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Champigny CM, Feldman SJ, Beribisky N, Desrocher M, Isaacs T, Krishnan P, Monette G, Dlamini N, Dirks P, Westmacott R. Predictors of neurocognitive outcome in pediatric ischemic and hemorrhagic stroke. Child Neuropsychol 2024; 30:444-461. [PMID: 37204222 DOI: 10.1080/09297049.2023.2213461] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 05/05/2023] [Indexed: 05/20/2023]
Abstract
This clinical study examined the impact of eight predictors (age at stroke, stroke type, lesion size, lesion location, time since stroke, neurologic severity, seizures post-stroke, and socioeconomic status) on neurocognitive functioning following pediatric stroke. Youth with a history of pediatric ischemic or hemorrhagic stroke (n = 92, ages six to 25) underwent neuropsychological testing and caregivers completed parent-report questionnaires. Hospital records were accessed for medical history. Spline regressions, likelihood ratios, one-way analysis of variance, Welch's t-tests, and simple linear regressions examined associations between predictors and neuropsychological outcome measures. Large lesions and lower socioeconomic status were associated with worse neurocognitive outcomes across most neurocognitive domains. Ischemic stroke was associated with worse outcome in attention and executive functioning compared to hemorrhagic stroke. Participants with seizures had more severe executive functioning impairments than participants without seizures. Youth with cortical-subcortical lesions scored lower on a few measures than youth with cortical or subcortical lesions. Neurologic severity predicted scores on few measures. No differences were found based on time since stroke, lesion laterality, or supra- versus infratentorial lesion. In conclusion, lesion size and socioeconomic status predict neurocognitive outcome following pediatric stroke. An improved understanding of predictors is valuable to clinicians who have responsibilities related to neuropsychological assessment and treatments for this population. Findings should inform clinical practice through enhanced appraisals of prognosis and the use of a biopsychosocial approach when conceptualizing neurocognitive outcome and setting up support services aimed at fostering optimal development for youth with stroke.
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Affiliation(s)
- Claire M Champigny
- Department of Psychology, The Hospital for Sick Children, Toronto, Canada
- Department of Psychology, York University, Toronto, Canada
| | - Samantha J Feldman
- Department of Psychology, The Hospital for Sick Children, Toronto, Canada
- Department of Psychology, York University, Toronto, Canada
| | | | - Mary Desrocher
- Department of Psychology, The Hospital for Sick Children, Toronto, Canada
- Department of Psychology, York University, Toronto, Canada
| | - Tamiko Isaacs
- Department of Psychology, York University, Toronto, Canada
| | - Pradeep Krishnan
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Canada
| | | | - Nomazulu Dlamini
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| | - Peter Dirks
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, Canada
| | - Robyn Westmacott
- Department of Psychology, The Hospital for Sick Children, Toronto, Canada
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada
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Chung JW, Hwang J, Kim HJ, Seo WK, Ahn MJ, Saver JL, Bang OY. Edoxaban for the treatment of hypercoagulability and cerebral thromboembolism associated with cancer: A randomized clinical trial of biomarker targets. Int J Stroke 2024:17474930241239266. [PMID: 38429253 DOI: 10.1177/17474930241239266] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
BACKGROUND This study aimed compare efficacy of edoxaban and enoxaparin upon biomarkers of hypercoagulability in patients with cancer-related embolic stroke of undetermined source (ESUS). METHODS In this open-label, randomized, pilot trial, patients with cancer-related ESUS within 30 days of diagnosis were randomly assigned (1:1) to receive edoxaban (60 mg once daily) or enoxaparin (1 mg/kg twice daily) for 90 days. The primary endpoint was interval change of serum D-dimer level between days 0 and 7. The secondary endpoints were microembolic signals detected by transcranial Doppler at 7 and 90 days, the modified Rankin scale score, and stroke recurrence during 90 days. Safety outcomes included major bleeding and all-cause death at 90 days. RESULTS Of 303 patients with ischemic stroke and cancer, 40 fully met enrollment criteria and were randomized. Baseline D-dimer levels were numerically higher in the edoxaban group (22.9 ± 15.9 μg/mL vs 16.9 ± 16.9 μg/mL). D-dimer level change (%) between days 0 and 7 was similar in the two groups (53.2 ± 25.7 vs 52.2 ± 52.0; P = 0.11). Microembolic signals were detected in 41.1% and 43.8% at baseline, 41.2% and 42.9% at day 7, and 25.0% and 28.6% at day 90 in the edoxaban and enoxaparin groups, respectively. Non-significantly higher major bleeding (35.0% vs 10.0%, P = 0.06) and 90-day mortality (40.0% vs 25.0%, P = 0.31) were noted in the edoxaban group. CONCLUSION Edoxaban and enoxaparin were comparable with respect to the biomarkers of hypercoagulability and cerebral thromboembolism. Larger trials are warranted to compare effects of edoxaban and enoxaparin upon recurrent stroke and major bleeding in patients with cancer-related ESUS. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT03570281 (https://clinicaltrials.gov/ct2/show/NCT03570281).
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Affiliation(s)
- Jong-Won Chung
- Department of Neurology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| | - Jaechun Hwang
- Department of Neurology, School of Medicine, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Hyung Jun Kim
- Department of Neurology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| | - Myung-Ju Ahn
- Division of Hematology/Oncology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| | - Jeffrey L Saver
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
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Nakada S, Ho FK, Celis‐Morales C, Pell JP. Schizophrenia and Types of Stroke: A Mendelian Randomization Study. J Am Heart Assoc 2024; 13:e032011. [PMID: 38420769 PMCID: PMC10944050 DOI: 10.1161/jaha.123.032011] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/22/2023] [Indexed: 03/02/2024]
Abstract
BACKGROUND Previous studies suggest an association between schizophrenia and stroke, but no studies have investigated stroke subtypes. We examined potential causal associations between schizophrenia and a range of atherosclerotic, embolic, and hemorrhagic stroke outcomes. METHODS AND RESULTS Two-sample Mendelian randomization analyses were conducted. The summary-level data (restricted to European ancestry) were obtained for schizophrenia and stroke: ischemic stroke, large-artery stroke, small-vessel stroke, cardioembolic stroke, and intracerebral hemorrhage. The associations between schizophrenia and each outcome were analyzed by an inverse variance weighting method primarily and Mendelian randomization Egger, weighted median, and weighted mode subsequently. The presence of pleiotropy was also tested by Cochran Q statistic, I2 index, and Mendelian randomization Egger intercept with scatter and funnel plots. We found associations between schizophrenia and cardioembolic stroke (odds ratio [OR], 1.070 [95% CI, 1.023-1.119]) and intracerebral hemorrhage (OR, 1.089 [95% CI, 1.005-1.180]) using inverse variance weighting. Little evidence of associations with the other stroke subtypes was found. Different Mendelian randomization methods corroborated the association with cardioembolic stroke but not intracerebral hemorrhage. CONCLUSIONS We have provided evidence of a potentially causal association between schizophrenia and cardioembolic stroke. Our findings suggest that cardiac evaluation should be considered for those with schizophrenia.
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Affiliation(s)
- Shinya Nakada
- School of Health and WellbeingUniversity of GlasgowGlasgowUnited Kingdom
| | - Frederick K. Ho
- School of Health and WellbeingUniversity of GlasgowGlasgowUnited Kingdom
| | - Carlos Celis‐Morales
- School of Health and WellbeingUniversity of GlasgowGlasgowUnited Kingdom
- School of Cardiovascular and Metabolic HealthUniversity of GlasgowUnited Kingdom
- Human Performance Laboratory, Education, Physical Activity and Health Research UnitUniversidad Católica del MauleTalcaChile
| | - Jill P. Pell
- School of Health and WellbeingUniversity of GlasgowGlasgowUnited Kingdom
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DiPaola E, Cameron S, Rylander H, Zidan N, Hetzel S. Comparison of D-dimer concentration and thromboelastography for diagnosis of cerebrovascular accidents in dogs: A retrospective study. J Vet Intern Med 2024; 38:1083-1091. [PMID: 38328940 PMCID: PMC10937503 DOI: 10.1111/jvim.17000] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 01/19/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Cerebrovascular accidents (CVAs) in dogs are diagnosed using magnetic resonance imaging (MRI). This modality is sometimes unavailable, and CVAs can resemble other lesions on MRI. D-dimer concentration and thromboelastography (TEG) are utilized in human medicine in addition to diagnostic imaging to support diagnosis of CVAs, but their use in veterinary patients has not been assessed. OBJECTIVE Assess utility of blood D-dimer concentration and TEG in supporting the imaging diagnosis of CVAs in dogs. ANIMALS Sixty-eight client-owned dogs with neurologic signs that had brain MRI and D-dimer concentration or TEG performed. METHODS Multicenter, retrospective study. The incidence of abnormal D-dimer concentration or TEG was compared between patients with MRI evidence of CVA and a control population. Analysis methods included Fisher's exact test or Chi-squared test for association and comparison of independent proportions. RESULTS Neither D-dimer concentration nor TEG was significantly associated with a CVA (P = .38 and .2, respectively). D-dimer testing was performed in a low-risk population and showed low sensitivity (30.8%; 95% confidence interval [CI], 10%-61%) and high specificity (86.4%; 95% CI, 64%-96%) for CVA diagnosis. Thromboelastography was performed in a high-risk population and showed moderate sensitivity (64.3%; 95% CI, 44%-81%) and specificity (66.7%; 95% CI, 24%-94%) for CVA diagnosis. Abnormal D-dimer concentration or TEG were not helpful in differentiating hemorrhagic from ischemic stroke (P = .43 and .41, respectively). CONCLUSIONS Although blood D-dimer concentration or TEG alone are not diagnostic of CVAs in dogs, a positive D-dimer result supports additional testing for CVA.
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Affiliation(s)
- Elizabeth DiPaola
- Department of Medical SciencesUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Starr Cameron
- Department of Medical SciencesUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Helena Rylander
- Department of Medical SciencesUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Natalia Zidan
- Department of Medical SciencesUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Scott Hetzel
- Department of Biostatistics and Medical InformaticsUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
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Yang Y, Gao L, Shen F, Miao J, Liu H. A cross-sectional analysis of the relationship between ischemic stroke and uric acid in young people in highland areas. Front Endocrinol (Lausanne) 2024; 14:1325629. [PMID: 38274224 PMCID: PMC10808705 DOI: 10.3389/fendo.2023.1325629] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 12/13/2023] [Indexed: 01/27/2024] Open
Abstract
Objective To investigate the relationship between serum uric acid (SUA) levels and ischemic stroke in young patients in the Ganzi Tibetan plateau area. Methods A cross-sectional survey was undertaken from January 2020 to June 2023 involving young patients (age: 15-45 years) diagnosed with ischemic stroke. The survey was conducted at the Department of Internal Medicine of the People's Hospital of Derong County, Ganzi Prefecture. The participants underwent a comprehensive assessment, including questionnaire surveys, physical examinations, laboratory tests, and head computed tomography (CT) examinations. Based on the tertiles of serum uric acid (SUA) levels, the patients were stratified into three groups. Furthermore, stroke severity was classified into mild (1-4 points), moderate (5-15 points), and severe (>15 points) categories using the National Institute of Health Stroke Scale. Results The severe stroke group exhibited higher levels of age, glucose, systolic blood pressure, serum triglyceride, low-density lipoprotein cholesterol, and serum uric acid (SUA) compared to the mild stroke group (P < 0.05). Furthermore, the likelihood of male sex, advanced age, smoking, and a family history of stroke, diabetes mellitus, and heart disease were significantly elevated in the severe stroke group compared to the moderate stroke group (P < 0.05). Multivariate logistic regression analysis conducted on young adults residing in highland areas revealed a significant association between SUA levels and the risk of stroke. Conclusion Elevated SUA levels serve as a distinct risk factor for the development of a major stroke in young patients in highland areas. At SUA levels of 320.56 mol/L, the risk of a moderate-to-severe stroke is noticeably elevated.
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Affiliation(s)
- Yifan Yang
- Department of Neurology, the Affiliated Hospital of Southwest Jiaotong University & The Third People’s Hospital of Chengdu, Chengdu, Sichuan, China
| | | | | | | | - Hua Liu
- Department of Neurology, the Affiliated Hospital of Southwest Jiaotong University & The Third People’s Hospital of Chengdu, Chengdu, Sichuan, China
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Makharia A, Agarwal A, Garg D, Vishnu VY, Srivastava MVP. The Pitfalls of NIHSS: Time for a New Clinical Acute Stroke Severity Scoring System in the Emergency? Ann Indian Acad Neurol 2024; 27:15-18. [PMID: 38495237 PMCID: PMC10941908 DOI: 10.4103/aian.aian_842_23] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/02/2023] [Accepted: 11/24/2023] [Indexed: 03/19/2024] Open
Abstract
Stroke is the second leading cause of death and a major cause of disability worldwide. Stroke severity scales serve as reliable means to track a patient's neurological deficit, predict outcome, and guide treatment decisions in clinical practice. The National Institute of Health Stroke Scale (NIHSS) was introduced over 30 years ago, marking a significant milestone in the field of stroke. Over the years, there have been notable advancements in acute stroke care. Despite several modifications made to NIHSS, none has yet succeeded in effectively capturing all the complex effects of a stroke. This review focuses on the pitfalls of NIHSS and emphasizes the need for a quick and comprehensive clinical and upgraded version of the stroke severity rating scale.
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Affiliation(s)
- Archita Makharia
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Ayush Agarwal
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Divyani Garg
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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Grace VM, Rajesh RP. Concomitants of Diabetic Foot Ulcer - A Review. Curr Diabetes Rev 2024; 20:e050523216594. [PMID: 37151066 DOI: 10.2174/1573399819666230505142514] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/03/2023] [Accepted: 03/06/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND Diabetes mellitus leading to foot ulcer is a serious complication, and it is considered a global epidemic. Neuropathyand high blood glucose levels are the primary causes of foot ulcers. Fifteen percent of people with diabetes develop foot ulcers, and these foot disorders are the main cause of lower extremity amputation among such patients. INTRODUCTION Complications of diabetic foot, affecting the lower extremities are common and quite complex and life-threatening. This review focuses on the life-threatening factors associated with diabetic foot ulcers and also the diagnosing and preventive measures. Neuropathy assessment and the range of foot ulcers were accurately examined. CONCLUSION Novel therapies focusing on the vascularity of the lower limbs, infection control, and ischemic control are being developed to mainly treat nonhealing ulcers.
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Affiliation(s)
- Vanathi M Grace
- Centre for Molecular and Nanomedical Sciences, Centre for Nanoscience and Nanotechnology, Sathyabama Institute of Science and Technology, Chennai 600119, Tamil Nadu, India
| | - R P Rajesh
- Centre for Molecular and Nanomedical Sciences, Centre for Nanoscience and Nanotechnology, Sathyabama Institute of Science and Technology, Chennai 600119, Tamil Nadu, India
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Mustaqe P, Dimopoulos P, Dogjani A, Leivaditis V, Akrida I, Panagiotopoulos I, Katinioti A, Kostopoulou IE, Antzoulas A, Bouchagier K, Papadoulas S, Mulita F. Prevalence of stroke-related risk factors in Albania: a single-center experience. Arch Med Sci Atheroscler Dis 2023; 8:e123-e127. [PMID: 38283926 PMCID: PMC10811531 DOI: 10.5114/amsad/176811] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 12/12/2023] [Indexed: 01/30/2024] Open
Abstract
Introduction Stroke, a prominent global cause of mortality and disability, is broadly categorized into ischemic and hemorrhagic types. An epidemiological survey of stroke and its risk factors can help identify individuals at higher risk and therefore promote stroke prevention strategies. The aim of this study was to estimate the current prevalence of stroke and evaluate stroke-associated risk factors in Albania. Material and methods This was a single-center retrospective analysis conducted in Albania for the period from May 2015 to September 2021. Data were collected retrospectively through hospital records. Stroke was defined as sudden onset of a nonconvulsive and focal neurological deficit, and ischemic stroke was diagnosed using brain computed tomography (CT), magnetic resonance (MR) imaging, or both. We examined patient history characteristics encompassing demographics, stroke history, conventional vascular risk factors, and lifestyle-related risk factors. Results The mean age of the 3860 patients was 74.6 ±10.4 years, and 73.5% were men. The prevalence of carotid stenosis, arrhythmia, obesity, and hypertension was significantly higher in males than in females (p < 0.001). Out of the 3860 patients in the study cohort, 641 (16.6%) subjects died, while 335 (8.7%) patients achieved complete recovery. Hemiparesis was observed in 386 (10%) patients and hemiplegia in 868 (22.4%) patients. Conclusions Our analysis underscores the male predominance (2.2 : 1) in stroke cases. Carotid and vertebral artery stenosis is a significant factor, emphasizing the life-saving potential of early intervention. Social and economic factors in Albania pose challenges, demanding comprehensive strategies. Prospective trials are crucial to explore intervention efficacy, and timing, and address socioeconomic impacts on timely stroke management.
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Affiliation(s)
- Petraq Mustaqe
- Department of Vascular Surgery, General Hospital of Vlore, Vlore, Albania
| | - Platon Dimopoulos
- Department of Radiology, General University Hospital of Patras, Patras, Greece
| | - Agron Dogjani
- Department of General Surgery, University of Medicine, Tirana, Tirana, Albania
| | - Vasileios Leivaditis
- Department of Cardiothoracic and Vascular Surgery, Westpfalz-Klinikum, Kaiserslautern, Germany
| | - Ioanna Akrida
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | | | | | | | - Andreas Antzoulas
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | | | - Spyros Papadoulas
- Department of Vascular Surgery, General University Hospital of Patras, Patras, Greece
| | - Francesk Mulita
- Department of Surgery, General University Hospital of Patras, Patras, Greece
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Mullen MT, Gurol ME, Prabhakaran S, Messé SR, Kleindorfer DO, Smith EE, Fonarow GC, Xu H, Zhao X, Cigarroa JE, Schwamm LH. Hospital-Level Variability in Reporting of Ischemic Stroke Subtypes and Supporting Diagnostic Evaluation in GWTG-Stroke Registry. J Am Heart Assoc 2023; 12:e031303. [PMID: 38108258 PMCID: PMC10863791 DOI: 10.1161/jaha.123.031303] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/18/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Secondary prevention of ischemic stroke (IS) requires adequate diagnostic evaluation to identify the likely etiologic subtype. We describe hospital-level variability in diagnostic testing and IS subtyping in a large nationwide registry. METHODS AND RESULTS We used the GWTG-Stroke (Get With The Guidelines-Stroke) registry to identify patients hospitalized with a diagnosis of acute IS at 1906 hospitals between January 1, 2016, and September 30, 2017. We compared the documentation rates and presence of risk factors, diagnostic testing, achievement/quality measures, and outcomes between patients with and without reported IS subtype. Recording of diagnostic evaluation was optional in all IS subtypes except cryptogenic, where it was required. Of 607 563 patients with IS, etiologic IS subtype was documented in 57.4% and missing in 42.6%. Both the rate of missing stroke pathogenesis and the proportion of cryptogenic strokes were highly variable across hospitals. Patients missing stroke pathogenesis less frequently had documentation of risk factors, evidence-based interventions, or discharge to home. The reported rates of major diagnostic testing, including echocardiography, carotid and intracranial vascular imaging, and short-term cardiac monitoring were <50% in patients with documented IS pathogenesis, although these variables were missing in >40% of patients. Long-term cardiac rhythm monitoring was rarely reported, even in cryptogenic stroke. CONCLUSIONS Reporting of IS etiologic subtype and supporting diagnostic testing was low overall, with high rates of missing optional data. Improvement in the capture of these data elements is needed to identify opportunities for quality improvement in the diagnostic evaluation and secondary prevention of stroke.
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Affiliation(s)
| | - M. Edip Gurol
- Massachusetts General HospitalHarvard UniversityBostonMA
| | | | - Steven R. Messé
- Hospital of the University of PennsylvaniaThe University of PennsylvaniaPhiladelphiaPA
| | | | - Eric E. Smith
- Hotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
| | | | - Haolin Xu
- Duke Clinical Research InstituteDurhamNC
| | - Xin Zhao
- Duke Clinical Research InstituteDurhamNC
| | | | - Lee H. Schwamm
- Massachusetts General HospitalHarvard UniversityBostonMA
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Gajate L, de la Hoz I, Espiño M, Martin Gonzalez MDC, Fernandez Martin C, Martín-Grande A, Parise Roux D, Pastor O, Villahoz J, Rodriguez-Gandía MÁ, Nuño Vazquez J. Intravenous Ascorbic Acid for the Prevention of Postreperfusion Syndrome in Orthotopic Liver Transplantation: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e50091. [PMID: 38100226 PMCID: PMC10757222 DOI: 10.2196/50091] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 11/23/2023] [Accepted: 11/27/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Liver transplantation is the last therapeutic option for patients with end-stage liver disease. Postreperfusion syndrome (PRS), defined as a fall in mean arterial pressure of more than 30% within the first 5 minutes after reperfusion of at least 1 minute, can occur in liver transplantation as a deep hemodynamic instability with associated hyperfibrinolysis immediately after reperfusion of the new graft. Its incidence has remained unchanged since it was first described in 1987. PRS is related to ischemia-reperfusion (I/R) injury, whose pathophysiology involves the release of several mediators from both the donor and the recipient. The antioxidant effect of ascorbic acid has been studied in resuscitating patients with septic shock and burns. Even today, there are publications with conflicting results, and there is a need for further studies to confirm or rule out the usefulness of this drug in this group of patients. The addition of ascorbic acid to preservation solutions used in solid organ transplantation is under investigation to harness its antioxidant effect and mitigate I/R injury. Since PRS could be considered a manifestation of I/R injury, we believe that the possible beneficial effect of ascorbic acid on the occurrence of PRS should be investigated. OBJECTIVE The aim of this randomized controlled trial is to assess the benefits of ascorbic acid over saline in the development of PRS in adult liver transplantation. METHODS We plan to conduct a single-center randomized controlled trial at the Hospital Universitario Ramón y Cajal in Spain. A total of 70 participants aged 18 years or older undergoing liver transplantation will be randomized to receive either ascorbic acid or saline. The primary outcome will be the difference between groups in the incidence of PRS. The randomized controlled trial will be conducted under conditions of respect for fundamental human rights and ethical principles governing biomedical research involving human participants and in accordance with the international recommendations contained in the Declaration of Helsinki and its subsequent revisions. RESULTS The enrollment process began in 2020. A total of 35 patients have been recruited so far. Data cleaning and analysis are expected to occur in the first months of 2024. Results are expected around the middle of 2024. CONCLUSIONS We believe that this study could be particularly relevant because it will be the first to analyze the clinical effect of ascorbic acid in liver transplantation. Moreover, we believe that this study fills an important gap in the knowledge of the potential benefits of ascorbic acid in the field of liver transplantation, particularly in relation to PRS. TRIAL REGISTRATION European Union Drug Regulating Authorities Clinical Trials Database 2020-000123-39; https://tinyurl.com/2cfzddw8; ClinicalTrials.gov NCT05754242; https://tinyurl.com/346vw7sm. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/50091.
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Affiliation(s)
- Luis Gajate
- Department of Anesthesiology and Critical Care, Instituto Ramon y Cajal de Investigacion Sanitaria, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - Inés de la Hoz
- Department of Anesthesiology and Critical Care, Instituto Ramon y Cajal de Investigacion Sanitaria, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - Mercedes Espiño
- Department of Immunology, Instituto Ramon y Cajal de Investigacion Sanitaria, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - Maria Del Carmen Martin Gonzalez
- Department of Anesthesiology and Critical Care, Instituto Ramon y Cajal de Investigacion Sanitaria, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - Cristina Fernandez Martin
- Department of Anesthesiology and Critical Care, Instituto Ramon y Cajal de Investigacion Sanitaria, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - Ascensión Martín-Grande
- Department of Anesthesiology and Critical Care, Instituto Ramon y Cajal de Investigacion Sanitaria, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - Diego Parise Roux
- Department of Anesthesiology and Critical Care, Instituto Ramon y Cajal de Investigacion Sanitaria, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - Oscar Pastor
- Department of Biochemistry, Instituto Ramon y Cajal de Investigacion Sanitaria, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - Judith Villahoz
- Department of Anesthesiology and Critical Care, Instituto Ramon y Cajal de Investigacion Sanitaria, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - Miguel Ángel Rodriguez-Gandía
- Department of Digestive Diseases, Instituto Ramon y Cajal de Investigacion Sanitaria, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - Javier Nuño Vazquez
- Department of Liver Surgery, Instituto Ramon y Cajal de Investigacion Sanitaria, Hospital Universitario Ramon y Cajal, Madrid, Spain
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Li N, Zhang J, Li SJ, Du Y, Zhou Q, Gu HQ, Zhao XQ. Multidimensional Outcomes of IV Thrombolysis in Minor Ischemic Stroke: Motor, Psychocognitive, and Dependence. Neuropsychiatr Dis Treat 2023; 19:2341-2351. [PMID: 37936866 PMCID: PMC10625889 DOI: 10.2147/ndt.s434296] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 10/24/2023] [Indexed: 11/09/2023] Open
Abstract
Background The presence of mild deficit is the most common reason for nonuse of intravenous alteplase in ischemic stroke. We analyzed within a national prospective cohort on whether patients with minor stroke can benefit from intravenous alteplase. Methods This observational study included patients with acute ischemic stroke with a National Institutes of Health Stroke Scale (NIHSS) score 0 to 5 at admission. The short-term outcomes at discharge and 3-month were analyzed including the modified Rankin Scale score, gait speed, Montreal Cognitive Assessment, Patient Health Questionnaire-9, General Anxiety Disorder-7 and Stroke Impact Scale-16. Multivariate regression models were performed to evaluate the association between intravenous thrombolysis and clinical outcomes. Results A total of 1876 consecutive patients were included in the current analyses with 102 patients (5.4%) received alteplase and 1774 patients (94.5%) were in non-alteplase group. We found that 10.9% patients presented unfavorable functional outcome with a mRS ≥ 2 at 3-month. Patients with alteplase treatment had a more favorable outcome in SIS-16 at discharge (OR, 5.45; 95% CI, 2.22-8.68) and 3-month after stroke (OR, 2.34; 95% CI, 0.17-4.50). There was an association of alteplase with better gait speed in the restricted sample of age >60 (OR,0.14; 95% CI, 0.02-0.25), while an unfavorable effect was found in anxiety (OR, 2.23; 95% CI, 2.23, 0.91-3.55) and depression (OR, 1.54; 95% CI, 0.17-2.91) in female. Conclusion Alteplase showed a suggestive benefit in function and motor outcomes in patients with low NIHSS score of 0-5. Meanwhile, female seemed more inclined to post-stroke emotional problems after alteplase treatment, which should be further explored in the future.
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Affiliation(s)
- Ning Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Jia Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
- China National Clinical Research Center for Neurological Diseases, Beijing, People’s Republic of China
| | - Si-Jia Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yang Du
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
- China National Clinical Research Center for Neurological Diseases, Beijing, People’s Republic of China
| | - Qi Zhou
- China National Clinical Research Center for Neurological Diseases, Beijing, People’s Republic of China
| | - Hong-Qiu Gu
- China National Clinical Research Center for Neurological Diseases, Beijing, People’s Republic of China
| | - Xing-Quan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
- China National Clinical Research Center for Neurological Diseases, Beijing, People’s Republic of China
- Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
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Brohan MP, Daly FP, Kelly L, McCarthy FP, Khashan AS, Kublickiene K, Barrett PM. Hypertensive disorders of pregnancy and long-term risk of maternal stroke-a systematic review and meta-analysis. Am J Obstet Gynecol 2023; 229:248-268. [PMID: 36990309 DOI: 10.1016/j.ajog.2023.03.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Received: 11/06/2022] [Revised: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE Hypertensive disorders of pregnancy are associated with a long-term risk for cardiovascular disease among parous patients later in life. However, relatively little is known about whether hypertensive disorders of pregnancy are associated with an increased risk for ischemic stroke or hemorrhagic stroke in later life. This systematic review aimed to synthesize the available literature on the association between hypertensive disorders of pregnancy and the long-term risk for maternal stroke. DATA SOURCES PubMed, Web of Science, and CINAHL were searched from inception to December 19, 2022. STUDY ELIGIBILITY CRITERIA Studies were only included if the following criteria were met: case-control or cohort studies that were conducted with human participants, were available in English, and that measured the exposure of a history of hypertensive disorders of pregnancy (preeclampsia, gestational hypertension, chronic hypertension, or superimposed preeclampsia) and the outcome of maternal ischemic stroke or hemorrhagic stroke. METHODS Three reviewers extracted the data and appraised the study quality following the Meta-analyses of Observational Studies in Epidemiology guidelines and using the Newcastle-Ottawa scale for risk of bias assessment. RESULTS The primary outcome was any stroke (undifferentiated) and secondary outcomes included ischemic stroke and hemorrhagic stroke. The protocol for this systematic review was registered in the International Prospective Register of Systematic Reviews under identifier CRD42021254660. Of 24 studies included (10,632,808 study participants), 8 studies examined more than 1 outcome of interest. Hypertensive disorders of pregnancy were significantly associated with any stroke (adjusted risk ratio, 1.74; 95% confidence interval, 1.45-2.10). Preeclampsia was significantly associated with any stroke (adjusted risk ratio, 1.75; 95% confidence interval, 1.56-1.97), ischemic stroke (adjusted risk ratio, 1.74; 95% confidence interval, 1.46-2.06), and hemorrhagic stroke (adjusted risk ratio, 2.77; 95% confidence interval, 2.04-3.75). Gestational hypertension was significantly associated with any stroke (adjusted risk ratio, 1.23; 95% confidence interval, 1.20-1.26), ischemic stroke (adjusted risk ratio, 1.35; 95% confidence interval, 1.19-1.53), and hemorrhagic stroke (adjusted risk ratio, 2.66; 95% confidence interval, 1.02-6.98). Chronic hypertension was associated with ischemic stroke (adjusted risk ratio, 1.49; 95% confidence interval, 1.01-2.19). CONCLUSION In this meta-analysis, exposure to hypertensive disorders of pregnancy, including preeclampsia and gestational hypertension, seems to be associated with an increased risk for any stroke and ischemic stroke among parous patients in later life. Preventive interventions may be warranted for patients who experience hypertensive disorders of pregnancy to reduce their long-term risk for stroke.
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Affiliation(s)
- Matthew P Brohan
- School of Public Health, University College Cork, Cork, Ireland; School of Medicine, University College Cork, Cork, Ireland.
| | - Fionn P Daly
- School of Medicine, University College Cork, Cork, Ireland
| | - Louise Kelly
- Department of General Medicine, Beaumont Hospital, Dublin, Ireland
| | - Fergus P McCarthy
- Irish Centre for Maternal & Child Health, University College Cork, Cork, Ireland
| | - Ali S Khashan
- School of Public Health, University College Cork, Cork, Ireland
| | - Karolina Kublickiene
- Division of Renal Medicine, Department of Clinical Intervention, Science and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Peter M Barrett
- School of Public Health, University College Cork, Cork, Ireland
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Bala F, Cimflova P, Singh N, Zhang J, Kappelhof M, Kim BJ, Najm M, Golan R, Elebute I, Benali F, Terreros NA, Marquering H, Majoie C, Almekhlafi M, Goyal M, Hill MD, Qiu W, Menon BK. Impact of vessel tortuosity and radiological thrombus characteristics on the choice of first-line thrombectomy strategy: Results from the ESCAPE-NA1 trial. Eur Stroke J 2023; 8:675-683. [PMID: 37345551 PMCID: PMC10472967 DOI: 10.1177/23969873231183766] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/05/2023] [Indexed: 06/23/2023] Open
Abstract
INTRODUCTION Despite improvements in device technology, only one-third of stroke patients undergoing endovascular thrombectomy (EVT) achieve first-pass effect (FPE). We investigated the effect of arterial tortuosity and thrombus characteristics on the relationship between first-line EVT strategy and angiographic outcomes. PATIENTS AND METHODS Patients with thin-slice baseline CT-angiography from the ESCAPE-NA1 trial (Efficacy and safety of nerinetide for the treatment of acute ischemic stroke) were included. Tortuosity was estimated using the tortuosity index extracted from catheter pathway, and radiological thrombus characteristics were length, non-contrast density, perviousness and hyperdense artery sign. We assessed the association of first-line EVT strategy (stent-retriever [SR] versus contact aspiration [CA] versus combined SR+CA) with FPE (eTICI score 2c/3 after one pass), final eTICI 2b/3, number of passes and procedure duration using multivariable regression. Interaction of tortuosity and thrombus characteristics with first-line technique were assessed using interaction terms. RESULTS Among 520 included patients, SR as a first-line modality was used in 165 (31.7%) patients, CA in 132 (25.4%), and combined SR+CA in 223 (42.9%). FPE was observed in 166 patients (31.9%). First-line strategy was not associated with FPE. Tortuosity had a significant effect on FPE only in the CA group (aOR = 0.90 [95% CI 0.83-0.98]) compared with stent-retrievers and combined first-line approach (p interaction = 0.03). There was an interaction between thrombus length and first-line strategy for number of passes (p interaction = 0.04). Longer thrombi were associated with higher number of passes only in the CA group (acOR 1.03 [95% CI 1.00-1.06]). CONCLUSION Our study suggests that vessel tortuosity and longer thrombi may negatively affect the performance of first-line contact aspiration catheters in acute stroke patients undergoing EVT.
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Affiliation(s)
- Fouzi Bala
- Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
- Diagnostic and Interventional Neuroradiology Department, University Hospital of Tours, France
| | - Petra Cimflova
- Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
- Department of Medical Imaging, St Anne’s University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Nishita Singh
- Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Jianhai Zhang
- Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Manon Kappelhof
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Beom Joon Kim
- Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Mohamed Najm
- Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Rotem Golan
- Circle Neurovascular Imaging Inc., Calgary, AB, Canada
| | | | - Faysal Benali
- Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center+ MUMC+, Maastricht, The Netherlands
| | - Nerea Arrarte Terreros
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Department of Biomedical Engineering and Physics, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Henk Marquering
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Department of Biomedical Engineering and Physics, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Charles Majoie
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Mohammed Almekhlafi
- Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Mayank Goyal
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Michael D Hill
- Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Wu Qiu
- Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
- School of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Bijoy K Menon
- Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
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Verhaar N, Kopp V, Pfarrer C, Neudeck S, König K, Rohn K, Kästner S. Alpha 2 Antagonist Vatinoxan Does Not Abolish the Preconditioning Effect of Dexmedetomidine on Experimental Ischaemia-Reperfusion Injury in the Equine Small Intestine. Animals (Basel) 2023; 13:2755. [PMID: 37685019 PMCID: PMC10486550 DOI: 10.3390/ani13172755] [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: 08/02/2023] [Revised: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 09/10/2023] Open
Abstract
Pharmacological preconditioning with dexmedetomidine has been shown to ameliorate intestinal ischaemia reperfusion injury in different species, including horses. However, it remains unknown if this effect is related to alpha2 adrenoreceptor activity. Therefore, the aim of this study was to determine the effect of dexmedetomidine preconditioning with and without the administration of the peripheral alpha2 antagonist vatinoxan. This prospective randomized experimental trial included 12 horses equally divided between two treatment groups. Horses in group Dex received a bolus of dexmedetomidine followed by a continuous rate infusion (CRI), while group DexV additionally received vatinoxan as bolus and CRI. A median laparotomy was performed under general anaesthesia, and jejunal ischaemia was applied for 90 min, followed by 30 min of reperfusion. Mucosal damage was evaluated in full thickness biopsies by use of a semiquantitative mucosal injury score and by determining the apoptotic cell counts with immunohistochemical staining for cleaved caspase-3 and TUNEL. Comparisons between the groups and time points were performed using non-parametric tests (p < 0.05). During pre-ischaemia and ischaemia, no differences could be found in mucosal injury between the groups. After reperfusion, group DexV showed lower mucosal injury scores compared to group Dex. The apoptotic cell counts did not differ between the groups. In conclusion, antagonizing the peripheral alpha2 adrenoreceptors did not negatively affect dexmedetomidine preconditioning.
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Affiliation(s)
- Nicole Verhaar
- Clinic for Horses, University of Veterinary Medicine Hannover, 30559 Hannover, Germany
| | - Veronika Kopp
- Clinic for Horses, University of Veterinary Medicine Hannover, 30559 Hannover, Germany
| | - Christiane Pfarrer
- Institute for Anatomy, University of Veterinary Medicine Hannover, 30559 Hannover, Germany
| | - Stephan Neudeck
- Small Animal Clinic, University of Veterinary Medicine Hannover, 30559 Hannover, Germany
| | - Kathrin König
- Clinic for Horses, University of Veterinary Medicine Hannover, 30559 Hannover, Germany
| | - Karl Rohn
- Department of Biometry, University of Veterinary Medicine Hannover, 30559 Hannover, Germany
| | - Sabine Kästner
- Clinic for Horses, University of Veterinary Medicine Hannover, 30559 Hannover, Germany
- Small Animal Clinic, University of Veterinary Medicine Hannover, 30559 Hannover, Germany
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Hussein HM, Kashyap B, O'Keefe L, Droegemueller C, Othman SI, Yang MK, Hanson LR. Stroke Characteristics in a Cohort of Hmong American Patients. J Am Heart Assoc 2023; 12:e026763. [PMID: 37466390 PMCID: PMC10492969 DOI: 10.1161/jaha.122.026763] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 05/18/2023] [Indexed: 07/20/2023]
Abstract
Background Prior studies have indicated high rates of vascular risk factors, but little is known about stroke in Hmong. Methods and Results The institutional Get With The Guidelines (GWTG) database was used to identify patients discharged with acute ischemic stroke, intracerebral hemorrhage, or subarachnoid hemorrhage between 2010 and 2019. Hmong patients were identified using clan names and primary language. Univariate analysis was used to compare Hmong and White patients. A subarachnoid hemorrhage comparison was not conducted because of the small sample size. We identified 128 Hmong patients and 3084 White patients. Hmong patients had more prevalent hemorrhagic stroke (31% versus 15%; P<0.0016). In the acute ischemic stroke cohort, compared with White patients, Hmong patients were younger (60±13 versus 71±15 years; P<0.0001), presented to the emergency department almost 4 hours later; and had a lower thrombolysis usage rate (6% versus 14%; P=0.03496), worse lipid profile, higher hemoglobin A1C, similar stroke severity, and less frequent discharge to rehabilitation facilities. The most common ischemic stroke mechanism for Hmong patients was small-vessel disease. In the intracerebral hemorrhage cohort, Hmong patients were younger (55±13 versus 70±15 years; P<0.0001), had higher blood pressure, and had a lower rate of independent ambulation on discharge (9% versus 30%; P=0.0041). Conclusions Hmong patients with stroke were younger and had poorer risk factor control compared with White patients. There was a significant delay in emergency department arrival and low use of acute therapies among the Hmong acute ischemic stroke cohort. Larger studies are needed to confirm these observations, but action is urgently needed to close gaps in primary care and stroke health literacy.
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Affiliation(s)
- Haitham M. Hussein
- Department of NeurologyUniversity of MinnesotaMinneapolisMNUSA
- Neuroscience Research, HealthPartners Neuroscience CenterBloomingtonMNUSA
- Regions Hospital Comprehensive Stroke CenterSaint PaulMNUSA
| | - Bhavani Kashyap
- Neuroscience Research, HealthPartners Neuroscience CenterBloomingtonMNUSA
- HealthPartners InstituteSaint PaulMNUSA
| | | | | | - Sally I. Othman
- Neuroscience Research, HealthPartners Neuroscience CenterBloomingtonMNUSA
| | - Mai Kau Yang
- Department of NeurologyUniversity of MinnesotaMinneapolisMNUSA
| | - Leah R. Hanson
- Neuroscience Research, HealthPartners Neuroscience CenterBloomingtonMNUSA
- HealthPartners InstituteSaint PaulMNUSA
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Crawford AH, Beltran E, Danciu C, Yaffy D. Clinical presentation, diagnosis, treatment, and outcome in 8 dogs and 2 cats with global hypoxic- ischemic brain injury (2010-2022). J Vet Intern Med 2023; 37:1428-1437. [PMID: 37316975 PMCID: PMC10365066 DOI: 10.1111/jvim.16790] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 05/27/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Global hypoxic-ischemic brain injury (GHIBI) results in variable degrees of neurological dysfunction. Limited data exists to guide prognostication on likelihood of functional recovery. HYPOTHESIS Prolonged duration of hypoxic-ischemic insult and absence of neurological improvement in the first 72 hours are negative prognostic indicators. ANIMALS Ten clinical cases with GHIBI. METHODS Retrospective case series describing 8 dogs and 2 cats with GHIBI, including clinical signs, treatment, and outcome. RESULTS Six dogs and 2 cats experienced cardiopulmonary arrest or anesthetic complication in a veterinary hospital and were promptly resuscitated. Seven showed progressive neurological improvement within 72 hours of the hypoxic-ischemic insult. Four fully recovered and 3 had residual neurological deficits. One dog presented comatose after resuscitation at the primary care practice. Magnetic resonance imaging confirmed diffuse cerebral cortical swelling and severe brainstem compression and the dog was euthanized. Two dogs suffered out-of-hospital cardiopulmonary arrest, secondary to a road traffic accident in 1 and laryngeal obstruction in the other. The first dog was euthanized after MRI that identified diffuse cerebral cortical swelling with severe brainstem compression. In the other dog, spontaneous circulation was recovered after 22 minutes of cardiopulmonary resuscitation. However, the dog remained blind, disorientated, and ambulatory tetraparetic with vestibular ataxia and was euthanized 58 days after presentation. Histopathological examination of the brain confirmed severe diffuse cerebral and cerebellar cortical necrosis. CONCLUSIONS AND CLINICAL IMPORTANCE Duration of hypoxic-ischemic insult, diffuse brainstem involvement, MRI features, and rate of neurological recovery could provide indications of the likelihood of functional recovery after GHIBI.
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Affiliation(s)
- Abbe Harper Crawford
- Clinical Science and ServicesRoyal Veterinary College, Hawkshead Lane, North MymmsHatfield AL9 7TAUnited Kingdom
| | - Elsa Beltran
- Clinical Science and ServicesRoyal Veterinary College, Hawkshead Lane, North MymmsHatfield AL9 7TAUnited Kingdom
| | - Cecilia‐Gabriella Danciu
- Clinical Science and ServicesRoyal Veterinary College, Hawkshead Lane, North MymmsHatfield AL9 7TAUnited Kingdom
| | - Dylan Yaffy
- Pathobiology and Population SciencesRoyal Veterinary College, Hawkshead Lane, North MymmsHatfield AL9 7TAUnited Kingdom
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Kobeissi H, Adusumilli G, Ghozy S, Kadirvel R, Brinjikji W, Albers GW, Heit JJ, Kallmes DF. Endovascular thrombectomy for ischemic stroke with large core volume: An updated, post-TESLA systematic review and meta-analysis of the randomized trials. Interv Neuroradiol 2023:15910199231185738. [PMID: 37376869 DOI: 10.1177/15910199231185738] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Limited randomized controlled trials (RCTs) have been performed comparing endovascular thrombectomy (EVT) to medical therapy (MEDT) for acute ischemic stroke with extensive baseline ischemic injury (AIS-EBI). We conducted a systematic review and meta-analysis of RCTs reporting EVT for AIS-EBI. METHODS Using the Nested Knowledge AutoLit software, we conducted a systematic literature review from inception to 12 February 2023 within Web of Science, Embase, Scopus, and PubMed databases. Results of the TESLA trial were included on 10 June 2023. We included RCTs that compared EVT to MEDT for AIS with large ischemic core volume. The primary outcome of interest was a modified Rankin Score (mRS) 0-2. Secondary outcomes of interest included early neurological improvement (ENI), mRS 0-3, thrombolysis in cerebral infarction (TICI) 2b-3, symptomatic intracranial hemorrhage (sICH), and mortality. A random-effects model was used to calculate risk ratios (RRs) and their corresponding 95% confidence intervals (CIs). RESULTS We included four RCTs with 1310 patients, 661 of whom underwent EVT and 649 of whom were treated with MEDT. EVT was associated with greater rates of mRS 0-2 (RR = 2.33, 95% CI = 1.75-3.09; P-value < 0.001), mRS 0-3 (RR = 1.68, 95% CI = 1.33-2.12; P-value < 0.001), and ENI (RR = 2.24, 95% CI = 1.55-3.24; P-value < 0.001). Rates of sICH (RR = 1.99, 95% CI = 1.07-3.69; P-value = 0.03) were greater in the EVT group. Mortality (RR = 0.98, 95% CI = 0.83-1.15; P-value = 0.79) was comparable between the EVT and MEDT groups. The rate of successful reperfusion in the EVT group was 79.9% (95% CI = 75.6-83.6). CONCLUSIONS Although the rate of sICH was greater in the EVT group, EVT conferred a greater clinical benefit to MEDT for AIS-EBI based on available RCTs.
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Affiliation(s)
- Hassan Kobeissi
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- College of Medicine, Central Michigan University, Mount Pleasant, MI, USA
| | - Gautam Adusumilli
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Sherief Ghozy
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Ramanathan Kadirvel
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Jeremy J Heit
- Department of Radiology and Neurosurgery, Stanford University, Stanford, CA, USA
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Chen Y, Yang H, Wang W, Chen Y, Jiang D, Li Y, Li L, Yang W, Wang A. Staged management of a large ischemic heel ulcer in a diabetes patient: a case report. Front Endocrinol (Lausanne) 2023; 14:1198818. [PMID: 37396178 PMCID: PMC10313132 DOI: 10.3389/fendo.2023.1198818] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 05/29/2023] [Indexed: 07/04/2023] Open
Abstract
Heel ulcer is one of the severe complications of patients with diabetes mellitus, which poses a high risk for foot infection and amputation, especially in patients with peripheral arterial disease and neuropathy. Researchers have searched for new treatments for treating diabetic foot ulcers in recent years. In this case report, we demonstrated the treatment of large ischemic ulcers for the first time in a diabetic patient. The overall treatment goal of this patient was designed to improve blood supply to her diseased lower extremities and close the ulcer. This two-stage reconstruction approach resulted in an ulcer-free, stable, plantigrade foot at postoperative follow-up.
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Affiliation(s)
- Yuedong Chen
- Diabetic Foot Center, Nanjing Junxie Hospital, Nanjing, Jiangsu, China
| | - Hui Yang
- Diabetic Foot Center, Nanjing Junxie Hospital, Nanjing, Jiangsu, China
| | - Wei Wang
- Diabetic Foot Center, Nanjing Junxie Hospital, Nanjing, Jiangsu, China
| | - Yinchen Chen
- Diabetic Foot Center, Nanjing Junxie Hospital, Nanjing, Jiangsu, China
| | - Dong Jiang
- Diabetic Foot Center, Nanjing Junxie Hospital, Nanjing, Jiangsu, China
| | - Yihui Li
- Diabetic Foot Center, Nanjing Junxie Hospital, Nanjing, Jiangsu, China
| | - Liyi Li
- Diabetic Foot Center, Nanjing Junxie Hospital, Nanjing, Jiangsu, China
| | - Wengbo Yang
- Department of Orthopaedics, Nanjing First Hospital, Nanjing, Jiangsu, China
| | - Aiping Wang
- Diabetic Foot Center, Nanjing Junxie Hospital, Nanjing, Jiangsu, China
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Zhang XH, He JH, Zhang XS, Zhang J, Wang CJ, Dong YP, Tao W. Comparison of revascularization and conservative treatment for hemorrhagic moyamoya disease in East Asian Countries: a single-center case series and a systematic review with meta-analysis. Front Neurol 2023; 14:1169440. [PMID: 37332987 PMCID: PMC10272728 DOI: 10.3389/fneur.2023.1169440] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 04/28/2023] [Indexed: 06/20/2023] Open
Abstract
Objective The optimal treatment approach for hemorrhagic moyamoya disease (HMMD) remains a topic of debate, particularly regarding the comparative efficacy of revascularization versus conservative treatment. Our study, which included a single-center case series and a systematic review with meta-analysis, aimed to determine whether surgical revascularization is associated with a significant reduction in postoperative rebleeding, ischemic events, and mortality compared to conservative treatment among East Asian HMMD patients. Methods We conducted a systematic literature review by searching PubMed, Google Scholar, Wanfang Med Online (WMO), and the China National Knowledge Infrastructure (CNKI). The outcomes of surgical revascularization and conservative treatment, including rebleeding, ischemic events and mortality, were compared. The authors' institutional series of 24 patients were also included and reviewed in the analysis. Results A total of 19 East Asian studies involving 1,571 patients as well as our institution's retrospective study of 24 patients were included in the study. In the adult patients-only studies, those who underwent revascularization had significantly lower rates of rebleeding, ischemic events, and mortality compared to those who received conservative treatment (13.1% (46/352) vs. 32.4% (82/253), P < 0.00001; 4.0% (5/124) vs. 14.9% (18/121), P = 0.007; and 3.3% (5/153) vs. 12.6% (12/95), P = 0.01, respectively). In the adult/pediatric patients' studies, similar statistical results of rebleeding, ischemic events, and mortality have been obtained (70/588 (11.9%) vs. 103/402 (25.6%), P = 0.003 or <0.0001 in a random or fixed-effects model, respectively; 14/296 (4.7%) vs. 26/183 (14.2%), P = 0.001; and 4.6% (15/328) vs. 18.7% (23/123), P = 0.0001, respectively). Conclusion The current single-center case series and systematic review with meta-analysis of studies demonstrated that surgical revascularization, including direct, indirect, and a combination of both, significantly reduces rebleeding, ischemic events, and mortality in HMMD patients in the East Asia region. More well-designed studies are warranted to further confirm these findings.
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Affiliation(s)
- Xiang-Hua Zhang
- Department of Neurosurgery, Beijing Friendship Hospital Affiliated With Capital Medical University, Beijing, China
| | - Jun-Hua He
- Department of Neurosurgery, Zhejiang Provincial Tongde Hospital, Hangzhou, China
| | - Xiang-Sheng Zhang
- Department of Neurosurgery, Beijing Friendship Hospital Affiliated With Capital Medical University, Beijing, China
| | - Jing Zhang
- Department of Neurosurgery, Beijing Friendship Hospital Affiliated With Capital Medical University, Beijing, China
| | - Cheng-jun Wang
- Department of Neurosurgery, Beijing Friendship Hospital Affiliated With Capital Medical University, Beijing, China
| | - Yi-Peng Dong
- Department of Neurosurgery, Beijing Friendship Hospital Affiliated With Capital Medical University, Beijing, China
| | - Wu Tao
- Department of Neurosurgery, Beijing Friendship Hospital Affiliated With Capital Medical University, Beijing, China
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Amalia L. Factors Affecting the Delay of intravenous Thrombolysis in Hyperacute Ischemic Stroke Patients: A Single Centre Study. Int J Gen Med 2023; 16:2157-2163. [PMID: 37284035 PMCID: PMC10239640 DOI: 10.2147/ijgm.s412262] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/24/2023] [Indexed: 06/08/2023] Open
Abstract
Introduction Intravenous thrombolysis with r-tPA is the gold standard procedure in managing acute ischemic stroke recommended by the World Stroke Association, which is performed by injecting the drug r-tPA (Alteplase) intravenously. Generally, the preparation time to achieve thrombolysis is divided into pre-hospital and in-hospital. If this time can be shortened, the efficacy of thrombolysis can be increased. This study aims to determine the factors that can affect the delay in thrombolysis. Methods This is an analytic observational study with a retrospective cohort design in ischemic stroke confirmed by a neurologist at the neurology emergency unit of Hasan Sadikin Hospital (RSHS) from January 2021 to December 2021 and divided into two groups, delay and non-delay thrombolysis. A logistic regression test was performed to determine the independent predictor of delayed thrombolysis. Results There were 141 patients with an ischemic stroke diagnosis confirmed by a neurologist at the neurological emergency unit at Hasan Sadikin Hospital (RSHS) from January 2021 to December 2021. A total of 118 (83.69%) patients were included in the "delay" category, while 23 (16.31%) patients were included in the "non-delay" category. Patients included in the "delay" category had an average age of 58.29+11.19 years with a male-to-female sex ratio of 57%, while patients included in the "non-delay" category had an average age of 55.57+15.55 years with a male-to-female sex ratio of 66%. The NIHSS admission score was a significant risk factor for delayed thrombolysis. Through multiple logistic regression, it was found that age, onset, female gender, NIHSS admission score, and NIHSS discharge score were independent predictors of delayed thrombolysis. However, all of them were not statistically significant. Conclusion Gender, risk factors for dyslipidemia, and arrival onset are independent predictors of delayed thrombolysis. Prehospital factors contribute relatively more to the delay in thrombolytic action.
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Affiliation(s)
- Lisda Amalia
- Department of Neurology, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
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21
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Wang Y, Hou R, Liu Y. Plasma Homocysteine (Hcy) Concentration Functions as a Predictive Biomarker of SPECT-Evaluated Post- Ischemic Hyperperfusion in Acute Ischemic Stroke. Pharmgenomics Pers Med 2023; 16:481-489. [PMID: 37256202 PMCID: PMC10226540 DOI: 10.2147/pgpm.s400767] [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: 12/23/2022] [Accepted: 04/24/2023] [Indexed: 06/01/2023] Open
Abstract
Introduction Homocysteine (Hcy) concentration has been reported to be associated with ischemic stroke. In this study, we aimed to investigate the potential of plasma Hcy in the prediction of post-ischemic hyperperfusion in AIS patients, which was diagnosed with the single-photon emission computed tomography (SPECT) method. Methods A total of 112 ischemic stroke patients were recruited in this study. According to whether the patients were subjected to post-ischemic hyperperfusion, all recruited subjects were divided into a post-ischemic hyperperfusion (+) group (N=48) and post-ischemic hyperperfusion (-) group (N=64). The basic demographical data, clinicopathological data and laboratory biochemical data were collected and compared. Level of homocysteine (Hcy) and cystatin-C (Cys-C) and their potential as predictive biomarker are also investigated. Results No significant differences were spotted between the post-ischemic hyperperfusion group (+) and post-ischemic hyperperfusion (-) group in respect to the basic demographical and clinicopathological data. And the serum Hcy levels were lower in the post-ischemic hyperperfusion (+) group. Moreover, ROC analysis indicated significant relationships between Hcy levels and the onset of post-ischemic hyperperfusion. Conclusion In conclusion, we validated that the plasma Hcy concentration can be used as a predictive biomarker of SPECT-evaluated post-ischemic hyperperfusion in patients suffering from acute ischemic stroke.
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Affiliation(s)
- Yingqiu Wang
- Department of Nuclear Medicine, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, 200090, People’s Republic of China
| | - Renhua Hou
- Department of Nuclear Medicine, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, 200090, People’s Republic of China
| | - Yan Liu
- Department of Nuclear Medicine, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, 200090, People’s Republic of China
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Vincent M, Sereke SG, Nassanga R, Robert M, Ameda F. Correlation between clinical and brain computed tomography findings of stroke patients: A cross-sectional study. Health Sci Rep 2023; 6:e1248. [PMID: 37152223 PMCID: PMC10157266 DOI: 10.1002/hsr2.1248] [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: 11/20/2022] [Revised: 04/10/2023] [Accepted: 04/22/2023] [Indexed: 05/09/2023] Open
Abstract
Background and Aims In developing countries, the burden of stroke is growing and causing significant morbidity and disability with high mortality rates. Neuroimaging plays a crucial role in differentiating ischemic stroke from an intracerebral hemorrhage, as well as entities other than stroke. This study sought to determine the correlation between the clinical and brain CT scan findings of stroke patients attending three hospitals in Kampala, Uganda. Methods This was a cross-sectional study of clinically suspected stroke patients who were sent for brain CT scan at three selected hospitals in Kampala, Uganda. All brain CT scans of patients with suspected stroke were evaluated and the Alberta stroke program early CT score (ASPECTS) was used for middle cerebral artery (MCA) strokes. Univariate analysis was used to describe the clinico-demographic and brain CT features of stroke and summarized them as percentages. Bivariate and multivariate analysis were used to determine the adjusted odds ratios as a measure of association with a 95% confidence interval (CI). Results Of the 270 study participants, 141 (52.2%) were male. 162 (60%) had CT findings of stroke, and 90 (33.3%) had normal brain CT findings. Eighteen (6.7%) had other CT findings like tumor, dural hemorrhage, epidermoid cyst, and others. Ischemic stroke, hemorrhagic stroke, and subarachnoid hemorrhage accounted for 124 (45.9%), 34 (12.6%), and 4 (1.5%) respectively. Limb weakness (55.2%), headache (41.1%), and loss of consciousness (39.3%) were associated with stroke findings on CT. Among the acute ischemic strokes, 30 (73.2%) had a worse (0-7) ASPECT score. Those aged ≥65 years were associated with a worse ASPECTS [AOR: 22.01, (95% CI: 1.58-306.09) p = 0.021]. Conclusion More than a third of patients with a clinical diagnosis of stroke had either no CT features of stroke or had other findings. The most commonly affected vascular territory was left MCA. Old age was strongly associated with having the worst ASPECTS score.
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Affiliation(s)
- Mboizi Vincent
- Department of Radiology and Radiotherapy, College of Health SciencesMakerere UniversityKampalaUganda
| | - Senai Goitom Sereke
- Department of Radiology and Radiotherapy, College of Health SciencesMakerere UniversityKampalaUganda
| | - Rita Nassanga
- Department of Radiology and Radiotherapy, College of Health SciencesMakerere UniversityKampalaUganda
| | - Mukisa Robert
- Department of MedicineMulago National Referral HospitalKampalaUganda
| | - Faith Ameda
- Department of Radiology and Radiotherapy, College of Health SciencesMakerere UniversityKampalaUganda
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Ramzan A, Kobeissi H, Ghozy S, Kadirvel R, Kallmes DF. Transradial balloon guide catheter placement for acute ischemic stroke thrombectomy: A systematic review and meta-analysis. Interv Neuroradiol 2023:15910199231171955. [PMID: 37097886 DOI: 10.1177/15910199231171955] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Endovascular thrombectomy (EVT) is a treatment option for acute ischemic stroke due to large vessel occlusion. The use of a balloon-guided catheter (BGC) for EVT via transradial access (TRA) has emerged as a treatment approach, but its efficacy and safety compared to existing practices are uncertain. METHODS A systematic literature review was performed using Embase, PubMed, Scopus, Web of Science databases, and manual search. Studies reporting safety and efficacy metrics for TRA BGC EVT were included. Data regarding recanalization time, thrombolysis in cerebral infarction (TICI), modified Rankin scale (mRS), symptomatic intracranial hemorrhage (sICH), first pass effect (FPE), and additional complications was pooled using a random-effects model to calculate event rates and 95% confidence intervals (CI). RESULTS The search yielded five studies (n = 117). The mean time from puncture to final recanalization was 34.5 (95% CI = 30.5 to 39.14, I2 = 0%, P-value = 0.37) min. Successful recanalization (TICI 2b-3) and complete recanalization (TICI 3) occurred in 96.6% (95% CI = 91.24 to 98.71, I2 = 0%, P-value = 0.99) and 55.2% (95% CI = 42.14 to 67.54, I2 = 0%, P-value = 0.39) of cases, respectively. FPE occurred in 67.5% (95% CI = 51.73 to 80.10, I2 = 0%, P-value = 0.56) of patients. mRS 0-2 was achieved in 41.2% (95% CI = 27.34 to 56.65, I2 = 70%, P-value = 0.07) of patients. sICH occurred in 5.0% (95% CI = 1.25 to 17.91, I2 = 0%, P-value = 1.00) of patients. Local complications of radial hematoma and radial vasospasm occurred in 5.0% (95% CI = 0.49 to 12.36, I2 = 29%, P-value = 0.24) and 2.1% (95% CI = 1.25 to 17.91, I2 = 71%, P-value = 0.03) of cases, respectively. Switch to femoral access was necessary in 3.7% (95% CI = 0.00 to 14.07, I2 = 68%, P-value = 0.02) of procedures. The average number of passes per procedure was 1.6 (95% CI = 1.15 to 2.11, I2 = 88%, P-value < 0.001). CONCLUSION TRA BGC EVT has potential as a safe and efficacious treatment option compared to existing methods. However, additional, prospective studies are necessary to inform clinical decision making.
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Affiliation(s)
| | | | - Sherief Ghozy
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Ramanathan Kadirvel
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
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Tang HS, Kwan CT, He J, Ng PP, Hai SHJ, Kwok FYJ, Sze HF, So MH, Lo HY, Fong HTA, Wan EYF, Lee CH, Yu EYT, Lai YTA, Lee CYJ, Leung ST, Chan HL, Tse HF, Pennell DJ, Mohiaddin RH, Senior R, Yan AT, Yiu KH, Ng MY. Prognostic Utility of Cardiac MRI Myocardial Strain Parameters in Patients With Ischemic and Nonischemic Dilated Cardiomyopathy: A Multicenter Study. AJR Am J Roentgenol 2023; 220:524-538. [PMID: 36321987 DOI: 10.2214/ajr.22.28415] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND. Prior small single-center studies have yielded conflicting results regarding the prognostic significance of myocardial strain parameters derived from feature tracking (FT) on cardiac MRI in patients with dilated cardiomyopathy (DCM). OBJECTIVE. The purpose of this study was to evaluate the prognostic utility of FT parameters on cardiac MRI in patients with ischemic and nonischemic DCM and to determine the optimal strain parameter for outcome prediction. METHODS. This retrospective study included 471 patients (median age, 61 years; 365 men, 106 women) with ischemic (n = 233) or nonischemic (n = 238) DCM and left ventricular (LV) ejection fraction (EF) less than 50% who underwent cardiac MRI at any of four centers from January 2011 to December 2019. Cardiac MRI parameters were determined by manual contouring. In addition, software-based FT was used to calculate six myocardial strain parameters (LV and right ventricular [RV] global radial strain, global circumferential strain, and global longitudinal strain [GLS]). Late gadolinium enhancement (LGE) was also evaluated. Patients were assessed for a composite outcome of all-cause mortality and/or heart-failure hospitalization. Cox regression models were used to determine associations between strain parameters and the composite outcome. RESULTS. Mean LV EF was 27.5% and mean LV GLS was -6.9%. The median follow-up period was 1328 days. The composite outcome occurred in 220 patients (125 deaths, 95 heart-failure hospitalizations). All six myocardial strain parameters were significant independent predictors of the composite outcome (hazard ratio [HR] = 0.92-1.16; all p < .05). In multivariable models that included age, corrected LV and RV end-diastolic volume, LV and RV EF, and presence of LGE, the only strain parameter that was a significant independent predictor of the composite outcome was LV GLS (HR = 1.13, p = .006); LV EF and presence of LGE were not independent predictors of the composite outcome in the models (p > .05). A LV GLS threshold of -6.8% had sensitivity of 62.6% and specificity of 62.6% in predicting the composite outcome rate at 4.0 years. CONCLUSION. LV GLS, derived from FT on cardiac MRI, is a significant independent predictor of adverse outcomes in patients with DCM. CLINICAL IMPACT. This study strengthens the body of evidence supporting the clinical implementation of FT when performing cardiac MRI in patients with DCM.
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Affiliation(s)
- Hok Shing Tang
- Department of Diagnostic Radiology, The University of Hong Kong, Rm 406, Block K, Queen Mary Hospital, Hong Kong SAR
| | - Chi Ting Kwan
- Department of Diagnostic Radiology, The University of Hong Kong, Rm 406, Block K, Queen Mary Hospital, Hong Kong SAR
| | - Jianlong He
- Department of Medical Imaging, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Pan Pan Ng
- Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong SAR
| | - Siu Han Jojo Hai
- Department of Medicine, Division of Cardiology, Queen Mary Hospital, Hong Kong SAR
| | - Fung Yu James Kwok
- Department of Diagnostic Radiology, The University of Hong Kong, Rm 406, Block K, Queen Mary Hospital, Hong Kong SAR
| | - Ho Fung Sze
- Department of Diagnostic Radiology, The University of Hong Kong, Rm 406, Block K, Queen Mary Hospital, Hong Kong SAR
| | - Man Hon So
- Department of Diagnostic Radiology, The University of Hong Kong, Rm 406, Block K, Queen Mary Hospital, Hong Kong SAR
| | - Hong Yip Lo
- Department of Diagnostic and Interventional Radiology, Kwong Wah Hospital, Hong Kong SAR
| | - Ho Tung Ambrose Fong
- Department of Diagnostic Radiology, The University of Hong Kong, Rm 406, Block K, Queen Mary Hospital, Hong Kong SAR
| | - Eric Yuk Fai Wan
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR
- Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong SAR
| | - Chi-Ho Lee
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR
- State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Hong Kong SAR
| | - Esther Yee Tak Yu
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR
| | - Yee Tak Alta Lai
- Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR
| | - Chun Yin Jonan Lee
- Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong SAR
| | - Siu Ting Leung
- Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR
- Imaging and Intervention Radiology Centre, CUHK Medical Centre, Hong Kong SAR
| | - Hiu Lam Chan
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR
| | - Hung Fat Tse
- Department of Medicine, Division of Cardiology, Queen Mary Hospital, Hong Kong SAR
- Cardiac and Vascular Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Dudley J Pennell
- Department of Cardiovascular Magnetic Resonance, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Raad H Mohiaddin
- Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
- Department of Cardiology, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Roxy Senior
- Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
- Department of Cardiology, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Andrew T Yan
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Kai-Hang Yiu
- Department of Medicine, Division of Cardiology, Queen Mary Hospital, Hong Kong SAR
- Cardiac and Vascular Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Ming-Yen Ng
- Department of Diagnostic Radiology, The University of Hong Kong, Rm 406, Block K, Queen Mary Hospital, Hong Kong SAR
- Department of Medical Imaging, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
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Yoon HJ, Kim KH, Lee N, Park H, Kim HY, Cho JY, Ahn Y, Jeong MH. Sex-Specific Predictors of Long-Term Mortality in Elderly Patients with Ischemic Cardiomyopathy. J Clin Med 2023; 12:jcm12052012. [PMID: 36902797 PMCID: PMC10003953 DOI: 10.3390/jcm12052012] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/22/2023] [Accepted: 03/01/2023] [Indexed: 03/06/2023] Open
Abstract
Ischemic heart failure (HF) is one of the most common causes of morbidity and mortality in the world-wide, but sex-specific predictors of mortality in elderly patients with ischemic cardiomyopathy (ICMP) have been poorly studied. A total of 536 patients with ICMP over 65 years-old (77.8 ± 7.1 years, 283 males) were followed for a mean of 5.4 years. The development of death during clinical follow up was evaluated, and predictors of mortality were compared. Death was developed in 137 patients (25.6%); 64 females (25.3%) vs. 73 males (25.8%). Low-ejection fraction was only an independent predictor of mortality in ICMP, regardless of sex (HR 3.070 CI = 1.708-5.520 in female, HR 2.011, CI = 1.146-3.527 in male). Diabetes (HR 1.811, CI = 1.016-3.229), elevated e/e' (HR 2.479, CI = 1.201-5.117), elevated pulmonary artery systolic pressure (HR 2.833, CI = 1.197-6.704), anemia (HR 1.860, CI = 1.025-3.373), beta blocker non-use (HR2.148, CI = 1.010-4.568), and angiotensin receptor blocker non-use (HR 2.100, CI = 1.137-3.881) were bad prognostic factors of long term mortality in female, whereas hypertension (HR 1.770, CI = 1.024-3.058), elevated Creatinine (HR 2.188, CI = 1.225-3.908), and statin non-use (HR 3.475, CI = 1.989-6.071) were predictors of mortality in males with ICMP independently. Systolic dysfunction in both sexes, diastolic dysfunction, beta blocker and angiotensin receptor blockers in female, and statins in males have important roles for long-term mortality in elderly patients with ICMP. For improving long-term survival in elderly patients with ICMP, it may be necessary to approach sex specifically.
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Kurtz P, Bastos LSL, Zampieri FG, de Freitas GR, Bozza FA, Soares M, Salluh JIF. Trends in Intensive Care Admissions and Outcomes of Stroke Patients Over 10 Years in Brazil: Impact of the COVID-19 Pandemic. Chest 2023; 163:543-553. [PMID: 36347322 PMCID: PMC9636603 DOI: 10.1016/j.chest.2022.10.033] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 10/10/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The coronavirus 2019 (COVID-19) pandemic affected stroke care worldwide. Data from low- and middle-income countries are limited. RESEARCH QUESTION What was the impact of the pandemic in ICU admissions and outcomes of patients with stroke, in comparison with trends over the last 10 years? STUDY DESIGN AND METHODS Retrospective cohort study including prospectively collected data from 165 ICUs in Brazil between 2011 and 2020. We analyzed clinical characteristics and mortality over a period of 10 years and evaluated the impact of the pandemic on stroke outcomes, using the following approach: analyses of admissions for ischemic and hemorrhagic strokes and trends in in-hospital mortality over 10 years; analysis of variable life-adjusted display (VLAD) during 2020; and a mixed-effects multivariable logistic regression model. RESULTS A total of 17,115 stroke admissions were analyzed, from which 13,634 were ischemic and 3,481 were hemorrhagic. In-hospital mortality was lower after ischemic stroke as compared with hemorrhagic (9% vs 24%, respectively). Changes in VLAD across epidemiological weeks of 2020 showed that the rise in COVID-19 cases was accompanied by increased mortality, mainly after ischemic stroke. In logistic regression mixed models, mortality was higher in 2020 compared with 2019, 2018, and 2017 in patients with ischemic stroke, namely, in those without altered mental status. In hemorrhagic stroke, the increased mortality in 2020 was observed in patients 50 years of age or younger, as compared with 2019. INTERPRETATION Hospital outcomes of stroke admissions worsened during the COVID-19 pandemic, interrupting a trend of improvements in survival rates over 10 years. This effect was more pronounced during the surge of COVID-19 ICU admissions affecting predominantly patients with ischemic stroke without coma, and young patients with hemorrhagic stroke.
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Affiliation(s)
- Pedro Kurtz
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil; Hospital Copa Star, Rio de Janeiro, RJ, Brazil; Paulo Niemeyer State Brain Institute (IECPN), Rio de Janeiro, RJ, Brazil.
| | - Leonardo S L Bastos
- Department of Industrial Engineering (DEI), Pontifical Catholic University of Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ, Brazil
| | - Fernando G Zampieri
- Intensive Care Unit, Hospital Vila Nova Star, São Paulo, Brazil; Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Gabriel R de Freitas
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil; Department of Neurology, Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - Fernando A Bozza
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil; National Institute of Infectious Disease Evandro Chagas (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ, Brazil
| | - Marcio Soares
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil
| | - Jorge I F Salluh
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil; Postgraduate Program of Internal Medicine, Federal University of Rio de Janeiro, (UFRJ), Rio de Janeiro, Brazil
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Davis MG, Gangu K, Suriya S, Maringanti BS, Chourasia P, Bobba A, Tripathi A, Avula SR, Shekhar R, Sheikh AB. COVID-19 and Acute Ischemic Stroke Mortality and Clinical Outcomes among Hospitalized Patients in the United States: Insight from National Inpatient Sample. J Clin Med 2023; 12. [PMID: 36835876 DOI: 10.3390/jcm12041340] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/04/2023] [Accepted: 02/05/2023] [Indexed: 02/11/2023] Open
Abstract
Coronavirus-19, primarily a respiratory virus, also affects the nervous system. Acute ischemic stroke (AIS) is a well-known complication among COVID-19 infections, but large-scale studies evaluating AIS outcomes related to COVID-19 infection remain limited. We used the National Inpatient Sample database to compare acute ischemic stroke patients with and without COVID-19. A total of 329,240 patients were included in the study: acute ischemic stroke with COVID-19 (n = 6665, 2.0%) and acute ischemic stroke without COVID-19 (n = 322,575, 98.0%). The primary outcome was in-hospital mortality. Secondary outcomes included mechanical ventilation, vasopressor use, mechanical thrombectomy, thrombolysis, seizure, acute venous thromboembolism, acute myocardial infarction, cardiac arrest, septic shock, acute kidney injury requiring hemodialysis, length of stay, mean total hospitalization charge, and disposition. Acute ischemic stroke patients who were COVID-19-positive had significantly increased in-hospital mortality compared to acute ischemic stroke patients without COVID-19 (16.9% vs. 4.1%, aOR: 2.5 [95% CI 1.7-3.6], p < 0.001). This cohort also had significantly increased mechanical ventilation use, acute venous thromboembolism, acute myocardial infarction, cardiac arrest, septic shock, acute kidney injury, length of stay, and mean total hospitalization charge. Further research regarding vaccination and therapies will be vital in reducing worse outcomes in patients with acute ischemic stroke and COVID-19.
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Zhang X, Liu J, Han H, Zhang P, Chen X, Yuan H, Chen M, Zhu Q, Liebeskind DS, Miao Z. Effectiveness and safety of the Trevo® Retriever for mechanical thrombectomy in Chinese patients with acute ischemic stroke: Trevo Retriever China Registry. Interv Neuroradiol 2023:15910199231151275. [PMID: 36703568 DOI: 10.1177/15910199231151275] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND To quantify the effectiveness and safety of the Trevo® Retriever for endovascular treatment of acute ischemic stroke (AIS) patients in China. METHODS Trevo Retriever Registry (China) was a prospective, multicenter, non-comparative, open-label study of patients with AIS treated with the Trevo Retriever. The primary outcome was the proportion of patients achieving an expanded Thrombolysis in Cerebral Infarction (eTICI) score ≥2b at the end of endovascular treatment. Secondary outcomes included first-pass eTICI score ≥2b and 90-day modified Rankin Scale (mRS) score ≤2. RESULTS The Trevo Retriever Registry (China) enrolled and followed 201 patients (62.1 ± 12.5 years-old; 70.6% male) at 11 centers. The pre-procedure NIHSS score and ASPECTS were 16 (interquartile range (IQR), 13-21) and 7 (IQR, 6-9), respectively, and 188 (93.5%) patients had an mRS score of 0 prior to the stroke. The main stroke etiology was large artery atherosclerosis, accounting for 71.6% (144/201) of patients. Post-procedure eTICI ≥2b was 98.4% (187/190). First-pass eTICI ≥2b was 74.7% (136/182). The 90-day good outcome (mRS ≤2) rate was 73.6% (148/201). The 90-day all-cause mortality was 5.5% (11/201). Neurological deterioration at 24 h post-procedure was observed in 7.7% (15/195) patients. Embolism in a new territory was seen in one patient (0.5%). Two (1.0%) procedure-related adverse events (AEs) occurred, which were intra-procedure cerebral artery embolism. No Trevo related AEs occurred. CONCLUSIONS This real-world study of the Trevo Retriever in China demonstrated a high rate of revascularization and first-pass success that resulted in an overall high good function outcome rate and low mortality.
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Affiliation(s)
- Xuelei Zhang
- Department of Neurointerventional, 105738Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
| | - Jinchao Liu
- 117938Puyang Oilfield General Hospital, Puyang, China
| | - Hongxing Han
- Department of Neurology, 529858Linyi People's Hospital, Linyi, China
| | - Pinyuan Zhang
- Department of Neurosurgery (Cerebrovascular Disease), The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xianglin Chen
- Department of Cerebrovascular Disease, 534795Qingyuan People's Hospital, Qingyuan, China
| | - Haicheng Yuan
- Department of Neurology, Qingdao Central Hospital, Qingdao, China
| | - Maohua Chen
- Department of Neurosurgery, Wenzhou Central Hospital, Wenzhou, China
| | - Qiyi Zhu
- Department of Neurology, 529858Linyi People's Hospital, Linyi, China
| | - David S Liebeskind
- Department of Neurology and UCLA Stroke Center, University of California, Los Angeles, CA, USA
| | - Zhongrong Miao
- Department of Neurointerventional, 105738Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
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Abstract
Diabetic foot complications represent a substantial health burden and are the foremost cause of hospitalization in patients with diabetes. Diabetes mellitus (DM) is known to cause several other problems. Diabetes is rapidly becoming the leading cause of illness and death worldwide. Diabetic foot ulcers (DFU) are one of the most painful complications of diabetes. These complications cause problems in blood vessels, nerves, and other organs throughout the body. DFU pathophysiology is attributed to a triad of neuropathies, trauma with secondary infection, and arterial occlusive disease. This review aims to identify the types of wounds that diabetics can develop. Owing to the complexity of their disease pathology, diabetics are susceptible to a variety of wounds, such as diabetic ulcers due to trauma (DUDT); neuropathic, ischemic, neuroischemic, arterial, venous, and mixed wounds; and diabetic bullae, furuncles, cellulitis, and carbuncles. Therefore, it is essential for healthcare providers to recognize the specific classification of a diabetic wound based on its distinctive attributes to provide appropriate wound care and therapeutic interventions. In the context of individuals with diabetes, it is of paramount significance to precisely identify the types of wounds during the initial evaluation to provide appropriate care and treatment, thereby enhancing the probability of favorable outcomes.
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Affiliation(s)
- Suriadi Jais
- School of Nursing, The Institute of Technology and Health Muhammadiyah KALBAR, Pontianak, Indonesia
- Kitamura Wound Clinic, Pontianak, Indonesia
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Sun JM, Yen TL, Jan JS, Mwale PF, Teng RD, Taliyan R, Hsieh CT, Yang CH. Advances in Antibody-Based Therapeutics for Cerebral Ischemia. Pharmaceutics 2022; 15. [PMID: 36678774 DOI: 10.3390/pharmaceutics15010145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/18/2022] [Accepted: 12/29/2022] [Indexed: 01/04/2023] Open
Abstract
Cerebral ischemia is an acute disorder characterized by an abrupt reduction in blood flow that results in immediate deprivation of both glucose and oxygen. The main types of cerebral ischemia are ischemic and hemorrhagic stroke. When a stroke occurs, several signaling pathways are activated, comprising necrosis, apoptosis, and autophagy as well as glial activation and white matter injury, which leads to neuronal cell death. Current treatments for strokes include challenging mechanical thrombectomy or tissue plasminogen activator, which increase the danger of cerebral bleeding, brain edema, and cerebral damage, limiting their usage in clinical settings. Monoclonal antibody therapy has proven to be effective and safe in the treatment of a variety of neurological disorders. In contrast, the evidence for stroke therapy is minimal. Recently, Clone MTS510 antibody targeting toll-like receptor-4 (TLR4) protein, ASC06-IgG1 antibody targeting acid sensing ion channel-1a (ASIC1a) protein, Anti-GluN1 antibodies targeting N-methyl-D-aspartate (NMDA) receptor associated calcium influx, GSK249320 antibody targeting myelin-associated glycoprotein (MAG), anti-High Mobility Group Box-1 antibody targeting high mobility group box-1 (HMGB1) are currently under clinical trials for cerebral ischemia treatment. In this article, we review the current antibody-based pharmaceuticals for neurological diseases, the use of antibody drugs in stroke, strategies to improve the efficacy of antibody therapeutics in cerebral ischemia, and the recent advancement of antibody drugs in clinical practice. Overall, we highlight the need of enhancing blood-brain barrier (BBB) penetration for the improvement of antibody-based therapeutics in the brain, which could greatly enhance the antibody medications for cerebral ischemia in clinical practice.
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Toor SM, Aldous EK, Parray A, Akhtar N, Al-Sarraj Y, Abdelalim EM, Arredouani A, El-Agnaf O, Thornalley PJ, Pananchikkal SV, Pir GJ, Ayadathil R, Shuaib A, Alajez NM, Albagha OME. Circulating MicroRNA Profiling Identifies Distinct MicroRNA Signatures in Acute Ischemic Stroke and Transient Ischemic Attack Patients. Int J Mol Sci 2022; 24. [PMID: 36613546 DOI: 10.3390/ijms24010108] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 12/04/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022] Open
Abstract
Transient ischemic attack (TIA) refers to a momentary neurologic deficit caused by focal cerebral, spinal or retinal ischemic insult. TIA is associated with a high risk of impending acute ischemic stroke (AIS), a neurologic dysfunction characterized by focal cerebral, spinal or retinal infarction. Understanding the differences in molecular pathways in AIS and TIA has merit for deciphering the underlying cause for neuronal deficits with long-term effects and high risks of morbidity and mortality. In this study, we performed comprehensive investigations into the circulating microRNA (miRNA) profiles of AIS (n = 191) and TIA (n = 61) patients. We performed RNA-Seq on serum samples collected within 24 hrs of clinical diagnosis and randomly divided the study populations into discovery and validation cohorts. We identified a panel of 11 differentially regulated miRNAs at FDR < 0.05. Hsa-miR-548c-5p, -20a-5p, -18a-5p, -484, -652-3p, -486-3p, -24-3p, -181a-5p and -222-3p were upregulated, while hsa-miR-500a-3p and -206 were downregulated in AIS patients compared to TIA patients. We also probed the previously validated gene targets of our identified miRNA panel to highlight the molecular pathways affected in AIS. Moreover, we developed a multivariate classifier with potential utilization as a discriminative biomarker for AIS and TIA patients. The underlying molecular pathways in AIS compared to TIA may be explored further in functional studies for therapeutic targeting in clinical translation.
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Edrissi C, Rathfoot C, Knisely K, Sanders CB, Goodwin R, Nathaniel SI, Nathaniel T. Age Stratification in Acute Ischemic Stroke Patients with Heart Failure. J Clin Med 2022; 12:jcm12010038. [PMID: 36614839 PMCID: PMC9821452 DOI: 10.3390/jcm12010038] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/28/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
Background and Purpose. Heart failure (HF) is considered one of the major risk factors associated with the severity of acute ischemic stroke(AIS). The risk factors associated with stroke severity in AIS with a history of HF is not fully understood. Methods. A prospectively maintained database from comprehensive stroke centers in PRISMA Health Upstate Sc, was analyzed for patients with AIS and a history of HF from January 2010 to 30 June 2016. The primary outcome was risk factors associated with a National Institute of Health Stroke Scale score (NIHSS) < 7 indicating lower severity and a score ≥ 7 indicating high severity for 65−74 age category and ≥75 years age category for AIS-HF patients. Univariate analysis was used to determine risk factors based on age categories and stroke severities, while multivariable analysis was used to adjust for the effect of confounding variables. Results: A total 367 AIS-HF patients were identified in this study, 113 patients were between 65−74 years old, while 254 patients were in the ≥75 years old age category. In the adjusted analysis for 65−74 age category, history of smoking (OR = 0.105, 95% Confidence interval (CI): 0.018−0.614, p = 0.012), triglycerides (Odd ratio(OR) = 0.993, 95% (CI): 0.987−0.999, p = 0.019), and International Normalized Ratio (INR) (OR = 0.454, 95% CI: 0.196−1.050, p = 0.045), and direct admission treatment (OR = 0.355, 95% CI: 0.137−0.920, p = 0.033) were associated with a lower stroke severity, elevated heart rate (OR = 1.032, 95% CI: 1.009−1.057, p = 0.007) was associated with a higher stroke severity. For the ≥75 years old age category, previous stroke (OR = 2.297, 95% CI: 1.171−9.852, p = 0.024), peripheral vascular disease (OR = 6.784, 95% CI: 1.242−37.065, p = 0.027), heart rate (OR = 1.035, 95% CI: 1.008−1.063, p = 0.012), and systolic blood pressure (OR = 1.023, 95% CI: 1.005−1.041, p = 0.012) were associated with a higher severe stroke severity. Conclusions: After adjusting for the effect of potential confounders, more risk factors were associated with a high severity of stroke among ≥75 years old compared with 65−74 years old AIS-HF patients. Elevated heart rate was an independent risk factor associated with stroke severity in 65−74 and ≥75 years old AIS-HF patients. Elevated heart rate and other identified risk factors should be managed to reduce stroke severity among elderly AIS-HF patients.
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Affiliation(s)
- Camron Edrissi
- School of Medicine-Greenville, University of South Carolina, Greenville, SC 29605, USA
| | - Chase Rathfoot
- School of Medicine-Greenville, University of South Carolina, Greenville, SC 29605, USA
| | - Krista Knisely
- School of Medicine-Greenville, University of South Carolina, Greenville, SC 29605, USA
| | | | - Richard Goodwin
- School of Medicine-Greenville, University of South Carolina, Greenville, SC 29605, USA
| | - Samuel I. Nathaniel
- Department of Biology, North Greenville University, Tigerville, SC 29688, USA
| | - Thomas Nathaniel
- School of Medicine-Greenville, University of South Carolina, Greenville, SC 29605, USA
- Correspondence: ; Tel.: +1-86-44559846; Fax: +1-86-44558404
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Toor SM, Aldous EK, Parray A, Akhtar N, Al-Sarraj Y, Abdelalim EM, Arredouani A, El-Agnaf O, Thornalley PJ, Pananchikkal SV, Pir GJ, Kuni RAT, Shuaib A, Alajez NM, Albagha OME. Identification of distinct circulating microRNAs in acute ischemic stroke patients with type 2 diabetes mellitus. Front Cardiovasc Med 2022; 9:1024790. [PMID: 36277770 PMCID: PMC9582656 DOI: 10.3389/fcvm.2022.1024790] [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: 08/22/2022] [Accepted: 09/13/2022] [Indexed: 11/15/2022] Open
Abstract
Stroke is the second leading cause of global mortality and continued efforts aim to identify predictive, diagnostic, or prognostic biomarkers to reduce the disease burden. Circulating microRNAs (miRNAs) have emerged as potential biomarkers in stroke. We performed comprehensive circulating miRNA profiling of ischemic stroke patients with or without type 2 diabetes mellitus (T2DM), an important risk factor associated with worse clinical outcomes in stroke. Serum samples were collected within 24 h of acute stroke diagnosis and circulating miRNAs profiled using RNA-Seq were compared between stroke patients with T2DM (SWDM; n = 92) and those without T2DM (SWoDM; n = 98). Our analysis workflow involved random allocation of study cohorts into discovery (n = 96) and validation (n = 94) datasets. Five miRNAs were found to be differentially regulated in SWDM compared to SWoDM patients. Hsa-miR-361-3p and -664a-5p were downregulated, whereas miR-423-3p, -140-5p, and -17-3p were upregulated. We also explored the gene targets of these miRNAs and investigated the downstream pathways associated with them to decipher the potential pathways impacted in stroke with diabetes as comorbidity. Overall, our novel findings provide important insights into the differentially regulated miRNAs, their associated pathways and potential utilization for clinical benefits in ischemic stroke patients with diabetes.
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Affiliation(s)
- Salman M. Toor
- College of Health and Life Sciences (CHLS), Hamad Bin Khalifa University (HBKU), Qatar Foundation (QF), Doha, Qatar
| | - Eman K. Aldous
- College of Health and Life Sciences (CHLS), Hamad Bin Khalifa University (HBKU), Qatar Foundation (QF), Doha, Qatar,Diabetes Research Center, Qatar Biomedical Research Institute (QBRI), Hamad Bin Khalifa University (HBKU), Qatar Foundation (QF), Doha, Qatar
| | - Aijaz Parray
- The Neuroscience Institute, Academic Health System, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Naveed Akhtar
- The Neuroscience Institute, Academic Health System, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Yasser Al-Sarraj
- College of Health and Life Sciences (CHLS), Hamad Bin Khalifa University (HBKU), Qatar Foundation (QF), Doha, Qatar,Qatar Genome Program, Qatar Foundation Research, Development and Innovation, Qatar Foundation (QF), Doha, Qatar
| | - Essam M. Abdelalim
- College of Health and Life Sciences (CHLS), Hamad Bin Khalifa University (HBKU), Qatar Foundation (QF), Doha, Qatar,Diabetes Research Center, Qatar Biomedical Research Institute (QBRI), Hamad Bin Khalifa University (HBKU), Qatar Foundation (QF), Doha, Qatar
| | - Abdelilah Arredouani
- College of Health and Life Sciences (CHLS), Hamad Bin Khalifa University (HBKU), Qatar Foundation (QF), Doha, Qatar,Diabetes Research Center, Qatar Biomedical Research Institute (QBRI), Hamad Bin Khalifa University (HBKU), Qatar Foundation (QF), Doha, Qatar
| | - Omar El-Agnaf
- Neurological Disorders Research Center, Qatar Biomedical Research Institute (QBRI), Hamad Bin Khalifa University (HBKU), Qatar Foundation (QF), Doha, Qatar
| | - Paul J. Thornalley
- Diabetes Research Center, Qatar Biomedical Research Institute (QBRI), Hamad Bin Khalifa University (HBKU), Qatar Foundation (QF), Doha, Qatar
| | - Sajitha V. Pananchikkal
- The Neuroscience Institute, Academic Health System, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Ghulam Jeelani Pir
- The Neuroscience Institute, Academic Health System, Hamad Medical Corporation (HMC), Doha, Qatar
| | | | - Ashfaq Shuaib
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada,Department of Neurology, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Nehad M. Alajez
- College of Health and Life Sciences (CHLS), Hamad Bin Khalifa University (HBKU), Qatar Foundation (QF), Doha, Qatar,Translational Cancer and Immunity Center, Qatar Biomedical Research Institute (QBRI), Hamad Bin Khalifa University (HBKU), Qatar Foundation (QF), Doha, Qatar
| | - Omar M. E. Albagha
- College of Health and Life Sciences (CHLS), Hamad Bin Khalifa University (HBKU), Qatar Foundation (QF), Doha, Qatar,Rheumatology and Bone Disease Unit, Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, United Kingdom,*Correspondence: Omar M. E. Albagha,
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Minissian MB, Mehta PK, Hayes SN, Park K, Wei J, Bairey Merz CN, Cho L, Volgman AS, Elgendy IY, Mamas M, Davis MB, Reynolds HR, Epps K, Lindley K, Wood M, Quesada O, Piazza G, Pepine CJ. Ischemic Heart Disease in Young Women: JACC Review Topic of the Week. J Am Coll Cardiol 2022; 80:1014-1022. [PMID: 36049799 PMCID: PMC9847245 DOI: 10.1016/j.jacc.2022.01.057] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 01/21/2023]
Abstract
The Cardiovascular Disease in Women Committee of the American College of Cardiology convened a working group to develop a consensus regarding the continuing rise of mortality rates in young women aged 35 to 54 years. Heart disease mortality rates in young women continue to increase. Young women have increased mortality secondary to ischemic heart disease (IHD) compared with comparably aged men and similar mortality to that observed among older women. The authors reviewed the published evidence, including observational and mechanistic/translational data, and identified knowledge gaps pertaining to young women. This paper provides clinicians with pragmatic, evidence-based management strategies for young women at risk for IHD. Next-step research opportunities are outlined. This report presents highlights of the working group review and a summary of suggested research directions to advance the IHD field in the next decade.
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Affiliation(s)
- Margo B Minissian
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA; Brawerman Nursing Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
| | - Puja K Mehta
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sharonne N Hayes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ki Park
- University of Florida, Gainesville, Florida, USA
| | - Janet Wei
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Leslie Cho
- Cleveland Clinic, Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | | | - Islam Y Elgendy
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, Kentucky, USA
| | - Mamas Mamas
- Keele Cardiovascular Research Group, Keele University, Keele, United Kingdom
| | | | - Harmony R Reynolds
- Sarah Ross Soter Center for Women's Cardiovascular Research, NYU School of Medicine, New York, New York, USA
| | - Kelly Epps
- Inova Heart and Vascular Institute, Falls Church, Virginia, USA
| | | | - Malissa Wood
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Odayme Quesada
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA; Women's Heart Center, The Christ Hospital Heart and Vascular Institute, Cincinnati, Ohio, USA
| | - Gregory Piazza
- Harvard Medical School, Division of Cardiovascular Medicine at the Brigham and Women's Hospital, Boston, Massachusetts, USA
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Zhou KQ, Dhillon SK, Bennet L, Gunn AJ, Davidson JO. Targeting Persistent Neuroinflammation after Hypoxic- Ischemic Encephalopathy-Is Exendin-4 the Answer? Int J Mol Sci 2022; 23:10191. [PMID: 36077587 DOI: 10.3390/ijms231710191] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 07/31/2022] [Revised: 08/26/2022] [Accepted: 08/30/2022] [Indexed: 11/17/2022] Open
Abstract
Hypoxic-ischemic encephalopathy is brain injury resulting from the loss of oxygen and blood supply around the time of birth. It is associated with a high risk of death or disability. The only approved treatment is therapeutic hypothermia. Therapeutic hypothermia has consistently been shown to significantly reduce the risk of death and disability in infants with hypoxic-ischemic encephalopathy. However, approximately 29% of infants treated with therapeutic hypothermia still develop disability. Recent preclinical and clinical studies have shown that there is still persistent neuroinflammation even after treating with therapeutic hypothermia, which may contribute to the deficits seen in infants despite treatment. This suggests that potentially targeting this persistent neuroinflammation would have an additive benefit in addition to therapeutic hypothermia. A potential additive treatment is Exendin-4, which is a glucagon-like peptide 1 receptor agonist. Preclinical data from various in vitro and in vivo disease models have shown that Exendin-4 has anti-inflammatory, mitochondrial protective, anti-apoptotic, anti-oxidative and neurotrophic effects. Although preclinical studies of the effect of Exendin-4 in perinatal hypoxic-ischemic brain injury are limited, a seminal study in neonatal mice showed that Exendin-4 had promising neuroprotective effects. Further studies on Exendin-4 neuroprotection for perinatal hypoxic-ischemic brain injury, including in large animal translational models are warranted to better understand its safety, window of opportunity and effectiveness as an adjunct with therapeutic hypothermia.
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Bisevac E, Lazovic M, Nikolic D, Mahmutovic E, Dolicanin Z, Jurisic-Skevin A. Postacute Rehabilitation Impact on Functional Recovery Outcome and Quality of Life in Stroke Survivors: Six Month Follow-Up. Medicina (Kaunas) 2022; 58:medicina58091185. [PMID: 36143861 PMCID: PMC9505174 DOI: 10.3390/medicina58091185] [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] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/18/2022] [Accepted: 08/26/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: This study aimed to examine the impact of postacute rehabilitation duration on the outcome of the functional recovery and patients’ quality of life after the stroke. Materials and Methods: One hundred patients (52 females, 48 males, mean age: 66.5 ± 7.3; range 53 to 79 years) who experienced a stroke (50 with ischemic stroke (IS) and 50 with intracranial hemorrhage (ICH)) took part in the study. Patients (treated with postacute rehabilitation measures for six months) were examined after one, three, and six months of postacute rehabilitation. Functional independence was measured using the functional independence measure (FIM) test, while the EQ-5D-3L questionnaire was used to assess the quality of life. Results: Patients with ICH had a slightly lower FIM score (FIM motor = 29.8 ± 11.8; FIM cognitive = 14.4 ± 4.6) on admission compared to patients with IS (FIM motor = 41.8 ± 18.8; FIM cognitive = 18.7 ± 6.3), but, after six months of postacute rehabilitation, patients with ICH reached an approximate level of functional independence (FIM motor = 53.8 ± 14.4; FIM cognitive = 25.8 ± 4.7), as did patients with IS (FIM motor = 67.6 ± 16.4; FIM cognitive = 29.2 ± 4.0). The motor and cognitive FIM, as well as quality of life, was statistically significantly increased at all four measurement points (p < 0.001). Furthermore, there is a statistically significant connection between functional independence and quality of life at all tested times. Conclusion: Patients achieved the highest degree of functional independence after six months. Furthermore, our findings point out that inpatient rehabilitation as well as outpatient rehabilitation are effective in functionality and quality of life improvement after a stroke; thus, both should be emphasized and regularly implemented.
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Affiliation(s)
- Emir Bisevac
- Department of Physical Medicine and Rehabilitation, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovica 69, 34000 Kragujevac, Serbia
- Department of Biomedical Sciences, State University of Novi Pazar, 36300 Novi Pazar, Serbia
| | - Milica Lazovic
- Department of Biomedical Sciences, State University of Novi Pazar, 36300 Novi Pazar, Serbia
- Institute for Rehabilitation, 11000 Belgrade, Serbia
| | - Dejan Nikolic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Department of Physical Medicine and Rehabilitation, University Children’s Hospital, 11000 Belgrade, Serbia
- Correspondence:
| | - Elvis Mahmutovic
- Department of Biomedical Sciences, State University of Novi Pazar, 36300 Novi Pazar, Serbia
| | - Zana Dolicanin
- Department of Biomedical Sciences, State University of Novi Pazar, 36300 Novi Pazar, Serbia
| | - Aleksandra Jurisic-Skevin
- Department of Physical Medicine and Rehabilitation, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovica 69, 34000 Kragujevac, Serbia
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Kobeissi H, Liu M, Ghozy S, Kadirvel R, Kallmes DF. Outcomes of young patients following mechanical thrombectomy for stroke: A systematic review and meta-analysis. Interv Neuroradiol 2022; 30:15910199221121378. [PMID: 35979592 PMCID: PMC10956453 DOI: 10.1177/15910199221121378] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 06/22/2022] [Accepted: 08/03/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Young patients experience acute ischemic stroke (AIS) at much lower rates than their older counterparts. We performed a systematic review and meta-analysis to assess the question regarding outcomes and clinical characteristics of young stroke patients who underwent mechanical thrombectomy for AIS. METHODS Following PRISMA guidelines, a systematic review of the literature was conducted using the databases PubMed, MEDLINE, and Embase. The primary outcome of interest was 90-day modified Rankin Scale (mRS) 0-2. Secondary outcome variables included rate of successful reperfusion (TICI 2b/3), symptomatic intracerebral hemorrhage (sICH), and mortality. Using R software version 4.1.2, we calculated pooled event rates and their corresponding 95% confidence intervals (CI) for all outcomes. RESULTS Our analysis included eight studies with a total of 1903 patients. Definitions of young patients included age ranges of 18-49/50 years, 18-54/55 years, and 18-64/65 years. Functional independence was achieved in 62.0% of the patients, with an overall mortality of 9.0%. Moreover, successful reperfusion was achieved in 82.0% of the patients with sICH rates of 5.7%. There was significant heterogeneity among different analyses, which could not be attributed to the differences of the definition of young patients. CONCLUSIONS Following mechanical thrombectomy for AIS, patients aged 18-65 years achieved relatively high rates of functional independence and successful reperfusion and low rates of mortality and sICH.Clinical Perspective In this systematic review and meta-analysis of eight studies, we examined outcomes in young stroke patients, aged 18-65 years old, following mechanical thrombectomy for acute ischemic stroke. We found that young patients achieved high rates of functional independence, high rates of successful reperfusion, and low rates of mortality and symptomatic intracerebral hemorrhage.While there have been several papers examining outcomes following mechanical thrombectomy for acute ischemic stroke in young patients, the results of these studies have yet to be pooled together in a meta-analysis. Our results indicate that young patients have good outcomes following mechanical thrombectomy. Further studies that examine these outcomes are warranted so that a higher-powered analysis can be performed to better informed clinicians regarding outcomes in this patient age-group cohort.
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Affiliation(s)
- Hassan Kobeissi
- College of Medicine, Central Michigan University, Mt. Pleasant, MI, USA
| | - Michael Liu
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Sherief Ghozy
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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Liu R, Zhao J, Li X, Messe S, Fisher M, Rudd A. To use stroke 911 to improve stroke awareness for countries where 911 is used as an emergency phone number. CNS Neurosci Ther 2022; 28:1473-1475. [PMID: 35924380 PMCID: PMC9437232 DOI: 10.1111/cns.13931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/17/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Renyu Liu
- Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jing Zhao
- Department of Neurology, Minhang Hosptial, Fudan University, Shanghai, China
| | - Xiaobin Li
- Internal Medicine and President, Everest Medical Group, Philadelphi, Pennsylvania, USA
| | - Steven Messe
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Marc Fisher
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Anthony Rudd
- Stroke Medicine, Kings College London, London, UK
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Kobeissi H, Ghozy S, Liu M, Adusumilli G, Bilgin C, Kadirvel R, Kallmes DF, Brinjikji W. Mechanical Thrombectomy via Transradial Approach for Posterior Circulation Stroke: A Systematic Review and Meta-Analysis. Cureus 2022; 14:e26589. [PMID: 35936161 PMCID: PMC9351823 DOI: 10.7759/cureus.26589] [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] [Accepted: 07/05/2022] [Indexed: 01/26/2023] Open
Abstract
Mechanical thrombectomy for acute ischemic stroke (AIS) is traditionally performed via transfemoral access. While the majority of AISs are due to anterior circulation large vessel occlusions (AC-LVO), we performed a systematic review and meta-analysis to examine the feasibility of and outcomes following a transradial artery access for posterior circulation large vessel occlusion (PC-LVO) strokes. A systematic literature review of the English language literature was conducted using PubMed, MEDLINE, and Embase as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Outcomes of interest included 90-day modified Rankin scale (mRS) 0-2, puncture to recanalization time, and thrombolysis in cerebral infarction (TICI) scores 2b/3 and 3. We calculated pooled event rates and their corresponding 95% confidence intervals (CI) for all outcomes. We included seven studies with 68 patients in our analysis. All patients underwent mechanical thrombectomy via transradial artery access for AIS due to PC-LVO. The pooled meantime of puncture to recanalization was 29.19 (95% CI=24.05 to 35.42) minutes. Successful recanalization (TICI2b/3) was achieved in 98.69% (95% CI=93.50 to 100) of patients and complete recanalization (TICI 3) in 52.16% (95% CI=34.18 to 79.60) of the patients. Overall, 56.84% (95% CI=41.26 to 78.30) of patients achieved mRS 0-2. Transradial artery access for mechanical thrombectomy for PC-LVO stroke displays early promise and feasibility, particularly regarding very high rates of successful recanalization and low puncture to recanalization time.
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Affiliation(s)
- Hassan Kobeissi
- Medicine, Central Michigan University College of Medicine, Mt. Pleasant, USA
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Peine BR, Callaghan MU, Callaghan JH, Glaros AK. Prophylactic Hydroxyurea Treatment Is Associated with Improved Cerebral Hemodynamics as a Surrogate Marker of Stroke Risk in Sickle Cell Disease: A Retrospective Comparative Analysis. J Clin Med 2022; 11:3491. [PMID: 35743561 DOI: 10.3390/jcm11123491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 05/23/2022] [Revised: 06/10/2022] [Accepted: 06/15/2022] [Indexed: 11/21/2022] Open
Abstract
Sickle cell disease (SCD) increases the incidence of childhood stroke eighty-fold. Stroke risk can be estimated by measurement of the blood velocity through the middle cerebral artery (MCA) using transcranial doppler ultrasound (TCD). A high MCA blood velocity indicates increased stroke risk due to cerebral vasculopathy, and first-line treatment to prevent primary or recurrent strokes in high-risk children with SCD has classically been chronic blood transfusions. Research has more recently shown that many of these patients may safely transition from transfusions to oral hydroxyurea (HU) treatment while maintaining a decreased risk of stroke. However, the effect on stroke risk of truly prophylactic HU treatment beginning in infancy, prior to the onset of cerebral vasculopathy, is less well understood. Our retrospective study aimed to document the long-term effects of HU treatment compared with no HU treatment in children with SCD, using TCD measurements as our primary outcome and a surrogate marker of stroke risk. Our results showed that when accounting for age-related variability and duration of treatment, prophylactic HU treatment was independently associated with lower TCD MCA velocities compared with no HU treatment, providing further evidence supporting its early initiation for patients with SCD.
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Sartor R, Capozzoli F, Venturini S, Crapis M, Passadore P, Valente M. Rapidly progressive ischemic strokes and transient antiphospholipid syndrome during a mild SARS-CoV-2 infection. Acta Biomed 2022; 93:e2022107. [PMID: 35671113 PMCID: PMC10510985 DOI: 10.23750/abm.v93is1.12609] [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] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 06/15/2023]
Abstract
SARS-CoV-2 infection is associated with an increased risk of thrombotic events, especially during severe forms of disease. Here we describe the clinical history of a patient with a mild form of Covid-19 infection presenting with multiple cerebral ischemic lesions that evolved in an atypical way.
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Affiliation(s)
- Roberto Sartor
- a:1:{s:5:"en_US";s:52:"Clinical Neurology, Udine University Hospital, Udine";}.
| | - Francesca Capozzoli
- Department of Neurology, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy.
| | - Sergio Venturini
- Department of Infectious Diseases, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy.
| | - Massimo Crapis
- Department of Infectious Diseases, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy.
| | - Paolo Passadore
- Department of Neurology, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy.
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Cao Z, Xu J, Song B, Chen L, Sun T, He Y, Wei Y, Niu G, Zhang Y, Feng Q, Ding Z, Shi F, Shen D. Deep learning derived automated ASPECTS on non-contrast CT scans of acute ischemic stroke patients. Hum Brain Mapp 2022; 43:3023-3036. [PMID: 35357053 PMCID: PMC9189036 DOI: 10.1002/hbm.25845] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 09/24/2021] [Revised: 02/15/2022] [Accepted: 03/09/2022] [Indexed: 02/05/2023] Open
Abstract
Ischemic stroke is the most common type of stroke, ranked as the second leading cause of death worldwide. The Alberta Stroke Program Early CT Score (ASPECTS) is considered as a systematic method of assessing ischemic change on non-contrast CT scans (NCCT) of acute ischemic stroke (AIS) patients, while still suffering from the requirement of experts' experience and also the inconsistent results between readers. In this study, we proposed an automated ASPECTS method to utilize the powerful learning ability of neural networks for objectively scoring CT scans of AIS patients. First, we proposed to use the CT perfusion (CTP) from one-stop stroke imaging to provide the golden standard of ischemic regions for ASPECTS scoring. Second, we designed an asymmetry network to capture features when comparing the left and right sides for each ASPECTS region to estimate its ischemic status. Third, we performed experiments in a large main dataset of 870 patients, as well as an independent testing dataset consisting of 207 patients with radiologists' scorings. Experimental results show that our network achieved remarkable performance, as sensitivity and accuracy of 93.7 and 92.4% in the main dataset, and 95.5 and 91.3% in the independent testing dataset, respectively. In the latter dataset, our analysis revealed a high positive correlation between the ASPECTS score and the prognosis of patients in 90DmRs. Also, we found ASPECTS score is a good indicator of the size of CTP core volume of an infraction. The proposed method shows its potential for automated ASPECTS scoring on NCCT images.
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Affiliation(s)
- Zehong Cao
- School of Biomedical Engineering Southern Medical UniversityGuangzhouChina,Department of Research and DevelopmentShanghai United Imaging Intelligence Co., Ltd.ShanghaiChina
| | - Jiaona Xu
- The Fourth School of Clinical MedicineZhejiang Chinese Medicine UniversityHangzhouChina,Department of Neurology, Affiliated Hangzhou First People's HospitalZhejiang University School of MedicineHangzhouChina
| | - Bin Song
- Department of Radiology, West China HospitalSichuan UniversityChengduChina
| | - Lizhou Chen
- Department of Radiology, West China HospitalSichuan UniversityChengduChina
| | - Tianyang Sun
- Department of Research and DevelopmentShanghai United Imaging Intelligence Co., Ltd.ShanghaiChina
| | - Yichu He
- Department of Research and DevelopmentShanghai United Imaging Intelligence Co., Ltd.ShanghaiChina
| | - Ying Wei
- Department of Research and DevelopmentShanghai United Imaging Intelligence Co., Ltd.ShanghaiChina
| | - Guozhong Niu
- Department of Neurology, Affiliated Hangzhou First People's HospitalZhejiang University School of MedicineHangzhouChina
| | - Yu Zhang
- School of Biomedical Engineering Southern Medical UniversityGuangzhouChina
| | - Qianjin Feng
- School of Biomedical Engineering Southern Medical UniversityGuangzhouChina
| | - Zhongxiang Ding
- Department of Radiology, Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Affiliated Hangzhou First People's HospitalZhejiang University School of MedicineHangzhouChina
| | - Feng Shi
- Department of Research and DevelopmentShanghai United Imaging Intelligence Co., Ltd.ShanghaiChina
| | - Dinggang Shen
- Department of Research and DevelopmentShanghai United Imaging Intelligence Co., Ltd.ShanghaiChina,School of Biomedical EngineeringShanghaiTech UniversityShanghaiChina
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Wang F, Wang J, Han Y, Shi X, Xu X, Hou C, Gao J, Zhu S, Liu X. Triglyceride-glucose index and stroke recurrence in elderly patients with ischemic stroke. Front Endocrinol (Lausanne) 2022; 13:1005614. [PMID: 36105408 PMCID: PMC9467280 DOI: 10.3389/fendo.2022.1005614] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/11/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE This study aimed to explore the association between triglyceride-glucose (TyG) index and stroke recurrence in elderly patients with ischemic stroke in China. METHODS We enrolled ischemic stroke patients aged ≥ 65 years from the Nanjing Stroke Registry Program. The primary endpoint was defined as recurrent stroke within one year after the index stroke. We used multivariable Cox proportional hazards regression models to investigate the association between TyG index and stroke recurrence. We assessed the discriminative ability of TyG index with the receiver operative characteristic and the area under the curve. RESULTS A total of 955 patients (median age, 70.0 [67.0, 75.0]; male sex, 67.2%) from the Nanjing Stroke Registry Program were enrolled. During one year follow-up, 97 (10.2%) elderly patients experienced stroke recurrence. In multivariable analyses, the association between TyG index and stroke recurrence remained significant after adjusting for confounders (quartile 4 versus quartile 1; hazard ratio, 2.073, 95% confidence interval, 1.158-3.711; P = 0.014). The restricted cubic spline showed an increasing trend for TyG index and stroke recurrence (P for non-linearity = 0.072). The area under the curve to predict stroke recurrence with TyG index was 0.719 (95% confidence interval, 0.666-0.772). Besides, TyG index slightly improved the prediction for stroke recurrence. CONCLUSION Elevated TyG index was associated with stroke recurrence in elderly patients with ischemic stroke. Further studies are warranted to assess the role of TyG index in the development of stroke recurrence in the elderly.
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Affiliation(s)
- Fang Wang
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jinjing Wang
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yunfei Han
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xuan Shi
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xiaohui Xu
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Chao Hou
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jie Gao
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Shuanggen Zhu
- Department of Neurology, The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen, China
- Department of Neurology, People’s Hospital of Longhua, Shenzhen, China
- *Correspondence: Shuanggen Zhu, ; Xinfeng Liu,
| | - Xinfeng Liu
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
- *Correspondence: Shuanggen Zhu, ; Xinfeng Liu,
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Lan D, Song S, Liu Y, Jiao B, Meng R. Use of Batroxobin in Central and Peripheral Ischemic Vascular Diseases: A Systematic Review. Front Neurol 2021; 12:716778. [PMID: 34925203 PMCID: PMC8675357 DOI: 10.3389/fneur.2021.716778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/29/2021] [Accepted: 11/03/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose: The mechanism of action of Batroxobin included the decomposition of the fibrinogen to fibrin degradation products (FDPs) and D-dimer and mobilization of endothelial cells to release endogenous nt-PA and to promote thrombolysis. This review aims to summarize current study findings about batroxobin on correcting cerebral arterial, venous, and peripheral vascular diseases, to explore the mechanism of batroxobin on anti-thrombosis process. Methods: A thorough literature search was conducted utilizing the PubMed Central (PMC) and EMBASE databases to identify studies up to June 2021. Data from clinical studies and animal experiments about batroxobin were extracted, integrated and analyzed based on Cochrane handbook for systematic reviews of interventions approach and the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P), including the condition of subjects, the usage and dosage, research observation index and main findings. Results: A total of 62 studies were enrolled in this systematic review, including 26 clinical studies and 36 animal experiments. The 26 clinical studies involved 873 patients with arterial ischemic events, 92 cases with cerebral venous thrombosis, 13 cases with cerebral cortical vein thrombosis, and 1,049 cases with peripheral vascular diseases. These patients included 452 males and 392 females aged 65.6 ± 5.53 years. The results revealed that batroxobin had broad effects, including improving clinical prognosis (n = 12), preventing thrombosis (n = 7), promoting thrombolysis (n = 6), and improving vascular cognitive dysfunction (n = 1). The effects of batroxobin on reducing neuronal apoptosis (n = 8),relieving cellular edema (n = 4), improving spatial memory (n = 3), and promoting thrombolysis (n = 13) were concluded in animal experiments. The predominant mechanisms explored in animal experiments involved promoting depolymerization of fibrinogen polymers (n = 6), regulating the expression of related molecules (n = 9); such as intercellular adhesion molecule, heat shock proteins, tumor necrosis factor), reducing oxidative stress (n = 5), and reducing inflammation response (n = 4). Conclusion: Batroxobin can correct both arterial and venous ischemic diseases by promoting depolymerization of fibrinogen polymers, regulating the expression of related molecules, reducing oxidative stress, and reducing the inflammation response.
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Affiliation(s)
- Duo Lan
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Siying Song
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yunhuan Liu
- Huadong Hospital, Fudan University, Shanghai, China
| | - Baolian Jiao
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ran Meng
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
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45
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Yang P, Kang Y, Bae H, Sung J, Park H, Joung B. Mortality among ischemic and nonischemic heart failure patients with a primary implantable cardioverter-defibrillator. J Arrhythm 2021; 37:1537-1545. [PMID: 34887959 PMCID: PMC8637096 DOI: 10.1002/joa3.12651] [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: 06/14/2021] [Revised: 09/07/2021] [Accepted: 10/11/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The efficacy of implantable cardioverter defibrillators (ICDs) for primary prevention is controversial in patients with nonischemic heart failure (HF). We evaluated the mortality and predictors of mortality in patients with prophylactic ICD implantation for ischemic and nonischemic HF. METHODS From 2008 to 2017, 1097 patients (667, nonischemic HF and 430, ischemic HF) who underwent prophylactic ICD implantation, were identified from the Korean National Health Insurance Service database. We used propensity score overlap weighting to correct the differences between two groups. RESULTS Those with ischemic HF were older (67.0 ± 10.1 vs 61.8 ± 14.2 years), more often male (71.4% vs 63.7%), and had more comorbidities than patients with nonischemic HF. During a median follow-up of 37.3 months (interquartile range [IQR], 14.2-53.8 months), all-cause mortality was higher in unweighted patients with ischemic HF than in those with nonischemic HF (10.9 vs 6.4 per 100 person-years; hazard ratio [HR], 1.74; 95% confidence interval [CI], 1.38-2.20; P < .001). However, after weighting, the annual all-cause mortality rate was similar in both groups (9.5 vs 8.8 per 100 person-years), with no significant difference in the risk of all-cause mortality (HR, 1.08; 95% CI, 0.68-1.71; P = .755). Older age and chronic kidney disease were independent predictors of all-cause mortality in both groups. There was no significant difference in cardiac and noncardiac mortality between the weighted nonischemic and ischemic HF groups. CONCLUSIONS The all-cause, cardiac, and noncardiac mortality rates were similar between patients with nonischemic and ischemic HF who underwent prophylactic ICD implantation.
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Affiliation(s)
- Pil‐Sung Yang
- Department of CardiologyCHA Bundang Medical CenterCHA UniversitySeongnamRepublic of Korea
| | | | - Han‐Joon Bae
- Division of CardiologyDepartment of Internal MedicineDaegu Catholic University Medical CenterDaeguRepublic of Korea
| | - Jung‐Hoon Sung
- Department of CardiologyCHA Bundang Medical CenterCHA UniversitySeongnamRepublic of Korea
| | | | - Boyoung Joung
- Division of CardiologyDepartment of Internal MedicineSeverance Cardiovascular HospitalYonsei University College of MedicineSeoulRepublic of Korea
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Gómez-de Frutos MC, Laso-García F, García-Suárez I, Diekhorst L, Otero-Ortega L, Alonso de Leciñana M, Fuentes B, Piniella D, Ruiz-Ares G, Díez-Tejedor E, Gutiérrez-Fernández M. The Role of Ultrasound as a Diagnostic and Therapeutic Tool in Experimental Animal Models of Stroke: A Review. Biomedicines 2021; 9:1609. [PMID: 34829837 DOI: 10.3390/biomedicines9111609] [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: 10/07/2021] [Revised: 10/25/2021] [Accepted: 11/01/2021] [Indexed: 11/18/2022] Open
Abstract
Ultrasound is a noninvasive technique that provides real-time imaging with excellent resolution, and several studies demonstrated the potential of ultrasound in acute ischemic stroke monitoring. However, only a few studies were performed using animal models, of which many showed ultrasound to be a safe and effective tool also in therapeutic applications. The full potential of ultrasound application in experimental stroke is yet to be explored to further determine the limitations of this technique and to ensure the accuracy of translational research. This review covers the current status of ultrasound applied to monitoring and treatment in experimental animal models of stroke and examines the safety, limitations, and future perspectives.
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Shang J, He Y, Wang R, Xu Y, Xu J. Comparison of therapeutic effects of different acupuncture and moxibustion therapies on constipation after stroke treatment: A protocol for systematic review and network meta-analysis. Medicine (Baltimore) 2021; 100:e27397. [PMID: 34731111 PMCID: PMC8519190 DOI: 10.1097/md.0000000000027397] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/15/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Constipation is a common complication after stroke, which seriously affects patients' quality of life and recovery. Many evidences show that acupuncture and moxibustion therapy has advantages in the treatment of constipation after stroke. But different types of acupuncture and moxibustion have different effects, and there is no research to prove which one is more effective. METHODS According to the search strategy, we will retrieve the randomized controlled studies of acupuncture and moxibustion in the treatment of constipation after stroke from China Knowledge Network, Wanfang, VIP, China Biomedical medicine, PubMed, Embase, Web of Science, and The Cochrane Library databases. The retrieval time was from the establishment of the database to July 2021. Studies will be screened according to inclusion and exclusion criteria, and the quality of the studies will be assessed using the Cochrane Risk Bias Assessment Tool. All data analyses will be performed using Revman 5.4, Gemtc 0.14.3, and Stata 14.0. Finally, we will evaluate the strength of evidence using the Grading of Recommendations Assessment, Development, and Evaluation method. RESULTS In this study, the efficacy of different acupuncture and moxibustion therapies in the treatment of constipation after stroke will be evaluated by evaluating defecation frequency, stool property score, constipation symptom score, quality of life score, adverse reactions, etc. CONCLUSIONS This study will provide reliable evidence-based evidence for selecting the best acupuncture and moxibustion therapy for constipation after stroke.
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Affiliation(s)
- Jingwen Shang
- Chengdu Eighth People's Hospital (Geriatric Hospital of Chengdu Medical College), Chengdu, Sichuan Province, China
| | - Yongyang He
- Chengdu Eighth People's Hospital (Geriatric Hospital of Chengdu Medical College), Chengdu, Sichuan Province, China
| | - Rui Wang
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yifan Xu
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Jia Xu
- Chengdu Eighth People's Hospital (Geriatric Hospital of Chengdu Medical College), Chengdu, Sichuan Province, China
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Strilciuc S, Grad DA, Radu C, Chira D, Stan A, Ungureanu M, Gheorghe A, Muresanu FD. The economic burden of stroke: a systematic review of cost of illness studies. J Med Life 2021; 14:606-619. [PMID: 35027963 PMCID: PMC8742896 DOI: 10.25122/jml-2021-0361] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/23/2021] [Indexed: 01/02/2023] Open
Abstract
Stroke is one of the leading causes of morbidity and mortality worldwide. As the number of stroke cases is rising from one year to another, policymakers require data on the amount spent on stroke to enforce better financing policies for prevention, hospital care, outpatient rehabilitation services and social services. We aimed to systematically assess the economic burden of stroke at global level. Cost of stroke studies were retrieved from five databases. We retrieved the average cost per patient, where specified, or estimated it using a top-down approach. Resulting costs were grouped in two main categories: per patient per year and per patient lifetime. We extracted information from forty-six cost of illness studies. Per patient per year costs are larger in high income countries and in studies conducted from the payer perspective. The highest average per patient per year cost by country was reported in the United States ($59,900), followed by Sweden ($52,725) and Spain ($41,950). The highest per patient lifetime costs were reported in Australia ($232,100) for all identified definitions of stroke. Existing literature regarding the economic burden of stroke is concentrated in high-income settings, with very few studies conducted in South America and Africa. Published manuscripts on this topic highlight substantial methodological heterogeneity, rendering comparisons difficult or impossible, even within the same country or among studies with similar costing perspectives.
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Affiliation(s)
- Stefan Strilciuc
- Department of Neuroscience, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
- Department of Public Health, Faculty of Political, Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Diana Alecsandra Grad
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
- Department of Public Health, Faculty of Political, Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Constantin Radu
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Diana Chira
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Adina Stan
- Department of Neuroscience, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Marius Ungureanu
- Department of Public Health, Faculty of Political, Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania
- Center for Health Workforce Research and Policy, Faculty of Political, Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Adrian Gheorghe
- Department of Infectious Disease Epidemiology, Global Health and Development Group, Imperial College London, London, United Kingdom
| | - Fior-Dafin Muresanu
- Department of Neuroscience, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
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Di Tullio MR. Prevention of Patent Foramen Ovale-Related Stroke: An Evolving Concept. Stroke 2021; 52:3427-3429. [PMID: 34455824 DOI: 10.1161/strokeaha.121.035735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Marco R Di Tullio
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
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Amoda O, A E, Uwagbale E. A Case of Failed Dual Antiplatelet Therapy With Oral Anticoagulant in the Prevention of Acute Ischemic Stroke. Cureus 2021; 13:e15915. [PMID: 34322355 PMCID: PMC8310612 DOI: 10.7759/cureus.15915] [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] [Accepted: 06/24/2021] [Indexed: 11/17/2022] Open
Abstract
Cerebrovascular accidents (CVA) or strokes cause focal neurological deficits, which may be due to rupture or occlusion of blood vessels supplying areas of the brain. Atrial fibrillation (AF) is an independent and significant risk factor for ischemic CVA, mainly via the embolic pathway. This is evident as newly diagnosed patients with AF are typically started on anticoagulation therapy if their CHA2DS2-VASc score is equal to or greater than two. Furthermore, ischemic CVA may occur as a thrombotic phenomenon due to significant vessel atherosclerotic disease involving plaque ulceration and rupture. Such a phenomenon may be curtailed with antiplatelet therapy in at-risk patient populations, particularly as a form of secondary prevention. This case highlights the unfortunate incidence of an ischemic CVA in a patient using dual antiplatelet therapy (DAPT) and anticoagulation.
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Affiliation(s)
- Oluyemisi Amoda
- Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Elmarie A
- Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Ese Uwagbale
- Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
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