1
|
Abdelkader AA, Afifi LM, Maher EA, Atteya AA, El Salmawy DA. Comparison of Bilateral Versus Unilateral 5 Hz or 1 Hz Repetitive Transcranial Magnetic Stimulation in Subacute Stroke: Assessment of Motor Function in a Randomized Controlled Study. J Clin Neurophysiol 2024; 41:478-483. [PMID: 38935659 DOI: 10.1097/wnp.0000000000000987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024] Open
Abstract
PURPOSE Repetitive transcranial magnetic stimulation (rTMS) can enhance brain plasticity after stroke. At low frequencies, rTMS has an inhibitory effect, whereas at high frequencies, it has an excitatory effect. Combining both frequencies in bilateral stimulation is a new rTMS protocol under investigation, especially in the subacute stage. METHODS Fifty-five patients with subacute stroke were divided into four groups according to the rTMS protocol delivered: bilateral, inhibitory, excitatory, and control groups. All groups received concomitant task-oriented physiotherapy. Pretreatment to posttreatment assessment was performed twice, immediately after sessions and 1 month later. Volitional motor control was evaluated by Fugl-Meyer and Wolf motor function tests, and for spasticity, the Ashworth scale was used. RESULTS All groups showed significant improvement. Bilateral, inhibitory, and excitatory groups showed same efficacy, but the bilateral protocol was superior in spasticity. No correlations were found between improvement and stroke duration and site except for spasticity. CONCLUSIONS Bilateral rTMS shows a comparable effect to inhibitory and excitatory rTMS in improving motor disability in subacute stroke. However, it is superior for spasticity.
Collapse
Affiliation(s)
- Ann A Abdelkader
- Clinical Neurophysiology Unit, Department of Neurology, Kasr Alaini Hospital, Cairo University, Cairo, Egypt; and
| | - Lamia M Afifi
- Clinical Neurophysiology Unit, Department of Neurology, Kasr Alaini Hospital, Cairo University, Cairo, Egypt; and
| | - Eman A Maher
- Clinical Neurophysiology Unit, Department of Neurology, Kasr Alaini Hospital, Cairo University, Cairo, Egypt; and
| | | | - Dina A El Salmawy
- Clinical Neurophysiology Unit, Department of Neurology, Kasr Alaini Hospital, Cairo University, Cairo, Egypt; and
| |
Collapse
|
2
|
Ryan M, Rössler R, Rommers N, Iendra L, Peters EM, Kressig RW, Schmidt-Trucksäss A, Engelter ST, Peters N, Hinrichs T. Lower extremity physical function and quality of life in patients with stroke: a longitudinal cohort study. Qual Life Res 2024:10.1007/s11136-024-03713-0. [PMID: 38916661 DOI: 10.1007/s11136-024-03713-0] [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: 06/07/2024] [Indexed: 06/26/2024]
Abstract
PURPOSE Lower extremity physical function (LEPF) is a key component for mobility and is impacted in stroke-related disability. A reduction in LEPF can have a significant impact on an individual's Quality of Life (QoL). The aim of this study is to characterise the relationship between LEPF and QoL. METHODS The MOBITEC-Stroke Study is a longitudinal cohort-study including patients with their first occurrence of ischaemic stroke. Using a linear mixed-effects model, the relationship between LEPF (timed up-and-go performance (TUG); predictor) and QoL (Stroke Specific Quality of Life scale (SS-QoL); outcome) at 3 and 12 months post stroke was investigated and adjusted for sex, age, Instrumental Activities of Daily Living (IADL), fear of falling (Falls Efficacy Scale-International Version, FES-I), and stroke severity (National Institute of Stroke Severity scale, NIHSS), accounting for the repeated measurements. RESULTS Data of 51 patients (65 % males, 35% females) were analysed. The mean age was 71.1 (SD 10.4) years, median NIHSS score was 2.0. SS-QoL was 201.5 (SD 20.5) at 3 months and 204.2 (SD 17.4) at 12 months; the mean change was 2.7 (95% CI -2.4 to 7.7), p= 0.293. A positive association was found between baseline TUG performance (estimate log score -13.923; 95% CI -27.495 to -0.351; p=0.048) and change in SS-QoL score in multivariate regression analysis. CONCLUSION Higher LEPF (i.e better TUG performance) at baseline, was associated with an improvement in QoL from 3- to 12-months post stroke. These results highlight the critical role of physical function, particularly baseline LEPF, in influencing the QoL of stroke survivors.
Collapse
Affiliation(s)
- Michelle Ryan
- University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland
| | - Roland Rössler
- University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland.
| | - Nikki Rommers
- Department of Clinical Research, University of Basel, University Hospital Basel, Basel, Switzerland
| | - Laura Iendra
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Eva-Maria Peters
- University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland
| | - Reto W Kressig
- University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland
| | - Arno Schmidt-Trucksäss
- Division of Sport and Exercise Medicine, Department of Sport, Exercise, and Health, University of Basel, Grosse Allee 6, Basel, 4052, Switzerland
| | - Stefan T Engelter
- University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Nils Peters
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurology and Stroke Center, Klinik Hirslanden, Zurich, Switzerland
| | - Timo Hinrichs
- University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland
| |
Collapse
|
3
|
Guo D, Hu L, Xie P, Sun P, Yu W. Seipin is involved in oxygen-glucose deprivation/reoxygenation induced neuroinflammation by regulating the TLR3/TRAF3/NF-κB pathway. Int Immunopharmacol 2024; 134:112182. [PMID: 38703568 DOI: 10.1016/j.intimp.2024.112182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 04/25/2024] [Accepted: 04/27/2024] [Indexed: 05/06/2024]
Abstract
Seipin plays a crucial role in lipid metabolism and is involved in neurological disorders. However, the function and mechanism of action of seipin in acute ischemic stroke have not yet been elucidated. Here, we aimed to investigate the effect of seipin on neuroinflammation induced by oxygen-glucose deprivation/reoxygenation (OGD/R) and further explore the molecular mechanism by functional experiments. Our results revealed a significant decrease in seipin mRNA levels, accompanied by enhanced expression of TNF-α in patients with AIS, and a significant negative correlation between seipin and TNF-α was observed. Additionally, there was a negative correlation between seipin levels and the National Institutes of Health Stroke Scale (NIHSS) score. Furthermore, seipin levels were also decreased in middle cerebral artery occlusion/reperfusion (MCAO/R) mice and OGD/R-treated BV2 cells. RNA sequencing analysis showed that seipin knockdown altered the Toll-like receptor 3 (TLR3) signaling pathway. It was further confirmed in vitro that seipin knockdown caused significantly increased secretion of inflammatory factors including TNF-α, interleukin (IL)-1β, and interferon (IFN)-β. Meanwhile, seipin knockdown activated the Tlr3 signal pathway while this effect could be reversed by Tlr3 inhibitor in OGD/R treated BV2 cells. Furthermore, neuroinflammation induced by OGD/R was significantly reduced by seipin overexpression. Overall, our study demonstrate that seipin deficiency aggravates neuroinflammation by activating the TLR3/TRAF3/NF-κB signaling pathway after OGD/R stimuli, and suggest that seipin may be a potential therapeutic target for AIS.
Collapse
Affiliation(s)
- Dongfen Guo
- Key Laboratory of Endemic and Ethnic Diseases, Ministry of Education, School of Basic Medical Science, Guizhou Medical University, 09 Beijing Road, Guiyang 550004, Guizhou, China
| | - Lele Hu
- Department of Neurology, The Second People's Hospital of Guiyang, Guiyang 550023, Guizhou, China
| | - Peng Xie
- Key Laboratory of Endemic and Ethnic Diseases, Ministry of Education, School of Basic Medical Science, Guizhou Medical University, 09 Beijing Road, Guiyang 550004, Guizhou, China
| | - Ping Sun
- Department of Neurology, The Second People's Hospital of Guiyang, Guiyang 550023, Guizhou, China.
| | - Wenfeng Yu
- Key Laboratory of Endemic and Ethnic Diseases, Ministry of Education, School of Basic Medical Science, Guizhou Medical University, 09 Beijing Road, Guiyang 550004, Guizhou, China; Key Laboratory of Human Brain Bank for Functions and Diseases of Department of Education of Guizhou Province, Guizhou Medical University, Guiyang 550025, Guizhou, China.
| |
Collapse
|
4
|
Jiménez-Balado J, Fernández-Pérez I, Gallego-Fábrega C, Lazcano U, Soriano-Tárraga C, Vallverdú-Prats M, Mola-Caminal M, Rey-Álvarez L, Macias-Gómez A, Suárez-Pérez A, Giralt-Steinhauer E, Rodríguez-Campello A, Cuadrado-Godia E, Ois Á, Esteller M, Roquer J, Fernández-Cadenas I, Jiménez-Conde J. DNA methylation and stroke prognosis: an epigenome-wide association study. Clin Epigenetics 2024; 16:75. [PMID: 38845005 PMCID: PMC11155152 DOI: 10.1186/s13148-024-01690-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 05/29/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND AND AIMS Stroke is the leading cause of adult-onset disability. Although clinical factors influence stroke outcome, there is a significant variability among individuals that may be attributed to genetics and epigenetics, including DNA methylation (DNAm). We aimed to study the association between DNAm and stroke prognosis. METHODS AND RESULTS To that aim, we conducted a two-phase study (discovery-replication and meta-analysis) in Caucasian patients with ischemic stroke from two independent centers (BasicMar [discovery, N = 316] and St. Pau [replication, N = 92]). Functional outcome was assessed using the modified Rankin Scale (mRS) at three months after stroke, being poor outcome defined as mRS > 2. DNAm was determined using the 450K and EPIC BeadChips in whole-blood samples collected within the first 24 h. We searched for differentially methylated positions (DMPs) in 370,344 CpGs, and candidates below p-value < 10-5 were subsequently tested in the replication cohort. We then meta-analyzed DMP results from both cohorts and used them to identify differentially methylated regions (DMRs). After doing the epigenome-wide association study, we found 29 DMPs at p-value < 10-5 and one of them was replicated: cg24391982, annotated to thrombospondin-2 (THBS2) gene (p-valuediscovery = 1.54·10-6; p-valuereplication = 9.17·10-4; p-valuemeta-analysis = 6.39·10-9). Besides, four DMRs were identified in patients with poor outcome annotated to zinc finger protein 57 homolog (ZFP57), Arachidonate 12-Lipoxygenase 12S Type (ALOX12), ABI Family Member 3 (ABI3) and Allantoicase (ALLC) genes (p-value < 1·10-9 in all cases). DISCUSSION Patients with poor outcome showed a DMP at THBS2 and four DMRs annotated to ZFP57, ALOX12, ABI3 and ALLC genes. This suggests an association between stroke outcome and DNAm, which may help identify new stroke recovery mechanisms.
Collapse
Affiliation(s)
- Joan Jiménez-Balado
- Neurovascular Research Group, Department of Neurology, Hospital del Mar Research Institute, C/ del Dr. Aiguader, 88, 08003, Barcelona, Spain.
| | - Isabel Fernández-Pérez
- Neurovascular Research Group, Department of Neurology, Hospital del Mar Research Institute, C/ del Dr. Aiguader, 88, 08003, Barcelona, Spain
- Medicine Department, Autonomous University of Barcelona, Barcelona, Spain
| | | | - Uxue Lazcano
- Center for Cooperative Research in Biosciences (CIC bioGUNE), Basque Research and Technology Alliance (BRTA), Biscaia, Spain
| | - Carolina Soriano-Tárraga
- Department of Psychiatry, NeuroGenomics and Informatics, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Marta Vallverdú-Prats
- Neurovascular Research Group, Department of Neurology, Hospital del Mar Research Institute, C/ del Dr. Aiguader, 88, 08003, Barcelona, Spain
| | - Marina Mola-Caminal
- Unit of Medical Epidemiology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Lucía Rey-Álvarez
- Neurovascular Research Group, Department of Neurology, Hospital del Mar Research Institute, C/ del Dr. Aiguader, 88, 08003, Barcelona, Spain
| | - Adrià Macias-Gómez
- Neurovascular Research Group, Department of Neurology, Hospital del Mar Research Institute, C/ del Dr. Aiguader, 88, 08003, Barcelona, Spain
| | - Antoni Suárez-Pérez
- Neurovascular Research Group, Department of Neurology, Hospital del Mar Research Institute, C/ del Dr. Aiguader, 88, 08003, Barcelona, Spain
| | - Eva Giralt-Steinhauer
- Neurovascular Research Group, Department of Neurology, Hospital del Mar Research Institute, C/ del Dr. Aiguader, 88, 08003, Barcelona, Spain
| | - Ana Rodríguez-Campello
- Neurovascular Research Group, Department of Neurology, Hospital del Mar Research Institute, C/ del Dr. Aiguader, 88, 08003, Barcelona, Spain
- Medicine Department, DCEXS-Universitat Pompeu Fabra (UPF), 08002, Barcelona, Spain
| | - Elisa Cuadrado-Godia
- Neurovascular Research Group, Department of Neurology, Hospital del Mar Research Institute, C/ del Dr. Aiguader, 88, 08003, Barcelona, Spain
- Medicine Department, DCEXS-Universitat Pompeu Fabra (UPF), 08002, Barcelona, Spain
| | - Ángel Ois
- Neurovascular Research Group, Department of Neurology, Hospital del Mar Research Institute, C/ del Dr. Aiguader, 88, 08003, Barcelona, Spain
- Medicine Department, DCEXS-Universitat Pompeu Fabra (UPF), 08002, Barcelona, Spain
| | - Manel Esteller
- Cancer Epigenetics Group, Josep Carreras Leukaemia Research Institute (IJC), Badalona, Barcelona, Catalonia, Spain
- Centro de Investigacion Biomedica en Red Cancer (CIBERONC), Madrid, Spain
- Institucio Catalana de Recerca I Estudis Avançats (ICREA), Barcelona, Catalonia, Spain
- Physiological Sciences Department, School of Medicine and Health Sciences, University of Barcelona (UB), Barcelona, Catalonia, Spain
| | - Jaume Roquer
- Neurovascular Research Group, Department of Neurology, Hospital del Mar Research Institute, C/ del Dr. Aiguader, 88, 08003, Barcelona, Spain
| | | | - Jordi Jiménez-Conde
- Neurovascular Research Group, Department of Neurology, Hospital del Mar Research Institute, C/ del Dr. Aiguader, 88, 08003, Barcelona, Spain.
- Medicine Department, DCEXS-Universitat Pompeu Fabra (UPF), 08002, Barcelona, Spain.
| |
Collapse
|
5
|
Gjestad E, Nerdal V, Saltvedt I, Lydersen S, Kliem E, Ryum T, Grambaite R. Delirium in acute stroke is associated with increased cognitive and psychiatric symptoms over time: The Nor-COAST study. J Stroke Cerebrovasc Dis 2024; 33:107667. [PMID: 38423153 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/21/2024] [Accepted: 02/26/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Delirium, an acute and fluctuating mental disturbance of attention, cognition, and consciousness, commonly occurs in acute stroke. Research on long-term outcomes of stroke patients experiencing delirium is limited, especially regarding cognitive and psychiatric symptoms. METHODS As part of the Nor-COAST study, 373 patients were screened for delirium using the Confusion Assessment Method (CAM) in the acute phase of stroke. Patients were included in the mixed-model linear regression analyses if they had available data from the follow-ups at three, 18 or 36 months, totaling 334 (44.6 % women, mean (SD) age: 72.1 (12.5) years, 17 (5.1 %) diagnosed with delirium). Global cognition was measured using the Montreal Cognitive Assessment (MoCA). Psychiatric symptoms were measured using the Hospital Anxiety and Depression Scale (HADS) and the Neuropsychiatric Inventory-Questionnaire (NPI-Q). RESULTS At three months, delirium was associated with a higher NPI-Q score (Mean (SD) 2.9 (3.6) vs 1.4 (2.2)). At 18 and 36 months, delirium was associated with a lower MoCA score (Mean (SD) 19.7 (6.6) vs 24.3 (5.0), and 20.6 (7.6) vs 24.6 (4.8)), higher HADS anxiety symptoms (5.0 (4.3) vs 3.3 (3.3), and 5.9 (4.1) vs 3.4 (3.6)), higher HADS depression symptoms (7.2 (4.7) vs 3.4 (3.3), and 6.6 (5.1) vs 3.7 (3.7)), and higher NPI-Q score (2.4 (4.4) vs 1.7 (2.3), 2.6 (4.5) vs 1.0 (1.9)). Delirium significantly predicted the psychiatric symptoms hallucinations and agitation. CONCLUSIONS Patients with delirium in the acute phase of stroke may be particularly vulnerable to developing cognitive and psychiatric symptoms in the chronic phase.
Collapse
Affiliation(s)
- Elise Gjestad
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Vilde Nerdal
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ingvild Saltvedt
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway; Department of Geriatrics, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Stian Lydersen
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Elisabeth Kliem
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway; Health Services Research Unit (HØKH), Akershus University Hospital, Lørenskog, Norway
| | - Truls Ryum
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ramune Grambaite
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Health Services Research Unit (HØKH), Akershus University Hospital, Lørenskog, Norway.
| |
Collapse
|
6
|
Yang HL, Wang M, Xu YF, Mo BR, Liu XL, Redding SR. Understanding adherence to continuous positive airway pressure in patients with obstructive sleep apnea post-stroke: A prospective study based on the Andersen model. Nurs Health Sci 2024; 26:e13129. [PMID: 38781983 DOI: 10.1111/nhs.13129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 04/09/2024] [Accepted: 05/07/2024] [Indexed: 05/25/2024]
Abstract
Adherence to continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea (OSA) post-stroke is often problematic, despite potential benefits. This study aimed to evaluate CPAP adherence in patients with OSA post-stroke based on the Andersen behavioral model of health services utilization. A total of 227 eligible participants were recruited from a Chinese hospital. After baseline assessment, participants were followed for 6 months to determine short-term CPAP adherence. Those with good short-term adherence were followed for an additional 6 months to explore long-term adherence and influencing factors. Short-term CPAP adherence rate was 33%. Being married or living with a partner, having an associate degree or baccalaureate degree or higher, and stronger health beliefs independently predicted short-term CPAP adherence. Only 25% of participants from the adherent group showed good long-term adherence. The factor associated with long-term CPAP adherence was participants not using alcohol. Adherence to CPAP is suboptimal among patients having OSA post-stroke. Addressing unfavorable predisposing factors and modifying health beliefs are suggested.
Collapse
Affiliation(s)
- Hua-Lu Yang
- Department of Nursing, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, Guangdong Province, China
| | - Mian Wang
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
- Joint Research Centre for Primary Health Care, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Yan-Fei Xu
- Department of Respiratory and Critical Care Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, Guangdong Province, China
| | - Bei-Rong Mo
- Department of Nursing, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, Guangdong Province, China
| | - Xian-Liang Liu
- Department of Nursing, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, Guangdong Province, China
- College of Nursing and Midwifery, Charles Darwin University, Brisbane, Queensland, Australia
| | - Sharon R Redding
- Project HOPE (Health Opportunities for People Everywhere), Washington, DC, USA
| |
Collapse
|
7
|
Krastev G, Mako M, Števková Z, Havranová R, Andrášiková K. Analysis of Safety and Efficacy of the Early Initiation of Antithrombotic Secondary Prevention in Patients Treated with Intravenous Thrombolysis for Acute Ischemic Stroke. J Clin Med 2024; 13:2710. [PMID: 38731239 PMCID: PMC11084356 DOI: 10.3390/jcm13092710] [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: 03/18/2024] [Revised: 04/29/2024] [Accepted: 04/30/2024] [Indexed: 05/13/2024] Open
Abstract
Background and Objectives: Current guidelines and the alteplase product insert recommend that antithrombotic therapy be avoided within 24 h of intravenous thrombolytic therapy with rt-PA in acute ischemic stroke. Therefore, the rate of stroke recurrence is unclear in terms of early neurological deterioration, which we could prevent with the early administration of antithrombotic therapy. We do not know the effect of early antithrombotic therapy after intravenous thrombolysis with rt-PA in acute stroke on the outcome in patients after 90 days either. Design: Prospective monocentric observational cohort study. Methods: Data were collected from consecutive patients treated with alteplase for acute ischemic stroke between January 2015 and January 2023. We examined functional outcome at 90 days, including the risk of symptomatic intracranial hemorrhage and mortality rate as safety indicators and stroke recurrence events in both early and standard antithrombotic therapy at 24 h after intravenous thrombolysis. Results: A total of 489 patients were included, of which 278 (56.9%) were men. Of these, 407 (83.2%) patients received early antithrombotic therapy. No symptomatic intracranial hemorrhage occurred in any participants. There was a significantly higher number of patients with an excellent outcome (mRS 0-1) in early antithrombotic treatment (211 (53.1%) versus 28 (34.6%) in standard antithrombotic treatment (p = 0.002, OR 0.47, 95% CI: 0.28-0.76). Conclusions: Early antithrombotic treatment after intravenous therapy in patients with acute ischemic stroke revealed no safety concerns compared with standard antithrombotic therapy and resulted in a significantly higher proportion of patients with an excellent functional outcome.
Collapse
Affiliation(s)
- Georgi Krastev
- Clinic of Neurology, Faculty Hospital Trnava, A. Žarnova 11, 91701 Trnava, Slovakia; (G.K.); (M.M.); (R.H.); (K.A.)
- Clinic of Neurology in Trnava, Slovak Medical University, Limbová 12, 83303 Bratislava, Slovakia
| | - Miroslav Mako
- Clinic of Neurology, Faculty Hospital Trnava, A. Žarnova 11, 91701 Trnava, Slovakia; (G.K.); (M.M.); (R.H.); (K.A.)
- Clinic of Neurology in Trnava, Slovak Medical University, Limbová 12, 83303 Bratislava, Slovakia
| | - Zuzana Števková
- Clinic of Neurology, Faculty Hospital Trnava, A. Žarnova 11, 91701 Trnava, Slovakia; (G.K.); (M.M.); (R.H.); (K.A.)
- Clinic of Neurology in Trnava, Slovak Medical University, Limbová 12, 83303 Bratislava, Slovakia
| | - Romana Havranová
- Clinic of Neurology, Faculty Hospital Trnava, A. Žarnova 11, 91701 Trnava, Slovakia; (G.K.); (M.M.); (R.H.); (K.A.)
- Clinic of Neurology in Trnava, Slovak Medical University, Limbová 12, 83303 Bratislava, Slovakia
| | - Kristína Andrášiková
- Clinic of Neurology, Faculty Hospital Trnava, A. Žarnova 11, 91701 Trnava, Slovakia; (G.K.); (M.M.); (R.H.); (K.A.)
- Clinic of Neurology in Trnava, Slovak Medical University, Limbová 12, 83303 Bratislava, Slovakia
| |
Collapse
|
8
|
Sandvig HV, Aam S, Alme KN, Lydersen S, Magne Ueland P, Ulvik A, Wethal T, Saltvedt I, Knapskog AB. Neopterin, kynurenine metabolites, and indexes related to vitamin B6 are associated with post-stroke cognitive impairment: The Nor-COAST study. Brain Behav Immun 2024; 118:167-177. [PMID: 38428649 DOI: 10.1016/j.bbi.2024.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/24/2024] [Accepted: 02/27/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND AND AIMS We have previously shown that systemic inflammation was associated with post-stroke cognitive impairment (PSCI). Because neopterin, kynurenine pathway (KP) metabolites, and B6 vitamers are linked to inflammation, in our study we investigated whether those biomarkers were associated with PSCI. MATERIAL AND METHODS The Norwegian Cognitive Impairment After Stroke study is a prospective multicenter cohort study of patients with acute stroke recruited from May 2015 through March 2017. Plasma samples of 422 participants (59 % male) with ischemic stroke from the index hospital stay and 3 months post-stroke were available for analyses of neopterin, KP metabolites, and B6 vitamers using liquid chromatography-tandem mass spectrometry. Mixed linear regression analyses adjusted for age, sex, and creatinine, were used to assess whether there were associations between those biomarkers and cognitive outcomes, measured by the Montreal Cognitive Assessment scale (MoCA) at 3-, 18-, and 36-month follow-up. RESULTS Participants had a mean (SD) age of 72 (12) years, with a mean (SD) National Institutes of HealthStroke Scale score of 2.7 (3.6) at Day 1. Higher baseline values of quinolinic acid, PAr (i.e., an inflammatory marker based on vitamin B6 metabolites), and HKr (i.e., a marker of functional vitamin B6 status based on selected KP metabolites) were associated with lower MoCA score at 3, 18, and 36 months post-stroke (p < 0.01). Higher baseline concentrations of neopterin and 3-hydroxykynurenine were associated with lower MoCA scores at 18 and 36 months, and higher concentrations of xanthurenic acid were associated with higher MoCA score at 36 months (p < 0.01). At 3 months post-stroke, higher concentrations of neopterin and lower values of pyridoxal 5́-phosphate were associated with lower MoCA scores at 18- and 36-month follow-up, while lower concentrations of picolinic acid were associated with a lower MoCA score at 36 months (p < 0.01). CONCLUSION Biomarkers and metabolites of systemic inflammation, including biomarkers of cellular immune activation, indexes of vitamin B6 homeostasis, and several neuroactive metabolites of the KP pathway, were associated with PSCI. TRIAL REGISTRATION ClinicalTrials.gov: NCT02650531.
Collapse
Affiliation(s)
- Heidi Vihovde Sandvig
- Department of Medicine, Kristiansund Hospital, Møre og Romsdal Hospital Trust, Kristiansund, Norway; Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Stina Aam
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway; Department of Geriatric Medicine, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Katinka N Alme
- Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Stian Lydersen
- Department of Mental Health, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Arve Ulvik
- Bevital A/S, Laboratoriebygget, 5021 Bergen, Norway
| | - Torgeir Wethal
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway; Department of Stroke, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Ingvild Saltvedt
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway; Department of Geriatric Medicine, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Anne-Brita Knapskog
- Department of Geriatric Medicine, Oslo University Hospital, Ullevaal, Oslo, Norway
| |
Collapse
|
9
|
Küçükakgün H, Tulek Z, Kılıçaslan K, Dursun Uncu J, Bayrak C, Soltanalizadeh R, Krespi Y. Validation of the Turkish version of the Neurological Fatigue Index for Stroke. Cogn Neuropsychiatry 2024; 29:141-153. [PMID: 38606870 DOI: 10.1080/13546805.2024.2337155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 03/12/2024] [Indexed: 04/13/2024]
Abstract
INTRODUCTION Post-stroke fatigue is an often overlooked problem that hinders recovery. Therefore, stroke patients should be evaluated for fatigue during the recovery period. This study aimed to adapt the Neurological Fatigue Index for Stroke (NFI-Stroke) into the Turkish language. METHODS This methodological study was carried out on 110 stroke patients admitted to a university hospital in Istanbul. In addition to the NFI-Stroke, Functional Independence Measure, National Institutes of Health Stroke Scale, modified-Rankin Scale, Fatigue Severity-Scale, and Stroke Self Efficacy Questionnaire were used to collect data. RESULTS Since the linguistic validity study of the scale has already been carried out, only psychometric properties were evaluated. The items in the scale were grouped under two factors. The Cronbach`s alpha coefficient was found to be 0.96 for the physical sub-dimension and 0.84 for the cognitive sub-dimension. Item-total correlation coefficients were found between 0.74-0.91 for the physical sub-dimension, and 0.82-0.91 for the cognitive sub-dimension. The test-retest evaluation confirmed the consistency of the responses to the scale against time. The scale was correlated with other scales used in the study as expected. CONCLUSIONS The NFI-Stroke will be useful in clinical practice in assessment of fatigue, which may affect the adaptation of patients to rehabilitation.
Collapse
Affiliation(s)
- Hilalnur Küçükakgün
- Institute of Graduate Studies, Medical Nursing Doctorate Program, Istanbul University-Cerrahpasa, Istanbul, Türkiye
- Florence Nightingale Faculty of Nursing, Istanbul University-Cerrahpasa, Istanbul, Türkiye
| | - Zeliha Tulek
- Florence Nightingale Faculty of Nursing, Istanbul University-Cerrahpasa, Istanbul, Türkiye
| | - Kimya Kılıçaslan
- Institute of Graduate Studies, Medical Nursing Doctorate Program, Istanbul University-Cerrahpasa, Istanbul, Türkiye
- Florence Nightingale Faculty of Nursing, Istanbul University-Cerrahpasa, Istanbul, Türkiye
| | - Jbid Dursun Uncu
- Institute of Graduate Studies in Health Sciences, Advanced Neurological Sciences Doctorate Program, Istanbul University, Istanbul, Türkiye
- Department of Neurology, Stroke Center, Istinye University Liv Hospital Bahcesehir, Istanbul, Türkiye
| | - Ceren Bayrak
- Department of Neurology, Stroke Center, Istinye University Liv Hospital Bahcesehir, Istanbul, Türkiye
- Institute of Graduate Studies, Neurological Physiotherapy and Rehabilitation Master's Program, Istanbul University-Cerrahpasa, Istanbul, Türkiye
| | - Roya Soltanalizadeh
- Physical Medicine and Rehabilitation Clinic, Istinye University Liv Hospital Bahcesehir, Istanbul, Türkiye
| | - Yakup Krespi
- Department of Neurology, Stroke Center, Istinye University Liv Hospital Bahcesehir, Istanbul, Türkiye
| |
Collapse
|
10
|
Nimbvikar AA, Panchawagh S, Chavan AP, Ingole JR, Pargaonkar Y, Pai R. Modified rankin scale is a reliable tool for the rapid assessment of stroke severity and predicting disability outcomes. J Family Med Prim Care 2024; 13:1085-1090. [PMID: 38736805 PMCID: PMC11086762 DOI: 10.4103/jfmpc.jfmpc_1431_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/28/2023] [Accepted: 12/30/2023] [Indexed: 05/14/2024] Open
Abstract
Background 'Time is brain' goes the adage. Rapid and precise management of stroke is of the utmost essence. The modified National Institutes of Health Stroke Scale (mNIHSS) and the modified Rankin Scale (mRS) predict stroke severity and functional disability outcomes. However, the mRS can be administered more rapidly than the mNIHSS and therefore might be better to assess patient outcomes. Hence, the aim of this study was to assess the correlation of stroke severity on admission and functional disability outcomes on the day of discharge or on the 8th day of hospitalization. Materials and Methods This was an observational, cross-sectional study with a sample size of 61 participants. The mNIHSS score was calculated on admission for patients with clinical features suggestive of stroke and mRS was calculated on the 8th day of hospitalization or on discharge. Evaluation of the association between continuous variables was done using Spearman's correlation analysis. Results Correlation between mNIHSS and mRS was positive and statistically significant (rho = 0.866, 95% CI [0.751, 0.925]. For each point increase in the mNIHSS, the odds of having higher mRS scores are 153% more than the odds of having lower mRS scores (aOR = 2.534, 95% CI [1.904, 3.560]). Conclusion Our study concluded that mRS can be reliably used to predict the functional outcomes for patients with stroke in circumstances where the mNIHSS may prove to be lengthy. Thus, where 'time is brain', the mRS can be used with a similar power to predict the outcome.
Collapse
Affiliation(s)
- Apoorv A. Nimbvikar
- Department of Medicine, Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India
| | - Suhrud Panchawagh
- Department of Medicine, Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India
- ReQuir Statistical Solutions, All India Institute of Medical Sciences, New Delhi, India
| | - Abhijit P. Chavan
- Department of Medicine, Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India
| | - Jitendra R. Ingole
- Department of Medicine, Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India
| | - Yash Pargaonkar
- Department of Medicine, Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India
| | - Rohan Pai
- Department of Medicine, Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
11
|
Denis C, Jaussent I, Guiraud L, Mestejanot C, Arquizan C, Mourand I, Chenini S, Abril B, Wacongne A, Tamisier R, Baillieul S, Pepin JL, Barateau L, Dauvilliers Y. Functional recovery after ischemic stroke: Impact of different sleep health parameters. J Sleep Res 2024; 33:e13964. [PMID: 37338010 DOI: 10.1111/jsr.13964] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/24/2023] [Accepted: 06/05/2023] [Indexed: 06/21/2023]
Abstract
Sleep disturbances after ischaemic stroke include alterations of sleep architecture, obstructive sleep apnea, restless legs syndrome, daytime sleepiness and insomnia. Our aim was to explore their impacts on functional outcomes at month 3 after stroke, and to assess the benefit of continuous positive airway pressure in patients with severe obstructive sleep apnea. Ninety patients with supra-tentorial ischaemic stroke underwent clinical screening for sleep disorders and polysomnography at day 15 ± 4 after stroke in a multisite study. Patients with severe obstructive apnea (apnea-hypopnea index ≥ 30 per hr) were randomized into two groups: continuous positive airway pressure-treated and sham (1:1 ratio). Functional independence was assessed with the Barthel Index at month 3 after stroke in function of apnea-hypopnea index severity and treatment group. Secondary objectives were disability (modified Rankin score) and National Institute of Health Stroke Scale according to apnea-hypopnea index. Sixty-one patients (71.8 years, 42.6% men) completed the study: 51 (83.6%) had obstructive apnea (21.3% severe apnea), 10 (16.7%) daytime sleepiness, 13 (24.1%) insomnia, 3 (5.7%) depression, and 20 (34.5%) restless legs syndrome. Barthel Index, modified Rankin score and Stroke Scale were similar at baseline and 3 months post-stroke in the different obstructive sleep apnea groups. Changes at 3 months in those three scores were similar in continuous positive airway pressure versus sham-continuous positive airway pressure patients. In patients with worse clinical outcomes at month 3, mean nocturnal oxygen saturation was lower whereas there was no association with apnea-hypopnea index. Poorer outcomes at 3 months were also associated with insomnia, restless legs syndrome, depressive symptoms, and decreased total sleep time and rapid eye movement sleep.
Collapse
Affiliation(s)
- Claire Denis
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU, Montpellier, France
| | | | - Lily Guiraud
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU, Montpellier, France
| | - Caroline Mestejanot
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU, Montpellier, France
| | - Caroline Arquizan
- Stroke University, Department of Neurology, Gui-de-Chauliac Hospital, CHU, Montpellier, France
| | - Isabelle Mourand
- Stroke University, Department of Neurology, Gui-de-Chauliac Hospital, CHU, Montpellier, France
| | - Sofiène Chenini
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU, Montpellier, France
- INM, University Montpellier, INSERM, Montpellier, France
- National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome, Montpellier, France
| | - Beatriz Abril
- Sleep University, Carémeau Hospital, CHU, Nîmes, France
| | - Anne Wacongne
- Neurology Department, Carémeau Hospital, CHU, Nîmes, France
| | - Renaud Tamisier
- University Grenoble Alpes, Inserm, U1300, CHU Grenoble Alpes, Service Universitaire de Pneumologie Physiologie, Grenoble, France
| | - Sébastien Baillieul
- University Grenoble Alpes, Inserm, U1300, CHU Grenoble Alpes, Service Universitaire de Pneumologie Physiologie, Grenoble, France
| | - Jean-Louis Pepin
- University Grenoble Alpes, Inserm, U1300, CHU Grenoble Alpes, Service Universitaire de Pneumologie Physiologie, Grenoble, France
| | - Lucie Barateau
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU, Montpellier, France
- INM, University Montpellier, INSERM, Montpellier, France
- National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome, Montpellier, France
| | - Yves Dauvilliers
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU, Montpellier, France
- INM, University Montpellier, INSERM, Montpellier, France
- National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome, Montpellier, France
| |
Collapse
|
12
|
Navickaite E, Saltvedt I, Lydersen S, Munthe-Kaas R, Ihle-Hansen H, Grambaite R, Aam S. Diagnostic accuracy of the Clock Drawing Test in screening for early post-stroke neurocognitive disorder: the Nor-COAST study. BMC Neurol 2024; 24:22. [PMID: 38195396 PMCID: PMC10775614 DOI: 10.1186/s12883-023-03523-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 12/25/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Post-stroke neurocognitive disorder, though common, is often overlooked by clinicians. Moreover, although the Montreal Cognitive Assessment (MoCA) has proven to be a valid screening test for neurocognitive disorder, even more time saving tests would be preferred. In our study, we aimed to determine the diagnostic accuracy of the Clock Drawing Test (CDT) for post-stroke neurocognitive disorder and the association between the CDT and MoCA. METHODS This study is part of the Norwegian Cognitive Impairment After Stroke study, a multicentre prospective cohort study following patients admitted with acute stroke. At the three-month follow-up, patients were classified with normal cognition, mild neurocognitive disorder, or major neurocognitive disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria. Any neurocognitive disorder compromised both mild- and major neurocognitive disorder. The CDT at the three-month assessment was given scores ranging from 0 to 5. Patients able to complete the CDT and whose cognitive status could be classified were included in analyses. The CDT diagnostic accuracy for post-stroke neurocognitive disorder was identified using receiver operating characteristic curves, sensitivity, specificity, positive predictive value, and negative predictive value. The association between the MoCA and CDT was analysed with Spearman's rho. RESULTS Of 554 participants, 238 (43.0%) were women. Mean (SD) age was 71.5 (11.8) years, while mean (SD) National Institutes of Health Stroke Scale score was 2.6 (3.7). The area under the receiver operating characteristic curve of the CDT for major neurocognitive disorder and any neurocognitive disorder was 0.73 (95% CI, 0.68-0.79) and 0.68 (95% CI, 0.63-0.72), respectively. A CDT cutoff of < 5 yielded 68% sensitivity and 60% specificity for any neurocognitive disorder and 78% sensitivity and 53% specificity for major neurocognitive disorder. Spearman's correlation coefficient between scores on the MoCA and CDT was 0.50 (95% CI, 0.44-0.57, p < .001). CONCLUSIONS The CDT is not accurate enough to diagnose post-stroke neurocognitive disorder but shows acceptable accuracy in identifying major neurocognitive disorder. Performance on the CDT was associated with performance on MoCA; however, the CDT is inferior to MoCA in identifying post-stroke neurocognitive disorder. TRIAL REGISTRATION ClinicalTrials.gov (NCT02650531). Retrospectively registered January 8, 2016.
Collapse
Affiliation(s)
- Egle Navickaite
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Faculty of Medicine and Health Science, Trondheim, Norway
| | - Ingvild Saltvedt
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Faculty of Medicine and Health Science, Trondheim, Norway.
- Department of Geriatric Medicine, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
| | - Stian Lydersen
- Department of Mental Health, Norwegian University of Science and Technology, Faculty of Medicine and Health Science, Trondheim, Norway
| | - Ragnhild Munthe-Kaas
- Department of Medicine, Kongsberg Hospital, Vestre Viken Hospital Trust, Kongsberg, Norway
- Department of Medicine, Bærum Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | - Hege Ihle-Hansen
- Stroke Unit, Department of Neurology, Oslo University Hospital, Ullevaal, Oslo, Norway
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | - Ramune Grambaite
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Stina Aam
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Faculty of Medicine and Health Science, Trondheim, Norway
- Department of Geriatric Medicine, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| |
Collapse
|
13
|
Sarfo FS, Voeks J, Adamu S, Agyei BA, Agbenorku M, Adu-Darko N, Oteng MA, Obese V, Gyamfi RA, Mensah NA, Tagge R, Ampofo M, Kontoh SA, Nguah SB, Ovbiagele B. A cardiovascular polypill for secondary stroke prevention in a tertiary centre in Ghana (SMAART): a phase 2 randomised clinical trial. Lancet Glob Health 2023; 11:e1619-e1628. [PMID: 37734804 PMCID: PMC10576526 DOI: 10.1016/s2214-109x(23)00347-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/10/2023] [Accepted: 07/12/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND A cardiovascular polypill containing generic drugs might facilitate sustained implementation of and adherence to evidence-based treatments, especially in resource-limited settings. However, the impact of a cardiovascular polypill in mitigating atherosclerotic risk among stroke survivors has not been assessed. We aimed to compare a polypill regimen with usual care on carotid intima-media thickness (CIMT) regression after ischaemic stroke. METHODS In SMAART, a phase 2 parallel, open-label, assessor-masked, randomised clinical trial, we randomly allocated individuals (aged ≥18 years) who had an ischaemic stroke within the previous 2 months, using a computer-generated randomisation sequence (1:1), to either a polypill or usual care group at a tertiary centre in Ghana. The polypill regimen was a fixed-dose pill containing 5 mg ramipril, 50 mg atenolol, 12·5 mg hydrochlorothiazide, 20 mg simvastatin, and 100 mg aspirin administered as two capsules once per day for 12 months. Usual care was tailored guideline-recommended secondary prevention medications. The primary outcome was the change in CIMT over 12 months with adjustment for baseline values, compared using ANCOVA in all participants with complete data at month 12. Safety was analysed in all randomly assigned participants. This trial is registered at ClinicalTrials.gov, NCT03329599, and is completed. FINDINGS Between Feb 12, 2019, and Dec 4, 2020, we randomly assigned 148 participants (74 to the usual care group and 74 to the polypill group), 74 (50%) of whom were male and 74 (50%) female. CIMT was assessed in 62 (84%) of 74 participants in the usual care group and 59 (80%) of 74 participants in the polypill group; the main reason for loss to follow-up was participants not completing the study. The mean CIMT change at month 12 was -0·092 mm (95% CI -0·130 to -0·051) in the usual care group versus -0·017 mm (-0·067 to 0·034) in the polypill group, with an adjusted mean difference of 0·049 (-0·008 to 0·109; p=0·11). Serious adverse events occurred among two (3%) participants in the usual care group, and eight (11%) participants in the polypill group (p=0·049). INTERPRETATION The polypill regimen resulted in similar regression in subclinical atherosclerosis and many secondary and tertiary outcome measures as the tailored drug regimen, but with more serious adverse events. Larger, longer-term, event-based studies, including patients with stroke in primary care settings, are warranted. FUNDING US National Institutes of Health. TRANSLATION For the Akan (Twi) translation of the abstract see Supplementary Materials section.
Collapse
Affiliation(s)
- Fred Stephen Sarfo
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Komfo Anokye Teaching Hospital, Kumasi, Ghana.
| | - Jenifer Voeks
- Medical University of South Carolina, Charleston, SC, USA
| | | | | | | | | | | | - Vida Obese
- Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | | | - Raelle Tagge
- Northern Californian Institute of Research and Education, San Francisco, CA, USA
| | | | | | - Samuel Blay Nguah
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Bruce Ovbiagele
- University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|
14
|
Mirza AM, Kulkarni GB, Ramakrishnan S, Mustare V, Yadav R, Gupta AK. Profile and Outcome of Prospective Non-Septic Lateral Sinus Thrombosis Patients from a Stroke Unit of a Developing Country. Neurol India 2023; 71:916-922. [PMID: 37929427 DOI: 10.4103/0028-3886.388114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Background Due to effective treatment of middle ear infections there is a change in etiologies causing lateral sinus thrombosis (LST) and outcome. There is a paucity of literature describing homogenous group of patients with nonseptic LST (NS-LST). Objective To describe the clinical profile, risk factors, outcome of patients of NS-LST seen at a single center from South India. Methods and Materials Prospective, observational study of 100 patients of NS-LST patients, diagnosed by magnetic resonance imaging (MRI) seen at the stroke unit. Results During 2 years, 100 patients of NS-LST (isolated: combined: 27:73) (male: female: 44:56), mean age: 31.45 ± 11.13 years, were seen. Subacute presentation (74%) with headache, seizures, focal deficits, and features of raised intracranial pressure were presenting features. Hyperhomocysteinemia (61%), anemia (57%), postpartum state (41%), OCP use (37%), and low VitB12 (32%) were commonly seen risk factors. Imaging with MRI compared withcomputerized tomography (CT) had better diagnostic sensitivity (100% vs. 67%), detection of parenchymal (81% vs. 67%)/hemorrhagic (79% vs. 74%) lesions, and cortical vein thrombosis (31% vs. 15.46%). Treatment with anticoagulation and supportive therapy resulted in good outcome (mRS (0-2)) at 3 months in 81%.There were four deaths, all during admission (one - isolated, three - combined) and 11 patients underwent decompressive surgery. Patients with low GCS level of sensoriumat admission, hemiparesis, combined LST, cerebellar involvement, and decompressive craniectomy had a poor outcome. Conclusion This single-center large cohort study of NS-LST patients brings out the clinical features, risk factors (peculiar to developing countries), and the superiority of MRI in the diagnosis. Majority of patients have good outcome, with low mortality with 10% requiring decompressive surgery.
Collapse
Affiliation(s)
- Abbas M Mirza
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, India
| | - Girish B Kulkarni
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, India
| | - Subasree Ramakrishnan
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, India
| | - Veerendrakumar Mustare
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, India
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, India
| | - Arun K Gupta
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, India
| |
Collapse
|
15
|
Chiang HY, Chen PT, Lee SC, Shieh YJ, Hsueh IP, Hsieh CL. Test-Retest Reliability and Responsiveness of the Computerized Adaptive Test of Social Functioning in Persons With Stroke. Arch Phys Med Rehabil 2023; 104:1432-1438. [PMID: 37028696 DOI: 10.1016/j.apmr.2023.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 02/20/2023] [Accepted: 03/08/2023] [Indexed: 04/09/2023]
Abstract
OBJECTIVE To examine the test-retest reliability, minimal detectable change (MDC), responsiveness, and efficiency of the Computerized Adaptive Test of Social Functioning (Social-CAT) in patients with stroke. DESIGN Repeated-assessments design. SETTING A department of rehabilitation of a medical center. PARTICIPANTS In total, 31 patients with chronic stroke and 65 patients with subacute stroke were recruited. INTERVENTION Not available. MAIN OUTCOME MEASURE Social-CAT. RESULTS The Social-CAT showed acceptable test-retest reliability (intraclass correlation coefficient, 0.80) and small random measurement error (MDC%: 18.0%). However, heteroscedasticity was found (r between the means and the absolute change scores: 0.32), so the MDC% adjusted cut-off score is recommended for determining real improvement. Regarding responsiveness, the Social-CAT showed large differences (Kazis' effect size and standardized mean response: 1.15 and 1.09, respectively) in subacute patients. Regarding efficiency, the Social-CAT required an average of 5 items and less than 2 minutes for completion. CONCLUSIONS Our findings indicate that the Social-CAT is a reliable and efficient measure with good test-retest reliability, small random measurement error, and good responsiveness. Thus, the Social-CAT is a useful outcome measure for routine monitoring of the changes in social function of patients with stroke.
Collapse
Affiliation(s)
- Hsin-Yu Chiang
- Department of Occupational Therapy, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Po-Ting Chen
- Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien; School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shih-Chieh Lee
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan; Institute of Long-Term Care, MacKay Medical College, New Taipei City; Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan; Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Yun-Jer Shieh
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - I-Ping Hsueh
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Ching-Lin Hsieh
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan; Department of Occupational Therapy, College of Medical and Health Science, Asia University, Taichung, Taiwan.
| |
Collapse
|
16
|
Koumo M, Maki Y, Goda A, Uchida K, Ogawa S, Matsui T, Hidemura N, Adachi T. The Clinical Variables Predicting the Acquisition of Independent Ambulation in the Acute Phase of Stroke: A Retrospective Study. Geriatrics (Basel) 2023; 8:80. [PMID: 37623273 PMCID: PMC10454264 DOI: 10.3390/geriatrics8040080] [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: 07/11/2023] [Revised: 08/05/2023] [Accepted: 08/09/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Predictive factors associated with independent ambulation post-stroke are less commonly reported for patients during the acute phase of stroke. This study aimed to identify the clinical variables predicting ambulation independence in the acute phase of stroke and test the superiority of their prediction accuracy. METHODS Sixty-nine patients, hospitalized in the acute phase for an initial unilateral, supratentorial stroke lesion, were divided into independent (n = 24) and dependent ambulation (n = 45) groups, with functional ambulation category scores of 4-5 and ≤ 3, respectively. They were evaluated upon admission using the modified Rankin scale (mRS), Stroke Impairment Assessment Set (SIAS) concerning the motor function of the lower extremities, Ability for Basic Movement Scale modified version 2 (ABMS2), and Functional Independence Measure (FIM). RESULTS The scores of the four measures were significantly different between the groups. A univariate logistic regression analysis identified these variables as prognostic factors for independent ambulation. A receiver operating characteristic curve analysis identified the cutoff values (area under the curve) for the mRS, SIAS, FIM, and ABMS2 as 3 (0.74), 12 (0.73), 55 (0.85), and 23 (0.84), respectively. CONCLUSION In summary, the FIM and ABMS2 may be more accurate in predicting ambulation independence in patients with stroke during the acute phase.
Collapse
Affiliation(s)
- Masatoshi Koumo
- Department of Rehabilitation, Hikari Hospital, Otsu 520-0002, Japan
- Department of Rehabilitation, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya 663-8211, Japan
| | - Yoshinori Maki
- Department of Rehabilitation, Hikari Hospital, Otsu 520-0002, Japan
- Department of Neurosurgery, Hikone Chuo Hospital, Hikone 522-0054, Japan
| | - Akio Goda
- Department of Physical Therapy, Faculty of Health and Medical Sciences, Hokuriku University, Kanazawa 920-1180, Japan
| | - Kensaku Uchida
- Department of Rehabilitation, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya 663-8211, Japan
| | - Shohei Ogawa
- Department of Rehabilitation, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya 663-8211, Japan
| | - Tatsumi Matsui
- Department of Rehabilitation, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya 663-8211, Japan
| | - Nozomu Hidemura
- Department of Rehabilitation, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya 663-8211, Japan
| | - Tomohiro Adachi
- Department of Rehabilitation, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya 663-8211, Japan
| |
Collapse
|
17
|
Allida SM, Hsieh CF, Cox KL, Patel K, Rouncefield-Swales A, Lightbody CE, House A, Hackett ML. Pharmacological, non-invasive brain stimulation and psychological interventions, and their combination, for treating depression after stroke. Cochrane Database Syst Rev 2023; 7:CD003437. [PMID: 37417452 PMCID: PMC10327406 DOI: 10.1002/14651858.cd003437.pub5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
BACKGROUND Depression is an important morbidity associated with stroke that impacts on recovery, yet is often undetected or inadequately treated. OBJECTIVES To evaluate the benefits and harms of pharmacological intervention, non-invasive brain stimulation, psychological therapy, or combinations of these to treat depression after stroke. SEARCH METHODS This is a living systematic review. We search for new evidence every two months and update the review when we identify relevant new evidence. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review. We searched the Specialised Registers of Cochrane Stroke, and Cochrane Depression Anxiety and Neurosis, CENTRAL, MEDLINE, Embase, five other databases, two clinical trials registers, reference lists and conference proceedings (February 2022). We contacted study authors. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing: 1) pharmacological interventions with placebo; 2) non-invasive brain stimulation with sham stimulation or usual care; 3) psychological therapy with usual care or attention control; 4) pharmacological intervention and psychological therapy with pharmacological intervention and usual care or attention control; 5) pharmacological intervention and non-invasive brain stimulation with pharmacological intervention and sham stimulation or usual care; 6) non-invasive brain stimulation and psychological therapy versus sham brain stimulation or usual care and psychological therapy; 7) pharmacological intervention and psychological therapy with placebo and psychological therapy; 8) pharmacological intervention and non-invasive brain stimulation with placebo and non-invasive brain stimulation; and 9) non-invasive brain stimulation and psychological therapy versus non-invasive brain stimulation and usual care or attention control, with the intention of treating depression after stroke. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, assessed risk of bias, and extracted data from included studies. We calculated mean difference (MD) or standardised mean difference (SMD) for continuous data, and risk ratio (RR) for dichotomous data, with 95% confidence intervals (CIs). We assessed heterogeneity using the I² statistic and certainty of the evidence according to GRADE. MAIN RESULTS We included 65 trials (72 comparisons) with 5831 participants. Data were available for: 1) 20 comparisons; 2) nine comparisons; 3) 25 comparisons; 4) three comparisons; 5) 14 comparisons; and 6) one comparison. We found no trials for comparisons 7 to 9. Comparison 1: Pharmacological interventions Very low-certainty evidence from eight trials suggests pharmacological interventions decreased the number of people meeting the study criteria for depression (RR 0.70, 95% CI 0.55 to 0.88; P = 0.002; 8 RCTs; 1025 participants) at end of treatment and very low-certainty evidence from six trials suggests that pharmacological interventions decreased the number of people with inadequate response to treatment (RR 0.47, 95% CI 0.32 to 0.70; P = 0.0002; 6 RCTs; 511 participants) compared to placebo. More adverse events related to the central nervous system (CNS) (RR 1.55, 95% CI 1.12 to 2.15; P = 0.008; 5 RCTs; 488 participants; very low-certainty evidence) and gastrointestinal system (RR 1.62, 95% CI 1.19 to 2.19; P = 0.002; 4 RCTs; 473 participants; very low-certainty evidence) were noted in the pharmacological intervention than in the placebo group. Comparison 2: Non-invasive brain stimulation Very low-certainty evidence from two trials show that non-invasive brain stimulation had little to no effect on the number of people meeting the study criteria for depression (RR 0.67, 95% CI 0.39 to 1.14; P = 0.14; 2 RCTs; 130 participants) and the number of people with inadequate response to treatment (RR 0.84, 95% CI 0.52, 1.37; P = 0.49; 2 RCTs; 130 participants) compared to sham stimulation. Non-invasive brain stimulation resulted in no deaths. Comparison 3: Psychological therapy Very low-certainty evidence from six trials suggests that psychological therapy decreased the number of people meeting the study criteria for depression at end of treatment (RR 0.77, 95% CI 0.62 to 0.95; P = 0.01; 521 participants) compared to usual care/attention control. No trials of psychological therapy reported on the outcome inadequate response to treatment. No differences in the number of deaths or adverse events were found in the psychological therapy group compared to the usual care/attention control group. Comparison 4: Pharmacological interventions with psychological therapy No trials of this combination reported on the primary outcomes. Combination therapy resulted in no deaths. Comparison 5: Pharmacological interventions with non-invasive brain stimulation Non-invasive brain stimulation with pharmacological intervention reduced the number of people meeting study criteria for depression at end of treatment (RR 0.77, 95% CI 0.64 to 0.91; P = 0.002; 3 RCTs; 392 participants; low-certainty evidence) but not the number of people with inadequate response to treatment (RR 0.95, 95% CI 0.69 to 1.30; P = 0.75; 3 RCTs; 392 participants; very low-certainty evidence) compared to pharmacological therapy alone. Very low-certainty evidence from five trials suggest no difference in deaths between this combination therapy (RR 1.06, 95% CI 0.27 to 4.16; P = 0.93; 487 participants) compared to pharmacological therapy intervention and sham stimulation or usual care. Comparison 6: Non-invasive brain stimulation with psychological therapy No trials of this combination reported on the primary outcomes. AUTHORS' CONCLUSIONS Very low-certainty evidence suggests that pharmacological, psychological and combination therapies can reduce the prevalence of depression while non-invasive brain stimulation had little to no effect on the prevalence of depression. Pharmacological intervention was associated with adverse events related to the CNS and the gastrointestinal tract. More research is required before recommendations can be made about the routine use of such treatments.
Collapse
Affiliation(s)
- Sabine M Allida
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Cheng-Fang Hsieh
- Division of Geriatrics and Gerontology, Department of Internal Medicine and Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Katherine Laura Cox
- Mental Health Program, The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Kulsum Patel
- Faculty of Health and Care, University of Central Lancashire, Preston, Lancashire, UK
| | | | - C Elizabeth Lightbody
- Faculty of Health and Care, University of Central Lancashire, Preston, Lancashire, UK
| | - Allan House
- Division of Psychological and Social Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Maree L Hackett
- Faculty of Health and Care, University of Central Lancashire, Preston, Lancashire, UK
- Mental Health Program, The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| |
Collapse
|
18
|
Lam MSH, Luoma AMV, Reddy U. Acute perioperative neurological emergencies. Int Anesthesiol Clin 2023; 61:53-63. [PMID: 37249171 DOI: 10.1097/aia.0000000000000404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Michelle S H Lam
- Department of Neuroanaesthesia and Neurocritical Care, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Astri M V Luoma
- Department of Neuroanaesthesia and Neurocritical Care, The National Hospital for Neurology and Neurosurgery, London, UK
- Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, London, UK
| | - Ugan Reddy
- Department of Neuroanaesthesia and Neurocritical Care, The National Hospital for Neurology and Neurosurgery, London, UK
- Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, London, UK
| |
Collapse
|
19
|
Bang HJ, Oh SH, Jeong WJ, Cha K, Park KN, Youn CS, Kim HJ, Lim JY, Kim HJ, Song H. A novel cardiac arrest severity score for the early prediction of hypoxic-ischemic brain injury and in-hospital death. Am J Emerg Med 2023; 66:22-30. [PMID: 36669440 DOI: 10.1016/j.ajem.2023.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 11/27/2022] [Accepted: 01/02/2023] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Out-of-hospital cardiac arrest (OHCA) outcomes are unsatisfactory despite postcardiac arrest care. Early prediction of prognoses might help stratify patients and provide tailored therapy. In this study, we derived and validated a novel scoring system to predict hypoxic-ischemic brain injury (HIBI) and in-hospital death (IHD). METHODS We retrospectively analyzed Korean Hypothermia Network prospective registry data collected from in Korea between 2015 and 2018. Patients without neuroprognostication data were excluded, and the remaining patients were randomly divided into derivation and validation cohorts. HIBI was defined when at least one prognostication predicted a poor outcome. IHD meant all deaths regardless of cause. In the derivation cohort, stepwise multivariate logistic regression was conducted for the HIBI and IHD scores, and model performance was assessed. We then classified the patients into four categories and analyzed the associations between the categories and cerebral performance categories (CPCs) at hospital discharge. Finally, we validated our models in an internal validation cohort. RESULTS Among 1373 patients, 240 were excluded, and 1133 were randomized into the derivation (n = 754) and validation cohorts (n = 379). In the derivation cohort, 7 and 8 predictors were selected for HIBI (0-8) and IHD scores (0-11), respectively, and the area under the curves (AUC) were 0.85 (95% CI 0.82-0.87) and 0.80 (95% CI 0.77-0.82), respectively. Applying optimum cutoff values of ≥6 points for HIBI and ≥7 points for IHD, the patients were classified as follows: HIBI (-)/IHD (-), Category 1 (n = 424); HIBI (-)/IHD (+), Category 2 (n = 100); HIBI (+)/IHD (-), Category 3 (n = 21); and HIBI (+)/IHD (+), Category 4 (n = 209). The CPCs at discharge were significantly different in each category (p < 0.001). In the validation cohort, the model showed moderate discrimination (AUC 0.83, 95% CI 0.79-0.87 for HIBI and AUC 0.77, 95% CI 0.72-0.81 for IHD) with good calibration. Each category of the validation cohort showed a significant difference in discharge outcomes (p < 0.001) and a similar trend to the derivation cohort. CONCLUSIONS We presented a novel approach for assessing illness severity after OHCA. Although external prospective studies are warranted, risk stratification for HIBI and IHD could help provide OHCA patients with appropriate treatment.
Collapse
Affiliation(s)
- Hyo Jin Bang
- Department of Emergency Medicine, Seoul St. Mary Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
| | - Sang Hoon Oh
- Department of Emergency Medicine, Seoul St. Mary Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
| | - Won Jung Jeong
- Department of Emergency Medicine, Suwon St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Suwon 16247, Republic of Korea.
| | - Kyungman Cha
- Department of Emergency Medicine, Suwon St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Suwon 16247, Republic of Korea.
| | - Kyu Nam Park
- Department of Emergency Medicine, Seoul St. Mary Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
| | - Chun Song Youn
- Department of Emergency Medicine, Seoul St. Mary Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
| | - Han Joon Kim
- Department of Emergency Medicine, Seoul St. Mary Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
| | - Jee Yong Lim
- Department of Emergency Medicine, Seoul St. Mary Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
| | - Hyo Joon Kim
- Department of Emergency Medicine, Seoul St. Mary Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Hwan Song
- Department of Emergency Medicine, Suwon St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Suwon 16247, Republic of Korea
| | | |
Collapse
|
20
|
The Use of Teach Back at Hospital Discharge to Support Self-Management of Prescribed Medication for Secondary Prevention after Stroke-Findings from A Feasibility Study. Healthcare (Basel) 2023; 11:healthcare11030391. [PMID: 36766966 PMCID: PMC9914903 DOI: 10.3390/healthcare11030391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/09/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023] Open
Abstract
The study aimed to investigate whether a structured discharge letter and the use of the person-centred communication method Teach Back for sharing information at hospital discharge could support perceived understanding and knowledge of and adherence to prescribed medication for secondary prevention after stroke. Data from a feasibility study of a codesigned care transition support for people with stroke was used. Patients who at discharge received both a structured discharge letter and participated in the person-centred communication method Teach Back (n = 17) were compared with patients receiving standard discharge procedures (n = 21). Questionnaires were used to compare the groups regarding perceived understanding of information about medical treatment, knowledge of information about medical treatment and medication adherence at 1 week and 3 months. There was a statistically significant difference in perceived understanding of information about medical treatment (p > 0.01) between the groups in favour of those who participated in Teach Back at the discharge encounter. No differences between groups were found regarding understanding health information about medical treatment and medication adherence. The results indicate that the use of Teach Back at the discharge encounter positively impacts perceived understanding of information about medical treatment in people with stroke. However, considering the nonrandomised study design and the small sample size, a large-scale trial is needed.
Collapse
|
21
|
Arslani K, Tontsch J, Todorov A, Gysi B, Kaufmann M, Kaufmann F, Hollinger A, Wildi K, Merdji H, Helms J, Siegemund M, Gebhard C, Gebhard CE. Temporal trends in mortality and provision of intensive care in younger women and men with acute myocardial infarction or stroke. Crit Care 2023; 27:14. [PMID: 36635740 PMCID: PMC9835383 DOI: 10.1186/s13054-022-04299-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/29/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Timely management of acute myocardial infarction (AMI) and acute stroke has undergone impressive progress during the last decade. However, it is currently unknown whether both sexes have profited equally from improved strategies. We sought to analyze sex-specific temporal trends in intensive care unit (ICU) admission and mortality in younger patients presenting with AMI or stroke in Switzerland. METHODS Retrospective analysis of temporal trends in 16,954 younger patients aged 18 to ≤ 52 years with AMI or acute stroke admitted to Swiss ICUs between 01/2008 and 12/2019. RESULTS Over a period of 12 years, ICU admissions for AMI decreased more in women than in men (- 6.4% in women versus - 4.5% in men, p < 0.001), while ICU mortality for AMI significantly increased in women (OR 1.2 [1.10-1.30], p = 0.032), but remained unchanged in men (OR 0.99 [0.94-1.03], p = 0.71). In stroke patients, ICU admission rates increased between 3.6 and 4.1% per year in both sexes, while ICU mortality tended to decrease only in women (OR 0.91 [0.85-0.95, p = 0.057], but remained essentially unaltered in men (OR 0.99 [0.94-1.03], p = 0.75). Interventions aimed at restoring tissue perfusion were more often performed in men with AMI, while no sex difference was noted in neurovascular interventions. CONCLUSION Sex and gender disparities in disease management and outcomes persist in the era of modern interventional neurology and cardiology with opposite trends observed in younger stroke and AMI patients admitted to intensive care. Although our study has several limitations, our data suggest that management and selection criteria for ICU admission, particularly in younger women with AMI, should be carefully reassessed.
Collapse
Affiliation(s)
- Ketina Arslani
- grid.410567.1Department of Cardiology, University Hospital Basel, Basel, Switzerland ,grid.4973.90000 0004 0646 7373Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Janna Tontsch
- grid.410567.1Intensive Care Unit, Department of Acute Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland ,grid.410567.1Department of Anesthesiology, University Hospital Basel, Basel, Switzerland
| | - Atanas Todorov
- grid.412004.30000 0004 0478 9977Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland ,grid.7400.30000 0004 1937 0650Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Bianca Gysi
- grid.410567.1Intensive Care Unit, Department of Acute Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Mark Kaufmann
- grid.410567.1Department of Anesthesiology, University Hospital Basel, Basel, Switzerland ,grid.6612.30000 0004 1937 0642University of Basel, Basel, Switzerland
| | - Fabian Kaufmann
- grid.410567.1Intensive Care Unit, Department of Acute Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Alexa Hollinger
- grid.410567.1Intensive Care Unit, Department of Acute Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland ,grid.6612.30000 0004 1937 0642University of Basel, Basel, Switzerland
| | - Karin Wildi
- grid.410567.1Intensive Care Unit, Department of Acute Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland ,grid.1003.20000 0000 9320 7537Critical Care Research Group, The University of Queensland, Brisbane, Australia ,Cardiovascular Research Group, Basel, Switzerland
| | - Hamid Merdji
- grid.410567.1Intensive Care Unit, Department of Acute Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland ,grid.11843.3f0000 0001 2157 9291Université de Strasbourg (UNISTRA), Faculté de Médecine; Hôpitaux universitaires de Strasbourg, Service de Médecine Intensive-Réanimation, Nouvel Hôpital Civil, Strasbourg, France ,grid.503388.5INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France
| | - Julie Helms
- grid.11843.3f0000 0001 2157 9291Université de Strasbourg (UNISTRA), Faculté de Médecine; Hôpitaux universitaires de Strasbourg, Service de Médecine Intensive-Réanimation, Nouvel Hôpital Civil, Strasbourg, France ,grid.503388.5INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France
| | - Martin Siegemund
- grid.410567.1Intensive Care Unit, Department of Acute Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland ,grid.6612.30000 0004 1937 0642University of Basel, Basel, Switzerland
| | - Catherine Gebhard
- grid.412004.30000 0004 0478 9977Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland ,grid.7400.30000 0004 1937 0650Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland ,grid.411656.10000 0004 0479 0855Department of Cardiology, University Hospital Bern, Bern, Switzerland
| | - Caroline E. Gebhard
- grid.410567.1Intensive Care Unit, Department of Acute Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland ,grid.6612.30000 0004 1937 0642University of Basel, Basel, Switzerland
| | | |
Collapse
|
22
|
Nam GH, Chang WH. Factors Associated with Unplanned Transfer of Patients with Brain Tumor from Inpatient Rehabilitation Unit to Primary Acute Care Units. J Pers Med 2023; 13:jpm13010131. [PMID: 36675792 PMCID: PMC9865004 DOI: 10.3390/jpm13010131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 12/30/2022] [Accepted: 01/06/2023] [Indexed: 01/11/2023] Open
Abstract
Inpatient rehabilitation should be assessed to improve each functional domain in patients with brain tumor. However, no previous study has reported risk factors for unplanned transfer of this patient population to primary acute care units during a comprehensive inpatient rehabilitation. The objective of this study was to investigate the percentage of unplanned transfer of brain tumor rehabilitation inpatients to primary acute care units compared with stroke patients and factors associated with such unplanned transfer. Data of 137 patients with brain tumor who were transferred to the department of physical and rehabilitation medicine were retrospectively reviewed. For comparison, data of 438 patients with subacute stroke were also obtained. Included patients were divided into an unplanned transfer group and a control group based on whether they required a transfer to another department for acute care before completing their comprehensive inpatient rehabilitation. Reasons for unplanned transfers were classified based on medical or surgical conditions. The incidence of unplanned transfers to the medical or surgical department was significantly higher in patients with brain tumor (15.3%) than in stroke patients (7.1%) (p < 0.05). Most of unplanned transfers occurred within two weeks of the comprehensive inpatient rehabilitation for patients with brain tumor. There was a significantly higher incidence of unplanned transfers in patients with a primary tumor than in those with a metastatic tumor (15.9% vs. 4.8%, p < 0.05). In addition, the frequency of chemotherapy or radiotherapy was significantly (p < 0.05) higher in the unplanned transfer group than in the control group. The most common cause of an unplanned transfer was a neurologic cause (90.0%) in patients with brain tumor and an infectious disease such as pneumonia (51.6%) in stroke patients. In conclusion, these results demonstrated a higher incidence of unplanned transfers in patients with brain tumor than in stroke patients during intensive inpatient rehabilitation. Proportions of those with neurological problems were relatively higher in patients with brain tumor than in patients with subacute stroke.
Collapse
Affiliation(s)
- Gyoung Ho Nam
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
- Department of Health Sciences and Technology, Department of Medical Device Management & Research, Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul 06355, Republic of Korea
- Correspondence: ; Tel.: +82-2-3410-6068
| |
Collapse
|
23
|
Chalet FX, Briasoulis O, Manalastas EJ, Talbot DA, Thompson JC, Macdonald RL. Clinical Burden of Angiographic Vasospasm and Its Complications After Aneurysmal Subarachnoid Hemorrhage: A Systematic Review. Neurol Ther 2023; 12:371-390. [PMID: 36609962 PMCID: PMC10043150 DOI: 10.1007/s40120-022-00436-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 12/22/2022] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Angiographic vasospasm (VSP), the narrowing of intracranial arteries, is a complication of aneurysmal subarachnoid hemorrhage (aSAH) and often results in delayed cerebral ischemia (DCI) and cerebral infarction. The objective of this systematic review was to summarize the clinical burden of angiographic VSP and its related complications (DCI and cerebral infarction) after aSAH. METHODS Systematic searches of MEDLINE, Embase, and the Cochrane Library were conducted (in January 2021) in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify studies reporting clinical outcomes of angiographic VSP and its related complications after aSAH. Study outcomes included measures of functional status (modified Rankin Scale [mRS], Glasgow Outcome Scale [GOS], extended Glasgow Outcome Scale [GOS-E], modified Barthel Index, or the modified National Institutes of Health Stroke Scale), cognitive status (Montreal Cognitive Assessment or the Mini Mental State Exam), clinical events (rebleeding), and mortality. Study selection, data extraction, and qualitative analyses were conducted. RESULTS Of 5704 abstracts reviewed, 110 studies were selected: 20 comparative and 39 regression-based studies were included in the qualitative synthesis, 51 descriptive studies were excluded. Most studies (51) were observational and conducted in a single country (53). The occurrence of angiographic VSP and its related complications after aSAH resulted in significantly poorer functional outcomes in three of nine comparative and 11 of 13 regression-based studies, measured by the mRS, and in five of six comparative and eight of nine regression-based studies, measured by the GOS and GOS-E. Angiographic VSP and its related complications were significantly associated with poor cognitive status in all five regression-based studies. Numerically or significantly higher mortality rates in patients with versus those without angiographic VSP and its related complications were reported in five of ten comparative studies and in eight of nine regression-based studies. Six studies looked at specific VSP populations (e.g., by severity or timing of VSP). CONCLUSION Patients with angiographic VSP and its related complications often had poor functional, neurological, and cognitive outcomes and reduced odds of survival both in hospital and at follow-up. We estimate that angiographic VSP and its related complications, DCI and cerebral infarction, lead to an approximately threefold higher odds of poor functional and cognitive outcomes, and about a twofold increase in the odds of death.
Collapse
Affiliation(s)
| | - Orestis Briasoulis
- Idorsia Pharmaceuticals Ltd, Hegenheimermattweg 91, 4123, Allschwil, Switzerland
| | | | - Darren A Talbot
- Idorsia Pharmaceuticals Ltd, Hegenheimermattweg 91, 4123, Allschwil, Switzerland
| | | | - R Loch Macdonald
- Community Health Partners, Community Neurosciences Institute, Fresno, CA, 93701, USA
| |
Collapse
|
24
|
Ladwig S, Werheid K, Südmeyer M, Volz M. Predictors of post-stroke depression: Validation of established risk factors and introduction of a dynamic perspective in two longitudinal studies. Front Psychiatry 2023; 14:1093918. [PMID: 36860505 PMCID: PMC9969555 DOI: 10.3389/fpsyt.2023.1093918] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/30/2023] [Indexed: 02/16/2023] Open
Abstract
INTRODUCTION Cerebral insults lead in many cases not only to cognitive impairment but also to disturbed emotionality. After stroke, one in three survivors develops a depression which impacts quality of life and rehabilitation. Meta-analyses have identified five main predictors of post-stroke depression (PSD): history of mental disorder, stroke severity, physical disability, cognitive impairment, and social support. However, these five established variables have never been conjointly investigated in a sample of stroke survivors. Therefore, their independent predictive values remain unclear. Moreover, predictors are most often used as time-invariant factors (status scores), neglecting the intraindividual dynamics after stroke. METHODS Our study analyses the data of two prospective longitudinal studies, investigating stroke survivors from two rehabilitation hospitals (N 1 = 273) and one acute care hospital (N 2 = 226). Baseline assessments included the five established predictors and depressive symptoms. After 6 months, depressive symptoms were reassessed in both studies (n 1 = 176, n 2 = 183), and physical disability and social support were reassessed in study 2. The predictivity of the five predictors and the additional predictivity of intraindividual dynamics for PSD were examined in multiple linear regression analyses. RESULTS History of mental disorder was a risk factor for depressive symptoms after stroke at all measurement times (B = 3.32 to 3.97; p < 0.01). Physical disability was a risk factor at all measurement times (B = -0.09 to -0.03; p < 0.05) except 6 months after rehabilitation. Social support was a protective factor (B = -2.69 to -1.91; p < 0.01) outside the acute phase (R 2 = 0.15-0.39). Intraindividual changes in physical disability and perceived social support were independent predictors of PSD 6 months after the acute phase (B = -0.08/-0.14; p < 0.01), in addition to status scores on established variables (ΔR 2 = 0.08, p < 0.001). DISCUSSION History of mental disorder, physical disability, and social support are independent predictors of depressive symptoms in the first year post-stroke, also when considered conjointly. Future studies should control for these variables when investigating new predictors of PSD. In addition, intraindividual changes in known predictors after stroke play a relevant role in the pathogenesis of PSD and should be considered in clinical practice and future research.
Collapse
Affiliation(s)
- Simon Ladwig
- Clinical Neuropsychology and Psychotherapy, Department of Psychology, Faculty of Psychology and Sport Science, Universität Bielefeld, Bielefeld, Germany
| | - Katja Werheid
- Clinical Neuropsychology and Psychotherapy, Department of Psychology, Faculty of Psychology and Sport Science, Universität Bielefeld, Bielefeld, Germany
| | - Martin Südmeyer
- Department of Neurology, Klinikum Ernst von Bergmann, Potsdam, Germany.,Department of Neurology, Heinrich-Heine-Universität, Düsseldorf, Germany
| | - Matthias Volz
- Clinical Psychology I, Department of Psychology, Faculty of Human Sciences, Universität Kassel, Kassel, Germany
| |
Collapse
|
25
|
Pierre K, Perez-Vega C, Fusco A, Olowofela B, Hatem R, Elyazeed M, Azab M, Lucke-Wold B. Updates in mechanical thrombectomy. EXPLORATION OF NEUROSCIENCE 2022; 1:83-99. [PMID: 36655054 PMCID: PMC9845048 DOI: 10.37349/en.2022.00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/26/2022] [Indexed: 01/01/2023]
Abstract
Stroke is a leading cause of morbidity and mortality. The advent of mechanical thrombectomy has largely improved patient outcomes. This article reviews the features and outcomes associated with aspiration, stent retrievers, and combination catheters used in current practice. There is also a discussion on clinical considerations based on anatomical features and clot composition. The reperfusion grading scale and outcome metrics commonly used following thrombectomy when a patient is still in the hospital are reviewed. Lastly, there are proposed discharge and outpatient follow-up goals in caring for patients hospitalized for a stroke.
Collapse
Affiliation(s)
- Kevin Pierre
- Department of Radiology, University of Florida, Gainesville, FL 32608, USA
| | - Carlos Perez-Vega
- Department of Neurosurgery, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Anna Fusco
- College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Bankole Olowofela
- College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Rami Hatem
- College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Mohammed Elyazeed
- Department of Neurosurgery, University of Florida, Gainesville, FL 32608, USA
| | - Mohammed Azab
- Biomolecular Sciences Graduate Program, Boise State University, Boise, ID 83725, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, FL 32608, USA
| |
Collapse
|
26
|
Hassan EM, Momtaz OM, Hamdy NA, Yahia MA, Afifi MK. Migraine and its relation to other risk factors in patients with acute ischemic stroke and acute coronary syndrome. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022. [DOI: 10.1186/s41983-022-00508-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Migraine has been recently studied as a risk factor for ischemic stroke (IS) and a possible link to a broader range of ischemic vascular disorders including angina and myocardial infarction is suggested.
Objectives
to study migraine and its relation to other risk factors in patients with acute IS and acute coronary syndrome (ACS).
Patients and methods
We studied 200 patients, 114 patients had acute IS and 86 patients with ACS, in addition to 850 control participants. All patients were subjected to detailed clinical and laboratory evaluation; including evaluation of traditional risk factors. All stroke patients were subjected to CT scan. Diagnosis of acute coronary syndrome was established clinically by ECG and cardiac specific enzymes. Migraine was diagnosed according to the international headache society and assessment of migraine severity was measured by the Migraine Disability Assessment (MIDAS) questionnaire.
Results
In patients with ischemic stroke, Risk Ratios (RR) of migraine was 3.3 for all migrainous patients, higher for migraine with aura (MA). In the cardiovascular group, it was 2.75 and again higher in MA. A positive correlation between migraine severity and both stroke severity and cardiac affection severity was found though non-significant in the cardiovascular group. There was no significant difference in hospital outcome in migrainous patients in both groups.
Conclusions
Patients with migraine have higher risk than non-migrainous patients for both cerebrovascular and coronary vascular diseases. Risk is stronger in MA in both conditions. Considering migraine in risk stratification of cerebrovascular and cardiovascular diseases is recommended.
Collapse
|
27
|
Pajediene E, Paulekas E, Salteniene V, Skieceviciene J, Arstikyte J, Petrikonis K, Kupcinskas J, Bassetti CL, Daiva R. Diurnal variation of clock genes expression and other sleep-wake rhythm biomarkers among acute ischemic stroke patients. Sleep Med 2022; 99:1-10. [DOI: 10.1016/j.sleep.2022.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/29/2022] [Accepted: 06/30/2022] [Indexed: 10/31/2022]
|
28
|
Budinčević H, Meštrović A, Demarin V. Stroke Scales as Assessment Tools in Emergency Settings: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1541. [PMID: 36363498 PMCID: PMC9696547 DOI: 10.3390/medicina58111541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/15/2022] [Accepted: 10/21/2022] [Indexed: 10/14/2023]
Abstract
In the last 20 years, substantial improvements have been made in stroke recanalization treatment. Good outcomes after modern reperfusion treatment require the rapid and accurate identification of stroke patients. Several stroke rating scales are available or have been proposed for the early recognition of stroke and the evaluation of stroke severity and outcome. This review aims to provide an overview of commonly used stroke scales in emergency and clinical settings. The most commonly used scale in a prehospital setting for stroke recognition is the Face, Arms, Speech, Time (FAST) test. Among many prehospital stroke scales, the Los Angeles Prehospital Stroke Screen has the highest sensitivity and specificity for confirming stroke diagnosis. The National Institutes of Health Stroke Scale (NIHSS) is the most recommended tool for the evaluation of stroke patients in hospital settings and research, and it has two variants: the shortened NIHSS for Emergency Medical Service and the modified NIHSS. The evaluation of comatose patients usually involves assessment with the Glasgow Coma Scale, which is very useful in patients with hemorrhagic stroke or traumatic brain injury. In patients with subarachnoid hemorrhage, the outcome is usually accessed with the Hunt and Hess scale. A commonly used tool for stroke outcome evaluation in clinical/hospital settings and research is the modified Rankin scale. The tools for disability evaluation are the Barthel Index and Functional Independence Measure.
Collapse
Affiliation(s)
- Hrvoje Budinčević
- Department of Neurology, Sveti Duh University Hospital, 10000 Zagreb, Croatia
- Department of Neurology and Neurosurgery, Faculty of Medicine, J.J. Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Andrija Meštrović
- Department of Neurology, Sveti Duh University Hospital, 10000 Zagreb, Croatia
| | - Vida Demarin
- International Institute for Brain Health, 10000 Zagreb, Croatia
| |
Collapse
|
29
|
Determinants of metabolic syndrome and its prognostic implications among stroke patients in Africa: Findings from the Stroke Investigative Research and Educational Network (SIREN) study. J Neurol Sci 2022; 441:120360. [PMID: 35985161 DOI: 10.1016/j.jns.2022.120360] [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: 05/04/2022] [Revised: 07/20/2022] [Accepted: 07/25/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND The prognostic implications of metabolic syndrome (METS) among African stroke patients are poorly understood. This study aimed to investigate the determinants of METS and its prognostic implications among Africans with newly diagnosed stroke in the SIREN study. METHODS We included stroke cases (adults aged >18 years with CT/MRI confirmed stroke). The validated tools comprehensively evaluated vascular, lifestyle, and psychosocial factors. We used logistic regression to estimate adjusted odds ratios (OR) with 95% CIs for the association between METS and risk factors. We also computed the prediction power of the domain of covariates in a sequential manner using the area under the receiver operating curve (ROC) curve. RESULTS Among 3998 stroke subjects enrolled in the study, 76.8% had METS by at least one of the clinical definitions. Factors associated with METS were age > 50 years (OR- 1.46, CI-1.19-1.80), male gender (OR 4.06, CI- 3.28-5.03), income >100USD (OR1.42, CI-1.17-1.71), stress (OR1.46, CI-1.14-1.87), family history of diabetes mellitus (OR1.38, CI-1.06-1.78), and cardiac disease (OR1.42, CI-1.18-1.65). Stroke severity was higher among those with METS (SLS = 5.8 ± 4.3) compared with those without METS (6.2 ± 4.5) at p = 0.037. METS was associated with higher odds (aOR 1.31, CI-1.08-1.58) of one-month fatality after adjusting for stroke severity, age > 50 years, and average monthly income >100USD. CONCLUSION METS is very common among African stroke patients and is associated with stroke severity and worse one-month fatality. Lifestyle interventions may prevent METS and attenuate its impact on stroke occurrence and outcomes.
Collapse
|
30
|
Ischemic stroke demographics, clinical features and scales and their correlations: an exploratory study from Jordan. Future Sci OA 2022; 8:FSO809. [PMID: 36248068 PMCID: PMC9540235 DOI: 10.2144/fsoa-2022-0017] [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: 03/14/2022] [Accepted: 07/22/2022] [Indexed: 11/23/2022] Open
Abstract
Aims: The authors aimed to assess the ischemic stroke risk factors and scales. Materials & methods: A retrospective cohort study was conducted on patients with acute ischemic stroke (from January 2017 to December 2018). The scores of the National Institutes of Health Stroke Scale (NIHSS) at admission and discharge and of the modified Rankin Scale (mRS) and Barthel Index (BI) scale post-month of the stroke were collected. Results: Out of 376 patients, 359 were included, with a mean (standard deviation) age of 67.8 (12.2) years and male predominance (56.2%). Hyperlipidemia and hypertension were the most prevalent comorbidities (91.1% and 80.5%, respectively). The NIHSS, BI and mRS scores were worse among women, with no significant effects for comorbidities. The NIHSS scores at admission and discharge were significantly correlated with the post-month BI and mRS scores. Conclusion: The study findings suggest a complex interplay of gender, strict control and prevention of the modifiable stroke risk factors, as well as the association of neurological deficits' intensity with the functional outcomes. This study aimed to explore the demographics, the clinical risk factors and the scores of the National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS) and Barthel Index (BI) scale at different points of time among the survivors of acute ischemic stroke at a tertiary hospital in Jordan. Also, the study aimed to investigate the differences in the scales' scores by the patients' characteristics and the correlations between these scales. Out of 376 screened patients, 359 were included. Their mean (standard deviation) age was 67.8 (12.2) years, and 56.2% were men. Compared with male participants, women scored significantly worse on the NIHSS at admission (7.61 [5.51] vs 9.47 [6.64]; p = 0.048), NIHSS at discharge (5.57 [4.72] vs 7.40 [5.88]; p = 0.028) and BI scale 1 month post-event (78.68 [28.33] vs 66.03 [35.86]; p = 0.011). The mean (standard deviation) mRS score post-month of stroke was lower in men (2.4 [1.7]) than in women (2.9 [1.9]), with a lack of statistical significance (p = 0.097). Thus, despite the male predominance in the cohort, women tended to have a more severe stroke, worse neurological impairment and poorer functional outcomes. Hyperlipidemia had the highest prevalence, sensitivity, positive predictive value and negative predictive value rates, followed by hypertension. No statistically significant differences existed in the comorbidities' NIHSS, BI scale and mRS scores. Strong and significant correlations were observed between the scores of NIHSS at admission and discharge and the BI scale and mRS scores at 1 month post-event. Thus, the authors concluded that neurological deficit severity has a potential role in predicting functioning outcomes and vice versa.
Collapse
|
31
|
Yi X, Chen H, Yu M, Luo H, Zhou J, Wei W, Wang Y, Chen X. Persistence of drug therapy is associated with ischemic stroke and other vascular events in high-risk stroke population. Front Neurol 2022; 13:925061. [PMID: 35959409 PMCID: PMC9358006 DOI: 10.3389/fneur.2022.925061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022] Open
Abstract
The high-risk stroke populations are significantly associated with an increased risk of stroke or other vascular events. Although proven primary and secondary stroke prevention medications are available, persistent use is required to be effective. However, the persistence of drug therapy and its association with outcomes in the high-risk stroke population have received limited study in China. Hence, according to the China National Stroke Screening Survey (CNSSS) program in 2015, we performed this multicenter population-based cross-sectional survey and prospective cohort study in Sichuan of southwestern China. The residents aged ≥ 40 years volunteered to participate in a face-to-face survey in 8 communities. Subjects with at least three of eight stroke-related risk factors or a history of stroke were defined as high-risk stroke population. The interviewers recorded individuals' medications at a face-to-face survey, and all the high-risk stroke population was followed up for 4.7 years. The persistence of antihypertensives, hypoglycemics, lipid-lowering medications, and antithrombotics for stroke was evaluated. The primary outcome was new stroke. Secondary outcomes included new composite vascular events of stroke, myocardial infarction, and death during follow-up periods. Among 16,892 participants, 2,893 (17.1%) participants were high-risk stroke population and 2,698 (93.3%) participants completed to follow-up. The 4.7-year persistence of therapy rate of antihypertensives, hypoglycemics, lipid-lowering medications, and antithrombotics was 38.0%, 39.9%, 43.9%, and 59.8%, respectively. The total persistence of therapy rate for antihypertensives, hypoglycemics, lipid-lowering medications, and antithrombotics was 47.6% (136/286) in patients with hypertension, diabetes, dyslipidemia, and stroke at the same time. During the 4.7-year follow-up, there were 118 (4.4%) new ischemic stroke, 24 (0.9%) hemorrhagic stroke, 53 (2.0%) myocardial infarctions, and 33 (1.2%) deaths. After adjusting for the covariates, 4.7-year persistence of antihypertensives, hypoglycemics, lipid-lowering therapy, antithrombotics, and total persistence was independently associated with less new ischemic stroke and less new composite vascular events. Thus, more effective public education and efforts to understand and enhance the persistence of drug therapy are crucial to improve population health and decrease stroke and other vascular events for the high-risk stroke population.
Collapse
Affiliation(s)
- Xingyang Yi
- Department of Neurology, People's Hospital of Deyang City, Deyang, China
| | - Hong Chen
- Department of Neurology, People's Hospital of Deyang City, Deyang, China
- *Correspondence: Hong Chen
| | - Ming Yu
- Department of Neurology, Suining Central Hospital, Suining, China
| | - Hua Luo
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Ju Zhou
- Department of Neurology, People's Hospital of Deyang City, Deyang, China
| | - Wei Wei
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yanfen Wang
- Department of Neurology, People's Hospital of Deyang City, Deyang, China
| | - Xiaorong Chen
- Department of Neurology, Suining Central Hospital, Suining, China
| |
Collapse
|
32
|
Beck da Silva Etges AP, Marcolino MAZ, Ogliari LA, de Souza AC, Zanotto BS, Ruschel R, Safanelli J, Magalhães P, Diegoli H, Weber KT, Araki AP, Nunes A, Ponte Neto OM, Nabi J, Martins SO, Polanczyk CA. Moving the Brazilian Ischemic Stroke Pathway to a Value-Based Care: Introduction of a Risk-Adjusted Cost Estimate Model for Stroke Treatment. Health Policy Plan 2022; 37:1098-1106. [PMID: 35866723 DOI: 10.1093/heapol/czac058] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 07/11/2022] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
The unsustainable increases in healthcare expenses and waste have motivated the migration of reimbursement strategies from volume to value. Value-based health care requires detailed comprehension of cost information at the patient level. This study introduces a clinical risk- and outcome-adjusted cost estimate model for stroke care sustained on time-driven activity-based costing (TDABC). In a cohort and multicenter study, a TDABC tool was developed to evaluate the costs per stroke patient, allowing us to identify and describe differences in cost by clinical risk at hospital arrival, treatment strategies, and modified Rankin Score (mRS) at discharge. The clinical risk was confirmed by multivariate analysis and considered patients' National Institute for Health Stroke Scale and age. Descriptive cost analyses were conducted, followed by univariate and multivariate models to evaluate the risk levels, therapies, and mRS stratification effect in costs. Then, the risk-adjusted cost estimate model for ischemic stroke treatment was introduced. All the hospitals collected routine prospective data from consecutive patients admitted with ischemic stroke diagnosis confirmed. A total of 822 patients were included. The median cost was I$2,210 (IQR: I$1,163-4,504). Fifty percent of the patients registered a favorable outcome mRS (0-2), costing less at all risk levels, while patients with the worst mRS (5-6) registered higher costs. Those undergoing mechanical thrombectomy had an incremental cost for all three risk levels, but this difference was lower for high-risk patients. Estimated costs were compared to observed costs per risk group, and there were no significant differences in most groups, validating the risk and outcome adjusted cost estimate model. By introducing a risk-adjusted cost estimate model, this study elucidates how healthcare delivery systems can generate local cost information to support value-based reimbursement strategies employing the data collection instruments and analysis developed in this study.
Collapse
Affiliation(s)
- Ana Paula Beck da Silva Etges
- National Institute of Science and Technology for Health Technology Assessment (IATS)- CNPq/Brazil (project: 465518/2014-1), Porto Alegre, Brazil.,School of Technology, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.,Programa de Pós-graduação em Epidemiologia da Escola de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Miriam Allein Zago Marcolino
- National Institute of Science and Technology for Health Technology Assessment (IATS)- CNPq/Brazil (project: 465518/2014-1), Porto Alegre, Brazil.,Programa de Pós-graduação em Epidemiologia da Escola de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Leonardo Alves Ogliari
- Programa de Pós-graduação em Engenharia de Produção da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Bruna Stella Zanotto
- National Institute of Science and Technology for Health Technology Assessment (IATS)- CNPq/Brazil (project: 465518/2014-1), Porto Alegre, Brazil.,Programa de Pós-graduação em Epidemiologia da Escola de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Renata Ruschel
- National Institute of Science and Technology for Health Technology Assessment (IATS)- CNPq/Brazil (project: 465518/2014-1), Porto Alegre, Brazil
| | | | | | | | - Karina Tavares Weber
- Neurology Division, Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Ana Paula Araki
- Neurology Division, Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Altacílio Nunes
- Neurology Division, Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Octávio Marques Ponte Neto
- Neurology Division, Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Sheila Ouriques Martins
- Hospital Moinhos de Vento, Porto Alegre, Brazil.,Hospital de Clínicas de Porto Alegre, Faculdade de Medicina Universidade Federal do Rio Grande do Sul
| | - Carisi Anne Polanczyk
- National Institute of Science and Technology for Health Technology Assessment (IATS)- CNPq/Brazil (project: 465518/2014-1), Porto Alegre, Brazil.,Programa de Pós-graduação em Epidemiologia da Escola de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.,Hospital Moinhos de Vento, Porto Alegre, Brazil.,Hospital de Clínicas de Porto Alegre, Faculdade de Medicina Universidade Federal do Rio Grande do Sul
| |
Collapse
|
33
|
Li W, Yuan S, Sui X, Bian H, Wei M, Chen Z, Shao H, Shi W, Shi S, Ji X. Higher serum occludin after successful reperfusion Is associated with early neurological deterioration. CNS Neurosci Ther 2022; 28:999-1007. [PMID: 35338575 PMCID: PMC9160448 DOI: 10.1111/cns.13830] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 11/26/2022] Open
Abstract
Aims Early neurological deterioration (END) is an important factor that affects prognosis in patients with acute ischemic stroke. We explored the relationship between serum occludin levels after successful reperfusion and END in patients treated with endovascular thrombectomy (EVT). Methods We prospectively enrolled 120 stroke patients who underwent EVT with successful reperfusion. Enzyme‐linked immunosorbent assay was used to detect the serum occludin levels on admission and within 1 h after successful reperfusion. Receiver operating characteristic curves (ROC) and regression analysis were used to compare the relationship between serum occludin and END after thrombectomy. Results Among the 120 patients, 36 (30%) experienced END. The END group had higher serum occludin levels than the non‐END group after successful reperfusion [4.31 (3.71–5.38) vs 6.32 (5.88–6.99), p < 0.001]. The ROC curve showed that postoperative serum occludin levels had a significant prediction value for END (AUC: 0.86, p < 0.001). Regression analysis showed that serum occludin was an independent risk factor for END in EVT patients (adjusted odds ratio: 4.46, 95% confidence interval: 1.92–10.32; p < 0.001). Conclusions The higher serum occludin levels were strongly related to END after successful reperfusion. Serum occludin may be an independent risk factor for END in EVT patients.
Collapse
Affiliation(s)
- Weili Li
- Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China.,Cerebrovascular Diseases Research Institute, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Shuhua Yuan
- Cerebrovascular Diseases Research Institute, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Xueqin Sui
- Department of General Medicine, Affiliated Hospital of Weifang Medical University, Shandong Province, China
| | - Hetao Bian
- Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China
| | - Ming Wei
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China
| | - Zhiying Chen
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Haitao Shao
- Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China
| | - Wenjuan Shi
- Cerebrovascular Diseases Research Institute, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Shuhai Shi
- Department of Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Xunming Ji
- Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China.,Cerebrovascular Diseases Research Institute, Xuanwu Hospital of Capital Medical University, Beijing, China.,Department of Neurosurgery, Xuanwu Hospital of Capital Medical University, Beijing, China
| |
Collapse
|
34
|
Nerdal V, Gjestad E, Saltvedt I, Munthe-Kaas R, Ihle-Hansen H, Ryum T, Lydersen S, Grambaite R. The relationship of acute delirium with cognitive and psychiatric symptoms after stroke: a longitudinal study. BMC Neurol 2022; 22:234. [PMID: 35761180 PMCID: PMC9235162 DOI: 10.1186/s12883-022-02756-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 06/14/2022] [Indexed: 12/03/2022] Open
Abstract
Objective Delirium, a common complication after stroke, is often overlooked, and long-term consequences are poorly understood. This study aims to explore whether delirium in the acute phase of stroke predicts cognitive and psychiatric symptoms three, 18 and 36 months later. Method As part of the Norwegian Cognitive Impairment After Stroke Study (Nor-COAST), 139 hospitalized stroke patients (49% women, mean (SD) age: 71.4 (13.4) years; mean (SD) National Institutes of Health Stroke Scale (NIHSS) 3.0 (4.0)) were screened for delirium with the Confusion Assessment Method (CAM). Global cognition was measured with the Montreal Cognitive Assessment (MoCA), while psychiatric symptoms were measured using the Hospital Anxiety and Depression Scale (HADS) and the Neuropsychiatric Inventory-Questionnaire (NPI-Q). Data was analyzed using mixed-model linear regression, adjusting for age, gender, education, NIHSS score at baseline and premorbid dementia. Results Thirteen patients met the criteria for delirium. Patients with delirium had lower MoCA scores compared to non-delirious patients, with the largest between-group difference found at 18 months (Mean (SE): 20.8 (1.4) versus (25.1 (0.4)). Delirium was associated with higher NPI-Q scores at 3 months (Mean (SE): 2.4 (0.6) versus 0.8 (0.1)), and higher HADS anxiety scores at 18 and 36 months, with the largest difference found at 36 months (Mean (SE): 6.2 (1.3) versus 2.2 (0.3)). Conclusions Suffering a delirium in the acute phase of stroke predicted more cognitive and psychiatric symptoms at follow-up, compared to non-delirious patients. Preventing and treating delirium may be important for decreasing the burden of post-stroke disability. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-022-02756-5.
Collapse
|
35
|
Chen L, Chen K, Hong Y, Xing L, Zhang J, Zhang K, Zhang Z. The landscape of isoform switches in sepsis: a multicenter cohort study. Sci Rep 2022; 12:10276. [PMID: 35715539 PMCID: PMC9205547 DOI: 10.1038/s41598-022-14231-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 06/02/2022] [Indexed: 11/09/2022] Open
Abstract
Sepsis is caused by an uncontrolled inflammatory response, whose underlying mechanisms are not fully understood. It is well known that the majority of human genes can be expressed as alternative isoforms. While isoform switching is implicated in many diseases and is particularly prominent in cancer, it has never been reported in the context of sepsis. Patients presented to the emergency department of three tertiary care hospitals from January 2020 to December 2020 were enrolled. Clinical variables and genome-wide transcriptome of peripheral blood mononuclear cells (PBMC) were obtained. Isoform switching analysis were performed to identify significant isoform switches and relevant biological consequences. A total of 48 subjects with sepsis, involving 42 survivors and 6 non-survivors, admitted to the emergency department of three tertiary care hospitals were enrolled in this study. PBMCs were extracted for RNA sequencing (RNA-seq). Patients (n = 4) with mild stroke or acute coronary syndrome without infection were enrolled in this study as controls. The most frequent functional changes resulting from isoform switching were changes affecting the open reading frame, protein domains and intron retention. Many genes without differences in gene expression showed significant isoform switching. Many genes with significant isoform switches ([Formula: see text]> 0.1) were associated with higher mortality risk, including PIGS, CASP3, LITAF, HBB and RUVBL2. The study for the first time described the landscape of isoform switching in sepsis, including differentially expressed isoform fractions between patients with and without sepsis and survivors and nonsurvivors. The biological consequences of isoform switching, including protein domain loss, signal peptide gain, and intron retention, were identified.
Collapse
Affiliation(s)
- Lin Chen
- Department of Critical Care Medicine, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Kun Chen
- Department of Critical Care Medicine, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Yucai Hong
- Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China
| | - Lifeng Xing
- Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China
| | - Jianjun Zhang
- Emergency Department, Zigong Fourth People's Hospital, 19 Tanmulin Road, Zigong, Sichuan, China
| | - Kai Zhang
- Department of Emergency Medicine, Huzhou Central Hospital, Huzhou, 310016, China
| | - Zhongheng Zhang
- Department of Emergency Medicine, Key Laboratory of Precision Medicine in Diagnosis and Monitoring Research of Zhejiang Province, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No 3, East Qingchun Road, Hangzhou, 310016, Zhejiang, China.
| |
Collapse
|
36
|
Lagebrant C, Ramgren B, Hassani Espili A, Marañon A, Kremer C. Sex Differences in Collateral Circulation and Outcome After Mechanical Thrombectomy in Acute Ischemic Stroke. Front Neurol 2022; 13:878759. [PMID: 35665053 PMCID: PMC9160377 DOI: 10.3389/fneur.2022.878759] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/19/2022] [Indexed: 11/23/2022] Open
Abstract
Background Collateral circulation is known to lead to smaller infarct volume and better functional outcome after mechanical thrombectomy (MT), but studies examining sex differences in collateral circulation are scarce. The aim of this study was to investigate if collateral circulation has a different impact on outcome in women and men. Methods A single-center retrospective study of 487 patients (230 men and 257 women) treated with MT for acute ischemic stroke in the anterior cerebral circulation. Collateral circulation was assessed on computed tomography angiography images. The outcome was evaluated at 90 days according to the modified Rankin Scale (mRS). Results Women were older, median age 76 years (IQR 68-83) vs. 71 years (IQR 63–78). Stroke severity and time to recanalization were comparable. More women had moderate or good collaterals in 58.4 vs. 47.0% for men (p = 0.01). Among patients with moderate and good collaterals significantly more men (61%) were functionally independent (mRS 0–2) than women (41.5%) (p = < 0.01). This difference remained significant after correcting for age by linear weighting, 60.4 vs. 46.8% (p = 0.03). Conclusion Women had better collateral flow but showed worse functional outcomes, while good collateral flow led to better outcomes in men, even after correcting for age. Further clinical studies on peri- and post-interventional care, factors affecting recovery after hospital discharge as well as basic research on the neurovascular unit are needed to find modifiable targets to improve clinical outcomes for women.
Collapse
Affiliation(s)
| | - Birgitta Ramgren
- Department of Diagnostic Radiology, Neuroradiology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | | | | | - Christine Kremer
- Neurology Department, Department of Clinical Sciences, Skåne University Hospital Malmö, Lund University, Lund, Sweden
- *Correspondence: Christine Kremer
| |
Collapse
|
37
|
Revised Use of the Modified National Institutes of Health Stroke Scale for Perioperative Stroke Screening. J Neurosurg Anesthesiol 2022; 34:253-255. [PMID: 35475938 DOI: 10.1097/ana.0000000000000850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
38
|
Mistry EA, Yeatts SD, Khatri P, Mistry AM, Detry M, Viele K, Harrell FE, Lewis RJ. National Institutes of Health Stroke Scale as an Outcome in Stroke Research: Value of ANCOVA Over Analyzing Change From Baseline. Stroke 2022; 53:e150-e155. [PMID: 35012328 PMCID: PMC8960347 DOI: 10.1161/strokeaha.121.034859] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
National Institutes of Health Stroke Scale (NIHSS), measured a few hours to days after stroke onset, is an attractive outcome measure for stroke research. NIHSS at the time of presentation (baseline NIHSS) strongly predicts the follow-up NIHSS. Because of the need to account for the baseline NIHSS in the analysis of follow-up NIHSS as an outcome measure, a common and intuitive approach is to define study outcome as the change in NIHSS from baseline to follow-up (ΔNIHSS). However, this approach has important limitations. Analyzing ΔNIHSS implies a very strong assumption about the relationship between baseline and follow-up NIHSS that is unlikely to be satisfied, drawing into question the validity of the resulting statistical analysis. This reduces the precision of the estimates of treatment effects and the power of clinical trials that use this approach to analysis. ANCOVA allows for the analysis of follow-up NIHSS as the dependent variable while adjusting for baseline NIHSS as a covariate in the model and addresses several challenges of using ΔNIHSS outcome using simple bivariate comparisons (eg, a t test, Wilcoxon rank-sum, linear regression without adjustment for baseline) for stroke research. In this article, we use clinical trial simulations to illustrate that variability in NIHSS outcome is less when follow-up NIHSS is adjusted for baseline compared to ΔNIHSS and how a reduction in this variability improves the power. We outline additional, important clinical and statistical arguments to support the superiority of ANCOVA using the final measurement of the NIHSS adjusted for baseline over, and caution against using, the simple bivariate comparison of absolute NIHSS change (ie, delta).
Collapse
Affiliation(s)
- Eva A. Mistry
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN
| | - Sharon D. Yeatts
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Pooja Khatri
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH
| | | | | | | | - Frank E Harrell
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN
| | - Roger J. Lewis
- Berry Consultants LLC, Austin, TX
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA
- Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| |
Collapse
|
39
|
Developing a Clinical Prediction Rule for Gait Independence at Discharge in Patients with Stroke: A Decision-Tree Algorithm Analysis. J Stroke Cerebrovasc Dis 2022; 31:106441. [PMID: 35305537 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 02/19/2022] [Accepted: 02/26/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To develop a clinical prediction rule (CPR) for gait independence at discharge in patients with stroke, using the decision-tree algorithm and to investigate the usefulness of CPR at admission to the rehabilitation ward. MATERIALS AND METHODS We included 181 subjects with stroke during the postacute phase. The Chi-squared automatic interaction detection analysis method with 10-fold cross-validation was used to develop two CPRs; CPR 1 using easily obtainable data available at admission; CPR 2 using easily obtainable data available 1 month after admission, for prediction of gait independence at discharge. RESULTS The degree of independence of toileting was extracted as a first node in the development of two CPRs to predict gait independence at discharge. CPR 1 included the presence of delirium. CPR 2 included problem-solving abilities. The accuracy and area under the curve of CPR 1 were 84.5% and 0.911, respectively; those of CPR 2 were 89.0% and 0.958, respectively. CONCLUSIONS Toileting independence is a key factor in predicting the gait independence for the discharge of patients with stroke during the postacute phase. Early intervention, during the acute phase, for delirium and cognitive decline, as well as for toileting, increases the possibility of gait independence at discharge.
Collapse
|
40
|
Yi X, Chen H, Wang Y, Yu M, Luo H, Wang C, Wei W, Chen X, Bao S. Prevalence and Risk Factors of High-Risk Population for Stroke: A Population-Based Cross-Sectional Survey in Southwestern China. Front Neurol 2022; 13:693894. [PMID: 35309575 PMCID: PMC8925860 DOI: 10.3389/fneur.2022.693894] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 01/26/2022] [Indexed: 12/25/2022] Open
Abstract
With the aging of the population and the change of lifestyle in China, the prevalence and risk factors of the high-risk population for stroke may change. However, few studies performed community-based high-risk stroke population surveys in China. Hence, we performed this multicenter, cross-sectional, and community-based survey in Sichuan of southwestern China, according to the China National Stroke Screening Survey (CNSSS) program in 2015. The residents aged ≥ 40 years volunteered to participate in the face-to-face survey in 8 communities in Sichuan. The 8 communities were selected using the cluster randomization method. Subjects with at least three of the eight stroke-related risk factors were classified as a high-risk population for stroke. Otherwise were classified as a low-risk population for stroke. Furthermore, 1,011 individuals were randomly selected among the low-risk population for stroke as controls. Among 16,892 participants, 2,369 (14.0%) were high-risk population for stroke. After full adjustments, all eight risk factors for stroke were significantly associated with the high-risk population for stroke (P < 0.001). The largest contributor was hypertension [population-attributable risk (PAR) 28.4%], followed by physical inactivity (PAR 14.2%), dyslipidemia (PAR 11.2%), overweight/obesity (PAR 9.4%), diabetes (PAR 7.2%), family history (PAR 6.8%), smoking (PAR 5.9%), and atrial fibrillation (PAR 3.5%). Carotid atherosclerosis was more serious in the high-risk population for stroke than in controls (P < 0.05). The prevalence of the high-risk population for stroke was high in southwestern China. Hypertension, physical inactivity, and dyslipidemia were stronger contributors for the high-risk population for stroke. Individual-level and population-level interventions for these leading risk factors are very important for the primary prevention of stroke.
Collapse
Affiliation(s)
- Xingyang Yi
- Department of Neurology, The People's Hospital of Deyang City, Deyang, China
| | - Hong Chen
- Department of Neurology, The People's Hospital of Deyang City, Deyang, China
- *Correspondence: Hong Chen
| | - Yanfen Wang
- Department of Neurology, The People's Hospital of Deyang City, Deyang, China
| | - Ming Yu
- Department of Neurology, The Suining Central Hospital, Suining, China
| | - Hua Luo
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Chun Wang
- Department of Neurology, The People's Hospital of Deyang City, Deyang, China
| | - Wei Wei
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Xiaorong Chen
- Department of Neurology, The Suining Central Hospital, Suining, China
| | - Shaozhi Bao
- Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Shaozhi Bao
| |
Collapse
|
41
|
Amornpojnimman T, Mitarnun W, Korathanakhun P. Predictors of seizures in patients with cerebral venous thrombosis in the Thai population: A retrospective study. Seizure 2022; 96:1-5. [PMID: 35038621 DOI: 10.1016/j.seizure.2022.01.005] [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] [Received: 09/07/2021] [Revised: 01/06/2022] [Accepted: 01/08/2022] [Indexed: 12/27/2022] Open
Abstract
PURPOSE This study aimed to define independent factors associated with the onset of early seizure (ES) amongst patients with cerebral venous thrombosis (CVT). METHODS This retrospective cohort study recruited patients diagnosed with CVT and hospitalised between 2002 and 2020. Demographic, clinical, and seizure characteristics; neuroimaging findings; and clinical outcomes were compared between the seizure and non-seizure groups. Factors with p-values of <0.05 in univariate analysis were included in multivariate logistic regression analysis to determine independent predictors of ES. RESULTS Amongst 180 CVT patients, the incidence of ES was 38.3%. Most seizures presented as the initial symptom. Focal to bilateral tonic-clonic seizure was the most common seizure type (82.6%). Recurrent serial seizure and non-fatal status epilepticus accounted for 56.5% and 8.7% cases, respectively. Intracerebral haemorrhage (adjusted odds ratio [aOR]=6.57, 95% confidence interval [CI], 2.25‒19.21, p = 0.001) and dependency status at admission (aOR=3.32, 95% CI, 1.08‒10.18, p = 0.036) independently predicted ES, whereas isolated increased intracranial pressure (aOR=0.05, 95% CI, 0.01‒0.24, p < 0.001), isolated headache (aOR=0.10, 95% CI, 0.02‒0.45, p = 0.002), straight sinus thrombosis (aOR=0.03, 95% CI, 0.00‒0.37, p = 0.007), and cavernous sinus thrombosis (aOR=0.50, 95% CI, 0.01‒0.53, p = 0.012) showed protective effects. CONCLUSION Intracerebral haemorrhage and dependency status at admission independently predicted seizures, whereas isolated increased intracranial pressure, isolated headache, straight sinus thrombosis, and cavernous sinus thrombosis showed preventive effects.
Collapse
Affiliation(s)
- Thanyalak Amornpojnimman
- Division of neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Wiwit Mitarnun
- Division of neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Pat Korathanakhun
- Division of neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.
| |
Collapse
|
42
|
Fan R, Gao Y, Zhang H, Xin X, Sang F, Tan Z, Zhang B, Li X, Huang X, Li S, Chang J. Lesion Distribution and Early Changes of Right Hemisphere in Chinese Patients With Post-stroke Aphasia. Front Aging Neurosci 2022; 13:632217. [PMID: 34987373 PMCID: PMC8722470 DOI: 10.3389/fnagi.2021.632217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 11/16/2021] [Indexed: 11/30/2022] Open
Abstract
The role of the right hemisphere (RH) in post-stroke aphasia (PSA) has not been completely understood. In general, the language alterations in PSA are normally evaluated from the perspective of the language processing models developed from Western languages such as English. However, the successful application of the models for assessing Chinese-language functions in patients with PSA has not been reported. In this study, the features of specific language-related lesion distribution and early variations of structure in RH in Chinese patients with PSA were investigated. Forty-two aphasic patients (female: 13, male: 29, mean age: 58 ± 12 years) with left hemisphere (LH) injury between 1 and 6 months after stroke were included. The morphological characteristics, both at the levels of gray matter (GM) and white matter (WM), were quantified by 3T multiparametric brain MRI. The Fridriksson et al.’s dual-stream model was used to compare language-related lesion regions. Voxel-based lesion-symptom mapping (VLSM) analysis has been performed. Our results showed that lesions in the precentral, superior frontal, middle frontal, and postcentral gyri were responsible for both the production and comprehension dysfunction of Chinese patients with PSA and were quite different from the lesions described by using the dual-stream model of Fridriksson et al. Furthermore, gray matter volume (GMV) was found significantly decreased in RH, and WM integrity was disturbed in RH after LH injury in Chinese patients with PSA. The different lesion patterns between Chinese patients with PSA and English-speaking patients with PSA may indicate that the dual-stream model of Fridriksson et al. is not suitable for the assessment of Chinese-language functions in Chinese patients with PSA in subacute phase of recovery. Moreover, decreased structural integrity in RH was found in Chinese patients with PSA.
Collapse
Affiliation(s)
- Ruiwen Fan
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Ying Gao
- Key Laboratory of Encephalopathy Treatment of Chinese Medicine, State Administration of Traditional Chinese Medicine of the People's Republic of China, Beijing, China
| | - Hua Zhang
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xiyan Xin
- TCM Department of Peking University Third Hospital, Peking University, Beijing, China
| | - Feng Sang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Zhongjian Tan
- Key Laboratory of Encephalopathy Treatment of Chinese Medicine, State Administration of Traditional Chinese Medicine of the People's Republic of China, Beijing, China
| | - Binlong Zhang
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xiaolin Li
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xing Huang
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Shuren Li
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Jingling Chang
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| |
Collapse
|
43
|
Adams HP. Clinical Scales to Assess Patients With Stroke. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00021-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
44
|
Sharma VK, Wong LK. Middle Cerebral Artery Disease. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00024-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
45
|
Vogt ML, Kollikowski AM, Weidner F, Strinitz M, Feick J, Essig F, Neugebauer H, Haeusler KG, Pham M, Maerz A. Safety and Effectiveness of the New Generation APERIO® Hybrid Stent-retriever Device in Large Vessel Occlusion Stroke. Clin Neuroradiol 2021; 32:141-151. [PMID: 34936016 PMCID: PMC8894307 DOI: 10.1007/s00062-021-01122-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 11/05/2021] [Indexed: 11/28/2022]
Abstract
Background It is unknown whether technological advancement of stent-retriever devices influences typical observational indicators of safety or effectiveness. Methods Observational retrospective study of APERIO® (AP) vs. new generation APERIO® Hybrid (APH) (Acandis®, Pforzheim, Germany) stent-retriever device (01/2019–09/2020) for mechanical thrombectomy (MT) in large vessel occlusion (LVO) stroke. Primary effectiveness endpoint was successful recanalization eTICI (expanded Thrombolysis In Cerebral Ischemia) ≥ 2b67, primary safety endpoint was occurrence of hemorrhagic complications after MT. Secondary outcome measures were time from groin puncture to first pass and successful reperfusion, and the total number of passes needed to achieve the final recanalization result. Results A total of 298 patients with LVO stroke who were treated by MT matched the inclusion criteria: 148 patients (49.7%) treated with AP vs. 150 patients (50.3%) treated with new generation APH. Successful recanalization was not statistically different between both groups: 75.7% for AP vs. 79.3% for APH; p = 0.450. Postinterventional hemorrhagic complications and particularly subarachnoid hemorrhage as the entity possibly associated with stent-retriever device type was significantly less frequent in the group treated with the APH: 29.7% for AP and 16.0% for APH; p = 0.005; however, rates of symptomatic hemorrhage with clinical deterioration and in domo mortality were not statistically different. Neither the median number of stent-retriever passages needed to achieve final recanalization, time from groin puncture to first pass, time from groin puncture to final recanalization nor the number of cases in which successful recanalization could only be achieved by using a different stent-retriever as bail-out device differed between both groups. Conclusion In the specific example of the APERIO® stent-retriever device, we observed that further technological developments of the new generation device were not associated with disadvantages with respect to typical observational indicators of safety or effectiveness.
Collapse
Affiliation(s)
- Marius L Vogt
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Würzburg, Würzburg, Germany.
| | - Alexander M Kollikowski
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Würzburg, Würzburg, Germany
| | - Franziska Weidner
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Würzburg, Würzburg, Germany
| | - Marc Strinitz
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Würzburg, Würzburg, Germany
| | - Jörn Feick
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Würzburg, Würzburg, Germany
| | - Fabian Essig
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Hermann Neugebauer
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | | | - Mirko Pham
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Würzburg, Würzburg, Germany
| | - Alexander Maerz
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Würzburg, Würzburg, Germany
| |
Collapse
|
46
|
Young gastric cancer patient with high CA19-9 complicated by Trousseau syndrome. Clin J Gastroenterol 2021; 15:85-89. [PMID: 34731429 DOI: 10.1007/s12328-021-01541-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 10/19/2021] [Indexed: 10/19/2022]
Abstract
A 47-year-old Japanese woman presented with epigastric discomfort and anorexia. Upper endoscopy showed type 4 advanced gastric cancer in the gastric antrum with stenosis of the pyloric portion. Abdominopelvic CT revealed peritoneal dissemination, and stage IV advanced gastric cancer was diagnosed. Laparoscopic gastrojejunostomy and enterostomy were performed. Trousseau syndrome occurred 7 days post-surgery. Despite appropriate treatment, the patient developed a pulmonary embolism 13 days later and died 18 days post-surgery. Even in young cancer patients without lifestyle disease complications, it is important to pay attention to Trousseau syndrome as part of cancer management.
Collapse
|
47
|
Kjeverud A, Andersson S, Lerdal A, Schanke AK, Østlie K. A cross-sectional study exploring overlap in post-stroke fatigue caseness using three fatigue instruments: Fatigue Severity Scale, Fatigue Questionnaire and the Lynch's Clinical Interview. J Psychosom Res 2021; 150:110605. [PMID: 34517302 DOI: 10.1016/j.jpsychores.2021.110605] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/27/2021] [Accepted: 08/30/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Post stroke fatigue (PSF) is a frequent symptom affecting 25-73% of stroke survivors. The variability in estimates of prevalence found across studies reflects differences in fatigue measures and use of different cut-offs for defining clinically significant fatigue. The main aim of this study is to explore the frequency and overlap in caseness of fatigue using three different fatigue measures in a sample of patients at 3 months post stroke. Furthermore, we wanted to explore the instrument's associations with demographic and clinical characteristics. METHODS The sample consists of 93 patients with new onset stroke. This cross-sectional study includes three measurements of fatigue, The Fatigue Severity Scale (FSS), The Chalder Fatigue Questionnaire (FQ) and the Lynch Interview. Medical, physical, psychological data and estimates of pre-stroke fatigue were collected 3 months post stroke. RESULTS The FQ using the bimodal scoring yielded about 2.5 more fatigue cases (n = 57) than the FSS with a cut-off mean score of 5 (n = 22). The Lynch interview identified 48 patients as fatigue cases. Conducting multivariate analyses, the three instruments were differently associated with predictor variables such as prestroke fatigue, reduced balance and burden of symptoms reported post stroke. CONCLUSION The use of different instruments leads to a large variability in identifying fatigue cases in a sample of stroke patients. Scientifically and clinically a clarification and consensus on how to measure fatigue is warranted. Without correct identification of PSF-cases, knowledge about the causes of fatigue and development of tailored and interdisciplinary interventions are further delayed.
Collapse
Affiliation(s)
- Anita Kjeverud
- Department of Physical Medicine and Rehabilitation, Innlandet Hospital Trust, Ottestad, Norway.
| | | | - Anners Lerdal
- Research Department, Lovisenberg Diaconal Hospital, Oslo, Norway; Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Norway
| | - Anne-Kristine Schanke
- Department of Psychology, University of Oslo, Norway; Research Department, Sunnaas Rehabilitation Hospital, Nesodden, Norway
| | - Kristin Østlie
- Department of Physical Medicine and Rehabilitation, Innlandet Hospital Trust, Ottestad, Norway
| |
Collapse
|
48
|
Zanotto BS, Beck da Silva Etges AP, Dal Bosco A, Cortes EG, Ruschel R, De Souza AC, Andrade CMV, Viegas F, Canuto S, Luiz W, Ouriques Martins S, Vieira R, Polanczyk C, André Gonçalves M. Stroke Outcome Measurements From Electronic Medical Records: Cross-sectional Study on the Effectiveness of Neural and Nonneural Classifiers. JMIR Med Inform 2021; 9:e29120. [PMID: 34723829 PMCID: PMC8593798 DOI: 10.2196/29120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/27/2021] [Accepted: 08/05/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND With the rapid adoption of electronic medical records (EMRs), there is an ever-increasing opportunity to collect data and extract knowledge from EMRs to support patient-centered stroke management. OBJECTIVE This study aims to compare the effectiveness of state-of-the-art automatic text classification methods in classifying data to support the prediction of clinical patient outcomes and the extraction of patient characteristics from EMRs. METHODS Our study addressed the computational problems of information extraction and automatic text classification. We identified essential tasks to be considered in an ischemic stroke value-based program. The 30 selected tasks were classified (manually labeled by specialists) according to the following value agenda: tier 1 (achieved health care status), tier 2 (recovery process), care related (clinical management and risk scores), and baseline characteristics. The analyzed data set was retrospectively extracted from the EMRs of patients with stroke from a private Brazilian hospital between 2018 and 2019. A total of 44,206 sentences from free-text medical records in Portuguese were used to train and develop 10 supervised computational machine learning methods, including state-of-the-art neural and nonneural methods, along with ontological rules. As an experimental protocol, we used a 5-fold cross-validation procedure repeated 6 times, along with subject-wise sampling. A heatmap was used to display comparative result analyses according to the best algorithmic effectiveness (F1 score), supported by statistical significance tests. A feature importance analysis was conducted to provide insights into the results. RESULTS The top-performing models were support vector machines trained with lexical and semantic textual features, showing the importance of dealing with noise in EMR textual representations. The support vector machine models produced statistically superior results in 71% (17/24) of tasks, with an F1 score >80% regarding care-related tasks (patient treatment location, fall risk, thrombolytic therapy, and pressure ulcer risk), the process of recovery (ability to feed orally or ambulate and communicate), health care status achieved (mortality), and baseline characteristics (diabetes, obesity, dyslipidemia, and smoking status). Neural methods were largely outperformed by more traditional nonneural methods, given the characteristics of the data set. Ontological rules were also effective in tasks such as baseline characteristics (alcoholism, atrial fibrillation, and coronary artery disease) and the Rankin scale. The complementarity in effectiveness among models suggests that a combination of models could enhance the results and cover more tasks in the future. CONCLUSIONS Advances in information technology capacity are essential for scalability and agility in measuring health status outcomes. This study allowed us to measure effectiveness and identify opportunities for automating the classification of outcomes of specific tasks related to clinical conditions of stroke victims, and thus ultimately assess the possibility of proactively using these machine learning techniques in real-world situations.
Collapse
Affiliation(s)
- Bruna Stella Zanotto
- National Institute of Health Technology Assessment - INCT/IATS (CNPQ 465518/2014-1), Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Graduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Ana Paula Beck da Silva Etges
- National Institute of Health Technology Assessment - INCT/IATS (CNPQ 465518/2014-1), Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,School of Technology, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Avner Dal Bosco
- School of Technology, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Eduardo Gabriel Cortes
- Graduate Program of Computer Science, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Renata Ruschel
- National Institute of Health Technology Assessment - INCT/IATS (CNPQ 465518/2014-1), Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Claudio M V Andrade
- Computer Science Department, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Felipe Viegas
- Computer Science Department, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Sergio Canuto
- Computer Science Department, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Washington Luiz
- Computer Science Department, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Renata Vieira
- Centro Interdisciplinar de História, Culturas e Sociedades (CIDEHUS), Universidade de Évora, Évora, Portugal
| | - Carisi Polanczyk
- National Institute of Health Technology Assessment - INCT/IATS (CNPQ 465518/2014-1), Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Graduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Marcos André Gonçalves
- Computer Science Department, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| |
Collapse
|
49
|
Aam S, Gynnild MN, Munthe-Kaas R, Saltvedt I, Lydersen S, Knapskog AB, Ihle-Hansen H, Ellekjær H, Eldholm RS, Fure B. The Impact of Vascular Risk Factors on Post-stroke Cognitive Impairment: The Nor-COAST Study. Front Neurol 2021; 12:678794. [PMID: 34421786 PMCID: PMC8374055 DOI: 10.3389/fneur.2021.678794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 06/07/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Post-stroke cognitive impairment (PSCI) is common, but evidence on the impact of vascular risk factors is lacking. We explored the association between pre-stroke vascular risk factors and PSCI and studied the course of PSCI. Materials and Methods: Vascular risk factors were collected at baseline in stroke survivors (n = 635). Cognitive assessments of attention, executive function, memory, language, and the Montreal Cognitive Assessment (MoCA) were performed at 3 and/or 18 months post-stroke. Stroke severity was assessed with the National Institutes of Health Stroke Scale (NIHSS). PSCI was measured with global z; MoCA z-score; and z-score of the four assessed cognitive domains. Mixed-effect linear regression was applied with global z, MoCA z-score, and z-scores of the cognitive domains as dependent variables. Independent variables were the vascular risk factors (hypertension, hypercholesterolemia, smoking, diabetes mellitus, atrial fibrillation, coronary heart disease, previous stroke), time, and the interaction between these. The analyses were adjusted for age, education, and sex. There were between 5 and 25% missing data for the variables for PSCI. Results: Mean age was 71.6 years (SD 11.7); 42% were females; and the mean NIHSS score at admittance was 3.8 (SD 4.8). Regardless of vascular risk factors, global z, MoCA, and all the assessed cognitive domains were impaired at 3 and 18 months, with MoCA being the most severely impaired. Atrial fibrillation (AF) was associated with poorer language at 18 months and coronary heart disease (CHD) with poorer MoCA at 18 months (LR = 12.80, p = 0.002, and LR = 8.32, p = 0.004, respectively). Previous stroke was associated with poorer global z and attention at 3 and 18 months (LR = 15.46, p < 0.001, and LR = 16.20, p < 0.001). In patients without AF, attention improved from 3 to 18 months, and in patients without CHD, executive function improved from 3 to 18 months (LR = 10.42, p < 0.001, and LR = 9.33, p = 0.009, respectively). Discussion: Our findings indicate that a focal stroke lesion might be related to pathophysiological processes leading to global cognitive impairment. The poorer prognosis of PSCI in patients with vascular risk factors emphasizes the need for further research on complex vascular risk factor interventions to prevent PSCI.
Collapse
Affiliation(s)
- Stina Aam
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.,Department of Geriatric Medicine, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Mari Nordbø Gynnild
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.,Stroke Unit, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Ragnhild Munthe-Kaas
- Department of Medicine, Vestre Viken Hospital Trust, Bærum Hospital, Drammen, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingvild Saltvedt
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.,Department of Geriatric Medicine, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Stian Lydersen
- Department of Mental Health, Faculty of Medicine and Health Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Hege Ihle-Hansen
- Department of Medicine, Vestre Viken Hospital Trust, Bærum Hospital, Drammen, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Hanne Ellekjær
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.,Stroke Unit, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Rannveig Sakshaug Eldholm
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.,Department of Geriatric Medicine, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Brynjar Fure
- Department of Internal Medicine, Central Hospital, Karlstad, Sweden.,School of Medical Sciences, Örebro University, Örebro, Sweden
| |
Collapse
|
50
|
Sakai Y, Yoshikawa G, Sato K. Mechanical Thrombectomy for ICA Top Occlusion with Twig-Like MCA: A Case Report. JOURNAL OF NEUROENDOVASCULAR THERAPY 2021; 16:175-180. [PMID: 37502284 PMCID: PMC10370778 DOI: 10.5797/jnet.cr.2020-0202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 06/11/2021] [Indexed: 07/29/2023]
Abstract
Objective We report a case of hemorrhagic complication after mechanical thrombectomy (MT) for internal carotid artery (ICA) occlusion with twig-like middle cerebral artery (MCA). Case Presentation A 75-year-old man was admitted to our hospital with ICA occlusion. Recanalization was achieved by a direct aspiration first pass technique (ADAPT). The peripheral MCA was twig-like, but operators thought that a thrombus remained in the MCA first segment. The procedure was continued and suspended with perforation of the microguidewire. Conclusion When performing MT for large vessel occlusion (LVO) with twig-like MCA, it is difficult to proceed a device to the periphery and there is a risk of hemorrhage.
Collapse
Affiliation(s)
- Yu Sakai
- Department of Neurosurgery, Showa General Hospital, Kodaira, Tokyo, Japan
| | - Gakushi Yoshikawa
- Department of Neurosurgery, Showa General Hospital, Kodaira, Tokyo, Japan
| | - Katsuya Sato
- Department of Neurosurgery, Showa General Hospital, Kodaira, Tokyo, Japan
| |
Collapse
|