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Jacq G, Crepon B, Resche-Rigon M, Schenck M, Geeraerts T, Meziani F, Megarbane B, Chaffaut C, Cariou A, Legriel S. Clinician-Reported Physical and Cognitive Impairments After Convulsive Status Epilepticus: Post Hoc Study of a Randomized Controlled Trial. Neurocrit Care 2024; 40:495-505. [PMID: 37286846 DOI: 10.1007/s12028-023-01758-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/08/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Clinician-reported outcome (ClinRO) measures are emerging as useful contributors to assessments of treatment benefits. The objective of this study was to collect ClinRO measures of physical and cognitive impairments after convulsive status epilepticus (CSE) requiring intensive care unit admission. METHODS We conducted a post hoc analysis of the data from HYBERNATUS, a multicenter open-label controlled trial that randomized 270 critically ill patients with CSE requiring mechanical ventilation in 11 French intensive care units to therapeutic hypothermia (32-34 °C for 24 h) plus standard care or standard care alone. We included all patients who attended a day 90 in-person neurologist visit with measurement of the functional independence measure (FIM) score (range from 18 [total assistance] to 126 [total independence]), Mini-Mental State Examination (MMSE) score (range 0-30), and Glasgow outcome scale (GOS) score (1, death; 2, vegetative state; 3, severe disability; 4, moderate disability; and 5, mild or no disability). These three scores were compared across groups defined by several patient and CSE characteristics. RESULTS Of 229 patients with GOS scores ≥ 3 on day 90 (male sex, 58.2%; median age, 56 years [47-67]), 67 (29%) attended an in-person neurologist visit. Twenty-nine (43%) patients had a previous history of epilepsy, and 16 (24%) patients had a primary brain insult. CSE was refractory in 22 (33%) patients. On day 90 after CSE onset, median FIM and MMSE scores were 121 (112-125) and 26.0 (24.0-28.8), respectively. The GOS score was 3 in 16 (33.8%) patients, 4 in 9 (13.4%) patients, and 5 in 42 (62.7%) patients. Worse GOS score values were significantly associated with worse FIM and MMSE scores. CONCLUSIONS In patients attending the in-person neurologist visit on day 90 after CSE onset, ClinRO measures indicated that the main impairments were cognitive. FIM and MMSE scores were associated with GOS scores. Further studies are needed to evaluate the possible impact of neuroprotective and rehabilitation strategies on disability and cognitive impairments in survivors of CSE. Clinical trial registration NCT01359332.
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Affiliation(s)
- Gwenaëlle Jacq
- Intensive Care Department, Centre Hospitalier de Versailles - Site André Mignot, 177 Rue de Versailles, 78150, Le Chesnay Cedex, France.
- IctalGroup, Le Chesnay, France.
- CESP, Inserm, Université Paris-Saclay, UVSQ, 94807, Villejuif, France.
| | - Benoit Crepon
- Neurology Department, Centre Hospitalier de Versailles - Site André Mignot, 177 Rue de Versailles, 78150, Le Chesnay Cedex, France
| | - Matthieu Resche-Rigon
- SBIM Biostatistics and Medical Information, Assistance Publique-Hôpitaux de Paris, Saint Louis University Hospital, 1 Avenue Claude Vellefaux, Paris, France
- Université Paris Diderot, Paris, France
- ECSTRA Team (Epidémiologie Clinique et Statistiques Pour la Recherche en Santé), UMR 1153 INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Maleka Schenck
- Medical Intensive Care Unit, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Thomas Geeraerts
- Anesthesiology and Critical Care Department, Toulouse University Hospital, University Toulouse 3 Paul Sabatier, Toulouse, France
| | - Ferhat Meziani
- Medical Intensive Care Unit, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- EA 7293, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de Médecine, Université de Strasbourg, Strasbourg, France
| | - Bruno Megarbane
- Medical Intensive Care Unit, Lariboisière University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Cendrine Chaffaut
- SBIM Biostatistics and Medical Information, Assistance Publique-Hôpitaux de Paris, Saint Louis University Hospital, 1 Avenue Claude Vellefaux, Paris, France
- Université Paris Diderot, Paris, France
| | - Alain Cariou
- Medical Intensive Care Unit, Cochin University Hospital, Hôpitaux Universitaires-Paris Centre, Assistance Publique-Hôpitaux de Paris, Paris, France
- Sorbonne Paris Cité-Medical School, Paris Descartes University, Paris, France
- INSERM U970, Paris Cardiovascular Research Center, Paris, France
| | - Stephane Legriel
- Intensive Care Department, Centre Hospitalier de Versailles - Site André Mignot, 177 Rue de Versailles, 78150, Le Chesnay Cedex, France
- IctalGroup, Le Chesnay, France
- CESP, Inserm, Université Paris-Saclay, UVSQ, 94807, Villejuif, France
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Saverino A, Sonabend R, Wong S, Symeon C. The Wolfson Assessment Matrix: a potential tool to support clinicians in establishing access to specialized neuro rehabilitation by capturing important prognostic factors. Sharing more equitable and transparent criteria. Eur J Phys Rehabil Med 2022; 58:161-170. [PMID: 34823336 PMCID: PMC9981235 DOI: 10.23736/s1973-9087.21.07022-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Specialized Rehabilitation Services (SRSs) are designed to offer intensive multidisciplinary rehabilitation to patients with complex needs, who are expected to make significant functional gains in their ADLs over a relatively limited period of time. Although national guidelines offer a guidance on how to band patients by complexity, there is no consensus on how to screen patients with regard to rehabilitation prognosis. AIM The aim of this study was to improve the selection of patients admitted to an SRS, defining transparent and equitable prognostic criteria to guide clinicians' decision making. DESIGN This is a retrospective observational study SETTING: an SRS in the UK. POPULATION We included 121 patients affected by a neurological condition consecutively admitted for multidisciplinary rehabilitation. METHODS Rehabilitation Complexity Scale Extended is used to describe rehabilitation complexity. A short list of potential barriers to rehabilitation was analysed to predict the functional outcome measured by the Functional Independent Measure and the Barthel Index. RESULTS Older age, a heavier burden of co-morbidities, pre-morbid cognitive difficulties or dementia and a lower function level at admission were the most important variables to predict a lower functional gain. CONCLUSIONS We have used this list of barriers to create the Wolfson Assessment Matrix as a potential support tool to guide clinicians navigating through the different rehabilitation service options when assessing complex patients for eligibility to an SRS. CLINICAL REHABILITATION IMPACT SRSs are highly expensive services representing a possible step along the rehabilitation pathway for patients with complex needs. A tool such as the Wolfson Assessment Matrix would represent a step forward to help consistency in decision making regarding appropriateness for SRSs. It would also help to set realistic long-term goals with patients and families and support Health Services in the further development of alternative rehabilitation settings.
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Affiliation(s)
- Alessia Saverino
- Wolfson Neuro Rehabilitation Center, St George's Hospital, London, UK - .,Maugeri Clinical Scientific Institute, Genoa, Italy -
| | - Raphael Sonabend
- Department of Statistical Science, University College London, London, UK
| | - Sancho Wong
- Wolfson Neuro Rehabilitation Center, St George's Hospital, London, UK
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Afshar S, Akbarfahimi N, Rassafiani M, Vahedi M, Azimian M, Pashang S, Etemadifar M. Validity and reliability of Persian version of the Arm Function in Multiple Sclerosis Questionnaire. Br J Occup Ther 2021. [DOI: 10.1177/03080226211008710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction This study aimed to determine the validity and reliability of the Persian version of the Arm Function in Multiple Sclerosis Questionnaire which is a self-report questionnaire for persons with multiple sclerosis (MS). Method This methodological study was performed in the following stages: translation, validity, internal consistency, and test–retest reliability of Persian-AMSQ. The Nine-Hole Peg Test (9HPT), Coin Rotation Task (CRT), and Functional Independence Measure (FIM) for construct validity were used. Psychometric testing was done to ascertain the validity and reliability of the questionnaire. Results In this study, 155 people with MS participated. There were no major linguistic or cultural difficulties in the translation of AMSQ. Face and content validity confirmed by experts and people with MS. The internal consistency was high (Cronbach’s α = 0.99). Test–retest reliability, as measured with intra-class coefficient, was 0.98. Correlations with 9HPT (r = 0.54), CRT (r = 0.16), and FIM (r = −0.54) were significant ( p < 0.05). Conclusion The Persian-AMSQ appears to be a valid and reliable questionnaire for measuring upper extremity dysfunction in MS.
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Affiliation(s)
- Sara Afshar
- Department of Occupational Therapy, School of Rehabilitation, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Nazila Akbarfahimi
- Department of Occupational Therapy, School of Rehabilitation, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mehdi Rassafiani
- Department of Occupational Therapy, Faculty of Allied Health Sciences, Kuwait University, Kuwait
- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohsen Vahedi
- Department of Biostatistics and Epidemiology, School of Rehabilitation, University of Social Welfare and Rehabilitation Science, Tehran, Iran
| | - Mojtaba Azimian
- MS Clinic, Rofeideh Hospital, University of Social Welfare and Rehabilitation Science, Tehran, Iran
| | | | - Masoud Etemadifar
- Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran
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Effects of a Music-Based Rhythmic Auditory Stimulation on Gait and Balance in Subacute Stroke. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042032. [PMID: 33669715 PMCID: PMC7923168 DOI: 10.3390/ijerph18042032] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 12/19/2022]
Abstract
Gait and balance impairments are common after stroke. This study aimed to evaluate the effect of a music-based rhythmic auditory stimulation (RAS) in combination with conventional physiotherapy on gait parameters and walking ability in subacute stroke. This single-blind, historical controlled trial, included 55 patients who had suffered a stroke within the three weeks prior to enrolment. Patients from 2018 (n = 27) were assigned as the historical control group whereas 2019 patients (n = 28) received music-based RAS three times a week. Both groups received 11 h of conventional physiotherapy per week during hospitalization. Primary outcomes were gait and balance parameters (Tinetti test and Timed Up&Go test) and walking ability (Functional Ambulation Category scale). Secondary outcomes were trunk control, assistive devices, functional independence (Functional Independence Measure, Barthel index), and stroke severity and disability (modified Rankin scale, National Institutes of Health Stroke Scale). Results: No between-group differences were identified for gait and balance parameters nor for secondary outcomes. Significant between-group differences were observed in the Functional Ambulation Category: the intervention group (Δmean ± SD; 3.43 ± 1.17) showed greater improvement (p = 0.002) than the control group (Δmean ± SD; 2.48 ± 1.09). Compared with conventional physiotherapy alone, our results suggest that the walking ability of subacute stroke patients might be improved with music-based RAS combined with conventional physiotherapy, but this treatment is not more effective than conventional physiotherapy in obtaining gait and balance gains.
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D'Andrea A, Le Peillet D, Fassier T, Prendki V, Trombert V, Reny JL, Roux X. Functional Independence Measure score is associated with mortality in critically ill elderly patients admitted to an intermediate care unit. BMC Geriatr 2020; 20:334. [PMID: 32907534 PMCID: PMC7488031 DOI: 10.1186/s12877-020-01729-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 08/23/2020] [Indexed: 11/11/2022] Open
Abstract
Background Age alone is not a robust predictor of mortality in critically ill elderly patients. Chronic health status and functional status before admission could be better predictors. This study aimed to determine whether functional status, assessed using the Functional Independence Measure (FIM), could be an independent predictor of mortality in a geriatric population admitted to an intermediate care unit (IMCU). Methods A monocentric, retrospective, observational study of all patients aged ≥75 years old admitted to Geneva University Hospitals’ geriatric IMCU between 01.01.2012 and 31.05.2016. The study’s primary outcome metrics were one-year mortality’s associations with a pre-admission FIM score and other relevant prospectively recorded prognostic variables. Results A total of 345 patients were included (56% female, mean age 85 +/− 6.5 years). Mean FIM score was 66 +/− 26. One-year mortality was 57%. Dichotomized low (≤ 63) and high FIM (> 63) scores were associated with one-year mortalities of 68 and 44%, respectively. Logistic regression calculations found an association between pre-admission FIM score and one-year mortality (p < 0.0001), including variables usually associated with mortality (e.g., age, sex, comorbidities, mini-mental health state score, renal function). Multivariate survival analysis showed a significant difference between groups, with a hazard ratio of 0.29 (95% CI: 0.13–0.65) for patients with high FIM scores. Conclusions In the present study, higher functional status, assessed using the FIM tool before admission to an IMCU, was significantly and independently associated with lower one-year mortality. This opens up perspectives on the potential value of FIM for establishing a finer prognosis and better triage of critically ill older patients.
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Affiliation(s)
- A D'Andrea
- Division of anesthesiology, Département of anesthesiology, Hospital Riviera Chablais, Vaud Valais, Rennaz, Switzerland
| | - D Le Peillet
- Divison of Internal Medecine of the Aged, Departement of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
| | - T Fassier
- Divison of Internal Medecine of the Aged, Departement of Rehabilitation and Geriatrics, Geneva University Hospitals & Interprofessionnal Simulation Center, Geneva, Switzerland
| | - V Prendki
- Divison of Internal Medecine of the Aged, Departement of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
| | - V Trombert
- Divison of Internal Medecine of the Aged, Departement of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
| | - J-L Reny
- Divison of Internal Medecine of the Aged, Departement of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
| | - X Roux
- Divison of Internal Medecine of the Aged, Departement of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland.
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Shirahama K, Fudano Y, Imai K, Kawabata A, Mihara N, Yasuda T. The role of the functional independence measure score in predicting the home discharge of inpatients with cerebrovascular diseases in convalescent rehabilitation wards. J Phys Ther Sci 2020; 32:385-390. [PMID: 32581430 PMCID: PMC7276776 DOI: 10.1589/jpts.32.385] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 03/24/2020] [Indexed: 11/30/2022] Open
Abstract
[Purpose] To clarify the cutoff point of the Functional Independence Measure tool for
predicting home discharge of patients in convalescent rehabilitation wards. [Participants
and Methods] This retrospective observational study analyzed the data of 91 inpatients
with cerebrovascular disease who received rehabilitation treatment at a convalescent
rehabilitation ward. We categorized the participants into two groups: the home-discharged
group and the non-home discharged group. We divided the outcome parameters in the two
groups into different categories and compared them using the Mann-Whitney U test. To
identify the relevant cutoff points in a clinical setting, we applied the receiver
operating characteristic curve. [Results] In patients with cerebrovascular disease, the
Functional Independence Measure motor, cognitive, and total scores were significantly
higher in the home-discharged group than in the non-home discharged group. We
statistically calculated the Functional Independence Measure motor score cutoff point that
can predict home discharge, and the predicted Functional Independence Measure motor score
at the time of hospitalization was 53.5–60.0 points. [Conclusion] It is important to start
rehabilitation at an early stage and increase the amount of training to increase the
likelihood of returning home.
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Affiliation(s)
- Kunji Shirahama
- Division of Occupational Therapy, School of Rehabilitation, Kanagawa University of Human Services: 1-10-1 Heiseicho, Yokosuka 238-8522, Japan
| | | | | | | | | | - Tomonori Yasuda
- Division of Occupational Therapy, School of Rehabilitation, Kumamoto Health Science University, Japan
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Zarshenas S, Colantonio A, Horn SD, Jaglal S, Jacob B, Cullen N. Occupational and Physical Therapy Activities and Level of Effort in Patients With Traumatic Brain Injury: Association With Functional Outcomes. PM R 2019; 12:339-348. [PMID: 31600430 DOI: 10.1002/pmrj.12260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 09/17/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Although some attention has been given to the association of functional outcomes with rehabilitation intensity, the evidence is still sparse in this field. OBJECTIVE To investigate the effect of inpatient rehabilitation (IR) on discharge cognitive and motor function and the association of time spent in occupational and physical therapy and level of effort with cognitive and motor function in patients with traumatic brain injury (TBI). DESIGN Secondary analysis of TBI-Practice Based Evidence dataset. SETTINGS Inpatient rehabilitation. PARTICIPANTS One hundred forty-nine patients with TBI who were consecutively admitted for IR between 2008 and 2011 in Ontario, Canada. INTERVENTIONS Not applicable. MAIN OUTCOME MEASUREMENTS Admission and discharge Functional Independence Measure-Rasch Cognitive and Motor Scores. RESULTS Patients showed significant improvement in cognitive and motor function from admission to discharge (P < .0001). After controlling for confounding factors, discharge FIM-Rasch cognitive and motor scores were not associated with either level of effort or time spent in physical therapy activities. Discharge motor, but not cognitive function, was associated with more time spent in the complex (β = 0.20, confidence interval [CI] 0.005, 0.05) and less time spent in simple OT activities (β = -0.13, CI -0.13, -0.01). CONCLUSION This study provides valuable information for clinicians about the effectiveness of IR on the improvement of motor and cognitive outcomes and the importance of considering the amount of time spent in activities based on their level of complexity rather than the total time of therapy to improve motor outcomes in this population. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Sareh Zarshenas
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,University Health Network, Toronto Rehabilitation Institute, University Centre, Toronto, Canada
| | - Angela Colantonio
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,University Health Network, Toronto Rehabilitation Institute, University Centre, Toronto, Canada.,Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Susan D Horn
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake, UT
| | - Susan Jaglal
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,University Health Network, Toronto Rehabilitation Institute, University Centre, Toronto, Canada
| | - Binu Jacob
- University Health Network, Toronto Rehabilitation Institute, University Centre, Toronto, Canada
| | - Nora Cullen
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,University Health Network, Toronto Rehabilitation Institute, University Centre, Toronto, Canada
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Huang X, Wan M, Yang Q, Ding X, Zhou Z. The stromal cell-derived factor-1 α (SDF-1α)/cysteine-X-cysteine chemokine receptor 4 (CXCR4) axis: a possible prognostic indicator of acute ischemic stroke. J Int Med Res 2019; 47:1897-1907. [PMID: 30760134 PMCID: PMC6567759 DOI: 10.1177/0300060519827173] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Objective The stromal cell-derived factor-1α/cysteine-X-cysteine chemokine receptor 4 (SDF-1α/CXCR4) axis promotes neuroprotection and angiogenesis in animal studies. Few studies have investigated the potential clinical implications of the SDF-1α/CXCR4 axis in patients with acute ischemic stroke (AIS). We evaluated the prognostic values of the SDF-1α/CXCR4 axis in patients with proximal middle cerebral artery occlusion. Methods Fifty-five patients and 18 age- and sex-matched volunteers were enrolled. Baseline clinical characteristics and risk factors of stroke were recorded. Peripheral whole blood cells were double stained with anti-CD34 and anti-CXCR4 (CD184). CD34+CXCR4+ cells were analyzed by flow cytometry. Plasma SDF-1α levels were measured by enzyme-linked immunosorbent assay. Results In the AIS group, plasma SDF-1α levels and the number of circulating CD34+CXCR4+ cells were significantly higher than those in controls. Day 1 SDF-1α levels were negatively correlated with infarct volume (r = −0.521) and the initial National Institutes of Health Stroke Scale score (r = −0.489). SDF-1α levels (day 1: r = −0.514; day 3: r = −0.275; day 7: r = −0.375) and circulating CD34+CXCR4+ cells (day 7: r = −0.282) were inversely associated with the 90-day modified Rankin Scale score. Conclusion The SDF-1α/CXCR4 axis has potential applications for predicting the clinical outcome of AIS.
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Affiliation(s)
- Xianjun Huang
- 1 Department of Neurology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui Province, China
| | - Mei Wan
- 2 Department of Neurology, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Huangshi, Hubei Province, China
| | - Qian Yang
- 1 Department of Neurology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui Province, China
| | - Xianhui Ding
- 1 Department of Neurology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui Province, China
| | - Zhiming Zhou
- 1 Department of Neurology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui Province, China
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