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Kumar A, Witsch J, Frontera J, Qureshi AI, Oermann E, Yaghi S, Melmed KR. Predicting hematoma expansion using machine learning: An exploratory analysis of the ATACH 2 trial. J Neurol Sci 2024; 461:123048. [PMID: 38749281 DOI: 10.1016/j.jns.2024.123048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 05/07/2024] [Accepted: 05/10/2024] [Indexed: 06/13/2024]
Abstract
INTRODUCTION Hematoma expansion (HE) in patients with intracerebral hemorrhage (ICH) is a key predictor of poor prognosis and potentially amenable to treatment. This study aimed to build a classification model to predict HE in patients with ICH using deep learning algorithms without using advanced radiological features. METHODS Data from the ATACH-2 trial (Antihypertensive Treatment of Acute Cerebral Hemorrhage) was utilized. Variables included in the models were chosen as per literature consensus on salient variables associated with HE. HE was defined as increase in either >33% or 6 mL in hematoma volume in the first 24 h. Multiple machine learning algorithms were employed using iterative feature selection and outcome balancing methods. 70% of patients were used for training and 30% for internal validation. We compared the ML models to a logistic regression model and calculated AUC, accuracy, sensitivity and specificity for the internal validation models respective models. RESULTS Among 1000 patients included in the ATACH-2 trial, 924 had the complete parameters which were included in the analytical cohort. The median [interquartile range (IQR)] initial hematoma volume was 9.93.mm3 [5.03-18.17] and 25.2% had HE. The best performing model across all feature selection groups and sampling cohorts was using an artificial neural network (ANN) for HE in the testing cohort with AUC 0.702 [95% CI, 0.631-0.774] with 8 hidden layer nodes The traditional logistic regression yielded AUC 0.658 [95% CI, 0.641-0.675]. All other models performed with less accuracy and lower AUC. Initial hematoma volume, time to initial CT head, and initial SBP emerged as most relevant variables across all best performing models. CONCLUSION We developed multiple ML algorithms to predict HE with the ANN classifying the best without advanced radiographic features, although the AUC was only modestly better than other models. A larger, more heterogenous dataset is needed to further build and better generalize the models.
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Affiliation(s)
- Arooshi Kumar
- Rush University Medical Center, Department of Neurology, Chicago, IL 60612, United States of America.
| | - Jens Witsch
- Hospital of the University of Pennsylvania, Department of Neurology, Philadelphia, PA 19104, United States of America
| | - Jennifer Frontera
- NYU Langone Medical Center, Department of Neurology, New York, NY 10016, United States of America
| | - Adnan I Qureshi
- Zeenat Qureshi Stroke Institutes and Department of Neurology, University of Missouri, Columbia, MO 65201, United States of America
| | - Eric Oermann
- NYU Langone Medical Center, Department of Neurology, New York, NY 10016, United States of America
| | - Shadi Yaghi
- Warren Alpert Medical School of Brown University, Department of Neurology, Providence, RI 02903, United States of America
| | - Kara R Melmed
- NYU Langone Medical Center, Department of Neurology, New York, NY 10016, United States of America; NYU Langone Medical Center, Department of Neurosurgery, New York, NY 10016, United States of America
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Liu Y, Zhao F, Niu E, Chen L. Machine learning for predicting hematoma expansion in spontaneous intracerebral hemorrhage: a systematic review and meta-analysis. Neuroradiology 2024:10.1007/s00234-024-03399-8. [PMID: 38862772 DOI: 10.1007/s00234-024-03399-8] [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: 12/04/2023] [Accepted: 06/06/2024] [Indexed: 06/13/2024]
Abstract
PURPOSE Early identification of hematoma enlargement and persistent hematoma expansion (HE) in patients with cerebral hemorrhage is increasingly crucial for determining clinical treatments. However, due to the lack of clinically effective tools, radiomics has been gradually introduced into the early identification of hematoma enlargement. Though, radiomics has limited predictive accuracy due to variations in procedures. Therefore, we conducted a systematic review and meta-analysis to explore the value of radiomics in the early detection of HE in patients with cerebral hemorrhage. METHODS Eligible studies were systematically searched in PubMed, Embase, Cochrane and Web of Science from inception to April 8, 2024. English articles are considered eligible. The radiomics quality scoring (RQS) tool was used to evaluate included studies. RESULTS A total of 34 studies were identified with sample sizes ranging from 108 to 3016. Eleven types of models were involved, and the types of modeling contained mainly clinical, radiomic, and radiomic plus clinical features. The radiomics models seem to have better performance (0.77 and 0.73 C-index in the training cohort and validation cohort, respectively) than the clinical models (0.69 C-index in the training cohort and 0.70 C-index in the validation cohort) in discriminating HE. However, the C-index was the highest for the combined model in both the training (0.82) and validation (0.79) cohorts. CONCLUSIONS Machine learning based on radiomic plus clinical features has the best predictive performance for HE, followed by machine learning based on radiomic features, and can be used as a potential tool to assist clinicians in early judgment.
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Affiliation(s)
- Yihua Liu
- Department of General medical subjects, Ezhou Central Hospital, Ezhou Hubei, 436000, China
| | - Fengfeng Zhao
- School of Clinical Medicine, Weifang Medical University, Weifang, 261000, China
| | - Enjing Niu
- Department of Adult Internal Medicine, Qingdao Women's and Children's Hospital, No. 217 Liaoyang West Street, Shibei District, Qingdao, 266000, Shandong, China
| | - Liang Chen
- Department of Adult Internal Medicine, Qingdao Women's and Children's Hospital, No. 217 Liaoyang West Street, Shibei District, Qingdao, 266000, Shandong, China.
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Takahashi S, Ishizuka K, Hoshino T, Mizuno T, Nishimura A, Toi S, Kitagawa K. Long-Term Outcome in Patients With Acute Ischemic Stroke and Heart Failure. Circ J 2023; 87:401-408. [PMID: 35444111 DOI: 10.1253/circj.cj-21-0937] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND This study aimed to identify the association between long term functional outcomes and acute ischemic stroke (AIS) in patients with heart failure (HF) in Japan and whether 1-year event risks can be related to these patients.Methods and Results: This was a prospective observational study, and 651 patients registered in the Tokyo Women's Medical University Stroke Registry were classified into the HF and non-HF groups. Functional outcome at 1 year after stroke onset was defined as either good (modified Rankin Scale [mRS] score of 0-2) or poor (mRS score of 3-6). The primary outcome was a composite of major adverse cardiovascular events (MACE), including non-fatal stroke, non-fatal acute coronary syndrome, and vascular death. Patients with HF had a higher poor functional outcome rate at 1 year than those without HF (54.7% vs. 28.2%, P<0.001). Multivariate logistic regression analysis also demonstrated the prevalence of HF was an independent predictor of an mRS score of ≥3 at 1 year after stroke onset (odds ratio, 1.05; 95% confidence interval, 1.00-1.10; P=0.036). Furthermore, patients with HF tended to have a higher risk of MACE and all-cause mortality than those without HF. CONCLUSIONS AIS patients with HF were associated with poor functional outcome at the 1-year follow up. Further multicenter studies involving a larger number of patients are warranted to verify these results.
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Affiliation(s)
- Shuntaro Takahashi
- Department of Neurology, Tokyo Women's Medical University School of Medicine
| | - Kentaro Ishizuka
- Department of Neurology, Tokyo Women's Medical University School of Medicine
| | - Takao Hoshino
- Department of Neurology, Tokyo Women's Medical University School of Medicine
| | - Takafumi Mizuno
- Department of Neurology, Tokyo Women's Medical University School of Medicine
| | - Ayako Nishimura
- Department of Neurology, Tokyo Women's Medical University School of Medicine
| | - Sono Toi
- Department of Neurology, Tokyo Women's Medical University School of Medicine
| | - Kazuo Kitagawa
- Department of Neurology, Tokyo Women's Medical University School of Medicine
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Muacevic A, Adler JR, Alanazi AS, Alamro AA, Alagedi FH, Alshehri YA, Masuadi E, Alotaibi N, Alkhateeb M. Hyperlipidemia and Hypertension Are Associated With Intracerebral Hemorrhage Incidence: A Retrospective Study. Cureus 2023; 15:e33236. [PMID: 36733545 PMCID: PMC9888596 DOI: 10.7759/cureus.33236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2023] [Indexed: 01/04/2023] Open
Abstract
Introduction Stroke places a huge burden on the socioeconomic systems. Hemorrhagic stroke (HS) is the second most common type of stroke and the second leading cause of disability and death. The updated data on the prevalence of intracerebral hemorrhage (ICH) stroke and related physiological risk factors in Saudi Arabia were limited. The aim of this study was to identify the prevalence of ICH stroke and the related physiological risk factors. Methods This was a retrospective, hospital-based, and chart review study that utilized the BESTCare system at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia. Patients who attended the neurology department (inpatient/outpatient) between 2015 and 2020 were studied. The statistical tool JMP (JMP Inc., Cary, NC, USA) was used for data entry and analysis. Results Patient data (N = 1,870, 58.6 ± 13.87 years old) were screened for comorbidities, hypertension (66.1%), diabetes mellitus (DM) (57.7%), hyperlipidemia (28.4%), and history of an old stroke (22.3%). Ischemic stroke (IS) was more dominant than ICH stroke with ratios of 94.5% (n = 1767) versus 5.5% (n = 103), respectively. The prevalence of ICH stroke among the patients (n = 103) was 10.6%, 20.3%, 24.2%, and 28.1% in the age groups of <40, 41-50, 51-60, and 61-70 years old, respectively. There was a significant gender effect on the distribution of both IS and ICH (p = 0.003). ICH strokes were more prevalent in males than in females. Body mass index (BMI) has no significant effect on the prevalence of IS and ICH stroke (p = 0.081). ICH stroke was significantly associated with DM (p = 0.032), hypertension (p = 0.01), and hyperlipidemia (p = 0.002). Regression analyses show that only hypertension (positive association) and hyperlipidemia (negative association) were significantly associated with the incidence of ICH stroke. Conclusion IS was more prevalent than ICH stroke. ICH strokes were more prevalent in males than in females. Also, hypertension was the most common factor leading to ICH stroke, unlike hyperlipidemia, which was revealed to be protective against ICH stroke.
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Hostettler IC, Seiffge D, Wong A, Ambler G, Wilson D, Shakeshaft C, Banerjee G, Sharma N, Jäger HR, Cohen H, Yousry TA, Al-Shahi Salman R, Lip GYH, Brown MM, Muir K, Houlden H, Werring DJ. APOE and Cerebral Small Vessel Disease Markers in Patients With Intracerebral Hemorrhage. Neurology 2022; 99:e1290-e1298. [PMID: 36123141 PMCID: PMC9576291 DOI: 10.1212/wnl.0000000000200851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 04/28/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVE We investigated the associations between the APOE genotype, intracerebral hemorrhage (ICH), and neuroimaging markers of cerebral amyloid angiopathy (CAA). METHODS We included patients from a prospective, multicenter UK observational cohort study of patients with ICH and representative UK population controls. First, we assessed the association of the APOE genotype with ICH (compared with controls without ICH). Second, among patients with ICH, we assessed the association of APOE status with the hematoma location (lobar or deep) and brain CT markers of CAA (finger-like projections [FLP] and subarachnoid extension [SAE]). RESULTS We included 907 patients with ICH and 2,636 controls. The mean age was 73.2 (12.4 SD) years for ICH cases vs 69.6 (0.2 SD) for population controls; 50.3% of cases and 42.1% of controls were female. Compared with controls, any APOE ε2 allele was associated with all ICH (lobar and nonlobar) and lobar ICH on its own in the dominant model (OR 1.38, 95% CI 1.13-1.7, p = 0.002 and OR 1.50, 95% CI 1.1-2.04, p = 0.01, respectively) but not deep ICH in an age-adjusted analyses (OR 1.26, 95% CI 0.97-1.63, p = 0.08). In the cases-only analysis, the APOE ε4 allele was associated with lobar compared with deep ICH in an age-adjusted analyses (OR 1.56, 95% CI 1.1-2.2, p = 0.01). When assessing CAA markers, APOE alleles were independently associated with FLP (ε4: OR 1.74, 95% CI 1.04-2.93, p = 0.04 and ε2/ε4: 2.56, 95% CI 0.99-6.61, p = 0.05). We did not find an association between APOE alleles and SAE. DISCUSSION We confirmed associations between APOE alleles and ICH including lobar ICH. Our analysis shows selective associations between APOE ε2 and ε4 alleles with FLP, a CT marker of CAA. Our findings suggest that different APOE alleles might have diverging influences on individual neuroimaging biomarkers of CAA-associated ICH.
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Affiliation(s)
- Isabel Charlotte Hostettler
- From the Stroke Research Centre (I.C.H., D.S., Duncan Wilson, C.S., G.B., M.M.B., David Werring), University College London, Institute of Neurology; Neurogenetics Laboratory (I.C.H., H.H.), The National Hospital of Neurology and Neurosurgery, London, UK; Department of Neurosurgery (I.C.H.), Cantonal Hospital St. Gallen, Switzerland; Stroke Centre (D.S.), Department of Neurology and Department of Clinical Research, University of Basel and University Hospital Basel; Department of Neurology and Stroke Centre (D.S.), University Hospital Berne; MRC Unit for Lifelong Health and Ageing at UCL (A.W.), London; Department of Statistical Science (G.A.), UCL, London; Department of Clinical and Movement Neuroscience (N.S.), Institute of Neurology, London; Neuroradiological Academic Unit (H.R.J., T.A.Y.), Department of Brain Repair & Rehabilitation, University College London, Institute of Neurology; Haemostasis Research Unit (H.C.), Department of Haematology, University College London; Centre for Clinical Brain Sciences (R.A.-S.S.), School of Clinical Sciences, University of Edinburgh; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart & Chest Hospital; Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark; and Institute of Neuroscience & Psychology (K.M.), University of Glasgow, Queen Elizabeth University Hospital, UK
| | - David Seiffge
- From the Stroke Research Centre (I.C.H., D.S., Duncan Wilson, C.S., G.B., M.M.B., David Werring), University College London, Institute of Neurology; Neurogenetics Laboratory (I.C.H., H.H.), The National Hospital of Neurology and Neurosurgery, London, UK; Department of Neurosurgery (I.C.H.), Cantonal Hospital St. Gallen, Switzerland; Stroke Centre (D.S.), Department of Neurology and Department of Clinical Research, University of Basel and University Hospital Basel; Department of Neurology and Stroke Centre (D.S.), University Hospital Berne; MRC Unit for Lifelong Health and Ageing at UCL (A.W.), London; Department of Statistical Science (G.A.), UCL, London; Department of Clinical and Movement Neuroscience (N.S.), Institute of Neurology, London; Neuroradiological Academic Unit (H.R.J., T.A.Y.), Department of Brain Repair & Rehabilitation, University College London, Institute of Neurology; Haemostasis Research Unit (H.C.), Department of Haematology, University College London; Centre for Clinical Brain Sciences (R.A.-S.S.), School of Clinical Sciences, University of Edinburgh; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart & Chest Hospital; Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark; and Institute of Neuroscience & Psychology (K.M.), University of Glasgow, Queen Elizabeth University Hospital, UK
| | - Andrew Wong
- From the Stroke Research Centre (I.C.H., D.S., Duncan Wilson, C.S., G.B., M.M.B., David Werring), University College London, Institute of Neurology; Neurogenetics Laboratory (I.C.H., H.H.), The National Hospital of Neurology and Neurosurgery, London, UK; Department of Neurosurgery (I.C.H.), Cantonal Hospital St. Gallen, Switzerland; Stroke Centre (D.S.), Department of Neurology and Department of Clinical Research, University of Basel and University Hospital Basel; Department of Neurology and Stroke Centre (D.S.), University Hospital Berne; MRC Unit for Lifelong Health and Ageing at UCL (A.W.), London; Department of Statistical Science (G.A.), UCL, London; Department of Clinical and Movement Neuroscience (N.S.), Institute of Neurology, London; Neuroradiological Academic Unit (H.R.J., T.A.Y.), Department of Brain Repair & Rehabilitation, University College London, Institute of Neurology; Haemostasis Research Unit (H.C.), Department of Haematology, University College London; Centre for Clinical Brain Sciences (R.A.-S.S.), School of Clinical Sciences, University of Edinburgh; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart & Chest Hospital; Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark; and Institute of Neuroscience & Psychology (K.M.), University of Glasgow, Queen Elizabeth University Hospital, UK
| | - Gareth Ambler
- From the Stroke Research Centre (I.C.H., D.S., Duncan Wilson, C.S., G.B., M.M.B., David Werring), University College London, Institute of Neurology; Neurogenetics Laboratory (I.C.H., H.H.), The National Hospital of Neurology and Neurosurgery, London, UK; Department of Neurosurgery (I.C.H.), Cantonal Hospital St. Gallen, Switzerland; Stroke Centre (D.S.), Department of Neurology and Department of Clinical Research, University of Basel and University Hospital Basel; Department of Neurology and Stroke Centre (D.S.), University Hospital Berne; MRC Unit for Lifelong Health and Ageing at UCL (A.W.), London; Department of Statistical Science (G.A.), UCL, London; Department of Clinical and Movement Neuroscience (N.S.), Institute of Neurology, London; Neuroradiological Academic Unit (H.R.J., T.A.Y.), Department of Brain Repair & Rehabilitation, University College London, Institute of Neurology; Haemostasis Research Unit (H.C.), Department of Haematology, University College London; Centre for Clinical Brain Sciences (R.A.-S.S.), School of Clinical Sciences, University of Edinburgh; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart & Chest Hospital; Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark; and Institute of Neuroscience & Psychology (K.M.), University of Glasgow, Queen Elizabeth University Hospital, UK
| | - Duncan Wilson
- From the Stroke Research Centre (I.C.H., D.S., Duncan Wilson, C.S., G.B., M.M.B., David Werring), University College London, Institute of Neurology; Neurogenetics Laboratory (I.C.H., H.H.), The National Hospital of Neurology and Neurosurgery, London, UK; Department of Neurosurgery (I.C.H.), Cantonal Hospital St. Gallen, Switzerland; Stroke Centre (D.S.), Department of Neurology and Department of Clinical Research, University of Basel and University Hospital Basel; Department of Neurology and Stroke Centre (D.S.), University Hospital Berne; MRC Unit for Lifelong Health and Ageing at UCL (A.W.), London; Department of Statistical Science (G.A.), UCL, London; Department of Clinical and Movement Neuroscience (N.S.), Institute of Neurology, London; Neuroradiological Academic Unit (H.R.J., T.A.Y.), Department of Brain Repair & Rehabilitation, University College London, Institute of Neurology; Haemostasis Research Unit (H.C.), Department of Haematology, University College London; Centre for Clinical Brain Sciences (R.A.-S.S.), School of Clinical Sciences, University of Edinburgh; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart & Chest Hospital; Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark; and Institute of Neuroscience & Psychology (K.M.), University of Glasgow, Queen Elizabeth University Hospital, UK
| | - Clare Shakeshaft
- From the Stroke Research Centre (I.C.H., D.S., Duncan Wilson, C.S., G.B., M.M.B., David Werring), University College London, Institute of Neurology; Neurogenetics Laboratory (I.C.H., H.H.), The National Hospital of Neurology and Neurosurgery, London, UK; Department of Neurosurgery (I.C.H.), Cantonal Hospital St. Gallen, Switzerland; Stroke Centre (D.S.), Department of Neurology and Department of Clinical Research, University of Basel and University Hospital Basel; Department of Neurology and Stroke Centre (D.S.), University Hospital Berne; MRC Unit for Lifelong Health and Ageing at UCL (A.W.), London; Department of Statistical Science (G.A.), UCL, London; Department of Clinical and Movement Neuroscience (N.S.), Institute of Neurology, London; Neuroradiological Academic Unit (H.R.J., T.A.Y.), Department of Brain Repair & Rehabilitation, University College London, Institute of Neurology; Haemostasis Research Unit (H.C.), Department of Haematology, University College London; Centre for Clinical Brain Sciences (R.A.-S.S.), School of Clinical Sciences, University of Edinburgh; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart & Chest Hospital; Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark; and Institute of Neuroscience & Psychology (K.M.), University of Glasgow, Queen Elizabeth University Hospital, UK
| | - Gargi Banerjee
- From the Stroke Research Centre (I.C.H., D.S., Duncan Wilson, C.S., G.B., M.M.B., David Werring), University College London, Institute of Neurology; Neurogenetics Laboratory (I.C.H., H.H.), The National Hospital of Neurology and Neurosurgery, London, UK; Department of Neurosurgery (I.C.H.), Cantonal Hospital St. Gallen, Switzerland; Stroke Centre (D.S.), Department of Neurology and Department of Clinical Research, University of Basel and University Hospital Basel; Department of Neurology and Stroke Centre (D.S.), University Hospital Berne; MRC Unit for Lifelong Health and Ageing at UCL (A.W.), London; Department of Statistical Science (G.A.), UCL, London; Department of Clinical and Movement Neuroscience (N.S.), Institute of Neurology, London; Neuroradiological Academic Unit (H.R.J., T.A.Y.), Department of Brain Repair & Rehabilitation, University College London, Institute of Neurology; Haemostasis Research Unit (H.C.), Department of Haematology, University College London; Centre for Clinical Brain Sciences (R.A.-S.S.), School of Clinical Sciences, University of Edinburgh; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart & Chest Hospital; Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark; and Institute of Neuroscience & Psychology (K.M.), University of Glasgow, Queen Elizabeth University Hospital, UK
| | - Nikhil Sharma
- From the Stroke Research Centre (I.C.H., D.S., Duncan Wilson, C.S., G.B., M.M.B., David Werring), University College London, Institute of Neurology; Neurogenetics Laboratory (I.C.H., H.H.), The National Hospital of Neurology and Neurosurgery, London, UK; Department of Neurosurgery (I.C.H.), Cantonal Hospital St. Gallen, Switzerland; Stroke Centre (D.S.), Department of Neurology and Department of Clinical Research, University of Basel and University Hospital Basel; Department of Neurology and Stroke Centre (D.S.), University Hospital Berne; MRC Unit for Lifelong Health and Ageing at UCL (A.W.), London; Department of Statistical Science (G.A.), UCL, London; Department of Clinical and Movement Neuroscience (N.S.), Institute of Neurology, London; Neuroradiological Academic Unit (H.R.J., T.A.Y.), Department of Brain Repair & Rehabilitation, University College London, Institute of Neurology; Haemostasis Research Unit (H.C.), Department of Haematology, University College London; Centre for Clinical Brain Sciences (R.A.-S.S.), School of Clinical Sciences, University of Edinburgh; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart & Chest Hospital; Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark; and Institute of Neuroscience & Psychology (K.M.), University of Glasgow, Queen Elizabeth University Hospital, UK
| | - Hans Rolf Jäger
- From the Stroke Research Centre (I.C.H., D.S., Duncan Wilson, C.S., G.B., M.M.B., David Werring), University College London, Institute of Neurology; Neurogenetics Laboratory (I.C.H., H.H.), The National Hospital of Neurology and Neurosurgery, London, UK; Department of Neurosurgery (I.C.H.), Cantonal Hospital St. Gallen, Switzerland; Stroke Centre (D.S.), Department of Neurology and Department of Clinical Research, University of Basel and University Hospital Basel; Department of Neurology and Stroke Centre (D.S.), University Hospital Berne; MRC Unit for Lifelong Health and Ageing at UCL (A.W.), London; Department of Statistical Science (G.A.), UCL, London; Department of Clinical and Movement Neuroscience (N.S.), Institute of Neurology, London; Neuroradiological Academic Unit (H.R.J., T.A.Y.), Department of Brain Repair & Rehabilitation, University College London, Institute of Neurology; Haemostasis Research Unit (H.C.), Department of Haematology, University College London; Centre for Clinical Brain Sciences (R.A.-S.S.), School of Clinical Sciences, University of Edinburgh; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart & Chest Hospital; Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark; and Institute of Neuroscience & Psychology (K.M.), University of Glasgow, Queen Elizabeth University Hospital, UK
| | - Hannah Cohen
- From the Stroke Research Centre (I.C.H., D.S., Duncan Wilson, C.S., G.B., M.M.B., David Werring), University College London, Institute of Neurology; Neurogenetics Laboratory (I.C.H., H.H.), The National Hospital of Neurology and Neurosurgery, London, UK; Department of Neurosurgery (I.C.H.), Cantonal Hospital St. Gallen, Switzerland; Stroke Centre (D.S.), Department of Neurology and Department of Clinical Research, University of Basel and University Hospital Basel; Department of Neurology and Stroke Centre (D.S.), University Hospital Berne; MRC Unit for Lifelong Health and Ageing at UCL (A.W.), London; Department of Statistical Science (G.A.), UCL, London; Department of Clinical and Movement Neuroscience (N.S.), Institute of Neurology, London; Neuroradiological Academic Unit (H.R.J., T.A.Y.), Department of Brain Repair & Rehabilitation, University College London, Institute of Neurology; Haemostasis Research Unit (H.C.), Department of Haematology, University College London; Centre for Clinical Brain Sciences (R.A.-S.S.), School of Clinical Sciences, University of Edinburgh; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart & Chest Hospital; Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark; and Institute of Neuroscience & Psychology (K.M.), University of Glasgow, Queen Elizabeth University Hospital, UK
| | - Tarek A Yousry
- From the Stroke Research Centre (I.C.H., D.S., Duncan Wilson, C.S., G.B., M.M.B., David Werring), University College London, Institute of Neurology; Neurogenetics Laboratory (I.C.H., H.H.), The National Hospital of Neurology and Neurosurgery, London, UK; Department of Neurosurgery (I.C.H.), Cantonal Hospital St. Gallen, Switzerland; Stroke Centre (D.S.), Department of Neurology and Department of Clinical Research, University of Basel and University Hospital Basel; Department of Neurology and Stroke Centre (D.S.), University Hospital Berne; MRC Unit for Lifelong Health and Ageing at UCL (A.W.), London; Department of Statistical Science (G.A.), UCL, London; Department of Clinical and Movement Neuroscience (N.S.), Institute of Neurology, London; Neuroradiological Academic Unit (H.R.J., T.A.Y.), Department of Brain Repair & Rehabilitation, University College London, Institute of Neurology; Haemostasis Research Unit (H.C.), Department of Haematology, University College London; Centre for Clinical Brain Sciences (R.A.-S.S.), School of Clinical Sciences, University of Edinburgh; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart & Chest Hospital; Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark; and Institute of Neuroscience & Psychology (K.M.), University of Glasgow, Queen Elizabeth University Hospital, UK
| | - Rustam Al-Shahi Salman
- From the Stroke Research Centre (I.C.H., D.S., Duncan Wilson, C.S., G.B., M.M.B., David Werring), University College London, Institute of Neurology; Neurogenetics Laboratory (I.C.H., H.H.), The National Hospital of Neurology and Neurosurgery, London, UK; Department of Neurosurgery (I.C.H.), Cantonal Hospital St. Gallen, Switzerland; Stroke Centre (D.S.), Department of Neurology and Department of Clinical Research, University of Basel and University Hospital Basel; Department of Neurology and Stroke Centre (D.S.), University Hospital Berne; MRC Unit for Lifelong Health and Ageing at UCL (A.W.), London; Department of Statistical Science (G.A.), UCL, London; Department of Clinical and Movement Neuroscience (N.S.), Institute of Neurology, London; Neuroradiological Academic Unit (H.R.J., T.A.Y.), Department of Brain Repair & Rehabilitation, University College London, Institute of Neurology; Haemostasis Research Unit (H.C.), Department of Haematology, University College London; Centre for Clinical Brain Sciences (R.A.-S.S.), School of Clinical Sciences, University of Edinburgh; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart & Chest Hospital; Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark; and Institute of Neuroscience & Psychology (K.M.), University of Glasgow, Queen Elizabeth University Hospital, UK
| | - Gregory Y H Lip
- From the Stroke Research Centre (I.C.H., D.S., Duncan Wilson, C.S., G.B., M.M.B., David Werring), University College London, Institute of Neurology; Neurogenetics Laboratory (I.C.H., H.H.), The National Hospital of Neurology and Neurosurgery, London, UK; Department of Neurosurgery (I.C.H.), Cantonal Hospital St. Gallen, Switzerland; Stroke Centre (D.S.), Department of Neurology and Department of Clinical Research, University of Basel and University Hospital Basel; Department of Neurology and Stroke Centre (D.S.), University Hospital Berne; MRC Unit for Lifelong Health and Ageing at UCL (A.W.), London; Department of Statistical Science (G.A.), UCL, London; Department of Clinical and Movement Neuroscience (N.S.), Institute of Neurology, London; Neuroradiological Academic Unit (H.R.J., T.A.Y.), Department of Brain Repair & Rehabilitation, University College London, Institute of Neurology; Haemostasis Research Unit (H.C.), Department of Haematology, University College London; Centre for Clinical Brain Sciences (R.A.-S.S.), School of Clinical Sciences, University of Edinburgh; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart & Chest Hospital; Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark; and Institute of Neuroscience & Psychology (K.M.), University of Glasgow, Queen Elizabeth University Hospital, UK
| | - Martin M Brown
- From the Stroke Research Centre (I.C.H., D.S., Duncan Wilson, C.S., G.B., M.M.B., David Werring), University College London, Institute of Neurology; Neurogenetics Laboratory (I.C.H., H.H.), The National Hospital of Neurology and Neurosurgery, London, UK; Department of Neurosurgery (I.C.H.), Cantonal Hospital St. Gallen, Switzerland; Stroke Centre (D.S.), Department of Neurology and Department of Clinical Research, University of Basel and University Hospital Basel; Department of Neurology and Stroke Centre (D.S.), University Hospital Berne; MRC Unit for Lifelong Health and Ageing at UCL (A.W.), London; Department of Statistical Science (G.A.), UCL, London; Department of Clinical and Movement Neuroscience (N.S.), Institute of Neurology, London; Neuroradiological Academic Unit (H.R.J., T.A.Y.), Department of Brain Repair & Rehabilitation, University College London, Institute of Neurology; Haemostasis Research Unit (H.C.), Department of Haematology, University College London; Centre for Clinical Brain Sciences (R.A.-S.S.), School of Clinical Sciences, University of Edinburgh; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart & Chest Hospital; Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark; and Institute of Neuroscience & Psychology (K.M.), University of Glasgow, Queen Elizabeth University Hospital, UK
| | - Keith Muir
- From the Stroke Research Centre (I.C.H., D.S., Duncan Wilson, C.S., G.B., M.M.B., David Werring), University College London, Institute of Neurology; Neurogenetics Laboratory (I.C.H., H.H.), The National Hospital of Neurology and Neurosurgery, London, UK; Department of Neurosurgery (I.C.H.), Cantonal Hospital St. Gallen, Switzerland; Stroke Centre (D.S.), Department of Neurology and Department of Clinical Research, University of Basel and University Hospital Basel; Department of Neurology and Stroke Centre (D.S.), University Hospital Berne; MRC Unit for Lifelong Health and Ageing at UCL (A.W.), London; Department of Statistical Science (G.A.), UCL, London; Department of Clinical and Movement Neuroscience (N.S.), Institute of Neurology, London; Neuroradiological Academic Unit (H.R.J., T.A.Y.), Department of Brain Repair & Rehabilitation, University College London, Institute of Neurology; Haemostasis Research Unit (H.C.), Department of Haematology, University College London; Centre for Clinical Brain Sciences (R.A.-S.S.), School of Clinical Sciences, University of Edinburgh; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart & Chest Hospital; Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark; and Institute of Neuroscience & Psychology (K.M.), University of Glasgow, Queen Elizabeth University Hospital, UK
| | - Henry Houlden
- From the Stroke Research Centre (I.C.H., D.S., Duncan Wilson, C.S., G.B., M.M.B., David Werring), University College London, Institute of Neurology; Neurogenetics Laboratory (I.C.H., H.H.), The National Hospital of Neurology and Neurosurgery, London, UK; Department of Neurosurgery (I.C.H.), Cantonal Hospital St. Gallen, Switzerland; Stroke Centre (D.S.), Department of Neurology and Department of Clinical Research, University of Basel and University Hospital Basel; Department of Neurology and Stroke Centre (D.S.), University Hospital Berne; MRC Unit for Lifelong Health and Ageing at UCL (A.W.), London; Department of Statistical Science (G.A.), UCL, London; Department of Clinical and Movement Neuroscience (N.S.), Institute of Neurology, London; Neuroradiological Academic Unit (H.R.J., T.A.Y.), Department of Brain Repair & Rehabilitation, University College London, Institute of Neurology; Haemostasis Research Unit (H.C.), Department of Haematology, University College London; Centre for Clinical Brain Sciences (R.A.-S.S.), School of Clinical Sciences, University of Edinburgh; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart & Chest Hospital; Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark; and Institute of Neuroscience & Psychology (K.M.), University of Glasgow, Queen Elizabeth University Hospital, UK
| | - David J Werring
- From the Stroke Research Centre (I.C.H., D.S., Duncan Wilson, C.S., G.B., M.M.B., David Werring), University College London, Institute of Neurology; Neurogenetics Laboratory (I.C.H., H.H.), The National Hospital of Neurology and Neurosurgery, London, UK; Department of Neurosurgery (I.C.H.), Cantonal Hospital St. Gallen, Switzerland; Stroke Centre (D.S.), Department of Neurology and Department of Clinical Research, University of Basel and University Hospital Basel; Department of Neurology and Stroke Centre (D.S.), University Hospital Berne; MRC Unit for Lifelong Health and Ageing at UCL (A.W.), London; Department of Statistical Science (G.A.), UCL, London; Department of Clinical and Movement Neuroscience (N.S.), Institute of Neurology, London; Neuroradiological Academic Unit (H.R.J., T.A.Y.), Department of Brain Repair & Rehabilitation, University College London, Institute of Neurology; Haemostasis Research Unit (H.C.), Department of Haematology, University College London; Centre for Clinical Brain Sciences (R.A.-S.S.), School of Clinical Sciences, University of Edinburgh; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart & Chest Hospital; Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark; and Institute of Neuroscience & Psychology (K.M.), University of Glasgow, Queen Elizabeth University Hospital, UK.
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6
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Tani T, Imai S, Fushimi K. Rehabilitation of Patients With Acute Ischemic Stroke Who Required Assistance Before Hospitalization Contributes to Improvement in Activities of Daily Living: A Nationwide Database Cohort Study. Arch Rehabil Res Clin Transl 2022; 4:100224. [PMID: 36545520 PMCID: PMC9761257 DOI: 10.1016/j.arrct.2022.100224] [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] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To assess the effect of early implementation of and longer daily duration of rehabilitation on patients with acute ischemic stroke who require assistance with activities of daily living (ADL) before hospital admission. DESIGN Nationwide, cohort, observational study from April 2018 to March 2019. SETTING Acute care hospitals in Japan. PARTICIPANTS The Japanese national Diagnosis Procedure Combination database was searched for the period between April 2018 and March 2019. Of the 330,672 patients with ischemic strokes identified, 53,523 met the inclusion criteria of being older than 20 years, having a prehospital modified Rankin Scale score of 3, 4, or 5, and having undergone rehabilitation (N=53,523). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Improvement in ADL from admission to discharge using the Barthel Index. The effects of the following 3 rehabilitation variables on ADL improvement were evaluated: (1) average daily duration of rehabilitation; (2) rehabilitation started within 3 days after admission (early rehabilitation); and (3) rehabilitation started 1 day after admission (very early rehabilitation). RESULTS Early rehabilitation was significantly associated with improvements in ADL (odds ratio, 1.19; 95% confidence interval, 1.10-1.28; P≤.001). A longer duration of rehabilitation was also significantly associated with ADL improvement (≥2.0 hours: odds ratio, 2.49; 95% confidence interval, 2.26-2.75; P≤.001) compared with a ≤1 hour of rehabilitation (1.1-2.0 hours: odds ratio, 1.35; 95% confidence interval, 1.29-1.42; P≤.001). CONCLUSIONS Early implementation of rehabilitation and a longer duration of rehabilitation per day improved the ADL of patients who required assistance before the onset of cerebral infarction.
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Affiliation(s)
- Takuaki Tani
- Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, Tokyo, Japan,Clinical Research Center National Hospital Organization, Tokyo, Japan
| | - Shinobu Imai
- Clinical Research Center National Hospital Organization, Tokyo, Japan,Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | - Kiyohide Fushimi
- Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, Tokyo, Japan,Clinical Research Center National Hospital Organization, Tokyo, Japan,Corresponding author Kiyohide Fushimi, MD, PhD, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan.
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7
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Hattori Y, Hamada S, Ishizaki T, Sakata N, Iwagami M, Tamiya N, Akishita M, Yamanaka T. National trends in gastrostomy in older adults between 2014 and 2019 in Japan. Geriatr Gerontol Int 2022; 22:648-652. [PMID: 35790216 DOI: 10.1111/ggi.14433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/19/2022] [Accepted: 06/08/2022] [Indexed: 11/26/2022]
Abstract
AIM Previous studies have shown temporal trends in the number of gastrostomies until 2016, but the recent trend is yet to be analyzed. This study aimed to evaluate temporal trends in gastrostomy (mostly percutaneous endoscopic gastrostomy) in older adults in Japan in more recent years. METHODS We extracted data on the numbers of gastrostomies and swallowing function assessment prior to gastrostomy, using the national aggregated open data (NDB Open Data) from 2014 to 2019. RESULTS Adults in their 80s accounted for the largest portion of gastrostomy during the study period. A decreasing trend in the total number of gastrostomy was observed in older adults from 2014 to 2016, but became almost stable thereafter (57 103 in 2014, 47 228 in 2016, and 47 944 in 2019). The age group-stratified numbers of gastrostomy per 100 000 individuals decreased by -33.9% (≥90 years group) to -6.1% (65-69 years group) from 2014 to 2019. The implementation rate of the swallowing function assessment remained relatively low, despite a slight increase (21.4% in 2015 to 23.7% in 2019). CONCLUSION We showed that the total number of gastrostomies remained almost stable after 2016 despite population aging. We considered that the avoidance of gastrostomy in frail or disabled older adults might explain the decrease, particularly for those aged over 80 years. Our findings would regain attention to appropriate decision-making for gastrostomy. Geriatr Gerontol Int ••; ••: ••-•• Geriatr Gerontol Int 2022; ••: ••-••.
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Affiliation(s)
- Yukari Hattori
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shota Hamada
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan.,Department of Home Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tatsuro Ishizaki
- Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Nobuo Sakata
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masao Iwagami
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Nanako Tamiya
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takashi Yamanaka
- Department of Home Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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8
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Suda S, Nito C, Ihara M, Iguchi Y, Urabe T, Matsumaru Y, Sakai N, Kimura K. Randomised placebo-controlled multicentre trial to evaluate the efficacy and safety of JTR-161, allogeneic human dental pulp stem cells, in patients with Acute Ischaemic stRoke (J-REPAIR). BMJ Open 2022; 12:e054269. [PMID: 35613802 PMCID: PMC9125710 DOI: 10.1136/bmjopen-2021-054269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION JTR-161 is a novel allogeneic human cell product consisting of dental pulp stem cells isolated from the extracted teeth of healthy adults. It is currently under development as a cell-based therapy for ischaemic stroke. The aim of this study is to evaluate the safety and efficacy of JTR-161 in patients with acute ischaemic stroke when given as a single intravenous administration within 48 hours of symptom onset. METHODS AND ANALYSIS This is a first-in-human, randomised, double-blind, placebo-controlled, multicentre, phase 1/2 clinical trial to be conducted in Japan (from January 2019 to July 2021). Patients with a clinical diagnosis of anterior circulation ischaemic stroke with a National Institutes of Health Stroke Scale (NIHSS)score of 5-20 at baseline were enrolled. Patients previously treated with recombinant tissue-type plasminogen activator and/or endovascular thrombectomy were allowed to be enrolled. The study consists of three cohorts: cohorts 1 and 2 (each eight patients) and cohort 3 (60 patients). Subjects were randomly assigned to receive either JTR-161 or placebo in a 3:1 ratio in cohorts 1 and 2, and in a 1:1 ratio in cohort 3. The number of cells administered was increased sequentially from 1×108 (cohort 1) to 3 x 108 (cohort 2). In cohort 3, the higher tolerated dose among the two cohorts was administered. The primary endpoint is the proportion of patients who achieve an excellent outcome as defined by all of the following criteria at day 91 in cohort 3: modified Rankin Scale ≤1, NIHSS ≤1 and Barthel Index ≥95. ETHICS AND DISSEMINATION The protocol and informed consent form were approved by the institutional review board at each participating study site. A manuscript with the results of the primary study will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT04608838; JapicCTI-194570 and Clinical Trials. gov.
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Affiliation(s)
- Satoshi Suda
- Department of Neurology, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Chikako Nito
- Department of Neurology, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Masafumi Ihara
- Neurology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yasuyuki Iguchi
- Department of Neurology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Takao Urabe
- Department of Neurology, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Yuji Matsumaru
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Kazumi Kimura
- Department of Neurology, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
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9
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Irregular shape as an independent predictor of prognosis in patients with primary intracerebral hemorrhage. Sci Rep 2022; 12:8552. [PMID: 35595831 PMCID: PMC9123162 DOI: 10.1038/s41598-022-12536-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 05/12/2022] [Indexed: 11/09/2022] Open
Abstract
The utility of noncontrast computed tomography markers in the prognosis of spontaneous intracerebral hemorrhage has been studied. This study aimed to investigate the predictive value of the computed tomography (CT) irregularity shape for poor functional outcomes in patients with spontaneous intracerebral hemorrhage. We retrospectively reviewed all 782 patients with intracranial hemorrhage in our stroke emergency center from January 2018 to September 2019. Laboratory examination and CT examination were performed within 24 h of admission. After three months, the patient's functional outcome was assessed using the modified Rankin Scale. Multinomial logistic regression analyses were applied to identify independent predictors of functional outcome in patients with intracerebral hemorrhage. Out of the 627 patients included in this study, those with irregular shapes on CT imaging had a higher proportion of poor outcomes and mortality 90 days after discharge (P < 0.001). Irregular shapes were found to be significant independent predictors of poor outcome and mortality on multiple logistic regression analysis. In addition, the increase in plasma D-dimer was associated with the occurrence of irregular shapes (P = 0.0387). Patients with irregular shapes showed worse functional outcomes after intracerebral hemorrhage. The elevated expression level of plasma D-dimers may be directly related to the formation of irregular shapes.
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10
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Hsu HT, Chen PY, Tzeng IS, Hsu PJ, Lin SK. Correlation of Immune-Inflammatory Markers with Clinical Features and Novel Location-Specific Nomograms for Short-Term Outcomes in Patients with Intracerebral Hemorrhage. Diagnostics (Basel) 2022; 12:diagnostics12030622. [PMID: 35328175 PMCID: PMC8947714 DOI: 10.3390/diagnostics12030622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 02/27/2022] [Accepted: 02/28/2022] [Indexed: 02/05/2023] Open
Abstract
(1) Background: We investigated the association of four immune-inflammatory markers with clinical features and established location-specific nomograms to predict mortality risk in patients with intracerebral hemorrhage (ICH). (2) Methods: We retrospectively enrolled 613 inpatients with acute ICH. (3) Results: Overall mortality was 22%, which was highest in pontine hemorrhage and lowest in thalamic hemorrhage. All four immune-inflammatory markers exhibited a positive linear correlation with glucose, ICH volume, ICH score, and discharge Modified Rankin Scale (mRS) score. Significant predictors of death due to lobar/putaminal hemorrhage were age, glucose and creatinine levels, initial Glasgow Coma Scale (GCS) score, ICH volume, and presence of intraventricular hemorrhage. None of the immune-inflammatory markers were significant predictors of unfavorable outcome or death. We selected significant factors to establish nomograms for predicting death due to lobar/putaminal, thalamic, pontine, and cerebellar hemorrhages. The C-statistic for predicting death in model I (comprising factors in the establishment of the nomogram) in each type of ICH was higher than that in model II (comprising ICH score alone), except for cerebellar hemorrhage. These nomograms for predicting death had good discrimination (C-index: 0.889 to 0.975) and prediction probabilities (C-index: 0.890 to 0.965). (4) Conclusions: Higher immune-inflammatory markers were associated with larger ICH volume, worse initial GCS, and unfavorable outcomes, but were not independent prognostic predictors. The location-specific nomograms provided novel and accurate models for predicting mortality risk.
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Affiliation(s)
- Hsien-Ta Hsu
- Division of Neurosurgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 23142, Taiwan;
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan;
| | - Pei-Ya Chen
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan;
- Stroke Center and Department of Neurology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 23142, Taiwan;
| | - I-Shiang Tzeng
- Department of Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 23142, Taiwan;
| | - Po-Jen Hsu
- Stroke Center and Department of Neurology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 23142, Taiwan;
| | - Shinn-Kuang Lin
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan;
- Stroke Center and Department of Neurology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 23142, Taiwan;
- Correspondence: or
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11
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Rahman MM, Islam MR, Islam MT, Harun-Or-Rashid M, Islam M, Abdullah S, Uddin MB, Das S, Rahaman MS, Ahmed M, Alhumaydhi FA, Emran TB, Mohamed AAR, Faruque MRI, Khandaker MU, Mostafa-Hedeab G. Stem Cell Transplantation Therapy and Neurological Disorders: Current Status and Future Perspectives. BIOLOGY 2022; 11:147. [PMID: 35053145 PMCID: PMC8772847 DOI: 10.3390/biology11010147] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/26/2021] [Accepted: 12/29/2021] [Indexed: 02/07/2023]
Abstract
Neurodegenerative diseases are a global health issue with inadequate therapeutic options and an inability to restore the damaged nervous system. With advances in technology, health scientists continue to identify new approaches to the treatment of neurodegenerative diseases. Lost or injured neurons and glial cells can lead to the development of several neurological diseases, including Parkinson's disease, stroke, and multiple sclerosis. In recent years, neurons and glial cells have successfully been generated from stem cells in the laboratory utilizing cell culture technologies, fueling efforts to develop stem cell-based transplantation therapies for human patients. When a stem cell divides, each new cell has the potential to either remain a stem cell or differentiate into a germ cell with specialized characteristics, such as muscle cells, red blood cells, or brain cells. Although several obstacles remain before stem cells can be used for clinical applications, including some potential disadvantages that must be overcome, this cellular development represents a potential pathway through which patients may eventually achieve the ability to live more normal lives. In this review, we summarize the stem cell-based therapies that have been explored for various neurological disorders, discuss the potential advantages and drawbacks of these therapies, and examine future directions for this field.
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Affiliation(s)
- Mohammad Mominur Rahman
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka 1207, Bangladesh; (M.M.R.); (M.R.I.); (M.T.I.); (M.H.-O.-R.); (M.I.); (M.B.U.); (S.D.); (M.S.R.); (M.A.)
| | - Mohammad Rezaul Islam
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka 1207, Bangladesh; (M.M.R.); (M.R.I.); (M.T.I.); (M.H.-O.-R.); (M.I.); (M.B.U.); (S.D.); (M.S.R.); (M.A.)
| | - Mohammad Touhidul Islam
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka 1207, Bangladesh; (M.M.R.); (M.R.I.); (M.T.I.); (M.H.-O.-R.); (M.I.); (M.B.U.); (S.D.); (M.S.R.); (M.A.)
| | - Mohammad Harun-Or-Rashid
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka 1207, Bangladesh; (M.M.R.); (M.R.I.); (M.T.I.); (M.H.-O.-R.); (M.I.); (M.B.U.); (S.D.); (M.S.R.); (M.A.)
| | - Mahfuzul Islam
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka 1207, Bangladesh; (M.M.R.); (M.R.I.); (M.T.I.); (M.H.-O.-R.); (M.I.); (M.B.U.); (S.D.); (M.S.R.); (M.A.)
| | - Sabirin Abdullah
- Space Science Center, Universiti Kebangsaan Malaysia, Bangi 43600, Selangor, Malaysia;
| | - Mohammad Borhan Uddin
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka 1207, Bangladesh; (M.M.R.); (M.R.I.); (M.T.I.); (M.H.-O.-R.); (M.I.); (M.B.U.); (S.D.); (M.S.R.); (M.A.)
| | - Sumit Das
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka 1207, Bangladesh; (M.M.R.); (M.R.I.); (M.T.I.); (M.H.-O.-R.); (M.I.); (M.B.U.); (S.D.); (M.S.R.); (M.A.)
| | - Mohammad Saidur Rahaman
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka 1207, Bangladesh; (M.M.R.); (M.R.I.); (M.T.I.); (M.H.-O.-R.); (M.I.); (M.B.U.); (S.D.); (M.S.R.); (M.A.)
| | - Muniruddin Ahmed
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka 1207, Bangladesh; (M.M.R.); (M.R.I.); (M.T.I.); (M.H.-O.-R.); (M.I.); (M.B.U.); (S.D.); (M.S.R.); (M.A.)
| | - Fahad A. Alhumaydhi
- Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Buraydah 52571, Saudi Arabia;
| | - Talha Bin Emran
- Department of Pharmacy, BGC Trust University Bangladesh, Chittagong 4381, Bangladesh
| | | | | | - Mayeen Uddin Khandaker
- Centre for Applied Physics and Radiation Technologies, School of Engineering and Technology, Sunway University, Bandar Sunway 47500, Selangor, Malaysia;
| | - Gomaa Mostafa-Hedeab
- Pharmacology Department & Health Sciences Research Unit, Medical College, Jouf University, Sakaka 72446, Saudi Arabia;
- Pharmacology Department, Faculty of Medicine, Beni-Suef University, Beni-Suef 62521, Egypt
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12
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Tan KS, Yoon BW, Lin RT, Mehndiratta MM, Suwanwela NC, Venketasubramanian N. 10th Anniversary of Asia Pacific Stroke Organization: State of Stroke Care and Stroke Research in the Asia Pacific. Cerebrovasc Dis Extra 2021; 12:14-22. [PMID: 34856544 PMCID: PMC8958597 DOI: 10.1159/000521272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 11/28/2021] [Indexed: 11/25/2022] Open
Abstract
The Asia Pacific Stroke Organization is the largest international and professional stroke group in the region. It has worked consistently over the last 10 years to gain visibility and consistency across the Asia-Pacific and beyond. The 10-year journey will be reviewed in the background of many internal and external developments including changes in Asia-Pacific stroke epidemiology, stroke care systems, and stroke service developments as well as major research studies in the Asia-Pacific.
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Affiliation(s)
- Kay-Sin Tan
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- *Kay-Sin Tan,
| | - Byung-Woo Yoon
- Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Gyeonggi-do, Republic of Korea
| | - Ruey-Tay Lin
- Department of Neurology, Stroke Centre, Kaohsiung Medical University and Hospital, Kaohsiung, Taiwan
| | - Man Mohan Mehndiratta
- Department of Neurology, B.L.Kapur Hospital (Max Health Care Group), Centre for Neurosciences, New Dehli, India
| | - Nijasri C. Suwanwela
- 7th Floor, Chulalongkorn Comprehensive Stroke Center, Bhumisiri Building, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
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Gao JH, Ling JY, Hong JC, Yasuda K, Muroi D, Iwata H. Investigation of optimal gait speed for motor learning of walking using the vibro-tactile biofeedback system. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:4662-4665. [PMID: 34892253 DOI: 10.1109/embc46164.2021.9629551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In stroke patients, sensory loss often reduces the sensation of ground contact, which impairs motor learning during rehabilitation. In our previous study, we proposed a vibro-tactile biofeedback system (which we called the perception-empathy biofeedback system) for gait rehabilitation. The results of our 9-week pilot clinical test suggested that patients who had reached the autonomous phase in gait learning had difficulty noticing the external vibratory feedback provided by the biofeedback system, leading to ineffective intervention. We considered the possibility that slower walking speed might return the patient to the association phase and allow patients to improve their gait according to the sensory feedback provided. Thus, in this research, a method based on reducing walking speed to guide patients' attention was derived. A pilot clinical trial shows that there is a statistically significant increase of ankle dorsiflexion in the initial contact phase and increase of ankle plantarflexion in the push-off phase after vibro-tactile biofeedback system intervention with speed reduction, compared to intervention without speed reduction. The results suggest that, by reducing their walking speed during intervention, patients return to the association phase and recognize external vibratory feedback, which may result in better intervention effects.Clinical Relevance-This study provides knowledge about the optimal walking speed when using vibro-tactile biofeedback for motor learning in stroke patients.
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14
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Hu H, Fukunaga A, Yokoya T, Nakagawa T, Honda T, Yamamoto S, Okazaki H, Miyamoto T, Sasaki N, Ogasawara T, Gonmori N, Yamamoto K, Hori A, Tomita K, Nagahama S, Konishi M, Katayama N, Morioka H, Kabe I, Mizoue T, Dohi S. Non-High-Density Lipoprotein Cholesterol and Risk of Cardiovascular disease: the Japan Epidemiology Collaboration on Occupational Health Study. J Atheroscler Thromb 2021; 29:1295-1306. [PMID: 34690212 PMCID: PMC9444673 DOI: 10.5551/jat.63118] [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] [Indexed: 11/11/2022] Open
Abstract
AIMS We aimed to investigate the association between non-high-density lipoprotein cholesterol (non-HDL-C) levels and the risk of cardiovascular disease (CVD) and its subtypes. METHODS In this contemporary cohort study, we analyzed the data of 63,814 Japanese employees aged ≥ 30 years, without known CVD in 2012 and who were followed up for up to 8 years. The non-HDL-C level was divided into 5 groups: <110, 110-129, 130-149, 150-169, and ≥ 170 mg/dL. The Cox proportional hazards model was used to calculate the hazard ratios (HRs) and the corresponding 95% confidence intervals (CIs) for CVD and its subtypes associated with each non-HDL-C group, considering 130-149 mg/dL as the reference group. RESULTS During the study period, 271 participants developed CVD, including 78 myocardial infarctions and 193 strokes (102 ischemic strokes, 89 hemorrhagic strokes, and 2 unknowns). A U-shaped association between non-HDL-C and stroke was observed. In the analysis of stroke subtypes, the multivariable-adjusted HR (95% CI) for hemorrhagic stroke was 2.61 (1.19-5.72), 2.02 (0.95-4.29), 2.10 (1.01-4.36), and 1.98 (0.96-4.08), while that for ischemic stroke was 1.54 (0.77-3.07), 0.91 (0.46-1.80), 0.73 (0.38-1.41), and 1.50 (0.87-2.56) in the <110, 110-129, 150-169, and ≥ 170 mg/dL groups, respectively. Individuals with elevated non-HDL-C levels had a higher risk of myocardial infarction. CONCLUSIONS High non-HDL-C levels were associated with an increased risk of myocardial infarction. Moreover, high and low non-HDL-C levels were associated with a high risk of stroke and its subtypes among Japanese workers.
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Affiliation(s)
- Huan Hu
- Department of Public Health, Tokushima University Graduate School of Biomedical Sciences.,Department of Epidemiology and Prevention, National Center for Global Health and Medicine
| | - Ami Fukunaga
- Department of Epidemiology and Prevention, National Center for Global Health and Medicine
| | | | | | - Toru Honda
- Hitachi Health Care Center, Hitachi, Ltd
| | | | | | | | | | | | | | - Kenya Yamamoto
- Division of Chemical Information, National Institute of Occupational Safety and Health
| | - Ai Hori
- Department of Global Public Health, Faculty of Medicine, University of Tsukuba
| | | | | | - Maki Konishi
- Department of Epidemiology and Prevention, National Center for Global Health and Medicine
| | - Nobumi Katayama
- Department of Epidemiology and Prevention, National Center for Global Health and Medicine
| | - Hisayoshi Morioka
- Department of Public Health, Tokushima University Graduate School of Biomedical Sciences
| | | | - Tetsuya Mizoue
- Department of Epidemiology and Prevention, National Center for Global Health and Medicine
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15
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Han HJ, Park KY, Kim J, Lee W, Lee YH, Jang CK, Cho KC, Park SK, Chung J, Kwon YS, Kim YB, Lee JW, Kim SY. Delays in Intracerebral Hemorrhage Management Is Associated with Hematoma Expansion and Worse Outcomes: Changes in COVID-19 Era. Yonsei Med J 2021; 62:911-917. [PMID: 34558870 PMCID: PMC8470569 DOI: 10.3349/ymj.2021.62.10.911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/25/2021] [Accepted: 06/25/2021] [Indexed: 12/23/2022] Open
Abstract
PURPOSE The coronavirus disease 2019 (COVID-19) pandemic disrupted the emergency medical care system worldwide. We analyzed the changes in the management of intracerebral hemorrhage (ICH) and compared the pre-COVID-19 and COVID-19 eras. MATERIALS AND METHODS From March to October of the COVID-19 era (2020), 83 consecutive patients with ICH were admitted to four comprehensive stroke centers. We retrospectively reviewed the data of patients and compared the treatment workflow metrics, treatment modalities, and clinical outcomes with the patients admitted during the same period of pre-COVID-19 era (2017-2019). RESULTS Three hundred thirty-eight patients (83 in COVID-19 era and 255 in pre-COVID-19 era) were included in this study. Symptom onset/detection-to-door time [COVID-19; 56.0 min (34.0-106.0), pre-COVID-19; 40.0 min (27.0-98.0), p=0.016] and median door to-intensive treatment time differed between the two groups [COVID-19; 349.0 min (177.0-560.0), pre-COVID-19; 184.0 min (134.0-271.0), p<0.001]. Hematoma expansion was detected more significantly in the COVID-19 era (39.8% vs. 22.1%, p=0.002). At 3-month follow-up, clinical outcomes of patients were worse in the COVID-19 era (Good modified Rankin Scale; 33.7% in COVID19, 46.7% in pre-COVID-19, p=0.039). CONCLUSION During the COVID-19 era, delays in management of ICH was associated with hematoma expansion and worse outcomes.
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Affiliation(s)
- Hyun Jin Han
- Department of Neurosurgery, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Keun Young Park
- Department of Neurosurgery, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Junhyung Kim
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Woosung Lee
- Department of Neurosurgery, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yun Ho Lee
- Department of Neurosurgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Chang Ki Jang
- Department of Neurosurgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Kwang-Chun Cho
- Department of Neurosurgery, International St. Mary's Hospital, Catholic Kwandong University, Inchoen, Korea
| | - Sang Kyu Park
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Joonho Chung
- Department of Neurosurgery, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Sub Kwon
- Department of Neurosurgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Yong Bae Kim
- Department of Neurosurgery, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Whan Lee
- Department of Neurosurgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - So Yeon Kim
- Department of Neurosurgery, International St. Mary's Hospital, Catholic Kwandong University, Inchoen, Korea.
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Ling J, Yasuda K, Hayashi Y, Imamura S, Iwata H. Development of a vibrotactile cueing device that implicitly increases walking speed during gait training in stroke patients: an observational case series study. J Med Eng Technol 2021; 46:25-31. [PMID: 34542000 DOI: 10.1080/03091902.2021.1970839] [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: 01/11/2023]
Abstract
One of the main sequelae of stroke is difficulty walking, which is characterised by decreased walking speed and asymmetrical walking patterns. Physical therapists often rely on explicit motor learning strategies, i.e., providing mainly verbal instructions for how movements should be performed. However, the voluntary movement induced by explicit instruction may lead to associated unintended muscle contractions or higher cognitive demand, which could be detrimental. We introduce a vibrotactile cueing device that implicitly improves walking speed. The stroke patient walks while alternating vibrational cues are given to the left and right sides of their waist. At each specified step, cueing frequency increases in the cueing group without the patient's awareness. The four patients in the cueing group did not notice the increase in walking speed during training; however, we observed an improvement in walking speed and cadence in patients using the proposed cueing system, which was maintained during the posttest phase. Additionally, patients using the cueing system were able to suppress excessive compensatory movements during training compared with patients who did not use the system. This case series study indicates that the proposed system for gait rehabilitation of stroke patients can enable an increase in walking speed without excessive effort.
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Affiliation(s)
- Jiayi Ling
- Graduate School of Creative Science and Engineering, Waseda University, Tokyo, Japan
| | - Kazuhiro Yasuda
- Research Institute for Science and Engineering, Waseda University, Tokyo, Japan
| | - Yuki Hayashi
- Graduate School of Creative Science and Engineering, Waseda University, Tokyo, Japan
| | - Saeko Imamura
- Graduate School of Creative Science and Engineering, Waseda University, Tokyo, Japan
| | - Hiroyasu Iwata
- Research Institute for Science and Engineering, Waseda University, Tokyo, Japan
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17
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Soen S, Usuba K, Crawford B, Adachi K. Family caregiver burden of patients with osteoporotic fracture in Japan. J Bone Miner Metab 2021; 39:612-622. [PMID: 33595773 DOI: 10.1007/s00774-020-01197-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 12/10/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Osteoporotic fractures are the most common serious consequence of osteoporosis. Patients who suffer such fractures often require caregiver assistance afterwards. This study characterized the humanistic burden experienced by family caregivers of patients with osteoporotic fractures in Japan. MATERIALS AND METHODS Family caregivers were defined as individuals who provided non-professional care to an osteoporotic fracture patient (> 50 years old). Caregivers were asked through an online survey panel about their caregiving situation, health-related quality of life (HRQoL), work impairment, and the health status of their patient. The Zarit Caregiver Burden Interview (ZBI-22), 8-item Short Form Health Survey (SF-8), and Work Productivity and Activity Impairment Caregiver version (WPAI-CG) were used to better understand the impact of osteoporotic fracture caregiving. RESULTS Respondents (n = 309) were family caregivers who were employed (81.6%) and cared for a parent (71.5%). Over 75% of caregivers had HRQoL physical and mental component scores below 50 on SF-8. Although most patients received welfare services (78.3%), the mean ZBI-22 score was 42.2 and 57.0% of caregivers perceived their burden to be moderate or severe (ZBI-22 score ≥ 41). Over half of caregivers changed their employment status due to their caregiving responsibilities and experienced 61.4% overall work impairment. The mean productivity loss for caregivers was estimated to be over 43,000 JPY per week. CONCLUSION The substantial humanistic and financial burden of caregiving by family members to osteoporotic fracture patients should be considered when evaluating the impact of fragility fractures, disease management and support systems for osteoporosis.
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Affiliation(s)
- Satoshi Soen
- Soen Orthopaedics, Osteoporosis and Rheumatology Clinic, Kobe, Japan.
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18
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Lin PBC, Wang PK, Pang CY, Hu WF, Tsai APY, Oblak AL, Liew HK. Moderate Ethanol Pre-treatment Mitigates ICH-Induced Injury via ER Stress Modulation in Rats. Front Mol Neurosci 2021; 14:682775. [PMID: 34248500 PMCID: PMC8267178 DOI: 10.3389/fnmol.2021.682775] [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: 03/19/2021] [Accepted: 05/26/2021] [Indexed: 11/29/2022] Open
Abstract
Intracerebral hemorrhage (ICH) is a life-threatening type of stroke that disrupts the normal neurological function of the brain. Clinical studies have reported a non-linear J-shaped association between alcohol consumption levels and the occurrence of cerebral stroke. Specifically, alcohol intoxication increases stroke incidence, while moderate alcohol pre-conditioning decreases stroke frequency and improves outcomes. Although alcohol pre-consumption is likely a crucial player in ICH, the underlying mechanism remains unclear. We performed 1-h alcohol pre-conditioning followed by ICH induction in Sprague-Dawley (SD) rats to investigate the role of alcohol pre-conditioning in ICH. Interestingly, behavioral test analysis found that ethanol intoxication (3 g/kg) aggravated ICH-induced neurological deficits, but moderate ethanol pre-conditioning (0.75 g/kg) ameliorated ICH-induced neurological deficits by reducing the oxidative stress and proinflammatory cytokines release. Moreover, we found that moderate ethanol pretreatment improved the striatal endoplasmic reticulum (ER) homeostasis by increasing the chaperone protein expression and reducing oxidative stress and apoptosis caused by ICH. Our findings show that the mechanism regulated by moderate ethanol pre-conditioning might be beneficial for ICH, indicating the importance of ER homeostasis, oxidative stress, and differential cytokines release in ICH.
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Affiliation(s)
- Peter Bor-Chian Lin
- Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Po-Kai Wang
- Department of Anesthesiology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Cheng-Yoong Pang
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.,Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
| | - Wei-Fen Hu
- Department of Pharmacology and Toxicology, Tzu Chi University, Hualien, Taiwan
| | - Andy Po-Yi Tsai
- Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Adrian L Oblak
- Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Hock-Kean Liew
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.,Department of Pharmacology and Toxicology, Tzu Chi University, Hualien, Taiwan.,Neuro-Medical Scientific Center, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
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19
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Wang Z, Li M, Song Y, Peng R. Levels of non-high-density-lipoprotein cholesterol are positively correlated with the risk of cognitive impairment in patients with intracerebral hemorrhage stroke. Int J Neurosci 2020; 132:910-916. [PMID: 33175604 DOI: 10.1080/00207454.2020.1849192] [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: 10/23/2022]
Abstract
BACKGROUND Intracerebral hemorrhage (ICH) is one of the most common strokes, especially in developing countries. Recently, level of non-high-density lipoprotein cholesterol (non-HDL-C) has been implicated to be a better indicator for several lipid-related disorders. However, whether non-HDL-C can be used as an indicator for the risk of cognitive impairment in ICH patients remains to be elucidated. METHODS In this study, we performed a retrospective study on patients with ICH treated at our institution to investigate the association between the level of non-HDL-C and various neuropsychological assessments, including mini-mental state examination (MMSE), Montreal cognitive assessment (MoCA), activity of daily living scale (ADL), neuropsychiatric Inventory (NPI) and Hamilton depression rating scale 21 (HAMD21). RESULTS We found that all scores of the tested assessments were significantly altered in ICH patients with a high non-HDL-C level. In addition, we revealed that non-HDL-C was negatively correlated with MMSE and MoCA scores and was positively correlated with ADL, NPI and HAMD21 scores. CONCLUSIONS Our study suggests that non-HDL-C level can be used as a potential indicator for the risk of cognitive impairment in ICH patients.
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Affiliation(s)
- Zetuo Wang
- Department of Neurology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Miaoduan Li
- Department of Neurology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Yehua Song
- Department of Neurology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Ruiqiang Peng
- Department of Neurology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
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Ling J, Hong JC, Hayashi Y, Yasuda K, Kitaji Y, Harashima H, Iwata H. A Haptic-Based Perception-Empathy Biofeedback System with Vibration Transition: Verifying the Attention Amount. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:3779-3782. [PMID: 33018824 DOI: 10.1109/embc44109.2020.9176213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
In this paper, a perception-empathy biofeedback (PEBF) system is proposed that supplements the foot pressure status of a paralyzed foot with a wearable vibrotactile biofeedback (BF) vest to the back. Improvements in the ankle dorsiflexion and push-off movement in the swing phase and pre-swing phase, respectively, can be expected after using the proposed system. However, the results of the 3 week pilot clinical tests suggest that significant improvement is only observed for the push-off movement. It is assumed that the attention required to recognize the BF was beyond the ability of the patients. In this paper, a dual task (40 s walking and performing mental arithmetic at the same time) was conducted with the following conditions: no vibrations and providing BF to the lower back and the entire back. According to the results, the ankle joint angle of the paralyzed side at push-off under the entire back condition is statistically significant (p = 0.0780); however, there are no significant changes under the lower back condition (p = 0.4998). Moreover, the ankle joint angle of the paralyzed side at the initial contact is statistically significant with respect to the lower back condition (p = 0.0233) and shows a significant trend for the entire back condition (p = 0.0730). The results suggest that the limited attention capacity of hemiplegic patients fails to improve both dorsiflexion and push-off movements; moreover, ankle motion can be promoted if attention is concentrated on recognizing focalized vibratory feedback patterns.
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21
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Ohtani R, Nirengi S, Sakane N. Association Between Serum Apolipoprotein A1 Levels, Ischemic Stroke Subtypes and Plaque Properties of the Carotid Artery. J Clin Med Res 2020; 12:598-603. [PMID: 32849948 PMCID: PMC7430921 DOI: 10.14740/jocmr4284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 07/22/2020] [Indexed: 11/23/2022] Open
Abstract
Background This study aimed to investigate the association between serum apolipoprotein A1 (ApoA1) levels, ischemic stroke subtypes and plaque properties. Methods We enrolled 92 patients with ischemic stroke and 21 age-matched controls (CONT). The stroke patients were divided into three subtypes: cardioembolic (CE, n = 15), atherothrombotic infraction (ATBI, n = 52), and lacunar infarction (LI, n = 25). Carotid plaques were classified as low, intermediate, or high intensity, and either simple or mixed type. Serum lipids (total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglyceride (TG)), ApoA1, and ApoB were analyzed using commercially available kits. Results There was no difference in TC, LDL-C, HDL-C, and ApoB levels among the four groups. Serum ApoA1 levels in the ATBI group were significantly lower compared with the CONT group. Among the ATBI group, the serum ApoA1 levels in the low-intensity plaque-type were significantly lower than those in the intermediate or hard-intensity plaque-type. Furthermore, serum ApoA1 levels in the mixed plaque-type were significantly lower than those in the simple type. Conclusions These findings suggest that serum ApoA1 levels might be associated with the development of ATBI and plaque properties of the carotid artery.
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Affiliation(s)
- Ryo Ohtani
- Department of Neurology, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
| | - Shinsuke Nirengi
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
| | - Naoki Sakane
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
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22
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Asymptomatic Striatocapsular slit-like Hemorrhage as a Severity Marker in Patients with Hypertensive Angiopathy. J Stroke Cerebrovasc Dis 2020; 29:105153. [PMID: 32912549 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/07/2020] [Accepted: 07/12/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Concomitant asymptomatic striatocapsular slit-like hemorrhage (SSH) is occasionally found in patients of spontaneous intracerebral hemorrhage (ICH), but was seldomly described in the literature. In this study, we described the clinico-radiological features of asymptomatic SSH in ICH patients with hypertensive microangiopathy. METHODS AND RESULTS 246 patients with strictly deep or mixed deep and lobar ICH/microbleeds were included. SSH was defined as hypointense lesions involving the lateral aspect of lentiform nucleus or external capsule in slit shape (>1.5 cm) on susceptibility-weighted imaging without history of associated symptoms. Demographics and neuroimaging markers were compared between patients with SSH and those without. Patients with SSH (n=24, 10%) and without SSH had comparable age (62.0 ± 12.6 vs. 62.3 ± 13.5, p = 0.912) and vascular risk factor profiles including the diagnosis of chronic hypertension, diabetes, and dyslipidemia (all p>0.05). SSH was associated with more common lobar microbleeds (79.2% vs 48.2%, p = 0.005), lacunes (75% vs. 41.4%, p = 0.002) and higher white matter hyperintensity (WMH) volumes (24.1 [10.4-46.3] vs. 13.9 [7.0-24.8] mL, p = 0.012) on MRI, as well as more frequent left ventricular hypertrophy (LVH) (50.0% vs. 20.5%, p = 0.004) and albuminuria (41.7% vs. 19.4%, p = 0.018). In multivariable analyses, SSH remains independently associated with LVH (p = 0.017) and albuminuria (p = 0.032) after adjustment for age, sex, microbleed, lacune and WMH volume. CONCLUSIONS Asymptomatic SSH is associated with more severe cerebral small vessel disease-related change on brain MRI, and hypertensive cardiac and renal injury, suggesting a more advanced stage of chronic hypertension.
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Resch ZJ, Ovsiew GP, Soble JR. Recurrent intracerebral hemorrhages due to central nervous system vasculitis: A neuropsychological case report. Clin Neuropsychol 2020; 36:699-720. [PMID: 32715901 DOI: 10.1080/13854046.2020.1794044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Primary angiitis of the central nervous system (PACNS) is a rare and devastating form of vasculitis that destroys the vessels of the brain and spinal cord, resulting in progressive and debilitating neurologic symptoms. The objective of the present study was to detail the diagnostic process of a case of a patient with PACNS who suffered from six intracerebral hemorrhages (ICHs). METHOD The patient was an African American woman with a history of recurrent ICHs of unclear etiology who received serial neuropsychological evaluations over the course of a 5-year period. Two comprehensive neuropsychological evaluations are included, as well as an overview of her clinical course, including differential diagnostic considerations and treatment planning. RESULTS Neuropsychological assessment revealed marked deficits in visuospatial abilities and processing speed associated with her underlying neuropathology. Integrated review of her medical records indicated a probable diagnosis of PACNS as the likely etiology of her recurrent ICHs. CONCLUSIONS This study demonstrates the importance of differential diagnosis of low base-rate conditions, functional neuroanatomy and neurobehavioral phenomenology, serial assessment, and cognitive reserve in clinical neuropsychological practice.
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Affiliation(s)
- Zachary J Resch
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA.,Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA
| | - Gabriel P Ovsiew
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA
| | - Jason R Soble
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA.,Department of Neurology, University of Illinois College of Medicine, Chicago, IL, USA
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Kamesaki T, Nishimura JI, Wada H, Yu E, Tsao E, Morales J, Kanakura Y. Demographic characteristics, thromboembolism risk, and treatment patterns for patients with cold agglutinin disease in Japan. Int J Hematol 2020; 112:307-315. [DOI: 10.1007/s12185-020-02899-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/30/2020] [Accepted: 05/29/2020] [Indexed: 12/30/2022]
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25
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Kim JY, Lee KJ, Kang J, Kim BJ, Kim SE, Oh H, Park HK, Cho YJ, Park JM, Park KY, Lee KB, Lee SJ, Kim T, Lee JS, Lee J, Yang KH, Choi AR, Kang MY, Bae HJ. Acute Stroke Care in Korea in 2013-2014: National Averages and Disparities. J Korean Med Sci 2020; 35:e167. [PMID: 32449325 PMCID: PMC7246192 DOI: 10.3346/jkms.2020.35.e167] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 03/18/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND This study aimed to describe the current status of acute stroke care in Korea and explore disparities among hospitals and regions. METHODS The 2013 and 2014 national stroke audit data and the national health insurance claims data were linked and used for this study. Stroke patients hospitalized via emergency rooms within 7 days of stroke onset were selected. RESULTS A total of 19,608 patients treated in 216 hospitals were analyzed. Among them 76% had ischemic stroke; 15%, intracerebral hemorrhage (ICH); and 9%, subarachnoid hemorrhage (SAH). Of the hospitals, 31% provided inpatient stroke unit care. Ambulances were used in 56% of cases, and the median interval from onset to arrival was 4.5 hours. One-quarter of patients were referred from other hospitals. Intravenous thrombolysis (IVT) and endovascular treatment (EVT) rates were 11% and 4%, respectively. Three-quarters of the analyzed hospitals provided IVT and/or EVT, whereas 47% of hospitals providing IVT and 67% of hospitals providing EVT had less than one case per month. Decompressive surgery was performed on 28% of ICH patients, and clipping and coiling were performed in 17.2% and 14.3% of SAH patients, respectively. There were noticeable regional disparities between the various interventions, ambulance use, arrival time, and stroke unit availability. CONCLUSION This study describes the current status of acute stroke care in Korea. Despite quite acceptable quality of stroke care, it suggests regional and hospital disparities. Expansion of stroke units, stroke center certification or accreditation, and connections between stroke centers and emergency medical services are highly recommended.
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Affiliation(s)
- Jun Yup Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Keon Joo Lee
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jihoon Kang
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Beom Joon Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seong Eun Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hyunji Oh
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hong Kyun Park
- Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Yong Jin Cho
- Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Jong Moo Park
- Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Kwang Yeol Park
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Kyung Bok Lee
- Department of Neurology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Soo Joo Lee
- Department of Neurology, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Korea
| | - Tackeun Kim
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Ji Sung Lee
- Clinical Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea
| | - Juneyoung Lee
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Ki Hwa Yang
- Health Insurance Review and Assessment Service, Wonju, Korea
| | - Ah Rum Choi
- Health Insurance Review and Assessment Service, Wonju, Korea
| | - Mi Yeon Kang
- Health Insurance Review and Assessment Service, Wonju, Korea
| | - Hee Joon Bae
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
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Cao J, Eshak ES, Liu K, Yang J, Gero K, Liu Z, Yu C. An Age-Period-Cohort Analysis of Stroke Mortality Attributable to Low Physical Activity in China and Japan: Data from the GBD Study 1990-2016. Sci Rep 2020; 10:6525. [PMID: 32300134 PMCID: PMC7162896 DOI: 10.1038/s41598-020-63307-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 03/17/2020] [Indexed: 12/03/2022] Open
Abstract
Stroke is the first and fourth leading cause of death in China and Japan, respectively. Physical inactivity was suggested to be one of the most important risk factors for stroke mortality. Therefore, this study aimed to assess long-term trends in stroke mortality attributable to low physical activity (LPA) in China and Japan during the period 1990–2016. Mortality data were obtained from the Global Burden of Disease Study 2016 (GBD 2016) and were analyzed with an age-period-cohort method. The age-standardized mortality rates (ASMRs) showed declining trends for LPA-attributable stroke mortality. The overall net drift per year was −1.3% for Chinese men, −2.9% for Chinese women, −3.9% for Japanese men, and −5.6% for Japanese women. In both countries, the local drift values were below zero in all age groups. The longitudinal age curves of LPA-attributable stroke mortality were higher in men than in women in all age groups. The period and cohort rate ratios showed similar downward patterns for both sexes, with a faster decline for women than for men. However, the physically active population is still small in both countries. Therefore, policymakers should further promote physical activity as one of the most recommended effective strategies in stroke prevention.
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Affiliation(s)
- Jinhong Cao
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan, China
| | - Ehab S Eshak
- Department of Public Health, Community and Preventive Medicine, Faculty of Medicine, Minia University, Minia, Egypt
| | - Keyang Liu
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Jin Yang
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan, China
| | - Krisztina Gero
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, USA
| | | | - Chuanhua Yu
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan, China.
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Srithumsuk W, Kabayama M, Gondo Y, Masui Y, Akagi Y, Klinpudtan N, Kiyoshige E, Godai K, Sugimoto K, Akasaka H, Takami Y, Takeya Y, Yamamoto K, Ikebe K, Ogawa M, Inagaki H, Ishizaki T, Arai Y, Rakugi H, Kamide K. The importance of stroke as a risk factor of cognitive decline in community dwelling older and oldest peoples: the SONIC study. BMC Geriatr 2020; 20:24. [PMID: 31969126 PMCID: PMC6977260 DOI: 10.1186/s12877-020-1423-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/10/2020] [Indexed: 12/31/2022] Open
Abstract
Background Cognitive impairment is a major health concern among older and oldest people. Moreover, stroke is a relevant contributor for cognitive decline and development of dementia. The study of cognitive decline focused on stroke as the important risk factor by recruiting older and oldest is still lagging behind. Therefore, the aim of this study was to investigate the importance of stroke as a risk factor of cognitive decline during 3 years in community dwelling older and oldest people. Methods This study was longitudinal study with a 3-year follow-up in Japan. The participants were 1333 community dwelling older and oldest people (70 years old = 675, 80 years old = 589, and 90 years old = 69). Data collected included basic data (age, sex, and history of stroke), vascular risk factors (hypertension, diabetes mellitus, dyslipidemia, atrial fibrillation, and current smoking), and social factors (educational level, frequency of going outdoors, long-term care (LTC) service used, and residential area). The Japanese version of the Montreal Cognitive Assessment (MoCA-J) was decline of ≥2 points was defined as cognitive decline. Multiple logistic regression analysis was used to investigate the association between stroke and other risk factors with cognitive decline during a 3-year follow-up. Results The fit of the hypothesized model by multiple logistic regression showed that a history of stroke, advanced age, and greater MoCA-J score at the baseline were important risk factors, while the presence of dyslipidemia and a higher educational level were protective factors that were significantly correlated with cognitive decline during the 3-year follow-up. Conclusions The cognitive decline after the 3-year follow-up was influenced by the history of stroke and advanced age, while greater MoCA-J score at the baseline was positively associated with subsequent 3 years cognitive decline. The protective factors were the presence of dyslipidemia and a higher educational level. Therefore, these factors are considered important and should be taken into consideration when searching for creative solutions to prevent cognitive decline after stroke in community dwelling older and oldest people.
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Affiliation(s)
- Werayuth Srithumsuk
- Department of Health Promotion System Sciences, Division of Health Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Mai Kabayama
- Department of Health Promotion System Sciences, Division of Health Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yasuyuki Gondo
- Department of Clinical Thanatology and Geriatric Behavioral Science, Graduate School of Human Sciences, Osaka University, Osaka, Japan
| | - Yukie Masui
- Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Yuya Akagi
- Department of Health Promotion System Sciences, Division of Health Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Nonglak Klinpudtan
- Department of Health Promotion System Sciences, Division of Health Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Eri Kiyoshige
- Department of Health Promotion System Sciences, Division of Health Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Kayo Godai
- Department of Health Promotion System Sciences, Division of Health Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Ken Sugimoto
- Department of Geriatric and General Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Hiroshi Akasaka
- Department of Geriatric and General Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yoichi Takami
- Department of Geriatric and General Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yasushi Takeya
- Department of Geriatric and General Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Koichi Yamamoto
- Department of Geriatric and General Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Kazunori Ikebe
- Department of Prosthodontics, Gerodontology and Oral Rehabilitation, Graduate School of Dentistry, Osaka University, Osaka, Japan
| | - Madoka Ogawa
- Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Hiroki Inagaki
- Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Tatsuro Ishizaki
- Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Yasumichi Arai
- Center for Supercentenarian Medical Research, Keio University School of Medicine, Tokyo, Japan
| | - Hiromi Rakugi
- Department of Geriatric and General Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Kei Kamide
- Department of Health Promotion System Sciences, Division of Health Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan.
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28
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Miki K, Natori Y, Kai Y, Yamada T, Mori M, Noguchi N, Koga H. Absence of Microbleeds Reduces the Risk for Recurrent Intracerebral Hemorrhage. J Stroke Cerebrovasc Dis 2019; 29:104585. [PMID: 31883791 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 11/04/2019] [Accepted: 11/28/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Many known risk factors, including hypertension and hyperlipidemia cause intracerebral hemorrhage (ICH). Recently, microbleeds have been identified as one of the factors leading to ICH. While some patients have been found to have recurrent ICH, risk factors for recurrent ICH are scarcely reported. We conducted an observational study on the risk-factors of recurrent ICH, comparing stroke patients with a single hemorrhagic episode and those with recurrent ICH. METHODS A retrospective analysis of a single-center database was performed to analyze the clinical presentation and characteristics of patients with a single and recurrent ICH. From January 2016 to December 2017, a total of 317 patients were analyzed based on suspected factors including patients' sex, age, medical history, antiplatelet therapy use, and presence of microbleeds on images. RESULTS Of the 317 patients, 36 patients (11.4%) developed a second episode of cerebral hemorrhage. Brain magnetic resonance imaging (MRI) of the patients without microbleeds, predicted reduced risk of recurrence. This is the first report strongly associating the presence of microbleeds with the possibility of a recurrent ICH. Other factors under study did not show an apparent association with recurrent ICH probably because of the high statistical significance obtained with the presence of microbleeds. CONCLUSION Our findings revealed that the absence of microbleeds on images is a factor that strongly predicts a reduced risk for recurrent ICH and that the detection of microbleeds on MRI performed in patients with a single hemorrhagic episode, is useful in defining further therapeutic management. These findings may benefit physicians treating stroke patients.
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Affiliation(s)
- Kenji Miki
- Department of Neurosurgery, Aso Iizuka hospital, Iizuka, Fukuoka, Japan.
| | - Yoshihiro Natori
- Department of Neurosurgery, Aso Iizuka hospital, Iizuka, Fukuoka, Japan
| | - Yasutoshi Kai
- Department of Neurosurgery, Aso Iizuka hospital, Iizuka, Fukuoka, Japan
| | - Tetsuhisa Yamada
- Department of Neurosurgery, Aso Iizuka hospital, Iizuka, Fukuoka, Japan
| | - Megumu Mori
- Department of Neurosurgery, Aso Iizuka hospital, Iizuka, Fukuoka, Japan
| | - Naoki Noguchi
- Department of Neurosurgery, Aso Iizuka hospital, Iizuka, Fukuoka, Japan
| | - Hidenobu Koga
- Crinical Research Support Office, Aso Iizuka hospital, Iizuka, Fukuoka, Japan
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29
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Affiliation(s)
- Kazunori Toyoda
- Department of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita Japan
| | - Manabu Inoue
- Department of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita Japan
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita Japan
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30
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Hostettler IC, Seiffge DJ, Werring DJ. Intracerebral hemorrhage: an update on diagnosis and treatment. Expert Rev Neurother 2019; 19:679-694. [PMID: 31188036 DOI: 10.1080/14737175.2019.1623671] [Citation(s) in RCA: 147] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Introduction: Spontaneous non-traumatic intracerebral hemorrhage (ICH) is most often caused by small vessel diseases: deep perforator arteriopathy (hypertensive arteriopathy) or cerebral amyloid angiopathy (CAA). Although ICH accounts for only 10-15% of all strokes it causes a high proportion of stroke mortality and morbidity, with few proven effective acute or preventive treatments. Areas covered: We conducted a literature search on etiology, diagnosis, treatment, management and current clinical trials in ICH. In this review, We describe the causes, diagnosis (including new brain imaging biomarkers), classification, pathophysiological understanding, treatment (medical and surgical), and secondary prevention of ICH. Expert opinion: In recent years, significant advances have been made in deciphering causes, understanding pathophysiology, and improving acute treatment and prevention of ICH. However, the clinical outcome remains poor and many challenges remain. Acute interventions delivered rapidly (including medical therapies - targeting hematoma expansion, hemoglobin toxicity, inflammation, edema, anticoagulant reversal - and minimally invasive surgery) are likely to improve acute outcomes. Improved classification of the underlying arteriopathies (from neuroimaging and genetic studies) and prognosis should allow tailored prevention strategies (including sustained blood pressure control and optimized antithrombotic therapy) to further improve longer-term outcome in this devastating disease.
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Affiliation(s)
- Isabel C Hostettler
- a UCL Stroke Research Centre, Department of Brain Repair and Rehabilitation , UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery , London , UK
| | - David J Seiffge
- a UCL Stroke Research Centre, Department of Brain Repair and Rehabilitation , UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery , London , UK.,b Stroke Center, Department of Neurology and Department of Clinical Research , University of Basel and University Hospital Basel , Basel , Switzerland
| | - David J Werring
- a UCL Stroke Research Centre, Department of Brain Repair and Rehabilitation , UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery , London , UK
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Saji N, Sakurai T, Ito K, Tomimoto H, Kitagawa K, Miwa K, Tanaka Y, Kozaki K, Kario K, Eto M, Suzuki K, Shimizu A, Niida S, Hirakawa A, Toba K. Protective effects of oral anticoagulants on cerebrovascular diseases and cognitive impairment in patients with atrial fibrillation: protocol for a multicentre, prospective, observational, longitudinal cohort study (Strawberry study). BMJ Open 2018; 8:e021759. [PMID: 30478106 PMCID: PMC6254414 DOI: 10.1136/bmjopen-2018-021759] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Non-valvular atrial fibrillation (NVAF) is known as a robust risk factor for stroke. Recent reports have suggested a risk of dementia with NVAF, but much remains unknown regarding the relationship between this mechanism and the potential protective effects of novel anticoagulants (direct oral anticoagulants (DOACs), or non-vitamin K oral anticoagulants). METHODS AND ANALYSIS This study, the strategy to obtain warfarin or DOAC's benefit by evaluating registry, is an investigator-initiated, multicentre, prospective, observational, longitudinal cohort study comparing the effects of warfarin therapy and DOACs on cerebrovascular diseases and cognitive impairment over an estimated duration of 36 months. Once a year for 3 years, the activities of daily living and cognitive functioning of non-demented patients with NVAF will be assessed. Demographics, risk factors, laboratory investigations, lifestyle, social background and brain MRI will be assessed. ETHICS AND DISSEMINATION This protocol has been approved by the ethics committee of the National Center for Geriatrics and Gerontology (No. 1017) and complies with the Declaration of Helsinki. Informed consent will be obtained before study enrolment and only coded data will be stored in a secured database. The results will be published in peer-reviewed journals and presented at scientific meetings to ensure the applicability of the findings in clinical practice. TRIAL REGISTRATION NUMBER UMIN000025721.
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Affiliation(s)
- Naoki Saji
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Takashi Sakurai
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan
- Department of Cognition and Behavioural Science, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kengo Ito
- Innovation Center for Clinical Research, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hidekazu Tomimoto
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Kazuo Kitagawa
- Department of Neurology, Tokyo Women’s Medical University School of Medicine, Tokyo, Japan
| | - Kaori Miwa
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yuji Tanaka
- Department of Neurology, Gifu Municipal Hospital, Gifu, Japan
- Health Service Center, Aichi University of Education, Kariya, Japan
| | - Koichi Kozaki
- Department of Geriatric Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Masato Eto
- International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Keisuke Suzuki
- Innovation Center for Clinical Research, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Atsuya Shimizu
- Department of Cardiology, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Shumpei Niida
- Medical Genome Center, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Akihiro Hirakawa
- Department of Biostatistics and Bioinformatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kenji Toba
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan
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Harris S, Sungkar S, Rasyid A, Kurniawan M, Mesiano T, Hidayat R. TOAST Subtypes of Ischemic Stroke and Its Risk Factors: A Hospital-Based Study at Cipto Mangunkusumo Hospital, Indonesia. Stroke Res Treat 2018; 2018:9589831. [PMID: 30534355 PMCID: PMC6252221 DOI: 10.1155/2018/9589831] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 10/25/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND PURPOSE Stroke is a leading cause of death and disability, with ischemic stroke as the highest prevalent cases in Indonesia. Ischemic stroke can be classified further into five subtypes according to TOAST classification. Numerous studies have revealed that stroke risk factor has variable correlation with different stroke subtype. Currently, there is no data regarding this phenomenon in Indonesia. The aim of study is to identify characteristic of ischemic stroke subtypes and the risk factors in TOAST classification. METHODS A retrospective, cross-sectional study of patients diagnosed with ischemic stroke at Cipto Mangunkusumo Hospital from January till December 2016. Demographic data, ischemic stroke subtypes, risk factors, and other relevant data were documented. Bivariate and multivariate analysis was done using SPSS 23. RESULTS 235 recorded data patients were included. Large artery atherosclerosis (LAA) was the most prevalent stroke subtypes at 59,6%, followed with small vessel disease (SVD) at 26,7%, undetermined etiology at 9,8%, cardioembolism (CE) at 2,1%, and other determined etiology at 0,9%. Hypertension was the most common vascular risk factor. However, it was only significant in SVD (p=0,023) and undetermined etiology subtypes (p<0,001). Significant risk factor in LAA was diabetes (55%; p=0,016) while in CE subtypes was atrial fibrillation (60%;p<0,001). In multivariate analyses, hypertension (OR 3; 95% CI 1,12-8,05) was the only variable that was related to SVD while in CE it was atrial fibrillation (OR 113,5; 95% CI 13,6-946,5). CONCLUSION LAA was the most common stroke ischemic subtypes. Associated risk factor in LAA was diabetes while in SVD and undetermined etiology subtypes it was hypertension. Atrial fibrillation was associated with cardioembolism.
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Affiliation(s)
- Salim Harris
- Division of Neurovascular-Neurosonology-Neurointervention, Department of Neurology, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Saleha Sungkar
- Department of Parasitology, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Al Rasyid
- Division of Neurovascular-Neurosonology-Neurointervention, Department of Neurology, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Mohammad Kurniawan
- Division of Neurovascular-Neurosonology-Neurointervention, Department of Neurology, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Taufik Mesiano
- Division of Neurovascular-Neurosonology-Neurointervention, Department of Neurology, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Rakhmad Hidayat
- Division of Neurovascular-Neurosonology-Neurointervention, Department of Neurology, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
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Lim JX, Han JX, See AAQ, Lew VH, Chock WT, Ban VF, Pothiawala S, Lim WEH, McAdory LE, James ML, King NKK. External Validation of Hematoma Expansion Scores in Spontaneous Intracerebral Hemorrhage in an Asian Patient Cohort. Neurocrit Care 2018; 30:394-404. [PMID: 30377910 DOI: 10.1007/s12028-018-0631-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Hematoma expansion (HE) occurs in approximately one-third of patients with intracerebral hemorrhage (ICH) and is known to be a strong predictor of neurological deterioration as well as poor functional outcome. This study aims to externally validate three risk prediction models of HE (PREDICT, 9-point, and BRAIN scores) in an Asian population. METHODS A prospective cohort of 123 spontaneous ICH patients admitted to a tertiary hospital (certified stroke center) in Singapore was recruited. Logistic recalibrations were performed to obtain updated calibration slopes and intercepts for all models. The discrimination (c-statistic), calibration (Hosmer-Lemeshow test, le Cessie-van Houwelingen-Copas-Hosmer test, Akaike information criterion), overall performance (Brier score, R2), and clinical usefulness (decision curve analysis) of the risk prediction models were examined. RESULTS Overall, the recalibrated PREDICT performed best among the three models in our study cohort based on the novel matrix comprising of Akaike information criterion and c-statistic. The PREDICT model had the highest R2 (0.26) and lowest Brier score (0.14). Decision curve analyses showed that recalibrated PREDICT was more clinically useful than 9-point and BRAIN models over the greatest range of threshold probabilities. The two scores (PREDICT and 9-point) which incorporated computed tomography (CT) angiography spot sign outperformed the one without (BRAIN). CONCLUSIONS To our knowledge, this is the first study to validate HE scores, namely PREDICT, 9-Point and BRAIN, in a multi-ethnic Asian ICH patient population. The PREDICT score was the best performing model in our study cohort, based on the performance metrics employed in this study. Our findings also showed support for CT angiography spot sign as a predictor of outcome after ICH. Although the models assessed are sufficient for risk stratification, the discrimination and calibration are at best moderate and could be improved.
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Affiliation(s)
- Jia Xu Lim
- Department of Neurosurgery, National Neuroscience Institute, 11, Jalan Tan Tock Seng, Singapore, 308433, Singapore.,Department of Neurosurgery, Singapore General Hospital, Singapore, Singapore
| | - Julian Xinguang Han
- Department of Neurosurgery, National Neuroscience Institute, 11, Jalan Tan Tock Seng, Singapore, 308433, Singapore.,Department of Neurosurgery, Singapore General Hospital, Singapore, Singapore
| | - Angela An Qi See
- Department of Neurosurgery, National Neuroscience Institute, 11, Jalan Tan Tock Seng, Singapore, 308433, Singapore.,Department of Neurosurgery, Singapore General Hospital, Singapore, Singapore
| | - Voon Hao Lew
- Department of Neurosurgery, National Neuroscience Institute, 11, Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Wan Ting Chock
- Department of Neurosurgery, Singapore General Hospital, Singapore, Singapore
| | - Vin Fei Ban
- Department of Neurosurgery, Singapore General Hospital, Singapore, Singapore
| | - Sohil Pothiawala
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Winston Eng Hoe Lim
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore, Singapore
| | - Louis Elliot McAdory
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore, Singapore
| | - Michael Lucas James
- Departments of Anesthesiology, Brain Injury Translational Research Center, Duke University, Durham, NC, USA.,Departments of Neurology, Brain Injury Translational Research Center, Duke University, Durham, NC, USA
| | - Nicolas Kon Kam King
- Department of Neurosurgery, National Neuroscience Institute, 11, Jalan Tan Tock Seng, Singapore, 308433, Singapore. .,Department of Neurosurgery, Singapore General Hospital, Singapore, Singapore. .,Duke-NUS Medical School, Singapore, Singapore.
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Xu YM, Wang XC, Zhang SJ, Xu TT, Li HY, Hei SY, Wen ZH, Ma YZ, Wang Q, Liang WX. Role of Xingnaojing combined with naloxone in treating intracerebral haemorrhage: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2018; 97:e12967. [PMID: 30412118 PMCID: PMC6221641 DOI: 10.1097/md.0000000000012967] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Xingnaojing injection (XNJ) sharpen the mind and induce consciousness and are widely used in acute phases of intracerebral hemorrhage (ICH). Naloxone hydrochloride injection (NX) performs equally well and replace the effects of morphine-like substances to promote conscious awareness. The applications of XNJ combined with NX for ICH show some advantages compared with NX applied individually. The aim of this systematic review is to evaluate the effectiveness and safety of XNJ combined with NX for ICH. METHODS Comprehensive searches were conducted in 8 medical databases (PubMed, Cochrane Library, Web of Science, Embase, CNKI, VIP, CBM and Wanfang database) from inceptions to October 2017 for randomized controlled trials (RCTs) that compared the applications of XNJ and NX with NX applied individually in ICH. Literature screening, assessing risk of bias and data extraction were conducted by 2 reviewers independently. According to the Cochrane Collaboration's RevMan5.3 software to perform the data analysis. RESULTS 32 RCTs (3068 cases) were selected and the quality of studies were low. All trials compared XNJ and NX with NX applied individually. The overall meta-analysis results showed that XNJ combined with NX have significant effect on clinical efficacy (OR 3.78, 95% CI: 3.03-4.73; P < .00001), GCS score (MD 3.86, 95% CI: 3.46-4.25; P < .00001), coma duration (MD -5.59, 95% CI: -6.96 to -4.22; P < .00001), NIHSS score (MD -6.24, 95% CI: -8.05 to -4.42; P < .00001), Barthel Index score (MD 14.12, 95% CI: 6.7-21.54; P < .0002), cerebral hematoma volume (MD -6.05, 95% CI: -6.85 to -5.24; P < .00001) than NX applied individually. Adverse events reported in 4 studies and included mild discomfort symptoms. CONCLUSION The effectiveness and safety of XNJ combined with NX for ICH cannot be determined due to the low quality of literature, publication bias and heterogeneity. More rigorous RCTs are necessary to verify the role of XNJ combined with NX in the treatment of ICH.
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Affiliation(s)
- Yu-Min Xu
- The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
- Institute of Clinical Pharmacology, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xin-Chen Wang
- Institute of Clinical Pharmacology, Guangzhou University of Chinese Medicine, Guangzhou, China
- School of Food and Pharmaceutical Engineering, Zhaoqing University, Guangdong, China
| | - Shi-Jie Zhang
- Institute of Clinical Pharmacology, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ting-Ting Xu
- Institute of Clinical Pharmacology, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Hong-Ying Li
- Institute of Clinical Pharmacology, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shang-Yan Hei
- Institute of Clinical Pharmacology, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ze-Huai Wen
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Yun-Zhi Ma
- The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Qi Wang
- Institute of Clinical Pharmacology, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wei-Xiong Liang
- Institute of Clinical Pharmacology, Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
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Lee SA, Park EC, Shin J, Ju YJ, Choi Y, Lee HY. Patient and hospital factors associated with 30-day unplanned readmission in patients with stroke. J Investig Med 2018; 67:52-58. [DOI: 10.1136/jim-2018-000748] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/23/2018] [Accepted: 06/23/2018] [Indexed: 11/03/2022]
Abstract
Stroke is frequently associated with readmission; moreover, readmission is regarded as an important indicator of the quality of stroke care. Thus, we investigated factors associated with 30-day readmission in patients with stroke in South Korea. We used claims data from 2013 for stroke (I60–I62) patients (n=44 729) in 94 hospitals and classified unplanned readmission according to the Centers for Medicare and Medicaid guidelines. We used multilevel models to investigate patient (age, gender, type of insurance, admission via emergency room, length of stay, type of stroke, Elixhauser Index Score) and hospital (stroke care quality grade, location of hospital, type of hospital, number of doctors and nurses per 100 beds) factors associated with readmission within 30 days of discharge. Among the 44 729 patients admitted due to stroke, 9.2% (n=4124) were readmitted to hospital and 7.6% (n=3379) had unplanned readmissions. Regarding patient characteristics, medical aid and longer hospital stay were associated with 30-day readmission rate. Among hospital factors, patients admitted to a low-grade hospital or a non-capital area hospital were more likely to be readmitted within 30 days of discharge. We identified patient and hospital factors associated with 30-day readmission among stroke patients. In particular, patients admitted to hospitals with higher quality stroke care showed lower readmission rates.
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Harris S, Kurniawan M, Rasyid A, Mesiano T, Hidayat R. Cerebral small vessel disease in Indonesia: Lacunar infarction study from Indonesian Stroke Registry 2012-2014. SAGE Open Med 2018; 6:2050312118784312. [PMID: 29977554 PMCID: PMC6024285 DOI: 10.1177/2050312118784312] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 05/24/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND AND PURPOSE Stroke is the number one cause of morbidity and mortality in Indonesia. Lacunar infarction is one of cerebral small vessel disease spectrum. This study aimed to present stroke epidemiology in Indonesia and risk factors associated with cerebral small vessel disease. METHODS A multicenter prospective cross-sectional study of 18 hospitals in Indonesia was conducted using Stroke Case Report Form from 2012 to 2014. Stroke was diagnosed based on clinical findings confirmed with non-contrast computed tomography of the brain. Subjects were classified into two large groups: ischemic (lacunar and non-lacunar) and hemorrhagic (intracranial and subarachnoid hemorrhage). Other risk factors were assessed on admission. RESULTS We enrolled 5411 patients, of whom 3627 (67.03%) had ischemic stroke and 1784 (32.97%) had hemorrhagic stroke. Male patients were prevalent in both large groups, although found less in subarachnoid hemorrhage group. Among patients with hemorrhagic stroke, 1603 (89.54%) of them had intracerebral hemorrhage and 181 (10.46%) had subarachnoid hemorrhage. From 3627 ischemic stroke patients, 1635 (45.07%) of them had lacunar infarction. We found that age above 55 years old, male gender, hypertension, dyslipidemia, and diabetes were important risk factors associated with lacunar stroke (p < 0.05). CONCLUSION Ischemic stroke was the leading cause of stroke in Indonesia. In total, 45% of the total ischemic stroke patients had lacunar infarction. Important risk factors associated with lacunar infarction were hypertension, dyslipidemia, diabetes, age over 55, and male population.
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Affiliation(s)
- Salim Harris
- Department of Neurology, Faculty of Medicine, Universitas Indonesia and Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Mohammad Kurniawan
- Department of Neurology, Faculty of Medicine, Universitas Indonesia and Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Al Rasyid
- Department of Neurology, Faculty of Medicine, Universitas Indonesia and Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Taufik Mesiano
- Department of Neurology, Faculty of Medicine, Universitas Indonesia and Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Rakhmad Hidayat
- Department of Neurology, Faculty of Medicine, Universitas Indonesia and Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
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Kim BJ, Lee EJ, Kwon SU, Park JH, Kim YJ, Hong KS, Wong LKS, Yu S, Hwang YH, Lee JS, Lee J, Rha JH, Heo SH, Ahn SH, Seo WK, Park JM, Lee JH, Kwon JH, Sohn SI, Jung JM, Navarro JC, Kang DW, Kwon SU, Lee J, Kang DW, Rha JH, Park JM, Lee YS, Lee JH, Kim YJ, Hong KS, Yu KH, Sohn SI, Ahn SH, Cha JK, Park MS, Kim JS, Yoon BW, Lee BC, Nam CM, Koo JS, Nam HS, Park KY, Park JM, Lee JH, Kim DH, Rha JH, Nah HW, Lee YS, Cho YJ, Kim DE, Han MK, Lee KB, Heo SH, Heo JH, Kim BJ, Cho KH, Kim HY, Kim YD, Cho AH, Lee KY, Lee JS, Park JH, Seo WK, Kim EG, Koh IS, Choi NC, Kwon JH, Lee J, Hwang YH, Song HJ, Shin BS, Kim JT, Lee SJ, Chung PW, Kim SH, Lee JH, Shin DI, Do JK, Lee SB, Lee YB, Yoo BG, Sung SM, Jung JM, Park JW, Lee TK, Navarro JC, San Jos MCZ, Roxas A, Mallarl-Alvarez RJ, Collantes MEV, WONG LK, Fong WC, Tsoi TH, Ng PW, Lee EJ, Lee JS. Prevention of cardiovascular events in Asian patients with ischaemic stroke at high risk of cerebral haemorrhage (PICASSO): a multicentre, randomised controlled trial. Lancet Neurol 2018; 17:509-518. [DOI: 10.1016/s1474-4422(18)30128-5] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 03/22/2018] [Accepted: 03/22/2018] [Indexed: 12/18/2022]
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Yasuda K, Saichi K, Kaibuki N, Harashima H, Iwata H. Haptic-based perception-empathy biofeedback system for balance rehabilitation in patients with chronic stroke: Concepts and initial feasibility study. Gait Posture 2018; 62:484-489. [PMID: 29677663 DOI: 10.1016/j.gaitpost.2018.04.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 03/19/2018] [Accepted: 04/10/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Most individuals have sensory disturbances post stroke, and these deficits contribute to post-stroke balance impairment. The haptic-based biofeedback (BF) system appears to be one of the promising tools for balance rehabilitation in patients with stroke, and the BF system can increase the objectivity of feedback and encouragement than that provided by a therapist. RESEARCH QUESTION Studies in skill science indicated that feedback or encouragement from a coach or trainer enhances motor learning effect. Nevertheless, the optimal BF system (or its concept) which would refine the interpersonal feedback between patients and therapist has not been proposed. Thus, the purpose of this study was to propose a haptic-based perception-empathy BF system which provides information regarding the patient's center-of-foot pressure (CoP) pattern to the patient and the physical therapist to enhance the motor learning effect and validate the feasibility of this balance-training regimen in patients with chronic stroke. METHODS This study used a pre-post design without control group. Nine chronic stroke patients (mean age: 64.4 ± 9.2 years) received a balance-training regimen using this BF system twice a week for 4 weeks. Testing comprised quantitative measures (i.e., CoP) and clinical balance scale (Berg Balance Scale, BBS; Functional Reach Test, FRT; and Timed-Up and Go test, TUG). RESULTS AND SIGNIFICANCE Post training, patients demonstrated marginally reduced postural spatial variability (i.e., 95% confidence elliptical area), and clinical balance performance significantly improved at post-training. Although the changes in FRT and TUG exceeded the minimal detectable change (MDC), changes in BBS did not reach clinical significance (i.e., smaller than MDC). These results may provide initial knowledge (i.e., beneficial effects, utility and its limitation) of the proposed BF system in designing effective motor learning strategies for stroke rehabilitation. More studies are required addressing limitations due to research design and training method for future clinical use.
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Affiliation(s)
- Kazuhiro Yasuda
- Research Institute for Science and Engineering, Waseda University, 3-4-1 Okubo, Shinjuku-ku, Tokyo 169-8555, Japan.
| | - Kenta Saichi
- Graduate School of Creative Science and Engineering, Waseda University 3-4-1 Okubo, Shinjuku-ku, Tokyo 169-8555, Japan.
| | - Naomi Kaibuki
- Department of Rehabilitation, Tokyo General Hospital, 3-15-2 Ekota, Nakano-ku, Tokyo 165-0022, Japan.
| | - Hiroaki Harashima
- Department of Rehabilitation, Tokyo General Hospital, 3-15-2 Ekota, Nakano-ku, Tokyo 165-0022, Japan.
| | - Hiroyasu Iwata
- Graduate School of Creative Science and Engineering, Waseda University 3-4-1 Okubo, Shinjuku-ku, Tokyo 169-8555, Japan.
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Wei L, Wei ZZ, Jiang MQ, Mohamad O, Yu SP. Stem cell transplantation therapy for multifaceted therapeutic benefits after stroke. Prog Neurobiol 2017; 157:49-78. [PMID: 28322920 PMCID: PMC5603356 DOI: 10.1016/j.pneurobio.2017.03.003] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 01/30/2017] [Accepted: 03/05/2017] [Indexed: 02/06/2023]
Abstract
One of the exciting advances in modern medicine and life science is cell-based neurovascular regeneration of damaged brain tissues and repair of neuronal structures. The progress in stem cell biology and creation of adult induced pluripotent stem (iPS) cells has significantly improved basic and pre-clinical research in disease mechanisms and generated enthusiasm for potential applications in the treatment of central nervous system (CNS) diseases including stroke. Endogenous neural stem cells and cultured stem cells are capable of self-renewal and give rise to virtually all types of cells essential for the makeup of neuronal structures. Meanwhile, stem cells and neural progenitor cells are well-known for their potential for trophic support after transplantation into the ischemic brain. Thus, stem cell-based therapies provide an attractive future for protecting and repairing damaged brain tissues after injury and in various disease states. Moreover, basic research on naïve and differentiated stem cells including iPS cells has markedly improved our understanding of cellular and molecular mechanisms of neurological disorders, and provides a platform for the discovery of novel drug targets. The latest advances indicate that combinatorial approaches using cell based therapy with additional treatments such as protective reagents, preconditioning strategies and rehabilitation therapy can significantly improve therapeutic benefits. In this review, we will discuss the characteristics of cell therapy in different ischemic models and the application of stem cells and progenitor cells as regenerative medicine for the treatment of stroke.
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Affiliation(s)
- Ling Wei
- Laboratories of Stem Cell Biology and Regenerative Medicine, Department of Neurology, Experimental Research Center and Neurological Disease Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China; Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA 30322, USA; Department of Neurology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Zheng Z Wei
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Michael Qize Jiang
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Osama Mohamad
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Shan Ping Yu
- Laboratories of Stem Cell Biology and Regenerative Medicine, Department of Neurology, Experimental Research Center and Neurological Disease Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China; Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA 30322, USA.
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Venketasubramanian N, Yoon BW, Pandian J, Navarro JC. Stroke Epidemiology in South, East, and South-East Asia: A Review. J Stroke 2017; 19:286-294. [PMID: 29037005 PMCID: PMC5647629 DOI: 10.5853/jos.2017.00234] [Citation(s) in RCA: 164] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 09/07/2017] [Accepted: 09/14/2017] [Indexed: 11/29/2022] Open
Abstract
Asia, which holds 60% of the world’s population, comprises some developing countries which are in economic transition. This paper reviews the epidemiology of stroke in South, East and South-East Asia. Data on the epidemiology of stroke in South, East, and South-East Asia were derived from the Global Burden of Disease study (mortality, disability-adjusted life-years [DALYs] lost because of stroke), World Health Organization (vascular risk factors in the community), and publications in PubMed (incidence, prevalence, subtypes, vascular risk factors among hospitalized stroke patients). Age- and sex-standardized mortality is the lowest in Japan, and highest in Mongolia. Community-based incidence data of only a few countries are available, with the lowest rates being observed in Malaysia, and the highest in Japan and Taiwan. The availability of prevalence data is higher than incidence data, but different study methods were used for case-finding, with different age bands. For DALYs, Japan has the lowest rates, and Mongolia the highest. For community, a high prevalence of hypertension is seen in Mongolia and Pakistan; diabetes mellitus in Papua New Guinea, Pakistan, and Mongolia; hypercholesterolemia in Japan, Singapore, and Brunei; inactivity in Malaysia; obesity in Brunei, Papua New Guinea, and Mongolia; tobacco smoking in Indonesia. Hypertension is the most frequent risk factor, followed by diabetes mellitus and smoking. Ischemic stroke occurs more frequently than hemorrhagic stroke, and subarachnoid hemorrhages are uncommon. There are variations in the stroke epidemiology between countries in South, East, and South-East Asia. Further research on stroke burden is required.
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Affiliation(s)
| | - Byung Woo Yoon
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Jeyaraj Pandian
- Department of Neurology, Christian Medical College, Ludhiana, India
| | - Jose C Navarro
- Neuroscience Institute, St. Luke's Medical Center, Jose R. Reyes Medical Center, Manila, Philippines
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Saichi K, Yasuda K, Kitaji Y, Kaibuki N, Iwata H. Development and pilot clinical evaluation of a haptic-based perception-empathy biofeedback device for gait rehabilitation. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:6158-6161. [PMID: 28269658 DOI: 10.1109/embc.2016.7592134] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Recent studies have shown that haptic feedback on the body, either at or away from the desired gait parameter to be changed, can improve gait performance. Here we introduced a haptic-based biofeedback device to supplement the foot pressure information of a paretic foot with a wearable vibrotactile biofeedback device attached to the back. This system provides information regarding a patient's foot pressure pattern to the patient and physical therapist. Therefore, the biofeedback system can share information regarding abnormal gait patterns between patients and therapists. This pilot study showed that the device immediately improved the stride length during walking, but not walking speed. Furthermore, subjective reports indicated that synchronizing foot pressure pattern information between the patient and therapist induced higher patient motivation for gait rehabilitation.
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An SJ, Kim TJ, Yoon BW. Epidemiology, Risk Factors, and Clinical Features of Intracerebral Hemorrhage: An Update. J Stroke 2017; 19:3-10. [PMID: 28178408 PMCID: PMC5307940 DOI: 10.5853/jos.2016.00864] [Citation(s) in RCA: 488] [Impact Index Per Article: 69.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 12/18/2016] [Accepted: 01/06/2017] [Indexed: 12/15/2022] Open
Abstract
Intracerebral hemorrhage (ICH) is the second most common subtype of stroke and a critical disease usually leading to severe disability or death. ICH is more common in Asians, advanced age, male sex, and low- and middle-income countries. The case fatality rate of ICH is high (40% at 1 month and 54% at 1 year), and only 12% to 39% of survivors can achieve long-term functional independence. Risk factors of ICH are hypertension, current smoking, excessive alcohol consumption, hypocholesterolemia, and drugs. Old age, male sex, Asian ethnicity, chronic kidney disease, cerebral amyloid angiopathy (CAA), and cerebral microbleeds (CMBs) increase the risk of ICH. Clinical presentation varies according to the size and location of hematoma, and intraventricular extension of hemorrhage. Patients with CAA-related ICH frequently have concomitant cognitive impairment. Anticoagulation related ICH is increasing recently as the elderly population who have atrial fibrillation is increasing. As non-vitamin K antagonist oral anticoagulants (NOACs) are currently replacing warfarin, management of NOAC-associated ICH has become an emerging issue.
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Affiliation(s)
- Sang Joon An
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Tae Jung Kim
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Byung-Woo Yoon
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
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Kim YD, Song D, Nam HS, Choi D, Kim JS, Kim BK, Chang HJ, Choi HY, Lee K, Yoo J, Lee HS, Nam CM, Heo JH. Increased Risk of Cardiovascular Events in Stroke Patients Who had Not Undergone Evaluation for Coronary Artery Disease. Yonsei Med J 2017; 58:114-122. [PMID: 27873503 PMCID: PMC5122626 DOI: 10.3349/ymj.2017.58.1.114] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 07/25/2016] [Accepted: 07/26/2016] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Although asymptomatic coronary artery occlusive disease is common in stroke patients, the long-term advantages of undergoing evaluation for coronary arterial disease using multi-detector coronary computed tomography (MDCT) have not been well established in stroke patients. We compared long-term cardio-cerebrovascular outcomes between patients who underwent MDCT and those who did not. MATERIALS AND METHODS This was a retrospective study in a prospective cohort of consecutive ischemic stroke patients. Of the 3117 patients who were registered between July 2006 and December 2012, MDCT was performed in 1842 patients [MDCT (+) group] and not in 1275 patients [MDCT (-) group]. Occurrences of death, cardiovascular events, and recurrent stroke were compared between the groups using Cox proportional hazards models and propensity score analyses. RESULTS During the mean follow-up of 38.0±24.8 months, 486 (15.6%) patients died, recurrent stroke occurred in 297 (9.5%), and cardiovascular events occurred in 60 patients (1.9%). Mean annual risks of death (9.34% vs. 2.47%), cardiovascular events (1.2% vs. 0.29%), and recurrent stroke (4.7% vs. 2.56%) were higher in the MDCT (-) group than in the MDCT (+) group. The Cox proportional hazards model and the five propensity score-adjusted models consistently demonstrated that the MDCT (-) group was at a high risk of cardiovascular events (hazard ratios 3.200, 95% confidence interval 1.172-8.735 in 1:1 propensity matching analysis) as well as death. The MDCT (-) group seemed to also have a higher risk of recurrent stroke. CONCLUSION Acute stroke patients who underwent MDCT experienced fewer deaths, cardiovascular events, and recurrent strokes during follow-up.
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Affiliation(s)
- Young Dae Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Dongbeom Song
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Hyo Suk Nam
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Donghoon Choi
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Sun Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byeong Keuk Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyuk Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Yeon Choi
- Department of Neurology, Kyung Hee University College of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Kijeong Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Joonsang Yoo
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Sun Lee
- Department of Biostatistics, Yonsei University College of Medicine, Seoul, Korea
| | - Chung Mo Nam
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Hoe Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.
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Fukuyama S, Matsumoto K, Kaneko Y, Kan-o K, Noda N, Tajiri-Asai Y, Nakano T, Ishii Y, Kiyohara Y, Nakanishi Y, Inoue H. Prevalence of Airflow Limitation Defined by Pre- and Post-Bronchodilator Spirometry in a Community-Based Health Checkup: The Hisayama Study. TOHOKU J EXP MED 2016; 238:179-84. [PMID: 26888697 DOI: 10.1620/tjem.238.179] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Spirometry in health checkup may contribute to early diagnosis of chronic obstructive pulmonary disease (COPD) and asthma. Although post-bronchodilator airflow limitation is essential for definite diagnosis of COPD and post-bronchodilator normalization of airflow is suggestive of asthma, this test has not been prevailed in health checkup. The objective of this study was to estimate the prevalence of airflow limitation defined by pre- and post-bronchodilator spirometry in health checkup. Post-bronchodilator spirometry was conducted for participants with airflow limitation in a town-wide health checkup for residents aged 40 years and older in Hisayama, a town in the western part of Japan. The prevalence of pre- and post-bronchodilator airway limitation defined by FEV1/FVC < 70% were estimated. A total of 2,232 participants underwent pre-bronchodilator spirometry. In males, the age of current smokers was significantly younger than those of never smokers and former smokers. In females, the ages of current- and former smokers were significantly younger than never smokers. The values of %FEV1 and %FVC in current smokers were significantly lower than those in former smokers and never smokers. Two hundred sixty nine subjects, 85% of total subjects with a pre-bronchodilator FEV1/FVC < 70%, completed post-bronchodilator spirometry. The prevalence of pre-bronchodilator airflow limitation was 14.6% in males and 13.7% in females, and the prevalence of post-bronchodilator airway limitation was 8.7% and 8.7%, respectively. Post-bronchodilator spirometry in health checkup would reduce the number of subjects with probable COPD to two-third. Recommendation for those examinees to take further evaluations may pave the way for early intervention.
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Affiliation(s)
- Satoru Fukuyama
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University
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Plasma thrombin-cleaved osteopontin as a potential biomarker of acute atherothrombotic ischemic stroke. Hypertens Res 2016; 40:61-66. [PMID: 27558929 DOI: 10.1038/hr.2016.110] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 06/17/2016] [Accepted: 07/13/2016] [Indexed: 12/28/2022]
Abstract
We investigated whether thrombin-cleaved osteopontin N-terminal is useful as a blood biomarker of acute atherothrombotic ischemic stroke. Acute ischemic stroke patients were prospectively evaluated with brain magnetic resonance imaging and cardiac evaluations for etiological diagnosis according to the Trial of Org 10172 in Acute Stroke Treatment classification. They were divided into the atherothrombotic and non-atherothrombotic groups. Thrombin-cleaved osteopontin N-terminal, osteopontin, matrix metalloproteinase-9, S100B, C-reactive protein and D-dimer levels were measured from blood samples collected at admission. After excluding patients who met the exclusion criteria or had stroke of other/undetermined etiology, 60 of the 100 patients initially enrolled were included in the final analysis. The ischemic stroke subtypes were atherothrombotic (n=28, 46.7%), cardioembolic (n=19, 31.7%) and lacunar (n=13, 21.7%). Thrombin-cleaved osteopontin N-terminal and matrix metalloproteinase-9 levels were significantly higher in the atherothrombotic than in the non-atherothrombotic group (median (interquartile range): 5.83 (0.0-8.6 ) vs. 0.0 (0.0-3.3) pmol l-1, P=0.03 and 544 (322-749 ) vs. 343 (254-485) ng ml-1, P=0.01, respectively). After adjustment for the prevalence of hypertension, diabetes and dyslipidemia, thrombin-cleaved osteopontin N-terminal levels of >5.47 pmol l-1 (odds ratio, 16.81; 95% confidence interval, 3.53-80.10) and matrix metalloproteinase-9 levels of >605.5 ng ml-1 (6.59; 1.77-24.60) were identified as independent predictors of atherothrombosis. Within 3 h from stroke onset, only thrombin-cleaved osteopontin N-terminal independently predicted atherothrombosis and thus may add valuable, time-sensitive diagnostic information in the early evaluation of ischemic stroke, especially the atherothrombotic subtype.
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Nakashita S, Wada-Isoe K, Uemura Y, Tanaka K, Yamamoto M, Yamawaki M, Nakashima K. Clinical assessment and prevalence of parkinsonism in Japanese elderly people. Acta Neurol Scand 2016; 133:373-9. [PMID: 26234395 DOI: 10.1111/ane.12472] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Parkinsonism is often observed in the elderly. To clarify the prevalence of parkinsonism-associated diseases and conditions, we conducted a population-based study in a rural island town in western Japan, Ama-cho. METHODS Participants included 924 subjects aged 65 years or older residing in the town. Between 2008 and 2011, participants were assessed via standardized neurological examination scales, and Brain MRIs were carried out in 2010. Based on the results of assessment using the modified Unified Parkinson's Disease Rating Scale and a standardized neurological examination, participants were diagnosed as having parkinsonism or mild parkinsonian signs (MPS), or as displaying normal motor conditions (M-normal). RESULTS Of the 729 participants screened, 70 subjects were diagnosed as having parkinsonism, corresponding to a crude prevalence rate of 9.6% (95% CI, 7.9-11.3%), while 167 MPS subjects (22.9%) and 492 subjects experiencing M-normal (67.5%) were observed. Parkinsonism was found in association with various diseases such as Vascular parkinsonism, Lewy body disease, Alzheimer's disease (AD), and idiopathic normal-pressure hydrocephalus. Among the subjects with dementia, the proportion with parkinsonism was higher in the non-AD dementia group. CONCLUSION(S) Parkinsonism occurs in association with several diseases in elderly people. Parkinsonism was also found to be commonly associated with cognitive impairment.
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Affiliation(s)
- S. Nakashita
- Division of Neurology; Department of Brain and Neurosciences; Faculty of Medicine; Tottori University; Yonago Japan
| | - K. Wada-Isoe
- Division of Neurology; Department of Brain and Neurosciences; Faculty of Medicine; Tottori University; Yonago Japan
| | - Y. Uemura
- Division of Neurology; Department of Brain and Neurosciences; Faculty of Medicine; Tottori University; Yonago Japan
| | - K. Tanaka
- Division of Neurology; Department of Brain and Neurosciences; Faculty of Medicine; Tottori University; Yonago Japan
| | - M. Yamamoto
- Division of Neurology; Department of Brain and Neurosciences; Faculty of Medicine; Tottori University; Yonago Japan
| | - M. Yamawaki
- Division of Neurology; Department of Brain and Neurosciences; Faculty of Medicine; Tottori University; Yonago Japan
| | - K. Nakashima
- Division of Neurology; Department of Brain and Neurosciences; Faculty of Medicine; Tottori University; Yonago Japan
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Cadilhac DA, Kim J, Lannin NA, Kapral MK, Schwamm LH, Dennis MS, Norrving B, Meretoja A. National stroke registries for monitoring and improving the quality of hospital care: A systematic review. Int J Stroke 2016; 11:28-40. [DOI: 10.1177/1747493015607523] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
BackgroundRoutine monitoring of the quality of stroke care is becoming increasingly important since patient outcomes could be improved with better access to proven treatments. It remains unclear how many countries have established a national registry for monitoring stroke care.AimsTo describe the current status of national, hospital-based stroke registries that have a focus on monitoring access to evidence-based care and patient outcomes and to summarize the main features of these registries.Summary of reviewWe undertook a systematic search of the published literature to identify the registries that are considered in their country to represent a national standardized dataset for acute stroke care and outcomes. Our initial keyword search yielded 5002 potential papers, of which we included 316 publications representing 28 national stroke registries from 26 countries. Where reported, data were most commonly collected with a waiver of patient consent (70%). Most registries used web-based systems for data collection (57%) and 25% used data linkage. Few variables were measured consistently among the registries reflecting their different local priorities. Funding, resource requirements, and coverage also varied.ConclusionsThis review provides an overview of the current use of national stroke registries, a description of their common features relevant to monitoring stroke care in hospitals. Formal registration and description of registries would facilitate better awareness of efforts in this field.
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Affiliation(s)
- Dominique A Cadilhac
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Joosup Kim
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Natasha A Lannin
- College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia
- Alfred Health, Prahran, Australia
| | - Moira K Kapral
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Lee H Schwamm
- Department of Neurology, Stroke Service Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Martin S Dennis
- Centre for Clinical Brain Sciences, University of Edinburgh, Scotland
| | - Bo Norrving
- Department of Clinical Sciences, Neurology, Lund University, Sweden
| | - Atte Meretoja
- Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
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Kim AS, Cahill E, Cheng NT. Global Stroke Belt: Geographic Variation in Stroke Burden Worldwide. Stroke 2015; 46:3564-70. [PMID: 26486867 DOI: 10.1161/strokeaha.115.008226] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 09/11/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Anthony S Kim
- From the Department of Neurology, University of California, San Francisco.
| | - Elizabeth Cahill
- From the Department of Neurology, University of California, San Francisco
| | - Natalie T Cheng
- From the Department of Neurology, University of California, San Francisco
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Abstract
Although stroke is a world-wide problem, the burden of stroke is particularly serious in Asia; its mortality is higher than in Europe or North America. The situation in Asia is dichotomized. Stroke mortality and case fatality has been declining in northern-eastern countries such as Korea, Japan, Taiwan, and urbanized areas of China. This is attributed to both the risk factor control and stroke care improvement. However, declining stroke incidence is rarely observed, which is in part due to rapidly aging population. As a result, there is an increase in the number of stroke survivors who require long-term, costly care. The extremely low birth rate and relatively insecure social health system markedly increases the caregiver burden. The problem in southern Asian countries, such as India, Pakistan, Bangladesh, and Indonesia is more fundamental. With the improving control of infectious diseases, life expectancy is prolonged. However, risk factors such as hypertension, diabetes, obesity and cigarette smoking become prevalent, and are poorly controlled. Stroke neurologists, organized stroke centers, and diagnostic tools are insufficient, which has resulted in high stroke fatality and mortality. Throughout Asia, the most urgent priority should be the primary stroke prevention through promoting a healthy lifestyle, e.g. low salt intake, regular physical exercise, stopping smoking, government sectors should take a stronger initiative to accomplish this. The rapidly aging populations and stroke burden will shrink the economy and destabilize the society, not only in Asia but also globally unless appropriate efforts are promptly initiated, this may result in a global disaster.
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Smith-Palmer J, Boye KS, Perez-Nieves M, Valentine W, Bae JP. Cardiovascular risk profiles in Type 2 diabetes and the impact of geographical setting. Expert Rev Endocrinol Metab 2015; 10:243-257. [PMID: 30293513 DOI: 10.1586/17446651.2015.995167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cardiovascular (CV) disease is a leading morbidity and mortality in Type 2 diabetes (T2DM). Previous studies have shown geographic differences in the prevalence of CV and renal diseases. A literature review of longitudinal (≥5 years) studies including ≥1000 T2DM patients and reporting CV endpoints was performed to compare risk profiles. Key differences between geographies included a relatively higher prevalence of microalbuminuria in East Asian relative to North American and European patients, which in turn is an important CV risk factor. Patients from East Asia also have a relatively higher incidence of stroke and lower incidence of coronary heart disease. Overall, there are differences in CV risk in T2DM patients between different regions and that long-term studies from Africa, the Middle East and Latin America are lacking.
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Affiliation(s)
- Jayne Smith-Palmer
- a 1 Ossian Health Economics and Communications GmbH, Bäumleingasse 20, 4051 Basel, Switzerland
| | | | | | - William Valentine
- a 1 Ossian Health Economics and Communications GmbH, Bäumleingasse 20, 4051 Basel, Switzerland
| | - Jay P Bae
- b 2 Eli Lilly and Company, Indianapolis, IN, USA
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