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Oldham MA, Kukla B, Walsh P, Lee HB. Sex Differences in Delirium after Coronary Artery Bypass Graft Surgery and Perioperative Neuropsychiatric Conditions: A Secondary Analysis of a Cohort Study. J Geriatr Psychiatry Neurol 2024:8919887241246226. [PMID: 38604978 DOI: 10.1177/08919887241246226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
BACKGROUND Biological sex influences the risk of depression and cognitive impairment, but its role in relation to postoperative delirium is unclear. This analysis investigates sex differences in delirium risk after coronary artery bypass graft (CABG) surgery and sex-related differences in relation to affective and cognitive symptoms. METHODS This is a secondary analysis of the Neuropsychiatric Outcomes After Heart Surgery (NOAHS) study, a single-site, observational study of a CABG surgery cohort (n = 149). Preoperative characteristics are stratified by sex, and baseline variables that differ by sex are evaluated to understand whether sex modifies their relationships with delirium. We also evaluate sex differences in one-month depression and cognition. RESULTS Female sex is associated with several delirium risk factors, including higher risk of preoperative depression and middle cerebral artery (MCA) stenosis. MCA stenosis was statistically associated with delirium only among women (OR 15.6, 95% CI 1.5, 164.4); mild cognitive impairment (MCI) was associated with delirium only in men (OR 4.6, 95% CI 1.2, 17.9). Other sex-based differences failed to reach statistical significance. Depression remained commoner among women 1 month post-CABG. CONCLUSIONS Women in this CABG cohort were more likely to have depression at baseline and 1 month postoperatively, as well as MCA stenosis and postoperative delirium. Sex might modify the relationship between post-CABG delirium and its risk factors including MCA stenosis and MCI. Cerebrovascular disease deserves study as a potential explanation linking female sex and a range of poor outcomes among women with coronary heart disease.
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Affiliation(s)
- Mark A Oldham
- Department of Psychiatry University of Rochester Medical Center, Rochester, NY, USA
| | - Bennett Kukla
- College of Arts and Sciences, Cornell University, Ithaca, NY, USA
| | - Patrick Walsh
- Department of Psychiatry University of Rochester Medical Center, Rochester, NY, USA
| | - Hochang B Lee
- Department of Psychiatry University of Rochester Medical Center, Rochester, NY, USA
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Diagnosis of middle cerebral artery stenosis using the transcranial Doppler images based on convolutional neural network. World Neurosurg 2022; 161:e118-e125. [PMID: 35077885 DOI: 10.1016/j.wneu.2022.01.068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/16/2022] [Accepted: 01/17/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND The purpose of this study was to explore the diagnostic value of convolutional neural networks (CNNs) in middle cerebral artery (MCA) stenosis by analyzing the transcranial Doppler (TCD) images. METHODS Overall 278 patients who underwent cerebral vascular TCD and cerebral angiography were enrolled and classified into stenosis and non-stenosis groups based on cerebral angiography findings. Manual measurements were performed on TCD images. The patients were divided into a training set and a test set, and the CNNs architecture was used to classify TCD images. The diagnostic accuracies of manual measurements, CNNs, and TCD parameters for MCA stenosis were calculated and compared. RESULTS Overall, 203 patients without stenosis and 75 patients with stenosis were evaluated. The sensitivity, specificity, and area under the curve (AUC) for manual measurements of MCA stenosis were 0.80, 0.83, and 0.81, respectively. After 24 iterations of the running model in the training set, the sensitivity, specificity, and AUC of the CNNs in the test set were 0.84, 0.86, and 0.80, respectively. The diagnostic value of CNNs differed minimally from that of manual measurements. Two parameters of TCD, peak systolic velocity and mean flow velocity, were higher in patients with stenosis than in those without stenosis; however, their diagnostic values were significantly lower than those of CNNs (P < 0.05). CONCLUSIONS The diagnostic value of CNNs for MCA stenosis based on TCD images paralleled that of manual measurements. CNNs could be used as an auxiliary diagnostic tool to improve the diagnosis of MCA stenosis.
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Hao Q, Feldmann E, Balucani C, Zubizarreta N, Zhong X, Levine SR. A New Transcranial Doppler Scoring System for Evaluating Middle Cerebral Artery Stenosis. J Neuroimaging 2019; 30:97-103. [PMID: 31721367 DOI: 10.1111/jon.12678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 10/29/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE Transcranial Doppler (TCD) criteria for cerebrovascular stenosis are only based on velocity with unsatisfactory positive predictive value (PPV) in previous studies. We refined a published scoring system that integrates several characteristics of TCD data in diagnosing middle cerebral artery (MCA) stenosis. METHODS Using the TCD-digital subtraction angiography (DSA) database from Stroke Outcomes and Neuroimaging of Intracranial Atherosclerosis (SONIA) trial, velocity, spectrum pattern, diffuse ratio, and asymmetry ratio were assessed. The cutpoints were defined for each parameter and a point value was assigned to each category within that parameter. A summed score was calculated for each MCA. The accuracy was assessed for different cutpoints in predicting ≥50% MCA stenosis measured by DSA. Logistic regression and C-statistics were used for analysis. RESULTS A total of 114 MCAs were included in vessel-based and 87 patients were included in patient-based analysis. Compared to the velocity-only cutpoints in SONIA, the score results in much improved PPV while negative predictive value (NPV) remains unchanged. The score based on mean velocity (score 0: <140 cm/s, score 3: ≥140 cm/s), spectrum pattern (score 0: no turbulence; score 1: mild turbulence; 2: significant turbulence), and asymmetry ratio (score 0: ratio <1.5, score 1: ratio 1.5-2; score 2: ratio ≥2.1) has the highest NPV while PPV remains favorable (PPV: 72% [95% CI 54-90%]; NPV: 84% [95% CI: 75-93%], area under curve [AUC]: .76 [95% CI: .66-.86]). CONCLUSIONS The multiparameter scoring system incorporating several characteristics of TCD measures yielded higher PPV while maintaining high NPV compared with the single-parameter velocity criteria in diagnosing MCA ≥50% stenosis.
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Affiliation(s)
- Qing Hao
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Edward Feldmann
- Department of Neurology, University of Massachusetts School of Medicine-Baystate, MA
| | - Clotilde Balucani
- Department of Neurology, The Johns Hopkins University, Baltimore, MD
| | - Nicole Zubizarreta
- Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Xiaobo Zhong
- Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Steven R Levine
- Department of Neurology and Emergency Medicine, State University of New York Downstate Health Sciences University, and Department of Neurology, Kings County Hospital Center, Brooklyn, NY
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Depression Predicts Delirium After Coronary Artery Bypass Graft Surgery Independent of Cognitive Impairment and Cerebrovascular Disease: An Analysis of the Neuropsychiatric Outcomes After Heart Surgery Study. Am J Geriatr Psychiatry 2019; 27:476-486. [PMID: 30709616 PMCID: PMC6443412 DOI: 10.1016/j.jagp.2018.12.025] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 12/19/2018] [Accepted: 12/19/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Although depression is a known risk factor for delirium after coronary artery bypass graft (CABG) surgery, it is unclear whether this risk is independent of delirium risk attributable to cognitive impairment or cerebrovascular disease. This study examines depression, mild cognitive impairment (MCI), and cerebrovascular disease as post-CABG delirium risk factors. METHODS This prospective observational cohort study was performed in a tertiary-care academic hospital. Subjects were without dementia and undergoing CABG surgery. Preoperative cognitive assessment included Clinical Dementia Rating and neuropsychological battery; depression was assessed using Depression Interview and Structured Hamilton. Baseline intracranial stenosis was evaluated by transcranial Doppler of bilateral middle cerebral arteries (MCAs). Study psychiatrists assessed delirium on postoperative days 2-5 using the Confusion Assessment Method. RESULTS Our analytic sample comprised 131 subjects (average age: 65.8 ± 9.2years, 27% women). MCI prevalence was 24%, preoperative depression 10%, lifetime depression 35%, and MCA stenosis (≥50%) 28%. Sixteen percent developed delirium. Multivariate analysis revealed that age, MCI (odds ratio [OR]: 5.1; 95% confidence interval [CI]: 1.3-20.1), and preoperative depression (OR: 9.9; 95% CI: 1.3-77.9)-but not lifetime depression-predicted delirium. MCA stenosis and severity predicted delirium in univariate but not multivariate analysis. Right MCA stenosis severity predicted delirium severity, but left-sided stenosis severity did not. CONCLUSION We established that the risk of delirium attributable to depression extends beyond the potential moderating influence of cognitive impairment and cerebrovascular disease alone. Even mild depression and cognitive impairment before CABG deserve recognition for their effect on post-CABG cognitive health.
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Jeng JS, Hsieh FI, Yeh HL, Chen WH, Chiu HC, Tang SC, Liu CH, Lin HJ, Hsu SP, Lo YK, Chan L, Chen CH, Lin RT, Chen YW, Lee JT, Yeh CH, Sun MH, Lai TC, Sun Y, Sun MC, Chen PL, Chiang TR, Lin SK, Yip BS, Chen CI, Bai CH, Chen ST, Chiou HY, Lien LM, Hsu CY. Impact of MCA stenosis on the early outcome in acute ischemic stroke patients. PLoS One 2017; 12:e0175434. [PMID: 28388675 PMCID: PMC5384773 DOI: 10.1371/journal.pone.0175434] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 03/24/2017] [Indexed: 11/26/2022] Open
Abstract
Background Asians have higher frequency of intracranial arterial stenosis. The present study aimed to compare the clinical features and outcomes of ischemic stroke patients with and without middle cerebral artery (MCA) stenosis, assessed by transcranial sonography (TCS), based on the Taiwan Stroke Registry (TSR). Methods Patients with acute ischemic stroke or transient ischemic attack registered in the TSR, and received both carotid duplex and TCS assessment were categorized into those with stenosis (≥50%) and without (<50%) in the extracranial internal carotid artery (ICA) and MCA, respectively. Logistic regression analysis, Kaplan-Meier method and Cox proportional hazard model were applied to assess relevant variables between groups. Results Of 6003 patients, 23.3% had MCA stenosis, 10.1% ICA stenosis, and 3.9% both MCA and ICA stenosis. Patients with MCA stenosis had greater initial NIHSS, higher likelihood of stroke-in-evolution, and more severe disability than those without (all p<0.001). Patients with MCA stenosis had higher prevalence of hypertension, diabetes and hypercholesterolemia. Patients with combined MCA and extracranial ICA stenosis had even higher NIHSS, worse functional outcome, higher risk of stroke recurrence or death (hazard ratio, 2.204; 95% confidence intervals, 1.440–3.374; p<0.001) at 3 months after stroke than those without MCA stenosis. Conclusions In conclusion, MCA stenosis was more prevalent than extracranial ICA stenosis in ischemic stroke patients in Taiwan. Patients with MCA stenosis, especially combined extracranial ICA stenosis, had more severe neurological deficit and worse outcome.
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Affiliation(s)
- Jiann-Shing Jeng
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Fang-I Hsieh
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Hsu-Ling Yeh
- Department of Neurology, Shin Kong Wu-Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Wei-Hung Chen
- Department of Neurology, Shin Kong Wu-Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Hou-Chang Chiu
- Department of Neurology, Shin Kong Wu-Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Sung-Chun Tang
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chung-Hsiang Liu
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan
| | - Huey-Juan Lin
- Department of Neurology, Chi Mei Medical Center, Tainan, Taiwan
| | - Shih-Pin Hsu
- Department of Neurology, E Da Hospital, Kaohsiung, Taiwan
| | - Yuk-Keung Lo
- Section of Neurology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Lung Chan
- Department of Neurology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
| | - Chih-Hung Chen
- Department of Neurology, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Ruey-Tay Lin
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yu-Wei Chen
- Department of Neurology, Landseed Hospital, Taoyuan, Taiwan
| | - Jiunn-Tay Lee
- Department of Neurology, Tri-Service General Hospital, Taipei, Taiwan
| | - Chung-Hsin Yeh
- Department of Neurology, Yuan Rung Hospital, Yuanlin Township, Changhua, Taiwan
| | - Ming-Hui Sun
- Department of Neurology, Kuang Tien General Hospital, Taichung, Taiwan
| | - Ta-Chang Lai
- Department of Neurology, Cheng-Hsin General Hospital, Taipei, Taiwan
| | - Yu Sun
- Department of Neurology, En Chu Kong Hospital, New Taipei City, Taiwan
| | - Mu-Chien Sun
- Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan
| | - Po-Lin Chen
- Department of Neurology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Tsuey-Ru Chiang
- Department of Neurology, Cathay General Hospital, Taipei, Taiwan
| | - Shinn-Kuang Lin
- Department of Neurology, Buddhist Tzu Chi General Hospital Taipei Branch, New Taipei City, Taiwan
| | - Bak-Sau Yip
- Department of Neurology, National Taiwan University Hospital, Hsinchu Branch, Hsinchu, Taiwan
| | - Chin-I Chen
- Department of Neurology, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan
| | - Chi-Huey Bai
- Department of Public Health, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Sien-Tsong Chen
- Department of Neurology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Hung-Yi Chiou
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Li-Ming Lien
- Department of Neurology, Shin Kong Wu-Ho-Su Memorial Hospital, Taipei, Taiwan
- Department of Neurology, College of Medicine, Taipei Medical University, Taipei, Taiwan
- * E-mail:
| | - Chung Y. Hsu
- Graduate Institute of Clinical Medical Science, China Medical University and Hospital, Taichung, Taiwan
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Chen J, Bai Q, Zhao Z, Sui H, Xie X. Ginsenoside Represses Symptomatic Intracerebral Hemorrhage after Recombinant Tissue Plasminogen Activator Therapy by Promoting Transforming Growth Factor-β1. J Stroke Cerebrovasc Dis 2015; 25:549-55. [PMID: 26683593 DOI: 10.1016/j.jstrokecerebrovasdis.2015.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 10/19/2015] [Accepted: 11/03/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Currently, the most effective treatment for brain ischemic stroke is recombinant tissue plasminogen activator (rt-PA); however, increased incidence of symptomatic intracerebral hemorrhage severely reduced its favorable treatment outcome. METHODS We aimed to investigate the effect of ginsenoside (Gs) on symptomatic intracerebral hemorrhage after rt-PA treatment. Stroke patients were randomly divided into 2 treatment groups, one receiving rt-PA + placebo (Pc) and the other rt-PA + Gs. Twenty-four hours after the treatment, outcomes were assessed with transcranial Doppler (TCD) ultrasonography and National Institutes of Health Stroke Scale (NIHSS), and plasma levels of transforming growth factor-β1 (TGF-β1), matrix metalloproteinase (MMP)-2, and MMP-9 were also measured. After initial cotreatment, the patients were continuously administered with either Pc or Gs, and the treatment outcomes at 7 days were assessed with TCD, NIHSS, modified Rankin scale (MRS), and Glasgow outcome scale (GOS). RESULTS Cotreatment of rt-PA with Gs significantly improved outcomes in patients compared to the Pc group, as indicated by improved TCD and NIHSS scores and reduced incidence of symptomatic intracerebral hemorrhage, which could be attributed to a Gs-induced increase in TGF-β1 and a decrease in both MMP-2 and MMP-9 serum levels. Seven days of Gs treatment also significantly improved outcomes in patients compared to the Pc group, assessed by TCD, NIHSS, MRS, and GOS. CONCLUSION Our study supports the clinical use of Gs as a potential supplement with rt-PA treatment, which reduces symptomatic intracerebral hemorrhage, therefore improving the treatment outcome of stroke patients.
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Affiliation(s)
- Juan Chen
- Department of Neurology, Pudong People's Hospital, Shanghai
| | - Qingke Bai
- Department of Neurology, Pudong People's Hospital, Shanghai.
| | - Zhenguo Zhao
- Department of Radiology, Pudong People's Hospital, Shanghai, China
| | - Haijing Sui
- Department of Radiology, Pudong People's Hospital, Shanghai, China
| | - Xiuhai Xie
- Department of Radiology, Pudong People's Hospital, Shanghai, China
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Wang L, Xing Y, Li Y, Han K, Chen J. Evaluation of flow velocity in unilateral middle cerebral artery stenosis by Transcranial Doppler. Cell Biochem Biophys 2015; 70:823-30. [PMID: 24833432 DOI: 10.1007/s12013-014-9986-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
To determine the optimal velocity values in diagnosing unilateral middle cerebral artery (MCA) stenosis by Transcranial Doppler (TCD), and improve the diagnostic accuracy using magnetic resonance angiography (MRA), a total of 302 unilateral MCA stenosis patients undergoing TCD also consented to a MRA of the intracranial arteries. The peak systolic velocity (PSV) and each MCA spectrum for each patient were recorded. Using the MRA to confirm, the degree of middle cerebral artery stenosis was categorized into four groups: normal (normal caliber and signal), mild (<50 %), moderate (50-69 %), severe (70-99 %, or no flow detected). The velocity difference among these four groups was significant (P < 0.001). The optimal PSV values for normal and stenosis were 160 cm/s. For mild and moderate were 200 cm/s, for moderate and severe were 280 cm/s. Using PSV as the diagnostic criteria, the Kappa number was >0.668. The optimal PSV differential value for mild and moderate was 70 cm/s, for moderate and severe at 120 cm/s. Optimal combined criteria for moderate stenosis were PSV >200 cm/s and PSV differential value >70 cm/s (specificity 87.2 %), for severe stenosis were PSV >280 cm/s and PSV differential value >120 cm/s (sensibility 81.6 %). Transcranial Doppler distinguishes normal and MCA stenosis with a reduced lumen diameter of less than 50 %. Using the PSV criteria, TCD has a high coincidence rate with MRA in the diagnosis of MCA stenosis. Combined PSV differential value and the abnormal spectrum may improve the accuracy of TCD in diagnosing moderate or severe stenosis.
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Affiliation(s)
- Lin Wang
- Department of Neurology, First Norman Bethune Hospital of Jilin University, 71 Xinmin Street, Changchun, Jilin, 130021, People's Republic of China
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Zhong J, Chen XY, Leung TWH, Ou A, Shi X, Cai Y, Huang Y, Wong KS. Significance of Raised Flow Velocity in Basilar Artery in Patients with Acute Ischemic Stroke: Focal Stenosis, Coexistent Stenosis, and Collateral Flow. J Neuroimaging 2015; 25:922-6. [PMID: 25940508 DOI: 10.1111/jon.12245] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 02/22/2015] [Accepted: 02/27/2015] [Indexed: 11/28/2022] Open
Affiliation(s)
- Jingxin Zhong
- Cerebrovascular Disease Center; Guangdong Province Traditional Medicine Hospital; Guangzhou Guangdong
| | - Xiang-Yan Chen
- Departments of Medicine and Therapeutics, Chinese University of Hong Kong; Hong Kong Special Administrative Region; Hong Kong China
| | - Thomas Wai Hong Leung
- Departments of Medicine and Therapeutics, Chinese University of Hong Kong; Hong Kong Special Administrative Region; Hong Kong China
| | - Aihua Ou
- Cerebrovascular Disease Center; Guangdong Province Traditional Medicine Hospital; Guangzhou Guangdong
| | - Xiaogeng Shi
- Cerebrovascular Disease Center; Guangdong Province Traditional Medicine Hospital; Guangzhou Guangdong
| | - Yefeng Cai
- Cerebrovascular Disease Center; Guangdong Province Traditional Medicine Hospital; Guangzhou Guangdong
| | - Yan Huang
- Cerebrovascular Disease Center; Guangdong Province Traditional Medicine Hospital; Guangzhou Guangdong
| | - Ka Sing Wong
- Departments of Medicine and Therapeutics, Chinese University of Hong Kong; Hong Kong Special Administrative Region; Hong Kong China
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Intracranial Arterial Stenosis. J Stroke Cerebrovasc Dis 2014; 23:599-609. [DOI: 10.1016/j.jstrokecerebrovasdis.2013.06.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 05/14/2013] [Accepted: 06/05/2013] [Indexed: 11/21/2022] Open
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Chen J, Wang L, Bai J, Lun Z, Zhang J, Xing Y. The Optimal Velocity Criterion in the Diagnosis of Unilateral Middle Cerebral Artery Stenosis by Transcranial Doppler. Cell Biochem Biophys 2013; 69:81-7. [DOI: 10.1007/s12013-013-9771-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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