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Relander A, Jaakkola S, Virri H, Niemelä E, Vasankari T, Nuotio I, Airaksinen KEJ, Kiviniemi T. Fibrillatory wave amplitude and thromboembolic risk in non-anticoagulated patients with atrial fibrillation. Ann Med 2024; 56:2317362. [PMID: 38350436 PMCID: PMC10866044 DOI: 10.1080/07853890.2024.2317362] [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: 09/07/2023] [Accepted: 02/05/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND The benefit of oral anticoagulation in atrial fibrillation (AF) is well established for patients at elevated stroke risk, but less clear for those at intermediate risk. We investigated whether analysis of electrocardiogram (ECG) derived fibrillatory waves (F-waves) could help identify patients at risk for stroke and systemic embolism (SSE). METHODS The Finnish Cardioversion (FinCV) study included patients not on permanent anticoagulation therapy who underwent cardioversion for an acute AF episode. We identified 739 individuals with a valid ECG and complete follow-up data. The maximum amplitudes of the F-waves in leads II and V1 were manually measured from the pre-procedure ECG. Patients were categorized into fine and coarse F-wave groups. The optimal lead and amplitude threshold for grouping were found in an events per person-years analysis. SSE were identified from the patient medical records until either anticoagulation was prescribed, AF was deemed chronic, the patient had deceased, or the end of follow-up. RESULTS Overall 37 (5.0%) patients suffered SSE during the median follow-up time of 5.4 years (1.9-10.8). Measured from lead V1 the SSE rates per 100 person-years were 1.5 and 0.7 in fine and coarse F-wave groups, respectively. Fine F-waves were observed in 112 (15.2%). Baseline characteristics were similar between the groups. Fine F-wave predicted SSE in a competing risk analysis (SHR 2.34, 95%CI 1.12-4.87, p = .023). Analyses from lead II did not provide significant results. CONCLUSION Electrocardiographic F-wave amplitude may provide additional information on stroke risk in patients with paroxysmal AF and borderline indications or contraindications for anticoagulation.
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Affiliation(s)
- Arto Relander
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Samuli Jaakkola
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Hilla Virri
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Eelis Niemelä
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Tuija Vasankari
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Ilpo Nuotio
- Department of Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | | | - Tuomas Kiviniemi
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
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Tseng KC, Wang L, Hsieh C, Wong AM. Portable robots for upper-limb rehabilitation after stroke: a systematic review and meta-analysis. Ann Med 2024; 56:2337735. [PMID: 38640459 PMCID: PMC11034452 DOI: 10.1080/07853890.2024.2337735] [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: 10/18/2023] [Accepted: 02/28/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Robot-assisted upper-limb rehabilitation has been studied for many years, with many randomised controlled trials (RCTs) investigating the effects of robotic-assisted training on affected limbs. The current trend directs towards end-effector devices. However, most studies have focused on the effectiveness of rehabilitation devices, but studies on device sizes are relatively few. GOAL Systematically review the effect of a portable rehabilitation robot (PRR) on the rehabilitation effectiveness of paralysed upper limbs compared with non-robotic therapy. METHODS A meta-analysis was conducted on literature that included the Fugl-Meyer Assessment (FMA) obtained from the PubMed and Web of Science (WoS) electronic databases until June 2023. RESULTS A total of 9 studies, which included RCTs, were completed and a meta-analysis was conducted on 8 of them. The analysis involved 295 patients. The influence on upper-limb function before and after treatment in a clinical environment is analysed by comparing the experimental group using the portable upper-limb rehabilitation robot with the control group using conventional therapy. The result shows that portable robots prove to be effective (FMA: SMD = 0.696, 95% = 0.099 to.293, p < 0.05). DISCUSSION Both robot-assisted and conventional rehabilitation effects are comparable. In some studies, PRR performs better than conventional rehabilitation, but conventional treatments are still irreplaceable. Smaller size with better portability has its advantages, and portable upper-limb rehabilitation robots are feasible in clinical rehabilitation. CONCLUSION Although portable upper-limb rehabilitation robots are clinically beneficial, few studies have focused on portability. Further research should focus on modular design so that rehabilitation robots can be decomposed, which benefits remote rehabilitation and household applications.
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Affiliation(s)
- Kevin C. Tseng
- Department of Industrial Design, National Taipei University of Technology, Taipei, Taiwan, ROC
- Product Design and Development Laboratory, Taoyuan, Taiwan, ROC
| | - Le Wang
- Product Design and Development Laboratory, Taoyuan, Taiwan, ROC
| | - Chunkai Hsieh
- Product Design and Development Laboratory, Taoyuan, Taiwan, ROC
| | - Alice M. Wong
- Product Design and Development Laboratory, Taoyuan, Taiwan, ROC
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Taoyuan, Taoyuan, Taiwan, ROC
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3
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Ito K, Uehara S, Yuasa A, Ushizawa K, Tanabe S, Otaka Y. Gamified exercise for the distal upper extremity in people with post- stroke hemiparesis: feasibility study on subjective perspectives during daily continuous training. Ann Med 2024; 56:2306905. [PMID: 38294958 PMCID: PMC10833108 DOI: 10.1080/07853890.2024.2306905] [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: 08/24/2023] [Accepted: 01/13/2024] [Indexed: 02/02/2024] Open
Abstract
INTRODUCTION Dose (number of repetitions) has been suggested as a key element in the effectiveness of rehabilitation exercises to promote motor recovery of the hemiparetic upper limb. However, rehabilitation exercises tend to be monotonous and require significant motivation to continue, making it difficult to increase the exercise dose. To address this issue, gamification technology has been implemented in exercises to promote self-engagement for people with hemiparesis in continuing monotonous repetitive movements. This study aimed to investigate how subjective perspectives, specifically enjoyability, motivation to continue, and expectancy of effectiveness, change through continuous daily exercise using a developed gamified exercise system. MATERIALS AND METHOD Ten people with stroke suffering upper limb dysfunction underwent daily gamified exercise for seven days. The gamified exercise consisted of an electromyography (EMG)-controlled operating system that enabled users to play virtual games using repetitive finger movements. The participants performed conventional self-exercise on the same day as the control exercise, and rated their subjective perspectives on both exercises on a numerical rating scale on each exercise day. RESULTS Ratings for enjoyability and motivation to continue consistently showed significantly higher scores for the gamified exercise than for conventional self-exercise on all exercise days. A similar trend was observed in the ratings for the expectancy of effectiveness. No changes over time were found in any of the ratings throughout the exercise period. CONCLUSIONS Exercise using the developed EMG-controlled gamified system may have the potential to maintain motivation and enjoyment in people with stroke to continue monotonous repetitive finger movements.
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Affiliation(s)
- Kazuki Ito
- Department of Rehabilitation, Fujita Health University Hospital, Aichi, Japan
- Fujita Health University Graduate School of Health Sciences, Aichi, Japan
| | - Shintaro Uehara
- Faculty of Rehabilitation, Fujita Health University School of Health Sciences, Aichi, Japan
| | - Akiko Yuasa
- Department of Rehabilitation Medicine I, Fujita Health University School of Medicine, Aichi, Japan
| | - Kazuki Ushizawa
- Fujita Health University Graduate School of Health Sciences, Aichi, Japan
- Department of Rehabilitation Medicine I, Fujita Health University School of Medicine, Aichi, Japan
| | - Shigeo Tanabe
- Faculty of Rehabilitation, Fujita Health University School of Health Sciences, Aichi, Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine I, Fujita Health University School of Medicine, Aichi, Japan
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Huang J, Zheng H, Zhu X, Zhang K, Ping X. Tenecteplase versus alteplase for the treatment of acute ischemic stroke: a meta-analysis of randomized controlled trials. Ann Med 2024; 56:2320285. [PMID: 38442293 PMCID: PMC10916912 DOI: 10.1080/07853890.2024.2320285] [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: 02/28/2023] [Accepted: 02/13/2024] [Indexed: 03/07/2024] Open
Abstract
OBJECTIVES Tenecteplase, a modified variant of alteplase with greater fibrin specificity and longer plasma half-life, may have better efficacy and safety than alteplase in patients with acute ischemic stroke (AIS). We aimed to compare the benefits and risks of tenecteplase versus alteplase in the treatment of AIS. METHODS Electronic databases were searched up to 10 February 2023 for randomized controlled trials evaluating the effect of tenecteplase versus alteplase in the treatment of AIS. The primary outcome was functional outcome at 90 days, and secondary outcomes including the symptomatic intracranial haemorrhage (SICH), and major neurological improvement. Subgroup analysis was performed based on the different dosage of tenecteplase. RESULTS Ten studies with a total of 5123 patients were analysed in this meta-analysis. Overall, no significant difference between tenecteplase and alteplase was observed for functional outcome at 90 days (excellent: OR 1.08, 95%CI 0.93-1.26, I2 = 26%; good: OR 1.04, 95%CI 0.83-1.30, I2 = 56%; poor: OR 0.95, 95%CI 0.75-1.21, I2 = 31%), SICH (OR 1.12, 95%CI 0.79-1.59, I2 = 0%), and early major neurological improvement (OR 1.26, 95%CI 0.80-1.96, I2 = 65%). The subgroup analysis suggested that the 0.25 mg/kg dose of tenecteplase had potentially greater efficacy and lower symptomatic intracerebral haemorrhage risk compared with 0.25 mg/kg dose tenecteplase. CONCLUSIONS Among AIS patients, there was no significant difference on clinical outcomes between tenecteplase and alteplase. Subgroup analysis demonstrated that 0.25 mg/kg doses of tenecteplase were more beneficial than 0.4 mg/kg doses of tenecteplase. Further studies are required to identify the optimal dosage of tenecteplase.
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Affiliation(s)
- Jian Huang
- Department of Critical Care Medicine, Hangzhou Ninth People’s Hospital, Hangzhou, China
| | - Hui Zheng
- Department of Emergency Medicine, Hangzhou Ninth People’s Hospital, Hangzhou, China
| | - Xianfeng Zhu
- Department of Critical Care Medicine, Hangzhou Ninth People’s Hospital, Hangzhou, China
| | - Kai Zhang
- Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaofeng Ping
- Department of Critical Care Medicine, Hangzhou Ninth People’s Hospital, Hangzhou, China
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Lee NP, Pearson ES, Sanzo P, Klarner T. Exploring the personal stroke and rehabilitation experiences of older adults with chronic stroke during the COVID-19 pandemic: a qualitative descriptive study. Int J Qual Stud Health Well-being 2024; 19:2331431. [PMID: 38511399 PMCID: PMC10962289 DOI: 10.1080/17482631.2024.2331431] [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: 08/12/2023] [Accepted: 03/13/2024] [Indexed: 03/22/2024] Open
Abstract
PURPOSE The purpose of this study was to explore the personal stroke and rehabilitation experiences of older adults with chronic stroke living in a mid-sized Northwestern Ontario city in Canada during the COVID-19 pandemic. METHODS A qualitative descriptive approach with a constructivist worldview was used. In addition, a semi-structured interview guide was used to gather the participants' perspectives on their experiences throughout stroke recovery. Ten participants were interviewed, including six males and four females. The interviews were completed, transcribed, and analysed using inductive and deductive content analysis. Multiple steps were taken to enhance data trustworthiness. RESULTS Six main themes and eight related subthemes emerged. These included: getting help is complex, the effects of stroke are multifaceted, losing rehabilitation services during the COVID-19 pandemic, overcoming hardships but not alone, "If you don't use it, you lost it": rehabilitative success is based on one's actions, and "look at me now": the importance of taking pride in one's successes. CONCLUSIONS One unique finding was that the participants used this study as an opportunity to teach and advocate for future stroke survivors which is not often seen in qualitative stroke rehabilitation research. Future stroke research should place emphasis on both the positive and negative experiences of this population.
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Affiliation(s)
- Nicole P. Lee
- CONTACT Nicole P. Lee School of Kinesiology, Lakehead University, 955 Oliver Rd, Thunder Bay, OntarioP7B5E1, Canada
| | | | - Paolo Sanzo
- School of Kinesiology, Lakehead University, Thunder Bay, Ontario, Canada
| | - Taryn Klarner
- School of Kinesiology, Lakehead University, Thunder Bay, Ontario, Canada
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Wang Y, Zhang L, Lyu T, Cui L, Zhao S, Wang X, Wang M, Wang Y, Li Z. Association of DNA methylation/demethylation with the functional outcome of stroke in a hyperinflammatory state. Neural Regen Res 2024; 19:2229-2239. [PMID: 38488557 PMCID: PMC11034580 DOI: 10.4103/1673-5374.392890] [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: 06/12/2023] [Revised: 10/07/2023] [Accepted: 11/13/2023] [Indexed: 04/24/2024] Open
Abstract
JOURNAL/nrgr/04.03/01300535-202410000-00024/figure1/v/2024-02-06T055622Z/r/image-tiff Inflammation is closely related to stroke prognosis, and high inflammation status leads to poor functional outcome in stroke. DNA methylation is involved in the pathogenesis and prognosis of stroke. However, the effect of DNA methylation on stroke at high levels of inflammation is unclear. In this study, we constructed a hyperinflammatory cerebral ischemia mouse model and investigated the effect of hypomethylation and hypermethylation on the functional outcome. We constructed a mouse model of transient middle cerebral artery occlusion and treated the mice with lipopolysaccharide to induce a hyperinflammatory state. To investigate the effect of DNA methylation on stroke, we used small molecule inhibitors to restrain the function of key DNA methylation and demethylation enzymes. 2,3,5-Triphenyltetrazolium chloride staining, neurological function scores, neurobehavioral tests, enzyme-linked immunosorbent assay, quantitative reverse transcription PCR and western blot assay were used to evaluate the effects after stroke in mice. We assessed changes in the global methylation status by measuring DNA 5-mc and DNA 5-hmc levels in peripheral blood after the use of the inhibitor. In the group treated with the DNA methylation inhibitor, brain tissue 2,3,5-triphenyltetrazolium chloride staining showed an increase in infarct volume, which was accompanied by a decrease in neurological scores and worsening of neurobehavioral performance. The levels of inflammatory factors interleukin 6 and interleukin-1 beta in ischemic brain tissue and plasma were elevated, indicating increased inflammation. Related inflammatory pathway exploration showed significant overactivation of nuclear factor kappa B. These results suggested that inhibiting DNA methylation led to poor functional outcome in mice with high inflammation following stroke. Further, the effects were reversed by inhibition of DNA demethylation. Our findings suggest that DNA methylation regulates the inflammatory response in stroke and has an important role in the functional outcome of hyperinflammatory stroke.
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Affiliation(s)
- Yubo Wang
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ling Zhang
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tianjie Lyu
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lu Cui
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shunying Zhao
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xuechun Wang
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Meng Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yongjun Wang
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Chinese Institute for Brain Research, Beijing, China
- Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
- Beijing Engineering Research Center of Digital Healthcare for Neurological Diseases, Beijing, China
| | - Zixiao Li
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Chinese Institute for Brain Research, Beijing, China
- Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
- Beijing Engineering Research Center of Digital Healthcare for Neurological Diseases, Beijing, China
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Myllykangas K, Härkönen H, Kääriäinen M, Kärppä M, Jansson M. Patient experiences on the quality of cerebrovascular diseases counselling using digital solutions in hospital-A qualitative research study. J Clin Nurs 2024; 33:2259-2273. [PMID: 38413773 DOI: 10.1111/jocn.17025] [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] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 12/29/2023] [Accepted: 01/15/2024] [Indexed: 02/29/2024]
Abstract
AIM To describe patients' experiences of the quality of counselling to develop new digital counselling solutions for patients with cerebrovascular disease. DESIGN A descriptive, qualitative approach. METHODS Semi-structured in-person interviews were conducted among 22 patients diagnosed with acute cerebrovascular disease and treated as inpatients at a single university hospital in Finland between September 2021 and February 2022. Data were analysed using deductive and inductive content analysis. RESULTS The identified facilitators, barriers and possible solutions for the development of new digital counselling solutions were deductively categorized into five main categories: (1) background factors, (2) resources, (3) implementation, (4) sufficiency, and (5) effects and 12 generic categories. Patients with cerebrovascular diseases worry about symptoms affecting their ability to receive information and valued a supportive atmosphere. Staff should have more time for counselling and use motivational digital counselling solutions in plain language, moderate length and with multimedia content. Patients desired reminders, easy search functions and possibilities for two-way communication. CONCLUSION New digital counselling solutions could be beneficial in supporting the patients' knowledge, emotions and adherence. For the success of such solutions, patients' special needs concerning different levels of cognitive impairment need to be considered. IMPACT The results of this study may benefit healthcare organizations in the development of digital counselling solutions that meet the patients' needs. REPORTING METHOD We have adhered to relevant EQUATOR guidelines with the COREQ reporting method. PATIENT OR PUBLIC CONTRIBUTION Patients were involved as the study population.
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Affiliation(s)
- Kirsi Myllykangas
- Research Unit of Health Sciences and Technology (HST), University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Henna Härkönen
- Research Unit of Health Sciences and Technology (HST), University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Maria Kääriäinen
- Research Unit of Health Sciences and Technology (HST), University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Mikko Kärppä
- Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
- Neurocenter, Neurology, Oulu University Hospital and Research Unit of Clinical Medicine, Neurology, Oulu University, Oulu University Hospital, Oulu, Finland
| | - Miia Jansson
- Research Unit of Health Sciences and Technology (HST), University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
- Royal Melbourne Institute of Technology RMIT University, Melbourne, Australia
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Wang T, Wang C, Chen K, Yang D, Xi X, Kong W. Evaluating stroke rehabilitation using brain functional network and corticomuscular coupling. Int J Neurosci 2024; 134:234-242. [PMID: 35815432 DOI: 10.1080/00207454.2022.2099386] [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: 02/24/2022] [Revised: 06/01/2022] [Accepted: 06/30/2022] [Indexed: 10/17/2022]
Abstract
Objective: Stroke is the leading cause of disability worldwide. Traditionally, doctors assess stroke rehabilitation assessment, which can be subjective. Therefore, an objective assessment method is required. Methods: In this context, we investigated the changes in brain functional connectivity patterns and corticomuscular coupling in stroke patients during rehabilitation. In this study, electroencephalogram (EEG) and electromyogram (EMG) of stroke patients were collected synchronously at baseline(BL), two weeks after BL, and four weeks after BL. A brain functional network was established, and the corticomuscular coupling relationship was calculated using phase transfer entropy (PTE). Results: We found that during the rehabilitation of stroke patients, the overall connection of the brain functional network was strengthened, and the network characteristic value increased. The average corticomuscular PTE appeared to first decrease and subsequently increase, and the PTE increase in the frontal lobe was significant. Value: In this study, PTE was used for the first time to analyze the relationship between EEG signals in patients with hemiplegia. We believe that our findings contribute to evaluating the rehabilitation of stroke patients with hemiplegia.
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Affiliation(s)
- Ting Wang
- School of Automation, Hangzhou Dianzi University, Hangzhou, China
- Key Laboratory of Brain Machine Collaborative Intelligence of Zhejiang Province, Hangzhou, China
| | - Chenghao Wang
- School of Automation, Hangzhou Dianzi University, Hangzhou, China
- Key Laboratory of Brain Machine Collaborative Intelligence of Zhejiang Province, Hangzhou, China
| | - Kai Chen
- Hangzhou Mingzhou Naokang Rehabilitation Hospital, Hangzhou, China
| | - Donghui Yang
- School of Automation, Hangzhou Dianzi University, Hangzhou, China
- Key Laboratory of Brain Machine Collaborative Intelligence of Zhejiang Province, Hangzhou, China
| | - Xugang Xi
- School of Automation, Hangzhou Dianzi University, Hangzhou, China
- Key Laboratory of Brain Machine Collaborative Intelligence of Zhejiang Province, Hangzhou, China
| | - Wanzeng Kong
- Key Laboratory of Brain Machine Collaborative Intelligence of Zhejiang Province, Hangzhou, China
- School of Computer Science and Technology, Hangzhou Dianzi University, Hangzhou, China
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Barra ME, Giulietti JM, DiCarlo JA, Erler KS, Krenz J, Roberts RJ, Lin DJ. Medication Profiles at Hospital Discharge Predict Poor Outcomes After Acute Ischemic Stroke. J Pharm Pract 2024; 37:600-606. [PMID: 36604314 DOI: 10.1177/08971900221150282] [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: 01/07/2023]
Abstract
Objectives: To examine the relationship between medications prescribed during the first 6-months post-stroke and functional outcome. Materials and Methods: A retrospective analysis of ischemic stroke survivors enrolled in an observational stroke recovery study from June-2017 to July-2019 was performed. Survivors with favorable outcomes (modified rankin scale (mRS) score 0-2) were compared to those with unfavorable outcomes (mRS ≥3) 6-months after stroke on the following: discharge medication classes prescribed, achievement of recommended targets for blood pressure control, glycemic control, and LDL ≤70 mg/dL, medication changes, medication interactions, and medication list discrepancies. Results: Unfavorable 6-month outcomes occurred in 36/78 (46.2%) of survivors. Survivors with unfavorable outcomes were more likely to be prescribed a central nervous system-acting agent (97.2% vs 71.4%; P = .0022) and/or an anti-hyperglycemic agent (25.0% vs 9.5%; P = .009) at discharge. After adjustment of baseline covariates, total number of medications prescribed was associated with unfavorable 6-month outcomes (OR 1.13, 95% CI 1.0-1.28). Secondary stroke prevention measures were not achieved in a high proportion of survivors. Medication changes during 6-month follow up were common and survivors with unfavorable outcomes were more likely to have clinically significant drug-drug interactions. Discussion: At 6-months, survivors with unfavorable outcomes were found to be prescribed more medications, particularly central nervous system-acting and anti-hyperglycemic agents. There were also more drug-drug interactions in the medications prescribed compared to those with favorable outcomes. Together, these data suggest the need for enhanced screening of high-risk stroke survivors focused on close monitoring of polypharmacy, drug-drug interactions, and adverse events with pharmacotherapy.
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Affiliation(s)
- Megan E Barra
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA
| | - Jennifer M Giulietti
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA
- School of Pharmacy, Northeastern University, Boston, MA, USA
| | - Julie A DiCarlo
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Kimberly S Erler
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - James Krenz
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA
| | - Russel J Roberts
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA
| | - David J Lin
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
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10
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Yuan L, Shen J, Ye S, Zhou N. Assessing care dependence status and associated influencing factors among middle-aged hemiplegic stroke patients during the post-acute rehabilitation phase: A correlational study. J Clin Nurs 2024; 33:2249-2258. [PMID: 38509780 DOI: 10.1111/jocn.17124] [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: 02/03/2024] [Revised: 03/03/2024] [Accepted: 03/11/2024] [Indexed: 03/22/2024]
Abstract
AIMS To comprehensively examine the prevailing condition of care dependence among middle-aged individuals who have experienced hemiplegia subsequent to a stroke and were currently undergoing post-acute rehabilitation. Additionally, the study sought to analyse the determinants that impacted this phenomenon. DESIGN A single-centre, cross-sectional study design. METHODS During the period from January 2020 to October 2022, a cohort of 196 hemiplegic stroke patients, aged between 40 and 65, and within 6 months of their stroke onset, was selected from the cerebrovascular outpatient clinic at a tertiary hospital in Hangzhou. The demographic and disease-related data, care dependence level, mental state, nutrition and depression status were collected. Furthermore, all collected data were analysed by descriptive and correlative statistical methods. RESULTS The care dependence level was 51.04 ± 9.42, with an incidence of care dependence of 78.1%. Multivariate regression analysis showed that age, history of falls, physical dysfunction, chronic comorbidities, depression, nutritional status and cognitive dysfunction were influencing factors for care dependence in the participants after a stroke. CONCLUSION The incidence of care dependence among hemiplegic patients aged from 40 to 65 years old in the early stage after a stroke was high. Nursing staff should focus on these patients with a history of falling, physical dysfunction, comorbidity, depression status, nutritional status and cognitive dysfunction in clinical practice. RELEVANCE TO CLINICAL PRACTICE The incidence of care dependence in middle-aged hemiplegic patients following a stroke is significantly increased. Some risk factors should be assessed, monitored, and controlled by nursing staff as early as possible in order to reduce the dependence levels in post-acute rehabilitation period and improve the quality of life of hemiplegia patients. REPORTING METHOD Our study complies with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Checklist: cross-sectional studies (see Table S1). PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Lianfeng Yuan
- Nursing Department, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jun Shen
- Nursing Department, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Shan Ye
- Nursing Department, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Na Zhou
- Nursing Department, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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Zhang M, Guo L, Namassevayam G, Wei M, Xie Y, Guo Y, Liu Y. Factors associated with health behaviours among stroke survivors: A mixed-methods study using COM-B model. J Clin Nurs 2024; 33:2138-2152. [PMID: 38590015 DOI: 10.1111/jocn.17103] [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] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/04/2024] [Accepted: 02/28/2024] [Indexed: 04/10/2024]
Abstract
AIMS To identify factors associated with health behaviours among stroke survivors, through a multi-centre study. DESIGN A sequential mixed methods design. METHODS In the quantitative research phase, a total of 350 participants were recruited through multi-stage sampling from December 2022 to June 2023. General information questionnaires, The Stroke Prevention Knowledge Questionnaire (SPKQ), Short Form Health Belief Model Scale (SF-HBMS), Health Promoting Lifestyle Profile (HPLPII), and the WHOQOL-BREF (World Health Organization Quality of Life Questionnaire, Brief Version) were distributed across five tertiary hospitals in Henan province, China. For the qualitative research component, semi-structured interviews were conducted to explore the barriers and facilitators of health behaviour. This study adheres to the GRAMMS guidelines. RESULTS A total of 315 participants (90.0%) completed the survey. Identified barriers to health behaviour included residing in rural areas, higher scores on the Charlson Comorbidity Index (CCI) and mRS, as well as lower scores on SPKQ, SF-HBMS and WHOQOL-BREF. Twenty-four individuals participated in qualitative interviews. Twenty-eight themes were identified and categorised by frequency, covering areas such as knowledge, skills, intentions, social influences, social/professional role and identity, environmental context and resources, beliefs about capabilities, beliefs about consequences and behavioural regulation. Both quantitative and qualitative data suggested that health behaviour among stroke survivors is at a moderate level, and the identified barrier factors can be mapped into the COM-B model (Capability, Opportunity, Motivation and Behaviour). CONCLUSION The study indicates that key barriers to health behaviour among stroke survivors align with the COM-B model. These identified factors should be carefully considered in the planning of future systematic interventions aimed at improving health behaviours among stroke survivors. PATIENT OR PUBLIC CONTRIBUTION Patients were invited to completed questionnaires in the study and semi-structured interviews. The investigators provided explanation of this study' content, purpose and addressed issues during the data collection.
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Affiliation(s)
- Mengyu Zhang
- College of Nursing, Zhengzhou University, Zhengzhou, China
| | - Lina Guo
- Department of Neurology, National Advanced Stroke Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Genoosha Namassevayam
- Department of Neurology, National Advanced Stroke Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Department of Supplementary Health Sciences, Faculty of Health-Care Sciences, Eastern University, Trincomalee, Sri Lanka
| | - Miao Wei
- Department of Neurology, National Advanced Stroke Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - YuYing Xie
- College of Nursing, Zhengzhou University, Zhengzhou, China
| | - Yuanli Guo
- Department of Neurology, National Advanced Stroke Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yanjin Liu
- Department of Nursing, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
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Wilbers M, Geusgens C, van Heugten CM. Does cognitive learning potential measured with the dynamic Wisconsin Card Sorting Test predict rehabilitation outcome in elderly patients post- stroke? Brain Inj 2024; 38:417-424. [PMID: 38406989 DOI: 10.1080/02699052.2024.2309257] [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: 05/05/2022] [Accepted: 01/19/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVE To determine whether cognitive learning potential measured with the dynamic Wisconsin Card Sorting Test has added value in predicting rehabilitation outcome in elderly patients post-stroke after controlling for age, ADL independence at admission, global cognitive functioning and depressive symptoms. METHODS Participants were patients with stroke admitted to a geriatric rehabilitation unit. ADL independence (Barthel Index) at discharge was used as measure for rehabilitation outcome. Predictor variables included age, ADL independence at admission, global cognitive functioning (Montreal Cognitive Assessment), depressive symptoms (Geriatric Depression Scale) and cognitive learning potential measured with the dWCST. RESULTS Thirty participants were included. Bivariate analyses showed that rehabilitation outcome was significantly correlated with ADL independence at admission (r = 0.443, p = 0.014) and global cognitive functioning (r = 0.491, p = 0.006). Regression analyses showed that the dWCST was not an independent predictor of rehabilitation outcome. ADL independence at admission was the only significant predictor of rehabilitation outcome (beta = 0.480, p = 0.007). CONCLUSIONS Cognitive learning potential, measured with the dWCST has no added value in predicting rehabilitation outcome in elderly patients post-stroke. ADL independence at admission was the only significant predictor of rehabilitation outcome. REGISTRATION NUMBER NETHERLANDS TRIAL REGISTER Trial NL7947.
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Affiliation(s)
- Martine Wilbers
- Department of Clinical and Medical Psychology, Zuyderland Medical Center, Sittard & Heerlen, The Netherlands
| | - Chantal Geusgens
- Department of Clinical and Medical Psychology, Zuyderland Medical Center, Sittard & Heerlen, The Netherlands
| | - Caroline M van Heugten
- Department of Neuropsychology & Psychopharmacology, Maastricht University, The Netherlands
- Limburg Brain Injury Center, Maastricht University, The Netherlands
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Şimşek C, Tav Şimşek D, Özüçelik DN, Sümer E, Hacıhasanoğlu E, Sarıkaya S. Experımental Study: The Effect Of 20% Intralıpıd Emulsıon Therapy In Cerebral Ischemıc Reperfusıon. Brain Inj 2024; 38:489-498. [PMID: 38420951 DOI: 10.1080/02699052.2024.2318596] [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: 05/01/2023] [Accepted: 02/09/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND This experimental study was conducted to investigate the effect of 20% Intralipid Emulsion (ILE) treatment on Cerebral Ischemia Reperfusion Injury (CIRI) after reperfusion in acute ischemic stroke. METHODS In this experimental study, seven rats without any intervention (control group), seven rats (sham group) for which CIRI was created after the common carotid artery was ligated for 2 hours, and seven rats who were treated with 20% ILE after CIRI (CIRI + ILE group) were sacrificed after 24 hours, and histopathological findings were investigated. RESULTS In rats that were not treated after CIRI, 52.7% had level-1, 32.7% had level-2. and 14.5% had level-3. histopathological findings. While 72.2% of the rats treated with ILE had level-1 and 27.8% had level-2 findings, no level-3 histopathological findings were detected in any of the rats. While no signs of coagulative necrosis, spongiosis of surrounding tissue and polymorphonuclear leukocytes were observed histopathological in any of the rats given ILE, there was no macrophages finding in 85.6% of the rats. ILE treatment also reduced the histopathological findings of eosinophilic neurons, astrogliosis, neovascularization, vascular thrombosis and mononuclear inflammatory cells. CONCLUSION This study showed that 20% ILE treatment reduces the histopathological damage seen in cerebral ischemia and CIRI.
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Affiliation(s)
- Cem Şimşek
- Emergency Department, Yeditepe Üniversity, İstanbul, Turkey
| | - Dijan Tav Şimşek
- Emergency Department, Sancaktepe Prof. Dr. İlhan Varank Training and Research Hospital, İstanbul, Turkey
| | - Doğaç Niyazi Özüçelik
- Health Science Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
- UNEC Social Work and Social Innovation Center, Baku, Azerbaijan
| | - Engin Sümer
- Faculty of Medicine Experimental Research Center, Yeditepe University İstanbul, Turkey
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Jeong T, Chung Y. The effects of visual information deprivation and feedback balance training on balance in patients with stroke. NeuroRehabilitation 2024:NRE230358. [PMID: 38607770 DOI: 10.3233/nre-230358] [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: 04/14/2024]
Abstract
BACKGROUND Patients with stroke depend on visual information due to balance deficits. Therefore, it is believed that appropriate visual deprivation training could have an impact on improving balance abilities. OBJECTIVE The purpose of this study was to compare the effects of balance training performed in visual deprivation and feedback conditions on balance in stroke survivors. METHODS The 39 participants were randomly assigned to either the Visual Deprivation Group (VDG; n = 13), the Visual Feedback Group (VFG; n = 13), or the Control Group (CG; n = 13). The training sessions were conducted five times a week for three weeks. Participants completed the Berg Balance Scale (BBS), Timed Up and Go test (TUG), Four Square Step Test (FSST), and Limit of Stability (LOS) assessments. RESULTS The VDG showed significant improvements in BBS, FSST, TUG, and LOS. In VFG, significant improvements were observed in BBS and TUG. There were statistically significant differences among the groups in all variables related to balance. CONCLUSION The results of this study suggest that balance training under visual deprivation is effective in improving static and dynamic balance and gait in patients with stroke. In other words, patients with stroke need to reduce their over-reliance on visual information.
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Affiliation(s)
- Taewoong Jeong
- Department of Physical Therapy, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Yijung Chung
- Department of Physical Therapy, College of Health and Welfare, Sahmyook University, Seoul, Republic of Korea
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15
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Kajimoto C, Takebayashi T, Okita Y, Fleming J, Shimada S. Development of the Japanese version of the awareness questionnaire for assessment of self-awareness after acquired brain injury: reliability and validity. Top Stroke Rehabil 2024; 31:372-380. [PMID: 37880195 DOI: 10.1080/10749357.2023.2271707] [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: 07/13/2023] [Accepted: 10/08/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND The evaluation of impaired self-awareness (ISA) after brain injury is not widespread in Japan, and there is a lack of Japanese assessments of self-awareness. OBJECTIVES To translate the original version of the Awareness Questionnaire (AQ), an instrument for assessing ISA, into Japanese using a validated method and examine its reliability and validity in inpatients with stroke. METHODS This cross-sectional, prospective study enrolled 130 participants. The double-translation process was used to develop the Japanese version of the AQ. RESULTS Data were collected from 120 patients. High intra-rater reliability was observed for the patient (Cronbach's α = 0.824) and clinician samples (Cronbach's α = 0.933). High intra- and inter-rater reliability were found for all AQ items [interclass coefficient (ICC) (1, 1) = 0.828, ICC (2, 1) = 0.852, ICC (3, 1) = 0.848]; however, the sub-item analysis revealed only moderate reliability. Validity assessment revealed a low but significant positive correlation (r = 0.209; p < 0.05) between the Japanese version of the AQ and the Japanese version of the Self-Regulation Skills Interview and a low but significant negative correlation (r = 0.197; p < 0.05) between the Japanese version of the AQ and the Mini-Mental State Examination. CONCLUSIONS The Japanese version of the AQ was developed and applied to stroke patients, but the concept of post-stroke ISA may differ from ISA after traumatic brain injury, highlighting the need for a stroke-specific version of the AQ.
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Affiliation(s)
- Chinaru Kajimoto
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan
- Graduate School of Rehabilitation Science, Osaka Metropolitan University, Osaka, Japan
| | - Takashi Takebayashi
- Graduate School of Rehabilitation Science, Osaka Metropolitan University, Osaka, Japan
| | - Yuho Okita
- School of Health Science, Swinburne University of Technology, Melbourne, Australia
| | - Jennifer Fleming
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Shinichi Shimada
- Department of Neurosurgery, Itami Kousei Neurosurgical Hospital, Itami, Japan
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16
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Li S. Patterns and assessment of spastic hemiplegic gait. Muscle Nerve 2024; 69:516-522. [PMID: 38372396 DOI: 10.1002/mus.28052] [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: 11/11/2023] [Revised: 01/15/2024] [Accepted: 01/21/2024] [Indexed: 02/20/2024]
Abstract
Hemiparetic gait disorders are common in stroke survivors. A circumductory gait is often considered the typical hemiparetic gait. In clinical practice, a wide spectrum of abnormal gait patterns is observed, depending on the severity of weakness and spasticity, and the anatomical distribution of spasticity. Muscle strength is the key determinant of gait disorders in hemiparetic stroke survivors. Spasticity and its associated involuntary activation of synergistic spastic muscles often alter posture of involved joint(s) and subsequently the alignment of hip, knee, and ankle joints, resulting in abnormal gait patterns. Due to combinations of various levels of muscle weakness and spasticity and their interactions with ground reaction force, presentations of gait disorders are variable. From a neuromechanical perspective, a stepwise visual gait analysis approach is proposed to identify primary underlying causes. In this approach, the pelvic and hip joint movement is examined first. The pelvic girdle constitutes three kinematic determinants. Its abnormality determines the body vector and compensatory kinetic chain reactions in the knee and ankle joints. The second step is to assess the ankle and foot complex abnormality. The last step is to examine abnormality of the knee joint. Assessment of muscle strength and spasticity of hip, knee, and ankle/foot joints needs to be performed before these steps. Lidocaine nerve blocks can be a useful diagnostic tool. Recognizing different patterns and identifying the primary causes are critical to developing clinical interventions to improve gait functions.
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Affiliation(s)
- Sheng Li
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, University of Texas Health Science Center-Houston, Houston, Texas, USA
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Guterud M, Hardeland C, Bugge HF, Sandset EC, Svendsen EJ, Hov MR. Experiences from a cluster-randomized trial (ParaNASPP) exploring triage and diagnostic accuracy in paramedic-suspected stroke: a qualitative interview study. Eur J Neurol 2024; 31:e16252. [PMID: 38404142 DOI: 10.1111/ene.16252] [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] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/17/2024] [Accepted: 02/02/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND AND PURPOSE Timely prehospital stroke recognition was explored in the Paramedic Norwegian Acute Stroke Prehospital Project (ParaNASPP) by implementation of stroke education for paramedics and use of the National Institutes of Health Stroke Scale (NIHSS) through a mobile application. The study tested triage and facilitated communication between paramedics and stroke physicians. To complement the quantitative results of the clinical trial, a qualitative approach was used to identify factors that influence triage decisions and diagnostic accuracy in prehospital stroke recognition experienced by paramedics and stroke physicians. METHOD Semi-structured qualitative individual interviews were performed following an interview guide. Informants were recruited from the enrolled paramedics and stroke physicians who participated in the ParaNASPP trial from Oslo University Hospital. Interviews were audio recorded, transcribed verbatim and approached inductively using the principles of thematic analysis. RESULTS Fourteen interviews were conducted, with seven paramedics and seven stroke physicians. Across both groups two overarching themes were identified related to triage decisions and diagnostic accuracy in prehospital stroke recognition: prehospital NIHSS reliably improves clinical assessment and communication quality; overtriage is widely accepted whilst undertriage is not. CONCLUSION Paramedics and stroke physicians described how prehospital NIHSS improved communication quality and reliably improved prehospital clinical assessment. The qualitative results support a rationale of an application algorithm to decide which NIHSS items should prompt immediate prenotification rather than a complete NIHSS as default.
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Affiliation(s)
- Mona Guterud
- Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway
- Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Camilla Hardeland
- Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
- Department of Nursing, Health and Laboratory Science, Østfold University College, Halden, Norway
| | - Helge Fagerheim Bugge
- Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Else Charlotte Sandset
- Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Edel Jannecke Svendsen
- Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
- Department of Research, Sunnaas Rehabilitation Hospital, Oslo, Norway
| | - Maren Ranhoff Hov
- Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway
- Department of Nursing, Health and Laboratory Science, Østfold University College, Halden, Norway
- Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
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He D, Sikora WA, James SA, Williamson JN, Lepak LV, Cheema CF, Sidorov E, Li S, Yang Y. Alteration in Resting-State Brain Activity in Stroke Survivors After Repetitive Finger Stimulation. Am J Phys Med Rehabil 2024; 103:395-400. [PMID: 38261754 PMCID: PMC11031333 DOI: 10.1097/phm.0000000000002393] [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] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
OBJECTIVE This quasi-experimental study examined the effect of repetitive finger stimulation on brain activation in eight stroke and seven control subjects, measured by quantitative electroencephalogram. METHODS We applied 5 mins of 2-Hz repetitive bilateral index finger transcutaneous electrical nerve stimulation and compared differences pre- and post-transcutaneous electrical nerve stimulation using quantitative electroencephalogram metrics delta/alpha ratio and delta-theta/alpha-beta ratio. RESULTS Between-group differences before and after stimulation were significantly different in the delta/alpha ratio ( z = -2.88, P = 0.0040) and the delta-theta/alpha-beta ratio variables ( z = -3.90 with P < 0.0001). Significant decrease in the delta/alpha ratio and delta-theta/alpha-beta ratio variables after the transcutaneous electrical nerve stimulation was detected only in the stroke group (delta/alpha ratio diff = 3.87, P = 0.0211) (delta-theta/alpha-beta ratio diff = 1.19, P = 0.0074). CONCLUSIONS The decrease in quantitative electroencephalogram metrics in the stroke group may indicate improved brain activity after transcutaneous electrical nerve stimulation. This finding may pave the way for a future novel therapy based on transcutaneous electrical nerve stimulation and quantitative electroencephalogram measures to improve brain recovery after stroke.
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Affiliation(s)
- Dorothy He
- University of Oklahoma Health Sciences Center, College of Medicine, Oklahoma City, Oklahoma
| | - William A. Sikora
- University of Oklahoma, Stephenson School of Biomedical Engineering, Norman, Oklahoma
| | - Shirley A. James
- University of Oklahoma Health Sciences Center, Hudson College of Public Health, Oklahoma City, Oklahoma
| | - Jordan N. Williamson
- University of Illinois Urbana-Champaign, Department of Bioengineering, Urbana, Illinois, USA
| | - Louis V. Lepak
- University of Oklahoma Health Sciences Center, Department of Rehabilitation Sciences, Tulsa, Oklahoma
| | - Carolyn F. Cheema
- University of Oklahoma Health Sciences Center, Department of Rehabilitation Sciences, Tulsa, Oklahoma
| | - Evgeny Sidorov
- University of Oklahoma Health Sciences Center, Department of Neurology, Oklahoma City, Oklahoma
| | - Sheng Li
- UT Health Huston McGovern Medical School, Department of Physical Medicine and Rehabilitation, Houston, Texas
| | - Yuan Yang
- University of Illinois Urbana-Champaign, Department of Bioengineering, Urbana, Illinois, USA
- University of Oklahoma Health Sciences Center, Department of Rehabilitation Sciences, Tulsa, Oklahoma
- Carle Foundation Hospital, Clinical Imaging Research Center, Stephenson Family Clinical Research Institute, Urbana, Illinois, USA
- Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign, Urbana, IL 61820, USA
- Northwestern University, Department of Physical Therapy and Human Movement Sciences, Chicago, Illinois, USA
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Colangelo G, Ribo M, Montiel E, Dominguez D, Olivé-Gadea M, Muchada M, Garcia-Tornel Á, Requena M, Pagola J, Juega J, Rodriguez-Luna D, Rodriguez-Villatoro N, Rizzo F, Taborda B, Molina CA, Rubiera M. PRERISK: A Personalized, Artificial Intelligence-Based and Statistically-Based Stroke Recurrence Predictor for Recurrent Stroke. Stroke 2024; 55:1200-1209. [PMID: 38545798 DOI: 10.1161/strokeaha.123.043691] [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: 04/26/2023] [Accepted: 01/31/2024] [Indexed: 04/24/2024]
Abstract
BACKGROUND Predicting stroke recurrence for individual patients is difficult, but individualized prediction may improve stroke survivors' engagement in self-care. We developed PRERISK: a statistical and machine learning classifier to predict individual risk of stroke recurrence. METHODS We analyzed clinical and socioeconomic data from a prospectively collected public health care-based data set of 41 975 patients admitted with stroke diagnosis in 88 public health centers over 6 years (2014-2020) in Catalonia-Spain. A new stroke diagnosis at least 24 hours after the index event was considered as a recurrent stroke, which was considered as our outcome of interest. We trained several supervised machine learning models to provide individualized risk over time and compared them with a Cox regression model. Models were trained to predict early, late, and long-term recurrence risk, within 90, 91 to 365, and >365 days, respectively. C statistics and area under the receiver operating characteristic curve were used to assess the accuracy of the models. RESULTS Overall, 16.21% (5932 of 36 114) of patients had stroke recurrence during a median follow-up of 2.69 years. The most powerful predictors of stroke recurrence were time from previous stroke, Barthel Index, atrial fibrillation, dyslipidemia, age, diabetes, and sex, which were used to create a simplified model with similar performance, together with modifiable vascular risk factors (glycemia, body mass index, high blood pressure, cholesterol, tobacco dependence, and alcohol abuse). The areas under the receiver operating characteristic curve were 0.76 (95% CI, 0.74-0.77), 0.60 (95% CI, 0.58-0.61), and 0.71 (95% CI, 0.69-0.72) for early, late, and long-term recurrence risk, respectively. The areas under the receiver operating characteristic curve of the Cox risk class probability were 0.73 (95% CI, 0.72-0.75), 0.59 (95% CI, 0.57-0.61), and 0.67 (95% CI, 0.66-0.70); machine learning approaches (random forest and AdaBoost) showed statistically significant improvement (P<0.05) over the Cox model for the 3 recurrence time periods. Stroke recurrence curves can be simulated for each patient under different degrees of control of modifiable factors. CONCLUSIONS PRERISK is a novel approach that provides a personalized and fairly accurate risk prediction of stroke recurrence over time. The model has the potential to incorporate dynamic control of risk factors.
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Affiliation(s)
- Giorgio Colangelo
- Vall d'Hebron Research Institute, Passeig de la Vall d'Hebron, Barcelona, Spain (G.C., M. Ribo, M.O.-G., M.M., Á.G.-T., M. Requena, J.P., J.J., D.R.-L., N.R.-V., F.R., B.T., C.A.M., M. Rubiera)
- Nora Health, Passeig de la Vall d'Hebron, Barcelona, Spain (G.C., E.M.)
| | - Marc Ribo
- Vall d'Hebron Research Institute, Passeig de la Vall d'Hebron, Barcelona, Spain (G.C., M. Ribo, M.O.-G., M.M., Á.G.-T., M. Requena, J.P., J.J., D.R.-L., N.R.-V., F.R., B.T., C.A.M., M. Rubiera)
- Hospital Universitari Vall d'Hebron, Stroke Unit, Neurology Department, Passeig de la Vall d'Hebron, Barcelona, Spain (M. Ribo, M.O.-G., M.M., Á.G.-T., M. Requena, J.P., J.J., D.R.-L., N.R.-V., F.R., B.T., C.A.M., M. Rubiera)
| | - Estefanía Montiel
- Nora Health, Passeig de la Vall d'Hebron, Barcelona, Spain (G.C., E.M.)
| | - Didier Dominguez
- Programa d'Analítica de Dades per a la Recerca i la Innovació en Salut, Agència de Qualitat i Avaluació Sanitàries de Catalunya, Departament de Salut, Generalitat de Catalunya, Carrer de Roc Boronat, Barcelona, Spain (D.D.)
| | - Marta Olivé-Gadea
- Vall d'Hebron Research Institute, Passeig de la Vall d'Hebron, Barcelona, Spain (G.C., M. Ribo, M.O.-G., M.M., Á.G.-T., M. Requena, J.P., J.J., D.R.-L., N.R.-V., F.R., B.T., C.A.M., M. Rubiera)
- Hospital Universitari Vall d'Hebron, Stroke Unit, Neurology Department, Passeig de la Vall d'Hebron, Barcelona, Spain (M. Ribo, M.O.-G., M.M., Á.G.-T., M. Requena, J.P., J.J., D.R.-L., N.R.-V., F.R., B.T., C.A.M., M. Rubiera)
| | - Marian Muchada
- Vall d'Hebron Research Institute, Passeig de la Vall d'Hebron, Barcelona, Spain (G.C., M. Ribo, M.O.-G., M.M., Á.G.-T., M. Requena, J.P., J.J., D.R.-L., N.R.-V., F.R., B.T., C.A.M., M. Rubiera)
- Hospital Universitari Vall d'Hebron, Stroke Unit, Neurology Department, Passeig de la Vall d'Hebron, Barcelona, Spain (M. Ribo, M.O.-G., M.M., Á.G.-T., M. Requena, J.P., J.J., D.R.-L., N.R.-V., F.R., B.T., C.A.M., M. Rubiera)
| | - Álvaro Garcia-Tornel
- Vall d'Hebron Research Institute, Passeig de la Vall d'Hebron, Barcelona, Spain (G.C., M. Ribo, M.O.-G., M.M., Á.G.-T., M. Requena, J.P., J.J., D.R.-L., N.R.-V., F.R., B.T., C.A.M., M. Rubiera)
- Hospital Universitari Vall d'Hebron, Stroke Unit, Neurology Department, Passeig de la Vall d'Hebron, Barcelona, Spain (M. Ribo, M.O.-G., M.M., Á.G.-T., M. Requena, J.P., J.J., D.R.-L., N.R.-V., F.R., B.T., C.A.M., M. Rubiera)
| | - Manuel Requena
- Vall d'Hebron Research Institute, Passeig de la Vall d'Hebron, Barcelona, Spain (G.C., M. Ribo, M.O.-G., M.M., Á.G.-T., M. Requena, J.P., J.J., D.R.-L., N.R.-V., F.R., B.T., C.A.M., M. Rubiera)
- Hospital Universitari Vall d'Hebron, Stroke Unit, Neurology Department, Passeig de la Vall d'Hebron, Barcelona, Spain (M. Ribo, M.O.-G., M.M., Á.G.-T., M. Requena, J.P., J.J., D.R.-L., N.R.-V., F.R., B.T., C.A.M., M. Rubiera)
| | - Jorge Pagola
- Vall d'Hebron Research Institute, Passeig de la Vall d'Hebron, Barcelona, Spain (G.C., M. Ribo, M.O.-G., M.M., Á.G.-T., M. Requena, J.P., J.J., D.R.-L., N.R.-V., F.R., B.T., C.A.M., M. Rubiera)
- Hospital Universitari Vall d'Hebron, Stroke Unit, Neurology Department, Passeig de la Vall d'Hebron, Barcelona, Spain (M. Ribo, M.O.-G., M.M., Á.G.-T., M. Requena, J.P., J.J., D.R.-L., N.R.-V., F.R., B.T., C.A.M., M. Rubiera)
| | - Jesús Juega
- Vall d'Hebron Research Institute, Passeig de la Vall d'Hebron, Barcelona, Spain (G.C., M. Ribo, M.O.-G., M.M., Á.G.-T., M. Requena, J.P., J.J., D.R.-L., N.R.-V., F.R., B.T., C.A.M., M. Rubiera)
- Hospital Universitari Vall d'Hebron, Stroke Unit, Neurology Department, Passeig de la Vall d'Hebron, Barcelona, Spain (M. Ribo, M.O.-G., M.M., Á.G.-T., M. Requena, J.P., J.J., D.R.-L., N.R.-V., F.R., B.T., C.A.M., M. Rubiera)
| | - David Rodriguez-Luna
- Vall d'Hebron Research Institute, Passeig de la Vall d'Hebron, Barcelona, Spain (G.C., M. Ribo, M.O.-G., M.M., Á.G.-T., M. Requena, J.P., J.J., D.R.-L., N.R.-V., F.R., B.T., C.A.M., M. Rubiera)
- Hospital Universitari Vall d'Hebron, Stroke Unit, Neurology Department, Passeig de la Vall d'Hebron, Barcelona, Spain (M. Ribo, M.O.-G., M.M., Á.G.-T., M. Requena, J.P., J.J., D.R.-L., N.R.-V., F.R., B.T., C.A.M., M. Rubiera)
| | - Noelia Rodriguez-Villatoro
- Vall d'Hebron Research Institute, Passeig de la Vall d'Hebron, Barcelona, Spain (G.C., M. Ribo, M.O.-G., M.M., Á.G.-T., M. Requena, J.P., J.J., D.R.-L., N.R.-V., F.R., B.T., C.A.M., M. Rubiera)
- Hospital Universitari Vall d'Hebron, Stroke Unit, Neurology Department, Passeig de la Vall d'Hebron, Barcelona, Spain (M. Ribo, M.O.-G., M.M., Á.G.-T., M. Requena, J.P., J.J., D.R.-L., N.R.-V., F.R., B.T., C.A.M., M. Rubiera)
| | - Federica Rizzo
- Vall d'Hebron Research Institute, Passeig de la Vall d'Hebron, Barcelona, Spain (G.C., M. Ribo, M.O.-G., M.M., Á.G.-T., M. Requena, J.P., J.J., D.R.-L., N.R.-V., F.R., B.T., C.A.M., M. Rubiera)
- Hospital Universitari Vall d'Hebron, Stroke Unit, Neurology Department, Passeig de la Vall d'Hebron, Barcelona, Spain (M. Ribo, M.O.-G., M.M., Á.G.-T., M. Requena, J.P., J.J., D.R.-L., N.R.-V., F.R., B.T., C.A.M., M. Rubiera)
| | - Belén Taborda
- Vall d'Hebron Research Institute, Passeig de la Vall d'Hebron, Barcelona, Spain (G.C., M. Ribo, M.O.-G., M.M., Á.G.-T., M. Requena, J.P., J.J., D.R.-L., N.R.-V., F.R., B.T., C.A.M., M. Rubiera)
- Hospital Universitari Vall d'Hebron, Stroke Unit, Neurology Department, Passeig de la Vall d'Hebron, Barcelona, Spain (M. Ribo, M.O.-G., M.M., Á.G.-T., M. Requena, J.P., J.J., D.R.-L., N.R.-V., F.R., B.T., C.A.M., M. Rubiera)
| | - Carlos A Molina
- Vall d'Hebron Research Institute, Passeig de la Vall d'Hebron, Barcelona, Spain (G.C., M. Ribo, M.O.-G., M.M., Á.G.-T., M. Requena, J.P., J.J., D.R.-L., N.R.-V., F.R., B.T., C.A.M., M. Rubiera)
- Hospital Universitari Vall d'Hebron, Stroke Unit, Neurology Department, Passeig de la Vall d'Hebron, Barcelona, Spain (M. Ribo, M.O.-G., M.M., Á.G.-T., M. Requena, J.P., J.J., D.R.-L., N.R.-V., F.R., B.T., C.A.M., M. Rubiera)
| | - Marta Rubiera
- Vall d'Hebron Research Institute, Passeig de la Vall d'Hebron, Barcelona, Spain (G.C., M. Ribo, M.O.-G., M.M., Á.G.-T., M. Requena, J.P., J.J., D.R.-L., N.R.-V., F.R., B.T., C.A.M., M. Rubiera)
- Hospital Universitari Vall d'Hebron, Stroke Unit, Neurology Department, Passeig de la Vall d'Hebron, Barcelona, Spain (M. Ribo, M.O.-G., M.M., Á.G.-T., M. Requena, J.P., J.J., D.R.-L., N.R.-V., F.R., B.T., C.A.M., M. Rubiera)
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Kanamaru H, Zhu S, Dong S, Takemoto Y, Huang L, Sherchan P, Suzuki H, Tang J, Zhang JH. UDP-Glucose/P2Y14 Receptor Signaling Exacerbates Neuronal Apoptosis After Subarachnoid Hemorrhage in Rats. Stroke 2024; 55:1381-1392. [PMID: 38525592 PMCID: PMC11039370 DOI: 10.1161/strokeaha.123.044422] [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: 07/05/2023] [Accepted: 02/13/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Subarachnoid hemorrhage (SAH) is a severe subtype of stroke with poor outcomes. Abnormal glucose metabolism often occurs after SAH, but the strict control of blood glucose levels is not always beneficial. This study aimed to investigate the contribution of uridine diphosphate glucose (UDP-G), an intermediate of glucose/glycogen metabolism, and its receptor P2Y14 (P2Y purinoceptor 14) to SAH pathology and explored the potential targeted treatments in rats. METHODS A total of 218 Sprague-Dawley male rats were used. SAH was induced by endovascular perforation. Brain expressions of P2Y14, uridine diphosphate glucose (UDP-G), and its converting enzyme UGP2 (UDP-G pyrophosphorylase-2) were evaluated. Exogenous UDP-G or selective P2Y14 inhibitor was administered intranasally at 1 hour after SAH to explore their potential effects. Intranasal Ugp2 or P2ry14 siRNA was delivered 24 hours before SAH for mechanistic evaluation. Primary neuron culture and hemoglobin stimulation were used as in vitro model of SAH. Post-SAH evaluation included liquid chromatography-mass spectrometry measurement of brain endogenous UDP-G level, neurobehavioral assessments, Western blotting, immunohistochemistry, TUNEL staining, and Nissl staining. RESULTS There was an acute elevation of endogenous brain UDP-G and UGP2 after SAH, and P2Y14 was expressed in neurons. Although P2Y14 inhibitor decreased neurological dysfunction, neuronal apoptosis, and proapoptotic molecules, exogenous UDP-G exacerbated these outcomes at 24 hours after SAH. Early inhibition of P2Y14 preserved long-term neuronal survival in the hippocampus, amygdala, and cortex with improved neurocognition and depressive-like behavior. In addition, in vivo knockdown of Ugp2- and P2ry14-reduced neurological deficits and proapoptotic molecules at 24 hours after SAH, and furthermore in vitro knockdown of P2ry14-reduced apoptosis in hemoglobin stimulated primary neuron. CONCLUSIONS These findings suggest a detrimental role of brain UDP-G/P2Y14 signaling in SAH, as a part of glucose metabolic pathology at the tissue level. P2Y14 inhibitor 4-[4-(4-piperidinyl)phenyl]-7-[4-(trifluoromethyl)phenyl]-2-naphthalenecarboxylic acid hydrochloride may serve as a potential therapeutic target in treating patients with SAH.
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Affiliation(s)
- Hideki Kanamaru
- Departments of Physiology and Pharmacology (H.K., S.Z., S.D., Y.T., L.H., P.S., J.T., J.H.Z.,), Loma Linda University, CA
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Japan (H.K., H.S.)
| | - Shiyi Zhu
- Departments of Physiology and Pharmacology (H.K., S.Z., S.D., Y.T., L.H., P.S., J.T., J.H.Z.,), Loma Linda University, CA
| | - Siyuan Dong
- Departments of Physiology and Pharmacology (H.K., S.Z., S.D., Y.T., L.H., P.S., J.T., J.H.Z.,), Loma Linda University, CA
| | - Yushin Takemoto
- Departments of Physiology and Pharmacology (H.K., S.Z., S.D., Y.T., L.H., P.S., J.T., J.H.Z.,), Loma Linda University, CA
- Department of Neurosurgery, Kumamoto University School of Medicine, Japan (Y.T.)
| | - Lei Huang
- Departments of Physiology and Pharmacology (H.K., S.Z., S.D., Y.T., L.H., P.S., J.T., J.H.Z.,), Loma Linda University, CA
- Neurosurgery, (L.H., J.H.Z.), Loma Linda University, CA
| | - Prativa Sherchan
- Departments of Physiology and Pharmacology (H.K., S.Z., S.D., Y.T., L.H., P.S., J.T., J.H.Z.,), Loma Linda University, CA
| | - Hidenori Suzuki
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Japan (H.K., H.S.)
| | - Jiping Tang
- Departments of Physiology and Pharmacology (H.K., S.Z., S.D., Y.T., L.H., P.S., J.T., J.H.Z.,), Loma Linda University, CA
| | - John H Zhang
- Departments of Physiology and Pharmacology (H.K., S.Z., S.D., Y.T., L.H., P.S., J.T., J.H.Z.,), Loma Linda University, CA
- Neurosurgery, (L.H., J.H.Z.), Loma Linda University, CA
- Anesthesiology (J.H.Z.), Loma Linda University, CA
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Loan A, Syal C, Lui M, He L, Wang J. Promising use of metformin in treating neurological disorders: biomarker-guided therapies. Neural Regen Res 2024; 19:1045-1055. [PMID: 37862207 PMCID: PMC10749596 DOI: 10.4103/1673-5374.385286] [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: 02/09/2023] [Revised: 04/25/2023] [Accepted: 07/29/2023] [Indexed: 10/22/2023] Open
Abstract
Neurological disorders are a diverse group of conditions that affect the nervous system and include neurodegenerative diseases (Alzheimer's disease, multiple sclerosis, Parkinson's disease, Huntington's disease), cerebrovascular conditions (stroke), and neurodevelopmental disorders (autism spectrum disorder). Although they affect millions of individuals around the world, only a limited number of effective treatment options are available today. Since most neurological disorders express mitochondria-related metabolic perturbations, metformin, a biguanide type II antidiabetic drug, has attracted a lot of attention to be repurposed to treat neurological disorders by correcting their perturbed energy metabolism. However, controversial research emerges regarding the beneficial/detrimental effects of metformin on these neurological disorders. Given that most neurological disorders have complex etiology in their pathophysiology and are influenced by various risk factors such as aging, lifestyle, genetics, and environment, it is important to identify perturbed molecular functions that can be targeted by metformin in these neurological disorders. These molecules can then be used as biomarkers to stratify subpopulations of patients who show distinct molecular/pathological properties and can respond to metformin treatment, ultimately developing targeted therapy. In this review, we will discuss mitochondria-related metabolic perturbations and impaired molecular pathways in these neurological disorders and how these can be used as biomarkers to guide metformin-responsive treatment for the targeted therapy to treat neurological disorders.
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Affiliation(s)
- Allison Loan
- Regenerative Medicine Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Biology, Faculty of Science, University of Ottawa, Ottawa, ON, Canada
| | - Charvi Syal
- Regenerative Medicine Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Margarita Lui
- Regenerative Medicine Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Ling He
- Department of Pediatrics and Medicine, Johns Hopkins Medical School, Baltimore, MD, USA
| | - Jing Wang
- Regenerative Medicine Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- University of Ottawa Brain and Mind Research Institute, Ottawa, ON, Canada
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22
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Ahn AB, Kulhari S, Karimi A, Sundararajan S, Sajatovic M. Readability of patient education material in stroke: a systematic literature review. Top Stroke Rehabil 2024; 31:345-360. [PMID: 37724783 DOI: 10.1080/10749357.2023.2259177] [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: 07/10/2023] [Accepted: 09/09/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Stroke education materials are crucial for the recovery of stroke patients, but their effectiveness depends on their readability. The American Medical Association (AMA) recommends patient education materials be written at a sixth-grade level. Studies show existing paper and online materials exceed patients' reading levels and undermine their health literacy. Low health literacy among stroke patients is associated with worse health outcomes and decreased efficacy of stroke rehabilitation. OBJECTIVE We reviewed the readability of paper (i.e brochures, factsheets, posters) and online (i.e American Stroke Association, Google, Yahoo!) stroke patient education materials, reading level of stroke patients, accessibility of online health information, patients' perceptions on gaps in stroke information, and provided recommendations for improving readability. METHOD A PRISMA-guided systematic literature review was conducted using PUBMED, Google Scholar, and EbscoHost databases and "stroke", "readability of stroke patient education", and "stroke readability" search terms to discover English-language articles. A total of 12 articles were reviewed. RESULTS SMOG scores for paper and online material ranged from 11.0 - 12.0 grade level and 7.8 - 13.95 grade level respectively. Reading level of stroke patients ranged from 3rd grade to 9th grade level or above. Accessibility of online stroke information was high. Structured patient interviews illustrated gaps in patient education materials and difficulty with comprehension. CONCLUSION Paper and online patient education materials exceed the reading level of stroke patients and the AMA recommended 6th grade level. Due to limitations in readability, stroke patients are not being adequately educated about their condition.
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Affiliation(s)
- Aaron B Ahn
- Department of Neurology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Sajal Kulhari
- Department of Neurology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Amir Karimi
- Department of Neurology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Sophia Sundararajan
- Department of Neurology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Martha Sajatovic
- Department of Psychiatry, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
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23
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Elguindy MM, Haddad AF, Lu A, Savastano LE. Minimally Invasive Endoscopic Evacuation of Cerebellar Intracerebral Hemorrhage: An Illustrative Case Report. Stroke 2024; 55:e144-e147. [PMID: 38511319 DOI: 10.1161/strokeaha.123.045924] [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: 03/22/2024]
Affiliation(s)
- Mahmoud M Elguindy
- Department of Neurological Surgery, University of California, San Francisco
| | - Alexander F Haddad
- Department of Neurological Surgery, University of California, San Francisco
| | - Alex Lu
- Department of Neurological Surgery, University of California, San Francisco
| | - Luis E Savastano
- Department of Neurological Surgery, University of California, San Francisco
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24
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Broocks G, McDonough RV, Bechstein M, Klapproth S, Faizy TD, Schön G, Kniep HC, Bester M, Hanning U, Kemmling A, Zeleñák K, Fiehler J, Meyer L. Thrombectomy in Patients With Ischemic Stroke Without Salvageable Tissue on CT Perfusion. Stroke 2024; 55:1317-1325. [PMID: 38572635 DOI: 10.1161/strokeaha.123.044916] [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: 08/21/2023] [Accepted: 02/22/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Computed tomography perfusion (CTP) imaging is regularly used to guide patient selection for mechanical thrombectomy (MT). However, the effect of MT in patients without salvageable tissue on CTP has not been investigated. The purpose of this study was to assess the effect of MT in patients with stroke without perfusion mismatch profiles. METHODS This observational study analyzed patients with ischemic stroke consecutively treated between March 1, 2015, and January 31, 2022, triaged by multimodal-computed tomography undergoing MT. CTP lesion-core mismatch profiles were defined using a mismatch volume/ratio of ≥10 mL/1.2, respectively. The primary end point was the rate of functional independence at 90 days, defined as the modified Rankin Scale score of 0 to 2. Recanalization was evaluated with the modified Thrombolysis in Cerebral Infarction scale. The effect of baseline variables on functional outcome was assessed using multivariable logistic regression analysis. Outcomes of patients with and without CTP-mismatch profiles were compared using 1:1 propensity score matching. RESULTS Of 724 patients who met the inclusion criteria of this retrospective observational study, 110 (15%) patients had no CTP mismatch and were analyzed. The median age was 74 (interquartile range, 62-80) years and 53% were women. Successful recanalization (modified Thrombolysis in Cerebral Infarction score, ≥2b) was achieved in 66% (73) and associated with functional independence at 90 days (adjusted odds ratio, 7.33 [95% CI, 1.22-43.70]; P=0.03). A significant interaction was observed between recanalization and age, as well as the extent of infarction, indicating MT to be most effective in patients <70 years and with a baseline Alberta Stroke Program Early Computed Tomography Score range between 3 and 7. These findings remained stable after propensity score matching, analyzing 152 matched pairs with similar rates of functional independence between patients with and without CTP-mismatch profiles (17% versus 23%; P=0.42). CONCLUSIONS In patients without CTP-mismatch profiles defined according to the EXTEND (Extending the Time for Thrombolysis in Emergency Neurological Deficits) criteria, recanalization was associated with improved functional outcomes. This effect was associated with baseline Alberta Stroke Program Early Computed Tomography Score and age, but not with the time from onset to imaging.
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Affiliation(s)
- Gabriel Broocks
- Department of Diagnostic and Interventional Neuroradiology (G.B., R.V.M., M.B., S.K., T.D.F., H.C.K., M.B., U.H., J.F., L.M.), University Medical Center Hamburg-Eppendorf, Germany
- Department of Neuroradiology, HELIOS Medical Center, Campus of MSH Medical School Hamburg, Schwerin, Germany (G.B.)
| | | | - Matthias Bechstein
- Department of Diagnostic and Interventional Neuroradiology (G.B., R.V.M., M.B., S.K., T.D.F., H.C.K., M.B., U.H., J.F., L.M.), University Medical Center Hamburg-Eppendorf, Germany
| | - Susan Klapproth
- Department of Diagnostic and Interventional Neuroradiology (G.B., R.V.M., M.B., S.K., T.D.F., H.C.K., M.B., U.H., J.F., L.M.), University Medical Center Hamburg-Eppendorf, Germany
| | - Tobias D Faizy
- Department of Diagnostic and Interventional Neuroradiology (G.B., R.V.M., M.B., S.K., T.D.F., H.C.K., M.B., U.H., J.F., L.M.), University Medical Center Hamburg-Eppendorf, Germany
| | - Gerhard Schön
- Institute of Medical Biometry and Epidemiology (G.S.) University Medical Center Hamburg-Eppendorf, Germany
| | - Helge C Kniep
- Department of Diagnostic and Interventional Neuroradiology (G.B., R.V.M., M.B., S.K., T.D.F., H.C.K., M.B., U.H., J.F., L.M.), University Medical Center Hamburg-Eppendorf, Germany
| | - Maxim Bester
- Department of Diagnostic and Interventional Neuroradiology (G.B., R.V.M., M.B., S.K., T.D.F., H.C.K., M.B., U.H., J.F., L.M.), University Medical Center Hamburg-Eppendorf, Germany
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology (G.B., R.V.M., M.B., S.K., T.D.F., H.C.K., M.B., U.H., J.F., L.M.), University Medical Center Hamburg-Eppendorf, Germany
| | - André Kemmling
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Marburg, Marburg, Germany (A.K.)
| | - Kamil Zeleñák
- Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.)
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology (G.B., R.V.M., M.B., S.K., T.D.F., H.C.K., M.B., U.H., J.F., L.M.), University Medical Center Hamburg-Eppendorf, Germany
| | - Lukas Meyer
- Department of Diagnostic and Interventional Neuroradiology (G.B., R.V.M., M.B., S.K., T.D.F., H.C.K., M.B., U.H., J.F., L.M.), University Medical Center Hamburg-Eppendorf, Germany
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25
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Senff JR, Singh SD, Pasi M, Jolink WMT, Rodrigues MA, Schreuder FHBM, Staals J, Schreuder T, Douwes JPJ, Talsma J, McKaig BN, Kourkoulis C, Yechoor N, Anderson CD, Puy L, Cordonnier C, Wermer MJH, Rothwell PM, Rosand J, Klijn CJM, Al-Shahi Salman R, Rinkel GJE, Viswanathan A, Goldstein JN, Brouwers HB. Long-Term Outcomes in Patients With Spontaneous Cerebellar Hemorrhage: An International Cohort Study. Stroke 2024; 55:1210-1217. [PMID: 38487876 DOI: 10.1161/strokeaha.123.044622] [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: 07/26/2023] [Accepted: 12/13/2023] [Indexed: 04/19/2024]
Abstract
BACKGROUND Spontaneous intracerebral hemorrhage (ICH) in the cerebellum has a poor short-term prognosis, whereas data on the long-term case fatality and recurrent vascular events are sparse. Herewith, we aimed to assess the long-term case fatality and recurrence rate of vascular events after a first cerebellar ICH. METHODS In this international cohort study, we included patients from 10 hospitals (the United States and Europe from 1997 to 2017) aged ≥18 years with a first spontaneous cerebellar ICH who were discharged alive. Data on long-term case fatality and recurrence of vascular events (recurrent ICH [supratentoria or infratentorial], ischemic stroke, myocardial infarction, or major vascular surgery) were collected for survival analysis and absolute event rate calculation. RESULTS We included 405 patients with cerebellar ICH (mean age [SD], 72 [13] years, 49% female). The median survival time was 67 months (interquartile range, 23-100 months), with a cumulative survival rate of 34% at 10-year follow-up (median follow-up time per center ranged: 15-80 months). In the 347 patients with data on vascular events 92 events occurred in 78 patients, after initial cerebellar ICH: 31 (8.9%) patients had a recurrent ICH (absolute event rate, 1.8 per 100 patient-years [95% CI, 1.2-2.6]), 39 (11%) had an ischemic stroke (absolute event rate, 2.3 [95% CI, 1.6-3.2]), 13 (3.7%) had a myocardial infarction (absolute event rate, 0.8 [95% CI, 0.4-1.3]), and 5 (1.4%) underwent major vascular surgery (absolute event rate, 0.3 [95% CI, 0.1-0.7]). The median time to a first vascular event during follow-up was 27 months (interquartile range, 8.7-50 months), with a cumulative hazard of 47% at 10 years. CONCLUSIONS The long-term prognosis of patients who survive a first spontaneous cerebellar ICH is poor and comparable to that of patients who survive a first supratentorial ICH. Further identification of patients at high risk of vascular events following the initial cerebellar ICH is needed. Including patients with cerebellar ICH in randomized controlled trials on secondary prevention of patients with ICH is warranted.
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Affiliation(s)
- Jasper R Senff
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands (J.R.S., S.D.S., J.P.J.D., J.T., G.J.E.R., H.B.B.)
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston (J.R.S., S.D.S., C.K., N.Y., C.D.A., J.R.)
- Department of Neurology (J.R.S., S.D.S., C.K., N.Y., J.R.), Massachusetts General Hospital, Boston
- Center for Genomic Medicine (J.R.S., C.K., N.Y., C.D.A., S.D.S., J.R.), Massachusetts General Hospital, Boston
- Broad Institute, Cambridge (J.R.S., S.D.S., J.R.S., C.K., N.Y., C.D.A., J.R.)
| | - Sanjula D Singh
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands (J.R.S., S.D.S., J.P.J.D., J.T., G.J.E.R., H.B.B.)
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston (J.R.S., S.D.S., C.K., N.Y., C.D.A., J.R.)
- JPK Stroke Center (S.D.S., M.P., A.V.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston
- Department of Neurology (J.R.S., S.D.S., C.K., N.Y., J.R.), Massachusetts General Hospital, Boston
- Center for Genomic Medicine (J.R.S., C.K., N.Y., C.D.A., S.D.S., J.R.), Massachusetts General Hospital, Boston
- Broad Institute, Cambridge (J.R.S., S.D.S., J.R.S., C.K., N.Y., C.D.A., J.R.)
| | - Marco Pasi
- JPK Stroke Center (S.D.S., M.P., A.V.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston
- University Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, France (M.P., L.P., C.C.)
- Neurology Department, University Hospital of Tours, INSERM U1253 iBrain, France (M.P.)
| | - Wilmar M T Jolink
- Department of Neurology, Isala Hospital, Zwolle, the Netherlands (W.M.T.J.)
| | - Mark A Rodrigues
- Centre for Clinical Brain Sciences, The University of Edinburgh, United Kingdom (M.A.R., R.A.-S.S.)
- Department of Neuroradiology, NHS Lothian, United Kingdom (M.A.R.)
| | - Floris H B M Schreuder
- Department of Neurology, Donders Institute for Brain Cognition & Behavior, Radboud University Medical Center, Nijmegen, the Netherlands (F.H.B.M.S., C.J.M.K.)
| | - Julie Staals
- Department of Neurology and School for Cardiovascular Diseases (CARIM), Maastricht University Medical Center, the Netherlands (J.S.)
| | - Tobien Schreuder
- Department of Neurology, Zuyderland Medical Center, Heerlen, the Netherlands (T.S.)
| | - Jules P J Douwes
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands (J.R.S., S.D.S., J.P.J.D., J.T., G.J.E.R., H.B.B.)
| | - Jelmer Talsma
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands (J.R.S., S.D.S., J.P.J.D., J.T., G.J.E.R., H.B.B.)
| | - Brenna N McKaig
- Department of Emergency Medicine (B.N.M., J.N.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston
| | - Christina Kourkoulis
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston (J.R.S., S.D.S., C.K., N.Y., C.D.A., J.R.)
- Department of Neurology (J.R.S., S.D.S., C.K., N.Y., J.R.), Massachusetts General Hospital, Boston
- Center for Genomic Medicine (J.R.S., C.K., N.Y., C.D.A., S.D.S., J.R.), Massachusetts General Hospital, Boston
- Broad Institute, Cambridge (J.R.S., S.D.S., J.R.S., C.K., N.Y., C.D.A., J.R.)
| | - Nirupama Yechoor
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston (J.R.S., S.D.S., C.K., N.Y., C.D.A., J.R.)
- Department of Neurology (J.R.S., S.D.S., C.K., N.Y., J.R.), Massachusetts General Hospital, Boston
- Center for Genomic Medicine (J.R.S., C.K., N.Y., C.D.A., S.D.S., J.R.), Massachusetts General Hospital, Boston
- Broad Institute, Cambridge (J.R.S., S.D.S., J.R.S., C.K., N.Y., C.D.A., J.R.)
| | - Christopher D Anderson
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston (J.R.S., S.D.S., C.K., N.Y., C.D.A., J.R.)
- Center for Genomic Medicine (J.R.S., C.K., N.Y., C.D.A., S.D.S., J.R.), Massachusetts General Hospital, Boston
- Broad Institute, Cambridge (J.R.S., S.D.S., J.R.S., C.K., N.Y., C.D.A., J.R.)
- Department of Neurology, Brigham and Women's Hospital, Boston (C.D.A.)
| | - Laurent Puy
- University Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, France (M.P., L.P., C.C.)
| | - Charlotte Cordonnier
- University Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, France (M.P., L.P., C.C.)
| | | | - Peter M Rothwell
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom (P.M.R.)
| | - Jonathan Rosand
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston (J.R.S., S.D.S., C.K., N.Y., C.D.A., J.R.)
- Department of Neurology (J.R.S., S.D.S., C.K., N.Y., J.R.), Massachusetts General Hospital, Boston
- Center for Genomic Medicine (J.R.S., C.K., N.Y., C.D.A., S.D.S., J.R.), Massachusetts General Hospital, Boston
- Broad Institute, Cambridge (J.R.S., S.D.S., J.R.S., C.K., N.Y., C.D.A., J.R.)
| | - Catharina J M Klijn
- Department of Neurology, Donders Institute for Brain Cognition & Behavior, Radboud University Medical Center, Nijmegen, the Netherlands (F.H.B.M.S., C.J.M.K.)
| | - Rustam Al-Shahi Salman
- Centre for Clinical Brain Sciences, The University of Edinburgh, United Kingdom (M.A.R., R.A.-S.S.)
| | - Gabriël J E Rinkel
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands (J.R.S., S.D.S., J.P.J.D., J.T., G.J.E.R., H.B.B.)
| | - Anand Viswanathan
- JPK Stroke Center (S.D.S., M.P., A.V.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston
| | - Joshua N Goldstein
- Department of Emergency Medicine (B.N.M., J.N.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston
| | - H Bart Brouwers
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands (J.R.S., S.D.S., J.P.J.D., J.T., G.J.E.R., H.B.B.)
- Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands (H.B.B.)
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Li D, Tang T, Hu T, Thomas AM, Li S. Utilization of Optical Coherence Tomography in the Diagnosis of Intraplaque Hemorrhage Causing Severe Basilar Artery Stenosis. Stroke 2024; 55:e132-e133. [PMID: 38465587 DOI: 10.1161/strokeaha.123.045940] [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: 03/12/2024]
Affiliation(s)
- Di Li
- Department of Neurointervention, Dalian Municipal Central Hospital, China (D.L., T.H.)
| | - Tao Tang
- Department of Neurology and Psychiatry, Emergency and Critical Care Medical Center, Beijing Shijitan Hospital (T.T., S.L.), Capital Medical University, China
| | - Teng Hu
- Department of Neurointervention, Dalian Municipal Central Hospital, China (D.L., T.H.)
| | - Aline M Thomas
- The Russell H. Morgan Department of Radiology and Radiological Sciences, the Johns Hopkins University School of Medicine, Baltimore, MD (A.M.T.)
| | - Shen Li
- Department of Neurology and Psychiatry, Emergency and Critical Care Medical Center, Beijing Shijitan Hospital (T.T., S.L.), Capital Medical University, China
- Beijing Institute of Brain Disorders (S.L.), Capital Medical University, China
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27
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Mehdipanah R, Morgenstern LB, Bettger JP, Kwicklis M, Case E, Almendarez E, Lisabeth LD. Caring for Stroke Survivors: Ethnic Differences in Informal Caregiver Needs Among Mexican American and Non-Hispanic White Communities. Stroke 2024; 55:1271-1277. [PMID: 38567501 PMCID: PMC11039376 DOI: 10.1161/strokeaha.123.043275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 02/06/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND After stroke, Mexican American (MA) individuals have worse 90-day neurological, functional, cognitive, and quality of life outcomes and a higher prevalence of poststroke depression compared with non-Hispanic White (NHW) individuals. MA individuals receive more help through informal, unpaid caregiving than NHW individuals. We examined ethnic differences in needs identified by MA and NHW stroke caregivers. METHODS Caregivers were identified from the population-based BASIC study (Brain Attack Surveillance in Corpus Christi) in Nueces County, Texas from October 2019 to November 2021. Responses to the Caregiver Needs and Concerns Checklist were collected at 90-day poststroke to assess caregiver needs. Using the cross-sectional sample, prevalence scores and bivariate analyses were used to examine ethnic differences between Caregiver Needs and Concerns Checklist items. Linear regression was used to examine adjusted associations of ethnicity with the total average needs for each domain. Models were adjusted for patient and caregiver age and sex, caregiver education level, and employment status, patient insurance status, prestroke function, cognitive status, language, and functional outcome at 90 days, intensity and duration of caregiving, presence of other caregivers (paid/unpaid), and cohabitation of patient and caregiver. RESULTS A total of 287 were approached, and 186 stroke caregivers were included with a median age of 54.2 years and 80.1% being women caregivers: 74.3% MA and 25.7% NHW individuals. MA caregivers had significantly lower education ( CONCLUSIONS MA stroke caregivers have greater information needs compared with NHW caregivers and a greater number of needs overall. This information can help improve resources to help with poststroke recovery, improve caregiver well-being, and strengthen health equity.
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Affiliation(s)
| | | | | | | | - Erin Case
- School of Public Health, University of Michigan, Ann Arbor, MI
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28
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Shah JT, Shah KT, Mazori DR, Caplan AS, Hejazi E, Garshick MS, Femia AN. Cardiovascular comorbidities are associated with dermatomyositis: A cross-sectional study in the All of Us Research Program. J Am Acad Dermatol 2024; 90:1013-1016. [PMID: 38160810 PMCID: PMC11015981 DOI: 10.1016/j.jaad.2023.12.037] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 11/29/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Jill T Shah
- NYU Grossman School of Medicine, New York, New York
| | - Keya T Shah
- Department of Medicine, NYU Langone Hospital-Long Island, Mineola, New York
| | - Daniel R Mazori
- NYU Grossman School of Medicine, New York, New York; The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, NYU Langone Health, New York, New York
| | - Avrom S Caplan
- NYU Grossman School of Medicine, New York, New York; The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, NYU Langone Health, New York, New York
| | - Emily Hejazi
- NYU Grossman School of Medicine, New York, New York; The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, NYU Langone Health, New York, New York
| | - Michael S Garshick
- NYU Grossman School of Medicine, New York, New York; The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, NYU Langone Health, New York, New York; Center for the Prevention of Cardiovascular Disease, The Leon H. Charney Division of Cardiology, Department of Medicine, New York University Langone Health, New York, New York
| | - Alisa N Femia
- NYU Grossman School of Medicine, New York, New York; The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, NYU Langone Health, New York, New York.
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Mayer-Suess L, Marto JP, Strambo D, Ntaios G, Nguyen T, Kiechl S, Pechlaner R, Nogueira R, Michel P, Knoflach M. Sex differences in acute stroke metrics and outcome dependent on COVID status. Eur J Neurol 2024; 31:e16221. [PMID: 38288522 DOI: 10.1111/ene.16221] [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] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/10/2023] [Accepted: 01/09/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND AND PURPOSE Biological sex is known to have an impact on quality metrics of acute stroke. We aimed to determine whether COVID positivity accentuates this effect and constitutes worse outcome. METHODS The present analysis was based on the Global COVID-19 Stroke Registry, a retrospective, international, cohort study of consecutive ischemic stroke patients receiving intravenous thrombolysis and/or endovascular thrombectomy between 1 March 2020 and 30 June 2021. We investigated differences between the sexes in patient characteristics, acute stroke metrics as well as post-stroke outcome in COVID-positive and COVID-negative stroke patients undergoing acute revascularization procedures. RESULTS A total of 15,128 patients from 106 centers were recorded in the Global COVID-19 Stroke Registry, 853 (5.6%) of whom were COVID-positive. Overall, COVID-positive individuals were treated significantly slower according to every acute stroke metric compared to COVID-negative patients. We were able to show that key quality indicators in acute stroke treatment were unfavorable for COVID-negative women compared to men (last-seen-well-to-door time + 11 min in women). Furthermore, COVID-negative women had worse 3-month outcomes (3-month modified Rankin Scale score [interquartile range] 3.0 [4.0] vs. 2.0 [3.0]; p < 0.01), even after adjusting for confounders. In COVID-positive individuals no such difference between the sexes, either in acute management metrics or in 3-month outcome, was seen. CONCLUSION Known sex-related differences in acute stroke management exist and extend to times of crisis. Nevertheless, if patients were COVID-19-positive at stroke onset, women and men were treated the same, which could be attributed to structured treatment pathways.
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Affiliation(s)
- Lukas Mayer-Suess
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - João Pedro Marto
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Davide Strambo
- Stroke Centre, Neurology Service, Department of Neurological Sciences, Lausanne University Hospital, Lausanne, Switzerland
| | - George Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Thanh Nguyen
- Department of Neurology, Radiology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Stefan Kiechl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- VASCage, Research Center on Vascular Ageing and Stroke, Innsbruck, Austria
| | - Raimund Pechlaner
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Raul Nogueira
- Departments of Radiology, Neurology and Neurosurgery, Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Patrik Michel
- Stroke Centre, Neurology Service, Department of Neurological Sciences, Lausanne University Hospital, Lausanne, Switzerland
| | - Michael Knoflach
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- VASCage, Research Center on Vascular Ageing and Stroke, Innsbruck, Austria
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Doi T, Langsted A, Nordestgaard BG. Mass changes in remnant cholesterol and LDL cholesterol explain part of the results of gemfibrozil and non-gemfibrozil fibrate trials. J Intern Med 2024; 295:707-710. [PMID: 38343109 DOI: 10.1111/joim.13771] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Affiliation(s)
- Takahito Doi
- Department of Clinical Biochemistry, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark
- The Copenhagen General Population Study, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark
- Faculty of Health and Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anne Langsted
- Department of Clinical Biochemistry, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark
- The Copenhagen General Population Study, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark
- Faculty of Health and Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Børge G Nordestgaard
- Department of Clinical Biochemistry, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark
- The Copenhagen General Population Study, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark
- Faculty of Health and Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Mancia G, Brunström M, Burnier M, Grassi G, Januszewicz A, Kjeldsen SE, Muiesan ML, Thomopoulos C, Tsioufis K, Kreutz R. Rationale for the Inclusion of β-Blockers Among Major Antihypertensive Drugs in the 2023 European Society of Hypertension Guidelines. Hypertension 2024; 81:1021-1030. [PMID: 38477109 PMCID: PMC11025609 DOI: 10.1161/hypertensionaha.124.22821] [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] [Indexed: 03/14/2024]
Abstract
We address the reasons why, unlike other guidelines, in the 2023 guidelines of the European Society of Hypertension β-blockers (BBs) have been regarded as major drugs for the treatment of hypertension, at the same level as diuretics, calcium channel blockers, and blockers of the renin-angiotensin system. We argue that BBs, (1) reduce blood pressure (the main factor responsible for treatment-related protection) not less than other drugs, (2) reduce pooled cardiovascular outcomes and mortality in placebo-controlled trials, in which there has also been a sizeable reduction of all major cause-specific cardiovascular outcomes, (3) have been associated with a lower global cardiovascular protection in 2 but not in several other comparison trials, in which the protective effect of BBs versus the other major drugs has been similar or even greater, with a slightly smaller or no difference of global benefit in large trial meta-analyses and a similar protective effect when comparisons extend to BBs in combination versus other drug combinations. We mention the large number of cardiac and other comorbidities for which BBs are elective drugs, and we express criticism against the exclusion of BBs because of their lower protective effect against stroke in comparison trials, because, for still uncertain reasons, differences in protection against cause-specific events (stroke, heart failure, and coronary disease) have been reported for other major drugs. These partial data cannot replace global benefits as the main deciding factor for drug choice, also because in the general hypertensive population whether and which type of event might occur is unknown.
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Affiliation(s)
| | - Mattias Brunström
- Department of Public Health and Clinical Medicine, Umea University, Sweden (Mattias Brunström)
| | - Michel Burnier
- Faculty of Biology and Medicine, University of Lausanne, Switzerland (Michel Burnier)
| | - Guido Grassi
- Clinica Medica, University Milano-Bicocca, Milan, Italy (G.G.)
| | - Andrzej Januszewicz
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland (A.J.)
| | - Sverre E. Kjeldsen
- Institute for Clinical Medicine, University of Oslo, Norway (S.E.K.)
- Departments of Cardiology and Nephrology, Ullevaal Hospital, Oslo, Norway (S.E.K.)
| | - Maria Lorenza Muiesan
- UOC 2 Medicina, ASST Spedali Civili di Brescia, Department of Clinical and Experimental Sciences, University of Brescia, Italy (M.L.M.)
| | - Costas Thomopoulos
- Department of Cardiology, General Hospital of Athens “Laiko”, Greece (C.T.)
| | - Konstantinos Tsioufis
- First Department of Cardiology, Medical School, University of Athens, Hippokration Hospital, Greece (K.T.)
| | - Reinhold Kreutz
- Charite-Universitaetsmedizin Berlin, Institute of Clinical Pharmacology and Toxicology, Germany (R.K.)
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Labib H, Tjerkstra MA, Coert BA, Post R, Vandertop WP, Verbaan D, Müller MCA. Sodium and Its Impact on Outcome After Aneurysmal Subarachnoid Hemorrhage in Patients With and Without Delayed Cerebral Ischemia. Crit Care Med 2024; 52:752-763. [PMID: 38206089 PMCID: PMC11008454 DOI: 10.1097/ccm.0000000000006182] [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] [Indexed: 01/12/2024]
Abstract
OBJECTIVES To perform a detailed examination of sodium levels, hyponatremia and sodium fluctuations, and their association with delayed cerebral ischemia (DCI) and poor outcome after aneurysmal subarachnoid hemorrhage (aSAH). DESIGN An observational cohort study from a prospective SAH Registry. SETTING Tertiary referral center focused on SAH treatment in the Amsterdam metropolitan area. PATIENTS A total of 964 adult patients with confirmed aSAH were included between 2011 and 2021. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 277 (29%) developed DCI. Hyponatremia occurred significantly more often in DCI patients compared with no-DCI patients (77% vs. 48%). Sodium levels, hyponatremia, hypernatremia, and sodium fluctuations did not predict DCI. However, higher sodium levels were significantly associated with poor outcome in DCI patients (DCI onset -7, DCI +0, +1, +2, +4, +5, +8, +9 d), and in no-DCI patients (postbleed day 6-10 and 12-14). Also, hypernatremia and greater sodium fluctuations were significantly associated with poor outcome in both DCI and no-DCI patients. CONCLUSIONS Sodium levels, hyponatremia, and sodium fluctuations were not associated with the occurrence of DCI. However, higher sodium levels, hypernatremia, and greater sodium fluctuations were associated with poor outcome after aSAH irrespective of the presence of DCI. Therefore, sodium levels, even with mild changes in levels, warrant close attention.
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Affiliation(s)
- Homeyra Labib
- Department of Neurosurgery, Amsterdam UMC location University of Amsterdam, Neurosurgery, Amsterdam, The Netherlands
- Amsterdam Neurosciences, Neurovascular Disorders, Amsterdam, The Netherlands
| | - Maud A Tjerkstra
- Department of Neurosurgery, Amsterdam UMC location University of Amsterdam, Neurosurgery, Amsterdam, The Netherlands
- Amsterdam Neurosciences, Neurovascular Disorders, Amsterdam, The Netherlands
| | - Bert A Coert
- Department of Neurosurgery, Amsterdam UMC location University of Amsterdam, Neurosurgery, Amsterdam, The Netherlands
- Amsterdam Neurosciences, Neurovascular Disorders, Amsterdam, The Netherlands
| | - René Post
- Department of Neurosurgery, Amsterdam UMC location University of Amsterdam, Neurosurgery, Amsterdam, The Netherlands
- Amsterdam Neurosciences, Neurovascular Disorders, Amsterdam, The Netherlands
| | - W Peter Vandertop
- Department of Neurosurgery, Amsterdam UMC location University of Amsterdam, Neurosurgery, Amsterdam, The Netherlands
- Amsterdam Neurosciences, Neurovascular Disorders, Amsterdam, The Netherlands
| | - Dagmar Verbaan
- Department of Neurosurgery, Amsterdam UMC location University of Amsterdam, Neurosurgery, Amsterdam, The Netherlands
- Amsterdam Neurosciences, Neurovascular Disorders, Amsterdam, The Netherlands
| | - Marcella C A Müller
- Department of Intensive Care, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
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Liu C, Wang G, Han W, Tian Q, Li M. Ferroptosis: a potential therapeutic target for stroke. Neural Regen Res 2024; 19:988-997. [PMID: 37862200 PMCID: PMC10749612 DOI: 10.4103/1673-5374.385284] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/05/2023] [Accepted: 08/03/2023] [Indexed: 10/22/2023] Open
Abstract
Ferroptosis is a form of regulated cell death characterized by massive iron accumulation and iron-dependent lipid peroxidation, differing from apoptosis, necroptosis, and autophagy in several aspects. Ferroptosis is regarded as a critical mechanism of a series of pathophysiological reactions after stroke because of iron overload caused by hemoglobin degradation and iron metabolism imbalance. In this review, we discuss ferroptosis-related metabolisms, important molecules directly or indirectly targeting iron metabolism and lipid peroxidation, and transcriptional regulation of ferroptosis, revealing the role of ferroptosis in the progression of stroke. We present updated progress in the intervention of ferroptosis as therapeutic strategies for stroke in vivo and in vitro and summarize the effects of ferroptosis inhibitors on stroke. Our review facilitates further understanding of ferroptosis pathogenesis in stroke, proposes new targets for the treatment of stroke, and suggests that more efforts should be made to investigate the mechanism of ferroptosis in stroke.
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Affiliation(s)
- Chengli Liu
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Guijun Wang
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Wenrui Han
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Qi Tian
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Mingchang Li
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
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Zhou M, Stobbe R, Szczepankiewicz F, Budde M, Buck B, Kate M, Lloret M, Fairall P, Butcher K, Shuaib A, Emery D, Nilsson M, Westin CF, Beaulieu C. Tensor-valued diffusion MRI of human acute stroke. Magn Reson Med 2024; 91:2126-2141. [PMID: 38156813 DOI: 10.1002/mrm.29975] [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] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/18/2023] [Accepted: 11/27/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE Tensor-valued diffusion encoding can disentangle orientation dispersion and subvoxel anisotropy, potentially offering insight into microstructural changes after cerebral ischemia. The purpose was to evaluate tensor-valued diffusion MRI in human acute ischemic stroke, assess potential confounders from diffusion time dependencies, and compare to Monte Carlo diffusion simulations of axon beading. METHODS Linear (LTE) and spherical (STE) b-tensor encoding with inherently different effective diffusion times were acquired in 21 acute ischemic stroke patients between 3 and 57 h post-onset at 3 T in 2.5 min. In an additional 10 patients, STE with 2 LTE yielding different effective diffusion times were acquired for comparison. Diffusional variance decomposition (DIVIDE) was used to estimate microscopic anisotropy (μFA), as well as anisotropic, isotropic, and total diffusional variance (MKA , MKI , MKT ). DIVIDE parameters, and diffusion tensor imaging (DTI)-derived mean diffusivity and fractional anisotropy (FA) were compared in lesion versus contralateral white matter. Monte Carlo diffusion simulations of various cylindrical geometries for all b-tensor protocols were used to interpret parameter measurements. RESULTS MD was ˜40% lower in lesions for all LTE/STE protocols. The DIVIDE parameters varied with effective diffusion time: higher μFA and MKA in lesion versus contralateral white matter for STE with longer effective diffusion time LTE, whereas the shorter effective diffusion time LTE protocol yielded lower μFA and MKA in lesions. Both protocols, regardless of diffusion time, were consistent with simulations of greater beading amplitude and intracellular volume fraction. CONCLUSION DIVIDE parameters depend on diffusion time in acute stroke but consistently indicate neurite beading and larger intracellular volume fraction.
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Affiliation(s)
- Mi Zhou
- Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Robert Stobbe
- Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
- Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | | | - Matthew Budde
- Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Brian Buck
- Neurology, University of Alberta, Edmonton, Alberta, Canada
| | - Mahesh Kate
- Neurology, University of Alberta, Edmonton, Alberta, Canada
| | - Mar Lloret
- Neurology, University of Alberta, Edmonton, Alberta, Canada
| | - Paige Fairall
- Neurology, University of Alberta, Edmonton, Alberta, Canada
| | - Ken Butcher
- School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Ashfaq Shuaib
- Neurology, University of Alberta, Edmonton, Alberta, Canada
| | - Derek Emery
- Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Markus Nilsson
- Clinical Sciences Lund, Lund University, Lund, Scania, Sweden
| | - Carl-Fredrik Westin
- Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Christian Beaulieu
- Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
- Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
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Mohr NL, Krannich A, Jung H, Hulde N, von Dossow V. Intraoperative Blood Pressure Management and Its Effects on Postoperative Delirium After Cardiac Surgery: A Single-Center Retrospective Cohort Study. J Cardiothorac Vasc Anesth 2024; 38:1127-1134. [PMID: 38369449 DOI: 10.1053/j.jvca.2024.01.027] [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: 10/30/2023] [Revised: 01/17/2024] [Accepted: 01/23/2024] [Indexed: 02/20/2024]
Abstract
OBJECTIVES There is accumulating evidence that blood pressure management might be associated with end-organ dysfunction after cardiac surgery. This study aimed to investigate the impact of intraoperative hypotension (IOH) on adverse neurologic outcomes and mortality. DESIGN A single-center retrospective cohort study. SETTING The Heart and Diabetes Centre Bad Oeynhausen NRW, Ruhr-University Bochum. PARTICIPANTS This retrospective cohort study included 31,315 adult patients who underwent elective cardiac surgery at the authors' institution between January 2009 and December 2018. INTERVENTIONS All cardiac surgery procedures except assist device implantation, organ transplantation, and emergency surgery. MEASUREMENTS AND MAIN RESULTS Adverse neurologic outcomes were defined as postoperative delirium and stroke. IOH was defined as mean arterial pressure below 60 mmHg for >2 minutes. The frequency of IOH episodes and the cumulative IOH duration were recorded. The association between IOH and adverse neurologic outcomes was examined with unadjusted statistical analysis and multiple logistic regression analysis. Eight hundred forty-nine (2.9%) patients developed postoperative stroke, and 2,401 (7.7%) patients developed postoperative delirium. The frequency of IOH episodes was independently associated with postoperative delirium in the multiple logistic regression analysis (odds ratio 1.02, 95% CI 1.003-1.03, p < 0.001), whereas there was no association between it and stroke. CONCLUSION This large retrospective monocentric cohort study revealed that increased episodes of IOH were associated with the risk of developing postoperative delirium after cardiac surgery. This might have important clinical implications with respect to careful and precise hemodynamic monitoring and proactive treatment, especially in patients with increased risk for postoperative delirium.
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Affiliation(s)
- Niklas L Mohr
- Institute of Anesthesiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | | | - Hilke Jung
- Institute of Congenital heart diseases, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Nikolai Hulde
- Institute of Anesthesiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Vera von Dossow
- Institute of Anesthesiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-University Bochum, Bad Oeynhausen, Germany.
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Hao X, Yang Y, Qin Y, Lv M, Zhao X, Wu S, Li K. The Effect of Respiratory Muscle Training on Swallowing Function in Patients With Stroke: A Systematic Review and Meta-Analysis. West J Nurs Res 2024; 46:389-399. [PMID: 38545931 DOI: 10.1177/01939459241242533] [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] [Indexed: 04/13/2024]
Abstract
BACKGROUND The improvement of swallowing function after stroke is a significant challenge faced by patients and health care professionals. However, the current evidence synthesis of the effects of respiratory muscle training (RMT) on swallowing function is limited. OBJECTIVE To assess the effectiveness of RMT on swallowing recovery in patients undergoing stroke. METHODS The CKNI, WanFang Data, PubMed, CINAHL, Web of Science, Embase, MEDLINE, and Cochrane Library databases were searched for studies evaluating RMT interventions' effect on swallowing outcomes. Risks of bias were evaluated using the approach recommended by the Cochrane Collaboration tool and a summary of findings table was generated using the GRADE approach. Outcomes were synthesized using a random-effects meta-analysis model. RESULTS RMT interventions reduced the risk of aspiration (SMD = 1.19; 95% CI, 0.53-1.84), the recovery process of water swallowing function (RR = 1.22; 95% CI, 1.05-1.42), and the activity of the swallowing muscles (SMD = 2.91; 95% CI, 2.22-3.61). However, there was no significant effect of RMT on the functional level of oral intake (SMD = 0.70; 95% CI, -0.03 to 1.42). CONCLUSIONS RMT can be regarded as an innovative, auxiliary means in the near future to better manage and improve swallowing function, given its improving effect on work outcomes in this review.
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Affiliation(s)
- Xiaonan Hao
- School of Nursing, Jilin University, Changchun, China
| | - Yuhang Yang
- School of Nursing, Jilin University, Changchun, China
| | - Yuan Qin
- School of Nursing, Jilin University, Changchun, China
| | - Miaohua Lv
- School of Nursing, Jilin University, Changchun, China
| | - Xuetong Zhao
- School of Nursing, Jilin University, Changchun, China
| | - Shuang Wu
- School of Nursing, Jilin University, Changchun, China
| | - Kun Li
- School of Nursing, Jilin University, Changchun, China
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Labori F, Persson J, Svensson M, Bonander C. The impact of stroke on spousal and family income: a difference-in-difference study from Swedish national registries. Top Stroke Rehabil 2024; 31:381-389. [PMID: 37842918 DOI: 10.1080/10749357.2023.2269674] [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: 05/14/2023] [Accepted: 10/08/2023] [Indexed: 10/17/2023]
Abstract
AIM To investigates the financial consequences in the overall population spouses of persons with stroke in Sweden as well as for subgroups based on spouses age, sex and modified Rankin Scale (mRS) of the person with stroke. METHODS The study population consists of spouses aged ≤ 60 during the year of their partner's stroke event. Each spouse was matched to four reference individuals. This longitudinal registry data covers spouses and a reference population between 2005 and 2016. We use difference-in-differences to estimate the impact on individual income from paid work, disposable individual income, and disposable family income. RESULTS The primary analysis shows a small and statistically insignificant decrease on spouses' individual income from paid work and disposable individual income. In the subgroup analysis based on mRS, the largest effect is seen in mRS 4-5, where spouses' individual income from paid work and disposable individual income increases after their partner's stroke. Further, younger female spouses' individual income from paid work decreases by 1 614 EUR (p = 0.008) on average. CONCLUSION The financial consequences are small in the overall population of spouses. However, for some subgroups, younger women, and spouses of persons with stroke and mRS 4-5, the financial consequences are more prominent.
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Affiliation(s)
- Frida Labori
- Health Economics and Policy, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Josefine Persson
- Health Economics and Policy, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Mikael Svensson
- Health Economics and Policy, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, USA
| | - Carl Bonander
- Health Economics and Policy, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Centre for Societal Risk Research, Karlstad University, Karlstad, Sweden
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Boccuto F, Carabetta N, Cacia MA, Kanagala SG, Panuccio G, Torella D, De Rosa S. Clinical impact of cerebral protection during transcatheter aortic valve implantation. Eur J Clin Invest 2024; 54:e14166. [PMID: 38269600 DOI: 10.1111/eci.14166] [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: 10/23/2023] [Revised: 12/12/2023] [Accepted: 12/23/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Embolization of debris can complicate transcatheter aortic valve implantation (TAVI) causing stroke. Cerebral embolism protection (CEP) devices can divert or trap debris. PURPOSE To evaluate the efficacy of CEP during TAVI vs the standard procedure. DATA SOURCES PubMed, SCOPUS and DOAJ 1/01/2014-04/12/2023. STUDY SELECTION Randomized and observational studies comparing CEP versus standard TAVI, according to PRISMA. PRIMARY OUTCOME stroke. SECONDARY OUTCOMES death, bleeding, vascular access complications, acute kidney injury and infarct area. DATA EXTRACTION Two investigators independently assessed study quality and extracted data. DATA SYNTHESIS Twenty-six articles were included (540.247 patients). The primary endpoint was significantly lower (RR = 0.800 95%CI:0.682-0.940; p = 0.007) with CEP. Similarly, death rates were significantly lower with CEP (RR = 0.610 95%CI:0.482-0.771; p < 0.001). No difference was found for bleeding (RR = 1.053 95%CI:0.793-1.398; p = 0.721), vascular complications (RR = 0.937 95%CI:0.820-1.070; p = 0.334) or AKI (RR = 0.982 95%CI:0.754-1.279; p = 0.891). CONCLUSIONS Use of CEP during TAVI is associated with improved outcomes. Future studies will identify patients who benefit most from CEP.
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Affiliation(s)
- Fabiola Boccuto
- Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy
| | - Nicole Carabetta
- Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy
| | - Michele Antonio Cacia
- Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy
| | - Sai Gautham Kanagala
- Department of Internal Medicine, Metropolitan Hospital Center, New York, NY, USA
| | - Giuseppe Panuccio
- Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy
| | - Daniele Torella
- Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
| | - Salvatore De Rosa
- Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy
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Khattar G, Asmar S, Sanayeh EB, Keesari P, Rahi W, Sakr F, Khoury M, Cinelli M, Lee S, Weinberg M, Kowalski M, Parikh V. Unveiling the Hidden Stroke Threat in Patients With Atrial Fibrillation and Primary Hyperparathyroidism. Am J Cardiol 2024; 218:94-101. [PMID: 38452840 DOI: 10.1016/j.amjcard.2024.03.003] [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: 01/09/2024] [Revised: 02/17/2024] [Accepted: 03/01/2024] [Indexed: 03/09/2024]
Abstract
Recent American College of Cardiology (ACC), American Heart Association (AHA), American College of Clinical Pharmacy (ACCP), and Heart Rhythm Society (HRS) guidelines suggest that patients with atrial fibrillation (AF) at intermediate to low annual risk of ischemic stroke can benefit from consideration of factors that might modify their risk of stroke. The role of nontraditional risk factors, such as primary hyperparathyroidism (PHPT), remains unexplored. In our study, we investigated the potential association between PHPT and the risk of ischemic stroke in patients with AF. Using data from the Nationwide Inpatient Sample Database, a retrospective cohort study focused on the adult population with AF, we stratified the participants based on PHPT presence. Demographic information, co-morbidities, and hospitalization details were extracted using International Classification of Diseases, Tenth revision codes. Propensity score matching was applied, encompassing over 20 confounding variables, including the risk factors outlined in the CHA2DS2-VASc (Congestive heart failure (C), Hypertension (H), Age ≥75 years (A₂), Diabetes Mellitus (D), Stroke/Transient Ischemic Attack (TIA)/Thromboembolism (S₂), Vascular disease (V), Age 65-74 years (A), Sex category [female] (Sc)) score. Multivariate logistic regression analysis was performed after matching to assess the independent impact of PHPT as an ischemic stroke risk factor. A total of 2,051 of the identified 395,249 patients with AF had PHPT. The PHPT group had an average age of 74 years and consisted of more women (66.1% vs 53.0%). After matching, it was observed that the PHPT group had longer hospital stays (5 vs 4 days) and higher hospitalization charges ($45,126 vs $36,644). This group exhibited higher rates of ischemic stroke (6.0% vs 4.4%) and mortality (6.3% vs 4.9%). The adjusted outcomes showed a 1.4-fold increased risk for ischemic stroke and a 1.32-fold increased risk for mortality in the PHPT cohort. The subgroup analysis showed a higher incidence of mortality in men with a high CHA2DS2-VASc score. In conclusion, this study highlights a marked association between PHPT and ischemic stroke in patients with AF, independent of the conventional CHA2DS2-VASc score. The potential mechanisms implicated include vascular changes, cardiac dysfunction, and coagulation cascade alterations. The presence of PHPT should be taken into consideration when deciding the assessment of thromboembolic risk.
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Affiliation(s)
- Georges Khattar
- Department of Internal Medicine, Staten Island University Hospital/Northwell Health, Staten Island, New York.
| | - Samer Asmar
- Department of Internal Medicine, Staten Island University Hospital/Northwell Health, Staten Island, New York
| | - Elie Bou Sanayeh
- Department of Internal Medicine, Staten Island University Hospital/Northwell Health, Staten Island, New York
| | - Praneeth Keesari
- Department of Internal Medicine, Staten Island University Hospital/Northwell Health, Staten Island, New York
| | - Wissam Rahi
- Department of Internal Medicine, Lankeneau Medical Center, Wynnewood, Pennsylvania; Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Fouad Sakr
- Department of Internal Medicine, Staten Island University Hospital/Northwell Health, Staten Island, New York
| | - Michel Khoury
- Department of Cardiology, Staten Island University Hospital/Northwell Health, Staten Island, New York
| | - Michael Cinelli
- Department of Cardiology, Staten Island University Hospital/Northwell Health, Staten Island, New York
| | - Samantha Lee
- Department of Cardiology, Staten Island University Hospital/Northwell Health, Staten Island, New York
| | - Mitchell Weinberg
- Department of Interventional Cardiology and Vascular Medicine, Staten Island University Hospital/Northwell Health, Staten Island, New York; Chair of Cardiology, Staten Island University Hospital/Northwell Health, Staten Island, New York
| | - Marcin Kowalski
- Department of Cardiology, Staten Island University Hospital/Northwell Health, Staten Island, New York; Department of Cardiac Electrophysiology, Staten Island University Hospital/Northwell Health, Staten Island, New York; Zucker School of Medicine at Hofstra/Northwell, New York
| | - Valay Parikh
- Department of Cardiology, Staten Island University Hospital/Northwell Health, Staten Island, New York; Department of Cardiac Electrophysiology, Staten Island University Hospital/Northwell Health, Staten Island, New York; Zucker School of Medicine at Hofstra/Northwell, New York
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40
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Cao Z, Zhang J, Lu Z, Chen H, Min J, Hou Y, Wang X, Xu C. Physical Activity, Mental Activity, and Risk of Incident Stroke: A Prospective Cohort Study. Stroke 2024; 55:1278-1287. [PMID: 38533647 DOI: 10.1161/strokeaha.123.044322] [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: 06/24/2023] [Accepted: 02/28/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Cumulative evidence suggests a correlation between physical or mental activity and the risk of stroke. However, the combined impact of these activities on stroke onset remains unexplored. This study identified physical and mental activity patterns using principal component analysis and investigated their associations with risk of incident stroke in the general population. METHODS Our study was sourced from the UK Biobank cohort between 2006 and 2010. Information on physical and mental-related activities were obtained through a touch-screen questionnaire. The incident stroke was diagnosed by physicians and subsequently verified through linkage to Hospital Episode Statistics. Principal component analysis was used to identify potential physical and mental activity patterns. Cox proportional hazard regression models were performed to calculate hazard ratios (HRs) and 95% CIs of incident stroke, adjusting for potential confounders. RESULTS The initial UK Biobank cohort originally consisted of 502 411 individuals, of whom a total of 386 902 participants (aged 38-79 years) without any history of stroke at baseline were included in our study. During a median follow-up of 7.7 years, 6983 (1.8%) cases of stroke were documented. The mean age of the included participants was 55.9 years, and the proportion of women was 55.1%. We found that multiple individual items related to physical and mental activity showed significant associations with risk of stroke. We identified 4 patterns of physical activity and 3 patterns of mental activity using principal component analysis. The adherence to activity patterns of vigorous exercise, housework, and walking predominant patterns were associated with a lower risk of stroke by 17% (HR, 0.83 [95% CI, 0.78-0.89]; 20% (HR, 0.80 [95% CI, 0.75-0.85]; and 20% (HR, 0.80 [95% CI, 0.75-0.86), respectively. Additionally, the transportation predominant pattern (HR, 1.36 [95% CI, 1.28-1.45) and watching TV pattern (HR, 1.43 [95% CI, 1.33-1.53) were found to be significantly associated with a higher risk of stroke. These associations remained consistent across all subtypes of stroke. CONCLUSIONS Activity patterns mainly related to frequent vigorous exercise, housework, and walking were associated with lower risks of stroke and all its subtypes. Our findings provide new insights for promoting suitable patterns of physical and mental activity for primary prevention of stroke.
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Affiliation(s)
- Zhi Cao
- School of Public Health, Hangzhou Normal University, China (Z.C., J.Z., H.C., J.M., X.W., C.X.)
- School of Public Health, Zhejiang University, Hangzhou, China (Z.C.)
| | - Jing Zhang
- School of Public Health, Hangzhou Normal University, China (Z.C., J.Z., H.C., J.M., X.W., C.X.)
| | - Zuolin Lu
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands (Z.L.)
| | - Han Chen
- School of Public Health, Hangzhou Normal University, China (Z.C., J.Z., H.C., J.M., X.W., C.X.)
| | - Jiahao Min
- School of Public Health, Hangzhou Normal University, China (Z.C., J.Z., H.C., J.M., X.W., C.X.)
| | - Yabing Hou
- Yanjing Medical College, Capital Medical University, Beijing, China (Y.H.)
| | - Xiaohe Wang
- School of Public Health, Hangzhou Normal University, China (Z.C., J.Z., H.C., J.M., X.W., C.X.)
- Hangzhou International Urbanology Research Center and Center for Urban Governance Studies, China (X.W., C.X.)
| | - Chenjie Xu
- School of Public Health, Hangzhou Normal University, China (Z.C., J.Z., H.C., J.M., X.W., C.X.)
- Hangzhou International Urbanology Research Center and Center for Urban Governance Studies, China (X.W., C.X.)
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Pacholko A, Iadecola C. Hypertension, Neurodegeneration, and Cognitive Decline. Hypertension 2024; 81:991-1007. [PMID: 38426329 PMCID: PMC11023809 DOI: 10.1161/hypertensionaha.123.21356] [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] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Elevated blood pressure is a well-established risk factor for age-related cognitive decline. Long linked to cognitive impairment on vascular bases, increasing evidence suggests a potential association of hypertension with the neurodegenerative pathology underlying Alzheimer disease. Hypertension is well known to disrupt the structural and functional integrity of the cerebral vasculature. However, the mechanisms by which these alterations lead to brain damage, enhance Alzheimer pathology, and promote cognitive impairment remain to be established. Furthermore, critical questions concerning whether lowering blood pressure by antihypertensive medications prevents cognitive impairment have not been answered. Recent developments in neurovascular biology, brain imaging, and epidemiology, as well as new clinical trials, have provided insights into these critical issues. In particular, clinical and basic findings on the link between neurovascular dysfunction and the pathobiology of neurodegeneration have shed new light on the overlap between vascular and Alzheimer pathology. In this review, we will examine the progress made in the relationship between hypertension and cognitive impairment and, after a critical evaluation of the evidence, attempt to identify remaining knowledge gaps and future research directions that may advance our understanding of one of the leading health challenges of our time.
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Affiliation(s)
- Anthony Pacholko
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY
| | - Costantino Iadecola
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY
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Park M, Jang SI, Hurh K, Park EC, Kim SH. Association between Sudden Sensorineural Hearing Loss and the Risk of Cardio Cerebrovascular Disease. Laryngoscope 2024; 134:2372-2376. [PMID: 37987243 DOI: 10.1002/lary.31186] [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] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/18/2023] [Accepted: 11/02/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVES This study investigated the association between sudden sensorineural hearing loss (SSNHL) and the risk of cardio-cerebrovascular disease (CCVD) among older adults in South Korea. METHODS Data from 38,426 patients in the Korean National Health Insurance Service-Senior Cohort from 2002 to 2019 were collected. The risk of CCVD includes both stroke and acute myocardial infarction. Propensity score matching (1:1) was used to identify pairs of individuals with and without SSNHL (n = 19,213 for cases and controls). Cox proportional hazards regression models were used to analyze the associations between variables. RESULTS Patients with SSNHL had a higher risk of CCVD (hazard ratio [HR] = 1.17, 95% confidence interval [CI] = 1.11-1.24) compared to those without. The risk of CCVD was higher among those who experienced a stroke than those who did not (HR = 1.17 95% CI = 1.10-1.25). Compared to their matched controls, patients with SSNHL were 1.69 times (HR = 1.69 CI = 1.46-1.94) more likely to have CCVD during the first 12 months of the follow-up period. CONCLUSION Older patients with SSNHL are at an increased risk of CCVD. Hence, a more attentive approach featuring aggressive monitoring of patients with SSNHL is required to lessen their risk of CCVD. LEVEL OF EVIDENCE 3 Laryngoscope, 134:2372-2376, 2024.
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Affiliation(s)
- Minah Park
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Preventive Medicine, Eulji University College of Medicine, Daejun, Republic of Korea
| | - Sung-In Jang
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyungduk Hurh
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung Hoon Kim
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Preventive Medicine, Eulji University College of Medicine, Daejun, Republic of Korea
- Department of Ophthalmology, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
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Hostnik JS, Strong B, Reeves MJ. Utilization and Reporting of Patient-Reported Outcome Measures in Randomized Clinical Trials of Acute Stroke (2010-2020). Stroke 2024; 55:1174-1180. [PMID: 38511342 DOI: 10.1161/strokeaha.123.046209] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) describe health status from the perspective of the patient. There is growing interest in incorporating PROMs into clinical trials, but the extent that such measures are used in contemporary stroke trials is uncertain. We sought to determine how often acute stroke trials included PROMs as outcome measures and assessed the completeness of methodological reporting. METHODS We searched MEDLINE for randomized controlled trials published in 9 high-impact journals between 2010 and 2020. Eligible studies were phase 2 or 3 trials that tested therapeutic interventions within 1 month of stroke onset. Using the trial's primary publication and protocol, we abstracted key study characteristics including all primary and secondary outcome measures. We defined PROMs as self-reported measures of quality of life, symptoms, or function collected without interpretation of an external party. RESULTS Of 116 trials that met eligibility, 57 (49%) included at least 1 PROM. Of these, 41 trials (35%) included a PROM in its primary publication, while 16 (14%) identified a PROM in its protocol. Only 1 trial used a PROM as a primary outcome. Among the 57 total trials, the most commonly used measures were Euro-QOL (n=41, 72%), Stroke Impact Scale (n=10, 18%), and Short-Form 36 (n=6, 11%). Trials were more likely to include a PROM if they were published after 2016, were phase 3, or included only hemorrhagic stroke. Of the 41 trials that included a PROM in the primary publication, 40 (97%) provided PROM results, but only 9 (22%) found statistically significant differences between treatment groups. Quality of methodological reporting was generally poor. CONCLUSIONS Half of contemporary acute stroke trials published in high-impact journals listed at least 1 PROM as a secondary outcome, but they played a minor role in the presentation of the final trial results. Inclusion of PROMs in acute stroke trials requires greater attention during both the design and reporting phases of the trial. REGISTRATION URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42019128727.
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Affiliation(s)
- Joseph S Hostnik
- College of Human Medicine (J.S.H.), Michigan State University, East Lansing
| | - Brent Strong
- Department of Epidemiology and Biostatistics (B.S., M.J.R.), Michigan State University, East Lansing
| | - Mathew J Reeves
- Department of Epidemiology and Biostatistics (B.S., M.J.R.), Michigan State University, East Lansing
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Thirugnanachandran T, Ma H, Donnan GA, Reutens DC, Phan TG. Introducing the Concept of Sanctuary Sites in Ischemic Stroke. Stroke 2024; 55:1405-1408. [PMID: 38533665 DOI: 10.1161/strokeaha.123.046083] [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: 08/06/2023] [Accepted: 02/29/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND The topography of arterial territories has been defined using digital maps of supratentorial infarcts. Regions with a high probability of infarction (Pi) exist in the deep compartment due to a paucity of collaterals. However, less attention has been given to regions with a low Pi. METHODS Using published digital maps, patients with cortical stroke and documented vessel occlusion were included. Infarcts from T2-weighted magnetic resonance images were segmented and registered onto a standard brain template (Montreal Neurological Institute 152). Segmented magnetic resonance images were averaged to yield the Pi at a voxel level. The overall Pi for the combined arterial territories was calculated to ensure that Pi was in the range of 0 to 1. Sanctuary sites were identified as regions with Pi <0.1. RESULTS There were 154 patients (63% men; median age, 69 years; and interquartile range, 57-78 years). The magnetic resonance imaging scan used for segmentation was performed at a median interval of 35 (interquartile range, 3-66) days after stroke onset. Sanctuary sites were present in the frontal (gyrus rectus, the paracentral lobule, and orbitofrontal and precentral gyrus), parietal (postcentral, supramarginal, and angular gyrus, superior and inferior parietal lobule, and precuneus and posterior cingulate), and occipital cortex (cuneus, middle, and superior occipital gyrus). CONCLUSIONS We propose that following vessel occlusion, there are cortical regions with a low Pi, which we termed sanctuary sites. The anatomic basis for this observation is the compensatory capacity of leptomeningeal collaterals.
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Affiliation(s)
- Tharani Thirugnanachandran
- Stroke and Ageing Research (STAR), Department of Medicine, School of Clinical Sciences at Monash Health, Melbourne, Victoria, Australia (T.T., H.M., T.P.)
| | - Henry Ma
- Stroke and Ageing Research (STAR), Department of Medicine, School of Clinical Sciences at Monash Health, Melbourne, Victoria, Australia (T.T., H.M., T.P.)
| | - Geoffrey A Donnan
- Melbourne Brain Centre, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Australia (G.A.D.)
| | - David C Reutens
- Department of Neurology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia, and Centre for Advanced Imaging, University of Queensland, Brisbane, Australia (D.C.R.)
| | - Thanh G Phan
- Stroke and Ageing Research (STAR), Department of Medicine, School of Clinical Sciences at Monash Health, Melbourne, Victoria, Australia (T.T., H.M., T.P.)
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45
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Pai AM, To T, deVeber GA, Nichol D, Kassner A, Ertl-Wagner B, Rafay MF, Dlamini N. Health Inequity and Time From Pediatric Stroke Onset to Arrival. Stroke 2024; 55:1299-1307. [PMID: 38488379 DOI: 10.1161/strokeaha.123.045411] [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: 10/03/2023] [Accepted: 02/06/2024] [Indexed: 04/24/2024]
Abstract
BACKGROUND Time from stroke onset to hospital arrival determines treatment and impacts outcome. Structural, socioeconomic, and environmental factors are associated with health inequity and onset-to-arrival in adult stroke. We aimed to assess the association between health inequity and onset-to-arrival in a pediatric comprehensive stroke center. METHODS A retrospective observational study was conducted on a consecutive cohort of children (>28 days-18 years) diagnosed with acute arterial ischemic stroke (AIS) between 2004 and 2019. Neighborhood-level material deprivation was derived from residential postal codes and used as a proxy measure for health inequity. Patients were stratified by level of neighborhood-level material deprivation, and onset-to-arrival was categorized into 3 groups: <6, 6 to 24, and >24 hours. Association between neighborhood-level material deprivation and onset-to-arrival was assessed in multivariable ordinal logistic regression analyses adjusting for sociodemographic and clinical factors. RESULTS Two hundred and twenty-nine children were included (61% male; median age [interquartile range] at stroke diagnosis 5.8-years [1.1-11.3]). Over the 16-year study period, there was an increase in proportion of children diagnosed with AIS living in the most deprived neighborhoods and arriving at the emergency room within 6 hours (P=0.01). Among Asian patients, a higher proportion lived in the most deprived neighborhoods (P=0.02) and level of material deprivation was associated with AIS risk factors (P=0.001). CONCLUSIONS Our study suggests an increase in pediatric stroke in deprived neighborhoods and certain communities, and earlier arrival times to the emergency room over time. However, whether these changes are due to an increase in incidence of childhood AIS or increased awareness and diagnosis is yet to be determined. The association between AIS risk factors and material deprivation highlights the intersectionality of clinical factors and social determinants of health. Finally, whether material deprivation impacts onset-to-arrival is likely complex and requires further examination.
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Affiliation(s)
- Akshat M Pai
- Division of Neurology (A.M.P., G.A.V., N.D.), The Hospital for Sick Children, Toronto, Canada
- Child Health Evaluative Sciences Program, Research Institute (A.M.P., T.T., G.A.V., N.D.), The Hospital for Sick Children, Toronto, Canada
- Institute of Medical Science (A.M.P., T.T., G.A.V., A.K., N.D.), University of Toronto, Canada
| | - Teresa To
- Child Health Evaluative Sciences Program, Research Institute (A.M.P., T.T., G.A.V., N.D.), The Hospital for Sick Children, Toronto, Canada
- Institute of Medical Science (A.M.P., T.T., G.A.V., A.K., N.D.), University of Toronto, Canada
- Dalla Lana School of Public Health (T.T.), University of Toronto, Canada
| | - Gabrielle A deVeber
- Division of Neurology (A.M.P., G.A.V., N.D.), The Hospital for Sick Children, Toronto, Canada
- Child Health Evaluative Sciences Program, Research Institute (A.M.P., T.T., G.A.V., N.D.), The Hospital for Sick Children, Toronto, Canada
- Institute of Medical Science (A.M.P., T.T., G.A.V., A.K., N.D.), University of Toronto, Canada
| | - Daniel Nichol
- Neurosciences & Mental Health Program, Research Institute (D.N., N.D.), The Hospital for Sick Children, Toronto, Canada
| | - Andrea Kassner
- Division of Translational Medicine (A.K.), The Hospital for Sick Children, Toronto, Canada
- Institute of Medical Science (A.M.P., T.T., G.A.V., A.K., N.D.), University of Toronto, Canada
- Department of Medical Imaging (A.K., B.E.-W.), University of Toronto, Canada
| | - Birgit Ertl-Wagner
- and Division of Neuroradiology (B.E.-W.), The Hospital for Sick Children, Toronto, Canada
- Department of Medical Imaging (A.K., B.E.-W.), University of Toronto, Canada
| | - Mubeen F Rafay
- Section of Pediatric Neurology, Department of Pediatric and Child Health, University of Manitoba, Winnipeg, Canada (M.F.R.)
| | - Nomazulu Dlamini
- Division of Neurology (A.M.P., G.A.V., N.D.), The Hospital for Sick Children, Toronto, Canada
- Child Health Evaluative Sciences Program, Research Institute (A.M.P., T.T., G.A.V., N.D.), The Hospital for Sick Children, Toronto, Canada
- Neurosciences & Mental Health Program, Research Institute (D.N., N.D.), The Hospital for Sick Children, Toronto, Canada
- Institute of Medical Science (A.M.P., T.T., G.A.V., A.K., N.D.), University of Toronto, Canada
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46
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Naeem F, Quinn TJ. Stroke Literature Synopsis (Clinical). Stroke 2024; 55:e138-e139. [PMID: 38648284 DOI: 10.1161/strokeaha.124.046761] [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: 04/25/2024]
Affiliation(s)
- Fariha Naeem
- School of Cardiovascular and Metabolic Health, University of Glasgow, United Kingdom
| | - Terence J Quinn
- School of Cardiovascular and Metabolic Health, University of Glasgow, United Kingdom
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47
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Tjoumakaris SI, Hanel R, Mocco J, Ali-Aziz Sultan M, Froehler M, Lieber BB, Coon A, Tateshima S, Altschul DJ, Narayanan S, El Naamani K, Taussky P, Hoh BL, Meyers P, Gounis MJ, Liebeskind DS, Volovici V, Toth G, Arthur A, Wakhloo AK. ARISE I Consensus Review on the Management of Intracranial Aneurysms. Stroke 2024; 55:1428-1437. [PMID: 38648283 DOI: 10.1161/strokeaha.123.046208] [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: 10/24/2023] [Accepted: 03/19/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Intracranial aneurysms (IAs) remain a challenging neurological diagnosis associated with significant morbidity and mortality. There is a plethora of microsurgical and endovascular techniques for the treatment of both ruptured and unruptured aneurysms. There is no definitive consensus as to the best treatment option for this cerebrovascular pathology. The Aneurysm, Arteriovenous Malformation, and Chronic Subdural Hematoma Roundtable Discussion With Industry and Stroke Experts discussed best practices and the most promising approaches to improve the management of brain aneurysms. METHODS A group of experts from academia, industry, and federal regulators convened to discuss updated clinical trials, scientific research on preclinical system models, management options, screening and monitoring, and promising novel device technologies, aiming to improve the outcomes of patients with IA. RESULTS Aneurysm, Arteriovenous Malformation, and Chronic Subdural Hematoma Roundtable Discussion With Industry and Stroke Experts suggested the incorporation of artificial intelligence to capture sequential aneurysm growth, identify predictors of rupture, and predict the risk of rupture to guide treatment options. The consensus strongly recommended nationwide systemic data collection of unruptured IA radiographic images for the analysis and development of machine learning algorithms for rupture risk. The consensus supported centers of excellence for preclinical multicenter trials in areas such as genetics, cellular composition, and radiogenomics. Optical coherence tomography and magnetic resonance imaging contrast-enhanced 3T vessel wall imaging are promising technologies; however, more data are needed to define their role in IA management. Ruptured aneurysms are best managed at large volume centers, which should include comprehensive patient management with expertise in microsurgery, endovascular surgery, neurology, and neurocritical care. CONCLUSIONS Clinical and preclinical studies and scientific research on IA should engage high-volume centers and be conducted in multicenter collaborative efforts. The future of IA diagnosis and monitoring could be enhanced by the incorporation of artificial intelligence and national radiographic and biologic registries. A collaborative effort between academic centers, government regulators, and the device industry is paramount for the adequate management of IA and the advancement of the field.
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Affiliation(s)
- Stavropoula I Tjoumakaris
- Department of Neurosurgery, Thomas Jefferson University at Sidney Kimmel Medical College, Philadelphia, PA (S.I.T., K.E.N.)
| | - Ricardo Hanel
- Baptist Neurological Institute, Jacksonville, FL (R.H.)
| | - J Mocco
- Department of Neurosurgery, Mount Sinai University Hospital, New York, NY (J.M.)
| | - M Ali-Aziz Sultan
- Department of Neurosurgery, Harvard Medical School, Boston, MA (M.A.-A.S.)
| | - Michael Froehler
- Department of Neurology, Vanderbilt University, Nashville, TN (M.F.)
| | - Barry B Lieber
- Department of Neurology, Tufts School of Medicine, Boston, MA (B.B.L.)
| | - Alexander Coon
- Department of Neurosurgery, Carondelet Neurological Institute of St. Joseph's and St. Mary's Hospitals in Tucson, AZ (A.C.)
| | - Satoshi Tateshima
- Department of Radiology (S.T.), University of California, Los Angeles
| | - David J Altschul
- Department of Neurological Surgery, Einstein Montefiore Medical Center, Bronx, NY (D.J.A.)
| | - Sandra Narayanan
- Department of Neurology, Pacific Neuroscience Institute, Santa Monica, CA (S.N.)
| | - Kareem El Naamani
- Department of Neurosurgery, Thomas Jefferson University at Sidney Kimmel Medical College, Philadelphia, PA (S.I.T., K.E.N.)
| | - Phil Taussky
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, MA (P.T.)
| | - Brian L Hoh
- Department of Neurosurgery, University of Florida, Gainesville (B.L.H.)
| | - Philip Meyers
- Department of Radiology, Saint Luke's Clinic, Boise, ID (P.M.)
| | - Matthew J Gounis
- Department of Radiology, University of Massachusetts, Worcester (M.J.G.)
| | | | - Victor Volovici
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus MC University Medical Center, Rotterdam, the Netherlands (V.V.)
| | - Gabor Toth
- Department of Neurosurgery, Cleveland Clinic, OH (G.T.)
| | - Adam Arthur
- Department of Neurosurgery, Semmes Murphey Clinic, Memphis, TN (A.A.)
| | - Ajay K Wakhloo
- Department of Radiology, Tufts University School of Medicine, Boston, MA (A.K.W.)
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48
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Russo M, Dono F, Onofrj M, Sensi SL. Circulatory shock associated with left insular stroke and chronic steroid treatment. Eur J Neurol 2024; 31:e16225. [PMID: 38299386 DOI: 10.1111/ene.16225] [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: 11/20/2023] [Revised: 01/11/2024] [Accepted: 01/15/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Damage to the insula has been associated with various types of cardiovascular dysfunction, including arrhythmias and blood pressure imbalances. Acute neuroendocrine disturbances following insular damage have also been described. CASE PRESENTATION A 50-year-old right-handed man with a left insular ischemic lesion exhibited aphasia and right central VII nerve palsy. Five days after the stroke, the patient exhibited severe bradycardia and hypotension. He had been treated for ocular trauma with prednisone for the preceding 3 weeks. Cortisol and adrenocorticotropic hormone levels indicated secondary adrenal insufficiency. Despite adequate fluid intake, the patient's blood pressure dropped, requiring norepinephrine administration. Midodrine was also initiated, leading to clinical improvement. The therapy was gradually discontinued as vital signs normalized. By Day 24, electrocardiogram monitoring was unremarkable, hormonal levels normalized, and the neurological examination revealed only mild residual speech fluency impairment. Computed tomography scans confirmed a recovering ischemic lesion of the left insula. CONCLUSIONS This case reveals the inhibitory effect exerted by a left-sided insular stroke on the autonomic system. It also highlights the still largely unexplored neuroendocrine complications of damage to this brain region.
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Affiliation(s)
- Mirella Russo
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
- Center for Advanced Studies and Technology (CAST), "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
- Institute of Neurology, University Hospital of Chieti, Chieti, Italy
| | - Fedele Dono
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
- Center for Advanced Studies and Technology (CAST), "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
- Institute of Neurology, University Hospital of Chieti, Chieti, Italy
| | - Marco Onofrj
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
- Center for Advanced Studies and Technology (CAST), "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
- Institute of Neurology, University Hospital of Chieti, Chieti, Italy
| | - Stefano L Sensi
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
- Center for Advanced Studies and Technology (CAST), "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
- Institute of Neurology, University Hospital of Chieti, Chieti, Italy
- Institute for Advanced Biomedical Technologies (ITAB), "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
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Tsai SS, Wu VCC, Chan YH, Chen DY, Cheng YT, Hung KC, Hsiao FC, Tung YC, Lin CP, Chu PH, Chu Y, Chen SW. Early Surgery for Infective Endocarditis Complicated With Neurologic Injury. J Cardiothorac Vasc Anesth 2024; 38:1161-1168. [PMID: 38467525 DOI: 10.1053/j.jvca.2024.02.011] [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: 10/30/2023] [Revised: 02/05/2024] [Accepted: 02/09/2024] [Indexed: 03/13/2024]
Abstract
OBJECTIVES To estimate the association between early surgery and the risk of mortality in patients with left-sided infective endocarditis in the context of stroke. DESIGN Retrospective cohort study. SETTING This study was a multiinstitution study based on the Chang Gung Research Database, which contains electronic medical records from 7 hospitals in northern and southern Taiwan; these include 2 medical centers, 2 regional hospitals, and 3 district hospitals. PARTICIPANTS Patients with active left-sided infective endocarditis who underwent valve surgery between September 2002 and December 2018. INTERVENTIONS The authors divided patients into 2 groups, with versus without preoperative neurologic complications, had undergone early (within 7 d) or later surgery, and with brain ischemia or hemorrhage. MEASUREMENTS AND MAIN RESULTS Three hundred ninety-two patients with a median time from diagnosis to surgery of 6 days were included. No significant differences in postoperative stroke, in-hospital mortality, or follow-up outcomes were observed between the patients with and without neurologic complications. Among the patients with preoperative neurologic complications, patients who underwent early surgery had a lower 30-day postoperative mortality rate (13.1% v 25.8%; hazard ratio, 0.21; 95% CI 0.07-0.67). In the subgroup analysis of the comparison between brain ischemia and hemorrhage groups, there was no significant between-group difference in the in-hospital outcomes or outcomes after discharge. CONCLUSIONS Early cardiac surgery may be associated with more favorable clinical outcomes in patients with preoperative neurologic complications. Thus, preoperative neurologic complications should not delay surgical interventions.
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Affiliation(s)
- Sing-Siou Tsai
- Department of Education, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Victor Chien-Chia Wu
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Yi-Hsin Chan
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Dong-Yi Chen
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Yu-Ting Cheng
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Kuo-Chun Hung
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Fu-Chih Hsiao
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Ying-Chang Tung
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Chia-Pin Lin
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Pao-Hsien Chu
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Yen Chu
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan; Department of Medical Research and Development, Linkou Medical Center, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, Department of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Shao-Wei Chen
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan; Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.
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50
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Singh SD, Senff JR, van Duijn CM, Rosand J. Treating Hypertension: Important for Heart Health, Fundamental for Brain Health. Stroke 2024; 55:1464-1466. [PMID: 38488382 PMCID: PMC11039372 DOI: 10.1161/strokeaha.123.046179] [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] [Indexed: 04/24/2024]
Abstract
The Brain Health crisis stands as one of humankind's most pressing threats, with age-related noncommunicable brain diseases, particularly stroke, and dementia, affecting hundreds of millions annually and jeopardizing the economic well-being of populations worldwide. Epidemiological studies indicate that ≈40% of dementia and 60% of stroke cases are attributable to modifiable risk factors. In this Comments and Opinions article, we underscore the pivotal role of blood pressure (BP) control in reducing suffering, enhancing economic well-being, and promoting healthy longevity for populations worldwide. Emphasizing that BP control is crucial for both brain and heart health, it advocates for heightened awareness, positioning hypertension as a primary focus for preventing dementia and stroke with potential global impact. Despite its significance, BP control encounters global challenges, with proportions of the population maintaining adequately controlled hypertension ranging from 23% to 90%. The World Health Organization estimated that 46% of the 1.28 billion people with hypertension are unaware of their elevated BP. Given the notable disparities in BP management, addressing BP management also contributes to combating significant health inequalities. The next time you are faced with a patient anxious about the prospect of experiencing a fate similar to a parent with dementia or a sister with a stroke, we suggest a straightforward answer for health care providers: start ensuring BP control. BP is a matter of brain health, and it is a matter of our economic future.
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Affiliation(s)
- Sanjula D. Singh
- Henry and Allison McCance Center for Brain Health, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Jasper R. Senff
- Henry and Allison McCance Center for Brain Health, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | | | - Jonathan Rosand
- Henry and Allison McCance Center for Brain Health, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
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