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Iancu A, Buleu F, Chita DS, Tutelca A, Tudor R, Brad S. Early Hemorrhagic Transformation after Reperfusion Therapy in Patients with Acute Ischemic Stroke: Analysis of Risk Factors and Predictors. Brain Sci 2023; 13:brainsci13050840. [PMID: 37239312 DOI: 10.3390/brainsci13050840] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/10/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023] Open
Abstract
Background: The standard reperfusion therapy for acute ischemic stroke (AIS) is considered to be thrombolysis, but its application is limited by the high risk of hemorrhagic transformation (HT). This study aimed to analyze risk factors and predictors of early HT after reperfusion therapy (intravenous thrombolysis or mechanical thrombectomy). Material and methods: Patients with acute ischemic stroke who developed HT in the first 24 h after receiving rtPA thrombolysis or performing mechanical thrombectomy were retrospectively reviewed. They were divided into two groups, respectively, the early-HT group and the without-early-HT group based on cranial computed tomography performed at 24 h, regardless of the type of hemorrhagic transformation. Results: A total of 211 consecutive patients were enrolled in this study. Among these patients, 20.37% (n = 43; age: median 70.00 years; 51.2% males) had early HT. Multivariate analysis of independent risk factors associated with early HT found that male gender increased the risk by 2.7-fold, the presence of baseline high blood pressure by 2.4-fold, and high glycemic values by 1.2-fold. Higher values of NIHSS at 24 h increased the risk of hemorrhagic transformation by 1.18-fold, while higher values of ASPECTS at 24 h decreased the risk of hemorrhagic transformation by 0.6-fold. Conclusions: In our study, male gender, baseline high blood pressure, and high glycemic values, along with higher values of NIHSS were associated with the increased risk of early HT. Furthermore, the identification of early-HT predictors is critical in patients with AIS for the clinical outcome after reperfusion therapy. Predictive models to be used in the future to select more careful patients with a low risk of early HT need to be developed in order to minimize the impact of HT associated with reperfusion techniques.
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Affiliation(s)
- Aida Iancu
- Department of Radiology, "Victor Babes" University of Medicine and Pharmacy, E. Murgu Square No. 2, 300041 Timisoara, Romania
- County Emergency Clinical Hospital "Pius Brinzeu", 300732 Timisoara, Romania
| | - Florina Buleu
- County Emergency Clinical Hospital "Pius Brinzeu", 300732 Timisoara, Romania
- Department of Cardiology, "Victor Babes" University of Medicine and Pharmacy, E. Murgu Square No. 2, 300041 Timisoara, Romania
| | - Dana Simona Chita
- Department of Neurology, Faculty of General Medicine, "Vasile Goldis" Western University of Arad, 310025 Arad, Romania
| | - Adrian Tutelca
- Department of Radiology, "Victor Babes" University of Medicine and Pharmacy, E. Murgu Square No. 2, 300041 Timisoara, Romania
- County Emergency Clinical Hospital "Pius Brinzeu", 300732 Timisoara, Romania
| | - Raluca Tudor
- County Emergency Clinical Hospital "Pius Brinzeu", 300732 Timisoara, Romania
- Department of Neurology, "Victor Babes" University of Medicine and Pharmacy, E. Murgu Square No. 2, 300041 Timisoara, Romania
| | - Silviu Brad
- Department of Radiology, "Victor Babes" University of Medicine and Pharmacy, E. Murgu Square No. 2, 300041 Timisoara, Romania
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Majersik JJ, Wong KH, O'Donnell SM, Johnson J, Garcia-Esperon C, Hamilton BJ, Tekiela P, Ledyard HK, Taillac P. Telestroke value through the eyes of emergency medicine providers: A counterfactual analysis. Heliyon 2023; 9:e14767. [PMID: 37089373 PMCID: PMC10119505 DOI: 10.1016/j.heliyon.2023.e14767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 03/06/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
Objectives Emergency Medicine (EM) provider experiences consulting telestroke (TS) are poorly studied. In this qualitative study, we aimed to determine how TS changes patient management and to measure TS effects on EM provider confidence with acute ischemic stroke (AIS) treatment. Materials and methods We designed a survey for EM providers querying perceptions of TS value, confidence with treating AIS, and counterfactuals regarding what EM providers would have done without TS. Eligible EM providers participated in an audio-visual TS consult within a 6-state TS network between 11/2016-11/2017. Results We received 48 surveys (response rate 43%). The most common reason (71%) for using TS was tPA eligibility expert opinion. Most EM providers (94%) thought the patient/family were satisfied with TS and none felt their medical knowledge was doubted because of using TS. EM providers had high confidence in diagnosing AIS (95%) and tPA decision-making (86%), but not in determining thrombectomy eligibility (10%). Among EM providers who administered tPA, 85% said tPA would not have been given without TS consultation. TS consultation changed patient diagnosis in 60% of all patients and treatment plans in 56% of non-stroke patients. Most EM providers (86%) had increased confidence in their knowledge of future stroke patient management. Nearly all TS consults (93%) resulted in EM providers being more likely to use TS again. Conclusions TS consult frequently results in both patient management change and increased EM knowledge of stroke management with increased likelihood of repeat usage. Discomfort in determining eligibility for thrombectomy points to educational opportunities.
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Affiliation(s)
- Jennifer Juhl Majersik
- Neurology, University of Utah, United States
- Corresponding author. Third Floor Stroke Center, University of Utah, 175 N Medical Center Drive, Salt Lake City, UT 84132, United States.
| | - Ka-Ho Wong
- Department of Neurology, University of Utah, United States
| | | | | | | | | | - Piotr Tekiela
- Division of Vascular Neurology, Department of Neurology, University of Utah, United States
| | - Holly K. Ledyard
- Neurology and Emergency Medicine, University of Utah, United States
| | - Peter Taillac
- Emergency Medicine, University of Utah, United States
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Varela S, Carrera D, Elazim AA, Robinson MB, Torbey M, Carlson AP. Continuous Tissue Plasminogen Activator Infusion Using a Minimally Invasive Irrigating Catheter for the Treatment of Intraparenchymal Hemorrhage Within the Basal Ganglia: Case Reports. Oper Neurosurg (Hagerstown) 2022; 23:e387-e391. [PMID: 36227254 PMCID: PMC10586848 DOI: 10.1227/ons.0000000000000408] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/28/2022] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND AND IMPORTANCE Intraparenchymal hemorrhage (IPH) is a debilitating and highly morbid type of stroke with limited effective treatment modalities. Minimally invasive evacuation with tissue plasminogen activator (rt-PA) has demonstrated promise for mortality/functional improvements with adequate clot volume reduction. In this study, we report 2 cases of continuous rt-PA infusion using a closed circuit, dual lumen catheter, and irrigation system (IRRAflow) for IPH treatment. CLINICAL PRESENTATION A 55-year-old man was admitted for acute onset left hemiparesis; he was found to have right basal ganglia IPH. He was treated with continuous rt-PA irrigation using the IRRAflow device, at a rate of 30 mL/h for 119 hours, with a total volume reduction of 87.8 mL and post-treatment volume of 1.2 mL. At 3-month follow-up, he exhibited a modified Rankin score of 4 and improved hemiparesis. A 39-year-old woman was admitted for acute onset left facial droop, left hemianopsia, and left hemiparesis; she was diagnosed with a right basal ganglia IPH. She was treated with drainage and continuous rt-PA irrigation at 30 mL/h for 24 hours, with a total hematoma volume reduction of 41 mL and with a final post-treatment volume of 9.1 mL. At 3-month follow-up, she exhibited a modified Rankin score of 3 with some improvement in left hemiparesis. CONCLUSION Continuous rt-PA infusion using a minimally invasive catheter with saline irrigation was feasible and resulted in successful volume reduction in 2 patients with IPH. This technique is similar to the Minimally Invasive Surgery Plus rt-PA for Intracerebral Hemorrhage Evacuation (MISTIE) approach but offers the potential advantages of less breaks in the sterile circuit, continuous intracranial pressure monitoring, and may provide more efficient clot lysis compared with intermittent bolusing.
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Affiliation(s)
- Samantha Varela
- School of Medicine, University of New Mexico (UNM), Albuquerque, New Mexico, USA
| | - Diego Carrera
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, New Mexico, USA
| | - Ahmed Abd Elazim
- Department of Neurology, University of New Mexico Hospital (UNMH), Albuquerque, New Mexico, USA
| | - Myranda B. Robinson
- School of Medicine, University of New Mexico (UNM), Albuquerque, New Mexico, USA
| | - Michel Torbey
- Department of Neurology, University of New Mexico Hospital (UNMH), Albuquerque, New Mexico, USA
| | - Andrew P. Carlson
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, New Mexico, USA
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Ogba FN, Ogba KTU, Ugwu LE, Emma-Echiegu N, Eze A, Agu SA, Aneke BA. Moderating Role of Initiative on the Relationship Between Intrinsic Motivation, and Self-Efficacy on Entrepreneurial Intention. Front Psychol 2022; 13:866869. [PMID: 36312071 PMCID: PMC9597323 DOI: 10.3389/fpsyg.2022.866869] [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: 01/31/2022] [Accepted: 06/06/2022] [Indexed: 12/03/2022] Open
Abstract
The growing population of new graduates and the increasing scarcity of employment opportunities have made entrepreneurship an unavoidable option for employment and self-sustenance. This study investigates the effect of the initiative in moderating the relationship between intrinsic motivation, self-efficacy, and entrepreneurship intention through the integrated framework of theory of planned behaviour, self-determination, and humanism. This study contributes insights to how these factors moderated by initiative influence entrepreneurial intention among graduating students of tertiary institutions in Nigeria. This study adopted a cross-sectional design to examine the moderating role of initiative on the relationship between intrinsic motivation, and self-efficacy on entrepreneurial intention among Nigerian graduates. A total number of 688 graduate students, including 266 (38.6%) males and 422 (61.4%) females with a mean age of 24.30 years (SD = 3.69), participated in the study. Participants responded to a self-report questionnaire containing Initiative, Intrinsic motivation, self-efficacy, and entrepreneurial intention scales. Results showed that all the variables correlated positively with entrepreneurial intention. Furthermore, initiative moderated the relationship between self-efficacy and entrepreneurial intention [value and start-ups/operations (OPS)], such that high self-efficacy with high initiative showed higher entrepreneurial intention (value). While to those with low self-efficacy and low initiative, high self-efficacy with high initiative showed higher entrepreneurial intention (OPS) compared to low self-efficacy and low initiative. The study highlighted the role of initiative in transforming young graduates' entrepreneurial intention into full-fledged entrepreneurs.
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Affiliation(s)
- Francisca N Ogba
- Department of Educational Foundations, Alex Ekwueme Federal University Ndufu Alike Ikwo, Abakaliki, Nigeria
| | - Kalu T U Ogba
- Department of Psychology, University of Nigeria Nsukka, Nsukka, Nigeria
| | - Lawrence E Ugwu
- Department of Psychology, Renaissance University, Enugu, Nigeria
- Department of Psychology, Coal City University Ugbawka, Enugu, Nigeria
| | - Nkechi Emma-Echiegu
- Department of Psychology and Sociological Studies, Ebonyi State University, Ebonyi, Nigeria
| | - Adaobi Eze
- Department of Psychology, Enugu State University of Science and Technology, Enugu, Nigeria
| | - Solomon Amaechi Agu
- Department of Psychology, Enugu State University of Science and Technology, Enugu, Nigeria
| | - Bernard Akonam Aneke
- Department of Psychology, Enugu State University of Science and Technology, Enugu, Nigeria
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Liu Z, Gao W, Xu Y. Eleutheroside E alleviates cerebral ischemia-reperfusion injury in a 5-hydroxytryptamine receptor 2C (Htr2c)-dependent manner in rats. Bioengineered 2022; 13:11718-11731. [PMID: 35502892 PMCID: PMC9275941 DOI: 10.1080/21655979.2022.2071009] [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] [Indexed: 12/02/2022] Open
Abstract
Stroke is the central disorder underlined by ischemia-reperfusion (I/R) injury. Eleutheroside E (EE) is administered as the shield in some ischemia tissues with anti-inflammatory action. However, whether EE defends I/R-induced damage in the brain remains unknown. Here, we demonstrated that EE significantly alleviated the cerebral I/R injury and reduced the apoptosis of hippocampal neuron cells in rats. During the anti-apoptosis process, EE significantly upregulated the expression of 5-hydroxytryptamine receptor 2C (Htr2c) gene. Silencing Htr2c expression dramatically weakened the protective effect of EE on I/R-induced apoptosis of rat hippocampal neuron. EE-regulated Htr2c also remarkably inhibited the expression of caspase-3, −6 and −7, thereby suggesting a plausible anti-apoptosis mechanism associated with Htr2c/caspase axis. These findings elicit the potentially clinical strategy that targets Htr2c to improve outcome of ischemia brain.
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Affiliation(s)
- Zheng Liu
- Department Of Neurology, The Second Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science & Technology, Baotou, Inner Mongolia, China
| | - Wenwei Gao
- Department Of Neurology, The Second Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science & Technology, Baotou, Inner Mongolia, China
| | - Yuanqin Xu
- Department Of Neurology, The Second Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science & Technology, Baotou, Inner Mongolia, China
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Intrahematomal Ultrasound Enhances RtPA-Fibrinolysis in a Porcine Model of Intracerebral Hemorrhage. J Clin Med 2021; 10:jcm10040563. [PMID: 33546160 PMCID: PMC7913235 DOI: 10.3390/jcm10040563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 01/20/2021] [Accepted: 01/26/2021] [Indexed: 11/30/2022] Open
Abstract
Catheter-based ultrasound-thrombolysis has been successfully used in a small clinical trial in order to enhance recombinant tissue plasminogen activator (rtPA)-fibrinolysis, for the treatment of spontaneous intracerebral hemorrhages (ICHs). The aim of this study was to investigate the ultra-early effects of ultrasound on hematoma and the surrounding brain tissue in a porcine ICH-model. To achieve this, 21 pigs with a right frontal ICH were randomly assigned to four groups: (1) drainage (n = 3), (2) drainage + rtPA (n = 6), (3) drainage + ultrasound (n = 6), and (4) drainage + ultrasound + rtPA (n = 6). The hematoma volume assessment was performed using cranial MRI before and after the treatments. Subsequently, the brain sections were analyzed using HE-staining and immunohistochemistry. The combined treatment using rtPA and ultrasound led to a significantly higher hematoma reduction (62 ± 5%) compared to the other groups (Group 1: 2 ± 1%; Group 2: 30 ± 12%; Group 3: 18 ± 8% (p < 0.0001)). In all groups, the MRI revealed an increase in diffusion restriction but neither hyper- or hypoperfusion, nor perihematomal edema. HE stains showed perihematomal microhemorrhages were equally distributed in each group, while edema was more pronounced within the control group. Immunohistochemistry did not reveal any ultra-early side effects. The combined therapy of drainage, rtPA and ultrasound is a safe and effective technique for hematoma-reduction and protection of the perihematomal tissue in regard to ultra-early effects.
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Tsay JS, Winstein CJ. Five Features to Look for in Early-Phase Clinical Intervention Studies. Neurorehabil Neural Repair 2021; 35:3-9. [PMID: 33243083 PMCID: PMC9873309 DOI: 10.1177/1545968320975439] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Neurorehabilitation relies on core principles of neuroplasticity to activate and engage latent neural connections, promote detour circuits, and reverse impairments. Clinical interventions incorporating these principles have been shown to promote recovery and demote compensation. However, many clinicians struggle to find interventions centered on these principles in our nascent, rapidly growing body of literature. Not to mention the immense pressure from regulatory bodies and organizational balance sheets that further discourage time-intensive recovery-promoting interventions, incentivizing clinicians to prioritize practical constraints over sound clinical decision making. Modern neurorehabilitation practices that result from these pressures favor strategies that encourage compensation over those that promote recovery. To narrow the gap between the busy clinician and the cutting-edge motor recovery literature, we distilled 5 features found in early-phase clinical intervention studies-ones that value the more enduring biological recovery processes over the more immediate compensatory remedies. Filtering emerging literature through this lens and routinely integrating promising research into daily practice can break down practical barriers for effective clinical translation and ultimately promote durable long-term outcomes. This perspective is meant to serve a new generation of mechanistically minded and caring clinicians, students, activists, and research trainees, who are poised to not only advance rehabilitation science, but also erect evidence-based policy changes to accelerate recovery-based stroke care.
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8
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IL-4/STAT6 signaling facilitates innate hematoma resolution and neurological recovery after hemorrhagic stroke in mice. Proc Natl Acad Sci U S A 2020; 117:32679-32690. [PMID: 33293423 DOI: 10.1073/pnas.2018497117] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Intracerebral hemorrhage (ICH) is a devastating form of stroke affecting millions of people worldwide. Parenchymal hematoma triggers a series of reactions leading to primary and secondary brain injuries and permanent neurological deficits. Microglia and macrophages carry out hematoma clearance, thereby facilitating functional recovery after ICH. Here, we elucidate a pivotal role for the interleukin (IL)-4)/signal transducer and activator of transcription 6 (STAT6) axis in promoting long-term recovery in both blood- and collagenase-injection mouse models of ICH, through modulation of microglia/macrophage functions. In both ICH models, STAT6 was activated in microglia/macrophages (i.e., enhanced expression of phospho-STAT6 in Iba1+ cells). Intranasal delivery of IL-4 nanoparticles after ICH hastened STAT6 activation and facilitated hematoma resolution. IL-4 treatment improved long-term functional recovery in young and aged male and young female mice. In contrast, STAT6 knockout (KO) mice exhibited worse outcomes than WT mice in both ICH models and were less responsive to IL-4 treatment. The construction of bone marrow chimera mice demonstrated that STAT6 KO in either the CNS or periphery exacerbated ICH outcomes. STAT6 KO impaired the capacity of phagocytes to engulf red blood cells in the ICH brain and in primary cultures. Transcriptional analyses identified lower level of IL-1 receptor-like 1 (ST2) expression in microglia/macrophages of STAT6 KO mice after ICH. ST2 KO diminished the beneficial effects of IL-4 after ICH. Collectively, these data confirm the importance of IL-4/STAT6/ST2 signaling in hematoma resolution and functional recovery after ICH. Intranasal IL-4 treatment warrants further investigation as a clinically feasible therapy for ICH.
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9
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The Prognostic Value of Quantitative EEG in Patients Undergoing Mechanical Thrombectomy for Acute Ischemic Stroke. J Clin Neurophysiol 2020; 39:276-282. [PMID: 32804879 DOI: 10.1097/wnp.0000000000000769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Previous work has shown that quantitative EEG measures correlate with the severity of ischemic stroke. This has not been systematically validated in patients with acute ischemic stroke who have undergone mechanical thrombectomy. METHODS Data were collected from 73 patients who underwent mechanical thrombectomy and had a standard head set EEG performed during their hospital admission. For each patient, the global delta-alpha ratio (DAR) and its difference between the two hemispheres were calculated. Associations between the global and interhemispheric DAR difference with the patients' National Institutes of Health Stroke and Modified Rankin Scale scores at discharge and 3 months after thrombectomy were assessed. RESULTS The interhemispheric DAR difference correlated with the National Institutes of Health Stroke scores at discharge (Spearman R = 0.41, P = 0.0008), National Institutes of Health Stroke scores at 3 months (Spearman R = 0.60, P = 0.02) and Modified Rankin Scale scores at 3 months (Spearman R = 0.27, P = 0.01). In contrast, the global DAR did not correlate significantly with any of these clinical outcomes when evaluated as continuous variables. In a multivariate logistic regression model, both the interhemispheric DAR difference (β = 0.25, P = 0.03) and the infarct volume (β = 0.02, P = 0.03) were independently predictive of good versus poor functional outcome (Modified Rankin Scale score ≤2 vs. >2) at 3 months. CONCLUSIONS The quantitative EEG measure of interhemispheric slow relative to fast frequencies power asymmetry correlated with the discharge and 3-month National Institutes of Health Stroke and Modified Rankin Scale scores and provided added value to infarct volume in predicting functional outcome at 3 months. These data support the prognostic value of quantitative EEG in ischemic stroke patients who have undergone mechanical thrombectomy.
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Wattanapan P, Lukkanapichonchut P, Massakulpan P, Suethanapornkul S, Kuptniratsaikul V. Effectiveness of Stroke Rehabilitation Compared between Intensive and Nonintensive Rehabilitation Protocol: A Multicenter Study. J Stroke Cerebrovasc Dis 2020; 29:104809. [PMID: 32312631 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104809] [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: 12/18/2019] [Revised: 02/15/2020] [Accepted: 03/04/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND AND AIM Stroke is one of the leading causes of death, physical disability, and economic burden. Nowadays, various types of rehabilitation are available. Rehabilitation centers in Thailand provide services in different ways, including starting time, duration, and frequency of each therapy. In addition, many rehabilitation wards have a standing policy to reduce length of stay (LOS) due to economic considerations. This study aimed to compare the effectiveness and efficiency between intensive and nonintensive rehabilitation protocol for stroke patients. METHODS This prospective, multicenter cohort study was conducted among stroke patients who admitted to rehabilitation wards at 14 centers. All participants received either intensive or non-intensive rehabilitation program. Barthel Index (BI) at admission (BIad), BI at discharge (BIdc), and LOS were recorded. The effectiveness was difference in BIdc and BIad score (ΔBI), and the efficiency was ΔBI divided by LOS (ΔBI/LOS). RESULTS Seven hundred and eighty stroke patients were included. Mean age was 61.9 ± 13.3 years, and 59.7% were male. The majority of patients (79.5%) were admitted for intensive rehabilitation. Effectiveness and efficiency were significantly higher in the intensive group than in the nonintensive group (4.5 ± 3.4 versus 2.6 ± 3.2 and .24 ± .30 versus .18 ± .33, respectively). LOS, intensive rehabilitation, and quality of life were significantly positively correlated with effectiveness; whereas, age, onset to admission interval (OAI), and BIad were significantly negatively correlated with the effectiveness of stroke rehabilitation. CONCLUSIONS Stroke patients admitted for intensive rehabilitation had better effectiveness and efficiency than those admitted for non-intensive rehabilitation. Younger patients with shorter OAI, lower BIad, and longer LOS realized significantly enhanced effectiveness.
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Affiliation(s)
- Pattra Wattanapan
- Department of Rehabilitation Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Pranee Lukkanapichonchut
- Department of Rehabilitation Medicine, Ratchaburi Hospital, Ministry of Public Health, Ratchaburi, Thailand
| | - Pornpimon Massakulpan
- Department of Rehabilitation Medicine, Prasat Neurological Institute, Ministry of Public Health, Bangkok, Thailand
| | - Sumalee Suethanapornkul
- Department of Rehabilitation Medicine Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Vilai Kuptniratsaikul
- Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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Awad IA, Polster SP, Carrión-Penagos J, Thompson RE, Cao Y, Stadnik A, Money PL, Fam MD, Koskimäki J, Girard R, Lane K, McBee N, Ziai W, Hao Y, Dodd R, Carlson AP, Camarata PJ, Caron JL, Harrigan MR, Gregson BA, Mendelow AD, Zuccarello M, Hanley DF. Surgical Performance Determines Functional Outcome Benefit in the Minimally Invasive Surgery Plus Recombinant Tissue Plasminogen Activator for Intracerebral Hemorrhage Evacuation (MISTIE) Procedure. Neurosurgery 2020; 84:1157-1168. [PMID: 30891610 DOI: 10.1093/neuros/nyz077] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 02/14/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Minimally invasive surgery procedures, including stereotactic catheter aspiration and clearance of intracerebral hemorrhage (ICH) with recombinant tissue plasminogen activator hold a promise to improve outcome of supratentorial brain hemorrhage, a morbid and disabling type of stroke. A recently completed Phase III randomized trial showed improved mortality but was neutral on the primary outcome (modified Rankin scale score 0 to 3 at 1 yr). OBJECTIVE To assess surgical performance and its impact on the extent of ICH evacuation and functional outcomes. METHODS Univariate and multivariate models were used to assess the extent of hematoma evacuation efficacy in relation to mRS 0 to 3 outcome and postulated factors related to patient, disease, and protocol adherence in the surgical arm (n = 242) of the MISTIE trial. RESULTS Greater ICH reduction has a higher likelihood of achieving mRS of 0 to 3 with a minimum evacuation threshold of ≤15 mL end of treatment ICH volume or ≥70% volume reduction when controlling for disease severity factors. Mortality benefit was achieved at ≤30 mL end of treatment ICH volume, or >53% volume reduction. Initial hematoma volume, history of hypertension, irregular-shaped hematoma, number of alteplase doses given, surgical protocol deviations, and catheter manipulation problems were significant factors in failing to achieve ≤15 mL goal evacuation. Greater surgeon/site experiences were associated with avoiding poor hematoma evacuation. CONCLUSION This is the first surgical trial reporting thresholds for reduction of ICH volume correlating with improved mortality and functional outcomes. To realize the benefit of surgery, protocol objectives, surgeon education, technical enhancements, and case selection should be focused on this goal.
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Affiliation(s)
- Issam A Awad
- Neurovascular Surgery Program, Section of Neurosurgery, Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, Illinois
| | - Sean P Polster
- Neurovascular Surgery Program, Section of Neurosurgery, Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, Illinois
| | - Julián Carrión-Penagos
- Neurovascular Surgery Program, Section of Neurosurgery, Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, Illinois
| | - Richard E Thompson
- Division of Brain Injury Outcomes, Department of Neurology, Johns Hopkins University Medical Institutions, Baltimore, Maryland
| | - Ying Cao
- Neurovascular Surgery Program, Section of Neurosurgery, Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, Illinois
| | - Agnieszka Stadnik
- Neurovascular Surgery Program, Section of Neurosurgery, Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, Illinois
| | - Patricia Lynn Money
- Department of Neurosurgery, University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Maged D Fam
- Neurovascular Surgery Program, Section of Neurosurgery, Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, Illinois
| | - Janne Koskimäki
- Neurovascular Surgery Program, Section of Neurosurgery, Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, Illinois
| | - Romuald Girard
- Neurovascular Surgery Program, Section of Neurosurgery, Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, Illinois
| | - Karen Lane
- Division of Brain Injury Outcomes, Department of Neurology, Johns Hopkins University Medical Institutions, Baltimore, Maryland
| | - Nichol McBee
- Division of Brain Injury Outcomes, Department of Neurology, Johns Hopkins University Medical Institutions, Baltimore, Maryland
| | - Wendy Ziai
- Division of Brain Injury Outcomes, Department of Neurology, Johns Hopkins University Medical Institutions, Baltimore, Maryland
| | - Yi Hao
- Division of Brain Injury Outcomes, Department of Neurology, Johns Hopkins University Medical Institutions, Baltimore, Maryland
| | - Robert Dodd
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Andrew P Carlson
- Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Paul J Camarata
- Department of Neurosurgery, University of Kansas School of Medicine, Kansas City, Kansas
| | - Jean-Louis Caron
- Department of Neurosurgery, University of Texas, San Antonio, Texas
| | - Mark R Harrigan
- Division of Neurosurgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Barbara A Gregson
- Neurosurgical Trials Group, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - A David Mendelow
- Neurosurgical Trials Group, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Mario Zuccarello
- Department of Neurosurgery, University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Daniel F Hanley
- Division of Brain Injury Outcomes, Department of Neurology, Johns Hopkins University Medical Institutions, Baltimore, Maryland
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Davis SM, Hacke W, Norrving B, Brainin M, Lees KR, Donnan GA. International Impact of
Stroke. Stroke 2020; 51:1036-1039. [DOI: 10.1161/strokeaha.119.028422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Stephen M. Davis
- From the Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Australia (S.M.D., G.A.D.)
| | - Werner Hacke
- Department of Neurology, University of Heidelberg, Germany (W.H.)
| | - Bo Norrving
- Department of Clinical Sciences/Neurology, Skane University Hospital, Lund University, Sweden (B.N.)
| | - Michael Brainin
- Department for Neurosciences and Preventive Medicine, Danube University Krems, Austria (M.B.)
| | - Kennedy R. Lees
- School of Medicine, Dentistry and Nursing, University of Glasgow, United Kingdom (K.R.L.)
| | - Geoffrey A. Donnan
- From the Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Australia (S.M.D., G.A.D.)
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13
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Burridge J, Alt Murphy M, Buurke J, Feys P, Keller T, Klamroth-Marganska V, Lamers I, McNicholas L, Prange G, Tarkka I, Timmermans A, Hughes AM. A Systematic Review of International Clinical Guidelines for Rehabilitation of People With Neurological Conditions: What Recommendations Are Made for Upper Limb Assessment? Front Neurol 2019; 10:567. [PMID: 31293493 PMCID: PMC6603199 DOI: 10.3389/fneur.2019.00567] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 05/13/2019] [Indexed: 11/27/2022] Open
Abstract
Background: Upper limb impairment is a common problem for people with neurological disabilities, affecting activity, performance, quality of life, and independence. Accurate, timely assessments are required for effective rehabilitation, and development of novel interventions. International consensus on upper limb assessment is needed to make research findings more meaningful, provide a benchmark for quality in clinical practice, more cost-effective neurorehabilitation and improved outcomes for neurological patients undergoing rehabilitation. Aim: To conduct a systematic review, as part of the output of a European COST Action, to identify what recommendations are made for upper limb assessment. Methods: We systematically reviewed published guidance on measures and protocols for assessment of upper limb function in neurological rehabilitation via electronic databases from January 2007–December 2017. Additional records were then identified through other sources. Records were selected for inclusion based on scanning of titles, abstracts and full text by two authors working independently, and a third author if there was disagreement. Records were included if they referred to “rehabilitation” and “assessment” or “measurement”. Reasons for exclusion were documented. Results: From the initial 552 records identified (after duplicates were removed), 34 satisfied our criteria for inclusion, and only six recommended specific outcome measures and /or protocols. Records were divided into National Guidelines and other practice guidelines published in peer reviewed Journals. There was agreement that assessment is critical, should be conducted early and at regular intervals and that there is a need for standardized measures. Assessments should be conducted by a healthcare professional trained in using the measure and should encompass body function and structure, activity and participation. Conclusions: We present a comprehensive, critical, and original summary of current recommendations. Defining a core set of measures and agreed protocols requires international consensus between experts representing the diverse and multi-disciplinary field of neurorehabilitation including clinical researchers and practitioners, rehabilitation technology researchers, and commercial developers. Current lack of guidance may hold-back progress in understanding function and recovery. Together with a Delphi consensus study and an overview of systematic reviews of outcome measures it will contribute to the development of international guidelines for upper limb assessment in neurological conditions.
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Affiliation(s)
- Jane Burridge
- Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Margit Alt Murphy
- Institute of Neuroscience and Physiology, Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jaap Buurke
- Roessingh Research and Development, Enschede, Netherlands.,Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, Netherlands
| | - Peter Feys
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | | | | | - Ilse Lamers
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Lauren McNicholas
- Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Gerdienke Prange
- Roessingh Research and Development, Enschede, Netherlands.,Faculty of Engineering Technology, University of Twente, Enschede, Netherlands
| | - Ina Tarkka
- Faculty of Sport and Health Sciences, University of Jyväskylá, Jyväskylä, Finland
| | - Annick Timmermans
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Ann-Marie Hughes
- Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
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14
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Ye S, Hu S, Lei Z, Li Z, Li W, Sui Y, Ren L. Shenzhen stroke emergency map improves access to rt-PA for patients with acute ischaemic stroke. Stroke Vasc Neurol 2019; 4:115-122. [PMID: 31709116 PMCID: PMC6812643 DOI: 10.1136/svn-2018-000212] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 02/12/2019] [Accepted: 02/13/2019] [Indexed: 01/01/2023] Open
Abstract
Prehospital delay is one of the major causes of low rate of intravenous recombinant tissue plasminogen activator (rt-PA) thrombolysis for acute ischaemic stroke in China. Regional emergency systems have been proven a successful approach to improve access to thrombolysis. Shenzhen is a high population density city with great geographical disparity of healthcare resources, leading to limited access to rt-PA thrombolysis for most patients with acute ischaemic stroke. To improve rapid access to rt-PA thrombolysis in Shenzhen, a Shenzhen stroke emergency map was implemented by Shenzhen healthcare administrations. This map comprised certification of qualified local hospitals, identification of patients with stroke, acute stroke transport protocol and maintenance of the map. We conducted a retrospective observational study to compare consecutive patients with acute stroke arriving at qualified local hospitals before and after implementation of the Shenzhen stroke emergency map. After implementation of the map, the rate of patients receiving rt-PA thrombolysis increased from 8.3% to 9.7% (p=0.003), and the rate of patients treated with endovascular thrombectomy increased from 0.9% to 1.6% (p<0.001). Sixteen of 20 hospitals have an increase in the number of patients with stroke treated with rt-PA thrombolysis. The median time between receipt of the call and arrival on the scene reduced significantly (17.0 min vs 9.0 min, p<0.001). In Shenzhen Second People's Hospital, the median onset-to-needle time and door-to-needle time were reduced (175.5 min vs 149.5 min, p=0.039; 71.5 min vs 51.5 min, p<0.001). No statistically significant differences were found in the proportion of rt-PA-treated patients within various geographical distances. Currently, there are more than 40 cities in China implementing a stroke emergency map. The Shenzhen stroke emergency map improves access to rt-PA thrombolysis for acute ischaemic stroke, and the novel model has been expanded to multiple areas in China. Future efforts should be conducted to optimise the stroke emergency map.
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Affiliation(s)
- Shisheng Ye
- Department of Neurology, Shenzhen University First Affiliated Hospital, Shenzhen Second People's Hospital, Shenzhen, China
| | - Shiyu Hu
- Department of Neurology, Shenzhen University First Affiliated Hospital, Shenzhen Second People's Hospital, Shenzhen, China
| | - Zhihao Lei
- Department of Neurology, Shenzhen University First Affiliated Hospital, Shenzhen Second People's Hospital, Shenzhen, China
| | - Zhichao Li
- Department of Neurology, Shenzhen University First Affiliated Hospital, Shenzhen Second People's Hospital, Shenzhen, China
| | - Weiping Li
- Department of Neurology, Shenzhen University First Affiliated Hospital, Shenzhen Second People's Hospital, Shenzhen, China
| | - Yi Sui
- Department of Neurology, Shenyang First People's Hospital, Shenyang Medical College, Shenyang, China
| | - Lijie Ren
- Department of Neurology, Shenzhen University First Affiliated Hospital, Shenzhen Second People's Hospital, Shenzhen, China
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15
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Hanley DF, Thompson RE, Rosenblum M, Yenokyan G, Lane K, McBee N, Mayo SW, Bistran-Hall AJ, Gandhi D, Mould WA, Ullman N, Ali H, Carhuapoma JR, Kase CS, Lees KR, Dawson J, Wilson A, Betz JF, Sugar EA, Hao Y, Avadhani R, Caron JL, Harrigan MR, Carlson AP, Bulters D, LeDoux D, Huang J, Cobb C, Gupta G, Kitagawa R, Chicoine MR, Patel H, Dodd R, Camarata PJ, Wolfe S, Stadnik A, Money PL, Mitchell P, Sarabia R, Harnof S, Barzo P, Unterberg A, Teitelbaum JS, Wang W, Anderson CS, Mendelow AD, Gregson B, Janis S, Vespa P, Ziai W, Zuccarello M, Awad IA. Efficacy and safety of minimally invasive surgery with thrombolysis in intracerebral haemorrhage evacuation (MISTIE III): a randomised, controlled, open-label, blinded endpoint phase 3 trial. Lancet 2019; 393:1021-1032. [PMID: 30739747 PMCID: PMC6894906 DOI: 10.1016/s0140-6736(19)30195-3] [Citation(s) in RCA: 495] [Impact Index Per Article: 99.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 01/13/2019] [Accepted: 01/22/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Acute stroke due to supratentorial intracerebral haemorrhage is associated with high morbidity and mortality. Open craniotomy haematoma evacuation has not been found to have any benefit in large randomised trials. We assessed whether minimally invasive catheter evacuation followed by thrombolysis (MISTIE), with the aim of decreasing clot size to 15 mL or less, would improve functional outcome in patients with intracerebral haemorrhage. METHODS MISTIE III was an open-label, blinded endpoint, phase 3 trial done at 78 hospitals in the USA, Canada, Europe, Australia, and Asia. We enrolled patients aged 18 years or older with spontaneous, non-traumatic, supratentorial intracerebral haemorrhage of 30 mL or more. We used a computer-generated number sequence with a block size of four or six to centrally randomise patients to image-guided MISTIE treatment (1·0 mg alteplase every 8 h for up to nine doses) or standard medical care. Primary outcome was good functional outcome, defined as the proportion of patients who achieved a modified Rankin Scale (mRS) score of 0-3 at 365 days, adjusted for group differences in prespecified baseline covariates (stability intracerebral haemorrhage size, age, Glasgow Coma Scale, stability intraventricular haemorrhage size, and clot location). Analysis of the primary efficacy outcome was done in the modified intention-to-treat (mITT) population, which included all eligible, randomly assigned patients who were exposed to treatment. All randomly assigned patients were included in the safety analysis. This study is registered with ClinicalTrials.gov, number NCT01827046. FINDINGS Between Dec 30, 2013, and Aug 15, 2017, 506 patients were randomly allocated: 255 (50%) to the MISTIE group and 251 (50%) to standard medical care. 499 patients (n=250 in the MISTIE group; n=249 in the standard medical care group) received treatment and were included in the mITT analysis set. The mITT primary adjusted efficacy analysis estimated that 45% of patients in the MISTIE group and 41% patients in the standard medical care group had achieved an mRS score of 0-3 at 365 days (adjusted risk difference 4% [95% CI -4 to 12]; p=0·33). Sensitivity analyses of 365-day mRS using generalised ordered logistic regression models adjusted for baseline variables showed that the estimated odds ratios comparing MISTIE with standard medical care for mRS scores higher than 5 versus 5 or less, higher than 4 versus 4 or less, higher than 3 versus 3 or less, and higher than 2 versus 2 or less were 0·60 (p=0·03), 0·84 (p=0·42), 0·87 (p=0·49), and 0·82 (p=0·44), respectively. At 7 days, two (1%) of 255 patients in the MISTIE group and ten (4%) of 251 patients in the standard medical care group had died (p=0·02) and at 30 days, 24 (9%) patients in the MISTIE group and 37 (15%) patients in the standard medical care group had died (p=0·07). The number of patients with symptomatic bleeding and brain bacterial infections was similar between the MISTIE and standard medical care groups (six [2%] of 255 patients vs three [1%] of 251 patients; p=0·33 for symptomatic bleeding; two [1%] of 255 patients vs 0 [0%] of 251 patients; p=0·16 for brain bacterial infections). At 30 days, 76 (30%) of 255 patients in the MISTIE group and 84 (33%) of 251 patients in the standard medical care group had one or more serious adverse event, and the difference in number of serious adverse events between the groups was statistically significant (p=0·012). INTERPRETATION For moderate to large intracerebral haemorrhage, MISTIE did not improve the proportion of patients who achieved a good response 365 days after intracerebral haemorrhage. The procedure was safely adopted by our sample of surgeons. FUNDING National Institute of Neurological Disorders and Stroke and Genentech.
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Affiliation(s)
- Daniel F Hanley
- Division of Brain Injury Outcomes, Johns Hopkins University, Baltimore, MD, USA.
| | - Richard E Thompson
- Department of Biostatistics, School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Michael Rosenblum
- Department of Biostatistics, School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Gayane Yenokyan
- Department of Biostatistics, School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Karen Lane
- Division of Brain Injury Outcomes, Johns Hopkins University, Baltimore, MD, USA
| | - Nichol McBee
- Division of Brain Injury Outcomes, Johns Hopkins University, Baltimore, MD, USA
| | | | | | | | - W Andrew Mould
- Division of Brain Injury Outcomes, Johns Hopkins University, Baltimore, MD, USA
| | | | - Hasan Ali
- Division of Brain Injury Outcomes, Johns Hopkins University, Baltimore, MD, USA
| | | | | | - Kennedy R Lees
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Jesse Dawson
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Alastair Wilson
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Joshua F Betz
- Department of Biostatistics, School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Elizabeth A Sugar
- Department of Biostatistics, School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Yi Hao
- Division of Brain Injury Outcomes, Johns Hopkins University, Baltimore, MD, USA
| | - Radhika Avadhani
- Division of Brain Injury Outcomes, Johns Hopkins University, Baltimore, MD, USA
| | | | | | | | - Diederik Bulters
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - David LeDoux
- Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Judy Huang
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Cully Cobb
- Mercy Neurological Institute Stroke Center, Sacramento, California, USA
| | - Gaurav Gupta
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Ryan Kitagawa
- University of Texas, McGovern Medical Center, Houston, TX, USA
| | | | | | - Robert Dodd
- Stanford University School of Medicine, Stanford, California, USA
| | | | - Stacey Wolfe
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | | | | | | | | | - Pal Barzo
- University of Szeged, Szeged, Hungary
| | | | - Jeanne S Teitelbaum
- Montreal Neurological Institute and Hospital at McGill University, Montreal, QC, Canada
| | - Weimin Wang
- Guangzhou Neuroscience Institute, Guangzhou Liuhua Qiao Hospital, Guangzhou, China
| | - Craig S Anderson
- The George Institute for Global Health China at Peking University Health Science Center, Beijing, China; The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | | | | | - Scott Janis
- National Institutes of Health, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Paul Vespa
- University of California, Los Angeles, CA, USA
| | - Wendy Ziai
- Division of Brain Injury Outcomes, Johns Hopkins University, Baltimore, MD, USA
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16
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Borschmann K, Hayward KS, Raffelt A, Churilov L, Kramer S, Bernhardt J. Rationale for Intervention and Dose Is Lacking in Stroke Recovery Trials: A Systematic Review. Stroke Res Treat 2018; 2018:8087372. [PMID: 30515288 PMCID: PMC6234440 DOI: 10.1155/2018/8087372] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 10/08/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The ineffectiveness of most complex stroke recovery trials may be explained by inadequate intervention design. The primary aim of this review was to explore the rationales given for interventions and dose in stroke rehabilitation randomised controlled trials (RCTs). METHODS We searched the Cochrane Stroke Group library for RCTs that met the following criteria: (1) training based intervention; (2) >50% participants who were stroke survivors; (3) full peer-reviewed text; (4) English language. We extracted data on 16 quality items covering intervention dose (n= 3), trial design (n= 10), and risk of bias (n= 3) and 18 items related to trial method. Logistic regression analyses were performed to determine whether (1) reporting of trial quality items changed over time; (2) reporting of quality items was associated with the likelihood of a positive trial, adjusted for sample size and number of outcomes. RESULTS 27 Cochrane reviews were included, containing 9,044 participants from 194 trials. Publication dates were 1979 to 2013, sample size was median 32 (IQR 20,58), and primary outcome was reported in 49 trials (25%). The median total quality score was 4 (IQR 3,6) and improved significantly each year (OR 1.12, 95% CI 1.07, 1.16, p<0.001). Total quality score was not associated with likelihood of a positive trial, but trials containing a biological rationale for the intervention were more likely to find a difference in patient outcome (OR 2.18, 95% CI 1.14, 4.19, p=0.02). CONCLUSION To develop breakthrough treatments we need to build the rationale for research interventions and testing of intervention dosage. This will be achieved through a collective research agenda to understand the mechanistic principles that drive recovery and identification of clearer targets for clinical trials.
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Affiliation(s)
- Karen Borschmann
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, 245 Burgundy St., Heidelberg 3084, VIC, Australia
- NHMRC CRE Stroke Rehabilitation & Brain Recovery, 245 Burgundy St., Heidelberg 3084, VIC, Australia
| | - Kathryn S. Hayward
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, 245 Burgundy St., Heidelberg 3084, VIC, Australia
- NHMRC CRE Stroke Rehabilitation & Brain Recovery, 245 Burgundy St., Heidelberg 3084, VIC, Australia
- Brain Behaviour Laboratory, Department of Physical Therapy, The University of British Columbia, Koerner Pavilion UBC Hospital, 2211 Wesbrook Mall, Vancouver, BC, Canada V6T2B7
| | - Audrey Raffelt
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, 245 Burgundy St., Heidelberg 3084, VIC, Australia
| | - Leonid Churilov
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, 245 Burgundy St., Heidelberg 3084, VIC, Australia
- NHMRC CRE Stroke Rehabilitation & Brain Recovery, 245 Burgundy St., Heidelberg 3084, VIC, Australia
| | - Sharon Kramer
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, 245 Burgundy St., Heidelberg 3084, VIC, Australia
- NHMRC CRE Stroke Rehabilitation & Brain Recovery, 245 Burgundy St., Heidelberg 3084, VIC, Australia
| | - Julie Bernhardt
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, 245 Burgundy St., Heidelberg 3084, VIC, Australia
- NHMRC CRE Stroke Rehabilitation & Brain Recovery, 245 Burgundy St., Heidelberg 3084, VIC, Australia
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17
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Ito KL, Kumar A, Zavaliangos-Petropulu A, Cramer SC, Liew SL. Pipeline for Analyzing Lesions After Stroke (PALS). Front Neuroinform 2018; 12:63. [PMID: 30319385 PMCID: PMC6165891 DOI: 10.3389/fninf.2018.00063] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 09/05/2018] [Indexed: 02/04/2023] Open
Abstract
Lesion analyses are critical for drawing insights about stroke injury and recovery, and their importance is underscored by growing efforts to collect and combine stroke neuroimaging data across research sites. However, while there are numerous processing pipelines for neuroimaging data in general, few can be smoothly applied to stroke data due to complications analyzing the lesioned region. As researchers often use their own tools or manual methods for stroke MRI analysis, this could lead to greater errors and difficulty replicating findings over time and across sites. Rigorous analysis protocols and quality control pipelines are thus urgently needed for stroke neuroimaging. To this end, we created the Pipeline for Analyzing Lesions after Stroke (PALS; DOI: https://doi.org/10.5281/zenodo.1266980), a scalable and user-friendly toolbox to facilitate and ensure quality in stroke research specifically using T1-weighted MRIs. The PALS toolbox offers four modules integrated into a single pipeline, including (1) reorientation to radiological convention, (2) lesion correction for healthy white matter voxels, (3) lesion load calculation, and (4) visual quality control. In the present paper, we discuss each module and provide validation and example cases of our toolbox using multi-site data. Importantly, we also show that lesion correction with PALS significantly improves similarity between manual lesion segmentations by different tracers (z = 3.43, p = 0.0018). PALS can be found online at https://github.com/npnl/PALS. Future work will expand the PALS capabilities to include multimodal stroke imaging. We hope PALS will be a useful tool for the stroke neuroimaging community and foster new clinical insights.
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Affiliation(s)
- Kaori L Ito
- Neural Plasticity and Neurorehabilitation Laboratory, University of Southern California, Los Angeles, CA, United States
| | - Amit Kumar
- Neural Plasticity and Neurorehabilitation Laboratory, University of Southern California, Los Angeles, CA, United States
| | - Artemis Zavaliangos-Petropulu
- Neural Plasticity and Neurorehabilitation Laboratory, University of Southern California, Los Angeles, CA, United States.,Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, United States
| | - Steven C Cramer
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Sook-Lei Liew
- Neural Plasticity and Neurorehabilitation Laboratory, University of Southern California, Los Angeles, CA, United States.,Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, United States
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18
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Relationship of Serum Uric Acid Level with Demographic Features, Risk Factors, Severity, Prognosis, Serum Levels of Vitamin D, Calcium, and Magnesium in Stroke. Stroke Res Treat 2018; 2018:6580178. [PMID: 30057737 PMCID: PMC6051071 DOI: 10.1155/2018/6580178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 04/10/2018] [Accepted: 05/13/2018] [Indexed: 01/09/2023] Open
Abstract
Introduction Stroke is one of the most common neurological disorders with high mortality rates. A large financial burden is imposed on the families and health systems of countries in addition to the problems related to the disabilities caused by the disease for the patients. Extensive research is being conducted on the disease, including studies seeking possible relationships between some biomarkers such as uric acid and stroke. Methods This descriptive-analytic cross-sectional study was conducted on 170 stroke patients at Babol Ayatollah Rohani Hospital during 2015-2016. Serum uric acid (SUA) levels were measured and recorded at admission time. Patients' demographic data as well as the stroke type and some of their risk factors were entered in a checklist. The data were analyzed by SPSS.v.23 using chi-square and logistic regression tests. P < 0.05 was considered as significant in all analyses. Results Of the total 170 included patients, 57% had normal, 25% had low, and the remaining patients (18%) had high SUA levels. There was no significant difference in SUA levels in different types of stroke in both genders. Diabetic ischemic embolic patients had higher levels of SUA than diabetic ischemic thrombotic cases. Patients with low magnesium levels had higher rate of low levels of SUA in ischemic stroke. Conclusion Serum uric acid levels are not associated with stroke types and gender. Diabetic embolic ischemic stroke cases had high SUA levels than thrombotic types and in ischemic stroke patients with low serum levels of magnesium, SUA levels were also lower.
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19
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Hammerman M, Dietrich-Zagonel F, Blomgran P, Eliasson P, Aspenberg P. Different mechanisms activated by mild versus strong loading in rat Achilles tendon healing. PLoS One 2018; 13:e0201211. [PMID: 30044869 PMCID: PMC6059492 DOI: 10.1371/journal.pone.0201211] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 07/10/2018] [Indexed: 11/19/2022] Open
Abstract
Background Mechanical loading stimulates Achilles tendon healing. However, various degrees of loading appear to have different effects on the mechanical properties of the healing tendon, and strong loading might create microdamage in the tissue. This suggests that different mechanisms might be activated depending on the magnitude of loading. The aim of this study was to investigate these mechanisms further. Methods Female rats had their right Achilles tendon cut transversely and divided into three groups: 1) unloading (calf muscle paralysis by Botox injections, combined with joint fixation by a steel-orthosis), 2) mild loading (Botox only), 3) strong loading (free cage activity). Gene expression was analyzed by PCR, 5 days post-injury, and mechanical testing 8 days post-injury. The occurrence of microdamage was analyzed 3, 5, or 14 days post-injury, by measuring leakage of injected fluorescence-labelled albumin in the healing tendon tissue. Results Peak force, peak stress, and elastic modulus of the healing tendons gradually improved with increased loading as well as the expression of extracellular matrix genes. In contrast, only strong loading increased transverse area and affected inflammation genes. Strong loading led to higher fluorescence (as a sign of microdamage) compared to mild loading at 3 and 5 days post-injury, but not at 14 days. Discussion Our results show that strong loading improves both the quality and quantity of the healing tendon, while mild loading only improves the quality. Strong loading also induces microdamage and alters the inflammatory response. This suggests that mild loading exert its effect via mechanotransduction mechanisms, while strong loading exert its effect both via mechanotransduction and the creation of microdamage. Conclusion In conclusion, mild loading is enough to increase the quality of the healing tendon without inducing microdamage and alter the inflammation in the tissue. This supports the general conception that early mobilization of a ruptured tendon in patients is advantageous.
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Affiliation(s)
- Malin Hammerman
- Experimental orthopedics, Department of Clinical and Experimental Medicine, Faculty of Health Science, Linköping University, Linköping, Sweden
| | - Franciele Dietrich-Zagonel
- Experimental orthopedics, Department of Clinical and Experimental Medicine, Faculty of Health Science, Linköping University, Linköping, Sweden
| | - Parmis Blomgran
- Experimental orthopedics, Department of Clinical and Experimental Medicine, Faculty of Health Science, Linköping University, Linköping, Sweden
| | - Pernilla Eliasson
- Experimental orthopedics, Department of Clinical and Experimental Medicine, Faculty of Health Science, Linköping University, Linköping, Sweden
- * E-mail:
| | - Per Aspenberg
- Experimental orthopedics, Department of Clinical and Experimental Medicine, Faculty of Health Science, Linköping University, Linköping, Sweden
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20
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Walker MF, Hoffmann TC, Brady MC, Dean CM, Eng JJ, Farrin AJ, Felix C, Forster A, Langhorne P, Lynch EA, Radford KA, Sunnerhagen KS, Watkins CL. Improving the development, monitoring and reporting of stroke rehabilitation research: Consensus-based core recommendations from the Stroke Recovery and Rehabilitation Roundtable. Int J Stroke 2018; 12:472-479. [PMID: 28697706 DOI: 10.1177/1747493017711815] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Recent reviews have demonstrated that the quality of stroke rehabilitation research has continued to improve over the last four decades but despite this progress, there are still many barriers in moving the field forward. Rigorous development, monitoring and complete reporting of interventions in stroke trials are essential in providing rehabilitation evidence that is robust, meaningful and implementable. An international partnership of stroke rehabilitation experts committed to develop consensus-based core recommendations with a remit of addressing the issues identified as limiting stroke rehabilitation research in the areas of developing, monitoring and reporting stroke rehabilitation interventions. Work exploring each of the three areas took place via multiple teleconferences and a two-day meeting in Philadelphia in May 2016. A total of 15 recommendations were made. To validate the need for the recommendations, the group reviewed all stroke rehabilitation trials published in 2015 (n = 182 papers). Our review highlighted that the majority of publications did not clearly describe how interventions were developed or monitored during the trial. In particular, under-reporting of the theoretical rationale for the intervention and the components of the intervention call into question many interventions that have been evaluated for efficacy. More trials were found to have addressed the reporting of interventions recommendations than those related to development or monitoring. Nonetheless, the majority of reporting recommendations were still not adequately described. To progress the field of stroke rehabilitation research and to ensure stroke patients receive optimal evidence-based clinical care, we urge the research community to endorse and adopt our recommendations.
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Affiliation(s)
- Marion F Walker
- 1 School of Medicine, University of Nottingham, Nottingham, UK
| | - Tammy C Hoffmann
- 2 Centre for Research in Evidence-Based Practice, Bond University, Queensland, Australia
| | - Marian C Brady
- 3 Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Catherine M Dean
- 4 Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Janice J Eng
- 5 Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Amanda J Farrin
- 6 Clinical Trials Research Unit at the Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, UK
| | - Cynthia Felix
- 7 The George Institute for Global Health, Hyderabad, India
| | - Anne Forster
- 6 Clinical Trials Research Unit at the Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, UK
| | - Peter Langhorne
- 8 Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Elizabeth A Lynch
- 9 NHMRC Centre of Research Excellence in Stroke Rehabilitation and Recovery, Florey Institute of Neuroscience and Mental Health, Parkville, Australia and University of Adelaide, Adelaide, Australia
| | | | - Katharina S Sunnerhagen
- 10 Department of Clinical Neuroscience at the Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Caroline L Watkins
- 11 University of Central Lancashire, Preston, UK and Australian Catholic University, Sydney, Australia
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21
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Padir Şensöz N, Türk Börü Ü, Bölük C, Bilgiç A, Öztop Çakmak Ö, Duman A, Taşdemir M. Stroke epidemiology in Karabük city Turkey: Community based study. eNeurologicalSci 2017; 10:12-15. [PMID: 29736423 PMCID: PMC5933997 DOI: 10.1016/j.ensci.2017.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 12/20/2017] [Indexed: 11/30/2022] Open
Abstract
Introduction Stroke has been projected to increase in developing countries like Turkey. Information about the prevalence of stroke may uncover the etiology of stroke and overcome its impact burden. However, data is limited due to a lack of studies based in Turkey and neighboring regions. We aimed to investigate the prevalence and risk factors of stroke in the Turkish city of Karabük and to pave the way for future epidemiological studies in Turkey. Methods The study was designed as a cross-sectional, door-to-door survey. The questionnaire was completed by a trained team in the presence of the participants according to their answers. Patients who had been diagnosed with stroke prior to the survey were re-examined by a neurologist. Results 3131 persons who were above 44 years old were screened. 129 of them were found to have had a stroke previously. The prevalence rate of stroke above 44 years was found to be 4.12% (98% confidence level and ± 2% margin of error). 72.1% of stroke patients had hypertension. Male/female ratio was 0.72. Conclusion This study showed a high prevalence rate of stroke in Karabük Turkey with a low male/female ratio when compared to other studies.
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Affiliation(s)
- Nilay Padir Şensöz
- University of Health Sciences, Dr. Lütfi Kırdar Kartal Research and Training Hospital, Department of Neurology, Istanbul, Turkey
| | - Ülkü Türk Börü
- University of Health Sciences, Dr. Lütfi Kırdar Kartal Research and Training Hospital, Department of Neurology, Istanbul, Turkey
| | - Cem Bölük
- University of Health Sciences, Dr. Lütfi Kırdar Kartal Research and Training Hospital, Department of Neurology, Istanbul, Turkey
| | - Adnan Bilgiç
- Eregli State Hospital, Department of Neurology, Eregli, Turkey
| | | | - Arda Duman
- Maltepe State Hospital, Department of Neurology, Istanbul, Turkey
| | - Mustafa Taşdemir
- Istanbul Medeniyet University, Department of Public Health, Istanbul, Turkey
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22
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Walker MF, Hoffmann TC, Brady MC, Dean CM, Eng JJ, Farrin AJ, Felix C, Forster A, Langhorne P, Lynch EA, Radford KA, Sunnerhagen KS, Watkins CL. Improving the Development, Monitoring and Reporting of Stroke Rehabilitation Research: Consensus-Based Core Recommendations from the Stroke Recovery and Rehabilitation Roundtable. Neurorehabil Neural Repair 2017; 31:877-884. [DOI: 10.1177/1545968317732686] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Recent reviews have demonstrated that the quality of stroke rehabilitation research has continued to improve over the last four decades but despite this progress, there are still many barriers in moving the field forward. Rigorous development, monitoring and complete reporting of interventions in stroke trials are essential in providing rehabilitation evidence that is robust, meaningful and implementable. An international partnership of stroke rehabilitation experts committed to develop consensus-based core recommendations with a remit of addressing the issues identified as limiting stroke rehabilitation research in the areas of developing, monitoring and reporting stroke rehabilitation interventions. Work exploring each of the three areas took place via multiple teleconferences and a two-day meeting in Philadelphia in May 2016. A total of 15 recommendations were made. To validate the need for the recommendations, the group reviewed all stroke rehabilitation trials published in 2015 (n=182 papers). Our review highlighted that the majority of publications did not clearly describe how interventions were developed or monitored during the trial. In particular, under-reporting of the theoretical rationale for the intervention and the components of the intervention call into question many interventions that have been evaluated for efficacy. More trials were found to have addressed the reporting of interventions recommendations than those related to development or monitoring. Nonetheless, the majority of reporting recommendations were still not adequately described. To progress the field of stroke rehabilitation research and to ensure stroke patients receive optimal evidence-based clinical care, we urge the research community to endorse and adopt our recommendations.
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Affiliation(s)
| | - Tammy C. Hoffmann
- Centre for Research in Evidence-Based Practice, Bond University, Queensland, Australia
| | - Marian C. Brady
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Catherine M. Dean
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Janice J. Eng
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Amanda J. Farrin
- Clinical Trials Research Unit at the Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, UK
| | - Cynthia Felix
- The George Institute for Global Health, Hyderabad, India
| | - Anne Forster
- Clinical Trials Research Unit at the Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, UK
| | - Peter Langhorne
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Elizabeth A. Lynch
- NHMRC Centre of Research Excellence, Florey Institute of Neuroscience and Mental Health, Parkville, Australia and University of Adelaide, Adelaide, Australia
| | | | - Katharina S. Sunnerhagen
- Department of Clinical Neuroscience at the Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Caroline L. Watkins
- University of Central Lancashire, Preston, UK and Australian Catholic University, Sydney, Australia
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23
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Liu RZ, Fan CX, Zhang ZL, Zhao X, Sun Y, Liu HH, Nie ZX, Pu XP. Effects of Dl-3-n-butylphthalide on Cerebral Ischemia Infarction in Rat Model by Mass Spectrometry Imaging. Int J Mol Sci 2017; 18:ijms18112451. [PMID: 29165327 PMCID: PMC5713418 DOI: 10.3390/ijms18112451] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 11/09/2017] [Accepted: 11/14/2017] [Indexed: 12/27/2022] Open
Abstract
Dl-3-n-butylphthalide (NBP) is a drug that is used in the treatment of ischaemic stroke. However, to the best of our knowledge, there are no systematic studies investigating the effects of dl-3-n-butylphtalide on the brain metabolism of small molecules. In this study, we first investigated the effects of dl-3-n-butylphthalide on the spatial distribution of small molecules in the brains of rats with permanent middle cerebral artery occlusion (pMCAO) using matrix-assisted laser desorption ionization time of flight mass spectrometry (MALDI–TOF–MS) imaging. After pMCAO modelling or a sham operation, rats were given four mg/kg of dl-3-n-butylphthalide through the caudal vein or saline once a day for nine days. The degree of neurological deficit in rats was evaluated using the modified neurological severity score (mNSS). MALDI–TOF–MS imaging was used to observe the content and distribution of small molecules related to metabolism during focal cerebral ischaemia. Multiple reaction monitoring (MRM) mode with liquid chromatography tandem mass spectrometry (LC–MS/MS) was used to verify the results obtained from MALDI–TOF–MS imaging. These small molecules were found to be involved in glucose metabolism, ATP metabolism, the glutamate–glutamine cycle, malate aspartate shuttle, oxidative stress, and inorganic ion homeostasis. Of the 13 metabolites identified by MALDI–TOF–MS imaging, seven compounds, ATP, ADP, AMP, GMP, N-acetylaspartic acid, ascorbic acid and glutathione, were further validated by LC–MS/MS. Taken together, these results indicate that dl-3-n-butylphthalide significantly improved ATP metabolism, level of antioxidants, and sodium-potassium ion balance in a rat model of pMCAO.
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Affiliation(s)
- Run-Zhe Liu
- National Key Research Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing 100191, China.
- Department of Molecular and Cellular Pharmacology, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China.
| | - Chao-Xin Fan
- National Key Research Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing 100191, China.
- Department of Molecular and Cellular Pharmacology, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China.
| | - Zhi-Lin Zhang
- National Key Research Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing 100191, China.
- Department of Molecular and Cellular Pharmacology, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China.
| | - Xin Zhao
- National Key Research Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing 100191, China.
- Department of Molecular and Cellular Pharmacology, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China.
| | - Yi Sun
- National Key Research Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing 100191, China.
- Department of Molecular and Cellular Pharmacology, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China.
| | - Hui-Hui Liu
- Key Laboratory of Analytical Chemistry for Living Biosystems, Institute of Chemistry Chinese Academy of Sciences, Beijing 100190, China.
| | - Zong-Xiu Nie
- Key Laboratory of Analytical Chemistry for Living Biosystems, Institute of Chemistry Chinese Academy of Sciences, Beijing 100190, China.
| | - Xiao-Ping Pu
- National Key Research Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing 100191, China.
- Department of Molecular and Cellular Pharmacology, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China.
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24
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Wang H, Tian Y, Guo Y, Wang Y, Lip GYH. Multiple risk factors and ischaemic stroke in the elderly Asian population with and without atrial fibrillation. Thromb Haemost 2017; 115:184-92. [DOI: 10.1160/th15-07-0577] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 07/21/2015] [Indexed: 11/05/2022]
Abstract
SummaryIschaemic stroke risk rises with the increasing cardiovascular risk factors. How atrial fibrillation (AF) incrementally contributes to the risk for ischaemic stroke with increasing age and multiple cardiovascular risk factors is unclear. In an individual patient with AF the mechanism of ischaemic stroke may be related directly to AF itself or to risk factors associated with AF. It was this study’s objective to investigate incident ischaemic stroke in relation to age and increasing cardiovascular risk factor(s), and the incremental impact of AF on stroke rates. We studied a 5 % random sampling from Chinese medical insurance data covering more than 10 million individuals, for the years 2001 to 2012. The rate of ischaemic stroke was calculated amongst the individuals with no prior history of ischaemic stroke, in relation to age groups (aged < 65, 65–74,75 years old; n = 348,431, n = 56,952, n = 20,217, respectively), and increasing risk factors using the CHA2DS2-VASc score. Among the randomly sampled 425,600 individuals with total follow-up of 1,864,232 patient-years [63.8 % male, mean age 60 years; 880 with AF, vs 424,720 non-AF], there were 13,242 (3.1 %) ischaemic strokes after 64,834 person-years follow-up. Overall, ischaemic stroke incidence (per 100 person-years) was 0.35 (95 %CI 0.34–0.35) in the non-AF population and 1.11 (0.84–1.45) with AF. The AF population age < 65 and 65–74 had higher CHA2DS2-VASc scores than the nonAF population (p< 0.001), but this was non-significant between the non-AF and AF population age75 (p=0.086). For the population age75 years, incident stroke rates were 2.07 (0.86–4.76) and 4.29 (4.08–4.51) in non-AF and AF populations, respectively. The non-AF population age65 years with2 additional comorbidities (hyper-tension, vascular disease, diabetic, or heart failure) had ischaemic stroke rates similar to an AF population with CHA2DS2-VASc4. In both non-AF and AF populations, those with CHA2DS2-VASc =1 had a 1.9 fold increase in stroke risk, and those with CHA2DS2-VASc2 had more than four-fold increased risk for stroke, compared with those with CHA2DS2-VASc=0. In conclusion, an increasing cluster of multiple cardiovascular risk factors (besides AF) contributes to a greater risk for ischaemic stroke, especially in the elderly population. If elderly and with multiple risk factors, non-AF patients may have a risk of incident ischaemic stroke that is comparable or even higher than patients with AF, suggesting that the incremental stroke risk attributable to AF is marginal in such ‘high risk’ patients.
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25
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Nelson ML, McKellar KA, Munce S, Kelloway L, Hans PK, Fortin M, Lyons R, Bayley M. Addressing the Evidence Gap in Stroke Rehabilitation for Complex Patients: A Preliminary Research Agenda. Arch Phys Med Rehabil 2017; 99:1232-1241. [PMID: 28947162 DOI: 10.1016/j.apmr.2017.08.488] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 08/16/2017] [Accepted: 08/23/2017] [Indexed: 12/21/2022]
Abstract
Evidence suggests that a stroke occurs in isolation (no comorbid conditions) in less than 6% of patients. Multimorbidity, compounded by psychosocial issues, makes treatment and recovery for stroke increasingly complex. Recent research and health policy documents called for a better understanding of the needs of this patient population, and for the development and testing of models of care that meet their needs. A research agenda specific to complexity is required. The primary objective of the think tank was to identify and prioritize research questions that meet the information needs of stakeholders, and to develop a research agenda specific to stroke rehabilitation and patient complexity. A modified Delphi and World Café approach underpinned the think tank meeting, approaches well recognized to foster interaction, dialogue, and collaboration between stakeholders. Forty-three researchers, clinicians, and policymakers attended a 2-day meeting. Initial question-generating activities resulted in 120 potential research questions. Sixteen high-priority research questions were identified, focusing on predetermined complexity characteristics-multimorbidity, social determinants, patient characteristics, social supports, and system factors. The final questions are presented as a prioritized research framework. An emergent result of this activity is the development of a complexity and stroke rehabilitation research network. The research agenda reflects topics of importance to stakeholders working with stroke patients with increasingly complex care needs. This robust process resulted in a preliminary research agenda that could provide policymakers with the evidence needed to make improvements toward better-organized services, better coordination between settings, improved patient outcomes, and lower system costs.
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Affiliation(s)
- Michelle L Nelson
- Bridgepoint Collaboratory, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada.
| | - Kaileah A McKellar
- Bridgepoint Collaboratory, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Sarah Munce
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Linda Kelloway
- Cardiac Care Network of Ontario, Toronto, Ontario, Canada
| | - Parminder Kaur Hans
- Bridgepoint Collaboratory, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Martin Fortin
- Department of Family Medicine, Sherbrooke University, Sherbrooke, Quebec, Canada
| | - Renee Lyons
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Mark Bayley
- University of Toronto, Toronto, Ontario, Canada; Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
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26
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Bernhardt J, Borschmann K, Boyd L, Carmichael ST, Corbett D, Cramer SC, Hoffmann T, Kwakkel G, Savitz S, Saposnik G, Walker M, Ward N. Moving Rehabilitation Research Forward: Developing Consensus Statements for Rehabilitation and Recovery Research. Neurorehabil Neural Repair 2017; 31:694-698. [DOI: 10.1177/1545968317724290] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Stroke recovery is the next frontier in stroke medicine. While growth in rehabilitation and recovery research is exponential, a number of barriers hamper our ability to rapidly progress the field. Standardized terminology is absent in both animal and human research, methods are poorly described, recovery biomarkers are not well defined, and we lack consistent timeframes or measures to examine outcomes. Agreed methods and conventions for developing, monitoring, evaluating and reporting interventions directed at improving recovery are lacking, and current approaches are often not underpinned by biology. We urgently need to better understand the biology of recovery and its time course in both animals and humans to translate evidence from basic science into clinical trials. A new international partnership of stroke recovery and rehabilitation experts has committed to advancing the research agenda. In May 2016, the first Stroke Recovery and Rehabilitation Roundtable will be held, with the aim of achieving an agreed approach to the development, conduct and reporting of research. A range of methods will be used to achieve consensus in four priority areas: pre-clinical recovery research; biomarkers of recovery; intervention development, monitoring and reporting; and measurement in clinical trials. We hope to foster a global network of researchers committed to advancing this exciting field. Recovery from stroke is challenging for many survivors. They deserve effective treatments underpinned by our evolving understanding of brain recovery and human behaviour. Working together, we can develop game-changing interventions to improve recovery and quality of life in those living with stroke.
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Affiliation(s)
- Julie Bernhardt
- NHMRC Centre for Research Excellence in Stroke Rehabilitation and Recovery, Victoria, Australia
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Australia
| | - Karen Borschmann
- NHMRC Centre for Research Excellence in Stroke Rehabilitation and Recovery, Victoria, Australia
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Australia
| | - Lara Boyd
- Department of Physical Therapy and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, BC, Canada
| | - S. Thomas Carmichael
- Departments of Neurology and Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Dale Corbett
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Canada
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, University of Ottawa, Ottawa, Canada
| | - Steven C. Cramer
- Departments of Neurology, Anatomy & Neurobiology, and Physical Medicine & Rehabilitation, University of California, Irvine, USA
| | - Tammy Hoffmann
- Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Queensland, Australia
| | - Gert Kwakkel
- Department of Rehabilitation Medicine, Neuroscience Campus Amsterdam, VU University Medical Centre, Amsterdam, The Netherlands
| | - Sean Savitz
- Stroke Program, McGovern Medical School, UT Health, Houston, Texas, USA
| | | | - Marion Walker
- Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK
| | - Nick Ward
- Sobell Department of Motor Neuroscience UCL Institute of Neurology, Queen Square, London, UK
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
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27
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EEG patterns of subacute stroke patients performing motor tasks correlate with motor functional outcome: Preliminary results. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:4674-4677. [PMID: 28325012 DOI: 10.1109/embc.2016.7591770] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
If an early predictor of motor functional outcome after stroke were available, stroke patients would receive more appropriate treatments for motor recovery. We performed a correlation analysis of the electroencephalography (EEG) signal patterns of nine subacute stroke patients (recorded 22.9 ± 7.1 days after onset) and their motor recovery rates (measured 100.2 ± 8.9 days after onset). The beta band spectral power in the bilateral motor cortex after physical upper limb movement correlated significantly with the motor recovery rates [Fugl-Meyer assessment (FMA) scores; Pearson's linear correlation, p <; 0.05]. The R-squared of a regression model of the FMA scores and the EEG features was 0.89. These results suggest that the EEG patterns in motor areas correlate with motor recovery after stroke and can be used as an early predictor of motor functional outcome.
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28
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Thayabaranathan T, Andrew NE, Immink MA, Hillier S, Stevens P, Stolwyk R, Kilkenny M, Cadilhac DA. Determining the potential benefits of yoga in chronic stroke care: a systematic review and meta-analysis. Top Stroke Rehabil 2017; 24:279-287. [DOI: 10.1080/10749357.2016.1277481] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Tharshanah Thayabaranathan
- Translational Public Health and Evaluation Division, Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Nadine E. Andrew
- Translational Public Health and Evaluation Division, Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Maarten A. Immink
- School of Health Sciences, University of South Australia, Adelaide, Australia
| | - Susan Hillier
- Division of Health Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Philip Stevens
- School of Primary Health Care, Monash University, Clayton, Australia
| | - Rene Stolwyk
- School of Psychological Sciences, Monash University, Clayton, Australia
| | - Monique Kilkenny
- Translational Public Health and Evaluation Division, Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Germany
| | - Dominique A. Cadilhac
- Translational Public Health and Evaluation Division, Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Germany
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29
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Bernhardt J, Borschmann K, Boyd L, Thomas Carmichael S, Corbett D, Cramer SC, Hoffmann T, Kwakkel G, Savitz SI, Saposnik G, Walker M, Ward N. Moving rehabilitation research forward: Developing consensus statements for rehabilitation and recovery research. Int J Stroke 2016; 11:454-8. [PMID: 27073187 DOI: 10.1177/1747493016643851] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 03/15/2016] [Indexed: 12/18/2022]
Abstract
Stroke recovery is the next frontier in stroke medicine. While growth in rehabilitation and recovery research is exponential, a number of barriers hamper our ability to rapidly progress the field. Standardized terminology is absent in both animal and human research, methods are poorly described, recovery biomarkers are not well defined, and we lack consistent timeframes or measures to examine outcomes. Agreed methods and conventions for developing, monitoring, evaluating and reporting interventions directed at improving recovery are lacking, and current approaches are often not underpinned by biology. We urgently need to better understand the biology of recovery and its time course in both animals and humans to translate evidence from basic science into clinical trials. A new international partnership of stroke recovery and rehabilitation experts has committed to advancing the research agenda. In May 2016, the first Stroke Recovery and Rehabilitation Roundtable will be held, with the aim of achieving an agreed approach to the development, conduct and reporting of research. A range of methods will be used to achieve consensus in four priority areas: pre-clinical recovery research; biomarkers of recovery; intervention development, monitoring and reporting; and measurement in clinical trials. We hope to foster a global network of researchers committed to advancing this exciting field. Recovery from stroke is challenging for many survivors. They deserve effective treatments underpinned by our evolving understanding of brain recovery and human behaviour. Working together, we can develop game-changing interventions to improve recovery and quality of life in those living with stroke.
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Affiliation(s)
- Julie Bernhardt
- NHMRC Centre for Research Excellence in Stroke Rehabilitation and Recovery, Victoria, Australia The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Karen Borschmann
- NHMRC Centre for Research Excellence in Stroke Rehabilitation and Recovery, Victoria, Australia The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Lara Boyd
- Department of Physical Therapy and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, BC, Canada
| | - S Thomas Carmichael
- Departments of Neurology and Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Dale Corbett
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Canada Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, University of Ottawa, Ottawa, Canada
| | - Steven C Cramer
- Departments of Neurology, Anatomy & Neurobiology, and Physical Medicine & Rehabilitation, University of California, Irvine, USA
| | - Tammy Hoffmann
- Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Queensland, Australia
| | - Gert Kwakkel
- Department of Rehabilitation Medicine, Neuroscience Campus Amsterdam, VU University Medical Centre, Amsterdam, The Netherlands
| | - Sean I Savitz
- Stroke Program, McGovern Medical School, UTHealth, Houston, Texas, USA
| | - Gustavo Saposnik
- Department of Medicine, University of Toronto, Toronto, Canada Stroke Outcomes Research Center, Li Ka Shing Knowledge Institute, Toronto, Canada
| | - Marion Walker
- Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK
| | - Nick Ward
- Sobell Department of Motor Neuroscience UCL Institute of Neurology, Queen Square, London, UK National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
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30
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Sacco RL, Sandercock P, Endres M, Feigin V, Pandian J, Shinohara Y, Spence JD. Review and prioritization of stroke research recommendations to address the mission of the World Stroke Organization: a call to action from the WSO Research Committee. Int J Stroke 2015; 10 Suppl A100:4-9. [DOI: 10.1111/ijs.12625] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Ralph L. Sacco
- Department of Neurology, Evelyn McKnight Brain Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Peter Sandercock
- DCN, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - Matthias Endres
- Klinik und Hochschulambulanz für Neurologie Charité-Universitätsmedizin Berlin Charitéplatz, Berlin, Germany
| | - Valery Feigin
- National Institute for Stroke & Applied Neurosciences, Faculty of Health and Environmental Sciences, AUT University, NZ
| | - Jeyaraj Pandian
- Department of Neurology, Christian Medical College, Ludhiana, Punjab, India
| | - Yukito Shinohara
- Federation of National Public Service Personnel Mutual Aid Associations, Tachikawa Hospital, Tokyo, Japan
| | - J. David Spence
- Stroke Prevention & Atherosclerosis Research Centre, Robarts Research Institute, London, ON, Canada
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31
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Santalucia P, Baviera M, Cortesi L, Tettamanti M, Marzona I, Nobili A, Riva E, Fortino I, Bortolotti A, Merlino L, Roncaglioni MC. Epidemiologic Trends in Hospitalized Ischemic Stroke from 2002 to 2010: Results from a Large Italian Population-Based Study. J Stroke Cerebrovasc Dis 2015; 24:1917-23. [DOI: 10.1016/j.jstrokecerebrovasdis.2015.05.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 03/10/2015] [Accepted: 05/06/2015] [Indexed: 01/08/2023] Open
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32
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Daneshfard B, Izadi S, Shariat A, Toudaji MA, Beyzavi Z, Niknam L. Epidemiology of stroke in Shiraz, Iran. IRANIAN JOURNAL OF NEUROLOGY 2015; 14:158-63. [PMID: 26622981 PMCID: PMC4662689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Stroke is the main cause of physical disability and the second leading cause of death worldwide. Two-thirds of all strokes occur in the developing countries. Despite being preventable, stroke is increasingly becoming a major health issue in these countries. The aim of this study was to evaluate the epidemiology of stroke in Shiraz, Iran, one of the main referral centers in the southwestern part of Iran. METHODS A cross-sectional study was conducted on all stroke patients admitted to the Namazee Hospital, affiliated to Shiraz University of Medical Sciences, between August 2010 and January 2011. Patients' demographic data, atherosclerosis risk factors, type of stroke, drug history, outcomes, and neurological signs were recorded. Chi-square test, Kolmogorov-Smirnov test, t-test, and Mann-Whitney U-test were used to analyze the data. RESULTS A total of 305 patients with stroke, aged 27-97 years (mean ± SD = 68.33 ± 12.99), 269 patients (88.2%) had ischemic stroke (IS) and 36 (11.8%) had hemorrhagic stroke (HS). 133 patients (43.6%) were men and 172 (56.4%) were women. 11.4% of the patients with IS and 40.6% with HS died during hospitalization, causing 12.1% death in all stroke patients [Odds ratio (Or) = 5.34, 95% Confidence intervals (CI) = 2.35-12.11]. Hypertension, ischemic heart disease, diabetes, and recurrent stroke were the most common risk factors. CONCLUSION This study provides evidence that the epidemiology of stroke in the southwestern part of Iran may be similar to other places. However, it seems necessary and helpful to design a registration system for patients with stroke in Shiraz Namazee Hospital.
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Affiliation(s)
- Babak Daneshfard
- Research Center for Traditional Medicine and History of Medicine AND Essence of Parsiyan Wisdom Institute, Traditional Medicine and Medicinal Plant Incubator, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sadegh Izadi
- Shiraz Neuroscience Research Center AND Department of Neurology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abdolhamid Shariat
- Shiraz Neuroscience Research Center AND Clinical Neurology Research Center AND Department of Neurology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Amin Toudaji
- Shiraz Neuroscience Research Center AND Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Beyzavi
- Shiraz Neuroscience Research Center AND Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Leila Niknam
- Shiraz Neuroscience Research Center AND Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
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Affiliation(s)
- Julie Bernhardt
- From the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Australia (J.B., C.E., L.J., T.B.C.); International Centre for Allied Health Evidence, University of South Australia, Australia (C.E.); Institute of Sport, Exercise and Active Living, Victoria University, Melbourne, Australia (L.J.)
| | - Coralie English
- From the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Australia (J.B., C.E., L.J., T.B.C.); International Centre for Allied Health Evidence, University of South Australia, Australia (C.E.); Institute of Sport, Exercise and Active Living, Victoria University, Melbourne, Australia (L.J.)
| | - Liam Johnson
- From the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Australia (J.B., C.E., L.J., T.B.C.); International Centre for Allied Health Evidence, University of South Australia, Australia (C.E.); Institute of Sport, Exercise and Active Living, Victoria University, Melbourne, Australia (L.J.)
| | - Toby B. Cumming
- From the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Australia (J.B., C.E., L.J., T.B.C.); International Centre for Allied Health Evidence, University of South Australia, Australia (C.E.); Institute of Sport, Exercise and Active Living, Victoria University, Melbourne, Australia (L.J.)
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Saposnik G, Ovbiagele B, Raptis S, Fisher M, Johnston SC. Effect of English proficiency and research funding on acceptance of submitted articles to stroke journal. Stroke 2014; 45:1862-8. [PMID: 24876265 DOI: 10.1161/strokeaha.114.005413] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Gustavo Saposnik
- From the Division of Neurology, Department of Medicine, Stroke Outcomes Research Centre, St. Michael's Hospital (G.S.) and Applied Health Research Center, Li Ka Shing Institute, St Michael's Hospital (S.R.), University of Toronto, Toronto, Ontario, Canada; Department of Neuroscience, Medical University of South Carolina (MUSC), Charleston (B.O.); Editor, Stroke Editorial Office, American Heart Association, Boston, MA (M.F.); Department of Neurology, University of Massachusetts Medical School, Worcester (M.F.); and Department of Medicine, Dell Medical School University of Texas, Austin (S.C.J.).
| | - Bruce Ovbiagele
- From the Division of Neurology, Department of Medicine, Stroke Outcomes Research Centre, St. Michael's Hospital (G.S.) and Applied Health Research Center, Li Ka Shing Institute, St Michael's Hospital (S.R.), University of Toronto, Toronto, Ontario, Canada; Department of Neuroscience, Medical University of South Carolina (MUSC), Charleston (B.O.); Editor, Stroke Editorial Office, American Heart Association, Boston, MA (M.F.); Department of Neurology, University of Massachusetts Medical School, Worcester (M.F.); and Department of Medicine, Dell Medical School University of Texas, Austin (S.C.J.)
| | - Stavroula Raptis
- From the Division of Neurology, Department of Medicine, Stroke Outcomes Research Centre, St. Michael's Hospital (G.S.) and Applied Health Research Center, Li Ka Shing Institute, St Michael's Hospital (S.R.), University of Toronto, Toronto, Ontario, Canada; Department of Neuroscience, Medical University of South Carolina (MUSC), Charleston (B.O.); Editor, Stroke Editorial Office, American Heart Association, Boston, MA (M.F.); Department of Neurology, University of Massachusetts Medical School, Worcester (M.F.); and Department of Medicine, Dell Medical School University of Texas, Austin (S.C.J.)
| | - Marc Fisher
- From the Division of Neurology, Department of Medicine, Stroke Outcomes Research Centre, St. Michael's Hospital (G.S.) and Applied Health Research Center, Li Ka Shing Institute, St Michael's Hospital (S.R.), University of Toronto, Toronto, Ontario, Canada; Department of Neuroscience, Medical University of South Carolina (MUSC), Charleston (B.O.); Editor, Stroke Editorial Office, American Heart Association, Boston, MA (M.F.); Department of Neurology, University of Massachusetts Medical School, Worcester (M.F.); and Department of Medicine, Dell Medical School University of Texas, Austin (S.C.J.)
| | - S Claiborne Johnston
- From the Division of Neurology, Department of Medicine, Stroke Outcomes Research Centre, St. Michael's Hospital (G.S.) and Applied Health Research Center, Li Ka Shing Institute, St Michael's Hospital (S.R.), University of Toronto, Toronto, Ontario, Canada; Department of Neuroscience, Medical University of South Carolina (MUSC), Charleston (B.O.); Editor, Stroke Editorial Office, American Heart Association, Boston, MA (M.F.); Department of Neurology, University of Massachusetts Medical School, Worcester (M.F.); and Department of Medicine, Dell Medical School University of Texas, Austin (S.C.J.)
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Modulation of cortical interhemispheric interactions by motor facilitation or restraint. Neural Plast 2014; 2014:210396. [PMID: 24707408 PMCID: PMC3953668 DOI: 10.1155/2014/210396] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 01/13/2014] [Indexed: 11/28/2022] Open
Abstract
Cortical interhemispheric interactions in motor control are still poorly understood and it is important to clarify how these depend on inhibitory/facilitatory limb movements and motor expertise, as reflected by limb dominance. Here we addressed this problem using functional magnetic resonance imaging (fMRI) and a task involving dominant/nondominant limb mobilization in the presence/absence of contralateral limb restraint. In this way we could modulate excitation/deactivation of the contralateral hemisphere. Blocks of arm elevation were alternated with absent/present restraint of the contralateral limb in 17 participants. We found the expected activation of contralateral sensorimotor cortex and ipsilateral cerebellum during arm elevation. In addition, only the dominant arm elevation (hold period) was accompanied by deactivation of ipsilateral sensorimotor cortex, irrespective of presence/absence of contralateral restraint, although the latter increased deactivation. In contrast, the nondominant limb yielded absent deactivation and reduced area of contralateral activation upon restriction. Our results provide evidence for a difference in cortical communication during motor control (action facilitation/inhibition), depending on the “expertise” of the hemisphere that controls action (dominant versus nondominant). These results have relevant implications for the development of facilitation/inhibition strategies in neurorehabilitation, namely, in stroke, given that fMRI deactivations have recently been shown to reflect decreases in neural responses.
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Borschmann K, Pang MYC, Iuliano S, Churilov L, Brodtmann A, Ekinci EI, Bernhardt J. Changes to volumetric bone mineral density and bone strength after stroke: a prospective study. Int J Stroke 2013; 10:396-9. [PMID: 24373530 DOI: 10.1111/ijs.12228] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 10/10/2013] [Indexed: 01/04/2023]
Abstract
RATIONALE AND AIM Stroke survivors experience accelerated bone loss and increased fracture risk, particularly in paretic weight bearing limbs. Understanding how these changes unfold and their relationship to stroke severity and physical activity could help in the development of targeted interventions to prevent or reduce the severity of these outcomes. The primary aim of this study is to investigate the time course and magnitude of changes in volumetric bone mineral density within the first year after stroke, and to examine relationships with physical activity and motor recovery. DESIGN This is a prospective, observational study of 43 nondiabetic, nonambulant adults with first ever hemispheric stroke. PRIMARY OUTCOME The primary outcome was the difference in six-month change of total volumetric bone mineral density between paretic and nonparetic distal tibiae, measured at 7% of bone length site using high-resolution peripheral quantitative computed tomography. SECONDARY OUTCOMES The secondary outcomes are cortical and trabecular volumetric bone mineral density, cortical thickness, and total and cross-sectional areas of distal tibiae and radii of paretic and nonparetic limbs. Also included are total body and regional bone mineral density derived using dual-energy X-ray absorptiometry, physical activity measured using accelerometry, and motor recovery (Chedoke McMaster Stroke Assessment). DISCUSSION Measuring the timing and magnitude of changes to volumetric bone mineral density and bone structure from immediately after stroke, and relationships between these changes with physical activity and motor recovery will provide the basis for targeted interventions to reduce fracture risk in stroke survivors.
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Affiliation(s)
- Karen Borschmann
- School of Health Science, Latrobe University, Melbourne, Victoria, Australia; Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia
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Toward a Modern Delivery of Stroke Care in Emerging Economies. J Stroke Cerebrovasc Dis 2013; 22:e1-3. [DOI: 10.1016/j.jstrokecerebrovasdis.2012.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Revised: 02/29/2012] [Accepted: 03/03/2012] [Indexed: 01/22/2023] Open
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Baumann M, Bucki B. Lifestyle as a health risk for family caregivers with least life satisfaction, in home-based post-stroke caring. Healthc Policy 2013; 9:98-111. [PMID: 24289943 PMCID: PMC4750154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
Our purpose was to clarify that caregiving roles represent a situation of risk for the health of family caregivers, in home-based caring two years after cerebrovascular disease. Our aim was to determine the social and emotional repercussions of the event on family caregivers. Family caregivers living at home with stroke survivors were identified by a national survey. The Life Satisfaction (LS) national indicator for Luxembourg is 7.9/10, while in Canada it stands at 7.7. Caregivers with a LS level ≤ 7 were more likely to care for survivors affected by motor, sensory and memory neurological impairments. For a great majority, these impairments led to serious upheaval among families, and for spouses it was "a drama." For family caregivers with a least life satisfaction, their lifestyle poses a real health risk for the public health system.
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Affiliation(s)
- Michèle Baumann
- Professor, Medical Sociology & Public Health, INtegrative research unit on Social and Individual DEvelopment (INSIDE), University of Luxembourg, Walferdange, Luxembourg
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Affiliation(s)
- Gustavo Saposnik
- From the Division of Neurology, Department of Medicine, Stroke Outcomes Research Centre, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada (G.S.); Department of Neurology, Clinical and Translational Science Institute, University of California, San Francisco (S.C.J.); Applied Health Research Center, Li Ka Shin Institute, St. Michael’s Hospital, Toronto, Canada (S.R.); Department of Neurology, Medical University of South Carolina (MUSC), Charleston, SC (B.O.); Editor Stroke
| | - S. Claiborne Johnston
- From the Division of Neurology, Department of Medicine, Stroke Outcomes Research Centre, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada (G.S.); Department of Neurology, Clinical and Translational Science Institute, University of California, San Francisco (S.C.J.); Applied Health Research Center, Li Ka Shin Institute, St. Michael’s Hospital, Toronto, Canada (S.R.); Department of Neurology, Medical University of South Carolina (MUSC), Charleston, SC (B.O.); Editor Stroke
| | - Stavroula Raptis
- From the Division of Neurology, Department of Medicine, Stroke Outcomes Research Centre, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada (G.S.); Department of Neurology, Clinical and Translational Science Institute, University of California, San Francisco (S.C.J.); Applied Health Research Center, Li Ka Shin Institute, St. Michael’s Hospital, Toronto, Canada (S.R.); Department of Neurology, Medical University of South Carolina (MUSC), Charleston, SC (B.O.); Editor Stroke
| | - Bruce Ovbiagele
- From the Division of Neurology, Department of Medicine, Stroke Outcomes Research Centre, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada (G.S.); Department of Neurology, Clinical and Translational Science Institute, University of California, San Francisco (S.C.J.); Applied Health Research Center, Li Ka Shin Institute, St. Michael’s Hospital, Toronto, Canada (S.R.); Department of Neurology, Medical University of South Carolina (MUSC), Charleston, SC (B.O.); Editor Stroke
| | - Marc Fisher
- From the Division of Neurology, Department of Medicine, Stroke Outcomes Research Centre, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada (G.S.); Department of Neurology, Clinical and Translational Science Institute, University of California, San Francisco (S.C.J.); Applied Health Research Center, Li Ka Shin Institute, St. Michael’s Hospital, Toronto, Canada (S.R.); Department of Neurology, Medical University of South Carolina (MUSC), Charleston, SC (B.O.); Editor Stroke
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A. McNulty P, G. Thompson-Butel A, T. Shiner C, Trinh T. Wii-based Movement Therapy benefits stroke patients with low and very low movement ability. ACTA ACUST UNITED AC 2013. [DOI: 10.1108/scn-04-2013-0018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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EEG in ischaemic stroke: Quantitative EEG can uniquely inform (sub-)acute prognoses and clinical management. Clin Neurophysiol 2013; 124:10-9. [DOI: 10.1016/j.clinph.2012.07.003] [Citation(s) in RCA: 167] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 06/13/2012] [Accepted: 07/03/2012] [Indexed: 11/22/2022]
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Affiliation(s)
- Ian Clark
- Research School of Biology, Australian National University, Canberra, ACT 0200, Australia.
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Di Legge S, Koch G, Diomedi M, Stanzione P, Sallustio F. Stroke prevention: managing modifiable risk factors. Stroke Res Treat 2012; 2012:391538. [PMID: 23213626 PMCID: PMC3504482 DOI: 10.1155/2012/391538] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 10/08/2012] [Indexed: 12/12/2022] Open
Abstract
Prevention plays a crucial role in counteracting morbidity and mortality related to ischemic stroke. It has been estimated that 50% of stroke are preventable through control of modifiable risk factors and lifestyle changes. Antihypertensive treatment is recommended for both prevention of recurrent stroke and other vascular events. The use of antiplatelets and statins has been shown to reduce the risk of recurrent stroke and other vascular events. Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are indicated in stroke prevention because they also promote vascular health. Effective secondary-prevention strategies for selected patients include carotid revascularization for high-grade carotid stenosis and vitamin K antagonist treatment for atrial fibrillation. The results of recent clinical trials investigating new anticoagulants (factor Xa inhibitors and direct thrombin inhibitors) clearly indicate alternative strategies in stroke prevention for patients with atrial fibrillation. This paper describes the current landscape and developments in stroke prevention with special reference to medical treatment in secondary prevention of ischemic stroke.
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Affiliation(s)
- Silvia Di Legge
- Stroke Unit, Department of Neuroscience, University of Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Giacomo Koch
- Stroke Unit, Department of Neuroscience, University of Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
- Santa Lucia Foundation, IRCCS, Viale Ardeatina 306, 00134 Rome, Italy
| | - Marina Diomedi
- Stroke Unit, Department of Neuroscience, University of Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Paolo Stanzione
- Stroke Unit, Department of Neuroscience, University of Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
- Santa Lucia Foundation, IRCCS, Viale Ardeatina 306, 00134 Rome, Italy
| | - Fabrizio Sallustio
- Stroke Unit, Department of Neuroscience, University of Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
- Santa Lucia Foundation, IRCCS, Viale Ardeatina 306, 00134 Rome, Italy
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