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Sample records for moderately disabling ischaemic

  1. Assessment of brain tissue injury after moderate hypothermia in neonates with hypoxic–ischaemic encephalopathy: a nested substudy of a randomised controlled trial

    OpenAIRE

    Rutherford, Mary; Ramenghi, Luca A; Edwards, A. David; Brocklehurst, Peter; Halliday, Henry; Levene, Malcolm; Strohm, Brenda; Thoresen, Marianne; Whitelaw, Andrew; Azzopardi, Denis

    2010-01-01

    Summary Background Moderate hypothermia in neonates with hypoxic–ischaemic encephalopathy might improve survival and neurological outcomes at up to 18 months of age, although complete neurological assessment at this age is difficult. To ascertain more precisely the effect of therapeutic hypothermia on neonatal cerebral injury, we assessed cerebral lesions on MRI scans of infants who participated in the Total Body Hypothermia for Neonatal Encephalopathy (TOBY) trial. Methods In the TOBY trial ...

  2. Restraints in daily care for people with moderate intellectual disabilities

    NARCIS (Netherlands)

    van der Meulen, A.P.S.; Hermsen, Maaike; Embregts, P.J.C.M.

    2016-01-01

    Background: Self-determination is an important factor in improving the quality of life of people with moderate intellectual disabilities. A focus on self-determination implies that restraints on the freedom of people with intellectual disabilities should be decreased. In addition, according to the D

  3. Restraints in daily care for people with moderate intellectual disabilities

    NARCIS (Netherlands)

    van der Meulen, A.P.S.; Hermsen, Maaike; Embregts, P.J.C.M.

    2017-01-01

    Background: Self-determination is an important factor in improving the quality of life of people with moderate intellectual disabilities. A focus on self-determination implies that restraints on the freedom of people with intellectual disabilities should be decreased. In addition, according to the

  4. Sexuality among Adolescents with Moderate Disabilities: Promoting Positive Sexual Development

    Science.gov (United States)

    Harader, Dana L.; Fullwood, Harry; Hawthorne, Melissa

    2009-01-01

    Adolescents with moderate disabilities are not being given vital information regarding their sexuality and ways to behave responsibly with their peers. This article examines the laws that govern the education of all persons with disabilities, how societal norms and attitudes have contributed to this lack of sexuality knowledge, how these…

  5. Parental Education Moderates Genetic Influences on Reading Disability

    OpenAIRE

    Friend, Angela; DeFries, John C.; Olson, Richard K.

    2008-01-01

    Environmental moderation of the level of genetic influence on children's reading disabilities (RD) was explored in a sample of 545 identical and fraternal twins (mean age = 11.5 years). Parents' years of education, which are correlated with a broad range of environmental factors related to reading development, were significantly related to the level of genetic influence on reading disability (t = 3.23, Prep = .99). Genetic influence was higher and environmental influence was lower among child...

  6. Vector Communication Curriculum: Moderate and Severe, Multiple Disabilities.

    Science.gov (United States)

    Baine, David

    This CD-ROM disk contains a curriculum on vector communication for students with moderate and severe multiple disabilities. Section 1 discusses pragmatic communication, functional analysis of behavior, augmentative and alternative communication, including gestures and signs, use of pictures and pictographs, and low, medium, and high tech…

  7. Parental education moderates genetic influences on reading disability.

    Science.gov (United States)

    Friend, Angela; DeFries, John C; Olson, Richard K

    2008-11-01

    Environmental moderation of the level of genetic influence on children's reading disabilities was explored in a sample of 545 identical and fraternal twins (mean age = 11.5 years). Parents' number of years of education, which is correlated with a broad range of environmental factors related to reading development, was significantly related to the level of genetic influence on reading disability. Genetic influence was higher and environmental influence was lower among children whose parents had a high level of education, compared with children whose parents had a lower level of education. We discuss the implications of these results for behavior genetic and molecular genetic research, for the diagnosis and remediation of reading disabilities, and for policy in public education.

  8. De Novo Mutations in Moderate or Severe Intellectual Disability

    OpenAIRE

    Hamdan, Fadi F; Myriam Srour; Jose-Mario Capo-Chichi; Hussein Daoud; Christina Nassif; Lysanne Patry; Christine Massicotte; Amirthagowri Ambalavanan; Dan Spiegelman; Ousmane Diallo; Edouard Henrion; Alexandre Dionne-Laporte; Anne Fougerat; Pshezhetsky, Alexey V; Sunita Venkateswaran

    2014-01-01

    Genetics is believed to have an important role in intellectual disability (ID). Recent studies have emphasized the involvement of de novo mutations (DNMs) in ID but the extent to which they contribute to its pathogenesis and the identity of the corresponding genes remain largely unknown. Here, we report a screen for DNMs in subjects with moderate or severe ID. We sequenced the exomes of 41 probands and their parents, and confirmed 81 DNMs affecting the coding sequence or consensus splice site...

  9. Short term outcome of therapeutic hypothermia in term infants with moderate to severe hypoxic ischaemic encephalopathy; the Sungai Buloh experience.

    Science.gov (United States)

    See, K C; Jamal, S J Syed; Chiam, M L

    2012-06-01

    This analysis is a case-series to document the outcome of term newborns with hypoxic ischaemic encephalopathy (HIE), enrolled into total body hypothermia therapy, in a tertiary neonatal unit in Malaysia. The method used to achieve total body hypothermia is a novel method using just environmental temperature, without the need of expensive equipment. A total of 17 babies were eligible to be included in this study, from the 1st of January 2010 to the 31st of December 2010. 14 out of 15 babies who had Stage 2 HIE had no neurological deficit at follow-up. All Stage 3 HIE babies passed away. Allowing for the small sample size, we can conclude that total body hypothermia therapy is feasible and is a safe treatment modality for HIE Stage 2 babies in a Malaysian setting, by manipulating environmental temperature to achieve therapeutic hypothermia. Further work is needed to determine the long-term outcome of passive cooling total body hypothermia in Stage 2 HIE babies in Malaysia.

  10. Moderators of the synchrony of change between decreasing depression severity and disability

    NARCIS (Netherlands)

    Verboom, C. E.; Ormel, J.; Nolen, W. A.; Penninx, B. W. J. H.; Sijtsema, J. J.

    2012-01-01

    Verboom CE, Ormel J, Nolen WA, Penninx BWJH, Sijtsema JJ. Moderators of the synchrony of change between decreasing depression severity and disability. Objective: To identify moderators of synchrony of change between depression severity and disability. Method: From a large cohort study with 2 years o

  11. Implementing a Problem-Solving Intervention with Students with Mild to Moderate Disabilities

    Science.gov (United States)

    Cote, Debra L.

    2011-01-01

    Students with mild and moderate disabilities need to be skillful at problem solving. This article provides an overview of a problem-solving intervention designed to teach students with mild and moderate disabilities the skills of problem solving. An explanation of the assessments, materials, instructional outline, and methods is presented.…

  12. Moderators of the synchrony of change between decreasing depression severity and disability

    NARCIS (Netherlands)

    Verboom, C. E.; Ormel, J.; Nolen, W. A.; Penninx, B. W. J. H.; Sijtsema, J. J.

    2012-01-01

    Verboom CE, Ormel J, Nolen WA, Penninx BWJH, Sijtsema JJ. Moderators of the synchrony of change between decreasing depression severity and disability. Objective: To identify moderators of synchrony of change between depression severity and disability. Method: From a large cohort study with 2 years o

  13. Processing of Facial Expressions of Emotions by Adults with Down Syndrome and Moderate Intellectual Disability

    Science.gov (United States)

    Carvajal, Fernando; Fernandez-Alcaraz, Camino; Rueda, Maria; Sarrion, Louise

    2012-01-01

    The processing of facial expressions of emotions by 23 adults with Down syndrome and moderate intellectual disability was compared with that of adults with intellectual disability of other etiologies (24 matched in cognitive level and 26 with mild intellectual disability). Each participant performed 4 tasks of the Florida Affect Battery and an…

  14. Permanent work disability before and after ischaemic heart disease or stroke event: a nationwide population-based cohort study in Sweden.

    Science.gov (United States)

    Ervasti, Jenni; Virtanen, Marianna; Lallukka, Tea; Friberg, Emilie; Mittendorfer-Rutz, Ellenor; Lundström, Erik; Alexanderson, Kristina

    2017-09-29

    We examined the risk of disability pension before and after ischaemic heart disease (IHD) or stroke event, the burden of stroke compared with IHD and which factors predicted disability pension after either event. A population-based cohort study with follow-up 5 years before and after the event. Register data were analysed with general linear modelling with binary and Poisson distributions including interaction tests for event type (IHD/stroke). All people living in Sweden, aged 25‒60 years at the first event year, who had been living in Sweden for 5 years before the event and had no indication of IHD or stroke prior to the index event in 2006‒2008 were included, except for cases in which death occurred within 30 days of the event. People with both IHD and stroke were excluded, resulting in 18 480 cases of IHD (65%) and 9750 stroke cases (35%). Disability pension. Of those going to suffer IHD or stroke event, 25% were already on disability pension a year before the event. The adjusted OR for disability pension at first postevent year was 2.64-fold (95% CI 2.25 to 3.11) for people with stroke compared with IHD. Economic inactivity predicted disability pension regardless of event type (OR=3.40; 95% CI 2.85 to 4.04). Comorbid mental disorder was associated with the greatest risk (OR=3.60; 95% CI 2.69 to 4.83) after an IHD event. Regarding stroke, medical procedure, a proxy for event severity, was the largest contributor (OR=2.27, 95% CI 1.43 to 3.60). While IHD event was more common, stroke involved more permanent work disability. Demographic, socioeconomic and comorbidity-related factors were associated with disability pension both before and after the event. The results help occupational and other healthcare professionals to identify vulnerable groups at risk for permanent labour market exclusion after such an event. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial

  15. Effects of aspirin plus extended-release dipyridamole versus clopidogrel and telmisartan on disability and cognitive function after recurrent stroke in patients with ischaemic stroke in the Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) trial : a double-blind, active and placebo-controlled study

    NARCIS (Netherlands)

    Dienert, Hans-Christoph; Saccot, Ralph L.; Yusuft, Salim; Cotton, Daniel; Ounpuu, Stephanie; Lawton, William A.; Palesch, Yuko; Martin, Renee H.; Albers, Gregory W.; Bath, Philip; Bornstein, Natan; Chan, Bernard P. L.; Chen, Sien-Tsong; Cunha, Luis; Dahlof, Bjorn; De Keyser, Jacques; Donnan, Geoffrey A.; Estol, Conrado; Gorelick, Philip; Gu, Vivian; Hermansson, Karin; Hilbrich, Lutz; Kaste, Markku; Lu, Chuanzhen; Machnig, Thomas; Pais, Prem; Roberts, Robin; Skvortsova, Veronika; Teal, Philip; Toni, Danilo; VanderMaelen, Cam; Voigt, Thor; Weber, Michael; Yoon, Byung-Woo

    2008-01-01

    Background The treatment of ischaemic stroke with neuroprotective drugs has been unsuccessful, and whether these compounds can be used to reduce disability after recurrent stroke is unknown. The putative neuroprotective effects of antiplatelet compounds and the angiotensin II receptor antagonist

  16. De novo mutations in moderate or severe intellectual disability.

    Science.gov (United States)

    Hamdan, Fadi F; Srour, Myriam; Capo-Chichi, Jose-Mario; Daoud, Hussein; Nassif, Christina; Patry, Lysanne; Massicotte, Christine; Ambalavanan, Amirthagowri; Spiegelman, Dan; Diallo, Ousmane; Henrion, Edouard; Dionne-Laporte, Alexandre; Fougerat, Anne; Pshezhetsky, Alexey V; Venkateswaran, Sunita; Rouleau, Guy A; Michaud, Jacques L

    2014-10-01

    Genetics is believed to have an important role in intellectual disability (ID). Recent studies have emphasized the involvement of de novo mutations (DNMs) in ID but the extent to which they contribute to its pathogenesis and the identity of the corresponding genes remain largely unknown. Here, we report a screen for DNMs in subjects with moderate or severe ID. We sequenced the exomes of 41 probands and their parents, and confirmed 81 DNMs affecting the coding sequence or consensus splice sites (1.98 DNMs/proband). We observed a significant excess of de novo single nucleotide substitutions and loss-of-function mutations in these cases compared to control subjects, suggesting that at least a subset of these variations are pathogenic. A total of 12 likely pathogenic DNMs were identified in genes previously associated with ID (ARID1B, CHD2, FOXG1, GABRB3, GATAD2B, GRIN2B, MBD5, MED13L, SETBP1, TBR1, TCF4, WDR45), resulting in a diagnostic yield of ∼29%. We also identified 12 possibly pathogenic DNMs in genes (HNRNPU, WAC, RYR2, SET, EGR1, MYH10, EIF2C1, COL4A3BP, CHMP2A, PPP1CB, VPS4A, PPP2R2B) that have not previously been causally linked to ID. Interestingly, no case was explained by inherited mutations. Protein network analysis indicated that the products of many of these known and candidate genes interact with each other or with products of other ID-associated genes further supporting their involvement in ID. We conclude that DNMs represent a major cause of moderate or severe ID.

  17. De novo mutations in moderate or severe intellectual disability.

    Directory of Open Access Journals (Sweden)

    Fadi F Hamdan

    2014-10-01

    Full Text Available Genetics is believed to have an important role in intellectual disability (ID. Recent studies have emphasized the involvement of de novo mutations (DNMs in ID but the extent to which they contribute to its pathogenesis and the identity of the corresponding genes remain largely unknown. Here, we report a screen for DNMs in subjects with moderate or severe ID. We sequenced the exomes of 41 probands and their parents, and confirmed 81 DNMs affecting the coding sequence or consensus splice sites (1.98 DNMs/proband. We observed a significant excess of de novo single nucleotide substitutions and loss-of-function mutations in these cases compared to control subjects, suggesting that at least a subset of these variations are pathogenic. A total of 12 likely pathogenic DNMs were identified in genes previously associated with ID (ARID1B, CHD2, FOXG1, GABRB3, GATAD2B, GRIN2B, MBD5, MED13L, SETBP1, TBR1, TCF4, WDR45, resulting in a diagnostic yield of ∼29%. We also identified 12 possibly pathogenic DNMs in genes (HNRNPU, WAC, RYR2, SET, EGR1, MYH10, EIF2C1, COL4A3BP, CHMP2A, PPP1CB, VPS4A, PPP2R2B that have not previously been causally linked to ID. Interestingly, no case was explained by inherited mutations. Protein network analysis indicated that the products of many of these known and candidate genes interact with each other or with products of other ID-associated genes further supporting their involvement in ID. We conclude that DNMs represent a major cause of moderate or severe ID.

  18. Physical fitness of people with moderate and considerable intellectual disabilities

    National Research Council Canada - National Science Library

    Marzena Ślężyńska; Grzegorz Mięsok; Kamila Mięsok

    2013-01-01

    Introduction: The aim of the physical activity of the intellectually disabled is the strengthening of health, creating movement habits, promoting active recreation, and maintaining exercise capacity...

  19. BEHAVIORAL PROBLEMS IN CHILDREN WITH MILD AND MODERATE INTELLECTUAL DISABILITY

    Directory of Open Access Journals (Sweden)

    Vesna KOSTIKJ-IVANOVIKJ

    2009-06-01

    Full Text Available Large number of children with intellectual disabilities encounters behavioral problems or show disharmonic behavior within the family, at school and in the community. Researches show that 30-50% of persons with intellectual disabilities have some behavioral problems. The behavior of children with intellectual disabilities depends on many factors: age of the child, level of intellectual disability, cognitive potentials, level of psycho-physical development, differentiation of emotions, communicative skills, social status and conditions of the environment (in the family and the wider community where the child lives. The influence of some of these factors has been analyzed by this research. There are many ins truments (questionnaires, scales that evaluate behavior of persons with intellectual disabilities, and reveal problems that these persons have in their psychosocial development and social life. This research used the AAMD Adaptive behavior Scale (part II and Scale for evaluating behavior of the child in school by authors Bojanin, Savanovikj.

  20. The influence of the snoezelen approach on persons with moderate, severe and profound developmental disabilities

    OpenAIRE

    Likovnik Gorjup, Vesna

    2016-01-01

    The determination of effective educational-therapeutic approaches of work with persons with moderate, severe and profound developmental disabilities, especially with persons with severe and profound developmental disabilities, is of the utmost importance in order to improve their quality of life. The master’s thesis titled “The Influence Of The Snoezelen Approach On Persons With Moderate, Severe And Profound Developmental Disabilities” defines on the basis of theoretical findings snoezele...

  1. Connecting the GPE and APE Curricula for Students with Mild and Moderate Disabilities

    Science.gov (United States)

    Kelly, Luke E.

    2011-01-01

    Many physical educators today face the challenge of including students with mild and moderate disabilities in their general physical education (GPE) programs. While most GPE teachers are willing to modify their instructional methods and activities to accommodate students with disabilities, this may not be enough to adequately address the students'…

  2. Comparative Effects of Spanish and English Vocabulary Instruction for English Language Learners with Moderate Intellectual Disability

    Science.gov (United States)

    Rivera, Christopher J.; Wood, Charles L.; Spooner, Fred

    2012-01-01

    Schools across the country are inadequately prepared to meet the educational needs of English language learners (ELLs), much less the needs of ELLs who also have an intellectual disability (ID). In this exploratory study, three Mexican American elementary students with moderate ID were given vocabulary word instruction in English and Spanish using…

  3. Teaching Personal Finance Mathematical Problem Solving to Individuals with Moderate Intellectual Disability

    Science.gov (United States)

    Root, Jenny; Saunders, Alicia; Spooner, Fred; Brosh, Chelsi

    2017-01-01

    The ability to solve mathematical problems related to purchasing and personal finance is important in promoting skill generalization and increasing independence for individuals with moderate intellectual disabilities (IDs). Using a multiple probe across participant design, this study investigated the effects of modified schema-based instruction…

  4. Effectiveness of Video Modeling to Teach "iPod" Use to Students with Moderate Intellectual Disabilities

    Science.gov (United States)

    Hammond, Diana L.; Whatley, Abigail D.; Ayres, Kevin M.; Gast, David L.

    2010-01-01

    The primary purpose of this study was to examine the effects of video modeling delivered via computer on accurate and independent use of an iPod by three participants with moderate intellectual disabilities. In the context of combined multiple probes across participants and replicated across tasks, three female middle school students learned to…

  5. Grade-Aligned Math Instruction for Secondary Students with Moderate Intellectual Disability

    Science.gov (United States)

    Browder, Diane M.; Jimenez, Bree A.; Trela, Katherine

    2012-01-01

    The purpose of this study was to examine the effects of grade-aligned math instruction on math skill acquisition of four middle schools with moderate intellectual disability. Teachers were trained to follow a task analysis to teach grade-aligned math to middle school students using adapted math problem stories and graphic organizers. The teacher…

  6. Constructing Adulthood in Discussions about the Futures of Young People with Moderate-Profound Intellectual Disabilities

    Science.gov (United States)

    Murphy, Elizabeth; Clegg, Jennifer; Almack, Kathryn

    2011-01-01

    Background: This study examines how those planning futures for young people with moderate-profound intellectual disabilities invoke, deploy and interpret contrasting definitions of adulthood and perceived capacity for autonomy and self-determination. Methods: Twenty-eight young people were followed through transition from children: s to adult…

  7. People with mild to moderate intellectual disability talking about their diabetes and how they manage.

    NARCIS (Netherlands)

    Cardol, M.; Rijken, M.; Schrojenstein Lantman-de Valk, H. van

    2012-01-01

    Background: The prevalence of diabetes is relatively high in people with intellectual disability (ID). However, little is known about how people with ID experience having diabetes and how they manage the condition. Method: Seventeen people with mild to moderate ID who have diabetes were interviewed.

  8. Teaching Personal Finance Mathematical Problem Solving to Individuals with Moderate Intellectual Disability

    Science.gov (United States)

    Root, Jenny; Saunders, Alicia; Spooner, Fred; Brosh, Chelsi

    2017-01-01

    The ability to solve mathematical problems related to purchasing and personal finance is important in promoting skill generalization and increasing independence for individuals with moderate intellectual disabilities (IDs). Using a multiple probe across participant design, this study investigated the effects of modified schema-based instruction…

  9. Comparison of Three Video Perspectives When Using Video Prompting by Students with Moderate Intellectual Disability

    Science.gov (United States)

    Spencer, Galen P.; Mechling, Linda C.; Ivey, Alexandria N.

    2015-01-01

    The purpose of this study was to compare the effects of three video perspectives: point-of-view, scene view, and a combination of point-of-view and scene view on task completion by three young adults with moderate intellectual disability. The comparison was made, using an Adapted Alternating Treatments Design, across three sets of fundamentally…

  10. Grade-Aligned Math Instruction for Secondary Students with Moderate Intellectual Disability

    Science.gov (United States)

    Browder, Diane M.; Jimenez, Bree A.; Trela, Katherine

    2012-01-01

    The purpose of this study was to examine the effects of grade-aligned math instruction on math skill acquisition of four middle schools with moderate intellectual disability. Teachers were trained to follow a task analysis to teach grade-aligned math to middle school students using adapted math problem stories and graphic organizers. The teacher…

  11. Compliance of Children with Moderate to Severe Intellectual Disability to Treadmill Walking: A Pilot Study

    Science.gov (United States)

    Vashdi, E.; Hutzler, Y.; Roth, D.

    2008-01-01

    Background: Individuals with Intellectual Disability (ID) exhibit reduced levels of compliance to exercise, including treadmill walking. The purpose of this study was to measure the effects of several training conditions on compliance to participation in treadmill walking of children with moderate to severe ID. Method: Criteria for compliance were…

  12. Early Detection of Depression and Associated Risk Factors in Adults with Mild/Moderate Intellectual Disability

    Science.gov (United States)

    McGillivray, Jane A.; McCabe, Marita P.

    2007-01-01

    The aim of this study was to determine the presentation and risk factors for depression in adults with mild/moderate intellectual disability (ID). A sample of 151 adults (83 males and 68 females) participated in a semi-structured interview. According to results on the Beck Depression Inventory II, 39.1% of participants evinced symptoms of…

  13. People with mild to moderate intellectual disability talking about their diabetes and how they manage.

    NARCIS (Netherlands)

    Cardol, M.; Rijken, M.; Schrojenstein Lantman-de Valk, H. van

    2012-01-01

    Background: The prevalence of diabetes is relatively high in people with intellectual disability (ID). However, little is known about how people with ID experience having diabetes and how they manage the condition. Method: Seventeen people with mild to moderate ID who have diabetes were interviewed.

  14. People with mild to moderate intellectual disability talking about their diabetes and how they manage.

    NARCIS (Netherlands)

    Cardol, M.; Rijken, M.; Schrojenstein Lantman-de Valk, H.M. van

    2012-01-01

    BACKGROUND: The prevalence of diabetes is relatively high in people with intellectual disability (ID). However, little is known about how people with ID experience having diabetes and how they manage the condition. METHOD: Seventeen people with mild to moderate ID who have diabetes were interviewed.

  15. Determinants of disability and quality of life in mild to moderate Parkinson disease

    NARCIS (Netherlands)

    Muslimovic, D.; Post, B.; Speelman, J.D.; Schmand, B.; de Haan, R.J.

    2008-01-01

    Objective: To identify factors that independently contribute to disability and quality of life (QoL) in patients with mild to moderate Parkinson disease (PD). Methods: A group of 190 patients with PD recruited from outpatient clinics and the Dutch Parkinson’s Disease Association participated in this

  16. Using Progressive Video Prompting to Teach Students with Moderate Intellectual Disability to Shoot a Basketball

    Science.gov (United States)

    Lo, Ya-yu; Burk, Bradley; Burk, Bradley; Anderson, Adrienne L.

    2014-01-01

    The current study examined the effects of a modified video prompting procedure, namely progressive video prompting, to increase technique accuracy of shooting a basketball in the school gymnasium of three 11th-grade students with moderate intellectual disability. The intervention involved participants viewing video clips of an adult model who…

  17. People with Mild to Moderate Intellectual Disability Talking about Their Diabetes and How They Manage

    Science.gov (United States)

    Cardol, M.; Rijken, M.; van Schrojenstein Lantman-de Valk, H.

    2012-01-01

    Background: The prevalence of diabetes is relatively high in people with intellectual disability (ID). However, little is known about how people with ID experience having diabetes and how they manage the condition. Method: Seventeen people with mild to moderate ID who have diabetes were interviewed. A framework on illness perceptions having an…

  18. Effectiveness of Treatment Programmes for Depression among Adults with Mild/Moderate Intellectual Disability

    Science.gov (United States)

    McCabe, M. P.; McGillivray, J. A.; Newton, D. C.

    2006-01-01

    Background: The current study describes the development and evaluation of group treatment programme for people with mild/moderate intellectual disability (ID). Methods: A total of 34 participants (16 males, 18 females) completed the treatment programme and 15 participants (six males, nine females) comprised a control group. Results: Compared to…

  19. Relation between paralinguistic skills and social skills in adults with mild and moderate intellectual disability

    Directory of Open Access Journals (Sweden)

    Đorđević Mirjana

    2016-01-01

    Full Text Available Facial expressions and prosodic acoustic characteristics jointly present paralinguistic features of communication. By analyzing literature, we observe that respondents with intellectual disabilities manifest emphasized difficulties in detecting emotions in tasks of facial and vocal expression. However, we do not know if there are data on how paralinguistic abilities correlate with social skills in adults with intellectual disabilities. This research was conducted in order to determine the relation between the ability of paralinguistic production and paralinguistic understanding, on one side, and social skills on the other side. The sample consisted of 44 adults of both genders with mild (N=22 and moderate intellectual disabilities (N=22, aged between 20 and 50 (M=32.41, SD=9.36. The Paralinguistic scale from the battery for the assessment of communication (The Assessment Battery for Communication, Abaco, Sacco et al., 2008 was used for the assessment of paralinguistic skills, and three subscales of Vineland adaptive behavior scale - teaching form (Sparrow, Cicchetti & Balla, 2006 were used for the assessment of social skills. The results show that the achievement on subscales of Playing and leisure time positively correlated with the ability to understand emotions in communication (r = 0.486, p < 0.05 in respondents with mild intellectual disability. Achievements on the subscales Skills of adapting had a moderate and positive correlation with the ability to understand emotions in communication (r=0.522, p<0.05 in subjects with mild intellectual disability. Statistically significant correlations between the examined variables were not observed in the group of respondents with moderate intellectual disability. We can conclude that in adults with mild intellectual disability the ability to understand emotional paralinguistic elements significantly correlates with the ability to organize social activities and to adapt behavior in social interactions.

  20. Using Science Inquiry Methods to Promote Self-Determination and Problem-Solving Skills for Students with Moderate Intellectual Disability

    Science.gov (United States)

    Miller, Bridget; Doughty, Teresa; Krockover, Gerald

    2015-01-01

    This study investigated the use of guided science inquiry methods with self-monitoring checklists to support problem-solving for students and increased autonomy during science instruction for students with moderate intellectual disability. Three students with moderate intellectual disability were supported in not only accessing the general…

  1. Using Science Inquiry Methods to Promote Self-Determination and Problem-Solving Skills for Students with Moderate Intellectual Disability

    Science.gov (United States)

    Miller, Bridget; Doughty, Teresa; Krockover, Gerald

    2015-01-01

    This study investigated the use of guided science inquiry methods with self-monitoring checklists to support problem-solving for students and increased autonomy during science instruction for students with moderate intellectual disability. Three students with moderate intellectual disability were supported in not only accessing the general…

  2. Effects of aspirin plus extended-release dipyridamole versus clopidogrel and telmisartan on disability and cognitive function after recurrent stroke in patients with ischaemic stroke in the Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) trial : a double-blind, active and placebo-controlled study

    NARCIS (Netherlands)

    Dienert, Hans-Christoph; Saccot, Ralph L.; Yusuft, Salim; Cotton, Daniel; Ounpuu, Stephanie; Lawton, William A.; Palesch, Yuko; Martin, Renee H.; Albers, Gregory W.; Bath, Philip; Bornstein, Natan; Chan, Bernard P. L.; Chen, Sien-Tsong; Cunha, Luis; Dahlof, Bjorn; De Keyser, Jacques; Donnan, Geoffrey A.; Estol, Conrado; Gorelick, Philip; Gu, Vivian; Hermansson, Karin; Hilbrich, Lutz; Kaste, Markku; Lu, Chuanzhen; Machnig, Thomas; Pais, Prem; Roberts, Robin; Skvortsova, Veronika; Teal, Philip; Toni, Danilo; VanderMaelen, Cam; Voigt, Thor; Weber, Michael; Yoon, Byung-Woo

    2008-01-01

    Background The treatment of ischaemic stroke with neuroprotective drugs has been unsuccessful, and whether these compounds can be used to reduce disability after recurrent stroke is unknown. The putative neuroprotective effects of antiplatelet compounds and the angiotensin II receptor antagonist tel

  3. Beyond misconceptions: assessing pain in children with mild to moderate intellectual disability.

    Science.gov (United States)

    Zabalia, Marc

    2013-07-26

    To assess and manage pain in children and adolescents with mild to moderate intellectual disability, healthcare providers need access to updated tools and current knowledge. Recent studies show that these children can verbally express pain and use self-assessment tools accurately. Moreover, they know pain coping strategies. Finally, they show mental imaging skills and are able to recall autobiographical memories. These new data suggest that such children and adolescents could be candidates to for hypno-analgesia protocols and behavioral relaxation.

  4. Beyond misconceptions: Assessing pain in children with mild to moderate intellectual disability

    OpenAIRE

    Marc eZabalia

    2013-01-01

    To assess and manage pain in children and adolescents with mild to moderate intellectual disability, healthcare providers need access to updated tools and current knowledge. Recent studies show that these children can verbally express pain and use self-assessment tools accurately. Moreover, they know pain coping strategies. Finally, they show mental imaging skills and are able to recall autobiographical memories. These new data suggest that such children and adolescents could be candidates to...

  5. Effects of aspirin plus extended-release dipyridamole versus clopidogrel and telmisartan on disability and cognitive function after recurrent stroke in patients with ischaemic stroke in the Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) trial

    DEFF Research Database (Denmark)

    Diener, Hans-Christoph; Sacco, Ralph L; Yusuf, Salim

    2008-01-01

    telmisartan were investigated in the Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) trial. METHODS: Patients who had had an ischaemic stroke were randomly assigned in a two by two factorial design to receive either 25 mg aspirin (ASA) and 200 mg extended-release dipyridamole (ER......-DP) twice a day or 75 mg clopidogrel once a day, and either 80 mg telmisartan or placebo once per day. The predefined endpoints for this substudy were disability after a recurrent stroke, assessed with the modified Rankin scale (mRS) and Barthel index at 3 months, and cognitive function, assessed...... of 2.4 years. Recurrent strokes occurred in 916 (9%) patients randomly assigned to ASA with ER-DP and 898 (9%) patients randomly assigned to clopidogrel; 880 (9%) patients randomly assigned to telmisartan and 934 (9%) patients given placebo had recurrent strokes. mRS scores were not statistically...

  6. Ischaemic penumbra: highlights.

    Science.gov (United States)

    Pestalozza, Isabella F; Di Legge, Silvia; Calabresi, Marco; Lenzi, Gian Luigi

    2002-01-01

    The ischaemic penumbra was described for the first time in the late 1970s as a ring of hypoperfused zone surrounding the region of complete infarction. The penumbral zone is a functionally silent tissue which is able to regain its function if promptly reperfused. This implies that the ischaemic penumbra is not a static but a "dynamic" and "time-dependent" concept. In this paper we describe the role of neuroimmaging tecniques such as single photon emission tomography (SPET), positron emission tomography (PET), and diffusion-weighted and perfusion-weighted magnetic resonance imaging (DWI and PWI) in the study of ischaemic penumbra. These functional imaging techniques have the advantage of giving "in vivo" quantitative estimate of cerebral blood flow (CBF) as well as information on how the ischaemic tissue metabolic changes develop. It follows that, as therapeutic options for treating acute stroke evolve, neuroimaging strategies are assuming an increasingly important role in the initial evaluation and management of the acute ischaemic patient. In this regard, a wide range of therapeutic approaches have been investigated for either ameliorating the perfusion, or interfering with the pathobiochemical cascade leading to ischaemic neuronal damage, or improving endogenous neuroprotection pathways. The "time windows" required for these treatments to be effective varies being rather short for reperfusion and longer for neuroprotection. Salvaging more penumbra would enhance recovery and thereby allow the most appropriate candidate for therapeutic trials to be selected.

  7. Age Moderates the Relationships between Family Functioning and Neck Pain/Disability.

    Science.gov (United States)

    Guzy, Grażyna; Polczyk, Romuald; Szpitalak, Malwina; Vernon, Howard

    2016-01-01

    This cross-sectional clinical study was designed to explore the relationships between family functioning, coping styles, and neck pain and neck disability. It was hypothesized that better family functioning and more effective coping styles would be associated with less pain and pain-related disability. It also was hypothesized that these relationships would be stronger in older people because they have fewer resources, more limited coping styles, and may depend more on their family for support. In this study, 88 women with chronic non-traumatic neck pain completed the Family Assessment Measure (FAM), Coping Inventory for Stressful Situations (CISS), Neck Disability Index (NDI), and a Visual-Analogue Scale (VAS) measuring the subjective intensity of neck pain. Zero-order and partial correlations and hierarchical stepwise regression were performed. CISS was not correlated with the NDI orVAS. Good family functioning was correlated with lower NDI and VAS scores. Age was found to moderate the relationship between the FAM and both NDI and VAS. This relationship was significant and positive in older patients, but non-significant in younger patients. It was concluded that better family functioning is associated with lower neck disability and pain intensity, especially in the case of older women suffering from non-traumatic neck pain.

  8. Beyond misconceptions: Assessing pain in children with mild to moderate intellectual disability

    Directory of Open Access Journals (Sweden)

    Marc eZabalia

    2013-07-01

    Full Text Available To assess and manage pain in children and adolescents with mild to moderate intellectual disability, healthcare providers need access to updated tools and current knowledge. Recent studies show that these children can verbally express pain and use self-assessment tools accurately. Moreover, they know pain coping strategies. Finally, they show mental imaging skills and are able to recall autobiographical memories. These new data suggest that such children and adolescents could be candidates to for hypno-analgesia protocols and behavioral relaxation

  9. A Validity Study of the Working Group's Autobiographical Memory Test for Individuals with Moderate to Severe Intellectual Disability

    Science.gov (United States)

    Pyo, Geunyeong; Ala, Tom; Kyrouac, Gregory A.; Verhulst, Steven J.

    2011-01-01

    The purpose of the present study was to investigate the validity of the Working Group's Autobiographical Memory Test as a dementia screening tool for individuals with moderate to severe intellectual disabilities (ID). Twenty-one participants with Dementia of Alzheimer's Type (DAT) and moderate to severe ID and 42 controls with similar levels of ID…

  10. Clinical trials with neuroprotective drugs in acute ischaemic stroke : are we doing the right thing?

    NARCIS (Netherlands)

    De Keyser, J; Luiten, PG; Sulter, G.

    1999-01-01

    Ischaemic stroke is a leading cause of death and long-lasting disability. Several neuroprotective drugs have been developed that have the potential to limit ischaemic brain damage and improve outcome for patients. While promising results with these drugs have been achieved in animal stroke models, a

  11. Compiling a register of patients with moderate or severe learning disabilities: experience at one United Kingdom general practice

    Science.gov (United States)

    2011-01-01

    Background Identifying patients with learning disabilities within primary care is central to initiatives for improving the health of this population. UK general practitioners (GPs) receive additional income for maintaining registers of patients with learning disabilities as part of the Quality and Outcomes Framework (QOF), and may opt to provide Directed Enhanced Services (DES), which requires practices to maintain registers of patients with moderate or severe learning disabilities and offer them annual health checks. Objectives This paper describes the development of a register of patients with moderate or severe learning disabilities at one UK general practice. Methods A Read code search of one UK general practice's electronic medical records was conducted in order to identify patients with learning disabilities. Confirmation of diagnoses was sought by scrutinising records and GP verification. Cross-referencing with the practice QOF register of patients with learning disabilities of any severity, and the local authority's list of clients with learning disabilities, was performed. Results Of 15 001 patients, 229 (1.5%) were identified by the Read code search as possibly having learning disabilities. Scrutiny of records and GP verification confirmed 64 had learning disabilities and 24 did not, but the presence or absence of learning disability remained unclear in 141 cases. Cross-referencing with the QOF register (n=81) and local authority list (n=49) revealed little overlap. Conclusion Identifying learning disability and assessing its severity are tasks GPs may be unfamiliar with, and relying on Read code searches may result in under-detection. Further research is needed to define optimum strategies for identifying, cross-referencing and validating practice-based registers of patients with learning disabilities. PMID:22479290

  12. Compiling a register of patients with moderate or severe learning disabilities: experience at one United Kingdom general practice.

    Science.gov (United States)

    Lodge, Keri-Michèle; Milnes, David; Gilbody, Simon M

    2011-03-01

    Background Identifying patients with learning disabilities within primary care is central to initiatives for improving the health of this population. UK general practitioners (GPs) receive additional income for maintaining registers of patients with learning disabilities as part of the Quality and Outcomes Framework (QOF), and may opt to provide Directed Enhanced Services (DES), which requires practices to maintain registers of patients with moderate or severe learning disabilities and offer them annual health checks.Objectives This paper describes the development of a register of patients with moderate or severe learning disabilities at one UK general practice.Methods A Read code search of one UK general practice's electronic medical records was conducted in order to identify patients with learning disabilities. Confirmation of diagnoses was sought by scrutinising records and GP verification. Cross-referencing with the practice QOF register of patients with learning disabilities of any severity, and the local authority's list of clients with learning disabilities, was performed.Results Of 15 001 patients, 229 (1.5%) were identified by the Read code search as possibly having learning disabilities. Scrutiny of records and GP verification confirmed 64 had learning disabilities and 24 did not, but the presence or absence of learning disability remained unclear in 141 cases. Cross-referencing with the QOF register (n=81) and local authority list (n=49) revealed little overlap.Conclusion Identifying learning disability and assessing its severity are tasks GPs may be unfamiliar with, and relying on Read code searches may result in under-detection. Further research is needed to define optimum strategies for identifying, cross-referencing and validating practice-based registers of patients with learning disabilities.

  13. Reduction of cervical and respiratory muscle strength in patients with chronic nonspecific neck pain and having moderate to severe disability.

    Science.gov (United States)

    López-de-Uralde-Villanueva, Ibai; Sollano-Vallez, Ernesto; Del Corral, Tamara

    2017-06-11

    To investigate whether patients with chronic nonspecific neck pain and having moderate to severe disability have a greater cervical motor function impairment and respiratory disturbances compared with patients with chronic nonspecific neck pain having mild disability and asymptomatic subjects; and the association between these outcomes in patients with chronic nonspecific neck pain and healthy controls. Cross-sectional study, 44 patients with chronic nonspecific neck pain and 31 healthy subjects participated. The neck disability index was used to divide the patients into 2 groups: 1) mild disability group (scores between 5 and 14 points); and 2) moderate to severe disability group (scores >14 points). Cervical motor function was measured by cervical range of motion, forward head posture, neck flexor, and extensor muscle strength. Respiratory function and maximum respiratory pressures were also measured. Statistically differences were found between the patients with chronic nonspecific neck pain having a moderate to severe disability and the asymptomatic subjects for cervical and respiratory muscle strength. Comparisons between chronic nonspecific neck pain and the asymptomatic groups showed differences for all the variables, except for forward head posture. The regression model determined that strength of cervical flexion explained 36.4 and 45.6% of the variance of maximum inspiratory pressures and maximum expiratory pressures, respectively. Only the chronic nonspecific neck pain group with moderate to severe disability showed differences compared with the healthy subjects. Neck muscle strength could be a good predictor of respiratory muscle function. Implications for rehabilitation Neck pain severity could be closely associated with decreased respiratory pressure in patients with chronic nonspecific neck pain. These findings suggest a new therapeutic approach for patients with moderate to severe disability, such as respiratory muscle training. The regression

  14. Oral antiplatelet therapy for acute ischaemic stroke.

    Science.gov (United States)

    Sandercock, Peter A G; Counsell, Carl; Tseng, Mei-Chiun; Cecconi, Emanuela

    2014-03-26

    In people with acute ischaemic stroke, platelets become activated and can cause blood clots to form and block an artery in the brain, resulting in damage to part of the brain. Such damage gives rise to the symptoms of stroke. Antiplatelet therapy might reduce the volume of brain damaged by ischaemia and also reduce the risk of early recurrent ischaemic stroke, thereby reducing the risk of early death and improving long-term outcomes in survivors. However, antiplatelet therapy might also increase the risk of fatal or disabling intracranial haemorrhage. To assess the efficacy and safety of immediate oral antiplatelet therapy (that is started as soon as possible and no later than two weeks after stroke onset) in people with acute presumed ischaemic stroke. We searched the Cochrane Stroke Group Trials Register (last searched 16 October 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 4, 2013), MEDLINE (June 1998 to May 2013), and EMBASE (June 1998 to May 2013). In 1998, for a previous version of this review, we searched the register of the Antiplatelet Trialists' Collaboration, MedStrategy and contacted relevant drug companies. Randomised trials comparing oral antiplatelet therapy (started within 14 days of the stroke) with control in people with definite or presumed ischaemic stroke. Two review authors independently applied the inclusion criteria and assessed trial quality. For the included trials, they extracted and cross-checked the data. We included eight trials involving 41,483 participants. No new trials have been added since the last update.Two trials testing aspirin 160 mg to 300 mg once daily, started within 48 hours of onset, contributed 98% of the data. The risk of bias was low. The maximum follow-up was six months. With treatment, there was a significant decrease in death or dependency at the end of follow-up (odds ratio (OR) 0.95, 95% confidence interval (CI) 0.91 to 0.99). For every 1000 people treated with

  15. Binge drinking, drinking frequency, and risk of ischaemic heart disease

    DEFF Research Database (Denmark)

    Skov-Ettrup, Lise; Eliasen, Marie; Ekholm, Ola

    2011-01-01

    INTRODUCTION: Light-to-moderate alcohol drinking is associated with a decreased risk of ischaemic heart disease (IHD). However, drinking heavily and in binges has been suggested to increase IHD risk. This complexity makes the issue of binge drinking within the light-to-moderate alcohol range...

  16. Genetics of ischaemic stroke.

    Science.gov (United States)

    Sharma, Pankaj; Yadav, Sunaina; Meschia, James F

    2013-12-01

    Recent advances in genomics and statistical computation have allowed us to begin addressing the genetic basis of stroke at a molecular level. These advances are at the cusp of making important changes to clinical practice of some monogenic forms of stroke and, in the future, are likely to revolutionise the care provided to these patients. In this review we summarise the state of knowledge in ischaemic stroke genetics particularly in the context of how a practicing clinician can best use this knowledge.

  17. Moderate to severe psychological distress, disability, and non-receipt of past year visits to a mental health professional.

    Science.gov (United States)

    Houston, Allison; Gomes, Anne-Marie; Naccarato, Toni

    2016-10-01

    Studies of mental health care received by persons with disabilities who make up a significant group of the U.S. population are limited. This cross-sectional study examined the relationship between disability and non-receipt of past year visits to a mental health professional among individuals with moderate to severe psychological distress. Study participants included a nationally representative sample of 5,566 people with moderate to severe psychological distress, extracted from 2011 to 2013 Integrated Health Interview using the 6-item Kessler Psychological Distress Scale. Self-reported disability domains included vision, hearing, mobility, upper body self-care difficulty, learning difficulty, communication difficulty, and cognition difficulty. Sixty-four percent of participants reported a disability. Logistic regression analyses showed that (adjusting for nativity, other mental health conditions, and chronic pain) people aged 18-64 years old with disabilities have significantly lower odds (OR = 0.52, p people without disabilities. However, foreign-born respondents have significantly higher odds (OR = 2.91; p people aged 65 and above with disabilities have higher non-significant odds (OR = 1.34, p = 0.361) of unmet mental health care services than people without disabilities. Additionally, females have significantly higher odds (OR = 1.63, p = 0.039) than males. Findings indicate the importance of identifying demographic characteristics associated with an increased risk for psychological distress and increased unmet mental health care services among people with and without disabilities. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Using iPads to Teach Inquiry Science to Students with a Moderate to Severe Intellectual Disability: A Pilot Study

    Science.gov (United States)

    Miller, Bridget T.; Krockover, Gerald H.; Doughty, Teresa

    2013-01-01

    Multiple illustrative case studies were used to investigate guided inquiry methods and the benefits of traditional science notebooks versus electronic science notebooks for students with moderate to severe intellectual disabilities. Results indicated students successfully acquired science content and increased motivation through science inquiry…

  19. Peer-Implemented Time Delay Procedures on the Acquisition of Chained Tasks by Students with Moderate and Severe Disabilities

    Science.gov (United States)

    Godsey, Janet Read; Schuster, John W.; Lingo, Amy Shearer; Collins, Belva C.; Kleinert, Harold L.

    2008-01-01

    This study evaluated the effectiveness of and reliability of peer tutors implementing a constant time delay procedure when teaching four high school students with moderate and severe disabilities to prepare foods using picture recipes. We used a multiple probe design across subjects to determine the effectiveness of the peer tutor implemented…

  20. A Comparison of the Social Competence of Children with Moderate Intellectual Disability in Inclusive versus Segregated School Settings

    Science.gov (United States)

    Hardiman, Sharon; Guerin, Suzanne; Fitzsimons, Elaine

    2009-01-01

    This is the first study to compare the social competence of children with moderate intellectual disability in inclusive versus segregated school settings in the Republic of Ireland. A convenience sample was recruited through two large ID services. The sample comprised 45 children across two groups: Group 1 (n = 20; inclusive school) and Group 2 (n…

  1. Demystifying Moderators and Mediators in Intellectual and Developmental Disabilities Research: A Primer and Review of the Literature

    Science.gov (United States)

    Farmer, C.

    2012-01-01

    Background: Intellectual and developmental disability (IDD) researchers have been relatively slow to adopt the search for moderators and mediators, although these variables are key in understanding how and why relationships exist between variables. Although the traditional method of causal steps is useful for describing and understanding…

  2. SENZITIVE COMUNICATION WITH CHILDREN WITH MODERATE INTELLECTUAL DISABILITY TROUGH THE EMOTIONAL-EXPRESIVE PRINCIPLES OF THE ICDP PROGRAME

    Directory of Open Access Journals (Sweden)

    Nergis RAMO AKGJUN

    2011-09-01

    Full Text Available While working with pupils with special educational needs, the necessity of compassion while communicating with them is more obvious. The exchange of emotions between the child and the special educator, as well as the way the special educator responds to them, is fundamental for the further development of their feelings. For this reason, the goal of our research was to confirm the necessity of more sensitive communication while working with pupils with moderate intellectual disability following the emotional-expressive principles of the ICDP program. According to the defined goal, the subject of this research was to gather information regarding the level of sensitive communication in our special educational system, trough special educators' self-evaluation procedure and evaluation of pupils with moderate intellectual disability and their parents. The representative sample was consisted of three groups: special educators, pupils with moderate intellectual disability and their parents. Every group was consisted of twenty examinees or in total the research included 60 participants. The statistical data processing was achieved via tables, graphics and with determination of the R X C Exact Contingency Table. The research results showed strong statistically significant difference in the answers provided by the three groups of examinees. Based on the results, the main conclusion is that during the educational activities in the special educational system, the pupils with moderate intellectual disability have needs for greater sensitivity in the communication and interaction with their special educators.

  3. Comparing Simultaneous Prompting and Constant Time Delay to Teach Leisure Skills to Students with Moderate Intellectual Disability

    Science.gov (United States)

    Seward, Jannike; Schuster, John W.; Ault, Melinda Jones; Collins, Belva C.; Hall, Meada

    2014-01-01

    We compared the effects of simultaneous prompting and constant time delay in teaching two solitaire card games to five high school students with moderate intellectual disability. An adapted alternating treatments within a multiple probe design was used to evaluate the effectiveness and efficiency of the procedures. Both procedures were effective…

  4. Continuous Video Modeling to Prompt Completion of Multi-Component Tasks by Adults with Moderate Intellectual Disability

    Science.gov (United States)

    Mechling, Linda C.; Ayres, Kevin M.; Purrazzella, Kaitlin; Purrazzella, Kimberly

    2014-01-01

    This investigation examined the ability of four adults with moderate intellectual disability to complete multi-component tasks using continuous video modeling. Continuous video modeling, which is a newly researched application of video modeling, presents video in a "looping" format which automatically repeats playing of the video while…

  5. Brief Report: Learning via the Electronic Interactive Whiteboard for Two Students with Autism and a Student with Moderate Intellectual Disability

    Science.gov (United States)

    Yakubova, Gulnoza; Taber-Doughty, Teresa

    2013-01-01

    The effects of a multicomponent intervention (a self-operated video modeling and self-monitoring delivered via an electronic interactive whiteboard (IWB) and a system of least prompts) on skill acquisition and interaction behavior of two students with autism and one student with moderate intellectual disability were examined using a multi-probe…

  6. A Pilot Study of a Test for Visual Recognition Memory in Adults with Moderate to Severe Intellectual Disability

    Science.gov (United States)

    Pyo, Geunyeong; Ala, Tom; Kyrouac, Gregory A.; Verhulst, Steven J.

    2010-01-01

    Objective assessment of memory functioning is an important part of evaluation for Dementia of Alzheimer Type (DAT). The revised Picture Recognition Memory Test (r-PRMT) is a test for visual recognition memory to assess memory functioning of persons with intellectual disabilities (ID), specifically targeting moderate to severe ID. A pilot study was…

  7. Evaluation of Generalized Performance across Materials When Using Video Technology by Students with Autism Spectrum Disorder and Moderate Intellectual Disability

    Science.gov (United States)

    Mechling, Linda C.; Ayres, Kevin M.; Foster, Ashley L.; Bryant, Kathryn J.

    2015-01-01

    The purpose of this study was to evaluate the ability of four high school-aged students with a diagnosis of autism spectrum disorder and moderate intellectual disability to generalize performance of skills when using materials different from those presented through video models. An adapted alternating treatments design was used to evaluate student…

  8. Teaching Core Content Embedded in a Functional Activity to Students with Moderate Intellectual Disability Using a Simultaneous Prompting Procedure

    Science.gov (United States)

    Karl, Jennifer; Collins, Belva C.; Hager, Karen D.; Ault, Melinda Jones

    2013-01-01

    The purpose of this study was to investigate the effects of a simultaneous prompting procedure in teaching four secondary students with moderate intellectual disability to acquire and generalize core content embedded in a functional activity. Data gathered within the context of a multiple probe design revealed that all participants learned the…

  9. An Assistive Computerized System with Tangible User Interfaces for Children with Moderate Intellectual and Learning Disabilities

    Directory of Open Access Journals (Sweden)

    Jihad Mohamad Aljaam

    2011-05-01

    Full Text Available In this paper we propose an assistive learning system for children with moderate intellectual and learning disabilities that supports collaboration, data exploration, communication and creativity. The system offers a wide range of tutorials on basic concepts of elementary sciences with some edutainment games and puzzles based on different tangible user interfaces TUIs. The system can enhance the communications, memorization, reasoning and learning capabilities of the children with special needs. The tutorials contain multimedia elements that help the children understand effectively the topics and allow them to interact and be more proactive. An assessment component is developed to evaluate the children understanding. Parents are actively involved in the learning process by being able to add or customize contents specific to their children. The children can use the TUIs alone and get prompted on all the steps to perform some daily activities like the school day activity, the tooth brushing activity, etc. This will increase their self-reliance and self-dependence.

  10. A qualitative evaluation of a healthy cookery course in Ireland designed for adults with mild to moderate intellectual disability.

    LENUS (Irish Health Repository)

    Bennett, Annemarie E

    2014-08-06

    Adults with an intellectual disability have poorer diets than the general adult population. The Able 2 Cook 4 Health cookery course aims to improve the diets of adults with mild to moderate intellectual disability. This study aims to evaluate the course by obtaining the views of course participants and the views of managers hosting the course. Thirty course participants took part in focus groups. Five managers hosting the course participated in a semi-structured interview. Positive features of the course included the group cooking, social interaction and course instructors. Collaboration between centres hosting the course and participants\\' home environment is needed to help transfer the skills learned to all home settings. The Able 2 Cook 4 Health cookery course provided participants with an important social outlet to learn essential occupational skills. These findings could particularly influence the diets of adults with an intellectual disability moving into independent living.

  11. Factors Predictive of Return to Work After Stroke in Patients With Mild-Moderate Disability in India

    OpenAIRE

    Bonner, Bryant

    2015-01-01

    Background: Successful return to work after stroke may improve economic circumstances, quality of life, and overall life satisfaction but not everyone is able to return to work. Aims: To determine what proportion of previously employed patients return to work after an acute stroke with mild to moderate disability and examine factors associated with successful return to work. Methods: Patient interviews and chart review collected information and assessed anxiety, depression and socia...

  12. Ischaemic optic neuropathy.

    Directory of Open Access Journals (Sweden)

    Hayreh Sohan

    2000-01-01

    Full Text Available Ischaemic optic neuropathy is of two types: anterior (AION and posterior (PION, the first involving the optic nerve head (ONH and the second, the rest of the optic nerve. Pathogenetically AION and PION are very different diseases. AION represents an acute ischaemic disorder of the ONH supplied by the posterior ciliary artery (PCA, while PION has no specific location in the posterior part of the optic nerve and does not represent an ischaemic disorder of any definite artery. The most important step towards a logical understanding of the underlying causes, clinical features, pathogenesis and rational management of AION, is to understand the basic scientific issues involved; these are discussed in some detail. AION clinically is of two types: (1 that due to giant cell arteritis (arteritic AION: A-AION and (2 non-arteritic AION (NA-AION. NA-AION, the more common of the two, is one of the most prevalent and visually crippling diseases in the middle-aged and elderly, and is potentially bilateral. NA-AION is a multifactorial disease, with many risk factors collectively contributing to its development. Although there is no known treatment for NA-AION, reduction of risk factors is important in decreasing chances of involvement of the second eye and of further episodes. Our studies have suggested that nocturnal arterial hypotension is an important risk factor for the development and progression of NA-AION. The role of nocturnal arterial hypotension in the pathogenesis of NA-AION and management of nocturnal hypotension is discussed. Potent antihypertensive drugs, when used aggressively and/or given at bedtime, are emerging as an important risk factor for nocturnal hypotension, and there is some evidence that NA-AION may be occurring as an iatrogenic disease in some individuals. A-AION, by contrast, is an ocular emergency and requires immediate treatment with systemic corticosteroids to prevent further visual loss. The clinical parameters which help to

  13. The relationship between self-regulation skills and academic success in students with mild and moderate intellectual disabilities

    Directory of Open Access Journals (Sweden)

    Kaljača Svetlana

    2016-01-01

    Full Text Available Students with intellectual disabilities (ID have considerable difficulties in adjusting to the requirements of the academic environment. The major risk factors are: cognition deficiency, insufficiently developed adaptive skills, lower levels of self-regulation of behavior, and social and functional incompetence. The goal of this research was to establish the relationship among self-regulation skills, the level of intellectual disability, academic success, and sex in students with mild and moderate intellectual disabilities. The sample included 131 students with mild and moderate ID, of both sexes, between 8 and 24 years of age. Self-Control Rating Scale (SCRS was used to assess the level of self-regulation skills. Academic success of students was expressed as the average grade at the end of the school year. A considerable interrelation was found between the level of adoption of self-regulation skills, the level of intellectual development and general academic success in students with ID. Significant influence of the participants' sex on the quality of self-regulation was found only in participants with moderate ID. Female participants had better achievements than male participants.

  14. Ischaemic heart disease

    DEFF Research Database (Denmark)

    Hansen, Louise Houlberg; Mikkelsen, Søren

    2013-01-01

    Purpose. Correct prehospital diagnosis of ischaemic heart disease (IHD) may accelerate and improve the treatment. We sought to evaluate the accuracy of prehospital diagnoses of ischemic heart diseases assigned by physicians. Methods. The Mobile Emergency Care Unit (MECU) in Odense, Denmark...... to the relevant ward. Of these patients, 40,0% had their preliminary diagnosis of IHD confirmed. 14,1% of all patients admitted to the hospital were diagnosed with nonheart conditions. Preliminary diagnoses of STEMI had an accuracy of 87,5%. Conclusions. The preliminary IHD diagnoses assigned by the MECU...... physicians were acceptable. In case of STEMI patients the diagnostic accuracy was excellent. In this study there was an apparent overtriage....

  15. Teaching Adults with Moderate Intellectual Disability ATM Use via the "iPod"

    Science.gov (United States)

    Scott, Renee; Collins, Belva; Knight, Victoria; Kleinert, Harold

    2013-01-01

    Money management can increase independence and access to communities for individuals with disabilities. Although research on computer-based instruction for teaching banking skills to students with intellectual disability is established, the use of portable electronic devices (e.g., iPod) has not been evaluated. iPods may be an effective, portable,…

  16. Piracetam for acute ischaemic stroke.

    Science.gov (United States)

    Ricci, Stefano; Celani, Maria Grazia; Cantisani, Teresa Anna; Righetti, Enrico

    2012-09-12

    Piracetam has neuroprotective and antithrombotic effects that may help to reduce death and disability in people with acute stroke. This is an update of a Cochrane Review first published in 1999, and previously updated in 2006 and 2009. To assess the effects of piracetam in acute, presumed ischaemic stroke. We searched the Cochrane Stroke Group Trials Register (last searched 15 May 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 2), MEDLINE (1966 to May 2011), EMBASE (1980 to May 2011), and ISI Science Citation Index (1981 to May 2011). We also contacted the manufacturer of piracetam to identify further published and unpublished studies. Randomised trials comparing piracetam with control, with at least mortality reported and entry to the trial within three days of stroke onset. Two review authors extracted data and assessed trial quality and this was checked by the other two review authors. We contacted study authors for missing information. We included three trials involving 1002 patients, with one trial contributing 93% of the data. Participants' ages ranged from 40 to 85 years, and both sexes were equally represented. Piracetam was associated with a statistically non-significant increase in death at one month (approximately 31% increase, 95% confidence interval 81% increase to 5% reduction). This trend was no longer apparent in the large trial after correction for imbalance in stroke severity. Limited data showed no difference between the treatment and control groups for functional outcome, dependence or proportion of patients dead or dependent. Adverse effects were not reported. There is some suggestion (but no statistically significant result) of an unfavourable effect of piracetam on early death, but this may have been caused by baseline differences in stroke severity in the trials. There is not enough evidence to assess the effect of piracetam on dependence.

  17. Spontaneous ischaemic stroke in dogs

    DEFF Research Database (Denmark)

    Gredal, Hanne Birgit; Skerritt, G. C.; Gideon, P.

    2013-01-01

    Translation of experimental stroke research into the clinical setting is often unsuccessful. Novel approaches are therefore desirable. As humans, pet dogs suffer from spontaneous ischaemic stroke and may hence offer new ways of studying genuine stroke injury mechanisms.......Translation of experimental stroke research into the clinical setting is often unsuccessful. Novel approaches are therefore desirable. As humans, pet dogs suffer from spontaneous ischaemic stroke and may hence offer new ways of studying genuine stroke injury mechanisms....

  18. Perceived social support as a moderator between perceived discrimination and subjective well-being among people with physical disabilities in Israel.

    Science.gov (United States)

    Itzick, Michal; Kagan, Maya; Tal-Katz, Patricia

    2017-05-26

    Perceived social support has gained importance as a significant preventive factor of depressive symptoms and as helpful for rebuilding feelings of self-worth and subjective well-being among people with physical disabilities. The current study examined whether perceived social support moderates the association between perceived discrimination and subjective well-being among people with physical disabilities in Israel. Data were collected by means of structured questionnaires among a convenience sample of 433 people with physical disabilities in Israel and hierarchical multiple regression was performed. The findings reveal that perceived social support has a moderating role in the association between perceived discrimination and subjective well-being among people with physical disabilities, such that those with low and moderate levels of perceived social support showed a negative association between perceived discrimination and subjective well-being, while those with high levels of perceived social support showed no association between perceived discrimination and subjective well-being. Findings are discussed in light of the social model of disability, and practical implications are suggested. Implications for Rehabilitation A negative association was found between perceived discrimination and subjective well-being among people with physical disabilities with low and moderate levels of perceived social support. Professionals working with people with physical disabilities must acknowledge the importance of social support for people with physical disabilities and for their families. Professionals working with people with physical disabilities should take a proactive approach to locating disabled people who do not receive or do not have adequate social support and offer them assistance. Professionals working with people with physical disabilities should engage in wide social activities aimed at providing resources and opportunities to service beneficiaries. Society

  19. Participation in daytime activities among people with mild or moderate intellectual disability.

    NARCIS (Netherlands)

    Dusseljee, J.C.E.; Rijken, P.M.; Cardol, M.; Curfs, L.M.G.; Groenewegen, P.P.

    2011-01-01

    Background: Community participation has been defined as performing daytime activities by people while interacting with others. Previous studies on community participation among people with intellectual disability (ID) have mainly focused on the domestic life aspect. This study investigates the varia

  20. Participation in daytime activities among people with mild or moderate intellectual disability.

    NARCIS (Netherlands)

    Dusseljee, J.C.E.; Rijken, P.M.; Cardol, M.; Curfs, L.M.G.; Groenewegen, P.P.

    2011-01-01

    Background Community participation has been defined as performing daytime activities by people while interacting with others. Previous studies on community participation among people with intellectual disability (ID) have mainly focused on the domestic life aspect. This study investigates

  1. Participation in daytime activities among people with mild or moderate intellectual disability.

    NARCIS (Netherlands)

    Dusseljee, J.C.E.; Rijken, P.M.; Cardol, M.; Curfs, L.M.G.; Groenewegen, P.P.

    2011-01-01

    Background: Community participation has been defined as performing daytime activities by people while interacting with others. Previous studies on community participation among people with intellectual disability (ID) have mainly focused on the domestic life aspect. This study investigates the

  2. Vestibulo-Ocular Response and Balance Control in Children and Young Adults with Mild-to-Moderate Intellectual and Developmental Disability: A Pilot Study

    Science.gov (United States)

    Zur, Oz; Ronen, Ayelet; Melzer, Itshak; Carmeli, Eli

    2013-01-01

    The vestibulo-ocular response (VOR) may not be fully developed in children with an intellectual and developmental disability (IDD). This study aimed to identify the presence of VOR deficit in children and young adults with unspecified mild-to-moderate intellectual and developmental disability and its effect on balance control. Twenty-one children…

  3. The association between stress and physical health in parents caring for children with intellectual disabilities is moderated by children's challenging behaviours.

    Science.gov (United States)

    Gallagher, Stephen; Whiteley, Jennifer

    2013-09-01

    The present study examined the moderating role of social support and challenging behaviour on the stress-physical health relationship in parents caring for children with intellectual disabilities. Parents of children with intellectual disabilities (n = 70) reported more physical health problems compared to control parents (n = 45) and were more likely to visit their general practitioner. Furthermore, challenging behaviours, but not social support, moderated this association: parents of children with intellectual disabilities reported poorer physical health when both challenging behaviours and stress were perceived to be high. These findings suggest that interventions need to be directed towards ameliorating the impact of challenging behaviours.

  4. Functional magnetic resonance imaging in chronic ischaemic stroke.

    Science.gov (United States)

    Lake, Evelyn M R; Bazzigaluppi, Paolo; Stefanovic, Bojana

    2016-10-05

    Ischaemic stroke is the leading cause of adult disability worldwide. Effective rehabilitation is hindered by uncertainty surrounding the underlying mechanisms that govern long-term ischaemic injury progression. Despite its potential as a sensitive non-invasive in vivo marker of brain function that may aid in the development of new treatments, blood oxygenation level-dependent (BOLD) functional magnetic resonance imaging (fMRI) has found limited application in the clinical research on chronic stage stroke progression. Stroke affects each of the physiological parameters underlying the BOLD contrast, markedly complicating the interpretation of BOLD fMRI data. This review summarizes current progress on application of BOLD fMRI in the chronic stage of ischaemic injury progression and discusses means by which more information may be gained from such BOLD fMRI measurements. Concomitant measurements of vascular reactivity, neuronal activity and metabolism in preclinical models of stroke are reviewed along with illustrative examples of post-ischaemic evolution in neuronal, glial and vascular function. The realization of the BOLD fMRI potential to propel stroke research is predicated on the carefully designed preclinical research establishing an ischaemia-specific quantitative model of BOLD signal contrast to provide the framework for interpretation of fMRI findings in clinical populations.This article is part of the themed issue 'Interpreting BOLD: a dialogue between cognitive and cellular neuroscience'. © 2016 The Author(s).

  5. Cause-Specific Mortality and Death Certificate Reporting in Adults with Moderate to Profound Intellectual Disability

    Science.gov (United States)

    Tyrer, F.; McGrother, C.

    2009-01-01

    Background: The study of premature deaths in people with intellectual disability (ID) has become the focus of recent policy initiatives in England. This is the first UK population-based study to explore cause-specific mortality in adults with ID compared with the general population. Methods: Cause-specific standardised mortality ratios (SMRs) and…

  6. The occurrence of aggression in children with mild and moderate developmental cognitive disabilities

    OpenAIRE

    Radivojević, Monika

    2012-01-01

    My thesis entitled “The occurrence of aggression in children with mild and moderate developmental cognitive disabilities” is divided into two parts. The first part introduces the phenomenon of aggression and the development of children with mild and moderate dysfunctions in cognitive development, whereas the focus of the second part is on the empirical research, the results acquired through questionnaire survey and the summary results. The essence of my thesis lies in determining the occur...

  7. A comparison of the social competence of children with moderate intellectual disability in inclusive versus segregated school settings.

    LENUS (Irish Health Repository)

    Hardiman, Sharon

    2009-03-01

    This is the first study to compare the social competence of children with moderate intellectual disability in inclusive versus segregated school settings in the Republic of Ireland. A convenience sample was recruited through two large ID services. The sample comprised 45 children across two groups: Group 1 (n=20; inclusive school) and Group 2 (n=25; segregated school). Parents and teachers completed the Strengths and Difficulties Questionnaire and the Adaptive Behaviour Scale-School: 2nd edition. A series of 2 x 2 ANOVAs were carried out on social competence scores using educational placement type (inclusive vs segregated school) and proxy rater (parent vs teacher) as the independent variables. Key findings indicated that children in inclusive schools did not differ significantly from children in segregated schools on the majority of proxy ratings of social competence. This supports the belief that children with intellectual disabilities can function well in different educational settings. Present findings highlight the importance of utilising the functional model of ID when selecting and designing school placements for children with moderate ID.

  8. Possible association between moderate intellectual disability and weight gain in valproic acid–treated patients with epilepsy

    Directory of Open Access Journals (Sweden)

    Tanamachi Y

    2015-04-01

    Full Text Available Yukiko Tanamachi,1 Junji Saruwatari,1 Madoka Noai,1 Ryoko Kamihashi,1 Hiromi Soraoka,1 Yuki Yoshimori,1 Naoki Ogusu,1 Kentaro Oniki,1 Norio Yasui-Furukori,2 Takateru Ishitsu,3,4 Kazuko Nakagawa1,5 1Division of Pharmacology and Therapeutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan; 2Department of Neuropsychiatry, Hirosaki University School of Medicine, Hirosaki, Japan; 3Kumamoto Saishunso National Hospital, Koshi, Japan; 4Kumamoto Ezuko Ryoiku Iryo Center, Kumamoto, Japan; 5Center for Clinical Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan Background: Although patients with moderate intellectual disability (ID are known to have higher rates of being overweight and obese than those without ID, there are no current data regarding the relationship between ID and weight gain in epilepsy patients treated with valproic acid (VPA. Patients and methods: The possible association between moderate ID and an overweight status at the time of initiation of VPA therapy (baseline was investigated using a logistic regression analysis in 143 patients with epilepsy. Among the 119 nonoverweight patients at baseline, the longitudinal association between moderate ID and the weight status during VPA therapy was retrospectively examined using a Cox hazards regression analysis and the generalized estimating equations approach, while also paying careful attention to associations with other patient characteristics. Results: The proportion of patients with moderate ID was 52.4% among the 143 study subjects. The presence of moderate ID was not associated with an overweight status at baseline (P=0.762. Among the nonoverweight patients at baseline, 16 subjects were newly diagnosed as being overweight during treatment with VPA (3.6±2.1 years. The presence of moderate ID was significantly associated with the incidence of an overweight status after starting VPA therapy (adjusted hazard ratio =6.72, P=0.007. The patient age

  9. Co-Teaching Students with Mild to Moderate Disabilities Using Literature-Based Reading Instruction

    Science.gov (United States)

    Swicegood, Philip; Miller, Melinda

    2015-01-01

    Literacy instruction for students with mild to moderate special needs should include authentic literature. Literature-based reading instruction provides time for students to develop new knowledge and strategies in a supportive context. When reading instruction occurs in an inclusion classroom, it also allows time for general education and special…

  10. Brief report: learning via the electronic interactive whiteboard for two students with autism and a student with moderate intellectual disability.

    Science.gov (United States)

    Yakubova, Gulnoza; Taber-Doughty, Teresa

    2013-06-01

    The effects of a multicomponent intervention (a self-operated video modeling and self-monitoring delivered via an electronic interactive whiteboard (IWB) and a system of least prompts) on skill acquisition and interaction behavior of two students with autism and one student with moderate intellectual disability were examined using a multi-probe across students design. Students were taught to operate and view video modeling clips, perform a chain of novel tasks and self-monitor task performance using a SMART Board IWB. Results support the effectiveness of a multicomponent intervention in improving students' skill acquisition. Results also highlight the use of this technology as a self-operated and interactive device rather than a traditional teacher-operated device to enhance students' active participation in learning.

  11. Afrikaans-speaking parents' perceptions of the rights of their children with mild to moderate intellectual disabilities: A descriptive investigation.

    Science.gov (United States)

    Erasmus, Alta; Bornman, Juan; Dada, Shakila

    2016-06-01

    This study aimed to describe the perceptions of Afrikaans-speaking parents regarding the human rights, as defined by the United Nation's Convention on the Rights of the Child (CRC), of their children, aged between 8.0 and 14.11 (years/months), with mild to moderate intellectual disabilities. The underlying premise is that the CRC defines the rights of children, whereas the International Classification of Functioning, Disability and Health, Child and Youth version (ICF-CY) can provide the framework for documenting a deprivation of rights and the conditions under which those rights can be realized. Forty-seven Afrikaans-speaking parents completed a custom-designed survey. The results of the closed-ended questions indicated that most parents felt that their children had rights and that these rights were met. A theme analysis performed on the open-ended questions revealed that parents were mostly concerned about their children's rights pertaining to school education and safety. These rights were discussed in terms of the CRC articles and linked to environmental codes of the ICF-CY. Finally, the limitations and implications of the study are discussed and recommendations are made.

  12. Disabilities

    Science.gov (United States)

    ... unable, and it isn't a sickness. Most people with disabilities can - and do - work, play, learn, and enjoy ... five people in the United States has a disability. Some people are born with one. Others have them as ...

  13. A community-based aquatic exercise program to improve endurance and mobility in adults with mild to moderate intellectual disability.

    Science.gov (United States)

    Hakim, Renée M; Ross, Michael D; Runco, Wendy; Kane, Michael T

    2017-02-01

    The purpose of this study was to investigate the impact of a community-based aquatic exercise program on physical performance among adults with mild to moderate intellectual disability (ID). Twenty-two community-dwelling adults with mild to moderate ID volunteered to participate in this study. Participants completed an 8-week aquatic exercise program (2 days/wk, 1 hr/session). Measures of physical performance, which were assessed prior to and following the completion of the aquatic exercise program, included the timed-up-and-go test, 6-min walk test, 30-sec chair stand test, 10-m timed walk test, hand grip strength, and the static plank test. When comparing participants' measures of physical performance prior to and following the 8-week aquatic exercise program, improvements were seen in all measures, but the change in scores for the 6-min walk test, 30-sec chair stand test, and the static plank test achieved statistical significance (Paquatic exercise program for adults with ID may promote improvements in endurance and balance/mobility.

  14. The misdiagnosis of ischaemic colitis

    Energy Technology Data Exchange (ETDEWEB)

    Rudd, Joanne [Department of Radiology, West Suffolk Hospital, Hardwick Lane, Bury St Edmunds, Suffolk IP33 2QZ (United Kingdom)]. E-mail: joanne.rudd@wsh.nhs.uk

    2006-11-15

    This case study followed the pathway taken by an elderly patient who presented as an emergency with rectal bleeding. Views obtained of the colon by flexible sigmoidoscopy suggested an initial diagnosis of colorectal carcinoma but this proved to be incorrect. It was a combination of the histology obtained from the initial and subsequent endoscopies, barium enema and the clinical history that finally gave rise to the correct diagnosis of ischaemic colitis. Opinion is currently divided as to whether sigmoidoscopy or colonoscopy is the most appropriate test for those patients presenting with rectal bleeding. Ischaemic colitis is a disease that can present with many differing symptoms depending on the degree of severity of the ischaemia.

  15. Evaluation of a Portable DVD Player and System of Least Prompts to Self-Prompt Cooking Task Completion by Young Adults with Moderate Intellectual Disabilities

    Science.gov (United States)

    Mechling, Linda C.; Gast, David L.; Fields, Elizabeth A.

    2008-01-01

    This study evaluated the effectiveness of a portable DVD player plus the system of least prompts (SLP) for DVD player use as a self-prompting device to teach cooking tasks to three young adults with moderate intellectual disabilities. A multiple probe design across three cooking tasks and replicated across three students was used to evaluate the…

  16. Effects of a Community-Based Progressive Resistance Training Program on the Work Productivity of Adolescents with Moderate to Severe Intellectual Disabilities.

    Science.gov (United States)

    Zetts, Raymond A.; And Others

    1995-01-01

    Effects of a community-based progressive resistance physical training program on simulated work productivity were evaluated with six students (mean age 17 years) having moderate to severe intellectual disabilities. Strength values increased from preprogram to postprogram assessment. Mean values for all work productivity tasks increased during the…

  17. Computer-Based Video Instruction to Teach Young Adults with Moderate Intellectual Disabilities to Perform Multiple Step, Job Tasks in a Generalized Setting

    Science.gov (United States)

    Mechling, Linda C.; Ortega-Hurndon, Fanny

    2007-01-01

    This study evaluated the effectiveness of computer-based video instruction (CBVI) to teach three young adults with moderate intellectual disabilities to perform complex, multiple step, job tasks in a generalized setting. A multiple probe design across three job tasks and replicated across three students was used to evaluate the effectiveness of…

  18. Effects of a Peer-Delivered System of Least Prompts Intervention and Adapted Science Read-Alouds on Listening Comprehension for Participants with Moderate Intellectual Disability

    Science.gov (United States)

    Hudson, Melissa E.; Browder, Diane M.; Jimenez, Bree A.

    2014-01-01

    This study investigated the effects of a peer-delivered system of least prompts intervention and adapted grade-level science read-alouds on correct listening comprehension responses for participants with moderate intellectual disability. The intervention package included prompts in which selected text was read again. Participants directed the…

  19. Interpersonal Sources of Conflict in Young People with and without Mild to Moderate Intellectual Disabilities at Transition from Adolescence to Adulthood

    Science.gov (United States)

    Larkin, P.; Jahoda, A.; MacMahon, K.; Pert, C.

    2012-01-01

    Background: Interpersonal conflict is a source of stress and contributes to poor mental health in people with mild to moderate intellectual disabilities. Understanding the contexts in which conflict typically occurs can better equip services to help people with such difficulties. However, existing studies into the contexts of conflict have…

  20. Use of a Proximity Sensor Switch for "Hands Free" Operation of Computer-Based Video Prompting by Young Adults with Moderate Intellectual Disability

    Science.gov (United States)

    Ivey, Alexandria N.; Mechling, Linda C.; Spencer, Galen P.

    2015-01-01

    In this study, the effectiveness of a "hands free" approach for operating video prompts to complete multi-step tasks was measured. Students advanced the video prompts by using a motion (hand wave) over a proximity sensor switch. Three young adult females with a diagnosis of moderate intellectual disability participated in the study.…

  1. Using Simultaneous Prompting to Teach Restaurant Words and Classifications as Non-Target Information to Secondary Students with Moderate to Severe Disabilities

    Science.gov (United States)

    Smith, Bethany R.; Schuster, John W.; Collins, Belva; Kleinert, Harold

    2011-01-01

    This paper reviews selected literature pertaining to simultaneous prompting and the acquisition of non-target information for individuals with moderate to severe disabilities. The purpose of this review was to discuss the definition of non-target information (NTI) and the various places it can be embedded within an instructional trial. The…

  2. The Effects of a Color-Embedded Writing Strategy on the Written Expression Skills of Students with Mild-Moderate Disabilities

    Science.gov (United States)

    Otto, Claudia Cecilia

    2013-01-01

    This research is a classroom case study to determine the effectiveness of a color-embedded writing strategy on the writing performance of adolescents with mild-moderate disabilities. Assessment and documentation of students' composition skills progress was made using the TOWL-4 writing assessments. Comparisons were made between those students who…

  3. Comparing Teacher-Directed and Computer-Assisted Constant Time Delay for Teaching Functional Sight Words to Students with Moderate Intellectual Disability

    Science.gov (United States)

    Coleman, Mari Beth; Hurley, Kevin J.; Cihak, David F.

    2012-01-01

    The purpose of this study was to compare the effectiveness and efficiency of teacher-directed and computer-assisted constant time delay strategies for teaching three students with moderate intellectual disability to read functional sight words. Target words were those found in recipes and were taught via teacher-delivered constant time delay or…

  4. Continuous Video Modeling to Assist with Completion of Multi-Step Home Living Tasks by Young Adults with Moderate Intellectual Disability

    Science.gov (United States)

    Mechling, Linda C.; Ayres, Kevin M.; Bryant, Kathryn J.; Foster, Ashley L.

    2014-01-01

    The current study evaluated a relatively new video-based procedure, continuous video modeling (CVM), to teach multi-step cleaning tasks to high school students with moderate intellectual disability. CVM in contrast to video modeling and video prompting allows repetition of the video model (looping) as many times as needed while the user completes…

  5. Comparison of the Effects of Continuous Video Modeling, Video Prompting, and Video Modeling on Task Completion by Young Adults with Moderate Intellectual Disability

    Science.gov (United States)

    Mechling, Linda C.; Ayres, Kevin M.; Bryant, Kathryn J.; Foster, Ashley L.

    2014-01-01

    This study compared the effects of three procedures (video prompting: VP, video modeling: VM, and continuous video modeling: CVM) on task completion by three high school students with moderate intellectual disability. The comparison was made across three sets of fundamentally different tasks (putting away household items in clusters of two items;…

  6. Fine and Gross Motor Task Performance When Using Computer-Based Video Models by Students with Autism and Moderate Intellectual Disability

    Science.gov (United States)

    Mechling, Linda C.; Swindle, Catherine O.

    2013-01-01

    This investigation examined the effects of video modeling on the fine and gross motor task performance by three students with a diagnosis of moderate intellectual disability (Group 1) and by three students with a diagnosis of autism spectrum disorder (Group 2). Using a multiple probe design across three sets of tasks, the study examined the…

  7. Effects of Modeling, Story Templates, and Self-Graphing in the Use of Story Elements by Students with Moderate Intellectual Disability

    Science.gov (United States)

    Pennington, Robert; Koehler, Mallory

    2017-01-01

    There is limited research on teaching narrative writing skills to students with moderate to severe intellectual disability. In the current study, we used a multiple probe across participants single case design to evaluate the effects of an intervention package comprised of modeling, story templates, and self-graphing, on the inclusion of story…

  8. Effects of a Video Model to Teach Students with Moderate Intellectual Disability to Use Key Features of an iPhone

    Science.gov (United States)

    Walser, Kathryn; Ayres, Kevin; Foote, Erika

    2012-01-01

    This study evaluated the effects of video modeling on teaching three high school students with moderate intellectual disability to perform three activities on an iPhone 3GS. This study is a replication and extension of the Hammond, Whatley, Ayres, and Gast (2010) study in which researchers taught this same set of skills using a slightly different…

  9. Use of an iPhone 4 with Video Features to Assist Location of Students with Moderate Intellectual Disability When Lost in Community Settings

    Science.gov (United States)

    Purrazzella, Kaitlin; Mechling, Linda C.

    2013-01-01

    This study evaluated the acquisition of use of an iPhone 4 by adults with moderate intellectual disability to take and send video captions of their location when lost in the community. A multiple probe across participants design was used to evaluate the effectiveness of the intervention which used video modeling, picture prompts, and instructor…

  10. Effect of moderate-intensity exercise training on the cognitive function of young adults with intellectual disabilities.

    Science.gov (United States)

    Pastula, Robert M; Stopka, Christine B; Delisle, Anthony T; Hass, Chris J

    2012-12-01

    In addition to cognitive impairment, young adults with intellectual disabilities (IDs) are also more likely to be in poor health. Exercise may help ameliorate both of these deficits. While the health benefits of exercise are well documented and understood, the cognitive benefits of exercise are emerging. Exercise has been shown to improve the cognitive function of young, old, and diseased populations but few studies have evaluated the effect of exercise training on the cognitive functioning of individuals with IDs. The purpose of this study was to determine the effect of moderate-intensity exercise training on the cognitive function of young adults with IDs. Fourteen students (age, 19.4 ± 1.3 years) with mild to moderate IDs participated in an 8-week comprehensive exercise intervention program based on circuit training, aerobic dancing, and adapted sport activities. Sessions lasted 45 minutes, and intensity was maintained at 60-70% of maximum heart rate (HR(max)). Aerobic fitness was assessed via the Young Men's Christian Association (YMCA) step test, and intellectual functioning was assessed via 3 subtests from the Woodcock-Johnson III Tests of Cognitive Abilities once before and after the intervention. Performance was significantly improved on all 3 cognitive tests (all, p Aerobic fitness also significantly improved (p speed, a measure taking into account each individual's performance on the 3 subtests, was 103%. The mean individual improvement in aerobic fitness was 17.5%. Moderate-intensity exercise training can yield robust improvements in the cognitive functioning and aerobic fitness of young adults with IDs. These effects support the inclusion of exercise into the lives of young adults with ID to promote their physical and cognitive health. Fourteen students (age, 19.4 ± 1.3 years) with mild to moderate IDs participated in an 8-week comprehensive exercise intervention program based on circuit training, aerobic dancing, and adapted sport activities

  11. Feasibility and Impact of an 8-Week Integrative Yoga Program in People with Moderate Multiple Sclerosis–Related Disability

    Science.gov (United States)

    Kietrys, David; Fogerite, Susan Gould; Silva, Mariella; Logan, Kristen; Barone, Donald A.; Parrott, J. Scott

    2017-01-01

    Background: This pilot study determined the feasibility of a specifically designed 8-week yoga program for people with moderate multiple sclerosis (MS)–related disability. We explored the program's effect on quality of life (QOL) and physical and mental performance. Methods: We used a single-group design with repeated measurements at baseline, postintervention, and 8-week follow-up. Feasibility was examined through cost, recruitment, retention, attendance, and safety. Outcomes included the Multiple Sclerosis Quality of Life Inventory (MSQLI), 12-item Multiple Sclerosis Walking Scale (MSWS-12), Timed 25-Foot Walk test (T25FW), 6-Minute Walk Test (6MWT), Nine-Hole Peg Test (NHPT), Five-Times Sit-to-Stand Test (FTSTS), Multidirectional Reach Test (MDRT), maximum expiratory pressure, and Paced Auditory Serial Addition Test-3″ (PASAT-3″). Results: Fourteen participants completed the study. The program was feasible. There were significant main effects on the 36-item Short Form Health Status Survey Mental Component Summary (SF-36 MCS), Modified Fatigue Impact Scale (MFIS), Bladder Control Scale (BLCS), Perceived Deficits Questionnaire (PDQ), Mental Health Inventory (MHI), MSWS-12, T25FW, NHPT, PASAT-3″, 6MWT, FTSTS, and MDRT-Back. Improvements were found on the SF-36 MCS, MFIS, BLCS, PDQ, MHI, and MSWS-12 between baseline and postintervention. The effect on PDQ persisted at follow-up. Improvements were found on the T25FW, NHPT, 6MWT, FTSTS, and MDRT-Back between baseline and postintervention that persisted at follow-up. The PASAT-3″ did not change between baseline and postintervention but did between postintervention and follow-up. Conclusions: The yoga program was safe and feasible. Improvements in certain measures of QOL and performance were seen at postintervention and follow-up. PMID:28243184

  12. An Investigation of the Effects of Differential Reinforcement of Alternative Behavior on Students with Mild/Moderate Disabilities in a School Classroom

    OpenAIRE

    Spangenberg, Katrina

    2008-01-01

    This study investigated the effects of differential reinforcement of alternative behavior (DRA), a behavior reduction procedure, on problem behavior exhibited by three elementary school students in a general education classroom. DRA involves reinforcement of an alternative behavior while withholding reinforcement for the inappropriate behavior. The three participants were classified as experiencing mild/moderate disabilities but received most services (and participated in this research) in a ...

  13. Endovascular therapy for acute ischaemic stroke: the Pragmatic Ischaemic Stroke Thrombectomy Evaluation (PISTE) randomised, controlled trial

    Science.gov (United States)

    Muir, Keith W; Ford, Gary A; Messow, Claudia-Martina; Ford, Ian; Murray, Alicia; Clifton, Andrew; Brown, Martin M; Madigan, Jeremy; Lenthall, Rob; Robertson, Fergus; Dixit, Anand; Cloud, Geoffrey C; Wardlaw, Joanna; Freeman, Janet; White, Philip

    2017-01-01

    Objective The Pragmatic Ischaemic Thrombectomy Evaluation (PISTE) trial was a multicentre, randomised, controlled clinical trial comparing intravenous thrombolysis (IVT) alone with IVT and adjunctive intra-arterial mechanical thrombectomy (MT) in patients who had acute ischaemic stroke with large artery occlusive anterior circulation stroke confirmed on CT angiography (CTA). Design Eligible patients had IVT started within 4.5 hours of stroke symptom onset. Those randomised to additional MT underwent thrombectomy using any Conformité Européene (CE)-marked device, with target interval times for IVT start to arterial puncture of <90 min. The primary outcome was the proportion of patients achieving independence defined by a modified Rankin Scale (mRS) score of 0–2 at day 90. Results Ten UK centres enrolled 65 patients between April 2013 and April 2015. Median National Institutes of Health Stroke Scale score was 16 (IQR 13–21). Median stroke onset to IVT start was 120 min. In the intention-to-treat analysis, there was no significant difference in disability-free survival at day 90 with MT (absolute difference 11%, adjusted OR 2.12, 95% CI 0.65 to 6.94, p=0.20). Secondary analyses showed significantly greater likelihood of full neurological recovery (mRS 0–1) at day 90 (OR 7.6, 95% CI 1.6 to 37.2, p=0.010). In the per-protocol population (n=58), the primary and most secondary clinical outcomes significantly favoured MT (absolute difference in mRS 0–2 of 22% and adjusted OR 4.9, 95% CI 1.2 to 19.7, p=0.021). Conclusions The trial did not find a significant difference between treatment groups for the primary end point. However, the effect size was consistent with published data and across primary and secondary end points. Proceeding as fast as possible to MT after CTA confirmation of large artery occlusion on a background of intravenous alteplase is safe, improves excellent clinical outcomes and, in the per-protocol population, improves disability

  14. Examining the Moderating Effect of Disability Status on the Relationship between Trauma Symptomatology and Select Career Variables

    Science.gov (United States)

    Strauser, David R.; Lustig, Daniel C.; Uruk, Aye Ciftci

    2006-01-01

    In the current study, the authors examined whether the influence of trauma symptomatology on select career variables differs based on disability status. A total of 131 college students and 81 individuals with disabilities completed the "Career Thoughts Inventory," "My Vocational Situation," "Developmental Work Personality…

  15. The cause of ischaemic nocturnal rest pain

    DEFF Research Database (Denmark)

    Jelnes, Rolf; Bülow, J; Tønnesen, K H

    1988-01-01

    of symptomatology. In two limbs, with a normal peripheral circulation, blood flow decreased by 8 +/- 7%. In five limbs with arterial insufficiency, but no rest pain, blood flow decreased by 16 +/- 8% and in eight limbs with ischaemic nocturnal rest pain blood flow was reduced by 32 +/- 12% during sleep....... It is concluded that nocturnal hypotension is a major factor in the production of nocturnal ischaemic rest pain....

  16. Acute Ischaemic Colitis- A Case Report

    Directory of Open Access Journals (Sweden)

    M Basra

    2012-03-01

    Full Text Available Acute ischaemic colitis (AIC is being increasingly recognised as an uncommon cause of abdominal pain associated with fresh bleeding per rectum. It is paramount to maintain a high index of suspicion and adopt appropriate management strategies to avoid complications and inappropriate interventions. In this paper, we describe a case of AIC and review literature pertinent to the management of this condition. Keywords: Ischaemic colitis, acute abdomen, management.

  17. [The moderator role of family type in the relationship between functional disability and quality of life in patients with chronic low back pain].

    Science.gov (United States)

    Ferreira, Maria Salomé Martins; Pereira, Maria da Graça

    2016-01-01

    Chronic low back pain is a disease that interferes with quality of life and the patient's functional capability. This study aimed to identify the moderating effect of the "Type of Family" in the relationship between functional disability and quality of life in patients with chronic low back pain. Two hundred and three patients with low back pain for longer than 3 months participated in the study. The instruments used were: Medical Outcome Study (MOS 20); Roland Morris Disability Questionnaire (RMDO; Family Adaptability and Cohesion Evaluation Scales (FACES II). Regression analyses were performed in order to test the moderating effect of the type of family. The results showed that patients with lower levels of disability presented better quality of life in the intermediate and balanced families, and this relationship was even stronger in balanced families. According to the results, intervention programs in chronic low back pain, besides the patient, should include the family particularly in balanced families since they are the ones that feel the impact of the disease on their quality of life the most.

  18. Self-esteem as mediator and moderator of the relationship between stigma perception and social alienation of Chinese adults with disability.

    Science.gov (United States)

    Zhang, Lin; Li, Wentao; Liu, Binbin; Xie, Wenlan

    2014-01-01

    Several studies show the relationship between self-esteem and stigma perception and also between self-esteem and social alienation, but none sufficiently analyze the relationship between stigma perception and social alienation of people with disability. The primary aim of this paper is to investigate the mediator and moderator effects of self-esteem on the relationship between stigma perception and social alienation of people with disability. The participants were 129 adults with disability (80 males and 49 females) from eight communities in China. Data was collected by using the stigma perception scale, self-esteem scale, social avoidance scale, social anxiety subscale of the self-consciousness scale, and loneliness scale. Each item is rated on a 5-point scale (1 = "strongly disagree" to 5 = "strongly agree"). Stigma perception was positively correlated with social avoidance (p stigma perception (p stigma perception and social avoidance, social anxiety and loneliness. Moreover, self-esteem moderated the relationship between stigma perception and social avoidance, but not on social anxiety and loneliness. Copyright © 2014 Elsevier Inc. All rights reserved.

  19. Plasticity in the Neonatal Brain following Hypoxic-Ischaemic Injury

    Directory of Open Access Journals (Sweden)

    Eridan Rocha-Ferreira

    2016-01-01

    Full Text Available Hypoxic-ischaemic damage to the developing brain is a leading cause of child death, with high mortality and morbidity, including cerebral palsy, epilepsy, and cognitive disabilities. The developmental stage of the brain and the severity of the insult influence the selective regional vulnerability and the subsequent clinical manifestations. The increased susceptibility to hypoxia-ischaemia (HI of periventricular white matter in preterm infants predisposes the immature brain to motor, cognitive, and sensory deficits, with cognitive impairment associated with earlier gestational age. In term infants HI causes selective damage to sensorimotor cortex, basal ganglia, thalamus, and brain stem. Even though the immature brain is more malleable to external stimuli compared to the adult one, a hypoxic-ischaemic event to the neonate interrupts the shaping of central motor pathways and can affect normal developmental plasticity through altering neurotransmission, changes in cellular signalling, neural connectivity and function, wrong targeted innervation, and interruption of developmental apoptosis. Models of neonatal HI demonstrate three morphologically different types of cell death, that is, apoptosis, necrosis, and autophagy, which crosstalk and can exist as a continuum in the same cell. In the present review we discuss the mechanisms of HI injury to the immature brain and the way they affect plasticity.

  20. Cognitive performance after ischaemic stroke

    Directory of Open Access Journals (Sweden)

    Maria Gabriela R. Ferreira

    Full Text Available Cognitive impairment after stroke affects the patient recovery process. Therefore, the identification of factors associated with cognitive outcomes is important since it allows risk profiles of stroke survivors to be determined. OBJECTIVE: To assess cognitive outcome of stroke outpatients and investigate associations among clinical and demographic variables, vascular risk factors, depression symptoms and functional ability; and to describe the neuropsychological profile of these patients. METHODS: A cross-sectional design study was conducted. Subjects who suffered a first-ever ischaemic stroke 6 to 10 months prior to data collection underwent neuropsychological assessment and screening for depressive symptoms and functional ability. The outcome "cognitive performance" was analyzed considering two groups: "cognitive impairment" and "no cognitive impairment". RESULTS: There was a statistically significant association between cognitive impairment and female gender, age, stroke severity and functional ability. Regarding neuropsychological profile, the cognitive impairment group exhibited more generalized deficits in attention, visuospatial organization, verbal functions and verbal memory domains compared to the community control group. CONCLUSION: The occurrence of cognitive impairment among patients was high, especially in women, older participants, individuals with more severe stroke, and greater impairment in functional ability. Multiple cognitive domains are affected and this may hamper recovery and negatively impact independence and quality of life after stroke.

  1. Cyber Victimization and Depression among Adolescents with Intellectual Disabilities and Developmental Disorders: The Moderation of Perceived Social Support

    Science.gov (United States)

    Wright, Michelle F.

    2017-01-01

    The aim of this study was to examine the mitigating effect of perceived social support from parents, teachers, and friends on the association between cyber victimization and depression, accessed one year later. Adolescents (n = 131; 13-15 years old; 73% male) with intellectual and developmental disabilities completed questionnaires on their…

  2. Diffusion-weighted MR imaging in transient ischaemic attacks

    Energy Technology Data Exchange (ETDEWEB)

    Lamy, C.; Calvet, D.; Domigo, V.; Mas, J. [de l' Hopital Sainte-Anne, Service de Neurologie, Paris Cedex 14 (France); Oppenheim, C.; Naggara, O.; Meder, J.F. [Hoepital Sainte-Anne, Departement d' Imagere Morphologique et Fonchonnille, Paris (France)

    2006-05-15

    The purpose of this study was to determine frequency and the characteristics of diffusion-weighted imaging (DWI) abnormalities in patients with transient ischaemic attack (TIA). We analysed data of 98 consecutive patients (mean age: 60.6{+-}15.4 years, 56 men) admitted between January 2003 and April 2004 for TIA. Age, gender, symptom type and duration, delay from onset to magnetic resonance imaging (MRI), probable or possible TIA and cause of TIA were compared in patients with (DWI+) and without (DWI-) lesions on DWI. Volume and apparent diffusion coefficient (ADC) values of DWI lesions were computed. DWI revealed ischaemic lesions in 34 patients (34.7%). Lesions were small (mean volume: 1.9 cm{sup 3}{+-}3.3), and ADC was moderately decreased (mean ADC ratio: 79.5%). The diagnosis of TIA was considered as probable in all DWI+ patients. A multiple logistic regression model demonstrated that TIA duration greater than or equal to 60 min (OR, 7.6; 95% CI, 2.3-25.7), aphasia (OR, 9.2; 95% CI, 2.7-31.4) and motor deficit (OR, 5.1; 95% CI, 1.5-17.8) were independent predictors of DWI lesions. Prolonged TIA duration, aphasia and motor deficits are associated with DWI lesions. More than half of TIA patients with symptoms lasting more than 60 min have DWI lesions. (orig.)

  3. Group-based cognitive-behavioural anger management for people with mild to moderate intellectual disabilities: cluster randomised controlled trial.

    Science.gov (United States)

    Willner, Paul; Rose, John; Jahoda, Andrew; Kroese, Biza Stenfert; Felce, David; Cohen, David; Macmahon, Pamela; Stimpson, Aimee; Rose, Nicola; Gillespie, David; Shead, Jennifer; Lammie, Claire; Woodgate, Christopher; Townson, Julia; Nuttall, Jacqueline; Hood, Kerenza

    2013-09-01

    Many people with intellectual disabilities find it hard to control their anger and this often leads to aggression which can have serious consequences, such as exclusion from mainstream services and the need for potentially more expensive emergency placements. To evaluate the effectiveness of a cognitive-behavioural therapy (CBT) intervention for anger management in people with intellectual disabilities. A cluster-randomised trial of group-based 12-week CBT, which took place in day services for people with intellectual disabilities and was delivered by care staff using a treatment manual. Participants were 179 service users identified as having problems with anger control randomly assigned to either anger management or treatment as usual. Assessments were conducted before the intervention, and at 16 weeks and 10 months after randomisation (trial registration: ISRCTN37509773). The intervention had only a small, and non-significant, effect on participants' reports of anger on the Provocation Index, the primary outcome measure (mean difference 2.8, 95% CI -1.7 to 7.4 at 10 months). However, keyworker Provocation Index ratings were significantly lower in both follow-up assessments, as were service-user ratings on another self-report anger measure based on personally salient triggers. Both service users and their keyworkers reported greater usage of anger coping skills at both follow-up assessments and keyworkers and home carers reported lower levels of challenging behaviour. The intervention was effective in improving anger control by people with intellectual disabilities. It provides evidence of the effectiveness of a CBT intervention for this client group and demonstrates that the staff who work with them can be trained and supervised to deliver such an intervention with reasonable fidelity.

  4. The psychometric properties of the Attention-Distraction, Inhibition-Excitation Classroom Assessment Scale (ADIECAS) in a sample of children with moderate and severe intellectual disabilities.

    Science.gov (United States)

    Guerin, Suzanne; Buckley, Sarah; McEvoy, John; Hillery, John; Dodd, Philip

    2009-01-01

    The Attention-Distraction, Inhibition-Excitation Classroom Assessment Scale (ADIECAS) [Evans, P. L. C. (1975). Inhibition and stimulus generalization in the discrimination learning of ESN(S) and ESN(M) children. Unpublished Ph.D. thesis. Manchester, UK: University of Manchester] assesses attention-related difficulties in children with intellectual disabilities (ID). The present study explored the psychometric properties of the ADIECAS with a sample of 84 children with moderate and severe ID whose teachers completed the ADIECAS and the Conners' Teachers Rating Scale [Goyette, C. H, Conners, C. K., & Ulrich, R. F. (1978). Normative data on revised Conners' parent and teachers rating scales. Journal of Abnormal Child Psychology, 6, 221-236]. Following factor analysis the Evans and Hogg [Evans, P. L. C., & Hogg, J. (1984). A classroom rating scale for use with mentally retarded children. British Journal of Clinical Psychology, 23, 187-194] structure was the most appropriate for use with this sample. Moderate to strong positive relationships were found between the ADIECAS and the Conners', and the ADIECAS factors were significant predictors of the Conners' subscales. This study provides further support for the ADIECAS as a reliable and valid measure of ADHD-related symptoms among children with moderate and severe ID.

  5. A Validity Study of the Working Group's Orientation Test for Individuals with Moderate to Severe Intellectual Disability

    Science.gov (United States)

    Pyo, G.; Curtis, K.; Curtis, R.; Markwell, S.

    2009-01-01

    Background: Decline in orientation skill has been reported as an early indicator of Dementia of Alzheimer's Type (DAT). Orientation subtest of the Working Group's Test Battery was examined whether this test is useful to identify DAT patients among adults with moderate to severe ID. Methods: Sixteen DAT patients and 35 non-demented normal controls…

  6. Discrimination and other barriers to accessing health care: perspectives of patients with mild and moderate intellectual disability and their carers.

    Directory of Open Access Journals (Sweden)

    Afia Ali

    Full Text Available BACKGROUND: People with intellectual disability have a higher prevalence of physical health problems but often experience disparities in accessing health care. In England, a number of legislative changes, policies and recommendations have been introduced to improve health care access for this population. The aim of this qualitative study was to examine the extent to which patients with intellectual disability and their carers experience discrimination or other barriers in accessing health services, and whether health care experiences have improved over the last decade years. METHOD AND MAIN FINDINGS: Twenty nine participants (14 patient and carer dyads, and one carer took part in semi-structured interviews. The interviews were audio-taped and transcribed and analysed using thematic analysis. Eight themes were identified. Half the participants thought that the patient had been treated unfairly or had been discriminated against by health services. There were accounts of negative staff attitudes and behaviour, and failure of services to make reasonable adjustments. Other barriers included problems with communication, and accessing services because of lack of knowledge of local services and service eligibility issues; lack of support and involvement of carers; and language problems in participants from minority ethnic groups. Most participants were able to report at least one example of good practice in health care provision. Suggestions for improving services are presented. CONCLUSION: Despite some improvements to services as a result of health policies and recommendations, more progress is required to ensure that health services make reasonable adjustments to reduce both direct and indirect discrimination of people with intellectual disability.

  7. Impact of a Teacher-as-Coach Model: Improving Paraprofessionals Fidelity of Implementation of Discrete Trial Training for Students with Moderate-to-Severe Developmental Disabilities.

    Science.gov (United States)

    Mason, Rose A; Schnitz, Alana G; Wills, Howard P; Rosenbloom, Raia; Kamps, Debra M; Bast, Darcey

    2017-03-14

    Ensuring educational progress for students with moderate-to-severe developmental disabilities requires exposure to well executed evidence-based practices. This necessitates that the special education workforce, including paraprofessionals, be well-trained. Yet evidence regarding effective training mechanisms for paraprofessionals is limited. A multiple baseline design across five teachers was used to evaluate the impact of online instructional modules and a Practice-Based Coaching (PBC) model with teacher-as-coach on their paraprofessionals' fidelity of discrete trial training (DTT). Implementation of the instructional modules yielded little to no change in paraprofessionals' DTT fidelity, however, a clear functional relation between PBC and improvement in paraprofessionals' fidelity of implementation of DTT was demonstrated. Implications for future research and practice are discussed.

  8. Injuries and Individuals with Disabilities

    Science.gov (United States)

    Waldman, H. Barry; Perlman, Steven P.; Chaudhry, Ramiz A.

    2009-01-01

    Children and adults with disabilities are at an increased risk of injury. Falls are the leading mechanism of injury regardless of the disability status and are even more common in those with moderate or severe disabilities. The setting for the injury differs with the disability status. Compared to individuals with moderate or no disabilities,…

  9. Successful Aging in the Context of the Disablement Process: Working and Volunteering as Moderators on the Association Between Chronic Conditions and Subsequent Functional Limitations.

    Science.gov (United States)

    Kail, Ben Lennox; Carr, Dawn C

    2017-03-01

    This study evaluated the successful aging model by assessing the impact of two forms of productive engagement-working and volunteering-as potential interventions in the process of disablement. The Health and Retirement Study was used to (a) estimate two-stage selection equations of (i) currently working part time and full time and (ii) currently volunteering less than 100 hours and volunteering 100 hours or more per year (net of chronic health problems) and (b) assess whether, net of selection, working, and volunteering moderate the association between chronic conditions and subsequent functional limitations. Chronic conditions were associated with elevated levels of subsequent functional limitations, whereas both working and volunteering were associated with lower levels of subsequent functional limitations. Moreover, workers and volunteers of less than 100 hours per year experienced a reduction in the association of chronic conditions on subsequent functional limitations. This research highlights the role of productive engagement as a key element in successful aging. Not only do work and volunteering have direct associations with health outcomes themselves, but they also act as potential interventions in the process of disablement by attenuating the way in which chronic conditions are translated into subsequent functional limitations. This suggests that (a) future research should apply successful aging models to health processes as well as health outcomes and (b) policy makers should support social institutions that foster late-life productive engagement.

  10. Case report on the use of the Waldon Approach on an adult with severe to moderate intellectual disability with autistic tendencies.

    Directory of Open Access Journals (Sweden)

    Walter G Solomon

    2016-03-01

    Full Text Available This clinical case report describes a patient diagnosed with severe to moderate intellectual disability with autistic tendencies, resident in a home for adults with a range of disabilities. She had been resident for 18 years prior to intervention by the author when she was 48 years of age. The author worked with her from June 25th 2013 until January 12th 2015 for a total of 55 Waldon Approach1, movement based lessons each of about 45 minutes of which 33 were documented by video. This report describes changes in her cognition and her social behaviour at a time when there were no other changes in her life. As far as the author is aware this is the first clinical case report on the Waldon Approach to appear in a peer reviewed journal and is unique in that most of the work using the approach is with children who are usually receiving other therapies at the same time as their Waldon Lessons, making it harder to evaluate the attribution of change. During the period of this report she received no other therapy or intervention beyond that provided at Maon Roglit which itself had not changed during this period. The patient remains without speech but there has been real, meaningful and noticeable change in her life from which she appears to derive pleasure. There has been a significant improvement in the patient’s group participation, facial expression and general demeanour.

  11. Is adiponectin a risk factor for transient ischaemic attacks?

    Science.gov (United States)

    Sener, Ufuk; Uludag, Irem Fatma; Kose, Sukran; Ozcelik, Murat; Zorlu, Yasar

    2015-01-01

    Adiponectin is an adipocytokine, and it plays a role in atherosclerosis. The role of adiponectin in the development of ischaemic stroke is controversial. Up to now, adiponectin was not evaluated in transient ischaemic stroke. In this study, we investigated the relationship between adiponectin and transient ischaemic attack. Forty patients with transient ischaemic attack were included into the study. In all patients, traditional risk factors of ischaemic stroke and intima-media thickness of carotid arteries were determined. Also, the relationship between these parameters and adiponectin levels were examined. No difference was found in terms of adiponectin levels between patients and healthy subjects. In addition, there was no association between adiponectin levels and traditional risk factors. Our results suggest that adiponectin may not be a predictive risk factor of transient ischaemic attack.

  12. Moderators, mediators, and bidirectional relationships in the International Classification of Functioning, Disability and Health (ICF) framework: An empirical investigation using a longitudinal design and Structural Equation Modeling (SEM).

    Science.gov (United States)

    Rouquette, Alexandra; Badley, Elizabeth M; Falissard, Bruno; Dub, Timothée; Leplege, Alain; Coste, Joël

    2015-06-01

    The International Classification of Functioning, Disability and Health (ICF) published in 2001 describes the consequences of health conditions with three components of impairments in body structures or functions, activity limitations and participation restrictions. Two of the new features of the conceptual model were the possibility of feedback effects between each ICF component and the introduction of contextual factors conceptualized as moderators of the relationship between the components. The aim of this longitudinal study is to provide empirical evidence of these two kinds of effect. Structural equation modeling was used to analyze data from a French population-based cohort of 548 patients with knee osteoarthritis recruited between April 2007 and March 2009 and followed for three years. Indicators of the body structure and function, activity and participation components of the ICF were derived from self-administered standardized instruments. The measurement model revealed four separate factors for body structures impairments, body functions impairments, activity limitations and participation restrictions. The classic sequence from body impairments to participation restrictions through activity limitations was found at each assessment time. Longitudinal study of the ICF component relationships showed a feedback pathway indicating that the level of participation restrictions at baseline was predictive of activity limitations three years later. Finally, the moderating role of personal (age, sex, mental health, etc.) and environmental factors (family relationships, mobility device use, etc.) was investigated. Three contextual factors (sex, family relationships and walking stick use) were found to be moderators for the relationship between the body impairments and the activity limitations components. Mental health was found to be a mediating factor of the effect of activity limitations on participation restrictions.

  13. Costura Basica (Principios Basicos para el Estudiante con Impedimentos Leves y Moderados) Documento de Trabajo Guia Curricular para el Curso. Basic Sewing (Basic Principles for the Student with Light and Moderate Disabilities. Course Curriculum Guide. Working Document).

    Science.gov (United States)

    Puerto Rico State Dept. of Education, Hato Rey. Office of Special Education.

    This guide has been prepared by the Puerto Rico Department of Public Instruction for special education teachers teaching domestic sewing. It includes informative and easy to comprehend material for students of both sexes with mild to moderate disabilities. The material is developed through varied strategies and activities that relate to the…

  14. Intentional Weight Loss Improved Performance in Obese Ischaemic Heart Patient

    DEFF Research Database (Denmark)

    Geiker, Nina; Myint, Khin Swe; Heck, Patrick

    2014-01-01

    Aims: The risk of heart failure (HF) increases with BMI, but paradoxically obesity has been associated with reduced mortality in patients with HF. The effect of intentional or therapeutic weight loss on HF is not well known. We examined the effect of weight loss induced by low energy diet (LED......) on physical performance and cardiovascular risk factors in obese patients with moderate-to-severe HF and/or ischaemic heart disease (IHD). Methods and Results: Results from two weight loss interventions at two centres, one in Denmark (DK - 12 week intervention in 21 subjects (14 LED, 7 controls)) and one.......1 in the intervention group versus -22.1% ± 25.6 in the control group (P=0.000). Treatment also improved triglycerides (P=0.000), very low lipoprotein (P=0.001) and C-reactive protein (P=0.010). Conclusion: Weight loss induced by LED in obese patients with moderate-to-severe HF or IHD resulted in clinically significant...

  15. Hypertension and atherosclerotic (ischaemic) heart disease.

    Science.gov (United States)

    Davies, M J

    1991-08-01

    Epidemiological surveys show the clear association of hypertension with an increased risk of developing ischaemic heart disease. One method of quantifying atherosclerosis is to measure, at necropsy, the percentage of the intimal surface of the coronary arteries or aorta which is occupied by raised plaques. When this is done in a large number of subjects the amount of intimal involvement in any particular geographical population correlates directly with the frequency of ischaemic heart disease. In all these populations, whether at a high risk or low risk of developing ischaemic heart disease, hypertensive subjects have a greater intimal involvement by plaques than normotensive subjects. Thus, the increased risk in hypertension is, in part, mediated by possession of more plaques. Plaque growth is due to the accumulation of lipid from the plasma, the ingress of monocytes with their conversion to lipid filled foam cells and the formation of collagen by smooth muscle cells. Hypertension may act by altering endothelial function to potentiate all these processes. Mechanical stress on endothelial cells will evoke the formation of growth factors for smooth muscle cells. Plaque growth in man is also episodic due to the formation of thrombi; a proportion of these episodes are symptomatic producing acute myocardial ischaemia but the majority are silent leading to sudden plaque expansion. Thrombi over plaques are either due to endothelial denudation injury or more commonly due to the tearing of the cap of a plaque leading to deep intimal injury. Necropsy surveys of control populations show that subjects with hypertension have a greater frequency of recent plaque tears compared with normotensive subjects.

  16. Genetically elevated bilirubin and risk of ischaemic heart disease

    DEFF Research Database (Denmark)

    Stender, Stefan; Frikke-Schmidt, R; Nordestgaard, B G

    2013-01-01

    Elevated plasma levels of bilirubin, an endogenous antioxidant, have been associated with reduced risk of ischaemic heart disease (IHD) and myocardial infarction (MI). Whether this is a causal relationship remains unclear.......Elevated plasma levels of bilirubin, an endogenous antioxidant, have been associated with reduced risk of ischaemic heart disease (IHD) and myocardial infarction (MI). Whether this is a causal relationship remains unclear....

  17. Anti-social behaviour and police contact among 13- to 15-year-old English adolescents with and without mild/moderate intellectual disability.

    Science.gov (United States)

    Emerson, Eric; Halpin, Sarah

    2013-09-01

    To describe the rates of anti-social behaviour (ASB) among adolescents with/without mild/moderate intellectual disability (MMID). To estimate whether any differences could be attributable to differences in exposure to extraneous risk factors. Secondary analysis of the Longitudinal Study of Young People in England. Participants with MMID were identified through data linkage with educational records. Parents of children with MMID were more likely to report police contact, children with MMID were more likely to self-report fighting/public disturbance, shoplifting and graffiti. When controlling for differences in exposure to extraneous risk factors, MMID was associated with increased rates of police contact and self-reported graffiti, no difference in self-reported shoplifting, reduced rates of self-reported fighting/public disturbance and vandalism. Differences in the rates of exposure to extraneous risk factors play an important role in accounting for the differences in the prevalence of self-reported ASB among adolescents with and without MMID. © 2013 John Wiley & Sons Ltd.

  18. EVALUATION OF CAROTID ARTERY STENOSIS IN STROKE/TRANSIENT ISCHAEMIC ATTACK

    Directory of Open Access Journals (Sweden)

    Nambakam Tanuja

    2015-07-01

    Full Text Available BACKGROUND : Stroke remains the second leading cause of death worldwide, after ischaemic heart disease. Patients with carotid artery stenosis are at higher risk of development of stroke. Carotid atherosclerosis occurs in patients with atheros clerotic risk factors like diabetes mellitus, hypertension, smoking and hyperlipidemia. Carotid artery stenosis can be assessed by means of noninvasive high - resolution B - mode ultrasonography of the carotid arteries. AIMS AND O BJECTIVES: 1. To estimate the prevalence of carotid artery stenosis in ischaemic stroke/transient ishaemic attack patients. 2. To estimate whether there was any association between carotid artery stenosis and important risk factors such as diabetes mellitus, hypertension, hyper lipid emia with control group. METHODS AND MATERIALS : Acute ischaemic / TIA stroke patients with CT - Brain showing infarcts were enrolled for the study. All patients were subjected to CT scan brain study and colour Doppler study of extracranial carotid arteries. The systolic and diastolic velocity of blood flow, and the ratio of peak systolic velocities of common carotid arteries were assessed. RESULTS : DM, HTN, Smoking & Hyperlipidemia acted as risk factors for carotid stenosis. The prevalence of carotid stenosi s in our study was 60%. The prevalence of mild, moderate and severe stenosis were 34%, 10% and 16% respectively. The distribution of carotid stenosis was equal on both sides. The statistical significance was calculated using Chi - square test. Statistical si gnificance was taken when P value was <0.05. Statistical analysis was carried using standard formulae. Microsoft Excel 2007 and SPSS (Statistical Package for Social Sciences Version 17.0 software were used for data entry and analysis. CONCLUSIONS : Caroti d stenosis was one of the common causes of ischaemic stroke. There was a statistically significant correlation between increasing age, male gender, smoking, d iabetes mellitus, hypertension

  19. [Oxidative stress in perinatal asphyxia and hypoxic-ischaemic encephalopathy].

    Science.gov (United States)

    Nuñez, Antonio; Benavente, Isabel; Blanco, Dorotea; Boix, Héctor; Cabañas, Fernando; Chaffanel, Mercedes; Fernández-Colomer, Belén; Fernández-Lorenzo, José Ramón; Loureiro, Begoña; Moral, María Teresa; Pavón, Antonio; Tofé, Inés; Valverde, Eva; Vento, Máximo

    2017-06-22

    Birth asphyxia is one of the principal causes of early neonatal death. In survivors it may evolve to hypoxic-ischaemic encephalopathy and major long-term neurological morbidity. Prolonged and intense asphyxia will lead to energy exhaustion in tissues exclusively dependent on aerobic metabolism, such as the central nervous system. Energy deficit leads to ATP-dependent pumps blockage, with the subsequent loss of neuronal transmembrane potential. The most sensitive areas of the brain will die due to necrosis. In more resistant areas, neuronal hyper-excitability, massive entrance of ionic calcium, activation of NO-synthase, free radical generation, and alteration in mitochondrial metabolism will lead to a secondary energy failure and programmed neuronal death by means of the activation of the caspase pathways. A third phase has recently been described that includes persistent inflammation and epigenetic changes that would lead to a blockage of oligodendrocyte maturation, alteration of neurogenesis, axonal maturation, and synaptogenesis. In this scenario, oxidative stress plays a critical role causing direct damage to the central nervous system and activating metabolic cascades leading to apoptosis and inflammation. Moderate whole body hypothermia to preserve energy stores and to reduce the formation of oxygen reactive species attenuates the mechanisms that lead to the amplification of cerebral damage upon resuscitation. The combination of hypothermia with coadjuvant therapies may contribute to improve the prognosis. Copyright © 2017. Publicado por Elsevier España, S.L.U.

  20. Nerve compression as an essential factor in causing ischaemic and post-ischaemic paraesthesiae

    Directory of Open Access Journals (Sweden)

    Eros Abrantes Erhart

    1950-03-01

    Full Text Available In order to explain why ischaemia produced by compression at the proximal part of the forearm or at the wrist, does not cause sensory disturbances identical to those observed in compression at the upper arm, several experiments were made on ourselves and other subjects. The method used was essentially that of Lewis and Pochin. Circulation was blocked at different levels of the limb by applying the pressure of 200 mm/Hg with a sphygmomanometer cuff; compression of the median, ulnar and tibial nerve trunks was made with the aid of a small cushion under the cuff. We observed always that the nerve compression is an essential factor in causing ischaemic and post-ischaemic paraesthesiae.

  1. Screening and risk evaluation for sudden cardiac death in ischaemic and non-ischaemic cardiomyopathy

    DEFF Research Database (Denmark)

    Proclemer, Alessandro; Lewalter, Thorsten; Bongiorni, Maria Grazia;

    2013-01-01

    The purpose of this EHRA survey was to examine the current clinical practice of screening and risk evaluation for sudden cardiac death in ischaemic and non-ischaemic cardiomyopathy with a focus on selection of candidates for implantable cardioverter-defibrillator (ICD) therapy, timing of ICD...... centres (32.2%), and in patients with permanent dialysis in 8 centres (33.3%). Signal-averaged electrocardiography and heart rate variability were never considered as risk stratification tools in 23 centres (74.2%). Implantation of a loop recorder was performed in patients with borderline indications...... on the clinical risk stratification and not on non-invasive and invasive diagnostic tests or implantable loop recorder use....

  2. Clinical implications of eye deviation on admission CT examination of acute ischaemic stroke patients.

    Science.gov (United States)

    Payabvash, S; Qureshi, I; Qureshi, A I

    2016-12-01

    To determine the frequency and prognostic value of eye deviation detected on the admission computed tomography (CT) of acute ischaemic stroke patients. The clinical and imaging data from the Albumin in Acute Stroke (ALIAS) Trials 1 and 2 were analysed. Two reviewers evaluated all admission CT images for the presence of eye deviation, and Alberta Stroke Program Early CT Score (ASPECTS). The admission National Institutes of Health Stroke Scale (NIHSS) scores and 3-month modified Rankin scale (mRs) scores were ascertained. Disability or death was defined as mRS score >2, at 3-month follow-up. Of 1,223 patients included in the present series, 352 (28.8%) had rightward and 331 (27.1%) had leftward eye deviation on admission CT. Patients with eye deviation on CT had higher admission NIHSS score and larger middle cerebral artery (MCA) territory infarct volume (based on ASPECTS). The presence of eye deviation on CT was associated with higher rates of haemorrhagic transformation at 24 hours (19.8% versus 13.5%, p=0.004), and higher rates of disability or death at 3-month follow-up (53.1% versus 35.7%, peye deviation relation with higher rate of disability or death is predominantly due to its association with higher admission NIHSS scores, lower ASPECTS, and to a lesser extent patients' older age. The presence of eye deviation on CT examination of acute ischaemic stroke patients is associated with larger anterior circulation stroke volumes, higher risk of 24-hour haemorrhagic transformation, and 3-month disability or death. Copyright © 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  3. Imaging the ischaemic penumbra after acute ischaemic stroke using PET and {sup 18}F-Fluoromisonidazole

    Energy Technology Data Exchange (ETDEWEB)

    Read, S.J.; Hirano, T.; Abbott, D.F.; Sachinidis, J.I.; Tochon-Danguy, H.J.; Chan, J.G.; Egan, F.; Scott, A.M.; Bladin, C.F.; McKay, W.J.; Donna, G.A. [Austin and Repatriation Medical Centre, Melbourne, VIC (Australia). Departments of Neurology, Nuclear Medicine and Centre for Positron Emission Tomogrpahy]|[University of Melbourne, Melbourne, VIC (Australia). Department of Medicine

    1998-06-01

    Full text: Using PET with {sup 15}O-labelled oxygen and water, the ischaemic penumbra is currently defined as peri-infarct areas demonstrating misery perfusion. We have used PET with the hypoxic tissue marker {sup l8}F-fluoromisonidazole ({sup 18}F-FMISO) to detect hypoxic but viable peri-infarct tissue in patients after acute ischaemic stroke. Fifteen patients with acute ischaemic strokes were studied using PET and {sup 18}F-FMISO. Studies were performed within 48 hours of stroke in 7 patients, at 6-11 days after stroke in 2 patients, and serially during both time epochs in 6 patients. We objectively assessed tracer uptake using a statistically-based image thresholding method. The mean activity in the contralateral (normal) hemisphere was calculated, and the whole image thresholded so that pixels with activity > 3 SD above the mean were identified. Positive studies were those with high activity pixels ipsilateral to the infarct. Hypoxic tissue was detected in peri-infarct regions in 9 of the 13 patients studied within 48 hours of stroke. These areas were generally distributed in the peripheries of the final infarct volume. None of the 8 patients studied 6-11 days after stroke exhibited increased {sup I8}F- FMISO activity. The 6 patients studied both early and late all exhibited areas of increased activity on the early but not the late study, consistent with resolution of the penumbra by this time. The distribution of the hypoxic tissue identified with this method supports the hypothesis that these tissues are likely to comprise the ischaemic penumbra.

  4. Predictive value of the amplitude integrated EEG in infants with hypoxic ischaemic encephalopathy: data from a randomised trial of therapeutic hypothermia.

    Science.gov (United States)

    Azzopardi, Denis

    2014-01-01

    The amplitude integrated EEG (aEEG) is reputed to be one of the best predictors of neurological outcome following hypoxic ischaemic encephalopathy in term newborns and was used to select infants into trials of neuroprotection with hypothermia, but its predictive value and the effect of moderate hypothermia on the aEEG have not previously been examined in a randomised study. The positive predictive value (PPV) of the aEEG recorded within 6 h of birth for death or disability at 18 months of age was determined in 314 infants born after 35 weeks gestation who were randomised to receive standard care with or without cooling for 72 h. The aEEG was classified according to voltage and by pattern. The PPV of a severely abnormal aEEG assessed by the voltage and pattern methods was 0.63 and 0.59 respectively in non-cooled infants and 0.55 and 0.51 in cooled infants (p>0.05). Although the differences in PPV between cooled and non-cooled groups were not significant, they are consistent with observational studies showing a lower PPV in infants treated with hypothermia, probably due to a neuroprotective effect of cooling.

  5. Cerebral small vessel disease, medial temporal lobe atrophy and cognitive status in patients with ischaemic stroke and transient ischaemic attack.

    Science.gov (United States)

    Arba, F; Quinn, T; Hankey, G J; Ali, M; Lees, K R; Inzitari, D

    2017-02-01

    Small vessel disease (SVD) and Alzheimer's disease (AD) are two common causes of cognitive impairment and dementia, traditionally considered as distinct processes. The relationship between radiological features suggestive of AD and SVD was explored, and the association of each of these features with cognitive status at 1 year was investigated in patients with stroke or transient ischaemic attack. Anonymized data were accessed from the Virtual International Stroke Trials Archive (VISTA). Medial temporal lobe atrophy (MTA; a marker of AD) and markers of SVD were rated using validated ordinal visual scales. Cognitive status was evaluated with the Mini Mental State Examination (MMSE) 1 year after the index stroke. Logistic regression models were used to investigate independent associations between (i) baseline SVD features and MTA and (ii) all baseline neuroimaging features and cognitive status 1 year post-stroke. In all, 234 patients were included, mean (±SD) age 65.7 ± 13.1 years, 145 (62%) male. Moderate to severe MTA was present in 104 (44%) patients. SVD features were independently associated with MTA (P SVD features are associated with MTA, which is a common finding in stroke survivors. SVD and AD type neurodegeneration coexist, but the AD marker MTA, rather than SVD markers, is associated with post-stroke cognitive impairment. © 2016 EAN.

  6. Management Of Ischaemic Stroke – Recent Advances | Ogun ...

    African Journals Online (AJOL)

    Management Of Ischaemic Stroke – Recent Advances. ... There is a better understanding of the natural course of stroke as well as its pathogenesis. ... Contemporary management of stroke is divided into 4 phases; acute, early subacute, late ...

  7. Dual-energy x-ray absorptiometry to measure the effects of a thirteen-week moderate to vigorous aquatic exercise and nutritional education intervention on percent body fat in adults with intellectual disabilities from group home settings.

    Science.gov (United States)

    Casey, Amanda; Boyd, Colin; Mackenzie, Sasho; Rasmussen, Roy

    2012-05-01

    People with intellectual disability are more likely to be obese and extremely obese than people without intellectual disability with rates remaining elevated among adults, women and individuals living in community settings. Dual-energy X-ray absorptiometry measured the effects of a 13-week aquatic exercise and nutrition intervention on percent body fat in eight adults with intellectual disabilities (aged 41.0 ± 13.7 yrs) of varying fat levels (15%-39%) from two group homes. A moderate to vigorous aquatic exercise program lasted for the duration of 13 weeks with three, one-hour sessions held at a 25m pool each week. Nutritional assistants educated participants as to the importance of food choice and portion size. A two-tailed Wilcoxon matched-pairs signed-ranks test determined the impact of the combined intervention on body fat percentage and BMI at pre and post test. Median body fat percentage (0.8 %) and BMI (0.3 kg/m(2)) decreased following the exercise intervention, but neither were statistically significant, p = .11 and p = .55, respectively. The combined intervention was ineffective at reducing percent body fat in adults with intellectual disability according to dual-energy X-ray absorptiometry. These results are in agreement with findings from exercise alone interventions and suggest that more stringent nutritional guidelines are needed for this population and especially for individuals living in group home settings. The study did show that adults with intellectual disability may participate in moderate to vigorous physical activity when given the opportunity.

  8. Prevalence and immediate outcomes of hypoxic Ischaemic ...

    African Journals Online (AJOL)

    resources especially in the labour ward which make birth asphyxia to be one ... neurological disabilities, aspiration pneumonia or systemic ... neonates who satisfied the inclusion criteria then were further .... Birth asphyxia: A review. East Asian ...

  9. Per capita alcohol consumption and ischaemic heart disease mortality.

    Science.gov (United States)

    Hemström, O

    2001-02-01

    To test the hypothesis that alcohol consumption is inversely related to ischaemic heart disease (IHD) mortality at the population level. Most individual-level studies find a reduced risk of IHD with a moderate level of alcohol consumption, but it is as yet unknown whether this association also exists at the aggregate level. The study period was approximately 1950 to 1995; 14 EU countries and Norway were included. Time series analyses on different data were utilized, and age-standardized IHD mortality for men and women in the age groups 30-44, 45-59, 60-74 and 30-74 years was measured. The effects of alcohol (sales per capita) were controlled for a weighted lag of per capita sales of cigarettes. There was a random distribution of insignificant negative and positive alcohol effect estimates. A slight indication of a cardioprotective effect of alcohol among 30- to 44-year-old women in high consumption countries could be observed (significant for Italy). Mean alcohol effect estimates were nearly exactly zero (absent alcohol effect) among men and weakly positive among women. Because changes in cigarette consumption were often significantly and positively related to subsequent changes in IHD mortality, poor validity in the IHD time series cannot explain the unsystematic findings. Including a 6-year weighted lag of alcohol consumption changed the weak positive effect among women to an absent alcohol effect. A brief analysis of abstinence rates indicated no particular relationship to IHD mortality. The alleged cardioprotective alcohol effect is absent at the population level, and great caution should be taken concerning alcohol policies for cardioprotective purposes.

  10. Is it important to classify ischaemic stroke?

    LENUS (Irish Health Repository)

    Iqbal, M

    2012-02-01

    Thirty-five percent of all ischemic events remain classified as cryptogenic. This study was conducted to ascertain the accuracy of diagnosis of ischaemic stroke based on information given in the medical notes. It was tested by applying the clinical information to the (TOAST) criteria. Hundred and five patients presented with acute stroke between Jan-Jun 2007. Data was collected on 90 patients. Male to female ratio was 39:51 with age range of 47-93 years. Sixty (67%) patients had total\\/partial anterior circulation stroke; 5 (5.6%) had a lacunar stroke and in 25 (28%) the mechanism of stroke could not be identified. Four (4.4%) patients with small vessel disease were anticoagulated; 5 (5.6%) with atrial fibrillation received antiplatelet therapy and 2 (2.2%) patients with atrial fibrillation underwent CEA. This study revealed deficiencies in the clinical assessment of patients and treatment was not tailored to the mechanism of stroke in some patients.

  11. Genetics of ischaemic stroke; single gene disorders.

    Science.gov (United States)

    Flossmann, Enrico

    2006-08-01

    Examples of single gene disorders have been described for all major subtypes of ischaemic stroke: accelerated atherosclerosis and subsequent thrombo-embolism (e.g. homocysteinuria), weakening of connective tissue resulting in arterial dissections (e.g. Ehler-Danlos type IV), disorders of cerebral small vessels (e.g. cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy and the collagen COL4A1 mutation), disorders increasing the thrombogenic potential of the heart through affecting the myocardium or the heart valves or through disturbance of the heart rhythm (e.g. hypertrophic cardiomyopathy), mitochondrial cytopathies increasing cerebral tissue susceptibility to insults (e.g. mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes), and finally disorders of coagulation that can either directly cause stroke or act synergistically with the aforementioned abnormalities (e.g. sickle cell disease). Most of these disorders are rare but they are important to consider particularly in young patients with stroke, those with a family history or those who have other characteristics of a particular syndrome.

  12. Aseptic meningoencephalitis mimicking transient ischaemic attacks.

    Science.gov (United States)

    Papavasileiou, V; Milionis, H; Cordier, M; Eskandari, A; Ntaios, G; Michel, P

    2013-04-01

    To highlight meningoencephalitis as a transient ischaemic attack (TIA) mimic and suggest clinical clues for differential diagnosis. This was an observational study of consecutively admitted patients over a 9.75-year period presenting as TIAs at a stroke unit. A total of 790 patients with TIAs and seven with TIA-like symptoms but a final diagnosis of viral meningoencephalitis were recognised. The most frequent presentations of meningoencephalitis patients were acute sensory hemisyndrome (6) and cognitive deficits (5). Signs of meningeal irritation were minor or absent on presentation. Predominantly lymphocytic pleocytosis, hyperproteinorachia and a normal cerebrospinal fluid (CSF)/serum glucose index (in 5 out of 6 documented patients) were present. Meningeal thickening on a brain magnetic resonance imaging (MRI) scan was the only abnormal imaging finding. Six patients received initial vascular treatment; one thrombolysed. Finally, six patients were treated with antivirals and/or antibiotics. Although neither bacterial nor viral agents were identified on extensive testing, viral meningoencephalitis was the best explanation for all clinical and laboratory findings. Aseptic meningoencephalitis should be part of the differential diagnosis in patients presenting as TIA. The threshold for a lumbar puncture in such patients should be set individually and take into account the presence of mild meningeal symptoms, age and other risk factors for vascular disease, the results of brain imaging and the basic diagnostic work-up for a stroke source.

  13. Is it important to classify ischaemic stroke?

    LENUS (Irish Health Repository)

    Iqbal, M

    2012-02-01

    Thirty-five percent of all ischemic events remain classified as cryptogenic. This study was conducted to ascertain the accuracy of diagnosis of ischaemic stroke based on information given in the medical notes. It was tested by applying the clinical information to the (TOAST) criteria. Hundred and five patients presented with acute stroke between Jan-Jun 2007. Data was collected on 90 patients. Male to female ratio was 39:51 with age range of 47-93 years. Sixty (67%) patients had total\\/partial anterior circulation stroke; 5 (5.6%) had a lacunar stroke and in 25 (28%) the mechanism of stroke could not be identified. Four (4.4%) patients with small vessel disease were anticoagulated; 5 (5.6%) with atrial fibrillation received antiplatelet therapy and 2 (2.2%) patients with atrial fibrillation underwent CEA. This study revealed deficiencies in the clinical assessment of patients and treatment was not tailored to the mechanism of stroke in some patients.

  14. [Ischaemic lesions of cerebral after carotid stenting].

    Science.gov (United States)

    Medvedev, R B; Tanashian, M M; Kuntsevich, G I; Lagoda, O V; Skrylev, S I; Krotenkova, M V; Koshcheev, A Iu; Suslin, A S; Gemdzhian, É G

    2015-01-01

    Carotid angioplasty with stenting is a reliable method of primary and secondary prevention of ischaemic stroke in patients with stenosing lesions of the internal carotid artery. However, carrying out such operations is sometimes associated with risk for the development of intraoperative impairments of cerebral circulation due to arterioarterial embolism in cerebral arteries, as well as vasospasm. Presented herein are the results of following up a total of 64 patients with pronounced atherosclerotic lesions of internal carotid arteries (>70%) - "symptomatic" and "asymptomatic", undergoing carotid stenting. Acute foci of ischaemia in the brain after stenting according to the findings of diffusion-weighted magnetic resonance tomography were revealed in 40% of cases, and in only 6% of patients they manifested themselves by symptoms of acute cerebral circulatory impairment. We revealed a direct correlation between the number, size of infarctions in the brain, and the appearance of neurological symptomatology. Intraoperative monitoring of blood flow in the middle cerebral artery during stenting makes it possible to predict the appearance of acute foci of cerebral ischaemia, to specify the genesis of perioperative stroke, as well as to evaluate clinical significance of vasospasm and material microembolism. The obtained findings should concentrate neurologists' attention on active postoperative follow up of patients subjected to carotid angioplasty with stenting in order to perform adequate personified neuroprotective correction, including preventive one.

  15. Piloting a manualised weight management programme (Shape Up-LD) for overweight and obese persons with mild-moderate learning disabilities: study protocol for a pilot randomised controlled trial.

    Science.gov (United States)

    Beeken, Rebecca J; Spanos, Dimitrios; Fovargue, Sally; Hunter, Rachael; Omar, Rumana; Hassiotis, Angela; King, Michael; Wardle, Jane; Croker, Helen

    2013-03-12

    National obesity rates have dramatically risen over the last decade. Being obese significantly reduces life expectancy, increases the risk of a range of diseases, and compromises quality of life. Costs to both the National Health Service and society are high. An increased prevalence of obesity in people with learning disabilities has been demonstrated. The consequences of obesity are particularly relevant to people with learning disabilities who are already confronted by health and social inequalities. In order to provide healthcare for all, and ensure equality of treatment for people with learning disabilities, services must be developed specifically with this population in mind. The aim of this project is to pilot the evaluation of a manualised weight management programme for overweight and obese persons with mild-moderate learning disabilities (Shape Up-LD). An individually randomised, controlled pilot trial in 60 overweight and obese (body mass index ≥ 25) adults (age ≥ 18) with mild-moderate learning disabilities and their carers will be carried out, comparing "Shape Up-LD" with usual care. The manualised Shape Up-LD intervention will involve 12 weekly sessions, which include healthy eating messages, advice on physical activity and use of behaviour change techniques to help people manage their weight. Assessments of participants will be conducted at baseline, 12 weeks and 6 months. Service users and their carers and service providers will also give their perspectives on the experience of Shape Up-LD in qualitative interviews at 12 weeks. Feasibility outcomes will include recruitment rates, loss to follow-up, compliance rates, completion rates, collection of information for a cost-effectiveness analysis and an estimation of the treatment effect on weight. The findings from this study will inform our preparation for a definitive randomised controlled trial to test the efficacy of the programme with respect to weight loss and maintenance in this population

  16. Reduction in dynamin-2 is implicated in ischaemic cardiac arrhythmias.

    Science.gov (United States)

    Shi, Dan; Xie, Duanyang; Zhang, Hong; Zhao, Hong; Huang, Jian; Li, Changming; Liu, Yi; Lv, Fei; The, Erlinda; Liu, Yuan; Yuan, Tianyou; Wang, Shiyi; Chen, Jinjin; Pan, Lei; Yu, Zuoren; Liang, Dandan; Zhu, Weidong; Zhang, Yuzhen; Li, Li; Peng, Luying; Li, Jun; Chen, Yi-Han

    2014-10-01

    Ischaemic cardiac arrhythmias cause a large proportion of sudden cardiac deaths worldwide. The ischaemic arrhythmogenesis is primarily because of the dysfunction and adverse remodelling of sarcolemma ion channels. However, the potential regulators of sarcolemma ion channel turnover and function in ischaemic cardiac arrhythmias remains unknown. Our previous studies indicate that dynamin-2 (DNM2), a cardiac membrane-remodelling GTPase, modulates ion channels membrane trafficking in the cardiomyocytes. Here, we have found that DNM2 plays an important role in acute ischaemic arrhythmias. In rat ventricular tissues and primary cardiomyocytes subjected to acute ischaemic stress, the DNM2 protein and transcription levels were markedly down-regulated. This DNM2 reduction was coupled with severe ventricular arrhythmias. Moreover, we identified that the down-regulation of DNM2 within cardiomyocytes increases the action potential amplitude and prolongs the re-polarization duration by depressing the retrograde trafficking of Nav1.5 and Kir2.1 channels. These effects are likely to account for the DNM2 defect-induced arrhythmogenic potentials. These results suggest that DNM2, with its multi-ion channel targeting properties, could be a promising target for novel antiarrhythmic therapies.

  17. Effects of surgery on ischaemic mitral regurgitation: a prospective multicentre registry (SIMRAM registry)

    DEFF Research Database (Denmark)

    Lancellotti, P.; Donal, E.; Cosyns, B.

    2008-01-01

    AIMS: Functional ischaemic mitral regurgitation (IMR) is common in patients with ischaemic left ventricular dysfunction undergoing coronary artery bypass surgery. Although the presence of IMR negatively affects prognosis, the additional benefit of valve repair is debated, particularly with mild I...

  18. Profound retinal ischaemia after ranibizumab administration in an eye with ocular ischaemic syndrome

    DEFF Research Database (Denmark)

    Kofoed, Peter Kristian; Munch, Inger Christine; Larsen, Michael

    2009-01-01

    Abstract. Purpose: To report the result of ranibizumab administration in an eye with ocular ischaemic syndrome. Methods: Fluorescein angiography, ocular pneumoplethysmography and retinal vessel calibre measurement. Results: An 85-year-old man with ocular ischaemic syndrome demonstrated vision loss...

  19. Ischaemic strokes : management in first six hours.

    Directory of Open Access Journals (Sweden)

    Dalal P

    2001-04-01

    Full Text Available Cerebrovascular disease (CVD or stroke is one of the foremost causes of high morbidity and mortality for many nations of the world, posing a major socio-economic challenge in the occupational and neuro-rehabilitational programmes of the ′stroke-survivors′. For example, in USA alone it has been estimated that a sum of 3261 million dollars is spent as direct cost for treatment, in addition to 4104 million dollars as indirect costs, consequent on economic losses of ′stroke victims′. Thus, the new concept in stroke pathophysiology and strategies for stroke prevention have assumed global importance. Among all risk factors for strokes, hypertension is one of the most important and treatable factor. Community screening surveys, by well defined WHO protocol, have shown that nearly 15% of urban population is hypertensive (160/95 mm Hg or more. Though high blood pressure has the highest attributable risk for stroke, there are many other reasons such as patient′s compliance in taking medicine and poor followup in clinical practice that may lead to failure in reducing stroke mortality. In subjects, who have transient ischaemic attacks (TIAs, regular use of antiplatelet agents like aspirin is well established in prevention of stroke. It is also mandatory to prohibit tobacco use and adjust dietary habits to control body weight. Associated conditions like diabetes mellitus etc. should also be treated. It is advisable to initiate community screening surveys on well defined populations for early detection of hypertension and TIAs. Primary health care centres should be the base stations for these surveys, because data gathered from urban hospitals will not truly reflect the crude prevalence rates for the community to design practical prevention programmes.

  20. French Validation of the Multidimensional Attitude Scale toward Persons with Disabilities (MAS): The Case of Attitudes toward Autism and Their Moderating Factors

    Science.gov (United States)

    Dachez, Julie; Ndobo, Andre; Ameline, Anaïs

    2015-01-01

    This research investigates the renewed interest in autism, the stigmatization of persons with autism and the need to better measure such stigmatization. Two studies were thus conducted on 101 and 104 participants in order to validate the French version of the Multidimensional Attitude Scale toward persons with disabilities, and examine the…

  1. Clinical Measures Are Feasible and Sensitive to Assess Balance and Gait Capacities in Older Persons with Mild to Moderate Intellectual Disabilities

    Science.gov (United States)

    Enkelaar, Lotte; Smulders, Ellen; Lantman-de Valk, Henny van Schrojenstein; Weerdesteyn, Vivian; Geurts, Alexander C. H.

    2013-01-01

    Mobility limitations are common in persons with Intellectual Disabilities (ID). Differences in balance and gait capacities between persons with ID and controls have mainly been demonstrated by instrumented assessments (e.g. posturography and gait analysis), which require sophisticated and expensive equipment such as force plates or a 3D motion…

  2. Clinical measures are feasible and sensitive to assess balance and gait capacities in older persons with mild to moderate Intellectual Disabilities

    NARCIS (Netherlands)

    Enkelaar, L.; Smulders, E.; Schrojenstein Lantman, H.M.J. van; Weerdesteijn, V.G.M.; Geurts, A.C.H.

    2013-01-01

    Mobility limitations are common in persons with Intellectual Disabilities (ID). Differences in balance and gait capacities between persons with ID and controls have mainly been demonstrated by instrumented assessments (e.g. posturography and gait analysis), which require sophisticated and expensive

  3. Cuaderno de Proyectos Manuales Sugeridos para Estudiantes con Impedimentos (Notebook of Manual Projects Suggested for Students with Light and Moderate Disabilities).

    Science.gov (United States)

    Puerto Rico State Dept. of Education, Hato Rey. Office of Special Education.

    This notebook is a reference source that lists suggested manual projects that can be completed by students with disabilities. The projects were developed for use with special education students and those in prevocational education. Information is included about materials, hardware, equipment, and safety, with recommendations for each project and…

  4. Teaching Students with Autism Spectrum Disorder and Moderate Intellectual Disabilities to Use Counting-on Strategies to Enhance Independent Purchasing Skills

    Science.gov (United States)

    Cihak, David F.; Grim, Joan

    2008-01-01

    The demands of basic math skills often limit the ability of students with autism spectrum disorders to master purchasing skills. This study examined the use of counting-on math skills in conjunction with the next-dollar strategy to enhance independent purchasing skills. Four students with autism and intellectual disabilities successfully acquired…

  5. Osteoprotegerin concentrations and prognosis in acute ischaemic stroke

    DEFF Research Database (Denmark)

    Jensen, Jesper Khédri; Ueland, T; Gullestad, L;

    2010-01-01

    .1365-2796.2009.02163.x.Aim. Concentrations of osteoprotegerin (OPG) have been associated with the presence of vascular and cardiovascular diseases, but the knowledge of this marker in the setting of ischaemic stroke is limited. Methods and results. In 244 patients with acute ischaemic stroke (age: 69......Abstract. Jensen JK, Ueland T, Atar D, Gullestad L, Mickley H, Aukrust P, Januzzi JL (Odense University Hospital, Denmark; Rikshospitalet, Oslo, Norway; Massachusetts General Hospital, USA). Osteoprotegerin concentrations and prognosis in acute ischaemic stroke. J Intern Med 2009; doi: 10.1111/j...... at presentation included haemoglobin (T = -2.82; P = 0.005), creatinine (T = 4.56; P age (T = 9.66; P

  6. Ischaemic stroke in children secondary to post varicella angiopathy.

    LENUS (Irish Health Repository)

    Hayes, B

    2007-01-01

    Varicella in childhood is a self-limiting disease, which usually follows a benign course. However, complications, although rare, may have serious consequences. Ischaemic stroke secondary to post varicella angiopathy is a well-described complication and is estimated to account for up to a third of all strokes in infants. We present three previously healthy children who presented to our centre with ischaemic cerebrovascular infarction due to varicella angiopathy. All three children first presented within six weeks after onset of varicella infection and had MRI changes characteristic of ischaemic stroke secondary to post varicella angiopathy. While one child made an excellent recovery being left with only a minor deficit, the remaining two children were left with considerable morbidity severely affecting quality of life. The varicella vaccine has been proven to be well tolerated, safe and effective. We conclude that varicella vaccination should be considered for inclusion in the vaccination schedule to prevent serious complications which while rare may have devastating consequences.

  7. Acute myeloid leukaemia as a cause of acute ischaemic heart disease

    NARCIS (Netherlands)

    van Haelst, P.L.; Schot, Bart; Hoendermis, E.S.; van den Berg, M.P.

    2006-01-01

    Ischaemic heart disease is almost invariably the result of atherosclerotic degeneration of the coronary arteries. However, other causes of ischaemic heart disease should always be considered. Here we describe two patients with a classic presentation of ischaemic heart disease resulting from acute le

  8. Acute myeloid leukaemia as a cause of acute ischaemic heart disease

    NARCIS (Netherlands)

    van Haelst, P.L.; Schot, Bart; Hoendermis, E.S.; van den Berg, M.P.

    2006-01-01

    Ischaemic heart disease is almost invariably the result of atherosclerotic degeneration of the coronary arteries. However, other causes of ischaemic heart disease should always be considered. Here we describe two patients with a classic presentation of ischaemic heart disease resulting from acute

  9. Acute myeloid leukaemia as a cause of acute ischaemic heart disease

    NARCIS (Netherlands)

    van Haelst, P.L.; Schot, Bart; Hoendermis, E.S.; van den Berg, M.P.

    2006-01-01

    Ischaemic heart disease is almost invariably the result of atherosclerotic degeneration of the coronary arteries. However, other causes of ischaemic heart disease should always be considered. Here we describe two patients with a classic presentation of ischaemic heart disease resulting from acute le

  10. Absence epilepsy and the CHD2 gene: an adolescent male with moderate intellectual disability, short-lasting psychoses, and an interstitial deletion in 15q26.1–q26.2

    Science.gov (United States)

    Verhoeven, Willem MA; Egger, Jos IM; Knegt, Alida C; Zuydam, José; Kleefstra, Tjitske

    2016-01-01

    Deletions of the 15q26 region encompassing the chromodomain helicase DNA binding domain 2 (CHD2) gene have been associated with intellectual disability, behavioral problems, and several types of epilepsy. Including the cases mentioned in ECARUCA (European cytogeneticists association register of unbalanced chromosome aberrations) and DECIPHER (database of genomic variation and phenotype in humans using ensembl resources), so far, a total of 13 intellectually disabled patients with a genetically proven deletion of the CHD2 gene are described, of whom eleven had a history of severe forms of epilepsy starting from a young age. In this article, a moderately intellectually disabled 15-year-old male with a 15q26.1–q26.2 interstitial deletion is reported, who was referred for analysis of two recent short-lasting psychotic episodes that were nonresponsive to antipsychotic treatment and recurrent disinhibited behaviors since early infancy. Careful interdisciplinary assessment revealed that the psychotic phenomena originated from a previously unrecognized absence epilepsy. Treatment with valproic acid was started which resulted in full remission of psychotic symptoms, and consequently, substantial improvement of behavior. It was concluded that in case of (rare) developmental disorders with genetically proven etiology, a detailed inventory of anamnestic data and description of symptomatology over time may elucidate epilepsy-related psychopathology for which a specific treatment regimen is needed. PMID:27274247

  11. Cuaderno de Recetas Ilustradas para Jovenes con Impedimentos--Para Estudiantes con Impedimentos Leves v Moderados (Notebook of Illustrated Recipes for Youth with Disabilities--For Students with Light and Moderate Disabilities).

    Science.gov (United States)

    Puerto Rico State Dept. of Education, Hato Rey. Office of Special Education.

    This collection of recipes has been prepared with attention to the needs of students with disabilities who lack reading skills sufficient to be able to use ordinary cookbooks. Presentation in this illustrated form helps them understand the processes of food preparation as it introduces a basic culinary vocabulary. The teacher can use this…

  12. Ankylosing spondylitis and risk of ischaemic heart disease

    DEFF Research Database (Denmark)

    Essers, Ivette; Stolwijk, Carmen; Boonen, Annelies;

    2016-01-01

    OBJECTIVE: To investigate the incidence and risk of ischaemic heart disease (IHD) and acute myocardial infarction (AMI), including the role of non-steroidal anti-inflammatory drugs (NSAID), in patients with ankylosing spondylitis (AS) compared with population controls. METHODS: All patients...

  13. Predicting the effect of prevention of ischaemic heart disease

    DEFF Research Database (Denmark)

    Brønnum-Hansen, Henrik

    2002-01-01

    Priority setting in public health policy must be based on information on the effectiveness of alternative preventive and therapeutic interventions. The purpose of this study is to predict the effect on mortality from ischaemic heart disease (IHD) in Denmark of reduced exposure to the risk factors...

  14. Patterns of neonatal hypoxic-ischaemic brain injury

    Energy Technology Data Exchange (ETDEWEB)

    Vries, Linda S. de [University Medical Centre, Department of Neonatology, Wilhelmina Children' s Hospital, Utrecht (Netherlands); Wilhelmina Children' s Hospital, University Medical Centre, Department of Neonatology, KE 04.123.1, P.O. Box 85090, Utrecht (Netherlands); Groenendaal, Floris [University Medical Centre, Department of Neonatology, Wilhelmina Children' s Hospital, Utrecht (Netherlands)

    2010-06-15

    Enormous progress has been made in assessing the neonatal brain, using magnetic resonance imaging (MRI). In this review, we will describe the use of MRI and proton magnetic resonance spectroscopy in detecting different patterns of brain injury in (full-term) human neonates following hypoxic-ischaemic brain injury and indicate the relevance of these findings in predicting neurodevelopmental outcome. (orig.)

  15. Pregnancy loss and risk of ischaemic stroke and myocardial infarction

    NARCIS (Netherlands)

    Maino, Alberto; Siegerink, Bob; Algra, Ale|info:eu-repo/dai/nl/07483472X; Martinelli, Ida; Peyvandi, Flora; Rosendaal, Frits R.

    2016-01-01

    We investigated whether pregnancy loss increases the risk of arterial thrombosis in young women. Women (age 18–50 years) with ischaemic stroke (IS) or myocardial infarction (MI) and at least one pregnancy were compared for pregnancy loss in a control group. Odds ratios (OR) with 95% confidence inter

  16. Transient ischaemic attack caused by an ingested stingray barb.

    Science.gov (United States)

    Gan, Desmond C C; Huilgol, Ravi L; Westcott, Mark J

    A 76-year-old woman reported a fishbone stuck in her throat, but no foreign body was identified. Eight weeks later, she experienced a transient ischaemic attack, and a stingray barb was subsequently removed from the right common carotid artery. To our knowledge, this is the first report of the migration of an ingested stingray barb.

  17. Detection of differentially regulated genes in ischaemic equine intestinal mucosa.

    NARCIS (Netherlands)

    Tschetter, J.R.; Blikslager, A.T.; Little, D.; Howard, R.; Woody, S.L.; Beex, L.V.A.M.; Crisman, M.V.

    2005-01-01

    REASONS FOR PERFORMING STUDY: Colic is a serious disease syndrome in horses. Much of the mortality is associated with ischaemic-injured intestine during strangulating obstruction, yet there is limited understanding of the associated molecular events. Identification of differentially expressed genes

  18. Extracranial arterial aneurysms: a cause of crescendo transient ischaemic attacks.

    Science.gov (United States)

    Paterson, H M; Holdsworth, R J

    2000-12-01

    Crescendo transient ischaemic attacks (TIAs) should be regarded as a medical emergency. Patients require hospitalisation with urgent assessment and symptom control with anticoagulant therapy. We report on three patients, all of whom had atherosclerotic aneurysmal disease of the extracranial arterial circulation who presented with crescendo TIAs. The possibility of extracranial aneurysmal disease should always be considered and excluded.

  19. Radial optic neurotomy for ischaemic central vein occlusion

    Science.gov (United States)

    Martínez-Jardón, C S; Meza-de Regil, A; Dalma-Weiszhausz, J; Leizaola-Fernández, C; Morales-Cantón, V; Guerrero-Naranjo, J L; Quiroz-Mercado, H

    2005-01-01

    Background/aims: Ischaemic central retinal vein occlusion (CRVO) accounts for 20–50% of all CRVO. No treatment has been proved to be effective. The efficacy of radial optic neurotomy (RON) was evaluated in eyes with ischaemic CRVO. Methods: 10 patients with ischaemic CRVO underwent RON. After pars plana vitrectomy, a microvitreoretinal blade was used to incise the scleral ring, cribriform plate, and adjacent sclera at the nasal edge of the optic disc. Best corrected visual acuity (BCVA), intraocular pressure (IOP), fluorescein angiography (FA), multifocal electroretinography (mfERG), and optical coherence tomography (OCT) were measured preoperatively and at 1, 3, and 6 months postoperatively. Results: No visual improvement was noted in the eyes that underwent RON. FA and mfERG showed no increase in retinal perfusion or retinal function postoperatively. Mean macular central thickness changed from 841 (SD 170) μm preoperatively to 162 (SD 34) μm at the sixth postoperative month. One patient had retinal central artery perforation intraoperatively. One patient developed neovascular glaucoma. Conclusion: RON in ischaemic CRVO did not improve visual function (by mfERG) or visual acuity although macular thickness did improve. This technique may be associated with potential risks. Randomised studies are needed to corroborate these results. PMID:15834084

  20. Carotid endarterectomy after intravenous thrombolysis for acute cerebral ischaemic attack

    DEFF Research Database (Denmark)

    Rathenborg, Lisbet Knudsen; Jensen, L P; Baekgaard, N;

    2013-01-01

    Intravenous thrombolysis (IVT) has proven effective in the treatment of acute cerebral ischaemic attack in selected cases. In the presence of a carotid artery stenosis, such patients may be candidates for carotid endarterectomy (CEA). Few studies have been made on the safety of CEA performed afte...

  1. Thrombo-ischaemic pinnal necrosis associated with fenbendazole treatment in a dog.

    Science.gov (United States)

    Nuttall, T J; Burrow, R; Fraser, I; Kipar, A

    2005-05-01

    An 11-week-old, female West Highland white terrier was presented with necrosis of the distal third of both pinnae. Haematology, biochemistry and urinalysis, Coombs test, antinuclear antibody and cold autoagglutinin antibody tests were normal. A drug reaction to fenbendazole was diagnosed. The necrotic ear tips were surgically removed. Histopathology revealed extensive coagulative necrosis of the epidermis and superficial to mid-dermis, a moderate interstitial neutrophilic infiltrate and complete thrombotic occlusion and necrosis of blood vessels. There was also endothelial cell activation and proliferation with endothelial cell cushions protruding into the vascular lumen. Immunohistochemistry for factor VIII-related antigen confirmed endothelial cell involvement. This case represents an unusual, drug-induced, thrombo-ischaemic necrosis of the pinnae. It is also, to the authors' knowledge, the first report of fenbendazole sensitivity in a dog. The histopathology is similar to previous cases of proliferative thrombovascular pinnal necrosis, suggesting that drug reactions should be considered in this condition.

  2. Semi-automatic software based detection of atrial fibrillation in acute ischaemic stroke and transient ischaemic attack.

    Science.gov (United States)

    Nickelsen, M N; Snoer, A; Ali, A M; Wienecke, T

    2017-02-01

    Paroxysmal atrial fibrillation (PAF) is often asymptomatic and increases the risk of ischaemic stroke. Detection of PAF is challenging but crucial because a change of treatment decreases the risk of ischaemic stroke. Post-stroke investigations recommend at least 24-h continuous cardiac rhythm monitoring. Extended monitoring detects more PAF but is limited by costs due to manual analysis. Interpretive software might be a reasonable screening tool. The aim was to validate the performance and utility of Pathfinder SL software compared to manual analysis. In all, 135 ischaemic stroke patients with no prior history of PAF or atrial fibrillation and who had done a 7-day continuous electrocardiogram monitoring (Holter) were included. Manual analysis was compared with Pathfinder SL software including a systematic control of registered events. Seventeen (12.6%) patients were diagnosed with PAF (atrial fibrillation > 30 s). Pathfinder SL software including a systematic control of events registered 16 (94.1%) patients with PAF. Manually 15 (88.2%) patients were detected with PAF. Pathfinder SL had a negative predictive value of 99% and sensitivity of 94%. Pathfinder SL software including a systematic evaluation of events is an acceptable alternative compared to manual analysis in PAF detection following ischaemic stroke. It is less time consuming and therefore a reliable, cheaper alternative compared to manual analysis. © 2016 EAN.

  3. Quantification of coronary flow reserve in patients with ischaemic and non-ischaemic cardiomyopathy and its association with clinical outcomes

    Science.gov (United States)

    Majmudar, Maulik D.; Murthy, Venkatesh L.; Shah, Ravi V.; Kolli, Swathy; Mousavi, Negareh; Foster, Courtney R.; Hainer, Jon; Blankstein, Ron; Dorbala, Sharmila; Sitek, Arkadiusz; Stevenson, Lynne W.; Mehra, Mandeep R.; Di Carli, Marcelo F.

    2015-01-01

    Aims Patients with left ventricular systolic dysfunction frequently show abnormal coronary vascular function, even in the absence of overt coronary artery disease. Moreover, the severity of vascular dysfunction might be related to the aetiology of cardiomyopathy. We sought to determine the incremental value of assessing coronary vascular dysfunction among patients with ischaemic (ICM) and non-ischaemic (NICM) cardiomyopathy at risk for adverse cardiovascular outcomes. Methods and results Coronary flow reserve (CFR, stress/rest myocardial blood flow) was quantified in 510 consecutive patients with rest left ventricular ejection fraction (LVEF) ≤45% referred for rest/stress myocardial perfusion PET imaging. The primary end point was a composite of major adverse cardiovascular events (MACE) including cardiac death, heart failure hospitalization, late revascularization, and aborted sudden cardiac death. Median follow-up was 8.2 months. Cox proportional hazards model was used to adjust for clinical variables. The annualized MACE rate was 26.3%. Patients in the lowest two tertiles of CFR (CFR ≤ 1.65) experienced higher MACE rates than those in the highest tertile (32.6 vs. 15.5% per year, respectively, P = 0.004), irrespective of aetiology of cardiomyopathy. Conclusion Impaired coronary vascular function, as assessed by reduced CFR by PET imaging, is common in patients with both ischaemic and non-ischaemic cardiomyopathy and is associated with MACE. PMID:25719181

  4. Absence epilepsy and the CHD2 gene: an adolescent male with moderate intellectual disability, short-lasting psychoses, and an interstitial deletion in 15q26.1–q26.2

    Directory of Open Access Journals (Sweden)

    Verhoeven WMA

    2016-05-01

    Full Text Available Willem MA Verhoeven,1,2 Jos IM Egger,1,3,4 Alida C Knegt,5 José Zuydam,6 Tjitske Kleefstra7 1Centre of Excellence for Neuropsychiatry, Vincent van Gogh Institute for Psychiatry, Venray, 2Department of Psychiatry, Erasmus University Medical Center, Rotterdam, 3Donders Institute for Brain, Cognition and Behaviour, 4Behavioural Science Institute, Radboud University, Nijmegen, 5Department of Clinical Genetics, University of Amsterdam Medical Center, Amsterdam, 6Reigersdaal Institute for Intellectual Disabilities, Heerhugowaard, 7Department of Genetics, Radboud University Medical Centre, Nijmegen, the Netherlands Abstract: Deletions of the 15q26 region encompassing the chromodomain helicase DNA binding domain 2 (CHD2 gene have been associated with intellectual disability, behavioral problems, and several types of epilepsy. Including the cases mentioned in ECARUCA (European cytogeneticists association register of unbalanced chromosome aberrations and DECIPHER (database of genomic variation and phenotype in humans using ensembl resources, so far, a total of 13 intellectually disabled patients with a genetically proven deletion of the CHD2 gene are described, of whom eleven had a history of severe forms of epilepsy starting from a young age. In this article, a moderately intellectually disabled 15-year-old male with a 15q26.1–q26.2 interstitial deletion is reported, who was referred for analysis of two recent short-lasting psychotic episodes that were nonresponsive to antipsychotic treatment and recurrent disinhibited behaviors since early infancy. Careful interdisciplinary assessment revealed that the psychotic phenomena originated from a previously unrecognized absence epilepsy. Treatment with valproic acid was started which resulted in full remission of psychotic symptoms, and consequently, substantial improvement of behavior. It was concluded that in case of (rare developmental disorders with genetically proven etiology, a detailed inventory of

  5. The metabolomic profile of umbilical cord blood in neonatal hypoxic ischaemic encephalopathy.

    Directory of Open Access Journals (Sweden)

    Brian H Walsh

    Full Text Available BACKGROUND: Hypoxic ischaemic encephalopathy (HIE in newborns can cause significant long-term neurological disability. The insult is a complex injury characterised by energy failure and disruption of cellular homeostasis, leading to mitochondrial damage. The importance of individual metabolic pathways, and their interaction in the disease process is not fully understood. The aim of this study was to describe and quantify the metabolomic profile of umbilical cord blood samples in a carefully defined population of full-term infants with HIE. METHODS AND FINDINGS: The injury severity was defined using both the modified Sarnat score and continuous multichannel electroencephalogram. Using these classification systems, our population was divided into those with confirmed HIE (n = 31, asphyxiated infants without encephalopathy (n = 40 and matched controls (n = 71. All had umbilical cord blood drawn and biobanked at -80 °C within 3 hours of delivery. A combined direct injection and LC-MS/MS assay (AbsolutIDQ p180 kit, Biocrates Life Sciences AG, Innsbruck, Austria was used for the metabolomic analyses of the samples. Targeted metabolomic analysis showed a significant alteration between study groups in 29 metabolites from 3 distinct classes (Amino Acids, Acylcarnitines, and Glycerophospholipids. 9 of these metabolites were only significantly altered between neonates with Hypoxic ischaemic encephalopathy and matched controls, while 14 were significantly altered in both study groups. Multivariate Discriminant Analysis models developed showed clear multifactorial metabolite associations with both asphyxia and HIE. A logistic regression model using 5 metabolites clearly delineates severity of asphyxia and classifies HIE infants with AUC = 0.92. These data describe wide-spread disruption to not only energy pathways, but also nitrogen and lipid metabolism in both asphyxia and HIE. CONCLUSION: This study shows that a multi-platform targeted approach to

  6. Echocardiographic Assessment of Ischaemic Mitral Regurgitation, Mechanism, Severity, Impact on Treatment Strategy and Long Term Outcome

    Science.gov (United States)

    Naser, Nabil; Dzubur, Alen; Kusljugic, Zumreta; Kovacevic, Katarina; Kulic, Mehmed; Sokolovic, Sekib; Terzic, Ibrahim; Haxihibeqiri-Karabdic, Ilirijana; Hondo, Zorica; Brdzanovic, Snjezana; Miseljic, Sanja

    2016-01-01

    echocardiography for detection and assessment of ischaemic mitral regurgitation (IMR) with baseline age (62 ± 9), ejection fraction (EF 41±12%), the regurgitant volume (RV) were 42±21 mL/beat, and effective regurgitant orifice area (EROA) 20±16 mm2, the regurgitant fraction (RF) were 48±10%, Jet/LA area 47±12%. Also we measured the of vena contracta width (VC width cm) 0,4±0,6 for assessment of IMR severity. During 5 years follow up, total mortality for patients with moderate/severe IMR–grade II-IV (54.2±1.8%) were higher than for those with mild IMR–grade I (30.4±2.9%) (P<0.05), the total mortality for patients with EROA ≥20 mm2(54±1.9%) were higher than for those with EROA <20 mm2(27.2±2.7%) (P<0.05), and the total mortality for patients with RVol ≥30 mL (56.8±1.7%) were higher than for those with RVol<30ml (29.4±2.9%) (P<0.05). After assessment of IMR and during follow up period 64 patients (46%) underwent CABG alone or combined CABG with mitral valve repair or replacement. In this study, the procedure of concomitant down-sized ring annuloplasty at the time if CABG surgery has a failure rate around 24% in terms of high late recurrence rate of IMR during the follow period especially after 18–42 months. Conclusion: The presence of ischaemic MR is associated with increased morbidity and mortality. Chronic IMR, an independent predictor of mortality with a reported survival of 40–60% at 5 years. Ischaemic mitral regurgitation has important prognosis implications in patients with coronary heart disease. Recognizing the mechanism of valve incompetence is an essential point for the surgical planning and for a good result of the mitral repair. It is important that echocardiographers understand the complex nature of the condition. Despite remarkable progress in reparative surgery, further investigation is still necessary to find the best approach to treat ischaemic mitral regurgitation. PMID:27482130

  7. Effects of aspirin on risk and severity of early recurrent stroke after transient ischaemic attack and ischaemic stroke : time-course analysis of randomised trials

    NARCIS (Netherlands)

    Rothwell, Peter M; Algra, Ale; Chen, Zhengming; Diener, Hans-Christoph; Norrving, Bo; Mehta, Ziyah

    2016-01-01

    BACKGROUND: Aspirin is recommended for secondary prevention after transient ischaemic attack (TIA) or ischaemic stroke on the basis of trials showing a 13% reduction in long-term risk of recurrent stroke. However, the risk of major stroke is very high for only the first few days after TIA and minor

  8. Effects of aspirin on risk and severity of early recurrent stroke after transient ischaemic attack and ischaemic stroke : time-course analysis of randomised trials

    NARCIS (Netherlands)

    Rothwell, Peter M; Algra, Ale; Chen, Zhengming; Diener, Hans-Christoph; Norrving, Bo; Mehta, Ziyah

    2016-01-01

    BACKGROUND: Aspirin is recommended for secondary prevention after transient ischaemic attack (TIA) or ischaemic stroke on the basis of trials showing a 13% reduction in long-term risk of recurrent stroke. However, the risk of major stroke is very high for only the first few days after TIA and minor

  9. Advances in the Management of Transient Ischaemic Attack and Stroke

    Directory of Open Access Journals (Sweden)

    Mayra J Montalvo

    2016-07-01

    Full Text Available Among many important advances in the management of transient ischaemic attack (TIA and stroke are: the updated definition of TIA; risk stratification scores for TIA; the urgent diagnostic and treatment process for TIA; thrombectomy treatment for large vessel occlusive ischaemic stroke; cryptogenic stroke evaluation and treatment, including long-term monitoring for paroxysmal atrial fibrillation; and strategies to improve outcomes for patients including mirror therapy for neglect and timing of mobilisation after stroke. Future research will focus on: antiplatelet strategies after TIA; selecting patients for treatment with recanalisation therapies in an extended time window; uncovering the cause of strokes previously defined as cryptogenic; and better defining the optimal timing and dose of mobilisation after stroke.

  10. Epidemiology, pathophysiology, and treatment of hypertension in ischaemic stroke patients.

    Science.gov (United States)

    Hisham, Nur Fatirul; Bayraktutan, Ulvi

    2013-10-01

    Stroke continues to be one of the leading causes of mortality and morbidity worldwide. There are 2 main types of stroke: ischaemic strokes, which are caused by obstruction of the blood vessels leading to or within the brain, and haemorrhagic strokes, which are induced by the disruption of blood vessels. Stroke is a disease of multifactorial aetiology that may develop as an end state in patients with serious vascular conditions--most notably, uncontrolled arterial hypertension--thereby necessitating the effective control of this risk factor to prevent stroke or its recurrence. This paper focuses specifically on the epidemiology and pathogenesis of ischaemic stroke mainly in chronically hypertensive patients and pays particular attention to the efficacy of a select group of routinely used major antihypertensive drugs (i.e., angiotensin-converting enzyme inhibitors, angiotensin II type 1 receptor blockers, and calcium channel blockers) in the treatment of strokes. Copyright © 2013 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  11. Survival and clinical outcome of dogs with ischaemic stroke

    DEFF Research Database (Denmark)

    Gredal, Hanne Birgit; Toft, Nils; Westrup, Ulrik

    2013-01-01

    The objectives of the present study were to investigate survival time, possible predictors of survival and clinical outcome in dogs with ischaemic stroke. A retrospective study of dogs with a previous diagnosis of ischaemic stroke diagnosed by magnetic resonance imaging (MRI) was performed....... The association between survival and the hypothesised risk factors was examined using univariable exact logistic regression. Survival was examined using Kaplan-Meier and Cox regression. Twenty-two dogs were identified. Five dogs (23%) died within the first 30days of the stroke event. Median survival in 30-day...... survivors was 505days. Four dogs (18%) were still alive by the end of the study. Right-sided lesions posed a significantly increased risk of mortality with a median survival time in dogs with right-sided lesions of 24days vs. 602days in dogs with left sided lesions (P=0.006). Clinical outcome was considered...

  12. Nitric oxide and its role in ischaemic brain injury.

    Science.gov (United States)

    Keynes, Robert G; Garthwaite, John

    2004-03-01

    The role of the neural messenger nitric oxide (NO) in cerebral ischaemia has been investigated extensively in the past decade. NO may play either a protective or destructive role in ischaemia and the literature is plagued with contradictory findings. Working with NO presents many unique difficulties and here we review the potential artifacts that may have contributed to discrepancies and cause future problems for the unwary investigator. Recent evidence challenges the idea that NO from neurones builds up to levels (micromolar) sufficient to directly elicit cell death during the post-ischaemic period. Concomitantly, the case is strengthened for a role of NO in delayed death mediated post-ischaemia by the inducible NO synthase. Mechanistically it seems unlikely that NO is released in high enough quantities to inhibit respiration in vivo; the formation of reactive nitrogen species, such as peroxynitrite, represents the more likely pathway to cell death. The protective and restorative properties of NO have become of increasing interest. NO from endothelial cells may, via stimulating cGMP production, protect the ischaemic brain by acutely augmenting blood flow, and by helping to form new blood vessels in the longer term (angiogenesis). Elevated cGMP production may also stop cells dying by inhibiting apoptosis and help repair damage by stimulating neurogenesis. In addition NO may act as a direct antioxidant and participate in the triggering of protective gene expression programmes that underlie cerebral ischaemic preconditioning. Better understanding of the molecular mechanisms by which NO is protective may ultimately identify new potential therapeutic targets.

  13. ELECTROCARDIOGRAPHIC CHANGES OBSERVED IN HAEMORRHAGIC AND ISCHAEMIC CEREBROVASCULAR DISEASES

    Directory of Open Access Journals (Sweden)

    Channappa

    2016-03-01

    Full Text Available INTRODUCTION Cardiac abnormalities are relatively common after acute neurologic injury. Disturbances can vary in severity from transient ECG abnormalities to profound myocardial injury and dysfunction. CNS is involved in the generation of cardiac arrhythmias and dysfunction even in an otherwise normal myocardium. AIM To find out proportion of ECG changes observed in ischaemic and haemorrhagic stroke. MATERIALS AND METHODS The Electrocardiographs of 100 patients with acute stroke were studied to find out the types of ECG abnormalities among different types of stroke. RESULTS In our study, the most common ECG abnormalities associated with stroke were prolonged QTc interval, ST-T segment abnormalities, prominent U wave and arrhythmias. Trop-I was positive in 12.8% patients with ECG changes. Statistical significance was found in association with Trop-I positivity and ST depression. CONCLUSION Usually patients with heart disease present with arrhythmias and Ischaemic like ECG changes. But these changes are also seen most often in the patients with presenting with stroke who didn’t have any past history of heart disease. This shows that arrhythmias and ischaemic ECG abnormalities are primarily evolved due to central nervous system disorders.

  14. Genetics Home Reference: SYNGAP1-related intellectual disability

    Science.gov (United States)

    ... Conditions SYNGAP1-related intellectual disability SYNGAP1-related intellectual disability Printable PDF Open All Close All Enable Javascript ... the expand/collapse boxes. Description SYNGAP1 -related intellectual disability is a neurological disorder characterized by moderate to ...

  15. Observer reliability of CT angiography in the assessment of acute ischaemic stroke: data from the Third International Stroke Trial

    Energy Technology Data Exchange (ETDEWEB)

    Mair, Grant; Farrall, Andrew J.; Sellar, Robin J.; Mollison, Daisy; Sakka, Eleni; Palmer, Jeb; Wardlaw, Joanna M. [University of Edinburgh, Western General Hospital, Division of Neuroimaging Sciences, Edinburgh (United Kingdom); Kummer, Ruediger von [Dresden University Stroke Centre, University Hospital, Department of Neuroradiology, Dresden (Germany); Adami, Alessandro [Sacro Cuore-Don Calabria Hospital, Stroke Center, Department of Neurology, Negrar (Italy); White, Philip M. [Stroke Research Group, Newcastle upon Tyne (United Kingdom); Adams, Matthew E. [National Hospital for Neurology and Neurosurgery, Department of Neuroradiology, London (United Kingdom); Yan, Bernard [Royal Melbourne Hospital, Neurovascular Research Group, Parkville (Australia); Demchuk, Andrew M. [Calgary Stroke Program, Department of Clinical Neurosciences, Calgary (Canada); Ramaswamy, Rajesh; Rodrigues, Mark A.; Samji, Karim; Baird, Andrew J. [Royal Infirmary of Edinburgh, Department of Radiology, Edinburgh (United Kingdom); Boyd, Elena V. [Northwick Park Hospital, Department of Radiology, Harrow (United Kingdom); Cohen, Geoff; Perry, David; Sandercock, Peter A.G. [University of Edinburgh, Western General Hospital, Division of Clinical Neurosciences, Edinburgh (United Kingdom); Lindley, Richard [University of Sydney, Westmead Hospital Clinical School and The George Institute for Global Health, Sydney (Australia); Collaboration: The IST-3 Collaborative Group

    2014-10-07

    CT angiography (CTA) is often used for assessing patients with acute ischaemic stroke. Only limited observer reliability data exist. We tested inter- and intra-observer reliability for the assessment of CTA in acute ischaemic stroke. We selected 15 cases from the Third International Stroke Trial (IST-3, ISRCTN25765518) with various degrees of arterial obstruction in different intracranial locations on CTA. To assess inter-observer reliability, seven members of the IST-3 expert image reading panel (>5 years experience reading CTA) and seven radiology trainees (<2 years experience) rated all 15 scans independently and blind to clinical data for: presence (versus absence) of any intracranial arterial abnormality (stenosis or occlusion), severity of arterial abnormality using relevant scales (IST-3 angiography score, Thrombolysis in Cerebral Infarction (TICI) score, Clot Burden Score), collateral supply and visibility of a perfusion defect on CTA source images (CTA-SI). Intra-observer reliability was assessed using independently repeated expert panel scan ratings. We assessed observer agreement with Krippendorff's-alpha (K-alpha). Among experienced observers, inter-observer agreement was substantial for the identification of any angiographic abnormality (K-alpha = 0.70) and with an angiography assessment scale (K-alpha = 0.60-0.66). There was less agreement for grades of collateral supply (K-alpha = 0.56) or for identification of a perfusion defect on CTA-SI (K-alpha = 0.32). Radiology trainees performed as well as expert readers when additional training was undertaken (neuroradiology specialist trainees). Intra-observer agreement among experts provided similar results (K-alpha = 0.33-0.72). For most imaging characteristics assessed, CTA has moderate to substantial observer agreement in acute ischaemic stroke. Experienced readers and those with specialist training perform best. (orig.)

  16. Predicting outcome in term neonates with hypoxic-ischaemic encephalopathy using simplified MR criteria

    Energy Technology Data Exchange (ETDEWEB)

    Jyoti, Rajeev; O' Neil, Ross [Canberra Hospital, Medical Imaging, Canberra, ACT (Australia)

    2006-01-01

    MRI is an established investigation in the evaluation of neonates with suspected hypoxic-ischaemic encephalopathy (HIE). However, its role as a predictor of neurodevelopmental outcome remains complex. To establish reproducible simplified MR criteria and evaluate their role in predicting neurodevelopmental outcome in term neonates with HIE. Term neonates with suspected HIE had MRI at 7-10 days of age. MR scans were interpreted according to new simplified criteria by two radiologists blinded to the clinical course and outcome. The new simplified criteria allocated grade 1 to cases with no central and less than 10% peripheral change, grade 2 to those with less than 30% central and/or 10-30% peripheral area change, and grade 3 to those with more than 30% central or peripheral change. MRI changes were compared with clinical neurodevelopmental outcome evaluated prospectively at 1 year of age. Neurodevelopmental outcome was based upon the DQ score (revised Griffith's) and cerebral palsy on neurological assessment. Of 20 subjects, all those showing severe (grade 3) MR changes (35%) died or had poor neurodevelopmental outcome. Subjects with a normal MR scan or with scans showing only mild (grade 1) MR changes (55%) had normal outcomes. One subject showing moderate (grade 2) changes on MRI had a moderate outcome (5%), while another had an atypical pattern of MR changes with a normal outcome (5%). Assessment of full-term neonates with suspected HIE using the simplified MR criteria is highly predictive of neurodevelopmental outcome. (orig.)

  17. Risk of ischaemic heart disease in patients with inflammatory bowel disease

    DEFF Research Database (Denmark)

    Rungoe, Christine; Basit, Saima; Ranthe, Mattis Flyvholm

    2013-01-01

    Inflammatory bowel disease (IBD) is a chronic inflammatory disorder. Systemic inflammation increases the risk of atherosclerosis and ischaemic heart disease (IHD).......Inflammatory bowel disease (IBD) is a chronic inflammatory disorder. Systemic inflammation increases the risk of atherosclerosis and ischaemic heart disease (IHD)....

  18. Neurological signs in 23 dogs with suspected rostral cerebellar ischaemic stroke

    DEFF Research Database (Denmark)

    Thomsen, Barbara Blicher; Garosi, Laurent; Skerritt, Geoff

    2016-01-01

    Background: In dogs with ischaemic stroke, a very common site of infarction is the cerebellum. The aim of this study was to characterise neurological signs in relation to infarct topography in dogs with suspected cerebellar ischaemic stroke and to report short-term outcome confined to the hospita...

  19. Chronic ischaemic mitral regurgitation. Current treatment results and new mechanism-based surgical approaches

    NARCIS (Netherlands)

    Bouma, Wobbe; van der Horst, Iwan C. C.; Wijdh-den Hamer, Inez J.; Erasmus, Michiel E.; Zijlstra, Felix; Mariani, Massimo A.; Ebels, Tjark

    2010-01-01

    Chronic ischaemic mitral regurgitation (CIMR) remains one of the most complex and unresolved aspects in the management of ischaemic heart disease. This review provides an overview of the present knowledge about the different aspects of CIMR with an emphasis on mechanisms, current surgical treatment

  20. Neurological signs in 23 dogs with suspected rostral cerebellar ischaemic stroke

    DEFF Research Database (Denmark)

    Thomsen, Barbara; Garosi, Laurent; Skerritt, Geoff;

    2016-01-01

    Background: In dogs with ischaemic stroke, a very common site of infarction is the cerebellum. The aim of this study was to characterise neurological signs in relation to infarct topography in dogs with suspected cerebellar ischaemic stroke and to report short-term outcome confined to the hospita...

  1. Statin Use and Functional Outcome after Tissue Plasminogen Activator Treatment in Acute Ischaemic Stroke

    NARCIS (Netherlands)

    Miedema, I; Uyttenboogaart, M; Koopman, K; De Keyser, J; Luijckx, G J

    2010-01-01

    Background: Preliminary findings suggest that statins may have a neuroprotective effect in patients with acute ischaemic stroke. This study investigated whether patients prior on statin therapy and treated with tissue plasminogen activator (tPA) for acute ischaemic stroke have a better functional ou

  2. Relation between hormone replacement therapy and ischaemic heart disease in women

    DEFF Research Database (Denmark)

    Løkkegaard, E; Pedersen, A T; Heitmann, B L

    2003-01-01

    To investigate the risk of ischaemic heart disease and myocardial infarction among women using hormone replacement therapy, especially the potential modifying effect of cardiovascular risk factors.......To investigate the risk of ischaemic heart disease and myocardial infarction among women using hormone replacement therapy, especially the potential modifying effect of cardiovascular risk factors....

  3. Association of plasma uric acid with ischaemic heart disease and blood pressure

    DEFF Research Database (Denmark)

    Palmer, Tom M; Nordestgaard, Børge G; Benn, Marianne

    2013-01-01

    To assess the associations between both uric acid levels and hyperuricaemia, with ischaemic heart disease and blood pressure, and to explore the potentially confounding role of body mass index.......To assess the associations between both uric acid levels and hyperuricaemia, with ischaemic heart disease and blood pressure, and to explore the potentially confounding role of body mass index....

  4. Can colonoscopy diagnose transmural ischaemic colitis after abdominal aortic surgery? An evidence-based approach

    DEFF Research Database (Denmark)

    Houe, T; Thorböll, J E; Sigild, U;

    2000-01-01

    to assess the diagnostic value of colonoscopy in ischaemic colitis following abdominal aortic surgery, based on a literature review, and to introduce the concept of evidence-based medicine.......to assess the diagnostic value of colonoscopy in ischaemic colitis following abdominal aortic surgery, based on a literature review, and to introduce the concept of evidence-based medicine....

  5. Xanthelasmata, arcus corneae, and ischaemic vascular disease and death in general population: prospective cohort study

    DEFF Research Database (Denmark)

    Christoffersen, Mette; Frikke-Schmidt, Ruth; Schnohr, Peter

    2011-01-01

    To test the hypothesis that xanthelasmata and arcus corneae, individually and combined, predict risk of ischaemic vascular disease and death in the general population.......To test the hypothesis that xanthelasmata and arcus corneae, individually and combined, predict risk of ischaemic vascular disease and death in the general population....

  6. The association between early menopause and risk of ischaemic heart disease: Influence of Hormone Therapy?

    DEFF Research Database (Denmark)

    Løkkegaard, E; Andersen, Zorana Jovanovic; Heitmann, B L

    2006-01-01

    Randomised clinical trials find no protection against development of ischaemic heart disease by use of Hormone Therapy (HT) after the age of 50 years. Observational studies suggest that early menopause is a risk factor for ischaemic heart disease. Yet, a clinical very relevant question is whether...... HT reduces this risk associated with early menopause....

  7. Nonarteritic anterior ischaemic optic neuropathy in Addison's disease.

    Science.gov (United States)

    Ross, A H; Haider, S; Bailey, C C

    2010-10-01

    To report three cases of Nonarteritic anterior ischaemic optic neuropathy (NAAION) in patients with Addison's disease. We present a retrospective review of patients presenting with NAAION with underlying Addison's disease. Three eyes of two young patients presented with NAAION. Both patients had underlying Addison's disease with episodes of prolonged hypotension. To our knowledge, this is the first published report of NAAION associated with Addison's disease. As hypotension may be one of the few situations, in which NAAION may be treatable and the visual loss reversible, it is important to recognize and treat sustained episodes of hypotension in these individuals.

  8. Dramatic response to levetiracetam in post-ischaemic Holmes’ tremor

    Science.gov (United States)

    Striano, P; Elefante, Andrea; Coppola, Antonietta; Tortora, Fabio; Zara, Federico; Minetti, Carlo

    2009-01-01

    Holmes’ tremor refers to an unusual combination of rest, postural and kinetic tremor of extremities. Common causes of Holmes’ tremor include stroke, trauma, vascular malformations and multiple sclerosis, with lesions involving the thalamus, brain stem or cerebellum. Although some drugs (eg, levodopa and dopaminergic drugs, clonazepam and propranolol) have been occasionally reported to give some benefit, medical treatment of Holmes’ tremor is unsatisfactory, and many patients require thalamic surgery to achieve satisfactory control. We report a patient in whom post-ischaemic Holmes’ tremor dramatically responded to levetiracetam treatment. PMID:21686707

  9. Graves' disease presenting as unilateral anterior ischaemic optic neuropathy.

    Science.gov (United States)

    Monigari, Naresh; Deshpande, Anirudda; Nalabothu, Murali; Rao, Shilpa

    2014-03-19

    We report a case of a 28-year-old man who presented with 1-day history of sudden diminution of vision in the right eye. Examination showed unilateral exophthalmos with restricted eyeball movement on upward gaze in the right eye. MRI of the orbit showed no evidence of compression of the optic nerve on the right side. Visual-evoked potential showed prolonged P100 in the right eye. Fundus examination revealed swollen optic disc and para papillary nerve fibre layer splinter haemorrhages with corresponding altitudinal field defect on perimetry suggestive of anterior ischaemic optic neuropathy.

  10. Sildenafil: Can Cause Acute Ischaemic Stroke? A Case Report

    Directory of Open Access Journals (Sweden)

    Zeynep Özözen Ayas

    2015-12-01

    Full Text Available Sildenafil is an inhibitor of phosphodiesterase type-5 (PDE-5, is used for erectile dysfunction. There is not enough information about its effects on the central nervous system Headache, nasal congestion, facial flushing, nausea are the most common side effects. However, neurological complications such as third cranial nerve palsy, transient global amnesia, seizures, cerebral hemorrhage, and infarction are less commonly observed. We present a case of a 60-year-old man with acute ischaemic stroke, which we considered to be interrelated to sildenafil intake. Clinicians must be aware of the possibility of neurological side effects when the patient use sildenafil.

  11. The importance of physician-patient relationship for improvement of adherence to long-term therapy: data of survey in a cohort of multiple sclerosis patients with mild and moderate disability.

    Science.gov (United States)

    Koudriavtseva, Tatiana; Onesti, Emanuela; Pestalozza, Isabella Fernanda; Sperduti, Isabella; Jandolo, Bruno

    2012-06-01

    Patient involvement in the improvement of health care is important for the best long-term treatment outcomes. Our objective is to assess patient satisfaction with offered care service and to identify parameters which influence the adherence to long-term therapy. A prospective single-center study based on the administration of a structured interview to multiple sclerosis (MS) patients attending our MS Centre with mild and moderate disabilities. The interview regarding clinical parameters, quality of life and satisfaction of care service was structured in three parts with multiple-choice answers to close- or open-ended questions. Patient satisfaction was evaluated by the concordance between the level of patient attention and judgment regarding the services offered. The impact of all variables on the adherence to therapy and on the perceived utility of treatment was evaluated. The concordance between patient attention and judgment on health care services resulted statistically significant for almost all parameters. The perceived utility of treatment was significantly correlated to patients feeling confident in the clinical staff, to their perception of being involved in therapeutic decision (p<0.05), and associated to therapy adherence (p=0.0001). In a multivariate model, the adherence to therapy resulted associated to possibility of choosing the physician (p=0.037) and inversely to therapy duration (p=0.001). Our conclusion reveals that, to improve the adherence to long-term therapy and the perceived utility of treatment, a particular attention should be devoted to physician-patient relationship.

  12. Effect of screening and lifestyle counselling on incidence of ischaemic heart disease in general population

    DEFF Research Database (Denmark)

    Jørgensen, Torben; Jacobsen, Rikke Kart; Toft, Ulla

    2014-01-01

    OBJECTIVE: To investigate the effect of systematic screening for risk factors for ischaemic heart disease followed by repeated lifestyle counselling on the 10 year development of ischaemic heart disease at a population level. DESIGN: Randomised controlled community based trial. SETTING: Suburbs...... times over a five year period. All participants with an unhealthy lifestyle had individually tailored lifestyle counselling at all visits (at baseline and after one and three years); those at high risk of ischaemic heart disease, according to predefined criteria, were furthermore offered six sessions...... OUTCOME MEASURES: The primary outcome measure was incidence of ischaemic heart disease in the intervention group compared with the control group. Secondary outcome measures were stroke, combined events (ischaemic heart disease, stroke, or both), and mortality. RESULTS: 6091 (52.4%) people...

  13. Intellectual Disability

    Science.gov (United States)

    ... Knows What? (log-in required) Select Page Intellectual Disability Jun 16, 2010 NICHCY Disability Fact Sheet 8 ... ready! Back to top What is an Intellectual Disability? Intellectual disability is a term used when a ...

  14. Learning Disabilities

    Science.gov (United States)

    ... Loss Surgery? A Week of Healthy Breakfasts Shyness Learning Disabilities KidsHealth > For Teens > Learning Disabilities Print A ... study engineering as he'd hoped? What Are Learning Disabilities? For someone diagnosed with a learning disability, ...

  15. Mitochondrial reprogramming through cardiac oxygen sensors in ischaemic heart disease.

    Science.gov (United States)

    Cadenas, Susana; Aragonés, Julián; Landázuri, Manuel O

    2010-11-01

    Under hypoxic conditions, mitochondria can represent a threat to the cell because of their capacity to generate toxic reactive oxygen species (ROS). However, cardiomyocytes are equipped with an oxygen-sensing pathway that involves prolyl hydroxylase oxygen sensors and hypoxia-inducible factors (HIFs), which induces a tightly regulated programme to keep ischaemic mitochondrial activity under control. The aim of this review is to provide an update on the pathways leading to mitochondrial reprogramming, which occurs in the myocardium during ischaemia, with particular emphasis on those induced by HIF activation. We start by studying the mechanisms of mitochondrial damage during ischaemia and upon reperfusion, highlighting the importance of the formation of the mitochondrial permeability transition pore during reperfusion and its consequences for cardiomyocyte survival. Next, we analyse hypoxia-induced metabolic reprogramming through HIF and its important consequences for mitochondrial bioenergetics, as well as the phenomenon known as the hibernating myocardium. Subsequently, we examine the mechanisms underlying ischaemic preconditioning, focusing, in particular, on those that involve the HIF pathway, such as adenosine signalling, sub-lethal ROS generation, and nitric oxide production. Finally, the role of the mitochondrial uncoupling proteins in ischaemia tolerance is discussed.

  16.  Psychosocial working environment for patients with ischaemic heart disease and association to adverse cardiac events

    DEFF Research Database (Denmark)

    Biering, Karin; Lund, Thomas; Hviid Andersen, Johan;

    2014-01-01

    OBJECTIVES: During the last decades a possible association between the psychosocial working environment and increased risk of Ischaemic heart disease (IHD) has been debated. A systematic review from 2009 found moderate evidence that high psychological demands, lack of social support and iso......-strain was associated with IHD. Whether the psychosocial working environment plays a role for patients with existing cardiovascular disease on the risk of new cardiac events and readmissions is unknown METHOD: A cohort of patients under 65 years and treated with Percutaneous Coronary Intervention was established...... readmissions and events. We examined the association between psychosocial working environment and adverse events among those who had returned to work at 3 months by Cox Regression analysis. RESULTS: We were not able to detect any significant associations between psychosocial working environment in terms...

  17. Early predictors of outcome in infants treated with hypothermia for hypoxic-ischaemic encephalopathy.

    Science.gov (United States)

    Merchant, Nazakat; Azzopardi, Denis

    2015-04-01

    Hypoxic-ischaemic encephalopathy (HIE) is a leading cause of acquired neonatal brain injury. Assessment of the severity of cerebral injury and likely neurological outcome in infants with HIE is important for determining management and prognosis, for counselling parents, and for selection for neuroprotective trials. The condition of the infant at birth, the severity of HIE, neurophysiological tests, including amplitude-integrated electroencephalography (aEEG), biochemical markers, and neuroimaging have been used to assess prognosis and predict long-term outcome. The predictive accuracy of these indicators in the early postnatal period is modest. Neurophysiological assessment seems to be most helpful during the first 24 to 48 hours after birth whilst magnetic resonance imaging (MRI) seems most informative later. Several biochemical markers, including serum S100β and neuron-specific enolase (NSE), are also associated with HIE but their levels depend on the timing of sampling and their prognostic value is uncertain. Comprehensive neurophysiological assessment and neuroimaging may be limited to specialist centres. Therapeutic hypothermia is now standard care in infants with moderate to severe HIE so it is important to examine the influence of hypothermia on the assessment of prognosis in these infants.

  18. Relationship between Pretend Play and Theory of Mind for Moderately Intellectual Disability Children%中度智力障碍儿童装扮游戏与心理理论发展水平的关系

    Institute of Scientific and Technical Information of China (English)

    兰继军; 王利平; 贾兆娜; 刘智慧

    2013-01-01

    Objective To analyze the ability of pretend play and the development level of Theory of Mind (ToM) in moderately intellec-tual disability (ID) children, and the relationship between them. Methods 30 children aged 10~15 years were observed with experiment and behavior observation. Results The development levels of ToM and pretend play were different with their age (P<0.05). ToM score signifi-cantly correlated with the ability of role assignment, imagination and role playing after controlling the age (P<0.05). Conclusion The ability of pretend play develops unbalancedly in the moderately ID children, and the development level of ToM correlates with some categories of pretend play.%  目的分析中度智力障碍儿童的装扮游戏能力、心理理论发展水平的特点及其关系。方法采用实验法和行为观察法对30名10~15岁在校中度智障儿童进行调查。结果中度智障儿童装扮游戏与心理理论发展水平总体具有显著的年龄差异(P<0.05)。控制年龄因素后,10~15岁中度智障儿童的心理理论与其装扮游戏中的“角色分配”、“想象”和“角色扮演”呈正相关(P<0.05)。结论中度智障儿童装扮游戏能力的各个成分发展速度不均衡;中度智障儿童心理理论发展与装扮游戏中的某些特定成分相关。

  19. Citicoline in the treatment of acute ischaemic stroke: an international, randomised, multicentre, placebo-controlled study (ICTUS trial).

    Science.gov (United States)

    Dávalos, Antoni; Alvarez-Sabín, José; Castillo, José; Díez-Tejedor, Exuperio; Ferro, Jose; Martínez-Vila, Eduardo; Serena, Joaquín; Segura, Tomás; Cruz, Vitor T; Masjuan, Jaime; Cobo, Erik; Secades, Julio J

    2012-07-28

    Citicoline is approved in some countries for the treatment of acute ischaemic stroke. The drug has shown some evidence of efficacy in a pooled analysis. We sought to confirm the efficacy of citicoline in a larger trial. We undertook a randomised, placebo-controlled, sequential trial in patients with moderate-to-severe acute ischaemic stroke admitted at university hospitals in Germany, Portugal, and Spain. Using a centralised minimisation process, patients were randomly assigned in a 1:1 ratio to receive citicoline or placebo within 24 h after the onset of symptoms (1000 mg every 12 h intravenously during the first 3 days and orally thereafter for a total of 6 weeks [2×500 mg oral tablets given every 12 h]). All study participants were masked. The primary outcome was recovery at 90 days measured by a global test combining three measures of success: National Institutes of Health Stroke Scale ≤1, modified Rankin score ≤1, and Barthel Index ≥95. Safety endpoints included symptomatic intracranial haemorrhage in patients treated with recombinant tissue plasminogen activator, neurological deterioration, and mortality. This trial is registered, NCT00331890. 2298 patients were enrolled into the study from Nov 26, 2006, to Oct 27, 2011. 37 centres in Spain, 11 in Portugal, and 11 in Germany recruited patients. Of the 2298 patients who gave informed consent and underwent randomisation, 1148 were assigned to citicoline and 1150 to placebo. The trial was stopped for futility at the third interim analysis on the basis of complete data from 2078 patients. The final randomised analysis was based on data for 2298 patients: 1148 in citicoline group and 1150 in placebo group. Global recovery was similar in both groups (odds ratio 1·03, 95% CI 0·86-1·25; p=0·364). No significant differences were reported in the safety variables nor in the rate of adverse events. Under the circumstances of the ICTUS trial, citicoline is not efficacious in the treatment of moderate

  20. Genetic risk factors for ischaemic stroke and its subtypes (the METASTROKE collaboration)

    DEFF Research Database (Denmark)

    Traylor, Matthew; Farrall, Martin; Holliday, Elizabeth G

    2012-01-01

    Various genome-wide association studies (GWAS) have been done in ischaemic stroke, identifying a few loci associated with the disease, but sample sizes have been 3500 cases or less. We established the METASTROKE collaboration with the aim of validating associations from previous GWAS and identify...... and identifying novel genetic associations through meta-analysis of GWAS datasets for ischaemic stroke and its subtypes.......Various genome-wide association studies (GWAS) have been done in ischaemic stroke, identifying a few loci associated with the disease, but sample sizes have been 3500 cases or less. We established the METASTROKE collaboration with the aim of validating associations from previous GWAS...

  1. Guidelines for the treatment of acute ischaemic stroke.

    Science.gov (United States)

    Alonso de Leciñana, M; Egido, J A; Casado, I; Ribó, M; Dávalos, A; Masjuan, J; Caniego, J L; Martínez Vila, E; Díez Tejedor, E; Fuentes, B; Álvarez-Sabin, J; Arenillas, J; Calleja, S; Castellanos, M; Castillo, J; Díaz-Otero, F; López-Fernández, J C; Freijo, M; Gállego, J; García-Pastor, A; Gil-Núñez, A; Gilo, F; Irimia, P; Lago, A; Maestre, J; Martí-Fábregas, J; Martínez-Sánchez, P; Molina, C; Morales, A; Nombela, F; Purroy, F; Rodríguez-Yañez, M; Roquer, J; Rubio, F; Segura, T; Serena, J; Simal, P; Tejada, J; Vivancos, J

    2014-03-01

    Update of Acute Ischaemic Stroke Treatment Guidelines of the Spanish Neurological Society based on a critical review of the literature. Recommendations are made based on levels of evidence from published data and studies. Organized systems of care should be implemented to ensure access to the optimal management of all acute stroke patients in stroke units. Standard of care should include treatment of blood pressure (should only be treated if values are over 185/105 mmHg), treatment of hyperglycaemia over 155 mg/dl, and treatment of body temperature with antipyretic drugs if it rises above 37.5 °C. Neurological and systemic complications must be prevented and promptly treated. Decompressive hemicraniectomy should be considered in cases of malignant cerebral oedema. Intravenous thrombolysis with rtPA should be administered within 4.5 hours from symptom onset, except when there are contraindications. Intra-arterial pharmacological thrombolysis can be considered within 6 hours, and mechanical thrombectomy within 8 hours from onset, for anterior circulation strokes, while a wider window of opportunity up to 12-24 hours is feasible for posterior strokes. There is not enough evidence to recommend routine use of the so called neuroprotective drugs. Anticoagulation should be administered to patients with cerebral vein thrombosis. Rehabilitation should be started as early as possible. Treatment of acute ischaemic stroke includes management of patients in stroke units. Systemic thrombolysis should be considered within 4.5 hours from symptom onset. Intra-arterial approaches with a wider window of opportunity can be an option in certain cases. Protective and restorative therapies are being investigated. Copyright © 2011 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.

  2. Disability Identity--Disability Pride

    Science.gov (United States)

    Martin, Nicola

    2012-01-01

    This paper discusses a way of thinking about disability which has emerged out of the UK Disabled People's Movement over the last three decades in opposition to the preceding medical model of disability which viewed disability as synonymous with problem. Disabled people are increasingly challenging the notion that their embodiment is inherently…

  3. Acute Ischaemic Stroke | EU Clinical Trials Register [EU Clinical Trials Register

    Lifescience Database Archive (English)

    Full Text Available ease under investigation E.1.1Medical condition(s) being investigated Acute Ischa...F.3.3.6.1Details of subjects incapable of giving consent Acute Ischaemic Stroke patients with communication

  4. Effect of screening and lifestyle counselling on incidence of ischaemic heart disease in general population

    DEFF Research Database (Denmark)

    Jørgensen, Torben; Jacobsen, Rikke Kart; Toft, Ulla

    2014-01-01

    OBJECTIVE: To investigate the effect of systematic screening for risk factors for ischaemic heart disease followed by repeated lifestyle counselling on the 10 year development of ischaemic heart disease at a population level. DESIGN: Randomised controlled community based trial. SETTING: Suburbs...... (stroke 0.98, 0.87 to 1.11; combined endpoint 1.01, 0.93 to 1.09; total mortality 1.00, 0.91 to 1.09). CONCLUSION: A community based, individually tailored intervention programme with screening for risk of ischaemic heart disease and repeated lifestyle intervention over five years had no effect...... to four times over a five year period. All participants with an unhealthy lifestyle had individually tailored lifestyle counselling at all visits (at baseline and after one and three years); those at high risk of ischaemic heart disease, according to predefined criteria, were furthermore offered six...

  5. Effect of screening and lifestyle counselling on incidence of ischaemic heart disease in general population

    DEFF Research Database (Denmark)

    Jørgensen, Torben; Jacobsen, Rikke Kart; Toft, Ulla

    2014-01-01

    OBJECTIVE: To investigate the effect of systematic screening for risk factors for ischaemic heart disease followed by repeated lifestyle counselling on the 10 year development of ischaemic heart disease at a population level. DESIGN: Randomised controlled community based trial. SETTING: Suburbs...... (stroke 0.98, 0.87 to 1.11; combined endpoint 1.01, 0.93 to 1.09; total mortality 1.00, 0.91 to 1.09). CONCLUSION: A community based, individually tailored intervention programme with screening for risk of ischaemic heart disease and repeated lifestyle intervention over five years had no effect...... times over a five year period. All participants with an unhealthy lifestyle had individually tailored lifestyle counselling at all visits (at baseline and after one and three years); those at high risk of ischaemic heart disease, according to predefined criteria, were furthermore offered six sessions...

  6. l-arginine and l-NMMA for assessing cerebral endothelial dysfunction in ischaemic cerebrovascular disease

    DEFF Research Database (Denmark)

    Karlsson, William K; Sørensen, Caspar G; Kruuse, Christina

    2017-01-01

    Endothelial dysfunction (ED), in particular cerebral ED, may be an essential biomarker for ischaemic cerebrovascular disease. However, there is no consensus on methods to best estimate cerebral ED. In this systematic review, we evaluate the use of l-arginine and NG -monomethyl-l-arginine (l......-NMMA) for assessment of cerebral ED. A systematic search of PubMed, EMBASE and the Cochrane Library was done. We included studies investigating cerebrovascular response to l-arginine or l-NMMA in human subjects with vascular risk factors or ischaemic cerebrovascular disease. Seven studies (315 subjects) were eligible...... according to inclusion and exclusion criteria. Studies investigated the effect of age (n=2), type 2 diabetes mellitus (DM) (n=1), cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) (n=1), leukoaraiosis (n=1), and prior ischaemic stroke or transient ischaemic...

  7. Effect of screening and lifestyle counselling on incidence of ischaemic heart disease in general population

    DEFF Research Database (Denmark)

    Jørgensen, Torben; Jacobsen, Rikke Kart; Toft, Ulla;

    2014-01-01

    of Copenhagen, Denmark PARTICIPANTS: 59 616 people aged 30-60 years randomised with different age and sex randomisation ratios to an intervention group (n=11 629) and a control group (n=47 987). INTERVENTION: The intervention group was invited for screening, risk assessment, and lifestyle counselling up to four...... OUTCOME MEASURES: The primary outcome measure was incidence of ischaemic heart disease in the intervention group compared with the control group. Secondary outcome measures were stroke, combined events (ischaemic heart disease, stroke, or both), and mortality. RESULTS: 6091 (52.4%) people...... in the intervention group participated at baseline. Among 5978 people eligible at five year follow-up (59 died and 54 emigrated), 4028 (67.4%) attended. A total of 3163 people died in the 10 year follow-up period. Among 58 308 without a history of ischaemic heart disease at baseline, 2782 developed ischaemic heart...

  8. Measuring Disability: Comparing the Impact of Two Data Collection Approaches on Disability Rates

    Directory of Open Access Journals (Sweden)

    Carla Sabariego

    2015-08-01

    Full Text Available The usual approach in disability surveys is to screen persons with disability upfront and then ask questions about everyday problems. The objectives of this paper are to demonstrate the impact of screeners on disability rates, to challenge the usual exclusion of persons with mild and moderate disability from disability surveys and to demonstrate the advantage of using an a posteriori cut-off. Using data of a pilot study of the WHO Model Disability Survey (MDS in Cambodia and the polytomous Rasch model, metric scales of disability were built. The conventional screener approach based on the short disability module of the Washington City Group and the a posteriori cut-off method described in the World Disability Report were compared regarding disability rates. The screener led to imprecise rates and classified persons with mild to moderate disability as non-disabled, although these respondents already experienced important problems in daily life. The a posteriori cut-off applied to the general population sample led to a more precise disability rate and allowed for a differentiation of the performance and needs of persons with mild, moderate and severe disability. This approach can be therefore considered as an inclusive approach suitable to monitor the Convention on the Rights of Persons with Disabilities.

  9. Measuring Disability: Comparing the Impact of Two Data Collection Approaches on Disability Rates.

    Science.gov (United States)

    Sabariego, Carla; Oberhauser, Cornelia; Posarac, Aleksandra; Bickenbach, Jerome; Kostanjsek, Nenad; Chatterji, Somnath; Officer, Alana; Coenen, Michaela; Chhan, Lay; Cieza, Alarcos

    2015-08-25

    The usual approach in disability surveys is to screen persons with disability upfront and then ask questions about everyday problems. The objectives of this paper are to demonstrate the impact of screeners on disability rates, to challenge the usual exclusion of persons with mild and moderate disability from disability surveys and to demonstrate the advantage of using an a posteriori cut-off. Using data of a pilot study of the WHO Model Disability Survey (MDS) in Cambodia and the polytomous Rasch model, metric scales of disability were built. The conventional screener approach based on the short disability module of the Washington City Group and the a posteriori cut-off method described in the World Disability Report were compared regarding disability rates. The screener led to imprecise rates and classified persons with mild to moderate disability as non-disabled, although these respondents already experienced important problems in daily life. The a posteriori cut-off applied to the general population sample led to a more precise disability rate and allowed for a differentiation of the performance and needs of persons with mild, moderate and severe disability. This approach can be therefore considered as an inclusive approach suitable to monitor the Convention on the Rights of Persons with Disabilities.

  10. Measuring Disability: Comparing the Impact of Two Data Collection Approaches on Disability Rates

    Science.gov (United States)

    Sabariego, Carla; Oberhauser, Cornelia; Posarac, Aleksandra; Bickenbach, Jerome; Kostanjsek, Nenad; Chatterji, Somnath; Officer, Alana; Coenen, Michaela; Chhan, Lay; Cieza, Alarcos

    2015-01-01

    The usual approach in disability surveys is to screen persons with disability upfront and then ask questions about everyday problems. The objectives of this paper are to demonstrate the impact of screeners on disability rates, to challenge the usual exclusion of persons with mild and moderate disability from disability surveys and to demonstrate the advantage of using an a posteriori cut-off. Using data of a pilot study of the WHO Model Disability Survey (MDS) in Cambodia and the polytomous Rasch model, metric scales of disability were built. The conventional screener approach based on the short disability module of the Washington City Group and the a posteriori cut-off method described in the World Disability Report were compared regarding disability rates. The screener led to imprecise rates and classified persons with mild to moderate disability as non-disabled, although these respondents already experienced important problems in daily life. The a posteriori cut-off applied to the general population sample led to a more precise disability rate and allowed for a differentiation of the performance and needs of persons with mild, moderate and severe disability. This approach can be therefore considered as an inclusive approach suitable to monitor the Convention on the Rights of Persons with Disabilities. PMID:26308039

  11. Yield of CT perfusion for the evaluation of transient ischaemic attack.

    Science.gov (United States)

    Kleinman, Jonathan T; Mlynash, Michael; Zaharchuk, Greg; Ogdie, Alyshia A; Straka, Matus; Lansberg, Maarten G; Schwartz, Neil E; Singh, Paul; Kemp, Stephanie; Bammer, Roland; Albers, Gregory W; Olivot, Jean-Marc

    2015-10-01

    Magnetic resonance diffusion-weighted imaging and perfusion-weighted imaging are able to identify ischaemic 'footprints' in transient ischaemic attack. Computed tomography perfusion (CTP) may be useful for patient triage and subsequent management. To date, less than 100 cases have been reported, and none have compared computed tomography perfusion to perfusion-weighted imaging (PWI). We sought to define the yield of computed tomography perfusion for the evaluation of transient ischaemic attack. Consecutive patients with a discharge diagnosis of possible or definite transient ischaemic event who underwent computed tomography perfusion were included in this study. The presence of an ischaemic lesion was assessed on noncontrast computed tomography, automatically deconvolved CTPTMax (Time till the residue function reaches its maximum), and when available on diffusion-weighted imaging and PWITMax maps. Thirty-four patients were included and 17 underwent magnetic resonance imaging. Median delay between onset and computed tomography perfusion was 4·4 h (Interquartile range [IQR]: 1·9-9·6), and between computed tomography perfusion and magnetic resonance imaging was 11 h (Interquartile range: 3·8-22). Noncontrast computed tomography was negative in all cases, while CTPTMax identified an ischaemic lesion in 12/34 patients (35%). In the subgroup of patients with multimodal magnetic resonance imaging, an ischaemic lesion was found in six (35%) patients using CTPTMax versus nine (53%) on magnetic resonance imaging (five diffusion-weighted imaging, nine perfusion-weighted imaging). The additional yield of CTPTMax over computed tomography angiography was significant in the evaluation of transient ischaemic attack (12 vs. 3, McNemar, P = 0·004). CTPTMax found an ischaemic lesion in one-third of acute transient ischaemic attack patients. Computed tomography perfusion may be an acceptable substitute when magnetic resonance imaging is unavailable or contraindicated, and

  12. Identification of patients at risk for ischaemic cerebral complications after carotid endarterectomy with TCD monitoring

    DEFF Research Database (Denmark)

    Horn, J; Naylor, A R; Laman, D M;

    2005-01-01

    Transcranial Doppler (TCD) monitoring for micro embolic signals (MES), directly after carotid endarterectomy (CEA) may identify patients at risk of developing ischaemic complications. In this retrospective multicentre study, this hypothesis was investigated.......Transcranial Doppler (TCD) monitoring for micro embolic signals (MES), directly after carotid endarterectomy (CEA) may identify patients at risk of developing ischaemic complications. In this retrospective multicentre study, this hypothesis was investigated....

  13. Platelet degranulation and monocyte-platelet complex formation are increased in the acute and convalescent phases after ischaemic stroke or transient ischaemic attack.

    LENUS (Irish Health Repository)

    McCabe, Dominick J H

    2004-06-01

    Flow cytometric studies suggest that platelets are activated in ischaemic stroke or transient ischaemic attack (TIA). However, few studies have measured circulating leucocyte-platelet complexes in this patient population. Whole blood flow cytometry was used to quantify the expression of CD62P-, CD63-, and PAC1-binding, and the percentages of leucocyte-platelet complexes in acute (1-27 d, n = 79) and convalescent (79-725 d, n = 70) ischaemic cerebrovascular disease (CVD) patients compared with controls without CVD (n = 27). We performed a full blood count, and measured plasma levels of soluble P-selectin, soluble E-selectin, and von Willebrand factor antigen (VWF:Ag) as additional markers of platelet and\\/or endothelial cell activation. The median percentage CD62P expression and the median percentage monocyte-platelet complexes were higher in both acute and convalescent CVD patients than controls (P <\\/= 0.02). The mean white cell count and mean VWF:Ag levels were significantly elevated in the acute and convalescent phases after ischaemic stroke or TIA (P <\\/= 0.02). Otherwise, there was no significant increase in any other marker of platelet or endothelial activation in CVD patients. There was a positive correlation between the percentage expression of CD62P and the percentages of both neutrophil-platelet and monocyte-platelet complexes in the acute phase, and the percentages of all leucocyte-platelet complexes in the convalescent phase after ischaemic CVD. This study provides evidence for ongoing excessive platelet and\\/or endothelial activation in ischaemic CVD patients despite treatment with antithrombotic therapy.

  14. Moderate Bravery

    DEFF Research Database (Denmark)

    Majgaard, Klaus

    2016-01-01

    Purpose: The ability to act in a purposeful and effective way amid institutional tensions and paradoxes is, right now, a highly prized quality in public leadership. The purpose of this chapter is to qualify moderately brave acts as a learning format that combines the analytical and performative...... skills implied in this kind of agency. Design/methodology/approach: The chapter explores the engagement with paradoxes as a narrative praxis. From existing literature, it sums up an understanding of agency as a social process of mediating paradoxes in order to make action possible. Drawing on Northrop...

  15. Tissue-factor-bearing microparticles (MPs-TF) in patients with acute ischaemic stroke: the influence of stroke treatment on MPs-TF generation.

    Science.gov (United States)

    Świtońska, M; Słomka, A; Sinkiewicz, W; Żekanowska, E

    2015-02-01

    Stroke is an important cause of death and disability throughout the world. Microparticles play a cardinal role in vascular hemostasis. The primary aim of this study was to evaluate the procoagulant activity of microparticles and levels of tissue-factor-bearing microparticles (MPs-TF), tissue factor (TF) and tissue factor pathway inhibitor (TFPI) in patients with acute ischaemic stroke. Seventy-three patients with a diagnosis of acute ischaemic stroke were included. Venous blood samples were drawn on the first day and the seventh day after stroke onset. Plasma microparticles, MPs-TF, TF and TFPI were determined by enzyme-linked immunosorbent assay. Assessment variables were timing of blood collection, type of stroke treatment, presence or absence of diabetes mellitus and hypertension, and scores on the National Institutes of Health Stroke Scale together with scores on the modified Rankin Scale. Whilst MPs-TF and TFPI levels of stroke subjects were significantly higher (median, 1.63 vs. 0.73 pg/ml; median, 114.26 vs. 78.60 ng/ml, respectively), TF levels in the plasma of stroke patients were significantly lower (median, 82.27 vs. 97.80 pg/ml) than those of healthy individuals. Lower levels of TF were detected in patients with severe stroke in comparison with patients with mild stroke. Moreover, the data also showed that in stroke patients not treated with alteplase the activity of microparticles was significantly higher 1 week after diagnosis in comparison with the activity at the time of diagnosis. Our findings suggest that patients with acute ischaemic stroke have increased generation of MPs-TF. Nevertheless, further studies are needed in order to confirm such inference. © 2014 EAN.

  16. Quantification of structural changes in the corpus callosumin children with profound hypoxic-ischaemic brain injury

    Energy Technology Data Exchange (ETDEWEB)

    Stivaros, Stavros M. [Manchester Academic Health Science Centre, Academic Unit of Paediatric Radiology, Royal Manchester Children' s Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester (United Kingdom); University of Manchester, Centre for Imaging Sciences, Institute of Population Health, Manchester (United Kingdom); Radon, Mark R. [The Walton Centre NHS Foundation Trust, Department of Neuroradiology, Liverpool (United Kingdom); Mileva, Reneta; Gledson, Ann; Keane, John A. [University of Manchester, School of Computer Science, Manchester (United Kingdom); Connolly, Daniel J.A.; Batty, Ruth [Sheffield Children' s Hospital NHS Foundation Trust, Department of Neuroradiology, Sheffield (United Kingdom); Cowell, Patricia E. [University of Sheffield, Department of Human Communication Sciences, Sheffield (United Kingdom); Hoggard, Nigel; Griffiths, Paul D. [University of Sheffield, Academic Unit of Radiology, Sheffield (United Kingdom); Wright, Neville B.; Tang, Vivian [Manchester Academic Health Science Centre, Academic Unit of Paediatric Radiology, Royal Manchester Children' s Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester (United Kingdom)

    2016-01-15

    Birth-related acute profound hypoxic-ischaemic brain injury has specific patterns of damage including the paracentral lobules. To test the hypothesis that there is anatomically coherent regional volume loss of the corpus callosum as a result of this hemispheric abnormality. Study subjects included 13 children with proven acute profound hypoxic-ischaemic brain injury and 13 children with developmental delay but no brain abnormalities. A computerised system divided the corpus callosum into 100 segments, measuring each width. Principal component analysis grouped the widths into contiguous anatomical regions. We conducted analysis of variance of corpus callosum widths as well as support vector machine stratification into patient groups. There was statistically significant narrowing of the mid-posterior body and genu of the corpus callosum in children with hypoxic-ischaemic brain injury. Support vector machine analysis yielded over 95% accuracy in patient group stratification using the corpus callosum centile widths. Focal volume loss is seen in the corpus callosum of children with hypoxic-ischaemic brain injury secondary to loss of commissural fibres arising in the paracentral lobules. Support vector machine stratification into the hypoxic-ischaemic brain injury group or the control group on the basis of corpus callosum width is highly accurate and points towards rapid clinical translation of this technique as a potential biomarker of hypoxic-ischaemic brain injury. (orig.)

  17. Neurotoxic Dorsal CA1 Lesions versus 4 VO Ischaemic Lesions: Behavioural Comparisons

    Directory of Open Access Journals (Sweden)

    J. A. Nunn

    1999-01-01

    Full Text Available Anterograde amnesia, a common consequence of transient cerebral ischaemia, has been attributed to cell loss in the hippocampal CA1 subfield. However, variable, widespread damage outside hippocampal CA1 can also occur following ischaemia. We compared the functional consequences of ischaemia and ibotenate acid CA1 lesions on 2 spatial memory tasks (water maze ‘place’ and ‘matching-to-position’ to address the possibility that extra-CA1 loss contributes to ischaemia-induced memory deficits in the rat. During place task acquisition, ischaemic rats showed deficits on more measures than ibotenic rats, and during a 1 min probe trial, only ischaemic rats were impaired. On the matching-to-position task, ibotenic rats showed greater impairment than ischaemic rats in terms of one-trial learning, whereas ischaemic rats were more impaired after Trial 2. Ischaemia and ibotenic acid lesions resulted in equivalent CA1 loss, but silver impregnation revealed additional extra-CA1 cell loss in ischaemic rats. Together with the greater behavioural deficits of ischaemic rats, these data indicate a role for extra-CA1 cell loss in ischaemia-induced memory impairments in both animals and humans.

  18. Adding the implantable cardioverter-defibrillator to cardiac resynchronization therapy is associated with improved long-term survival in ischaemic, but not in non-ischaemic cardiomyopathy

    DEFF Research Database (Denmark)

    Witt, Christoffer Tobias; Kronborg, Mads Brix; Nohr, Ellen Aagaard;

    2015-01-01

    Hospital, Denmark from 2000 to 2010 were included. Baseline characteristics were retrieved from patient files and survival data were obtained from the Danish Civil Registration System. The primary outcome was all-cause mortality. The effect of ICD backup was estimated using Cox proportional hazards model...... to ischaemic cardiomyopathy (ICM) or non-ischaemic cardiomyopathy (NICM) treated with a CRT device with or without defibrillator backup. METHODS AND RESULTS: In this observational study, consecutive patients with an ejection fraction ≤35% and QRS width ≥120 ms receiving a CRT device at Aarhus University...

  19. The combined influence of leisure-time physical activity and weekly alcohol intake on fatal ischaemic heart disease and all-cause mortality

    DEFF Research Database (Denmark)

    Pedersen, Jane Østergaard; Heitmann, Berit Lilienthal; Schnohr, Peter

    2008-01-01

    AIMS: To determine the combined influence of leisure-time physical activity and weekly alcohol intake on the risk of subsequent fatal ischaemic heart disease (IHD) and all-cause mortality. METHODS AND RESULTS: Prospective cohort study of 11 914 Danes aged 20 years or older and without pre......-existing IHD. During approximately 20 years of follow-up, 1242 cases of fatal IHD occurred and 5901 died from all causes. Within both genders, being physically active was associated with lower hazard ratios (HR) of both fatal IHD and all-cause mortality than being physically inactive. Further, weekly alcohol...... had the highest HR of both fatal IHD and all-cause mortality within each category of weekly alcohol intake. Thus, the HR of both fatal IHD and all-cause mortality were low among the physically active who had a moderate alcohol intake. Conclusion Leisure-time physical activity and a moderate weekly...

  20. Evaluation of the neuroprotective effect of dextromethorphan in the acute phase of ischaemic stroke

    Science.gov (United States)

    Mousavi, Seyed Ali; Saadatnia, Mohammad; Khorvash, Faribourz; Hoseini, Tahereh; Sariaslani, Payam

    2011-01-01

    Introduction Stroke is the second leading cause of death in the world. However, there is still no approved neuroprotective drug for acute ischaemic stroke. To clarify the neuroprotective efficacy and safety of dextromethorphan in stroke, the following study was carried out. Material and methods Forty patients with acute stroke causing moderate deficit were randomized to be treated with either dextromethorphan 300 mg per day or placebo for 5 days. Plasma level of dextromethorphan and its active metabolite was not evaluated in this study. The NIHSS score was calculated on day 5 and the Barthel activities of daily living index and Rankin score were checked after 3 months by a blinded investigator. Collected data were analysed using the t-test and χ2 test. Results In the dextromethorphan-treated group, the mean NIHSS score was 16.8 ±3.9 at baseline, and was 14.2 ±4.8 for the placebo-treated group (p = 0.069). At day 5, there was also no significant difference regarding NIHSS score (p = 0.167). At the 3-month follow-up, there was no significant difference regarding Barthel scale and Rankin score between the dextromethorphan and placebo groups. Conclusions The results of our study suggest that although low-dose and short-term oral administration of dextromethorphan seems to be not neuroprotective, it does not worsen either patients’ condition or NIHSS score. Moreover, patients treated with dextromethorphan showed a significant reduction in seizures (complication after stroke), but had increased chance of MI and renal failure by almost 5% when compared to the placebo-treated groups. More prolonged studies with a higher number of cases are recommended. PMID:22295030

  1. National survey on perioperative anaesthetic management in the endovascular treatment of acute ischaemic stroke.

    Science.gov (United States)

    Romero Kräuchi, O; Valencia, L; Iturri, F; Mariscal Ortega, A; López Gómez, A; Valero, R

    2017-09-15

    To assess the anaesthetic management of treatment for endovascular acute ischaemic stroke (AIS) in Spain. A survey was designed by the SEDAR Neuroscience Section and sent to the Spanish anaesthesiology departments with a primary stroke centre between July and November 2016. Of the 47 hospitals where endovascular treatment of AIS is performed, 37 anaesthesiology departments participated. Thirty responses were obtained; three of which were eliminated due to duplication (response rate of 72.9%). Health coverage for AIS endovascular treatment was available 24hours a day in 63% of the hospitals. The anaesthesiologist in charge of the procedure was physically present in the hospital in 55.3%. There was large inter-hospital variability in non-standard monitoring and type of anaesthesia. The most important criterion for selecting type of anaesthesia was multidisciplinary choice made by the anaesthesiologist, neurologist and neuroradiologist (59.3%). The duration of time from arrival to arterial puncture was 10-15minutes in 59.2%. In 44.4%, systolic blood pressure was maintained between 140-180mmHg, and diastolic blood pressure<105mmHg. Glycaemic levels were taken in 81.5% of hospitals. Intravenous heparinisation was performed during the procedure in 66.7% with different patterns of action. In cases of moderate neurological deterioration with no added complications, 85.2% of the included hospitals awakened and extubated the patients. The wide variability observed in the anaesthetic management and the organization of the endovascular treatment of AIS demonstrates the need to create common guidelines for anaesthesiologists in Spain. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  2. Is There Really a Difference? Distinguishing Mild Intellectual Disability from "Similar" Disability Categories

    Science.gov (United States)

    Bouck, Emily C.; Satsangi, Rajiv

    2015-01-01

    Students with mild intellectual disability generally garner less individual attention in research, as they are often aggregated with students with moderate and severe intellectual disability or students with other high incidence disabilities. This study used the National Longitudinal Transition Study-2 (NLTS2) to look at the personal…

  3. Is There Really a Difference? Distinguishing Mild Intellectual Disability from "Similar" Disability Categories

    Science.gov (United States)

    Bouck, Emily C.; Satsangi, Rajiv

    2015-01-01

    Students with mild intellectual disability generally garner less individual attention in research, as they are often aggregated with students with moderate and severe intellectual disability or students with other high incidence disabilities. This study used the National Longitudinal Transition Study-2 (NLTS2) to look at the personal…

  4. Low density lipoprotein receptor related protein 1 and 6 gene variants and ischaemic stroke risk.

    Science.gov (United States)

    Harriott, A M; Heckman, M G; Rayaprolu, S; Soto-Ortolaza, A I; Diehl, N N; Kanekiyo, T; Liu, C-C; Bu, G; Malik, R; Cole, J W; Meschia, J F; Ross, O A

    2015-08-01

    Low density lipoprotein receptor related proteins (LRPs) 1 and 6 have been implicated in cerebral ischaemia. In addition, genetic variation in LRP1 and LRP6 has been linked with various factors that are related to risk of ischaemic stroke. The aim of this study was to examine the association of LRP1 and LRP6 gene variants with risk of ischaemic stroke as part of the Ischemic Stroke Genetics Study (ISGS). A Caucasian series (434 stroke patients, 319 controls) and an African American series (161 stroke patients, 116 controls) were included. Fourteen LRP6 variants and three LRP1 variants were genotyped and assessed for association with ischaemic stroke. In the Caucasian series, significant associations with ischaemic stroke were observed for LRP6 rs2075241 [odds ratio (OR) 0.42, P = 0.023], rs2302685 (OR 0.44, P = 0.049), rs7975614 (OR 0.07, P = 0.017), rs10492120 (OR 0.62, P = 0.036) and rs10743980 (OR 0.66, P = 0.037). Risk of ischaemic stroke was significantly lower for carriers of any of these five protective LRP6 variants (24.0% of subjects) compared to non-carriers (OR 0.57, P = 0.003). The protective association for LRP6 rs2075241 was observed at a similar magnitude across ischaemic stroke subtypes, whilst the effects of rs23022685, rs10492120 and rs10743980 were most apparent for cardioembolic and large vessel stroke. In the African American series, LRP1 rs11172113 was associated with an increased risk of stroke (OR 1.89, P = 0.006). The results of our preliminary study provide evidence that LRP6 and LRP1 variants may be associated with risk of ischaemic stroke. Validation in larger studies is warranted. © 2015 EAN.

  5. Repeated ischaemic preconditioning: a novel therapeutic intervention and potential underlying mechanisms.

    Science.gov (United States)

    Thijssen, Dick H J; Maxwell, Joseph; Green, Daniel J; Cable, N Timothy; Jones, Helen

    2016-06-01

    What is the topic of this review? This review discusses the effects of repeated exposure of tissue to ischaemic preconditioning on cardiovascular function, the attendant adaptations and their potential clinical relevance. What advances does it highlight? We discuss the effects of episodic exposure to ischaemic preconditioning to prevent and/or attenuate ischaemic injury and summarize evidence pertaining to improvements in cardiovascular function and structure. Discussion is provided regarding the potential mechanisms that contribute to both local and systemic adaptation. Findings suggest that clinical benefits result from both the prevention of ischaemic events and the attenuation of their consequences. Ischaemic preconditioning (IPC) refers to the phenomenon whereby short periods of cyclical tissue ischaemia confer subsequent protection against ischaemia-induced injury. As a consequence, IPC can ameliorate the myocardial damage following infarction and can reduce infarct size. The ability of IPC to confer remote protection makes IPC a potentially feasible cardioprotective strategy. In this review, we discuss the concept that repeated exposure of tissue to IPC may increase the 'dose' of protection and subsequently lead to enhanced protection against ischaemia-induced myocardial injury. This may be relevant for clinical populations, who demonstrate attenuated efficacy of IPC to prevent or attenuate ischaemic injury (and therefore myocardial infarct size). Furthermore, episodic IPC facilitates repeated exposure to local (e.g. shear stress) and systemic stimuli (e.g. hormones, cytokines, blood-borne substances), which may induce improvement in vascular function and health. Such adaptation may contribute to prevention of cardio- and cerebrovascular events. The clinical benefits of repeated IPC may, therefore, result from both the prevention of ischaemic events and the attenuation of their consequences. We provide an overview of the literature pertaining to the impact

  6. Delayed ischaemic neurological deficits after subarachnoid haemorrhage are associated with clusters of spreading depolarizations.

    Science.gov (United States)

    Dreier, Jens P; Woitzik, Johannes; Fabricius, Martin; Bhatia, Robin; Major, Sebastian; Drenckhahn, Chistoph; Lehmann, Thomas-Nicolas; Sarrafzadeh, Asita; Willumsen, Lisette; Hartings, Jed A; Sakowitz, Oliver W; Seemann, Jörg H; Thieme, Anja; Lauritzen, Martin; Strong, Anthony J

    2006-12-01

    Progressive ischaemic damage in animals is associated with spreading mass depolarizations of neurons and astrocytes, detected as spreading negative slow voltage variations. Speculation on whether spreading depolarizations occur in human ischaemic stroke has continued for the past 60 years. Therefore, we performed a prospective multicentre study assessing incidence and timing of spreading depolarizations and delayed ischaemic neurological deficit (DIND) in patients with major subarachnoid haemorrhage (SAH) requiring aneurysm surgery. Spreading depolarizations were recorded by electrocorticography with a subdural electrode strip placed on cerebral cortex for up to 10 days. A total of 2110 h recording time was analysed. The clinical state was monitored every 6 h. Delayed infarcts after SAH were verified by serial CT scans and/or MRI. Electrocorticography revealed 298 spreading depolarizations in 13 of the 18 patients (72%). A clinical DIND was observed in seven patients 7.8 days (7.3, 8.2) after SAH. DIND was time-locked to a sequence of recurrent spreading depolarizations in every single case (positive and negative predictive values: 86 and 100%, respectively). In four patients delayed infarcts developed in the recording area. As in the ischaemic penumbra of animals, delayed infarction was preceded by progressive prolongation of the electrocorticographic depression periods associated with spreading depolarizations to >60 min in each case. This study demonstrates that spreading depolarizations have a high incidence in major SAH and occur in ischaemic stroke. Repeated spreading depolarizations with prolonged depression periods are an early indicator of delayed ischaemic brain damage after SAH. In view of experimental evidence and the present clinical results, we suggest that spreading depolarizations with prolonged depressions are a promising target for treatment development in SAH and ischaemic stroke.

  7. Endothelial Repair in Childhood Arterial Ischaemic Stroke with Cerebral Arteriopathy

    Directory of Open Access Journals (Sweden)

    Despina Eleftheriou

    2015-06-01

    Full Text Available Background: We have previously shown that recurrent arterial ischaemic stroke (AIS in children with cerebral arteriopathy is associated with increased circulating endothelial cells and endothelial microparticles, consistent with ongoing endothelial injury. To date, however, little is known about endothelial repair responses in childhood AIS. We examined the relationship between the number and function of circulating endothelial progenitor cells (EPC, the levels of brain-derived neurotrophic factor (BDNF and AIS recurrence. Methods: Flow cytometry was used to identify peripheral blood mononuclear cells positive for CD34/kinase insert domain-containing receptor (KDR. In a subgroup of patients (5 in each group selected at random, monocytic EPC function was assessed by colony-forming unit (EPC-CFU capacity and incorporation into endothelial cell networks in Matrigel. BDNF was measured using ELISA. Results: Thirty-five children, aged 12 years (range: 5-16.5; 9 males, with AIS and cerebral arteriopathy were studied; 10 had recurrent AIS. CD34+/KDR+ cells were significantly higher in recurrent AIS compared to non-recurrent AIS patients (p = 0.005 and controls (p = 0.0002. EPC-CFU and EPC incorporation into endothelial cell networks were significantly reduced in recurrent compared to non-recurrent AIS patients (p = 0.04 and p = 0.01, respectively. Levels of BDNF were significantly higher in recurrent compared to non-recurrent AIS patients (p = 0.0008 and controls (p = 0.0002. Conclusions: Children with recurrent AIS and cerebral arteriopathy had increased circulating CD34+/KDR+ cells and BDNF consistent with an endothelial repair response. However, EPC function was impaired. Future studies are needed to examine whether suboptimal endothelial repair contributes to childhood AIS recurrence.

  8. ExStroke Pilot Trial of the effect of repeated instructions to improve physical activity after ischaemic stroke

    DEFF Research Database (Denmark)

    Boysen, Gudrun; Krarup, Lars-Henrik; Zeng, Xianrong;

    2009-01-01

    To investigate if repeated verbal instructions about physical activity to patients with ischaemic stroke could increase long term physical activity.......To investigate if repeated verbal instructions about physical activity to patients with ischaemic stroke could increase long term physical activity....

  9. Novel insights into the complexity of ischaemic heart disease derived from combined coronary pressure and flow velocity measurements

    NARCIS (Netherlands)

    van de Hoef, T.P.

    2015-01-01

    This thesis concerns the complexity of ischaemic heart disease, and the crucial role of the coronary microcirculation in its diagnosis and prognosis. After five decades of a stenosis-centered approach towards both its diagnosis and treatment, it is increasingly acknowledged that ischaemic heart

  10. Only a fraction of patients with ischaemic diseases or diabetes are treated to recommended target values for plasma lipids

    DEFF Research Database (Denmark)

    Siggaard-Andersen, Niels; Freiberg, Jacob J; Nordestgaard, Børge G

    2012-01-01

    We tested the hypothesis that individuals in the general population with and without ischaemic cardiovascular disease, or with diabetes, are treated to recommended target values for plasma lipids.......We tested the hypothesis that individuals in the general population with and without ischaemic cardiovascular disease, or with diabetes, are treated to recommended target values for plasma lipids....

  11. Only a fraction of patients with ischaemic diseases or diabetes are treated to recommended target values for plasma lipids

    DEFF Research Database (Denmark)

    Siggaard-Andersen, Niels; Freiberg, Jacob J; Nordestgaard, Børge G

    2012-01-01

    We tested the hypothesis that individuals in the general population with and without ischaemic cardiovascular disease, or with diabetes, are treated to recommended target values for plasma lipids.......We tested the hypothesis that individuals in the general population with and without ischaemic cardiovascular disease, or with diabetes, are treated to recommended target values for plasma lipids....

  12. Prothrombotic factors and the risk of myocardial infarction and ischaemic stroke in young women : differences similarities and implications

    NARCIS (Netherlands)

    Siegerink, Bob

    2013-01-01

    Myocardial infarction and ischaemic stroke are both forms of arterial thrombosis. It is unclear to what extent hypercoagulability is a causal factor of these diseases and whether this effect might be different for myocardial infarction and ischaemic stroke. Several measures of hypercoagulability

  13. Including Students with Moderate and Severe Complexity of Disability in Kindergarten and First Grade: Investigating the Relationship between Inclusive Classroom Quality Indicators, Level of Inclusive Education, and Social Competence

    Science.gov (United States)

    Matz, Amy Kristen

    2013-01-01

    The development of social competence for children is critical to their ability to navigate social decision making processes; however, children with complex disabilities have many difficulties in developing social competence. In an educational environment, the optimal setting for a child to develop social competence is within the inclusive…

  14. Atrial fibrillation, ischaemic heart disease, and the risk of death in patients with heart failure

    DEFF Research Database (Denmark)

    Pedersen, Ole Dyg; Søndergaard, Peter; Nielsen, Tonny

    2006-01-01

    AIMS: Atrial fibrillation (AF) is a risk factor for death in patients with a myocardial infarction, but highly variable results are reported in patients with heart failure. We studied the prognostic impact of AF in heart failure patients with and without ischaemic heart disease. METHODS AND RESULTS......: During a period of 2 years, 3587 patients admitted to hospital because of heart failure were included in this study. All patients were examined by echocardiography and the presence of AF was recorded. Follow-up was available for 8 years. Twenty four percent of those discharged alive from hospital had AF......), 1.02-1.23, P=0.018]. There was a significant interaction between the importance of AF and the presence of ischaemic heart disease (P=0.034). In patients with AF at the time of discharge and ischaemic heart disease, HR was 1.25 (95% CI: 1.09-1.42) and P

  15. Use of acupuncture therapy as a supplement to conventional medical treatments for acute ischaemic stroke patients in an academic medical centre in Korea.

    Science.gov (United States)

    Chang, Hyejung; Kwon, Young Dae; Yoon, Sung Sang

    2011-10-01

    Acupuncture has served as a major complementary and alternative therapy that supplements conventional medicine and is the subject of growing public interest. This study was conducted to estimate the usage rate of acupuncture as a supplemental treatment in acute ischaemic stroke patients and to identify factors associated with the choice to use this therapy. Using the registry of stroke patients admitted to an academic medical centre in Korea, the use of acupuncture therapy was recorded and analysed, along with the patients' socio-demographic characteristics, hospital access variables, risk factors for ischaemic stroke and clinical characteristics. The data were analysed using descriptive statistics, chi-square tests and multiple logistic regression analyses. Of 2167 patients, 18% received acupuncture therapy. The choice of acupuncture therapy was significantly associated with stroke severity as well as gender, age, geographical residence and previous history of stroke. After controlling for other significant factors, there was an approximately 3.4-fold greater usage in patients with moderately severe strokes (95% confidence interval (CI)=2.5-4.6) and 4.1-fold greater usage in patients with severe strokes (95% CI=2.7-6.4). The findings provide a better understanding of patients' utilization of acupuncture therapy as a supplement to conventional medical treatments and of factors associated with the utilization of acupuncture in patients with acute ischemic stroke. Strategic implications of acupuncture therapy are suggested for both health-care providers and policy makers. Copyright © 2011 Elsevier Ltd. All rights reserved.

  16. Persistent lactic acidosis in neonatal hypoxic-ischaemic encephalopathy correlates with EEG grade and electrographic seizure burden.

    LENUS (Irish Health Repository)

    Murray, D M

    2012-02-03

    BACKGROUND: Predicting at birth which infants with perinatal hypoxic-ischaemic injury will progress to significant encephalopathy remains a challenge. OBJECTIVE: To determine whether lactic acidosis at birth in asphyxiated neonates could predict the grade of EEG encephalopathy by examining the relationship between time taken for the normalisation of lactate, severity of encephalopathy and seizure burden. METHODS: Continuous early video-EEG monitoring was performed in babies at risk for hypoxic-ischaemic encephalopathy. Encephalopathy was graded from the EEG data. Total seizure burden (seconds) was calculated for each baby. Initial blood gas measurements of pH, base deficit and lactate were taken within 30 minutes of delivery. Time to normal serum lactate was determined in hours from birth for each infant. RESULTS: All 50 term infants had raised initial serum lactate (median (lower, upper quartiles) 11.7 (10.2, 14.9)). There were no significant differences between the initial serum lactate, pH and base deficit in infants with normal\\/mildly abnormal (n = 24), moderately abnormal (n = 14), severely abnormal (n = 5) and inactive EEGs (n = 7). Time to normal lactate varied significantly with EEG grade (median (lower, upper quartile) 6.0 (4.1, 9.5) for mild\\/normal EEG, 13.5 (6.8, 23.5) moderate EEG, 41.5 (30.0, 55.5) severe group, 12.0 (8.1, 21.5) inactive group; p<0.001). Time to normal lactate correlated significantly with EEG seizure burden (seconds; R = 0.446, p = 0.002). Mean (SD) time to normal lactate was 10.0 (7.2) hours in infants who did not have seizures and 27.3 (19.0) hours in the 13 infants with electrographic seizures (p = 0.002). CONCLUSIONS: Serum lactate levels in the first 30 minutes of life do not predict the severity of the ensuing encephalopathy. In contrast, sustained lactic acidosis is associated with severe encephalopathy on EEG and correlates with seizure burden.

  17. Interleukin 6-preconditioned neural stem cells reduce ischaemic injury in stroke mice.

    Science.gov (United States)

    Sakata, Hiroyuki; Narasimhan, Purnima; Niizuma, Kuniyasu; Maier, Carolina M; Wakai, Takuma; Chan, Pak H

    2012-11-01

    Transplantation of neural stem cells provides a promising therapy for stroke. Its efficacy, however, might be limited because of massive grafted-cell death after transplantation, and its insufficient capability for tissue repair. Interleukin 6 is a pro-inflammatory cytokine involved in the pathogenesis of various neurological disorders. Paradoxically, interleukin 6 promotes a pro-survival signalling pathway through activation of signal transducer and activator of transcription 3. In this study, we investigated whether cellular reprogramming of neural stem cells with interleukin 6 facilitates the effectiveness of cell transplantation therapy in ischaemic stroke. Neural stem cells harvested from the subventricular zone of foetal mice were preconditioned with interleukin 6 in vitro and transplanted into mouse brains 6 h or 7 days after transient middle cerebral artery occlusion. Interleukin 6 preconditioning protected the grafted neural stem cells from ischaemic reperfusion injury through signal transducer and activator of transcription 3-mediated upregulation of manganese superoxide dismutase, a primary mitochondrial antioxidant enzyme. In addition, interleukin 6 preconditioning induced secretion of vascular endothelial growth factor from the neural stem cells through activation of signal transducer and activator of transcription 3, resulting in promotion of angiogenesis in the ischaemic brain. Furthermore, transplantation of interleukin 6-preconditioned neural stem cells significantly attenuated infarct size and improved neurological performance compared with non-preconditioned neural stem cells. This interleukin 6-induced amelioration of ischaemic insults was abolished by transfecting the neural stem cells with signal transducer and activator of transcription 3 small interfering RNA before transplantation. These results indicate that preconditioning with interleukin 6, which reprograms neural stem cells to tolerate oxidative stress after ischaemic reperfusion

  18. Evolution of DWI signal abnormalities after transient ischemic attack and minor ischaemic stroke

    LENUS (Irish Health Repository)

    Merwick, A

    2011-05-01

    Background: Diffusion weighted imaging (DWI) signal abnormality after transient ischaemic attack (TIA) predicts early stroke, independently of other risk markers included in the ABCD3-I score. Early stroke recurrence detected on follow-up DWI after the acute-phase DWI may identify patients at high risk for subsequent clinicalstrokesstroke, cognitive impairment, and seizures. We aimed to determine the evolution of acute DWI lesions and rate of new ischaemic lesion (NIL) occurrence on follow-up DWI after TIA and minor stroke.\\r\

  19. Bone marrow-derived mesenchymal stromal cell treatment in patients with severe ischaemic heart failure

    DEFF Research Database (Denmark)

    Mathiasen, Anders Bruun; Qayyum, Abbas Ali; Jørgensen, Erik

    2015-01-01

    AIMS: Regenerative treatment with mesenchymal stromal cells (MSCs) has been promising in patients with ischaemic heart failure but needs confirmation in larger randomized trials. We aimed to study effects of intra-myocardial autologous bone marrow-derived MSC treatment in patients with severe.......001). Compared with placebo, there were also significant improvements in LVEF of 6.2% (Pside effects were...... ischaemic heart failure. METHODS AND RESULTS: The MSC-HF trial is a randomized, double-blind, placebo-controlled trial. Patients were randomized 2 : 1 to intra-myocardial injections of MSC or placebo, respectively. The primary endpoint was change in left ventricular end-systolic volume (LVESV), measured...

  20. Electrocardiographic and signal monitoring in ischaemic heart disease: state of the art and perspective.

    Science.gov (United States)

    Emdin, M; Taddei, A; Varanini, M; Raciti, M; Pola, S; Marchesi, C; L'Abbate, A

    1997-01-01

    The current role of ECG and signal monitoring in the diagnosis of Ischaemic Heart Disease is outlined in relation to imaging techniques giving accurate information on myocardial anatomy and function. ECG monitoring during stress testing remains the first step non-invasive method providing pathophysiological information. Long term continuous monitoring of the ECG and of other signals (e.g. arterial blood pressure and respiration) is commonly used to control patients with suspected or ascertained IHD. Progress of technology and of signal processing methods are driving the exploitation of signal information for diagnosis, prognosis and therapy control of ischaemic patients.

  1. Retinal angiographic blood flowmetry is reduced in the ocular ischaemic syndrome

    DEFF Research Database (Denmark)

    Hansen, Grith Lssrkholm; Kofoed, Peter Kristian; Munch, Inger Christine;

    2013-01-01

    with ocular ischaemic syndrome (OIS) and 20 control eyes from subjects with carotid artery stenosis but without signs of ocular ischaemia. Analyses of video fluorescein angiograms extracting time intervals for the time delay between specific phases of the angiogram were performed. Time delay was compared...... and a correlation between flow and ocular perfusion pressure. While angiographic flowmetry proved effective in discriminating between groups of individuals, it can only be used to support the diagnosis of the ocular ischaemic syndrome in patients with extreme flow reduction....

  2. Cardiac magnetic resonance imaging: a new tool to identify cardioaortic sources in ischaemic stroke.

    Science.gov (United States)

    Yaghi, Shadi; Liberman, Ava L; Atalay, Michael; Song, Christopher; Furie, Karen L; Kamel, Hooman; Bernstein, Richard A

    2017-01-01

    Stroke of undetermined aetiology or 'cryptogenic' stroke accounts for 30-40% of ischaemic strokes despite extensive diagnostic evaluation. The role and yield of cardiac imaging is controversial. Cardiac MRI (CMR) has been used for cardiac disorders, but its use in cryptogenic stroke is not well established. We reviewed the literature (randomised trials, exploratory comparative studies and case series) on the use of CMR in the diagnostic evaluation of patients with ischaemic stroke. The literature on the use of CMR in the diagnostic evaluation of ischaemic stroke is sparse. However, studies have demonstrated a potential role for CMR in the diagnostic evaluation of patients with cryptogenic stroke to identify potential aetiologies such as cardiac thrombi, cardiac tumours, aortic arch disease and other rare cardiac anomalies. CMR can also provide data on certain functional and structural parameters of the left atrium and the left atrial appendage which have been shown to be associated with ischaemic stroke risk. CMR is a non-invasive modality that can help identify potential mechanisms in cryptogenic stroke and patients who may be targeted for enrolment into clinical trials comparing anticoagulation to antiplatelet therapy in secondary stroke prevention. Prospective studies are needed to compare the value of CMR as compared to transthoracic and transesophageal echocardiography in the diagnostic evaluation of cryptogenic stroke. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  3. Pre-stroke use of beta-blockers does not affect ischaemic stroke severity and outcome

    NARCIS (Netherlands)

    De Raedt, S.; Haentjens, P.; De Smedt, A.; Brouns, R.; Uyttenboogaart, Maarten; Luijckx, G. J.; De Keyser, J.

    2012-01-01

    Background and purpose: It is unclear whether pre-stroke beta-blockers use may influence stroke outcome. This study evaluates the independent effect of pre-stroke use of beta-blockers on ischaemic stroke severity and 3 months functional outcome. Methods: Pre-stroke use of beta-blockers was investiga

  4. Aspects of Subcortical Ischaemic Vascular Disease : Early clinical manifestations and associations with Type 2 diabetes mellitus

    NARCIS (Netherlands)

    Harten, van B.

    2006-01-01

    Summary Subcortical ischaemic vascular disease (SIVD) is an important cause of cognitive impairment in elderly patients. Screening and diagnostic tests are needed to identify these patients. The HIV dementia scale (HDS) is a reliable and quantitative scale for identifying HIV dementia1. The cogniti

  5. Neurone-specific enolase and N-acetyl-aspartate as potential peripheral markers of ischaemic stroke

    NARCIS (Netherlands)

    Stevens, H; Jakobs, C; de Jager, AEJ; Cunningham, RT; Korf, J

    1999-01-01

    Background After stroke, brain-specific proteins (including neurone-specific enolase) leak into the blood. The question addressed in the present study was whether N-acetyl-aspartate (amino acid derivative localized in cerebral neurones) could also serve as a peripheral marker of ischaemic damage. N-

  6. Foetal hypoxia increases cardiac AT2R expression and subsequent vulnerability to adult ischaemic injury

    Science.gov (United States)

    Xue, Qin; Dasgupta, Chiranjib; Chen, Man; Zhang, Lubo

    2011-01-01

    Aims Hypoxia is a common stress to the foetus and results in increased cardiac vulnerability to adult ischaemic injury. This study tested the hypothesis that foetal hypoxia causes programming of increased AT2 receptor (AT2R) expression in the heart, resulting in the heightened cardiac susceptibility to adult ischaemic injury. Methods and results Time-dated pregnant rats were divided between normoxic and hypoxic (10.5% O2 from days 15 to 21 of gestation) groups. Hypoxia resulted in significantly increased AT2R in the heart of adult offspring. Multiple glucocorticoid response elements (GREs) were identified at the AT2R promoter, deletion of which increased the promoter activity. Consistently, ex vivo treatment of isolated foetal hearts with dexamethasone for 48 h decreased AT2R expression, which was inhibited by RU 486. Hypoxia decreased glucocorticoid receptors (GRs) in the hearts of foetal, 3-week-old and 3-month-old offspring, resulting in decreased GR binding to the GREs at the AT2R promoter. The inhibition of AT2R improved postischaemic recovery of left ventricular function and rescued the foetal hypoxia-induced cardiac ischaemic vulnerability in male adult animals. In contrast, the inhibition of AT1 receptors decreased the postischaemic recovery. Conclusion The results demonstrate that in utero hypoxia causes programming of increased AT2R gene expression in the heart by downregulating GR, which contributes to the increased cardiac vulnerability to adult ischaemic injury caused by prenatal hypoxic exposure. PMID:20870653

  7. Income inequality and ischaemic heart disease in Danish men and women

    DEFF Research Database (Denmark)

    Osler, Merete; Christensen, Ulla; Due, Pernille;

    2003-01-01

    BACKGROUND: It has been hypothesized that areas with an unequal income distribution are less likely to invest in health and more likely to have a social environment that influences the development of ischaemic heart disease (IHD) METHODS: We used pooled data from two cohort studies conducted in C...

  8. Epilepsy in Hemiplegic Cerebral Palsy Due to Perinatal Arterial Ischaemic Stroke

    Science.gov (United States)

    Wanigasinghe, Jithangi; Reid, Susan M.; Mackay, Mark T.; Reddihough, Dinah S.; Harvey, A. Simon; Freeman, Jeremy L.

    2010-01-01

    Aim: The aim of this study was to describe the frequency, risk factors, manifestations, and outcome of epilepsy in children with hemiplegic cerebral palsy (CP) due to perinatal arterial ischaemic stroke (AIS). Method: The study group comprised 63 participants (41 males, 22 females) from a population-based CP register whose brain imaging showed…

  9. Pre-stroke use of beta-blockers does not affect ischaemic stroke severity and outcome

    NARCIS (Netherlands)

    De Raedt, S.; Haentjens, P.; De Smedt, A.; Brouns, R.; Uyttenboogaart, Maarten; Luijckx, G. J.; De Keyser, J.

    Background and purpose: It is unclear whether pre-stroke beta-blockers use may influence stroke outcome. This study evaluates the independent effect of pre-stroke use of beta-blockers on ischaemic stroke severity and 3 months functional outcome. Methods: Pre-stroke use of beta-blockers was

  10. MMP-2 and MMP-9 as prognostic factors in ischaemic stroke

    Directory of Open Access Journals (Sweden)

    Justyna Zielińska-Turek

    2016-09-01

    Full Text Available Objectives: No widely available, adequately sensitive diagnostic test to establish prognosis in stroke patients has been developed thus far. The aim of this study was to analyse changes in plasma levels of MMP-9 and MMP-2 as potential prognostic factors in patients with ischaemic stroke. Methods: The study included 56 patients presenting with the signs of ischaemic stroke for less than 24 hours, and 60 healthy controls without a history of neurological and/or inflammatory disorders. Plasma concentrations of MMP-2 and MMP-9 were determined immunoenzymatically at admission (i.e. within 24 hours of the cerebrovascular episode and on the 7th day of hospital stay. Results: Median concentrations of MMP-9 in stroke patients were significantly lower than in the controls, both at admission and on the 7th day of hospital stay. No significant changes in the concentration of MMP-2 in ischaemic stroke patients were observed during the course of hospital stay. No significant association was found between both MMP concentrations and neurological status of patients with cerebrovascular episodes. Conclusions: The lack of significant associations between plasma concentrations of MMP-2/MMP-9 and clinical status suggests that these metalloproteinases should not be used as prognostic factors in patients with ischaemic cerebral episodes.

  11. Cell therapy for ischaemic heart disease: focus on the role of resident cardiac stem cells

    NARCIS (Netherlands)

    S.A.J. Chamuleau; K.R. Vrijsen; D.G. Rokosh; X.L. Tang; J.J. Piek; R. Bolli

    2009-01-01

    Myocardial infarction results in loss of cardiomyocytes, scar formation, ventricular remodelling, and eventually heart failure. In recent years, cell therapy has emerged as a potential new strategy for patients with ischaemic heart disease. This includes embryonic and bone marrow derived stem cells.

  12. Does aetiology of neonatal encephalopathy and hypoxic-ischaemic encephalopathy influence the outcome of treatment?

    Science.gov (United States)

    Mcintyre, Sarah; Badawi, Nadia; Blair, Eve; Nelson, Karin B

    2015-04-01

    Neonatal encephalopathy, a clinical syndrome affecting term-born and late preterm newborn infants, increases the risk of perinatal death and long-term neurological morbidity, especially cerebral palsy. With the advent of therapeutic hypothermia, a treatment designed for hypoxic or ischaemic injury, associated mortality and morbidity rates have decreased. Unfortunately, only about one in eight neonates (95% confidence interval) who meet eligibility criteria for therapeutic cooling apparently benefit from the treatment. Studies of infants in representative populations indicate that neonatal encephalopathy is a potential result of a variety of antecedents and that asphyxial complications at birth account for only a small percentage of neonatal encephalopathy. In contrast, clinical case series suggest that a large proportion of neonatal encephalopathy is hypoxic or ischaemic, and trials of therapeutic hypothermia are specifically designed to include only infants exposed to hypoxia or ischaemia. This review addresses the differences, definitional and methodological, between infants studied and investigations undertaken, in population studies compared with cooling trials. It raises the question if there may be subgroups of infants with a clinical diagnosis of hypoxic-ischaemic encephalopathy (HIE) in whom the pathobiology of neonatal neurological depression is not fundamentally hypoxic or ischaemic and, therefore, for whom cooling may not be beneficial. In addition, it suggests approaches to future trials of cooling plus adjuvant therapy that may contribute to further improvement of care for these vulnerable neonates.

  13. Ischaemic memory imaging using metabolic radiopharmaceuticals: overview of clinical settings and ongoing investigations

    Energy Technology Data Exchange (ETDEWEB)

    Yoshinaga, Keiichiro [Hokkaido University Graduate School of Medicine, Department of Molecular Imaging, Sapporo (Japan); Naya, Masanao [Hokkaido University Graduate School of Medicine, Department of Cardiology, Sapporo (Japan); Shiga, Tohru; Suzuki, Eriko; Tamaki, Nagara [Hokkaido University Graduate School of Medicine, Department of Nuclear Medicine, Sapporo (Japan)

    2014-02-15

    ''Ischaemic memory'' is defined as a prolonged functional and/or biochemical alteration remaining after a particular episode of severe myocardial ischaemia. The biochemical alteration has been reported as metabolic stunning. Metabolic imaging has been used to detect the footprint left by previous ischaemic episodes evident due to delayed recovery of myocardial metabolism (persistent dominant glucose utilization with suppression of fatty acid oxidation). β-Methyl-p-[{sup 123}I]iodophenylpentadecanoic acid (BMIPP) is a single-photon emission computed tomography (SPECT) radiotracer widely used for metabolic imaging in clinical settings in Japan. In patients with suspected coronary artery disease but no previous myocardial infarction, BMIPP has shown acceptable diagnostic accuracy. In particular, BMIPP plays an important role in the identification of prior ischaemic insult in patients arriving at emergency departments with acute chest pain syndrome. Recent data also show the usefulness of {sup 123}I-BMIPP SPECT for predicting cardiovascular events in patients undergoing haemodialysis. Similarly, SPECT or PET imaging with {sup 18}F-FDG injected during peak exercise or after exercise under fasting conditions shows an increase in FDG uptake in postischaemic areas. This article will overview the roles of ischaemic memory imaging both under established indications and in ongoing investigations. (orig.)

  14. EVALUATION OF CAROTID ARTERY STENOSIS IN STROKE/TRANSIENT ISCHAEMIC ATTACK

    OpenAIRE

    Nambakam Tanuja; Naveen Kumar; Girish P.

    2015-01-01

    BACKGROUND : Stroke remains the second leading cause of death worldwide, after ischaemic heart disease. Patients with carotid artery stenosis are at higher risk of development of stroke. Carotid atherosclerosis occurs in patients with atheros clerotic risk factors like diabetes mellitus, hypertension, smoking and hyperlipidemia. Carotid artery stenosis can be assessed by means of noninvasive high - resolution B - mode ultrasonography of the carotid arteries. ...

  15. Prevalence of significant carotid artery stenosis in patients with transient ischaemic attack

    DEFF Research Database (Denmark)

    Rappeport, Yael; Simonsen, Lene; Christiansen, Hanne Hjertmann;

    2002-01-01

    Carotid artery stenosis is one of the risk factors for transient ischaemic attack (TIA) and stroke. The purpose of this study was to investigate the prevalence of carotid artery stenosis and the prevalence of candidates for carotid endarterectomy in a hospital-based cohort of TIA patients under 71...

  16. Income inequality and ischaemic heart disease in Danish men and women

    DEFF Research Database (Denmark)

    Osler, Merete; Christensen, Ulla; Due, Pernille

    2003-01-01

    BACKGROUND: It has been hypothesized that areas with an unequal income distribution are less likely to invest in health and more likely to have a social environment that influences the development of ischaemic heart disease (IHD) METHODS: We used pooled data from two cohort studies conducted...

  17. Income inequality and ischaemic heart disease in Danish men and women

    DEFF Research Database (Denmark)

    Osler, Merete; Christensen, Ulla; Due, Pernille

    2003-01-01

    It has been hypothesized that areas with an unequal income distribution are less likely to invest in health and more likely to have a social environment that influences the development of ischaemic heart disease (IHD) METHODS: We used pooled data from two cohort studies conducted in Copenhagen...

  18. Aspects of Subcortical Ischaemic Vascular Disease : Early clinical manifestations and associations with Type 2 diabetes mellitus

    NARCIS (Netherlands)

    Harten, van B.

    2006-01-01

    Summary Subcortical ischaemic vascular disease (SIVD) is an important cause of cognitive impairment in elderly patients. Screening and diagnostic tests are needed to identify these patients. The HIV dementia scale (HDS) is a reliable and quantitative scale for identifying HIV dementia1. The

  19. Lipid profile, statin use, and outcome after intravenous thrombolysis for acute ischaemic stroke

    NARCIS (Netherlands)

    Uyttenboogaart, M; Koch, M W; Koopman, K; Vroomen, P C; Luijckx, G J; De Keyser, J

    BACKGROUND: Low cholesterol levels have been associated with an increased risk of haemorrhagic stroke. This study investigated whether lipid levels or prior statin use influence outcome in patients with acute ischaemic stroke treated with IV thrombolysis. METHODS: The relation between admission

  20. Epilepsy in Hemiplegic Cerebral Palsy Due to Perinatal Arterial Ischaemic Stroke

    Science.gov (United States)

    Wanigasinghe, Jithangi; Reid, Susan M.; Mackay, Mark T.; Reddihough, Dinah S.; Harvey, A. Simon; Freeman, Jeremy L.

    2010-01-01

    Aim: The aim of this study was to describe the frequency, risk factors, manifestations, and outcome of epilepsy in children with hemiplegic cerebral palsy (CP) due to perinatal arterial ischaemic stroke (AIS). Method: The study group comprised 63 participants (41 males, 22 females) from a population-based CP register whose brain imaging showed…

  1. CD163 interacts with TWEAK to regulate tissue regeneration after ischaemic injury.

    Science.gov (United States)

    Akahori, Hirokuni; Karmali, Vinit; Polavarapu, Rohini; Lyle, Alicia N; Weiss, Daiana; Shin, Eric; Husain, Ahsan; Naqvi, Nawazish; Van Dam, Richard; Habib, Anwer; Choi, Cheol Ung; King, Adrienne L; Pachura, Kimberly; Taylor, W Robert; Lefer, David J; Finn, Aloke V

    2015-08-05

    Macrophages are an essential component of the immune response to ischaemic injury and play an important role in promoting inflammation and its resolution, which is necessary for tissue repair. The type I transmembrane glycoprotein CD163 is exclusively expressed on macrophages, where it acts as a receptor for haemoglobin:haptoglobin complexes. An extracellular portion of CD163 circulates in the blood as a soluble protein, for which no physiological function has so far been described. Here we show that during ischaemia, soluble CD163 functions as a decoy receptor for TWEAK, a secreted pro-inflammatory cytokine of the tumour necrosis factor family, to regulate TWEAK-induced activation of canonical nuclear factor-κB (NF-κB) and Notch signalling necessary for myogenic progenitor cell proliferation. Mice with deletion of CD163 have transiently elevated levels of TWEAK, which stimulate muscle satellite cell proliferation and tissue regeneration in their ischaemic and non-ischaemic limbs. These results reveal a role for soluble CD163 in regulating muscle regeneration after ischaemic injury.

  2. Apixaban compared with warfarin in patients with atrial fibrillation and previous stroke or transient ischaemic attack

    DEFF Research Database (Denmark)

    Easton, J Donald; Lopes, Renato D; Bahit, M Cecilia

    2012-01-01

    In the ARISTOTLE trial, the rate of stroke or systemic embolism was reduced by apixaban compared with warfarin in patients with atrial fibrillation (AF). Patients with AF and previous stroke or transient ischaemic attack (TIA) have a high risk of stroke. We therefore aimed to assess the efficacy ...

  3. Ischaemic heart disease during pregnancy or post-partum : systematic review and case series

    NARCIS (Netherlands)

    Lameijer, H.; Kampman, M. A. M.; Oudijk, M. A.; Pieper, P. G.

    2015-01-01

    The risk of manifestations of ischaemic heart disease (IHD) in fertile women is elevated during pregnancy and the post-partum period. With increasing maternal age and a higher prevalence of cardiac risk factors, the incidence of IHD during pregnancy is rising. However, information in the literature

  4. Ischaemic heart disease during pregnancy or post-partum: systematic review and case series

    NARCIS (Netherlands)

    Lameijer, H.; Kampman, M.A.; Oudijk, M.A.; Pieper, P.G.

    2015-01-01

    The risk of manifestations of ischaemic heart disease (IHD) in fertile women is elevated during pregnancy and the post-partum period. With increasing maternal age and a higher prevalence of cardiac risk factors, the incidence of IHD during pregnancy is rising. However, information in the literature

  5. Development of a person-centred lifestyle intervention for older adults following a stroke or transient ischaemic attack.

    Science.gov (United States)

    Lund, Anne; Michelet, Mona; Kjeken, Ingvild; Wyller, Torgeir Bruun; Sveen, Unni

    2012-03-01

    Older adults with mild to moderate stroke or transient ischaemic attack often experience anxiety, depression and reduced social participation in their daily lives. Interventions addressing the long-term consequences of stroke are needed. To describe the process of developing a person-centred lifestyle intervention for older adults with stroke. The Canadian Occupational Performance Measure was used to develop the content of the intervention. Lifestyle groups were implemented at senior centres once a week for nine months. Content analysis was used to analyse the intervention content. A total of 132 participants (median age 79 years, 55% women, 52% lived alone) were recruited from hospitals. The participants prioritized 392 occupational problems, mainly related to active recreation, household and community management, mobility, and socialization. The occupational issues were addressed in the group interventions. New themes also emerged in line with the participants' choices through group discussions, such as information on stroke and prevention of new strokes, outdoor mobility and transportation, "brain use" and memory. The study demonstrates the development of intervention following stroke, addressing its process, structure, and components. Whether the person-centred process increases the potential for enhancing participants' social participation and well-being should be evaluated in future studies.

  6. Plasma uric acid concentrations and risk of ischaemic stroke in women.

    Science.gov (United States)

    Jiménez, M C; Curhan, G C; Choi, H K; Forman, J P; Rexrode, K M

    2016-07-01

    Elevated plasma uric acid has been inconsistently associated with an increased risk of total stroke; however, data are sparse amongst women. The association between plasma uric acid concentrations and ischaemic stroke amongst women was examined and the effect modification by key cardiovascular risk factors was evaluated. A nested case-control design with matching by age, race/ethnicity, smoking status, menopausal status, postmenopausal hormone therapy use, date of blood draw and fasting status was utilized amongst female participants of the Nurses' Health Study who provided blood samples between 1989 and 1990. Plasma uric acid was measured on stored blood samples. The National Survey of Stroke criteria were utilized to confirm 460 incident cases of ischaemic stroke by medical records from 1990 to 2006. Multivariable conditional logistic regression models were estimated. In matched analysis, risk of ischaemic stroke increased by 15% for each 1 mg/dl increase in plasma uric acid [95% confidence interval (CI) 3%-28%], but was no longer significant after adjustment for cardiovascular risk factors, particularly history of hypertension. The highest quartile of uric acid was significantly associated with greater risk of ischaemic stroke (relative risk 1.56; 95% CI 1.06-2.29, extreme quartiles) in matched analysis, but estimates were no longer significant after adjustment for cardiovascular risk factors (relative risk 1.43; 95% CI 0.93-2.18). Significant effect modification by key cardiovascular risk factors was not observed. Plasma uric acid levels were not independently associated with increased risk of ischaemic stroke in this cohort of women. Whilst plasma uric acid was associated with stroke risk factors, it was not independently associated with stroke risk. © 2016 EAN.

  7. [Operations on carotid arteries in an acute stage of ischaemic stroke].

    Science.gov (United States)

    Ignat'ev, I M

    2011-01-01

    The present study was aimed at specifying the indications for operations performed on carotid arteries in an acute period of ischaemic stroke and assessing the results thus obtained. Between January 2008 and July 2010, we carried out a total of 372 operations on carotid arteries in three hundred and sixty patients. Of these, thirty-two subjects were operated on in an acute period of stroke. Neurovisualization was performed by means of magnetic resonance imaging (MRI) and computed tomography (CT). The condition of the carotid arteries was assessed by means of duplex scanning (DS). The operations performed on the carotid arteries were as follows: thrombembolectomy (n=4), carotid thrombendarterectomy (n 5), carotid endarterectomy (CEAE, n=21), and stent grafting of the internal carotid arteries (1СA, n 2). Five CEAE operations were carried out after thrombolysis. The interventions on the carotid arteries were performed within 6 hours to 12 days from the onset of the first symptoms of ischaemic stroke. Neurologists were actively engaged in both determining the indications for the operations and monitoring of neurological functions. There were no perioperative complications encountered. Regression of the neurological deficit during 7 days of in-hospital follow up occurred in sixteen patients (50%) (neurological deficit scoring 1-2 by the Rankin scale). One patient (3%) developed ischaemic stroke on postoperative day 3 after CEAE. Two patients were diagnosed as having transitory ischaemic attacks. Stenting turned out successful in the both patients. The remote results at terms ranging from 12 months to 2 years were followed up in fifteen patients. Of these, twelve patients (80%) showed complete restoration of neurological functions (Rankin scale scoring 0). Neither lethal outcomes nor relapsing strokes were observed over the follow-up period. The obtained outcomes strongly suggest certain advantages and advisability of active surgical policy of treating patients

  8. Bronchogenic adenocarcinoma presenting as a synchronous solitary lytic skull lesion with ischaemic stroke--case report and literature review.

    LENUS (Irish Health Repository)

    O'Connell, David

    2011-01-01

    The authors describe a rare case of metastatic bronchogenic adenocarcinoma in a 55-year-old man presenting with concomittant solitary lytic skull lesion and ischaemic stroke. Metastatic bronchogenic carcinoma is known to present as lytic skull lesions. Primary brain tumours are also known to cause ischaemic brain injury. An underlying stroke risk may be exagerated by cranial tumour surgery. Patients with brain tumours are well known to be predisposed to an increased risk of developing thromboembolic disease. It is unusual to see metastatic bronchogenic adenocarcinoma presenting as ischaemic stroke with a background of concomittant cerebral metastasis. The aetio-pathogenesis of this rare occurrence is discussed with a review of literature.

  9. The Use of Exergaming with Developmentally Disabled Students

    Science.gov (United States)

    Cai, Sean X.; Kornspan, Alan S.

    2012-01-01

    The physical activity patterns of students with disabilities have been studied in order to understand how much moderate and vigorous daily physical exercise is obtained. Literature suggests that students with disabilities are less physically active as compared to children without disabilities. As a result of being less physically active, these…

  10. Using Model, Cover, Copy, Compare, a Token Economy Program, and Discrete Trail Match to Sample Training for Teaching Functional Life Skills for a 13-Year-Old Middle School Student with Moderate Disabilities

    Directory of Open Access Journals (Sweden)

    KATHERINE J. HOOT

    2014-08-01

    Full Text Available The purpose of this study was to evaluate the effectiveness of model, cover, copy, compare (MCCC, token system, and match to sample for teaching basic functional life skills with a middle age single student with disabilities. MCCC is a student-managed strategy that teaches discrete skills through errorless correction. Match to sample is another strategy that teaches how to identify and discriminate based on a visual representation of the identical information. The effectiveness of MCCC and match to sample was evaluated using a multiple baseline design. The results indicated that MCCC and match to sample was effective in teaching a single middle age school student with disabilities his name, phone number, home address, and emergency contact name and phone number. Maintenance of the basic functional life skills was also found; except for the emergency contact name. However, even if maintenance was not conducted on the final set, emergency phone number was maintained; this is attributed to the length of teaching sessions on the final set. The MCCC and match to sample interventions were both easy to implement and employ in the special education middle school classroom.

  11. Life satisfaction in spouses of stroke survivors and control subjects: A 7-year follow-up of participants in the Sahlgrenska Academy study on ischaemic stroke

    Directory of Open Access Journals (Sweden)

    Tamar Abzhandadze

    2017-05-01

    Full Text Available Objective: To investigate life satisfaction in spouses of middle-aged stroke survivors from the long-term perspective and to identify factors that explain their life satisfaction. Design: Cross-sectional, case-control study. Subjects: Cohabitant spouses of survivors of ischaemic stroke aged < 70 years at stroke onset (n = 248 and spouses of controls (n = 246. Methods: Assessments were made 7 years after inclusion to the study. Spouses’ life satisfaction was assessed with the Fugl-Meyer’s Life Satisfaction Check-List (LiSAT 11. Stroke-related factors were examined with the National Institutes of Health stroke scale, Mini-Mental State Examination, Barthel Index and modified Rankin Scale. Results: Spouses of stroke survivors had significantly lower satisfaction with general life, leisure, sexual life, partner relationship, family life, and poorer somatic and psychological health than spouses of controls. Caregiving spouses had significantly lower scores on all life domains except vocation and own activities of daily living than non-caregiving spouses. Spouses’ satisfaction on different life domains was explained mainly by their age, sex, support given to the partner, and the survivor’s level of global disability, to which both physical and cognitive impairments contributed. Conclusion: Seven years after stroke, spouses of stroke survivors reported lower life satisfaction compared with spouses of controls. Life satisfaction in stroke survivors’ spouses was associated with spouses’ age, sex, giving support, and the stroke survivors’ level of global disability.

  12. Anger management for people with mild to moderate learning disabilities: Study protocol for a multi-centre cluster randomized controlled trial of a manualized intervention delivered by day-service staff

    Directory of Open Access Journals (Sweden)

    Nuttall Jacqueline

    2011-02-01

    Full Text Available Abstract Background Cognitive behaviour therapy (CBT is the treatment of choice for common mental health problems, but this approach has only recently been adapted for people with learning disabilities, and there is a limited evidence base for the use of CBT with this client group. Anger treatment is the one area where there exists a reasonable number of small controlled trials. This study will evaluate the effectiveness of a manualized 12-week CBT intervention for anger. The intervention will be delivered by staff working in the day services that the participants attend, following training to act as 'lay therapists' by a Clinical Psychologist, who will also provide supervision. Methods/Design This is a multi-centre cluster randomized controlled trial of a group intervention versus a 'support as usual' waiting-list control group, with randomization at the level of the group. Outcomes will be assessed at the end of the intervention and again 6-months later. After completion of the 6-month follow-up assessments, the intervention will also be delivered to the waiting-list groups. The study will include a range of anger/aggression and mental health measures, some of which will be completed by service users and also by their day service key-workers and by home carers. Qualitative data will be collected to assess the impact of the intervention on participants, lay therapists, and services, and the study will also include a service-utilization cost and consequences analysis. Discussion This will be the first trial to investigate formally how effectively staff working in services providing day activities for people with learning disabilities are able to use a therapy manual to deliver a CBT based anger management intervention, following brief training by a Clinical Psychologist. The demonstration that service staff can successfully deliver anger management to people with learning disabilities, by widening the pool of potential therapists, would have

  13. Anger management for people with mild to moderate learning disabilities: study protocol for a multi-centre cluster randomized controlled trial of a manualized intervention delivered by day-service staff.

    Science.gov (United States)

    Willner, Paul; Jahoda, Andrew; Rose, John; Stenfert-Kroese, Biza; Hood, Kerenza; Townson, Julia K; Nuttall, Jacqueline; Gillespie, David; Felce, David

    2011-02-09

    Cognitive behaviour therapy (CBT) is the treatment of choice for common mental health problems, but this approach has only recently been adapted for people with learning disabilities, and there is a limited evidence base for the use of CBT with this client group. Anger treatment is the one area where there exists a reasonable number of small controlled trials. This study will evaluate the effectiveness of a manualized 12-week CBT intervention for anger. The intervention will be delivered by staff working in the day services that the participants attend, following training to act as 'lay therapists' by a Clinical Psychologist, who will also provide supervision. This is a multi-centre cluster randomized controlled trial of a group intervention versus a 'support as usual' waiting-list control group, with randomization at the level of the group. Outcomes will be assessed at the end of the intervention and again 6-months later. After completion of the 6-month follow-up assessments, the intervention will also be delivered to the waiting-list groups. The study will include a range of anger/aggression and mental health measures, some of which will be completed by service users and also by their day service key-workers and by home carers. Qualitative data will be collected to assess the impact of the intervention on participants, lay therapists, and services, and the study will also include a service-utilization cost and consequences analysis. This will be the first trial to investigate formally how effectively staff working in services providing day activities for people with learning disabilities are able to use a therapy manual to deliver a CBT based anger management intervention, following brief training by a Clinical Psychologist. The demonstration that service staff can successfully deliver anger management to people with learning disabilities, by widening the pool of potential therapists, would have very significant benefits in relation to the current policy of

  14. Intellectual disability

    Science.gov (United States)

    ... mercury, and other toxins reduces the risk of disability. Teaching women about the risks of alcohol and drugs during ... 2013;33-41. Shapiro BK, Batshaw ML. Intellectual disability. In: Kliegman RM, Stanton BF, ... Assistant Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also ...

  15. Lateralisation of cerebral response to active acupuncture in patients with unilateral ischaemic stroke: an fMRI study

    National Research Council Canada - National Science Library

    Huang, Yong; Chen, Jun-Qi; Lai, Xin-Sheng; Tang, Chun-Zhi; Yang, Jun-Jun; Chen, Hua; Wu, Jun-Xian; Xiao, Hui-Ling; Qu, Shan-Shan; Zhang, Yi-Dan; Zhang, Zhang-Jin

    2013-01-01

    Acupuncture is beneficial in treating stroke neuropsychiatric symptoms. The present study aimed to identify functional brain response to active acupuncture in patients with unilateral ischaemic stroke using functional MRI (fMRI...

  16. No relation between body temperature and arterial recanalization at three days in patients with acute ischaemic stroke

    NARCIS (Netherlands)

    M. Geurts (Marjolein); H.B. Van Der Worp (H. Bart); A.D. Horsch (Alexander D.); L.J. Kappelle (Jaap); G.J. Biessels (Geert Jan); B.K. Velthuis (Birgitta); C.B. Majoie (Charles); Y.B.W.E.M. Roos; L.E.M. Duijm (Lucien); K. Keizer (Koos); A. van der Lugt (Aad); D.W.J. Dippel (Diederik); K.E. Droogh-De Greve; H.P. Bienfait; M.A. van Walderveen (M.); M.J.H. Wermer (Marieke); G.J. Lycklama à Nijeholt (Geert); J. Boiten (Jelis); A. Duyndam (Anita); V.I.H. Kwa; F.J. Meijer (F.); E.J. van Dijk (Ewoud); A.M. Kesselring (Anouk); J. Hofmeijer; J.A. Vos (Jan Albert); W.J. Schonewille (W.); W.J. van Rooij (W.); P.L.M. de Kort (Paul); C.C. Pleiter (C.); S.L.M. Bakker (Stef); J. Bot (Joseph); M.C. Visser (Marieke); I.C. van der Schaaf (Irene); J.W. Dankbaar (Jan); W.P. Mali (Willem); T. van Seeters (Tom); A.D. Horsch (Alexander D.); J.M. Niesten (Joris); G.J. Biessels; L.J. Kappelle; J.S.K. Luitse; Y. van der Graaf (Yolanda)

    2015-01-01

    textabstractBackground: Recanalization of an occluded intracranial artery is influenced by temperature-dependent enzymes, including alteplase. We assessed the relation between body temperature on admission and recanalization. Methods: We included 278 patients with acute ischaemic stroke within nine

  17. In vivo bioimpedance measurement of healthy and ischaemic rat brain: implications for stroke imaging using electrical impedance tomography.

    Science.gov (United States)

    Dowrick, T; Blochet, C; Holder, D

    2015-06-01

    In order to facilitate the imaging of haemorrhagic and ischaemic stroke using frequency difference electrical impedance tomography (EIT), impedance measurements of normal and ischaemic brain, and clotted blood during haemorrhage, were gathered using a four-terminal technique in an in vivo animal model, a first for ischaemic measurements. Differences of 5-10% in impedance were seen between the frequency spectrums of healthy and ischaemic brain, over the frequency range 0-3 kHz, while the spectrum of blood was predominately uniform. The implications of imaging blood/ischaemia in the brain using electrical impedance tomography are discussed, supporting the notion that it will be possible to differentiate stroke from haemorrhage.

  18. No relation between body temperature and arterial recanalization at three days in patients with acute ischaemic stroke

    NARCIS (Netherlands)

    M. Geurts (Marjolein); H.B. Van Der Worp (H. Bart); A.D. Horsch (Alexander D.); L.J. Kappelle (Jaap); G.J. Biessels (Geert Jan); B.K. Velthuis (Birgitta); C.B. Majoie (Charles); Y.B.W.E.M. Roos; L.E.M. Duijm (Lucien); K. Keizer (Koos); A. van der Lugt (Aad); D.W.J. Dippel (Diederik); K.E. Droogh-De Greve; H.P. Bienfait; M.A. van Walderveen (M.); M.J.H. Wermer (Marieke); G.J. Lycklama à Nijeholt (Geert); J. Boiten (Jelis); A. Duyndam (Anita); V.I.H. Kwa; F.J. Meijer (F.); E.J. van Dijk (Ewoud); A.M. Kesselring (Anouk); J. Hofmeijer; J.A. Vos (Jan Albert); W.J. Schonewille (W.); W.J. van Rooij (W.); P.L.M. de Kort (Paul); C.C. Pleiter (C.); S.L.M. Bakker (Stef); J. Bot (Joseph); M.C. Visser (Marieke); I.C. van der Schaaf (Irene); J.W. Dankbaar (Jan); W.P. Mali (Willem); T. van Seeters (Tom); A.D. Horsch (Alexander D.); J.M. Niesten (Joris); G.J. Biessels; L.J. Kappelle; J.S.K. Luitse; Y. van der Graaf (Yolanda)

    2015-01-01

    textabstractBackground: Recanalization of an occluded intracranial artery is influenced by temperature-dependent enzymes, including alteplase. We assessed the relation between body temperature on admission and recanalization. Methods: We included 278 patients with acute ischaemic stroke within nine

  19. Acute ischaemic brain lesions in intracerebral haemorrhage: multicentre cross-sectional magnetic resonance imaging study.

    Science.gov (United States)

    Gregoire, Simone M; Charidimou, Andreas; Gadapa, Naveen; Dolan, Eamon; Antoun, Nagui; Peeters, Andre; Vandermeeren, Yves; Laloux, Patrice; Baron, Jean-Claude; Jäger, Hans R; Werring, David J

    2011-08-01

    Subclinical acute ischaemic lesions on brain magnetic resonance imaging have recently been described in spontaneous intracerebral haemorrhage, and may be important to understand pathophysiology and guide treatment. The underlying mechanisms are uncertain. We tested the hypothesis that ischaemic lesions are related to magnetic resonance imaging markers of the severity and type of small-vessel disease (hypertensive arteriopathy or cerebral amyloid angiopathy) in a multicentre, cross-sectional study. We studied consecutive patients with intracerebral haemorrhage from four specialist stroke centres, and age-matched stroke service referrals without intracerebral haemorrhage. Acute ischaemic lesions were assessed on magnetic resonance imaging (imaging. White matter changes and cerebral microbleeds were rated with validated scales. We investigated associations between diffusion-weighted imaging lesions, clinical and radiological characteristics. We included 114 patients with intracerebral haemorrhage (39 with clinically probable cerebral amyloid angiopathy) and 47 age-matched controls. The prevalence of diffusion-weighted imaging lesions was 9/39 (23%) in probable cerebral amyloid angiopathy-related intracerebral haemorrhage versus 6/75 (8%) in the remaining patients with intracerebral haemorrhage (P = 0.024); no diffusion-weighted imaging lesions were found in controls. Diffusion-weighted imaging lesions were mainly cortical and were associated with mean white matter change score (odds ratio 1.14 per unit increase, 95% confidence interval 1.02-1.28, P = 0.024) and the presence of strictly lobar cerebral microbleeds (odds ratio 3.85, 95% confidence interval 1.15-12.93, P = 0.029). Acute, subclinical ischaemic brain lesions are frequent but previously underestimated after intracerebral haemorrhage, and are three times more common in cerebral amyloid angiopathy-related intracerebral haemorrhage than in other intracerebral haemorrhage types. Ischaemic brain lesions are

  20. Human neural stem cells in patients with chronic ischaemic stroke (PISCES): a phase 1, first-in-man study.

    Science.gov (United States)

    Kalladka, Dheeraj; Sinden, John; Pollock, Kenneth; Haig, Caroline; McLean, John; Smith, Wilma; McConnachie, Alex; Santosh, Celestine; Bath, Philip M; Dunn, Laurence; Muir, Keith W

    2016-08-20

    CTX0E03 is an immortalised human neural stem-cell line from which a drug product (CTX-DP) was developed for allogeneic therapy. Dose-dependent improvement in sensorimotor function in rats implanted with CTX-DP 4 weeks after middle cerebral artery occlusion stroke prompted investigation of the safety and tolerability of this treatment in stroke patients. We did an open-label, single-site, dose-escalation study. Men aged 60 years or older with stable disability (National Institutes of Health Stroke Scale [NIHSS] score ≥6 and modified Rankin Scale score 2-4) 6-60 months after ischaemic stroke were implanted with single doses of 2 million, 5 million, 10 million, or 20 million cells by stereotactic ipsilateral putamen injection. Clinical and brain imaging data were collected over 2 years. The primary endpoint was safety (adverse events and neurological change). This trial is registered with ClinicalTrials.gov, number NCT01151124. 13 men were recruited between September, 2010, and January, 2013, of whom 11 (mean age 69 years, range 60-82) received CTX-DP. Median NIHSS score before implantation was 7 (IQR 6-8) and the mean time from stroke was 29 (SD 14) months. Three men had subcortical infarcts only and seven had right-hemisphere infarcts. No immunological or cell-related adverse events were seen. Other adverse events were related to the procedure or comorbidities. Hyperintensity around the injection tracts on T2-weighted fluid-attenuation inversion recovery MRI was seen in five patients. At 2 years, improvement in NIHSS score ranged from 0 to 5 (median 2) points. Single intracerebral doses of CTX-DP up to 20 million cells induced no adverse events and were associated with improved neurological function. Our observations support further investigation of CTX-DP in stroke patients. ReNeuron Limited. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. The Norwegian tenecteplase stroke trial (NOR-TEST): Randomised controlled trial of tenecteplase vs. alteplase in acute ischaemic stroke

    OpenAIRE

    2014-01-01

    Background: Alteplase is the only approved thrombolytic agent for acute ischaemic stroke. The overall benefit from alteplase is substantial, but some evidence indicates that alteplase also has negative effects on the ischaemic brain. Tenecteplase may be more effective and less harmfull than alteplase, but large randomised controlled phase 3 trials are lacking. The Norwegian Tenecteplase Stroke Trial (NOR-TEST) aims to compare efficacy and safety of tenecteplase vs. alteplase. Methods/Desig...

  2. Effect of a deproteinized blood extract on the recovery of blood circulation in an ischaemic skin lesion.

    OpenAIRE

    Smahel, J.

    1982-01-01

    An experimental model was used to study the revascularization of an ischaemic skin lesion and the effect on this process of the blood extract Solcoseryl. Under the conditions given in the experiment, restoration of the circulation was by 2 modes--re-flow in the original vessels, and neovascularization. Solcoseryl given daily i.p. encouraged the re-flow phenomenon and therefore, by improving the microcirculation and nutrition, the healing of the ischaemic lesions.

  3. Obesity, Intentional Weight Loss, and Physical Disability in Older Adults

    OpenAIRE

    Rejeski, W. Jack; Marsh, Anthony P.; Chmelo, Elizabeth; Rejeski, Jared J.

    2010-01-01

    We examine obesity, intentional weight loss, and physical disability in older adults. Based on prospective epidemiological studies, BMI exhibits a curvilinear relationship with physical disability; there appears to be some protective effect associated with older adults being overweight. Whereas the greatest risk for physical disability occurs in older adults who are ≥class II obesity, the effects of obesity on physical disability appears to be moderated by both sex and race. Obesity at age 30...

  4. Rehabilitation time before disability pension

    Directory of Open Access Journals (Sweden)

    Støver Morten

    2012-10-01

    Full Text Available Abstract Background The decision to grant a disability pension is usually the end of a long process of medical examinations, treatment and rehabilitation attempts. This study investigates to what extent the time spent on rehabilitation time prior to disability pension is associated with characteristics of the individual or the local employment and welfare office, measured as municipality variance. Methods A study of 2,533 40 to 42 year olds who received disability pension over a period of 18 years. The logarithm of the rehabilitation time before granting a disability pension was analysed with multilevel regression. Results The rehabilitation time before a disability pension was granted ranged from 30 to 5,508 days. Baseline health characteristics were only moderately associated with rehabilitation time. Younger people and people with unemployment periods had longer rehabilitation time before a disability pension was granted. There were only minor differences in rehabilitation time between men and women and between different levels of education. Approximately 2% of the total variance in rehabilitation time could be attributed to the municipality of residence. Conclusions There is a higher threshold for granting a disability pension to younger persons and those who are expecting periods of unemployment, which is reflected in the extended rehabilitation requirements for these groups. The longer rehabilitation period for persons with psychiatric disorders might reflect a lack of common knowledge on the working capacity of and the fitted rehabilitation programs for people with psychiatric disorders.

  5. Psoriasis and risk of atrial fibrillation and ischaemic stroke: a Danish Nationwide Cohort Study

    DEFF Research Database (Denmark)

    Ahlehoff, Ole; Gislason, Gunnar H; Jørgensen, Casper H;

    2011-01-01

    AimsPsoriasis is a chronic inflammatory disease and inflammation contributes to the pathogenesis of atrial fibrillation (AF) and ischaemic stroke. We therefore investigated the risk of these endpoints in patients with psoriasis.Methods and resultsCohort study of the entire Danish population...... followed from 1997 to 2006 by individual-level-linkage of nationwide prospectively recorded registers. Multivariable Poisson's regression and sensitivity analyses were used to assess the psoriasis-related risk of AF and ischaemic stroke. A total of 36 765 patients with mild psoriasis and 2793 with severe...... psoriasis were compared with 4 478 926 individuals, i.e. the reference population. In patients with mild psoriasis, the adjusted rate ratios (RRs) for AF were 1.50 (1.21-1.86) and 1.16 (1.08-1.24) in patients aged...

  6. Acute Ischaemic Stroke | EU Clinical Trials Register [EU Clinical Trials Register

    Lifescience Database Archive (English)

    Full Text Available der investigation E.1.1Medical condition(s) being investigated Acute Ischaemic Stroke E.1.1.1Medical conditi...on in easily understood language Acute stroke caused by blockage in a blood vesse....6.1Details of subjects incapable of giving consent Acute stroke F.3.3.7Others No F.4 Planned number of subj

  7. Angiographic and risk factor characteristics of subjects with early onset ischaemic heart disease.

    OpenAIRE

    Nitter-Hauge, S; Erikssen, J; Thaulow, E; Vatne, K

    1981-01-01

    Sixty-six consecutive patients less than 40 years of age with angiographically documented coronary artery disease and coronary heart disease took part in a study aimed at (1) identifying the presence of factors which might explain the premature onset of ischaemic heart disease, and (2) assessing the distribution and severity of the coronary artery lesions. For comparisons we have used a study of risk factors in 1832 men defined as "normals" according to a recent comprehensive examination. The...

  8. MicroRNA expression and function in neonatal hypoxic ischaemic encephalopathy

    OpenAIRE

    Looney, Ann-Marie

    2016-01-01

    Hypoxic ischaemic encephalopathy (HIE) is a devastating neonatal condition which affects 2-3 per 1000 infants annually. The current gold standard of treatment - induced hypothermia, has the ability to reduce neonatal mortality and improve neonatal morbidity. However, to be effective it needs to be initiated within the therapeutic window which exists following initial insult until approximately 6 hours after birth. Current methods of assessment which are relied upon to identify infants with HI...

  9. The evaluation of cerebral oxygenation by oximetry in patients with ischaemic stroke.

    Directory of Open Access Journals (Sweden)

    Demet G

    2000-04-01

    Full Text Available AIMS: To evaluate the clinical significance of estimation of the regional cerebral oxygen saturation (rSO2 in the patients with ischaemic stroke by the cerebral oximetry during acute, sub-acute and chronic phases. SUBJECTS AND METHODS: In this prospective study, 24 patients with ischaemic stroke in the middle cerebral artery territory were included. A detailed clinical examination and appropriate laboratory investigations were carried out. The rSO2 was determined by oximetery (INVOS 3100-SD bilaterally on the first, third, seventh, and fifteenth days. The blood pressure, the peripheral capillary oxygen saturation and the arterial blood gas values were noted too. the changes were evaluated along with Glasgow coma scale (GCS using unpaired student t-test and one way ANOVA test. RESULTS: There were significant differences between the rSO2 values in acute, subacute and chronic phases on the side of the lesion (p value < 0.05. The values of oxygen saturation gradually increased throughout the chronic phase. These values showed a positive correlation with GCS, but the results were not significant statistically. The rSO2 values were also significantly higher on the non-lesional side than those on the lesion side in the acute phase (p= 0.0034, the discrepancy disappeared during the sub-acute and chronic phases. CONCLUSION: Cerebral oximetry can be used as a measure to evaluate the cerebral oxygenation during the various phases of ischaemic stroke. It has a potential to serve as a useful marker for detection of cerebral oxygenation imbalances, to judge the effectiveness of the management and for the follow-up of patients with ischaemic stroke.

  10. Early blood glucose profile and neurodevelopmental outcome at two years in neonatal hypoxic-ischaemic encephalopathy.

    LENUS (Irish Health Repository)

    Nadeem, Montasser

    2012-01-31

    BACKGROUND: To examine the blood glucose profile and the relationship between blood glucose levels and neurodevelopmental outcome in term infants with hypoxic-ischaemic encephalopathy. METHODS: Blood glucose values within 72 hours of birth were collected from 52 term infants with hypoxic-ischaemic encephalopathy. Hypoglycaemia [< 46.8 mg\\/dL (2.6 mmol\\/L)] and hyperglycaemia [> 150 mg\\/dL (8.3 mmol\\/L)] were correlated to neurodevelopmental outcome at 24 months of age. RESULTS: Four fifths of the 468 blood samples were in the normoglycaemic range (392\\/468:83.8%). Of the remaining 76 samples, 51.3% were in the hypoglycaemic range and (48.7%) were hyperglycaemic. A quarter of the hypoglycaemic samples (28.2%:11\\/39) and a third of the hyperglycaemic samples (32.4%:12\\/37) were recorded within the first 30 minutes of life. Mean (SD) blood glucose values did not differ between infants with normal and abnormal outcomes [4.89(2.28) mmol\\/L and 5.02(2.35) mmol\\/L, p value = 0.15] respectively. In term infants with hypoxic-ischaemic encephalopathy, early hypoglycaemia (between 0-6 hours of life) was associated with adverse outcome at 24 months of age [OR = 5.8, CI = 1.04-32)]. On multivariate analysis to adjust for grade of HIE this association was not statistically significant. Late hypoglycaemia (6-72 hours of life) was not associated with abnormal outcome [OR = 0.22, CI (0.04-1.14)]. The occurrence of hyperglycaemia was not associated with adverse outcome. CONCLUSION: During the first 72 hours of life, blood glucose profile in infants with hypoxic-ischaemic encephalopathy varies widely despite a management protocol. Early hypoglycaemia (0-6 hours of life) was associated with severe HIE, and thereby; adverse outcome.

  11. Early blood glucose profile and neurodevelopmental outcome at two years in neonatal hypoxic-ischaemic encephalopathy

    LENUS (Irish Health Repository)

    Nadeem, Montasser

    2011-02-04

    Abstract Background To examine the blood glucose profile and the relationship between blood glucose levels and neurodevelopmental outcome in term infants with hypoxic-ischaemic encephalopathy. Methods Blood glucose values within 72 hours of birth were collected from 52 term infants with hypoxic-ischaemic encephalopathy. Hypoglycaemia [< 46.8 mg\\/dL (2.6 mmol\\/L)] and hyperglycaemia [> 150 mg\\/dL (8.3 mmol\\/L)] were correlated to neurodevelopmental outcome at 24 months of age. Results Four fifths of the 468 blood samples were in the normoglycaemic range (392\\/468:83.8%). Of the remaining 76 samples, 51.3% were in the hypoglycaemic range and (48.7%) were hyperglycaemic. A quarter of the hypoglycaemic samples (28.2%:11\\/39) and a third of the hyperglycaemic samples (32.4%:12\\/37) were recorded within the first 30 minutes of life. Mean (SD) blood glucose values did not differ between infants with normal and abnormal outcomes [4.89(2.28) mmol\\/L and 5.02(2.35) mmol\\/L, p value = 0.15] respectively. In term infants with hypoxic-ischaemic encephalopathy, early hypoglycaemia (between 0-6 hours of life) was associated with adverse outcome at 24 months of age [OR = 5.8, CI = 1.04-32)]. On multivariate analysis to adjust for grade of HIE this association was not statistically significant. Late hypoglycaemia (6-72 hours of life) was not associated with abnormal outcome [OR = 0.22, CI (0.04-1.14)]. The occurrence of hyperglycaemia was not associated with adverse outcome. Conclusion During the first 72 hours of life, blood glucose profile in infants with hypoxic-ischaemic encephalopathy varies widely despite a management protocol. Early hypoglycaemia (0-6 hours of life) was associated with severe HIE, and thereby; adverse outcome.

  12. Ischaemic wound complications in above-knee amputations in relation to the skin perfusion pressure

    DEFF Research Database (Denmark)

    Holstein, P

    1980-01-01

    Healing of the stumps in 59 above-knee amputations was correlated with the local skin perfusion pressure (SPP) measured preoperatively as the external pressure required to stop isotope washout using 131I-(-) or 125I-(-) antipyrine mixed with histamine. Out of the 11 cases with an SPP below 30 mm...... ischaemic wound complications in above-knee amputations as has previously been shown to be the case in below-knee amputations....

  13. UPDATE ON THE GLOBAL BURDEN OF ISCHAEMIC AND HAEMORRHAGIC STROKE IN 1990–2013: THE GBD 2013 STUDY

    Science.gov (United States)

    Feigin, Valery L.; Krishnamurthi, Rita; Parmar, Priya; Norrving, Bo; Mensah, George A.; Bennett, Derrick A.; Barker-Collo, Suzanne; Moran, Andrew; Sacco, Ralph L.; Truelsen, Thomas; Davis, Stephen; Pandian, Jeyaraj Durai; Naghavi, Mohsen; Forouzanfar, Mohammad H.; Nguyen, Grant; Johnson, Catherine O.; Vos, Theo; Meretoja, Atte; Murray, Christopher; Roth, Gregory A.; Thrift, Amanda; Banerjee, Amitava; Kengne, Andre Pascal; Misganaw, Awoke; Kissela, Brett M.; Wolfe, Charles; Yu, Chuanhua; Anderson, Craig; Kim, Daniel; Rojas-Rueda, David; Tanne, David; Tirschwell, David Lawrence; Nand, Devina; Kazi, Dhruv S.; Pourmalek, Farshad; Catalá-López, Ferrán; Abd-Allah, Foad; Gankpé, Fortuné; deVeber, Gabrielle; Donnan, Geoffrey; Hankey, Graeme J.; Christensen, Hanne K.; Campos-Nonato, Ismael; Shiue, Ivy; Fernandes, Jefferson G.; Jonas, Jost B.; Sheth, Kevin; Kim, Yunjin; Dokova, Klara; Stroumpoulis, Konstantinos; Sposato, Luciano A.; Bahit, Maria Cecilia; Geleijnse, Johanna M.; Mackay, Mark T.; Mehndiratta, Man Mohan; Endres, Matthias; Giroud, Maurice; Brainin, Michael; Kravchenko, Michael; Piradov, Michael; Soljak, Michael; Liu, Ming; Connor, Myles; Venketasubramanian, Narayanaswamy; Bornstein, Natan; Shamalov, Nikolay; Roy, Nobhojit; Cabral, Norberto; Beauchamp, Norman J.; Lavados, Pablo M.; Jeemon, Panniyammakal; Lotufo, Paulo A.; Chowdhury, Rajiv; Sahathevan, Ramesh; Hamadeh, Randah R.; Malekzadeh, Reza; Gillium, Richard; Westerman, Ronny; Akinyemi, Rufus Olusola; Salman, Rustam Al-Shahi; Dharmaratne, Samath D.; Basu, Sanjay; Abera, Semaw Ferede; Kosen, Soewarta; Sampson, Uchechukwu K. A.; Caso, Valeria; Vlassov, Vasiliy; Melaku, Yohannes Adama; Kokubo, Yoshiohiro; Shinohara, Yukito; Varakin, Yuri; Wang, Wenzhi

    2015-01-01

    Background Global stroke epidemiology is changing rapidly. Although age-standardised rates of stroke mortality have decreased worldwide in the past two decades, the absolute numbers of people who have a stroke every year, live with the consequences of stroke, and die from their stroke are increasing. Regular updates on the current level of stroke burden are important for advancing our knowledge on stroke epidemiology and facilitate organization and planning of evidence-based stroke care. Objectives To estimate incidence, prevalence, mortality, disability-adjusted life-years (DALYs) and years lived with disability (YLDs), and their trends for ischaemic stroke (IS) and haemorrhagic stroke (HS) for 188 countries from 1990–2013. Methodology Stroke incidence, prevalence, mortality, DALYs and YLDs were estimated using all available data on mortality and stroke incidence, prevalence and excess mortality. Statistical models and country-level covariate data were employed and all rates were age-standardised to a global population. All estimated were produced with 95% uncertainty intervals (UI). Results In 2013, there were globally almost 25.7 million stroke survivors (71% with IS), 6.5 million deaths from stroke (51% died from IS), 113 million DALYs due to stroke (58% due to IS), and 10.3 million new strokes (67% IS). Over the 1990–2013 period, there was a significant increase in the absolute number of DALYs due to IS, and of deaths from IS and HS, survivors and incident events for both IS and HS. The preponderance of the burden of stroke continued to reside in developing countries, comprising 75.2% of deaths from stroke and 81.0% of stroke-related DALYs. Globally, the proportional contribution of stroke-related DALYs and deaths due to stroke compared to all diseases increased from 1990 (3.54% [95% UI 3.11–4.00%] and 9.66% [95% UI 8.47–10.70%]) to 2013 (4.62% [95% UI 4.01–5.30%] and 11.75% [95% UI 10.45–13.31%], respectively), but there was a diverging trend in

  14. Postmortem MR quantification of the heart for characterization and differentiation of ischaemic myocardial lesions

    Energy Technology Data Exchange (ETDEWEB)

    Zech, Wolf-Dieter; Schwendener, Nicole; Jackowski, Christian [University of Bern, Institute of Forensic Medicine, Bern (Switzerland); Persson, Anders; Warntjes, Marcel J. [University of Linkoeping, Center for Medical Image Science and Visualization (CMIV), Linkoeping (Sweden)

    2015-07-15

    Recently, an MRI quantification sequence has been developed which can be used to acquire T1- and T2-relaxation times as well as proton density (PD) values. Those three quantitative values can be used to describe soft tissue in an objective manner. The purpose of this study was to investigate the applicability of quantitative cardiac MRI for characterization and differentiation of ischaemic myocardial lesions of different age. Fifty post-mortem short axis cardiac 3 T MR examinations have been quantified using a quantification sequence. Myocardial lesions were identified according to histology and appearance in MRI images. Ischaemic lesions were assessed for mean T1-, T2- and proton density values. Quantitative values were plotted in a 3D-coordinate system to investigate the clustering of ischaemic myocardial lesions. A total of 16 myocardial lesions detected in MRI images were histologically characterized as acute lesions (n = 8) with perifocal oedema (n = 8), subacute lesions (n = 6) and chronic lesions (n = 2). In a 3D plot comprising the combined quantitative values of T1, T2 and PD, the clusters of all investigated lesions could be well differentiated from each other. Post-mortem quantitative cardiac MRI is feasible for characterization and discrimination of different age stages of myocardial infarction. (orig.)

  15. [Endovascular treatment in acute ischaemic stroke. A stroke care plan for the region of Madrid].

    Science.gov (United States)

    Alonso de Leciñana, M; Díaz-Guzmán, J; Egido, J A; García Pastor, A; Martínez-Sánchez, P; Vivancos, J; Díez-Tejedor, E

    2013-09-01

    Endovascular therapies (intra-arterial thrombolysis and mechanical thrombectomy) after acute ischaemic stroke are being implemented in the clinical setting even as they are still being researched. Since we lack sufficient data to establish accurate evidence-based recommendations for use of these treatments, we must develop clinical protocols based on current knowledge and carefully monitor all procedures. After review of the literature and holding work sessions to reach a consensus among experts, we developed a clinical protocol including indications and contraindications for endovascular therapies use in acute ischaemic stroke. The protocol includes methodology recommendations for diagnosing and selecting patients, performing revascularisation procedures, and for subsequent patient management. Its objective is to increase the likelihood of efficacy and treatment benefit and minimise risk of complications and ineffective recanalisation. Based on an analysis of healthcare needs and available resources, a cooperative inter-hospital care system has been developed. This helps to ensure availability of endovascular therapies to all patients, a fast response time, and a good cost-to-efficacy ratio. It includes also a prospective register which serves to monitor procedures in order to identify any opportunities for improvement. Implementation of endovascular techniques for treating acute ischaemic stroke requires the elaboration of evidence-based clinical protocols and the establishment of appropriate cooperative healthcare networks guaranteeing both the availability and the quality of these actions. Such procedures must be monitored in order to improve methodology. Copyright © 2012 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.

  16. Role of ischaemic preconditioning in liver regeneration following major liver resection and transplantation

    Institute of Scientific and Technical Information of China (English)

    D Gomez; S Homer-Vanniasinkam; AM Graham; KR Prasad

    2007-01-01

    Liver ischaemic preconditioning (IPC) is known to protect the liver from the detrimental effects of ischaemicreperfusion injury (IRI), which contributes significantly to the morbidity and mortality following major liver surgery.Recent studies have focused on the role of IPC in liver regeneration, the precise mechanism of which are not completely understood. This review discusses the current understanding of the mechanism of liver regeneration and the role of IPC in this setting. Relevant articles were reviewed from the published literature using the Medline database. The search was performed using the keywords "liver", "ischaemic reperfusion", "ischaemic preconditioning", "regeneration", "hepatectomy"and "transplantation". The underlying mechanism of liver regeneration is a complex process involving the interaction of cytokines, growth factors and the metabolic demand of the liver. IPC, through various mediators, promotes liver regeneration by up-regulating growthpromoting factors and suppresses growth-inhibiting factors as well as damaging stresses. The increased understanding of the cellular mechanisms involved in IPC will enable the development of alternative treatment modalities aimed at promoting liver regeneration following major liver resection and transplantation.

  17. Effects of flunixin meglumine on the recovery of ischaemic equine colonic mucosa in vitro.

    Science.gov (United States)

    Morton, A J; Grosche, A; Matyjaszek, S A; Polyak, M M R; Freeman, D E

    2011-08-01

    The effects of prostaglandins and nonsteroidal anti-inflammatory drugs (NSAIDs) on repair of equine intestinal mucosa are important since most horses with gastrointestinal diseases are routinely treated with NSAIDs, such as flunixin meglumine (FM), and these drugs can be toxic to equine gastrointestinal mucosa. Flunixin meglumine would not affect recovery of equine colonic mucosa in vitro, 18 h after a reversible ischaemic injury. In 14 anaesthetised horses, a segment of pelvic flexure was subjected to 2 h of ischaemia and the horses were allowed to recover for 18 h. Seven horses received normal saline and 7 received FM, 1.1 mg/kg bwt i.v., at the end of ischaemia and 12 h later. Colonic mucosa was harvested during a second anaesthesia, 18 h after recovery from ischaemia and then horses were subjected to euthanasia. Transepithelial electrical resistance (TER) and transepithelial flux of tritiated mannitol were used to measure mucosal permeability during 4 h of incubation in Ussing chambers, with the following in vitro treatments: 1) no addition, 2) FM 14 µmol/l as powder, 3) FM 14 µmol/l in injectable form and 4) diluent for injectable FM. Histomorphological changes were assessed by light microscopy. There were no significant differences in any of the measurements between saline and FM treated horses. The mucosal height of the ischaemic FM tissues incubated in diluent was significantly decreased compared to the nonischaemic tissues. Flunixin meglumine did not adversely affect barrier integrity in ischaemic equine colonic mucosa. © 2011 EVJ Ltd.

  18. Mitochondrial fatty acid oxidation alterations in heart failure, ischaemic heart disease and diabetic cardiomyopathy.

    Science.gov (United States)

    Fillmore, N; Mori, J; Lopaschuk, G D

    2014-04-01

    Heart disease is a leading cause of death worldwide. In many forms of heart disease, including heart failure, ischaemic heart disease and diabetic cardiomyopathies, changes in cardiac mitochondrial energy metabolism contribute to contractile dysfunction and to a decrease in cardiac efficiency. Specific metabolic changes include a relative increase in cardiac fatty acid oxidation rates and an uncoupling of glycolysis from glucose oxidation. In heart failure, overall mitochondrial oxidative metabolism can be impaired while, in ischaemic heart disease, energy production is impaired due to a limitation of oxygen supply. In both of these conditions, residual mitochondrial fatty acid oxidation dominates over mitochondrial glucose oxidation. In diabetes, the ratio of cardiac fatty acid oxidation to glucose oxidation also increases, although primarily due to an increase in fatty acid oxidation and an inhibition of glucose oxidation. Recent evidence suggests that therapeutically regulating cardiac energy metabolism by reducing fatty acid oxidation and/or increasing glucose oxidation can improve cardiac function of the ischaemic heart, the failing heart and in diabetic cardiomyopathies. In this article, we review the cardiac mitochondrial energy metabolic changes that occur in these forms of heart disease, what role alterations in mitochondrial fatty acid oxidation have in contributing to cardiac dysfunction and the potential for targeting fatty acid oxidation to treat these forms of heart disease.

  19. Bruton's tyrosine kinase is essential for NLRP3 inflammasome activation and contributes to ischaemic brain injury.

    Science.gov (United States)

    Ito, Minako; Shichita, Takashi; Okada, Masahiro; Komine, Ritsuko; Noguchi, Yoshiko; Yoshimura, Akihiko; Morita, Rimpei

    2015-06-10

    Inflammasome activation has been implicated in various inflammatory diseases including post-ischaemic inflammation after stroke. Inflammasomes mediate activation of caspase-1, which subsequently induces secretion of pro-inflammatory cytokines such as IL-1β and IL-18, as well as a form of cell death called pyroptosis. In this study, we report that Bruton's tyrosine kinase (BTK) is an essential component of the NLRP3 inflammasome, in which BTK physically interacts with ASC and NLRP3. Inhibition of BTK by pharmacological or genetic means severely impairs activation of the NLRP3 inflammasome. The FDA-approved BTK inhibitor ibrutinib (PCI-32765) efficiently suppresses infarct volume growth and neurological damage in a brain ischaemia/reperfusion model in mice. Ibrutinib inhibits maturation of IL-1β by suppressing caspase-1 activation in infiltrating macrophages and neutrophils in the infarcted area of ischaemic brain. Our study indicates that BTK is essential for NLRP3 inflammasome activation and could be a potent therapeutic target in ischaemic stroke.

  20. Protein supplementation may enhance the spontaneous recovery of neurological alterations in patients with ischaemic stroke.

    Science.gov (United States)

    Aquilani, Roberto; Scocchi, Marco; Iadarola, Paolo; Franciscone, Piero; Verri, Manuela; Boschi, Federica; Pasini, Evasio; Viglio, Simona

    2008-12-01

    To determine whether protein supplementation could enhance neurological recovery in subacute patients with ischaemic stroke. Alimentation-independent patients with ischaemic stroke were randomly allocated to either 21 days of protein supplementation (protein-supplemented group; n=20) or to a spontaneous diet only (control group; n=21) in order to investigate the recovery of neurological changes (measured using the National Institute of Health (NIH) Stroke Scale). Tertiary care rehabilitation in Italy. Forty-two patients (27 male and 15 female; 66.4 +/- 11 years) 16 +/-2 days after the acute event. Supplementation with a hyperproteic nutritional formula (10% protein). NIH Stroke Scale and protein intake. At admission to rehabilitation, both groups of patients were homogeneous for demographic, clinical and functional characteristics. After 21 days from the start of the protocol, the NIH Stroke Scale was found to be enhanced in the group with supplemental proteins (-4.4 +/- 1.5 score versus -3 +/- 1.4 of control group; P<0.01). When expressed as difference (triangle up) between baseline and 21 days, the NIH Stroke Scale correlated negatively with change in protein intake (g/day) (r=-0.50, P= 0.001) and positively with change in carbohydrate/protein ratio (r = +0.40, P=0.01) Protein supplementation may enhance neurological recovery in subacute patients with ischaemic stroke.

  1. Learning Disabilities

    Science.gov (United States)

    ... NICHD) See all related organizations Publications Problemas de aprendizaje Order NINDS Publications Patient Organizations CHADD - Children and ... NICHD) See all related organizations Publications Problemas de aprendizaje Order NINDS Publications Definition Learning disabilities are disorders ...

  2. Added prognostic value of ischaemic threshold in radionuclide myocardial perfusion imaging: a common-sense integration of exercise tolerance and ischaemia severity

    Energy Technology Data Exchange (ETDEWEB)

    Marini, Cecilia [IRCCS AOU San Martino-National Institute for Cancer Research, CNR Institute of Bioimaging and Molecular Physiology, Section of Genoa c/o Nuclear Medicine, Pad. Sommariva, Genoa (Italy); Acampa, Wanda [National Council of Research, Naples (Italy); Bauckneht, Matteo; Capitanio, Selene; Fiz, Francesco; Dib, Bassam; Sambuceti, Gianmario [University of Genoa, IRCCS-AOU San Martino-National Institute for Cancer Research, Nuclear Medicine, Department of Health Science, Genoa (Italy); Daniele, Stefania; Cantoni, Valeria; Zampella, Emilia; Assante, Roberta; Cuocolo, Alberto [University Federico II, Nuclear Medicine, Naples (Italy); Bruzzi, Paolo [IRCCS AOU San Martino-National Institute for Cancer Research, Epidemiology Unit, Genoa (Italy)

    2015-04-01

    Reversible ischaemia at radionuclide myocardial perfusion imaging (MPI) accurately predicts risk of cardiac death and nonfatal myocardial infarction (major adverse cardiac events, MACE). This prognostic penetrance might be empowered by accounting for exercise tolerance as an indirect index of ischaemia severity. The present study aimed to verify this hypothesis integrating imaging assessment of ischaemia severity with exercise maximal rate pressure product (RPP) in a large cohort of patients with suspected or known coronary artery disease (CAD). We analysed 1,502 consecutive patients (1,014 men aged 59 ± 10 years) submitted to exercise stress/rest MPI. To account for exercise tolerance, the summed difference score (SDS) was divided by RPP at tracer injection providing a clinical prognostic index (CPI). Reversible ischaemia was documented in 357 patients (24 %) and was classified by SDS as mild (SDS 2-4) in 180, moderate (SDS 5-7) in 118 and severe (SDS >7) in 59. CPI values of ischaemic patients were clustered into tertiles with lowest and highest values indicating low and high risk, respectively. CPI modified SDS risk prediction in 119/357 (33 %) patients. During a 60-month follow-up, MACE occurred in 68 patients. Kaplan-Meier analysis revealed that CPI significantly improved predictive power for MACE incidence with respect to SDS alone. Multivariate Cox analysis confirmed the additive independent value of CPI-derived information. Integration of ischaemic threshold and ischaemia extension and severity can improve accuracy of exercise MPI in predicting long-term outcome in a large cohort of patients with suspected or known CAD. (orig.)

  3. Ten-Year Employment Patterns of Working Age Individuals After Moderate to Severe Traumatic Brain Injury: A National Institute on Disability and Rehabilitation Research Traumatic Brain Injury Model Systems Study.

    Science.gov (United States)

    Cuthbert, Jeffrey P; Pretz, Christopher R; Bushnik, Tamara; Fraser, Robert T; Hart, Tessa; Kolakowsky-Hayner, Stephanie A; Malec, James F; O'Neil-Pirozzi, Therese M; Sherer, Mark

    2015-12-01

    To describe the 10-year patterns of employment for individuals of working age discharged from a Traumatic Brain Injury Model Systems (TBIMS) center between 1989 and 2009. Secondary data analysis. Inpatient rehabilitation centers. Patients aged 16 to 55 years (N=3618) who were not retired at injury, received inpatient rehabilitation at a TBIMS center, were discharged alive between 1989 and 2009, and had at least 3 completed follow-up interviews at postinjury years 1, 2, 5, and 10. Not applicable. Employment. Patterns of employment were generated using a generalized linear mixed model, where these patterns were transformed into temporal trajectories of probability of employment via random effects modeling. Covariates demonstrating significant relations to growth parameters that govern the trajectory patterns were similar to those noted in previous cross-sectional research and included age, sex, race/ethnicity, education, preinjury substance misuse, preinjury vocational status, and days of posttraumatic amnesia. The calendar year in which the injury occurred also greatly influenced trajectories. An interactive tool was developed to provide visualization of all postemployment trajectories, with many showing decreasing probabilities of employment between 5 and 10 years postinjury. These results highlight that postinjury employment after moderate to severe traumatic brain injury (TBI) is a dynamic process, with varied patterns of employment for individuals with specific characteristics. The overall decline in trajectories of probability of employment between 5 and 10 years postinjury suggests that moderate to severe TBI may have unfavorable chronic effects and that employment outcome is highly influenced by national labor market forces. Additional research targeting the underlying drivers of the decline between 5 and 10 years postinjury is recommended, as are interventions that target influencing factors. Copyright © 2015 American Congress of Rehabilitation Medicine

  4. {sup 99m}TcO(BAT-NI), a novel nitroimidazole tracer: in vivo uptake studies in ischaemic myocardium

    Energy Technology Data Exchange (ETDEWEB)

    Hoffend, J.; Linke, G.; Mohammed, A.; Haberkorn, U. [Department of Radiology, Division of Nuclear Medicine, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg (Germany); Tiefenbacher, C.P. [Department of Internal Medicine, Division of Cardiology, University of Heidelberg, Heidelberg (Germany); Eisenhut, M. [German Cancer Research Centre, Heidelberg (Germany)

    2003-04-01

    Myocardial perfusion single-photon emission tomography (SPET) performed with cationic technetium-99m complexes indicates ischaemic areas as cold lesions. By contrast, nitroimidazole derivatives labelled with fluorine-18 or {sup 99m}Tc have recently shown promising results for hot spot imaging of ischaemic myocardium. This study evaluates {sup 99m}TcO(BAT-NI), a new {sup 99m}Tc complex comprising the nitroimidazole ligand, 2,10-dimercapto-2,10-dimethyl-4,8-diaza-6-[4-(2-nitroimidazolyl)butyl]undecane, in a low-flow in vivo model of myocardial ischaemia in thoracotomised rats. To elucidate the influence of the 2-nitroimidazole group on ischaemia-induced uptake, comparisons with ligand derivatives were performed where (a) the 2-nitro group was deleted [{sup 99m}TcO(BAT-I)], (b) the 2-nitroimidazole functionality was replaced by a Br atom [{sup 99m}TcO(BAT-Br)] and (c) the {sup 99m}TcO(BAT) moiety was replaced by an iodine-125 iodophenoxybutyl ligand ({sup 125}IP-NI). The radiolabelled compounds were i.v. injected 15 min after reducing resting myocardial blood flow by 50-60% and the uptake of radioactivity was assessed 90 min post injection. Autoradiography of left ventricular short-axis slices showed median uptake ratios of ischaemic/non-ischaemic myocardium (I/N) of 3.4, 4.5 and 3.4 for {sup 99m}TcO(BAT-NI), {sup 99m}TcO(BAT-I) and {sup 99m}TcO(BAT-Br), respectively. In contrast, {sup 125}IP-NI was not preferentially taken up by ischaemic myocardium. Accumulation of {sup 99m}TcO(BAT-NI) in ischaemic heart regions was comparable to that in the liver. Biodistribution studies showed a median uptake of 0.65% ID/g of {sup 99m}TcO(BAT-NI) in ischaemic tissue and an I/N of 3.3. On planar images of the thorax and upper abdomen the ischaemic hearts were visualised faintly; the median heart to lung count ratio for {sup 99m}TcO(BAT-NI) was 1.7, and the median heart to liver count ratio was 1.0. We conclude that uptake of {sup 99m}TcO(BAT-NI) in ischaemic myocardium does not

  5. Effect of repeated intracoronary injection of bone marrow cells in patients with ischaemic heart failure the Danish stem cell study - congestive heart failure trial (DanCell-CHF)

    DEFF Research Database (Denmark)

    Diederichsen, A.C.; Møller, Jacob Eifer; Thayssen, P.;

    2008-01-01

    BACKGROUND: It has been suggested that myocardial regeneration may be achieved by a single intracoronary bone marrow derived stem cell infusion in selected patients with ischaemic heart disease. The effect is uncertain in patients with chronic ischaemic heart failure and it is not known whether...... repeated infusions would have additional positive effects. AIMS: To assess whether two treatments of intracoronary infusion of bone marrow stem cells, administered 4 months apart, could improve left ventricular (LV) systolic function in patients with chronic ischaemic heart failure. METHODS: The study......, NYHA class improved (pstem cell treatment in patients with chronic ischaemic heart failure Udgivelsesdato: 2008/7...

  6. The effect of ABCA1 gene polymorphisms on ischaemic stroke risk and relationship with lipid profile

    Directory of Open Access Journals (Sweden)

    Whalley Lawrence

    2007-06-01

    Full Text Available Abstract Background Ischaemic stroke is a common disorder with genetic and environmental components contributing to overall risk. Atherothromboembolic abnormalities, which play a crucial role in the pathogenesis of ischaemic stroke, are often the end result of dysregulation of lipid metabolism. The ATP Binding Cassette Transporter (ABCA1 is a key gene involved in lipid metabolism. It encodes the cholesterol regulatory efflux protein which mediates the transfer of cellular phospholipids and cholesterol to acceptor apolipoproteins such as apolipoprotein A-I (ApoA-I. Common polymorphisms in this gene affect High Density Lipoprotein Cholesterol (HDL-C and Apolipoprotein A-I levels and so influence the risk of atherosclerosis. This study has assessed the distribution of ABCA1 polymorphisms and haplotype arrangements in patients with ischaemic stroke and compared them to an appropriate control group. It also examined the relationship of these polymorphisms with serum lipid profiles in cases and controls. Methods We studied four common polymorphisms in ABCA1 gene: G/A-L158L, G/A-R219K, G/A-G316G and G/A-R1587K in 400 Caucasian ischaemic stroke patients and 487 controls. Dynamic Allele Specific Hybridisation (DASH was used as the genotyping assay. Results Genotype and allele frequencies of all polymorphisms were similar in cases and controls, except for a modest difference in the ABCA1 R219K allele frequency (P-value = 0.05. Using the PHASE2 program, haplotype frequencies for the four loci (158, 219, 316, and 1587 were estimated in cases and controls. There was no significant difference in overall haplotypes arrangement in patients group compared to controls (p = 0.27. 2211 and 1211 haplotypes (1 = common allele, 2 = rare allele were more frequent in cases (p = 0.05. Adjusted ORs indicated 40% and 46% excess risk of stroke for these haplotypes respectively. However, none of the adjusted ORs were statistically significant. Individuals who had R219K "22

  7. By how much does fruit and vegetable consumption reduce the risk of ischaemic heart disease: response to commentary

    Science.gov (United States)

    Law; Morris

    1999-11-01

    In our review (Law & Morris, 1998), we presented analyses of data from 10 cohort studies yielding the summary estimate that the risk of ischaemic heart disease was 15% lower at the 90th than at the 10th centile of fruit and vegetable consumption. This 10th-90th centile difference in consumption is a realistic increase for an individual (Zino et al, 1997). The estimate of a 15% difference in heart disease mortality was similar to the expected difference in risk from the increase in potassium consumption (given the corresponding decrease in blood pressure) and the increase in folate consumption (given the corresponding decrease in plasma homocysteine) that would result from this specified increase in fruit and vegetable consumption. Ness and colleagues' own approach to such a review was to tabulate the studies with their methodological details and list the result of each study as showing 'no association' or 'protective effect' (Ness & Powles, 1997), when the evidence did not justify the implicit dichotomy. Associations were reproduced as published, in different formats for different studies, and confidence intervals commonly not reported. This left the reader with little impression of the average size of the association nor the degree of consistency between studies. Ness and colleagues express disapproval of our quantitative approach but provide no sound basis for rejecting it. We believe that our results are valid, and that the quantification of the effect is useful in establishing for the first time the moderate but important reduction in heart disease risk that results from a realistic increase in fruit and vegetable consumption. The main argument of Ness and colleagues is that estimates of effect derived from cohort studies are unreliable. We respond to this first, and then to four methodological issues that they raise.

  8. A systematic review of studies in the contributions of the work environment to ischaemic heart disease development.

    Science.gov (United States)

    Theorell, Töres; Jood, Katarina; Järvholm, Lisbeth Slunga; Vingård, Eva; Perk, Joep; Östergren, Per Olov; Hall, Charlotte

    2016-06-01

    There is need for an updated systematic review of associations between occupational exposures and ischaemic heart disease (IHD), using the GRADE system. (i) publication in English in peer-reviewed journal between 1985 and 2014, (ii) quantified relationship between occupational exposure (psychosocial, organizational, physical and other ergonomic job factors) and IHD outcome, (iii) cohort studies with at least 1000 participants or comparable case-control studies with at least 50 + 50 participants, (iv) assessments of exposure and outcome at baseline as well as at follow-up and (v) gender and age analysis. Relevance and quality were assessed using predefined criteria. Level of evidence was then assessed using the GRADE system. Consistency of findings was examined for a number of confounders. Possible publication bias was discussed. Ninety-six articles of high or medium high scientific quality were finally included. There was moderately strong evidence (grade 3 out of 4) for a relationship between job strain and small decision latitude on one hand and IHD incidence on the other hand. Limited evidence (grade 2) was found for iso-strain, pressing work, effort-reward imbalance, low support, lack of justice, lack of skill discretion, insecure employment, night work, long working week and noise in relation to IHD. No difference between men and women with regard to the effect of adverse job conditions on IHD incidence. There is scientific evidence that employees, both men and women, who report specific occupational exposures, such as low decision latitude, job strain or noise, have an increased incidence of IHD. © The Author 2016. Published by Oxford University Press on behalf of the European Public Health Association.

  9. The Heart Health Study - increasing cardiovascular risk assessment in family practice for first degree relatives of patients with premature ischaemic heart disease: a randomised controlled trial.

    Science.gov (United States)

    Stocks, Nigel P; Broadbent, Jessica L; Lorimer, Michelle F; Tideman, Philip; Chew, Derek P; Wittert, Gary; Ryan, Philip

    2015-09-03

    This study aimed to increase cardiovascular disease (CVD) risk assessment in adult first degree relatives of patients with premature ischaemic heart disease (PIHD) using written and verbal advice. A prospective, randomised controlled trial. Cardiovascular wards at three South Australian hospitals. Cardiovascular risk assessments were performed in general practice. Patients experiencing PIHD (heart disease in men aged risk assessment or general information about heart disease only, to their first degrees relatives. The primary outcome was the proportion of relatives who attended their GP for CVD risk assessment within 6 months of the patients' PIHD event. One hundred forty four patients were recruited who had 541 eligible relatives; 97/541 (18 %) of relatives agreed to participate. A larger number of intervention 41/55 (75 %) than control group 9/42 (21 %) [difference 53 %, 95 % CI 36 % - 71 %] relatives attended their GP for a CVD assessment, and 34 % of these had moderate to very high 5-year absolute risk for CVD. This low cost intervention demonstrates that individuals who have a family history of PIHD and are at moderate or high risk of CVD can be targeted for early intervention of modifiable risk factors. Further research is required to improve the uptake of the intervention in relatives. The trial was registered with the Australian Clinical Trials Registry (ACTRN), Registration ID 12613000557730 .

  10. No evidence that genetically reduced 25-hydroxyvitamin D is associated with increased risk of ischaemic heart disease or myocardial infarction

    DEFF Research Database (Denmark)

    Brøndum-Jacobsen, Peter; Benn, Marianne; Afzal, Shoaib

    2015-01-01

    that genetically reduced plasma 25(OH)D is associated with increased risk of ischaemic heart disease and myocardial infarction. METHODS: We used a Mendelian randomization design in the Copenhagen City Heart Study, the Copenhagen General Population Study, and the Copenhagen Ischaemic Heart Disease Study. Two 25(OH......)D reducing genetic variants in the DCHR7 gene (rs7944926 and rs11234027) and two in the CYP2R1 gene (rs10741657 and rs12794714) were genotyped in 92 416 participants of Danish descent, of whom 14 455 developed ischaemic heart disease (ICD-8:410-414; ICD-10:I20-I25) and 7061 myocardial infarction (ICD-8...... (CI): 1.42-2.32] for ischaemic heart disease. Each allele increase in a combined allele score was associated with a 1.9-nmol/l decrease in p-25(OH)D (P = 7 × 10(-55); R(2) = 0.9%). The genetic variants were, however, not associated with increased risk of ischaemic heart disease. In instrumental...

  11. Hospital arrival time and functional outcome after acute ischaemic stroke: results from the PREMIER study.

    Science.gov (United States)

    León-Jiménez, C; Ruiz-Sandoval, J L; Chiquete, E; Vega-Arroyo, M; Arauz, A; Murillo-Bonilla, L M; Ochoa-Guzmán, A; Carrillo-Loza, K; Ramos-Moreno, A; Barinagarrementeria, F; Cantú-Brito, C

    2014-05-01

    Information regarding hospital arrival times after acute ischaemic stroke (AIS) has mainly been gathered from countries with specialised stroke units. Little data from emerging nations is available. We aim to identify factors associated with achieving hospital arrival times of less than 1, 3, and 6 hours, and analyse how arrival times are related to functional outcomes after AIS. We analysed data from patients with AIS included in the PREMIER study (Primer Registro Mexicano de Isquemia Cerebral) which defined time from symptom onset to hospital arrival. The functional prognosis at 30 days and at 3, 6, and 12 months was evaluated using the modified Rankin Scale. Among 1096 patients with AIS, 61 (6%) arrived in <1 hour, 250 (23%) in <3 hours, and 464 (42%) in <6 hours. The factors associated with very early (<1 hour) arrival were family history of ischemic heart disease and personal history of migraines; in <3 hours: age 40-69 years, family history of hypertension, personal history of dyslipidaemia and ischaemic heart disease, and care in a private hospital; in <6 hours: migraine, previous stroke, ischaemic heart disease, care in a private hospital, and family history of hypertension. Delayed hospital arrival was associated with lacunar stroke and alcoholism. Only 2.4% of patients underwent thrombolysis. Regardless of whether or not thrombolysis was performed, arrival time in <3 hours was associated with lower mortality at 3 and 6 months, and with fewer in-hospital complications. A high percentage of patients had short hospital arrival times; however, less than 3% underwent thrombolysis. Although many factors were associated with early hospital arrival, it is a priority to identify in-hospital barriers to performing thrombolysis. Copyright © 2013 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.

  12. Changes in ischaemic ECG abnormalities and subsequent risk of cardiovascular disease

    Science.gov (United States)

    Sawai, Takeshi; Imano, Hironori; Muraki, Isao; Hayama-Terada, Mina; Shimizu, Yuji; Cui, Renzhe; Kitamura, Akihiko; Kiyama, Masahiko; Okada, Takeo; Ohira, Tetsuya; Yamagishi, Kazumasa; Umesawa, Mitsumasa; Sankai, Tomoko; Iso, Hiroyasu

    2017-01-01

    Objective The prognostic importance of changes in ischaemic ECG abnormalities over time (especially ST-T abnormalities) among Asians has not been fully investigated. We examined the associations between changes in ischaemic abnormalities upon serial ECG (improvement, persistence, deterioration) and cardiovascular disease (CVD) risk. Methods A prospective study cohort was conducted with 9374 men and women aged 40–69 years in four communities. Participants had multiple ECGs at study entry and during the next 10 years, and were followed up for a median period of 23.0 years. Total CVD (stroke and coronary heart disease) was ascertained under systematic surveillance. ECG abnormalities were defined by the Minnesota Code, ST depression (Code4), abnormal T wave (Code5) and categorised into nine groups (no–no, no–minor, no–major, minor–no, minor–minor, minor–major, major–no, major–minor, major–major) by comparison with the point of entrance and maximum change. Results We documented 1196 CVD events. Compared with no–no abnormality, no–minor, minor–major and major–major in Code4, HRs (95% CI) adjusted for cardiovascular risk factors were 1.19 (1.00–1.42), 1.57 (1.15–2.12) and 1.87 (1.42–2.47). Similar results were observed in Code5. Conclusions Changes in ischaemic ECG abnormalities from none to minor, and minor to major, as well as persistent major abnormalities, were associated with an increased risk of CVD. PMID:28176973

  13. Use of indocyanine green videoangiography during intracranial aneurysm surgery reduces the incidence of postoperative ischaemic complications.

    Science.gov (United States)

    Lai, Leon Tat; Morgan, Michael Kerin

    2014-01-01

    Microscope-integrated near-infrared indocyanine green videoangiography (ICGVA) has been shown to be a useful adjunct for intracranial aneurysm surgery. That the routine application of this technique reduces the risk of postoperative ischaemic complication, however, has not been reported. We present a retrospective matched-pair comparison of ICGVA guided aneurysm surgery versus historic control surgical cohort treated by the same author. Index patients and controls were matched for aneurysm size, location, patient demographics, risk factors, comorbidities, and surgical treatments. Ninety-one eligible patients with 100 intracranial aneurysms were treated using ICGVA assistance. There were no statistically significant differences between the two groups in terms of patient age, sex, risk factors, comorbidities and aneurysm characteristics. Of the 100 aneurysms in the ICGVA group, 107 investigations of ICGVA were performed. In 79 aneurysms (79.0%), ICGVA was considered useful but did not affect surgical management. In six patients (6.0%), ICGVA led to a crucial change of intraoperative strategies. In nine patients (9.0%), it was considered critical in assuring patency of small perforators. ICGVA was of no benefit in four patients (4.0%) and was misleading in two (2.0%). Postoperative ischaemic complications occurred in three patients (3.3%) in the ICGVA group compared with seven patients (7.7%) in the control group (paneurysm surgery as a safe and effective modality of intraoperative blood flow assessment. With all limitations of a retrospective matched-pair comparison, the use of ICGVA during routine aneurysm surgery reduces the incidence of postoperative ischaemic complications.

  14. Automatic detection of paroxysmal atrial fibrillation in patients with ischaemic stroke: better than routine diagnostic workup?

    Science.gov (United States)

    Uphaus, T; Grings, A; Gröschel, S; Müller, A; Weber-Krüger, M; Wachter, R; Gröschel, K

    2017-07-01

    Prolonged electrocardiogram (ECG) monitoring after ischaemic stroke increases the diagnostic yield of paroxysmal atrial fibrillation (pAF). In order to facilitate the additional workload involved in ECG analysis due to prolonged monitoring times, we investigated the effectiveness of pAF detection with an automated software algorithm (SA) in comparison to the routine staff-based analysis (RA) during standard stroke-unit care. Therefore, patients with acute ischaemic stroke or transitory ischaemic attack presenting with sinus rhythmus on the admission ECG and no history of atrial fibrillation were prospectively included. A 24-h Holter ECG assessment was performed using either RA based on a computer-aided evaluation and subsequent review by a cardiologist or a commercially available automated SA. In the case of discordant results concerning the occurrence of pAF between the two methods, the data underwent an independent external rating. Of 809 prospectively enrolled patients, 580 patients fulfilled the inclusion criteria. pAF was ultimately diagnosed in 3.3% of the cohort (19 patients). SA and RA correctly diagnosed pAF in 17 patients resulting in a comparable diagnostic effectiveness of the analysis methods (sensitivity: SA 89.5% vs. RA 89.5%; specificity: SA 99.3% vs. RA 99.1%; κ, 0.686; P Holter ECG reaches a high diagnostic effectiveness for the detection of pAF and can be used for a rapid and resource-saving analysis of ECG data to deal with prolonged monitoring times. © 2017 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.

  15. FDG PET as a predictor of response to resynchronisation therapy in patients with ischaemic cardiomyopathy

    Energy Technology Data Exchange (ETDEWEB)

    Campen, C.M.C. van; Visser, Frans C.; Weerdt, Arno P. van der; Knaapen, Paul; Cock, Carel C. de; Visser, Cees A. [VU University Medical Centre, Department of Cardiology, Amsterdam (Netherlands); Comans, Emile F.I.; Lammertsma, Adriaan A. [VU University Medical Centre, Deparment of Nuclear Medicine and PET Research, Amsterdam (Netherlands)

    2007-03-15

    Although resynchronisation therapy (CRT) is a promising addition to heart failure therapy, a substantial number of patients do not respond to CRT. As FDG PET has routinely been used for prediction of improvement after revascularisation in ischaemic cardiomyopathy, it was hypothesised that there is also a relationship between the extent of viable tissue and improvement as a result of CRT. Thirty-nine patients with ischaemic cardiomyopathy (ejection fraction 27 {+-} 9%) and a wide QRS complex underwent temporary pacing to determine the optimal pacing combination, i.e. that with the highest increase in cardiac index (CI) compared with baseline (measured by Doppler echocardiography). All patients also underwent FDG PET imaging. In 19 patients, CI measurements were repeated 10-12 weeks after permanent biventricular pacemaker implantation. Echocardiography (13-segment model) showed a mean of 9.8 {+-} 1.6 dyssynergic segments, with preserved FDG uptake in 4.1 {+-} 2.4 segments. CI improvement at the optimal pacing site was 20 {+-} 9%. There was a linear relationship between the extent of viable tissue and CI improvement during pacing (p < 0.001). Using a cut-off value of more than three viable segments (ROC analysis), FDG PET had a sensitivity of 72% and a specificity of 71% for detection of the presence of haemodynamic improvement (i.e. a CI improvement >15%). The relation between CI improvement and viable tissue was similar at follow-up. A correlation was found between the extent of viable tissue and the haemodynamic response to CRT in patients with ischaemic cardiomyopathy, suggesting that FDG PET imaging may be useful to discriminate between responders and non-responders to CRT. (orig.)

  16. Administration of bone marrow-derived stem cells suppresses cellular necrosis and apoptosis induced by reperfusion of ischaemic kidneys in rats

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    @@ Ischaemic reperfusion injury (IRI) is a crucial element in the pathogenesis of acute ischaemic renal failure and influences the early functional recovery and even long term survival of a transplanted kidneyIt is generally thought that renal repair following IRI requires the replacement or regeneration of renal tubular epithelial cells that are detached or damaged.

  17. Health care in patients 1 year post-stroke in general practice : research on the utilisation of the Dutch Transmural Protocol transient ischaemic attack/cerebrovascular accident

    NARCIS (Netherlands)

    de Weerd, L.; Rutgers, A.W.F.; Groenier, K.H.; van der Meer, K.

    2012-01-01

    This study evaluates the kind of aftercare that ischaemic stroke patients receive and the extent that aftercare fulfils the criteria of the 'Dutch Transmural Protocol transient ischaemic attack/cerebrovascular accident'. Fifty-seven patients were interviewed 1 year post-stroke about secondary

  18. REACTOR MODERATOR STRUCTURE

    Science.gov (United States)

    Greenstreet, B.L.

    1963-12-31

    A system for maintaining the alignment of moderator block structures in reactors is presented. Integral restraining grids are placed between each layer of blocks in the moderator structure, at the top of the uppermost layer, and at the bottom of the lowermost layer. Slots are provided in the top and bottom surfaces of the moderator blocks so as to provide a keying action with the grids. The grids are maintained in alignment by vertical guiding members disposed about their peripheries. (AEC)

  19. Non-ketotic hyperglycaemia hemichorea–hemiballismus and acute ischaemic stroke

    Science.gov (United States)

    Carrion, Diego M; Carrion, Andres F

    2013-01-01

    Here we describe a patient with a rare movement disorder, hemichorea–hemiballismus, which is described as a complication of non-ketotic hyperglycaemia. This complication may be seen in individuals with poorly controlled long-standing diabetes mellitus. Proper diagnosis is established with CT and MRI of the brain, which typically show classic findings in the basal ganglia. Treatment focuses on improvement of glycaemic control and usually results in rapid resolution of the movement disorder. Nevertheless, recurrent episodes of hemichorea–hemiballismus, and even more ominous complications such as ischaemic stroke may occur. PMID:23470671

  20. Non-ketotic hyperglycaemia hemichorea-hemiballismus and acute ischaemic stroke.

    Science.gov (United States)

    Carrion, Diego M; Carrion, Andres F

    2013-03-06

    Here we describe a patient with a rare movement disorder, hemichorea-hemiballismus, which is described as a complication of non-ketotic hyperglycaemia. This complication may be seen in individuals with poorly controlled long-standing diabetes mellitus. Proper diagnosis is established with CT and MRI of the brain, which typically show classic findings in the basal ganglia. Treatment focuses on improvement of glycaemic control and usually results in rapid resolution of the movement disorder. Nevertheless, recurrent episodes of hemichorea-hemiballismus, and even more ominous complications such as ischaemic stroke may occur.

  1. Case Report: Ischaemic appendicitis post mesenteric biopsy [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Marianna Zukiwskyj

    2016-01-01

    Full Text Available A common indication for laparoscopic mesenteric lymph node biopsy is to provide a tissue diagnosis in the absence of palpable peripheral nodes via a minimally invasive approach.  There are no reports to date of ischaemia to the appendix as a complication of this procedure.   We report the case of a 34-year-old lady who underwent a mesenteric biopsy for a lesion found incidentally on CT to investigate longstanding abdominal pain, and 2 days later required an appendicectomy for ischaemic appendicitis.

  2. Ischaemic necrosis of the tongue as a rare complication of cardiogenic shock.

    Science.gov (United States)

    Hulstaert, E; Roggeman, E; Beeckman, A-S; Moerman, M; Vanderstraeten, E; Rasquin, K; Monsaert, E; Baert, D; Dewint, P; Burvenich, P; Van Steenkiste, C

    2015-12-01

    Ischaemic necrosis of the tongue is an unusual clinical finding. In most cases it is associated with vasculitis, particularly giant cell arteritis (GCA). Other causes include profound cardiogenic shock. We report a case of tongue necrosis in an 81-year-old Caucasian woman. The patient was admitted to the intensive care unit (ICU) for cardiogenic shock. Swelling of the tongue was reported before intubation and evolved into tongue ischaemia and necrosis of the tip of the tongue. After surgical debridement the patient recovered. To our knowledge, this is the second report of a patient surviving tongue necrosis resulting from cardiogenic shock.

  3. {sup 18}F-FDG PET/CT imaging factors that predict ischaemic stroke in cancer patients

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jahae; Song, Ho-Chun [Chonnam National University Hospital, Department of Nuclear Medicine, Gwangju (Korea, Republic of); Choi, Kang-Ho [Chonnam National University Hospital, Cerebrovascular Center, Gwangju (Korea, Republic of); Chonnam National University Hwasun Hospital, Department of Neurology, Hwasun-gun, Jeollanam-do (Korea, Republic of); Kim, Joon-Tae; Park, Man-Seok; Cho, Ki-Hyun [Chonnam National University Hospital, Cerebrovascular Center, Gwangju (Korea, Republic of)

    2016-11-15

    {sup 18}F-FDG PET/CT can acquire both anatomical and functional images in a single session. We investigated which factors of {sup 18}F-FDG PET/CT imaging have potential as biomarkers for an increased risk of ischaemic stroke in cancer patients. From among cancer patients presenting with various neurological symptoms and hemiparesis, 134 were selected as eligible for this retrospective analysis. A new infarct lesion on brain MRI within 1 year of FDG PET/CT defined future ischaemic stroke. The target-to-background ratio (TBR) of each arterial segment was used to define arterial inflammation on PET imaging. Abdominal obesity was defined in terms of the area and proportion of visceral adipose tissue (VAT), subcutaneous adipose tissue and total adipose tissue (TAT) on a single CT slice at the umbilical level. Ischaemic stroke confirmed by MRI occurred in 30 patients. Patients with stroke had higher TBRs in the carotid arteries and abdominal aorta (P < 0.001) and a higher VAT proportion (P = 0.021) and TAT proportion (P = 0.041) than patients without stroke. Multiple logistic regression analysis showed that TBRs of the carotid arteries and abdominal aorta, VAT and TAT proportions, and the presence of a metabolically active tumour were significantly associated with future ischaemic stroke. Combining PET and CT variables improved the power for predicting future ischaemic stroke. Our findings suggest that arterial FDG uptake and hypermetabolic malignancy on PET and the VAT proportion on CT could be independent predictors of future ischaemic stroke in patients with cancer and could identify those patients who would benefit from medical treatment. (orig.)

  4. l-arginine and l-NMMA for assessing cerebral endothelial dysfunction in ischaemic cerebrovascular disease: A systematic review.

    Science.gov (United States)

    Karlsson, William K; Sørensen, Caspar G; Kruuse, Christina

    2017-01-01

    Endothelial dysfunction (ED), in particular cerebral ED, may be an essential biomarker for ischaemic cerebrovascular disease. However, there is no consensus on methods to best estimate cerebral ED. In this systematic review, we evaluate the use of l-arginine and N(G) -monomethyl-l-arginine (l-NMMA) for assessment of cerebral ED. A systematic search of PubMed, EMBASE and the Cochrane Library was done. We included studies investigating cerebrovascular response to l-arginine or l-NMMA in human subjects with vascular risk factors or ischaemic cerebrovascular disease. Seven studies (315 subjects) were eligible according to inclusion and exclusion criteria. Studies investigated the effect of age (n=2), type 2 diabetes mellitus (DM) (n=1), cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) (n=1), leukoaraiosis (n=1), and prior ischaemic stroke or transient ischaemic attack (TIA) (n=2) on cerebral ED. Most studies applied transcranial Doppler to quantify cerebral ED. Endothelium-dependent vasodilatation (EDV) induced by l-arginine was impaired in elderly and subjects with leukoaraiosis, but enhanced in CADASIL patients. Studies including subjects with prior ischaemic stroke or TIA reported both enhanced and impaired EDV to l-arginine. Responses to l-NMMA deviated between subjects with type 2 DM and the elderly. We found only few studies investigating cerebral endothelial responses to l-arginine and l-NMMA in subjects with vascular risk factors or ischaemic cerebrovascular disease. Inconsistencies in results were most likely due to variations in methods and included subject populations. In order to use cerebral ED as a prognostic marker, further studies are required to evaluate the association to cerebrovascular disease.

  5. [Disability among elderly women in Brazil].

    Science.gov (United States)

    Parahyba, Maria Isabel; Veras, Renato; Melzer, David

    2005-06-01

    To estimate disability rates and explore associations, identifying the most significant socioeconomic markers associated with the prevalence of mobility disability among elderly women. National mobility disability rates were estimated based on information from the 1998 National Household Survey (PNAD), conducted by the Instituto Brasileiro de Geografia e Estatística. The present study analyzes the elderly women population, totaling 16,186 subjects. Logistic regression models were constructed considering 'difficulty walking 100 meters' as the dependent variable. The prevalence of markers of mild, moderate and severe disability was greater among women, and increased with age. In logistic regression analysis, markers most strongly associated with increased prevalence of mobility disability were age, gender, low schooling, and low income. Rural residence was also associated with reduced prevalence. Our results suggest potential risk factors for the development of functional decline in elderly women, given that the associations encountered were consistent with those reported by other studies in the literature.

  6. Effect of a deproteinized blood extract on the recovery of blood circulation in an ischaemic skin lesion.

    Science.gov (United States)

    Smahel, J.

    1982-01-01

    An experimental model was used to study the revascularization of an ischaemic skin lesion and the effect on this process of the blood extract Solcoseryl. Under the conditions given in the experiment, restoration of the circulation was by 2 modes--re-flow in the original vessels, and neovascularization. Solcoseryl given daily i.p. encouraged the re-flow phenomenon and therefore, by improving the microcirculation and nutrition, the healing of the ischaemic lesions. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6 Fig. 7 Fig. 8 PMID:6176254

  7. CT analysis of the upper end of the femur: the asterisk sign and ischaemic bone necrosis of the femoral head.

    Science.gov (United States)

    Dihlmann, W

    1982-01-01

    In computed tomography (CT) of the head of the femur, a star-shaped structure can be seen which we refer to as the asterisk or asterisk sign. The asterisk is formed by thickened weight-bearing bone trabeculae. It can be shown by CT that the asterisk exhibits a characteristic change in ischaemic bone necrosis of the femoral head, even when the disease is in an early stage. CT of the hip joint is therefore an important examination for early diagnosis of ischaemic disease of the femoral head.

  8. Multiple risk factors and ischaemic stroke in the elderly Asian population with and without atrial fibrillation. An analysis of 425,600 Chinese individuals without prior stroke.

    Science.gov (United States)

    Guo, Yutao; Wang, Hao; Tian, Yingchun; Wang, Yutang; Lip, Gregory Y H

    2016-01-01

    Ischaemic stroke risk rises with the increasing cardiovascular risk factors. How atrial fibrillation (AF) incrementally contributes to the risk for ischaemic stroke with increasing age and multiple cardiovascular risk factors is unclear. In an individual patient with AF the mechanism of ischaemic stroke may be related directly to AF itself or to risk factors associated with AF. It was this study's objective to investigate incident ischaemic stroke in relation to age and increasing cardiovascular risk factor(s), and the incremental impact of AF on stroke rates. We studied a 5% random sampling from Chinese medical insurance data covering more than 10 million individuals, for the years 2001 to 2012. The rate of ischaemic stroke was calculated amongst the individuals with no prior history of ischaemic stroke, in relation to age groups (aged risk factors using the CHA2DS2-VASc score. Among the randomly sampled 425,600 individuals with total follow-up of 1,864,232 patient-years [63.8% male, mean age 60 years; 880 with AF, vs 424,720 non-AF], there were 13,242 (3.1%) ischaemic strokes after 64,834 person-years follow-up. Overall, ischaemic stroke incidence (per 100 person-years) was 0.35 (95%CI 0.34-0.35) in the non-AF population and 1.11 (0.84-1.45) with AF. The AF population age risk factors (besides AF) contributes to a greater risk for ischaemic stroke, especially in the elderly population. If elderly and with multiple risk factors, non-AF patients may have a risk of incident ischaemic stroke that is comparable or even higher than patients with AF, suggesting that the incremental stroke risk attributable to AF is marginal in such 'high risk' patients.

  9. Serial CT and MRI of ischaemic cerebral infarcts: frequency and clinical impact of haemorrhagic transformation

    Energy Technology Data Exchange (ETDEWEB)

    Mayer, T.E.; Brueckmann, H. [Muenchen Univ. (Germany). Abt. fuer Neuroradiologie; Schulte-Altedorneburg, G. [Dept. of Radiology/Neuroradiology, University Medical School of Luebeck (Germany); Droste, D.W. [Dept. of Neurology, University Medical School of Luebeck (Germany)

    2000-04-01

    The frequency, predisposing factors and clinical consequences of haemorrhagic infarcts and damaged blood-brain barrier as shown by contrast enhancement (CE) in ischaemic cerebral infarcts are controversial. We prospectively compared the sensitivity of CT and MRI to haemorrhagic transformation (HT) and CE. We also wished to investigate the clinical significance of HT and factors possibly associated with it. We studied 36 patients with acute ischaemic infarcts in the middle cerebral artery territory during the first 2 weeks after the ictus. After CT and rating of the neurological deficit on admission, serial examinations with clinical neuromonitoring, contrast-enhanced CT and MRI were done on the same day. The occurrence and severity of HT were correlated with CE, stroke mechanism, infarct size, development of neurological deficits and antithrombotic treatment. The frequency of HT detected by MRI was 80 %. CE usually preceded HT or was seen simultaneously. MRI had a higher sensitivity than CT to HT and CE. Severity of HT was positively correlated with infarct size (P < 0.01). HT had no influence on patient's neurological status. Neither the type of antithrombotic treatment nor the stroke mechanism was associated with the severity of HT. No parenchymal haemorrhage occurred. (orig.)

  10. Minimising time to treatment: targeted strategies to minimise time to thrombolysis for acute ischaemic stroke.

    Science.gov (United States)

    Tai, Y J; Yan, B

    2013-11-01

    Time to thrombolysis is a critical determinant of favourable outcomes in acute ischaemic stroke. It is not infrequent that patient outcomes are compromised due to out-of-hospital and in-hospital time delays. On the other hand, time delays could be minimised through the identification of barriers and the implementation of targeted solutions. This review outlines the different strategies in minimising treatment delays and offers recommendations. Literature search in PubMed, Medline and EBSCO Host was conducted to identify studies that are relevant to reduction of time to treatment from January 1995 to December 2012. Strategies to reduce time to thrombolysis are categorised into pre-hospital strategies, in-hospital strategies and post-treatment decision strategies. Proposed pre-hospital strategies include public education on stroke symptoms awareness, prioritising stroke by emergency medical services, increasing ease of access to medical records, pre-hospital notification, and mobile computed tomography scanning. In-hospital strategies include a streamlined code stroke system, computed tomography scanner co-location with emergency department, 24/7 availability of stroke physicians, point-of-care laboratory testing and access to expert neuroimaging interpretation. Post-decision strategies include increasing availability of intravenous thrombolysis and simplification of informed consent procurement. Time to thrombolysis delays is multifactorial. Effective reduction of time delays for acute ischaemic stroke requires the correct identification of and targeted strategies to overcome time barriers. © 2013 The Authors; Internal Medicine Journal © 2013 Royal Australasian College of Physicians.

  11. The third international stroke trial (IST-3 of thrombolysis for acute ischaemic stroke

    Directory of Open Access Journals (Sweden)

    Cantisani Teresa

    2008-06-01

    Full Text Available Abstract Background Intravenous recombinant tissue plasminogen activator (rt-PA is approved for use in selected patients with ischaemic stroke within 3 hours of symptom onset. IST-3 seeks to determine whether a wider range of patients may benefit. Design International, multi-centre, prospective, randomized, open, blinded endpoint (PROBE trial of intravenous rt-PA in acute ischaemic stroke. Suitable patients must be assessed and able to start treatment within 6 hours of developing symptoms, and brain imaging must have excluded intracerebral haemorrhage. With 1000 patients, the trial can detect a 7% absolute difference in the primary outcome. With3500 patients, it can detect a 4.0% absolute benefit & with 6000, (mostly treated between 3 & 6 hours, it can detect a 3% benefit. Trial procedures Patients are entered into the trial by telephoning a fast, secure computerised central randomisation system or via a secure web interface. Repeat brain imaging must be performed at 24–48 hours. The scans are reviewed 'blind' by expert readers. The primary measure of outcome is the proportion of patients alive and independent (Modified Rankin 0–2 at six months (assessed via a postal questionnaire mailed directly to the patient. Secondary outcomes include: events within 7 days (death, recurrent stroke, symptomatic intracranial haemorrhage, outcome at six months (death, functional status, EuroQol. Trial registration ISRCTN25765518

  12. Protective role of methylprednisolone and heparin in ischaemic-reperfusion injury of the rat testicle.

    Science.gov (United States)

    Mertoğlu, C; Senel, U; Cayli, S; Tas, U; Küskü Kiraz, Z; Özyurt, H

    2016-09-01

    This study evaluated the therapeutic efficacy of heparin and methylprednisolone in the treatment of ischaemic reperfusion (IR) injury of the testis. Twenty-four male Sprague-Dawley rats were allocated equally into three groups of eight animals each. The left testes were rotated 720° for 2 h in the rats in the torsion-detorsion group. Rats in the treatment groups underwent the same surgical procedure as the torsion-detorsion group but were also given methylprednisolone (group II) or heparin (group III) by an intraperitoneal route 30 min prior to detorsion. Left orchiectomy was performed in all rats from each experimental animal at 2 h after detorsion, and the tissue was harvested for the measurement of malondialdehyde (MDA), protein carbonyl (PC) and nitric oxide (NO) and the endogenous antioxidant enzymes, superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and catalase. Additional tissue was evaluated using histopathological and immunohistochemical changes. PC and MDA levels were significantly reduced in the treated groups compared to the control group. There was no statistically significant difference in NO level or SOD, GSH-Px and catalase activity among the treatment groups. Histopathological and immunohistochemical findings supported biochemical changes. It is concluded that pre-treatment with methylprednisolone or heparin protects the testis in ischaemic reperfusion injury caused by testicular torsion-detorsion.

  13. Commentary on a GWAS: HDAC9 and the risk for ischaemic stroke

    Directory of Open Access Journals (Sweden)

    Hacke Werner

    2012-07-01

    Full Text Available Abstract Modifiable risk factors like obesity, hypertension, smoking, physical inactivity or atrial fibrillation account for a significant proportion of the risk for ischaemic stroke, but genetic variation is also believed to contribute to the risk, although few genetic risk variants were identified to date. Common clinical subtypes of stroke are caused by cardiac embolism, large artery atherosclerosis and small cerebral vessel disease. Each of these underlying pathologies may have a specific genetic architecture. Previous genome-wide association studies (GWAS showed association of variants near PITX2 and ZFHX3 with atrial fibrillation and stroke. ANRIL (antisense Non-coding RNA in the INK4 Locus (harboring the CDKN2A/B genes variants were related to a variety of vascular diseases (myocardial infarction, aortic and intracranial aneurysm, including ischaemic stroke. Now a recent GWAS published in Nature Genetics confirmed these previous associations, analyzed the specificity of the previous associations with particular stroke subtypes and identified a new association between HDAC9 and large vessel stroke. The findings suggest that well-recognized clinical stroke subtypes correspond to distinct aetiological entities. However, the molecular pathways that are affected by the identified genetic variants are not yet pinpointed, and the observed associations apply only for some, but not all victims of a specific stroke aetiology.

  14. Hyperintense acute reperfusion marker is associated with higher contrast agent dosage in acute ischaemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Ostwaldt, Ann-Christin; Schaefer, Tabea; Villringer, Kersten; Fiebach, Jochen B. [Charite Universitaetsmedizin Berlin, Academic Neuroradiology, Center for Stroke Research Berlin (CSB), Berlin (Germany); Rozanski, Michal; Ebinger, Martin [Charite Universitaetsmedizin Berlin, Academic Neuroradiology, Center for Stroke Research Berlin (CSB), Berlin (Germany); Charite Universitaetsmedizin, Department of Neurology, Berlin (Germany); Jungehuelsing, Gerhard J. [Stiftung des Buergerlichen Rechts, Juedisches Krankenhaus Berlin, Berlin (Germany)

    2015-11-15

    The hyperintense acute reperfusion marker (HARM) on fluid-attenuated inversion recovery (FLAIR) images is associated with blood-brain barrier (BBB) permeability changes. The aim of this study was to examine the influence of contrast agent dosage on HARM incidence in acute ischaemic stroke patients. We prospectively included 529 acute ischaemic stroke patients (204 females, median age 71 years). Patients underwent a first stroke-MRI within 24 hours from symptom onset and had a follow-up on day 2. The contrast agent Gadobutrol was administered to the patients for perfusion imaging or MR angiography. The total dosage was calculated as ml/kg body weight and ranged between 0.04 and 0.31 mmol/kg on the first examination. The incidence of HARM was evaluated on day 2 FLAIR images. HARM was detected in 97 patients (18.3 %). HARM incidence increased significantly with increasing dosages of Gadobutrol. Also, HARM positive patients were significantly older. HARM was not an independent predictor of worse clinical outcome, and we did not find an association with increase risk of haemorrhagic transformation. A higher dosage of Gadobutrol in acute stroke patients on initial MRI is associated with increased HARM incidence on follow-up. MRI studies on BBB should therefore standardize contrast agent dosages. (orig.)

  15. Cardiac telocytes were decreased during myocardial infarction and their therapeutic effects for ischaemic heart in rat.

    Science.gov (United States)

    Zhao, Baoyin; Chen, Shang; Liu, Juanjuan; Yuan, Ziqiang; Qi, Xufeng; Qin, Junwen; Zheng, Xin; Shen, Xiaotao; Yu, Yanhong; Qnin, Thomas J; Chan, John Yeuk-Hon; Cai, Dongqing

    2013-01-01

    Recently, cardiac telocytes were found in the myocardium. However, the functional role of cardiac telocytes and possible changes in the cardiac telocyte population during myocardial infarction in the myocardium are not known. In this study, the role of the recently identified cardiac telocytes in myocardial infarction (MI) was investigated. Cardiac telocytes were distributed longitudinally and within the cross network of the myocardium, which was impaired during MI. Cardiac telocytes in the infarction zone were undetectable from approximately 4 days to 4 weeks after an experimental coronary occlusion was used to induce MI. Although cardiac telocytes in the non-ischaemic area of the ischaemic heart experienced cell death, the cell density increased approximately 2 weeks after experimental coronary occlusion. The cell density was then maintained at a level similar to that observed 1-4 days after left anterior descending coronary artery (LAD)-ligation, but was still lower than normal after 2 weeks. We also found that simultaneous transplantation of cardiac telocytes in the infarcted and border zones of the heart decreased the infarction size and improved myocardial function. These data indicate that cardiac telocytes, their secreted factors and microvesicles, and the microenvironment may be structurally and functionally important for maintenance of the physiological integrity of the myocardium. Rebuilding the cardiac telocyte network in the infarcted zone following MI may be beneficial for functional regeneration of the infarcted myocardium.

  16. Reconsidering the back door approach by targeting the coronary sinus in ischaemic heart disease.

    Science.gov (United States)

    De Maria, Giovanni Luigi; Kassimis, George; Raina, Tushar; Banning, Adrian P

    2016-08-15

    Coronary sinus interventions (CSI) are a class of invasive techniques (surgical and percutaneous) originally proposed in the first half of the 20th century, aiming to treat ischaemic heart disease by acting on the venous coronary system. Three main classes of CSI have been proposed and tested: (1) retroperfusion technique, (2) retroinfusion technique and (3) coronary sinus occlusion techniques. They all share the principle that a controlled increased pressure within the coronary sinus may promote a retrograde perfusion of the ischaemic myocardium with consequent cardioprotection. Development of arterial treatments including coronary aortic bypass grafting and then percutaneous coronary intervention deflected interest from interventions on the coronary venous system. However, CSI may still have a possible niche role today in specific and selected clinical contexts in which existing therapies are insufficient. In this review paper, we aim to revise the rationale for CSI, describing the details and the evidence collected so far about these techniques and to provide insights about the main clinical scenarios in which these strategies may find a contemporary application in combination or as an alternative to existing approaches.

  17. Music Therapy and the Education of Students with Severe Disabilities

    Science.gov (United States)

    Stephenson, Jennifer

    2006-01-01

    Music therapists regard music therapy as a valuable intervention for students with moderate to severe intellectual disability or multiple disabilities, but many special educators would regard it as a controversial practice, unsupported by empirical research. This paper reviews the goals and strategies used by music therapists working with students…

  18. Music Therapy and the Education of Students with Severe Disabilities

    Science.gov (United States)

    Stephenson, Jennifer

    2006-01-01

    Music therapists regard music therapy as a valuable intervention for students with moderate to severe intellectual disability or multiple disabilities, but many special educators would regard it as a controversial practice, unsupported by empirical research. This paper reviews the goals and strategies used by music therapists working with students…

  19. Disability Experience and Measurement.

    Science.gov (United States)

    Verbrugge, Lois M

    2016-10-01

    Top themes of international research on disability in the past three decades are discussed: disability dynamics, buffers and barriers for disability, disability trends, and disability among very old persons. Each theme is highlighted by research examples. Turning to measurement, I discuss traditional measures of disability, new longer and shorter ones, and composites like disability-free life expectancy, noting their merits. Contemporary models of disability are presented, ranging from visual images to formal theories. The article ends on how scientists can facilitate movement of disability science into health care practice and policy.

  20. Diffusional transport of the aminoterminal propeptide of type III procollagen in the interstitium of the globally ischaemic cat myocardium

    DEFF Research Database (Denmark)

    Høst, N B; Sejrsen, P; Jensen, L T;

    1996-01-01

    , no attention has yet been paid to the resistance to diffusion offered by the myocardial interstitium. We determined the diffusion coefficient of PIIINP in the interstitium of the globally ischaemic interstitium of the cat (D'37) by means of a "true transient diffusion' method, and compared with the free...

  1. Risk factors for perinatal arterial ischaemic stroke in full-term infants : a case-control study

    NARCIS (Netherlands)

    Harteman, Johanna C.; Groenendaal, Floris; Kwee, Anneke; Welsing, Paco M. J.; Benders, Manon J. N. L.; de Vries, Linda S.

    2012-01-01

    Objective The incidence of perinatal arterial ischaemic stroke (PAIS) is about 1 in 2300 live births. Evidence about the aetiology is still lacking. The aim of this study was to identify maternal, perinatal and neonatal risk factors for symptomatic PAIS in full-term infants. Methods Each full-term i

  2. Prevalence of risk factors for ischaemic stroke and their treatment among a cohort of stroke patients in Dublin.

    LENUS (Irish Health Repository)

    McDonnell, R

    2000-10-01

    The majority of strokes are due to ischaemia. Risk factors include atrial fibrillation, hypertension and smoking. The incidence can be reduced by addressing these risk factors. This study examines the prevalence of risk factors and their treatment in a cohort of patients with ischaemic stroke registered on a Dublin stroke database.

  3. Is valve repair preferable to valve replacement in ischaemic mitral regurgitation? A systematic review and meta-analysis.

    Science.gov (United States)

    Salmasi, Mohammad Yousuf; Acharya, Metesh; Humayun, Nada; Baskaran, Dinnish; Hubbard, Stephanie; Vohra, Hunaid

    2016-07-01

    Ischaemic mitral regurgitation (MR) is associated with poor survival. The favoured surgical option remains debatable. Our aim was to perform a meta-analysis to compare the outcomes of mitral valve repair (MVRp) with replacement (MVR). A literature search was conducted in PubMed, Medline and Ovid using the terms 'ischaemic mitral regurgitation', 'repair' and 'replacement'. The primary outcome measure was 30-day survival. The secondary outcome measures were MR recurrence and reoperation. Out of 310 articles, 18 fulfilled the inclusion criteria. A total of 3978 patients were included: 2563 (64%) MVRp cases and 1415 (36%) MVR cases. Operative techniques included annuloplasty for MVRp and subvalvular apparatus-sparing MVR techniques. Thirty-day mortality was lower after MVRp compared with MVR [OR 0.42; (95% CI 0.33-0.54; P = 0.0001)]. There was no difference in long-term survival ranging 1-5 years (HR 0.85, 95% CI 0.65-1.12). Recurrence of MR was significantly higher in the MVRp group (OR 4.26, 95% CI 2.52-7.22), as was the rate of reoperation (OR 2.03, 95% CI 1.49-2.77). Although MVR for ischaemic MR has a higher 30-day mortality rate compared with MVRp, MVRp is associated with the higher rate of MR recurrence and the need for reoperation. MVR remains an attractive option for ischaemic MR.

  4. Intravenous thrombolysis in acute ischaemic stroke: from trial exclusion criteria to clinical contraindications. An international Delphi study

    NARCIS (Netherlands)

    M. Dirks (Maaike); L.W. Niessen (Louis Wilhelmus); C.L. Franke (Cees); R.J. van Oostenbrugge (Robert Jan); D.W.J. Dippel (Diederik); P.J. Koudstaal (Peter Jan)

    2007-01-01

    textabstractOBJECTIVE: Several studies indicate that only a small proportion of patients with acute ischaemic stroke are treated with intravenous thrombolysis. Indications and contraindications for this treatment are usually based on the inclusion and exclusion criteria of randomised clinical trials

  5. The -148 C/T fibrinogen gene polymorphism and fibrinogen levels in ischaemic stroke: a case-control study

    NARCIS (Netherlands)

    M.P.J. van Goor (Marie-Louise); E.B. Gómez García (Encarna); F.W.G. Leebeek (Frank); G.J. Brouwers (Geert Jan); P.J. Koudstaal (Peter Jan); D.W.J. Dippel (Diederik)

    2005-01-01

    textabstractBACKGROUND: To determine whether -148 C/T fibrinogen gene promoter polymorphism increases stroke risk by modifying the fibrinogen level. DESIGN: A case-control study of patients with first ever ischaemic stroke, confirmed by computed tomography. METHODS: Venous blood samples were

  6. Loci associated with ischaemic stroke and its subtypes (SiGN) : A genome-wide association study

    NARCIS (Netherlands)

    Pulit, SL; Algra, A; de Bakker, Paul I W

    2016-01-01

    Background: The discovery of disease-associated loci through genome-wide association studies (GWAS) is the leading genetic approach to the identification of novel biological pathways underlying diseases in humans. Until recently, GWAS in ischaemic stroke have been limited by small sample sizes and

  7. Myocardial infarction, ischaemic stroke and pulmonary embolism before and after breast cancer hospitalisation. A population-based study.

    NARCIS (Netherlands)

    M.P.P. van Herk-Sukel (Myrthe); S. Shantakumar (Sumitra); P.W. Kamphuisen (Pieter Willem); F.J.A. Penning-Van Beest (Fernie); R.M.C. Herings (Ron)

    2011-01-01

    textabstractWe studied the occurrence of myocardial infarction (MI), ischaemic stroke (IS) and pulmonary embolism (PE) before and after breast cancer hospitalisation compared with cancer-free controls. For this, women with a first breast cancer hospitalisation during 2000-2007 were selected from the

  8. Cobalt-57 as a SPET tracer in the visualization of ischaemic brain damage in patients with middle cerebral artery stroke

    NARCIS (Netherlands)

    Stevens, H; Knollema, S; Piers, DA; Van de Wiele, C; Jansen, HML; De Jager, AEJ; De Reuck, J; Dierckx, RA; Korf, J

    1998-01-01

    In PET studies we have shown the usefulness of cobalt radionuclides for the visualization and quantification of ischaemic damage in stroke. In the present study, we explored Co-57(2+) as a SPET tracer. Uptake of radioactivity was estimated by using a cobalt enhancement ratio defined as the ratio of

  9. Coronary calcification with no flow limiting lesions: A potential cause for ischaemic dysfunction in syndrome X patients

    Directory of Open Access Journals (Sweden)

    Elisabetta Palmerini

    2015-12-01

    Conclusion: In symptomatic patients with no obstructive coronary lesions and with more than mild CAC, long axis disturbances and wall motion score index rise occur with stress, at the time of symptom development and correlate with severity of arterial calcification. These findings suggest CAC as a potential mechanism for coronary wall stiffness and consequently exertional ischaemic changes as a result of limited flow reserve.

  10. A Novel SCN5A Mutation in a Patient with Coexistence of Brugada Syndrome Traits and Ischaemic Heart Disease

    DEFF Research Database (Denmark)

    Holst, Anders G; Calloe, Kirstine; Jespersen, Thomas

    2009-01-01

    Brugada syndrome (BrS) is a primary electrical heart disease, which can lead to sudden cardiac death. In older patients with BrS, the disease may coexist with ischaemic heart disease (IHD) and recent studies support a synergistic proarrhythmic effect of the two disease entities. We report a case...

  11. Fatty acid dietary intake and the risk of ischaemic stroke: a multicentre case-control study. UFA Study Group.

    Science.gov (United States)

    Ricci, S; Celani, M G; Righetti, E; Caruso, A; De Medio, G; Trovarelli, G; Romoli, S; Stragliotto, E; Spizzichino, L

    1997-06-01

    A low dietary intake of unsaturated fatty acids has been found in male patients with stroke as compared with controls in Italy, and a high consumption of meat has been associated with an increased risk of stroke in Australia. We present a case-control study, comparing the unsaturated and saturated fatty acids content of red cell membranes (which reflects the dietary intake of saturated and unsaturated fats) in 89 patients with ischaemic stroke and 89 controls matched for age and sex. In univariate analysis, besides hypertension, atrial fibrillation, ischaemic changes in ECG and hypercholesterolaemia, stroke patients showed a lower level of oleic acid (P = 0.000), but a higher level of eicosatrienoic acid (P = 0.009). Conditional logistic regression (dependent variable; being a case) showed that the best model included atrial fibrillation, hypertension, oleic acid and eicosatrienoic acids. These results confirm a possible protective role of unsaturated fatty acids against vascular diseases; however, we did not find any difference in the content of omega3 acids, which have been considered in the past to protect against coronary heart disease. We conclude that the preceding diet of patients with ischaemic stroke may be poor in unsaturated fatty acids (namely, oleic acid), and this defect is independent of other vascular risk factors. Only further studies will show whether changes in diet and/or supplement of unsaturated fatty acids might reduce the incidence of ischaemic stroke.

  12. Risk factors for ischaemic heart disease mortality among men with different occupational physical demands. A 30-year prospective cohort study

    DEFF Research Database (Denmark)

    Holtermann, Andreas; Mortensen, Ole Steen; Søgaard, Karen

    2012-01-01

    Objectives Men with high physical work demands have elevated cardiovascular strain, which may lead to enhanced atherosclerosis. Theoretically, the impact of risk factors for ischaemic heart disease (IHD) may thus depend on physical work demands. The authors investigated this hypothesis. Design Pr...

  13. Genetics Home Reference: PPP2R5D-related intellectual disability

    Science.gov (United States)

    ... Conditions PPP2R5D-related intellectual disability PPP2R5D-related intellectual disability Printable PDF Open All Close All Enable Javascript ... the expand/collapse boxes. Description PPP2R5D -related intellectual disability is a neurological disorder characterized by moderate to ...

  14. The Importance of Counselor Disability Status: What We Know and What We Need to Know.

    Science.gov (United States)

    Strohmer, Douglas C.; And Others

    1996-01-01

    Reviews research that examined the effects of counselor disability status on counselor preferences and perceptions (expertness, attractiveness, and trustworthiness) as expressed by individuals with and without a disability. Results show that counselor disability status had a limited effect on perceptions and preferences, which were moderated by…

  15. Comparison of ischaemic preconditioning with surgical delay technique to increase the viability of single pedicle island venous flaps: an experimental study.

    Science.gov (United States)

    Ceylan, Refika; Kaya, Burak; Çaydere, Muzaffer; Terzioğlu, Ahmet; Aslan, Gürcan

    2014-12-01

    The aim of the present study was to investigate the effect of ischaemic preconditioning compared with the surgical delay procedure in an effort to increase the survival rate of single pedicle island venous flaps. Eighteen male Wistar albino rats (250-350 g) were included. A 3 × 4 cm flap was planned at the right lower abdomen of the rat. Superficial epigastric vein constituted the pedicle of the flap. The rats were divided into three groups, each consisting of six rats. In the control group, a single pedicle venous island flap was elevated on each rat and no other surgical procedure was performed. In the ischaemic preconditioning group, ischaemic preconditioning was performed and, in the surgical delay procedure group, the surgical delay technique was performed before flap elevation. The mean necrosis areas were 56.85 ± 14.60%, 28.73 ± 15.60%, and 12.08 ± 3.65% in the control, ischaemic preconditioning, and surgical delay procedure groups, respectively. The necrosis areas were significantly smaller in the ischaemic preconditioning group and surgical delay procedure groups compared to the control group (p = 0.004 and p surgical delay procedure groups. Histopathological parameters including necrosis, abscess formation, and skin ulceration scores were significantly lower in the ischaemic preconditioning group than in the control group, whereas the study groups were similar. In conclusion, ischaemic preconditioning may serve as an adjuvant technique in increasing venous island flap viability.

  16. The importance of lung function, non-malignant diseases associated with asbestos, and symptoms as predictors of ischaemic heart disease in shipyard workers exposed to asbestos.

    Science.gov (United States)

    Sandén, A; Järvholm, B; Larsson, S

    1993-01-01

    The mortality from ischaemic heart disease was studied in a prospective cohort of 1725 shipyard workers exposed to asbestos. The analyses were stratified for age and smoking habits and restricted to men. In agreement with other findings, men with impaired lung function had a significantly higher risk (relative risk (RR) = 3.5) of dying from ischaemic heart disease than men with normal lung function. Men with asbestosis or suspected asbestosis had a significantly higher risk (RR = 3.1) of dying from ischaemic heart disease than men without asbestosis. Thus asbestosis or suspected asbestosis also seemed to be a risk factor for ischaemic heart disease. This finding was independent of respiratory function. There was no increased risk for ischaemic heart disease in men with compared with men without pleural plaques. Men with production of phlegm or sputum and wheezing or whistling had no increased risk for ischaemic heart disease compared with men without these symptoms. In the group with normal lung function men with dyspnoea had a significantly higher risk of dying from ischaemic heart disease than men without dyspnoea. The findings for men with asbestosis or suspected asbestosis indicated a further risk factor besides impaired lung function, in persons exposed to asbestos. Perhaps this risk factor is due to lesions of the pericardium with consequences for heart function. PMID:8398871

  17. Disability in anxiety disorders

    NARCIS (Netherlands)

    Hendriks, S.M.; Spijker, J.; Licht, C.M.M.; Beekman, A.T.F.; Hardeveld, F.; Graaf, R. de; Batelaan, N.M.; Penninx, B.W.J.H.

    2014-01-01

    Background: This study compares disability levels between different anxiety disorders and healthy controls. We further investigate the role of anxiety arousal and avoidance behaviour in disability, and whether differences in these symptom patterns contribute to disability differences between anxiety

  18. Disability in anxiety disorders

    NARCIS (Netherlands)

    Hendriks, S.M.; Spijker, J.; Licht, C.M.; Beekman, A.T.; Hardeveld, F.; Graaf, R. de; Batelaan, N.M.; Penninx, B.W.J.H.

    2014-01-01

    BACKGROUND: This study compares disability levels between different anxiety disorders and healthy controls. We further investigate the role of anxiety arousal and avoidance behaviour in disability, and whether differences in these symptom patterns contribute to disability differences between anxiety

  19. Sexuality and Intellectual Disability

    Science.gov (United States)

    ... Curiae Briefs Legislative Goals Consortium for Citizens with Disabilities National Goals 2015 SIS Product Information Benefits of ... SIS-A Contact Us New 2017 Products Intellectual Disability Historical Context Definition FAQs on Intellectual Disability Diagnostic ...

  20. Disability and Obesity

    Science.gov (United States)

    ... Policy Makers CDC Employees and Reasonable Accommodations (RA) Disability and Obesity Language: English (US) Español (Spanish) ... for children and teens » Challenges Facing People with Disabilities People with disabilities can find it more difficult ...

  1. Disability and Health

    Science.gov (United States)

    ... sheets Fact files Questions & answers Features Multimedia Contacts Disability and health Fact sheet Reviewed November 2016 Key ... services and therefore experience unmet health care needs. Disability and health The International Classification of Functioning, Disability ...

  2. Effect of pre-ischaemic conditioning on hypoxic depolarization of dopamine efflux in the rat caudate brain slice measured in real-time with fast cyclic voltammetry.

    Science.gov (United States)

    Davidson, Colin; Coomber, Ben; Gibson, Claire L; Young, Andrew M J

    2011-10-01

    Fast cyclic voltammetry can be used to measure dopamine release after oxygen and glucose deprivation (OGD) induced anoxic depolarization in vitro. Here we measure dopamine efflux with 1s time resolution, which is appropriate to measure OGD-evoked dopamine efflux accurately. In the present study, we examined whether OGD-evoked dopamine efflux could be used to show pre-ischaemic conditioning in the rat caudate brain slice. Caudate slices were exposed to 0, 2, or 10 min OGD pre-ischaemic conditioning, then 60 min later exposed to a second OGD event of 15 min duration. We measured the OGD-evoked dopamine efflux using fast cyclic voltammetry and in some experiments caudate dopamine and DOPAC tissue levels were measured using HPLC and 20 μm cryostat sections were Nissl stained to indicate neuronal loss. We found that 10 but not 2 min OGD pre-ischaemic conditioning resulted in a longer time to onset of OGD-evoked dopamine efflux on the main OGD event (475 ± 31 and 287 ± 30 s for 10 Vs 0 min pre-ischaemic conditioning respectively). Further, 10 min OGD pre-ischaemic conditioning resulted in less dopamine efflux on the second OGD event (4.23 ± 1.12 and 8.14 ± 0.82 μM for 10 Vs 0 min pre-ischaemic conditioning respectively), despite these slices having similar tissue dopamine content and DOPAC/DA ratio, and the rate of dopamine release was slower in the main OGD event (21 ± 5 and 74 ± 8 nM/s for 10 Vs 0 min pre-ischaemic conditioning respectively). These data suggest that 10 min OGD pre-ischaemic conditioning can evoke tolerance to a second OGD event and that voltammetric recording of OGD-evoked dopamine efflux is a useful model of pre-ischaemic conditioning in neuronal tissue.

  3. Cardiomyocyte death induced by ischaemic/hypoxic stress is differentially affected by distinct purinergic P2 receptors.

    Science.gov (United States)

    Cosentino, Simona; Banfi, Cristina; Burbiel, Joachim C; Luo, Haijian; Tremoli, Elena; Abbracchio, Maria P

    2012-05-01

    Blood levels of extracellular nucleotides (e.g. ATP) are greatly increased during heart ischaemia, but, despite the presence of their specific receptors on cardiomyocytes (both P2X and P2Y subtypes), their effects on the subsequent myocardial damage are still unknown. In this study, we aimed at investigating the role of ATP and specific P2 receptors in the appearance of cell injury in a cardiac model of ischaemic/hypoxic stress. Cells were maintained in a modular incubator chamber in a controlled humidified atmosphere of 95% N(2) for 16 hrs in a glucose-free medium. In this condition, we detected an early increase in the release of ATP in the culture medium, which was followed by a massive increase in the release of cytoplasmic histone-associated-DNA-fragments, a marker of apoptosis. Addition of either apyrase, which degrades extracellular ATP, or various inhibitors of ATP release via connexin hemichannels fully abolished ischaemic/hypoxic stress-associated apoptosis. To dissect the role of specific P2 receptor subtypes, we used a combined approach: (i) non-selective and, when available, subtype-selective P2 antagonists, were added to cardiomyocytes before ischaemic/hypoxic stress; (ii) selected P2 receptors genes were silenced via specific small interfering RNAs. Both approaches indicated that the P2Y(2) and P2χ(7) receptor subtypes are directly involved in the induction of cell death during ischaemic/hypoxic stress, whereas the P2Y(4) receptor has a protective effect. Overall, these findings indicate a role for ATP and its receptors in modulating cardiomyocyte damage during ischaemic/hypoxic stress.

  4. Three-dimensional whole-brain perfused blood volume imaging with multimodal CT for evaluation of acute ischaemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Lu, J.; Zhang, M.; Cao, Y. [Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing (China); Ma, Q. [Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing (China); Chen, J. [Healthcare, Siemens Ltd. China, Beijing (China); Ji, X. [Department of Neurosurgery Xuanwu Hospital, Capital Medical University, Beijing (China); Li, K., E-mail: imaging@yeah.ne [Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing (China)

    2011-06-15

    Aim: To determine the diagnostic value of integrating three-dimensional perfused blood volume (3D PBV) with multimodal computed tomography (CT) [non-enhanced CT (NECT), CT perfusion (CTP), and CT angiography (CTA)] in acute ischaemic stroke. Materials and methods: NECT, CTP, and CTA were performed in 25 acute ischaemic stroke patients. The ischaemia detection rate of 3D PBV was compared with the results of baseline NECT and CTP. The correlation of ischaemic lesion volume between 3D PBV, CTP images, and follow-up NECT were analysed. Results: NECT demonstrated ischaemic signs in 12 of 25 patients with proven infarction. CTP maps of cerebral blood flow (CBF), cerebral blood volume (CBV), and time to peak (TTP) all demonstrated perfusion deficits in 21 of 25 patients. However, 3D PBV demonstrated perfusion deficits in all of the 25 patients. Among the 25 patients, a strong correlation was found between PBV and the follow-up NECT infarct (r = 0.858). The correlation between CTP and the follow-up NECT infarct as following: CBF (r = 0.718), CBV (r = 0.785), and TTP (r = 0.569). In 14 thrombolytic patients, strong correlation was found between the ischaemic volume on 3D PBV and follow-up NECT (r = 0.798). Conclusion: In acute stroke patients, the combination of 3D PBV and multimodal CT (NECT, CTP, and CTA) can improve the detection rate of ischaemia and enable assessment of the full extent of ischaemia, which correlates well with follow-up NECT.

  5. A pitfall in the measurement of arterial blood pressure in the ischaemic limb during elevation

    DEFF Research Database (Denmark)

    Bülow, J; Jelnes, Rolf

    1987-01-01

    In order to evaluate if elevation of the ischaemic limb above heart level is an alternative to the conventionally applied method with external counterpressure for estimation of skin perfusion pressure, femoral and popliteal artery pressures were measured directly in eight patients with occlusion...... of the superficial femoral artery. The measurements were done in the horizontal position and during elevation of the calf above heart level. During elevation relative blood flow, measured by arterio-venous oxygen saturation differences, decreased compared with the horizontal position. In contrast the popliteal...... arterial pressure decreased only by 20% of the value expected from the degree of elevation of the calf above the level of the heart. Thus, it could be calculated that calf vascular resistance increased two- to three-fold on average during elevation. Four patients were reexamined with the venous pressure...

  6. Psychosocial work environment and risk of ischaemic heart disease in women: the Danish Nurse Cohort Study

    DEFF Research Database (Denmark)

    Allesøe, Karen; Hundrup, Yrsa Andersen; Thomsen, Jane Frølund

    2010-01-01

    OBJECTIVES: To investigate the effect of work pressure and job influence on the development of ischaemic heart disease (IHD) in women. METHODS: The effect of work pressure and job influence on the 15-year incidence of IHD in women participating in the Danish Nurse Cohort Study was prospectively...... biological and behavioural risk factors for IHD were collected at baseline. RESULTS: During follow-up, 580 participants were hospitalised with IHD. In the fully adjusted model, nurses who reported work pressure to be much too high had a 1.4-fold increased risk of incident IHD (95% CI 1.04 to 1.81) compared...... with nurses who reported work pressure to be suitable. A tendency towards a dose-response effect was found. Age-stratified analysis showed that this effect was significant only among the younger nurses (

  7. Income and risk of ischaemic heart disease in men and women in a Nordic welfare country

    DEFF Research Database (Denmark)

    Andersen, Ingelise; Osler, Merete; Petersen, Liselotte;

    2003-01-01

    similar for both sexes. Median IHD-free life expectancy for low-income versus high-income groups was reduced by 9.4 and 7.0 years in men and women, respectively. CONCLUSIONS: The effect of household income on risk of IHD was graded and similar for men and women. The difference between high and low income......BACKGROUND: The inverse relation between ischaemic heart disease (IHD) and income is well known among men, but it remains to be clarified whether the relationship between social gradient and IHD is similar for men and women. The present study explores the associations between income and IHD in men......, taking traditional cardiovascular risk factors into account, and estimated IHD-free life expectancy by household income in men and women. RESULTS: During follow-up, 1803 men and 1258 women experienced an event of IHD (21% fatal). The hazards by deciles of income showed a non-linear graded inverse effect...

  8. Genetic variation in the cholesterol transporter NPC1L1, ischaemic vascular disease, and gallstone disease

    DEFF Research Database (Denmark)

    Lauridsen, Bo Kobberø; Stender, Stefan; Frikke-Schmidt, Ruth

    2015-01-01

    variation in NPC1L1, mimicking the effect of ezetimibe, was associated with reduced risk of ischaemic vascular disease (IVD) and with increased risk of symptomatic gallstone disease. METHODS AND RESULTS: We included 67 385 individuals from the general population. Of these, 5255 and 3886 individuals...... developed IVD or symptomatic gallstone disease, respectively, during follow-up from 1977 to 2013. We genotyped four common NPC1L1 variants, previously associated with reduced LDL cholesterol levels, thus mimicking the effect of ezetimibe, and calculated a weighted genotype score. With increasing genotype...... score, LDL cholesterol decreased stepwise up to 3.5% (0.12 mmol/L) and total cholesterol up to 1.9% (0.11 mmol/L) (P-trend: 2 × 10(-12) and 2 × 10(-9)). The cumulative incidence by age of IVD decreased, while that of symptomatic gallstone disease increased as a function of increasing genotype score (P...

  9. The Difficult Diagnosis of Ischaemic Papillary Muscle Rupture; Case report from an urban emergency department

    Directory of Open Access Journals (Sweden)

    Christian T. Braun

    2016-05-01

    Full Text Available We present a rare case of severe ischaemic papillary muscle rupture in a 67-year-old male patient who was admitted to the Emergency Department of the University Hospital Bern, Switzerland, in November 2013 with acute chest pain. On admission, the patient’s blood pressure was 60/40 mm/Hg, his pulse was 110 beats per minute and his respiratory rate was 20 breaths per minute. An electrocardiogram was normal and focused assessment with sonography in trauma was negative. Transthoracic echocardiography showed possible thickening of the mitral valve leaflet with no indications of severe mitral insufficiency or wall motion abnormalities. Triple-ruleout computed tomography angiography revealed no pulmonary emboli or aortic dissection, although coronary atherosclerosis was present. Finally, severe insufficiency of the mitral valve with rupture of the papillary muscle, likely due to ischaemia, was observed via transoesophageal echocardiography. The patient underwent a successful surgical intervention and was discharged 10 days later in stable condition.

  10. Trends in mortality, incidence and case fatality of ischaemic heart disease in Denmark, 1982-1992

    DEFF Research Database (Denmark)

    Osler, M; Sørensen, Thorkild I.A.; Sørensen, S;

    1996-01-01

    BACKGROUND: In Denmark, as in many other Western countries, a decline in mortality from ischaemic heart disease (IHD) has been observed. The present study assesses whether the decline in IHD mortality is due to a decrease in incidence and/or case-fatality, and whether parallel changes occurred...... identified. Cases of AMI and IHD were considered as incident cases if no admission for these diagnoses had occurred during the preceding 5 years. Sex-specific, age-standardized annual mortality, incidence and case-fatality rates of AMI (ICD8 code 410), narrowly defined IHD (NIHD, ICD8 codes 410...... in disease manifestation or diagnostic drift may also contribute because more broadly defined diagnostic groups showed less or no decline in incidence....

  11. Anterior ischaemic optic neuropathy in patient with rheumatoid arthritis--case report.

    Science.gov (United States)

    Perić, S; Cerovski, B; Perić, P

    2001-01-01

    This case report presents a patient with long-lasting rheumatoid arthritis (RA) of fourth clinical grade, having ocular complications. RA was diagnosed according to current modified ARA criteria from 1987. Upon admission to the Department of Ophthalmology clinical examination revealed anterior ischaemic optic neuropathy (AION), which is not characteristic manifestation of RA in the eye. The occurrence of AION in patients with RA has been explained in literature as a secondary manifestation of hypertension in these patients or, by the presence of other connective tissue disease apart from RA (for example, MCTD--mixed connective tissue disease). Both mentioned causes were excluded in our case, as well as any other condition that could lead to AION. Therefore, we had concluded that AION presented a late complication of RA.

  12. Income inequality and ischaemic heart disease in Danish men and women

    DEFF Research Database (Denmark)

    Osler, Merete; Christensen, Ulla; Due, Pernille;

    2003-01-01

    BACKGROUND: It has been hypothesized that areas with an unequal income distribution are less likely to invest in health and more likely to have a social environment that influences the development of ischaemic heart disease (IHD) METHODS: We used pooled data from two cohort studies conducted...... in Copenhagen to analyse the association between area income inequality and first admission to hospital or death from IHD in women and men while controlling for individual income and other IHD risk factors. A total of 11 685 women and 10 036 men, with initial health examinations between 1964 and 1992, were...... followed for a median of 13.8 years. Information on median income share at parish and municipality levels was obtained from population registers. RESULTS: During follow-up 1700 men and 1204 women experienced an IHD event. At parish level income share was inversely associated with an increased risk of IHD...

  13. Transient ischaemic attack and stroke risk: pilot of a primary care electronic decision support tool

    Directory of Open Access Journals (Sweden)

    Ranta A

    2013-06-01

    Full Text Available INTRODUCTION: Transient ischaemic attacks (TIAs indicate high risk for stroke and rapid management reduces stroke burden. Rapid specialist access to initiate timely management is often challenging to achieve. AIM: To assess the feasibility of implementing a TIA/Stroke electronic decision support (EDS tool intended to aid general practitioners (GPs in the timely management of TIAs. METHODS: An eight-week pilot provided access to the TIA/Stroke EDS to selected GPs in the MidCentral district, with subsequent patient record review and a post-pilot user satisfaction survey. RESULTS: Eleven patients from eight practices were entered into the tool and when EDS-rendered advice was followed, diagnosis was accurate and management was in accordance with New Zealand TIA guidelines. No adverse outcomes resulted and user feedback was positive. DISCUSSION: Results indicate that wider implementation of the TIA/Stroke EDS tool is feasible.

  14. Enhanced Vascular Endothelial Growth Factor Gene Expression in Ischaemic Skin of Critical Limb Ischaemia Patients

    Directory of Open Access Journals (Sweden)

    Silvia Bleda

    2012-01-01

    Full Text Available Objectives. To perform a quantitative analysis of the vascular endothelial growth factor (VEGF gene transcription in the skin of ischemic legs and provide information for VEGF in the pathogenesis in critical limb ischemia (CLI. Methods. Skin biopsies were obtained from 40 patients with CLI. Control samples came from 44 patients with chronic venous disease. VEGF gene expression was analysed using quantitative polymerase chain reaction. Results. Patients with CLI had higher skin VEGF expression than control group (RQ: 1.3 ± 0.1 versus 1, P=0.04. Conclusions. We found an association between ischemic skin and an elevated VEGF expression in legs from patients with CLI. These data support that the mechanism for VEGF upregulation in hypoxia conditions is intact and acts appropriately in the ischaemic limbs from patients with CLI.

  15. Stem cell therapy for chronic ischaemic heart disease and congestive heart failure.

    Science.gov (United States)

    Fisher, Sheila A; Doree, Carolyn; Mathur, Anthony; Taggart, David P; Martin-Rendon, Enca

    2016-12-24

    A promising approach to the treatment of chronic ischaemic heart disease and congestive heart failure is the use of stem cells. The last decade has seen a plethora of randomised controlled trials developed worldwide, which have generated conflicting results. The critical evaluation of clinical evidence on the safety and efficacy of autologous adult bone marrow-derived stem/progenitor cells as a treatment for chronic ischaemic heart disease and congestive heart failure. We searched CENTRAL in the Cochrane Library, MEDLINE, Embase, CINAHL, LILACS, and four ongoing trial databases for relevant trials up to 14 December 2015. Eligible studies were randomised controlled trials comparing autologous adult stem/progenitor cells with no cells in people with chronic ischaemic heart disease and congestive heart failure. We included co-interventions, such as primary angioplasty, surgery, or administration of stem cell mobilising agents, when administered to treatment and control arms equally. Two review authors independently screened all references for eligibility, assessed trial quality, and extracted data. We undertook a quantitative evaluation of data using random-effects meta-analyses. We evaluated heterogeneity using the I(2) statistic and explored substantial heterogeneity (I(2) greater than 50%) through subgroup analyses. We assessed the quality of the evidence using the GRADE approach. We created a 'Summary of findings' table using GRADEprofiler (GRADEpro), excluding studies with a high or unclear risk of selection bias. We focused our summary of findings on long-term follow-up of mortality, morbidity outcomes, and left ventricular ejection fraction measured by magnetic resonance imaging. We included 38 randomised controlled trials involving 1907 participants (1114 cell therapy, 793 controls) in this review update. Twenty-three trials were at high or unclear risk of selection bias. Other sources of potential bias included lack of blinding of participants (12 trials) and

  16. Spatial contrast sensitivity in unilateral cerebral ischaemic lesions involving the posterior visual pathway.

    Science.gov (United States)

    Bulens, C; Meerwaldt, J D; van der Wildt, G J; Keemink, C J

    1989-04-01

    Contrast sensitivity function was studied in 16 patients with unilateral ischaemic lesions involving the posterior visual pathway. Sixty-two percent of the patients showed contrast sensitivity loss in at least one eye for horizontal or vertical stimulus orientation. Visual perception was distorted in a qualitatively different way according to the anteroposterior site of the lesion. Patients with occipital or occipitotemporal lesions showed high spatial frequency selective losses and patients with temporal or parietal lesions low frequency selective losses. Stimulus orientation selectivity was observed in patients with lesions of the primary visual cortex as well as in patients with lesions anterior to the striate cortex. Contrast sensitivity orientation-selective losses were demonstrated in 14 of the 17 'affected' eyes.

  17. Should cerebral microbleeds on magnetic resonance imaging contraindicate thrombolysis in patients with ischaemic stroke?

    Energy Technology Data Exchange (ETDEWEB)

    Smith, Kate, E-mail: katesmith.mail@gmail.com [John Radcliffe Hospital, Oxford (United Kingdom); University of Salford (United Kingdom)

    2011-08-15

    Rationale: Cerebral microbleeds (CMBs) may be a marker for increased risk of symptomatic intracranial haemorrhage (SICH) following thrombolysis of patients with ischaemic stroke. This study aims to determine whether the risk of SICH in patients with CMBs is sufficient that thrombolysis should be withheld. Methodology: Systematic review, with literature searched using bibliographic databases and cross-referencing from relevant papers to identify papers meeting predefined criteria. Conclusions: Current research indicates that while risk of SICH may be slightly elevated in patients with CMBs who receive thrombolysis, it is outweighed by the potential benefits of thrombolysis. It is not clear whether large numbers, or particular patterns, of CMBs indicate significantly increased risk. Evidence was found of inconsistency in both the diagnosis and prevalence of CMBs in the studies. Further research should assess whether severe CMBs indicate a clinically significant risk, and investigate classification and epidemiology of CMBs.

  18. Reperfusion Strategies for Acute Ischaemic Stroke From Past to Present: An Overview Towards Future Perspectives

    Directory of Open Access Journals (Sweden)

    Isabella Canavero

    2015-07-01

    Full Text Available Timely reperfusion of brain ischaemic tissue is the main therapeutic target for acute stroke. In the last few decades many recanalisation strategies have been studied by randomised controlled trials (RCTs, including intravenous (IV, intra-arterial (IA, and combined approaches. Clinical research is addressed to identify the drug associated with the better reperfusion properties and the lower rate of side-effects. To date, according to current evidence-based guidelines, IV tissue plasminogen activator (tPA is the only approved treatment for acute ischaemic stroke (AIS within 4.5 hours from onset. Other IV thrombolytics, such as tenecteplase and desmoteplase, have shown promising results in preliminary RCTs and are currently being investigated to produce further evidence. Endovascular catheter-based treatments (including IA administration of thrombolytics or mechanical thrombectomy have quite inferior feasibility, being performed only by stroke-trained interventional neuroradiologists. Until a few months ago, many trials had investigated the safety and efficacy of endovascular techniques compared with IV tPA without consistent results, limiting their application to patients with contraindications or poor response to IV tPA. More recently, the Multicenter Randomized Clinical trial of Endovascular treatment for Acute ischemic stroke in the Netherlands (MR CLEAN, Endovascular treatment for Small Core and Anterior circulation Proximal occlusion with Emphasis on minimizing CT to recanalization times (ESCAPE, and Extending the Time for Thrombolysis in Emergency Neurological Deficits–Intra-arterial (EXTEND-IA trial results have demonstrated the superiority of endovascular procedures associated with standard care in AIS due to proximal arterial occlusion in the anterior cerebral circulation. These data are going to change the current decision-making process and the care pathway in AIS patients.

  19. Pregnancy outcome in patients with antiphospholipid syndrome after cerebral ischaemic events: an observational study.

    Science.gov (United States)

    Fischer-Betz, R; Specker, C; Brinks, R; Schneider, M

    2012-10-01

    Among the most prominent features associated with antiphospholipid syndrome (APS) are cerebral ischaemic events (CVE). Pregnancy with APS increases the risk of thrombosis, including CVE. This study was undertaken to assess the risk of obstetric complications and recurrence of CVE during pregnancy in women with APS and previous CVE. We prospectively observed 23 pregnancies in 20 women (median age 31 years) with primary (n = 8) or secondary APS (n = 12). Eight patients had transient ischaemic attacks (TIA) and 12 had stroke before pregnancy. All patients received aspirin 100 mg daily in combination with low molecular weight heparin (LMWH) during their pregnancies. The live birth rate was 91.3% (n = 21). Obstetrical complications consisted mainly of preeclampsia (n = 8, 34.8%) and preterm delivery (n = 9, 42.9%). The risk for preeclampsia increased in patients who were positive for multiple antiphospholipid antibodies (aPL) (odds ratio (OR) 3.06 (95% confidence interval (CI) 1.01-9.32)) per positive aPL test (i.e anticardiolipin antibody, anti-ß2-glycoprotein I antibody, lupus anticoagulant) (p 0.049). Three patients experienced recurrent CVE in the context of pregnancy (one during pregnancy, two in the postpartum period). We found an increased, but not significant, risk of a new episode of cerebral ischaemia in patients with pregnancies complicated by preeclampsia (two out of the eight preeclampsia (p 0.15). Despite treatment, there is a significant risk for pregnancy complications in APS patients with previous CVE. Especially in the context of preeclampsia, anticoagulation should be given rigorously to prevent recurrence of CVE.

  20. Annexin 1 and Melanocortin Peptide Therapy for Protection Against Ischaemic-Reperfusion Damage in the Heart

    Directory of Open Access Journals (Sweden)

    F.N.E. Gavins

    2006-01-01

    Full Text Available Cardiovascular disease is a major cause of mortality within the western world affecting 2.7 million British people. This review highlights the beneficial effects of naturally occurring hormones and their peptides, in myocardial ischaemic-injury (MI models, a disease pathology in which cytokines and neutrophils play a causal role. Here we discuss two distinct classes of endogenous peptides: the steroid inducible annexin 1 and the melanocortin peptides. Annexin 1 and the melanocortins counteract the most important part of the host inflammatory response, namely, the process of leukocyte extravasation, as well as release of proinflammatory mediators. Their biological effects are mediated via the seven transmembrane G-protein-coupled receptors, the fMLP receptor family (or FPR, and the melanocortin receptors, respectively. Pharmacological analysis has demonstrated that the first 24 amino acids of the N-terminus (termed Ac2-26 are the most active region. Both exogenous annexin 1 and its peptides demonstrate cardioprotectiveness and continuing work is required to understand this annexin 1/FPR relationship fully. The melanocortin peptides are derived from a precursor molecule called the POMC protein. These peptides display potent anti-inflammatory effects in human and animal models of disease. In MI, the MC3R has been demonstrated to play an important role in mediating the protective effects of these peptides. The potential anti-inflammatory role for endogenous peptides in cardiac disease is in its infancy. The inhibition of cell migration and release of cytokines and other soluble mediators appears to play an important role in affording protection in ischaemic injury and thus may lead to potential therapeutic targets.

  1. Effect of the Interaction between Recanalization and Collateral Circulation on Functional Outcome in Acute Ischaemic Stroke.

    Science.gov (United States)

    Mangiafico, Salvatore; Saia, Valentina; Nencini, Patrizia; Romani, Ilaria; Palumbo, Vanessa; Pracucci, Giovanni; Consoli, Arturo; Rosi, Andrea; Renieri, Leonardo; Nappini, Sergio; Limbucci, Nicola; Inzitari, Domenico; Gensini, Gian Franco

    2014-12-01

    Identification of patients with acute ischaemic stroke who could most benefit from arterial recanalization after endovascular treatment remains an unsettled issue. Although several classifications of collateral circulation have been proposed, the clinical role of collaterals is still debated. We evaluated the effect of the collateral circulation in relation to recanalization as a predictor of clinical outcome. Data were prospectively collected from 103 patients consecutively treated for proximal middle cerebral or internal carotid artery occlusion. The collateral circulation was evaluated with a novel semiquantitative-qualitative score, the Careggi collateral score (CCS), in six grades. Both CCS and recanalization grades (TICI) were analysed in relation to clinical outcome. A statistical analysis was performed to evaluate the effect of interaction between recanalization and collateral circulation on clinical outcome. Out of the 103 patients, 37 (36.3%) had poor collaterals, and 65 (63.7%) had good collaterals. Patients with good collaterals had lower basal National Institute of Health Stroke Scale (NIHSS), more distal occlusion, smaller lesions at 24h CT scan and better functional outcome. After multivariate analysis, the interaction between recanalization and collateral grades was significantly stronger as a predictor of good outcome (OR 6.87, 95% CI 2.11-22.31) or death (OR 4.66, 95%CI 1.48-14.73) compared to the effect of the single variables. Collaterals showed an effect of interaction with the recanalization grade in determining a favourable clinical outcome. Assessment of the collateral circulation might help predict clinical results after recanalization in patients undergoing endovascular treatment for acute ischaemic stroke.

  2. Interruption to antiplatelet therapy early after acute ischaemic stroke: a nested case-control study.

    Science.gov (United States)

    Mazlan-Kepli, Wardati; Macisaac, Rachael L; Walters, Matthew; Bath, Philip Michael William; Dawson, Jesse

    2017-09-01

    Antiplatelet drugs are often discontinued early after ischaemic stroke, either because of poor compliance, complications or withdrawal of care. It is unclear whether this places patients at increased risk of recurrence. We explored the association between cardiovascular event rate and persistence with prescribed antiplatelet drugs. We used a matched case-control design using the Virtual International Stroke Trials Archive (VISTA). Cases were patients who had an acute coronary syndrome, recurrent stroke or transient ischaemic attack within 90 days post-stroke and were matched for age ± 10 years and sex with up to four controls. Antiplatelet use was categorized as persistent (used for >3 days and continued up to day 90), early cessation (used antiplatelet 3 days but stopped prior to day 90). These categories were compared in cases and controls using a conditional logistic regression model that adjusted for potential confounders. A total of 970 patients were included, of whom 194 were cases and 776 were matched controls. At 90 days, 10 cases (5.2%) and 58 controls (7.5%) stopped/interrupted their antiplatelet. The risk of cardiovascular event was not different in stopped/interrupted users (adjusted odds ratio 0.70, 95% confidence interval 0.33, 1.48; P = 0.352) and early cessations (adjusted odds ratio 1.04, 95% confidence interval 0.62, 1.74; P = 0.876) when compared to persistent users. We found no increased risk in patients who stopped and interrupted antiplatelets early after stroke but the study was limited by a small sample size and further research is needed. © 2017 The British Pharmacological Society.

  3. Injected matrix stimulates myogenesis and regeneration of mouse skeletal muscle after ischaemic injury

    Directory of Open Access Journals (Sweden)

    D Kuraitis

    2012-09-01

    Full Text Available Biomaterial-guided regeneration represents a novel approach for the treatment of myopathies. Revascularisation and the intramuscular extracellular matrix are important factors in stimulating myogenesis and regenerating muscle damaged by ischaemia. In this study, we used an injectable collagen matrix, enhanced with sialyl LewisX (sLeX, to guide skeletal muscle differentiation and regeneration. The elastic properties of collagen and sLeX-collagen matrices were similar to those of skeletal muscle, and culture of pluripotent mESCs on the matrices promoted their differentiation into myocyte-like cells expressing Pax3, MHC3, myogenin and Myf5. The regenerative properties of matrices were evaluated in ischaemic mouse hind-limbs. Treatment with the sLeX-matrix augmented the production of myogenic-mediated factors insulin-like growth factor (IGF-1, and IGF binding protein-2 and -5 after 3 days. This was followed by muscle regeneration, including a greater number of regenerating myofibres and increased transcription of Six1, M-cadherin, myogenin and Myf5 after 10 days. Simultaneously, the sLeX-matrix promoted increased mobilisation and engraftment of bone marrow-derived progenitor cells, the development of larger arterioles and the restoration of tissue perfusion. Both matrix treatments tended to reduce maximal forces of ischaemic solei muscles, but sLeX-matrix lessened this loss of force and also prevented muscle fatigue. Only sLeX-matrix treatment improved mobility of mice on a treadmill. Together, these results suggest a novel approach for regenerative myogenesis, whereby treatment only with a matrix, which possesses an inherent ability to guide myogenic differentiation of pluripotent stem cells, can enhance the endogenous vascular and myogenic regeneration of skeletal muscle, thus holding promise for future clinical use.

  4. Injected matrix stimulates myogenesis and regeneration of mouse skeletal muscle after ischaemic injury.

    Science.gov (United States)

    Kuraitis, D; Ebadi, D; Zhang, P; Rizzuto, E; Vulesevic, B; Padavan, D T; Al Madhoun, A; McEwan, K A; Sofrenovic, T; Nicholson, K; Whitman, S C; Mesana, T G; Skerjanc, I S; Musarò, A; Ruel, M; Suuronen, E J

    2012-09-12

    Biomaterial-guided regeneration represents a novel approach for the treatment of myopathies. Revascularisation and the intramuscular extracellular matrix are important factors in stimulating myogenesis and regenerating muscle damaged by ischaemia. In this study, we used an injectable collagen matrix, enhanced with sialyl LewisX (sLeX), to guide skeletal muscle differentiation and regeneration. The elastic properties of collagen and sLeX-collagen matrices were similar to those of skeletal muscle, and culture of pluripotent mESCs on the matrices promoted their differentiation into myocyte-like cells expressing Pax3, MHC3, myogenin and Myf5. The regenerative properties of matrices were evaluated in ischaemic mouse hind-limbs. Treatment with the sLeX-matrix augmented the production of myogenic-mediated factors insulin-like growth factor (IGF)-1, and IGF binding protein-2 and -5 after 3 days. This was followed by muscle regeneration, including a greater number of regenerating myofibres and increased transcription of Six1, M-cadherin, myogenin and Myf5 after 10 days. Simultaneously, the sLeX-matrix promoted increased mobilisation and engraftment of bone marrow-derived progenitor cells, the development of larger arterioles and the restoration of tissue perfusion. Both matrix treatments tended to reduce maximal forces of ischaemic solei muscles, but sLeX-matrix lessened this loss of force and also prevented muscle fatigue. Only sLeX-matrix treatment improved mobility of mice on a treadmill. Together, these results suggest a novel approach for regenerative myogenesis, whereby treatment only with a matrix, which possesses an inherent ability to guide myogenic differentiation of pluripotent stem cells, can enhance the endogenous vascular and myogenic regeneration of skeletal muscle, thus holding promise for future clinical use.

  5. Interviewing the moderator

    DEFF Research Database (Denmark)

    Traulsen, Janine Morgall; Almarsdóttir, Anna Birna; Björnsdóttir, Ingunn

    2004-01-01

    of a one-on-one interview with the FG moderator by another member of the research team. The authors argue, with reference to a specific study, that interviewing the moderator adds a new and valuable dimension to group interviews used in research. They describe how this method came about and provide...... a concrete example of its use in a recently completed research project. They discuss several advantages of the interview, among them that it provides information about group interaction and participant behavior, and furnishes additional data on what is discussed when the tape recorder is turned off....

  6. Curved reformat of the paediatric brain MRI into a 'flat-earth map' - standardised method for demonstrating cortical surface atrophy resulting from hypoxic-ischaemic encephalopathy.

    Science.gov (United States)

    Simpson, Ewan; Andronikou, Savvas; Vedajallam, Schadie; Chacko, Anith; Thai, Ngoc Jade

    2016-09-01

    Hypoxic-ischaemic encephalopathy is optimally imaged with brain MRI in the neonatal period. However neuroimaging is often also performed later in childhood (e.g., when parents seek compensation in cases of alleged birth asphyxia). We describe a standardised technique for creating two curved reconstructions of the cortical surface to show the characteristic surface changes of hypoxic-ischaemic encephalopathy in children imaged after the neonatal period. The technique was applied for 10 cases of hypoxic-ischaemic encephalopathy and also for age-matched healthy children to assess the visibility of characteristic features of hypoxic-ischaemic encephalopathy. In the abnormal brains, fissural or sulcal widening was seen in all cases and ulegyria was identifiable in 7/10. These images could be used as a visual aid for communicating MRI findings to clinicians and other interested parties.

  7. Cost-effectiveness of remote ischaemic conditioning as an adjunct to primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction

    DEFF Research Database (Denmark)

    Sloth, Astrid D; Schmidt, Michael R; Munk, Kim

    2016-01-01

    infarction were randomly assigned to remote ischaemic conditioning as an adjunct to primary percutaneous coronary intervention (n=126) or to primary percutaneous coronary intervention alone (n=125). During a 4-year follow-up period, we used data from Danish medical registries and medical records to estimate...... within-trial cardiovascular medical care costs and major adverse cardiac and cerebrovascular event-free survival. After 4 years of follow-up, mean cumulative cardiovascular medical care costs were €2763 (95% confidence interval 207-5318, P=0.034) lower in the remote ischaemic conditioning group than......, remote ischaemic conditioning therapy was economically dominant (less costly and more effective) in 97.26% of 10,000 bootstrap replications. CONCLUSION: Remote ischaemic conditioning as an adjunct to primary percutaneous coronary intervention appears to be a cost-effective treatment strategy in patients...

  8. Selection of patients for intra-arterial treatment for acute ischaemic stroke : Development and validation of a clinical decision tool in two randomised trials

    NARCIS (Netherlands)

    E. Venema (Esmee); M.J.H.L. Mulder (Maxim); B. Roozenbeek (Bob); J.P. Broderick (Joseph P.); S.D. Yeatts (Sharon D.); P. Khatri (Pooja); O.A. Berkhemer (Olvert); B.J. Emmer (Bart J.); Y.B.W.E.M. Roos (Yvo); C.B. Majoie (Charles); R.J. Van Oostenbrugge; W.H. van Zwam (Wim); A. van der Lugt (Aad); E.W. Steyerberg (Ewout); D.W.J. Dippel (Diederik); H.F. Lingsma (Hester)

    2017-01-01

    markdownabstract__Objective__ To improve the selection of patients with acute ischaemic stroke for intra-arterial treatment using a clinical decision tool to predict individual treatment benefit. __Design__ Multivariable regression modelling with data from two randomised controlled clinical

  9. The anti-ischaemic activity of the novel compound, CERM 11956, compared with that of bepridil and nifedipine in isolated guinea-pig hearts.

    Science.gov (United States)

    Boddeke, E W; Wilffert, B; Heynis, J B; Hugtenburg, J G; Jap, W T; Veldsema-Currie, R D; Van Zwieten, P A

    1988-05-10

    A comparison between the protective activity of bepridil, its novel derivative, CERM 11956, and nifedipine in isolated electrically paced guinea-pig hearts after 60 min of global ischaemia followed by 30 min of reperfusion has been made. All three compounds exerted a significant anti-ischaemic effect, as indicated by an improved recovery of functional parameters (left ventricular pressure and coronary perfusion), a delayed onset of the ischaemic contracture, and an enhanced recovery of biochemical (CrP, ATP and adenylate energy charge) parameters. The most pronounced anti-ischaemic activity was shown by the compound CERM 11956 at concentrations that displayed only minor negative inotropic activity. From the results it may be concluded that the new bepridil derivative, CERM 11956, is a promising and potent anti-ischaemic compound, which has little influence on haemodynamic parameters.

  10. Remote ischaemic conditioning on recipients of deceased renal transplants, effect on immediate and extended kidney graft function : a multicentre, randomised controlled trial protocol (CONTEXT)

    NARCIS (Netherlands)

    Krogstrup, Nicoline V; Oltean, Mihai; Bibby, Bo M; Nieuwenhuijs-Moeke, Gertrude J; Dor, Frank J M F; Birn, Henrik; Jespersen, Bente

    2015-01-01

    Introduction: Delayed graft function due to ischaemia-reperfusion injury is a frequent complication in deceased donor renal transplantation. Experimental evidence indicates that remote ischaemic conditioning (RIC) provides systemic protection against ischaemia-reperfusion injury in various tissues.

  11. Exploratory study of plasma total homocysteine and its relationship to short-term outcome in acute ischaemic stroke in Nigerians

    Directory of Open Access Journals (Sweden)

    Awosanya Gbolahan O

    2008-07-01

    Full Text Available Abstract Background Hyperhomocysteinemia is a potentially modifiable risk factor for stroke, and may have a negative impact on the course of ischaemic stroke. The role of hyperhomocysteinemia as it relates to stroke in Africans is still uncertain. The objective of this study was to determine the prevalence and short-term impact of hyperhomocysteinemia in Nigerians with acute ischaemic stroke. We hypothesized that Hcy levels are significantly higher than in normal controls, worsen stroke severity, and increase short-term case fatality rates following acute ischaemic stroke. Methods The study employed both a case-control and prospective follow-up design to study hospitalized adults with first – ever acute ischaemic stroke presenting within 48 hours of onset. Clinical histories, neurological evaluation (including National Institutes of Health Stroke Scale (NIHSS scores on admission were documented. Total plasma Hcy was determined on fasting samples drawn from controls and stroke cases (within 24 hours of hospitalization. Outcome at 4 weeks was assessed in stroke patients using the Glasgow Outcome Scale (GOS. Results We evaluated 155 persons (69 acute ischaemic stroke and 86 healthy controls. The mean age ± SD of the cases was 58.8 ± 9.8 years, comparable to that of controls which was 58.3 ± 9.9 years (T = 0.32; P = 0.75. The mean duration of stroke (SD prior to hospitalization was 43.5 ± 38.8 hours, and mean admission NIHSS score was 10.1 ± 7.7. Total fasting Hcy in stroke patients was 10.2 ± 4.6 umol/L and did not differ significantly from controls (10.1 ± 3.6 umol/L; P = 0.88. Hyperhomocysteinemia, defined by plasma Hcy levels > 90th percentile of controls (>14.2 umol/L in women and >14.6 umol/L in men, was present in 7 (10.1% stroke cases and 11 (12.8% controls (odds ratio 0.86, 95% confidence interval 0.31 – 2.39; P > 0.05. In multiple regression analysis admission NIHSS score (but not plasma Hcy was a significant determinant of 4

  12. Moderator Chemistry Program

    Energy Technology Data Exchange (ETDEWEB)

    Dewitt, L.V.; Gibbs, A.; Lambert, D.P.; Bohrer, S.R.; Fanning, R.L.; Houston, M.W.; Stinson, S.L.; Deible, R.W.; Abdel-Khalik, S.I.

    1990-11-01

    Over the past fifteen months, the Systems Chemistry Group of the Reactor Engineering Department has undertaken a comprehensive study of the Department`s moderator chemistry program at Savannah River Site (SRS). An internal review was developed to formalize and document this program. Objectives were as outlined in a mission statement and action plan. In addition to the mission statement and action plan, nine separate task reports have been issued during the course of this study. Each of these task reports is included in this document as a chapter. This document is an organized compilation of the individual reports issued by the Systems Chemistry Group in assessment of SRS moderator chemistry to determine if there were significant gaps in the program as ft existed in October, 1989. While these reviews found no significant gaps in that mode of operation, or any items that adversely affected safety, items were identified that could be improved. Many of the items have already been dear with or are in the process of completion under this Moderator Chemistry Program and other Reactor Restart programs. A complete list of the items of improvement found under this assessment is found in Chapter 9, along with a proposed time table for correcting remaining items that can be improved for the chemistry program of SRS reactors. An additional external review of the moderator chemistry processes, recommendations, and responses to/from the Reactor Corrosion Mitigation Committee is included as Appendix to this compilation.

  13. Moderator Chemistry Program

    Energy Technology Data Exchange (ETDEWEB)

    Dewitt, L.V.; Gibbs, A.; Lambert, D.P.; Bohrer, S.R.; Fanning, R.L.; Houston, M.W.; Stinson, S.L.; Deible, R.W.; Abdel-Khalik, S.I.

    1990-11-01

    Over the past fifteen months, the Systems Chemistry Group of the Reactor Engineering Department has undertaken a comprehensive study of the Department's moderator chemistry program at Savannah River Site (SRS). An internal review was developed to formalize and document this program. Objectives were as outlined in a mission statement and action plan. In addition to the mission statement and action plan, nine separate task reports have been issued during the course of this study. Each of these task reports is included in this document as a chapter. This document is an organized compilation of the individual reports issued by the Systems Chemistry Group in assessment of SRS moderator chemistry to determine if there were significant gaps in the program as ft existed in October, 1989. While these reviews found no significant gaps in that mode of operation, or any items that adversely affected safety, items were identified that could be improved. Many of the items have already been dear with or are in the process of completion under this Moderator Chemistry Program and other Reactor Restart programs. A complete list of the items of improvement found under this assessment is found in Chapter 9, along with a proposed time table for correcting remaining items that can be improved for the chemistry program of SRS reactors. An additional external review of the moderator chemistry processes, recommendations, and responses to/from the Reactor Corrosion Mitigation Committee is included as Appendix to this compilation.

  14. Den moderate revolution

    DEFF Research Database (Denmark)

    Larsen, Bøje

    "normale" industrivirksomheder, men den er absolut set begrænset. Årsagerne til denne kun "moderate revolution" af organisationsformerne diskuteres: Er det fordi klassisk organisation og social nærkontakt er nødvendig i den nye økonomi, eller er det manglende fantasi og tryghedsbehov? Begge muligheder...

  15. Comparative study of disability-free life expectancy across six low- and middle-income countries.

    Science.gov (United States)

    Chirinda, Witness; Chen, He

    2017-04-01

    There is a knowledge gap about the disability-free life expectancy (DFLE) in low- and middle-income countries. The present study aimed to compute and compare DFLE in six such countries, and examine sex differences in DFLE in each country. Based on data from the World Health Organization Study on Global Aging and Adult Health wave 1 survey, we used the Sullivan method to estimate DFLE among persons aged years 50 years and older. Disability was divided into moderate disability and severe disability during the calculation. Of the six countries, China had the highest DFLE and lowest expected average lifetime with disability. India had the lowest DFLE and highest life years with moderate and severe disability. In each country, women live longer than men, but with more disabilities in both absolute and proportional terms. The huge sex difference in Russia requires special attention. In addition, most of the life expectancy lived with disability was spent with severe disability, rather than moderate disability. The study has shed some light on the disparities across the six countries with regard to DFLE at old ages. The low percentage of DFLE in life expectancy in some countries, such as India, calls for effective policies on healthy aging. The "sex disability-survival paradox" in DFLE is supported by our results. To differentiate the severity of disability should be routine in calculating DFLE. Geriatr Gerontol Int 2017; 17: 637-644. © 2016 Japan Geriatrics Society.

  16. Differences in HIV knowledge and sexual practices of learners with intellectual disabilities and non-disabled learners in Nigeria

    Directory of Open Access Journals (Sweden)

    Toyin J Aderemi

    2013-02-01

    Full Text Available Introduction: Individuals with intellectual disabilities are rarely targeted by the current human immunodeficiency virus (HIV response, thereby reducing their access to HIV information and services. Currently, little is known about the HIV knowledge and sexual practices of young Nigerians with intellectual disabilities. Thus, this study sought to compare the HIV knowledge and sexual practices of learners with mild/moderate intellectual disabilities and non-disabled learners (NDL in Nigeria. Findings could help in the development of HIV interventions that are accessible to Nigerian learners with intellectual impairments. Methods: This cross-sectional, comparative study utilized a survey to investigate HIV knowledge and sexual practices among learners with mild/moderate intellectual disabilities and NDL in Nigeria. Learners with mild/moderate intellectual disabilities (n=300 and NDL (n=300 within the age range of 12 to 19 years drawn from schools across Oyo State, Nigeria, completed a structured questionnaire to assess their knowledge of HIV transmission and sexual practices. Results: Significantly more learners with mild/moderate intellectual disabilities (62.2% than NDL 48 (37.8% reported having sexual experience (p=0.002. Of the sexually experienced female learners with mild/moderate intellectual disabilities, 28 (68.3% reported history of rape compared with 9 (2.9% of female NDL (p=0.053. Intellectual impairment was significantly associated with lower HIV transmission knowledge scores (p<0.001. Learners with mild/moderate intellectual disabilities were less likely than NDL (p<0.001 to have heard about HIV from most of the common sources of HIV information. In addition, when compared with non-disabled learners, learners with mild/moderate intellectual disabilities were significantly more likely to have reported inconsistent condom use with boyfriends/girlfriends (p<0.001, with casual sexual partners (p<0.001 and non-use of condom during last

  17. A large web-based observer reliability study of early ischaemic signs on computed tomography. The Acute Cerebral CT Evaluation of Stroke Study (ACCESS.

    Directory of Open Access Journals (Sweden)

    Joanna M Wardlaw

    Full Text Available BACKGROUND: Early signs of ischaemic stroke on computerised tomography (CT scanning are subtle but CT is the most widely available diagnostic test for stroke. Scoring methods that code for the extent of brain ischaemia may improve stroke diagnosis and quantification of the impact of ischaemia. METHODOLOGY AND PRINCIPAL FINDINGS: We showed CT scans from patients with acute ischaemic stroke (n = 32, with different patient characteristics and ischaemia signs to doctors in stroke-related specialties world-wide over the web. CT scans were shown twice, randomly and blindly. Observers entered their scan readings, including early ischaemic signs by three scoring methods, into the web database. We compared observers' scorings to a reference standard neuroradiologist using area under receiver operator characteristic curve (AUC analysis, Cronbach's alpha and logistic regression to determine the effect of scales, patient, scan and observer variables on detection of early ischaemic changes. Amongst 258 readers representing 33 nationalities and six specialties, the AUCs comparing readers with the reference standard detection of ischaemic signs were similar for all scales and both occasions. Being a neuroradiologist, slower scan reading, more pronounced ischaemic signs and later time to CT all improved detection of early ischaemic signs and agreement on the rating scales. Scan quality, stroke severity and number of years of training did not affect agreement. CONCLUSIONS: Large-scale observer reliability studies are possible using web-based tools and inform routine practice. Slower scan reading and use of CT infarct rating scales improve detection of acute ischaemic signs and should be encouraged to improve stroke diagnosis.

  18. A Large Web-Based Observer Reliability Study of Early Ischaemic Signs on Computed Tomography. The Acute Cerebral CT Evaluation of Stroke Study (ACCESS)

    Science.gov (United States)

    Wardlaw, Joanna M.; von Kummer, Rüdiger; Farrall, Andrew J.; Chappell, Francesca M.; Hill, Michael; Perry, David

    2010-01-01

    Background Early signs of ischaemic stroke on computerised tomography (CT) scanning are subtle but CT is the most widely available diagnostic test for stroke. Scoring methods that code for the extent of brain ischaemia may improve stroke diagnosis and quantification of the impact of ischaemia. Methodology and Principal Findings We showed CT scans from patients with acute ischaemic stroke (n = 32, with different patient characteristics and ischaemia signs) to doctors in stroke-related specialties world-wide over the web. CT scans were shown twice, randomly and blindly. Observers entered their scan readings, including early ischaemic signs by three scoring methods, into the web database. We compared observers' scorings to a reference standard neuroradiologist using area under receiver operator characteristic curve (AUC) analysis, Cronbach's alpha and logistic regression to determine the effect of scales, patient, scan and observer variables on detection of early ischaemic changes. Amongst 258 readers representing 33 nationalities and six specialties, the AUCs comparing readers with the reference standard detection of ischaemic signs were similar for all scales and both occasions. Being a neuroradiologist, slower scan reading, more pronounced ischaemic signs and later time to CT all improved detection of early ischaemic signs and agreement on the rating scales. Scan quality, stroke severity and number of years of training did not affect agreement. Conclusions Large-scale observer reliability studies are possible using web-based tools and inform routine practice. Slower scan reading and use of CT infarct rating scales improve detection of acute ischaemic signs and should be encouraged to improve stroke diagnosis. PMID:21209901

  19. The contribution of osteoarthritis to functional limitations and disability

    Science.gov (United States)

    McDonough, Christine M.; Jette, Alan M.

    2012-01-01

    Synopsis This article uses the Disablement Model conceptual framework to guide an analysis of the importance of OA in the development of disability. The Disablement Model describes the development and progression of disablement from impairments to specific functional limitations and disability, and the hypothesized role of predisposing risk factors, extra-individual factors, and intra-individual factors. A wide range of population and clinical studies have characterized the unequivocal contribution of arthritis to the development of functional limitations and disability. Evidence overwhelmingly supports a significant, moderate independent contribution of arthritis to the onset and progression of functional limitations and disability. With respect to important risk factors for the development of functional limitations and disability among those with OA, the evidence provides strong support for the role of physical impairments along with other predisposing and intra-individual factors such as age; body mass index, obesity, lack of exercise, comorbid conditions, depression; and depressive symptoms. Extra-individual factors included need for aids and assistance, and lack of access to public or private transportation. Future disablement research must clarify the causal mechanisms behind a potential risk factor’s impact on disability and delineate the interplay between and among the various hypothesized steps in the disablement process. PMID:20699161

  20. Safety and efficacy of thrombectomy in acute ischaemic stroke (REVASCAT): 1-year follow-up of a randomised open-label trial.

    Science.gov (United States)

    Dávalos, Antoni; Cobo, Erik; Molina, Carlos A; Chamorro, Angel; de Miquel, M Angeles; Román, Luis San; Serena, Joaquín; López-Cancio, Elena; Ribó, Marc; Millán, Mónica; Urra, Xabier; Cardona, Pere; Tomasello, Alejandro; Castaño, Carlos; Blasco, Jordi; Aja, Lucía; Rubiera, Marta; Gomis, Meritxell; Renú, Arturo; Lara, Blanca; Martí-Fàbregas, Joan; Jankowitz, Brian; Cerdà, Neus; Jovin, Tudor G

    2017-05-01

    The REVASCAT trial and other studies have shown that the neurovascular thrombectomy improves outcomes at 90 days post stroke. However, whether the observed benefit is sustained in the long term remains unknown. We report the results of the prespecified 12-month analysis of the REVASCAT trial. Patients with acute ischaemic stroke who could be treated within 8 h of symptom onset were randomly assigned to medical therapy (including intravenous alteplase when eligible) and neurovascular thrombectomy with Solitaire FR or medical therapy alone. The main secondary outcome measure at 1 year follow-up was disability, measured using the modified Rankin Scale (mRS), ranging from 0 (no symptoms) to 6 (death) with categories 5 (severe disability) and 6 (death) collapsed into one category (severe disability or death), analysed as the distribution of the mRS. Additional prespecified secondary outcome measures included health-related quality of life measured with the EuroQol five dimensions questionnaire (EQ-5D) utility index (ranging from -0·3 to 1, higher values indicate better quality of life), the rate of functional independence (mRS 0-2), and cognitive function measured with the Trail Making Test (reported elsewhere). Treatment allocation was open label but endpoints at 12 months were assessed by masked investigators. The trial was registered at ClinicalTrials.gov, number NCT01692379. From Nov 24, 2012, to Dec 12, 2014, 206 patients were randomly assigned to medical therapy plus endovascular treatment (n=103) or medical treatment alone (n=103), at four centres in Catalonia, Spain. At 12 months post randomisation, based on 205 of 206 outcomes available at 12 months, thrombectomy reduced disability over the range of the mRS (common adjusted odds ratio [aOR] 1·80, 95% CI 1·09-2·99), and improved functional independence (mRS=0-2; 45 [44%] of 103 patients vs 31 [30%] of 103 patients; aOR 1·86, 95% CI 1·01-3·44). Health-related quality of life was superior in the

  1. The use of conventional EEG for the assessment of hypoxic ischaemic encephalopathy in the newborn: a review.

    LENUS (Irish Health Repository)

    Walsh, B H

    2012-01-31

    Neonatal hypoxic ischaemic encephalopathy continues to be one of the leading causes of morbidity and mortality among neonates around the globe. With the advent of therapeutic hypothermia, the need to accurately classify the severity of injury in the early neonatal period is of great importance. As clinical measures cannot always accurately estimate the severity early enough for treatment to be initiated, clinicians have become more dependent on conventional and amplitude integrated EEG. Despite this, there is currently no single agreed classification scheme for the neonatal EEG in hypoxic ischaemic encephalopathy. In this review we discuss classification schemes of neonatal background EEG, published over the past 35 years, highlighting the urgent need for a universal visual analysis scheme.

  2. The use of conventional EEG for the assessment of hypoxic ischaemic encephalopathy in the newborn: a review.

    LENUS (Irish Health Repository)

    Walsh, B H

    2011-07-01

    Neonatal hypoxic ischaemic encephalopathy continues to be one of the leading causes of morbidity and mortality among neonates around the globe. With the advent of therapeutic hypothermia, the need to accurately classify the severity of injury in the early neonatal period is of great importance. As clinical measures cannot always accurately estimate the severity early enough for treatment to be initiated, clinicians have become more dependent on conventional and amplitude integrated EEG. Despite this, there is currently no single agreed classification scheme for the neonatal EEG in hypoxic ischaemic encephalopathy. In this review we discuss classification schemes of neonatal background EEG, published over the past 35 years, highlighting the urgent need for a universal visual analysis scheme.

  3. Subcutaneous fat necrosis in neonates with hypoxic ischaemic encephalopathy registered in the Swiss National Asphyxia and Cooling Register

    OpenAIRE

    Grass, Beate; Weibel, Lisa; Hagmann, Cornelia; Brotschi, Barbara

    2015-01-01

    Background Neonates with hypoxic ischaemic encephalopathy (HIE) are routinely treated with therapeutic hypothermia (TH) for 72 h in order to improve neurological outcome. Subcutaneous fat necrosis (SCFN) is an adverse event occurring in neonates with HIE. Methods We analyzed risk factors for SCFN regarding demographic factors, cooling methods and deviation from target temperature range during hypothermia therapy. Data of all neonates registered in the National Asphyxia and Cooling Register in...

  4. Women with Disabilities and Breast Cancer Screening

    Science.gov (United States)

    ... About CDC.gov . Disability & Health Home Disability Overview Disability Inclusion Barriers to Inclusion Inclusion Strategies Inclusion in Programs & Activities Resources Healthy Living Disability & Physical Activity Disability & Obesity Disability & Smoking Disability & Breast ...

  5. Diagnostic performance of PWI/DWI MRI parameters in discriminating hyperacute versus acute ischaemic stroke: Finding the best thresholds

    Energy Technology Data Exchange (ETDEWEB)

    Roldan-Valadez, E., E-mail: ernest.roldan@usa.net [Magnetic Resonance Unit, Medica Sur Hospital and Clinic Foundation, Mexico City (Mexico); Gonzalez-Gutierrez, O.; Martinez-Lopez, M. [Magnetic Resonance Unit, Medica Sur Hospital and Clinic Foundation, Mexico City (Mexico)

    2012-03-15

    Aim: To determine the accuracy of the perfusion/diffusion-weighted imaging (PWI/DWI) parameters [time to peak (TTP), mean time to peak (MTT), relative cerebral blood volume (rCBV), and relative cerebral blood flow (rCBF) maps]; in the evaluation of acute versus hyperacute ischaemic stroke. Materials and methods: Fifty-five patients with symptomatic hyperacute (first 6 h) or acute (7-24 h) ischaemic stroke underwent diffusion and perfusion evaluation. Statistical analysis included Student's t-test, receiver operating characteristics (ROC) analysis of apparent diffusion coefficient (ADC), TTP, MTT, CBV, and CBF; correlation, linear, and logistic regression analysis. Results: Area under receiver operating characteristics (AUROC) analysis identified the ADC cut-off value 385 Multiplication-Sign 10{sup -6} mm{sup 2}/s, MTT at 109.5%, TTP at 3.05 s, CBV at 129%, and CBF at 98.5% (the record of the time of onset was considered the reference standard). The best performance corresponded to TTP, which showed a sensitivity of 0.94 and specificity of 0.88 (p < 0.001). Conclusions: Based on the present findings, hyperacute penumbra is reliably defined with a TTP >3 s with no visible changes in diffusion. ADC, rCBF, and rCBV are not useful for discriminating between acute and hyperacute ischaemic stroke.

  6. Indomethacin treatment reduces microglia activation and increases numbers of neuroblasts in the subventricular zone and ischaemic striatum after focal ischaemia

    Indian Academy of Sciences (India)

    ROSANA S LOPES; MARCELO M CARDOSO; ARTHUR O SAMPAIO; MARIO SANTOS BARBOSA Jr; CELICE C SOUZA; MICHELLE C DA SILVA; ELANE MAGNO N FERREIRA; MARCO AURELIOM FREIRE; RAFAEL RODRIGUES LIMA; WALACE GOMES-LEAL

    2016-09-01

    Neuroblasts from the subventricular zone (SVZ) migrate to striatum following stroke, but most of them die inthe ischaemic milieu and this can be related to exacerbated microglial activation. Here, we explored theeffects of the non-steroidal anti-inflammatory indomethacin on microglial activation, neuronal preservation andneuroblast migration following experimental striatal stroke in adult rats. Animals were submitted toendothelin-1 (ET-1)-induced focal striatal ischaemia and were treated with indomethacin or sterile saline(i.p.) for 7 days, being perfused after 8 or 14 days. Immunohistochemistry was performed to assess neuronalloss (anti-NeuN), microglial activation (anti-Iba1, ED1) and migrating neuroblasts (anti-DCX) by countingNeuN, ED1 and DCX-positive cells in the ischaemic striatum or SVZ. Indomethacin treatment reducedmicroglia activation and the number of ED1^{+} cells in both 8 and 14 days post injury as compared withcontrols. There was an increase in the number of DCX^{+} cells in both SVZ and striatum at the same survivaltimes. Moreover, there was a decrease in the number of NeuN^{+} cells in indomethacin-treated animals ascompared with the control group at 8 days but not after 14 days post injury. Our results suggest thatindomethacin treatment modulates microglia activation, contributing to increased neuroblast proliferation inthe SVZ and migration to the ischaemic striatum following stroke.

  7. Future disability projections could be improved by connecting to the theory of a dynamic equilibrium.

    Science.gov (United States)

    Klijs, Bart; Mackenbach, Johan P; Kunst, Anton E

    2011-04-01

    Projections of future trends in the burden of disability could be guided by models linking disability to life expectancy, such as the dynamic equilibrium theory. This article tests the key assumption of this theory that severe disability is associated with proximity to death, whereas mild disability is not. Using data from the GLOBE study (Gezondheid en Levensomstandigheden Bevolking Eindhoven en omstreken), the association of three levels of self-reported disabilities in activities of daily living with age and proximity to death was studied using logistic regression models. Regression estimates were used to estimate the number of life years with disability for life spans of 75 and 85 years. Odds ratios of 0.976 (not significant) for mild disability, 1.137 for moderate disability, and 1.231 for severe disability showed a stronger effect of proximity to death for more severe levels of disability. A 10-year increase of life span was estimated to result in a substantial expansion of mild disability (4.6 years) compared with a small expansion of moderate (0.7 years) and severe (0.9 years) disability. These findings support the theory of a dynamic equilibrium. Projections of the future burden of disability could be substantially improved by connecting to this theory and incorporating information on proximity to death. Copyright © 2011 Elsevier Inc. All rights reserved.

  8. Anti-ischaemic efficacy of L-propionylcarnitine--a promising novel metabolic approach to ischaemia?

    Science.gov (United States)

    Bartels, G L; Remme, W J; Holwerda, K J; Kruijssen, D A

    1996-03-01

    L-propionylcarnitine, a naturally occurring derivative of L-carnitine, essential for mitochondrial fatty acid transport and high-energy phosphate exchange, acutely reduces myocardial ischaemia and improves ischaemia-induced cardiac dysfunction following intravenous administration. This randomized, crossover study was designed to compare the long-term anti-ischaemic effects of oral L-propionylcarnitine with diltiazem in patients with stable, exercise-induced angina. After a 2-week washout phase of anti-anginal medication and a 2-week single-blind placebo period, 46 patients were included in the study, 23 of whom received 1500 mg L-propionylcarnitine daily for 6 weeks, and 23 diltiazem (180 mg daily for 3 weeks, followed by 360 mg daily for 3 weeks), crossing over to the other treatment after a 1-week washout period. Three patients on L-propionylcarnitine and two on diltiazem discontinued. Both treatments resulted in comparable exercise duration (582 +/- 35 s and 588 +/- 33 s, mean +/- SEM), time to 0.1 mV ST depression (436 +/- 38 s and 465 +/- 36 s), and increase in time to 0.1 mV ST depression from baseline (20% and 28%), L-propionylcarnitine and diltiazem, respectively. Diltiazem decreased the rate-pressure product at rest and exercise, L-propionylcarnitine did not. Both compounds significantly reduced ST depression at maximal exercise [23% (L-propionylcarnitine) vs 35% (diltiazem), P propionylcarnitine]. Diltiazem increased the time to onset of angina by 22%. In contrast, no significant changes occurred with L-propionylcarnitine. During the study, anginal attacks were reduced by 70% and 57%, and nitroglycerin consumption decreased by 57% and 70%, L-propionylcarnitine and diltiazem, respectively. Thus, both L-propionylcarnitine and (high-dose) diltiazem result in anti-ischaemic effects and decrease anginal attacks in daily life. Although the effect of diltiazem on exercise-induced ischaemia appears more pronounced than that of L-propionylcarnitine, this novel

  9. CLINICAL PROFILE OF PATTERN OF DYSLIPIDAEMIA AND ISCHAEMIC HEART DISEASE IN TYPE II DIABETES MELLITUS PATIENTS

    Directory of Open Access Journals (Sweden)

    Atul Vijayrao Rajkondawar

    2017-07-01

    Full Text Available BACKGROUND The present research was undertaken to study the pattern of dyslipidaemia and varied clinical manifestations of ischaemic heart disease, its risk factors in type 2 diabetes mellitus patients. Diabetes Mellitus (DM has become major public health problem in India. It is not only increasing in morbidity and mortality, but also decreases the quality of life. Also, disease and its complications are causing heavy economic burden for patients suffering from it.1,2 Diabetes is endemic globally with increasing prevalence in both developing and developed countries. Diabetes is a major cause of mortality, but several studies indicate that it is likely underreported as a cause of death. A recent estimate suggested that diabetes was the fifth leading cause of death worldwide and was responsible for almost 3 million deaths annually (1.7-5.2% of all deaths. MATERIALS AND METHODS A total of 100 patients attending the outpatient department or admitted to medical wards, ICU of tertiary care centre and fulfilling the inclusion criteria were evaluated clinically. A baseline Electrocardiogram (ECG was taken in all cases irrespective of clinical evidence of cardiac involvement. Patients with normal ECG pattern were further evaluated by Treadmill Testing (TMT or stress test for subclinical cardiac involvement. Risk factor evaluation was done in all cases. RESULTS Prevalence of IHD was found to be 41% with a male predominance (1.067:1. Evaluation of risk factors has shown its strong association with IHD. Incidence of IHD was high when low HDL (P 25 had negatively significant association with IHD in type 2 diabetics (P=0.072. Smoking was not statistically associated (P=0.577 and in male alcoholics, IHD had positive association with alcohol (P=0.193. CONCLUSION The current study points out that there exists an increased incidence of ischaemic heart disease in diabetics with few, but not all risk factors contributing to it. Early detection, optimal glycaemic

  10. Cardiac rehabilitation adapted to transient ischaemic attack and stroke (CRAFTS: a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Blake Catherine

    2009-02-01

    Full Text Available Abstract Background Coronary Heart Disease and Cerebrovascular Disease share many predisposing, modifiable risk factors (hypertension, abnormal blood lipids and lipoproteins, cigarette smoking, physical inactivity, obesity and diabetes mellitus. Lifestyle interventions and pharmacological therapy are recognised as the cornerstones of secondary prevention. Cochrane review has proven the benefits of programmes incorporating exercise and lifestyle counselling in the cardiac disease population. A Cochrane review highlighted as priority, the need to establish feasibility and efficacy of exercise based interventions for Cerebrovascular Disease. Methods A single blind randomised controlled trial is proposed to examine a primary care cardiac rehabilitation programme for adults post transient ischemic attack (TIA and stroke in effecting a positive change in the primary outcome measures of cardiac risk scores derived from Blood Pressure, lipid profile, smoking and diabetic status and lifestyle factors of habitual smoking, exercise and healthy eating participation. Secondary outcomes of interest include health related quality of life as measured by the Hospital Anxiety and Depression Scale, the Stroke Specific Quality of Life scale and WONCA COOP Functional Health Status charts and cardiovascular fitness as measured by a sub-maximal fitness test. A total of 144 patients, over 18 years of age with confirmed diagnosis of ischaemic stroke or TIA, will be recruited from Dublin community stroke services and two tertiary T.I.A clinics. Exclusion criteria will include oxygen dependence, unstable cardiac conditions, uncontrolled diabetes, major medical conditions, claudication, febrile illness, pregnancy or cognitive impairment. Participants will be block-statified, randomly allocated to one of two groups using a pre-prepared computer generated randomisation schedule. Both groups will receive a two hour education class on risk reduction post stroke. The

  11. Recognizing primary emotions in communication in adults with intellectual disability

    Directory of Open Access Journals (Sweden)

    Đorđević Mirjana

    2017-01-01

    Full Text Available The ability to recognize emotions helps people understand social situations and plan their own behavior in specific social contexts. Paralinguistic segments of communication (facial expression and prosodic characteristics significantly contribute to drawing conclusions on the speaker's emotions, and according to some authors, they are considered even more dominant and more reliable than linguistic segments in decoding emotions tasks. The aim of this paper was to determine the ability to recognize primary emotions in communication with the help of paralinguistic indicators, in adults with mild and moderate intellectual disability. The sample consisted of 60 adult participants with mild (N=25 and moderate (N=35 intellectual disability, equal with regard to gender and type of housing. The participants with mild intellectual disability were aged 20-55 (M=31.24; SD=8.84, while those with moderate intellectual disability were 22-55 years of age (M=34.17; SD=8.76. The Assessment Battery for Communication, ABaCo, (Sacco et al., 2008 was used for assessing the ability to understand emotions in communication. The obtained results showed that adults with intellectual disability experienced most difficulties in detecting fear. By applying the T test for independent samples, it was determined that there were no statistically significant differences between men and women both with mild and moderate ID with regard to their ability to recognize emotions (p>0,05. With regard to the type of housing, statistically significant differences were obtained only in the group of participants with moderate intellectual disability in detecting fear (t (33=-3.51; p=0.01, in favor of those who lived in institutions. The length of living in an institution positively and moderately correlated with the ability to recognize anger in adults with intellectual disability (r=0.46, p<0.05.

  12. Disability among female garment workers. A comparison with a national sample.

    Science.gov (United States)

    Brisson, C; Vinet, A; Vézina, M

    1989-10-01

    An indicator of permanent disability was used to measure the chronic health problems associated with garment work. The study population comprised 800 female sewing-machine operators employed in the Quebec garment industry between 1976 and 1985. The workers were identified from public agency records. Their disability status was obtained in a personal interview. The disability prevalence of these workers was compared to national disability data of women employed in clerical work, services, and manufacturing industries. The garment workers who had left employment had an increased prevalence of severe disability (in comparison with that of workers who had left other types of employment) and an increased prevalence of moderate and slight disability. Currently employed garment workers had an increased prevalence of moderate and slight disability when compared with workers currently employed in other occupations. The risk ratios remained similarly elevated when the data were adjusted for age and smoking status.

  13. Magnetic resonance imaging assessment of intraventricular dyssynchrony and delayed enhancement as predictors of response to cardiac resynchronization therapy in patients with heart failure of ischaemic and non-ischaemic etiologies

    Energy Technology Data Exchange (ETDEWEB)

    Petryka, Joanna, E-mail: joannapetryka@hotmail.com [Department of Coronary Artery Disease and Structural Heart Diseases, Institute of Cardiology, Warsaw (Poland); Cardiovascular Magnetic Resonance Unit, Institute of Cardiology, Warsaw (Poland); Miśko, Jolanta [Cardiovascular Magnetic Resonance Unit, Institute of Cardiology, Warsaw (Poland); Department of Radiology, Institute of Cardiology, Warsaw (Poland); Przybylski, Andrzej [Department of Arrhythmia, Institute of Cardiology, Warsaw (Poland); Śpiewak, Mateusz [Department of Coronary Artery Disease and Structural Heart Diseases, Institute of Cardiology, Warsaw (Poland); Cardiovascular Magnetic Resonance Unit, Institute of Cardiology, Warsaw (Poland); Małek, Łukasz A. [Cardiovascular Magnetic Resonance Unit, Institute of Cardiology, Warsaw (Poland); Department of Cardiology and Interventional Angiology, Institute of Cardiology, Warsaw (Poland); Werys, Konrad [Cardiovascular Magnetic Resonance Unit, Institute of Cardiology, Warsaw (Poland); Mazurkiewicz, Łukasz [Cardiovascular Magnetic Resonance Unit, Institute of Cardiology, Warsaw (Poland); Department of Cardiomyopathy, Institute of Cardiology, Warsaw (Poland); Gepner, Katarzyna [Department of Coronary Artery Disease, Institute of Cardiology, Warsaw (Poland); Croisille, Pierre [Creatis Laboratory, UMR CNRS 5515, INSERM, U1044, CHU Saint-Etienne, Universite de Lyon (France); Demkow, Marcin [Department of Coronary Artery Disease and Structural Heart Diseases, Institute of Cardiology, Warsaw (Poland); Rużyłło, Witold [Institute of Cardiology, Warsaw (Poland)

    2012-10-15

    Purpose: To assess the value of dyssynchrony and myocardial viability assessment by cardiac magnetic resonance (CMR) in prediction of response to cardiac resynchronization therapy (CRT) in patients with heart failure (HF) of both ischaemic and non-ischaemic etiologies. Materials and methods: Patients scheduled for CRT in NYHA class II–IV, left ventricular ejection fraction <35%, QRS ≥ 120 ms were included. Tagged cine and late gadolinium enhancement (LGE) images were performed. Dyssynchrony was assessed with inTag toolbox and LGE was quantified using cutoff value at half of maximal signal in the scar. Cardiopulmonary exercise test, echocardiography and blood testing for NT-proBNP levels were done at baseline and 6 months after CRT. Results: 52 patients (age 60.3 ± 13 years) were included. 26 patients (50%) met response criteria. The ischaemic etiology of HF was more frequent (69% vs. 31%, p = 0.002), the percent of LGE was higher (7.7% [0–13.5%] vs. 19.0% (0–31.9%], p = 0.013), regional vector of circumferential strain variance (RVV) was lower (0.27 ± 0.08 vs. 0.34 ± 0.09, p = 0.009) and uniformity of radial strain was higher (0.72 ± 0.25 vs. 0.56 ± 0.29, p = 0.046) in non-responders vs. responders. Multivariate logistic regression showed that RVV predicted response to CRT (HR 2.3, 95% CI 1.02–5.02, p = 0.0430) independently of LGE and the etiology of heart failure. In the subgroup of patients with ischaemic HF the extend of transmural scar within myocardium was higher in non-responders vs. responders (26.3% vs. 15.0% respectively, p = 0.01) and was a predictor of response to CRT in univariable analysis (HR 0.87, 95% CI 0.77–0.98, p = 0.025) providing the sensitivity of 76% and specificity of 75% at the cutoff point of 18% in the prediction of poor response to CRT. In patients with non-ischaemic HF QRS was wider (162 ms vs. 140 ms, p = 0.04), regional vector of strain variance (RVV) was higher (0.39 vs. 0.25, p = 0.002) and uniformity of radial

  14. Holter-electrocardiogram-monitoring in patients with acute ischaemic stroke (Find-AFRANDOMISED): an open-label randomised controlled trial.

    Science.gov (United States)

    Wachter, Rolf; Gröschel, Klaus; Gelbrich, Götz; Hamann, Gerhard F; Kermer, Pawel; Liman, Jan; Seegers, Joachim; Wasser, Katrin; Schulte, Anna; Jürries, Falko; Messerschmid, Anna; Behnke, Nico; Gröschel, Sonja; Uphaus, Timo; Grings, Anne; Ibis, Tugba; Klimpe, Sven; Wagner-Heck, Michaela; Arnold, Magdalena; Protsenko, Evgeny; Heuschmann, Peter U; Conen, David; Weber-Krüger, Mark

    2017-04-01

    Atrial fibrillation is a major risk factor for recurrent ischaemic stroke, but often remains undiagnosed in patients who have had an acute ischaemic stroke. Enhanced and prolonged Holter-electrocardiogram-monitoring might increase detection of atrial fibrillation. We therefore investigated whether enhanced and prolonged rhythm monitoring was better for detection of atrial fibrillation than standard care procedures in patients with acute ischaemic stroke. Find-AFrandomised is an open-label randomised study done at four centres in Germany. We recruited patients with acute ischaemic stroke (symptoms for 7 days or less) aged 60 years or older presenting with sinus rhythm and without history of atrial fibrillation. Patients were included irrespective of the suspected cause of stroke, unless they had a severe ipsilateral carotid or intracranial artery stenosis, which were the exclusion criteria. We used a computer-generated allocation sequence to randomly assign patients in a 1:1 ratio with permuted block sizes of 2, 4, 6, and 8, stratified by centre, to enhanced and prolonged monitoring (ie, 10-day Holter-electrocardiogram [ECG]-monitoring at baseline, and at 3 months and 6 months of follow-up) or standard care procedures (ie, at least 24 h of rhythm monitoring). Participants and study physicians were not masked to group assignment, but the expert committees that adjudicated endpoints were. The primary endpoint was the occurrence of atrial fibrillation or atrial flutter (30 sec or longer) within 6 months after randomisation and before stroke recurrence. Because Holter ECG is a widely used procedure and not known to harm patients, we chose not to assess safety in detail. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01855035. Between May 8, 2013, and Aug 31, 2014, we recruited 398 patients. 200 patients were randomly assigned to the enhanced and prolonged monitoring group and 198 to the standard care group. After 6 months

  15. Efficient Cryosolid Positron Moderators

    Science.gov (United States)

    2012-08-01

    Howell, and Mr. Roy Larsen for infrastructure and equipment support. Mrs. Karen Clayton for administrative support. Mr. Byron Allmon for critical...showing explicitly the long, bent slow positron transport tube scaled to fit onto a 4x4-foot optical table. The sharp 90° bend in this tube is intended...half-cycle RPA scan of an N2 moderator. The ≈ 0.15 cps CEM signal is clearly visible above the ≈ 0.03 cps background. The very sharp absorption lines

  16. What is an Intellectual Disability?

    Science.gov (United States)

    ... Kids Talk About: Coaches What Is an Intellectual Disability? KidsHealth > For Kids > What Is an Intellectual Disability? ... becoming an independent person. continue What Causes Intellectual Disabilities? Intellectual disabilities happen because the brain gets injured ...

  17. Modelling far field pacing for terminating spiral waves pinned to ischaemic heterogeneities in cardiac tissue

    Science.gov (United States)

    Boccia, E.; Luther, S.; Parlitz, U.

    2017-05-01

    In cardiac tissue, electrical spiral waves pinned to a heterogeneity can be unpinned (and eventually terminated) using electric far field pulses and recruiting the heterogeneity as a virtual electrode. While for isotropic media the process of unpinning is much better understood, the case of an anisotropic substrate with different conductivities in different directions still needs intensive investigation. To study the impact of anisotropy on the unpinning process, we present numerical simulations based on the bidomain formulation of the phase I of the Luo and Rudy action potential model modified due to the occurrence of acute myocardial ischaemia. Simulating a rotating spiral wave pinned to an ischaemic heterogeneity, we compare the success of sequences of far field pulses in the isotropic and the anisotropic case for spirals still in transient or in steady rotation states. Our results clearly indicate that the range of pacing parameters resulting in successful termination of pinned spiral waves is larger in anisotropic tissue than in an isotropic medium. This article is part of the themed issue `Mathematical methods in medicine: neuroscience, cardiology and pathology'.

  18. Anthropometry, lipid profile and dietary pattern of patients with chronic ischaemic heart disease.

    Directory of Open Access Journals (Sweden)

    Vajifdar B

    1999-10-01

    Full Text Available The anthropometry, lipid profile and dietary characteristics of 114 patients with chronic ischaemic heart disease (IHD were evaluated. There were 91 (80% men and the mean age was 56 +/- 9 years. The body mass index was near normal (24.4 +/- 3.4, but the waist: hip ratio was high (0.94 +/- 0.06 suggesting central obesity. This was well in accordance of the step II recommendations of the NCEP guidelines as regards their caloric intake and its break-up in terms of carbohydrate, protein and fat (including saturated, mono-unsaturated and poly-unsaturated fatty acids content. Their daily cholesterol intake (31 +/- 32 mg/day, range 4-180 was very low. The total cholesterol (212 +/- 37 mg% was marginally elevated, HDL cholesterol (33 +/- 7.5 mg% was low, LDL cholesterol (148 +/- 39 mg% was high and the total: HDL ratio (6.8 +/- 2.0 was significantly abnormal. The serum triglyceride level (154 +/- 68 mg% was on the higher side of normal. These observations give further credence to the recently evolving view that there are different and hitherto unrecognised risk factors of IHD in Indians, who seem to have the highest incidence of IHD amongst all ethnic groups of the world despite consuming a diet low in fat and cholesterol content.

  19. Differential modulation of angiogenesis by erythropoiesis-stimulating agents in a mouse model of ischaemic retinopathy.

    Directory of Open Access Journals (Sweden)

    Carmel M McVicar

    Full Text Available BACKGROUND: Erythropoiesis stimulating agents (ESAs are widely used to treat anaemia but concerns exist about their potential to promote pathological angiogenesis in some clinical scenarios. In the current study we have assessed the angiogenic potential of three ESAs; epoetin delta, darbepoetin alfa and epoetin beta using in vitro and in vivo models. METHODOLOGY/PRINCIPAL FINDINGS: The epoetins induced angiogenesis in human microvascular endothelial cells at high doses, although darbepoetin alfa was pro-angiogenic at low-doses (1-20 IU/ml. ESA-induced angiogenesis was VEGF-mediated. In a mouse model of ischaemia-induced retinopathy, all ESAs induced generation of reticulocytes but only epoetin beta exacerbated pathological (pre-retinal neovascularisation in comparison to controls (p<0.05. Only epoetin delta induced a significant revascularisation response which enhanced normality of the vasculature (p<0.05. This was associated with mobilisation of haematopoietic stem cells and their localisation to the retinal vasculature. Darbepoetin alfa also increased the number of active microglia in the ischaemic retina relative to other ESAs (p<0.05. Darbepoetin alfa induced retinal TNFalpha and VEGF mRNA expression which were up to 4 fold higher than with epoetin delta (p<0.001. CONCLUSIONS: This study has implications for treatment of patients as there are clear differences in the angiogenic potential of the different ESAs.

  20. The Longitudinal Evolution of Cerebral Blood Flow Regulation after Acute Ischaemic Stroke

    Directory of Open Access Journals (Sweden)

    Angela S.M. Salinet

    2014-08-01

    Full Text Available Background: Acute stroke is known to impair cerebral blood flow (CBF regulation, but the longitudinal changes of these effects have been poorly reported. The main CBF regulatory mechanisms [cerebral autoregulation (CA and neurovascular coupling (NVC] were assessed over 3 months after acute ischaemic stroke. Methods: Recordings of CBF velocity (CBFv, blood pressure (BP, and end-tidal CO2 were performed during 5 min baseline and 1 min passive movement of the elbow. Stroke patients were assessed Results: Fifteen acute stroke subjects underwent all 4 sessions and were compared to 22 control subjects. Baseline recordings revealed a significantly lower CBFv in the affected hemisphere within 72 h after stroke compared to controls (p = 0.02 and a reduction in CA index most marked at 2 weeks (p = 0.009. CBFv rise in response to passive arm movement was decreased bilaterally after stroke, particularly in the affected hemisphere (p Conclusion: The major novel finding of this study was that both CA and NVC regulatory mechanisms deteriorated initially following stroke onset, but returned to control levels during the recovery period. These findings are relevant to guide the timing of interventions to manipulate BP and potentially for the impact of intensive rehabilitation strategies that may precipitate acute physiological perturbations but require further exploration in a larger population that better reflects the heterogeneity of stroke. Further, they will also enable the potential influence of stroke subtype to be investigated.

  1. Remote ischaemic preconditioning shortens QT intervals during exercise in healthy subjects.

    Science.gov (United States)

    Caru, Maxime; Lalonde, François; Gravel, Hugo; Daigle, Chantal; Tournoux, François; Jacquemet, Vincent; Curnier, Daniel

    2016-11-01

    The protective action of remote ischaemic preconditioning (RIPC) has been demonstrated in the context of surgical interventions in cardiology. Application of RIPC to sports performance has been proposed, but its effect on the electrocardiogram (ECG) during exercise remains unknown. This exploratory study aims to measure the changes in ventricular repolarization observed during exercise following RIPC in healthy subjects. In an experimental randomized crossover study, 17 subjects underwent two bouts of constant load exercise tests at 75% and 115% of gas exchange threshold (GET). Prior to exercise, they were allocated to either control or RIPC intervention with four cycles of 5 min of ischaemia followed by 5 min of reperfusion. ECG was continuously recorded during the protocol. QT and RR intervals were measured every 30 s (on an average tracing of the preceding 10 s). Although the time course of RR intervals did not differ between the two interventions (p = .56 at 75% GET and p = .74 at 115% GET), a significant shortening of QT intervals (measured from Q onset to T end) was observed during exercise (mean ± standard deviation of RIPC vs. -32 ± 19 ms at 75% GET (p exercise.

  2. A systematic review and meta-analysis of donor ischaemic preconditioning in liver transplantation.

    Science.gov (United States)

    Robertson, Francis P; Magill, Louise J; Wright, Graham P; Fuller, Barry; Davidson, Brian R

    2016-11-01

    Ischaemic preconditioning (IPC) is a strategy to reduce ischaemia-reperfusion (IR) injury. Its benefit in human liver transplantation is unclear. The aim of this study was to analyse the current evidence for donor IPC in liver transplantation. Systematic review and meta-analysis of studies involving IPC of liver transplant donors. Ovid Medline, Embase and Cochrane CENTRAL were searched up until January 2015. Data retrieved included the primary outcomes of 1-year mortality, incidence of primary graft non-function (PGNF) and retransplantation. Secondary outcomes included aspartate aminotransferase (AST) levels on day 3 post-op. Pooled odds ratios (ORs) were calculated for dichotomous data and mean weighted ratios for continuous data. Ten studies included 593 patients (286 IPC; 307 control). IPC was associated with a reduction in mortality at 1 year (6% vs. 11%) although this was not statistically significant (OR 0.54, 95% C.I. 0.28-1.04, P = 0.06). The IPC group had a significantly lower day 3 AST level (WMD -66.41iU, P = 0.04). This meta-analysis demonstrates that IPC reduces liver injury following transplantation and produces a large reduction in 1-year mortality which was not statistically significant. Confirmation of clinical benefit from IPC requires an adequately powered prospective RCT. © 2016 Steunstichting ESOT.

  3. Improved GFR and renal plasma perfusion following remote ischaemic conditioning in a porcine kidney transplantation model

    DEFF Research Database (Denmark)

    Krogstrup, Nicoline V; Soendergaard, Peter; Secher, Niels G

    2012-01-01

    systemic protection against ischaemic injuries. Using a porcine kidney transplantation model with donor (63 kg) recipient (15 kg) size mismatch, we investigated the effects of recipient rIC on early renal plasma perfusion and GFR. Brain death was induced in donor pigs (n = 8) and kidneys were removed...... and kept in cold storage until transplantation. Nephrectomized recipient pigs were randomized to rIC (n = 8) or non-rIC (n = 8) with one kidney from the same donor in each group. rIC consisted of 4 × 5 min clamping of the abdominal aorta. GFR was significantly higher in the rIC group compared with non......-rIC (7.2 ml/min vs. 3.4 ml/min; ΔGFR = 3.7 ml/min, 95%-CI: 0.3-7.2 ml/min, P = 0.038). Renal plasma perfusion in both cortex and medulla measured by dynamic contrast-enhanced magnetic resonance imaging (MRI) was significantly higher over time in the rIC group compared with non-rIC. This experimental...

  4. Optimising MR perfusion imaging: comparison of different software-based approaches in acute ischaemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Schaafs, Lars-Arne [Charite-Universitaetsmedizin, Department of Radiology, Berlin (Germany); Charite-Universitaetsmedizin, Academic Neuroradiology, Department of Neurology and Center for Stroke Research, Berlin (Germany); Porter, David [Fraunhofer Institute for Medical Image Computing MEVIS, Bremen (Germany); Audebert, Heinrich J. [Charite-Universitaetsmedizin, Department of Neurology with Experimental Neurology, Berlin (Germany); Fiebach, Jochen B.; Villringer, Kersten [Charite-Universitaetsmedizin, Academic Neuroradiology, Department of Neurology and Center for Stroke Research, Berlin (Germany)

    2016-11-15

    Perfusion imaging (PI) is susceptible to confounding factors such as motion artefacts as well as delay and dispersion (D/D). We evaluate the influence of different post-processing algorithms on hypoperfusion assessment in PI analysis software packages to improve the clinical accuracy of stroke PI. Fifty patients with acute ischaemic stroke underwent MRI imaging in the first 24 h after onset. Diverging approaches to motion and D/D correction were applied. The calculated MTT and CBF perfusion maps were assessed by volumetry of lesions and tested for agreement with a standard approach and with the final lesion volume (FLV) on day 6 in patients with persisting vessel occlusion. MTT map lesion volumes were significantly smaller throughout the software packages with correction of motion and D/D when compared to the commonly used approach with no correction (p = 0.001-0.022). Volumes on CBF maps did not differ significantly (p = 0.207-0.925). All packages with advanced post-processing algorithms showed a high level of agreement with FLV (ICC = 0.704-0.879). Correction of D/D had a significant influence on estimated lesion volumes and leads to significantly smaller lesion volumes on MTT maps. This may improve patient selection. (orig.)

  5. ATP synthase subunit alpha and LV mass in ischaemic human hearts.

    Science.gov (United States)

    Roselló-Lletí, Esther; Tarazón, Estefanía; Barderas, María G; Ortega, Ana; Molina-Navarro, Maria Micaela; Martínez, Alba; Lago, Francisca; Martínez-Dolz, Luis; González-Juanatey, Jose Ramón; Salvador, Antonio; Portolés, Manuel; Rivera, Miguel

    2015-02-01

    Mitochondrial dysfunction plays a critical role in the development of ischaemic cardiomyopathy (ICM). In this study, the mitochondrial proteome in the cardiac tissue of ICM patients was analysed by quantitative differential electrophoresis (2D-DIGE) and mass spectrometry (MS) for the first time to provide new insights into cardiac dysfunction in this cardiomyopathy. We isolated mitochondria from LV samples of explanted hearts of ICM patients (n = 8) and control donors (n = 8) and used a proteomic approach to investigate the variations in mitochondrial protein expression. We found that most of the altered proteins were involved in cardiac energy metabolism (82%). We focused on ATPA, which is involved in energy production, and dihydrolipoyl dehydrogenase, implicated in substrate utilization, and observed that these molecules were overexpressed and that the changes detected in the processes mediated by these proteins were closely related. Notably, we found that ATPA overexpression was associated with reduction in LV mass (r = -0.74, P ATPA could serve as a molecular target suitable for new therapeutic interventions.

  6. Ischaemic Heart Disease: Accuracy of the Prehospital Diagnosis—A Retrospective Study

    Directory of Open Access Journals (Sweden)

    Louise Houlberg Hansen

    2013-01-01

    Full Text Available Purpose. Correct prehospital diagnosis of ischaemic heart disease (IHD may accelerate and improve the treatment. We sought to evaluate the accuracy of prehospital diagnoses of ischemic heart diseases assigned by physicians. Methods. The Mobile Emergency Care Unit (MECU in Odense, Denmark, services a population of 260.000. All admissions in 2009 concerning patients diagnosed in the IHD category were assessed. Outcome and diagnosis of each patient were manually validated in accordance to the final diagnosis established following admission to hospital, using the discharge summary from the relevant department as reference. Results. 428 MECU runs with a prehospital diagnosis of IHD were registered. 422 of these were included in the study and 354 of those patients were suitable for this analysis. 73,4% of the patients hospitalized with a prehospital diagnosis of IHD were initially admitted to the relevant ward. Of these patients, 40,0% had their preliminary diagnosis of IHD confirmed. 14,1% of all patients admitted to the hospital were diagnosed with nonheart conditions. Preliminary diagnoses of STEMI had an accuracy of 87,5%. Conclusions. The preliminary IHD diagnoses assigned by the MECU physicians were acceptable. In case of STEMI patients the diagnostic accuracy was excellent. In this study there was an apparent overtriage.

  7. Ischaemic heart disease among workers in occupations associated with heavy lifting

    Directory of Open Access Journals (Sweden)

    Harald Hannerz

    2016-02-01

    Full Text Available Objectives: To investigate a hypothesized positive association between employment in occupations where heavy lifting is likely to occur, and the risk of ischaemic heart disease (IHD. Material and Methods: Male blue-collar workers from Denmark (N = 516 180 were monitored with respect to hospital treatment or death due to IHD, through national registers over the years 2001–2010. Poisson regression was used to estimate relative rates of IHD between “workers in occupations which, according to an expert opinion, are likely to involve heavy lifting” and “other blue-collar workers.” Prevalent cases were excluded from the analysis. Results: The rate ratio was estimated at 0.97 (95% confidence interval (CI: 0.94–1.00 for deaths or hospitalizations due to IHD and 1.07 (95% CI: 0.94–1.21 for deaths due to IHD. Conclusions: The results do not support the hypothesis that occupational heavy lifting is an important risk factor for IHD.

  8. Cell therapy for ischaemic heart disease: focus on the role of resident cardiac stem cells.

    Science.gov (United States)

    Chamuleau, S A J; Vrijsen, K R; Rokosh, D G; Tang, X L; Piek, J J; Bolli, R

    2009-05-01

    Myocardial infarction results in loss of cardiomyocytes, scar formation, ventricular remodelling, and eventually heart failure. In recent years, cell therapy has emerged as a potential new strategy for patients with ischaemic heart disease. This includes embryonic and bone marrow derived stem cells. Recent clinical studies showed ostensibly conflicting results of intracoronary infusion of autologous bone marrow derived stem cells in patients with acute or chronic myocardial infarction. Anyway, these results have stimulated additional clinical and pre-clinical studies to further enhance the beneficial effects of stem cell therapy. Recently, the existence of cardiac stem cells that reside in the heart itself was demonstrated. Their discovery has sparked intense hope for myocardial regeneration with cells that are obtained from the heart itself and are thereby inherently programmed to reconstitute cardiac tissue. These cells can be detected by several surface markers (e.g. c-kit, Sca-1, MDR1, Isl-1). Both in vitro and in vivo differentiation into cardiomyocytes, endothelial cells and vascular smooth muscle cells has been demonstrated, and animal studies showed promising results on improvement of left ventricular function. This review will discuss current views regarding the feasibility of cardiac repair, and focus on the potential role of the resident cardiac stem and progenitor cells. (Neth Heart J 2009;17:199-207.).

  9. Planning interventional trials in childhood arterial ischaemic stroke using a Delphi consensus process.

    Science.gov (United States)

    Steinlin, Maja; O'callaghan, Finbar; Mackay, Mark T

    2017-07-01

    There is a paucity of data from randomized controlled treatment trials in childhood arterial ischaemic stroke. Our objectives were to identify and plan a trial through use of a Delphi consensus process. The Delphi panel consisted of Australian, New Zealand, and European paediatric neurologists with interests in childhood stroke. Four rounds were conducted using a REDCap (Research Electronic Data Capture) Web-based application: the first consisted of open-ended questions; the second evaluated agreement for the most important trial; the third and fourth reached consensus on design. Forty-seven out of 66 neurologists answered the first round. Eight areas of research for important and feasible trials were identified. In the second round, 43 paediatric neurologists ranked the three highest rated trials: (1) aspirin versus aspirin plus steroids in focal arteriopathy (n=31); (2) heparin versus aspirin (n=6); and (3) heparin versus aspirin versus modern anticoagulation (n=6). The third and fourth surveys reached consensus among 43 out of 44 respondents on design of the highest ranked trial, and allowed agreement on inclusion/exclusion criteria, clinical/neuroimaging data, and treatment protocols. The Delphi consensus process is an efficient method of identifying and planning paediatric stroke trials. An international, multicentre trial is now in preparation. © 2017 Mac Keith Press.

  10. Clinical significance of post-interventional cerebral hyperdensities after endovascular mechanical thrombectomy in acute ischaemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Nikoubashman, Omid [Uniklinik Aachen, Klinik fuer Diagnostische und Interventionelle Neuroradiologie, Aachen (Germany); Uniklinik Aachen, Klinik fuer Neurologie, Aachen (Germany); Reich, Arno; Gindullis, Mirco; Schulz, Joerg B. [Uniklinik Aachen, Klinik fuer Neurologie, Aachen (Germany); Frohnhofen, Katharina; Pjontek, Rastislav; Brockmann, Marc-Alexander; Wiesmann, Martin [Uniklinik Aachen, Klinik fuer Diagnostische und Interventionelle Neuroradiologie, Aachen (Germany)

    2014-01-15

    This study aims to investigate the clinical significance of post-interventional cerebral hyperdensities (PCHD) after endovascular mechanical thrombectomy in acute ischaemic stroke. Data of 102 consecutive patients who received post-interventional CT scans within 4.5 h after mechanical thrombectomy were analysed retrospectively. Sixty-two of 102 patients (60.8 %) had PCHD on their post-interventional CT scans. The most common site of PCHD was the basal ganglia. PCHD were persisting in 13 of 62 patients (21.0 %), and transient in the remaining 49 patients (79.0 %) within 24 h. Four patients with PCHD and four patients without PCHD suffered from parenchymal haemorrhage. Neither ASA nor Clopidogrel, Tirofiban or rtPA were risk factors for PCHD. Final infarction size was congruent with or bigger than areas of PCHD in 93.3 % of cases in our series. PCHD was not a risk factor for parenchymal haemorrhage in our series. The occurrence of PCHD was strongly related to the prior presence of infarction. PCHD was also a strong predictor for final infarction size. (orig.)

  11. Bilateral Anterior Ischaemic Optic Neuropathy in a Child on Continuous Peritoneal Dialysis

    Science.gov (United States)

    Al-Kaabi, Abdullah; Haider, Agha S.; Shafeeq, Mohammed O.; El-Naggari, Mohammed A.; El-Nour, Ibtisam; Ganesh, Anuradha

    2016-01-01

    Non-arteritic anterior ischaemic optic neuropathy (NAION) is a serious complication of continuous peritoneal dialysis (CPD) which can lead to poor vision and blindness. We report a five-year-old girl who had undergone a bilateral nephrectomy at the age of one year and was on home CPD. She was referred to the Paediatric Ophthalmology Unit of Sultan Qaboos University Hospital, Muscat, Oman, in 2013 with acute bilateral vision loss, preceded by a three-day history of poor oral intake. At presentation, the patient had severe systemic hypotension. An ophthalmological examination revealed severe bilateral visual impairment and NAION. She was treated with intravenous methylprednisolone and normal saline boluses. At a five-month follow-up, the visual acuity of the right eye had improved but vision in the left eye remained the same. Acute bilateral blindness due to NAION while on CPD is a rare condition in childhood. Paediatricians should be aware of this complication in order to ensure prompt management. PMID:28003901

  12. Interdisciplinary rehabilitation outcomes following thrombolysis for acute ischaemic stroke: a case series.

    Science.gov (United States)

    Finch, Emma; Fleming, Jennifer; Clark, Kathy; Hayward, Kathryn S

    2014-01-01

    Thrombolysis with recombinant tissue plasminogen activator (rtPA) is part of routine acute stroke clinical practice worldwide. Yet, it is unclear how rtPA influences specific rehabilitation outcomes, such as motor, cognitive and communication function. The present study aimed to collect pilot data about the effects of rtPA on communication and motor recovery during the first three months post-rtPA. Four individuals who received thrombolysis with rtPA for a single left hemisphere ischaemic stroke completed an assessment battery two weeks and three months post-stroke. Information pertaining to allied health service usage was also investigated. Reliable changes in assessment scores were observed for lower limb function in two participants with severe functional limitations. There was no reliable change in lower limb function for the two milder participants, or for any participants in upper limb or language function. Service usage varied between participants. Two participants required extensive inpatient rehabilitation. Three participants required outpatient or community rehabilitation. Tailoring of the service delivery approach may be required for individuals who receive rtPA based on functional limitations evident post-rtPA. Future research into the impact of rtPA on motor, cognitive and communication recovery after stroke is vital to inform rehabilitation programs and optimize outcomes.

  13. MR imaging of term infants with hypoxic-ischaemic encephalopathy as a predictor of neurodevelopmental outcome and late MRI appearances

    Energy Technology Data Exchange (ETDEWEB)

    Twomey, Eilish; Ryan, Stephanie [Children' s University Hospital, Department of Radiology, Dublin (Ireland); Twomey, Anne; Murphy, John [National Maternity Hospital, Department of Neonatology, Dublin (Ireland); Donoghue, Veronica B. [National Maternity Hospital, Department of Radiology, Dublin (Ireland); Children' s University Hospital, Department of Radiology, Dublin (Ireland)

    2010-09-15

    Morbidity attributable to hypoxic-ischaemic injury (HIE) in the perinatal period remains problematic, and timely and accurate assessment of the degree of injury is required for clinical management and prognosis. Conventional MR sequences typically appear normal in the first 48 h post HIE. While diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) maps register the injury earlier, perhaps within the first 24 h, it has been suggested that there may be a propensity at that early stage to underestimate the lesion severity or extent. To assess whether MR imaging that included DWI, measured ADC values and T1- and T2-weighted sequences ultimately correlated with either neurodevelopmental outcome or with late MR imaging at 2 years of age. In addition, we wished to compare the performance of MR imaging with cranial US imaging. All infants presenting with HIE who had an MRI within 10 days of life were eligible for enrollment and subsequently underwent a full neurodevelopmental assessment at 2 years of age. All children underwent repeat MRI at this time. All neonates had at least one cranial US study. The US findings were categorized as normal, abnormalities confined to the cerebral cortex and subcortical white matter, isolated central grey matter hyperechogenicity, and central hyperechogenicity combined with cerebral cortical/subcortical changes. All MRI studies were retrospectively reviewed by three radiologists. The patterns of injury on the early DWI and ADC maps and early T1- and T2-W studies were recorded as diffuse, central, watershed or atypical. The patterns of signal abnormality were assessed using a scoring system that yielded four separate scores [basal ganglia (BG), watershed (W), BG/W and summation (S)] for the three sets of images, a total of 12 scores in all. The appearance of the posterior limb of the internal capsule (PLIC) on T1-W inversion recovery sequences and of the corpus callosum on all sequences was also documented. After

  14. China Disabled Persons' Federation

    Institute of Scientific and Technical Information of China (English)

    2004-01-01

    China Disabled Persons' Federation (CDPF), founded in Beijing in 1988, is a national organization of/for all persons with disabilities (PWDs) of different categories in China. Mr. Deng Pufang is currently the Chairman.

  15. What Are Learning Disabilities?

    Science.gov (United States)

    ... space, and writing down their thoughts. 6 , 7 Dyscalculia. People with this math learning disability may have ... National Center for Learning Disabilities. (2010). What is dyscalculia? Retrieved June 26, 2012, from https://www.understood. ...

  16. SSA Disability Claim Data

    Data.gov (United States)

    Social Security Administration — The dataset includes fiscal year data for initial claims for SSA disability benefits that were referred to a state agency for a disability determination. Specific...

  17. Care needs of children with disabilities - Use of the Pediatric Evaluation of Disability Inventory

    Science.gov (United States)

    Teles, Fernanda Moreira; Resegue, Rosa; Puccini, Rosana Fiorini

    2016-01-01

    Abstract Objective: To describe the care needs reported by caregivers of children with disabilities going through the school inclusion process using the Pediatric Evaluation of Disability Inventory. Methods: Cross-sectional study with 181 children aged 7-10 years with physical or mental disabilities, undergoing the inclusion process in elementary school in 2007. Location: 31 schools of the Regional Education Board-District of Penha, East Side the city of São Paulo. The children's care needs according to the caregivers were assessed in three areas-self-care, mobility and social function, using the Pediatric Evaluation of Disability Inventory, according to the following score: 5, Independent; 4, Supervision; 3, Minimum Assistance; 2, Moderate Assistance; 1, Maximum Assistance and 0, Total Assistance. For statistical analysis, we used Student's t-test and analysis of variance (ANOVA), with p<0.05 being statistically significant. Results: The lower means, with statistically significant differences, were observed for the items related to social function (55.8-72.0), followed by self-care functions (56.0-96.5); for all types of disabilities, except for children with physical disabilities, who had lower means for self-care (56.0) and mobility (63.8). Conclusions: Social function was the area referred to as the one that needed a higher degree of assistance from the caregiver and the Pediatric Evaluation of Disability Inventory is a tool that can help identify these needs and develop a more targeted intervention. PMID:27080218

  18. Assessment of functioning and disability in patients with schizophrenia using the WHO Disability Assessment Schedule 2.0 in a large-scale database.

    Science.gov (United States)

    Chen, Ruey; Liou, Tsan-Hon; Chang, Kwang-Hwa; Yen, Chia-Feng; Liao, Hua-Fang; Chi, Wen-Chou; Chou, Kuei-Ru

    2017-08-11

    Schizophrenia is a common mental disorder characterized by deficits in multiple domains of functioning. This study is arguably the first of its kind in Taiwan to examine, in a multifaceted and objective manner, the disability of patients with schizophrenia and the factors affecting it. A cross-sectional design was adopted to gather data from 24,299 patients with schizophrenia who were listed in the Taiwan Databank of Persons with Disabilities. The level of disability in these patients was measured using the World Health Organization Disability Assessment Schedule 2.0. Statistical analyses were conducted through the χ (2) statistic and Poisson regression. The highest level of disability was in participation and the lowest was in self-care. An analysis of disability in all six domains of functioning on the basis of sex, age, type of residence, and socioeconomic status (SES) showed significant differences (P disability in these domains were female gender, age, educational attainment, SES, type of residence, and employment status. The overall degree of disability in schizophrenia patients was moderate. Six domains were measured in this study. The degrees of disability in mobility and self-care were mild while cognition, getting along, life activities, and participation were moderate. Moreover, female gender, an age of 45 or older, low educational attainment, middle to low SES, staying at healthcare institutions, and unemployment were crucial factors affecting disability of the participants. Preventive and rehabilitation programs should be developed to delay disability and functional degeneration in schizophrenic patients with these characteristics.

  19. Enabling the Disabled

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    China tries to improve the quality of life for disabled people Based on achievements during the past five years, people with disabilities in China will have greater access to education and employment during the 12th Five-Year Plan period (2011-15), said Wang Naikun, Executive Vice President of the China Disabled Persons’ Federation (CDPF).

  20. Social Psychoanalytic Disability Studies

    Science.gov (United States)

    Goodley, Dan

    2011-01-01

    This paper explores connections and tensions between psychoanalysis and disability studies. The first part of the paper considers contemporaneous engagements with the psyche by a number of disability studies writers. These scholars have remained accountable to a politicised disability studies but have pushed for critical encounters with the…

  1. What Is 'Moderate' Exercise Anyway?

    Science.gov (United States)

    ... gov/news/fullstory_166905.html What Is 'Moderate' Exercise Anyway? How to figure out the best intensity ... most adults to get 30 minutes of moderate exercise on most days to stay fit. But what ...

  2. Is Remodelling of Corticospinal Tract Terminations Originating in the Intact Hemisphere Associated with Recovery following Transient Ischaemic Stroke in the Rat?

    Directory of Open Access Journals (Sweden)

    Emma J Mitchell

    Full Text Available Following large strokes that encompass the cerebral cortex, it has been suggested that the corticospinal tract originating from the non-ischaemic hemisphere reorganises its pattern of terminal arborisation within the spinal cord to compensate for loss of function. However many strokes in humans predominantly affect subcortical structures with minimal involvement of the cerebral cortex. The aim of the present study was to determine whether remodelling of corticospinal terminals arising from the non-ischaemic hemisphere was associated with spontaneous recovery in rats with subcortical infarcts. Rats were subjected to transient middle cerebral artery occlusion or sham surgery and 28 days later, when animals exhibited functional recovery, cholera toxin b subunit was injected into the contralesional, intact forelimb motor cortex in order to anterogradely label terminals within cervical spinal cord segments. Infarcts were limited to subcortical structures and resulted in partial loss of corticospinal tract axons from the ischaemic hemisphere. Quantitative analysis revealed there was no significant difference in the numbers of terminals on the contralesional side of the spinal grey matter between ischaemic and sham rats. The results indicate that significant remodelling of the corticospinal tract from the non-ischaemic hemisphere is not associated with functional recovery in animals with subcortical infarcts.

  3. Enhanced ex vivo inhibition of platelet function following addition of dipyridamole to aspirin after transient ischaemic attack or ischaemic stroke: first results from the TRinity AntiPlatelet responsiveness (TrAP) study.

    LENUS (Irish Health Repository)

    Tobin, William Oliver

    2012-02-01

    Ex vivo dipyridamole \\'non-responsiveness\\' has not been extensively studied in ischaemic cerebrovascular disease. Platelet surface marker expression, leucocyte-platelet complex formation and inhibition of platelet function at high shear stress as detected by the PFA-100(R) Collagen-Adenosine-diphosphate (C-ADP) and Collagen-Epinephrine cartridges was assessed in 52 patients within 4 weeks of transient ischaemic attack (TIA) or ischaemic stroke on aspirin, and then 14 d (14 d) and >90 d (90 d) after adding dipyridamole. A novel definition of \\'Dipyridamole non-responsiveness\\' was used. The median C-ADP closure time increased following addition of dipyridamole, remained elevated at 90 d (P <\\/= 0.03), and was unaffected by aspirin dose. 59% at 14 d and 56% at 90 d were \\'dipyridamole non-responders\\' on the PFA-100. The proportion of non-responders at 14 and 90 d was similar (P= 0.9). Compared with baseline (4.6%), median monocyte-platelet complexes increased at 14 d (5.0%, P= 0.03) and 90 d (4.9%, P= 0.04). Low C-ADP closure times were associated with increased monocyte-platelet complexes at 14 d (r= -0.32, P= 0.02) and 90 d (r= -0.33, P = 0.02). Monocyte-platelet complexes increased in the subgroup of dipyridamole non-responders on the PFA-100 (P<\\/= 0.045), but not in responders (P >\\/= 0.5), at 14 and 90 d versus baseline. Additional inhibition of platelet function has been detected with the PFA-100 when dipyridamole is added to aspirin. Elevated monocyte-platelet complexes may contribute to ex vivo dipyridamole non-responsiveness.

  4. Facing up to disability

    Directory of Open Access Journals (Sweden)

    Tom Shakespeare

    2013-05-01

    Full Text Available Ways of thinking about and responding to disability have radically changed in recent decades. Traditionally, disability was regarded in terms of sin, karma, or divine punishment. More recently, disability was made a medical issue and defined in terms of shortcomings of body or mind, which had to be prevented or cured at all costs. In the late 20th century, people with disabilities worldwide became more organised and created national and international disabled people’s organisations. They successfully demanded that disability be seen as a matter of equal opportunities and human rights, a shift which has now been described in the United Nations Convention on the Rights of Persons with Disabilities. This is a global treaty which has so far been signed by 155 states and passed into law by 127.

  5. Beyond (Models of) Disability?

    Science.gov (United States)

    Beaudry, Jonas-Sébastien

    2016-01-01

    The strategy of developing an ontology or models of disability as a prior step to settling ethical issues regarding disabilities is highly problematic for two reasons. First, key definitional aspects of disability are normative and cannot helpfully be made value-neutral. Second, if we accept that the contested concept of disability is value-laden, it is far from obvious that there are definitive reasons for choosing one interpretation of the concept over another. I conclude that the concept of disability is better left ethically open-ended or broad enough to encompass the examination of various ethical issues (such as oppression, minority rights, or physical discomfort). Alternatively, the concept of disability could be altogether abandoned in order to focus on specific issues without being hindered by debates about the nature of disability. Only political costs, rather than conceptual considerations internal to the models, could be weighed against such a conclusion. PMID:26892249

  6. Integrated Disability Management

    Directory of Open Access Journals (Sweden)

    Silvia Angeloni

    2013-10-01

    Full Text Available This article sets out to increase awareness regarding the wide and universal significance of disability, as well as the important benefits of an Integrated Disability Management (IDM approach. The scientific basis for IDM is explored in the first place through an analysis of its relationship to the International Classification of Functioning, Disability and Health (ICF. The conceptual paradigm of the ICF shares an ideological position with the IDM approach in that they are both underpinned by dynamic and multidimensional constructions of disability, which imply equally holistic and interdisciplinary responses. The IDM approach can be applied across a diversity of human situations to provide solutions that reflect the multifaceted and widespread nature of disability. The IDM approach is intended as a strategy capable of handling: inclusion of people with disabilities, active aging of human resources, health and safety in the workplace, prevention of disabilities and various diseases, return-to-work, absenteeism, and presenteeism.

  7. Occupational exposure to particles and incidence of acute myocardial infarction and other ischaemic heart disease.

    Science.gov (United States)

    Wiebert, Pernilla; Lönn, Maria; Fremling, Karin; Feychting, Maria; Sjögren, Bengt; Nise, Gun; Kauppinen, T; Plato, Nils; Gustavsson, Per

    2012-09-01

    Ambient particulate air pollution has been linked to cardiovascular disease. Occupational particle exposure levels may be several times higher than ambient levels but has been less studied. The authors investigated the association between occupational exposure to particles and the incidence of ischaemic heart disease (IHD). The cohort included all manual workers in the Swedish national census of 1980 with information on demographic data and occupation. Information on hospital admissions for acute myocardial infarction or other IHDs and cause of death were obtained from nation-wide registers. A job-exposure matrix for exposure to small (1 μm) particles was developed. HRs were calculated with Cox regression with adjustment for sex, age, socioeconomic group and urban/rural residential area. Exposure to small particles was associated with an increased HR for acute myocardial infarction of 1.12 (95% CI 1.09 to 1.15), and HR for exposure to large particles was 1.14 (95% CI 1.10 to 1.18). The association was somewhat stronger for workers exposed to small particles for more than 5 years, 1.21 (95% CI 1.11 to 1.31), but no trend with exposure intensity was found. The risk associated with exposure to small particles was higher among women than among men, 1.30 (95% CI 1.12 to 1.51) and 1.10 (95% CI 1.07 to 1.14), respectively. Findings were essentially similar for other IHDs. This explorative study gives some support to the hypothesis that occupational exposure to particles increases the risk of acute myocardial infarction and other IHD. The findings must be interpreted cautiously due to lack of smoking data.

  8. Ischaemic heart disease in first-degree relatives to coeliac patients.

    Science.gov (United States)

    Emilsson, Louise; James, Stefan; Ludvigsson, Jonas F

    2014-04-01

    Coeliac disease (CD) has been linked to an increased risk of ischaemic heart disease (IHD). We examined the risk of IHD in first-degree relatives and spouses to coeliac patients to ascertain the genetic contribution to IHD excess risk. Coeliac disease was defined as having a biopsy-verified villous atrophy (Marsh grade 3) in 1969-2008 (n = 29,096). Coeliac patients were matched to 144,522 controls. Through Swedish registers, we identified all first-degree relatives and spouses to coeliac patients and their controls, in total 87,622 unique coeliac relatives and 432,655 unique control relatives. Our main outcome measure was IHD defined according to relevant international classification of disease codes in the Swedish Inpatient Registry or in the Cause of Death Registry. Hazard ratios (HR) and confidence intervals (CI) were estimated through Cox regression adjusted for sex, age-group and calendar year at study entry of the relative. During a median follow-up of 10·8 years, 2880 coeliac relatives and 13,817 control relatives experienced IHD. First-degree relatives of coeliac patients were at increased risk of IHD (HR = 1·05; 95% CI = 1·00-1·09, P-value = 0·04), while spouses were at no increased risk (HR = 0·99; 95% CI = 0·87-1·12). The excess risk of IHD in coeliac first-degree relatives aged 40-59 years was 70/100,000 person-years. First-degree relatives to coeliac patients seem to be at an increased risk of IHD but the excess risk is so small that it has little clinical relevance. © 2014 Stichting European Society for Clinical Investigation Journal Foundation.

  9. Early postnatal EEG features of perinatal arterial ischaemic stroke with seizures.

    Directory of Open Access Journals (Sweden)

    Evonne Low

    Full Text Available Stroke is the second most common cause of seizures in term neonates and is associated with abnormal long-term neurodevelopmental outcome in some cases.To aid diagnosis earlier in the postnatal period, our aim was to describe the characteristic EEG patterns in term neonates with perinatal arterial ischaemic stroke (PAIS seizures.Retrospective observational study.Neonates >37 weeks born between 2003 and 2011 in two hospitals.Continuous multichannel video-EEG was used to analyze the background patterns and characteristics of seizures. Each EEG was assessed for continuity, symmetry, characteristic features and sleep cycling; morphology of electrographic seizures was also examined. Each seizure was categorized as electrographic-only or electroclinical; the percentage of seizure events for each seizure type was also summarized.Nine neonates with PAIS seizures and EEG monitoring were identified. While EEG continuity was present in all cases, the background pattern showed suppression over the infarcted side; this was quite marked (>50% amplitude reduction when the lesion was large. Characteristic unilateral bursts of theta activity with sharp or spike waves intermixed were seen in all cases. Sleep cycling was generally present but was more disturbed over the infarcted side. Seizures demonstrated a characteristic pattern; focal sharp waves/spike-polyspikes were seen at frequency of 1-2 Hz and phase reversal over the central region was common. Electrographic-only seizure events were more frequent compared to electroclinical seizure events (78 vs 22%.Focal electrographic and electroclinical seizures with ipsilateral suppression of the background activity and focal sharp waves are strong indicators of PAIS. Approximately 80% of seizure events were the result of clinically unsuspected seizures in neonates with PAIS. Prolonged and continuous multichannel video-EEG monitoring is advocated for adequate seizure surveillance.

  10. Fatigue, psychological and cognitive impairment following transient ischaemic attack and minor stroke: a systematic review.

    Science.gov (United States)

    Moran, G M; Fletcher, B; Feltham, M G; Calvert, M; Sackley, C; Marshall, T

    2014-10-01

    Transient ischaemic attack (TIA) and minor stroke are characterized by short-lasting symptoms; however, anecdotal and empirical evidence suggests that these patients experience ongoing cognitive/psychological impairment for which they are not routinely treated. The aims were (i) to investigate the prevalence and time course of fatigue, anxiety, depression, post-traumatic stress disorder(PTSD) and cognitive impairment following TIA/minor stroke; (ii) to explore the impact on quality of life (QoL), change in emotions and return to work; and (iii) to identify where further research is required and potentially inform an intervention study. A systematic review of MEDLINE, EMBASE, PSYCINFO, CINAHL, the Cochrane libraries and the grey literature between January 1993 and April 2013 was undertaken. Literature was screened and data were extracted by two independent reviewers. Studies were included of adult TIA/minor stroke participants with any of the outcomes of interest: fatigue, anxiety, depression, PTSD, cognitive impairment, QoL, change in emotions and return to work. Random-effects meta-analysis pooled outcomes by measurement tool. Searches identified 5976 records, 289 were assessed for eligibility and 31 studies were included. Results suggest high levels of cognitive impairment and depression post-TIA/minor stroke which decreased over time. However, frequencies varied between studies. Limited information was available on anxiety, PTSD and fatigue. Meta-analysis revealed that the measurement tool administered influenced the prevalence of cognitive impairment: Mini-Mental State Examination 17% [95% confidence interval (CI) 7, 26]; neuropsychological test battery 39% (95% CI 28, 50); Montreal Cognitive Assessment 54% (95% CI 43, 66). There is evidence to suggest that TIA/minor stroke patients may experience residual impairments; however, results should be interpreted with caution because of the few high quality studies. Notwithstanding, it is important to raise awareness

  11. Epicardial shock-wave therapy improves ventricular function in a porcine model of ischaemic heart disease.

    Science.gov (United States)

    Holfeld, Johannes; Zimpfer, Daniel; Albrecht-Schgoer, Karin; Stojadinovic, Alexander; Paulus, Patrick; Dumfarth, Julia; Thomas, Anita; Lobenwein, Daniela; Tepeköylü, Can; Rosenhek, Raphael; Schaden, Wolfgang; Kirchmair, Rudolf; Aharinejad, Seyedhossein; Grimm, Michael

    2016-12-01

    Previously we have shown that epicardial shock-wave therapy improves left ventricular ejection fraction (LVEF) in a rat model of myocardial infarction. In the present experiments we aimed to address the safety and efficacy of epicardial shock-wave therapy in a preclinical large animal model and to further evaluate mechanisms of action of this novel therapy. Four weeks after left anterior descending (LAD) artery ligation in pigs, the animals underwent re-thoracotomy with (shock-wave group, n = 6) or without (control group, n = 5) epicardial shock waves (300 impulses at 0.38 mJ/mm(2) ) applied to the infarcted anterior wall. Efficacy endpoints were improvement of LVEF and induction of angiogenesis 6 weeks after shock-wave therapy. Safety endpoints were haemodynamic stability during treatment and myocardial damage. Four weeks after LAD ligation, LVEF decreased in both the shock-wave (43 ± 3%, p wave animals 6 weeks after treatment (62 ± 9%, p = 0.006); no improvement was observed in controls (41 ± 4%, p = 0.36), yielding a significant difference. Quantitative histology revealed significant angiogenesis 6 weeks after treatment (controls 2 ± 0.4 arterioles/high-power field vs treatment group 9 ± 3; p = 0.004). No acute or chronic adverse effects were observed. As a potential mechanism of action in vitro experiments showed stimulation of VEGF receptors after shock-wave treatment in human coronary artery endothelial cells. Epicardial shock-wave treatment in a large animal model of ischaemic heart failure exerted a positive effect on LVEF improvement and did not show any adverse effects. Angiogenesis was induced by stimulation of VEGF receptors. Copyright © 2014 John Wiley & Sons, Ltd.

  12. Non-attendance and drop-out in cardiac rehabilitation among patients with ischaemic heart disease.

    Science.gov (United States)

    Mikkelsen, Tatsiana; Korsgaard Thomsen, Kristian; Tchijevitch, Olga

    2014-10-01

    Previous studies have shown drop-out from cardiac rehabilitation (CR) to have prognostic influence on morbidity and mortality among patients with ischaemic heart disease (IHD). We aimed to identify and clarify patients' reasons for non-attendance and drop-out from CR. A total of 872 consecutive patients with acute myocardial infarction and/or after percutaneous coronary intervention or coronary artery bypass surgery were asked by conventional mail to fill in a self-completion questionnaire on their choice of post-hospital CR and their reasons for drop-out or for non-attendance. Age, employment and marital status had a statistically significant influence on the overall course of CR. Younger age, affiliation with the labour market and living alone were related to a higher drop-out from CR in univariate analysis. We found no evidence of a gender difference among the patients who withdrew. Lack of time was stated as the prevailing reason for non-attendance and withdrawal from CR programmes among employed patients and in people aged 65 years or younger. Patients above 75 years of age asked for additional differentiation of exercise levels; currently two levels are offered. Or they found CR meaningless given their physical condition or their overall life situation. In patients with IHD, age, marital status and employment status play a role in the patient's attendance or drop out from CR. Different physical conditions, lack of time, too great a distance from residence to hospital, transport problems and lack of understanding of the benefits of CR explain why patients refuse to participate in or drop-out from CR. supported by grant from The Danish Ministry of Health. not relevant.

  13. Bone marrow mononuclear cell therapy in ischaemic stroke: a systematic review.

    Science.gov (United States)

    Kumar, A; Prasad, M; Jali, V P; Pandit, A K; Misra, S; Kumar, P; Chakravarty, K; Kathuria, P; Gulati, A

    2017-05-01

    Bone marrow mononuclear cell (BM-MNC) therapy has emerged as a potential therapy for the treatment of stroke. We performed a systematic review of published studies using BM-MNC therapy in patients with ischaemic stroke (IS). Literature was searched using MEDLINE, PubMed, EMBASE, Trip Database, Cochrane library and clinicaltrial.gov to identify studies on BM-MNC therapy in IS till June, 2016. Data were extracted independently by two reviewers. STATA version 13 was used for carrying out meta-analysis. We included non-randomized open-label, single-arm and non-randomized comparative studies or randomized controlled trials (RCTs) if BM-MNCs were used to treat patients with IS in any phase after the index stroke. One randomized trial, two non-randomized comparative trials and four single-arm open-label trials (total seven studies) involving 227 subjects (137 patients and 90 controls) were included in the systematic review and meta-analysis. The pooled proportion for favourable clinical outcome (modified Rankin Scale score ≤2) in six studies involving 122 subjects was 29% (95% CI 0.16-0.43) who were exposed to BM-MNCs and pooled proportion for favourable clinical outcome of 69 subjects (taken from two trials) who did not receive BM-MNCs was 20% (95% CI 0.12-0.32). The pooled difference in the safety outcomes was not significant between both the groups. Our systematic review suggests that BM-MNC therapy is safe up to 1 year post-intervention and is feasible; however, its efficacy in the case of IS patients is debatable. Well-designed randomized controlled trials are required to provide more information on the efficacy of BM-MNC transplantation in patients with IS. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  14. Implantation of healthy matrix-embedded endothelial cells rescues dysfunctional endothelium and ischaemic tissue in liver engraftment.

    Science.gov (United States)

    Melgar-Lesmes, Pedro; Balcells, Mercedes; Edelman, Elazer R

    2017-07-01

    Liver transplantation is limited by ischaemic injury which promotes endothelial cell and hepatocyte dysfunction and eventually organ failure. We sought to understand how endothelial state determines liver recovery after hepatectomy and engraftment. Matrix-embedded endothelial cells (MEECs) with retained healthy phenotype or control acellular matrices were implanted in direct contact with the remaining median lobe of donor mice undergoing partial hepatectomy (70%), or in the interface between the remaining median lobe and an autograft or isograft from the left lobe in hepatectomised recipient mice. Hepatic vascular architecture, DNA fragmentation and apoptosis in the median lobe and grafts, serum markers of liver damage and phenotype of macrophage and lymphocyte subsets in the liver after engraftment were analysed 7 days post-op. Healthy MEECs create a functional vascular splice in donor and recipient liver after 70% hepatectomy in mouse protecting these livers from ischaemic injury, hepatic congestion and inflammation. Macrophages recruited adjacent to the vascular nodes into the implants switched to an anti-inflammatory and regenerative profile M2. MEECs improved liver function and the rate of liver regeneration and prevented apoptosis in donor liver lobes, autologous grafts and syngeneic engraftment. Implants with healthy endothelial cells rescue liver donor and recipient endothelium and parenchyma from ischaemic injury after major hepatectomy and engraftment. This study highlights endothelial-hepatocyte crosstalk in hepatic repair and provides a promising new approach to improve regenerative medicine outcomes and liver transplantation. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  15. Plasma levels of the anti-coagulation protein C and the risk of ischaemic heart disease. A Mendelian randomisation study.

    Science.gov (United States)

    Schooling, C Mary; Zhong, Yi

    2017-01-26

    Protein C is an environmentally modifiable anticoagulant, which protects against venous thrombosis, whether it also protects against ischaemic heart disease is unclear, based on observational studies and relatively small genetic studies. It was our study aim to clarify the role of protein C in ischaemic heart disease. The risk of coronary artery disease/myocardial infarction (CAD/MI) was assessed according to genetically predicted protein C in very large studies. Associations with lipids and diabetes were similarly assessed to rule out effects via traditional cardiovascular disease risk factors. Separate sample instrumental variable analysis with genetic instruments (Mendelian randomisation) was used to obtain an unconfounded estimate of the association of protein C (based on (rs867186 (PROCR), rs3746429 (EDEM2), rs7580658 (inter/PROC)) with CAD/MI in an extensively genotyped case (n=64374)-control (n=130681) study, CARDIoGRAMplusC4D. Associations with lipids and diabetes were similarly assessed using the Global Lipids Genetics Consortium Results (n=196,475) and the DIAbetes Genetics Replication And Meta-analysis case (n=34,380)-control (n=114,981) study. Genetically predicted protein C was negatively associated with CAD/MI, odds ratio (OR) 0.85 µg/ml, 95 % confidence interval 0.80 to 0.90, but had no such negative association with lipids or diabetes. Results were similar for the SNP rs867186 functionally relevant to protein C, and including additional potentially pleiotropic SNPs (rs1260326 (GCKR), rs17145713 (BAZ1B) and rs4321325 (CYP27C1)). In conclusion, protein C may protect against CAD/MI. Whether environmental or dietary items that raise protein C protect against ischaemic cardiovascular disease by that mechanism should be investigated.

  16. Uric acid predicts mortality and ischaemic stroke in subjects with diastolic dysfunction: the Tromsø Study 1994-2013.

    Science.gov (United States)

    Norvik, Jon V; Schirmer, Henrik; Ytrehus, Kirsti; Storhaug, Hilde M; Jenssen, Trond G; Eriksen, Bjørn O; Mathiesen, Ellisiv B; Løchen, Maja-Lisa; Wilsgaard, Tom; Solbu, Marit D

    2017-05-01

    To investigate whether serum uric acid predicts adverse outcomes in persons with indices of diastolic dysfunction in a general population. We performed a prospective cohort study among 1460 women and 1480 men from 1994 to 2013. Endpoints were all-cause mortality, incident myocardial infarction, and incident ischaemic stroke. We stratified the analyses by echocardiographic markers of diastolic dysfunction, and uric acid was the independent variable of interest. Hazard ratios (HR) were estimated per 59 μmol/L increase in baseline uric acid. Multivariable adjusted Cox proportional hazards models showed that uric acid predicted all-cause mortality in subjects with E/A ratio 1.5 (HR 1.51, 95% CI 1.09-2.09, P for interaction between E/A ratio category and uric acid = 0.02). Elevated uric acid increased mortality risk in persons with E-wave deceleration time 220 ms (HR 1.46, 95% CI 1.01-2.12 and HR 1.13, 95% CI 1.02-1.26, respectively; P for interaction = 0.04). Furthermore, in participants with isovolumetric relaxation time ≤60 ms, mortality risk was higher with increasing uric acid (HR 4.98, 95% CI 2.02-12.26, P for interaction = 0.004). Finally, elevated uric acid predicted ischaemic stroke in subjects with severely enlarged left atria (HR 1.62, 95% CI 1.03-2.53, P for interaction = 0.047). Increased uric acid was associated with higher all-cause mortality risk in subjects with echocardiographic indices of diastolic dysfunction, and with higher ischaemic stroke risk in persons with severely enlarged left atria.

  17. Longitudinal assessment of thrombin generation potential in response to alteration of antiplatelet therapy after TIA or ischaemic stroke.

    LENUS (Irish Health Repository)

    Tobin, W O

    2013-02-01

    The impact of changing antiplatelet therapy on thrombin generation potential in patients with ischaemic cerebrovascular disease (CVD) is unclear. We assessed patients within 4 weeks of TIA or ischaemic stroke (baseline), and then 14 days (14d) and >90 days (90d) after altering antiplatelet therapy. Thrombin generation was assessed in platelet poor plasma. Ninety-one patients were recruited. Twenty-four were initially assessed on no antiplatelet therapy, and then after 14d (N = 23) and 90d (N = 8) on aspirin monotherapy; 52 were assessed on aspirin monotherapy, and after 14 and 90 days on aspirin and dipyridamole combination therapy; 21 patients were assessed on aspirin and after 14 days (N = 21) and 90 days (N = 19) on clopidogrel. Peak thrombin generation and endogenous thrombin potential were reduced at 14 and 90 days (p ≤ 0.04) in the overall cohort. We assessed the impact of individual antiplatelet regimens on thrombin generation parameters to investigate the cause of this effect. Lag time and time-to-peak thrombin generation were unchanged at 14 days, but reduced 90 days after commencing aspirin (p ≤ 0.009). Lag time, peak thrombin generation and endogenous thrombin potential were reduced at both 14 and 90 days after adding dipyridamole to aspirin (p ≤ 0.01). Lag time was reduced 14 days after changing from aspirin to clopidogrel (p = 0.045), but this effect was not maintained at 90 days (p = 0.2). This pilot study did not show any consistent effects of commencing aspirin, or of changing from aspirin to clopidogrel on thrombin generation potential during follow-up. The addition of dipyridamole to aspirin led to a persistent reduction in peak and total thrombin generation ex vivo, and illustrates the diverse, potentially beneficial, newly recognised \\'anti-coagulant\\' effects of dipyridamole in ischaemic CVD.

  18. Oxidative Stress and C-Reactive Protein in Patients with Cerebrovascular Accident (Ischaemic Stroke): The role of Ginkgo biloba extract.

    Science.gov (United States)

    Thanoon, Imad A-J; Abdul-Jabbar, Hilmy As; Taha, Dhia A

    2012-05-01

    This study aimed to investigate the presence of oxidative stress and inflammation in ischaemic stroke patients by measuring malondialdehyde (MDA), total antioxidant status (TAS), and highly-sensitivity C-reactive protein (hsCRP) in the early post-ischaemic period, and to determine the role of Ginkgo biloba therapy in correcting the markers of oxidative stress and inflammation. This study was conducted at Ibn Seena Hospital, Mosul City, Iraq and included 31 cerebrovascular accident (CVA) patients and 30 healthy controls. Ischaemic stroke patients were divided into two groups: group I (n = 15) received conventional therapy; group II (n = 16) received conventional therapy with G. biloba (1500 mg/day) for 30 days. Blood samples were obtained from patients and controls before treatment and assays done of serum levels of MDA, TAS, and hsCRP. For CVA patients, a post-treatment blood sample was taken and the same parameters reassessed. Compared with the controls, patients' serum levels of MDA, and hsCRP were significantly higher (P ≤0.001) and TAS significantly lower. Group I and II patients reported a significant reduction in serum levels of MDA and hsCRP and a significant increase in serum levels of TAS, in comparison with pre-treatment levels. There was no significant difference (P = 0.19) in serum MDA levels between groups I and II, whereas, serum TAS levels were significantly higher (P ≤0.01) and hsCRP significantly lower (P ≤0.01) in group II. Acute stroke is associated with oxidative stress and inflammatory response in the early period. G. biloba plays a potential role in reducing oxidative damage and inflammatory response.

  19. Principios de Nutricion y Alimentacion del Adolescente (Para Estudiantes con Impedimentos Leves y Moderados). Guia Curricular para el Curso Documento de Trabajar. Principles of Nutrition and Food for the Adolescent (For Students with Light and Moderate Disabilities. Course Curriculum Guide. Working Document).

    Science.gov (United States)

    Puerto Rico State Dept. of Education, Hato Rey. Office of Special Education.

    This curriculum guide, in Spanish, consists of a compilation of concepts, activities, and skills for the student with disabilities who receives services from the special education programs of Puerto Rico. Lesson plans cover the basic principles of nutrition, food handling, and food preparation for adolescents. The following units are presented…

  20. Impact of metabolic disorders on the relation between overweight/obesity and incident myocardial infarction and ischaemic stroke in fertile women

    DEFF Research Database (Denmark)

    Andersen, S S; Andersson, C; Berger, S M

    2015-01-01

    AIMS: Whether overweight is a risk factor for cardiovascular disease in the absence of metabolic disorders remains under debate and is largely unexamined in young women. We evaluated the risk of myocardial infarction and ischaemic stroke in fertile women conditional on time-dependent presence...... and smoking, the risk of the composite outcome of myocardial infarction and ischaemic stroke was assessed with metabolic disorders (i.e. hypertensive conditions, abnormal glucose metabolism and/or dyslipidaemia) included as time-dependent variables. RESULTS: The population comprised 261,489 women with median.......1 (CI = 67.6-112.2) and IRR 4.24 (CI = 5 3.11-5.79) in overweight. CONCLUSIONS: The risk of myocardial infarction and ischaemic stroke was more strongly associated with the presence of metabolic disorders than with overweight per se in fertile women. Targeting prevention of metabolic disorders might...

  1. Toward a Moderate Autoethnography

    Directory of Open Access Journals (Sweden)

    Sarah Stahlke Wall

    2016-10-01

    Full Text Available Autoethnography is an avant-garde method of qualitative inquiry that has captured the attention of an ever-increasing number of scholars from a variety of disciplines. Personal experience methods can offer a new and unique vantage point from which to make a contribution to social science yet, autoethnography has been criticized for being self-indulgent, narcissistic, introspective, and individualized. Methodological discussions about this method are polarized. As an autoethnographer and qualitative methodologist with an interest in personal experience methods, I have had the opportunity to review several autoethnographic manuscripts over the years. As my reviews accumulated, I began to see themes in my responses and it became apparent that I was advocating for an approach to autoethnography that lies in contrast to the frequently offered methodological polemics from philosophically divergent scholars. In this article, I draw from the reviews I have done to address topics such as applications and purposes for autoethnography, the degree of theory and analysis used within the method, data sources and dissemination of findings, and ethical issues. I then connect the concerns I see in the reviewed manuscripts to examples in the autoethnographic literature. Ultimately, I propose a moderate and balanced treatment of autoethnography that allows for innovation, imagination, and the representation of a range of voices in qualitative inquiry while also sustaining confidence in the quality, rigor, and usefulness of academic research.

  2. Attitudes and dilemmas of caregivers supporting people with intellectual disabilities who have diabetes.

    NARCIS (Netherlands)

    Cardol, M.; Rijken, M.; Schrojenstein Lantman-de Valk, H.M. van

    2012-01-01

    OBJECTIVE: To explore how professional caregivers in communal living arrangements support people with a mild or moderate intellectual disability (ID) who have diabetes. METHODS: A qualitative study, 13 caregivers participated in semi-structured interviews. RESULTS: Professional caregiver support in

  3. Attitudes and dilemmas of caregivers supporting people with intellectual disabilities who have diabetes.

    NARCIS (Netherlands)

    Cardol, M.; Rijken, M.; Schrojenstein Lantman-de Valk, H. van

    2012-01-01

    Objective: To explore how professional caregivers in communal living arrangements support people with a mild or moderate intellectual disability (ID) who have diabetes. Methods: A qualitative study, 13 caregivers participated in semi-structured interviews. Results: Professional caregiver support in

  4. The valuation of states of ill-health: the impact of age and disability.

    Science.gov (United States)

    Ebrahim, S; Brittis, S; Wu, A

    1991-01-01

    The effects of age and disability on valuations of health states used in deriving QALYs have not been examined. We compared the valuations of seven states of immobility and pain given by 88 subjects aged 20-89 years, and of various degrees of disability. They were asked to score each state, their present health and death, on a range from 'best' to 'worst' health. Only two states of health (no disability but moderate pain, and slight disability and moderate pain) were valued differently by older subjects. Disabled subjects tended to rate most ill-health states more adversely, and to rate death as substantially better than more severe states of ill-health. The development of explicit valuations of survival should take into account differences caused by disability, and examine other dimensions of illness experience.

  5. Successful Management of Gastrointestinal Haemorrhage Associated with Ischaemic Colonic Ulceration in Acute Pancreatitis with Video Assisted Retroperitoneal Debridement

    Directory of Open Access Journals (Sweden)

    Yogesh Puri

    2011-05-01

    Full Text Available Context Colonic involvement is an uncommon but potentially lethal complication of severe acute pancreatitis and has received little attention in the surgical literature. Such complications can range from localized colonic pathology to widespread ischaemic pancolitis. Treatment options have historically been limited to resection of the affected segment. Case report We describe the successful role of video assisted retroperitoneal pancreatic debridement in the management of two cases presenting with major gastrointestinal haemorrhage due to localised colonic ulceration on the background of acute necrotising pancreatitis. Conclusion Video assisted retroperitoneal debridement should be considered early in the management of local colonic complications associated with severe acute necrotising pancreatitis.

  6. Early and delayed distribution of N-isopropyl-[[sup 123]I]-p-iodoamphetamine in haemorrhagic and ischaemic brain

    Energy Technology Data Exchange (ETDEWEB)

    Steinling, M.; Lecouffe, P.; Rousseaux, M.; Mazingue, A.; Huglo, D.; Duhamel, A.; Vergnes, R. (Lille-2 Univ., 59 (France))

    1993-11-01

    Single photon emission computed tomography (SPECT) was used to study redistribution of N-isopropyl-[[sup 123]I]-p-iodoamphetamine (IAMP) in 10 patients with intracerebral haemorrhage and 7 with ischaemic stroke. Delayed/early IAMP uptake ratios (D/E) were calculated for four different cerebral zones: haematoma or infarct, perilesional, normal and crossed cerebellar diaschisis areas. Delayed uptake was observed in all areas, but there were no significant differences between the haematoma and infarct results nor between the lesional and perilesional results. Delayed redistribution of IAMP therefore did not seem to be associated with neuronal metabolic activity. (Author).

  7. Moderate head injury: completing the clinical spectrum of brain trauma.

    Science.gov (United States)

    Rimel, R W; Giordani, B; Barth, J T; Jane, J A

    1982-09-01

    We have divided head injury into three categories based on the Glasgow Coma Scale (GCS) (severe, 3-8; moderate, 9-12; and minor, 13-15). In a previous report, we described significant disability after minor head injury. The present report describes 199 patients with moderate head injury, 159 of whom underwent follow-up examinations at 3 months. In contrast to patients with minor head injury, half as many were students (17%) and twice as many were intoxicated (53%). Seventy-five patients were studied with computed tomographic (CT) scanning; 30% of the scans were negative and 31% showed a space-occupying mass. As reported by Gennarelli et al. in patients with severe head injuries, those with moderate head injury and subdural hematoma had a very poor outcome: 65% died or were severely disabled and none made a good recovery as measured by the Glasgow Outcome Scale. At 3 months, 38% of the moderate head injury patients had made a good recovery compared with 75% of the minor head injury patients. Within the good recovery category, however, there was much disability (headache, 93%; memory difficulties, 90%; difficulties with activities of daily living, 87%), and only 7% of the patients were asymptomatic. The Halstead-Reitan Neuropsychological Battery in an unselected subset (n = 32) showed significant deficits on all test measures. Sixty-six per cent of the patients previously employed had not returned to work, compared to 33% of the minor head injury patients. The major predictors of unemployment after minor head injury were premorbid characteristics (age, education, and socio-economic status). In contrast, all predictors in moderate head injury were measures of the severity of injury (length of coma, CT diagnosis, GCS on discharge). We conclude that: (a) moderate head injury, not described previously in the literature, results in mortality and substantial morbidity intermediate between those of severe and minor head injury; (b) unlike minor head injury, the principal

  8. Global and regional mortality from ischaemic heart disease and stroke attributable to higher-than-optimum blood glucose concentration: comparative risk assessment.

    Science.gov (United States)

    Danaei, Goodarz; Lawes, Carlene M M; Vander Hoorn, Stephen; Murray, Christopher J L; Ezzati, Majid

    2006-11-11

    Cardiovascular mortality risk increases continuously with blood glucose, from concentrations well below conventional thresholds used to define diabetes. We aimed to quantify population-level effects of all higher-than-optimum concentrations of blood glucose on mortality from ischaemic heart disease and stroke worldwide. We used population distribution of fasting plasma glucose to measure exposure to higher-than-optimum blood glucose. We collated exposure data in 52 countries from individual-level records in population health surveys, systematic reviews, and data provided by investigators. Relative risks for ischaemic heart disease and stroke mortality were from a meta-analysis of more than 200,000 participants in the Asia-Pacific region, with adjustment for other cardiovascular risk factors. In addition to 959,000 deaths directly assigned to diabetes, 1 490,000 deaths from ischaemic heart disease and 709,000 from stroke were attributable to high blood glucose, accounting for 21% and 13% of all deaths from these conditions. 1.8 million of these 2.2 million cardiovascular deaths (84%) were in low-and-middle-income countries (1,224,000 for ischaemic heart disease, 623,000 for stroke). 792,000 (53%) of deaths from ischaemic heart disease and 345,000 (49%) from stroke that were attributable to high blood glucose were in men. Largest numbers of deaths attributable to this risk factor from ischaemic heart disease were in low-and-middle-income countries of South Asia (548,000) and Europe and Central Asia (313,000), and from stroke in South Asia (215,000) and East Asia and Pacific (190,000). Higher-than-optimum blood glucose is a leading cause of cardiovascular mortality in most world regions. Programmes for cardiovascular risk and diabetes management and control at the population level need to be more closely integrated.

  9. The clinical profile of women with stable ischaemic heart disease in Spain. More effort is needed in secondary prevention. SIRENA study.

    Science.gov (United States)

    Gámez, J M; Ripoll, T; Barrios, V; Anguita, M; Pedreira, M; Madariaga, I

    2016-01-01

    Cardiovascular diseases are the leading cause of death for women, especially ischaemic heart disease, which is still considered a man's disease. In Spain, there are various registries on ischaemic heart disease, although none are exclusively for women. The objectives of the SIRENA study were to describe the clinical profile of women with ischaemic heart disease treated in cardiology consultations, to estimate its prevalence of cardiovascular risk factors and understand its clinical management. A multicentre observational study was conducted with a sample of 631 women with stable ischaemic heart disease, consecutively included during cardiology consultations. Forty-one researchers from all over Spain participated in the study. The mean age was 68.5 years. The clinical presentation was in the form of acute coronary syndrome in up to 67.2% of the patients. The prevalence of cardiovascular risk factors was high (77.7% of the patients had hypertension, 40.7% had diabetes and 68% had dyslipidaemia), with 30.7% having uncontrolled hypertension, 78.4% having LDL-cholesterol levels higher than 70mg/dL and 49.2% having HbA1c levels greater than 7%. The considerable majority of the patients underwent optimal medical treatment with antiplatelet agents, beta-blockers, renin-angiotensin-aldosterone system blockers and hypolipidaemic agents. Coronary angiography was performed for 88.3% of the patients, and 63.4% underwent percutaneous coronary intervention. Women with stable ischaemic heart disease in Spain initially present some form of acute coronary syndrome and a high prevalence of inadequately controlled cardiovascular risk factors, despite undergoing optimal medical therapy. A high percentage of these women undergo coronary revascularisation. Increased efforts are required for secondary prevention in women with stable ischaemic heart disease. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  10. Predictors of Care-Giver Stress in Families of Preschool-Aged Children with Developmental Disabilities

    Science.gov (United States)

    Plant, K. M.; Sanders, M. R.

    2007-01-01

    Background: This study examined the predictors, mediators and moderators of parent stress in families of preschool-aged children with developmental disability. Method: One hundred and five mothers of preschool-aged children with developmental disability completed assessment measures addressing the key variables. Results: Analyses demonstrated that…

  11. Effects of Teaching Simultaneous Prompting through Visual Supports to Parents of Children with Developmental Disabilities

    Science.gov (United States)

    Batu, Sema

    2014-01-01

    The present study was designed to examine the effectiveness of visual supports on teaching simultaneous prompting procedure to mothers to provide home-based instruction to their children with developmental disabilities. Three preschool-aged children with moderate developmental disabilities and their mothers were the participants. A multiple probe…

  12. The Legal Meaning of Specific Learning Disability for IDEA Eligibility: The Latest Case Law

    Science.gov (United States)

    Zirkel, Perry A.

    2013-01-01

    Specific learning disability (SLD), although moderately declining in recent years, continues to be the largest of the eligibility classifications under the Individuals with Disabilities Education Act (IDEA; NCES, 2012). The recognition of response to intervention (RTI) in the 2004 amendments of the IDEA as an approach for identifying students with…

  13. Thematic Analysis of the Effectiveness of an Inpatient Mindfulness Group for Adults with Intellectual Disabilities

    Science.gov (United States)

    Yildiran, Hatice; Holt, Rachel R.

    2015-01-01

    The study focused on the effectiveness of group mindfulness for people with intellectual disabilities in an assessment and treatment unit. Six participants with mild or moderate intellectual disabilities were interviewed using semi-structured interviews. The interviews focused on identifying the benefits and difficulties of using mindfulness. The…

  14. Functional Life Skills Curricular Interventions for Youth with Disabilities: A Systematic Review

    Science.gov (United States)

    Alwell, Morgen; Cobb, Brian

    2009-01-01

    The relationship between functional or life skills curricula (the intervention) and transition-related outcomes for secondary-aged youth with disabilities is explored in this systematic review. A total of 50 studies intervening with 482 youth with (largely) disability labels of moderate to severe mental retardation were reviewed. The findings of…

  15. Moderate maternal food restriction in mice impairs physical growth, behavior, and neurodevelopment of offspring.

    Science.gov (United States)

    Akitake, Yoshiharu; Katsuragi, Shinji; Hosokawa, Masato; Mishima, Kenichi; Ikeda, Tomoaki; Miyazato, Mikiya; Hosoda, Hiroshi

    2015-01-01

    Intrauterine growth retardation (IUGR) occurs in 3% to 7% of all pregnancies. Recent human studies have indicated that neurodevelopmental disabilities, learning disorders, memory impairment, and mood disturbance are common in IUGR offspring. However, the interactions between IUGR and neurodevelopmental disorders are unclear because of the wide range of causes of IUGR, such as maternal malnutrition, placental insufficiency, pregnancy toxemia, and fetal malformations. Meanwhile, many studies have shown that moderate food restriction enhances spatial learning and improves mood disturbance in adult humans and animals. To date, the effects of maternal moderate food restriction on fetal brain remain largely unknown. In this study, we hypothesized that IUGR would be caused by even moderate food restriction in pregnant females and that the offspring would have neurodevelopmental disabilities. Mid-pregnant mice received moderate food restriction through the early lactation period. The offspring were tested for aspects of physical development, behavior, and neurodevelopment. The results showed that moderate maternal food restriction induced IUGR. Offspring had low birth weight and delayed development of physical and coordinated movement. Moreover, IUGR offspring exhibited mental disabilities such as anxiety and poor cognitive function. In particular, male offspring exhibited significantly impaired cognitive function at 3 weeks of age. These results suggested that a restricted maternal diet could be a risk factor for developmental disability in IUGR offspring and that male offspring might be especially susceptible. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. Trajectories of Disability Among Older Persons Before and After a Hospitalization Leading to a Skilled Nursing Facility Admission.

    Science.gov (United States)

    Buurman, Bianca M; Han, Ling; Murphy, Terrence E; Gahbauer, Evelyne A; Leo-Summers, Linda; Allore, Heather G; Gill, Thomas M

    2016-03-01

    To identify distinct sets of disability trajectories in the year before and after a Medicare qualifying skilled nursing facility (Q-SNF) admission, evaluate the associations between the pre-and post-Q-SNF disability trajectories, and determine short-term outcomes (readmission, mortality). Prospective cohort study including 754 community-dwelling older persons, 70+ years, and initially nondisabled in their basic activities of daily living. The analytic sample included 394 persons, with a first hospitalization followed by a Q-SNF admission between 1998 and 2012. Disability in the year before and after a Q-SNF admission using 13 basic, instrumental, and mobility activities. Secondary outcomes included 30-day readmission and 12-month mortality. The mean (SD) age of the sample was 84.9 (5.5) years. We identified 3 disability trajectories in the year before a Q-SNF admission: minimal disability (37.3% of participants), mild disability (44.6%), and moderate disability (18.2%). In the year after a Q-SNF admission, all participants started with moderate to severe disability scores. Three disability trajectories were identified: substantial improvement (26.0% of participants), minimal improvement (36.5%), and no improvement (37.5%). Among participants with minimal disability pre-Q-SNF, 52% demonstrated substantial improvement; the other 48% demonstrated minimal improvement (32%) or no improvement (16%) and remained moderately to severely disabled in the year post-Q-SNF. Among participants with mild disability pre-Q-SNF, 5% showed substantial improvement, whereas 95% showed little to no improvement. Of participants with moderate disability pre-Q-SNF, 15% remained moderately disabled showing little improvement, whereas 85% showed no improvement. Participants who transitioned from minimal disability pre-Q-SNF to no improvement post-Q-SNF had the highest rates of 30-day readmission and 12-month mortality (rate/100 person-days 1.3 [95% CI 0.6-2.8] and 0.3 [95% CI 0

  17. Trajectories of disability among older persons before and after a hospitalization leading to a skilled nursing facility admission

    Science.gov (United States)

    Buurman, Bianca M.; Han, Ling; Murphy, Terrence E.; Gahbauer, Evelyne A.; Leo-Summers, Linda; Allore, Heather G.; Gill, Thomas M.

    2015-01-01

    Objectives To identify distinct sets of disability trajectories in the year before and after a Q-SNF admission, evaluate the associations between the pre- and post-Q-SNF disability trajectories, and determine short-term outcomes (readmission, mortality). Design, setting and participants Prospective cohort study including 754 community-dwelling older persons, 70+ years, and initially nondisabled in their basic activities of daily living. The analytic sample included 394 persons, with a first hospitalization followed by a Q-SNF admission between 1998–2012. Main outcomes and measures Disability in the year before and after a Q-SNF admission using 13 basic, instrumental and mobility activities. Secondary outcomes included 30-day readmission and 12-month mortality. Results The mean (SD) age of the sample was 84.9(5.5) years. We identified three disability trajectories in the year before a Q-SNF admission: minimal disability (37.3% of participants) mild disability (44.6%), and moderate disability (18.2%). In the year after a Q-SNF admission, all participants started with moderate to severe disability scores. Three disability trajectories were identified: substantial improvement (26.0% of participants), minimal improvement (36.5%), and no improvement (37.5%). Among participants with minimal disability pre-Q-SNF, 52% demonstrated substantial improvement; the other 48% demonstrated minimal improvement (32%) or no improvement (16%) and remained moderately to severely disabled in the year post-Q-SNF. Among participants with mild disability pre-Q-SNF, 5% showed substantial improvement, whereas 95% showed little to no improvement. Of participants with moderate disability pre-Q-SNF, 15% remained moderately disabled showing little improvement, whereas 85% showed no improvement. Participants who transitioned from minimal disability pre-Q-SNF to no improvement post-Q-SNF had the highest rates of 30-day readmission and 12-month mortality (rate/100 person days 1.3 [95% CI 0.6–2

  18. Post-ischaemic long-term synaptic potentiation in the striatum: a putative mechanism for cell type-specific vulnerability.

    Science.gov (United States)

    Calabresi, Paolo; Saulle, Emilia; Centonze, Diego; Pisani, Antonio; Marfia, Girolama A; Bernardi, Giorgio

    2002-04-01

    In the present in vitro study of rat brain, we report that transient oxygen and glucose deprivation (in vitro ischaemia) induced a post-ischaemic long-term synaptic potentiation (i-LTP) at corticostriatal synapses. We compared the physiological and pharmacological characteristics of this pathological form of synaptic plasticity with those of LTP induced by tetanic stimulation of corticostriatal fibres (t-LTP), which is thought to represent a cellular substrate of learning and memory. Activation of N-methyl-D-aspartate (NMDA) receptors was required for the induction of both forms of synaptic plasticity. The intraneuronal injection of the calcium chelator BAPTA [bis(2-aminophenoxy)ethane-N,N,N',N'-tetraacetate] and inhibitors of the mitogen-activated protein kinase pathway blocked both forms of synaptic plasticity. However, while t-LTP showed input specificity, i-LTP occurred also at synaptic pathways inactive during the ischaemic period. In addition, scopolamine, a muscarinic receptor antagonist, prevented the induction of t-LTP but not of i-LTP, indicating that endogenous acetylcholine is required for physiological but not for pathological synaptic potentiation. Finally, we found that striatal cholinergic interneurones, which are resistant to in vivo ischaemia, do not express i-LTP while they express t-LTP. We suggest that i-LTP represents a pathological form of synaptic plasticity that may account for the cell type-specific vulnerability observed in striatal spiny neurones following ischaemia and energy deprivation.

  19. Effect of stromal-cell-derived factor 1 on stem-cell homing and tissue regeneration in ischaemic cardiomyopathy

    Science.gov (United States)

    Askari, Arman T.; Unzek, Samuel; Popovic, Zoran B.; Goldman, Corey K.; Forudi, Farhad; Kiedrowski, Matthew; Rovner, Aleksandr; Ellis, Stephen G.; Thomas, James D.; DiCorleto, Paul E.; Topol, Eric J.; Penn, Marc S.

    2003-01-01

    BACKGROUND: Myocardial regeneration via stem-cell mobilisation at the time of myocardial infarction is known to occur, although the mechanism for stem-cell homing to infarcted tissue subsequently and whether this approach can be used for treatment of ischaemic cardiomyopathy are unknown. We investigated these issues in a Lewis rat model (ligation of the left anterior descending artery) of ischaemic cardiomyopathy. METHODS: We studied the effects of stem-cell mobilisation by use of granulocyte colony-stimulating factor (filgrastim) with or without transplantation of syngeneic cells. Shortening fraction and myocardial strain by tissue doppler imaging were quantified by echocardiography. FINDINGS: Stem-cell mobilisation with filgrastim alone did not lead to engraftment of bone-marrow-derived cells. Stromal-cell-derived factor 1 (SDF-1), required for stem-cell homing to bone marrow, was upregulated immediately after myocardial infarction and downregulated within 7 days. 8 weeks after myocardial infarction, transplantation into the peri-infarct zone of syngeneic cardiac fibroblasts stably transfected to express SDF-1 induced homing of CD117-positive stem cells to injured myocardium after filgrastim administration (control vs SDF-1-expressing cardiac fibroblasts mean 7.2 [SD 3.4] vs 33.2 [6.0] cells/mm2, n=4 per group, pmyocardial tissue must be initiated within days of myocardial infarction unless signalling for stem-cell homing is re-established.

  20. A qualitative study exploring patients' experiences of standard care or cardiac rehabilitation post minor stroke and transient ischaemic attack.

    Science.gov (United States)

    Hillsdon, Kaye M; Kersten, Paula; Kirk, Hayden J S

    2013-09-01

    To explore individuals' experiences of receiving either standard care or comprehensive cardiac rehabilitation post minor stroke or transient ischaemic attack. A qualitative study using semi-structured interviews, alongside a randomized controlled trial, exploring the effectiveness of comprehensive cardiac rehabilitation compared with standard care. Interviews were transcribed verbatim and subjected to thematic analysis. Individuals' homes. People who have experienced a minor stroke or transient ischaemic attack and who were partaking in a secondary prevention randomized controlled trial (6-7 months post the event, 17 males, five females; mean age 67 years). Not relevant. Not relevant. Four themes were identified: information delivery, comparing oneself with others, psychological impact, attitudes and actions regarding risk factor reduction. Participants indicated a need for improved information delivery, specific to their own risk factors and lifestyle changes. Many experienced psychological impact as a result of their minor stroke. Participants were found to make two types of social comparison; the comparison of self to another affected by stroke, and the comparison of self to cardiac patients. Comprehensive cardiac rehabilitation was reported to have positive effects on people's motivation to exercise. Following a minor stroke, many individuals do not recall information given or risk factors specific to them. Downward comparison with individuals who have had a cardiovascular event led to some underplaying the significance of their minor stroke.