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Axford D, Sohel F, Abedi V, Zhu Y, Zand R, Barkoudah E, Krupica T, Iheasirim K, Sharma UM, Dugani SB, Takahashi PY, Bhagra S, Murad MH, Saposnik G, Yousufuddin M. Development and internal validation of machine learning-based models and external validation of existing risk scores for outcome prediction in patients with ischaemic stroke. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2024; 5:109-122. [PMID: 38505491 PMCID: PMC10944684 DOI: 10.1093/ehjdh/ztad073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/14/2023] [Accepted: 10/30/2023] [Indexed: 03/21/2024]
Abstract
Aims We developed new machine learning (ML) models and externally validated existing statistical models [ischaemic stroke predictive risk score (iScore) and totalled health risks in vascular events (THRIVE) scores] for predicting the composite of recurrent stroke or all-cause mortality at 90 days and at 3 years after hospitalization for first acute ischaemic stroke (AIS). Methods and results In adults hospitalized with AIS from January 2005 to November 2016, with follow-up until November 2019, we developed three ML models [random forest (RF), support vector machine (SVM), and extreme gradient boosting (XGBOOST)] and externally validated the iScore and THRIVE scores for predicting the composite outcomes after AIS hospitalization, using data from 721 patients and 90 potential predictor variables. At 90 days and 3 years, 11 and 34% of patients, respectively, reached the composite outcome. For the 90-day prediction, the area under the receiver operating characteristic curve (AUC) was 0.779 for RF, 0.771 for SVM, 0.772 for XGBOOST, 0.720 for iScore, and 0.664 for THRIVE. For 3-year prediction, the AUC was 0.743 for RF, 0.777 for SVM, 0.773 for XGBOOST, 0.710 for iScore, and 0.675 for THRIVE. Conclusion The study provided three ML-based predictive models that achieved good discrimination and clinical usefulness in outcome prediction after AIS and broadened the application of the iScore and THRIVE scoring system for long-term outcome prediction. Our findings warrant comparative analyses of ML and existing statistical method-based risk prediction tools for outcome prediction after AIS in new data sets.
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Affiliation(s)
- Daniel Axford
- Department of Information Technology, Mathematics and Statistics, College of Science, Health, Engineering and Education, Murdoch University, Murdoch, Australia
| | - Ferdous Sohel
- Department of Information Technology, Mathematics and Statistics, College of Science, Health, Engineering and Education, Murdoch University, Murdoch, Australia
| | - Vida Abedi
- Department of Public Health Science, Penn State College of Medicine, Hershey, PA, USA
| | - Ye Zhu
- Robert D. and Patricia E. Kern Centre for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA
| | - Ramin Zand
- Neuroscience Institute, Geisinger Health System, 100 North Academy Ave, Danville, PA 17822, USA
- Neuroscience Institute, The Pennsylvania State University, Hershey, PA 17033, USA
| | - Ebrahim Barkoudah
- Internal Medicine/Hospital Medicine, Brigham and Women’s Hospital, Harvard University, Boston, MA, USA
| | - Troy Krupica
- Internal Medicine/Hospital Medicine, West Virginial University, Morgantown, WV, USA
| | - Kingsley Iheasirim
- Internal Medicine/Hospital Internal Medicine, Mayo Clinic Health System, Mankato, MN, USA
| | - Umesh M Sharma
- Hospital Internal Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Sagar B Dugani
- Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Sumit Bhagra
- Endocrinology, Diabetes and Metabolism, Mayo Clinic Health System, Austin, MN, USA
| | - Mohammad H Murad
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN, USA
| | - Gustavo Saposnik
- Stroke Outcomes and Decision Neuroscience Research Unit, Division of Neurology, Department of Medicine and Li Ka Shing Knowledge Institute, St.Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Mohammed Yousufuddin
- Hospital Internal Medicine, Mayo Clinic Health System, 1000 1st Drive NW, Austin, MN 55912, USA
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Optical Coherence Tomography in Cerebrovascular Disease: Open up New Horizons. Transl Stroke Res 2023; 14:137-145. [PMID: 35445969 DOI: 10.1007/s12975-022-01023-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 10/18/2022]
Abstract
Optical coherence tomography (OCT), based on the backscattering or reflection of near-infrared light, enables an ultra-high resolution of up to 10 μm. The successful application of OCT in coronary artery diseases has sparked increasing interest in its implementation in cerebrovascular diseases. OCT has shown promising potential in the atherosclerotic plaque structure characterization, plaque rupture risk stratification, pre-stenting and post-stenting evaluation, and long-term follow-up in extracranial and intracranial atherosclerotic stenosis (ICAS). In hemorrhagic cerebrovascular diseases, OCT plays an important role in the structure evaluation, rupture risk stratification, and healing and occlusion evaluation following initial treatment in intracranial aneurysms (IAs). In this study, we summarized the applications of OCT in the diagnosis, treatment, and follow-up of cerebrovascular diseases, especially in ICAS and IAs. The current limitations and future directions of OCT in the endovascular treatment of cerebrovascular diseases were also discussed.
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Mariana de Aquino Miranda J, Mendes Borges V, Bazan R, José Luvizutto G, Sabrysna Morais Shinosaki J. Early mobilization in acute stroke phase: a systematic review. Top Stroke Rehabil 2023; 30:157-168. [PMID: 34927568 DOI: 10.1080/10749357.2021.2008595] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Early mobilization is defined as out-of-bed activities in acute stroke phase, and has led to improvements in functional capacity and reduction of complications after stroke. OBJECTIVE This study aimed to investigate the effectiveness and safety of early mobilization in the acute stroke phase. METHODS This was a systematic review. We searched for studies with the keywords: "Stroke," "Early mobilization" and "Functional outcomes." Data source: NLM, LILACS, MEDLINE, PEDro, and Science Direct. Studies published up to June 2020 were included; (b) study eligibility criteria: clinical trials; (c) participants: stroke patients in the acute phase; (d) interventions: early mobilization; (e) study appraisal: two authors independently assessed the risk of bias, Grading of Recommendations Assessment, Development and Evaluation, and the Oxford Center for Evidence-Based Medicine Levels of Evidence. The safety was evaluated based on related and non-related adverse effects. RESULTS Altogether, 476 studies were retrieved. After exclusion, seven studies involving 8663 patients were included in the qualitative synthesis. The main activities were elevation of the headboard, sitting, standing, and walking. The most important outcome assessed was the modified Rankin scale score (disability) after 3 months of stroke, and two studies showed that early mobilization improves functional capacity after stroke. CONCLUSION the optimal time to start early mobilization is > 24 h of stroke according to hemodynamic stability and safety criteria. The duration of mobilization is recommended between 15 and 45 minutes, divided into one, two, or three times a day. The focus of early mobilization should be on sitting, standing, and walking activity.
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Affiliation(s)
| | - Viviany Mendes Borges
- Intensive Care Unit, Clinical Hospital of the Federal University of Uberlândia, Uberlândia Minas Gerais Brazil
| | - Rodrigo Bazan
- Professor of Department of Neurology Psychology and Psychiatry, Botucatu Medical School (UNESP), Botucatu São Paulo Brazil
| | - Gustavo José Luvizutto
- Professor of Department of Physical Therapy, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais Brazil
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Hanly A, Johnston RD, Lemass C, Jose A, Tornifoglio B, Lally C. Phosphotungstic acid (PTA) preferentially binds to collagen- rich regions of porcine carotid arteries and human atherosclerotic plaques observed using contrast enhanced micro-computed tomography (CE-µCT). Front Physiol 2023; 14:1057394. [PMID: 36818446 PMCID: PMC9932683 DOI: 10.3389/fphys.2023.1057394] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 01/16/2023] [Indexed: 02/05/2023] Open
Abstract
Background and aims: Atherosclerotic plaque rupture in the carotid artery can cause small emboli to travel to cerebral arteries, causing blockages and preventing blood flow leading to stroke. Contrast enhanced micro computed tomography (CEμCT) using a novel stain, phosphotungstic acid (PTA) can provide insights into the microstructure of the vessel wall and atherosclerotic plaque, and hence their likelihood to rupture. Furthermore, it has been suggested that collagen content and orientation can be related to mechanical integrity. This study aims to build on existing literature and establish a robust and reproducible staining and imaging technique to non-destructively quantify the collagen content within arteries and plaques as an alternative to routine histology. Methods: Porcine carotid arteries and human atherosclerotic plaques were stained with a concentration of 1% PTA staining solution and imaged using MicroCT to establish the in situ architecture of the tissue and measure collagen content. A histological assessment of the collagen content was also performed from picrosirius red (PSR) staining. Results: PTA stained arterial samples highlight the reproducibility of the PTA staining and MicroCT imaging technique used with a quantitative analysis showing a positive correlation between the collagen content measured from CEμCT and histology. Furthermore, collagen-rich areas can be clearly visualised in both the vessel wall and atherosclerotic plaque. 3D reconstruction was also performed showing that different layers of the vessel wall and various atherosclerotic plaque components can be differentiated using Hounsfield Unit (HU) values. Conclusion: The work presented here is unique as it offers a quantitative method of segmenting the vessel wall into its individual components and non-destructively quantifying the collagen content within these tissues, whilst also delivering a visual representation of the fibrous structure using a single contrast agent.
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Affiliation(s)
- A. Hanly
- Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland,Department of Mechanical, Manufacturing & Biomedical Engineering, School of Engineering, Trinity College Dublin, Dublin, Ireland
| | - R. D. Johnston
- Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland,Department of Mechanical, Manufacturing & Biomedical Engineering, School of Engineering, Trinity College Dublin, Dublin, Ireland
| | - C. Lemass
- Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland,Department of Mechanical, Manufacturing & Biomedical Engineering, School of Engineering, Trinity College Dublin, Dublin, Ireland
| | - A. Jose
- Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland,Department of Mechanical, Manufacturing & Biomedical Engineering, School of Engineering, Trinity College Dublin, Dublin, Ireland
| | - B. Tornifoglio
- Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland,Department of Mechanical, Manufacturing & Biomedical Engineering, School of Engineering, Trinity College Dublin, Dublin, Ireland
| | - C. Lally
- Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland,Department of Mechanical, Manufacturing & Biomedical Engineering, School of Engineering, Trinity College Dublin, Dublin, Ireland,Advanced Materials and Bioengineering Research Centre (AMBER), Royal College of Surgeons in Ireland and Trinity College Dublin, Dublin, Ireland,*Correspondence: C. Lally,
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Yazdani M, Chitsaz A, Zolaktaf V, Saadatnia M, Ghasemi M, Nazari F, Chitsaz A, Suzuki K, Nobari H. Can Early Neuromuscular Rehabilitation Protocol Improve Disability after a Hemiparetic Stroke? A Pilot Study. Brain Sci 2022; 12:brainsci12070816. [PMID: 35884625 PMCID: PMC9313239 DOI: 10.3390/brainsci12070816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 04/30/2022] [Accepted: 06/12/2022] [Indexed: 12/04/2022] Open
Abstract
Background: The impairment of limb function and disability are among the most important consequences of stroke. To date, however, little research has been done on the early rehabilitation trial (ERT) after stroke in these patients. The purpose of this study was to evaluate the impact of ERT neuromuscular protocol on motor function soon after hemiparetic stroke. The sample included twelve hemiparetic patients (54.3 ± 15.4 years old) with ischemic stroke (n = 7 control, n = 5 intervention patients). ERT was started as early as possible after stroke and included passive range of motion exercises, resistance training, assisted standing up, and active exercises of the healthy side of the body, in addition to encouraging voluntary contraction of affected limbs as much as possible. The rehabilitation was progressive and took 3 months, 6 days per week, 2–3 hours per session. Fugle-Meyer Assessment (FMA), Box and Blocks test (BBT) and Timed up and go (TUG) assessments were conducted. There was a significantly greater improvement in the intervention group compared to control: FMA lower limbs (p = 0.001), total motor function (p = 0.002), but no significant difference in FMA upper limb between groups (p = 0.51). The analysis of data related to BBT showed no significant differences between the experimental and control groups (p = 0.3). However, TUG test showed significant differences between the experimental and control groups (p = 0.004). The most important finding of this study was to spend enough time in training sessions and provide adequate rest time for each person. Our results showed that ERT was associated with improved motor function but not with the upper limbs. This provides a basis for a definitive trial.
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Affiliation(s)
- Mahdi Yazdani
- Faculty of Sport Sciences, University of Isfahan, Isfahan 81746-7344, Iran; (V.Z.); (A.C.)
- Isfahan Neurosciences Research Centre, Alzahra Research Institute, Isfahan University of Medical Sciences, Isfahan 81839-83434, Iran
- Correspondence: (M.Y.); (K.S.); or (H.N.)
| | - Ahmad Chitsaz
- Isfahan Neurosciences Research Centre, Alzahra Research Institute, Department of Neurology, Isfahan University of Medical Sciences, Isfahan 81839-83434, Iran; (A.C.); (M.S.); (M.G.)
| | - Vahid Zolaktaf
- Faculty of Sport Sciences, University of Isfahan, Isfahan 81746-7344, Iran; (V.Z.); (A.C.)
| | - Mohammad Saadatnia
- Isfahan Neurosciences Research Centre, Alzahra Research Institute, Department of Neurology, Isfahan University of Medical Sciences, Isfahan 81839-83434, Iran; (A.C.); (M.S.); (M.G.)
| | - Majid Ghasemi
- Isfahan Neurosciences Research Centre, Alzahra Research Institute, Department of Neurology, Isfahan University of Medical Sciences, Isfahan 81839-83434, Iran; (A.C.); (M.S.); (M.G.)
| | - Fatemeh Nazari
- Isfahan Neurosciences Research Centre, Department of Adult Health Nursing, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan 81839-83434, Iran;
| | - Abbas Chitsaz
- Faculty of Sport Sciences, University of Isfahan, Isfahan 81746-7344, Iran; (V.Z.); (A.C.)
| | - Katsuhiko Suzuki
- Faculty of Sport Sciences, Waseda University, Tokorozawa 359-1192, Japan
- Correspondence: (M.Y.); (K.S.); or (H.N.)
| | - Hadi Nobari
- Faculty of Sport Sciences, University of Isfahan, Isfahan 81746-7344, Iran; (V.Z.); (A.C.)
- Faculty of Sport Sciences, University of Extremadura, 10003 Caceres, Spain
- Department of Motor Performance, Faculty of Physical Education and Mountain Sports, Transilvania University of Brașov, 500068 Brașov, Romania
- Department of Exercise Physiology, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil 56199-11367, Iran
- Correspondence: (M.Y.); (K.S.); or (H.N.)
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Irie F, Matsuo R, Nakamura K, Wakisaka Y, Ago T, Kamouchi M, Kitazono T. Sex Differences in the Risk of 30-Day Death After Acute Ischemic Stroke. Neurol Clin Pract 2022; 11:e809-e816. [PMID: 34992963 DOI: 10.1212/cpj.0000000000001087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/23/2021] [Indexed: 11/15/2022]
Abstract
Objective To examine sex differences in early stroke deaths according to cause of death. Methods We investigated 30-day deaths in patients with acute ischemic stroke enrolled in a multicenter stroke registry between 2007 and 2019 in Fukuoka, Japan. We estimated the multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of cause-specific deaths for women vs men using Cox proportional hazards models and competing risk models. The risk of acute infections during hospitalization and the associated case fatality rates were also compared between the sexes. Results Among 17,956 patients with acute ischemic stroke (women: 41.3%), the crude 30-day death rate after stroke was higher in women than men. However, adjusting for age and stroke severity resulted in a lower risk of death among women (HR [95% CI]: 0.76 [0.62-0.92]). Analyses using competing risk models revealed that women were less likely to die of acute infections (subdistribution HR [95% CI]: 0.33 [0.20-0.54]). Further analyses showed that women were associated with a lower risk of acute infections during hospitalization (OR [95% CI]: 0.62 [0.52-0.74]) and a lower risk of death due to these infections (subdistribution HR [95% CI]: 052 [0.33-0.83]). Conclusions When adjusting for confounders, the female sex was associated with a lower risk of 30-day death after stroke, which could be explained by a female survival advantage in poststroke infections. Sex-specific strategies are needed to reduce early stroke deaths. Classification of Evidence This is a Class I prognostic study because it is a prospective population-based cohort with objective outcomes. Female sex appears to be protective against early stroke deaths and post stroke infections.
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Affiliation(s)
- Fumi Irie
- Department of Medicine and Clinical Science (FI, RM, KN, YW, TA, TK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Food Safety Commission Secretariat (FI), Cabinet Office, Government of Japan, Tokyo, Japan; Department of Health Care Administration and Management (RM, MK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; and Center for Cohort Studies (MK, TK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryu Matsuo
- Department of Medicine and Clinical Science (FI, RM, KN, YW, TA, TK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Food Safety Commission Secretariat (FI), Cabinet Office, Government of Japan, Tokyo, Japan; Department of Health Care Administration and Management (RM, MK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; and Center for Cohort Studies (MK, TK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kuniyuki Nakamura
- Department of Medicine and Clinical Science (FI, RM, KN, YW, TA, TK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Food Safety Commission Secretariat (FI), Cabinet Office, Government of Japan, Tokyo, Japan; Department of Health Care Administration and Management (RM, MK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; and Center for Cohort Studies (MK, TK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshinobu Wakisaka
- Department of Medicine and Clinical Science (FI, RM, KN, YW, TA, TK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Food Safety Commission Secretariat (FI), Cabinet Office, Government of Japan, Tokyo, Japan; Department of Health Care Administration and Management (RM, MK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; and Center for Cohort Studies (MK, TK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tetsuro Ago
- Department of Medicine and Clinical Science (FI, RM, KN, YW, TA, TK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Food Safety Commission Secretariat (FI), Cabinet Office, Government of Japan, Tokyo, Japan; Department of Health Care Administration and Management (RM, MK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; and Center for Cohort Studies (MK, TK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masahiro Kamouchi
- Department of Medicine and Clinical Science (FI, RM, KN, YW, TA, TK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Food Safety Commission Secretariat (FI), Cabinet Office, Government of Japan, Tokyo, Japan; Department of Health Care Administration and Management (RM, MK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; and Center for Cohort Studies (MK, TK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science (FI, RM, KN, YW, TA, TK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Food Safety Commission Secretariat (FI), Cabinet Office, Government of Japan, Tokyo, Japan; Department of Health Care Administration and Management (RM, MK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; and Center for Cohort Studies (MK, TK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Zhang S, Wang J, Pei L, Liu K, Gao Y, Fang H, Zhang R, Zhao L, Sun S, Wu J, Song B, Dai H, Li R, Xu Y. Interpretable CNN for ischemic stroke subtype classification with active model adaptation. BMC Med Inform Decis Mak 2022; 22:3. [PMID: 34986813 PMCID: PMC8729146 DOI: 10.1186/s12911-021-01721-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 12/07/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND TOAST subtype classification is important for diagnosis and research of ischemic stroke. Limited by experience of neurologist and time-consuming manual adjudication, it is a big challenge to finish TOAST classification effectively. We propose a novel active deep learning architecture to classify TOAST. METHODS To simulate the diagnosis process of neurologists, we drop the valueless features by XGB algorithm and rank the remaining ones. Utilizing active learning framework, we propose a novel causal CNN, in which it combines with a mixed active selection criterion to optimize the uncertainty of samples adaptively. Meanwhile, KL-focal loss derived from the enhancement of Focal loss by KL regularization is introduced to accelerate the iterative fine-tuning of the model. RESULTS To evaluate the proposed method, we construct a dataset which consists of totally 2310 patients. In a series of sequential experiments, we verify the effectiveness of each contribution by different evaluation metrics. Experimental results show that the proposed method achieves competitive results on each evaluation metric. In this task, the improvement of AUC is the most obvious, reaching 77.4. CONCLUSIONS We construct a backbone causal CNN to simulate the neurologist process of that could enhance the internal interpretability. The research on clinical data also indicates the potential application value of this model in stroke medicine. Future work we would consider various data types and more comprehensive patient types to achieve fully automated subtype classification.
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Affiliation(s)
- Shuo Zhang
- School of Information Engineering, Zhengzhou University, Zhengzhou, China.,Cooperative Innovation Center of Internet Healthcare, Zhengzhou University, Zhengzhou, China
| | - Jing Wang
- School of Information Engineering, Zhengzhou University, Zhengzhou, China.,Cooperative Innovation Center of Internet Healthcare, Zhengzhou University, Zhengzhou, China
| | - Lulu Pei
- The Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Kai Liu
- The Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuan Gao
- The Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hui Fang
- The Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Rui Zhang
- The Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lu Zhao
- The Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shilei Sun
- The Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jun Wu
- The Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Bo Song
- The Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Honghua Dai
- Cooperative Innovation Center of Internet Healthcare, Zhengzhou University, Zhengzhou, China.,Institute of Intelligent Systems, Deakin University, Burwood, Australia
| | - Runzhi Li
- Cooperative Innovation Center of Internet Healthcare, Zhengzhou University, Zhengzhou, China.
| | - Yuming Xu
- The Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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Kārkliņa A, Chen E, Bērziņa G, Stibrant Sunnerhagen K. Patients' physical activity in stroke units in Latvia and Sweden. Brain Behav 2021; 11:e02110. [PMID: 33759379 PMCID: PMC8119825 DOI: 10.1002/brb3.2110] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE A prospective, observational study to describe levels of physical activity in patients with stroke in a comprehensive stroke unit in Sweden and Latvia, comparing data between countries. METHODS The study was performed at stroke units in one hospital in Sweden (data were acquired over a 2-month period in 2017) and two hospitals in Latvia (data were acquired over a 3-month period between 2016 and 2017). Patients with stroke were observed for 1 min every 10 min. The level of physical activity, location, and the people present were noted at each time-point. RESULTS A total of 27 patients were observed in Latvia and 25 patients in Sweden. Patients from both countries were in bed half of the time and spent the majority of the day in their bedroom and alone. Patients in Sweden had higher physical activity levels, spent more time outside their bedroom and spent more time with rehabilitation specialists and visitors. CONCLUSION Patients are inactive and alone for a majority of the time during hospitalization at a comprehensive stroke unit in both countries. There are differences in environment in the stroke unit between countries.
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Affiliation(s)
- Agnese Kārkliņa
- Department of RehabilitationRiga East University HospitalRigaLatvia
| | - Erik Chen
- Department of Clinical NeuroscienceInstitute of Neuroscience and PhysiologyThe University of GothenburgGothenburgSweden
| | - Guna Bērziņa
- Department of RehabilitationRiga East University HospitalRigaLatvia
- Faculty of RehabilitationRiga Stradiņš UniversityRigaLatvia
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Sarecka-Hujar B, Kopyta I, Raczkiewicz D. Risk factors, types and outcomes of arterial ischemic stroke in Polish pediatric patients: a retrospective single-center study. Arch Med Sci 2021; 17:62-70. [PMID: 33488857 PMCID: PMC7811299 DOI: 10.5114/aoms.2017.71805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 10/14/2017] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Various neurological complications may occur as a consequence of arterial ischemic stroke (AIS) and have an impact on daily activity of the patients, costs of their medical care and rehabilitation. The aim of this study was to analyze risk factors, stroke symptoms and post-stroke consequences in Polish pediatric patients depending on stroke subtype. MATERIAL AND METHODS We retrospectively reviewed 77 children under the age of 18 years following their first AIS. Patients were white, Polish Caucasians, recruited in the Department of Pediatric Neurology at the Medical University of Silesia in Katowice (Poland). Statistical analysis was performed using Statistica 12.0. RESULTS Gender differed significantly between stroke subgroups (p = 0.030). The presence of focal cerebral arteriopathy (FCA) and chronic diseases was associated with type of AIS (p = 0.003 and p = 0.050, respectively). An outcome without neurological deterioration (normal outcome) was observed in 43% of children with lacunar anterior circulation infarct (LACI). Hemiparesis was present in almost all children with total anterior circulation infarct (TACI), in two thirds of children with partial anterior circulation infarct (PACI) and in almost 50% of children with LACI or posterior circulation infarct (POCI). In every child with hemiplegia the stroke symptom evolved into hemiparesis at follow-up. Additionally, patients with a normal outcome were older at the time of AIS than those with at least one neurological consequence (OR = 0.894, p = 0.034). CONCLUSIONS The presence and number of neurological outcomes depend on stroke subtypes. A relation between the presence of post-stroke deficits and age at onset was observed. The odds of deficit after ischemic stroke decreases by an average of 10.6% if the child is 1 year older at the time of AIS.
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Affiliation(s)
- Beata Sarecka-Hujar
- Department of Pharmaceutical Technology, School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia in Katowice, Poland
| | - Ilona Kopyta
- Department of Pediatric Neurology, School of Medicine, Medical University of Silesia, Katowice, Poland
| | - Dorota Raczkiewicz
- Institute of Statistics and Demography, Warsaw School of Economics, Warsaw, Poland
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Wang J, Ren Y, Wang SF, Kan LD, Zhou LJ, Fang HM, Fan H. Comparative efficacy and safety of glycerol versus mannitol in patients with cerebral oedema and elevated intracranial pressure: A systematic review and meta-analysis. J Clin Pharm Ther 2020; 46:504-514. [PMID: 33217016 DOI: 10.1111/jcpt.13314] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/29/2020] [Accepted: 10/29/2020] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Glycerol is thought to be superior to mannitol in the treatment of cerebral oedema and elevated intracranial pressure (ICP), particularly with safety concerns. However, the current evidence remains insufficient. Therefore, we aimed to compare the efficacy and safety of glycerol versus mannitol in this meta-analysis. METHODS PubMed, EMBASE, Web of Science, CENTRAL, China National Knowledge Infrastructure, Wanfang Database, Chongqing VIP information, ClinicalTrials.gov, and the reference lists of relevant articles were searched for randomized controlled trials comparing glycerol and mannitol in patients with brain oedema and elevated ICP. Two investigators independently identified the articles, assessed the study quality and extracted data. Data analyses were performed using RevMan software. RESULTS AND DISCUSSION Thirty trials involving 3144 patients met our inclusion criteria. Pooled data indicated that glycerol and mannitol had comparable effectiveness in controlling cerebral oedema (RR, 1.00; 95% CI, 0.97 to 1.03; p = .97), but the risks of acute kidney injury and electrolyte disturbances were significantly lower with glycerol (RR, 0.21; 95% CI, 0.16 to 0.27 and RR, 0.23; 95% CI, 0.17 to 0.30, respectively) than mannitol. Moreover, there seemed to be a lower probability of rebound ICP after the withdrawal of glycerol. Neither haemolysis nor elevated blood glucose levels were observed in the glycerol group. WHAT IS NEW AND CONCLUSION Regarding the balance between efficacy and safety, glycerol could be an effective and more tolerable alternative therapy for cerebral oedema and elevated ICP than mannitol, especially for high-risk populations of renal failure.
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Affiliation(s)
- Jia Wang
- Department of Pharmacy, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yan Ren
- Department of Nephrology, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Shuai-Fei Wang
- Department of Pharmacy, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lian-Di Kan
- Department of Pharmacy, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Li-Juan Zhou
- Department of Pharmacy, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hong-Mei Fang
- Department of Pharmacy, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hui Fan
- Department of Pharmacy, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
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11
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Lam MY, Haunton VJ, Panerai RB, Robinson TG. Cerebral hemodynamics in stroke thrombolysis (CHiST) study. PLoS One 2020; 15:e0238620. [PMID: 32956367 PMCID: PMC7505447 DOI: 10.1371/journal.pone.0238620] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 08/20/2020] [Indexed: 12/17/2022] Open
Abstract
Despite careful patient selection, successful recanalization in intravenous thrombolysis is only achieved in approximately 50% of cases. Understanding changes in cerebral autoregulation during and following successful recanalization in acute ischemic stroke patients who receive intravenous thrombolysis, may inform the management of common physiological perturbations, including blood pressure, in turn reducing the risk of reperfusion injury. Cerebral blood velocity (Transcranial Doppler), blood pressure (Finometer) and end-tidal carbon dioxide (capnography) were continuously recorded in 11 acute ischemic stroke patients who received intravenous thrombolysis (5 female, mean ± SD age 68±12 years) over 4-time points, during and at the following time intervals after intravenous thrombolysis: 23.9±2.6 hrs, 18.1±7.0 days and 89.6±4.2 days. Reductions in blood pressure (p = 0.04) were observed during intravenous thrombolysis. Reductions in heart rate (p<0.005) and critical closing pressure [Affected hemisphere (p = 0.02) and non-affected hemisphere (p<0.005)] were observed post intravenous thrombolysis. End-tidal CO2 increased during the sub-acute and chronic stages (p = 0.028). Reduction in affected hemisphere phase at low frequency was observed during intravenous thrombolysis (p = 0.021) and at subsequent visits (p = 0.048). No changes were observed in cerebral blood velocity, coherence, gain and Autoregulation Index during the follow-up period. Intravenous thrombolysis in acute ischemic stroke patients induced changes in affected hemisphere phase and other key hemodynamic parameters, but not Autoregulation Index. Further investigation of cerebral autoregulation is warranted in a larger acute ischemic stroke cohort to inform its potential role in individualized management plans.
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Affiliation(s)
- Man Y. Lam
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Victoria J. Haunton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
- National Institute for Health Research Leicester Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
| | - Ronney B. Panerai
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
- National Institute for Health Research Leicester Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
| | - Thompson G. Robinson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
- National Institute for Health Research Leicester Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
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12
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Kitaji Y, Harashima H, Miyano S. Relationship between first mobilization following the onset of stroke and clinical outcomes in patients with ischemic stroke in the general ward of a hospital: A cohort study. Phys Ther Res 2020; 23:209-215. [PMID: 33489661 PMCID: PMC7814213 DOI: 10.1298/ptr.e10022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 06/25/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The purpose of this study was to compare the effects of first mobilization following a stroke with independently performing the activities of daily living at discharge in acute phase ischemic stroke patients in a general ward of a hospital. METHODS A total of 158 patients with ischemic strokes were admitted to a general ward from June 1, 2014 to March 31, 2015. Of the 158 patients, 53 met the study's eligibility criteria. First mobilization was defined as the transfer of a patient from the bed to a wheelchair by a rehabilitation therapist. A favorable primary outcome at discharge was defined as a modified Rankin Scale score of < 3. The outcome was analyzed using the proportional hazards analysis and receiver operating characteristic curves. RESULTS The age of the participants was 78.2 ± 11.7 years, stroke severity evaluated by the National Institutes of Health Stroke Scale scores on admission was 14.3 ± 10.6 points, and first mobilization of this population was 6.4 ± 5.2 days. Thirteen [25%] patients had a favorable outcome. Hazards analysis showed a favorable outcome due to first mobilization (adjusted hazards ratio 0.80, 95% confidence interval 0.65-0.98; p < 0.05). The cutoff point for first mobilization to produce a favorable outcome was 6.5 days after the stroke onset (area under the curve 0.729; p < 0.05). CONCLUSION As seen in stroke units, early first mobilization is associated with improved clinical outcomes in ischemic stroke patients admitted to a general ward.
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13
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Oesch L, Arnold M, Bernasconi C, Kaesmacher J, Fischer U, Mosimann PJ, Jung S, Meinel T, Goeldlin M, Heldner M, Volbers B, Gralla J, Sarikaya H. Impact of pre-stroke dependency on outcome after endovascular therapy in acute ischemic stroke. J Neurol 2020; 268:541-548. [PMID: 32865630 PMCID: PMC7880932 DOI: 10.1007/s00415-020-10172-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 07/13/2020] [Accepted: 08/17/2020] [Indexed: 01/01/2023]
Abstract
Background and purpose Current demographic changes indicate that more people will be care-dependent due to increasing life expectancy. Little is known about impact of preexisting dependency on stroke outcome after endovascular treatment (EVT). Methods We compared prospectively collected baseline and outcome data of previously dependent vs. independent stroke patients (prestroke modified Rankin Scale score of 3–5 vs. 0–2) treated with EVT. Outcome measures were favorable 3-month outcome (mRS ≤ 3 for previously dependent and mRS ≤ 2 for independent patients, respectively), death and symptomatic intracranial hemorrhage (sICH). Results Among 1247 patients, 84 (6.7%) were dependent before stroke. They were older (81 vs. 72 years of age), more often female (61.9% vs. 46%), had a higher stroke severity at baseline (NIHSS 18 vs. 15 points), more often history of previous stroke (32.9% vs. 9.1%) and more vascular risk factors than independent patients. Favorable outcome and mortality were to the disadvantage of independent patients (26.2% vs. 44.4% and 46.4% vs. 25.5%, respectively), whereas sICH was comparable in both cohorts (4.9% vs. 5%). However, preexisting dependency was not associated with clinical outcome and mortality after adjusting for outcome predictors (OR 1.076, 95% CI 0.612–1.891; p = 0.799 and OR 1.267, 95% CI 0.758–2.119; p = 0.367, respectively). Conclusion Our study underscores the need for careful selection of care-dependent stroke patients when considering EVT, given a less favorable outcome observed in this cohort. Nonetheless, EVT should not systematically be withheld in patients with preexisting disability, since prior dependency does not significantly influence outcome.
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Affiliation(s)
- Lisa Oesch
- Department of Neurology, Bern University Hospital, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Marcel Arnold
- Department of Neurology, Bern University Hospital, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Corrado Bernasconi
- Department of Neurology, Bern University Hospital, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Johannes Kaesmacher
- Department of Diagnostic and Interventional Neuroradiology, Bern University Hospital, Freiburgstrasse 10, 3010, Bern, Switzerland.,Department of Diagnostic, Interventional and Pediatric Radiology, Bern University Hospital, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Urs Fischer
- Department of Neurology, Bern University Hospital, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Pascal J Mosimann
- Department of Diagnostic and Interventional Neuroradiology, Bern University Hospital, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Simon Jung
- Department of Neurology, Bern University Hospital, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Thomas Meinel
- Department of Neurology, Bern University Hospital, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Martina Goeldlin
- Department of Neurology, Bern University Hospital, Freiburgstrasse 10, 3010, Bern, Switzerland.,Department of Diagnostic and Interventional Neuroradiology, Bern University Hospital, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Mirjam Heldner
- Department of Neurology, Bern University Hospital, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Bastian Volbers
- Department of Neurology, Bern University Hospital, Freiburgstrasse 10, 3010, Bern, Switzerland.,Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Jan Gralla
- Department of Diagnostic and Interventional Neuroradiology, Bern University Hospital, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Hakan Sarikaya
- Department of Neurology, Bern University Hospital, Freiburgstrasse 10, 3010, Bern, Switzerland.
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14
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Naqvi IA, Kamal AK, Rehman H. Multiple versus fewer antiplatelet agents for preventing early recurrence after ischaemic stroke or transient ischaemic attack. Cochrane Database Syst Rev 2020; 8:CD009716. [PMID: 32813275 PMCID: PMC7437397 DOI: 10.1002/14651858.cd009716.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Stroke is a leading cause of morbidity and mortality worldwide. Antiplatelet agents are considered to be the cornerstone for secondary prevention of stroke, but the role of using multiple antiplatelet agents early after stroke or transient ischaemic attack (TIA) to improve outcomes has not been established. OBJECTIVES To determine the effectiveness and safety of initiating, within 72 hours after an ischaemic stroke or TIA, multiple antiplatelet agents versus fewer antiplatelet agents to prevent stroke recurrence. The analysis explores the evidence for different drug combinations. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (last searched 6 July 2020), the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 7 of 12, 2020) (last searched 6 July 2020), MEDLINE Ovid (from 1946 to 6 July 2020), Embase (1980 to 6 July 2020), ClinicalTrials.gov, and the WHO ICTRP. We also searched the reference lists of identified studies and reviews and used the Science Citation Index Cited Reference search for forward tracking of included studies. SELECTION CRITERIA We selected all randomised controlled trials (RCTs) that compared the use of multiple versus fewer antiplatelet agents initiated within 72 hours after stroke or TIA. DATA COLLECTION AND ANALYSIS We extracted data from eligible studies for the primary outcomes of stroke recurrence and vascular death, and secondary outcomes of myocardial infarction; composite outcome of stroke, myocardial infarction, and vascular death; intracranial haemorrhage; extracranial haemorrhage; ischaemic stroke; death from all causes; and haemorrhagic stroke. We computed an estimate of treatment effect and performed a test for heterogeneity between trials. We analysed data on an intention-to-treat basis and assessed bias for all studies. We rated the certainty of the evidence using the GRADE approach. MAIN RESULTS We included 15 RCTs with a total of 17,091 participants. Compared with fewer antiplatelet agents, multiple antiplatelet agents were associated with a significantly lower risk of stroke recurrence (5.78% versus 7.84%, risk ratio (RR) 0.73, 95% confidence interval (CI) 0.66 to 0.82; P < 0.001; moderate-certainty evidence) with no significant difference in vascular death (0.60% versus 0.66%, RR 0.98, 95% CI 0.66 to 1.45; P = 0.94; moderate-certainty evidence). There was a higher risk of intracranial haemorrhage (0.42% versus 0.21%, RR 1.92, 95% CI 1.05 to 3.50; P = 0.03; low-certainty evidence) and extracranial haemorrhage (6.38% versus 2.81%, RR 2.25, 95% CI 1.88 to 2.70; P < 0.001; high-certainty evidence) with multiple antiplatelet agents. On secondary analysis of dual versus single antiplatelet agent therapy, benefit for stroke recurrence (5.73% versus 8.06%, RR 0.71, 95% CI 0.62 to 0.80; P < 0.001; moderate-certainty evidence) was maintained as well as risk of extracranial haemorrhage (1.24% versus 0.40%, RR 3.08, 95% CI 1.74 to 5.46; P < 0.001; high-certainty evidence). The composite outcome of stroke, myocardial infarction, and vascular death (6.37% versus 8.77%, RR 0.72, 95% CI 0.64 to 0.82; P < 0.001; moderate-certainty evidence) and ischaemic stroke (6.30% versus 8.94%, RR 0.70, 95% CI 0.61 to 0.81; P < 0.001; high-certainty evidence) were significantly in favour of dual antiplatelet therapy, whilst the risk of intracranial haemorrhage became less significant (0.34% versus 0.21%, RR 1.53, 95% CI 0.76 to 3.06; P = 0.23; low-certainty evidence). AUTHORS' CONCLUSIONS Multiple antiplatelet agents are more effective in reducing stroke recurrence but increase the risk of haemorrhage compared to one antiplatelet agent. The benefit in reduction of stroke recurrence seems to outweigh the harm for dual antiplatelet agents initiated in the acute setting and continued for one month. There is lack of evidence regarding multiple versus multiple antiplatelet agents. Further studies are required in different populations to establish comprehensive safety profiles and long-term outcomes to establish duration of therapy.
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Affiliation(s)
- Imama A Naqvi
- Stroke Service, International Cerebrovascular Translational Clinical Research Training Program, Section of Neurology, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
- Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Columbia University, New York, USA
| | - Ayeesha K Kamal
- Stroke Service, International Cerebrovascular Translational Clinical Research Training Program, Section of Neurology, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Hasan Rehman
- Stroke Service, Section of Neurology, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
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15
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Abi-Ghanem C, Robison LS, Zuloaga KL. Androgens' effects on cerebrovascular function in health and disease. Biol Sex Differ 2020; 11:35. [PMID: 32605602 PMCID: PMC7328272 DOI: 10.1186/s13293-020-00309-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 05/20/2020] [Indexed: 12/18/2022] Open
Abstract
Androgens affect the cerebral vasculature and may contribute to sex differences in cerebrovascular diseases. Men are at a greater risk for stroke and vascular contributions to cognitive impairment and dementia (VCID) compared to women throughout much of the lifespan. The cerebral vasculature is a target for direct androgen actions, as it expresses several sex steroid receptors and metabolizing enzymes. Androgens’ actions on the cerebral vasculature are complex, as they have been shown to have both protective and detrimental effects, depending on factors such as age, dose, and disease state. When administered chronically, androgens are shown to be pro-angiogenic, promote vasoconstriction, and influence blood-brain barrier permeability. In addition to these direct effects of androgens on the cerebral vasculature, androgens also influence other vascular risk factors that may contribute to sex differences in cerebrovascular diseases. In men, low androgen levels have been linked to metabolic and cardiovascular diseases including hypertension, diabetes, hyperlipidemia, and obesity, which greatly increase the risk of stroke and VCID. Thus, a better understanding of androgens’ interactions with the cerebral vasculature under physiological and pathological conditions is of key importance.
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Affiliation(s)
- Charly Abi-Ghanem
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, 47 New Scotland Avenue, MC-136, Albany, NY, 12208, USA
| | - Lisa S Robison
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, 47 New Scotland Avenue, MC-136, Albany, NY, 12208, USA
| | - Kristen L Zuloaga
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, 47 New Scotland Avenue, MC-136, Albany, NY, 12208, USA.
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16
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Etminan N, Chang HS, Hackenberg K, de Rooij NK, Vergouwen MDI, Rinkel GJE, Algra A. Worldwide Incidence of Aneurysmal Subarachnoid Hemorrhage According to Region, Time Period, Blood Pressure, and Smoking Prevalence in the Population: A Systematic Review and Meta-analysis. JAMA Neurol 2020; 76:588-597. [PMID: 30659573 DOI: 10.1001/jamaneurol.2019.0006] [Citation(s) in RCA: 426] [Impact Index Per Article: 106.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Importance Subarachnoid hemorrhage (SAH) from ruptured intracranial aneurysms is a subset of stroke with high fatality and morbidity. Better understanding of a change in incidence over time and of factors associated with this change could facilitate primary prevention. Objective To assess worldwide SAH incidence according to region, age, sex, time period, blood pressure, and smoking prevalence. Data Sources We searched PubMed, Web of Science, and Embase for studies on SAH incidence published between January 1960 and March 2017. Worldwide blood pressure and smoking prevalence data were extracted from the Noncommunicable Disease Risk Factor and Global Burden of Disease data sets. Study Selection Population-based studies with prospective designs representative of the entire study population according to predefined criteria. Data Extraction and Synthesis Two reviewers independently extracted data according to PRISMA guidelines. Incidence of SAH was calculated per 100 000 person-years, and risk ratios (RRs) including 95% CIs were calculated with multivariable random-effects binomial regression. The association of SAH incidence with blood pressure and smoking prevalence was assessed with linear regression. Main Outcomes and Measures Incidence of SAH. Results A total of 75 studies from 32 countries were included. These studies comprised 8176 patients with SAH were studied over 67 746 051 person-years. Overall crude SAH incidence across all midyears was 7.9 (95% CI, 6.9-9.0) per 100 000 person-years; the RR for women was 1.3 (95% CI, 0.98-1.7). Compared with men aged 45 to 54 years, the RR in Japanese women older than 75 years was 2.5 (95% CI, 1.8-3.4) and in European women older than 75 years was 1.5 (95% CI, 0.9-2.5). Global SAH incidence declined from 10.2 (95% CI, 8.4-12.5) per 100 000 person-years in 1980 to 6.1 (95% CI, 4.9-7.5) in 2010 or by 1.7% (95% CI, 0.6-2.8) annually between 1955 and 2014. Incidence of SAH declined between 1980 and 2010 by 40.6% in Europe, 46.2% in Asia, and 14.0% in North America and increased by 59.1% in Japan. The global SAH incidence declined with every millimeter of mercury decrease in systolic blood pressure by 7.1% (95% CI, 5.8-8.4) and with every percentage decrease in smoking prevalence by 2.4% (95% CI, 1.6-3.3). Conclusions and Relevance Worldwide SAH incidence and its decline show large regional differences and parallel the decrease in blood pressure and smoking prevalence. Understanding determinants for regional differences and further reducing blood pressure and smoking prevalence may yield a diminished SAH burden.
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Affiliation(s)
- Nima Etminan
- Department of Neurosurgery, Mannheim University Hospital, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Han-Sol Chang
- Department of Neurosurgery, Mannheim University Hospital, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Katharina Hackenberg
- Department of Neurosurgery, Mannheim University Hospital, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Nicolien K de Rooij
- Department of Rehabilitation, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Mervyn D I Vergouwen
- Brain Centre Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Gabriel J E Rinkel
- Brain Centre Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Ale Algra
- Brain Centre Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
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17
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Iddagoda MT, Inderjeeth CA, Chan K, Raymond WD. Prognostication accuracy of final destination in poststroke patients requiring transitional care. Australas J Ageing 2019; 39:e194-e200. [PMID: 31742852 DOI: 10.1111/ajag.12742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 09/18/2019] [Accepted: 09/19/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Transitional care program in Australia targets older patients in hospitals requiring ongoing slow-stream restorative care prior to discharge. Poststroke patients often require extended care and are transferred to these facilities. Transitional care providers require a predicted discharge destination. The aim of this study was to assess the accuracy of this prediction. METHODOLOGY This study included all patients transferred to transitional care from a stroke rehabilitation unit over eight years. Information regarding the predicted final discharge destination was collected from medical records, and the actual discharge destination was obtained from the transitional care registry. RESULTS Final destination prediction was equivalent between medical and multidisciplinary teams (κ = 0.87). However, only 60% of the predictions were accurate. Subgroup analysis, as measured by the Modified Barthel Index, suggested that functional gain was a better predictor of final destination. Other characteristics, such as age, sex and type of stroke, did not demonstrate good correlation with the final destination. CONCLUSION Functional improvement, that is the Modified Barthel Index, is the best predictor of final destination after transitional care.
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Affiliation(s)
- Mayura Thilanka Iddagoda
- Department of Rehabilitation & Aged Care, Sir Charles Gairdner and Osborne Park Health Care Group, Perth, WA, Australia.,Department of Geriatric Medicine, Royal Perth Hospital, Perth, WA, Australia
| | - Charles Anoopkumar Inderjeeth
- Department of Rehabilitation & Aged Care, Sir Charles Gairdner and Osborne Park Health Care Group, Perth, WA, Australia.,School of Medicine, The University of Western Australia, Crawley, WA, Australia
| | - Kien Chan
- Department of Rehabilitation & Aged Care, Sir Charles Gairdner and Osborne Park Health Care Group, Perth, WA, Australia
| | - Warren David Raymond
- Department of Rehabilitation & Aged Care, Sir Charles Gairdner and Osborne Park Health Care Group, Perth, WA, Australia.,School of Medicine, The University of Western Australia, Crawley, WA, Australia
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18
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Tilling EJ, El Tawil S, Muir KW. Do Clinicians Overestimate the Severity of Intracerebral Hemorrhage? Stroke 2019; 50:344-348. [DOI: 10.1161/strokeaha.118.022606] [Citation(s) in RCA: 390] [Impact Index Per Article: 78.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Elliot J. Tilling
- From the Institute of Neuroscience and Psychology, University of Glasgow, Queen Elizabeth University Hospital, Scotland, UK
| | - Salwa El Tawil
- From the Institute of Neuroscience and Psychology, University of Glasgow, Queen Elizabeth University Hospital, Scotland, UK
| | - Keith W. Muir
- From the Institute of Neuroscience and Psychology, University of Glasgow, Queen Elizabeth University Hospital, Scotland, UK
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19
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Swanson JO, Moger TA. Comparisons of readmissions and mortality based on post-discharge ambulatory follow-up services received by stroke patients discharged home: a register-based study. BMC Health Serv Res 2019; 19:4. [PMID: 30611279 PMCID: PMC6321669 DOI: 10.1186/s12913-018-3809-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 12/11/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Few studies have focused on post-discharge ambulatory care for stroke patients and subsequent differences in readmission and mortality rates. Identifying groups at higher risk according to services received is important when planning post-discharge follow-up in ambulatory care. According to a recent Whitepaper by the Norwegian Government, patients receiving ambulatory care should have follow-up with a general practitioner (GP) within 14 days of hospital discharge. METHODS All home discharged stroke cases occurring in Oslo from 2009 to 2014 were included. 90- and 365-day all-cause readmissions and mortality were compared separately for patients categorized based on services received (no services, home nursing, ambulatory rehabilitation and home nursing with ambulatory rehabilitation) and early GP follow-up within 14 days following discharge. Variables used to adjust for differences in health status and demographics at admission included inpatient days and comorbidities the year prior to admission, calendar year, sex, age, income, education and functional score. Cox regression reporting hazard ratios (HR) was used. RESULTS There were no significant differences in readmission rates for early GP follow-up. Patients receiving home nursing and/or rehabilitation had higher unadjusted 90- and 365-day readmission rates than those without services (HR from 1.87 to 2.63 depending on analysis, p < 0.001), but the 90-day differences disappeared after risk adjustment, except for patients receiving only rehabilitation. There were no significant differences in mortality rates according to GP follow-up after risk adjustment. Patients receiving rehabilitation had higher mortality than those without services, even after adjustment (HR from 2.20 to 2.69, p < 0.001), whereas the mortality of patients receiving only home nursing did not differ from those without services. CONCLUSIONS Our results indicate that the observed differences in unadjusted readmission and mortality rates according to GP follow-up and home nursing were largely due to differences in health status at admission, likely unrelated to the stroke. On the other hand, mortality for patients receiving ambulatory rehabilitation was twice as high compared to those without, even after adjustment and irrespective of also receiving home nursing. Hence, assessing the needs of these patients during discharge planning and providing careful follow-up after discharge seems important.
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Affiliation(s)
- Jayson O. Swanson
- Department of Health Economics and Health Management, Institute of Health and Society, University of Oslo, PO Box 1089, Blindern, NO-0317 Oslo, Norway
| | - Tron Anders Moger
- Department of Health Economics and Health Management, Institute of Health and Society, University of Oslo, PO Box 1089, Blindern, NO-0317 Oslo, Norway
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20
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Tong Y, Cai L, Wang Z, Zhang Y, Guan X, Zhan F, Liu J, Lu Q. Association between PPARs Gene Functional Polymorphisms and Ischemic Stroke in Chinese Uyghur Population. J Nutr Health Aging 2019; 23:175-180. [PMID: 30697628 DOI: 10.1007/s12603-018-1140-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PPARγ and PPARα belong to a receptor family of ligand-activated transcription factors involved in the regulation of inflammation, cellular glucose uptake, protection against atherosclerosis and endothelial cell function. Through these effects, they might be involved with the ischemic stroke (IS). We recruited 100 IS patients diagnosed by CTs or/and magnetic resonance imaging (MRI) and 100 normal healthy controls from Chinese Uyghur Population to assess the nature of the functional polymorphisms of PPARs and any links with IS in this unique population which has 60% European ancestry and 40% East Asian ancestry. We found that the Ala allele of the PPARγ Pro12Ala polymorphism was more common in controls than IS subjects (P = 0.008, corrected for multiple testing) in the Uyghur Population. Pro/Ala carriage may be associated with a decreased risk of IS in Uyghurs (OR 0.542, 95% CI 0.346-0.850). Additionally, the 162Val allele frequency at the DNA-binding region of PPARα was extremely rare in Chinese Uguhur IS patients and controls. Our population and ethnic-based study demonstrates that the 162Val allele frequency was extremely low in the Chinese Uyghur Population different from Some European and African populations and the PPARγ 12 Pro/Ala resulting in an amino acid exchange in N-terminal sequence may be an independent protective factor for IS in the Chinese Uyghur Population.
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Affiliation(s)
- Y Tong
- Jiafa Liu, Center for Disease Control and Prevention, Hubei 430079, China,
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Singh RJ, Chen S, Ganesh A, Hill MD. Long-term neurological, vascular, and mortality outcomes after stroke. Int J Stroke 2018; 13:787-796. [DOI: 10.1177/1747493018798526] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Despite improved survival and short-term (90-day) outcomes of ischemic stroke patients, only sparse data exist describing the sustained benefits of acute stroke care interventions and long-term prognosis of stroke survivors. Aim We review the contemporary literature assessing long-term (5 years or more) outcomes after stroke and acute stroke treatment. Summary of review Acute stroke unit care and intravenous thrombolysis have sustained benefits over longer follow-up, but few data exist on the long-term outcome after endovascular thrombectomy (EVT). A large proportion of stroke survivors face challenges of residual disability and neuropsychiatric sequelae (especially affective disorders and epilepsy) which affects their quality of life and is associated with poorer prognosis due to increase in stroke recurrences/mortality. Nearly, a quarter of stroke survivors have a recurrent stroke at 5 years, and nearly double that at 10 years. Mortality after recurrent stroke is high, and half of the stroke survivors are deceased at 5 years after stroke and three fourth at 10 years. Long-term all-cause mortality is largely due to conditions other than stroke. Both stroke recurrence and long-term mortality are affected by several modifiable risk factors, and thus amenable to secondary prevention strategies. Conclusions There is a need for studies reporting longer term effects of acute interventions, especially EVT. Better preventive strategies are warranted to reduce the vascular and non-vascular mortality long after stroke.
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Affiliation(s)
- Ravinder-Jeet Singh
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Shuo Chen
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Aravind Ganesh
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Michael D Hill
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
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Baptista D, Abreu P, Azevedo E, Magalhães R, Correia M. Sex Differences in Stroke Incidence in a Portuguese Community-Based Study. J Stroke Cerebrovasc Dis 2018; 27:3115-3123. [PMID: 30093196 DOI: 10.1016/j.jstrokecerebrovasdis.2018.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 06/10/2018] [Accepted: 07/01/2018] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND AND AIM Stroke is a major health problem. Several studies reported sex differences regarding stroke. We aim to study this issue in an incidence stroke study. METHODS Data were retrieved from a community-based prospective register of patients that had a first ever stroke in a life time between October 2009 and September 2011. We studied sex differences regarding demographic data, vascular risk factors, stroke type, stroke severity (NIHSS), disability at 28days (modified Rankin scale (mRS)), and case fatality at 30 and 90days. RESULTS From 720 stroke patients, 45.3% were men. Women were older (75.0 ± 13.6 versus 67.2 ± 14.9 years), had a worse premorbid mRS (39.3% versus 25.5%, P < .001), and a higher prevalence of hypertension (P = .004) and atrial fibrillation (P < .001). Previous myocardial infarction was more frequent in men (P = .001), as well as smoking habits (P < .001). Ischemic stroke was more common in women than men (87.6% versus 81.3%, P = .038). The 28 days' outcome was worse in women (mRS ≥ 2, 77.2% versus 70.6%, P = .044). No differences were found in initial stroke severity (median NIHSS = 4) and case fatality at 30 and 90days, after adjusting for age and premorbid mRS. CONCLUSION No differences were found in stroke initial severity and mortality at 30 and 90days between men and women, despite the sex differences pertaining to the stroke profile-age, vascular risk factors, stroke type, and outcome. Our results are somewhat discrepant from those described in the literature; more research is needed to understand if this may be due to changes in stroke standard of care.
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Affiliation(s)
- Diana Baptista
- Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Pedro Abreu
- Faculty of Medicine, University of Porto, Porto, Portugal; Neurology Department, São João Hospital Centre (CHSJ), Porto, Portugal
| | - Elsa Azevedo
- Faculty of Medicine, University of Porto, Porto, Portugal; Neurology Department, São João Hospital Centre (CHSJ), Porto, Portugal
| | - Rui Magalhães
- Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal
| | - Manuel Correia
- Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal; Neurology Department, Santo António Hospital (CHP), Porto, Portugal
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Furlan NE, Bazan SGZ, Braga GP, Castro MCNE, Franco RJDS, Gut AL, Bazan R, Martin LC. Association between blood pressure and acute phase stroke case fatality rate: a prospective cohort study. ARQUIVOS DE NEURO-PSIQUIATRIA 2018; 76:436-443. [PMID: 30066794 DOI: 10.1590/0004-282x20180059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 04/04/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE ed to investigate the association between blood pressure and acute phase stroke lethality in a Brazilian intensive care unit. METHODS This was an observational, prospective cohort study of hemorrhagic and ischemic stroke intensive care patients. The primary outcome was all-cause mortality during the first seven days. RESULTS There were 146 patients, aged 66 ± 13.4 years, 56% men, 89% Caucasian, 69% had ischemic stroke, and 80% were hypertensive. The median of the National Institutes of Health Stroke Scale score was 16. There were 101 ischemic stroke patients and 45 hemorrhagic stroke patients. In the ischemic stroke patients, logistic regression analysis identified low systolic blood pressure as an independent ominous prognostic factor and the optimal cut off was a mean of systolic blood pressure ≤ 131 mmHg during the first 48 hours from admission for prediction of death. No association was found for hemorrhagic stroke. CONCLUSIONS There was a negative association between systolic blood pressure and case fatality ratio of acute phase stroke in ischemic stroke intensive care patients.
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Affiliation(s)
- Natalia Eduarda Furlan
- Universidade Estadual Paulista Julio de Mesquita Filho, Faculdade de Medicina, Botucatu SP , Brasil.,Serviço Nacional de Aprendizagem Comercial, Botucatu SP, Brasil
| | | | - Gabriel Pereira Braga
- Universidade Estadual Paulista Julio de Mesquita Filho, Faculdade de Medicina, Botucatu SP , Brasil
| | | | | | - Ana Lúcia Gut
- Universidade Estadual Paulista Julio de Mesquita Filho, Faculdade de Medicina, Botucatu SP , Brasil
| | - Rodrigo Bazan
- Universidade Estadual Paulista Julio de Mesquita Filho, Faculdade de Medicina, Botucatu SP , Brasil
| | - Luis Cuadrado Martin
- Universidade Estadual Paulista Julio de Mesquita Filho, Faculdade de Medicina, Botucatu SP , Brasil
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Langhorne P, Wu O, Rodgers H, Ashburn A, Bernhardt J. A Very Early Rehabilitation Trial after stroke (AVERT): a Phase III, multicentre, randomised controlled trial. Health Technol Assess 2018; 21:1-120. [PMID: 28967376 DOI: 10.3310/hta21540] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Mobilising patients early after stroke [early mobilisation (EM)] is thought to contribute to the beneficial effects of stroke unit care but it is poorly defined and lacks direct evidence of benefit. OBJECTIVES We assessed the effectiveness of frequent higher dose very early mobilisation (VEM) after stroke. DESIGN We conducted a parallel-group, single-blind, prospective randomised controlled trial with blinded end-point assessment using a web-based computer-generated stratified randomisation. SETTING The trial took place in 56 acute stroke units in five countries. PARTICIPANTS We included adult patients with a first or recurrent stroke who met physiological inclusion criteria. INTERVENTIONS Patients received either usual stroke unit care (UC) or UC plus VEM commencing within 24 hours of stroke. MAIN OUTCOME MEASURES The primary outcome was good recovery [modified Rankin scale (mRS) score of 0-2] 3 months after stroke. Secondary outcomes at 3 months were the mRS, time to achieve walking 50 m, serious adverse events, quality of life (QoL) and costs at 12 months. Tertiary outcomes included a dose-response analysis. DATA SOURCES Patients, outcome assessors and investigators involved in the trial were blinded to treatment allocation. RESULTS We recruited 2104 (UK, n = 610; Australasia, n = 1494) patients: 1054 allocated to VEM and 1050 to UC. Intervention protocol targets were achieved. Compared with UC, VEM patients mobilised 4.8 hours [95% confidence interval (CI) 4.1 to 5.7 hours; p < 0.0001] earlier, with an additional three (95% CI 3.0 to 3.5; p < 0.0001) mobilisation sessions per day. Fewer patients in the VEM group (n = 480, 46%) had a favourable outcome than in the UC group (n = 525, 50%) (adjusted odds ratio 0.73, 95% CI 0.59 to 0.90; p = 0.004). Results were consistent between Australasian and UK settings. There were no statistically significant differences in secondary outcomes at 3 months and QoL at 12 months. Dose-response analysis found a consistent pattern of an improved odds of efficacy and safety outcomes in association with increased daily frequency of out-of-bed sessions but a reduced odds with an increased amount of mobilisation (minutes per day). LIMITATIONS UC clinicians started mobilisation earlier each year altering the context of the trial. Other potential confounding factors included staff patient interaction. CONCLUSIONS Patients in the VEM group were mobilised earlier and with a higher dose of therapy than those in the UC group, which was already early. This VEM protocol was associated with reduced odds of favourable outcome at 3 months cautioning against very early high-dose mobilisation. At 12 months, health-related QoL was similar regardless of group. Shorter, more frequent mobilisation early after stroke may be associated with a more favourable outcome. FUTURE WORK These results informed a new trial proposal [A Very Early Rehabilitation Trial - DOSE (AVERT-DOSE)] aiming to determine the optimal frequency and dose of EM. TRIAL REGISTRATION The trial is registered with the Australian New Zealand Clinical Trials Registry number ACTRN12606000185561, Current Controlled Trials ISRCTN98129255 and ISRCTN98129255. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 54. See the NIHR Journals Library website for further project information. Funding was also received from the National Health and Medical Research Council Australia, Singapore Health, Chest Heart and Stroke Scotland, Northern Ireland Chest Heart and Stroke, and the Stroke Association. In addition, National Health and Medical Research Council fellowship funding was provided to Julie Bernhardt (1058635), who also received fellowship funding from the Australia Research Council (0991086) and the National Heart Foundation (G04M1571). The Florey Institute of Neuroscience and Mental Health, which hosted the trial, acknowledges the support received from the Victorian Government via the Operational Infrastructure Support Scheme.
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Affiliation(s)
- Peter Langhorne
- Academic Section of Geriatric Medicine, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Olivia Wu
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Helen Rodgers
- Institute for Ageing and Health, Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Ann Ashburn
- Rehabilitation Research Unit, Southampton General Hospital, Southampton, UK
| | - Julie Bernhardt
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia.,University of Melbourne, Parkville, VIC, Australia
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Nagendra CV, Kumar TSS, Bohra V, Wilben V, Karan V, Huded V. Factors Affecting the Effective Management of Acute Stroke: A Prospective Observational Study. Indian J Crit Care Med 2018; 22:138-143. [PMID: 29657369 PMCID: PMC5879854 DOI: 10.4103/ijccm.ijccm_232_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Stroke, characterized by sudden loss of cerebral function, is among one of the leading cause of death and disability world over. The newer treatment modalities have changed the landscape of stroke treatment but are very much time bound. Aim To characterize pre-hospital and in-hospital factors affecting acute stroke management thus defining lacunae in stroke management. Subjects and Methods A prospective observational study, conducted at the emergency department of a tertiary care center in southern India from August 2015 to July 2016. All stroke patients presenting within first 24 hours of onset were included. A pre -defined Knowledge-Attitude-Practice (KAP) questionnaire was used. Results Total of 133 patients were eligible out of which 28 were excluded for various reasons. Majority were >60 years age and male (61%). About 60% arrived within window. Distance from the hospital was one of the major factors for arrival within the window period. When compared by KAP questionnaire, bystanders of those arriving within window period had better awareness of stroke symptoms. Conclusions Improving awareness of stroke symptoms and increasing availability of EMS is likely increase chances of stroke patients receiving appropriate acute management.
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Affiliation(s)
- C V Nagendra
- Department of Emergency Medicine, Narayana Institute of Cardiac Sciences, Bengaluru, Karnataka, India
| | - T S Srinath Kumar
- Department of Emergency Medicine, Narayana Institute of Cardiac Sciences, Bengaluru, Karnataka, India
| | - Vikram Bohra
- Department of Neurology, Narayana Institute of Cardiac Sciences, Bengaluru, Karnataka, India
| | - Viju Wilben
- Department of Emergency Medicine, Narayana Institute of Cardiac Sciences, Bengaluru, Karnataka, India
| | - Vivek Karan
- Department of Neurology, Narayana Institute of Cardiac Sciences, Bengaluru, Karnataka, India
| | - Vikram Huded
- Department of Neurology, Narayana Institute of Cardiac Sciences, Bengaluru, Karnataka, India
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Fox MT, Sidani S, Brooks D, McCague H. Perceived acceptability and preferences for low-intensity early activity interventions of older hospitalized medical patients exposed to bed rest: a cross sectional study. BMC Geriatr 2018; 18:53. [PMID: 29463219 PMCID: PMC5819701 DOI: 10.1186/s12877-018-0722-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 01/22/2018] [Indexed: 12/21/2022] Open
Abstract
Background Hospitalized older patients spend most of their time in bed, putting them at risk of experiencing orthostatic intolerance. Returning persons to their usual upright activity level is the most effective way to prevent orthostatic intolerance but some older patients have limited activity tolerance, supporting the need for low-intensity activity interventions. Consistent with current emphasis on patient engagement in intervention design and evaluation, this study explored older hospitalized patients’ perceived acceptability of, and preference for, two low-intensity early activity interventions (bed-to-sitting and sitting-to-walking), and characteristics (gender, illness severity, comorbidity, illnesses and medications with orthostatic effects, and baseline functional capacity) associated with perceived acceptability and preference. Methods A convenience sample was recruited from in-patient medical units of two hospitals in Ontario, Canada and included 60 cognitively intact adults aged 65+ who were admitted for a medical condition within the past 72 h, spent ≥ 24 consecutive hours on a stretcher or in bed, presented with ≥ 2 chronic diseases, understood English, and were able to ambulate before admission. A cross-sectional observational design was used. Participants were presented written and oral descriptions and a 2-min video of each intervention. The sequence of the interventions’ presention was randomized. Following the presentation, a research nurse administered measures of perceived acceptability and preference, and collected health and demographic data. Perceived acceptability and preference for the interventions were measured using the Treatment Acceptability and Preferences Scale. Illness severity was measured using the Modified Early Warning Score. Comorbidity was assessed with the Age Adjusted Charlson Comorbidity Scale and the Cumulative Illness Rating Scale – for Geriatrics. Baseline functional capacity was measured using the Duke Activity Status Index. Results Participants’ perceived acceptability of both interventions clustered above the scale midpoint. Most preferred the sitting-to-walking intervention (n = 26; 43.3%). While none of the patient characteristics were associated with intervention acceptability, illness severity (odds ratio = 1.9, p = 0.04) and medications with orthostatic effects (odds ratio = 9.9, p = 0.03) were significantly associated with intervention preference. Conclusions The interventions examined in this study were found to be acceptable to older adults, supporting future research examining their feasibility and effectiveness.
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Affiliation(s)
- Mary T Fox
- York University Centre for Aging Research and Education, Faculty of Health, York University, HNES suite 343, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada.
| | - Souraya Sidani
- Faculty of Community Services, Ryerson University, 350 Victoria Street, Suite YNG 316, Toronto, ON, M5B 2K3, Canada
| | - Dina Brooks
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Hugh McCague
- Institute for Social Research, DB 5064, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
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Tong Y, Jiang S, Cai L, Guan X, Hou S, Wang Z, Lu Q, Liu J. Identification of Functional Genetic Polymorphisms at IL-10 Promoter Region and their Association with Risk of Ischemic Stroke in Chinese Han Population. J Nutr Health Aging 2018; 22:779-784. [PMID: 30080219 DOI: 10.1007/s12603-018-1012-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Pleiotropic cytokine interleukin-10 (IL-10) has been suggested as modifying risk for atherosclerosis. Promoter region genetic polymorphism of IL-10 gene is known to be associated with the level of IL-10 production. Through these effects, they might be involved with the ischemic stroke (IS). Our aim was to assess the nature of the functional polymorphisms in IL-10 promoter and any links with IS in Chinese Han population. METHODS The IL-10 -1082 G>A, -819 C>T and -592 C>A functional polymorphisms were determined by TaqMan SNP Genotyping assays in 1296 subjects (648 IS patients diagnosed by CTs or/and magnetic resonance imaging (MRI) and 648 normal healthy controls from Chinese Han Population). Multivariate logistic regression analysis was used to show the association between the IL-10 genotypes and the IS events. RESULTS We found that the CC genotype of -819 C>T was more common in controls than IS subjects (P<0.05, corrected for multiple testing) in the Han population. CC carriage may be associated with the decreased risk of IS in the Han ethnic group (OR 0.65, 95% CI 0.43-0.97). In addition, the CC genotype in -592 C>A and GG genotype in -1082 G>A are all extremely low in Chinese Han cases and controls. CONCLUSIONS The G allele frequency at the -1082 promoter region of IL-10 was rare in Chinese Han population which are diffierent from American/European populations.. IL-10 -819 C>T may be an independent protective factor for IS in the Chinese Han population.
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Affiliation(s)
- Y Tong
- Jiafa Liu and Qing Lu contributed equally as the corresponding authors: Center for Disease Control and Prevention, Hubei 430079, China, , School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China,
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Wen CP, Liu CH, Jeng JS, Hsu SP, Chen CH, Lien LM, Chen AC, Lee JT, Chen PK, Hsu CS, Chern CM, Chen CC, Hsu MC, Lu K, Chen HJ, Wang HK, Muo CH, Hsu CY. Pre-stroke physical activity is associated with fewer post-stroke complications, lower mortality and a better long-term outcome. Eur J Neurol 2017; 24:1525-1531. [PMID: 28926165 DOI: 10.1111/ene.13463] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 09/11/2017] [Indexed: 11/29/2022]
Affiliation(s)
- C.-P. Wen
- Institute of Population Health Sciences; National Health Research Institutes; Zhunan Taiwan
- Graduate Institute of Biomedical Sciences; College of Medicine; China Medical University; Taichung Taiwan
- Department of Medical Research; China Medical University Hospital; Taichung Taiwan
| | - C.-H. Liu
- Department of Neurology; China Medical University Hospital; Taichung Taiwan
| | - J.-S. Jeng
- Department of Neurology; National Taiwan University Hospital; Taipei Taiwan
| | - S.-P. Hsu
- Department of Neurology; E-Da Hospital / I-Shou University; Kaohsiung Taiwan
| | - C.-H. Chen
- Department of Neurology; College of Medicine; National Cheng Kung University; Tainan Taiwan
| | - L.-M. Lien
- Department of Neurology; Shin Kong Wu Ho-Su Memorial Hospital; Taipei Medical University College of Medicine; Taipei Taiwan
| | - A.-C. Chen
- Department Neurology; Chung Shan Medical University Hospital; Taichung Taiwan
| | - J.-T. Lee
- Department of Neurology; Tri-Service General Hospital; National Defense Medical Center; Taipei Taiwan
| | - P.-K. Chen
- Department of Neurology; Lin Shin Hospital; Taichung Taiwan
| | - C.-S. Hsu
- China Medical University Beigang Hospital; Yunlin Taiwan
| | - C.-M. Chern
- Taipei Veterans General Hospital; School of Medicine; National Yang-Ming University; Taipei Taiwan
| | - C.-C. Chen
- St. Martin De Porres Hospital; Chiayi Taiwan
| | - M.-C. Hsu
- Buddhist Dalin Tzu Chi General Hospital; Chiayi Taiwan
| | - K. Lu
- Department of Neurosurgery; E-Da Hospital/ I-Shou University; Kaohsiung Taiwan
| | - H.-J. Chen
- Department of Neurosurgery; E-Da Hospital/ I-Shou University; Kaohsiung Taiwan
| | - H.-K. Wang
- Department of Neurosurgery; E-Da Hospital/ I-Shou University; Kaohsiung Taiwan
| | - C.-H. Muo
- Department of Medical Research; China Medical University Hospital; Taichung Taiwan
| | - C.-Y. Hsu
- Department of Neurology; China Medical University Hospital; Taichung Taiwan
- Graduate Institute of Clinical Medical Science; China Medical University; Taichung Taiwan
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Bolayir A, Cigdem B, Gokce SF, Bolayir HA, Kayim Yildiz O, Bolayir E, Topaktas SA. The Effect of Eosinopenia on Mortality in Patients with Intracerebral Hemorrhage. J Stroke Cerebrovasc Dis 2017; 26:2248-2255. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Revised: 04/13/2017] [Accepted: 05/07/2017] [Indexed: 01/21/2023] Open
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Duncan PW, Bushnell CD, Rosamond WD, Jones Berkeley SB, Gesell SB, D'Agostino RB, Ambrosius WT, Barton-Percival B, Bettger JP, Coleman SW, Cummings DM, Freburger JK, Halladay J, Johnson AM, Kucharska-Newton AM, Lundy-Lamm G, Lutz BJ, Mettam LH, Pastva AM, Sissine ME, Vetter B. The Comprehensive Post-Acute Stroke Services (COMPASS) study: design and methods for a cluster-randomized pragmatic trial. BMC Neurol 2017; 17:133. [PMID: 28716014 PMCID: PMC5513078 DOI: 10.1186/s12883-017-0907-1] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 06/23/2017] [Indexed: 12/04/2022] Open
Abstract
Background Patients discharged home after stroke face significant challenges managing residual neurological deficits, secondary prevention, and pre-existing chronic conditions. Post-discharge care is often fragmented leading to increased healthcare costs, readmissions, and sub-optimal utilization of rehabilitation and community services. The COMprehensive Post-Acute Stroke Services (COMPASS) Study is an ongoing cluster-randomized pragmatic trial to assess the effectiveness of a comprehensive, evidence-based, post-acute care model on patient-centered outcomes. Methods Forty-one hospitals in North Carolina were randomized (as 40 units) to either implement the COMPASS care model or continue their usual care. The recruitment goal is 6000 patients (3000 per arm). Hospital staff ascertain and enroll patients discharged home with a clinical diagnosis of stroke or transient ischemic attack. Patients discharged from intervention hospitals receive 2-day telephone follow-up; a comprehensive clinic visit within 2 weeks that includes a neurological evaluation, assessments of social and functional determinants of health, and an individualized COMPASS Care Plan™ integrated with a community-specific resource database; and additional follow-up calls at 30 and 60 days post-stroke discharge. This model is consistent with the Centers for Medicare and Medicaid Services transitional care management services provided by physicians or advanced practice providers with support from a nurse to conduct patient assessments and coordinate follow-up services. Patients discharged from usual care hospitals represent the control group and receive the standard of care in place at that hospital. Patient-centered outcomes are collected from telephone surveys administered at 90 days. The primary endpoint is patient-reported functional status as measured by the Stroke Impact Scale 16. Secondary outcomes are: caregiver strain, all-cause readmissions, mortality, healthcare utilization, and medication adherence. The study engages patients, caregivers, and other stakeholders (including policymakers, advocacy groups, payers, and local community coalitions) to advise and support the design, implementation, and sustainability of the COMPASS care model. Discussion Given the high societal and economic burden of stroke, identifying a care model to improve recovery, independence, and quality of life is critical for stroke survivors and their caregivers. The pragmatic trial design provides a real-world assessment of the COMPASS care model effectiveness and will facilitate rapid implementation into clinical practice if successful. Trial registration Clinicaltrials.gov: NCT02588664; October 23, 2015. Electronic supplementary material The online version of this article (doi:10.1186/s12883-017-0907-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pamela W Duncan
- Department of Neurology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Cheryl D Bushnell
- Department of Neurology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Wayne D Rosamond
- Department of Epidemiology, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 135 Dauer Drive, Chapel Hill, 27599, USA
| | - Sara B Jones Berkeley
- Department of Epidemiology, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 135 Dauer Drive, Chapel Hill, 27599, USA.
| | - Sabina B Gesell
- Department of Social Sciences & Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Ralph B D'Agostino
- Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Walter T Ambrosius
- Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Blair Barton-Percival
- Piedmont Triad Regional Council Area Agency on Aging, 1398 Carrollton Crossing Drive, Kernersville, NC, 27284, USA
| | - Janet Prvu Bettger
- Duke University School of Medicine, 40 Medicine Circle DUMC 2919, Durham, NC, 27710, USA
| | - Sylvia W Coleman
- Department of Neurology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Doyle M Cummings
- East Carolina University, Brody School of Medicine, Family Medicine Center, MS #654, 101 Heart Drive, Greenville, NC, 27834, USA
| | - Janet K Freburger
- Department of Physical Therapy, University of Pittsburgh, Bridgeside Point 1, 100 Technology Drive, Suite 210, Pittsburgh, PA, 15219-3130, USA
| | - Jacqueline Halladay
- Department of Family Medicine, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr. Blvd., CB #7590, Chapel Hill, NC, 27599-7590, USA
| | - Anna M Johnson
- Department of Epidemiology, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 135 Dauer Drive, Chapel Hill, 27599, USA
| | - Anna M Kucharska-Newton
- Department of Epidemiology, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 135 Dauer Drive, Chapel Hill, 27599, USA
| | - Gladys Lundy-Lamm
- Minority Women Health Alliance (TriStroke), 5409 Olive Road, Raleigh, NC, 27606, USA
| | - Barbara J Lutz
- University of North Carolina Wilmington School of Nursing, 601 S. College Road, Wilmington, NC, 28403, USA
| | - Laurie H Mettam
- Department of Epidemiology, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 135 Dauer Drive, Chapel Hill, 27599, USA
| | - Amy M Pastva
- Department of Orthopaedic Surgery, Doctor of Physical Therapy Division, & Center for the Study of Aging and Human Development, Duke University, DUMC 104002, Durham, NC, 27708, USA
| | - Mysha E Sissine
- Department of Neurology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Betsy Vetter
- American Heart Association, 3131 RDU Center Drive, Suite 100, Morrisville, NC, 27560, USA
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Sarabadani Tafreshi A, Riener R, Klamroth-Marganska V. Quantitative analysis of externally-induced patterns and natural oscillations in the human cardiovascular response: Implications for development of a biofeedback system. Biomed Signal Process Control 2017. [DOI: 10.1016/j.bspc.2017.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Adachi T, Hoshino H, Takagi M, Fujioka S. Volume and Characteristics of Intracerebral Hemorrhage with Direct Oral Anticoagulants in Comparison with Warfarin
. Cerebrovasc Dis Extra 2017; 7:62-71. [PMID: 28376486 PMCID: PMC5425761 DOI: 10.1159/000462985] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 02/08/2017] [Indexed: 12/25/2022] Open
Abstract
Background Patients undergoing anticoagulation therapy often experience intracerebral hemorrhages (ICHs), and warfarin in particular is known to increase hematoma expansion in ICHs, which results in a poor outcome. Recent studies reported that, in comparison with warfarin, direct oral anticoagulants (DOACs) cause fewer ICHs with better functional outcome. However, since it is still unknown whether DOACs are associated with a smaller hematoma volume of ICHs, we aimed to compare the volume, hematoma expansion, and outcomes associated with ICHs treated with DOACs and warfarin. Methods We performed a prospective multicenter cross-sectional study. The subjects included patients with acute ICHs who received either DOACs or warfarin. We evaluated the clinical characteristics, and measured initial and follow-up ICH volumes. The volume of ICHs and hematoma expansion were compared between the DOAC and warfarin groups. Mortality and modified Rankin score at discharge were evaluated as outcomes. Results There were 18 patients in the DOAC group and 71 in the warfarin group. The baseline characteristics were similar between the 2 groups. Initial median hematoma volume of ICHs in the DOAC group was significantly lower than that in the warfarin group (6.2 vs. 24.2 mL, respectively; p = 0.04). In cases involving follow-up computed tomography scanning, the median hematoma volume of ICHs at follow-up was lower in the DOAC group than in the warfarin group (initial: DOACs 4.4 vs. warfarin 13.5 mL; follow-up: 5.0 vs. 18.4 mL, respectively; p = 0.05). Further, the hematoma in ICHs associated with DOACs did not expand. Although the mortality of ICHs associated with DOACs (11%) was lower than that associated with warfarin (24%), this difference was not statistically significant. The univariate analysis showed that the anticoagulant type (DOACs vs. warfarin) and sex (male vs. female) were associated with ICH volume. The multivariable linear regression showed that the use of DOACs (compared to warfarin; β: −0.23, p = 0.03) and female sex (compared to male; β: −0.25, p = 0.02) were associated with a small hematoma volume. Conclusions Based on the results of the present study, in terms of the risks associated with ICHs, the use of DOACs appears to be safer than warfarin for anticoagulation therapy. Further studies are required to validate these findings.
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Affiliation(s)
- Tomohide Adachi
- Department of Neurology, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Haruhiko Hoshino
- Department of Neurology, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Makoto Takagi
- Department of Neurology, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Shodo Fujioka
- Department of Neurosurgery, Saiseikai Misumi Hospital, Uki-city, Japan
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Modeling the effect of tilting, passive leg exercise, and functional electrical stimulation on the human cardiovascular system. Med Biol Eng Comput 2017; 55:1693-1708. [PMID: 28188470 DOI: 10.1007/s11517-017-1628-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 01/27/2017] [Indexed: 01/02/2023]
Abstract
Long periods of bed rest negatively affect the human body organs, notably the cardiovascular system. To avert these negative effects and promote functional recovery in patients dealing with prolonged bed rest, the goal is to mobilize them as early as possible while controlling and stabilizing their cardiovascular system. A robotic tilt table allows early mobilization by modulating body inclination, automated passive leg exercise, and the intensity of functional electrical stimulation applied to leg muscles (inputs). These inputs are used to control the cardiovascular variables heart rate (HR), and systolic and diastolic blood pressures (sBP, dBP) (outputs). To enhance the design of the closed-loop cardiovascular biofeedback controller, we investigated a subject-specific multi-input multi-output (MIMO) black-box model describing the relationship between the inputs and outputs. For identification of the linear part of the system, two popular linear model structures-the autoregressive model with exogenous input and the output error model-are examined and compared. The estimation algorithm is tested in simulation and then used in four study protocols with ten healthy participants to estimate transfer functions of HR, sBP and dBP to the inputs. The results show that only the HR transfer functions to inclination input can explain the variance in the data to a reasonable extent (on average 69.8%). As in the other input types, the responses are nonlinear; the models are either not reliable or explain only a negligible amount of the observed variance. Analysis of both, the nonlinearities and the occasionally occurring zero-crossings, is necessary before designing an appropriate MIMO controller for mobilization of bedridden patients.
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Abstract
Stroke is a major public health issue. Many are treatable in the acute stage, provided patients are admitted soon enough. The overall incidence of stroke in Western countries is approximately 2400 per year per million inhabitants, and 80% are due to cerebral ischaemia. The prevalence is approximately 12,000 per million inhabitants. Stroke is associated with increased long-term mortality, handicap, cognitive and behavioural impairments, recurrence, and an increased risk of other types of vascular events. There is strong evidence that stroke patients should be treated in dedicated stroke units; each time 24 patients are treated in a stroke unit, instead of a conventional ward, one death and one dependence are prevented. This effect does not depend on age, severity, and the stroke subtype. For this reason, stroke unit care is the cornerstone of the treatment of stroke, aiming at the detection and management of life-threatening emergencies, stabilization of most physiological parameters, and prevention of early complications. In cerebral ischaemia, besides this general management, specific therapies include intravenous recombinant tissue plasminogen activator, given as soon as possible and before 4.5hours, mechanical thrombectomy on top of rt-PA or alone in case of contra-indication to rt-PA, in patients with proximal large-vessel occlusion, aspirin 300mg, immediately or after 24hours in case of thrombolysis, and, in a few patients, decompressive surgery.
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Kroll ME, Green J, Beral V, Sudlow CLM, Brown A, Kirichek O, Price A, Yang TO, Reeves GK. Adiposity and ischemic and hemorrhagic stroke: Prospective study in women and meta-analysis. Neurology 2016; 87:1473-1481. [PMID: 27605176 PMCID: PMC5075975 DOI: 10.1212/wnl.0000000000003171] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 05/13/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare associations of body mass index (BMI) with ischemic stroke and hemorrhagic stroke risk, and to review the worldwide evidence. METHODS We recruited 1.3 million previously stroke-free UK women between 1996 and 2001 (mean age 57 years [SD 5]) and followed them by record linkage for hospital admissions and deaths. We used Cox regression to estimate adjusted relative risks for ischemic and hemorrhagic (intracerebral or subarachnoid hemorrhage) stroke in relation to BMI. We conducted a meta-analysis of published findings from prospective studies on these associations. RESULTS During an average follow-up of 11.7 years, there were 20,549 first strokes, of which 9,993 were specified as ischemic and 5,852 as hemorrhagic. Increased BMI was associated with an increased risk of ischemic stroke (relative risk 1.21 per 5 kg/m2 BMI, 95% confidence interval 1.18-1.23, p < 0.0001) but a decreased risk of hemorrhagic stroke (relative risk 0.89 per 5 kg/m2 BMI, 0.86-0.92, p < 0.0001). The BMI-associated trends for ischemic and hemorrhagic stroke were significantly different (heterogeneity: p < 0.0001) but were not significantly different for intracerebral hemorrhage (n = 2,790) and subarachnoid hemorrhage (n = 3,062) (heterogeneity: p = 0.5). Published data from prospective studies showed consistently greater BMI-associated relative risks for ischemic than hemorrhagic stroke with most evidence (prior to this study) coming from Asian populations. CONCLUSIONS In UK women, higher BMI is associated with increased risk of ischemic stroke but decreased risk of hemorrhagic stroke. The totality of the available published evidence suggests that BMI-associated risks are greater for ischemic than for hemorrhagic stroke.
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Affiliation(s)
- Mary E Kroll
- From the Nuffield Department of Population Health (M.E.K., J.G., V.B., A.B., O.K., A.P., T.O.Y., G.K.R.), University of Oxford; and Centre for Clinical Brain Sciences (C.L.M.S.), University of Edinburgh, UK
| | - Jane Green
- From the Nuffield Department of Population Health (M.E.K., J.G., V.B., A.B., O.K., A.P., T.O.Y., G.K.R.), University of Oxford; and Centre for Clinical Brain Sciences (C.L.M.S.), University of Edinburgh, UK
| | - Valerie Beral
- From the Nuffield Department of Population Health (M.E.K., J.G., V.B., A.B., O.K., A.P., T.O.Y., G.K.R.), University of Oxford; and Centre for Clinical Brain Sciences (C.L.M.S.), University of Edinburgh, UK
| | - Cathie L M Sudlow
- From the Nuffield Department of Population Health (M.E.K., J.G., V.B., A.B., O.K., A.P., T.O.Y., G.K.R.), University of Oxford; and Centre for Clinical Brain Sciences (C.L.M.S.), University of Edinburgh, UK
| | - Anna Brown
- From the Nuffield Department of Population Health (M.E.K., J.G., V.B., A.B., O.K., A.P., T.O.Y., G.K.R.), University of Oxford; and Centre for Clinical Brain Sciences (C.L.M.S.), University of Edinburgh, UK
| | - Oksana Kirichek
- From the Nuffield Department of Population Health (M.E.K., J.G., V.B., A.B., O.K., A.P., T.O.Y., G.K.R.), University of Oxford; and Centre for Clinical Brain Sciences (C.L.M.S.), University of Edinburgh, UK
| | - Alison Price
- From the Nuffield Department of Population Health (M.E.K., J.G., V.B., A.B., O.K., A.P., T.O.Y., G.K.R.), University of Oxford; and Centre for Clinical Brain Sciences (C.L.M.S.), University of Edinburgh, UK
| | - TienYu Owen Yang
- From the Nuffield Department of Population Health (M.E.K., J.G., V.B., A.B., O.K., A.P., T.O.Y., G.K.R.), University of Oxford; and Centre for Clinical Brain Sciences (C.L.M.S.), University of Edinburgh, UK
| | - Gillian K Reeves
- From the Nuffield Department of Population Health (M.E.K., J.G., V.B., A.B., O.K., A.P., T.O.Y., G.K.R.), University of Oxford; and Centre for Clinical Brain Sciences (C.L.M.S.), University of Edinburgh, UK.
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Abstract
Infections, in particular pneumonia, are common complications in patients with acute stroke and are associated with a less favorable neurologic and functional outcome. Patients with severe stroke and dysphagia are at highest risk of infection. Experimental and clinical data suggest stroke-induced immunodeficiency as a major factor contributing to the high incidence of infection after stroke. Preclinical studies support the potential benefit of preventive antibiotic therapy in acute stroke for lowering the incidence of infection and improving clinical outcome. Several smaller clinical trials on preventive antibiotic therapy in patients with stroke conducted during the last 10 years yielded inconclusive results. Recently, 2 large, open-label, controlled trials failed to demonstrate an improved clinical outcome after preventive antibiotic therapy in patients with acute stroke treated in specialized stroke units. In the "Preventive Antibiotics in Stroke Study", antibiotic therapy lowered the rate of infection but did not influence outcome. In the STROKE-INF study, performed in patients with dysphagia after stroke, antibiotic therapy did not lower the incidence of pneumonia and had no prognostic significance. At present, preventive antibiotic therapy cannot be recommended as a therapeutic option for acute stroke.
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Affiliation(s)
- Stefan Schwarz
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.
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Owolabi L, Nagode M, Ibrahim A, Uloko A, Gezawa I, Datti M. Stroke in patients with diabetes mellitus: a study from North Western Nigeria. Afr Health Sci 2016; 16:781-789. [PMID: 27917212 DOI: 10.4314/ahs.v16i3.19] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Stroke is one of the major causes of morbidity and mortality worldwide and apart from being exceedingly harmful in diabetics, stroke is a disabling disorder. The study was undertaken to describe the clinical characteristics, outcome pattern and predictors of mortality in a cohort of diabetic patients presenting with stroke in two tertiary health facilities in North Western Nigeria. METHOD Out of all stroke patients seen from June 2007 to February 2011, persons with diabetes mellitus presenting with stroke in the emergency unit of the two tertiary hospitals in Kano were consecutively recruited for the study. Classification of stroke into hemorrhagic and infarctive subtypes was based on brain computerized tomography (CT), brain magnetic resonance imaging (MRI) and World Health Organization (WHO) criteria. Follow-up period was for thirty days. RESULT Out of the five hundred and thirty six stroke patients seen during the study period, 85 (15.9%) patients, comprising 48 (56.5%) males, had diabetes. Thirty eight (44.7%) of the identified diabetics were previously undiagnosed. Sixty four (75.3%) had infarctive stroke. One-month case fatality rate was 30.6%. Factors associated with death included male sex, past history of TIA, abnormal respiratory pattern, hemorrhagic stroke, aspiration pneumonitis, and worsening GCS. Aspiration pneumonitis and worsening GCS were independent predictors of one month mortality of stroke in the patients. CONCLUSION In DM patients studied, infarctive stroke was more common, case fatality was 30.6%. Male gender, past history of TIA, abnormal respiratory pattern, hemorrhagic stroke, aspiration pneumonitis, and worsening Glasgow Coma Score (GCS) were associated with mortality. Aspiration pneumonitis and worsening GCS were independent predictors of one month mortality of stroke in diabetic patients.
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Affiliation(s)
| | - Mansur Nagode
- Murtala Muhammad Specialist Hospital, Department of Medicine
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Touzé E, Varenne O, Calvet D, Mas JL. Coronary Risk Stratification in Patients with Ischemic Stroke or Transient Ischemic Stroke Attack. Int J Stroke 2016; 2:177-83. [DOI: 10.1111/j.1747-4949.2007.00136.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background The risk of coronary artery disease (CAD) is traditionally considered high in patients who had an ischemic stroke or a transient ischemic attack (TIA). However, few studies have specifically assessed the absolute risk of coronary events in those patients and predictors of such events are not well known. Summary of review The overall risks of myocardial infarction and nonstroke vascular death are each around 2% per year. However, those risks are only about 1% per year in patients without CAD (i.e. the only ones who are likely to benefit from specific additional strategies). The prevalence of asymptomatic CAD ranges from 15% to 60%. Although potentially higher, the risk of CAD in patients with stroke/TIA related to atherosclerosis also seems to vary widely depending on the extent of the disease. Given the relatively low CAD risk, a simple systematic reinforcement of medical treatment in all patients may be not relevant. Up to now, there have been only limited ways to stratify the CAD risk in stroke/TIA patients. High-risk patients may be identified using the traditional cardiac scoring systems, but their validity has never been specifically assessed in stroke populations. The relative influence of traditional risk factors may be altered after a first vascular event. Stroke patients could also be screened for asymptomatic CAD. However, there is no simple and valid screening test for asymptomatic CAD that could be applied to all patients. Finally, there is still uncertainty about the potential benefits of treating asymptomatic CAD. Therefore, should the identification of patients with asymptomatic CAD requiring revascularization become feasible, the relevance of this strategy would remain to be evaluated by a randomized clinical trial. Conclusion The absolute risk of CAD in stroke/TIA patients is moderately high. More research is needed to identify high risk patients who could benefit from specific strategies.
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Hori YS, Kodera S, Sato Y, Shiojiri T. Eosinopenia as a Predictive Factor of the Short-Term Risk of Mortality and Infection after Acute Cerebral Infarction. J Stroke Cerebrovasc Dis 2016; 25:1307-12. [PMID: 26971036 DOI: 10.1016/j.jstrokecerebrovasdis.2015.12.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 12/02/2015] [Accepted: 12/12/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Eosinopenia has been shown to be a prognostic factor in bacteremia, chronic obstructive pulmonary disease, and myocardial infarction, but studies focusing on cerebral infarction are lacking. METHODS We conducted a retrospective study of 405 patients admitted to the Asahi General Hospital from June 2011 to September 2014 with a diagnosis of cerebral infarction within 24 hours after symptom onset. Differences in mortality, mortality associated with infection, and the prevalence of infection within 2 months of hospital admission were assessed between patients with and without eosinopenia at presentation. RESULTS Patients with eosinopenia had a significantly higher mortality rate (hazard ratio (HR) 2.54, 95% confidence interval (CI) 1.17-5.21, P = .01), mortality associated with infection (HR 28.7, 95% CI 4.9-542.2, P <.0001), and an increased prevalence of infection (HR 1.83, 95% CI 1.12-2.89, P = .01) than patients without eosinopenia. Patients with neutrophilia and eosinopenia showed a significantly higher mortality rate than patients without neutrophilia (HR 3.15, 95% CI 1.40-6.92, P = .007), whereas patients with neutrophilia without eosinopenia showed no significant difference in mortality compared with patients without neutrophilia (HR 1.57, 95% CI .56-3.93, P = .37). Eosinopenia was a significant risk factor in 2-month mortality rate in multivariate analyses (HR 2.34, 95% CI 1.05-4.95, P = .04). CONCLUSIONS Eosinopenia is a novel predictive factor for complications after acute cerebral infarction. Stroke patients with eosinopenia should be monitored carefully for infection.
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Affiliation(s)
- Yusuke S Hori
- Department of Internal Medicine, Asahi General Hospital, Chiba, Japan.
| | - Satoshi Kodera
- Department of Internal Medicine, Asahi General Hospital, Chiba, Japan
| | - Yasunori Sato
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Toshiaki Shiojiri
- Department of Internal Medicine, Asahi General Hospital, Chiba, Japan
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He MQ, Liu L, Ma J, Li J, Zhen XM, Zhang YY. Risk factors and clinical features in ischemic stroke patients with different tongue conditions. Chin J Integr Med 2016:10.1007/s11655-015-2442-5. [PMID: 26956463 DOI: 10.1007/s11655-015-2442-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the risk factors and clinical features in ischemic stroke patients with different tongue conditions. METHODS A total of 168 successive acute ischemic stroke inpatients (within 7 days of stroke onset) were recruited. Patients were assigned to groups according to tongue color (pink, pale, red, purple), tongue coating (no coating, thin coating, thick coating) and sublingual vessel (normal, abnormal). Risk factors and clinical features including National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS) and Barthel Index (BI), clinical classification, laboratory data and pulmonary infection complications were compared. RESULTS There were no significant differences in risk factors and clinical features among groups with different tongue colors. The incidence of smoking (4.5%) was lower in the no coating group compared with the thin (30.0%) and thick (39.3%) coating groups (P<0.017). NIHSS (19.05±10.68) in the no coating group was higher than the thin (6.40±6.18) and thick (7.41±7.05) coating groups (P<0.017), BI (20.91±29.99) was lower than the thin (67.61±28.78) and thick (63.02±33.54) coating groups (P<0.017), and the percentage of mRS >3 (90.9%) was higher than the thin (42.2%) and thick (42.9%) coating groups (P<0.017). The percentage of partial anterior circulation infarction patients in the no coating group was higher than the thin coating group (77.3% vs. 42.2%), and the percentage of lacunar infarction patients was lower than the thin coating group (4.5% vs. 37.8%, P<0.017). NIHSS in the abnormal sublingual vessel group was lower than the normal group (5.28±4.38 vs. 10.57±9.58, P=0.000), and BI was higher than the normal group (67.61±29.29 vs. 54.64±36.23, P=0.015). CONCLUSION Tongue conditions of acute stroke patients were relevant to clinical features.
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Affiliation(s)
- Meng-Qi He
- Stroke Unit, Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China
| | - Lin Liu
- Stroke Unit, Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China
| | - Jie Ma
- Stroke Unit, Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China
| | - Jia Li
- Stroke Unit, Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China
| | - Xiao-Min Zhen
- Stroke Unit, Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China
| | - Yun-Yun Zhang
- Stroke Unit, Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China.
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Long-Term Mortality and Its Risk Factors in Stroke Survivors. J Stroke Cerebrovasc Dis 2015; 25:635-41. [PMID: 26738815 DOI: 10.1016/j.jstrokecerebrovasdis.2015.11.039] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 11/18/2015] [Accepted: 11/25/2015] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Stroke is one of the leading causes of mortality worldwide. Understanding the risk factors associated with stroke mortality is important to improve patient management. Few studies have examined long-term mortality and its associated predictive risk factors. METHODS We examined long-term mortality in 1137 patients with acute stroke and compared it to a geographically age- and sex-matched, stroke-free control group. We followed the stroke patients for as long as 16.4 years. In 1018 of these patients we assessed the effect of demographic, clinical, and hematological factors on mortality. RESULTS At the end of the study period, 51.7% of the patients and 32.7% of the stroke-free control individuals had died (hazard ratio 2.2, confidence interval 1.9-2.5, P < .001). A total of 72.5% of the patients and 53% of the controls with 12 years' follow-up (n = 570) had died (P < .001). Regression analyses indicate that, in addition to known risk factors such as age, diabetes, and stroke severity, both low cholesterol (P < .001) and hemoglobin (P < .002), hyperhomocysteinemia (P = .005), and elevated serum creatinine (P < .001) at index stroke are associated with increased long-term mortality. CONCLUSIONS Stroke patients surviving the first year after stroke have a markedly increased mortality rate as seen in long-term follow-up. Furthermore, the results from this study indicate that changes in creatinine, homocysteine, and hemoglobin should be followed more carefully as standard practice after acute stroke.
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Kopyta I, Sarecka-Hujar B, Skrzypek M. Post-stroke epilepsy in Polish paediatric patients. Dev Med Child Neurol 2015; 57:821-8. [PMID: 25692742 DOI: 10.1111/dmcn.12711] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/06/2015] [Indexed: 11/27/2022]
Abstract
AIM The aim of this study was to characterize a group of children with early and late remote seizures, which occurred after arterial ischaemic stroke (AIS), and to find predictors of post-stroke seizures. METHOD The study group, recruited in the Department of Neuropediatrics (Medical University of Silesia, Katowice, Poland), comprised 78 individuals (range 1-18y) who had suffered a stroke: 13 participants had early seizures, occurring up to 7 days after AIS, seven participants had late remote seizures, occurring more than 7 days after AIS, and 58 participants had no seizures. RESULTS Post-stroke epilepsy occurred in 10 patients having post-stroke seizures. Participants affected by late remote seizures were younger, on average, than participants unaffected by seizures. The frequencies of total anterior circulation infarct (TACI) stroke subtype and focal cerebral arteriopathy (FCA) were significantly higher in the late seizure subgroup than in the subgroup without seizures (71% vs 26%, p=0.014, OR 7.17, and 100% vs 51%, p=0.015 respectively). Multivariable Cox analysis showed that age at time of stroke (p=0.027), FCA (p=0.010), and the number of infarct foci (p<0.001) were significant predictors of post-stroke seizures. INTERPRETATION Age at time of stroke, presence of FCA, and number of infarct foci are predictors of post-stroke seizures in Polish paediatric patients.
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Affiliation(s)
- Ilona Kopyta
- Department of Paediatrics and Developmental Age Neurology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Beata Sarecka-Hujar
- Department of Drug Form Technology, School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia, Katowice, Poland
| | - Michal Skrzypek
- Department of Biostatistics, School of Public Health in Bytom, Medical University of Silesia, Katowice, Poland
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Kopyta I, Sarecka-Hujar B. Retracted: Post-stroke epilepsy in Polish paediatric patients. Dev Med Child Neurol 2015; 57:780-5. [PMID: 24116889 DOI: 10.1111/dmcn.12283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/23/2013] [Indexed: 11/27/2022]
Abstract
The above article, published online on 5 October 2013 in Wiley Online Library Early View (http://onlinelibrary.wiley.com/), has been retracted by agreement between the authors, the journal Editor in Chief, Dr Peter Baxter, and John Wiley & Sons Ltd. The retraction has been agreed due to several errors in the statistics. These errors make interpretation of the data difficult and the validity of the conclusions questionable.
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Affiliation(s)
- Ilona Kopyta
- Department of Neuropediatrics, School of Medicine, Medical University of Silesia, Katowice, Poland
| | - Beata Sarecka-Hujar
- Department of Applied Pharmacy, Medical University of Silesia, Sosnowiec, Poland
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Krishnamurthi RV, Moran AE, Forouzanfar MH, Bennett DA, Mensah GA, Lawes CMM, Barker-Collo S, Connor M, Roth GA, Sacco R, Ezzati M, Naghavi M, Murray CJL, Feigin VL. The global burden of hemorrhagic stroke: a summary of findings from the GBD 2010 study. Glob Heart 2015; 9:101-6. [PMID: 25432119 DOI: 10.1016/j.gheart.2014.01.003] [Citation(s) in RCA: 131] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
This report summarizes the findings of the GBD 2010 (Global Burden of Diseases, Injuries, and Risk Factors) study for hemorrhagic stroke (HS). Multiple databases were searched for relevant studies published between 1990 and 2010. The GBD 2010 study provided standardized estimates of the incidence, mortality, mortality-to-incidence ratios (MIR), and disability-adjusted life years (DALY) lost for HS (including intracerebral hemorrhage and subarachnoid hemorrhage) by age, sex, and income level (high-income countries [HIC]; low- and middle-income countries [LMIC]) for 21 GBD 2010 regions in 1990, 2005, and 2010. In 2010, there were 5.3 million cases of HS and over 3.0 million deaths due to HS. There was a 47% increase worldwide in the absolute number of HS cases. The largest proportion of HS incident cases (80%) and deaths (63%) occurred in LMIC countries. There were 62.8 million DALY lost (86% in LMIC) due to HS. The overall age-standardized incidence rate of HS per 100,000 person-years in 2010 was 48.41 (95% confidence interval [CI]: 45.44 to 52.13) in HIC and 99.43 (95% CI: 85.37 to 116.28) in LMIC, and 81.52 (95% CI: 72.27 to 92.82) globally. The age-standardized incidence of HS increased by 18.5% worldwide between 1990 and 2010. In HIC, there was a reduction in incidence of HS by 8% (95% CI: 1% to 15%), mortality by 38% (95% CI: 32% to 43%), DALY by 39% (95% CI: 32% to 44%), and MIR by 27% (95% CI: 19% to 35%) in the last 2 decades. In LMIC countries, there was a significant increase in the incidence of HS by 22% (95% CI: 5% to 30%), whereas there was a significant reduction in mortality rates of 23% (95% CI: -3% to 36%), DALY lost of 25% (95% CI: 7% to 38%), and MIR by 36% (95% CI: 16% to 49%). There were significant regional differences in incidence rates of HS, with the highest rates in LMIC regions such as sub-Saharan Africa and East Asia, and lowest rates in High Income North America and Western Europe. The worldwide burden of HS has increased over the last 2 decades in terms of absolute numbers of HS incident events. The majority of the burden of HS is borne by LMIC. Rates for HS incidence, mortality, and DALY lost, as well as MIR decreased in the past 2 decades in HIC, but increased significantly in LMIC countries, particularly in those patients ≤75 years. HS affected people at a younger age in LMIC than in HIC. The lowest incidence and mortality rates in 2010 were in High Income North America, Australasia, and Western Europe, whereas the highest rates were in Central Asia, Southeast Asia, and sub-Saharan Africa. These results suggest that reducing the burden of HS is a priority particularly in LMIC. The GBD 2010 findings may be a useful resource for planning strategies to reduce the global burden of HS.
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Affiliation(s)
- Rita V Krishnamurthi
- Faculty of Health and Environmental Studies, National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand.
| | - Andrew E Moran
- Division of General Medicine, Columbia University Medical Centre, New York, NY, USA
| | | | - Derrick A Bennett
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - George A Mensah
- Center for Translation Research and Implementation Science (CTRIS), National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Carlene M M Lawes
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | | | - Myles Connor
- NHS Borders, Melrose, UK; Division of Clinical Neurosciences, University of Edinburgh, Edinburgh, UK; Bute Medical School, University of St. Andrews, St. Andrews, UK; School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Gregory A Roth
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Ralph Sacco
- Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Majid Ezzati
- MRC-HPA Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Valery L Feigin
- Faculty of Health and Environmental Studies, National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
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Poletto SR, Rebello LC, Valença MJM, Rossato D, Almeida AG, Brondani R, Chaves MLF, Nasi LA, Martins SCO. Early mobilization in ischemic stroke: a pilot randomized trial of safety and feasibility in a public hospital in Brazil. Cerebrovasc Dis Extra 2015; 5:31-40. [PMID: 26034487 PMCID: PMC4448047 DOI: 10.1159/000381417] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 03/05/2015] [Indexed: 12/31/2022] Open
Abstract
Background The effect of early mobilization after acute stroke is still unclear, although some studies have suggested improvement in outcomes. We conducted a randomized, single-blind, controlled trial seeking to evaluate the feasibility, safety, and benefit of early mobilization for patients with acute ischemic stroke treated in a public teaching hospital in Southern Brazil. This report presents the feasibility and safety findings for the pilot phase of this trial. Methods The primary outcomes were time to first mobilization, total duration of mobilization, complications during early mobilization, falls within 3 months, mortality within 3 months, and medical complications of immobility. We included adult patients with CT- or MRI-confirmed ischemic stroke within 48 h of symptom onset who were admitted from March to November 2012 to the acute vascular unit or general emergency unit of a large urban emergency department (ED) at the Hospital de Clínicas de Porto Alegre. The severity of the neurological deficit on admission was assessed by the National Institutes of Health Stroke Scale (NIHSS). The NIHSS and modified Rankin Scale (mRS, functional outcome) scores were assessed on day 14 or at discharge as well as at 3 months. Activities of daily living (ADL) were measured with the modified Barthel Index (mBI) at 3 months. Results Thirty-seven patients (mean age 65 years, mean NIHSS score 11) were randomly allocated to an intervention group (IG) or a control group (CG). The IG received earlier (p = 0.001) and more frequent (p < 0.0001) mobilization than the CG. Of the 19 patients in the CG, only 5 (26%) underwent a physical therapy program during hospitalization. No complications (symptomatic hypotension or worsening of neurological symptoms) were observed in association with early mobilization. The rates of complications of immobility (pneumonia, pulmonary embolism, and deep vein thrombosis) and mortality were similar in the two groups. No statistically significant differences in functional independence, disability, or ADL (mBI ≥85) were observed between the groups at the 3-month follow-up. Conclusions This pilot trial conducted at a public hospital in Brazil suggests that early mobilization after acute ischemic stroke is safe and feasible. Despite some challenges and limitations, early mobilization was successfully implemented, even in the setting of a large, complex ED, and without complications. Patients from the IG were mobilized much earlier than controls receiving the standard care provided in most Brazilian hospitals.
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Affiliation(s)
- Simone Rosa Poletto
- Hospital de Clínicas de Porto Alegre, Brazil ; Hospital Moinhos de Vento, Porto Alegre, Brazil
| | | | | | | | - Andrea Garcia Almeida
- Hospital de Clínicas de Porto Alegre, Brazil ; Hospital Moinhos de Vento, Porto Alegre, Brazil
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47
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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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48
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Lewsey J, Ebueku O, Jhund PS, Gillies M, Chalmers JWT, Redpath A, Briggs A, Walters M, Langhorne P, Capewell S, McMurray JJV, MacIntyre K. Temporal trends and risk factors for readmission for infections, gastrointestinal and immobility complications after an incident hospitalisation for stroke in Scotland between 1997 and 2005. BMC Neurol 2015; 15:3. [PMID: 25591718 PMCID: PMC4320501 DOI: 10.1186/s12883-014-0257-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 12/23/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Improvements in stroke management have led to increases in the numbers of stroke survivors over the last decade and there has been a corresponding increase of hospital readmissions after an initial stroke hospitalisation. The aim of this study was to examine the one year risk of having a readmission due to infective, gastrointestinal or immobility (IGI) complications and to identify temporal trends and any risk factors. METHODS Using a cohort of first hospitalised for stroke patients who were discharged alive, time to first event (readmission for IGI complications or death) within 1 year was analysed in a competing risks framework using cumulative incidence methods. Regression on the cumulative incidence function was used to model the risks of having an outcome using the covariates age, sex, socioeconomic status, comorbidity, discharge destination and length of hospital stay. RESULTS There were a total of 51,182 patients discharged alive after an incident stroke hospitalisation in Scotland between 1997-2005, and 7,747 (15.1%) were readmitted for IGI complications within a year of the discharge. Comparing incident stroke hospitalisations in 2005 with 1997, the adjusted risk of IGI readmission did not increase (HR = 1.00 95% CI (0.90, 1.11). However, there was a higher risk of IGI readmission with increasing levels of deprivation (most deprived fifth vs. least deprived fifth HR = 1.16 (1.08, 1.26). CONCLUSIONS Approximately 15 in 100 patients discharged alive after an incident hospitalisation for stroke in Scotland between 1997 and 2005 went on to have an IGI readmission within one year. The proportion of readmissions did not change over the study period but those living in deprived areas had an increased risk.
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Affiliation(s)
- James Lewsey
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK.
| | - Osaretin Ebueku
- Public Health, Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK.
| | - Pardeep S Jhund
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK.
| | - Michelle Gillies
- Public Health, Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK.
| | - Jim W T Chalmers
- Information Services Division, NHS National Services Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh, EH12 9 EB, UK.
| | - Adam Redpath
- Information Services Division, NHS National Services Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh, EH12 9 EB, UK.
| | - Andrew Briggs
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK.
| | - Matthew Walters
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Gardiner Institute, Western Infirmary, Glasgow, G11 6NT, UK.
| | - Peter Langhorne
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Gardiner Institute, Western Infirmary, Glasgow, G11 6NT, UK.
| | - Simon Capewell
- Public Health, University of Liverpool, Whelan Building, Quadrangle, Liverpool, L69 3GB, UK.
| | - John J V McMurray
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK.
| | - Kate MacIntyre
- School of Medicine, University of Tasmania, 17 Liverpool Street, Hobart, Australia.
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Rohweder G, Ellekjær H, Salvesen Ø, Naalsund E, Indredavik B. Functional Outcome After Common Poststroke Complications Occurring in the First 90 Days. Stroke 2015; 46:65-70. [DOI: 10.1161/strokeaha.114.006667] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
The aim of this study was to explore the associations of common medical complications with functional outcome at 90 days post stroke.
Methods—
Patients with unselected acute stroke were included and observed for 16 predefined complications during the first week. Fifty percent (244 patients) were allocated to follow-up of 13 complications until 90 days and then assessed with the modified Rankin Scale 90. Common complications were defined as complications with frequencies of ≥5%. Ordinal logistic regression (worsened outcome), as well as binary logistic regression for severe dependency and death (modified Rankin Scale score>3) was performed.
Results—
Seven of the 13 complications occurred at a frequency ≥5%. Recurrent stroke and chest infection were found to have an odds ratio for worsened outcome of 7.45 (95% confidence interval, 2.83–20.96;
P
<0.0001) and 3.28 (95% confidence interval, 1.16–9.29;
P
=0.025), respectively. Infections other than chest infections and urinary tract infections had an odds ratio for worsened outcome of 1.59 (95% confidence interval, 1.12–2.24;
P
=0.009) and falls an odds ratio of 1.43 (95% confidence interval, 1.06 to 1.93;
P
=0.021). Myocardial infarction, urinary tract infections, and pain were not associated with a worsened outcome in terms of modified Rankin Scale 90.
Conclusions—
Recurrent stroke and chest infections were strongly associated with a worsened outcome. Other infections and falls were associated with less worsening. For myocardial infarction, urinary tract infections, and pain no association with functional outcome was found. Active strategies for prevention and early treatment of the first 2 complications seem advisable; patient monitoring as part of comprehensive stroke unit care should ensure timely identification and treatment of all complications.
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Affiliation(s)
- Gitta Rohweder
- From the Stroke Unit, Department of Internal Medicine, St Olav’s Hospital, University Hospital of Trondheim, Trondheim, Norway (G.R., H.E., E.N., B.I.); and Department of Neuroscience (G.R., B.I.) and Unit for Applied Clinical Research (Ø.S.), Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Hanne Ellekjær
- From the Stroke Unit, Department of Internal Medicine, St Olav’s Hospital, University Hospital of Trondheim, Trondheim, Norway (G.R., H.E., E.N., B.I.); and Department of Neuroscience (G.R., B.I.) and Unit for Applied Clinical Research (Ø.S.), Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Øyvind Salvesen
- From the Stroke Unit, Department of Internal Medicine, St Olav’s Hospital, University Hospital of Trondheim, Trondheim, Norway (G.R., H.E., E.N., B.I.); and Department of Neuroscience (G.R., B.I.) and Unit for Applied Clinical Research (Ø.S.), Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Eirik Naalsund
- From the Stroke Unit, Department of Internal Medicine, St Olav’s Hospital, University Hospital of Trondheim, Trondheim, Norway (G.R., H.E., E.N., B.I.); and Department of Neuroscience (G.R., B.I.) and Unit for Applied Clinical Research (Ø.S.), Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Bent Indredavik
- From the Stroke Unit, Department of Internal Medicine, St Olav’s Hospital, University Hospital of Trondheim, Trondheim, Norway (G.R., H.E., E.N., B.I.); and Department of Neuroscience (G.R., B.I.) and Unit for Applied Clinical Research (Ø.S.), Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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50
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Bernhardt J, Churilov L, Dewey H, Lindley RI, Moodie M, Collier J, Langhorne P, Thrift AG, Donnan G. Statistical Analysis Plan (SAP) for a Very Early Rehabilitation Trial (AVERT): An International Trial to Determine the Efficacy and Safety of Commencing out of Bed Standing and Walking Training (Very Early Mobilization) within 24 h of Stroke Onset vs. Usual Stroke Unit Care. Int J Stroke 2014; 10:23-4. [DOI: 10.1111/ijs.12423] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 10/29/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Julie Bernhardt
- The Florey Institute of Neuroscience and Mental Health, Melbourne University, Melbourne, Vic, Australia
| | - Leonid Churilov
- The Florey Institute of Neuroscience and Mental Health, Melbourne University, Melbourne, Vic, Australia
| | - Helen Dewey
- Eastern Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic, Australia
| | - Richard I. Lindley
- George Institute for Global Health, Westmead Hospital Clinical School, Sydney Medical School, Sydney, Vic, Australia
| | - Marj Moodie
- Deakin Health Economics, Faculty of Health, Deakin University, Melbourne, Vic, Australia
| | - Janice Collier
- The Florey Institute of Neuroscience and Mental Health, Melbourne University, Melbourne, Vic, Australia
| | - Peter Langhorne
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - Amanda G. Thrift
- Stroke and Ageing Research Group, Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Vic, Australia
| | - Geoffrey Donnan
- The Florey Institute of Neuroscience and Mental Health, Melbourne University, Melbourne, Vic, Australia
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