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Åberg D, Gadd G, Jood K, Redfors P, Stanne TM, Isgaard J, Blennow K, Zetterberg H, Jern C, Åberg ND, Svensson J. Serum IGFBP-1 Concentration as a Predictor of Outcome after Ischemic Stroke-A Prospective Observational Study. Int J Mol Sci 2023; 24:ijms24119120. [PMID: 37298072 DOI: 10.3390/ijms24119120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/12/2023] [Accepted: 05/18/2023] [Indexed: 06/12/2023] Open
Abstract
Insulin-like growth factor-binding protein-1 (IGFBP-1) regulates insulin-like growth factor-I (IGF-I) bioactivity, and is a central player in normal growth, metabolism, and stroke recovery. However, the role of serum IGFBP-1 (s-IGFBP-1) after ischemic stroke is unclear. We determined whether s-IGFBP-1 is predictive of poststroke outcome. The study population comprised patients (n = 470) and controls (n = 471) from the Sahlgrenska Academy Study on Ischemic Stroke (SAHLSIS). Functional outcome was evaluated after 3 months, 2, and 7 years using the modified Rankin Scale (mRS). Survival was followed for a minimum of 7 years or until death. S-IGFBP-1 was increased after 3 months (p < 0.01), but not in the acute phase after stroke, compared with the controls. Higher acute s-IGFBP-1 was associated with poor functional outcome (mRS score > 2) after 7 years [fully adjusted odds ratio (OR) per log increase 2.9, 95% confidence interval (CI): 1.4-5.9]. Moreover, higher s-IGFBP-1 after 3 months was associated with a risk of poor functional outcome after 2 and 7 years (fully adjusted: OR 3.4, 95% CI: 1.4-8.5 and OR 5.7, 95% CI: 2.5-12.8, respectively) and with increased mortality risk (fully adjusted: HR 2.0, 95% CI: 1.1-3.7). Thus, high acute s-IGFBP-1 was only associated with poor functional outcome after 7 years, whereas s-IGFBP-1 after 3 months was an independent predictor of poor long-term functional outcome and poststroke mortality.
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Affiliation(s)
- Daniel Åberg
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Blå Stråket 5, 413 45 Gothenburg, Sweden
- Region Västra Götaland, Department of Specialist Medicine, Sahlgrenska University Hospital, Blå Stråket 5, 413 45 Gothenburg, Sweden
| | - Gustaf Gadd
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Blå Stråket 5, 413 45 Gothenburg, Sweden
- Region Västra Götaland, Department of Acute Medicine and Geriatrics, Sahlgrenska University Hospital, Blå Stråket 5, 413 45 Gothenburg, Sweden
| | - Katarina Jood
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
- Region Västra Götaland, Department of Neurology, Sahlgrenska University Hospital, Blå Stråket 5, 413 45 Gothenburg, Sweden
| | - Petra Redfors
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
- Region Västra Götaland, Department of Neurology, Sahlgrenska University Hospital, Blå Stråket 5, 413 45 Gothenburg, Sweden
| | - Tara M Stanne
- Department of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Jörgen Isgaard
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Blå Stråket 5, 413 45 Gothenburg, Sweden
- Region Västra Götaland, Department of Specialist Medicine, Sahlgrenska University Hospital, Blå Stråket 5, 413 45 Gothenburg, Sweden
| | - Kaj Blennow
- Region Västra Götaland, Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, 431 80 Mölndal, Sweden
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 431 80 Mölndal, Sweden
| | - Henrik Zetterberg
- Region Västra Götaland, Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, 431 80 Mölndal, Sweden
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 431 80 Mölndal, Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
- UK Dementia Research Institute, University College London (UCL), London WC1E 6BT, UK
- Hong Kong Center for Neurodegenerative Diseases, Clear Water Bay, Hong Kong, China
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53706-1380, USA
| | - Christina Jern
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
- Region Västra Götaland, Department of Genetics and Genomics, Sahlgrenska University Hospital, Blå Stråket 5, 413 45 Gothenburg, Sweden
| | - N David Åberg
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Blå Stråket 5, 413 45 Gothenburg, Sweden
- Region Västra Götaland, Department of Acute Medicine and Geriatrics, Sahlgrenska University Hospital, Blå Stråket 5, 413 45 Gothenburg, Sweden
| | - Johan Svensson
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Blå Stråket 5, 413 45 Gothenburg, Sweden
- Region Västra Götaland, Department of Internal Medicine, Skaraborg Central Hospital, 541 42 Skövde, Sweden
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Ramadhan MIA, Sitanaya SN, Hakim AHW, Ramli Y. The Role of Iron-Chelating Therapy in Improving Neurological Outcome in Patients with Intracerebral Hemorrhage: Evidence-Based Case Report. Medicina (Kaunas) 2023; 59:medicina59030453. [PMID: 36984454 PMCID: PMC10058021 DOI: 10.3390/medicina59030453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/12/2023] [Accepted: 02/14/2023] [Indexed: 03/30/2023]
Abstract
Current primary intracerebral hemorrhage (ICH) treatments focus on limiting hematoma volume by lowering blood pressure, reversing anticoagulation, or hematoma evacuation. Nevertheless, there is no effective strategy to protect the brain from secondary injury due to ICH. Excess heme and iron as by-products of lysing clots in ICH might contribute to this secondary injury by triggering perihematomal edema. We present a clinical situation of an ICH case where iron-chelating therapy might be beneficial, as supported by scientific evidence. We looked through four databases (Pubmed, Cochrane, Embase, and Google Scholar) to find studies assessing the efficacy of iron-chelating therapy in ICH patients. Validity, importance, and applicability (VIA) of the included articles were appraised using worksheets from the Oxford Centre for Evidence-Based Medicine. Two out of five eligible studies were valid, important, and applicable to our patient. Both studies showed the positive effects of iron-chelating therapy on neurological outcome, as measured by National Institutes of Health Stroke Scale (NIHSS) score and modified Rankin Score (mRS). The beneficial effects of deferoxamine were demonstrated within the moderate volume (10-30 mL) subgroup, with a positive relative risk reduction (RRR) and low number needed to treat (six persons). Based on our appraisal, we considered iron-chelating therapy as an additional therapy for ICH patients, given its benefits and adverse effects. More specific studies using a larger sample size, focusing on moderate-volume ICH, and using standardized neurological outcomes are encouraged.
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Affiliation(s)
- Mochamad Iskandarsyah Agung Ramadhan
- Dr. Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
- Department of Neurology, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia
| | - Shierly Novitawati Sitanaya
- Dr. Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
- Department of Neurology, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia
| | - Ariadri Hafian Wulandaru Hakim
- Dr. Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
- Department of Neurology, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia
| | - Yetty Ramli
- Dr. Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
- Department of Neurology, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia
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Sato K, Konta Y, Furuta K, Kamizato K, Furukawa A, Ono A, Ogawa R, Sato R, Endo K, Yamamoto T. Prognostic factors for acute ischemic stroke in patients undergoing hemodialysis. Clin Exp Nephrol 2021; 26:286-293. [PMID: 34767098 PMCID: PMC8847285 DOI: 10.1007/s10157-021-02146-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 09/28/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Acute ischemic stroke (AIS) is a critical complication in patients undergoing dialysis. Although the improvement of AIS management is an urgent requirement, few studies have evaluated the prognostic factors of AIS in these patients. This study aimed to assess the relationship between clinical factors in patients undergoing dialysis and the prognosis of AIS. METHODS Among 1267 patients who were hospitalized for AIS in Sendai City Hospital from January 2015 to June 2020, 81 patients undergoing hemodialysis were retrospectively enrolled. Multivariate analysis was performed to evaluate the effect of baseline characteristics, dialysis factors, and neurological severity of patients at admission [National Institutes of Health Stroke Scale (NIHSS) score] on in-hospital mortality, physical disability, and the need for rehabilitation transfer. RESULTS A higher NIHSS score was a critical risk factor for each outcome and the only significant factor for in-hospital mortality [odds ratio (OR)/point 1.156, 95% confidence interval (CI) 1.054-1.267]. The risk factors of physical disability were NIHSS score (OR/point 1.458, 95% CI 1.064-1.998), older age (OR/year 1.141, 95% CI 1.022-1.274), diabetic nephropathy (OR 7.096, 95% CI 1.066-47.218), and higher premorbid modified Rankin scale (mRS) score (OR/grade 2.144, 95% CI 1.155-3.978); while those of rehabilitation transfer were a higher NIHSS score (OR/point 1.253, 95% CI 1.080-1.455), dialysis vintage (OR/year 1.175, 95% CI 1.024-1.349), and intradialytic hypotension before onset (OR 5.430, 95% CI 1.320-22.338). CONCLUSIONS Along with neurological severity, dialysis vintage, intradialytic hypotension, and diabetic nephropathy could worsen the prognosis of patients with AIS undergoing hemodialysis.
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Affiliation(s)
- Koji Sato
- Division of Internal Medicine, Sendai City Hospital, 1-1-1 Asutonagamachi, Taihaku-ku, Sendai, Miyagi, 982-8502, Japan
| | - Yusuke Konta
- Division of Internal Medicine, Sendai City Hospital, 1-1-1 Asutonagamachi, Taihaku-ku, Sendai, Miyagi, 982-8502, Japan
| | - Kyohei Furuta
- Division of Internal Medicine, Sendai City Hospital, 1-1-1 Asutonagamachi, Taihaku-ku, Sendai, Miyagi, 982-8502, Japan
| | - Kenyu Kamizato
- Division of Internal Medicine, Sendai City Hospital, 1-1-1 Asutonagamachi, Taihaku-ku, Sendai, Miyagi, 982-8502, Japan
| | - Akiko Furukawa
- Division of Internal Medicine, Sendai City Hospital, 1-1-1 Asutonagamachi, Taihaku-ku, Sendai, Miyagi, 982-8502, Japan
| | - Akiyuki Ono
- Division of Neurology, Sendai City Hospital, 1-1-1 Asutonagamachi, Taihaku-ku, Sendai, Miyagi, 982-8502, Japan
| | - Ryo Ogawa
- Division of Neurology, Sendai City Hospital, 1-1-1 Asutonagamachi, Taihaku-ku, Sendai, Miyagi, 982-8502, Japan
| | - Ryosuke Sato
- Department of Clinical Engineering, Sendai City Hospital, 1-1-1 Asutonagamachi, Taihaku-ku, Sendai, Miyagi, 982-8502, Japan
| | - Kaoru Endo
- Division of Neurology, Sendai City Hospital, 1-1-1 Asutonagamachi, Taihaku-ku, Sendai, Miyagi, 982-8502, Japan
| | - Tae Yamamoto
- Division of Internal Medicine, Sendai City Hospital, 1-1-1 Asutonagamachi, Taihaku-ku, Sendai, Miyagi, 982-8502, Japan.
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Åberg D, Åberg ND, Jood K, Redfors P, Blomstrand C, Isgaard J, Jern C, Svensson J. Insulin-Like Growth Factor-II and Ischemic Stroke-A Prospective Observational Study. Life (Basel) 2021; 11:499. [PMID: 34072372 DOI: 10.3390/life11060499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/25/2021] [Accepted: 05/26/2021] [Indexed: 11/25/2022] Open
Abstract
Insulin-like growth factor-II (IGF-II) regulates prenatal brain development, but the role in adult brain function and injury is unclear. Here, we determined whether serum levels of IGF-II (s-IGF-II) are associated with mortality and functional outcome after ischemic stroke (IS). The study population comprised ischemic stroke cases (n = 492) and controls (n = 514) from the Sahlgrenska Academy Study on Ischemic Stroke (SAHLSIS). Functional outcome was evaluated after 3 months and 2 years using the modified Rankin Scale (mRS), and additionally, survival was followed at a minimum of 7 years or until death. S-IGF-II levels were higher in IS cases both in the acute phase and at 3-month follow-up compared to controls (p < 0.05 and p < 0.01, respectively). The lowest quintile of acute s-IGF-II was, compared to the four higher quintiles, associated with an increased risk of post-stroke mortality (median follow-up 10.6 years, crude hazard ratio (HR) 2.34, 95% confidence interval (CI) 1.56–3.49, and fully adjusted HR 1.64, 95% CI 1.02–2.61). In contrast, crude associations with poor functional outcome (mRS 3–6) lost significance after full adjustment for covariates. In conclusion, s-IGF-II was higher in IS cases than in controls, and low acute s-IGF-II was an independent risk marker of increased mortality.
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Quyet D, Hien NM, Khan MX, Dai PD, Thuan DD, Duc DM, Hai ND, Nam BV, Huy PQ, Ton MD, Truong DT, Nga VT, Duc DP. Risk Factors for Stroke Associated Pneumonia. Open Access Maced J Med Sci 2019; 7:4416-4419. [PMID: 32215105 PMCID: PMC7084006 DOI: 10.3889/oamjms.2019.873] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 11/20/2019] [Accepted: 11/25/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND: Stroke patients are at high risk for stroke-associated pneumonia (SAP). If patients suffer from pneumonia their prognosis will worsen. AIM: To identify factors that increases the risk of SAP in stroke patients. METHODS: A group of 508 patients hospitalized within 5 days after the onset of stroke were enrolled prospectively. RESULTS: The incidence of SAP was 13.4%. Some major risk factors for SAP are: mechanical ventilation (MV) had odds ratio (OR) 16.4 (p <0.01); the National Institutes of Health Stroke Scale (NIHSS) > 15 OR 9.1 (p <0.01); the Gugging Swallowing Screen (GUSS) 0-14 OR 11.7 (p <0.01). CONCLUSION: SAP is a frequent complication. We identified some risk factors of SAP, especially stroke severity (NIHSS > 15), swallowing disorder (GUSS < 15) and mechanical ventilation.
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Affiliation(s)
- Do Quyet
- Respiratory Center, Military Hospital 103, Hanoi, Vietnam
| | | | - Mai Xuan Khan
- Respiratory Center, Military Hospital 103, Hanoi, Vietnam
| | - Pham Dinh Dai
- Stroke Department, Military Hospital 103, Hanoi, Vietnam
| | - Do Duc Thuan
- Stroke Department, Military Hospital 103, Hanoi, Vietnam
| | - Dang Minh Duc
- Stroke Department, Military Hospital 103, Hanoi, Vietnam
| | | | - Bui Van Nam
- Stroke Department, Military Hospital 103, Hanoi, Vietnam
| | - Pham Quoc Huy
- Emergency Department, Military Hospital 103, Hanoi, Vietnam
| | - Mai Duy Ton
- Emergency Department, Bach Mai Hospital, Hanoi, Vietnam
| | | | - Vu Thi Nga
- Institute for Research and Development, Duy Tan University, Danang, Vietnam
| | - Dang Phuc Duc
- Stroke Department, Military Hospital 103, Hanoi, Vietnam
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Kozyolkin O, Kuznietsov A, Novikova L. Prediction of the Lethal Outcome of Acute Recurrent Cerebral Ischemic Hemispheric Stroke. Medicina (Kaunas) 2019; 55:medicina55060311. [PMID: 31242700 PMCID: PMC6631068 DOI: 10.3390/medicina55060311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/17/2019] [Accepted: 06/20/2019] [Indexed: 01/04/2023]
Abstract
Background and objectives. Stroke-induced mortality is the third most common cause of death in developed countries. Intense interest has focused on the recurrent ischemic stroke, which rate makes up 30% during first 5 years after first-ever stroke. This work aims to develop criteria for the prediction of acute recurrent cerebral ischemic hemispheric stroke (RCIHS) outcome on the basis of comprehensive baseline clinical, laboratory, and neuroimaging examinations. Materials and Methods. One hundred thirty-six patients (71 males and 65 females, median age 74 (65; 78)) with acute RCIHS were enrolled in the study. All patients underwent a detailed clinical and neurological examination using National Institutes of Health Stroke Scale (NIHSS), computed tomography of the brain, hematological, and biochemical investigations. In order to detect the dependent and independent risk factors of the lethal outcome of the acute period of RCIHS, univariable and multivariable regression analysis were conducted. A receiver operating characteristic (ROC) analysis with the calculation of sensitivity and specificity was performed to determine the prediction variables. Results. Twenty-five patients died. The independent predictors of the lethal outcome of acute RCIHS were: Baseline NIHSS score (OR 95% CІ 1.33 (1.08-1.64), p = 0.0003), septum pellucidum displacement (OR 95% CI 1.53 (1.17-2.00), p = 0.0021), glucose serum level (OR 95% CI 1.28 (1.09-1.50), p = 0.0022), neutrophil-to-lymphocyte ratio (OR 95% CI 1.11 (1.00-1.21), p = 0.0303). The mathematical model, which included these variables was developed and it could determine the prognosis of lethal outcome of the acute RCIHS with an accuracy of 86.8% (AUC = 0.88 ± 0.04 (0.88-0.93), p < 0.0001).
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Affiliation(s)
- Olexandr Kozyolkin
- Department of Nervous Disease Zaporizhzhia State Medical University, 69035 Zaporizhzhia, Ukraine.
| | - Anton Kuznietsov
- Department of Nervous Disease Zaporizhzhia State Medical University, 69035 Zaporizhzhia, Ukraine.
| | - Liubov Novikova
- Department of Nervous Disease Zaporizhzhia State Medical University, 69035 Zaporizhzhia, Ukraine.
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Lin SF, Chen CI, Hu HH, Bai CH. Predicting functional outcomes of posterior circulation acute ischemic stroke in first 36 h of stroke onset. J Neurol 2018; 265:926-932. [PMID: 29455362 PMCID: PMC5878189 DOI: 10.1007/s00415-018-8746-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 01/10/2018] [Accepted: 01/10/2018] [Indexed: 11/27/2022]
Abstract
Posterior circulation acute ischemic stroke constitutes one-fourth of all ischemic strokes and can be efficiently quantified using the posterior circulation Alberta stroke program early computed tomography score (PC-ASPECTS) through diffusion-weighted imaging. We investigated whether the PC-ASPECTS and National Institutes of Health Stroke Scale (NIHSS) facilitate functional outcome prediction among Chinese patients with posterior circulation acute ischemic stroke. Participants were selected from our prospective stroke registry from January 1, 2015, to December 31, 2016. The baseline NIHSS score was assessed on the first day of admission, and brain magnetic resonance imaging was performed within 36 h after stroke onset. Simple and multiple logistic regressions were conducted to determine stroke risk factors and the PC-ASPECTS. Receiver operating characteristics (ROC) curve analysis was performed to compare the NIHSS and PC-ASPECTS. Of 549 patients from our prospective stroke admission registry database, 125 (22.8%) had a diagnosis of posterior circulation acute ischemic stroke. The optimal cutoff for the PC-ASPECTS in predicting outcomes was 7. The odds ratios of the PC-ASPECTS (≤ 7 vs > 7) in predicting outcomes were 6.33 (p = 0.0002) and 8.49 (p = 0.0060) in the univariate and multivariate models, respectively, and 7.52 (p = 0.0041) in the aging group. On ROC curve analysis, the PC-ASPECTS demonstrated more reliability than the baseline NIHSS for predicting functional outcomes of minor posterior circulation stroke. In conclusion, both the PC-ASPECTS and NIHSS help clinicians predict functional outcomes. PC-ASPECTS > 7 is a helpful discriminator for achieving favorable functional outcome prediction in posterior circulation acute ischemic stroke.
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Affiliation(s)
- Sheng-Feng Lin
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Chin-I Chen
- Department of Neurology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Han-Hwa Hu
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Research Center of Cerebrovascular Disease Treatment, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Neurology, Taipei Medical University-Shaung Ho Hospital, Taipei, Taiwan
| | - Chyi-Huey Bai
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan. .,Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, 250 Wu-Hsing Street, Taipei City, 110, Taiwan.
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Wu W, Asakawa T, Yang Q, Zhao J, Lu L, Luo Y, Gong P, Han S, Li W, Namba H, Wang L. Effects of neuroserpin on clinical outcomes and inflammatory markers in Chinese patients with acute ischemic stroke. Neurol Res 2017; 39:862-868. [PMID: 28738762 DOI: 10.1080/01616412.2017.1357780] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Neuroserpin (NSP) is known for its neuroprotective effects. The aim of this study was to investigate the relationship between NSP level and clinical outcomes and inflammatory markers in Chinese patients with acute ischemic stroke. METHODS A total of 133 patients with acute cerebral infarction (ischemia group) and 44 controls were recruited. The modified Rankin Scale (mRS) was used to determine the functional outcome three months after onset. We investigated the relationship between serum NSP levels [on admission and a decrease in NSP levels (10 days after admission versus on admission)] and serum levels of several inflammatory markers. RESULTS We confirmed that NSP levels on admission in the ischemia group were significantly higher than those in the control group. NSP levels in patients with good outcomes were significantly higher than those in patients with poor outcomes. NSP levels on admission were associated with having a good outcome in these patients. We found that a larger decrease in NSP levels (on admission vs. 10 days after admission) was correlated with lower serum levels of IL-6, IL-1β, and ICAM-1 10 days after admission. CONCLUSIONS A larger decrease in NSP levels related to lower levels of inflammatory marker, while higher NSP levels were associated with lower inflammatory markers and better functional outcomes. Decreasing the infarct size may play a role in this process. These results provide more evidence of the neuroprotective effect of NSP in cerebral ischemic patients. Decrease in the Serum NSP level and NSP level at admission may be considered as potential predictive factors for outcome of acute ischemic stroke.
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Affiliation(s)
- Weiwen Wu
- a Department of Neurology , Huashan Hospital of Fudan University , Shanghai , People's Republic of China
- b Department of Neurology , Qingpu Hospital, Fudan University , Shanghai , People's Republic of China
| | - Tetsuya Asakawa
- c Department of Neurosurgery , Hamamatsu University School of Medicine , Hamamatsu , Japan
- d Department of Psychiatry , Hamamatsu University School of Medicine , Hamamatsu , Japan
| | - Qianghong Yang
- b Department of Neurology , Qingpu Hospital, Fudan University , Shanghai , People's Republic of China
| | - Jun Zhao
- b Department of Neurology , Qingpu Hospital, Fudan University , Shanghai , People's Republic of China
| | - Lixia Lu
- b Department of Neurology , Qingpu Hospital, Fudan University , Shanghai , People's Republic of China
| | - Yunhe Luo
- a Department of Neurology , Huashan Hospital of Fudan University , Shanghai , People's Republic of China
| | - Ping Gong
- a Department of Neurology , Huashan Hospital of Fudan University , Shanghai , People's Republic of China
| | - Sha Han
- a Department of Neurology , Huashan Hospital of Fudan University , Shanghai , People's Republic of China
| | - Wei Li
- a Department of Neurology , Huashan Hospital of Fudan University , Shanghai , People's Republic of China
- e Huashan Worldwide Medical Center, Huashan Hospital of Fudan University , Shanghai , People's Republic of China
| | - Hiroki Namba
- c Department of Neurosurgery , Hamamatsu University School of Medicine , Hamamatsu , Japan
| | - Liang Wang
- a Department of Neurology , Huashan Hospital of Fudan University , Shanghai , People's Republic of China
- f Institute of Neurology , Huashan Hospital of Fudan University , Shanghai , People's Republic of China
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Villalobos E, Barnes SR, Qureshi IA, Cruz-Flores S, Maud A, Rodriguez GJ. Spanish Version of the National Institutes of Health Stroke Scale: Awareness and Use in United States. A Survey Study. J Vasc Interv Neurol 2017; 9:1-6. [PMID: 28243343 PMCID: PMC5317283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To investigate the awareness and the use of Spanish version of National Institutes of Health Stroke Scale (NIHSS) throughout the United States (US) by regions using a web-based survey. METHODS A survey targeting physicians from two specialties that regularly manage acute stroke patients was conducted from February to August of 2015. Academic centers from the Accreditation Council for Graduate Medical Education online directory belonging to emergency medicine (EM) and neurology residency programs were identified. The questionnaire was composed of ten questions separated into three different groups. The responses received from the programs were separated by specialty and grouped into different regions in the US for comparison. RESULTS Out of 230 residency-invited programs, we received a total of 73 responses, 35 from EM and 26 responses from neurology residency programs. In addition, 12 respondents were categorized as unknown recipients. The South region had the highest response rate with 30.3%. There was no significant difference in the responses by region if Puerto Rico was not analyzed. Interviewees reported a substantial percentage of Spanish-speaking patients reported across the regions and more than 75% of the programs report lack of knowledge of the Spanish version of the NIHSS and/or the use of it. CONCLUSION There may be a need to increase awareness and to promote the use of the Spanish version of the NIHSS. Spanish-speaking population in the US may be inaccurately assessed for acute stroke and could impact the outcomes. Larger population studies should be conducted to confirm our findings. AUTHOR CONTRIBUTIONS Dr. Villalobos and Dr. Barnes are involved in formulating the study concept and design; Dr. Rodriguez and Dr. Maud are involved in manuscript writing; Dr. Qureshi is involved in statistical analysis of the data; Dr. Cruz-Flores is involved in critical revision of the manuscript. DISCLOSURES Dr. Villalobos reports no disclosure; Dr. Barnes reports no disclosure; Dr. Qureshi reports no disclosure; Dr. Cruz-Flores reports no disclosure; Dr. Maud reports no disclosure; Dr. Rodriguez reports no disclosure.
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Affiliation(s)
- Enrique Villalobos
- Department of Emergency Medicine, Texas Tech University Health Science Center, 4800 Alberta Avenue, El Paso, TX 79905, USA
| | - Scott R. Barnes
- Department of Emergency Medicine, Texas Tech University Health Science Center, 4800 Alberta Avenue, El Paso, TX 79905, USA
| | - Ihtesham A. Qureshi
- Department of Neurology, Texas Tech University Health Science Center, 4800 Alberta Avenue, El Paso, TX 79905, USA
| | - Salvador Cruz-Flores
- Department of Neurology, Texas Tech University Health Science Center, 4800 Alberta Avenue, El Paso, TX 79905, USA
| | - Alberto Maud
- Department of Neurology, Texas Tech University Health Science Center, 4800 Alberta Avenue, El Paso, TX 79905, USA
| | - Gustavo J. Rodriguez
- Department of Neurology, Texas Tech University Health Science Center, 4800 Alberta Avenue, El Paso, TX 79905, USA
| |
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