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Nakamura H, Hiu T, Yamamoto Y, Oda S, Izumo T, Matsuo T. Current status of stroke in hemodialysis patients on a remote island. PLoS One 2023; 18:e0288731. [PMID: 37682834 PMCID: PMC10490869 DOI: 10.1371/journal.pone.0288731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/03/2023] [Indexed: 09/10/2023] Open
Abstract
OBJECTIVES Hemodialysis patients have a higher incidence of stroke than healthy individuals. Hemodialysis patients living on remote islands are subject to additional distance and transportation difficulties. Therefore, we aimed to study the association between stroke and hemodialysis in patients living on remote islands. MATERIALS AND METHODS We conducted a retrospective cohort study based on the medical records of maintenance hemodialysis patients in Shinkamigoto-Cho, Nagasaki, Japan, between June 1, 2005, and June 31, 2022. The clinical characteristics, probability of hemorrhagic stroke, acute ischemic stroke-free rate, and survival probability with or without a history of anticoagulant/antiplatelet use were evaluated. The survival probability among the hemorrhagic stroke, acute ischemic stroke, and non-stroke groups was also evaluated. RESULTS This study involved 142 patients. Nine patients (6.3%) had intracerebral hemorrhage, one (0.7%) had subarachnoid hemorrhage, eight (5.6%) had acute ischemic stroke, and 124 (87.3%) had no stroke. The number of patients with severe disabilities (modified Rankin Scale 5/6) was significantly higher in the hemorrhagic stroke group. The probability of hemorrhagic stroke and acute ischemic stroke-free rate, or survival probability with or without a history of anticoagulant/antiplatelet use, were not significantly different. The acute ischemic stroke group was not associated with a lower survival probability than the other groups. The hemorrhagic stroke group had a significantly lower survival probability than the acute ischemic stroke group. CONCLUSIONS This is the first study to report the status of stroke in hemodialysis patients living on remote islands, thus providing valuable information for improved stroke management in such patients.
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Affiliation(s)
- Hikaru Nakamura
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Department of Internal Medicine, Nagasaki Kamigoto Hospital, Nagasaki, Japan
| | - Takeshi Hiu
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yasuhito Yamamoto
- Department of Internal Medicine, Nagasaki Kamigoto Hospital, Nagasaki, Japan
| | - Shinya Oda
- Department of Internal Medicine, Nagasaki Kamigoto Hospital, Nagasaki, Japan
| | - Tsuyoshi Izumo
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takayuki Matsuo
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Katsuki M, Kawahara J, Senda H, Yamagishi C, Mizusawa S, Ueki Y, Kawamura S, Kashiwagi K, Koh A, Hashiba R, Ono A, Watabe Y, Ando K, Kikuchi B, Yamashita S, Yamagishi F. School-Based Stroke Education Through On-Demand E-learning During Coronavirus Disease 2019 Pandemic: Itoigawa Stroke Awareness Campaign. Cureus 2023; 15:e37380. [PMID: 37181977 PMCID: PMC10171239 DOI: 10.7759/cureus.37380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2023] [Indexed: 05/16/2023] Open
Abstract
Introduction Raising stroke awareness is important to shorten the interval from onset to consultation. We performed a school-based stroke education by on-demand e-learning during the coronavirus disease 2019 pandemic. Methods We performed on-demand e-learning and distributed the online- and paper-based manga about stroke for students and parental guardians in August 2021. We carried out this in a manner similar to the prior effective online stroke awareness initiatives in Japan. An online post-educational survey in October 2021 was conducted to evaluate the awareness effects by asking participants about their knowledge. We also investigated the modified Rankin Scale (mRS) at the discharge of stroke patients who were treated in our hospital during the before- and after-campaign periods, respectively. Results We distributed the paper-based manga and asked to work on this campaign to all 2,429 students (1,545 elementary school and 884 junior high school students) who lived in Itoigawa. We acquired 261 (10.7%) online responses from the students and 211 (8.7%) responses from their parental guardians. The number of students who chose all correct answers in the survey significantly increased after the campaign (205/261, 78.5%) compared to that before the campaign (135/261, 51.7%) and those of parental guardians showed similar trends (before campaign 93/211, 44.1%; after campaign 198/211, 93.8%). We investigated 282 stroke patients (90 patients before and 192 patients after-campaign period), and their mRS at discharge after-campaign seemed to be improved. Conclusion Only 10.7% of students and 8.7% of the parental guardians worked on the online survey. However, the number of those who chose correct answers about stroke increased after the campaign. After this campaign, the mRS of stroke patients at discharge improved although it was unclear if this is a direct result of this activity.
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Affiliation(s)
- Masahito Katsuki
- Department of Neurosurgery, Itoigawa General Hospital, Itoigawa, JPN
| | - Junko Kawahara
- Department of Health Promotion, Itoigawa City Servant Service, Itoigawa, JPN
| | - Hiroyuki Senda
- Department of Fire, Itoigawa City Servant Service, Itoigawa, JPN
| | - Chinami Yamagishi
- Department of Health Promotion, Itoigawa City Servant Service, Itoigawa, JPN
| | - Satoshi Mizusawa
- Board of Education, Itoigawa City Servant Service, Itoigawa, JPN
| | - Yasuhide Ueki
- Board of Education, Itoigawa City Servant Service, Itoigawa, JPN
| | - Shin Kawamura
- Department of Neurosurgery, Itoigawa General Hospital, Itoigawa, JPN
| | - Kenta Kashiwagi
- Department of Neurology, Itoigawa General Hospital, Itoigawa, JPN
| | - Akihito Koh
- Department of Neurosurgery, Itoigawa General Hospital, Itoigawa, JPN
| | - Rie Hashiba
- Department of Neurosurgery, Itoigawa General Hospital, Itoigawa, JPN
| | - Atsuko Ono
- Department of Neurosurgery, Itoigawa General Hospital, Itoigawa, JPN
| | - Yuki Watabe
- Department of Neurosurgery, Niigata Prefectural Central Hospital, Joetsu, JPN
| | - Kazuhiro Ando
- Department of Neurosurgery, Niigata Prefectural Central Hospital, Joetsu, JPN
| | - Bumpei Kikuchi
- Department of Neurosurgery, Niigata Prefectural Central Hospital, Joetsu, JPN
| | - Shinya Yamashita
- Department of Neurosurgery, Niigata Prefectural Central Hospital, Joetsu, JPN
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Florez-Perdomo WA, Garcia-Ballestas E, Konar SK, Ramos-Gomez L, Al-Mufti F, Sursal T, Munakomi S, Agrawal A, Moscote-Salazar LR. Effect of Helicopter Transportation of Acute Ischemic Stroke Patients on Mortality and Functional Outcomes: A Systematic Review and Meta-Analysis. Air Med J 2022; 41:476-483. [PMID: 36153146 DOI: 10.1016/j.amj.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 06/07/2022] [Accepted: 07/15/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The "time is brain" concept denotes the importance of the expedited transfer of patients to stroke care centers. Helicopter emergency medical services (HEMS) can reduce the time to definitive care, which could improve neurologic prognosis and reduce mortality. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, a search for randomized controlled trials, nonrandomized controlled trials, and prospective and retrospective cohort studies was performed through specific databases from inception to February 2020. Helicopter, acute stroke, and their synonyms (according to Medical Subject Headings) were included in this search. The Newcastle-Ottawa Scale was used to assess the quality of the included studies, and the Egger test was used to assess for publication bias. RESULTS A total of 8 studies matched the inclusion criteria and were included for meta-analysis. The overall number recruited for helicopter transportation was 1,372, and for emergency standard transportation, it was 8,587. The association among HEMS and mortality was not statistically significant (odds ratio [OR] = 0.7; 95% confidence interval [CI], 0.60-1.06; P = .12). There was a significant association between good outcomes and HEMS (OR = 2; 95% CI, 1.79-2.34; P ≤ .001), and the overall poor neurologic outcome was reduced (OR = 0.52; 95% CI, 0.46-0.60; P ≤ .001). CONCLUSION A good neurologic outcome was higher with HEMS compared with emergency standard transportation. The mortality rate was less in the emergency standard transportation group after pooled analysis but was not significant; the reduction in a poor outcome was statistically significant.
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Affiliation(s)
| | - Ezequiel Garcia-Ballestas
- Latinoamerican Council of Neurocritical Care, Cartagena, Colombia; Center of Biomedical Research. Faculty of Medicine, University of Cartagena, Cartagena, Colombia.
| | - Subhas K Konar
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Lucia Ramos-Gomez
- Industrial Engineering School, El Sinu University, Cartagena, Colombia
| | - Fawaz Al-Mufti
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY
| | - Tolga Sursal
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY
| | - Sunil Munakomi
- Department of Neurosurgery, Kathmandu University, Kathmandu, Nepal
| | - Amit Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, Saket Nagar, Bhopal, India
| | - Luis Rafael Moscote-Salazar
- Latinoamerican Council of Neurocritical Care, Cartagena, Colombia; Center of Biomedical Research. Faculty of Medicine, University of Cartagena, Cartagena, Colombia
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Ochiai H, Kanemaru K, Matsuda S, Ohta H. A case of acute cerebral infarction with a favorable prognosis after rt-PA administration by a general physician with telestroke support. J Rural Med 2021; 16:119-122. [PMID: 33833839 PMCID: PMC8016670 DOI: 10.2185/jrm.2020-048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/28/2020] [Indexed: 11/27/2022] Open
Abstract
Objective: Herein, we report a patient with acute cerebral infarction with a
favorable prognosis after being managed by a general physician with support from the
telestroke program. Patient and Methods: An 85-year-old man was transferred to a regional
hospital due to sudden onset of dysarthria and left hemiparesis. As no neurosurgeons or
neurologists were available in that hospital or area, the patient was examined by a
general physician who diagnosed him with cardioembolic stroke on the left middle cerebral
artery territory. The physician consulted a stroke specialist using the telestroke system;
with the support from the telestroke program, the physician administered thrombolytic
therapy 4 hours and 10 minutes after the onset of symptoms. Results: The patient’s National Institutes of Health Stroke Scale score
improved from 9 to 3 and he was subsequently transferred to the stroke center. However,
the occluded left middle cerebral artery had already re-canalized. His hemiparesis
completely improved one week after the onset. Conclusion: A telemedicine system for general physicians is indispensable in
areas without accessible stroke specialists as it provides access to a standard of care
for hyper-acute stroke patient assessment and management, and helps improve
neuroprognosis.
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Affiliation(s)
- Hidenobu Ochiai
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Miyazaki, Japan
| | - Katsuhiro Kanemaru
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Miyazaki, Japan
| | - Shuntaro Matsuda
- Department of Internal Medicine, Kushima Municipal Hospital, Japan
| | - Hajime Ohta
- Department of Neurosurgery, Faculty of Medicine, University of Miyazaki, Japan
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Hiu T, Morimoto S, Matsuo A, Satoh K, Otsuka H, Kutsuna F, Ozono K, Hirayama K, Nakamichi C, Yamasaki K, Ogawa Y, Shiozaki E, Morofuji Y, Kawahara I, Horie N, Tateishi Y, Ono T, Haraguchi W, Izumo T, Tsujino A, Matsuo T, Tsutsumi K. Current status of a helicopter transportation system on remote islands for patients undergoing mechanical thrombectomy. PLoS One 2021; 16:e0245082. [PMID: 33465116 PMCID: PMC7815141 DOI: 10.1371/journal.pone.0245082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 12/21/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Mechanical thrombectomy (MT) is standard treatment for acute ischemic stroke (AIS) with large-vessel occlusion within 6 h of symptom onset to treatment initiation (OTP). Recent trials have extended the therapeutic time window for MT to within 24 h. However, MT treatment remains low in remote areas. Nagasaki Prefecture, Japan has many inhabited islands with no neurointerventionalists. Our hospital on the mainland is a regional hub for eight island hospitals. We evaluated clinical outcomes of MT for patients with AIS on these islands versus on the mainland. METHODS During 2014-2019, we reviewed consecutive patients with AIS who received MT at our hospital. Patients comprised the Islands group and Mainland group. Patient characteristics and clinical outcomes were compared between groups. RESULTS We included 91 patients (Islands group: 15 patients, Mainland group: 76 patients). Seven patients (46.7%) in the Islands group versus 43 (56.6%) in the Mainland group achieved favorable outcomes. Successful recanalization was obtained in 11 patients (73.3%) on the islands and 67 (88.2%) on the mainland. The median OTP time in the Islands was 365 min. In both the Islands and Mainland groups, the OTP time and successful recanalization were associated with functional outcome. The modified Rankin Scale (mRS) score at 90 days ≤2 was obtained in two patients and mRS = 3 in four patients among eight patients with OTP time >6 h. CONCLUSIONS Few patients with AIS on remote islands have received MT. Although patients who underwent MT on the islands had longer OTP, the clinical outcomes were acceptable. OTP time on remote islands must be shortened, as this is related to functional outcome. In some cases with successful recanalization, a favorable outcome can still be obtained even after 6 h. Even if OTP exceeds 6 h, it is desirable to appropriately select patients and actively perform MT.
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Affiliation(s)
- Takeshi Hiu
- Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- * E-mail:
| | - Shimpei Morimoto
- Innovation Platform & Office for Precision Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Clinical Research Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Ayaka Matsuo
- Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Kei Satoh
- Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Hiroaki Otsuka
- Department of Neurology, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Fumiya Kutsuna
- Department of Neurology, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Keisuke Ozono
- Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Kosuke Hirayama
- Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Chikaaki Nakamichi
- Department of Emergency, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Kazumi Yamasaki
- Clinical Research Center, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Yuka Ogawa
- Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Eri Shiozaki
- Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Yoichi Morofuji
- Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Ichiro Kawahara
- Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Nobutaka Horie
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yohei Tateishi
- Department of Neurology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tomonori Ono
- Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Wataru Haraguchi
- Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Tsuyoshi Izumo
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Akira Tsujino
- Department of Neurology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takayuki Matsuo
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Keisuke Tsutsumi
- Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
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Wakuta N, Yamamoto S, Adachi S, Motonaga E. Toward Inter-isolated Island Cooperation for the Drip, Ship, and Retrieve Method in the Sakishima Islands: A Case Report. JOURNAL OF NEUROENDOVASCULAR THERAPY 2020; 14:263-267. [PMID: 37502616 PMCID: PMC10370518 DOI: 10.5797/jnet.cr.2020-0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 03/13/2020] [Indexed: 07/29/2023]
Abstract
Objective Based on the findings of preferable outcomes from recanalization therapy in recent studies, regional partnerships for the endovascular treatment of acute ischemic stroke are being promoted. However, reports of inter-island cooperation between remote islands located far from high-volume centers on the mainland are rare. Case Presentation A 63-year-old man experienced an acute ischemic stroke on a small, isolated island in Okinawa, Japan. He was transferred by helicopter to the primary emergency hospital on Ishigaki Island, which was the nearest island on which he could be administered recombinant tissue plasminogen activator (rtPA). After this, he was carried again by helicopter and ambulance to the primary stroke center on Miyako Island using the drip and ship method. Mechanical thrombectomy with a stent retriever achieved recanalization of the occluded major vessels and improved the neurological disturbance. The patient became neurologically independent and could be discharged only 11 days after onset. Conclusion Building a local area network that includes hospitals providing mechanical thrombectomy is a meaningful approach to treating acute ischemic stroke occurring on isolated islands. It is necessary to recognize the specific restrictions imposed by helicopter transportation and to make efforts to shorten the time required for key processes to provide faster treatment.
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Affiliation(s)
- Naoki Wakuta
- Department of Neurosurgery, Okinawa Miyako Hospital, Miyakojima, Okinawa, Japan
- Department of Neurosurgery, Fukuoka University Hospital; School of Medicine, Fukuoka University, Fukuoka, Fukuoka, Japan
| | - Satoshi Yamamoto
- Department of Neurosurgery, Okinawa Miyako Hospital, Miyakojima, Okinawa, Japan
| | - Shinobu Adachi
- Department of Neurosurgery, Okinawa Yaeyama Hospital, Ishigaki, Okinawa, Japan
| | - Eiji Motonaga
- Department of Rehabilitation, Internal Medicine, and Family Medicine, Okinawa Miyako Hospital, Miyakojima, Okinawa, Japan
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