-2010. RESULTS The AF rate prior to stroke was similar in ischaemic stroke patients (1995-2000: 25%, 2001-2005: 24%, 2006-2010: 24%) but increased in patients with intracerebral haemorrhage (ICH) (6%, 11%, 19%, p = 0.003 since 2006). The proportion of patients with AF using VKAs before stroke has became higher in ischaemic stroke (10%, 16%, 28%, p < 0.001 since 2006) with non-significant trend in ICH (0%, 33%, 45%). The proportion of ischaemic strokes occurring in patients with AF using VKAs with INR < 2 tended to increase over time (58%, 83%, 80.3%). There was also tendency towards increasing proportion of ICHs occurring in patients with AF over treated with VKAs (INR > 3). CONCLUSIONS The prescription rate of VKA for stroke prevention appears to be improving. However, because of a high proportion of patients on non-therapeutic INR, the proportion of cardioembolic ischaemic strokes remains stable. It may suggest that everyday use of VKAs is still far from optimal.
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Affiliation(s)
- J P Bembenek
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
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14
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Zheng G, Chen B, Fang Q, Yi H, Lin Q, Chen L, Tao J, Li J, Zheng X, Li M, Lan X. Primary prevention for risk factors of ischemic stroke with Baduanjin exercise intervention in the community elder population: study protocol for a randomized controlled trial. Trials 2014; 15:113. [PMID: 24712684 PMCID: PMC3996200 DOI: 10.1186/1745-6215-15-113] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 03/27/2014] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Stroke is a major cause of death and disability in the world, and the prevalence of stroke tends to increase with age. Despite advances in acute care and secondary preventive strategies, primary prevention should play the most significant role in the reduction of the burden of stroke. As an important component of traditional Chinese Qigong, Baduanjin exercise is a simple, safe exercise, especially suitable for older adults. However, current evidence is insufficient to inform the use of Baduanjin exercise in the prevention of stroke.The aim of this trail is to systematically evaluate the prevention effect of Baduanjin exercise on ischemic stroke in the community elder population with high risk factors. METHODS A total of 170 eligible participants from the community elder population will be randomly allocated into the Baduanjin exercise group and usual physical activity control group in a 1:1 ratio. Besides usual physical activity, participants in the Baduanjin exercise group will accept a 12-week Baduanjin exercise training with a frequency of five days a week and 40 minutes a day. Primary and secondary outcomes will be measured at baseline, 13 weeks (at end of intervention) and 25 weeks (after additional 12-week follow-up period). DISCUSSION This study will be the randomized trial to evaluate the effectiveness of Baduanjin exercise for primary prevention of stroke in community elder population with high risk factors of stroke. The results of this trial will help to establish the optimal approach for primary prevention of stroke. TRIAL REGISTRATION Chinese Clinical Trial Registry: ChiCTR-TRC-13003588.Registration date: 24 July, 2013.
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Affiliation(s)
| | | | | | | | | | - Lidian Chen
- Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China.
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Wang X, Wang L, Li T, Huang Z, Lai Y, Ji H, Wan X, Xu J, Tian J, Zhang Y. Novel hybrids of optically active ring-opened 3-n-butylphthalide derivative and isosorbide as potential anti-ischemic stroke agents. J Med Chem 2013; 56:3078-89. [PMID: 23509954 DOI: 10.1021/jm4001693] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In search of novel anti-ischemic stroke agents with higher potency than a known drug 3-n-butylphthalide (NBP), a series of hybrids ((S)- and (R)-5a-f) from optically active ring-opened NBP derivative and isosorbide were synthesized for evaluating their anti-ischemic stroke activity. Compound (S)-5e displayed the strongest activity in inhibiting the adenosine diphosphate (ADP) and arachidonic acid (AA)-induced platelet aggregation in vitro, with 10.0- and 8.4-fold more effectiveness than (S)-NBP, respectively. Furthermore, (S)-5e was stable in artificial gastrointestinal fluids and could penetrate the blood-brain barrier (BBB) with an appreciate lipid/water partition coefficient relative to (S)-NBP. More importantly, oral treatment with (S)-5e protected from acute thrombosis and inhibited the ischemia/reperfusion-related brain injury in animals. Our findings suggest that (S)-5e may be promising for further evaluation for the intervention of ischemic stroke.
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Affiliation(s)
- Xiaoli Wang
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing 210009, PR China
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16
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Wang X, Wang L, Huang Z, Sheng X, Li T, Ji H, Xu J, Zhang Y. Synthesis and biological evaluation of nitric oxide releasing derivatives of 6-amino-3-n-butylphthalide as potential antiplatelet agents. Bioorg Med Chem Lett 2013; 23:1985-8. [PMID: 23481646 DOI: 10.1016/j.bmcl.2013.02.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 01/29/2013] [Accepted: 02/06/2013] [Indexed: 01/12/2023]
Abstract
A series of novel nitric oxide releasing derivatives of 6-amino-3-n-butylphthalide were designed, synthesized and evaluated as potential antiplatelet agents. Compound 10b significantly inhibited the adenosine diphosphate (ADP)-induced platelet aggregation in vitro, superior to 6-amino-3-n-butylphthalide, 3-n-butylphthalide (NBP) and ticlopidine. Meanwhile 10b released moderate levels of NO, which could be beneficial for improving cardiovascular and cerebral circulation. Furthermore, 10b had an enhanced aqueous solubility relative to NBP. These findings may provide new insights into the development of novel antiplatelet agents for the treatment of thrombosis-related ischemic stroke.
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Affiliation(s)
- Xiaoli Wang
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing 210009, PR China
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17
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What are the patient-held illness beliefs after a transient ischaemic attack, and do they determine secondary prevention activities: an exploratory study in a North London General Practice. Prim Health Care Res Dev 2012; 13:165-74. [PMID: 22433271 DOI: 10.1017/s146342361100051x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND A transient ischaemic attack (TIA) is a strong predictor of future stroke. Stroke is the most common cause of mortality in the United Kingdom. Management of risk factors can reduce the possibility of future strokes; however, these are often difficult to achieve optimally. Current evidence suggests that beliefs about causal attributions, severity and perceived risk of stroke may influence uptake of secondary prevention activities amongst this patient group. AIM To explore the illness beliefs of patients about TIAs and future risk of stroke, and to determine whether these beliefs determine secondary stroke prevention activities. METHOD A qualitative study comprising face-to-face, semi-structured interviews conducted in the homes of participants. Sampling was purposive and drawn from a single North London General Practice. A thematic framework analysis method was followed. FINDINGS Eleven participants took part in the study (aged 46-86 years, three female participants and eight male participants). Time since diagnosis ranged from 2 to 25 years. There was a commonly held belief that TIAs are 'short-lived events' associated with full recovery, whereas strokes always lead to permanent 'disability'. Only those who believed their TIAs to be 'serious' undertook activities to prevent further recurrence. Concordance with medication was the most popular prevention activity. CONCLUSION The traditional medical definition of TIA and stroke do not reflect the views of patients who have had TIAs. One's perception of the severity of the initial TIA event and the risk of future stroke episodes may influence the uptake of secondary stroke prevention activities. Post TIA stroke prevention interventions should include tailored discussions focussing on the importance of the acute event and its implications for long-term health and future stroke risk.
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18
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Bin Q, Hu X, Cao Y, Gao F. The role of vitamin E (tocopherol) supplementation in the prevention of stroke. A meta-analysis of 13 randomised controlled trials. Thromb Haemost 2011; 105:579-85. [PMID: 21264448 DOI: 10.1160/th10-11-0729] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 12/11/2010] [Indexed: 02/07/2023]
Abstract
It was the objective of this work to systematically evaluate the role of vitamin E supplementation in the prevention of stroke. Eligible studies were identified from Medline, Embase and Cochrane Library. The efficacy data is the relative risk (RR) for the events of stroke. Thirteen randomised controlled trials (RCTs), with 166,282 participants in total, were analysed. The pooled results showed no significant benefit in the vitamin E group with respect to stroke of any type (RR 1.01; 95% confidence interval [CI]: 0.96, 1.07); ischaemic stroke (RR 1.01; 95% CI: 0.94, 1.09), haemorrhagic stroke (RR 1.12; 95% CI: 0.94, 1.33), fatal stroke (RR 0.94; 95% CI: 0.77, 1.14), and non-fatal stroke (RR 0.99; 95% CI: 0.91, 1.08). Administration of vitamin E 300 IU/day or more also gain no benefit (RR 0.99; 95% CI: 0.92, 1.06), as well as vitamin E less than 300 IU (RR 1.05; 95% CI: 0.96, 1.15). Vitamin E supplementation gained benefit of preventing stroke for neither healthy people (0.92; 0.83, 1.03) nor others at high risks in baseline (RR 1.05; 95% CI: 0.98, 1.12). Administration of synthetic vitamin E gain no benefit (RR 1.02; 95% CI: 0.96, 1.09), as well as the natural source vitamin E (RR 0.99; 95% CI: 0.89, 1.09). In conclusion, there is a lack of statistically significant or clinically important benefit of vitamin E supplementation in the prevention of stroke.
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Affiliation(s)
- Qiong Bin
- Department of Colorectal and Anal Surgery, First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, P. R. China
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19
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Almeida OP, Marsh K, Alfonso H, Flicker L, Davis TME, Hankey GJ. B-vitamins reduce the long-term risk of depression after stroke: The VITATOPS-DEP trial. Ann Neurol 2010; 68:503-10. [PMID: 20976769 DOI: 10.1002/ana.22189] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The consumption of certain B-vitamins through diet or supplementation decreases the total plasma concentration of homocysteine (tHcy) and may enhance response to standard antidepressant treatment. It is unclear if treatment with B-vitamins can reduce the long-term prevalence of depression in people at risk, such as stroke survivors. The purpose of this research was to determine if treatment with B-vitamins reduces the hazard of poststroke depression compared with placebo. METHODS Randomized, double-blind, placebo-controlled trial of tHcy-lowering treatment with daily folic acid (2 mg), vitamin B6 (25 mg), and vitamin B12 (0.5 mg) for 1 to 10.5 years in survivors of stroke. The primary endpoint was the onset of Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) major depression after randomization. Secondary outcomes were the prevalence of DSM-IV major or minor depression at the end of treatment. Other measured factors included age, gender, poststroke handicap associated with stroke, recurrence of strokes, cognitive impairment, and use of antidepressants. RESULTS Among 273 people who completed the final assessment after 7.1 ± 2.1 years (mean ± standard deviation) of follow up, random assignment to B-vitamins was associated with a lower hazard of major depression compared with placebo (18.4% vs 23.3%, adjusted hazard ratio [HR] = 0.48; 95% confidence interval [CI] = 0.31-0.76) and a trend toward a lower odds of major or minor depression at the end of the trial compared with placebo (19.1% vs 27.7%; adjusted odds ratio [OR] = 0.58; 95%CI = 0.31-1.09). INTERPRETATION Long-term treatment of poststroke survivors with folic acid, B6, and B12 was associated with a reduction in the hazard of major depression in our patient population. If these findings can be validated externally, B-vitamin supplementation offers hope as an effective, safe, and affordable intervention to reduce the burden of poststroke depression.
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Affiliation(s)
- Osvaldo P Almeida
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Crawley, Perth, WA, Australia.
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Stapleton PA, Goodwill AG, James ME, D'Audiffret AC, Frisbee JC. Differential impact of familial hypercholesterolemia and combined hyperlipidemia on vascular wall and network remodeling in mice. Microcirculation 2010; 17:47-58. [PMID: 20141600 DOI: 10.1111/j.1549-8719.2009.00003.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Genetic familial hypercholesterolemia (FH) and combined hyperlipidemia (FCH) are characterized by elevated plasma low-density lipoprotein (LDL) (FH) and LDL/triglycerides (FCH), with mouse models represented by LDL receptor (LDLR) and apolipoprotein E (ApoE) gene deletion mice, respectively. Given the impact of FH and FCH on health outcomes, we determined the impact of FH/FCH on vascular structure in LDLR and ApoE mice. LDLR, ApoE and control mice were utilized at 12-13 and 22-23 weeks when gracilis arteries were studied for wall mechanics and gastrocnemius muscles were harvested for microvessel density measurements. Conduit arteries and plasma samples were harvested for biochemical analyses. Arteries from ApoE and LDLR exhibited blunted expansion versus control, reduced distensibility and left-shifted stress versus strain relation (LDLR > ApoE). Microvessel density was reduced in ApoE and LDLR (ApoE > LDLR). Secondary analyses suggested that wall remodeling in LDLR was associated with cholesterol and MCP-1, while rarefaction in ApoE was associated with tumor necrosis factors-alpha, triglycerides and vascular production of TxA(2). Remodeling in ApoE and LDLR appears distinct; as that in LDLR is preferential for vascular walls, while that for ApoE is stronger for rarefaction. Remodeling in LDLR may be associated with cellular adhesion, while that in ApoE may be associated with pro-apoptotsis and constrictor prostanoid generation.
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Affiliation(s)
- Phoebe A Stapleton
- Center for Cardiovascular and Respiratory Sciences, West Virginia University School of Medicine, Morgantown, WV 26506, USA
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21
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Mansia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, Grassi G, Heagerty AM, Kjeldsen SE, Laurent S, Narkiewicz K, Ruilope L, Rynkiewicz A, Schmieder RE, Struijker Boudier HA, Zanchetti A. 2007 ESH‐ESC Guidelines for the management of arterial hypertension. Blood Press 2009; 16:135-232. [PMID: 17846925 DOI: 10.1080/08037050701461084] [Citation(s) in RCA: 238] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Giuseppe Mansia
- Clinica Medica, Ospedale San Gerardo, Universita Milano-Bicocca, Via Pergolesi, 33 - 20052 MONZA (Milano), Italy.
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22
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Fagan SC. Urgent Need for Secondary Stroke Prevention After Transient Ischemic Attack. ACTA ACUST UNITED AC 2009; 23:131-40. [DOI: 10.4140/tcp.n.2008.131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Patel K, Schlundt D, Larson C, Wang H, Brown A, Hargreaves M. Chronic illness and smoking cessation. Nicotine Tob Res 2009; 11:933-9. [PMID: 19516050 DOI: 10.1093/ntr/ntp088] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Smoking is among the leading causes of premature mortality and preventable death in the United States. Although smoking contributes to the probability of developing chronic illness, little is known about the relationship between quitting smoking and the presence of chronic illness. The present study investigated the association between diagnoses of one or more chronic diseases (diabetes, hypertension, or high cholesterol) and smoking status (former or current smoker). METHODS The data analyzed were a subset of questions from a 155-item telephone-administered community survey that assessed smoking status, demographic characteristics, and presence of chronic disease. The study sample consisted of 3,802 randomly selected participants. RESULTS Participants with diabetes were more likely to report being former smokers, after adjusting for sociodemographic characteristics, whereas having hypertension or high cholesterol was not associated significantly with smoking status. The likelihood of being a former smoker did not increase as number of diagnosed chronic diseases increased. Participants who were women, older (aged 65+), or single were significantly less likely to be former smokers. Participants with at least a college degree, those with incomes of 50,000+ US dollars, and those who were underweight or obese were more likely to be former smokers. DISCUSSION These findings were inconsistent with research that has suggested that having a chronic illness or experiencing a serious medical event increases the odds of smoking cessation. Supporting prior research, we found that being male, having a higher income, and being obese were associated with greater likelihood of being a former smoker.
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Affiliation(s)
- Kushal Patel
- Department of Internal Medicine, Meharry Medical College, 1005 D.B. Todd Blvd., Nashville, TN 37208, USA.
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Schaer B, Sticherling C, Lyrer P, Osswald S. Cardiological diagnostic work-up in stroke patients - a comprehensive study of test results and therapeutic implications. Eur J Neurol 2009; 16:268-73. [DOI: 10.1111/j.1468-1331.2008.02413.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Cerebrovascular disease is a major cause of morbidity and mortality worldwide and its prevalence is expected to increase as a result of projected demographic trends. Stroke is one of the leading causes of disability and death of over 30 million people each year worldwide. Hypertension is the most important modifiable risk factor for stroke. Recent data indicate that treatment with antihypertensive drugs reduces the incidence of all strokes in men (by 34%), women (by 38%), the elderly (by 36%), including those older than 80 years (by 34%), younger persons, those with systolic and diastolic hypertension, persons with isolated systolic hypertension, and those with a history of stroke or transient ischemic attack (by 28%). Furthermore, several large, prospective, randomized, clinical outcome trials have shown that calcium channel blockers (CCBs) are effective and safe antihypertensive drugs compared with placebo and reduce the cardiovascular morbidity and mortality of treated patients. Moreover, when CCBs were compared with conventional antihypertensive drugs they demonstrated similar blood pressure-lowering effects and similar reductions in cardiovascular morbidity and mortality, with the exception of a higher incidence of heart failure and fatal myocardial infarction in some studies. Considering all the evidence available today, however, these drugs should be considered safe for the treatment of the uncomplicated hypertensive patient in combination with other drugs. They can also be used as first-line therapy for older, stroke-prone hypertensive patients. The aim of this review is to summarize the role of CCBs in the prevention of stroke.
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Riachy M, Sfeir F, Sleilaty G, Hage-Chahine S, Dabar G, Bazerbachi T, Aoun-Bacha Z, Khayat G, Koussa S. Prediction of the survival and functional ability of severe stroke patients after ICU therapeutic intervention. BMC Neurol 2008; 8:24. [PMID: 18582387 PMCID: PMC2443378 DOI: 10.1186/1471-2377-8-24] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2007] [Accepted: 06/26/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study evaluated the benefits and impact of ICU therapeutic interventions on the survival and functional ability of severe cerebrovascular accident (CVA) patients. METHODS Sixty-two ICU patients suffering from severe ischemic/haemorrhagic stroke were evaluated for CVA severity using APACHE II and the Glasgow coma scale (GCS). Survival was determined using Kaplan-Meier survival tables and survival prediction factors were determined by Cox multivariate analysis. Functional ability was assessed using the stroke impact scale (SIS-16) and Karnofsky score. Risk factors, life support techniques and neurosurgical interventions were recorded. One year post-CVA dependency was investigated using multivariate analysis based on linear regression. RESULTS The study cohort constituted 6% of all CVA (37.8% haemorrhagic/62.2% ischemic) admissions. Patient mean(SD) age was 65.8(12.3) years with a 1:1 male: female ratio. During the study period 16 patients had died within the ICU and seven in the year following hospital release. The mean(SD) APACHE II score at hospital admission was 14.9(6.0) and ICU mean duration of stay was 11.2(15.4) days. Mechanical ventilation was required in 37.1% of cases. Risk ratios were; GCS at admission 0.8(0.14), (p = 0.024), APACHE II 1.11(0.11), (p = 0.05) and duration of mechanical ventilation 1.07(0.07), (p = 0.046). Linear coefficients were: type of CVA - haemorrhagic versus ischemic: -18.95(4.58) (p = 0.007), GCS at hospital admission: -6.83(1.08), (p = 0.001), and duration of hospital stay -0.38(0.14), (p = 0.40). CONCLUSION To ensure a better prognosis CVA patients require ICU therapeutic interventions. However, as we have shown, where tests can determine the worst affected patients with a poor vital and functional outcome should treatment be withheld?
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Affiliation(s)
- Moussa Riachy
- Department of Pulmonary and Critical Care Medicine, Hotel Dieu de France, Beirut, Lebanon.
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O’Donnell MJ, Hankey GJ, Eikelboom JW. Antiplatelet Therapy for Secondary Prevention of Noncardioembolic Ischemic Stroke. Stroke 2008; 39:1638-46. [DOI: 10.1161/strokeaha.107.497271] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Martin J. O’Donnell
- From McMaster University (M.J.O., J.W.E.), Hamilton, ON, Canada; and the School of Medicine and Pharmacology (G.J.H.), University of Western Australia, Perth, Australia
| | - Graeme J. Hankey
- From McMaster University (M.J.O., J.W.E.), Hamilton, ON, Canada; and the School of Medicine and Pharmacology (G.J.H.), University of Western Australia, Perth, Australia
| | - John W. Eikelboom
- From McMaster University (M.J.O., J.W.E.), Hamilton, ON, Canada; and the School of Medicine and Pharmacology (G.J.H.), University of Western Australia, Perth, Australia
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Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, Grassi G, Heagerty AM, Kjeldsen SE, Laurent S, Narkiewicz K, Ruilope L, Rynkiewicz A, Schmieder RE, Boudier HAJS, Zanchetti A, Vahanian A, Camm J, De Caterina R, Dean V, Dickstein K, Filippatos G, Funck-Brentano C, Hellemans I, Kristensen SD, McGregor K, Sechtem U, Silber S, Tendera M, Widimsky P, Zamorano JL, Erdine S, Kiowski W, Agabiti-Rosei E, Ambrosion E, Fagard R, Lindholm LH, Manolis A, Nilsson PM, Redon J, Viigimaa M, Adamopoulos S, Agabiti-Rosei E, Bertomeu V, Clement D, Farsang C, Gaita D, Lip G, Mallion JM, Manolis AJ, Nilsson PM, O'Brien E, Ponikowski P, Ruschitzka F, Tamargo J, van Zwieten P, Viigimaa M, Waeber B, Williams B, Zamorano JL. [ESH/ESC 2007 Guidelines for the management of arterial hypertension]. Rev Esp Cardiol 2007; 60:968.e1-94. [PMID: 17915153 DOI: 10.1157/13109650] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Abstract
Stroke is the second most common cause of mortality and a major cause of long-term disability of adults in most countries. This study was performed to determine the level of knowledge and awareness regarding risk factors and warning signs of stroke in a selected sample. This cross-sectional study was carried out in Aydin between November and December 2005, utilizing a study sample of 920 people registered at urban health centers. The questionnaire, prepared by the investigators, was administered by 20 trained students utilizing face-to-face interviews at participants' homes. Two-thirds of the participants knew the organ effected by stroke. The participants reported that stroke was a consequence of occlusion (28.0%) or bleeding (18.0%) in brain arteries. Paralysis/weakness of one side of the body (37.1%), speech impairment (26.8%) and numbness of one side of the body (14.2%) were reported as three major stroke warning signs. Sixty-four percent of the participants knew at least one of these risk factors. Their primary sources of information were family and friends. Our study showed the great need for increasing awareness of risk factors and warning signs for stroke, perhaps utilizing community based education programs and the mass media.
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Affiliation(s)
- E D Evci
- Department of Public Health, Adnan Menderes University, School of Medicine, Aydin, Turkey.
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Bangalore S, Messerli FH. A review of stroke in patients with hypertension and coronary artery disease: Focus on calcium channel blockers. Int J Clin Pract 2006; 60:1281-6. [PMID: 16942591 DOI: 10.1111/j.1742-1241.2006.01135.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Stroke is a major cause of morbidity and mortality worldwide. Hypertension is one of the most important risk factors for stroke - increasing the risk significantly. The presence and severity of coronary artery disease (CAD), which often coexists with hypertension, also predicts an increased risk of stroke. Lowering blood pressure (BP) to target in patients with hypertension can significantly reduce the incidence of fatal and non-fatal stroke. Effective BP control is even more important in CAD patients who are at greater risk of stroke. Data regarding the effects of antihypertensive therapy on stroke in patients with angina or CAD are limited and have been variable. To date, BP management strategies in patients with CAD have relied on small subsets of data based on high-risk hypertensive patients. Results with calcium channel blockers (CCBs) have been more positive than those with other classes of antihypertensive agents. Findings from the ACTION trial have provided a significant insight into the benefits of CCBs in patients with CAD and hypertension. Nifedipine gastrointestinal therapeutic system (GITS), in addition to best practice therapy for stable angina pectoris, contributes to a significant reduction in the risk of stroke in patients with CAD and hypertension who are at high risk and require effective BP control. Moreover, the incidence of stroke is significantly related to baseline BP, which may be an important factor to consider when deciding on treatment strategies in high-risk patients with CAD.
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Affiliation(s)
- S Bangalore
- Division of Cardiology, Department of Medicine, St Luke's-Roosevelt Hospital and Columbia University, New York, NY 10025, USA
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Feigl B, Brown B, Lovie-Kitchin J, Swann P. Functional loss in early age-related maculopathy: the ischaemia postreceptoral hypothesis. Eye (Lond) 2006; 21:689-96. [PMID: 16680100 DOI: 10.1038/sj.eye.6702389] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
We review proposed models and psychophysical and electrophysiological tests performed in many studies for early age-related maculopathy (ARM). We suggest that ischaemia is the trigger for impaired retinal pigment epithelium function causing imbalance of secretion of vascular growth factors, reduced disc degradation capability and reduced metabolic activity and possible inflammatory response. This results in increased deposition of cell debris, such as drusen and thickens Bruch's membrane causing even more ischaemia of the overlying neurosensory retina. The photoreceptors are more resistant to ischaemia given their proximity to the choroid. Furthermore, being 'upstream' from the inner retinal layers, they act as an oxygen sink depriving retinal layers further from the choroid. Postreceptoral cell layers and especially parts of the inner nuclear layer that are located in the watershed zone between two sources of blood supply are preferentially vulnerable to ischaemia. Based on psychophysical and electrophysiological findings we propose that most of the function impairment in early ARM starts postreceptorally.
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Affiliation(s)
- B Feigl
- Institute of Health and Biomedical Innovation, School of Optometry, Queensland University of Technology, Brisbane, Queensland, Australia.
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