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Peter J, Ferraioli F, Mathew D, George S, Chan C, Alalade T, Salcedo SA, Saed S, Tatti E, Quartarone A, Ghilardi MF. Movement-related beta ERD and ERS abnormalities in neuropsychiatric disorders. Front Neurosci 2022; 16:1045715. [PMID: 36507340 PMCID: PMC9726921 DOI: 10.3389/fnins.2022.1045715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 10/31/2022] [Indexed: 11/24/2022] Open
Abstract
Movement-related oscillations in the beta range (from 13 to 30 Hz) have been observed over sensorimotor areas with power decrease (i.e., event-related desynchronization, ERD) during motor planning and execution followed by an increase (i.e., event-related synchronization, ERS) after the movement's end. These phenomena occur during active, passive, imaged, and observed movements. Several electrophysiology studies have used beta ERD and ERS as functional indices of sensorimotor integrity, primarily in diseases affecting the motor system. Recent literature also highlights other characteristics of beta ERD and ERS, implying their role in processes not strictly related to motor function. Here we review studies about movement-related ERD and ERS in diseases characterized by motor dysfunction, including Parkinson's disease, dystonia, stroke, amyotrophic lateral sclerosis, cerebral palsy, and multiple sclerosis. We also review changes of beta ERD and ERS reported in physiological aging, Alzheimer's disease, and schizophrenia, three conditions without overt motor symptoms. The review of these works shows that ERD and ERS abnormalities are present across the spectrum of the examined pathologies as well as development and aging. They further suggest that cognition and movement are tightly related processes that may share common mechanisms regulated by beta modulation. Future studies with a multimodal approach are warranted to understand not only the specific topographical dynamics of movement-related beta modulation but also the general meaning of beta frequency changes occurring in relation to movement and cognitive processes at large. Such an approach will provide the foundation to devise and implement novel therapeutic approaches to neuropsychiatric disorders.
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Affiliation(s)
- Jaime Peter
- Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine, New York, NY, United States
| | - Francesca Ferraioli
- Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine, New York, NY, United States
| | - Dave Mathew
- Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine, New York, NY, United States
| | - Shaina George
- Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine, New York, NY, United States
| | - Cameron Chan
- Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine, New York, NY, United States
| | - Tomisin Alalade
- Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine, New York, NY, United States
| | - Sheilla A. Salcedo
- Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine, New York, NY, United States
| | - Shannon Saed
- Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine, New York, NY, United States
| | - Elisa Tatti
- Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine, New York, NY, United States,*Correspondence: Elisa Tatti,
| | - Angelo Quartarone
- IRCCS Centro Neurolesi Bonino Pulejo-Piemonte, Messina, Italy,Angelo Quartarone,
| | - M. Felice Ghilardi
- Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine, New York, NY, United States,M. Felice Ghilardi,
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Leader–follower Stackelberg game oriented adaptive robust constraint-following control design for fuzzy exoskeleton robot systems. Inf Sci (N Y) 2022. [DOI: 10.1016/j.ins.2022.05.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Neves G, Cole T, Lee J, Bueso T, Shaw C, Montalvan V. Demographic and institutional predictors of stroke hospitalization mortality among adults in the United States. eNeurologicalSci 2022; 26:100392. [PMID: 35146139 PMCID: PMC8802002 DOI: 10.1016/j.ensci.2022.100392] [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: 07/12/2021] [Revised: 12/24/2021] [Accepted: 01/13/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Stroke remains a primary source of functional disability and inpatient mortality in the United States (US). Recent evidence reveals declining mortality associated with stroke hospitalizations in the US. However, data updating trends in inpatient mortality is lacking. This study aims to provide a renewed inpatient stroke mortality rate in a national sample and identify common predictors of inpatient stroke mortality. Methods In this cross-sectional study, we analyzed data from a nationwide database between 2010 and 2017. We included patient encounters for both ischemic (ICD9 433–434, ICD10 I630–I639) and hemorrhagic stroke (ICD9 430–432, ICD10 I600–I629). We performed an annual comparison of in-hospital stroke mortality rates, and a cross-sectional analytic approach of multiple variables identified common predictors of inpatient stroke mortality. Results Between 2010 and 2017, we identified 518,185 total stroke admissions (86.6% ischemic stroke and 13.4% hemorrhagic strokes). Stroke admissions steadily increased during the studied period, whereas we observed a steady decline in in-hospital mortality during the same time. The inpatient stroke mortality rate gradually declined from 4.8% in 2010 (95% CI 4.6–5.1) to 2.1% in 2017 (95% CI 2.0–2.1). Predictors of higher odds of dying from ischemic stroke were female (OR 1.059, 95% CI 1.015–1.105, p = 0.008), older age (OR 1.028, 95% CI 1.026–1.029, p < 0.001), and sicker patients (OR 1.091, 95% CI 1.089–1.093, p < 0.001). Predictors of higher odds of dying from hemorrhagic stroke were Hispanic ethnicity (OR 1.459, 95% CI 1.084–1.926, p < 0.001), older age (OR 1.021, 95% CI 1.019–1.023, p < 0.001), and sicker patients (OR 1.042, 95% CI 1.039–1.045, p < 0.001). All census regions and hospital types demonstrated improvements in in-hospital mortality. Conclusion This study identified a continuous declining rate in in-hospital mortality due to stroke in the United States, and it also identified demographic and hospital predictors of inpatient stroke mortality. Stroke remains a leading cause of morbidity and mortality in the United States Stroke hospitalization mortality trends are important to guide efforts in acute stroke care Vascular risk factors are still prevalent in the population admitted due to stroke and continue to be associated with higher odds of death There are important regional disparities in stroke hospitalization deaths in the United States Hospital characteristics influence odds of death from a stroke independent of stroke etiology
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Affiliation(s)
- Gabriel Neves
- Department of Neurology, Texas Tech University Medical Sciences Center, Lubbock, TX, USA
- Corresponding author at: Department of Neurology, Texas Tech University Health Sciences Center, Room 3A105, 3601 4 street, Lubbock, TX 79430, USA.
| | - Travis Cole
- Graduate School of Biomedical Sciences, Texas Tech University Medical Sciences Center, Lubbock, TX, USA
| | - Jeannie Lee
- Department of Neurology, Texas Tech University Medical Sciences Center, Lubbock, TX, USA
| | - Tulio Bueso
- Department of Neurology, Texas Tech University Medical Sciences Center, Lubbock, TX, USA
| | - Chip Shaw
- Graduate School of Biomedical Sciences, Texas Tech University Medical Sciences Center, Lubbock, TX, USA
| | - Victor Montalvan
- Department of Neurology, Texas Tech University Medical Sciences Center, Lubbock, TX, USA
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McKenzie AJ, Doyle BJ, Aman ZM. Micromechanical Force Measurement of Clotted Blood Particle Cohesion: Understanding Thromboembolic Aggregation Mechanisms. Cardiovasc Eng Technol 2022; 13:816-828. [PMID: 35419664 PMCID: PMC9750917 DOI: 10.1007/s13239-022-00618-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 03/19/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE Arterial shear forces may promote the embolization of clotted blood from the surface of thrombi, displacing particles that may occlude vasculature, with increased risk of physiological complications and mortality. Thromboemboli may also collide in vivo to form metastable aggregates that increase vessel occlusion likelihood. METHODS A micromechanical force (MMF) apparatus was modified for aqueous applications to study clot-liquid interfacial phenomena between clotted porcine blood particles suspended in modified continuous phases. The MMF measurement is based on visual observation of particle-particle separation, where Hooke's Law is applied to calculate separation force. This technique has previously been deployed to study solid-fluid interfacial phenomena in oil and gas pipelines, providing fundamental insight to cohesive and adhesive properties between solids in multiphase flow systems. RESULTS This manuscript introduces distributed inter-particle separation force properties as a function of governing physio-chemical parameters; pre-load (contact) force, contact time, and bulk phase chemical modification. In each experimental campaign, the hysteresis and distributed force properties were analysed, to derive insight as to the governing mechanism of cohesion between particles. Porcine serum, porcine albumin and pharmaceutical agents (alteplase, tranexamic acid and hydrolysed aspirin) reduced the measurement by an order of magnitude from the baseline measurement-the apparatus provides a platform to study how surface-active chemistries impact the solid-fluid interface. CONCLUSION These results provide new insight to potential mechanisms of macroscopic thromboembolic aggregation via particles cohering in the vascular system-data that can be directly applied to computational simulations to predict particle fate, better informing the mechanistic developments of embolic occlusion.
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Affiliation(s)
- Angus J. McKenzie
- grid.1012.20000 0004 1936 7910Department of Chemical Engineering, The Centre for Long Subsea Tiebacks, Fluid Science and Resources Cluster, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009 Australia
| | - Barry J. Doyle
- grid.1012.20000 0004 1936 7910Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, Nedlands, and Centre for Medical Research, The University of Western Australia, Crawley, PER Australia ,Australian Research Council Centre for Personalised Therapeutics Technologies, Parkville, Australia ,grid.4305.20000 0004 1936 7988BHF Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
| | - Zachary M. Aman
- grid.1012.20000 0004 1936 7910Department of Chemical Engineering, The Centre for Long Subsea Tiebacks, Fluid Science and Resources Cluster, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009 Australia
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5
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Ay H. Classification of Ischemic Stroke. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00020-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Parasram M, Parikh NS, Merkler AE, Falcone GJ, Sheth KN, Navi BB, Kamel H, Zhang C, Murthy SB. Risk of Mortality After an Arterial Ischemic Event Among Intracerebral Hemorrhage Survivors. Neurohospitalist 2022; 12:19-23. [PMID: 34950382 PMCID: PMC8689534 DOI: 10.1177/19418744211026709] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND AND PURPOSE The impact of arterial ischemic events after intracerebral hemorrhage (ICH) on outcomes is unclear. This study aimed to evaluate the risk of death among ICH survivors with and without an incident arterial ischemic event. METHODS We performed a retrospective cohort study using claims data from Medicare beneficiaries with a non-traumatic ICH from January 2008 to October 2015. Our exposure was an arterial ischemic event, a composite of acute ischemic stroke or myocardial infarction (MI), identified using validated ICD-9-CM diagnosis codes. The outcome was mortality. We used marginal structural models to analyze the risk of death among ICH patients with and without an arterial ischemic event, after adjusting for confounders as time-varying covariates. RESULTS Among 8,804 Medicare beneficiaries with ICH, 2,371 (26.9%) had an arterial ischemic event. During a median follow-up time of 1.9 years (interquartile range, 0.7-3.9), ICH patients with an arterial ischemic event had a mortality rate of 21.7 (95% confidence interval [CI], 20.4-23.0) per 100 person-years compared to a rate of 15.0 (95% CI, 14.4-15.6) per 100 person-years in those without. In the marginal structural model, an arterial ischemic event was associated with an increased risk of death (hazard ratio [HR], 1.8; 95% confidence interval [CI], 1.6-1.9). In secondary analyses, the mortality risk was elevated after an ischemic stroke (HR, 1.7; 95% CI, 1.5-1.8), and MI (HR, 3.0; 95% CI, 2.4-3.8). CONCLUSIONS We found that elderly patients who survived an ICH had an increased risk of death after a subsequent ischemic stroke or MI.
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Affiliation(s)
- Melvin Parasram
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Neal S. Parikh
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Alexander E. Merkler
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Guido J. Falcone
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | - Kevin N. Sheth
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | - Babak B. Navi
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Hooman Kamel
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Cenai Zhang
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Santosh B. Murthy
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA,Santosh Murthy, Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, 525 East 68th St, Room F610, New York, NY 10065, USA.
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7
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Hadanny A, Rittblat M, Bitterman M, May-Raz I, Suzin G, Boussi-Gross R, Zemel Y, Bechor Y, Catalogna M, Efrati S. Hyperbaric oxygen therapy improves neurocognitive functions of post-stroke patients - a retrospective analysis. Restor Neurol Neurosci 2021; 38:93-107. [PMID: 31985478 PMCID: PMC7081098 DOI: 10.3233/rnn-190959] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background: Previous studies have shown that hyperbaric oxygen therapy (HBOT) can improve the motor functions and memory of post-stroke patients in the chronic stage. Objective: The aim of this study is to evaluate the effects of HBOT on overall cognitive functions of post-stroke patients in the chronic stage. The nature, type and location of the stroke were investigated as possible modifiers. Methods: A retrospective analysis was conducted on patients who were treated with HBOT for chronic stroke (>3 months) between 2008-2018. Participants were treated in a multi-place hyperbaric chamber with the following protocols: 40 to 60 daily sessions, 5 days per week, each session included 90 min of 100% oxygen at 2 ATA with 5 min air brakes every 20 minutes. Clinically significant improvements (CSI) were defined as > 0.5 standard deviation (SD). Results: The study included 162 patients (75.3% males) with a mean age of 60.75±12.91. Of them, 77(47.53%) had cortical strokes, 87(53.7%) strokes were located in the left hemisphere and 121 suffered ischemic strokes (74.6%). HBOT induced a significant increase in all the cognitive function domains (p < 0.05), with 86% of the stroke victims achieving CSI. There were no significant differences post-HBOT of cortical strokes compared to sub-cortical strokes (p > 0.05). Hemorrhagic strokes had a significantly higher improvement in information processing speed post-HBOT (p < 0.05). Left hemisphere strokes had a higher increase in the motor domain (p < 0.05). In all cognitive domains, the baseline cognitive function was a significant predictor of CSI (p < 0.05), while stroke type, location and side were not significant predictors. Conclusions: HBOT induces significant improvements in all cognitive domains even in the late chronic stage. The selection of post-stroke patients for HBOT should be based on functional analysis and baseline cognitive scores rather than the stroke type, location or side of lesion.
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Affiliation(s)
- Amir Hadanny
- Neurosurgery Department, Galilee Medical Center, Naharyia, Israel.,Sagol Center for Hyperbaric Medicine and Research, Assaf Harofeh Medical Center, Zerifin, Israel.,Galilee Faculty of Medicine, Bar Ilan University, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Mor Rittblat
- Sagol Center for Hyperbaric Medicine and Research, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Mor Bitterman
- Sagol Center for Hyperbaric Medicine and Research, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Ido May-Raz
- Sagol Center for Hyperbaric Medicine and Research, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Gil Suzin
- Sagol Center for Hyperbaric Medicine and Research, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Rahav Boussi-Gross
- Sagol Center for Hyperbaric Medicine and Research, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Yonatan Zemel
- Sagol Center for Hyperbaric Medicine and Research, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Yair Bechor
- Sagol Center for Hyperbaric Medicine and Research, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Merav Catalogna
- Sagol Center for Hyperbaric Medicine and Research, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Shai Efrati
- Sagol Center for Hyperbaric Medicine and Research, Assaf Harofeh Medical Center, Zerifin, Israel.,Research and Development Unit, Assaf Harofeh Medical Center, Zerifin, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
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8
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Murthy SB, Wu X, Diaz I, Parasram M, Parikh NS, Iadecola C, Merkler AE, Falcone GJ, Brown S, Biffi A, Ch'ang J, Knopman J, Stieg PE, Navi BB, Sheth KN, Kamel H. Non-Traumatic Subdural Hemorrhage and Risk of Arterial Ischemic Events. Stroke 2020; 51:1464-1469. [PMID: 32178587 DOI: 10.1161/strokeaha.119.028510] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background and Purpose- The risk of arterial ischemic events after subdural hemorrhage (SDH) is poorly understood. This study aimed to evaluate the risk of acute ischemic stroke and myocardial infarction among patients with and without nontraumatic SDH. Methods- We performed a retrospective cohort study using claims data from 2008 through 2014 from a nationally representative sample of Medicare beneficiaries. The exposure was nontraumatic SDH. Our primary outcome was an arterial ischemic event, a composite of acute ischemic stroke and acute myocardial infarction. Secondary outcomes were ischemic stroke alone and myocardial infarction alone. We used validated International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes to identify our predictor and outcomes. Using Cox regression and corresponding survival probabilities, adjusted for demographics and vascular comorbidities, we computed the hazard ratio in 4-week intervals after SDH discharge. We performed secondary analyses stratified by strong indications for antithrombotic therapy (composite of atrial fibrillation, peripheral vascular disease, valvular heart disease, and venous thromboembolism). Results- Among 1.7 million Medicare beneficiaries, 2939 were diagnosed with SDH. In the 4 weeks after SDH, patients' risk of an arterial ischemic event was substantially increased (hazard ratio, 3.6 [95% CI, 1.9-5.5]). There was no association between SDH diagnosis and arterial ischemic events beyond 4 weeks. In secondary analysis, during the 4 weeks after SDH, patients' risk of ischemic stroke was increased (hazard ratio, 4.2 [95% CI, 2.1-7.3]) but their risk of myocardial infarction was not (hazard ratio, 0.8 [95% CI, 0.2-1.7]). Patients with strong indications for antithrombotic therapy had increased risks for arterial ischemic events similar to patients in the primary analysis, but those without such indications did not demonstrate an increased risk for arterial ischemic events. Conclusions- Among Medicare beneficiaries, we found a heightened risk of arterial ischemic events driven by an increased risk of ischemic stroke, in the 4 weeks after nontraumatic SDH. This increased risk may be due to interruption of antithrombotic therapy after SDH diagnosis.
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Affiliation(s)
- Santosh B Murthy
- From the Clinical and Translational Neuroscience Unit, Department of Neurology, Feil Family Brain and Mind Research Institute (S.B.M., M.P., N.S.P., C.I., A.E.M., J.C., B.B.N., H.K.), Weill Cornell Medicine, New York, NY
| | - Xian Wu
- Department of Healthcare Policy and Research (X.W., I.D.), Weill Cornell Medicine, New York, NY
| | - Ivan Diaz
- Department of Healthcare Policy and Research (X.W., I.D.), Weill Cornell Medicine, New York, NY
| | - Melvin Parasram
- From the Clinical and Translational Neuroscience Unit, Department of Neurology, Feil Family Brain and Mind Research Institute (S.B.M., M.P., N.S.P., C.I., A.E.M., J.C., B.B.N., H.K.), Weill Cornell Medicine, New York, NY
| | - Neal S Parikh
- From the Clinical and Translational Neuroscience Unit, Department of Neurology, Feil Family Brain and Mind Research Institute (S.B.M., M.P., N.S.P., C.I., A.E.M., J.C., B.B.N., H.K.), Weill Cornell Medicine, New York, NY
| | - Costantino Iadecola
- From the Clinical and Translational Neuroscience Unit, Department of Neurology, Feil Family Brain and Mind Research Institute (S.B.M., M.P., N.S.P., C.I., A.E.M., J.C., B.B.N., H.K.), Weill Cornell Medicine, New York, NY
| | - Alexander E Merkler
- From the Clinical and Translational Neuroscience Unit, Department of Neurology, Feil Family Brain and Mind Research Institute (S.B.M., M.P., N.S.P., C.I., A.E.M., J.C., B.B.N., H.K.), Weill Cornell Medicine, New York, NY
| | - Guido J Falcone
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (G.J.F., S.B., K.N.S.)
| | - Stacy Brown
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (G.J.F., S.B., K.N.S.)
| | - Alessandro Biffi
- Center for Genomic Medicine (A.B.), Massachusetts General Hospital, Boston.,Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center (A.B.), Massachusetts General Hospital, Boston
| | - Judy Ch'ang
- From the Clinical and Translational Neuroscience Unit, Department of Neurology, Feil Family Brain and Mind Research Institute (S.B.M., M.P., N.S.P., C.I., A.E.M., J.C., B.B.N., H.K.), Weill Cornell Medicine, New York, NY
| | - Jared Knopman
- Department of Neurological Surgery (J.K., P.E.S.), Weill Cornell Medicine, New York, NY
| | - Philip E Stieg
- Department of Neurological Surgery (J.K., P.E.S.), Weill Cornell Medicine, New York, NY
| | - Babak B Navi
- From the Clinical and Translational Neuroscience Unit, Department of Neurology, Feil Family Brain and Mind Research Institute (S.B.M., M.P., N.S.P., C.I., A.E.M., J.C., B.B.N., H.K.), Weill Cornell Medicine, New York, NY
| | - Kevin N Sheth
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (G.J.F., S.B., K.N.S.)
| | - Hooman Kamel
- From the Clinical and Translational Neuroscience Unit, Department of Neurology, Feil Family Brain and Mind Research Institute (S.B.M., M.P., N.S.P., C.I., A.E.M., J.C., B.B.N., H.K.), Weill Cornell Medicine, New York, NY
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Lekoubou A, Bishu KG, Ovbiagele B. Stroke Thrombectomy Utilization Rates by Sex: What were Things Like before 2015? J Stroke Cerebrovasc Dis 2020; 29:104587. [PMID: 31899074 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104587] [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: 09/07/2019] [Accepted: 12/01/2019] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Little is known about any potential sex disparities in access to mechanical thrombectomy (MT), including before the pivotal clinical trials establishing MT as a standard of care for acute ischemic stroke management. METHODS All ischemic stroke patients included in the National Inpatient Sample between 2006 and 2014, were identified using the international classification of disease, Ninth Revision, Clinical Modification 433.X1, 434.X1, and 436. Those who received MT were identified using the procedure code 39.74. We computed the rate and trend in MT utilization among stroke patient by sex. We also applied a logistic regression model to examine the association between sex and the rate of MT, accounting for potential extraneous confounders. RESULTS Of the 520,963 (weighted 1,032,940) with ischemic stroke, 6049 (.59%) received mechanical thrombectomy (MT), including 3012 (.58%) women and 3037 (.60%) men (P = .2807). For both men and women the rate of MT increased by nearly 30-fold from .04% in 2006 to 1.13% in 2014. On univariate analysis there was no difference in annual change in the utilization of MT; however, after adjusting for confounders, women with ischemic stroke were 12% more likely to have received treatment with MT than their male counterparts. CONCLUSION The rate of MT has increased in both genders by nearly 30-fold in the 9 years preceding the publication of pivotal clinical trials on MT in 2015 with a 12% higher likelihood for women to receive MT after ischemic stroke.
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Affiliation(s)
- Alain Lekoubou
- Department of Neurology, Penn State University, Hershey, Pennsylvania.
| | - Kinfe G Bishu
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina; Section of Health Systems Research and Policy, Medical University of South Carolina, Charleston, South Carolina
| | - Bruce Ovbiagele
- Department of Neurology, University of California, San Francisco
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10
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Murthy SB, Diaz I, Wu X, Merkler AE, Iadecola C, Safford MM, Sheth KN, Navi BB, Kamel H. Risk of Arterial Ischemic Events After Intracerebral Hemorrhage. Stroke 2020; 51:137-142. [PMID: 31771458 PMCID: PMC7001742 DOI: 10.1161/strokeaha.119.026207] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 11/04/2019] [Indexed: 01/04/2023]
Abstract
Background and Purpose- The risk of arterial ischemic events after intracerebral hemorrhage (ICH) is poorly understood given the lack of a control group in prior studies. This study aimed to evaluate the risk of acute ischemic stroke and myocardial infarction (MI) among patients with and without ICH. Methods- We performed a retrospective cohort study using claims data from Medicare beneficiaries from 2008 to 2014. Our exposure was acute ICH, identified using validated International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. Our primary outcome was a composite of acute ischemic stroke and MI, whereas secondary outcomes were ischemic stroke alone and MI alone. We used Cox regression analysis to compute hazard ratios during 1-month intervals after ICH. Sensitivity analyses entailed exclusion of patients with atrial fibrillation and valvular heart disease. Results- Among 1 760 439 Medicare beneficiaries, 5924 had ICH. The 1-year cumulative incidence of an arterial ischemic event was 5.7% (95% CI, 4.8-6.8) in patients with ICH and 1.8% (95% CI, 1.7-1.9) in patients without ICH. After adjusting for potential confounders, the risk of an arterial ischemic event remained significantly increased for the first 6 months after ICH and was especially high in the first month (hazard ratio, 6.7 [95% CI, 5.0-8.6]). In secondary analysis, the risk of ischemic stroke was increased in the first 6 months after ICH (hazard ratio, 6.1 [95% CI, 3.5-9.3]) but the risk of MI was not (hazard ratio, 1.6 [95% CI, 0.3-2.9]). In sensitivity analyses excluding patients with atrial fibrillation and valvular heart disease, the association between ICH and arterial ischemic events was similar to that of the primary analysis. Conclusions- In a large population-based cohort, we found that elderly patients with ICH had a substantially increased risk of ischemic stroke in the first 6 months after diagnosis. Further exploration of this risk is needed to determine optimal secondary prevention strategies for these patients.
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Affiliation(s)
- Santosh B Murthy
- From the Clinical and Translational Neuroscience Unit, Department of Neurology, Feil Family Brain and Mind Research Institute (S.B.M., I.D., X.W., A.E.M., C.I., B.B.N., H.K.), Weill Cornell Medicine, New York, NY
| | - Ivan Diaz
- From the Clinical and Translational Neuroscience Unit, Department of Neurology, Feil Family Brain and Mind Research Institute (S.B.M., I.D., X.W., A.E.M., C.I., B.B.N., H.K.), Weill Cornell Medicine, New York, NY
- Department of Healthcare Policy and Research (I.D., X.W.), Weill Cornell Medicine, New York, NY
| | - Xian Wu
- From the Clinical and Translational Neuroscience Unit, Department of Neurology, Feil Family Brain and Mind Research Institute (S.B.M., I.D., X.W., A.E.M., C.I., B.B.N., H.K.), Weill Cornell Medicine, New York, NY
- Department of Healthcare Policy and Research (I.D., X.W.), Weill Cornell Medicine, New York, NY
| | - Alexander E Merkler
- From the Clinical and Translational Neuroscience Unit, Department of Neurology, Feil Family Brain and Mind Research Institute (S.B.M., I.D., X.W., A.E.M., C.I., B.B.N., H.K.), Weill Cornell Medicine, New York, NY
| | - Costantino Iadecola
- From the Clinical and Translational Neuroscience Unit, Department of Neurology, Feil Family Brain and Mind Research Institute (S.B.M., I.D., X.W., A.E.M., C.I., B.B.N., H.K.), Weill Cornell Medicine, New York, NY
| | - Monika M Safford
- Department of Internal Medicine (M.M.S.), Weill Cornell Medicine, New York, NY
| | - Kevin N Sheth
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (K.N.S.)
| | - Babak B Navi
- From the Clinical and Translational Neuroscience Unit, Department of Neurology, Feil Family Brain and Mind Research Institute (S.B.M., I.D., X.W., A.E.M., C.I., B.B.N., H.K.), Weill Cornell Medicine, New York, NY
| | - Hooman Kamel
- From the Clinical and Translational Neuroscience Unit, Department of Neurology, Feil Family Brain and Mind Research Institute (S.B.M., I.D., X.W., A.E.M., C.I., B.B.N., H.K.), Weill Cornell Medicine, New York, NY
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11
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Chan SL, Bishop N, Li Z, Cipolla MJ. Inhibition of PAI (Plasminogen Activator Inhibitor)-1 Improves Brain Collateral Perfusion and Injury After Acute Ischemic Stroke in Aged Hypertensive Rats. Stroke 2019; 49:1969-1976. [PMID: 29991657 DOI: 10.1161/strokeaha.118.022056] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background and Purpose- Aging and hypertension, comorbidities prevalent in the stroke population, are associated with poor collateral status and worsened stroke outcome. However, underlying mechanisms by which these conditions affect stroke outcome are not clear. We studied the role of PAI (plasminogen activator inhibitor)-1 that is increased in aging and hypertension on brain and vascular expression of inflammatory factors and perfusion that may contribute to worse stroke outcomes. Methods- Aged (≈50 weeks) and young (≈18 weeks) spontaneously hypertensive rats (SHR) were subjected to ischemia by middle cerebral artery occlusion (2 hours) and reperfusion (2 hours) with or without treatment with the PAI-1 inhibitor TM5441. Changes in middle cerebral artery and collateral perfusion territories were measured by multisite laser Doppler. Reactivity to TM5441 was studied using isolated and pressurized leptomeningeal anastomotic arterioles. Brain injury was determined by 2,3,5-triphenyltetrazolium staining and quantitative immunohistochemistry of amyloid-β-42, PAI-1, and hemoglobin. Circulating inflammatory factors were measured by ELISA. Results- Changes in cerebral blood flow during middle cerebral artery occlusion were similar between groups, with both having poor collateral perfusion and incomplete reperfusion. However, aged SHR had greater brain injury versus young (41±2 versus 23±2%, P<0.05) as well as increased brain deposition of amyloid-β-42 and circulating oxLDL (oxidized low-density lipoprotein). Erythrocyte aggregation and hemorrhage within the injured brain was observed in 50% of aged but no young SHR, with increased circulating PAI-1 in this subgroup of aged SHR (16±3 versus 6±2 ng/mL, P<0.05). PAI-1 inhibition with TM5441 improved brain injury but did not affect hemorrhage. TM5441 increased collateral perfusion by 38±7% and dilated leptomeningeal anastomotic arterioles by 44±10%, which was abolished by nitric oxide synthase inhibition. Conclusions- Increased injury in aged SHR seemed to be related to poor collateral perfusion, hemorrhagic transformation, increased amyloid-β-42, and oxidative stress. PAI-1 inhibition reduced infarction in both groups of SHR that possibly due, in part, to increased collateral perfusion.
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Affiliation(s)
- Siu-Lung Chan
- From the Departments of Neurological Sciences (S.-L.C., N.B., Z.L., M.J.C.)
| | - Nicole Bishop
- From the Departments of Neurological Sciences (S.-L.C., N.B., Z.L., M.J.C.)
| | - Zhaojin Li
- From the Departments of Neurological Sciences (S.-L.C., N.B., Z.L., M.J.C.)
| | - Marilyn J Cipolla
- From the Departments of Neurological Sciences (S.-L.C., N.B., Z.L., M.J.C.).,Obstetrics, Gynecology and Reproductive Sciences (M.J.C.).,Pharmacology (M.J.C.), University of Vermont Larner College of Medicine, Burlington
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12
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Reynolds AS, Chen ML, Merkler AE, Chatterjee A, Díaz I, Navi BB, Kamel H. Effect of A Randomized trial of Unruptured Brain Arteriovenous Malformation on Interventional Treatment Rates for Unruptured Arteriovenous Malformations. Cerebrovasc Dis 2019; 47:299-302. [PMID: 31434094 DOI: 10.1159/000502314] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 07/17/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In 2013, investigators from A Randomized Trial of Unruptured Brain Arteriovenous Malformations (AVM; ARUBA) reported that interventions to obliterate unruptured AVMs caused more morbidity and mortality than medical management. OBJECTIVE We sought to determine whether interventions for unruptured AVM decreased after publication of ARUBA results. METHODS We used the Nationwide Readmissions Database to assess trends in interventional AVM management in patients ≥18 years of age from 2010 through 2015. Unruptured brain AVMs were identified using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code 747.81 and excluding any patient with a diagnosis of intracranial hemorrhage. Our primary outcome was interventional AVM treatment, identified using ICD-9-CM procedure codes for surgical resection, endovascular therapy, and stereotactic radiosurgery. Join-point regression was used to assess trends in the incidence of interventional AVM management among adults from 2010 through 2015. RESULTS There was no significant U.S. population level change in unruptured brain AVM intervention rates before versus after ARUBA (p = 0.59), with the incidence of AVM intervention ranging from 8.0 to 9.2 per 10 million U.S. residents before the trial publication to 7.7-8.3 per 10 million afterwards. CONCLUSIONS In a nationally representative sample, we found no change in rates of interventional unruptured AVM management after publication of the ARUBA trial results.
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Affiliation(s)
- Alexandra S Reynolds
- Department of Neurology, Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, New York, New York, USA.,Department of Neurology, Columbia College of Physicians and Surgeons, New York, New York, USA
| | - Monica L Chen
- Department of Neurology, Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, New York, New York, USA
| | - Alexander E Merkler
- Department of Neurology, Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, New York, New York, USA
| | - Abhinaba Chatterjee
- Department of Neurology, Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, New York, New York, USA
| | - Iván Díaz
- Department of Neurology, Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, New York, New York, USA.,Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, USA
| | - Babak B Navi
- Department of Neurology, Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, New York, New York, USA
| | - Hooman Kamel
- Department of Neurology, Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, New York, New York, USA,
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13
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Ai Q, Chen C, Chu S, Luo Y, Zhang Z, Zhang S, Yang P, Gao Y, Zhang X, Chen N. IMM-H004 Protects against Cerebral Ischemia Injury and Cardiopulmonary Complications via CKLF1 Mediated Inflammation Pathway in Adult and Aged Rats. Int J Mol Sci 2019; 20:E1661. [PMID: 30987181 PMCID: PMC6480569 DOI: 10.3390/ijms20071661] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 03/31/2019] [Accepted: 04/02/2019] [Indexed: 12/30/2022] Open
Abstract
(1) Background: Chemokine-like factor 1 (CKLF1) is a chemokine with potential to be a target for stroke therapy. Compound IMM-H004 is a novel coumarin derivative screened from a CKLF1/C-C chemokine receptor type 4 (CCR4) system and has been reported to improve cerebral ischemia/reperfusion injury. This study aims to investigate the protective effects of IMM-H004 on cerebral ischemia injury and its infectious cardiopulmonary complications in adult and aged rats from the CKLF1 perspective. (2) Methods: The effects of IMM-H004 on the protection was determined by 2,3,5-triphenyltetrazolium chloride (TTC) staining, behavior tests, magnetic resonance imaging (MRI) scans, enzyme-linked immunosorbent assay (ELISA), Nissl staining, histo-pathological examination, and cardiopulmonary function detection. Immunohistological staining, immunofluorescence staining, quantitative real-time PCR (qPCR), and western blotting were used to elucidate the underlying mechanisms. (3) Results: IMM-H004 protects against cerebral ischemia induced brain injury and its cardiopulmonary complications, inhibiting injury, and inflammation through CKLF1-dependent anti-inflammation pathway in adult and aged rats. IMM-H004 downregulates the amount of CKLF1, suppressing the followed inflammatory response, and further protects the damaged organs from ischemic injury. (4) Conclusions: The present study suggested that the protective mechanism of IMM-H004 is dependent on CKLF1, which will lead to excessive inflammatory response in cerebral ischemia. IMM-H004 could also be a therapeutic agent in therapy for ischemic stroke and cardiopulmonary complications in the aged population.
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Affiliation(s)
- Qidi Ai
- Hunan Engineering Technology Center of Standardization and Function of Chinese Herbal Decoction Pieces & College of Pharmacy, Hunan University of Chinese Medicine, Changsha 410208, China.
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica & Neuroscience Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100050, China.
| | - Chen Chen
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica & Neuroscience Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100050, China.
| | - Shifeng Chu
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica & Neuroscience Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100050, China.
| | - Yun Luo
- Institute of Medicinal Plant Development, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100193, China.
| | - Zhao Zhang
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica & Neuroscience Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100050, China.
| | - Shuai Zhang
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica & Neuroscience Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100050, China.
| | - Pengfei Yang
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica & Neuroscience Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100050, China.
| | - Yan Gao
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica & Neuroscience Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100050, China.
| | - Xiaoling Zhang
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica & Neuroscience Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100050, China.
| | - Naihong Chen
- Hunan Engineering Technology Center of Standardization and Function of Chinese Herbal Decoction Pieces & College of Pharmacy, Hunan University of Chinese Medicine, Changsha 410208, China.
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica & Neuroscience Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100050, China.
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14
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English SW, McIntyre L, Saigle V, Chassé M, Fergusson DA, Turgeon AF, Lauzier F, Griesdale D, Garland A, Zarychanski R, Algird A, van Walraven C. The Ottawa SAH search algorithms: protocol for a multi- centre validation study of primary subarachnoid hemorrhage prediction models using health administrative data (the SAHepi prediction study protocol). BMC Med Res Methodol 2018; 18:94. [PMID: 30219029 PMCID: PMC6139177 DOI: 10.1186/s12874-018-0553-3] [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] [Received: 03/11/2018] [Accepted: 08/31/2018] [Indexed: 01/07/2023] Open
Abstract
Background Conducting prospective epidemiological studies of hospitalized patients with rare diseases like primary subarachnoid hemorrhage (pSAH) are difficult due to time and budgetary constraints. Routinely collected administrative data could remove these barriers. We derived and validated 3 algorithms to identify hospitalized patients with a high probability of pSAH using administrative data. We aim to externally validate their performance in four hospitals across Canada. Methods Eligible patients include those ≥18 years of age admitted to these centres from January 1, 2012 to December 31, 2013. We will include patients whose discharge abstracts contain predictive variables identified in the models (ICD-10-CA diagnostic codes I60** (subarachnoid hemorrhage), I61** (intracranial hemorrhage), 162** (other nontrauma intracranial hemorrhage), I67** (other cerebrovascular disease), S06** (intracranial injury), G97 (other postprocedural nervous system disorder) and CCI procedural codes 1JW51 (occlusion of intracranial vessels), 1JE51 (carotid artery inclusion), 3JW10 (intracranial vessel imaging), 3FY20 (CT scan (soft tissue of neck)), and 3OT20 (CT scan (abdominal cavity)). The algorithms will be applied to each patient and the diagnosis confirmed via chart review. We will assess each model’s sensitivity, specificity, negative and positive predictive value across the sites. Discussion Validating the Ottawa SAH Prediction Algorithms will provide a way to accurately identify large SAH cohorts, thereby furthering research and altering care.
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Affiliation(s)
- S W English
- Department of Medicine (Critical Care), University of Ottawa, Ottawa, ON, K1Y 4E9, Canada. .,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
| | - L McIntyre
- Department of Medicine (Critical Care), University of Ottawa, Ottawa, ON, K1Y 4E9, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - V Saigle
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - M Chassé
- Department of Medicine, Division of Critical Care, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - D A Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - A F Turgeon
- Centre de recherche du CHU de Québec, Population Health and Optimal Health Practices Research Unit (Trauma - Emergency - Critical Care Medicine), Université Laval, Québec City, QC, Canada.,Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec City, QC, Canada
| | - F Lauzier
- Centre de recherche du CHU de Québec, Population Health and Optimal Health Practices Research Unit (Trauma - Emergency - Critical Care Medicine), Université Laval, Québec City, QC, Canada.,Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec City, QC, Canada.,Centre de recherche du Centre Hospitalier de l'Université de Québec, Université Laval, Québec City, QC, Canada
| | - D Griesdale
- Deparment of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, Canada
| | - A Garland
- Department of Internal Medicine, Sections of Critical Care and Respirology, University of Manitoba, Winnipeg, MB, Canada
| | - R Zarychanski
- Department of Internal Medicine, Sections of Critical Care and Hematology/Medical Oncology, University of Manitoba, Winnipeg, MB, Canada
| | - A Algird
- Department of Neurosurgy, McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada
| | - C van Walraven
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Department of Medicine, University of Ottawa, Ottawa, Canada
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15
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Zhao J, Li X, Liang Y, Zhao L, Zhang X, Liu Y. Evaluation of the implementation of a 24-hr stroke thrombolysis emergency treatment for patients with acute ischaemic stroke. J Clin Nurs 2018; 27:2161-2167. [PMID: 29345016 DOI: 10.1111/jocn.14272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2018] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To assess the trends of intravenous (IV) thrombolysis with recombinant tissue plasminogen activator (rt-PA) among patients with acute ischaemic stroke (AIS) admitted to our hospital between 2012-2014 and investigate the effects of a 24-hr stroke thrombolysis emergency treatment on the intrahospital clinical data and outcomes of these patients treated with IV rt-PA thrombolysis. BACKGROUND Although prenotification of stroke by emergency medical services has been endorsed by the national recommendations and implemented in some developed countries, the development in China is limited. DESIGN A retrospective, single-centre, observational study. METHODS Patients with AIS admitted to our hospital between January 2012-December 2014 were included; those who received IV rt-PA thrombolysis within 4.5 hr of onset were investigated. Demographic characteristics, including age and sex, and clinical data and outcomes, including onset-to-treatment time (OTT), door-to-needle time (DNT), premorbid modified Rankin Scale score and proportion of patients treated per year, were all recorded. RESULTS The proportion of patients with AIS who received thrombolytic therapy within 4.5 hr increased from 2012-2014. The baseline characteristics of all patients were similar. Since the implementation of 24-hr stroke thrombolysis emergency treatment in 2013, the median DNT significantly decreased in 2014 after implementation (42 min) compared with that in 2012 before implementation (81 min) (p < .05). Moreover, the admission-to-imaging time (37 vs. 33 vs. 36 min) and OTT (176 vs. 147 vs. 124 min) significantly decreased during the 3 years (p < .05). CONCLUSIONS The 24-hr stroke thrombolysis emergency treatment reduced in-hospital delay before thrombolytic therapy but had no effect on the functional outcomes of the patients with AIS. RELEVANCE TO CLINICAL PRACTICE This study provides opportunities to improve the experiences in using 24-h stroke thrombolysis emergency treatment in patients with AIS in clinical practice.
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Affiliation(s)
- Jun Zhao
- Department of Neurology, Taian City Central Hospital, Taian, China
| | - Xingqiang Li
- Department of Emergency, Shandong Coal Taishan Sanatorium, Taian, China
| | - Yingchun Liang
- Department of Neurology, Taian City Central Hospital, Taian, China
| | - Liang Zhao
- Department of Orthopaedics, Taian City Central Hospital, Taian, China
| | - Xinping Zhang
- Department of Neurology, Taian City Central Hospital, Taian, China
| | - Yunlin Liu
- Department of Neurology, Taian City Central Hospital, Taian, China
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16
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Murthy SB, Moradiya Y, Shah J, Merkler AE, Mangat HS, Iadacola C, Hanley DF, Kamel H, Ziai WC. Nosocomial Infections and Outcomes after Intracerebral Hemorrhage: A Population-Based Study. Neurocrit Care 2017; 25:178-84. [PMID: 27350549 DOI: 10.1007/s12028-016-0282-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Infections after intracerebral hemorrhage (ICH) may be associated with worse outcomes. We aimed to evaluate the association between nosocomial infections (>48 h) and outcomes of ICH at a population level. METHODS We identified patients with ICH using ICD-9-CM codes in the 2002-2011 Nationwide Inpatient Sample. Demographics, comorbidities, surgical procedures, and hospital characteristics were compared between patients with and without concomitant nosocomial infections. Primary outcomes were in-hospital mortality and home discharge. Secondary outcome was permanent cerebrospinal shunt placement. Logistic regression analyses were used to analyze the association between infections and outcomes. RESULTS Among 509,516 ICH patients, infections occurred in 117,636 (23.1 %). Rates of infections gradually increased from 18.7 % in 2002-2003 to 24.1 % in 2010-2011. Pneumonia was the most common nosocomial infection (15.4 %) followed by urinary tract infection (UTI) (7.9 %). Patients with infections were older (p < 0.001), predominantly female (56.9 % vs. 47.9 %, p < 0.001), and more often black (15.0 % vs. 13.4 %, p < 0.001). Nosocomial infection was associated with longer hospital stay (11 vs. 5 days, p < 0.001) and a more than twofold higher cost of care (p < 0.001). In the adjusted regression analysis, patients with infection had higher odds of mortality [odds ratio (OR) 2.11, 95 % CI 2.08-2.14] and cerebrospinal shunt placement (OR 2.19, 95 % CI 2.06-2.33) and lower odds of home discharge (OR 0.49, 95 % CI 0.47-0.51). Similar results were observed in subgroup analyses of individual infections. CONCLUSIONS In a nationally representative cohort of ICH patients, nosocomial infection was associated with worse outcomes and greater resource utilization.
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Affiliation(s)
- Santosh B Murthy
- Division of Stroke and Neurocritical Care, Department of Neurology, Weill Cornell Medical College, 525 E 68th Street, New York, NY, 10065, USA. .,Clinical and Translational Neuroscience Unit, Feil Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY, USA.
| | - Yogesh Moradiya
- Department of Neurosurgery, Northwell Long Island Jewish School of Medicine, New York, NY, USA
| | - Jharna Shah
- Division of Neurosciences Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alexander E Merkler
- Division of Stroke and Neurocritical Care, Department of Neurology, Weill Cornell Medical College, 525 E 68th Street, New York, NY, 10065, USA
| | - Halinder S Mangat
- Division of Stroke and Neurocritical Care, Department of Neurology, Weill Cornell Medical College, 525 E 68th Street, New York, NY, 10065, USA
| | - Costantino Iadacola
- Division of Stroke and Neurocritical Care, Department of Neurology, Weill Cornell Medical College, 525 E 68th Street, New York, NY, 10065, USA.,Clinical and Translational Neuroscience Unit, Feil Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY, USA
| | - Daniel F Hanley
- Division of Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hooman Kamel
- Division of Stroke and Neurocritical Care, Department of Neurology, Weill Cornell Medical College, 525 E 68th Street, New York, NY, 10065, USA.,Clinical and Translational Neuroscience Unit, Feil Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY, USA
| | - Wendy C Ziai
- Division of Neurosciences Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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17
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Incidence, Predictors, and Outcomes of Ventriculostomy-Associated Infections in Spontaneous Intracerebral Hemorrhage. Neurocrit Care 2017; 24:389-96. [PMID: 26337068 DOI: 10.1007/s12028-015-0199-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The impact of ventriculostomy-associated infections (VAI) on intracerebral hemorrhage (ICH) outcomes has not been clearly established, although prior studies have attempted to address the incidence and predictors of VAI. We aimed to explore VAI characteristics and its effect on ICH outcomes at a population level. METHODS ICH patients requiring ventriculostomy with and without VAI were identified from 2002 to 2011 Nationwide Inpatient Sample using ICD-9 codes. A retrospective cohort study was performed. Demographics, comorbidities, hospital characteristics, inpatient outcomes, and resource utilization measures were compared between the two groups. Pearson's Chi-square and Wilcoxon-Mann-Whitney tests were used for categorical and continuous variables, respectively. Logistic regression was used to analyze the predictors of VAI. RESULTS We included 34,238 patients in the analysis, of whom 1934 (5.6 %) had VAI. The rate of ventriculostomy utilization in ICH increased from 5.7 % in 2002-2003 to 7.0 % in 2010-2011 (trend p < 0.001) and the rate of VAI also showed a gradual upward trend from 6.1 to 7.0 % across the same interval (trend p < 0.001). The VAI group had significantly higher inpatient mortality (41.2 vs. 36.5 %, p < 0.001) and it remained higher after controlling for baseline demographics, hospital characteristics, comorbidity, and systemic infections (adjusted OR 1.38, 95 % CI 1.22-1.46, p < 0.001). The VAI group had longer length of hospital stay and higher inflation adjusted cost of care. Predictors of VAI included higher age, males, higher Charlson's comorbidity scores, longer length of stay, and presence of systemic infections mainly pneumonia and sepsis. CONCLUSION VAI resulted in higher inpatient mortality, more unfavorable discharge disposition, and higher resource utilization measures in ICH patients. Steps to mitigate VAI may help improve ICH outcomes and decrease hospital costs.
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18
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Robotics in Lower-Limb Rehabilitation after Stroke. Behav Neurol 2017; 2017:3731802. [PMID: 28659660 PMCID: PMC5480018 DOI: 10.1155/2017/3731802] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 04/02/2017] [Accepted: 04/10/2017] [Indexed: 12/02/2022] Open
Abstract
With the increase in the elderly, stroke has become a common disease, often leading to motor dysfunction and even permanent disability. Lower-limb rehabilitation robots can help patients to carry out reasonable and effective training to improve the motor function of paralyzed extremity. In this paper, the developments of lower-limb rehabilitation robots in the past decades are reviewed. Specifically, we provide a classification, a comparison, and a design overview of the driving modes, training paradigm, and control strategy of the lower-limb rehabilitation robots in the reviewed literature. A brief review on the gait detection technology of lower-limb rehabilitation robots is also presented. Finally, we discuss the future directions of the lower-limb rehabilitation robots.
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19
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Clissold BB, Sundararajan V, Cameron P, McNeil J. Stroke Incidence in Victoria, Australia-Emerging Improvements. Front Neurol 2017; 8:180. [PMID: 28522987 PMCID: PMC5415672 DOI: 10.3389/fneur.2017.00180] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 04/18/2017] [Indexed: 11/13/2022] Open
Abstract
Background Evidence of a decline in the incidence of stroke has emerged from population-based studies. These have included retrospective and prospective cohorts. However, in Australia and other countries, government bodies and stroke foundations predict a rise in the prevalence of stroke that is anticipated to increase the burden of stroke across the entire domain of care. This increase in prevalence must be viewed as different from the decline in incidence being observed, a measure of new stroke cases. In Victoria, all public emergency department visits and public and private hospital admissions are reported to the Department of Health and Human Services and include demographic, diagnostic, and procedural/treatment information. Methods We obtained data from financial years 1997/1998 to 2007/2008 inclusive, for all cases with a primary stroke diagnosis (ICD-10-AM categories) with associated data fields. Incident cases were established by using a 5-year clearance period. Results From 2003/2004 to 2007/2008 inclusive, there were 53,425 patients with a primary stroke or TIA diagnosis. The crude incident stroke rate for first ever stroke was 211 per 100,000 per year (95% CI 205–217) [females—205 per 100,000 per year (95% CI 196–214) and males—217 per 100,000 per year (95% CI 210–224)]. The overall stroke rates were seen to significantly decline over the period [males (per 100,000 per year) 227 in 2003/2004 to 202 in 2007/2008 (p = 0.0157) and females (per 100,000 per year) 214 in 2003/2004 to 188 in 2007/2008 (p = 0.0482)]. Ischemic stroke rates also appeared to decline; however, this change was not significant. Conclusion These results demonstrate a significant decline in stroke incidence during the study period and may suggest evidence for effectiveness of primary and secondary prevention strategies in cerebrovascular risk factor management.
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Affiliation(s)
- Benjamin B Clissold
- Stroke Unit, Monash Medical Centre, Clayton, VIC, Australia.,Stroke and Ageing Research Group, Department of Medicine, Monash University, Clayton, VIC, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Clayton, VIC, Australia
| | | | - Peter Cameron
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, VIC, Australia
| | - John McNeil
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, VIC, Australia
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20
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Murthy SB, Merkler AE, Omran SS, Gialdini G, Gusdon A, Hartley B, Roh D, Mangat HS, Iadecola C, Navi BB, Kamel H. Outcomes after intracerebral hemorrhage from arteriovenous malformations. Neurology 2017; 88:1882-1888. [PMID: 28424275 DOI: 10.1212/wnl.0000000000003935] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 01/11/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare outcomes after intracerebral hemorrhage (ICH) from cerebral arteriovenous malformation (AVM) rupture and other causes of ICH. METHODS We performed a retrospective population-based study using data from the Nationwide Inpatient Sample. We used standard diagnosis codes to identify ICH cases from 2002 to 2011. Our predictor variable was cerebral AVM. Our primary outcomes were inpatient mortality and home discharge. We used logistic regression to compare outcomes between patients with ICH with and without AVM while adjusting for demographics, comorbidities, and hospital characteristics. In a confirmatory analysis using a prospective cohort of patients hospitalized with ICH at our institution, we additionally adjusted for hematoma characteristics and the Glasgow Coma Scale score. RESULTS Among 619,167 ICH hospitalizations, the 4,485 patients (0.7%, 95% confidence interval [CI] 0.6-0.8) with an AVM were younger and had fewer medical comorbidities than patients without AVM. After adjustment for confounders, patients with AVM had lower odds of death (odds ratio [OR] 0.5, 95% CI 0.4-0.7) and higher odds of home discharge (OR 2.0, 95% CI 1.4-3.0) than patients without AVM. In a confirmatory analysis of 342 patients with ICH at our institution, the 34 patients (9.9%, 95% CI 7.2-13.6) with a ruptured AVM had higher odds of ambulatory independence at discharge (OR 4.4, 95% CI 1.4-13.1) compared to patients without AVM. CONCLUSIONS Patients with ICH due to ruptured AVM have more favorable outcomes than patients with ICH from other causes.
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Affiliation(s)
- Santosh B Murthy
- From the Department of Neurology (S.B.M., A.E.M., S.S.O., A.G., H.S.M., C.I., B.B.N., H.K.), Clinical and Translational Neuroscience Unit (S.B.M., A.E.M., G.G., C.I., B.B.N., H.K.), Feil Family Brain and Mind Research Institute, and Department of Neurological Surgery (B.H., H.S.M.), Weill Cornell Medicine; and Department of Neurology (D.R.), Columbia College of Physicians and Surgeons, New York, NY.
| | - Alexander E Merkler
- From the Department of Neurology (S.B.M., A.E.M., S.S.O., A.G., H.S.M., C.I., B.B.N., H.K.), Clinical and Translational Neuroscience Unit (S.B.M., A.E.M., G.G., C.I., B.B.N., H.K.), Feil Family Brain and Mind Research Institute, and Department of Neurological Surgery (B.H., H.S.M.), Weill Cornell Medicine; and Department of Neurology (D.R.), Columbia College of Physicians and Surgeons, New York, NY
| | - Setareh Salehi Omran
- From the Department of Neurology (S.B.M., A.E.M., S.S.O., A.G., H.S.M., C.I., B.B.N., H.K.), Clinical and Translational Neuroscience Unit (S.B.M., A.E.M., G.G., C.I., B.B.N., H.K.), Feil Family Brain and Mind Research Institute, and Department of Neurological Surgery (B.H., H.S.M.), Weill Cornell Medicine; and Department of Neurology (D.R.), Columbia College of Physicians and Surgeons, New York, NY
| | - Gino Gialdini
- From the Department of Neurology (S.B.M., A.E.M., S.S.O., A.G., H.S.M., C.I., B.B.N., H.K.), Clinical and Translational Neuroscience Unit (S.B.M., A.E.M., G.G., C.I., B.B.N., H.K.), Feil Family Brain and Mind Research Institute, and Department of Neurological Surgery (B.H., H.S.M.), Weill Cornell Medicine; and Department of Neurology (D.R.), Columbia College of Physicians and Surgeons, New York, NY
| | - Aaron Gusdon
- From the Department of Neurology (S.B.M., A.E.M., S.S.O., A.G., H.S.M., C.I., B.B.N., H.K.), Clinical and Translational Neuroscience Unit (S.B.M., A.E.M., G.G., C.I., B.B.N., H.K.), Feil Family Brain and Mind Research Institute, and Department of Neurological Surgery (B.H., H.S.M.), Weill Cornell Medicine; and Department of Neurology (D.R.), Columbia College of Physicians and Surgeons, New York, NY
| | - Benjamin Hartley
- From the Department of Neurology (S.B.M., A.E.M., S.S.O., A.G., H.S.M., C.I., B.B.N., H.K.), Clinical and Translational Neuroscience Unit (S.B.M., A.E.M., G.G., C.I., B.B.N., H.K.), Feil Family Brain and Mind Research Institute, and Department of Neurological Surgery (B.H., H.S.M.), Weill Cornell Medicine; and Department of Neurology (D.R.), Columbia College of Physicians and Surgeons, New York, NY
| | - David Roh
- From the Department of Neurology (S.B.M., A.E.M., S.S.O., A.G., H.S.M., C.I., B.B.N., H.K.), Clinical and Translational Neuroscience Unit (S.B.M., A.E.M., G.G., C.I., B.B.N., H.K.), Feil Family Brain and Mind Research Institute, and Department of Neurological Surgery (B.H., H.S.M.), Weill Cornell Medicine; and Department of Neurology (D.R.), Columbia College of Physicians and Surgeons, New York, NY
| | - Halinder S Mangat
- From the Department of Neurology (S.B.M., A.E.M., S.S.O., A.G., H.S.M., C.I., B.B.N., H.K.), Clinical and Translational Neuroscience Unit (S.B.M., A.E.M., G.G., C.I., B.B.N., H.K.), Feil Family Brain and Mind Research Institute, and Department of Neurological Surgery (B.H., H.S.M.), Weill Cornell Medicine; and Department of Neurology (D.R.), Columbia College of Physicians and Surgeons, New York, NY
| | - Costantino Iadecola
- From the Department of Neurology (S.B.M., A.E.M., S.S.O., A.G., H.S.M., C.I., B.B.N., H.K.), Clinical and Translational Neuroscience Unit (S.B.M., A.E.M., G.G., C.I., B.B.N., H.K.), Feil Family Brain and Mind Research Institute, and Department of Neurological Surgery (B.H., H.S.M.), Weill Cornell Medicine; and Department of Neurology (D.R.), Columbia College of Physicians and Surgeons, New York, NY
| | - Babak B Navi
- From the Department of Neurology (S.B.M., A.E.M., S.S.O., A.G., H.S.M., C.I., B.B.N., H.K.), Clinical and Translational Neuroscience Unit (S.B.M., A.E.M., G.G., C.I., B.B.N., H.K.), Feil Family Brain and Mind Research Institute, and Department of Neurological Surgery (B.H., H.S.M.), Weill Cornell Medicine; and Department of Neurology (D.R.), Columbia College of Physicians and Surgeons, New York, NY
| | - Hooman Kamel
- From the Department of Neurology (S.B.M., A.E.M., S.S.O., A.G., H.S.M., C.I., B.B.N., H.K.), Clinical and Translational Neuroscience Unit (S.B.M., A.E.M., G.G., C.I., B.B.N., H.K.), Feil Family Brain and Mind Research Institute, and Department of Neurological Surgery (B.H., H.S.M.), Weill Cornell Medicine; and Department of Neurology (D.R.), Columbia College of Physicians and Surgeons, New York, NY
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Ojaghihaghighi S, Vahdati SS, Mikaeilpour A, Ramouz A. Comparison of neurological clinical manifestation in patients with hemorrhagic and ischemic stroke. World J Emerg Med 2017; 8:34-38. [PMID: 28123618 DOI: 10.5847/wjem.j.1920-8642.2017.01.006] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cerebrovascular accident (CVA) is the third leading cause of death and disability in developed countries. Anyone suspected of having a stroke should be taken immediately to a medical facility for diagnosis and treatment. The symptoms that follow a stroke aren't significant and depend on the area of the brain that has been affected and the amount of tissue damaged. Parameters for predicting long-term outcome in such patients have not been clearly delineated, therefore the aim of this study was to investigate this possibility and to test a system that might practicably be used routinely to aid management and predict outcomes of individual stroke patients. METHODS A descriptive hospital-based study of the neurological symptoms and signs of 503 patients with ischemic stroke, including severe headache, seizure, eye movement disorder, pupil size, Glasgow Coma Scale (GCS), agitation were analyzed in this study. RESULTS In the current study, dilated pupils, agitation, acute onset headache, lower GCS score, seizure, and eye gaze impairment had significantly higher prevalence in hemorrhagic stroke patients (P<0.001). However, the rate of gradual progressive headache is significantly higher in ischemic stroke patients (P<0.001). CONCLUSION Although this result provides reliable indicators for discrimination of stroke types, imaging studies are still the gold standard modality for diagnosis.
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Affiliation(s)
| | - Samad Shams Vahdati
- Road Traffic Injury Research Center, Tabriz University of Medical Science, Tabriz, Iran
| | | | - Ali Ramouz
- Medicine Faculty and Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
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22
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Han EY, Kim BR, Joo SJ, Lee CS, Kang SY, Kim SY, Choi JH, Hyun CW. Arterial Stiffness in Subacute Stroke: Changing Pattern and Relationship with Functional Recovery. J Stroke Cerebrovasc Dis 2016; 26:922-929. [PMID: 28007328 DOI: 10.1016/j.jstrokecerebrovasdis.2016.10.040] [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: 08/03/2016] [Revised: 10/05/2016] [Accepted: 10/31/2016] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND To examine changing patterns in arterial stiffness and functional outcome in patients with subacute stroke, and to determine which parameter shows a strong correlation with the reversal of arterial stiffness, during a 3-month period of comprehensive rehabilitation therapy. METHODS This descriptive, observational cohort study enrolled 60 patients (43 male and 17 female; average age, 62.7 years), and all received conventional rehabilitation therapy, during a 3-month period. Brachial-ankle pulse wave velocity (baPWV) was measured as an index of arterial stiffness. Functional assessments included the 6-minute walk test (6MWT), Fugl-Meyer Assessment of hemiparetic upper and lower limbs, the functional ambulatory category, the Berg balance scale, the Korean Mini-Mental Status Examination, and the Korean-Modified Barthel Index. All measurements were conducted at baseline and 1 and 3 months after stroke onset. RESULTS Rehabilitation therapy resulted in a statistically significant improvement in baPWV since 3 months post stroke. Another functional outcome measure showed statistically significant improvements since 1 month after rehabilitation. Multivariable linear regression analysis revealed that a change in baPWV was significantly correlated with changes in the 6MWT. CONCLUSIONS Three months of comprehensive rehabilitation therapy led to statistically significant improvements in arterial stiffness and functional outcomes during the subacute phase of stroke. Thus, the comprehensive rehabilitation focused on improving gait endurance would be warranted in subacute stroke patients.
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Affiliation(s)
- Eun Young Han
- Department of Rehabilitation Medicine, Jeju National University School of Medicine, Jeju National University Hospital, Jeju, South Korea
| | - Bo Ryun Kim
- Department of Rehabilitation Medicine, Jeju National University School of Medicine, Jeju National University Hospital, Jeju, South Korea.
| | - Seung-Jae Joo
- Division of Cardiology, Department of Internal Medicine, Jeju National University School of Medicine, Jeju National University Hospital, Jeju, South Korea
| | - Chang Sub Lee
- Department of Neurosurgery, Jeju National University School of Medicine, Jeju National University Hospital, Jeju, South Korea
| | - Sa-Yoon Kang
- Department of Neurology, Jeju National University School of Medicine, Jeju National University Hospital, Jeju, South Korea
| | - Song-Yi Kim
- Division of Cardiology, Department of Internal Medicine, Jeju National University School of Medicine, Jeju National University Hospital, Jeju, South Korea
| | - Joon Hyouk Choi
- Division of Cardiology, Department of Internal Medicine, Jeju National University School of Medicine, Jeju National University Hospital, Jeju, South Korea
| | - Chul Woong Hyun
- Department of Rehabilitation Medicine, Jeju National University School of Medicine, Jeju National University Hospital, Jeju, South Korea
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23
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Elter JR, Offenbacher S, Toole JF, Beck JD. Relationship of Periodontal Disease and Edentulism to Stroke/TIA. J Dent Res 2016; 82:998-1001. [PMID: 14630902 DOI: 10.1177/154405910308201212] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Periodontitis has been shown to increase the systemic inflammatory response, which has been implicated in atherosclerosis and cerebrovascular events. We hypothesized an association between periodontitis or edentulism and Stroke/TIA in the ARIC Study. Data on 9415 dentate and 1491 edentulous adults included demographics, cardiovascular outcomes, lifestyle, laboratory measures, and, for 6436 of the dentate, a dental examination. The dependent variable was Stroke/TIA, and the exposure was extent (%) of attachment level 3+ millimeters (AL). Quartiles of AL and edentulism were compared for Stroke/TIA using odds ratios (OR) and 95% confidence intervals (CI), and confounders were controlled by logistic regression. Stroke/TIA was prevalent in 13.5% of periodontal examinees, 15.6% of dentate non-examinees, and 22.5% of edentulous persons. The highest quartile of AL (OR 1.3, CI 1.02-1.7) and edentulism (OR 1.4, CI 1.5-2.0) were associated with Stroke/TIA.
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Affiliation(s)
- J R Elter
- School of Dentistry, CB7450, University of North Carolina, Chapel Hill, NC 27599-7450, USA.
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24
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Swerdel JN, Rhoads GG, Cheng JQ, Cosgrove NM, Moreyra AE, Kostis JB, Kostis WJ. Ischemic Stroke Rate Increases in Young Adults: Evidence for a Generational Effect? J Am Heart Assoc 2016; 5:JAHA.116.004245. [PMID: 27881427 PMCID: PMC5210414 DOI: 10.1161/jaha.116.004245] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The incidence rates of ischemic stroke and ST-segment elevation myocardial infarction (STEMI) have decreased significantly in the United States since 1950. However, there is evidence of flattening of this trend or increasing rates for stroke in patients younger than 50 years. The objective of this study was to examine the changes in incidence rates of stroke and STEMI using an age-period-cohort model with statewide data from New Jersey. METHODS AND RESULTS We obtained stroke and STEMI data for the years 1995-2014 from the Myocardial Infarction Data Acquisition System, a database of hospital discharges in New Jersey. Rates by age for the time periods 1994-1999, 2000-2004, 2005-2009, and 2010-2014 were obtained using census estimates as denominators for each age group and period. The rate of stroke more than doubled in patients aged 35 to 39 years from 1995-1999 to 2010-2014 (rate ratio [RR], 2.47; 95% CI, 2.07-2.96 [P<0.0001]). We also found increased rates of stroke in those aged 40 to 44, 45 to 49, and 50 to 54 years. Strokes rates in those older than 55 years decreased during these time periods. Those born from 1945-1954 had lower age-adjusted rates of stroke than those born both in the prior 20 years and in the following 20 years. STEMI rates, in contrast, decreased in all age groups and in each successive birth cohort. CONCLUSIONS There appears to be a significant birth cohort effect in the risk of stroke, where patients born from 1945-1954 have lower age-adjusted rates of stroke compared with those born in earlier and later years.
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Affiliation(s)
- Joel N Swerdel
- The Cardiovascular Institute at Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ .,Department of Epidemiology, Rutgers University School of Public Health, Piscataway, NJ
| | - George G Rhoads
- Department of Epidemiology, Rutgers University School of Public Health, Piscataway, NJ
| | - Jerry Q Cheng
- The Cardiovascular Institute at Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Nora M Cosgrove
- The Cardiovascular Institute at Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Abel E Moreyra
- The Cardiovascular Institute at Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - John B Kostis
- The Cardiovascular Institute at Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - William J Kostis
- The Cardiovascular Institute at Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
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Pikija S, Magdic J, Trkulja V, Unterkreuter P, Mutzenbach JS, Novak HF, Weymayr F, Hauer L, Sellner J. Intracranial Thrombus Morphology and Composition Undergoes Time-Dependent Changes in Acute Ischemic Stroke: A CT Densitometry Study. Int J Mol Sci 2016; 17:ijms17111959. [PMID: 27886084 PMCID: PMC5133953 DOI: 10.3390/ijms17111959] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 11/13/2016] [Accepted: 11/18/2016] [Indexed: 11/16/2022] Open
Abstract
The aim of our study was to assess whether cerebral artery clots undergo time-dependent morphological and compositional changes in acute ischemic stroke. We performed a retrospective chart review of patients admitted within 5 h from symptom onset to three European stroke centers and evaluated non-contrast-enhanced CT (NECT) for hyperdense artery signs (HAS) in 2565 scans. The occlusion site, density of HAS expressed in Hounsfield units (HU), area of HAS, and relative density (rHU) (HU clot/HU non-affected artery) were studied and related to time from symptom onset, clinical severity, stroke etiology, and laboratory parameters. A HAS was present in the middle cerebral artery (MCA) in 185 (7.2%) and further explored. The mean time from symptom onset to CT was 100 min (range 17–300). We found a time-dependent loss of density in the occluded M1 segment within the first 5 h (N = 118, 95% CI [−15, −2], p = 0.01). Further, the thrombus area in the M2 segment decreased with time (cubic trend N = 67, 95% CI [−63, −8], p = 0.02). Overall, and especially in the M2 segment, a lower clot area was associated with higher fibrinogen (−21.7%, 95% CI [−34.8, −5.8], p = 0.009). In conclusion, our results disclosed time-dependent changes of intracranial thrombi with regard to occlusion site, density and area.
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Affiliation(s)
- Slaven Pikija
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, 5020 Salzburg, Austria.
| | - Jozef Magdic
- Department of Neurology, Univerzitetni Klinični Center, 2000 Maribor, Slovenia.
| | - Vladimir Trkulja
- Department for Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia.
| | | | | | - Helmut F Novak
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, 5020 Salzburg, Austria.
| | - Friedrich Weymayr
- Division of Neuroradiology, Christian Doppler Medical Center, Paracelsus Medical University, 5020 Salzburg, Austria.
| | - Larissa Hauer
- Department of Psychiatry, Christian Doppler Medical Center, Paracelsus Medical University, 5020 Salzburg, Austria.
| | - Johann Sellner
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, 5020 Salzburg, Austria.
- Department of Neurology, Klinikum rechts der Isar, Technische Universität, 81675 München, Germany.
- Institute of Linguistics, University of Salzburg, 5020 Salzburg, Austria.
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26
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Han EY, Im SH, Kim BR, Seo MJ, Kim MO. Robot-assisted gait training improves brachial-ankle pulse wave velocity and peak aerobic capacity in subacute stroke patients with totally dependent ambulation: Randomized controlled trial. Medicine (Baltimore) 2016; 95:e5078. [PMID: 27741123 PMCID: PMC5072950 DOI: 10.1097/md.0000000000005078] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Brachial-ankle pulse wave velocity (baPWV) evaluates arterial stiffness and also predicts early outcome in stroke patients. The objectives of this study were to investigate arterial stiffness of subacute nonfunctional ambulatory stroke patients and to compare the effects of robot-assisted gait therapy (RAGT) combined with rehabilitation therapy (RT) on arterial stiffness and functional recovery with those of RT alone. METHOD The RAGT group (N = 30) received 30 minutes of robot-assisted gait therapy and 30 minutes of conventional RT, and the control group (N = 26) received 60 minutes of RT, 5 times a week for 4 weeks. baPWV was measured and calculated using an automated device. The patients also performed a symptom-limited graded exercise stress test using a bicycle ergometer, and parameters of cardiopulmonary fitness were recorded. Clinical outcome measures were categorized into 4 categories: activities of daily living, balance, ambulatory function, and paretic leg motor function and were evaluated before and after the 4-week intervention. RESULTS Both groups exhibited significant functional recovery in all clinical outcome measures after the 4-week intervention. However, peak aerobic capacity, peak heart rate, exercise tolerance test duration, and baPWV improved only in the RAGT group, and the improvements in baPWV and peak aerobic capacity were more noticeable in the RAGT group than in the control group. CONCLUSION Robot-assisted gait therapy combined with conventional rehabilitation therapy represents an effective method for reversing arterial stiffness and improving peak aerobic capacity in subacute stroke patients with totally dependent ambulation. However, further large-scale studies with longer term follow-up periods are warranted to measure the effects of RAGT on secondary prevention after stroke.
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Affiliation(s)
- Eun Young Han
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University College of Medicine, Jeju
- Department of Physical & Rehabilitation Medicine, Inha University, School of Medicine, Inha University Hospital, Incheon, Republic of Korea
| | - Sang Hee Im
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University, Seongnam
| | - Bo Ryun Kim
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University College of Medicine, Jeju
| | - Min Ji Seo
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University College of Medicine, Jeju
| | - Myeong Ok Kim
- Department of Physical & Rehabilitation Medicine, Inha University, School of Medicine, Inha University Hospital, Incheon, Republic of Korea
- Correspondence: Myeong Ok Kim, Department of Physical & Rehabilitation Medicine, Inha University Hospital, 27, Inhang-Ro, Jung-Gu, Incheon 400-711, Republic of Korea (e-mail: )
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Nishimura A, Nishimura K, Kada A, Iihara K. Status and Future Perspectives of Utilizing Big Data in Neurosurgical and Stroke Research. Neurol Med Chir (Tokyo) 2016; 56:655-663. [PMID: 27680330 PMCID: PMC5221776 DOI: 10.2176/nmc.ra.2016-0174] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The management, analysis, and integration of Big Data have received increasing attention in healthcare research as well as in medical bioinformatics. The J-ASPECT study is the first nationwide survey in Japan on the real-world setting of stroke care using data obtained from the diagnosis procedure combination-based payment system. The J-ASPECT study demonstrated a significant association between comprehensive stroke care (CSC) capacity and the hospital volume of stroke interventions in Japan; further, it showed that CSC capabilities were associated with reduced in-hospital mortality rates. Our study aims to create new evidence and insight from ‘real world’ neurosurgical practice and stroke care in Japan using Big Data. The final aim of this study is to develop effective methods to bridge the evidence-practice gap in acute stroke healthcare. In this study, the authors describe the status and future perspectives of the development of a new method of stroke registry as a powerful tool for acute stroke care research.
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Affiliation(s)
- Ataru Nishimura
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University
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29
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English SW, McIntyre L, Fergusson D, Turgeon A, Dos Santos MP, Lum C, Chassé M, Sinclair J, Forster A, van Walraven C. Subarachnoid hemorrhage admissions retrospectively identified using a prediction model. Neurology 2016; 87:1557-1564. [PMID: 27629096 PMCID: PMC5067543 DOI: 10.1212/wnl.0000000000003204] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 06/29/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To create an accurate prediction model using variables collected in widely available health administrative data records to identify hospitalizations for primary subarachnoid hemorrhage (SAH). METHODS A previously established complete cohort of consecutive primary SAH patients was combined with a random sample of control hospitalizations. Chi-square recursive partitioning was used to derive and internally validate a model to predict the probability that a patient had primary SAH (due to aneurysm or arteriovenous malformation) using health administrative data. RESULTS A total of 10,322 hospitalizations with 631 having primary SAH (6.1%) were included in the study (5,122 derivation, 5,200 validation). In the validation patients, our recursive partitioning algorithm had a sensitivity of 96.5% (95% confidence interval [CI] 93.9-98.0), a specificity of 99.8% (95% CI 99.6-99.9), and a positive likelihood ratio of 483 (95% CI 254-879). In this population, patients meeting criteria for the algorithm had a probability of 45% of truly having primary SAH. CONCLUSIONS Routinely collected health administrative data can be used to accurately identify hospitalized patients with a high probability of having a primary SAH. This algorithm may allow, upon validation, an easy and accurate method to create validated cohorts of primary SAH from either ruptured aneurysm or arteriovenous malformation.
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Affiliation(s)
- Shane W English
- From the Department of Medicine (Critical Care) (S.W.E., L.M.), Clinical Epidemiology Program (S.W.E, L.M., D.F., A.F., C.v.W.), Ottawa Hospital Research Institute/The Ottawa Hospital; Department of Anesthesia (Critical Care) (A.T., M.C.), Hôpital de L'Enfant-Jésus, Quebec; and Departments of Medical Imaging (M.P.d.S., C.L.), Surgery (Neuro-Surgery) (J.S.), and Medicine (C.v.W, A.F.), The Ottawa Hospital, Canada.
| | - Lauralyn McIntyre
- From the Department of Medicine (Critical Care) (S.W.E., L.M.), Clinical Epidemiology Program (S.W.E, L.M., D.F., A.F., C.v.W.), Ottawa Hospital Research Institute/The Ottawa Hospital; Department of Anesthesia (Critical Care) (A.T., M.C.), Hôpital de L'Enfant-Jésus, Quebec; and Departments of Medical Imaging (M.P.d.S., C.L.), Surgery (Neuro-Surgery) (J.S.), and Medicine (C.v.W, A.F.), The Ottawa Hospital, Canada
| | - Dean Fergusson
- From the Department of Medicine (Critical Care) (S.W.E., L.M.), Clinical Epidemiology Program (S.W.E, L.M., D.F., A.F., C.v.W.), Ottawa Hospital Research Institute/The Ottawa Hospital; Department of Anesthesia (Critical Care) (A.T., M.C.), Hôpital de L'Enfant-Jésus, Quebec; and Departments of Medical Imaging (M.P.d.S., C.L.), Surgery (Neuro-Surgery) (J.S.), and Medicine (C.v.W, A.F.), The Ottawa Hospital, Canada
| | - Alexis Turgeon
- From the Department of Medicine (Critical Care) (S.W.E., L.M.), Clinical Epidemiology Program (S.W.E, L.M., D.F., A.F., C.v.W.), Ottawa Hospital Research Institute/The Ottawa Hospital; Department of Anesthesia (Critical Care) (A.T., M.C.), Hôpital de L'Enfant-Jésus, Quebec; and Departments of Medical Imaging (M.P.d.S., C.L.), Surgery (Neuro-Surgery) (J.S.), and Medicine (C.v.W, A.F.), The Ottawa Hospital, Canada
| | - Marlise P Dos Santos
- From the Department of Medicine (Critical Care) (S.W.E., L.M.), Clinical Epidemiology Program (S.W.E, L.M., D.F., A.F., C.v.W.), Ottawa Hospital Research Institute/The Ottawa Hospital; Department of Anesthesia (Critical Care) (A.T., M.C.), Hôpital de L'Enfant-Jésus, Quebec; and Departments of Medical Imaging (M.P.d.S., C.L.), Surgery (Neuro-Surgery) (J.S.), and Medicine (C.v.W, A.F.), The Ottawa Hospital, Canada
| | - Cheemun Lum
- From the Department of Medicine (Critical Care) (S.W.E., L.M.), Clinical Epidemiology Program (S.W.E, L.M., D.F., A.F., C.v.W.), Ottawa Hospital Research Institute/The Ottawa Hospital; Department of Anesthesia (Critical Care) (A.T., M.C.), Hôpital de L'Enfant-Jésus, Quebec; and Departments of Medical Imaging (M.P.d.S., C.L.), Surgery (Neuro-Surgery) (J.S.), and Medicine (C.v.W, A.F.), The Ottawa Hospital, Canada
| | - Michaël Chassé
- From the Department of Medicine (Critical Care) (S.W.E., L.M.), Clinical Epidemiology Program (S.W.E, L.M., D.F., A.F., C.v.W.), Ottawa Hospital Research Institute/The Ottawa Hospital; Department of Anesthesia (Critical Care) (A.T., M.C.), Hôpital de L'Enfant-Jésus, Quebec; and Departments of Medical Imaging (M.P.d.S., C.L.), Surgery (Neuro-Surgery) (J.S.), and Medicine (C.v.W, A.F.), The Ottawa Hospital, Canada
| | - John Sinclair
- From the Department of Medicine (Critical Care) (S.W.E., L.M.), Clinical Epidemiology Program (S.W.E, L.M., D.F., A.F., C.v.W.), Ottawa Hospital Research Institute/The Ottawa Hospital; Department of Anesthesia (Critical Care) (A.T., M.C.), Hôpital de L'Enfant-Jésus, Quebec; and Departments of Medical Imaging (M.P.d.S., C.L.), Surgery (Neuro-Surgery) (J.S.), and Medicine (C.v.W, A.F.), The Ottawa Hospital, Canada
| | - Alan Forster
- From the Department of Medicine (Critical Care) (S.W.E., L.M.), Clinical Epidemiology Program (S.W.E, L.M., D.F., A.F., C.v.W.), Ottawa Hospital Research Institute/The Ottawa Hospital; Department of Anesthesia (Critical Care) (A.T., M.C.), Hôpital de L'Enfant-Jésus, Quebec; and Departments of Medical Imaging (M.P.d.S., C.L.), Surgery (Neuro-Surgery) (J.S.), and Medicine (C.v.W, A.F.), The Ottawa Hospital, Canada
| | - Carl van Walraven
- From the Department of Medicine (Critical Care) (S.W.E., L.M.), Clinical Epidemiology Program (S.W.E, L.M., D.F., A.F., C.v.W.), Ottawa Hospital Research Institute/The Ottawa Hospital; Department of Anesthesia (Critical Care) (A.T., M.C.), Hôpital de L'Enfant-Jésus, Quebec; and Departments of Medical Imaging (M.P.d.S., C.L.), Surgery (Neuro-Surgery) (J.S.), and Medicine (C.v.W, A.F.), The Ottawa Hospital, Canada
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Diao Z, Jia G, Wu W, Wang C. Carotid endarterectomy versus carotid angioplasty for stroke prevention: a systematic review and meta-analysis. J Cardiothorac Surg 2016; 11:142. [PMID: 27608767 PMCID: PMC5017049 DOI: 10.1186/s13019-016-0532-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 08/23/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND This meta-analysis aimed to evaluate the efficacy of carotid endarterectomy (CE) compared with carotid angioplasty (CA) in preventing stroke. Whether the use of CE is more efficient in preventing stroke than CA is a matter of debate. METHODS Data were gathered from randomized controlled trials to evaluate the effect of CE compared with CA on the risk of stroke. Electronic searches in PubMed, Embase, and the Cochrane Library were performed to identify studies till November 2014. Only randomized controlled trials performed on patients who received either CE or CA for stroke prevention were included. RESULTS Nine relevant trials (n = 7163) that met the inclusion criteria were identified. In a pooled analysis, CE resulted in 35 % reduction in relative risk (RR) for short-term stroke [RR, 0.65; 95 % confidence interval (CI): 0.47-0.89; P = 0.007)] and 22 % reduction in RR for long-term stroke (RR, 0.78; 95 % CI: 0.66-0.93; P = 0.006) relative to CA. However, CE also increased the risk of 30-day myocardial infarction by 114 % compared with CA (RR, 2.14; 95 % CI: 1.30-3.53; P = 0.003). Sensitivity analyses suggested that CE might influence the risk of 30-day major vascular events and 1-year major vascular events compared with CA. CONCLUSIONS CE could reduce the risk of stroke (whether short term or long term), but resulted in a relative increase in the risk of myocardial infarction. This study might guide appropriate judgments about treatment approach. It also provided evidence to justify general guidelines for patients with carotid artery stenosis.
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Affiliation(s)
- Zengyan Diao
- Department of Neurology, Qilu Hospital of Shandong University, Jinan, 250012 Shandong Province China
| | - Guoyong Jia
- Department of Neurology, Qilu Hospital of Shandong University, Jinan, 250012 Shandong Province China
| | - Wei Wu
- Department of Neurology, Qilu Hospital of Shandong University, Jinan, 250012 Shandong Province China
| | - Cuilan Wang
- Department of Neurology, Qilu Hospital of Shandong University, Jinan, 250012 Shandong Province China
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Murthy SB, Shastri A, Merkler AE, Hanley DF, Ziai WC, Fink ME, Iadecola C, Kamel H, Navi BB. Intracerebral Hemorrhage Outcomes in Patients with Systemic Cancer. J Stroke Cerebrovasc Dis 2016; 25:2918-2924. [PMID: 27569708 DOI: 10.1016/j.jstrokecerebrovasdis.2016.08.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 08/05/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Single-center studies suggest that patients with cancer have similar outcomes after intracerebral hemorrhage (ICH) compared to patients without cancer. However, these studies were limited by small sample sizes and high rates of intratumoral hemorrhage. Our hypothesis was that systemic cancer patients without brain involvement fare worse after ICH than patients without cancer. METHODS We identified all patients diagnosed with spontaneous ICH from 2002 to 2011 in the Nationwide Inpatient Sample. Our predictor variable was systemic cancer. Our primary outcome was discharge disposition, dichotomized into favorable discharge (home/self-care or rehabilitation) or unfavorable discharge (nursing facility, hospice, or death). We used logistic regression to compare outcomes and performed secondary analyses by cancer subtype (i.e., nonmetastatic solid tumors, nonmetastatic hematologic tumors, and metastatic solid or hematologic tumors). RESULTS Among 597,046 identified ICH patients, 22,394 (3.8%) had systemic cancer. Stroke risk factors such as hypertension and diabetes were more common in patients without cancer, whereas anticoagulant use and higher Charlson comorbidity scores were more common among cancer patients. In multivariate logistic regression analysis adjusted for demographics, comorbidities, and hospital-level characteristics, patients with cancer had higher odds of death (OR 1.62, 95% CI 1.56-1.69) and lower odds of favorable discharge (OR .59, 95% CI .56-.63) than patients without cancer. Among cancer groups, patients with nonmetastatic hematologic tumors and those with metastatic disease fared the worst. CONCLUSIONS Patients with systemic cancer have higher mortality and less favorable discharge outcomes after ICH than patients without cancer. Cancer subtype may influence outcomes after ICH.
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Affiliation(s)
- Santosh B Murthy
- Department of Neurology, Weill Cornell Medical College, New York, New York; Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, New York.
| | - Aditi Shastri
- Department of Hematology and Medical Oncology, Albert Einstein College of Medicine, Bronx, New York
| | | | - Daniel F Hanley
- Division of Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Wendy C Ziai
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Matthew E Fink
- Department of Neurology, Weill Cornell Medical College, New York, New York
| | - Costantino Iadecola
- Department of Neurology, Weill Cornell Medical College, New York, New York; Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, New York
| | - Hooman Kamel
- Department of Neurology, Weill Cornell Medical College, New York, New York; Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, New York
| | - Babak B Navi
- Department of Neurology, Weill Cornell Medical College, New York, New York; Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, New York
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Liu L, Yang X, Long Y, Mallhi AK, Mehta K, Veznedaroglu E, Yin X. Changes in the prevalence of hospitalization and comorbidity in US adults with stroke: A three decade cross-sectional and birth cohort analysis. Int J Stroke 2016; 11:987-998. [PMID: 27412189 DOI: 10.1177/1747493016660107] [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: 11/15/2015] [Accepted: 06/09/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND PURPOSE Little attention was paid to the transition of care for stroke that may partially explain the long-term trend of stroke rates. We aimed to test the trend of hospitalization attributable to stroke in US adults. METHODS Data from National Hospital Discharge Surveys 1980-2010 in patients aged ≥18 (n = 6,527,304) were analyzed to examine the trend of patients with first-list diagnoses of stroke. Stroke comorbidities were classified in stroke patients with second- to seven-listed diagnoses of coronary heart disease, hypertension, diabetes, arrhythmias, or hyperlipidemia. Stroke trends by survey years and birth cohorts were analyzed using univariate, multivariate, and birth cohorts methods. RESULTS Of the total study sample, the prevalence of hospitalization due to stroke was 22.99%, 30.00%, and 27.03% in years of 1980-1989, 1990-1999, and 2000-2010 in males, and 17.30%, 22.04%, and 19.34% in females, respectively. Overall, hospitalization rates in stroke patients significantly increased among adults aged <65, and decreased in adults aged ≥65. There was an increase in stroke hospitalization rate in the old adults aged ≥65 in recent birth cohorts. Significant increased trends of comorbid hypertension, diabetes, arrhythmias, and hyperlipidemia were observed from 1980 to 2010. CONCLUSION A significant increase in stroke hospitalization rate was observed in adults aged <65 in the past three decades, and in old adults in recent years. Increases in stroke comorbidity rates were observed in all age groups. Findings from the study highlight that both public health and clinical practices face a serious challenge in controlling this unwelcome increased stroke trend.
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Affiliation(s)
- Longjian Liu
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, USA
| | - Xuan Yang
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, USA
| | - Yong Long
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, USA.,Department of Epidemiology, Fourth Military Medical University, Xi'an, China
| | - Arshpreet Kaur Mallhi
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, USA
| | - Kathan Mehta
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, USA.,Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Erol Veznedaroglu
- Drexel Neurosciences Institute and Department of Neurosurgery, Drexel University College of Medicine, Philadelphia, USA
| | - Xiaoyan Yin
- Department of Medicine, University of Pennsylvania, Philadelphia, USA
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Palliative Care Utilization in Nontraumatic Intracerebral Hemorrhage in the United States. Crit Care Med 2016; 44:575-82. [PMID: 26496450 DOI: 10.1097/ccm.0000000000001391] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Palliative care is now recognized as an essential component of comprehensive care in serious illness that interferes with quality of life. We explored utilization of palliative care in spontaneous intracerebral hemorrhage at a population level using a large national database. DESIGN Population based cross-sectional study. SETTING Inpatient hospital admissions from the Nationwide Inpatient Sample. PATIENTS A total of 311,217 patients with intracerebral hemorrhage. INTERVENTIONS Palliative care use. MEASUREMENTS AND MAIN RESULTS Intracerebral hemorrhage patients with and without palliative care were identified from the 2007-2011 Nationwide Inpatient Sample using International Classification of Diseases, 9th Revision, codes. Demographics, comorbidities, surgical procedures, and hospital characteristics were compared between patients receiving and not receiving palliative care (code V66.7). Resource utilization measures were inflation-adjusted cost of care and length of stay. Pearson chi square and Wilcoxon-Mann-Whitney tests were used for categorical and continuous variables respectively. Logistic regression was used to construct a predictive model of palliative care. Of the 311,217 intracerebral hemorrhage patients, 32,159 (10.3%) received palliative care. Utilization of palliative care increased from 4.3% in 2007 to 16.2% in 2011 (trend p < 0.001). Patients receiving palliative care had higher Charlson comorbidity scores (p < 0.001), higher all-patient refined diagnosis-related group mortality risk (p < 0.001), and lower resource utilization measures compared with those without palliative care. Independent predictors of palliative care use were older age (odds ratio, 4.06; 95% CI, 3.87-4.23; p < 0.001), female sex (odds ratio, 1.17; 95% CI, 1.14-1.20; p < 0.001), Caucasian race (p < 0.001), Medicare insurance (p < 0.001), hospitals in the west and mid-west (p < 0.001), hospital transfer (odds ratio, 1.23; 95% CI, 1.18-1.30; p < 0.001), high intracerebral hemorrhage case volume (p < 0.001), anticoagulant use (odds ratio, 1.24; 95% CI, 1.19-1.31; p < 0.001), higher Charlson comorbidity score, ventriculostomy placement (odds ratio, 1.18; 95% CI, 1.13-1.29; p < 0.001), and mechanical ventilation (odds ratio, 1.44; 95% CI, 1.39-1.49; p < 0.001). Cerebral angiogram, craniotomy, and gastrostomy were independently associated with absence of palliative care use. CONCLUSIONS An apparent increasing trend of palliative care utilization in intracerebral hemorrhage has occurred over the last decade. After clinical severity adjustment, gender and racial differences and hospital characteristics appear to influence palliative care use among intracerebral hemorrhage patients in the United States.
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Abstract
Anticoagulant agents, such as unfractionated heparin and warfarin, have been in use for roughly 50 years. Over the past decade, injectable agents such as low-molecular-weight heparins, pentasaccharide, and direct thrombin inhibitors have been major advances in preventing and treating thrombosis. Despite these somewhat recent additions, there is still enormous potential to improve on the pharmacokinetic and pharmacodynamic properties of these agents, as well as improve patient outcomes. There are currently a large number of anticoagulant agents (injectable and oral) that could be available for use in the next several years. Many of these new agents have unique mechanisms that may provide practitioners with anticoagulant alternatives. This review gives a detailed analysis of the anticoagulant agents that may add to our armamentarium in the management of thrombosis.
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Affiliation(s)
- Paul P. Dobesh
- Division of Pharmacy Practice, St. Louis College of Pharmacy, St. Louis, Missouri, St. Luke’s Hospital, Chesterfield, Missouri,
| | | | - Zachary Stacy
- Division of Pharmacy Practice, St. Louis College of Pharmacy, St. Louis, Missouri, St. Luke’s Hospital, Chesterfield, Missouri
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Yang HJ, Choi JD. Effects of Underwater Treadmill Gait Training on Gait, Balance, and Pulmonary Function in Stroke Patients. ACTA ACUST UNITED AC 2015. [DOI: 10.12674/ptk.2015.22.4.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Atalay Y, Asutay F, Agacayak KS, Koparal M, Adali F, Gulsun B. Evaluation of calcified carotid atheroma on panoramic radiographs and Doppler ultrasonography in an older population. Clin Interv Aging 2015; 10:1121-9. [PMID: 26185431 PMCID: PMC4501685 DOI: 10.2147/cia.s84683] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim The aim of this study is to determine the reliability of panoramic radiograph (PR) as a screening tool for the detection of calcified carotid atheroma (CCA) by comparing it with Doppler ultrasonography (DU) examination. A second aim was to evaluate the relationship among CCA, systemic diseases, smoking, and body mass index in an older population. Materials and methods A total of 1,650 PRs of patients aged over 45 years (736 males and 914 females) were randomly selected. All the patients had been referred to the Faculty of Dentistry, Afyon Kocatepe University, Afyonkarahisar, Turkey, during 2013–2014 for routine PR screening. Medical data were collected from the archival records of the dental school. The patients were divided into two groups: Group A (study group), CCA findings were confirmed by DU (n=59); and Group B (control group), CCA findings were not confirmed by DU (n=34). Results Of the 1,650 individuals, 93 (5.63%) were detected to have CCA on PR. The population consisted of 43 males and 50 females with mean age of 59.84±10.92 years. No difference was determined in respect of CCA between the sexes (P=0.745). There was a significant difference between Group A and Group B in respect of hypertension (P=0.004). But there was no difference between Group A and Group B in respect of age (P=0.495), BMI (P=0.756), diabetes (P=0.168), and smoking (P=0.482) distribution. Conclusion Although PR cannot be used as an initial diagnostic method when searching for CCA, dentists should be aware of CCA on a routine PR, particularly in older patients who may also have the risk factors of obesity, diabetes mellitus, hypertension, and smoking. Recognizing of CCA especially in hypertensive patients could potentially increase the length and quality of life for individuals.
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Affiliation(s)
- Yusuf Atalay
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Fatih Asutay
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Kamil Serkan Agacayak
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Dicle University, Diyarbakır, Turkey
| | - Mahmut Koparal
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Adıyaman University, Adıyaman, Turkey
| | - Fahri Adali
- Department of Cardiovascular Surgery, Faculty of Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Belgin Gulsun
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Dicle University, Diyarbakır, Turkey
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Jung HS, Park G, Kim YS, Jung HS. Development and evaluation of one-hand drivable manual wheelchair device for hemiplegic patients. APPLIED ERGONOMICS 2015; 48:11-21. [PMID: 25683527 DOI: 10.1016/j.apergo.2014.10.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 06/28/2014] [Accepted: 10/28/2014] [Indexed: 06/04/2023]
Abstract
This study was conducted for one-hand users including hemiplegic clients currently using standard manual wheelchairs, so as to analyze their specific problems and recommend solutions regarding usage. Thirty hemiplegic clients who were admitted to rehabilitation and convalescent hospitals participated as subjects. The research tools were standard manual wheelchairs commonly used by people with impaired gait and a "one-hand drivable manual wheelchair," which was developed for this study. The Wheelchair Skills Test (WST) was adopted for the objective assessment tool, while drivability, convenience, difference, and acceptability were developed for the subjective evaluation tools. The assessment procedures comprise two phases of pre-assessment and post-assessment. In the pre-assessment phase, the WST and subjective evaluation (drivability, convenience) were conducted using the existing standard manual wheelchair and with/without use of a foot to control the wheelchair. In the post-assessment phase, the WST and subjective evaluation (drivability, convenience, difference, acceptability) were also carried out using the developed one-hand drivable manual wheelchair. The results showed that the highest pass rate recorded for the WST items was 3.3% when the participants drove standard manual wheelchairs without the use of either foot and 96.7% when using the manual wheelchairs equipped with developed device. As compared to the existing wheelchair, statistical results showed significant effects on the WST, drivability, convenience, difference and acceptability when the participants drove wheelchairs equipped with the developed device. These findings imply that the one-hand drivable wheelchair equipped with the developed device can be an active and effective solution for hemiplegic clients using existing manual wheelchairs to increase their mobility and occupational performance.
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Affiliation(s)
- Hwa S Jung
- Department of Occupational Therapy, Dongshin University, 185 Geonjae-ro, Naju 520-714, Republic of Korea.
| | - Gemus Park
- Occupational Therapy Section, City Rehabilitation Hospital, 12-1 Ipha-gil, Namgu, Gwangju 503-820, Republic of Korea.
| | - Young-Shim Kim
- Division of Business Administration, Chosun University, 309 Pilmun-daero, Gwangju 501-759, Republic of Korea.
| | - Hyung-Shik Jung
- Division of Business Administration, Chosun University, 309 Pilmun-daero, Gwangju 501-759, Republic of Korea.
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Odden MC, Pletcher MJ, Coxson PG, Thekkethala D, Guzman D, Heller D, Goldman L, Bibbins-Domingo K. Cost-effectiveness and population impact of statins for primary prevention in adults aged 75 years or older in the United States. Ann Intern Med 2015; 162:533-41. [PMID: 25894023 PMCID: PMC4476404 DOI: 10.7326/m14-1430] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Evidence to guide primary prevention in adults aged 75 years or older is limited. OBJECTIVE To project the population impact and cost-effectiveness of statin therapy in adults aged 75 years or older. DESIGN Forecasting study using the Cardiovascular Disease Policy Model, a Markov model. DATA SOURCES Trial, cohort, and nationally representative data sources. TARGET POPULATION U.S. adults aged 75 to 94 years. TIME HORIZON 10 years. PERSPECTIVE Health care system. INTERVENTION Statins for primary prevention based on low-density lipoprotein cholesterol threshold of 4.91 mmol/L (190 mg/dL), 4.14 mmol/L (160 mg/dL), or 3.36 mmol/L (130 mg/dL); presence of diabetes; or 10-year risk score of at least 7.5%. OUTCOME MEASURES Myocardial infarction (MI), coronary heart disease (CHD) death, disability-adjusted life-years, and costs. RESULTS OF BASE-CASE ANALYSIS All adults aged 75 years or older in the National Health and Nutrition Examination Survey have a 10-year risk score greater than 7.5%. If statins had no effect on functional limitation or cognitive impairment, all primary prevention strategies would prevent MIs and CHD deaths and be cost-effective. Treatment of all adults aged 75 to 94 years would result in 8 million additional users and prevent 105 000 (4.3%) incident MIs and 68 000 (2.3%) CHD deaths at an incremental cost per disability-adjusted life-year of $25 200. RESULTS OF SENSITIVITY ANALYSIS An increased relative risk for functional limitation or mild cognitive impairment of 1.10 to 1.29 could offset the cardiovascular benefits. LIMITATION Limited trial evidence targeting primary prevention in adults aged 75 years or older. CONCLUSION At effectiveness similar to that in trials, statins are projected to be cost-effective for primary prevention; however, even a small increase in geriatric-specific adverse effects could offset the cardiovascular benefit. Improved data on the potential benefits and harms of statins are needed to inform decision making. PRIMARY FUNDING SOURCE American Heart Association Western States Affiliate, National Institute on Aging, and the National Institute for Diabetes on Digestive and Kidney Diseases.
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Affiliation(s)
- Michelle C. Odden
- School of Biological and Population Health Sciences, Oregon State University, Corvallis, OR
| | - Mark J. Pletcher
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA
| | - Pamela G. Coxson
- Department of Medicine, University of California, San Francisco, CA
| | - Divya Thekkethala
- School of Biological and Population Health Sciences, Oregon State University, Corvallis, OR
| | - David Guzman
- Department of Medicine, University of California, San Francisco, CA
| | - David Heller
- Department of Medicine, University of California, San Francisco, CA
| | - Lee Goldman
- College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Kirsten Bibbins-Domingo
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA
- Department of Medicine, University of California, San Francisco, CA
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Robotic-Assisted Gait Training in Neurological Patients: Who May Benefit? Ann Biomed Eng 2015; 43:1260-9. [DOI: 10.1007/s10439-015-1283-x] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 02/13/2015] [Indexed: 10/23/2022]
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Denby F, Harvey RL. An Educational Intervention for Stroke Rehabilitation Patients and Their Families: Healthy Living After Stroke. Top Stroke Rehabil 2015; 9:34-45. [PMID: 14523698 DOI: 10.1310/wpf9-k8jv-1bmy-vavd] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The education of stroke patients and their families on prevention of recurrent stroke is a rehabilitation challenge. The principal objective of this article is to share a process for creating a stroke education program that improves patient and caregiver knowledge of secondary prevention, stroke signs and symptoms, modifiable risk factors, and maintenance of functional independence. During stroke recovery, patient education is a continuous journey. The education program needs to take into consideration the individual's readiness to learn, unique learning styles, and timing of sessions. In our educational program, Healthy Living After Stroke, we used the stroke team to develop different venues of learning.
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Ali MM, O'Brien CE, Cleves MA, Martin BC. Exploring the possible association between montelukast and neuropsychiatric events among children with asthma: a matched nested case-control study. Pharmacoepidemiol Drug Saf 2015; 24:435-45. [DOI: 10.1002/pds.3758] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 12/19/2014] [Accepted: 12/23/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Mir M. Ali
- Division of Pharmaceutical Evaluation and Policy; University of Arkansas for Medical Sciences; Little Rock AR USA
| | - Catherine E. O'Brien
- College of Pharmacy; University of Arkansas for Medical Sciences; Little Rock AR USA
| | - Mario A. Cleves
- College of Medicine; University of Arkansas for Medical Sciences; Little Rock AR USA
| | - Bradley C. Martin
- Division of Pharmaceutical Evaluation and Policy; University of Arkansas for Medical Sciences; Little Rock AR USA
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Abstract
Stroke patients have profound cardiovascular and muscular deconditioning, with metabolic fitness levels that are about half those found in age-matched sedentary controls. Physical deconditioning, along with elevated energy demands of hemiparetic gait, define a detrimental combination termed diminished physiological fitness reserve that can greatly limit that can greatly limit performance of activities of daily living. The physiological features that underlie worsening metabolic fitness in the chronic phase of stroke include gross muscular atrophy, altered muscle molecular phenotype, increased intramuscular area fat, elevated tissue inflammatory markers, and diminished peripheral blood flow dynamics. Epidemiological evidence further suggests that the reduced cardiovascular fitness and secondary biological changes in muscle may propagate components of the metabolic syndrome, conferring added morbidity and mortality risk. This article reviews some of the consequences of poor fitness in chronic stroke and the potential biological underpinnings that support a rationale for more aggressive approaches to exercise therapy in this population.
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Affiliation(s)
- F M Ivey
- Department of Medicine, Division of Gerontology, University of Maryland School of Medicine and Baltimore Veterans Affairs Medical Center, Baltimore, MD, USA
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Cruz-Herranz A, Illán-Gala I, Martínez-Sánchez P, Fuentes B, Díez-Tejedor E. Recurrence of stroke amongst women of reproductive age: impact of and on subsequent pregnancies. Eur J Neurol 2015; 22:681-e42. [PMID: 25641184 DOI: 10.1111/ene.12630] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 10/27/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE The risk of recurrence of stroke after pregnancy is poorly known. METHODS This was an observational study of women younger than 45 years of age with transient ischaemic attack (TIA), cerebral infarction (CI), cerebral venous thrombosis (CVT) or intracerebral hemorrhage (ICH) treated in a stroke unit (January 1996-2011). The clinical data were prospectively collected in a database. Information on reproductive history after stroke was obtained using telephone surveys (2011). The variables were demographic data, vascular risk factors, stroke type, outcomes, medical advice concerning pregnancies after stroke, number of pregnancies after stroke, neurological assessment during pregnancy, antithrombotic treatments during pregnancy/puerperium, fertility treatments administered and information about hemorrhagic/ischaemic stroke recurrence. RESULTS Overall, 102 women were included: 24 TIA, 64 CI (four large vessel disease, 14 cardioembolic, 12 small vessel disease, 17 undetermined etiology, 17 uncommon etiology), 12 CVT and two ICH. Mean age at the time of first stroke was 35 (±7.5) years. Median follow-up was 7.4 years (range 1-17). Thirty-two pregnancies occurred in 27 patients (previous diagnosis: four TIA, 17 CI, five CVT and one ICH). One woman became pregnant using in vitro fertilization. Only eight pregnancies were followed up by a neurologist. Of 26 pregnancies without previous history of ICH, 18 (62%) underwent preventive antithrombotic treatment. No recurrence of stroke was observed during pregnancy/puerperium. Of the women without pregnancies after the first cerebrovascular event, four CIs and three TIAs were observed. CONCLUSION The recurrence of stroke after pregnancy is very low, which should be considered when counseling these patients.
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Affiliation(s)
- A Cruz-Herranz
- Department of Neurology and Stroke Center, La Paz University Hospital, IdiPAZ Health Research Institute, Autonomous University of Madrid, Madrid, Spain
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Al-Jarrah M, Shaheen S, Harries N, Kissani N, Molteni F, Bar Haim S. Individualized Treadmill and Strength Training for Chronic Stroke Rehabilitation: Effects of Imbalance. Top Stroke Rehabil 2015; 21 Suppl 1:S25-32. [DOI: 10.1310/tsr21s1-s25] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Shiri S, Feintuch U, Lorber-Haddad A, Moreh E, Twito D, Tuchner-Arieli M, Meiner Z. A Novel Virtual Reality System Integrating Online Self-Face Viewing and Mirror Visual Feedback for Stroke Rehabilitation: Rationale and Feasibility. Top Stroke Rehabil 2014; 19:277-86. [DOI: 10.1310/tsr1904-277] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Jones SA, Gottesman RF, Shahar E, Wruck L, Rosamond WD. Validity of hospital discharge diagnosis codes for stroke: the Atherosclerosis Risk in Communities Study. Stroke 2014; 45:3219-25. [PMID: 25190443 PMCID: PMC4290877 DOI: 10.1161/strokeaha.114.006316] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 08/15/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Characterizing International Classification of Disease 9th Revision, Clinical Modification (ICD-9-CM) code validity is essential given widespread use of hospital discharge databases in research. Using the Atherosclerosis Risk in Communities (ARIC) Study, we estimated the accuracy of ICD-9-CM stroke codes. METHODS Hospitalizations with ICD-9-CM codes 430 to 438 or stroke keywords in the discharge summary were abstracted for ARIC cohort members (1987-2010). A computer algorithm and physician reviewer classified definite and probable ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. Using ARIC classification as a gold standard, we calculated the positive predictive value (PPV) and sensitivity of ICD-9-CM codes grouped according to the American Heart Association/American Stroke Association (AHA/ASA) 2013 categories and an alternative code grouping for comparison. RESULTS Thirty-three percent of 4260 hospitalizations were validated as strokes (1251 ischemic, 120 intracerebral hemorrhage, 46 subarachnoid hemorrhage). The AHA/ASA code groups had PPV 76% and 68% sensitivity compared with PPV 72% and 83% sensitivity for the alternative code groups. The PPV of the AHA/ASA code group for ischemic stroke was slightly higher among blacks, individuals <65 years, and at teaching hospitals. Sensitivity was higher among older individuals and increased over time. The PPV of the AHA/ASA code group for intracerebral hemorrhage was higher among blacks, women, and younger individuals. PPV and sensitivity varied across study sites. CONCLUSIONS A new AHA/ASA discharge code grouping to identify stroke had similar PPV and lower sensitivity compared with an alternative code grouping. Accuracy varied by patient characteristics and study sites.
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Affiliation(s)
- Sydney A. Jones
- Gillings School of Global Public Health, University of North Carolina – Chapel Hill
| | | | - Eyal Shahar
- University of Arizona College of Public Health
| | - Lisa Wruck
- Gillings School of Global Public Health, University of North Carolina – Chapel Hill
| | - Wayne D. Rosamond
- Gillings School of Global Public Health, University of North Carolina – Chapel Hill
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Seifi A, Carr K, Maltenfort M, Moussouttas M, Birnbaum L, Parra A, Adogwa O, Bell R, Rincon F. The incidence and risk factors of associated acute myocardial infarction (AMI) in acute cerebral ischemic (ACI) events in the United States. PLoS One 2014; 9:e105785. [PMID: 25166915 PMCID: PMC4148319 DOI: 10.1371/journal.pone.0105785] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 07/23/2014] [Indexed: 01/17/2023] Open
Abstract
Objectives To determine the association between myocardial infarction (AMI) and clinical outcome in patients with primary admissions diagnosis of acute cerebral ischemia (ACI) in the US. Methods Data from Nationwide Inpatient Sample (NIS) was queried from 2002–2011 for inpatient admissions of patients with a primary diagnosis of ACI with and without AMI using International Classification of Diseases, Ninth Revision, Clinical Modification coding (ICD-9). A multivariate stepwise regression analysis was performed to assess the correlation between identifiable risk factors and clinical outcomes. Results During 10 years the NIS recorded 886,094 ACI admissions with 17,526 diagnoses of AMI (1.98%). The overall cumulative mortality of cohort was 5.65%. In-hospital mortality was associated with AMI (aOR 3.68; 95% CI 3.49–3.88, p≤0.0001), rTPA administration (aOR 2.39 CI, 2.11–2.71, p<0.0001), older age (aOR 1.03, 95% CI, 1.03–1.03, P<0.0001) and women (aOR 1.06, 95% CI 1.03–1.08, P<0.0001). Overall, mortality risk declined over the course of study; from 20.46% in 2002 to 11.8% in 2011 (OR 0.96, 95% CI 0.95–0.96, P<0.0001). Survival analysis demonstrated divergence between the AMI and non-AMI sub-groups over the course of study (log-rank p<0.0001). Conclusion Our study demonstrates that although the prevalence of AMI in patients hospitalized with primary diagnosis of ACI is low, it negatively impacts survival. Considering the high clinical burden of AMI on mortality of ACI patients, a high quality monitoring in the event of cardiac events should be maintained in this patient cohort. Whether prompt diagnosis and treatment of associated cardiovascular diseases may improve outcome, deserves further study.
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Affiliation(s)
- Ali Seifi
- Department of Neurological Surgery, University of Texas Health Sciences Center, San Antonio, Texas, United States of America
- * E-mail:
| | - Kevin Carr
- Department of Neurological Surgery, University of Texas Health Sciences Center, San Antonio, Texas, United States of America
| | - Mitchell Maltenfort
- Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Michael Moussouttas
- Division of Neuro Critical Care, Capital Institute for Neurosciences, Trenton, New Jersey, United States of America
| | - Lee Birnbaum
- Department of Neurological Surgery, University of Texas Health Sciences Center, San Antonio, Texas, United States of America
- Department of Neurology, University of Texas Health Sciences Center, San Antonio, Texas, United States of America
| | - Augusto Parra
- Department of Neurological Surgery, University of Texas Health Sciences Center, San Antonio, Texas, United States of America
- Department of Neurology, University of Texas Health Sciences Center, San Antonio, Texas, United States of America
| | - Owoicho Adogwa
- Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Rodney Bell
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
- Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Fred Rincon
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
- Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
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Moradiya Y, Murthy SB, Newman-Toker DE, Hanley DF, Ziai WC. Intraventricular thrombolysis in intracerebral hemorrhage requiring ventriculostomy: a decade-long real-world experience. Stroke 2014; 45:2629-35. [PMID: 25061080 DOI: 10.1161/strokeaha.114.006067] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Intraventricular thrombolysis (IVT) is a promising treatment in facilitating intraventricular clot resolution after intraventricular hemorrhage. We examined in-hospital outcomes and resource utilization after thrombolysis in patients with intraventricular hemorrhage requiring ventriculostomy in a real-world setting. METHODS We identified adult patients with primary diagnosis of nontraumatic intracerebral hemorrhage requiring ventriculostomy from the Nationwide Inpatient Sample from 2002 to 2011. We compared demographic and hospital characteristics, comorbidities, inpatient outcomes, and resource utilization measures between patients treated with IVT and those managed with ventriculostomy, but without IVT. Population estimates were extrapolated using standard Nationwide Inpatient Sample weighting algorithms. RESULTS We included 34 044 patients in the analysis, of whom 1133 (3.3%) received IVT. The thrombolysis group had significantly lower inpatient mortality (32.4% versus 41.6%; P=0.001) and it remained lower after controlling for baseline demographics, hospital characteristics, comorbidity, case severity, and withdrawal of care status (adjusted odds ratio, 0.670; 95% confidence interval, 0.520-0.865; P=0.002). There was a trend toward favorable discharge (home or rehabilitation) among the thrombolysis cohort (adjusted odds ratio, 1.335; 95% confidence interval, 0.983-1.812; P=0.064). The adjusted rates of bacterial meningitis and ventricular shunt placement were similar between groups. The thrombolysis group had longer length of stay and higher inflation-adjusted cost of care, but cost of care per day length of stay was similar to the non-IVT group. CONCLUSIONS IVT for intracerebral hemorrhage requiring ventriculostomy resulted in lower inpatient mortality and a trend toward favorable discharge outcome with similar rates of inpatient complications compared with the non-IVT group.
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Affiliation(s)
- Yogesh Moradiya
- From the Division of Neurosciences Critical Care (Y.M., S.B.M., W.C.Z.), Department of Neurology (D.E.N.-T.), Division of Brain Injury Outcomes (D.F.H.), Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Santosh B Murthy
- From the Division of Neurosciences Critical Care (Y.M., S.B.M., W.C.Z.), Department of Neurology (D.E.N.-T.), Division of Brain Injury Outcomes (D.F.H.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - David E Newman-Toker
- From the Division of Neurosciences Critical Care (Y.M., S.B.M., W.C.Z.), Department of Neurology (D.E.N.-T.), Division of Brain Injury Outcomes (D.F.H.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Daniel F Hanley
- From the Division of Neurosciences Critical Care (Y.M., S.B.M., W.C.Z.), Department of Neurology (D.E.N.-T.), Division of Brain Injury Outcomes (D.F.H.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Wendy C Ziai
- From the Division of Neurosciences Critical Care (Y.M., S.B.M., W.C.Z.), Department of Neurology (D.E.N.-T.), Division of Brain Injury Outcomes (D.F.H.), Johns Hopkins University School of Medicine, Baltimore, MD
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