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Quantitative Assessment of Motor Function by an End-Effector Upper Limb Rehabilitation Robot Based on Admittance Control. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11156854] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Various rehabilitation robots have been developed to assist the movement training of the upper limbs of stroke patients, among which some have been used to evaluate the motor recovery. However, how to understand the recovery of motor function from the quantitative assessment following robot-assisted rehabilitation training is still not clear. The objective of this study is to propose a quantitative assessment method of motor function based on the force and trajectory characteristics during robotic training to reflect motor functional recovery. To assist stroke patients who are not able to move voluntarily, an assistive training mode was developed for the robot-assisted rehabilitation system based on admittance control. Then, to validate the relationship between characteristic information and functional recovery, a clinical experiment was conducted, in which nine stroke patients and nine healthy subjects were recruited. The results showed a significant difference in movement range and movement smoothness during trajectory tracking tasks between stroke patients and healthy subjects. The two parameters above have a correlation with the Fugl-Meyer Assessment for Upper Extremity (FMU) of the involved patients. The multiple linear regression analysis showed FMU was positively correlated with parameters (R2=0.91,p<0.005). This finding indicated that the above-mentioned method can achieve quantitative assessment of motor function for stroke patients during robot-assisted rehabilitation training, which can contribute to promoting rehabilitation robots in clinical practice.
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Quantitative Assessment of Motor Function for Patients with a Stroke by an End-Effector Upper Limb Rehabilitation Robot. BIOMED RESEARCH INTERNATIONAL 2020; 2020:5425741. [PMID: 32462001 PMCID: PMC7224306 DOI: 10.1155/2020/5425741] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 01/15/2020] [Accepted: 02/15/2020] [Indexed: 11/17/2022]
Abstract
With the popularization of rehabilitation robots, it is necessary to develop quantitative motor function assessment methods for patients with a stroke. To make the assessment equipment easier to use in clinics and combine the assessment methods with the rehabilitation training process, this paper proposes an anthropomorphic rehabilitation robot based on the basic movement patterns of the upper limb, point-to-point reaching and circle drawing movement. This paper analyzes patients' movement characteristics in aspects of movement range, movement accuracy, and movement smoothness and the output force characteristics by involving 8 patients. Besides, a quantitative assessment method is also proposed based on multivariate fitting methods. It can be concluded that the area of the real trajectory and movement accuracy during circle drawing movement as well as the ratio of force along the sagittal axis in backward point-to-point movement are the unique parameters that are different remarkably between stroke patients and healthy subjects. The fitting function has a high goodness of fit with the Fugl-Meyer scores for the upper limb (R 2 = 0.91, p = 0.015), which demonstrates that the fitting function can be used to assess patients' upper limb movement function. The indicators are recorded during training movement, and the fitting function can calculate the scores immediately, which makes the functional assessment quantitative and timely. Combining the training process and assessment, the quantitative assessment method will farther expand the application of rehabilitation robots.
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Wang F, Huang Y, Xia Y, Zhang W, Fang K, Zhou X, Yu X, Cheng X, Li G, Wang X, Luo G, Wu D, Liu X, Campbell BC, Dong Q, Zhao Y. Personalized risk prediction of symptomatic intracerebral hemorrhage after stroke thrombolysis using a machine-learning model. Ther Adv Neurol Disord 2020; 13:1756286420902358. [PMID: 35173804 PMCID: PMC8842114 DOI: 10.1177/1756286420902358] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 01/04/2020] [Indexed: 11/23/2022] Open
Abstract
Background: Personalized prediction of the risk of symptomatic intracerebral hemorrhage
(sICH) after stroke thrombolysis is clinically useful.
Machine-learning-based modeling may provide the personalized prediction of
the risk of sICH after stroke thrombolysis. Methods: We identified 2578 thrombolysis-treated ischemic stroke patients between
January 2013 and December 2016 from a multicenter database, where 70% were
used to train models and the remaining 30% were used as the nominal test
sets. Another 136 consecutive tissue plasminogen-activated-treated patients
between January 2017 and December 2017 from our institute were enrolled as
the independent test sets for clinical usability evaluation. Five
machine-learning models were developed to predict the risk of sICH after
stroke thrombolysis, and the receiving operating characteristic (ROC) was
used to compare the prediction performance. Results: In total, 2237 cases were included in our study, of which 102 had sICH
transformation (4.56%). Finally, the three-layer neuro network was selected
with the best performance on nominal test sets (AUC = 0.82). The probability
of the model score was further categorized into three risk ranks (18.97%,
5.63%, and 0.81%) according to the risk distribution. Implementing our
system in clinical practice was associated with reduced computed tomography
(CT)-to-treatment time (CTT; 41 min versus 52 min,
p < 0.001). All sICH patients were correctly
predicted to be within the high-sICH risk rank. Conclusions: The machine-learning-based modeling is feasible for providing personalized
risk prediction of sICH after stroke thrombolysis, and is able to reduce the
CTT. More data are needed to further optimize the model and improve the
accuracy of prediction.
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Affiliation(s)
- Feng Wang
- Department of Neurology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Yuanhanqing Huang
- College of Electronics and Information Engineering, Tongji University, Shanghai, China
| | | | - Wei Zhang
- College of Electronics and Information Engineering, Tongji University, Shanghai, China
| | - Kun Fang
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaoyu Zhou
- Department of Neurology, Shanghai Tenth People’s Hospital, Tongji University, Shanghai, China
| | - Xiaofei Yu
- Department of Neurology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xin Cheng
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Gang Li
- Department of Neurology, East Hospital, Tongji University, Shanghai, China
| | - Xiaoping Wang
- Department of Neurology, Shanghai TongRen Hospital, Tongji University, Shanghai, China
| | - Guojun Luo
- Department of Neurology, Jinshan Branch of Shanghai Sixth People’s Hospital, Shanghai, China
| | - Danhong Wu
- Department of Neurology, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, China
| | - Xueyuan Liu
- Department of Neurology, Shanghai Tenth People’s Hospital, Tongji University, Shanghai, China
| | - Bruce C.V. Campbell
- Departments of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Qiang Dong
- Department of Neurology, Huashan Hospital, Fudan University, No.12, Wulumuqi Zhong Road, Jingan District, Shanghai, 200040, China
| | - Yuwu Zhao
- Department of Neurology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, No. 600, Yishan Road, Xuhui District, Shanghai, 200233, China
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Zhang W, Wang W, Yu DX, Xiao Z, He Z. Application of nanodiagnostics and nanotherapy to CNS diseases. Nanomedicine (Lond) 2018; 13:2341-2371. [PMID: 30088440 DOI: 10.2217/nnm-2018-0163] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Alzheimer's disease, Parkinson's disease and stroke are the most common CNS diseases, all characterized by progressive cellular dysfunction and death in specific areas of the nervous system. Therapeutic development for these diseases has lagged behind other disease areas due to difficulties in early diagnosis, long disease courses and drug delivery challenges, not least due to the blood-brain barrier. Over recent decades, nanotechnology has been explored as a potential tool for the diagnosis, treatment and monitoring of CNS diseases. In this review, we describe the application of nanotechnology to common CNS diseases, highlighting disease pathogenesis and the underlying mechanisms and promising functional outcomes that make nanomaterials ideal candidates for early diagnosis and therapy. Moreover, we discuss the limitations of nanotechnology, and possible solutions.
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Affiliation(s)
- Weiyuan Zhang
- Yunnan Key Laboratory of Stem Cell & Regenerative Medicine, Institute of Molecular & Clinical Medicine, Kunming Medical University, Kunming 650500, PR China
| | - Wenyue Wang
- Department of Anatomy & Developmental Biology, Monash University, Clayton, 3800 Clayton, Melbourne 3800, Australia
| | - David X Yu
- Department of Anatomy & Developmental Biology, Monash University, Clayton, 3800 Clayton, Melbourne 3800, Australia
| | - Zhicheng Xiao
- Department of Anatomy & Developmental Biology, Monash University, Clayton, 3800 Clayton, Melbourne 3800, Australia
| | - Zhiyong He
- Yunnan Key Laboratory of Stem Cell & Regenerative Medicine, Institute of Molecular & Clinical Medicine, Kunming Medical University, Kunming 650500, PR China.,Department of Anatomy & Developmental Biology, Monash University, Clayton, 3800 Clayton, Melbourne 3800, Australia
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Niego B, Broughton BRS, Ho H, Sobey CG, Medcalf RL. LDL receptor blockade reduces mortality in a mouse model of ischaemic stroke without improving tissue-type plasminogen activator-induced brain haemorrhage: towards pre-clinical simulation of symptomatic ICH. Fluids Barriers CNS 2017; 14:33. [PMID: 29157263 PMCID: PMC5696777 DOI: 10.1186/s12987-017-0081-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 10/31/2017] [Indexed: 12/24/2022] Open
Abstract
Background Symptomatic intracerebral haemorrhage (sICH) following tissue-type plasminogen activator (rt-PA) administration is the most feared and lethal complication of thrombolytic therapy for ischaemic stroke, creating a significant obstacle for a broader uptake of this beneficial treatment. rt-PA also undermines cerebral vasculature stability in a multimodal process which involves engagement with LDL receptor-related protein 1 (LRP-1), potentially underlying the development of sICH. Aims and methods We aimed to simulate rt-PA-induced haemorrhagic transformation (HT) in a mouse model of stroke and to assess if it drives symptomatic neurological deterioration and whether it is attenuated by LDL receptor blockade. rt-PA (10 mg/kg) or its vehicle, with or without the LDL receptor antagonist, receptor-associated protein (RAP; 2 mg/kg), were intravenously injected at reperfusion after 0.5 or 4 h of middle cerebral artery occlusion (MCAo). Albumin and haemoglobin content were measured in the perfused mouse brains 24 h post MCAo as indications of blood–brain barrier (BBB) compromise and HT, respectively. Results rt-PA did not elevate brain albumin and haemoglobin levels in sham mice or in mice subjected to 0.5 h MCAo. In contrast, administration of rt-PA after prolonged MCAo (4 h) caused a marked increase in HT (but similar changes in brain albumin) compared to vehicle, mimicking the clinical shift from a safe to detrimental intervention. Interestingly, this HT did not correlate with functional deficit severity at 24 h, suggesting that it does not play a symptomatic role in our mouse stroke model. Co-administration of RAP with or without rt-PA reduced mortality and neurological scores but did not effectively decrease brain albumin and haemoglobin levels. Conclusion Despite the proven causative relationship between severe HT and neurological deterioration in human stroke, rt-PA-triggered HT in mouse MCAo does not contribute to neurological deficit or simulate sICH. Model limitations, such as the long duration of occlusion required, the type of HT achieved and the timing of deficit assessment may account for this mismatch. Our results further suggest that blockade of LDL receptors improves stroke outcome irrespective of rt-PA, blood–brain barrier breakdown and HT.
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Affiliation(s)
- Be'eri Niego
- Molecular Neurotrauma and Haemostasis, Australian Centre for Blood Diseases, Monash University, Level 4 Burnet Building, 89 Commercial Road, Melbourne, 3004, VIC, Australia.
| | - Brad R S Broughton
- Cardiovascular & Pulmonary Pharmacology Group, Biomedicine Discovery Institute, Department of Pharmacology, Monash University, Clayton, VIC, Australia
| | - Heidi Ho
- Molecular Neurotrauma and Haemostasis, Australian Centre for Blood Diseases, Monash University, Level 4 Burnet Building, 89 Commercial Road, Melbourne, 3004, VIC, Australia
| | - Christopher G Sobey
- Vascular Biology and Immunopharmacology Group, Department of Physiology, Anatomy & Microbiology, School of Life Sciences, La Trobe University, Bundoora, VIC, Australia
| | - Robert L Medcalf
- Molecular Neurotrauma and Haemostasis, Australian Centre for Blood Diseases, Monash University, Level 4 Burnet Building, 89 Commercial Road, Melbourne, 3004, VIC, Australia
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Craig LE, McInnes E, Taylor N, Grimley R, Cadilhac DA, Considine J, Middleton S. Identifying the barriers and enablers for a triage, treatment, and transfer clinical intervention to manage acute stroke patients in the emergency department: a systematic review using the theoretical domains framework (TDF). Implement Sci 2016; 11:157. [PMID: 27894313 PMCID: PMC5126852 DOI: 10.1186/s13012-016-0524-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 11/18/2016] [Indexed: 11/10/2022] Open
Abstract
Background Clinical guidelines recommend that assessment and management of patients with stroke commences early including in emergency departments (ED). To inform the development of an implementation intervention targeted in ED, we conducted a systematic review of qualitative and quantitative studies to identify relevant barriers and enablers to six key clinical behaviours in acute stroke care: appropriate triage, thrombolysis administration, monitoring and management of temperature, blood glucose levels, and of swallowing difficulties and transfer of stroke patients in ED. Methods Studies of any design, conducted in ED, where barriers or enablers based on primary data were identified for one or more of these six clinical behaviours. Major biomedical databases (CINAHL, OVID SP EMBASE, OVID SP MEDLINE) were searched using comprehensive search strategies. The barriers and enablers were categorised using the theoretical domains framework (TDF). The behaviour change technique (BCT) that best aligned to the strategy each enabler represented was selected for each of the reported enablers using a standard taxonomy. Results Five qualitative studies and four surveys out of the 44 studies identified met the selection criteria. The majority of barriers reported corresponded with the TDF domains of “environmental, context and resources” (such as stressful working conditions or lack of resources) and “knowledge” (such as lack of guideline awareness or familiarity). The majority of enablers corresponded with the domains of “knowledge” (such as education for physicians on the calculated risk of haemorrhage following intravenous thrombolysis [tPA]) and “skills” (such as providing opportunity to treat stroke cases of varying complexity). The total number of BCTs assigned was 18. The BCTs most frequently assigned to the reported enablers were “focus on past success” and “information about health consequences.” Conclusions Barriers and enablers for the delivery of key evidence-based protocols in an emergency setting have been identified and interpreted within a relevant theoretical framework. This new knowledge has since been used to select specific BCTs to implement evidence-based care in an ED setting. It is recommended that findings from similar future reviews adopt a similar theoretical approach. In particular, the use of existing matrices to assist the selection of relevant BCTs.
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Affiliation(s)
- Louise E Craig
- Nursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University, Sydney, NSW, Australia.
| | - Elizabeth McInnes
- Nursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University, Sydney, NSW, Australia
| | - Natalie Taylor
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Rohan Grimley
- Sunshine Coast Hospital and Health Service/Sunshine Coast Clinical School, The University of Queensland, Nambour, QLD, Australia
| | - Dominique A Cadilhac
- Translational Public Health and Evaluation Division, Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia.,Public Health: Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Julie Considine
- Deakin University, Geelong, VIC, Australia.,Eastern Health - Deakin University Nursing and Midwifery Research Centre, Box Hill, VIC, Australia
| | - Sandy Middleton
- Nursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University, Sydney, NSW, Australia
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7
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Hua X, Zhou L, Liu P, He Y, Tan K, Chen Q, Gao Y, Gao Y. In vivo thrombolysis with targeted microbubbles loading tissue plasminogen activator in a rabbit femoral artery thrombus model. J Thromb Thrombolysis 2015; 38:57-64. [PMID: 24671732 DOI: 10.1007/s11239-014-1071-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The increasingly high incidence of ischemic stroke caused by thrombosis of the arterial vessels is one of the major factors that threaten people's health and lives in the world. The present treatments for thrombosis are unsatisfactory yet. We developed the microbubbles loading tissue plasminogen activator (tPA) and their in vitro thrombolysis efficacy under ultrasound exposure has been proved previously. We tried to investigate their thrombolysis effect in vivo in this present study. Thrombus model was made by clamping bilateral femoral arteries in 70 arteries of 40 rabbits. The targeted tPA-loaded microbubbles were made by lyophilization, taking arginine-glycine-aspartic acid-serine peptide as the targeting ligand. Its thrombolysis efficacy, calculated as count rate and efficiency rate of recanalization, was evaluated by Pearson's χ(2) and One-way ANOVA, respectively. The count rate of recanalization of the targeted tPA-loaded microbubbles under ultrasound exposure (70%) was similar to that of the combination of tPA, microbubbles and ultrasound exposure (80%) (P = 0.61), while its tPA dosage (0.06 mg/kg) was much less than that of latter (0.9 mg/kg). Its efficiency rate of recanalization was the highest among all groups (53.22 ± 40.39%) (P < 0.01). Ultrasound-induced targeted tPA-loaded microbubbles release is a promising thrombolytic method with satisfactory thrombolytic efficacy, lowered tPA dose and potentially decreased hemorrhagic risk.
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Affiliation(s)
- Xing Hua
- Department of Ultrasound, Southwest Hospital, Third Military Medical University, Chongqing, China
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Penaloza-Ramos MC, Sheppard JP, Jowett S, Barton P, Mant J, Quinn T, Mellor RM, Sims D, Sandler D, McManus RJ, Carr P, Greenfield S, Helliwell B, Nand C, Phillips N, Scott R, Singh S, Ward M. Cost-Effectiveness of Optimizing Acute Stroke Care Services for Thrombolysis. Stroke 2014; 45:553-62. [DOI: 10.1161/strokeaha.113.003216] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Maria Cristina Penaloza-Ramos
- From the Health Economics Unit (M.C.P.-R., S.J., P.B.) and Primary Care Clinical Sciences (J.P.S., R.M.M.), University of Birmingham, Edgbaston, Birmingham, UK; Department of Primary Care Health Sciences, University of Oxford, Oxford, UK (J.P.S., R.J.M.); Primary Care Unit, University of Cambridge, Cambridge, UK (J.M.); Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK (T.Q.); University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK (D. Sims); and Heart of
| | - James P. Sheppard
- From the Health Economics Unit (M.C.P.-R., S.J., P.B.) and Primary Care Clinical Sciences (J.P.S., R.M.M.), University of Birmingham, Edgbaston, Birmingham, UK; Department of Primary Care Health Sciences, University of Oxford, Oxford, UK (J.P.S., R.J.M.); Primary Care Unit, University of Cambridge, Cambridge, UK (J.M.); Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK (T.Q.); University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK (D. Sims); and Heart of
| | - Sue Jowett
- From the Health Economics Unit (M.C.P.-R., S.J., P.B.) and Primary Care Clinical Sciences (J.P.S., R.M.M.), University of Birmingham, Edgbaston, Birmingham, UK; Department of Primary Care Health Sciences, University of Oxford, Oxford, UK (J.P.S., R.J.M.); Primary Care Unit, University of Cambridge, Cambridge, UK (J.M.); Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK (T.Q.); University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK (D. Sims); and Heart of
| | - Pelham Barton
- From the Health Economics Unit (M.C.P.-R., S.J., P.B.) and Primary Care Clinical Sciences (J.P.S., R.M.M.), University of Birmingham, Edgbaston, Birmingham, UK; Department of Primary Care Health Sciences, University of Oxford, Oxford, UK (J.P.S., R.J.M.); Primary Care Unit, University of Cambridge, Cambridge, UK (J.M.); Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK (T.Q.); University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK (D. Sims); and Heart of
| | - Jonathan Mant
- From the Health Economics Unit (M.C.P.-R., S.J., P.B.) and Primary Care Clinical Sciences (J.P.S., R.M.M.), University of Birmingham, Edgbaston, Birmingham, UK; Department of Primary Care Health Sciences, University of Oxford, Oxford, UK (J.P.S., R.J.M.); Primary Care Unit, University of Cambridge, Cambridge, UK (J.M.); Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK (T.Q.); University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK (D. Sims); and Heart of
| | - Tom Quinn
- From the Health Economics Unit (M.C.P.-R., S.J., P.B.) and Primary Care Clinical Sciences (J.P.S., R.M.M.), University of Birmingham, Edgbaston, Birmingham, UK; Department of Primary Care Health Sciences, University of Oxford, Oxford, UK (J.P.S., R.J.M.); Primary Care Unit, University of Cambridge, Cambridge, UK (J.M.); Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK (T.Q.); University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK (D. Sims); and Heart of
| | - Ruth M. Mellor
- From the Health Economics Unit (M.C.P.-R., S.J., P.B.) and Primary Care Clinical Sciences (J.P.S., R.M.M.), University of Birmingham, Edgbaston, Birmingham, UK; Department of Primary Care Health Sciences, University of Oxford, Oxford, UK (J.P.S., R.J.M.); Primary Care Unit, University of Cambridge, Cambridge, UK (J.M.); Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK (T.Q.); University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK (D. Sims); and Heart of
| | - Don Sims
- From the Health Economics Unit (M.C.P.-R., S.J., P.B.) and Primary Care Clinical Sciences (J.P.S., R.M.M.), University of Birmingham, Edgbaston, Birmingham, UK; Department of Primary Care Health Sciences, University of Oxford, Oxford, UK (J.P.S., R.J.M.); Primary Care Unit, University of Cambridge, Cambridge, UK (J.M.); Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK (T.Q.); University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK (D. Sims); and Heart of
| | - David Sandler
- From the Health Economics Unit (M.C.P.-R., S.J., P.B.) and Primary Care Clinical Sciences (J.P.S., R.M.M.), University of Birmingham, Edgbaston, Birmingham, UK; Department of Primary Care Health Sciences, University of Oxford, Oxford, UK (J.P.S., R.J.M.); Primary Care Unit, University of Cambridge, Cambridge, UK (J.M.); Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK (T.Q.); University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK (D. Sims); and Heart of
| | - Richard J. McManus
- From the Health Economics Unit (M.C.P.-R., S.J., P.B.) and Primary Care Clinical Sciences (J.P.S., R.M.M.), University of Birmingham, Edgbaston, Birmingham, UK; Department of Primary Care Health Sciences, University of Oxford, Oxford, UK (J.P.S., R.J.M.); Primary Care Unit, University of Cambridge, Cambridge, UK (J.M.); Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK (T.Q.); University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK (D. Sims); and Heart of
| | | | | | | | | | | | | | - Satinder Singh
- Primary Care Clinical Sciences, University of Birmingham
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Wintermark M, Sanelli PC, Albers GW, Bello J, Derdeyn C, Hetts SW, Johnson MH, Kidwell C, Lev MH, Liebeskind DS, Rowley H, Schaefer PW, Sunshine JL, Zaharchuk G, Meltzer CC. Imaging recommendations for acute stroke and transient ischemic attack patients: A joint statement by the American Society of Neuroradiology, the American College of Radiology, and the Society of NeuroInterventional Surgery. AJNR Am J Neuroradiol 2013; 34:E117-27. [PMID: 23907247 DOI: 10.3174/ajnr.a3690] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
SUMMARY Stroke is a leading cause of death and disability worldwide. Imaging plays a critical role in evaluating patients suspected of acute stroke and transient ischemic attack, especially before initiating treatment. Over the past few decades, major advances have occurred in stroke imaging and treatment, including Food and Drug Administration approval of recanalization therapies for the treatment of acute ischemic stroke. A wide variety of imaging techniques has become available to assess vascular lesions and brain tissue status in acute stroke patients. However, the practical challenge for physicians is to understand the multiple facets of these imaging techniques, including which imaging techniques to implement and how to optimally use them, given available resources at their local institution. Important considerations include constraints of time, cost, access to imaging modalities, preferences of treating physicians, availability of expertise, and availability of endovascular therapy. The choice of which imaging techniques to employ is impacted by both the time urgency for evaluation of patients and the complexity of the literature on acute stroke imaging. Ideally, imaging algorithms should incorporate techniques that provide optimal benefit for improved patient outcomes without delaying treatment.
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Affiliation(s)
- M Wintermark
- Departments of Radiology, Neurology, Neurosurgery, and Biomedical Engineering, University of Virginia, Charlottesville, Virginia
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10
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Binsalamah ZM, Paul A, Prakash S, Shum-Tim D. Nanomedicine in cardiovascular therapy: recent advancements. Expert Rev Cardiovasc Ther 2013; 10:805-15. [PMID: 22894635 DOI: 10.1586/erc.12.41] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Cardiovascular disease (CVD) is comprised of a group of disorders affecting the heart and blood vessels of the human body and is one of the leading causes of death worldwide. Current therapy for CVD is limited to the treatment of already established disease, and it includes pharmacological and/or surgical procedures, such as percutaneous coronary intervention with stenting and coronary artery bypass grafting. However, lots of complications have been raised with these modalities of treatment, including systemic toxicity with medication, stent thrombosis with percutaneous coronary intervention and nonsurgical candidate patients for coronary artery bypass grafting. Nanomedicine has emerged as a potential strategy in dealing with these obstacles. Applications of nanotechnology in medicine are already underway and offer tremendous promise. This review explores the recent developments of nanotechnology in the field of CVD and gives an insight into its potential for diagnostics and therapeutics applications. The authors also explore the characteristics of the widely used biocompatible nanomaterials for this purpose and evaluate their opportunities and challenges for developing novel nanobiotechnological tools with high efficacy for biomedical applications, such as radiological imaging, vascular implants, gene therapy, myocardial infarction and targeted delivery systems.
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11
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Cougo-Pinto PT, Santos BLD, Dias FA, Fabio SRC, Werneck IV, Camilo MR, Abud DG, Leite JP, Pontes-Neto OM. Frequency and predictors of symptomatic intracranial hemorrhage after intravenous thrombolysis for acute ischemic stroke in a Brazilian public hospital. Clinics (Sao Paulo) 2012; 67:739-43. [PMID: 22892916 PMCID: PMC3400162 DOI: 10.6061/clinics/2012(07)06] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Accepted: 03/09/2012] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Scarce data are available on the occurrence of symptomatic intracranial hemorrhage related to intravenous thrombolysis for acute stroke in South America. We aimed to address the frequency and clinical predictors of symptomatic intracranial hemorrhage after stroke thrombolysis at our tertiary emergency unit in Brazil. METHOD We reviewed the clinical and radiological data of 117 consecutive acute ischemic stroke patients treated with intravenous thrombolysis in our hospital between May 2001 and April 2010. We compared our results with those of the Safe Implementation of Thrombolysis in Stroke registry. Univariate and multiple regression analyses were performed to identify factors associated with symptomatic intracranial transformation. RESULTS In total, 113 cases from the initial sample were analyzed. The median National Institutes of Health Stroke Scale score was 16 (interquartile range: 10-20). The median onset-to-treatment time was 188 minutes (interquartile range: 155-227). There were seven symptomatic intracranial hemorrhages (6.2%; Safe Implementation of Thrombolysis in Stroke registry: 4.9%; p = 0.505). In the univariate analysis, current statin treatment and elevated National Institute of Health Stroke Scale scores were related to symptomatic intracranial hemorrhage. After the multivariate analysis, current statin treatment was the only factor independently associated with symptomatic intracranial hemorrhage. CONCLUSIONS In this series of Brazilian patients with severe strokes treated with intravenous thrombolysis in a public university hospital at a late treatment window, we found no increase in the rate of symptomatic intracranial hemorrhage. Additional studies are necessary to clarify the possible association between statins and the risk of symptomatic intracranial hemorrhage after stroke thrombolysis.
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Affiliation(s)
- Pedro Telles Cougo-Pinto
- University of São Paulo, Ribeirão Preto School of Medicine, Department of Neuroscience and Behavioral Sciences, Ribeirão Preto/SP, Brazil
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Yoo AJ, Pulli B, Gonzalez RG. Imaging-based treatment selection for intravenous and intra-arterial stroke therapies: a comprehensive review. Expert Rev Cardiovasc Ther 2011; 9:857-76. [PMID: 21809968 DOI: 10.1586/erc.11.56] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Reperfusion therapy is the only approved treatment for acute ischemic stroke. The current approach to patient selection is primarily based on the time from stroke symptom onset. However, this algorithm sharply restricts the eligible patient population, and neglects large variations in collateral circulation that ultimately determine the therapeutic time window in individual patients. Time alone is unlikely to remain the dominant parameter. Alternative approaches to patient selection involve advanced neuroimaging methods including MRI diffusion-weighted imaging, magnetic resonance and computed tomography perfusion imaging and noninvasive angiography that provide potentially valuable information regarding the state of the brain parenchyma and the neurovasculature. These techniques have now been used extensively, and there is emerging evidence on how specific imaging data may result in improved clinical outcomes. This article will review the major studies that have investigated the role of imaging in patient selection for both intravenous and intra-arterial therapies.
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Affiliation(s)
- Albert J Yoo
- Massachusetts General Hospital, 55 Fruit Street, Gray 241, Boston, MA 02114, USA.
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Gumbinger C, Gruschka P, Böttinger M, Heerlein K, Barrows R, Hacke W, Ringleb P. Improved prediction of poor outcome after thrombolysis using conservative definitions of symptomatic hemorrhage. Stroke 2011; 43:240-2. [PMID: 21998049 DOI: 10.1161/strokeaha.111.623033] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Direct comparison of symptomatic intracerebral hemorrhage (sICH) rates among different thrombolysis studies is complicated by the variability of definitions of sICH. The prediction of outcome still remains unclear. METHODS Baseline data and clinical courses of patients treated with thrombolytic therapy were collected in a prospective database. The 3-month outcome was evaluated using the modified Rankin Scale. Results of 24-hour follow-up imaging were reevaluated by at least 2 independent raters. Four common definitions of sICH (National Institute of Neurological Disorders and Stroke [NINDS], European Cooperative Acute Stroke Study [ECASS] 2, Safe Implementation of Thrombolysis in Stroke [SITS], ECASS 3) were applied. Kappa interrater statistics were calculated. Our objective was to find the sICH definition with the highest predictive value for mortality, poor (modified Rankin Scale 5 or 6) and unfavorable (modified Rankin Scale ≥3) clinical outcome after 90 days. RESULTS The data of 314 patients were analyzed. The NINDS definition revealed the highest sICH rate (7.7%); the lowest rate was found for the ECASS 3 definition (3.2%) of sICH. The highest interrater agreement was found for the ECASS 2 definition (κ 0.85) and the lowest for the NINDS definition (κ 0.57). Patients with sICH according to the SITS definition had the highest risk for death (OR, 14.4) and poor outcome (OR, 26.6). CONCLUSIONS None of the different definitions contains an optimal combination of prediction of mortality and outcome and a high interrater agreement rate. For the clinical evaluation of mortality, we recommend using the SITS definition; for studies needing a high interrater agreement rate, we recommend using the ECASS 2 definition. Due to the lack of 1 single optimal definition, future thrombolytic trials should preferably use different definitions.
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Affiliation(s)
- Christoph Gumbinger
- Department of Neurology, University of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
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14
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Yoo AJ, González RG. Clinical applications of diffusion MR imaging for acute ischemic stroke. Neuroimaging Clin N Am 2011; 21:51-69, vii. [PMID: 21477751 DOI: 10.1016/j.nic.2011.02.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Diffusion magnetic resonance imaging is the best imaging tool for detecting acute ischemic brain injury. Studies have shown its high accuracy for delineating irreversible tissue damage within the first few hours after stroke onset; however, the true value of any diagnostic tool is whether it can be used to guide clinical management. This review discusses the role of diffusion imaging in the evaluation of the patient with acute ischemic stroke, and how this role is influenced by other important stroke-related variables, including the level of vessel occlusion and the clinical deficit. The review focuses on decision-making for intravenous and intra-arterial reperfusion therapies.
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Affiliation(s)
- Albert J Yoo
- Division of Diagnostic and Interventional Neuroradiology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Gray 241, Boston, MA 02114, USA.
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15
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Yoo AJ, Barak ER, Copen WA, Kamalian S, Gharai LR, Pervez MA, Schwamm LH, González RG, Schaefer PW. Combining acute diffusion-weighted imaging and mean transmit time lesion volumes with National Institutes of Health Stroke Scale Score improves the prediction of acute stroke outcome. Stroke 2010; 41:1728-35. [PMID: 20595665 DOI: 10.1161/strokeaha.110.582874] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to determine whether acute diffusion-weighted imaging (DWI) and mean transit time (MTT) lesion volumes and presenting National Institutes of Health Stroke Scale (NIHSS) can identify patients with acute ischemic stroke who will have a high probability of good and poor outcomes. METHODS Fifty-four patients with acute ischemic stroke who had MRI within 9 hours of symptom onset and 3-month follow-up with modified Rankin scale were evaluated. Acute DWI and MTT lesion volumes and baseline NIHSS scores were calculated. Clinical outcomes were considered good if the modified Rankin Scale was 0 to 2. RESULTS The 33 of 54 (61%) patients with good outcomes had significantly smaller DWI lesion volumes (P=0.0001), smaller MTT lesion volumes (P<0.0001), and lower NIHSS scores (P<0.0001) compared with those with poor outcomes. Receiver operating characteristic curves for DWI, MTT, and NIHSS relative to poor outcome had areas under the curve of 0.889, 0.854, and 0.930, respectively, which were not significantly different. DWI and MTT lesion volumes predicted outcome better than mismatch volume or percentage mismatch. All patients with a DWI volume >72 mL (13 of 54) and an NIHSS score >20 (6 of 54) had poor outcomes. All patients with an MTT volume of <47 mL (16 of 54) and an NIHSS score <8 (17 of 54) had good outcomes. Combining clinical and imaging thresholds improved prognostic yield (70%) over clinical (43%) or imaging (54%) thresholds alone (P=0.01). CONCLUSIONS Combining quantitative DWI and MTT with NIHSS predicts good and poor outcomes with high probability and is superior to NIHSS alone.
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Affiliation(s)
- Albert J Yoo
- Department of Radiology, Massachusetts General Hospital, Boston, Mass 02114, USA
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Construction of thrombus-targeted microbubbles carrying tissue plasminogen activator and their in vitro thrombolysis efficacy: a primary research. J Thromb Thrombolysis 2010; 30:29-35. [DOI: 10.1007/s11239-010-0450-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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17
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Latchaw RE, Alberts MJ, Lev MH, Connors JJ, Harbaugh RE, Higashida RT, Hobson R, Kidwell CS, Koroshetz WJ, Mathews V, Villablanca P, Warach S, Walters B. Recommendations for imaging of acute ischemic stroke: a scientific statement from the American Heart Association. Stroke 2009; 40:3646-78. [PMID: 19797189 DOI: 10.1161/strokeaha.108.192616] [Citation(s) in RCA: 286] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Micieli G, Marcheselli S, Tosi PA. Safety and efficacy of alteplase in the treatment of acute ischemic stroke. Vasc Health Risk Manag 2009; 5:397-409. [PMID: 19475777 PMCID: PMC2686258 DOI: 10.2147/vhrm.s4561] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
After publication of the results of the National Institute of Neurological Disorders and Stroke study, the application of intravenous thrombolysis for ischemic stroke was launched and has now been in use for more than 10 years. The approval of this drug represented only the first step of the therapeutic approach to this pathology. Despite proven efficacy, concerns remain regarding the safety of recombinant tissue-type plasminogen activator for acute ischemic stroke used in routine clinical practice. As a result, a small proportion of patients are currently treated with thrombolytic drugs. Several factors explain this situation: a limited therapeutic window, insufficient public knowledge of the warning signs for stroke, the small number of centers able to administer thrombolysis on a 24-hour basis and an excessive fear of hemorrhagic complications. The aim of this review is to explore the clinical efficacy of treatment with alteplase and consider the hemorrhagic risks.
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Affiliation(s)
- Giuseppe Micieli
- Neurology and Stroke Unit, IRCCS Istituto Clinico Humanitas, Rozzano, MI, Italy.
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Abstract
Stroke or cerebrovascular accident is the second most common cause of death in Western countries. Although stroke is a treatable disease, the majority of patients do not receive intravenous thrombolysis or catheter-based therapy. The lack of treatment is multifactorial. Several treatments have been studied. Research and development in the area of acute stroke treatment are ongoing.
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Affiliation(s)
- Rajan A G Patel
- Department of Cardiology, Ochsner Clinic Foundation, New Orleans, Louisiana 70121, USA
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Abstract
Acute stroke therapy took a major step forward in 1996 after the approval of Intravenous (IV) tissue plasminogen activator (t-PA) by the US Food and Drug Administration for patients presenting within 3 hours of the onset of stroke symptoms. Since that time, there have been considerable advances in imaging techniques as well as the advent of devices to help in the management of acute stroke patients. As a result, the arsenal to treat acute stroke has grown, and the field of stroke as a subspecialty of neurology has emerged. Despite these advances, only 3% to 8% of eligible patients with acute stroke in the United States are administered thrombolytics.(1) We herein review the use of thrombolytics in stroke and provide an overview of the imaging advances, new devices, and recent trials that are shaping modern stroke therapy. Finally, we provide a practical approach to the management of acute stroke, specifically for the practicing cardiologist, who may encounter stroke during cardiac catheterization, post myocardial infarction (MI), and in a variety of other settings.
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Affiliation(s)
- Manu Mehdiratta
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
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