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Long J, Wang J, Li Y, Chen S. Gut microbiota in ischemic stroke: Where we stand and challenges ahead. Front Nutr 2022; 9:1008514. [DOI: 10.3389/fnut.2022.1008514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 11/07/2022] [Indexed: 12/03/2022] Open
Abstract
Gut microbiota is increasingly recognized to affect host health and disease, including ischemic stroke (IS). Here, we systematically review the current understanding linking gut microbiota as well as the associated metabolites to the pathogenesis of IS (e.g., oxidative stress, apoptosis, and neuroinflammation). Of relevance, we highlight that the implications of gut microbiota-dependent intervention could be harnessed in orchestrating IS.
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Gao W, Cui Z, Yu Y, Mao J, Xu J, Ji L, Kan X, Shen X, Li X, Zhu S, Hong Y. Application of a Brain–Computer Interface System with Visual and Motor Feedback in Limb and Brain Functional Rehabilitation after Stroke: Case Report. Brain Sci 2022; 12:brainsci12081083. [PMID: 36009146 PMCID: PMC9405856 DOI: 10.3390/brainsci12081083] [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: 06/27/2022] [Revised: 08/05/2022] [Accepted: 08/10/2022] [Indexed: 11/25/2022] Open
Abstract
(1) Objective: To investigate the feasibility, safety, and effectiveness of a brain–computer interface (BCI) system with visual and motor feedback in limb and brain function rehabilitation after stroke. (2) Methods: First, we recruited three hemiplegic stroke patients to perform rehabilitation training using a BCI system with visual and motor feedback for two consecutive days (four sessions) to verify the feasibility and safety of the system. Then, we recruited five other hemiplegic stroke patients for rehabilitation training (6 days a week, lasting for 12–14 days) using the same BCI system to verify the effectiveness. The mean and Cohen’s w were used to compare the changes in limb motor and brain functions before and after training. (3) Results: In the feasibility verification, the continuous motor state switching time (CMSST) of the three patients was 17.8 ± 21.0s, and the motor state percentages (MSPs) in the upper and lower limb training were 52.6 ± 25.7% and 72.4 ± 24.0%, respectively. The effective training revolutions (ETRs) per minute were 25.8 ± 13.0 for upper limb and 24.8 ± 6.4 for lower limb. There were no adverse events during the training process. Compared with the baseline, the motor function indices of the five patients were improved, including sitting balance ability, upper limb Fugel–Meyer assessment (FMA), lower limb FMA, 6 min walking distance, modified Barthel index, and root mean square (RMS) value of triceps surae, which increased by 0.4, 8.0, 5.4, 11.4, 7.0, and 0.9, respectively, and all had large effect sizes (Cohen’s w ≥ 0.5). The brain function indices of the five patients, including the amplitudes of the motor evoked potentials (MEP) on the non-lesion side and lesion side, increased by 3.6 and 3.7, respectively; the latency of MEP on the non-lesion side was shortened by 2.6 ms, and all had large effect sizes (Cohen’s w ≥ 0.5). (4) Conclusions: The BCI system with visual and motor feedback is applicable in active rehabilitation training of stroke patients with hemiplegia, and the pilot results show potential multidimensional benefits after a short course of treatment.
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Affiliation(s)
- Wen Gao
- Department of Rehabilitation Medicine, The Second Hospital of Anhui Medical University, No. 678 Furong Road, Economic and Technological Development Zone, Hefei 230601, China
| | - Zhengzhe Cui
- Zhejiang Laboratory, Department of Intelligent Robot, Keji Avenue, Yuhang Zone, Hangzhou 311100, China
| | - Yang Yu
- Department of Rehabilitation Medicine, The Second Hospital of Anhui Medical University, No. 678 Furong Road, Economic and Technological Development Zone, Hefei 230601, China
| | - Jing Mao
- Department of Rehabilitation Medicine, The Second Hospital of Anhui Medical University, No. 678 Furong Road, Economic and Technological Development Zone, Hefei 230601, China
| | - Jun Xu
- Department of Rehabilitation Medicine, The Second Hospital of Anhui Medical University, No. 678 Furong Road, Economic and Technological Development Zone, Hefei 230601, China
| | - Leilei Ji
- Department of Rehabilitation Medicine, The Second Hospital of Anhui Medical University, No. 678 Furong Road, Economic and Technological Development Zone, Hefei 230601, China
| | - Xiuli Kan
- Department of Rehabilitation Medicine, The Second Hospital of Anhui Medical University, No. 678 Furong Road, Economic and Technological Development Zone, Hefei 230601, China
| | - Xianshan Shen
- Department of Rehabilitation Medicine, The Second Hospital of Anhui Medical University, No. 678 Furong Road, Economic and Technological Development Zone, Hefei 230601, China
| | - Xueming Li
- Department of Rehabilitation Medicine, The Second Hospital of Anhui Medical University, No. 678 Furong Road, Economic and Technological Development Zone, Hefei 230601, China
| | - Shiqiang Zhu
- Zhejiang Laboratory, Department of Intelligent Robot, Keji Avenue, Yuhang Zone, Hangzhou 311100, China
- Ocean College, Zhejiang University, No. 866 Yuhangtang Road, Xihu Zone, Hangzhou 310030, China
- Correspondence: (S.Z.); (Y.H.); Tel.: +86-0571-56390588 (S.Z.); +86-0551-65997012 (Y.H.)
| | - Yongfeng Hong
- Department of Rehabilitation Medicine, The Second Hospital of Anhui Medical University, No. 678 Furong Road, Economic and Technological Development Zone, Hefei 230601, China
- Correspondence: (S.Z.); (Y.H.); Tel.: +86-0571-56390588 (S.Z.); +86-0551-65997012 (Y.H.)
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Erler KS, Wu R, DiCarlo JA, Petrilli MF, Gochyyev P, Hochberg LR, Kautz SA, Schwamm LH, Cramer SC, Finklestein SP, Lin DJ. Association of Modified Rankin Scale With Recovery Phenotypes in Patients With Upper Extremity Weakness After Stroke. Neurology 2022; 98:e1877-e1885. [PMID: 35277444 PMCID: PMC9109148 DOI: 10.1212/wnl.0000000000200154] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 01/18/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Precise measurement of outcomes is essential for stroke trials and clinical care. Prior research has highlighted conceptual differences between global outcome measures such as the Modified Rankin Scale (mRS) and domain-specific measures (e.g. motor, sensory, language or cognitive function). This study related motor phenotypes to the mRS, specifically aiming to (1) determine whether mRS levels distinguish motor impairment and function phenotypes, and (2) compare mRS outcomes to meaningful changes in impairment and function from acute to subacute recovery after stroke. METHODS Patients with upper extremity weakness after ischemic stroke were assessed with a battery of impairment and functional measures within the first week and at 90-days post-stroke. Impairment and functional outcomes were examined in relation to 90-day mRS scores. Clinically meaningful changes in motor impairment, activities of daily living, and mobility were examined in relation to 90-day mRS. RESULTS In this cohort of n = 73 stroke patients, impairment and functional outcomes were associated with 90-day mRS scores but showed substantial variability within individual mRS levels: within mRS level 2, upper extremity impairment ranged from near hemiplegia (with an upper extremity Fugl-Meyer 8) to no deficits (upper extremity Fugl-Meyer 66). Overall, there were few differences in impairment and functional outcomes between adjacent mRS levels. While some outcome measures were significantly different between mRS levels 3 and 4 (Nine-Hole Peg, Leg Motor, Gait Velocity, Timed Up and Go, National Institutes of Health Stroke Scale, and Barthel Index), none of the outcome measures differed between mRS levels 1 and 2. Fugl-Meyer and Grip Strength were not different between any adjacent mRS levels. A substantial number of patients experienced clinically meaningful changes in impairment and function in the first 90 days post-stroke but did not achieve good mRS outcome (mRS ≤ 2). CONCLUSIONS The mRS broadly relates to domain-specific outcomes after stroke confirming its established value in stroke trials, but it does not precisely distinguish differences in impairment and function nor does it sufficiently capture meaningful clinical changes across impairment, ADL status, and mobility. These findings underscore the potential utility of incorporating detailed phenotypic measures alongside the mRS in future stroke trials.
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Affiliation(s)
- Kimberly S Erler
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA.,Department of Occupational Therapy, Massachusetts General Hospital, Boston, MA, USA
| | - Rui Wu
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Julie A DiCarlo
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Marina F Petrilli
- School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA
| | - Perman Gochyyev
- School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA
| | - Leigh R Hochberg
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Division of Neurocritical Care, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,VA RR&D Center for Neurorestoration and Neurotechnology, VA Medical Center, Providence, RI, USA.,School of Engineering and Carney Institute for Brain Science, Brown University, Providence, RI, USA
| | - Steven A Kautz
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC, USA.,Ralph H Johnson VA Medical Center, Charleston, SC, USA
| | - Lee H Schwamm
- Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Steven C Cramer
- Department of Neurology University of California, Los Angeles, CA, USA.,California Rehabilitation Institute, Los Angeles, CA, USA
| | - Seth P Finklestein
- Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - David J Lin
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA.,Division of Neurocritical Care, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,VA RR&D Center for Neurorestoration and Neurotechnology, VA Medical Center, Providence, RI, USA
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Sun C, Huang L, Li Z, Leng K, Xu Y, Jiang X, Cui Y. Long non-coding RNA MIAT in development and disease: a new player in an old game. J Biomed Sci 2018. [PMID: 29534728 PMCID: PMC5851271 DOI: 10.1186/s12929-018-0427-3] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background Long non-coding RNAs (lncRNAs), which are a portion of non-protein-coding RNAs (ncRNAs), have manifested a paramount role in the pathophysiology of human diseases, particularly in pathogenesis and progression of disease. Main body of the abstract Myocardial infarction associated transcript (MIAT), which was recently found to demonstrate aberrant expression in various diseases, such as myocardial infarction, schizophrenia, ischemic stroke, diabetic complications, age-related cataract and cancers, is a novel disease-related lncRNA. This work summarize current evidence regarding the biological functions and underlying mechanisms of lncRNA MIAT during disease development. Short conclusion LncRNA MIAT likely represents a feasible cancer biomarker or therapeutic target.
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Affiliation(s)
- Cheng Sun
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Harbin Medical University, No.246 XueFu Avenue, Harbin, Heilongjiang Province, China
| | - Lining Huang
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Harbin Medical University, No.246 XueFu Avenue, Harbin, Heilongjiang Province, China
| | - Zhenglong Li
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Harbin Medical University, No.246 XueFu Avenue, Harbin, Heilongjiang Province, China
| | - Kaiming Leng
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Harbin Medical University, No.246 XueFu Avenue, Harbin, Heilongjiang Province, China
| | - Yi Xu
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Harbin Medical University, No.246 XueFu Avenue, Harbin, Heilongjiang Province, China
| | - Xingming Jiang
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Harbin Medical University, No.246 XueFu Avenue, Harbin, Heilongjiang Province, China.
| | - Yunfu Cui
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Harbin Medical University, No.246 XueFu Avenue, Harbin, Heilongjiang Province, China.
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Zhu M, Li N, Luo P, Jing W, Wen X, Liang C, Tu J. Peripheral Blood Leukocyte Expression of lncRNA MIAT and Its Diagnostic and Prognostic Value in Ischemic Stroke. J Stroke Cerebrovasc Dis 2017; 27:326-337. [PMID: 29030044 DOI: 10.1016/j.jstrokecerebrovasdis.2017.09.009] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/29/2017] [Accepted: 09/06/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Ischemic stroke (IS) is an extremely heterogeneous disease with variable pathogenesis. Due to the lack of early diagnostic markers, the mortality rate of IS remains high. Cumulative evidence shows that long noncoding RNAs among noncoding RNAs play important roles in cardiovascular diseases. In the present study, we focused on the expression pattern of myocardial infarction-associated transcript (MIAT) and its clinical significance in IS. METHODS Blood samples were obtained from IS patients (n = 189) and healthy controls (n = 189). The National Institutes of Health Stroke Scale (NIHSS) was measured at the time of admission. Short-term functional outcome was measured by the modified Rankin Scale (mRS) at 3 months after admission. Multivariate analyses were performed using logistic regression models. The receiver operating characteristic (ROC) curve was used to evaluate the accuracy of MIAT in the diagnosis and prognosis of IS. RESULTS In IS patients, MIAT expression level was significantly upregulated and correlated with NIHSS scores (r = .421, P <.001), mRS (r = .339, P <.001), high-sensitivity C-reactive protein (r = .309, P <.001), and infarct volume (r = .318, P <.001). ROC curves indicated that MIAT could serve as a potential marker for discriminating IS patients from the controls with an area under the curve of .842 (95% confidence interval, .802-.881). The overall survival analysis showed that patients with higher MIAT expression had a relatively poor prognosis. Meanwhile, the multivariate analysis revealed that MIAT was an independent prognostic marker of functional outcome and death in patients with IS. CONCLUSION Our data suggested that MIAT might be a potential diagnostic and prognostic indicator in IS.
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Affiliation(s)
- Man Zhu
- Department of Clinical Laboratory & Center for Gene Diagnosis, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Nandi Li
- Department of Clinical Laboratory & Center for Gene Diagnosis, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Ping Luo
- Department of Clinical Laboratory & Center for Gene Diagnosis, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wei Jing
- Department of Clinical Laboratory & Center for Gene Diagnosis, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xue Wen
- Department of Clinical Laboratory & Center for Gene Diagnosis, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Chunzi Liang
- Department of Clinical Laboratory & Center for Gene Diagnosis, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jiancheng Tu
- Department of Clinical Laboratory & Center for Gene Diagnosis, Zhongnan Hospital of Wuhan University, Wuhan, China.
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Zhang X, Ji W, Li L, Yu C, Wang W, Liu S, Gao C, Qiu L, Tong X, Wang J, Wu J. The Predictive Value of Motor-Evoked Potentials and the Silent Period on Patient Outcome after Acute Cerebral Infarction. J Stroke Cerebrovasc Dis 2016; 25:1713-1720. [PMID: 27083069 DOI: 10.1016/j.jstrokecerebrovasdis.2016.03.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 02/04/2016] [Accepted: 03/15/2016] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The predictive value of neurophysiologic assessment on patients' outcome after acute cerebral infarction is poorly understood. The aim of this study was to investigate the prognostic value of motor-evoked potentials (MEPs) and the silent period (SP) on clinical outcome. METHODS A total of 202 patients with acute cerebral infarction were prospectively recruited. MEP and SP were recorded from the abductor pollicis brevis of the affected side within 10 days after stroke onset. Patient outcome was measured as the dependency rate. RESULTS Cortical MEP was induced in 78 patients whereas it was absent in 82 patients. The initial NIHSS (National Institutes of Health Stroke Scale) score was significantly lower in patients with MEP than in those without MEP (P < .001). Regression analysis demonstrated that a left-sided lesion (OR = .391, 95% CI .178-.858, P = .019), NIHSS at admission (OR = .826, 95% CI .744-.917, P < .001), and presence of MEP (OR = 3.918, 95% CI 1.770-8.672, P < .001) were independent predictors of outcome 3 months after stroke. Among patients with MEP, only the contralateral cortical SP value was significantly shorter in the good outcome subgroup (t = 2.541, P = .013). Receiver operating characteristic curve analysis demonstrated that SP was able to predict patients at higher risk of unfavorable outcome 3 months after stroke onset (area under the curve .721, 95% CI .58-.86, P = .008). CONCLUSIONS These data suggested that MEP and SP were useful tools to predict patients' acute outcomes following cerebral infarction.
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Affiliation(s)
- Xueqing Zhang
- Department of Electrophysiology, Tianjin Huanhu Hospital, Tianjin, China
| | - Wenzhen Ji
- Department of Electrophysiology, Tianjin Huanhu Hospital, Tianjin, China
| | - Lancui Li
- Department of Medical Insurance, Tianjin Huanhu Hospital, Tianjin, China
| | - Changshen Yu
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin, China
| | - Wanjun Wang
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin, China
| | - Shoufeng Liu
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin, China
| | - Chunlin Gao
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin, China
| | - Lina Qiu
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin, China
| | - Xiaoguang Tong
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin, China
| | - Jinhuan Wang
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin, China
| | - Jialing Wu
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin, China.
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Vuorio AF, Kovanen PT. Do statins reduce the incidence of stroke in familial hypercholesterolemia? Expert Rev Cardiovasc Ther 2014; 9:349-53. [DOI: 10.1586/erc.11.24] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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De Luca A, Giorgi Rossi P, Villa GF. The use of Cincinnati Prehospital Stroke Scale during telephone dispatch interview increases the accuracy in identifying stroke and transient ischemic attack symptoms. BMC Health Serv Res 2013; 13:513. [PMID: 24330761 PMCID: PMC3867422 DOI: 10.1186/1472-6963-13-513] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Accepted: 11/29/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Timely and appropriate hospital treatment of acute cerebrovascular diseases (stroke and Transient Ischemic Attacks - TIA) improves patient outcomes. Emergency Medical Service (EMS) dispatchers who can identify cerebrovascular disease symptoms during telephone requests for emergency service also contribute to these improved outcomes. The Italian Ministry of Health issued guidelines on the management of AC patients in pre-hospital emergency service, including Cincinnati Prehospital Stroke Scale (CPSS) use.We measured the sensitivity and Positive Predictive Value (PPV) of EMS dispatchers' ability to recognize stroke/TIA symptoms and evaluated whether the CPSS improves accuracy. METHODS A cross-sectional multicentre study was conducted to collect data from 38 Italian emergency operative centres on all cases identified with stroke/TIA symptoms at the time of dispatch and all cases with stroke/TIA symptoms identified on the scene by the ambulance personnel from November 2010 to May 2011. RESULTS The study included 21760 cases: 18231 with stroke/TIA symptoms at dispatch and 9791 with symptoms confirmed on the scene. The PPV of the dispatch stroke/TIA symptoms identification was 34.3% (95% CI 33.7-35.0; 6262/18231) and the sensitivity was 64.0% (95% CI 63.0-64.9; 6262/9791). Centres using CPSS more often (>10% of cases) had both higher PPV (56%; CI 95% 57-60 vs 18%; CI 95% 17-19) and higher sensitivity (71%; CI 95% 87-89 vs 52%; CI 95% 51-54).In the multivariate regression a centre's CPSS use was associated with PPV (beta 0.48 p = 0.014) and negatively associated with sensitivity (beta -0.36; p = 0.063); centre sensitivity was associated with CPSS (beta 0.32; p = 0.002), adjusting for PPV. CONCLUSIONS Centres that use CPSS more frequently during phone dispatch showed greater agreement with on-the-scene prehospital assessments, both in correctly identifying more cases with stroke/TIA symptoms and in giving fewer false positives for non-stroke/TIA cases. Our study shows an extreme variability in the performance among OCs, highlighting that form many centres there is room for improvement in both sensitivity and positive predictive value of the dispatch. Our results should be used for benchmarking proposals in the effort to identify best practices across the country.
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Affiliation(s)
- Assunta De Luca
- Health Direction of Regional Authority of Emergency Services (ARES 118) Lazio Region Italy. New affiliation, Health Direction of Sant’Andrea Hospital Sapienza Rome University, Via Tronto 32, Roma, CAP 00198 Italy
| | | | - Guido Francesco Villa
- Pre hospital emergency Operative Center of Lecco and coordinator of Italian Group Pre-hospital management of acute stroke – Italian Society of pre hospital emergency Services (SIS118). New affiliation: Azienda Regionale Emergenza Urgenza (AREU), Milan Lombardy, Italy
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Lam OL, McMillan AS, Samaranayake LP, Li LS, McGrath C. Randomized clinical trial of oral health promotion interventions among patients following stroke. Arch Phys Med Rehabil 2012; 94:435-43. [PMID: 23127306 DOI: 10.1016/j.apmr.2012.10.024] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Revised: 10/04/2012] [Accepted: 10/20/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of oral health promotion interventions on clinical oral health. DESIGN Single-blind randomized controlled trial conducted over 3 weeks of in-hospital rehabilitation. SETTING Stroke rehabilitation ward in Hong Kong. PARTICIPANTS Patients with stroke (N=102) admitted to the rehabilitation ward. INTERVENTIONS Patients were randomly assigned either: (1) oral hygiene instruction, (2) oral hygiene instruction and chlorhexidine mouthrinse, or (3) oral hygiene instruction, chlorhexidine mouthrinse, and assisted brushing. MAIN OUTCOME MEASURES Dental plaque, gingival bleeding, and oral functional status were assessed at baseline and review. Development of infectious complications were also monitored during the clinical trial. RESULTS Poor oral hygiene and an overall neglect of oral hygiene practices were observed at baseline. Reductions in dental plaque were significantly greater in the 2 groups receiving chlorhexidine compared with the group receiving oral hygiene instruction alone (P<.001). Reductions in gingival bleeding scores were 3- to 4-fold greater in groups receiving chlorhexidine. No cases of pneumonia were observed during the course of the clinical trial. CONCLUSIONS The oral health condition of patients may be safeguarded after acute stroke with the use of chlorhexidine mouthrinse in conjunction with a standard mechanical plaque removal tool, such as an electric toothbrush. These interventions are acceptable to the majority of patients, and their administration poses a minimal burden to rehabilitation ward staff.
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Affiliation(s)
- Otto L Lam
- Oral Rehabilitation, Faculty of Dentistry, University of Hong Kong, Hong Kong, China
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Baumann M, Lurbe K, Leandro ME, Chau N. Life satisfaction of two-year post-stroke survivors: effects of socio-economic factors, motor impairment, Newcastle stroke-specific quality of life measure and World Health Organization quality of life: bref of informal caregivers in Luxembourg and a rural area in Portugal. Cerebrovasc Dis 2012; 33:219-30. [PMID: 22261643 DOI: 10.1159/000333408] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Accepted: 08/29/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Life satisfaction of stroke survivors is known to be associated with socio-economic factors and the survivor's and his/her caregiver's quality of life, but their respective influence remains to be fully elucidated. PURPOSE To analyse the stroke survivors' life satisfaction 2 years after the event and its relationships with quality of life, socio-economic and stroke-related characteristics, and with informal caregivers' life satisfaction and quality of life . METHODS Over 18 months, all stroke patients from Luxembourg and north-eastern Portugal who lived at home were identified from the Inspection Générale de la Sécurité Sociale and hospital records, respectively. The clinical diagnosis of cerebrovascular disease was confirmed. We excluded all patients who declared that stroke did not result in neurological impairments at the time of stroke from the statistical analysis. The samples comprised 79 patients in Luxembourg and 48 in Portugal. Patients and the people they identified as their main caregivers were interviewed using validated questionnaires measuring life satisfaction, i.e. the Newcastle Stroke-Specific Quality of Life (Newsqol - 11 subscales), which identifies the areas affected by stroke among patients, and the World Health Organization Quality of Life - bref (Whoqol-bref - 4 subscales) of informal caregivers. Survivors without neurological impairment at the time of stroke were excluded. Data were analysed via multiple-regression models. RESULTS Life satisfaction was higher among women and lower among subjects with impaired motor functions. It was lower among Portuguese respondents with low-level education (<12th grade) and higher among those at work (37.6/100). In Luxembourg, retired people had more life satisfaction than did working people (-7.9/100). Controlling for socio-economic factors, life satisfaction was associated with feelings- Newsqol (slope 0.25) among Luxembourg residents, and with feelings-, mobility- and self-care-Newsqol (slopes 0.24, 0.27 and 0.33, respectively) among Portuguese respondents. Life satisfaction of patients was strongly related to that of family caregivers among the Portuguese respondents (slope 0.66) but the relationship was moderate in Luxembourg (slope 0.28). The survivors' life satisfaction was not correlated with any Whoqol-bref domain in the Luxembourg group, but was correlated with the Whoqol-bref psychological, social relationships and environment domains among the Portuguese respondents (slopes 0.55, 0.59 and 0.51, respectively). CONCLUSIONS The life satisfaction scale and the Newsqol stroke instrument, which identify areas of quality of life affected by stroke, are reliable patient-centred markers of intervention outcome. They can be used within the framework of medical follow-up (such as telephone assistance, clinical practice and prevention). Depending on the stroke survivor's and the family caregiver's habitual lifestyle and material circumstances, enhancement of a caregiver's quality of life can help maintain the patient's life satisfaction, particularly in a rural setting.
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Affiliation(s)
- Michèle Baumann
- University of Luxembourg, Research Unit INSIDE, Walferdange, Luxembourg
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Lurbe-Puerto K, Leandro ME, Baumann M. Experiences of caregiving, satisfaction of life, and social repercussions among family caregivers, two years post-stroke. SOCIAL WORK IN HEALTH CARE 2012; 51:725-742. [PMID: 22967023 DOI: 10.1080/00981389.2012.692351] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Cerebrovascular diseases are a public health and social policy priority in Europe due to their high prevalence and the long-term disability they may result in (as the principal cause of handicap). Increasingly, family caregivers take over the care at home of these patients. Two years post-stroke, our study analyzed the feelings of family caregivers from Luxembourg and northeastern Portugal toward their experience of caregiving and its repercussions on social and couple relationships, life satisfaction, and socioeconomic characteristics. Participating hospitals identified survivors and consent was sought by letter. Patients (n = 62) and their main caregivers (n = 46 pairs) were interviewed at home. The mean life satisfaction of caregivers was similar, but the experience of providing care differed in terms of family support, and disruptions of the caregivers' family responsibilities. More Portuguese respondents gave activities up, found little time for relaxation, and estimated that their health had deteriorated; more Luxembourgers felt strong enough to cope. More Portuguese spouses reported an impact on their sex lives. Family caregivers represent a "population at risk." Social workers can help them by providing domestic assistance, undertaking coaching activities, fostering favorable attitudes, and offering reassurance. Home-based rehabilitation in Europe involving family care must take account of cultural lifestyle issues.
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Affiliation(s)
- Kàtia Lurbe-Puerto
- Integrative research unit on Social and Individual DEvelopment (INSIDE), Walferdange, Luxembourg
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Ifejika-Jones NL, Barrett AM. Rehabilitation--emerging technologies, innovative therapies, and future objectives. Neurotherapeutics 2011; 8:452-62. [PMID: 21706265 PMCID: PMC3148149 DOI: 10.1007/s13311-011-0057-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Stroke is the leading cause of long-term disability. The goal of stroke rehabilitation is to improve recovery in the years after a stroke and to decrease long-term disability. This article, titled "Rehabilitation--Emerging Technologies, Innovative Therapies, and Future Objectives" gives evidence-based information on the type of rehabilitation approaches that are effective to improve functional mobility and to address cognitive impairments. We review the importance of taking a translational approach to neurorehabilitation, considering the interaction of motor and cognitive systems, skilled learned purposeful limb movement, and spatial navigation ability. Known biologic mechanisms of neurorecovery are targeted in relation to technology implemented by members of the multidisciplinary team. Results from proof-of-concept, within subjects, and randomized controlled trials are presented, and the implications for optimal stroke rehabilitation strategies are discussed. Developing clinical practices are highlighted and future research directions are proposed with goals to provide insight on what the next steps are for this burgeoning discipline.
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Affiliation(s)
- Nneka L. Ifejika-Jones
- Departments of Neurology and Physical Medicine & Rehabilitation, University of Texas Medical School at Houston, Houston, TX 77030 USA
| | - Anna M. Barrett
- Departments of Physical Medicine & Rehabilitation and Neurology & Neurosciences, University of Medicine and Dentistry New Jersey - New Jersey Medical School, Newark, NJ 07101 USA
- Kessler Foundation Research Center, West Orange, NJ 07052 USA
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Loring DW, Lowenstein DH, Barbaro NM, Fureman BE, Odenkirchen J, Jacobs MP, Austin JK, Dlugos DJ, French JA, Gaillard WD, Hermann BP, Hesdorffer DC, Roper SN, Van Cott AC, Grinnon S, Stout A. Common data elements in epilepsy research: development and implementation of the NINDS epilepsy CDE project. Epilepsia 2011; 52:1186-91. [PMID: 21426327 PMCID: PMC3535455 DOI: 10.1111/j.1528-1167.2011.03018.x] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The Common Data Element (CDE) Project was initiated in 2006 by the National Institute of Neurological Disorders and Stroke (NINDS) to develop standards for performing funded neuroscience-related clinical research. CDEs are intended to standardize aspects of data collection; decrease study start-up time; and provide more complete, comprehensive, and equivalent data across studies within a particular disease area. Therefore, CDEs will simplify data sharing and data aggregation across NINDS-funded clinical research, and where appropriate, facilitate the development of evidenced-based guidelines and recommendations. Epilepsy-specific CDEs were established in nine content areas: (1) Antiepileptic Drugs (AEDs) and Other Antiepileptic Therapies (AETs), (2) Comorbidities, (3) Electrophysiology, (4) Imaging, (5) Neurological Exam, (6) Neuropsychology, (7) Quality of Life, (8) Seizures and Syndromes, and (9) Surgery and Pathology. CDEs were developed as a dynamic resource that will accommodate recommendations based on investigator use, new technologies, and research findings documenting emerging critical disease characteristics. The epilepsy-specific CDE initiative can be viewed as part of the larger international movement toward "harmonization" of clinical disease characterization and outcome assessment designed to promote communication and research efforts in epilepsy. It will also provide valuable guidance for CDE improvement during further development, refinement, and implementation. This article describes the NINDS CDE Initiative, the process used in developing Epilepsy CDEs, and the benefits of CDEs for the clinical investigator and NINDS.
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Affiliation(s)
- David W Loring
- Department of Neurology, Emory University, Atlanta, Georgia, USA.
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Dietz GPH. Protection by neuroglobin and cell-penetrating peptide-mediated delivery in vivo: a decade of research. Comment on Cai et al: TAT-mediated delivery of neuroglobin protects against focal cerebral ischemia in mice. Exp Neurol. 2011; 227(1): 224-31. Exp Neurol 2011; 231:1-10. [PMID: 21620833 DOI: 10.1016/j.expneurol.2011.05.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 05/04/2011] [Accepted: 05/10/2011] [Indexed: 12/09/2022]
Abstract
Over the last decade, numerous studies have suggested that neuroglobin is able to protect against the effects of ischemia. However, such results have mostly been based on models using transgenic overexpression or viral delivery. As a therapy, new technology would need to be applied to enable delivery of high concentrations of neuroglobin shortly after the patient suffers the stroke. An approach to deliver proteins in ischemia in vivo in a timely manner is the use of cell-penetrating peptides (CPP). CPP have been used in animal models for brain diseases for about a decade as well. In a recent issue of Experimental Neurology, Cai and colleagues test the effect of CPP-coupled neuroglobin in an in vivo stroke model. They find that the fusion protein protects the brain against the effect of ischemia when applied before stroke onset. Here, a concise review of neuroglobin research and the application of CPP peptides in hypoxia and ischemia is provided.
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Affiliation(s)
- Gunnar P H Dietz
- Dep. 851, Neurodegeneration II, H. Lundbeck A/S, Ottiliavej 9, 2500 Valby, Denmark.
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Ifejika-Jones NL, Harun N, Mohammed-Rajput NA, Noser EA, Grotta JC. Thrombolysis with intravenous tissue plasminogen activator predicts a favorable discharge disposition in patients with acute ischemic stroke. Stroke 2011; 42:700-4. [PMID: 21293014 PMCID: PMC3045629 DOI: 10.1161/strokeaha.110.604108] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Accepted: 10/27/2010] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Acute ischemic stroke patients who receive recombinant tissue plasminogen activator (rt-PA) within 3 hours of symptom onset are 30% more likely to have minimal to no disability at 3 months. During hospitalization, short-term disability is subjectively measured by discharge disposition, whether to home, inpatient rehabilitation, a skilled nursing facility, or subacute care. There are no studies assessing the role of recombinant tissue plasminogen activator use as a predictor of poststroke discharge disposition. METHODS We conducted a retrospective analysis of all patients with ischemic stroke who presented within the original three hour window for intravenous thrombolysis, and who were admitted to the University of Texas Houston Medical School Stroke Service at Memorial Hermann Hospital - Texas Medical Center between January 2004 and October 2009. Baseline demographics and National Institute of Health Stroke Scale score were collected. Cerebrovascular disease risk factors were used for risk stratification in the multivariate regression. RESULTS Out of 2225 patients with acute ischemic stroke, 1019 were discharged to home, 719 to inpatient rehabilitation, 371 to a skilled nursing facility and 116 to subacute care. Patients who received recombinant tissue plasminogen activator therapy were more likely to be discharged home compared to the other levels of care (P<0.0001; OR, 1.945; 95% CI, 1.538 to 2.459). Considering post-acute inpatient rehabilitation versus skilled nursing facility/subacute care and disposition at a skilled nursing facility versus subacute care, there were no differences in disposition between patients who received recombinant tissue plasminogen activator therapy. Inpatient Rehabilitation versus Skilled Nursing Facility or Subacute Care (P = 0.123); Skilled Nursing Facility versus Subacute Care (P = 0.605). CONCLUSIONS Patients who receive intravenous recombinant tissue plasminogen activator as treatment for acute ischemic stroke are more likely to be discharged directly home after hospitalization. This study is limited by its retrospective nature and the undetermined role of psychosocial factors related to discharge.
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Affiliation(s)
- Nneka L Ifejika-Jones
- Department of Neurology, University of Texas Houston Medical School, 6431 Fannin, MSB 7.044, Houston, TX 77030, USA.
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