1
|
Quattrocelli S, Russo EF, Gatta MT, Filoni S, Pellegrino R, Cangelmi L, Cardone D, Merla A, Perpetuini D. Integrating Machine Learning with Robotic Rehabilitation May Support Prediction of Recovery of the Upper Limb Motor Function in Stroke Survivors. Brain Sci 2024; 14:759. [PMID: 39199453 PMCID: PMC11352886 DOI: 10.3390/brainsci14080759] [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: 07/01/2024] [Revised: 07/24/2024] [Accepted: 07/26/2024] [Indexed: 09/01/2024] Open
Abstract
Motor impairment is a common issue in stroke patients, often affecting the upper limbs. To this standpoint, robotic neurorehabilitation has shown to be highly effective for motor function recovery. Notably, Machine learning (ML) may be a powerful technique able to identify the optimal kind and intensity of rehabilitation treatments to maximize the outcomes. This retrospective observational research aims to assess the efficacy of robotic devices in facilitating the functional rehabilitation of upper limbs in stroke patients through ML models. Specifically, clinical scales, such as the Fugl-Meyer Assessment (A-D) (FMA), the Frenchay Arm Test (FAT), and the Barthel Index (BI), were used to assess the patients' condition before and after robotic therapy. The values of these scales were predicted based on the patients' clinical and demographic data obtained before the treatment. The findings showed that ML models have high accuracy in predicting the FMA, FAT, and BI, with R-squared (R2) values of 0.79, 0.57, and 0.74, respectively. The findings of this study suggest that integrating ML into robotic therapy may have the capacity to establish a personalized and streamlined clinical practice, leading to significant improvements in patients' quality of life and the long-term sustainability of the healthcare system.
Collapse
Affiliation(s)
- Sara Quattrocelli
- Department of Engineering and Geology, University “G. d’Annunzio” of Chieti-Pescara, 65127 Pescara, Italy; (S.Q.); (L.C.); (D.C.); (A.M.)
| | - Emanuele Francesco Russo
- Padre Pio Foundation and Rehabilitation Centers, 71013 San Giovanni Rotondo, Italy; (E.F.R.); (M.T.G.)
| | - Maria Teresa Gatta
- Padre Pio Foundation and Rehabilitation Centers, 71013 San Giovanni Rotondo, Italy; (E.F.R.); (M.T.G.)
| | - Serena Filoni
- I.R.R.C.S. Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy;
| | - Raffaello Pellegrino
- Department of Scientific Research, Campus Ludes, Off-Campus Semmelweis University, 6912 Lugano-Pazzallo, Switzerland;
- Santa Chiara Institute, 73100 Lecce, Italy
| | - Leonardo Cangelmi
- Department of Engineering and Geology, University “G. d’Annunzio” of Chieti-Pescara, 65127 Pescara, Italy; (S.Q.); (L.C.); (D.C.); (A.M.)
| | - Daniela Cardone
- Department of Engineering and Geology, University “G. d’Annunzio” of Chieti-Pescara, 65127 Pescara, Italy; (S.Q.); (L.C.); (D.C.); (A.M.)
| | - Arcangelo Merla
- Department of Engineering and Geology, University “G. d’Annunzio” of Chieti-Pescara, 65127 Pescara, Italy; (S.Q.); (L.C.); (D.C.); (A.M.)
| | - David Perpetuini
- Department of Engineering and Geology, University “G. d’Annunzio” of Chieti-Pescara, 65127 Pescara, Italy; (S.Q.); (L.C.); (D.C.); (A.M.)
| |
Collapse
|
2
|
Backhouse EV, Boardman JP, Wardlaw JM. Cerebral Small Vessel Disease: Early-Life Antecedents and Long-Term Implications for the Brain, Aging, Stroke, and Dementia. Hypertension 2024; 81:54-74. [PMID: 37732415 PMCID: PMC10734792 DOI: 10.1161/hypertensionaha.122.19940] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Cerebral small vessel disease is common in older adults and increases the risk of stroke, cognitive impairment, and dementia. While often attributed to midlife vascular risk factors such as hypertension, factors from earlier in life may contribute to later small vessel disease risk. In this review, we summarize current evidence for early-life effects on small vessel disease, stroke and dementia focusing on prenatal nutrition, and cognitive ability, education, and socioeconomic status in childhood. We discuss possible reasons for these associations, including differences in brain resilience and reserve, access to cognitive, social, and economic resources, and health behaviors, and we consider the extent to which these associations are independent of vascular risk factors. Although early-life factors, particularly education, are major risk factors for Alzheimer disease, they are less established in small vessel disease or vascular cognitive impairment. We discuss current knowledge, gaps in knowledge, targets for future research, clinical practice, and policy change.
Collapse
Affiliation(s)
- Ellen V. Backhouse
- Centre for Clinical Brain Sciences (E.V.B., J.P.B., J.M.W.), University of Edinburgh, Scotland, United Kingdom
- MRC UK Dementia Research Institute (E.V.B., J.M.W.), University of Edinburgh, Scotland, United Kingdom
| | - James P. Boardman
- Centre for Clinical Brain Sciences (E.V.B., J.P.B., J.M.W.), University of Edinburgh, Scotland, United Kingdom
- MRC Centre for Reproductive Health (J.P.B.), University of Edinburgh, Scotland, United Kingdom
| | - Joanna M. Wardlaw
- Centre for Clinical Brain Sciences (E.V.B., J.P.B., J.M.W.), University of Edinburgh, Scotland, United Kingdom
- MRC UK Dementia Research Institute (E.V.B., J.M.W.), University of Edinburgh, Scotland, United Kingdom
- Edinburgh Imaging (J.M.W.), University of Edinburgh, Scotland, United Kingdom
| |
Collapse
|
3
|
Stasolla A, Prosperini L, Haggiag S, Pezzella FR, Pingi A, Cozzolino V, Pampana E, Cotroneo E, Tortorella C, Menniti A, Gasperini C. Non-traumatic acute myelopathies: Clinical and imaging features in a real world emergency setting. Neuroradiol J 2022; 35:727-735. [PMID: 35575188 PMCID: PMC9626837 DOI: 10.1177/19714009221096823] [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: 11/16/2022] Open
Abstract
OBJECTIVE The aetiologic diagnosis of non-traumatic acute myelopathies (AMs), and their differentiation from other mimicking conditions (i.e. 'mimics'), are clinically challenging, especially in the emergency setting. Here, we sought to identify: (i) red flags suggesting diagnoses alternative to AMs and (ii) clinical signs and magnetic resonance imaging (MRI) features differentiating non-compressive from compressive AMs. MATERIALS AND METHODS We retrospectively retrieved MRI scans of spinal cord dictated at emergency room from January 2016 to December 2020 in the suspicion of AMs. Patients with traumatic myelopathies and those with subacute/chronic myelopathies (i.e. MRI scans acquired >48 h from symptom onset) were excluded from analysis. RESULTS Our search retrieved 105 patients; after excluding 16 cases of traumatic myelopathies and 14 cases of subacute/chronic myelopathies, we identified 30 cases with non-compressive AMs, 30 cases with compressive AMs and 15 mimics. The presence of pyramidal signs (p = 0.012) and/or pain (p = 0.048) correctly identified 88% of cases with AMs. We failed to identify clinical indicators for distinguishing non-compressive and compressive AMs, although cases with inflammatory AMs were younger than cases with all the remaining conditions (p < 0.05). Different MRI patterns could be described according to the final diagnosis: among non-compressive AMs, inflammatory lesions were more often posterior or central; vascular malformation had a fairly widespread distribution; spine ischaemia was more often central. Anterior or lateral compression were more often associated with neoplasms and disc herniation , whereas hemorrhages and infections produced spine compression on all sides. CONCLUSION We propose a simple clinical indicator (i.e. pyramidal signs and/or pain) to distinguish AMs from their mimics in an emergency setting. Urgent spinal cord MRI remains essential to discriminate compressive and non-compressive aetiologies.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Enrico Cotroneo
- Neuroradiology Unit, S. Camillo-Forlanini Hospital
- Neurology Unit, S. Camillo-Forlanini Hospital
- Stroke Unit, S. Camillo-Forlanini Hospital
- Neurosurgery Unit, S. Camillo-Forlanini Hospital
| | | | | | | |
Collapse
|
4
|
Liu J, Dong J, Guo J. The effects of nutrition supplement on rehabilitation for patients with stroke: Analysis based on 16 randomized controlled trials. Medicine (Baltimore) 2022; 101:e29651. [PMID: 36123946 PMCID: PMC9478301 DOI: 10.1097/md.0000000000029651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Malnutrition is a relatively common and often unrecognized condition in stroke survivors, which may negatively affect functional recovery and survival. Though previous studies have indicated significant role of nutrition supplement for rehabilitation of patients with stroke, the results still remain controversy. OBJECTIVE The present analysis was designed to systematically review effective evidence of nutrition supplement on rehabilitation for patients with stroke. METHODS A systematic search of PubMed, EMBASE, the Cochrane Library, and Web of Science up to August 1, 2021 was performed to find relevant studies that analyzed the effect of nutrition supplement on rehabilitation of patients with stroke. The primary outcome was functional outcomes and activities of daily living (ADL). The secondary outcomes included disability, all-cause mortality, infections, pneumonia, walking ability, stroke recurrence, and laboratory results indicating nutrition status of patients. All statistical analyses were performed using standard statistical procedures with Review Manager 5.2. RESULTS Ultimately, 16 studies including 7547 patients were identified. Our pooled results found no significant difference in total, cognitive and motor FIM score between nutrition supplement and placebo groups, with pooled MDs of 7.64 (95% CI - 1.67 to 16.94; P = .11), 0.74 (95% CI - 1.33 to 2.81; P = .48), 1.11 (95% CI - 1.68 to 3.90; P = .44), respectively. However, our result showed that nutritional interventions had significant effect on ADL for patients with stroke (MD 3.26; 95% CI 0.59 to 5.93; P = .02). In addition, nutrition supplement reduced the incidence of infections for patients with stroke, with a pooled RR of 0.65 (95% CI 0.51 to 0.84; P = .0008). No significant results were found in disabilities, complication and laboratory outcomes. CONCLUSIONS The present meta-analysis indicated no statistically significant effect of nutrition supplement on functional outcomes as well as disabilities, complication and laboratory outcomes for patients with stroke. However, it increased ADL and reduced the incidence of infections.
Collapse
Affiliation(s)
- Jianhua Liu
- Department of Physical Therapy, Beijing Bo’ai Hospital, Chinese Rehabilitation Research Centre, Beijing, China
| | - Jige Dong
- Department of Rehabilitation and Treatment, Wangjing Hospital, Chinese Academy of Traditional Chinese Medicine, Beijing, China
| | - Jiangzhou Guo
- Department of Rehabilitation and Treatment, Wangjing Hospital, Chinese Academy of Traditional Chinese Medicine, Beijing, China
- *Correspondence: Jiangzhou Guo, Department of Rehabilitation and Treatment, Wangjing Hospital, Chinese Academy of Traditional Chinese Medicine, Huajiadi Street, Chaoyang District, Beijing 100102, China (e-mail: )
| |
Collapse
|
5
|
Sayore C, Ouambi LI, Bechri H, Kaoukou F, Oudrhiri M, Boutarbouch M, Ouahabi A. Influence of seasonal factors on the incidence of ruptured intracranial aneurysms: Moroccan fifteen years’ experience. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
6
|
Short- and Long-Term Effects of Rehabilitation after Perimesencephalic Subarachnoid Hemorrhage. Diseases 2021; 9:diseases9040069. [PMID: 34698166 PMCID: PMC8544554 DOI: 10.3390/diseases9040069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 09/29/2021] [Accepted: 10/05/2021] [Indexed: 11/29/2022] Open
Abstract
In about 25% of patients with spontaneous subarachnoid hemorrhage (SAH), a bleeding source cannot be identified during radiological diagnostics. Generally, the outcome of perimesencephalic or prepontine (PM) SAH is known to be significantly better than after non-PM SAH. Data about long-term follow-up concerning physical and mental health are scarce, so this study is reports on long-term results. We measured the influence of PM SAH on a quality-of-life modified Rankin (mRs) scale after six months. For long-term follow-up, a SF-36 questionnaire was used. Questionnaires were sent out between 18 and 168 months after ictus. In 37 patients, a long-term follow-up was available (up to 14 years after SAH). Data detected with the SF-36 questionnaire are compared to reference applicability to the standard population. In total, 37 patients were included for further analysis and divided in 2 subgroups; 13 patients (35%) received subsequent rehabilitation after clinical stay and 24 (65%) did not. In the short-term outcome, a significant improvement from discharge until follow-up was identified in patients with subsequent rehabilitation, but not in the matched pair group without rehabilitation. When PM SAH was compared to the standard population, a reduction in quality of life was identified in physical items (role limitations because of physical health problems, physical functioning) as well as in psychological items (role limitations because of emotional problems). Subsequent rehabilitation on PM SAH patients probably leads to an increase in independence and better mRs. While better mRs was shown at discharge in patients without subsequent rehabilitation, the mRs of rehabilitants was nearly identical after rehabilitation. Patients with good mRs also reached high levels of health-related quality of life (HRQoL) without rehabilitation. Thus, subsequent rehabilitation needs to be encouraged on an individual basis. Indication criteria for subsequent rehabilitation should be defined in further studies to improve patient treatment and efficiency in health care.
Collapse
|
7
|
Romani I, Nencini P, Sarti C, Pracucci G, Zedde M, Nucera A, Cianci V, Moller J, Toni D, Orsucci D, Casella C, Pinto V, Palumbo P, Barbarini L, Bella R, Ragno M, Scoditti U, Mezzapesa DM, Tassi R, Diomedi M, Cavallini A, Volpi G, Chiti A, Bigliardi G, Sacco S, Linoli G, Ricci S, Giordano A, Bonetti B, Rasura M, Cecconi E, Princiotta Cariddi L, Currò Dossi R, Melis M, Consoli D, Guidetti D, Biagini S, Accavone D, Inzitari D. Fabry-Stroke Italian Registry (FSIR): a nationwide, prospective, observational study about incidence and characteristics of Fabry-related stroke in young-adults. Presentation of the study protocol. Neurol Sci 2021; 43:2433-2439. [PMID: 34609660 PMCID: PMC8918192 DOI: 10.1007/s10072-021-05615-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 09/17/2021] [Indexed: 11/28/2022]
Abstract
Background TIA and stroke, both ischemic and hemorrhagic, may complicate Fabry disease at young-adult age and be the first manifestation that comes to the clinician’s attention. No definite indications have yet been elaborated to guide neurologists in Fabry disease diagnostics. In current practice, it is usually sought in case of cryptogenic strokes (while Fabry-related strokes can also occur by classical pathogenic mechanisms) or through screening programs in young cerebrovascular populations. Data on recurrence and secondary prevention of Fabry’s stroke are scanty. Methods The study had a prospective observational design involving 33 Italian neurological Stroke Units. Considering the incidence of TIA/stroke in the European population aged < 60 years and the frequency of Fabry disease in this category (as foreseen by a pilot study held at the Careggi University-Hospital, Florence), we planned to screen for Fabry disease a total of 1740 < 60-year-old individuals hospitalized for TIA, ischemic, or hemorrhagic stroke. We investigated TIA and stroke pathogenesis through internationally validated scales and we gathered information on possible early signs of Fabry disease among all cerebrovascular patients. Every patient was tested for Fabry disease through dried blood spot analysis. Patients who received Fabry disease diagnosis underwent a 12-month follow-up to monitor stroke recurrence and multi-system progression after the cerebrovascular event. Discussion The potential implications of this study are as follows: (i) to add information about the yield of systematic screening for Fabry disease in a prospective large cohort of acute cerebrovascular patients; (ii) to deepen knowledge of clinical, pathophysiological, and prognostic characteristics of Fabry-related stroke.
Collapse
Affiliation(s)
- Ilaria Romani
- Department of Neurosciences, Psychology, Pharmacology, and Child Health (NEUROFARBA), University of Florence, Florence, Italy.
| | | | - Cristina Sarti
- Department of Neurosciences, Psychology, Pharmacology, and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Giovanni Pracucci
- Department of Neurosciences, Psychology, Pharmacology, and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | | | - Antonia Nucera
- Neurovascular Treatment Unit, Spaziani Hospital, Frosinone, Italy
| | - Vittoria Cianci
- Neurology, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy
| | | | - Danilo Toni
- Emergency Department Stroke Unit, Umberto I Polyclinic Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Carmela Casella
- Stroke Unit, Department of Clinical and Experimental Medicine, AOU Policlinico G. Martino, University of Messina, Messina, Italy
| | - Vincenza Pinto
- Neurology and Stroke Unit, Di Summa - Perrino Hospital, Brindisi, Italy
| | - Pasquale Palumbo
- Neurology, Neurophysiopathology, and Stroke Unit, Santo Stefano Hospital, Prato, Italy
| | | | - Rita Bella
- Acute Cerebrovascular Diseases Unit, Vittorio Emanuele University Hospital, Catania, Italy
| | - Michele Ragno
- Division of Neurology, C. e G. Mazzoni Hospital and Madonna del Soccorso Hospital, Ascoli Piceno, Italy
| | - Umberto Scoditti
- Neurology - Stroke Care Program, Parma University Hospital, Parma, Italy
| | | | - Rossana Tassi
- Neurosonology and Stroke Unit, Siena University Hospital, Siena, Italy
| | - Marina Diomedi
- Neurovascular Treatment Unit, Tor Vergata Polyclinic Hospital, Rome, Italy
| | | | - Gino Volpi
- Neurology, San Iacopo Hospital, Pistoia, Italy
| | | | - Guido Bigliardi
- Stroke Unit, Sant'Agostino Estense New Hospital, Modena, Italy
| | - Simona Sacco
- Neurology and Stroke Unit, SS Filippo e Nicola Hospital , Avezzano, Italy
| | | | - Stefano Ricci
- Stroke Center - Neurology, Città Di Castello Hospital and Gubbio-Gualdo Tadino Hospital, Città di Castello, Italy
| | | | - Bruno Bonetti
- Stroke Unit, Verona University Hospital, Verona, Italy
| | | | | | | | | | - Marta Melis
- Neurology, Monserrato University Hospital, Cagliari, Italy
| | | | | | - Silvia Biagini
- Department of Neurosciences, Psychology, Pharmacology, and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Donatella Accavone
- Department of Neurosciences, Psychology, Pharmacology, and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Domenico Inzitari
- Department of Neurosciences, Psychology, Pharmacology, and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| |
Collapse
|
8
|
Saeed S, Waje-Andreassen U, Naess H, Fromm A, Nilsson PM. The impact of age and 24-h blood pressure on arterial health in acute ischemic stroke patients: The Norwegian stroke in the young study. J Clin Hypertens (Greenwich) 2021; 23:1922-1929. [PMID: 34492149 PMCID: PMC8678672 DOI: 10.1111/jch.14361] [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: 07/17/2021] [Revised: 08/18/2021] [Accepted: 08/24/2021] [Indexed: 11/29/2022]
Abstract
The impact of age and 24‐h ambulatory blood pressure (ABPM) on arterial stiffness and carotid intima‐media thickness (cIMT) in ischemic stroke patients younger than 60 years of age is poorly explored. A total of 385 acute ischemic stroke patients (aged 49.6±9.7 years, 68% men) were prospectively included and grouped in younger (15–44 years, n = 93) and middle‐aged (45–60 years, n = 292). Arterial stiffness was measured by carotid‐femoral pulse wave velocity (PWV), and cIMT by carotid ultrasound. 24‐h ABPM was recorded. The middle‐aged stroke patients had higher prevalence of smoking, hypertension, diabetes mellitus, metabolic syndrome and hypercholesterolemia, and had higher PWV and cIMT (all p < .05). In multivariable linear regression analyses adjusted for sex, BMI, smoking, diabetes mellitus, total cholesterol, high‐density lipoprotein cholesterol, triglycerides, eGFR, systolic BP and concomitant antihypertensive treatment, 1SD (4.4 years) higher age was associated with higher PWV (β = 0.44,R2 = 0.46, p < .001) in the younger group, and with higher mean cIMT (β = 0.16, R2 = 0.21, p = .01) in the middle‐aged group. In the middle‐aged group, 24‐h pulse pressure had a significant association with PWV (β = 0.18, R2 = 0.19, p = .009), while the association with cIMT was attenuated (β = 0.13, R2 = 0.16, p = .065). 24‐h diastolic BP was associated with higher cIMT in the middle‐aged group (β = 0.24, p < .001, R2 = 0.23), but not with PWV in either age groups. Among ischemic stroke patients < 60 years, higher age was associated with increased arterial stiffness for patients up to age 44 years, and with cIMT in middle‐aged patients. 24‐h pulse pressure was associated with arterial stiffness, and 24‐h diastolic BP was associated with cIMT only in middle‐aged patients.
Collapse
Affiliation(s)
- Sahrai Saeed
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | | | - Halvor Naess
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Annette Fromm
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Peter M Nilsson
- Department of Clinical Sciences, Lund University, Skane University Hospital, Malmö, Sweden
| |
Collapse
|
9
|
Shang YX, Yan LF, Cornett EM, Kaye AD, Cui GB, Nan HY. Incidence of Cerebral Infarction in Northwest China From 2009 to 2018. Cureus 2021; 13:e17576. [PMID: 34646631 PMCID: PMC8480718 DOI: 10.7759/cureus.17576] [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] [Accepted: 08/27/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There is a lack of epidemiological analysis of patients with cerebral infarction in northwest China. In the present investigation, we conducted a retrospective analysis to collect information on epidemiological characteristics of patients with cerebral infarction in five provinces of northwest China and the Shanxi Province of patients who were hospitalized in the Tangdu Hospital. This project should provide a scientific basis for active prevention and treatment of cerebral infarction. MATERIAL AND METHODS A retrospective analysis of patients with epidemic characteristics of cerebral infarction that were admitted to the Tangdu Hospital of northwest China from January 2009 to December 2018. RESULTS A total of 18,302 patients (aged 1-97 years) with confirmed cerebral infarction, including 12,201 males and 6,101 females, were retrospectively enrolled in this study. The most common lesion site was the cerebellum (51.5%). The incidence of cerebral infarction was slightly higher in workers and laborers, favoring male patients and those aged 40-70 years. The difference between men and women gradually increased after the age of 30. CONCLUSIONS In this study, 18,302 hospitalized patients with cerebral infarction from different occupations were included. Those engaged in physical labor were more likely to have a cerebral infarction. The incidence of cerebral infarction in males was higher than in females. Cerebellar and cerebral area infarctions were the most common.
Collapse
Affiliation(s)
- Yu-Xuan Shang
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Fourth Military Medical University, Shaanxi, CHN
| | - Lin-Feng Yan
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Fourth Military Medical University, Shaanxi, CHN
| | - Elyse M Cornett
- Department of Anaesthesiology, Louisiana State University (LSU) Health Shreveport, Shreveport, USA
| | - Alan D Kaye
- Department of Anaesthesiology, Louisiana State University (LSU) Health Shreveport, Shreveport, USA
| | - Guang-Bin Cui
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Fourth Military Medical University, Shaanxi, CHN
| | - Hai-Yan Nan
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Fourth Military Medical University, Shaanxi, CHN
| |
Collapse
|
10
|
Malfertheiner MV, Koch A, Fisser C, Millar JE, Maier LS, Zeman F, Poschenrieder F, Lubnow M, Philipp A, Müller T. Incidence of early intra-cranial bleeding and ischaemia in adult veno-arterial extracorporeal membrane oxygenation and extracorporeal cardiopulmonary resuscitation patients: a retrospective analysis of risk factors. Perfusion 2021; 35:8-17. [PMID: 32397881 DOI: 10.1177/0267659120907438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cerebral complications in veno-arterial extracorporeal membrane oxygenation are known to have a strong impact on mortality and morbidity. Aim of this study is to investigate the early incidence, risk factors and in-hospital mortality of intra-cranial ischaemia and haemorrhage in adults undergoing veno-arterial extracorporeal membrane oxygenation treatment. METHODS This study is a single-centre retrospective analysis on adult patients undergoing veno-arterial extracorporeal membrane oxygenation for different indications. The inclusion criterion included patients with early routine cerebral computed tomography imaging during extracorporeal membrane oxygenation, with no clinical evidence of cerebral pathology prior to cannulation. Cerebral complications were grouped by aetiology and the territories of the brain's supplying arteries. RESULTS One hundred eighty-seven adult patients with a total of 190 veno-arterial extracorporeal membrane oxygenation treatments were included. A total of 16.3% (n = 31) had evidence of either cerebral ischaemia (11.1%) or haemorrhage (5.8%); one patient suffered from both. Cerebral computed tomography scans were performed early in median on the first day after extracorporeal membrane oxygenation cannulation; in-hospital mortality of intra-cranial ischaemia and haemorrhage was 71.4% and 45.5%, respectively. Associated with an increased risk for ischaemic lesions were cannulation of the ascending aorta, higher age, presence of an autoimmune disease and cardiac surgery prior to veno-arterial extracorporeal membrane oxygenation. An association with haemorrhagic lesions was found for a lower blood PaCO2 at 2 hours, lower blood flow through the extracorporeal membrane oxygenation device at 2 hours, higher international normalized ratio and constantly higher activated partial thromboplastin time values as well as higher mean arterial pressures until haemorrhagic lesions were evident. CONCLUSION Cerebral complications are frequent in patients on veno-arterial extracorporeal membrane oxygenation and may be clinically silent events. Careful monitoring with routine neuroimaging seems to be the most appropriate diagnostic approach at present. Intra-cranial ischaemia occurs more frequent than haemorrhage and is associated with cannulation of the aorta ascendens.
Collapse
Affiliation(s)
| | - Andrea Koch
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Christoph Fisser
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Jonathan Edward Millar
- Critical Care Research Group, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Lars Sigfried Maier
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Florian Zeman
- Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | | | - Matthias Lubnow
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Alois Philipp
- Department of Cardiothoracic Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Thomas Müller
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| |
Collapse
|
11
|
Handelsmann H, Herzog L, Kulcsar Z, Luft AR, Wegener S. Predictors for affected stroke territory and outcome of acute stroke treatments are different for posterior versus anterior circulation stroke. Sci Rep 2021; 11:10544. [PMID: 34006885 PMCID: PMC8131617 DOI: 10.1038/s41598-021-89871-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 04/26/2021] [Indexed: 01/14/2023] Open
Abstract
Distinct patient characteristics have been proposed for ischaemic stroke in the anterior versus posterior circulation. However, data on functional outcome according to stroke territory in patients with acute stroke treatment are conflicting and information on outcome predictors is scarce. In this retrospective study, we analysed functional outcome in 517 patients with stroke and thrombolysis and/or thrombectomy treated at the University Hospital Zurich. We compared clinical factors and performed multivariate logistic regression analyses investigating the effect of outcome predictors according to stroke territory. Of the 517 patients included, 80 (15.5%) suffered a posterior circulation stroke (PCS). PCS patients were less often female (32.5% vs. 45.5%, p = 0.031), received thrombectomy less often (28.7% vs. 48.3%, p = 0.001), and had lower median admission NIHSS scores (5 vs. 10, p < 0.001) as well as a better median three months functional outcome (mRS 1 vs. 2, p = 0.010). Predictors for functional outcome were admission NIHSS (OR 0.864, 95% CI 0.790–0.944, p = 0.001) in PCS and age (OR 0.952, 95% CI 0.935–0.970, p < 0.001), known symptom onset (OR 1.869, 95% CI 1.111–3.144, p = 0.018) and admission NIHSS (OR 0.840, 95% CI 0.806–0.876, p < 0.001) in ACS. Acutely treated PCS and ACS patients differed in their baseline and treatment characteristics. We identified specific functional outcome predictors of thrombolysis and/or thrombectomy success for each stroke territory.
Collapse
Affiliation(s)
- H Handelsmann
- Department of Neurology and Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland
| | - L Herzog
- Department of Neurology and Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland.,Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland.,Institute of Data Analysis and Process Design, ZHAW Winterthur, Winterthur, Switzerland
| | - Z Kulcsar
- Department of Neuroradiology and Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - A R Luft
- Department of Neurology and Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland.,Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - S Wegener
- Department of Neurology and Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland.
| |
Collapse
|
12
|
Nutakki A, Chomba M, Chishimba L, Zimba S, Gottesman RF, Bahouth MN, Saylor D. Risk factors and outcomes of hospitalized stroke patients in Lusaka, Zambia. J Neurol Sci 2021; 424:117404. [PMID: 33761379 DOI: 10.1016/j.jns.2021.117404] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/16/2021] [Accepted: 03/16/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Limited data exists about stroke risk factors and outcomes in sub-Saharan African countries, including Zambia. We aim to fill this gap by describing features of hospitalized stroke patients at University Teaching Hospital (UTH), the national referral hospital in Lusaka, Zambia. METHODS We conducted a retrospective study of consecutive adults with stroke admitted to UTH's inpatient neurology service from October 2018 to March 2019. Strokes were classified as ischemic or hemorrhagic based on CT scan results and unknown if CT scan was not obtained. Chi-square analyses and t-tests were used to compare characteristics between cohorts with differing stroke subtypes. RESULTS Adults with stroke constituted 43% (n = 324) of all neurological admissions, had an average age of 60 ± 18 years, and 62% of the cohort was female. Stroke subtypes were 58% ischemic, 28% hemorrhagic, and 14% unknown. Hypertension was present in 80% of all strokes and was significantly associated with hemorrhagic stroke (p = 0.03). HIV was present in 18% of all strokes and did not significantly differ by stroke subtype. Diabetes (16%), heart disease (34%), atrial fibrillation (9%), and past medical history of stroke (22%) were all significantly more common in patients with ischemic stroke (p < 0.05). In-hospital mortality was 24% overall and highest among individuals with hemorrhagic strokes (33%, p = 0.005). CONCLUSIONS This Zambian stroke cohort is notable for its young age, significant HIV burden, high in-hospital mortality, and high rates of uncontrolled hypertension. Our results demonstrate Zambia's substantial stroke burden, significant contribution of HIV to stroke, and the need to improve primary stroke prevention.
Collapse
Affiliation(s)
- Aparna Nutakki
- Rush Medical College of Rush University, Chicago, IL, USA
| | | | | | | | - Rebecca F Gottesman
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mona N Bahouth
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Deanna Saylor
- University of Zambia School of Medicine, Lusaka, Zambia; University Teaching Hospital, Lusaka, Zambia; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| |
Collapse
|
13
|
Zhang L, Ma F, Qi A, Liu L, Zhang J, Xu S, Zhong Q, Chen Y, Zhang CY, Cai C. Integration of ultra-high-pressure liquid chromatography-tandem mass spectrometry with machine learning for identifying fatty acid metabolite biomarkers of ischemic stroke. Chem Commun (Camb) 2021; 56:6656-6659. [PMID: 32409805 DOI: 10.1039/d0cc02329a] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
We report for the first time the integration of ultra-high-pressure liquid chromatography-tandem mass spectrometry with machine learning for identifying fatty acid metabolite biomarkers of ischemic stroke. In particular, we develop an optimal model to discriminate ischemic stroke patients from healthy persons with 100% sensitivity and 93.18% specificity. This research may facilitate understanding the roles of fatty acid metabolites in stroke occurrence, holding great potential in clinical stroke diagnosis.
Collapse
Affiliation(s)
- Lijian Zhang
- Analytical Center, Neurology Department of Affiliated Hospital, Institute of Neurology, Guangdong Medical University, Zhanjiang, Guangdong 524023, China.
| | - Fei Ma
- Collaborative Innovation Center of Functionalized Probes for Chemical Imaging in Universities of Shandong, Key Laboratory of Molecular and Nano Probes, Ministry of Education, Shandong Provincial Key Laboratory of Clean Production of Fine Chemicals, College of Chemistry, Chemical Engineering and Materials Science, Shandong Normal University, Jinan 250014, China.
| | - Ao Qi
- Analytical Center, Neurology Department of Affiliated Hospital, Institute of Neurology, Guangdong Medical University, Zhanjiang, Guangdong 524023, China.
| | - Lulu Liu
- Analytical Center, Neurology Department of Affiliated Hospital, Institute of Neurology, Guangdong Medical University, Zhanjiang, Guangdong 524023, China.
| | - Junjie Zhang
- Analytical Center, Neurology Department of Affiliated Hospital, Institute of Neurology, Guangdong Medical University, Zhanjiang, Guangdong 524023, China.
| | - Simin Xu
- Analytical Center, Neurology Department of Affiliated Hospital, Institute of Neurology, Guangdong Medical University, Zhanjiang, Guangdong 524023, China.
| | - Qisheng Zhong
- Shimadzu Global COE for Application & Technical Development, Guangzhou, Guangdong 510010, China
| | - Yusen Chen
- Analytical Center, Neurology Department of Affiliated Hospital, Institute of Neurology, Guangdong Medical University, Zhanjiang, Guangdong 524023, China.
| | - Chun-Yang Zhang
- Collaborative Innovation Center of Functionalized Probes for Chemical Imaging in Universities of Shandong, Key Laboratory of Molecular and Nano Probes, Ministry of Education, Shandong Provincial Key Laboratory of Clean Production of Fine Chemicals, College of Chemistry, Chemical Engineering and Materials Science, Shandong Normal University, Jinan 250014, China.
| | - Chun Cai
- Analytical Center, Neurology Department of Affiliated Hospital, Institute of Neurology, Guangdong Medical University, Zhanjiang, Guangdong 524023, China.
| |
Collapse
|
14
|
Mkoba EM, Sundelin G, Sahlen KG, Sörlin A. The characteristics of stroke and its rehabilitation in Northern Tanzania. Glob Health Action 2021; 14:1927507. [PMID: 34340643 PMCID: PMC8344769 DOI: 10.1080/16549716.2021.1927507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 05/05/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Stroke causes great suffering and severe disability worldwide, and rehabilitation following a stroke seeks to restore lost functions. The extent to which stroke patients get access to rehabilitation in Tanzania is not well estimated, and drawing a current picture of the rehabilitation services for these persons is the first step in developing a more effective rehabilitation model in the country. OBJECTIVE The objective of this study was to establish the characteristics of stroke and its rehabilitation at the Kilimanjaro Christian Medical Centre (KCMC), a consultant referral hospital in northern Tanzania. METHODS This was a records-based descriptive study in which demographic, clinical, and rehabilitation information of stroke patients admitted to the KCMC between January 2012 and December 2015 was collected and audited. The means, percentages, and proportions were used to summarise the demographic, clinical, and rehabilitation patterns using SPSS version 24.0 software. The chi-squared statistic was used to examine the relationships between categorical variables, and a p-value<0.05 was considered statistically significant. RESULTS Of the 17,975 patients admitted to the KCMC during the period of the study, 753 (4.2%) had suffered a stroke, with a mean age of 68.8 ± 16.4 years. The predominant cause of stroke was hypertension, which accounted for 546 (72.5%) patients. A total of 357 (47.4%) patients had various forms of rehabilitation during the admission to hospital. Following a discharge home 240 (31.9%) patients did not return to the hospital for the continuation of rehabilitation. CONCLUSION Stroke patients at the KCMC lack access to rehabilitation therapies. Insufficient access to rehabilitation therapies may warrant the need to explore alternative approaches such as tele-rehabilitation technologies in Tanzania.
Collapse
Affiliation(s)
- Egfrid Michael Mkoba
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
- Physiotherapy Department, Faculty of Rehabilitation Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Gunnevi Sundelin
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Klas-Göran Sahlen
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Ann Sörlin
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| |
Collapse
|
15
|
Legros V, Lefour S, Bard M, Giordano-Orsini G, Jolly D, Kanagaratnam L. Optic Nerve and Perioptic Sheath Diameter (ONSD), Eyeball Transverse Diameter (ETD) and ONSD/ETD Ratio on MRI in Large Middle Cerebral Artery Infarcts: A Case-Control Study. J Stroke Cerebrovasc Dis 2020; 30:105500. [PMID: 33360251 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/03/2020] [Accepted: 11/22/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Despite recent progress in the multidisciplinary management of large middle cerebral artery infarcts, the neurological prognosis remains worrying in a non-negligible number of cases. The objective of this study is to analyze the contribution of optic nerve and perioptic sheath measurement on MRI to the acute phase of large middle cerebral artery infarcts. METHODS A retrospective case-control study between January 2008 and December 2019 in a single academic medical center was performed. Cases and controls were selected by interrogation of International Classification of Diseases (ICD), 10th edition, with ischemic stroke as criterion (code I64). Decompressive hemicraniectomy was a criterion for large middle cerebral artery infarcts (cases). Cases were matched with controls (1:3) based on age (± 5 years), sex, and year of hospitalization (± 2 years) The examinations were performed on 3T MRI (Siemens IRM 3T Magnetom).Optic nerve and perioptic sheath diameter was calculated using electronic calipers, 3 mm behind retina and in a perpendicular vector with reference to the orbit in axial 3D TOF sequence. RESULTS Of 2612 patients, 22 patients met all the criteria of large middle cerebral artery infarcts and they were paired with 44 controls. Patients were mainly women, mean age of 53.6 years. There is a significant difference in the size of the optic nerve and perioptic sheath diameter measured on MRI at patient's admission (right: 5.13 ± 0.2 mm vs. 4.80 mm ± 0.18, p <0. 0001, left: 5.16 ± 0.17 vs 4.78 ± 0.20, p<0.0001). The AUC of optic nerve and perioptic sheath diameter was 0.93 (95%IC [0.85-1.00]), for a threshold at 5.03 mm, the sensitivity was 0.82 (95%IC [0.6-0.93]), specificity 0.94 (95%IC [0.85-0.98]). The Odds Ratio of large middle cerebral artery infarcts was 46.4 for optic nerve and perioptic sheath diameter the (95%IC [6.15-350.1] p=0.0002). CONCLUSION Optic nerve and perioptic sheath diameter in the first MRI can predict the risk of developing large middle cerebral artery infarcts requiring a decompressive hemicraniectomy.
Collapse
Affiliation(s)
- Vincent Legros
- Surgical and Trauma Intensive Care Unit, Trauma Center, Hopital Maison Blanche, Reims University Hospital, 45 rue Cognacq Jay, 51092 Reims Cedex, France.
| | - Sophie Lefour
- Department of Neurology, Hopital Maison Blanche, Reims University Hospital, 45 rue Cognacq Jay, 51092 Reims Cedex, France.
| | - Mathieu Bard
- Department of Anesthesiology and Critical Care, Hopital Maison Blanche, Reims University Hospital, 45 rue Cognacq Jay, 51092 Reims Cedex, France; University of Medicine of Reims Champagne-Ardennes, 51 rue Cognacq Jay, 51092 Reims Cedex, France.
| | - Guillaume Giordano-Orsini
- Department of emergency medicine, Hopital Maison Blanche, Reims University Hospital, 45 rue Cognacq Jay, 51092 Reims Cedex, France; University of Medicine of Reims Champagne-Ardennes, France.
| | - Damien Jolly
- University of Medicine of Reims Champagne-Ardennes, 51 rue Cognacq Jay, 51092 Reims Cedex, France; Department of clinical research, Hopital Robert Debré, Reims University Hospital, 51 avenue du General Koenig, 51092 Reims Cedex, France.
| | - Lukshe Kanagaratnam
- University of Medicine of Reims Champagne-Ardennes, 51 rue Cognacq Jay, 51092 Reims Cedex, France; Department of clinical research, Hopital Robert Debré, Reims University Hospital, 51 avenue du General Koenig, 51092 Reims Cedex, France.
| |
Collapse
|
16
|
Saeed S, Tadic M, Putaala J. The prevalence and Covariates of Stroke in Khyber Pakhtunkhwa; From a European Perspective. Pak J Med Sci 2020; 37:1-3. [PMID: 33437241 PMCID: PMC7794126 DOI: 10.12669/pjms.37.1.3815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Sahrai Saeed
- Sahrai Saeed MD, PhD, Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Marijana Tadic
- Marijana Tadic MD, PhD, University Hospital "Dr. Dragisa Misovic - Dedinje" Department of Cardiology, Heroja Milana Tepica 1, 11000 Belgrade, Serbia
| | - Jukka Putaala
- Jukka Putaala MD, PhD. Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| |
Collapse
|
17
|
Fabian R, Bunker L, Hillis AE. Is Aphasia Treatment Beneficial for the Elderly? A Review of Recent Evidence. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020; 8:478-492. [PMID: 33777504 DOI: 10.1007/s40141-020-00287-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Purpose We review recent literature regarding aphasia therapy in the elderly. Relevant articles from the last 5 years were identified to determine whether or not there is evidence to support that various therapeutic approaches can have a positive effect on post-stroke aphasia in the elderly. Recent findings There were no studies examining the effects of aphasia therapy specifically in the elderly within the timeframe searched. Therefore, we briefly summarize findings from 50 relevant studies that included large proportions of participants with post-stroke aphasia above the age of 65. A variety of behavioral and neuromodulation therapies are reported. Summary We found ample evidence suggesting that a variety of behavioral and neuromodulatory therapeutic approaches can benefit elderly individuals with post-stroke aphasia.
Collapse
Affiliation(s)
- Rachel Fabian
- Department of Neurology, Johns Hopkins University School of Medicine
| | - Lisa Bunker
- Department of Neurology, Johns Hopkins University School of Medicine
| | - Argye E Hillis
- Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine.,Department of Neurology, Johns Hopkins University School of Medicine
| |
Collapse
|
18
|
Endocrine Dysfunction Following Stroke. J Neuroimmune Pharmacol 2020; 16:425-436. [PMID: 32621001 DOI: 10.1007/s11481-020-09935-6] [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: 01/07/2020] [Accepted: 06/17/2020] [Indexed: 10/23/2022]
Abstract
Endocrine dysfunction is known to occur after traumatic brain injury. The purpose of this study was to examine the incidence of various endocrine dysfunctions after a stroke. The Taiwan National Health Insurance Research Database (NHIRD) was searched from 2001 to 2011 for patients with a diagnosis of stroke. Stroke patients were matched by diagnosis date, age, and sex to patients without a stroke. Cox proportional hazards regression analyses were performed to compare the incidence of goiter, acquired hypothyroidism, thyroiditis, pituitary dysfunction, and disorders of the adrenal glands between stroke and non-stroke patients. There were 131,951 patients in the stroke group, and 131,951 in the matched non- stroke group (mean age 66.1 ± 14.9 years). Stroke patients had significantly higher risk of acquired hypothyroidism (crude hazard ratio [cHR] = 1.65, 95% confidence interval [CI]: 1.44, 1.90; adjusted hazard ratio [aHR] = 1.65, 95% CI: 1.42, 1.91), pituitary dysfunction (cHR = 2.32, 95% CI: 1.79, 2.99; aHR = 1.92, 95% CI: 1.46, 2.52), and disorders of the adrenal glands (cHR = 1.79, 95% CI: 1.52, 2.12; aHR =1.62, 95% CI: 1.36, 1.92) than non-stroke patients. Pituitary dysfunction and disorders of the adrenal glands were found in both hemorrhagic stroke and ischemic stroke patients, while hypothyroidism was seen in ischemic stroke patients only. No significant association was found for goiter and thyroiditis. In conclusions, stroke survivors have an approximately 2-fold increased risk of developing acquired hypothyroidism, pituitary dysfunction, or disorders of the adrenal glands. These risks should be taken into account in the management of patients who have ischemic or hemorrhagic strokes. Graphical Abstract.
Collapse
|
19
|
Ambrosini E, Parati M, Ferriero G, Pedrocchi A, Ferrante S. Does cycling induced by functional electrical stimulation enhance motor recovery in the subacute phase after stroke? A systematic review and meta-analysis. Clin Rehabil 2020; 34:1341-1354. [PMID: 32613859 DOI: 10.1177/0269215520938423] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To investigate the effects of cycling with functional electrical stimulation on walking, muscle power and tone, balance and activities of daily living in subacute stroke survivors. DATA SOURCES Ten electronic databases were searched from inception to February 2020. REVIEW METHODS Inclusion criteria were: subacute stroke survivors (<6 months since stroke), an experimental group performing any type of cycling training with electrical stimulation, alone or in addition to usual care, and a control group performing usual care alone. Two reviewers assessed eligibility, extracted data and analyzed the risks of bias. Standardized Mean Difference (SMD) or Mean Difference (MD) with 95% Confidence Intervals (CI) were estimated using fixed- or random-effects models to evaluate the training effect. RESULTS Seven randomized controlled trials recruiting a total of 273 stroke survivors were included in the meta-analyses. There was a statistically significant, but not clinically relevant, effect of cycling with electrical stimulation compared to usual care on walking (six studies, SMD [95% CI] = 0.40 [0.13, 0.67]; P = 0.004), capability to maintain a sitting position (three studies, MD [95% CI] = 7.92 [1.01, 14.82]; P = 0.02) and work produced by the paretic leg during pedaling (2 studies, MD [95% CI] = 8.13 [1.03, 15.25]; P = 0.02). No significant between-group differences were found for muscular power, tone, standing balance, and activities of daily living. CONCLUSIONS Cycling training with functional electrical stimulation cannot be recommended in terms of being better than usual care in subacute stroke survivors. Further investigations are required to confirm these results, to determine the optimal training parameters and to evaluate long-term effects.
Collapse
Affiliation(s)
- Emilia Ambrosini
- Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, MI, Italy
| | - Monica Parati
- Bioengineering Laboratory, Scientific Institute of Milan, Istituti Clinici Scientifici Maugeri IRCCS, Milan, Italy
| | - Giorgio Ferriero
- Physical and Rehabilitation Medicine Unit, Scientific Institute of Tradate, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
| | - Alessandra Pedrocchi
- Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, MI, Italy
| | - Simona Ferrante
- Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, MI, Italy
| |
Collapse
|
20
|
Abstract
Introduction: Color Doppler and CT angiography are diagnostic methods commonly used to determine the degree of carotid stenosis. Aim: To evaluate how the degree of carotid stenosis determined by the Color Doppler correlates with the degree of stenosis determined by the CT angiography. Material and Methods: The study was designed as a retrospective study. It included 42 patients with carotid stenosis. From medical records we collected anamnestic data (gender, age and risk factors - hypertension, hyperlipidemia, diabetes, smoking and obesity) and the results regarding the degree of carotid stenosis determined by Color Doppler and CT angiography. Results: Out of the total number of patients (n=42), 73.8% were males and 26.2% were females. Average age of examined patients was 65.24±8.61. Most frequent risk factor of atherosclerosis was hypertension, followed by hyperlipidemia and smoking. NASCET grading distinguishes: first (0-29%), second (30-69%) and third (70-99%) degree of carotid stenosis. According to the Color Doppler evaluation findings, the second degree had 8 patients and 34 patients had the third degree of carotid stenosis. CT angiography have shown that 35 patients had third degree carotid stenosis, while 7 patients had the second degree carotid stenosis. In only one case results of evaluated methods differed regarding assessment of carotid stenosis. We have found that there is a significant positive correlation of the degree of carotid stenosis determined by the Color Doppler with the degree of stenosis determined by CT angiography (p=0.0002). Risk factors of atherosclerosis did not have a significant correlation with the degree of carotid stenosis (p>0.05). Conclusion: The degree of carotid stenosis estimated by the Color Doppler positively correlates with the degree of stenosis estimated by CT angiography.
Collapse
Affiliation(s)
- Nedzad Rustempasic
- Clinic for Cardiovascular Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Martina Gengo
- Clinic for Cardiovascular Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| |
Collapse
|
21
|
Kim J, Thayabaranathan T, Donnan GA, Howard G, Howard VJ, Rothwell PM, Feigin V, Norrving B, Owolabi M, Pandian J, Liu L, Cadilhac DA, Thrift AG. Global Stroke Statistics 2019. Int J Stroke 2020; 15:819-838. [PMID: 32146867 DOI: 10.1177/1747493020909545] [Citation(s) in RCA: 189] [Impact Index Per Article: 47.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Data on stroke epidemiology and availability of hospital-based stroke services around the world are important for guiding policy decisions and healthcare planning. AIMS To provide the most current incidence, mortality and case-fatality data on stroke and describe current availability of stroke units around the world by country. METHODS We searched multiple databases (based on our existing search strategy) to identify new original manuscripts and review articles published between 1 June 2016 and 31 October 2018 that met the ideal criteria for data on stroke incidence and case-fatality. For data on the availability of hospital-based stroke services, we searched PubMed for all literature published up until 31 June 2018. We further screened reference lists, citation history of manuscripts and gray literature for this information. Mortality codes for International Classification of Diseases-9 and International Classification of Diseases-10 were extracted from the World Health Organization mortality database for each country providing these data. Population denominators were obtained from the World Health Organization, and when these were unavailable within a two-year period of mortality data, population denominators within a two-year period were obtained from the United Nations. Using country-specific population denominators and the most recent years of mortality data available for each country, we calculated both the crude mortality from stroke and mortality adjusted to the World Health Organization world population. RESULTS Since our last report in 2017, there were two countries with new incidence studies, China (n = 1) and India (n = 2) that met the ideal criteria. New data on case-fatality were found for Estonia and India. The most current mortality data were available for the year 2015 (39 countries), 2016 (43 countries), and 2017 (7 countries). No new data on mortality were available for six countries. Availability of stroke units was noted for 63 countries, and the proportion of patients treated in stroke units was reported for 35/63 countries. CONCLUSION Up-to-date data on stroke incidence, case-fatality, and mortality statistics provide evidence of variation among countries and changing magnitudes of burden among high and low-middle income countries. Reporting of hospital-based stroke units remains limited and should be encouraged.
Collapse
Affiliation(s)
- Joosup Kim
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.,The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Tharshanah Thayabaranathan
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Geoffrey A Donnan
- Melbourne Brain Centre, University of Melbourne, Parkville, Victoria, Australia
| | - George Howard
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Peter M Rothwell
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Valery Feigin
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Bo Norrving
- Department of Clinical Sciences, Section of Neurology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Mayowa Owolabi
- Center for Genomic and Precision Medicine, University of Ibadan, Ibadan, Nigeria
| | - Jeyaraj Pandian
- Department of Neurology, Christian Medical College and Hospital, Ludhiana, India
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.,The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Amanda G Thrift
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| |
Collapse
|
22
|
Gandolfo C, Alberti F, Del Sette M, Gagliano A, Reale N. Results of an educational campaign on stroke awareness in the 2032 Rotary District in Northern-Western Italy. Neurol Sci 2020; 41:411-416. [DOI: 10.1007/s10072-019-04126-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 10/24/2019] [Indexed: 10/25/2022]
|
23
|
Gabet A, Grimaud O, de Peretti C, Béjot Y, Olié V. Determinants of Case Fatality After Hospitalization for Stroke in France 2010 to 2015. Stroke 2019; 50:305-312. [PMID: 30621528 DOI: 10.1161/strokeaha.118.023495] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- The aims of this study were to (1) describe early and late case fatality rates after stroke in France, (2) evaluate whether their determinants differed, and (3) analyze time trends between 2010 and 2015. Methods- Data were extracted from the Système National des données de santé database. Patients hospitalized for stroke each year from 2010 to 2015, aged ≥18 years, and affiliated to the general insurance scheme were selected. Cox regressions were used to separately analyze determinants of 30-day and 31- to 365-day case fatality rates for each stroke type (ischemic, intracerebral hemorrhage, and subarachnoid hemorrhage). Results- In 2015, of the 73 124 persons hospitalized for stroke, 26.8% died in the following year, with the majority of deaths occurring within the first 30 days (56.9%). Nonadmission to a stroke unit, older age, and having comorbidities were all associated with a poorer 30-day and 31- to 365-day prognosis. Female sex was associated with a lower 31- to 365-day case fatality rate for all patients with stroke. Living in an area with a high deprivation index was associated with both higher 30-day and 31- to 365-day case fatality rates for all stroke types. Between 2010 and 2015, significant decreases in both 30-day and 31- to 365-day case fatality rates for ischemic patients were observed. Conclusions- Case fatality rates after stroke remained high in 2015 in France, despite major improvements in stroke care and organization. Improvement in stroke awareness and preparedness, particularly in the most deprived areas, together with better follow-up after the acute phase are urgently needed.
Collapse
Affiliation(s)
- Amélie Gabet
- From Santé publique France, the French Public Health Agency, Saint-Maurice, France (A.G., V.O.)
| | - Olivier Grimaud
- French School of Public Health (EHESP), Rennes, France (O.G.)
| | - Christine de Peretti
- Directorate for Research, Studies, Assessment and Statistics, Ministry of Social Affairs and Health, Paris, France (C.d.P.)
| | - Yannick Béjot
- Dijon Stroke Registry, EA 7460 Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases (PEC2), University Hospital and Medical School of Dijon, University of Burgundy, France (Y.B.)
| | - Valérie Olié
- From Santé publique France, the French Public Health Agency, Saint-Maurice, France (A.G., V.O.)
| |
Collapse
|
24
|
Ambrosini E, Peri E, Nava C, Longoni L, Monticone M, Pedrocchi A, Ferriero G, Ferrante S. A multimodal training with visual biofeedback in subacute stroke survivors: a randomized controlled trial. Eur J Phys Rehabil Med 2019; 56:24-33. [PMID: 31556542 DOI: 10.23736/s1973-9087.19.05847-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Early interventions maximizing patient's involvement are essential to promote gait restoration and motor recovery after stroke. AIM The aim of this study is to evaluate the effects of a multimodal biofeedback training involving cycling augmented by functional electrical stimulation (FES) and balance exercises on walking ability and motor recovery. DESIGN Randomized controlled trial (NCT02439515). SETTING Inpatient rehabilitation facility. POPULATION Subacute stroke survivors (less than 6 months from the first event) aged up to 90 years old. METHODS Sixty-eight participants were randomly allocated to an experimental group, performing 15 sessions of biofeedback FES-cycling training followed by 15 sessions of biofeedback balance training (20 minutes each) in addition to usual care (70 minutes), and a control group performing 30 sessions (90 minutes) of usual care. Participants were evaluated before training, after 15 sessions, after 30 sessions, and at 6-month follow-up through: gait speed (primary outcome), spatiotemporal gait parameters, Six-Minute Walking Test, Functional Independence Measure, Motricity Index, Trunk Control Test, Berg Balance Scale, and Fall Efficacy Scale. RESULTS Both groups significantly improved over time, but no group and interaction effects were found for any outcomes. The 73% of the experimental group achieved a clinically meaningful change in gait speed compared to the 38% of the control group (P=0.048). These percentages were even more unbalanced for patients with a moderate to severe gait impairment at baseline (91% versus 36%; P=0.008). CONCLUSIONS The multimodal biofeedback training was not statistically superior to usual care, showing only a positive trend in favor of the experimental group on locomotion recovery. Patients initially not able to walk might be the best candidates for such a training. CLINICAL REHABILITATION IMPACT The multimodal biofeedback training is a task-specific, repetitive and intensive training requiring a minimal supervision, which might result in a lower staff to patient ratio if organized in group sessions. Therefore, it can represent a good alternative for early stroke rehabilitation.
Collapse
Affiliation(s)
- Emilia Ambrosini
- Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information Technology, and Bioengineering, Politecnico di Milano, Milan, Italy -
| | - Elisabetta Peri
- Rehabilitation Unit of Lissone Institute, Istituti Clinici Scientifici Maugeri IRCCS, Lissone, Monza e Brianza, Italy
| | - Claudia Nava
- Rehabilitation Unit of Lissone Institute, Istituti Clinici Scientifici Maugeri IRCCS, Lissone, Monza e Brianza, Italy
| | - Luca Longoni
- Rehabilitation Unit of Lissone Institute, Istituti Clinici Scientifici Maugeri IRCCS, Lissone, Monza e Brianza, Italy
| | - Marco Monticone
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Department of Neuroscience and Rehabilitation, G. Brotzu Hospital, Cagliari, Italy
| | - Alessandra Pedrocchi
- Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information Technology, and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Giorgio Ferriero
- Rehabilitation Unit of Lissone Institute, Istituti Clinici Scientifici Maugeri IRCCS, Lissone, Monza e Brianza, Italy
| | - Simona Ferrante
- Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information Technology, and Bioengineering, Politecnico di Milano, Milan, Italy
| |
Collapse
|
25
|
Béjot Y. Targeting blood pressure for stroke prevention: current evidence and unanswered questions. J Neurol 2019; 268:785-795. [PMID: 31243539 DOI: 10.1007/s00415-019-09443-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 06/20/2019] [Accepted: 06/22/2019] [Indexed: 12/22/2022]
Abstract
High blood pressure (BP) is the leading modifiable risk factor of stroke worldwide. Although randomized clinical trials have demonstrated the beneficial effect of BP reduction on stroke risk, there are still insufficiently explored issues concerning the optimal personalized management of BP in stroke patients in terms of thresholds to be achieved and drug classes to be prescribed. Few data are available about BP control in specific clinical contexts such as in older patients, in various stroke subtypes, or in association with co-morbidities such as diabetes. In addition, although drug trials based their conclusions on achieved mean BP values, recent findings indicate that aspects such as circadian variations of BP and BP variability should be taken into account as well. This article aims to highlight current knowledge about BP control in stroke prevention and to provide new perspectives to be addressed in future studies so as to guide clinicians in their day-to-day practice.
Collapse
Affiliation(s)
- Yannick Béjot
- Dijon Stroke Registry, E7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases (PEC2), University Hospital of Dijon, University of Burgundy, Dijon, France.
- Department of Neurology, University Hospital of Dijon, Hôpital François Mitterrand, 14 rue Paul Gaffarel, BP 77908, 21079, Dijon cedex, France.
| |
Collapse
|
26
|
Gürdoğan M, Kehaya S, Korkmaz S, Altay S, Özkan U, Kaya Ç. The Relationship between Diffusion-Weighted Magnetic Resonance Imaging Lesions and 24-Hour Rhythm Holter Findings in Patients with Cryptogenic Stroke. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E38. [PMID: 30720741 PMCID: PMC6409892 DOI: 10.3390/medicina55020038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 01/23/2019] [Accepted: 01/31/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND OBJECTIVES Cranial magnetic resonance imaging findings of patients considered to be cryptogenic stroke may be useful in determining the clinical and prognostic significance of arrhythmias, such as atrial premature beats and atrial run attacks, that are frequently encountered in rhythm Holter analysis. This study was conducted to investigate the relationship between short atrial runs and frequent premature atrial contractions detected in Holter monitors and infarct distributions in cranial magnetic resonance imaging of patients diagnosed with cryptogenic stroke. MATERIALS AND METHODS We enrolled the patients with acute ischemic stroke whose etiology were undetermined. We divided the patients in two groups according to diffusion-weighted magnetic resonance imaging as single or multiple vascular territory acute infarcts. The demographic, clinical, laboratory, echocardiographic, and rhythm Holter analyses were compared. RESULTS The study investigated 106 patients diagnosed with cryptogenic stroke. Acute cerebral infarctions were detected in 31% of the investigated patients in multiple territories and in 69% in a single territory. In multivariate logistic regression analysis, the total premature atrial contraction count (OR = 1.002, 95% CI: 1.001⁻1.004, p = 0.001) and short atrial run count (OR = 1.086, 95% CI: 1.021⁻1.155, p = 0.008) were found as independent variables that could distinguish between infarctions in a single or in multiple vascular territories. CONCLUSIONS Rhythm Holter monitoring of patients with infarcts detected in multiple vascular territories showed significantly higher premature atrial contractions and short atrial run attacks. More effort should be devoted to the identification of cardioembolic etiology in cryptogenic stroke patients with concurrent acute infarcts in the multiple vascular territories of the brain.
Collapse
Affiliation(s)
- Muhammet Gürdoğan
- Department of Cardiology, School of Medicine, Trakya University, 22030 Edirne, Turkey.
| | - Sezgin Kehaya
- Department of Neurology, School of Medicine, Trakya University, 22030 Edirne, Turkey.
| | - Selçuk Korkmaz
- Department of Biostatistics and Medical Informatics, School of Medicine, Trakya University, 22030 Edirne, Turkey.
| | - Servet Altay
- Department of Cardiology, School of Medicine, Trakya University, 22030 Edirne, Turkey.
| | - Uğur Özkan
- Department of Cardiology, School of Medicine, Trakya University, 22030 Edirne, Turkey.
| | - Çağlar Kaya
- Department of Cardiology, School of Medicine, Trakya University, 22030 Edirne, Turkey.
| |
Collapse
|
27
|
Ruiz-Pérez I, Bastos Á, Serrano-Ripoll MJ, Ricci-Cabello I. Effectiveness of interventions to improve cardiovascular healthcare in rural areas: a systematic literature review of clinical trials. Prev Med 2019; 119:132-144. [PMID: 30597226 DOI: 10.1016/j.ypmed.2018.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 12/11/2018] [Accepted: 12/16/2018] [Indexed: 12/16/2022]
Abstract
The objective of this systematic literature review is to examine the impact of interventions to improve cardiovascular disease healthcare provided to people living in rural areas. Systematic electronic searches were conducted in Medline, CINAHL, Embase, Scopus, and Web of Knowledge in July 2018. We included clinical trials assessing the effectiveness of interventions to improve cardiovascular disease healthcare in rural areas. Study eligibility assessment, data extraction, and critical appraisal were undertaken by two reviewers independently. We identified 18 trials (18 interventions). They targeted myocardial infarction (five interventions), stroke (eight), and heart failure (five). All the interventions for myocardial infarction were based on organizational changes (e.g. implementation of mobile coronary units). They consistently reduced time to treatment and decreased mortality. All the interventions for heart failure were based on the provision of patient education. They consistently improved patient knowledge and self-care behaviour, but mortality reductions were reported in only some of the trials. Among the interventions for stroke, those based on the implementation of telemedicine (tele-stroke systems or tele-consultations) improved monitoring of stroke survivors; those based on new or enhanced rehabilitation services did not consistently improve mortality or physical function; whereas educational interventions effectively improved patient knowledge and behavioural outcomes. In conclusion, a number of different strategies (based on enhancing structures and providing patient education) have been proposed to improve cardiovascular disease healthcare in rural areas. Although available evidence show that these interventions can improve healthcare processes, their impact on mortality and other important health outcomes still remains to be established.
Collapse
Affiliation(s)
- Isabel Ruiz-Pérez
- Andalusian School of Public Health, Cuesta del Observatorio, 4, 18011 Granada, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain; Ibs. Instituto de Investigación Biosanitaria de Granada, Spain.
| | - Ángel Bastos
- Andalusian School of Public Health, Cuesta del Observatorio, 4, 18011 Granada, Spain
| | - Maria Jesús Serrano-Ripoll
- Balearic Islands Health Research Institute (IdISBa), Spain; Atención Primaria Mallorca, IB-Salut, Spain; Universitat de les Illes Balears (UIB), Departament de Psicologia, Spain
| | - Ignacio Ricci-Cabello
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain; Balearic Islands Health Research Institute (IdISBa), Spain; Atención Primaria Mallorca, IB-Salut, Spain
| |
Collapse
|
28
|
Roque C, Mendes-Oliveira J, Baltazar G. G protein-coupled estrogen receptor activates cell type-specific signaling pathways in cortical cultures: relevance to the selective loss of astrocytes. J Neurochem 2019; 149:27-40. [PMID: 30570746 DOI: 10.1111/jnc.14648] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 11/23/2018] [Accepted: 12/11/2018] [Indexed: 12/11/2022]
Abstract
Selective activation of the G protein-coupled estrogen receptor has been proposed to avoid some of the side effects elicited by the activation of classical estrogen receptors α and β. Although its contribution to neuroprotection triggered by estradiol in brain disorders has been explored, the results regarding ischemic stroke are contradictory, and currently, there is no consensus on the role that this receptor may play. The present study aimed to investigate the role of GPER in the ischemic insult. For that, primary cortical cultures exposed to oxygen and glucose deprivation (OGD) were used as a model. Our results demonstrate that neuronal survival was strongly affected by the ischemic insult and concurrent GPER activation with G1 had no further impact. In contrast, OGD had a smaller impact on astrocytes survival but G1, alone or combined with OGD, promoted their apoptosis. This effect was prevented by the GPER antagonist G15. The results also show that ischemia did not change the expression levels of GPER in neurons and astrocytes. In this study, we also demonstrate that selective activation of GPER induced astrocyte apoptosis via the phospholipase C pathway and subsequent intracellular calcium rise, whereas in neurons, this effect was not observed. Taken together, this evidence supports a direct impact of GPER activity on the viability of astrocytes, which seems to be associated with the regulation of different signaling pathways in astrocytes and neurons.
Collapse
Affiliation(s)
- Cláudio Roque
- CICS-UBI - Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
| | | | - Graça Baltazar
- CICS-UBI - Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal.,Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
| |
Collapse
|
29
|
Carvalho R, Dias N, Cerqueira JJ. Brain-machine interface of upper limb recovery in stroke patients rehabilitation: A systematic review. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2019; 24:e1764. [PMID: 30609208 DOI: 10.1002/pri.1764] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Technologies such as brain-computer interfaces are able to guide mental practice, in particular motor imagery performance, to promote recovery in stroke patients, as a combined approach to conventional therapy. OBJECTIVE The aim of this systematic review was to provide a status report regarding advances in brain-computer interface, focusing in particular in upper limb motor recovery. METHODS The databases PubMed, Scopus, and PEDro were systematically searched for articles published between January 2010 and December 2017. The selected studies were randomized controlled trials involving brain-computer interface interventions in stroke patients, with upper limb assessment as primary outcome measures. Reviewers independently extracted data and assessed the methodological quality of the trials, using the PEDro methodologic rating scale. RESULTS From 309 titles, we included nine studies with high quality (PEDro ≥ 6). We found that the most common interface used was non-invasive electroencephalography, and the main neurofeedback, in stroke rehabilitation, was usually visual abstract or a combination with the control of an orthosis/robotic limb. Moreover, the Fugl-Meyer Assessment Scale was a major outcome measure in eight out of nine studies. In addition, the benefits of functional electric stimulation associated to an interface were found in three studies. CONCLUSIONS Neurofeedback training with brain-computer interface systems seem to promote clinical and neurophysiologic changes in stroke patients, in particular those with long-term efficacy.
Collapse
Affiliation(s)
- Raquel Carvalho
- Department of Physical Therapy, CESPU, Institute of Research and Advanced Training in Health Sciences and Technologies, Gandra, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
| | - Nuno Dias
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal.,2Ai - Polytechnic Institute of Cavado and Ave, Barcelos, Portugal
| | - João José Cerqueira
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| |
Collapse
|
30
|
Yiin GS, Li L, Bejot Y, Rothwell PM. Time Trends in Atrial Fibrillation-Associated Stroke and Premorbid Anticoagulation: Population-Based Study and Systematic Review. Stroke 2019; 50:21-27. [PMID: 30580714 PMCID: PMC6314508 DOI: 10.1161/strokeaha.118.022249] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 09/05/2018] [Accepted: 10/12/2018] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Prevalence of atrial fibrillation (AF) is increasing, but the impact on overall burden of stroke is uncertain, as is the proportion that could be attributed to under anticoagulation. We did a population-based study of AF-associated stroke and a systematic review of time trends in other stroke incidence studies and of rates of premorbid anticoagulation. Methods- The proportion of incident strokes with associated AF was determined in the OXVASC (Oxford Vascular Study; 2002-2017) and in other prospective, population-based stroke incidence studies published before December 2017. Proportions were pooled by Mantel Haenszel methods, and the pooled percentage of cases with premorbid anticoagulation was determined. Analyses were stratified by the age of study population, mid-study year, country, and ethnicity. Results- Of 1928 patients with incident ischemic stroke in OXVASC, 629 (32.6%; 95% CI, 30.5-34.7) were AF associated, consistent with the pooled estimate from 4 smaller studies over the same study period (608/1948; 31.2%, 30.0-32.4; Phet=0.80). The pooled estimate from all studies reporting premorbid AF over 25 million person-years of observation (1960 onwards; 33 reports) was lower (18.6%, 16.8-20.3) and more heterogeneous (Phet<0.0001), but 62% of heterogeneity was explained by the age of study population, study period, country, and ethnicity. The proportion of incident strokes on premorbid anticoagulation increased over time, both for ischemic stroke in OXVASC (2002-2007: 15.1%, 2008-2012: 19.6%, and 2013-2017: 35.9%; Ptrend<0.0001), and across all studies (P=0.002), but the pooled estimates suggested substantial undertreatment even in the most recent periods (2001-2015: 25.7%, 21.1-30.3 and ≥2010: 31.6%, 18.2-44.9). Conclusions- About 1 in 3 incident ischemic strokes are still AF associated, due partly to low rates of anticoagulation for known prior AF, which therefore represents a major public health opportunity to reduce the burden of stroke.
Collapse
Affiliation(s)
- Gabriel S.C. Yiin
- From the Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom (G.S.C.Y., L.L., P.M.R.)
| | - Linxin Li
- From the Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom (G.S.C.Y., L.L., P.M.R.)
| | - Yannick Bejot
- Dijon Stroke Registry, EA 7460 Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases (PEC2), University Hospital of Dijon, University of Burgundy, France (Y.B.)
| | - Peter M. Rothwell
- From the Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom (G.S.C.Y., L.L., P.M.R.)
| |
Collapse
|
31
|
Polivka J, Polivka J, Rohan V. Predictive and individualized management of stroke-success story in Czech Republic. EPMA J 2018; 9:393-401. [PMID: 30538791 PMCID: PMC6261911 DOI: 10.1007/s13167-018-0150-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 09/11/2018] [Indexed: 12/25/2022]
Abstract
The model of centralized stroke care in the Czech Republic was created in 2010-2012 by Ministry of Health (MH) in cooperation with professional organization-Cerebrovascular Section of the Czech Neurological Society (CSCNS). It defines priorities of stroke care, stroke centers, triage of suspected stroke patients, stroke care quality indicators, their monitoring, and reporting. Thirteen complex cerebrovascular centers (CCC) provide sophisticated stroke care, including intravenous thrombolysis (IVT), mechanical thrombectomy (MTE), as well as other endovascular (stenting, coiling) and neurosurgical procedures. Thirty-two stroke centers (SC) provide stroke care except endovascular procedures and neurosurgery. The triage is managed by emergency medical service (EMS). The most important quality indicators of stroke care are number of hospitalized stroke patients, number of IVT, number of MTE, stenting and coiling, number of neurosurgical procedures, and percentage of deaths within 30 days. Indicators provided into the register of stroke care quality (RES-Q) managed by CSCNS are time from stroke onset to hospital admission, door-to-needle time, door-to-groin time, type of ischemic stroke, and others. Data from RES-Q are shared to all centers. Within the last 5 years, the Czech Republic becomes one of the leading countries in acute stroke care. The model of centralized stroke care is highly beneficial and effective. The quality indicators serve as tool of control of stroke centers activities. The sharing of quality indicators is useful tool for mutual competition and feedback control in each center. This comprehensive system ensures high standard of stroke care. This system respects the substantial principles of personalized medicine-individualized treatment of acute stroke and other comorbidities at the acute disease stage; optimal prevention, diagnosis and treatment of possible complications; prediction of further treatment and outcome; individualized secondary prevention, exactly according to the stroke etiology. The described model of stroke care optimally meets criteria of predictive, preventive, and personalized medicine (PPPM), and could be used in other countries as well with the aim of improving stroke care quality in general.
Collapse
Affiliation(s)
- Jiri Polivka
- Department of Neurology, Faculty of Medicine in Pilsen, Charles University, Husova 3, 301 66 Plzen, Czech Republic
- Department of Neurology, University Hospital Pilsen, E. Benese 13, 305 99 Plzen, Czech Republic
| | - Jiri Polivka
- Department of Neurology, Faculty of Medicine in Pilsen, Charles University, Husova 3, 301 66 Plzen, Czech Republic
- Department of Neurology, University Hospital Pilsen, E. Benese 13, 305 99 Plzen, Czech Republic
- Department of Histology and Embryology, Charles University, Husova 3, 301 66 Plzen, Czech Republic
- Biomedical Centre, Faculty of Medicine in Pilsen, Charles University, Husova 3, 301 66 Plzen, Czech Republic
| | - Vladimir Rohan
- Department of Neurology, Faculty of Medicine in Pilsen, Charles University, Husova 3, 301 66 Plzen, Czech Republic
- Department of Neurology, University Hospital Pilsen, E. Benese 13, 305 99 Plzen, Czech Republic
| |
Collapse
|
32
|
Boursin P, Paternotte S, Dercy B, Sabben C, Maïer B. [Semantics, epidemiology and semiology of stroke]. SOINS; LA REVUE DE REFERENCE INFIRMIERE 2018; 63:24-27. [PMID: 30213310 DOI: 10.1016/j.soin.2018.06.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Stroke is a cerebrovascular disorder characterised by the sudden onset of symptoms and clinical signs. Each year, an estimated 140,000 people in France are hospitalised for stroke. Ischemic stroke is the most common kind of stroke, accounting for 80% of all cases. Haemorrhagic stroke accounts for about 20% of all strokes.
Collapse
Affiliation(s)
- Perrine Boursin
- Neuroradiologie interventionnelle, Fondation ophtalmologique Adolphe-de-Rothschild, 29, rue Manin, 75019 Paris, France.
| | - Sophie Paternotte
- Unité de soins intensifs neurovasculaires, Fondation ophtalmologique Adolphe-de-Rothschild, 29, rue Manin, 75019 Paris, France
| | - Burty Dercy
- Unité de soins intensifs neurovasculaires, Fondation ophtalmologique Adolphe-de-Rothschild, 29, rue Manin, 75019 Paris, France
| | - Candice Sabben
- Unité de soins intensifs neurovasculaires, Fondation ophtalmologique Adolphe-de-Rothschild, 29, rue Manin, 75019 Paris, France
| | - Benjamin Maïer
- Neuroradiologie interventionnelle, Fondation ophtalmologique Adolphe-de-Rothschild, 29, rue Manin, 75019 Paris, France
| |
Collapse
|
33
|
Legros V, Bard M, Rouget D, Kleiber JC, Gelisse E, Lepousé C. Complications extraneurologiques des hémorragies sous-arachnoïdiennes anévrismales. MEDECINE INTENSIVE REANIMATION 2018. [DOI: 10.3166/rea-2018-0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
L’hémorragie sous-arachnoïdienne anévrismale (HSA) est une pathologie rare, touchant principalement la femme jeune en bonne santé. Cette pathologie est bien connue, ainsi que son évolution. Les HSA peuvent se compliquer de nombreuses complications d’ordre neurologique comme l’hydrocéphalie aiguë, le vasospasme, la comitialité, l’hypertension intracrânienne par exemple. Cependant, d’autres complications extracrâniennes peuvent aggraver le pronostic de cette pathologie. Les mécanismes principaux de ces complications extraneurologiques sont un stress catécholaminergique et le syndrome de réponse inflammatoire systémique. Ces complications peuvent être d’ordre cardiovasculaire (défaillance cardiaque, modification de l’ECG…), pulmonaire (œdème pulmonaire neurogénique, PAVM…) et métabolique (anomalies ioniques, hyperglycémie, insuffisance rénale).
Collapse
|
34
|
Buchtele N, Schwameis M, Gilbert JC, Schörgenhofer C, Jilma B. Targeting von Willebrand Factor in Ischaemic Stroke: Focus on Clinical Evidence. Thromb Haemost 2018; 118:959-978. [PMID: 29847840 PMCID: PMC6193403 DOI: 10.1055/s-0038-1648251] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Despite great efforts in stroke research, disability and recurrence rates in ischaemic stroke remain unacceptably high. To address this issue, one potential target for novel therapeutics is the glycoprotein von Willebrand factor (vWF), which increases in thrombogenicity especially under high shear rates as it bridges between vascular sub-endothelial collagen and platelets. The rationale for vWF as a potential target in stroke comes from four bodies of evidence. (1) Animal models which recapitulate the pathogenesis of stroke and validate the concept of targeting vWF for stroke prevention and the use of the vWF cleavage enzyme ADAMTS13 in acute stroke treatment. (2) Extensive epidemiologic data establishing the prognostic role of vWF in the clinical setting showing that high vWF levels are associated with an increased risk of first stroke, stroke recurrence or stroke-associated mortality. As such, vWF levels may be a suitable marker for further risk stratification to potentially fine-tune current risk prediction models which are mainly based on clinical and imaging data. (3) Genetic studies showing an association between vWF levels and stroke risk on genomic levels. Finally, (4) studies of patients with primary disorders of excess or deficiency of function in the vWF axis (e.g. thrombotic thrombocytopenic purpura and von Willebrand disease, respectively) which demonstrate the crucial role of vWF in atherothrombosis. Therapeutic inhibition of VWF by novel agents appears particularly promising for secondary prevention of stroke recurrence in specific sub-groups of patients such as those suffering from large artery atherosclerosis, as designated according to the TOAST classification.
Collapse
Affiliation(s)
- Nina Buchtele
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Michael Schwameis
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - James C Gilbert
- Band Therapeutics, LLC, Boston, Massachusetts, United States
| | | | - Bernd Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
35
|
Giménez-Muñoz A, Ara J, Abad Díez J, Campello Morer I, Pérez Trullén J. Trends in stroke hospitalisation rates and in-hospital mortality in Aragon, 1998-2010. NEUROLOGÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.nrleng.2016.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
36
|
Giménez-Muñoz A, Ara J, Abad Díez J, Campello Morer I, Pérez Trullén J. Tendencia de las tasas de hospitalización y de letalidad hospitalaria de la enfermedad cerebrovascular aguda en Aragón en el periodo 1998-2010. Neurologia 2018; 33:224-232. [DOI: 10.1016/j.nrl.2016.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 06/14/2016] [Accepted: 06/30/2016] [Indexed: 11/26/2022] Open
|
37
|
Iacoviello L, Bonaccio M, Cairella G, Catani MV, Costanzo S, D'Elia L, Giacco R, Rendina D, Sabino P, Savini I, Strazzullo P. Diet and primary prevention of stroke: Systematic review and dietary recommendations by the ad hoc Working Group of the Italian Society of Human Nutrition. Nutr Metab Cardiovasc Dis 2018; 28:309-334. [PMID: 29482962 DOI: 10.1016/j.numecd.2017.12.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 12/28/2017] [Accepted: 12/29/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND AIMS To systematically review the latest evidence on established and emerging nutrition-related risk factors for incidence of and mortality from total, ischemic and haemorrhagic strokes. The present review was conducted in the framework of the work carried out through 2015 and 2016 for the preparation of the Italian Guidelines for the Prevention and Treatment of Stroke, 8th Edition, by ISO-SPREAD (Italian Stroke Organization and the Stroke Prevention and Educational Awareness Diffusion). METHODS AND RESULTS Systematic review of articles focused on primary prevention of stroke published between January 2013 to May 2016 through an extensive search of the literature using MEDLINE/PUBMED, EMBASE and the Cochrane Library. Articles were ranked according to the SIGN methodology while the GRADE system was used to establish the strength of recommendations. As a result of our literature search, we examined 87 meta-analyses overall (mainly of prospective studies), a few isolated more recent prospective studies not included in the meta-analyses, and a smaller number of available randomized controlled trials and case-control studies. Based on the analysis of the above articles, 36 Syntheses of the available evidence and 36 Recommendations were eventually prepared. The present document was developed by organizing the available evidence into three individual areas (nutrients, food groups and dietary patterns) to provide a systematic and user-friendly overview of the available evidence on the relationship between nutrition and primary prevention of stroke. Yet analysis of foods and food patterns allowed translating the information about nutrients in a tool more amenable to use in daily life also in the light of the argument that people eat foods rather than nutrients. CONCLUSIONS The present literature review and dietary recommendations provide healthcare professionals and all interested readers with a useful overview for the reduction of the risk of total, ischemic and haemorrhagic stroke through dietary modifications.
Collapse
Affiliation(s)
- L Iacoviello
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, 86077, Pozzilli, IS, Italy; Department of Medicine and Surgery, Research Center in Epidemiology and Preventive Medicine (EPIMED), University of Insubria, 21100, Varese, Italy.
| | - M Bonaccio
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, 86077, Pozzilli, IS, Italy
| | - G Cairella
- Servizio Igiene Alimenti e Nutrizione, ASL Rome B, Italy
| | - M V Catani
- Department of Experimental Medicine & Surgery, University of Rome 'Tor Vergata', 00133, Rome, Italy
| | - S Costanzo
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, 86077, Pozzilli, IS, Italy
| | - L D'Elia
- Department of Clinical Medicine and Surgery, Federico II University of Naples Medical School, 80131, Naples, Italy
| | - R Giacco
- Institute of Food Science, National Research Council, 83100, Avellino, Italy
| | - D Rendina
- Department of Clinical Medicine and Surgery, Federico II University of Naples Medical School, 80131, Naples, Italy
| | - P Sabino
- Department of Clinical Medicine and Surgery, Federico II University of Naples Medical School, 80131, Naples, Italy
| | - I Savini
- Department of Experimental Medicine & Surgery, University of Rome 'Tor Vergata', 00133, Rome, Italy
| | - P Strazzullo
- Department of Clinical Medicine and Surgery, Federico II University of Naples Medical School, 80131, Naples, Italy.
| |
Collapse
|
38
|
Mayr A, Quirbach E, Picelli A, Kofler M, Smania N, Saltuari L. Early robot-assisted gait retraining in non-ambulatory patients with stroke: a single blind randomized controlled trial. Eur J Phys Rehabil Med 2018; 54:819-826. [PMID: 29600688 DOI: 10.23736/s1973-9087.18.04832-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Restoration of walking function is a primary concern of neurorehabilitation with respect to the aspired social and vocational reintegration. To date, the best practice for improving gait early after stroke is still object of debate. On one hand, repetitive task-specific approaches with higher intensities of walking have been observed to result in greater improvements of gait after stroke. Conversely there is some evidence that conventional gait training would be more effective for facilitating walking ability after stroke. AIM To compare the effects of an early treatment protocol of add-on robot-assisted gait training with add-on conventional overground physiotherapy for improving locomotion in non-ambulatory adult stroke patients. DESIGN Single-blind randomized controlled trial. SETTING Neurorehabilitation hospital. POPULATION Seventy-four subacute patients with first-ever ischemic stroke. METHODS The patients were randomized into two groups. The training program consisted of forty, 2-hour sessions (including 45 minutes basic training, 45 minutes add-on training plus rest periods), 5 days a week, for 8 consecutive weeks. Patients allocated to the add-on robot-assisted gait training were treated by means of the Lokomat. Patients allocated to the add-on conventional overground gait training aimed at improving postural control during gait, body weight transfer, stability during the stance phase, free swing phase, adequate heel contact and gait pattern. Primary outcome was the modified Emory Functional Ambulation Profile. Secondary outcomes were the Rivermead Motor Index, the Mobility Milestones and the Hochzirl Walking Aids Profile. RESULTS No significant difference was observed between groups with regards to age (P=0.661), time from stroke onset (P=0.413) and the primary outcome (P=0.854) at baseline evaluation. As to the primary outcome, no significant differences were found between groups at the end of the study. As During the 8-week training, within-group comparisons showed significant improvements of mean modified Emory Functional Ambulation Profile in both groups (P<0.001). CONCLUSIONS Our results support the hypothesis that an early treatment protocol of robot-assisted gait retraining is not superior to add-on conventional gait training intervention for improving locomotion in non-ambulatory stroke patients. CLINICAL REHABILITATION IMPACT This study might help to better understand the role of robot-assisted gait training in early phase stroke rehabilitation.
Collapse
Affiliation(s)
- Andreas Mayr
- Department of Neurology, Hochzirl Hospital, Zirl, Austria -
| | - Ellen Quirbach
- Department of Neurology, Hochzirl Hospital, Zirl, Austria
| | - Alessandro Picelli
- Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,Unit of Neurorehabilitation, Department of Neurosciences, Hospital Trust of Verona, Verona, Italy
| | - Markus Kofler
- Department of Neurology, Hochzirl Hospital, Zirl, Austria
| | - Nicola Smania
- Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,Unit of Neurorehabilitation, Department of Neurosciences, Hospital Trust of Verona, Verona, Italy
| | - Leopold Saltuari
- Department of Neurology, Hochzirl Hospital, Zirl, Austria.,Research Department for Neurorehabilitation South Tyrol, Bolzano, Italy
| |
Collapse
|
39
|
Chwojnicki K, Ryglewicz D, Wojtyniak B, Zagożdżon P, Członkowska A, Jędrzejczyk T, Karaszewski B, Kozera G, Gierlotka M, Ezzati M, Zdrojewski T. Acute Ischemic Stroke Hospital Admissions, Treatment, and Outcomes in Poland in 2009-2013. Front Neurol 2018; 9:134. [PMID: 29593634 PMCID: PMC5858531 DOI: 10.3389/fneur.2018.00134] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 02/22/2018] [Indexed: 01/05/2023] Open
Abstract
Introduction Ischemic stroke (IS) still constitutes a serious problem for public health worldwide. The data on its burden in Poland before 2009 is limited and came only from a few metropolitan areas. The aims of the study were To assess temporal trends in the hospital admissions, treatment, and outcomes of IS in Poland in 2009-2013, to identify risk factors for IS mortality and to compare the results with other countries. Methods The data from the Polish Stroke Registry were analyzed. The data concerned all subjects hospitalized due to IS (classified according to the ICD10 classification as I63.0-I63.9) as primary diagnosis in Poland in 2009-2013. Temporal trends in treatment and outcome were analyzed. Hospital admissions rates as well as case fatality and 12-month mortality rates were calculated. Results Altogether, 360,556 patients (47.5% of males) were hospitalized due to IS in Poland in 2009-2013. The median of age was 75 years, IQR 18 (Women 78, IQR 14 vs. Men 70, IQR 17; p < 0.001). The hospital admissions age-standardized annual rate for IS in Poland in 2013 was 8% lower than in 2009 (169 vs. 157/100,000; p for trend < 0.001). In-hospital case fatality has slightly decreased (from 13.6% in 2009 to 12.9% in 2013; p for trend < 0.001). One-year posthospital mortality rate has not changed (19.3% in 2009 and 2013). The percentage of IS subjects treated with intravenous thrombolysis was low but increased from 1.7% in 2009 to 6.3% in 2013 (p for trend <0.001). Conclusion Since 2009, Poland has had national epidemiological data on the hospital admissions, treatment, and outcomes in IS. The data indicate a slow improvement of in-hospital survival and suggest the need for better stroke prevention and further dissemination of reperfusion therapy.
Collapse
Affiliation(s)
- Kamil Chwojnicki
- Department of Neurology, Medical University of Gdańsk, Gdańsk, Poland
| | - Danuta Ryglewicz
- Department of Neurology, Polish Institute of Psychiatry and Neurology, Warsaw, Poland
| | | | - Paweł Zagożdżon
- Department of Hygiene and Epidemiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Anna Członkowska
- Department of Neurology, Polish Institute of Psychiatry and Neurology, Warsaw, Poland
| | | | | | - Grzegorz Kozera
- Department of Neurology, Ludwik Rydygier Collegium Medicum of Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Marek Gierlotka
- Department of Cardiology, Department of Cardiovascular Diseases, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Majid Ezzati
- Faculty of Medicine, School of Public Health, Imperial College of London, London, United Kingdom
| | - Tomasz Zdrojewski
- Department of Arterial Hypertension and Diabetology, Medical University of Gdańsk, Gdańsk, Poland
| |
Collapse
|
40
|
Tsivgoulis G, Patousi A, Pikilidou M, Birbilis T, Katsanos AH, Mantatzis M, Asimis A, Papanas N, Skendros P, Terzoudi A, Karamanli A, Kouroumichakis I, Zebekakis P, Maltezos E, Piperidou C, Vadikolias K, Heliopoulos I. Stroke Incidence and Outcomes in Northeastern Greece: The Evros Stroke Registry. Stroke 2018; 49:288-295. [PMID: 29335330 DOI: 10.1161/strokeaha.117.019524] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 11/17/2017] [Accepted: 11/30/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND PURPOSE Data are scarce on both stroke incidence rates and outcomes in Greece and in rural areas in particular. We performed a prospective population-based study evaluating the incidence of first-ever stroke in the Evros prefecture, a region of a total 147 947 residents located in North Eastern Greece. METHODS Adult patients with first-ever stroke were registered during a 24-month period (2010-2012) and followed up for 12 months. To compare our stroke incidence with that observed in other studies, we standardized our incidence rate data according to the European Standard Population, World Health Organization, and Segi population. We also applied criteria of data quality proposed by the Monitoring Trends and Determinants in Cardiovascular Disease project. Stroke diagnosis and classification were performed using World Health Organization criteria on the basis of neuroimaging and autopsy data. RESULTS We prospectively documented 703 stroke cases (mean age: 75±12 years; 52.8% men; ischemic stroke: 80.8%; intracerebral hemorrhage: 11.8%; subarachnoid hemorrhage: 4.4%; undefined: 3.0%) with a total follow-up time of 119 805 person-years. The unadjusted and European Standard Population-adjusted incidences of all strokes were 586.8 (95% confidence interval [CI], 543.4-630.2) and 534.1 (95% CI, 494.6-573.6) per 100 000 person-years, respectively. The unadjusted incidence rates for ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage were 474.1 (95% CI, 435-513), 69.3 (95% CI, 54-84), and 25.9 (95% CI, 17-35) per 100 000 person-years, respectively. The corresponding European Standard Population-adjusted incidence rates per 100 000 person-years were 425.9 (95% CI, 390.9-460.9), 63.3 (95% CI, 49.7-76.9), and 25.8 (95% CI, 16.7-34.9) for ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage, respectively. The overall 28-day case fatality rate was 21.3% (95% CI, 18.3%-24.4%) for all strokes and was higher in hemorrhagic strokes than ischemic stroke (40.4%, 95% CI, 31.3%-49.4% versus 16.2%, 95% CI, 13.2%-19.2%). CONCLUSIONS This is the largest to date population-based study in Greece documenting one of the highest stroke incidences ever reported in South Europe, highlighting the need for efficient stroke prevention and treatment strategies in Northeastern Greece.
Collapse
Affiliation(s)
- Georgios Tsivgoulis
- From the Department of Neurology (G.T., A.P., A.T., A.K., C.P., K.V., I.H.), Department of Neurosurgery (T.B.), Department of Radiology (M.M.), Second Department of Internal Medicine (N.P., I.K., E.M.), and First Department of Internal Medicine (P.S.), University Hospital of Alexandroupolis, Democritus University of Thrace, School of Medicine, Greece; Second Department of Neurology, Attikon Hospital, National and Kapodistrian University of Athens, School of Medicine, Greece (G.T., A.H.K.); 1st Department of Internal Medicine, Hypertension Excellence Center, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece (M.P., P.Z.); Department of Neurology, School of Medicine, University of Ioannina, Greece (A.H.K.); and Didymoteicho General Hospital, Greece (A.A.).
| | - Athanasia Patousi
- From the Department of Neurology (G.T., A.P., A.T., A.K., C.P., K.V., I.H.), Department of Neurosurgery (T.B.), Department of Radiology (M.M.), Second Department of Internal Medicine (N.P., I.K., E.M.), and First Department of Internal Medicine (P.S.), University Hospital of Alexandroupolis, Democritus University of Thrace, School of Medicine, Greece; Second Department of Neurology, Attikon Hospital, National and Kapodistrian University of Athens, School of Medicine, Greece (G.T., A.H.K.); 1st Department of Internal Medicine, Hypertension Excellence Center, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece (M.P., P.Z.); Department of Neurology, School of Medicine, University of Ioannina, Greece (A.H.K.); and Didymoteicho General Hospital, Greece (A.A.)
| | - Maria Pikilidou
- From the Department of Neurology (G.T., A.P., A.T., A.K., C.P., K.V., I.H.), Department of Neurosurgery (T.B.), Department of Radiology (M.M.), Second Department of Internal Medicine (N.P., I.K., E.M.), and First Department of Internal Medicine (P.S.), University Hospital of Alexandroupolis, Democritus University of Thrace, School of Medicine, Greece; Second Department of Neurology, Attikon Hospital, National and Kapodistrian University of Athens, School of Medicine, Greece (G.T., A.H.K.); 1st Department of Internal Medicine, Hypertension Excellence Center, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece (M.P., P.Z.); Department of Neurology, School of Medicine, University of Ioannina, Greece (A.H.K.); and Didymoteicho General Hospital, Greece (A.A.)
| | - Theodosis Birbilis
- From the Department of Neurology (G.T., A.P., A.T., A.K., C.P., K.V., I.H.), Department of Neurosurgery (T.B.), Department of Radiology (M.M.), Second Department of Internal Medicine (N.P., I.K., E.M.), and First Department of Internal Medicine (P.S.), University Hospital of Alexandroupolis, Democritus University of Thrace, School of Medicine, Greece; Second Department of Neurology, Attikon Hospital, National and Kapodistrian University of Athens, School of Medicine, Greece (G.T., A.H.K.); 1st Department of Internal Medicine, Hypertension Excellence Center, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece (M.P., P.Z.); Department of Neurology, School of Medicine, University of Ioannina, Greece (A.H.K.); and Didymoteicho General Hospital, Greece (A.A.)
| | - Aristeidis H Katsanos
- From the Department of Neurology (G.T., A.P., A.T., A.K., C.P., K.V., I.H.), Department of Neurosurgery (T.B.), Department of Radiology (M.M.), Second Department of Internal Medicine (N.P., I.K., E.M.), and First Department of Internal Medicine (P.S.), University Hospital of Alexandroupolis, Democritus University of Thrace, School of Medicine, Greece; Second Department of Neurology, Attikon Hospital, National and Kapodistrian University of Athens, School of Medicine, Greece (G.T., A.H.K.); 1st Department of Internal Medicine, Hypertension Excellence Center, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece (M.P., P.Z.); Department of Neurology, School of Medicine, University of Ioannina, Greece (A.H.K.); and Didymoteicho General Hospital, Greece (A.A.)
| | - Michalis Mantatzis
- From the Department of Neurology (G.T., A.P., A.T., A.K., C.P., K.V., I.H.), Department of Neurosurgery (T.B.), Department of Radiology (M.M.), Second Department of Internal Medicine (N.P., I.K., E.M.), and First Department of Internal Medicine (P.S.), University Hospital of Alexandroupolis, Democritus University of Thrace, School of Medicine, Greece; Second Department of Neurology, Attikon Hospital, National and Kapodistrian University of Athens, School of Medicine, Greece (G.T., A.H.K.); 1st Department of Internal Medicine, Hypertension Excellence Center, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece (M.P., P.Z.); Department of Neurology, School of Medicine, University of Ioannina, Greece (A.H.K.); and Didymoteicho General Hospital, Greece (A.A.)
| | - Aristeidis Asimis
- From the Department of Neurology (G.T., A.P., A.T., A.K., C.P., K.V., I.H.), Department of Neurosurgery (T.B.), Department of Radiology (M.M.), Second Department of Internal Medicine (N.P., I.K., E.M.), and First Department of Internal Medicine (P.S.), University Hospital of Alexandroupolis, Democritus University of Thrace, School of Medicine, Greece; Second Department of Neurology, Attikon Hospital, National and Kapodistrian University of Athens, School of Medicine, Greece (G.T., A.H.K.); 1st Department of Internal Medicine, Hypertension Excellence Center, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece (M.P., P.Z.); Department of Neurology, School of Medicine, University of Ioannina, Greece (A.H.K.); and Didymoteicho General Hospital, Greece (A.A.)
| | - Nikolaos Papanas
- From the Department of Neurology (G.T., A.P., A.T., A.K., C.P., K.V., I.H.), Department of Neurosurgery (T.B.), Department of Radiology (M.M.), Second Department of Internal Medicine (N.P., I.K., E.M.), and First Department of Internal Medicine (P.S.), University Hospital of Alexandroupolis, Democritus University of Thrace, School of Medicine, Greece; Second Department of Neurology, Attikon Hospital, National and Kapodistrian University of Athens, School of Medicine, Greece (G.T., A.H.K.); 1st Department of Internal Medicine, Hypertension Excellence Center, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece (M.P., P.Z.); Department of Neurology, School of Medicine, University of Ioannina, Greece (A.H.K.); and Didymoteicho General Hospital, Greece (A.A.)
| | - Panagiotis Skendros
- From the Department of Neurology (G.T., A.P., A.T., A.K., C.P., K.V., I.H.), Department of Neurosurgery (T.B.), Department of Radiology (M.M.), Second Department of Internal Medicine (N.P., I.K., E.M.), and First Department of Internal Medicine (P.S.), University Hospital of Alexandroupolis, Democritus University of Thrace, School of Medicine, Greece; Second Department of Neurology, Attikon Hospital, National and Kapodistrian University of Athens, School of Medicine, Greece (G.T., A.H.K.); 1st Department of Internal Medicine, Hypertension Excellence Center, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece (M.P., P.Z.); Department of Neurology, School of Medicine, University of Ioannina, Greece (A.H.K.); and Didymoteicho General Hospital, Greece (A.A.)
| | - Aikaterini Terzoudi
- From the Department of Neurology (G.T., A.P., A.T., A.K., C.P., K.V., I.H.), Department of Neurosurgery (T.B.), Department of Radiology (M.M.), Second Department of Internal Medicine (N.P., I.K., E.M.), and First Department of Internal Medicine (P.S.), University Hospital of Alexandroupolis, Democritus University of Thrace, School of Medicine, Greece; Second Department of Neurology, Attikon Hospital, National and Kapodistrian University of Athens, School of Medicine, Greece (G.T., A.H.K.); 1st Department of Internal Medicine, Hypertension Excellence Center, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece (M.P., P.Z.); Department of Neurology, School of Medicine, University of Ioannina, Greece (A.H.K.); and Didymoteicho General Hospital, Greece (A.A.)
| | - Aikaterini Karamanli
- From the Department of Neurology (G.T., A.P., A.T., A.K., C.P., K.V., I.H.), Department of Neurosurgery (T.B.), Department of Radiology (M.M.), Second Department of Internal Medicine (N.P., I.K., E.M.), and First Department of Internal Medicine (P.S.), University Hospital of Alexandroupolis, Democritus University of Thrace, School of Medicine, Greece; Second Department of Neurology, Attikon Hospital, National and Kapodistrian University of Athens, School of Medicine, Greece (G.T., A.H.K.); 1st Department of Internal Medicine, Hypertension Excellence Center, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece (M.P., P.Z.); Department of Neurology, School of Medicine, University of Ioannina, Greece (A.H.K.); and Didymoteicho General Hospital, Greece (A.A.)
| | - Ioannis Kouroumichakis
- From the Department of Neurology (G.T., A.P., A.T., A.K., C.P., K.V., I.H.), Department of Neurosurgery (T.B.), Department of Radiology (M.M.), Second Department of Internal Medicine (N.P., I.K., E.M.), and First Department of Internal Medicine (P.S.), University Hospital of Alexandroupolis, Democritus University of Thrace, School of Medicine, Greece; Second Department of Neurology, Attikon Hospital, National and Kapodistrian University of Athens, School of Medicine, Greece (G.T., A.H.K.); 1st Department of Internal Medicine, Hypertension Excellence Center, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece (M.P., P.Z.); Department of Neurology, School of Medicine, University of Ioannina, Greece (A.H.K.); and Didymoteicho General Hospital, Greece (A.A.)
| | - Pantelis Zebekakis
- From the Department of Neurology (G.T., A.P., A.T., A.K., C.P., K.V., I.H.), Department of Neurosurgery (T.B.), Department of Radiology (M.M.), Second Department of Internal Medicine (N.P., I.K., E.M.), and First Department of Internal Medicine (P.S.), University Hospital of Alexandroupolis, Democritus University of Thrace, School of Medicine, Greece; Second Department of Neurology, Attikon Hospital, National and Kapodistrian University of Athens, School of Medicine, Greece (G.T., A.H.K.); 1st Department of Internal Medicine, Hypertension Excellence Center, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece (M.P., P.Z.); Department of Neurology, School of Medicine, University of Ioannina, Greece (A.H.K.); and Didymoteicho General Hospital, Greece (A.A.)
| | - Efstratios Maltezos
- From the Department of Neurology (G.T., A.P., A.T., A.K., C.P., K.V., I.H.), Department of Neurosurgery (T.B.), Department of Radiology (M.M.), Second Department of Internal Medicine (N.P., I.K., E.M.), and First Department of Internal Medicine (P.S.), University Hospital of Alexandroupolis, Democritus University of Thrace, School of Medicine, Greece; Second Department of Neurology, Attikon Hospital, National and Kapodistrian University of Athens, School of Medicine, Greece (G.T., A.H.K.); 1st Department of Internal Medicine, Hypertension Excellence Center, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece (M.P., P.Z.); Department of Neurology, School of Medicine, University of Ioannina, Greece (A.H.K.); and Didymoteicho General Hospital, Greece (A.A.)
| | - Charitomeni Piperidou
- From the Department of Neurology (G.T., A.P., A.T., A.K., C.P., K.V., I.H.), Department of Neurosurgery (T.B.), Department of Radiology (M.M.), Second Department of Internal Medicine (N.P., I.K., E.M.), and First Department of Internal Medicine (P.S.), University Hospital of Alexandroupolis, Democritus University of Thrace, School of Medicine, Greece; Second Department of Neurology, Attikon Hospital, National and Kapodistrian University of Athens, School of Medicine, Greece (G.T., A.H.K.); 1st Department of Internal Medicine, Hypertension Excellence Center, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece (M.P., P.Z.); Department of Neurology, School of Medicine, University of Ioannina, Greece (A.H.K.); and Didymoteicho General Hospital, Greece (A.A.)
| | - Konstantinos Vadikolias
- From the Department of Neurology (G.T., A.P., A.T., A.K., C.P., K.V., I.H.), Department of Neurosurgery (T.B.), Department of Radiology (M.M.), Second Department of Internal Medicine (N.P., I.K., E.M.), and First Department of Internal Medicine (P.S.), University Hospital of Alexandroupolis, Democritus University of Thrace, School of Medicine, Greece; Second Department of Neurology, Attikon Hospital, National and Kapodistrian University of Athens, School of Medicine, Greece (G.T., A.H.K.); 1st Department of Internal Medicine, Hypertension Excellence Center, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece (M.P., P.Z.); Department of Neurology, School of Medicine, University of Ioannina, Greece (A.H.K.); and Didymoteicho General Hospital, Greece (A.A.)
| | - Ioannis Heliopoulos
- From the Department of Neurology (G.T., A.P., A.T., A.K., C.P., K.V., I.H.), Department of Neurosurgery (T.B.), Department of Radiology (M.M.), Second Department of Internal Medicine (N.P., I.K., E.M.), and First Department of Internal Medicine (P.S.), University Hospital of Alexandroupolis, Democritus University of Thrace, School of Medicine, Greece; Second Department of Neurology, Attikon Hospital, National and Kapodistrian University of Athens, School of Medicine, Greece (G.T., A.H.K.); 1st Department of Internal Medicine, Hypertension Excellence Center, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece (M.P., P.Z.); Department of Neurology, School of Medicine, University of Ioannina, Greece (A.H.K.); and Didymoteicho General Hospital, Greece (A.A.)
| |
Collapse
|
41
|
Malá H, Rasmussen CP. The effect of combined therapies on recovery after acquired brain injury: Systematic review of preclinical studies combining enriched environment, exercise, or task-specific training with other therapies. Restor Neurol Neurosci 2018; 35:25-64. [PMID: 27858724 DOI: 10.3233/rnn-160682] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Acquired brain injuries (ABI) have devastating effects for the affected individual as well as society. Many studies have investigated the effect of different monotherapies. However, functional recovery is typically only partial. One possible strategy to promote a greater degree of recovery is to apply monotherapies in combination with one or more treatments. OBJECTIVE The objective of this systematic review is to investigate if approaches combining enriched environment (EE), exercise, or task-specific training with other monotherapies, further enhance the degree of recovery after ABI. METHOD Scopus, PsychINFO, and PubMed databases were searched in March 2016 with the following search strings: exercise (or) enriched environment (or) environmental enrichment (or) rehabilitation (and) traumatic brain injury (or) ischemia (or) stroke (and) rat (or) rodent. Studies were included if they (1) were in English, (2) used adult animals subjected to brain injury, (3) included EE, and/or exercise, and/or task-specific training as post-injury treatment strategies, (4) included at least one group receiving another monotherapy. Out of 2.168 hits, 29 studies fulfilled the inclusion criteria. RESULTS Despite several trends for enhanced recovery after combined therapies, this systematic review of 29 studies does not indicate that combined therapies confer consistent combined effects on motor, cognitive, or cerebral recovery according to present criteria for combined effect. CONCLUSION Combined treatments continue to provide hope for enhanced recovery after ABI, however, the research area is in its infancy. This systematic review does not provide conclusive evidence. This is likely due to sparse knowledge regarding optimal treatment parameters. Combined treatments, however, hold the best promise regarding treatment of the complex changes induced by ABI.
Collapse
|
42
|
Adoukonou T, Kossi O, Agbétou M, Tchaou B, Agballa G, Houinato D. Short Term (3 Months) Prognosis of Stroke in Parakou. ACTA ACUST UNITED AC 2018. [DOI: 10.4236/nm.2018.92009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
43
|
Bunch TJ, May HT, Bair TL, Crandall BG, Cutler MJ, Day JD, Jacobs V, Mallender C, Osborn JS, Weiss JP. Five-year impact of catheter ablation for atrial fibrillation in patients with a prior history of stroke. J Cardiovasc Electrophysiol 2017; 29:221-226. [PMID: 29131434 DOI: 10.1111/jce.13390] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 09/30/2017] [Accepted: 10/11/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Catheter ablation of atrial fibrillation (AF) is an established therapeutic rhythm approach. Patients with a prior history of a stroke (CVA) represent a unique high-risk population for recurrent thromboembolic events. The role of antiarrhythmic treatment on the natural history of stroke recurrence in these patients is not fully understood. METHODS Three patient groups with a prior CVA and 5 years of follow-up were matched 1:3:3 by propensity score (±0.01): AF ablation patients receiving their first ablation (n = 139), AF patients that did not receive an ablation (n = 416), and CVA patients without clinical AF (n = 416). Prior CVA was determined by medical chart review. Patients were followed for outcomes of recurrent CVA, heart failure, and death. RESULTS The average age of the population was 69 ± 11 years and 51% male. AF ablation patients had higher rates of hypertension and heart failure (P < 0.0001), but diabetes prevalence was similar between the groups (P = 0.5). Note that 5-year risk of CVA (HR = 2.26, P < 0.0001) and death (HR = 2.43, P < 0.0001) were higher in the AF, no ablation group compared those that were ablated. When comparing AF, ablation to no AF patients, there was not a significant difference in 5-year risk of for CVA (HR = 0.82, P = 0.39) and death (HR = 0.92, P = 0.70); however, heart failure risk was increased (HR = 3.08, P = 0.001). CONCLUSION In patients with AF and a prior CVA, patients undergoing ablation have lower rates of recurrent stroke compared to AF patients not ablated. Although the full mechanisms of benefit are unknown, as CVA rates are similar to patients without AF these data are suggestive of a potential altering of the natural history of disease progression.
Collapse
Affiliation(s)
- T Jared Bunch
- Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, UT, USA.,Department of Internal Medicine, Stanford University, Palo Alto, CA, USA
| | - Heidi T May
- Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, UT, USA
| | - Tami L Bair
- Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, UT, USA
| | - Brian G Crandall
- Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, UT, USA
| | - Michael J Cutler
- Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, UT, USA
| | - John D Day
- Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, UT, USA
| | - Victoria Jacobs
- Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, UT, USA
| | - Charles Mallender
- Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, UT, USA
| | - Jeffrey S Osborn
- Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, UT, USA
| | - J Peter Weiss
- Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, UT, USA
| |
Collapse
|
44
|
Nzwalo H, Nogueira J, Félix C, Guilherme P, Baptista A, Figueiredo T, Ferreira F, Marreiros A, Thomassen L, Logallo N. Incidence and case-fatality from spontaneous intracerebral hemorrhage in a southern region of Portugal. J Neurol Sci 2017; 380:74-78. [DOI: 10.1016/j.jns.2017.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 06/15/2017] [Accepted: 07/04/2017] [Indexed: 11/15/2022]
|
45
|
Fresson M, Dardenne B, Geurten M, Meulemans T. Stereotype content of people with acquired brain injury: Warm but incompetent. JOURNAL OF APPLIED SOCIAL PSYCHOLOGY 2017. [DOI: 10.1111/jasp.12459] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Megan Fresson
- Psychology and Neurosciences of Cognition Unit; University of Liège
| | - Benoit Dardenne
- Psychology and Neurosciences of Cognition Unit; University of Liège
| | - Marie Geurten
- Psychology and Neurosciences of Cognition Unit; University of Liège
| | | |
Collapse
|
46
|
Garkowski A, Zajkowska J, Zajkowska A, Kułakowska A, Zajkowska O, Kubas B, Jurgilewicz D, Hładuński M, Łebkowska U. Cerebrovascular Manifestations of Lyme Neuroborreliosis-A Systematic Review of Published Cases. Front Neurol 2017; 8:146. [PMID: 28473801 PMCID: PMC5397664 DOI: 10.3389/fneur.2017.00146] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 03/31/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Lyme neuroborreliosis (LNB) is a disease caused by spirochete Borrelia burgdorferi, involving the nervous system. It usually manifests as lymphocytic meningoradiculitis, but in rare cases, it can also lead to cerebrovascular complications. We aimed to perform a systematic review of all reported cases of LNB complicated by central nervous system vasculitis and stroke or transient ischemic attack (TIA). MATERIALS AND METHODS We conducted a systematic review of literature between May 1987 and December 2016 with patients who presented with cerebrovascular course of LNB. RESULTS This study included 88 patients with a median age of 46 years. The median interval from onset of symptoms suggesting Lyme disease to first symptoms of cerebrovascular manifestations of LNB was 3.5 months. The most common cerebrovascular manifestation of LNB was ischemic stroke (76.1%), followed by TIA (11.4%). The posterior circulation was affected alone in 37.8% of patients, the anterior circulation in 24.4% of patients, and in 37.8% of cases, posterior and anterior circulations were affected simultaneously. The most common affected vessels were middle cerebral artery-in 19 cases, basilar artery-in 17 cases, and anterior cerebral artery-in 16 cases. A good response to antibiotic treatment was achieved in the vast number of patients (75.3%). The overall mortality rate was 4.7%. CONCLUSION Cerebral vasculitis and stroke due to LNB should be considered, especially in patients who live in or have come from areas with high prevalence of tick-borne diseases, as well as in those without cardiovascular risk factors, but with stroke-like symptoms of unknown cause.
Collapse
Affiliation(s)
- Adam Garkowski
- Department of Radiology, Medical University of Białystok, Białystok, Poland
| | - Joanna Zajkowska
- Department of Infectious Diseases and Neuroinfections, Medical University of Białystok, Białystok, Poland
| | - Agata Zajkowska
- Department of Neurology, Medical University of Białystok, Białystok, Poland
| | - Alina Kułakowska
- Department of Neurology, Medical University of Białystok, Białystok, Poland
| | - Olga Zajkowska
- Faculty of Applied Informatics and Mathematics, Warsaw University of Life Sciences SGGW, Warsaw, Poland
| | - Bożena Kubas
- Independent Department, Laboratory of Molecular Imaging, Medical University of Białystok, Białystok, Poland
| | - Dorota Jurgilewicz
- Independent Department, Laboratory of Molecular Imaging, Medical University of Białystok, Białystok, Poland
| | - Marcin Hładuński
- Independent Department, Laboratory of Molecular Imaging, Medical University of Białystok, Białystok, Poland
| | - Urszula Łebkowska
- Department of Radiology, Medical University of Białystok, Białystok, Poland
| |
Collapse
|
47
|
Tamasauskiene L, Rastenyte D, Radisauskas R, Tamosiunas A, Tamasauskas D, Vaiciulis V, Kranciukaite-Butylkiniene D, Milinaviciene E. Relationship of meteorological factors and acute stroke events in Kaunas (Lithuania) in 2000-2010. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2017; 24:9286-9293. [PMID: 28229384 DOI: 10.1007/s11356-017-8590-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 02/06/2017] [Indexed: 06/06/2023]
Abstract
Some researchers have hypothesised that meteorological factors may have an impact on acute cerebrovascular diseases. The aim of this study was to determine an impact of some meteorological factors on occurrence of acute cerebrovascular events in the middle-aged Kaunas population. Kaunas stroke register data were used. Data on meteorological factors for the time period from 2000 to 2010 were obtained from the Lithuanian Hydrometeorological Service Kaunas Meteorological Station. We analysed 4038 cases with stroke. Ischemic strokes composed 80.4% and haemorrhagic strokes-19.6%. According to Poisson regression analysis, significant negative correlation between ischemic, haemorrhagic and all types of stroke and ambient air temperature was found (β coefficient - 0.007, -0.016, -0.009, p < 0.001, respectively). Results of ARIMA showed that ambient temperature of the day of stroke onset was associated with the occurrence of ischemic, haemorrhagic and all types of stroke: when temperature was lower, the risk of stroke was higher (-0.006, -0.003, -0.009, p < 0.001, respectively). Low temperature on the event day and 1 and 2 days before the event was associated with higher incidence of haemorrhagic stroke in women. Low ambient temperature on the event day increased incidence of haemorrhagic stroke in subjects 55-64 years. High wind speed on the event day was associated with higher incidence of ischemic stroke in older subjects. Meteorological factors may have some impact on the risk of acute cerebrovascular events. Health care providers should focus on preventive measures, which can reduce these risks.
Collapse
Affiliation(s)
- Laura Tamasauskiene
- Department of Immunology and Allergology, Lithuanian University of Health Sciences, Eiveniu Str. 2, LT-50009, Kaunas, Lithuania.
| | - Daiva Rastenyte
- Department of Neurology, Lithuanian University of Health Sciences, Eiveniu Str. 2, LT-50009, Kaunas, Lithuania
| | - Ricardas Radisauskas
- Institute of Cardiology, Lithuanian University of Health Sciences, Sukileliu Av. 15, LT-50161, Kaunas, Lithuania
- Department of Environmental and Occupational Medicine, Lithuanian University of Health Sciences, Tilzes Str. 18, LT-47181, Kaunas, Lithuania
| | - Abdonas Tamosiunas
- Institute of Cardiology, Lithuanian University of Health Sciences, Sukileliu Av. 15, LT-50161, Kaunas, Lithuania
| | - Domantas Tamasauskas
- Department of Neurosurgery, Lithuanian University of Health Sciences, Eiveniu Str. 2, LT-50009, Kaunas, Lithuania
| | - Vidmantas Vaiciulis
- Department of Environmental and Occupational Medicine, Lithuanian University of Health Sciences, Tilzes Str. 18, LT-47181, Kaunas, Lithuania
| | | | - Egle Milinaviciene
- Institute of Cardiology, Lithuanian University of Health Sciences, Sukileliu Av. 15, LT-50161, Kaunas, Lithuania
| |
Collapse
|
48
|
Schnitzer S, Deutschbein J, Nolte CH, Kohler M, Kuhlmey A, Schenk L. How does sex affect the care dependency risk one year after stroke? A study based on claims data from a German health insurance fund. Top Stroke Rehabil 2017; 24:415-421. [DOI: 10.1080/10749357.2017.1305645] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Susanne Schnitzer
- Department of Medical Sociology and Rehabilitation Science, Charité University Medical Center, Berlin, Germany
| | - Johannes Deutschbein
- Department of Medical Sociology and Rehabilitation Science, Charité University Medical Center, Berlin, Germany
| | - Christian H. Nolte
- Center for Stroke Research (CSB), Charité University Medical Center, Berlin, Germany
| | - Martin Kohler
- Central Research Institute of Ambulatory Health Care in Germany, Berlin, Germany
| | - Adelheid Kuhlmey
- Department of Medical Sociology and Rehabilitation Science, Charité University Medical Center, Berlin, Germany
| | - Liane Schenk
- Department of Medical Sociology and Rehabilitation Science, Charité University Medical Center, Berlin, Germany
| |
Collapse
|
49
|
Bender M, Jusufovic E, Railic V, Kelava S, Tinjak S, Dzevdetbegovic D, Mot D, Tresnjo M, Lakicevic S, Pejanovic-Skobic N, Sinanovic O. High Burden of Stroke Risk Factors in Developing Country: the Case Study of Bosnia-Herzegovina. Mater Sociomed 2017; 29:277-279. [PMID: 29284999 PMCID: PMC5723171 DOI: 10.5455/msm.2017.29.277-279] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Introduction: The burden of stroke has been increasing worldwide, especially in developing countries. Very few data regarding epidemiology of stroke are available in Bosnia and Herzegovina (BH). Patients and methods: We undertook a retrospective hospital-based study in all hospitals existing in five cantons and one district of BH. The patients were recruited between January 1st, 2014, and December 31st, 2014, and only first-ever-in-lifetime strokes (FES) were included for evaluation. Results: A FES was diagnosed in 1479 patients (age 71.83 ± 11.703 years) during the study period. FES occurred in 709 men (47.9%; age 69.64 ±12.002 years) and 770 women (52.1%; age 73.85± 11.051 years). Stroke was categorized into ischemic stroke (IS), primary intracerebral hemorrhage (PICH), subarachnoid hemorrhage (SAH) and cerebral venous thrombosis (CVT), which was diagnosed in 84%, 12,2%, 3,4% and 0,4% cases respectively. Early 28-day case-fatality was 18.5 % for all patients and both sexes combined. Short-term case-fatality was significantly greater in women (P=0.007). Among all patients with FES, 87% had hypertension, 35% diabetes mellitus, 39% hypercholesterolemia and almost 25 % atrial fibrillation. Discussion: This is the first study that provides us with information on epidemiology of stroke in BH. More than 90% of patients had one or more modifiable risk factors and the number would be even higher if we included smoking. The early stroke case-fatality was lower than that observed in other low- to middle-income countries. Conclusion: All modifiable stroke risk factors, especially high blood pressure, should be understood as a major public health problem in BH and efforts should be focused on the primary prevention of stroke. Our emphasis is on the designing of a stroke register in BH for a better health planning.
Collapse
Affiliation(s)
- Marija Bender
- University Clinical Hospital Mostar, Herzegovina-Neretva Canton, Bosnia and Herzegovina
| | - Edin Jusufovic
- University Clinical Hospital Tuzla, Tuzla Canton, Bosnia and Herzegovina
| | - Vesna Railic
- General Hospital Brčko, District Brčko, Bosnia and Herzegovina
| | - Sima Kelava
- County Hospital "Fra Mihovila Sučića", Herzeg-Bosnian Canton, Bosnia and Herzegovina
| | - Selma Tinjak
- County Hospital "Dr. Safet Mujić", Herzegovina-Neretva Canton, Bosnia and Herzegovina
| | | | - Dario Mot
- County Hospital Orašje, Posavina Canton, Bosnia and Herzegovina
| | - Mensuda Tresnjo
- General Hospital Konjic, Herzegovina-Neretva Canton, Bosnia and Herzegovina
| | - Sandra Lakicevic
- University Clinical Hospital Mostar, Herzegovina-Neretva Canton, Bosnia and Herzegovina
| | | | - Osman Sinanovic
- University Clinical Hospital Tuzla, Tuzla Canton, Bosnia and Herzegovina
| |
Collapse
|
50
|
Sedova P, Brown RD, Zvolsky M, Kadlecova P, Bryndziar T, Kubelka T, Weiss V, Volný O, Bednarik J, Mikulik R. Incidence of Hospitalized Stroke in the Czech Republic: The National Registry of Hospitalized Patients. J Stroke Cerebrovasc Dis 2016; 26:979-986. [PMID: 27955808 DOI: 10.1016/j.jstrokecerebrovasdis.2016.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 11/01/2016] [Accepted: 11/08/2016] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Contemporary stroke incidence data are not available in some countries and regions, including in Eastern Europe. Based on previous validation of the accuracy of the National Registry of Hospitalized Patients (NRHOSP), we report the incidence of hospitalized stroke in the Czech Republic (CR) using the NRHOSP. METHODS The results of the prior validation study assessing the accuracy of coding of stroke diagnoses in the NRHOSP were applied, and we calculated (1) the overall incidence of hospitalized stroke and (2) the incidence rates of hospitalized stroke for the three main stroke types: cerebral infarction (International Classification of Diseases Tenth Revision, CI I63), subarachnoid hemorrhage (SAH I60), and intracerebral hemorrhage (ICH I61). We calculated the average annual age- and sex-standardized incidence. RESULTS The overall incidence of hospitalized stroke was 241 out of 100,000 individuals. The incidence of hospitalized stroke for the main stroke types was 8.2 cases in SAH, 29.5 in ICH, and 211 in CI per 100,000 individuals. The standardized annual stroke incidence adjusted to the 2000 World Health Organization population for overall stroke incidence of hospitalized stroke was 131 per 100,000 individuals. Standardized stroke incidence for stroke subtypes was 5.7 cases in SAH, 16.7 in ICH, and 113 in CI per 100,000 individuals. CONCLUSIONS These studies provide an initial assessment of the burden of stroke in this part of the world. The estimates of hospitalized stroke in the CR and Eastern Europe suggest that ICH is about three times more common than SAH, and hemorrhagic stroke makes up about 18% of strokes.
Collapse
Affiliation(s)
- Petra Sedova
- Department of Neurology, Mayo Clinic, Rochester, New York; Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic; International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - Robert D Brown
- Department of Neurology, Mayo Clinic, Rochester, New York
| | - Miroslav Zvolsky
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Pavla Kadlecova
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - Tomas Bryndziar
- Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic; International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - Tomáš Kubelka
- Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic; International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - Viktor Weiss
- Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic; International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - Ondřej Volný
- Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic; International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - Josef Bednarik
- Department of Neurology, University Hospital Brno, and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Robert Mikulik
- Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic; International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic.
| |
Collapse
|