Sample records for stroke rate sr

  1. Critical stroke rate as a parameter for evaluation in swimming

    Directory of Open Access Journals (Sweden)

    Marcos Franken


    Full Text Available The purpose of this study was to investigate the critical stroke rate (CSR compared to the average stroke rate (SR when swimming at the critical speed (CS. Ten competitive swimmers performed five 200 m trials at different velocities relative to their CS (90, 95, 100, 103 and 105% in front crawl. The CSR was significantly higher than the SR at 90% of the CS and lower at 105% of the CS. Stroke length (SL at 103 and 105% of the CS were lower than the SL at 90, 95, and 100% of the CS. The combination of the CS and CSR concepts can be useful for improving both aerobic capacity/power and technique. CS and CSR could be used to reduce the SR and increase the SL, when swimming at the CS pace, or to increase the swimming speed when swimming at the CSR.

  2. Velocity, stroke rate, and distance per stroke during elite swimming competition. (United States)

    Craig, A B; Skehan, P L; Pawelczyk, J A; Boomer, W L


    The mean velocity of 9 out of 10 women's events during the U.S. Olympic Swimming Trials was greater in 1984 as compared to 1976. Three of the 10 men's events showed improvement. In 9 out of these 12 events, the increased velocity was accounted for by increased distance per stroke (range, -3 to -13%). In the women's 100-m butterfly and 100-m backstroke, increased velocity was due solely to faster stroke rates. The finalists in each event were compared to those whose velocities were 3-7% slower. In almost all events and stroke styles, the finalists achieved greater distances per stroke than did the slower group. In the men's events increased distance per stroke was associated with decreased stroke rate, except in the backstroke, in which both were increased for the finalists. Although the faster women swimmers generally had greater distances per stroke, they were more dependent than men on faster stroke rates to achieve superiority. The profile of velocity for races of 200 m and longer indicated that as fatigue developed the distance per stroke decreased. The faster swimmers compensated for this change by maintaining or increasing stroke rate more than did their slower competitors. This study indicates that improvements and superiority in stroke mechanics are reflected in the stroke rate and distance per stroke used to swim a race.

  3. Kinematic measures and stroke rate variability in elite female 200-m swimmers in the four swimming techniques: Athens 2004 Olympic semi-finalists and French National 2004 Championship semi-finalists. (United States)

    Hellard, P; Dekerle, J; Avalos, M; Caudal, N; Knopp, M; Hausswirth, C


    The aim of this study was to assess stroke rate variability in elite female swimmers (200-m events, all four techniques) by comparing the semi-finalists at the Athens 2004 Olympic Games (n = 64) and semi-finalists at the French National 2004 Championship (n = 64). Since swimming speed (V) is the product of stroke rate (SR) and stroke length (SL), these three variables and the coefficient of variation of stroke rate (CV(SR)) of the first and second 100 m were determined (V1, V2; SR1, SR2; SL1, SL2; CV(SR)1, CV(SR)2) and differences between the two parts of the events were calculated (DeltaV; DeltaSR; DeltaSL; DeltaCV(SR)). When the results for the four 200-m events were analysed together, SR1, SR2, SL1, and SL2 were higher (alpha = 0.05, Pbackstrokes and longer freestyle strokes (P backstroke races in the Olympic group than in the National group (P < 0.001). Our results suggest that stroke rate variability is dependent on an interaction between the biomechanical requisites of the task (techniques) and the standard of the swimmer.

  4. Validity and reliability of critical speed, critical stroke rate, and anaerobic capacity in relation to front crawl swimming performances. (United States)

    Dekerle, J; Sidney, M; Hespel, J M; Pelayo, P


    The purpose of this investigation was to determine whether the concepts of critical swimming speed, critical stroke rate and anaerobic swimming capacity could be used by coaches as a reliable index in order to monitor endurance performances in competitive swimmers. The results of this study conducted with well-trained swimmers showed that the 30-min test velocity (V30) is not different from the critical swimming speed determined from 200- and 400-m tests but is overestimated by 3.2 %. Furthermore, a regression analysis of the number of stroke cycles on time calculated for each swimmer showed a linear relationship (r(2) greater than 0.99 and p less than 0.01). The 30-min stroke rate test (SR30) was not different from the critical stroke rate determined from 200- and 400-m tests after a correction of minus 3.9 %. These data suggest that the slope of this regression line represents the critical stroke rate defined as the maximal stroke rate value, which can theoretically be maintained continuously without exhaustion. Coaches could easily use critical swimming speed combined with critical stroke rate in order not only to set aerobic training loads but also to control the swimming technique during training. Besides, anaerobic swimming capacity (ASC) values defined as the y-intercept of the regression line between distance and time were not correlated (p > 0.05) with the determined distance over which a significant drop in the maximal speed could be noticed on a 25-m test. Thus, ASC does not provide a reliable estimation of the anaerobic capacity.

  5. Decreased nighttime heart rate variability is associated with increased stroke risk

    DEFF Research Database (Denmark)

    Binici, Zeynep; Mouridsen, Mette Rauhe; Køber, Lars


    Prediction of stroke in healthy individuals is challenging and there is a diurnal variation of stroke onset. We hypothesized that heart rate variability with a focus on nighttime heart rate variability will predict the risk of stroke in apparently healthy middle-age and elderly subjects....

  6. Vadose Zone Infiltration Rate at Hanford, Washington, Inferred from Sr Isotope Measurements

    International Nuclear Information System (INIS)

    Maher, Katharine; DePaolo, Donald J.; Conrad, Mark E.; Serne, R. Jeffrey


    Sr isotope ratios were measured in the pore water, acid extracts, and sediments of a 70-m vadose zone core to obtain estimates of the long-term infiltration flux for a site in the Hanford/DOE complex in eastern Washington State. The 87Sr/86Sr values of the pore waters decrease systematically with depth, from a high value of 0.721 near the surface toward the bulk sediment average value of 0.711. Estimates of the bulk weathering rate combined with Sr isotopic data were used to constrain the long-term (century to millenial scale) natural diffuse infiltration flux for the site given both steady state and nonsteady state conditions. The models suggest that the infiltration fluc for the site is 7+- 3 mm/yr. The method shows potential for providing long-term in situ estimates of infiltration rates for deep heterogeneous vadose zones

  7. Heart rate as a predictor of stroke in high-risk, hypertensive patients with previous stroke or transient ischemic attack. (United States)

    Sandset, Else Charlotte; Berge, Eivind; Kjeldsen, Sverre E; Julius, Stevo; Holzhauer, Björn; Krarup, Lars-Henrik; Hua, Tsushung A


    Risk factors for first stroke are well established, but less is known about risk factors for recurrent stroke. In the present analysis, we aimed to assess the effect of heart rate and other possible predictors of stroke in a hypertensive population with previous stroke or transient ischemic attack (TIA). The Valsartan Antihypertensive Long-Term Use Evaluation trial was a multicentre, double-masked, randomized controlled, parallel group trial comparing the effects of an angiotensin receptor blocker (valsartan) and a calcium channel blocker (amlodipine) in patients with hypertension and high cardiovascular risk. We used Cox proportional hazard models to investigate the effect of baseline variables on the risk of stroke. Quadratic terms of the continuous variables were entered in the models to test for linearity. Of 15,245 patients included in the trial, 3014 had a previous stroke or TIA at baseline and were included in the present analysis. Stroke recurrence occurred in 239 patients (7.9%) during a median of 4.5 years of follow-up. Resting heart rate (per 10 beats per minute; hazard ratio [HR], 2.78; 95% confidence interval [CI], 1.18-6.58) and diabetes mellitus at baseline (HR, 1.47; 95% CI, 1.03-2.10) were significantly associated with an increased risk of stroke recurrence in the multivariable analysis. In high-risk, hypertensive patients with previous stroke or TIA, resting heart rate was the strongest predictor of recurrent stroke. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  8. Effect of stroke on fall rate, location and predictors: a prospective comparison of older adults with and without stroke.

    Directory of Open Access Journals (Sweden)

    Lisa A Simpson

    Full Text Available BACKGROUND: The literature suggests that stroke is a major risk factor for falls, but there is a lack of prospective, controlled studies which quantify fall-risk after stroke. The purpose of this study was to compare the rates, location and predictors among individuals recently discharged home from stroke rehabilitation to age and sex matched controls. METHODOLOGY/PRINCIPAL FINDINGS: A sample of 80 people with stroke and 90 controls received baseline assessments of balance, mobility and balance confidence. Falls were recorded prospectively over 13 months for both groups. Group differences in fall rates and contribution of clinical measures to falls were determined using negative binomial regression. Fall location was compared between groups using χ(2 statistics. The rate of falls for individuals with stroke was 1.77 times the rate for the control group. People with stroke were more likely to fall at home. Poorer balance (Berg Balance Scale was associated with greater falls for both stroke and control groups (incidence rate ratio [IRR]: 0.908 and IRR: 0.877 respectively. A faster Timed Up and Go Test was associated with greater falls for the stroke group (IRR: 0.955 while better walking endurance (Six Minute Walk Test was associated with greater falls for the controls (IRR: 1.004. Balance confidence was not an independent predictor in either group. CONCLUSIONS: Individuals recently discharged home are at greater risk of falling than individuals without stroke. Attention to home environment is warranted. Balance function can predict falls for both people with stroke and age and sex matched controls. Increased mobility may increase exposure to fall opportunities.

  9. Effect of stroke on fall rate, location and predictors: a prospective comparison of older adults with and without stroke. (United States)

    Simpson, Lisa A; Miller, William C; Eng, Janice J


    The literature suggests that stroke is a major risk factor for falls, but there is a lack of prospective, controlled studies which quantify fall-risk after stroke. The purpose of this study was to compare the rates, location and predictors among individuals recently discharged home from stroke rehabilitation to age and sex matched controls. A sample of 80 people with stroke and 90 controls received baseline assessments of balance, mobility and balance confidence. Falls were recorded prospectively over 13 months for both groups. Group differences in fall rates and contribution of clinical measures to falls were determined using negative binomial regression. Fall location was compared between groups using χ(2) statistics. The rate of falls for individuals with stroke was 1.77 times the rate for the control group. People with stroke were more likely to fall at home. Poorer balance (Berg Balance Scale) was associated with greater falls for both stroke and control groups (incidence rate ratio [IRR]: 0.908 and IRR: 0.877 respectively). A faster Timed Up and Go Test was associated with greater falls for the stroke group (IRR: 0.955) while better walking endurance (Six Minute Walk Test) was associated with greater falls for the controls (IRR: 1.004). Balance confidence was not an independent predictor in either group. Individuals recently discharged home are at greater risk of falling than individuals without stroke. Attention to home environment is warranted. Balance function can predict falls for both people with stroke and age and sex matched controls. Increased mobility may increase exposure to fall opportunities.

  10. Heart rate variability and baroreceptor sensitivity in acute stroke: a systematic review. (United States)

    Yperzeele, Laetitia; van Hooff, Robbert-Jan; Nagels, Guy; De Smedt, Ann; De Keyser, Jacques; Brouns, Raf


    Autonomic nervous system dysfunction is common after acute stroke and is associated with elevated risk of cardiac arrhythmia and mortality. Heart rate variability and baroreceptor sensitivity have been investigated as parameters of autonomic nervous system dysfunction for the prediction of stroke outcome. We performed a systematic literature review on heart rate variability and baroreceptor sensitivity as parameters for autonomic nervous function in acute stroke. Twenty-two studies were included. Associations between heart rate variability or baroreceptor sensitivity and stroke severity, early and late complications, dependency and mortality were reported. However, interpretability of most studies and extrapolation to general stroke population are limited due to many confounding factors such as varying methodology, small sample sizes, survival selection, and exclusion of patients with frequently occurring comorbidities in stroke. Key issues, such as the effect of thrombolytic therapy on autonomic function, autonomic nervous system dysfunction in the hyperacute phase of stroke, and correlation with the risk of recurrent stroke have not been investigated. Also, nonlinear techniques have remained largely unexplored in this domain, in spite of their advantage to provide more solid evaluation in the occurrence of arrhythmia. Cardiac autonomic dysfunction, represented by reduced heart rate variability or impaired baroreceptor sensitivity, is associated with stroke severity, early and late complications, dependency, and mortality. Large-scale prospective studies applying internationally accepted standards of measures for analysis of heart rate variability and baroreceptor sensitivity are needed in patients with acute stroke. © 2015 World Stroke Organization.

  11. Risk-adjusted hospital mortality rates for stroke: evidence from the Australian Stroke Clinical Registry (AuSCR). (United States)

    Cadilhac, Dominique A; Kilkenny, Monique F; Levi, Christopher R; Lannin, Natasha A; Thrift, Amanda G; Kim, Joosup; Grabsch, Brenda; Churilov, Leonid; Dewey, Helen M; Hill, Kelvin; Faux, Steven G; Grimley, Rohan; Castley, Helen; Hand, Peter J; Wong, Andrew; Herkes, Geoffrey K; Gill, Melissa; Crompton, Douglas; Middleton, Sandy; Donnan, Geoffrey A; Anderson, Craig S


    Hospital data used to assess regional variability in disease management and outcomes, including mortality, lack information on disease severity. We describe variance between hospitals in 30-day risk-adjusted mortality rates (RAMRs) for stroke, comparing models that include or exclude stroke severity as a covariate. Cohort design linking Australian Stroke Clinical Registry data with national death registrations. Multivariable models using recommended statistical methods for calculating 30-day RAMRs for hospitals, adjusted for demographic factors, ability to walk on admission, stroke type, and stroke recurrence. Australian hospitals providing at least 200 episodes of acute stroke care, 2009-2014. Hospital RAMRs estimated by different models. Changes in hospital rank order and funnel plots were used to explore variation in hospital-specific 30-day RAMRs; that is, RAMRs more than three standard deviations from the mean. In the 28 hospitals reporting at least 200 episodes of care, there were 16 218 episodes (15 951 patients; median age, 77 years; women, 46%; ischaemic strokes, 79%). RAMRs from models not including stroke severity as a variable ranged between 8% and 20%; RAMRs from models with the best fit, which included ability to walk and stroke recurrence as variables, ranged between 9% and 21%. The rank order of hospitals changed according to the covariates included in the models, particularly for those hospitals with the highest RAMRs. Funnel plots identified significant deviation from the mean overall RAMR for two hospitals, including one with borderline excess mortality. Hospital stroke mortality rates and hospital performance ranking may vary widely according to the covariates included in the statistical analysis.

  12. Geochronological synthesis of Bahia state and the crustal evolution, based in evolution diagram of Sr and initial rate of Sr87/Sr86

    International Nuclear Information System (INIS)

    Sato, K.


    The crustal evolution of the ancient terrains of the State of Bahia, Brazil, is attempted with the aid of Sr isotopic results as natural tracers. Some Nd and Pb isotopic data are also available, and support the main conclusions based on Sr evolution diagrams. The analysis of the Sr evolution diagrams shows that the Archean Terrains are mainly formed by accretion from mantle-derived material, but crustal reworking is indicated by the high initial 87 Sr/ 86 Sr value of the Jequie Complex. The Transamazonian mobile belt include both types of materials, but the 87 Sr/ 86 Sr value, generally lower than those of the Jequie Complex, markes improbable a direct derivation. During Middle and Late Proterozoic, the continental crust was already well consolidated, and reworking of crustal material predominated within the Espinhaco and Brasiliano folded systems [pt


    Directory of Open Access Journals (Sweden)

    Ekowati Rahajeng


    Full Text Available Stroke is the leading cause of death and disability in the world. Several studies have shown that stroke can be prevented through modifiable risk factors. The adequate treatment of hypertension may reduce the risk of stroke. Lifestyle modification such as reducing salt intake in hypertension management have demonstrated lowering blood pressure, enhancing the effectiveness of antihypertension drugs and also reducing stroke risk. This study aims to verify the survival rate of hypertension with lower sodium intake (<2000 mg per day on the incidence of stroke. The study was conducted through a prospective cohort study (4 years of follow-up in 1082 people with confirmed hypertension. Stroke were confirmed by neurologist. The consumption of sodium, sugar and fat were collected through 24-hour dietary recall. Hypertension survival rate was calculated using Life Table Survival analysis. This study has demonstrated evidence of the higher survival rate of hypertension with low sodium intake on the incidence of stroke, with the difference 2-year survival rate is 3 percent higher and 4-year survival rate is 5 percent higher. Sodium consumption of <2000 mg per day in people with hypertension has prevented a 78 percent incidence of stroke. Therefore, the intervention programs to reduce of the consumption of salt or sodium in Indonesia should be prioritized.

  14. estimated glomerular filtration rate and risk of survival in acute stroke

    African Journals Online (AJOL)


    Mar 3, 2014 ... the risk of survival in acute stroke. INTRODUCTION. Stroke is independently associated with impairment in the structure and function of the glomerulus. (1). Estimated Glomerular Filtration Rate (GFR) as determined by the four-item Modification of diet in renal disease (MDRD) equation is a fairly reliable.

  15. Rates and Determinants of 5-Year Outcomes After Atrial Fibrillation-Related Stroke: A Population Study. (United States)

    Hayden, Derek T; Hannon, Niamh; Callaly, Elizabeth; Ní Chróinín, Danielle; Horgan, Gillian; Kyne, Lorraine; Duggan, Joseph; Dolan, Eamon; O'Rourke, Killian; Williams, David; Murphy, Sean; Kelly, Peter J


    Demographic trends in atrial fibrillation (AF) incidence may yield a substantial rise in the societal burden of AF-related stroke (AF-stroke). Accurate population-wide outcome data are essential to inform health service planning to improve AF-stroke prevention, and provision of rehabilitation, nursing home, and community supports for AF-stroke survivors. We investigated rates and determinants of 5-year fatality, stroke recurrence, functional outcomes, and prescribing of secondary prevention medications in AF-stroke in the North Dublin Population Stroke Study. Ascertainment included hot and cold pursuit using multiple overlapping sources. Survival analysis was performed using lifetables and Kaplan-Meier survival curves, and Cox proportional hazard modeling was performed to identify predictors of death and recurrent stroke. Five hundred sixty-eight patients with new stroke were identified, including 177 (31.2%) AF-stroke. At 5 years, 39.2% (confidence interval, 31.5-46.8) of ischemic AF-stroke patients were alive. Congestive heart failure, hypertension, age stroke, transient ischemic attack or thromboembolism, vascular disease and female sex (CHA2DS2-VASc) score (hazard ratio [HR], 1.34; PStroke Scale (HR, 1.09; Pstroke onset (HR, 3.29; P=0.003) were independently associated with 5-year fatality, whereas warfarin (HR, 0.40; P=0.001) and statin use after index stroke (HR, 0.52; P=0.005) were associated with improved survival. The 5-year recurrence rate after ischemic AF-stroke was 21.5% (confidence interval, 14.5-31.3). Trends toward greater risk of recurrence were observed for persistent AF (HR, 3.09; P=0.07) and CHA2DS2-VASc score (HR, 1.34; P=0.07). Nursing home care was needed for 25.9% of patients. AF-stroke is associated with considerable long-term morbidity, fatality, stroke recurrence, and nursing home requirement. Adequately resourced national AF strategies to improve AF detection and prevention are needed. © 2015 American Heart Association, Inc.

  16. Stroke incidence rates among black residents of Harare - a ...

    African Journals Online (AJOL)

    general practitioners or the city health clinics directly to one of the four general hospitals. The city health clinics do not have beds for acute medical cases and the general practitioners do not visit patients in their homes, and cannot refer cases of stroke to nursing homes before acute treatment and evaluation by physicians in ...

  17. Rasch analysis in the development of a rating scale for assessment of mobility after stroke

    DEFF Research Database (Denmark)

    Engberg, A; Garde, B; Kreiner, S


    The study describes the development of a rating scale for assessment of mobility after stroke. It was based on 74 first-stroke patients, 40 men and 34 women, each assessed three times during rehabilitation. Their median age was 69 years, and they represented all degrees of severity of paresis....... Content, construct, criterion and convergent validity were examined, as well as the inter-rater reliability. The final rating scale has three special characteristics: 1) it reflects the regularity in the recovery of mobility after stroke; 2) the sum of item scores comprises the information contained...

  18. Impact of stroke unit in a public hospital on length of hospitalization and rate of early mortality of ischemic stroke patients

    Directory of Open Access Journals (Sweden)

    Maria Sheila G. Rocha


    Full Text Available We ascertained whether a public health stroke unit reduces the length of hospitalization, the rate of inpatient fatality, and the mortality rate 30 days after the stroke. Methods We compared a cohort of stroke patients managed on a general neurology/medical ward with a similar cohort of stroke patients managed in a str oke unit. The in-patient fatality rates and 30-day mortality rates were analyzed. Results 729 patients were managed in the general ward and 344 were treated at a comprehensive stroke unit. The in-patient fatality rates were 14.7% for the general ward group and 6.9% for the stroke unit group (p<0.001. The overall mortality rate 30 days after stroke was 20.9% for general ward patients and 14.2% for stroke unit patients (p=0.005. Conclusions We observed reduced in-patient fatalities and 30-day mortality rates in patients managed in the stroke unit. There was no impact on the length of hospitalization.

  19. Stroke subtypes, risk factors and mortality rate in northwest of Iran

    DEFF Research Database (Denmark)

    Farhoudi, Mehdi; Mehrvar, Kaveh; Sadeghi-Bazargani, Homayoun


    data, risk factors, types and mortality. Methods: A retrospective study was done in two university tertiary referral hospitals in Tabriz, northwest of Iran, from March 2008 to April 2013. Patients diagnosed with stroke were enrolled in the study. Demographic data, stroke subtypes, duration...... of hospitalization, stroke risk factors and hospital mortality rate were recorded for all the patients. Results: A total number of 5355 patients were evaluated in the present study. Mean age of the patients was 67.5 ± 13.8 years, and 50.6% were men. Final diagnosis of ischemic stroke was made in 76.......5% of the patients, intra-cerebral hemorrhage (ICH) with or without intra-ventricular hemorrhage (IVH) in 14.3% and subarachnoid hemorrhage (SAH) in 9.2%. Stroke risk factors among the patients were hypertension in 68.8% of the patients, diabetes mellitus (DM) in 23.9%, smoking in 12.6% and ischemic heart diseases...

  20. Carrier density independent scattering rate in SrTiO3-based electron liquids. (United States)

    Mikheev, Evgeny; Raghavan, Santosh; Zhang, Jack Y; Marshall, Patrick B; Kajdos, Adam P; Balents, Leon; Stemmer, Susanne


    We examine the carrier density dependence of the scattering rate in two- and three-dimensional electron liquids in SrTiO3 in the regime where it scales with T(n) (T is the temperature and n ≤ 2) in the cases when it is varied by electrostatic control and chemical doping, respectively. It is shown that the scattering rate is independent of the carrier density. This is contrary to the expectations from Landau Fermi liquid theory, where the scattering rate scales inversely with the Fermi energy (EF). We discuss that the behavior is very similar to systems traditionally identified as non-Fermi liquids (n density-independent scattering rates have been observed. The results indicate that the applicability of Fermi liquid theory should be questioned for a much broader range of correlated materials and point to the need for a unified theory.

  1. Pulsed laser deposition of SrRuO3 thin-films: The role of the pulse repetition rate

    Directory of Open Access Journals (Sweden)

    H. Schraknepper


    Full Text Available SrRuO3 thin-films were deposited with different pulse repetition rates, fdep, epitaxially on vicinal SrTiO3 substrates by means of pulsed laser deposition. The measurement of several physical properties (e.g., composition by means of X-ray photoelectron spectroscopy, the out-of-plane lattice parameter, the electric conductivity, and the Curie temperature consistently reveals that an increase in laser repetition rate results in an increase in ruthenium deficiency in the films. By the same token, it is shown that when using low repetition rates, approaching a nearly stoichiometric cation ratio in SrRuO3 becomes feasible. Based on these results, we propose a mechanism to explain the widely observed Ru deficiency of SrRuO3 thin-films. Our findings demand these theoretical considerations to be based on kinetic rather than widely employed thermodynamic arguments.

  2. Stroke (United States)

    ... adjust your treatment as needed. Rehabilitation After a stroke, you may need rehabilitation (rehab) to help you recover. Rehab may include working with speech, physical, and occupational therapists. Language, ... may have trouble communicating after a stroke. You may not be able to find the ...

  3. Addition and spin exchange rate constants by longitudinal field μSR: the Mu + NO reaction

    International Nuclear Information System (INIS)

    Senba, Masayoshi; Gonzalez, A.C.; Kempton, J.R.; Arseneau, D.J.; Pan, J.J.; Tempelmann, A.; Fleming, D.G.


    The addition reaction Mu + NO + M → MuNO + M and the spin exchange reaction Mu(↑) + NO(↓)→Mu(↓)+NO(↑) have been measured by longitudinal field μSR at room temperature in the presence of up to 58 atm of N 2 as inert collider. The pressure dependence of the longitudinal relaxation rate due to the addition reaction (λ c ) demonstrates that the system is still in the low pressure regime in this pressure range. The corresponding termolecular rate constant has been determined as k 0.Mu =(1.10±0.25)x10 -32 cm 6 molecules -2 s -1 , almost 4 times smaller than the corresponding H atom reaction k 0,H =3.90x10 -32 cm 6 molecules -2 s -1 . The average value of the spin exchange rate constants in the 2.5-58 atm pressure range, k SE = (3.16±0.06)x10 -10 cm 3 molecule -1 s -1 , is in good agreement with previous values obtained by transverse field μSR. (orig.)

  4. An apparent "vital effect" of calcification rate on the Sr/Ca temperature proxy in the reef coral Montipora capitata (United States)

    Kuffner, Ilsa; Jokiel, Paul L.; Rodgers, Kuulei; Andersson, Andreas; Mackenzie, Fred T.


    Measuring the strontium to calcium ratio in coral skeletons reveals information on seawater temperatures during skeletal deposition, but studies have shown additional variables may affect the ratio. Here we measured Sr/Ca in the reef coral, Montipora capitata, grown in six mesocosms continuously supplied with seawater from the adjacent reef flat. Three mesocosms were ambient controls, and three had seawater chemistry simulating "ocean acidification" (OA). We found that Sr/Ca was not affected by the OA treatment, and neither was coral calcification for these small colonies (larger colonies did show an OA effect). The lack of OA effects allowed us to test the hypothesis that coral growth rate can affect Sr/Ca using the natural range in calcification rates of the corals grown at the same temperature. We found that Sr/Ca was inversely related to calcification rate (Sr/Ca = 9.39 - 0.00404 mmol/mol * mg day-1 cm-2, R2 = 0.32). Using a previously published calibration curve for this species, a 22 mg day-1 colony-1 increase in calcification rate introduced a 1°C warmer temperature estimate, with the 27 corals reporting "temperatures" ranging from 24.9 to 28.9, with mean 26.6 ± 0.9°C SD. Our results lend support to hypotheses invoking kinetic processes and growth rate to explain vital effects on Sr/Ca. However, uncertainty in the slope of the regression of Sr/Ca on calcification and a low R-squared value lead us to conclude that Sr/Ca could still be a useful proxy in this species given sufficient replication or by including growth rate in the calibration.

  5. Impairment in glomerular filtration rate or glomerular filtration barrier and occurrence of stroke. (United States)

    Ovbiagele, Bruce


    Chronic kidney disease (CKD) is associated with substantial burden and is a strong risk factor for cardiovascular disease. However, data on the relationship between CKD and stroke are few and are limited by unreliable or inadequate assessment of renal function. To properly assess the relationship between renal insufficiency and stroke in stroke survivors in the United States by simultaneously examining the effect of guideline-recommended indices of renal disease that measure glomerular filtration rate (creatinine clearance) and glomerular filtration barrier (proteinuria). Cross sectional. Nationally representative survey of the United States. Participants aged 55 or older who participated in the National Health and Nutrition Examination Survey from 1999 to 2004. Indices of renal disease that measure glomerular filtration rate (creatinine clearance) and glomerular filtration barrier (microalbuminuria). Of 6382 adults who met inclusion criteria, 5624 (88%) had full and complete data, of which 414 (6%) reported having had a stroke. Stroke survivors were older and more likely to have CKD, diabetes, hypertension, coronary artery disease, elevated blood pressure, increased glycohemoglobin concentration, and lower hematocrit compared with respondents who did not report stroke. Multivariate models showed that microalbuminuria (odds ratio, 1.51; 95% confidence interval, 1.02-2.24), decreased glomerular filtration rate (odds ratio, 1.93; 95% confidence interval, 1.28-2.91), and stage 3 CKD (odds ratio, 2.09; 95% confidence interval, 1.38-3.16) were significantly associated with stroke. Stroke is independently associated with impairment in structure and function of the glomerulus, which supports the need to consider screening patients with stroke for CKD and to simultaneously assess for both indices of renal disease.

  6. External Counterpulsation Increases Beat-to-Beat Heart Rate Variability in Patients with Ischemic Stroke. (United States)

    Xiong, Li; Tian, Ge; Wang, Li; Lin, Wenhua; Chen, Xiangyan; Leung, Thomas Wai Hong; Soo, Yannie Oi Yan; Wong, Lawrence Ka Sing


    External counterpulsation (ECP) is a noninvasive method used to augment cerebral perfusion in ischemic stroke. However, the response of beat-to-beat heart rate variability (HRV) in patients with ischemic stroke during ECP remains unknown. Forty-eight patients with unilateral ischemic stroke at the subacute stage and 14 healthy controls were recruited. Beat-to-beat heart rate before, during, and after ECP was monitored. The frequency components of HRV were calculated using power spectral analysis. Very low frequency (VLF; <.04 Hz), low frequency (LF; .04-.15 Hz), high frequency (HF; .15-.40 Hz), total power spectral density (TP; <.40 Hz), and LF/HF ratio were calculated. In stroke patients, although there were no statistical differences in all of the HRV components, the HRV at VLF showed a trend of increase during ECP compared with baseline in the left-sided stroke patients (P = .083). After ECP, the HRV at LF and TP remained higher than baseline in the right-sided stroke patients (LF, 209.4 versus 117.9, P = .050; TP, 1275.6 versus 390.2, P = .017, respectively). Besides, the HRV at TP also increased after ECP compared with baseline in the left-sided stroke patients (563.0 versus 298.3, P = .029). Irrespective of the side of the ischemia, patients showed an increased beat-to-beat HRV after ECP. Additionally, sympathetic and parasympathetic cardiac modulations were increased after ECP in patients after right-sided subacute stroke. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  7. Erythrocyte sedimentation rate: Can be a prognostic marker in acute ischemic stroke?

    Directory of Open Access Journals (Sweden)

    Selim Selçuk Çomoğlu


    Full Text Available OBJECTIVE: The aim of this study is to investigate the relationship between the erythrocyte sedimentation rate (ESR values and the severity of neurological findings on admission, short- term prognosis, risk factors and etiology of the patients with acute ischemic stroke. MATERIAL and METHODS: One hundred and fifty-eight consecutive patients who admitted to the hospital within 24 hours of stroke onset were retrospectively analyzed. National Institutes of Health Stroke Scale (NIHSS and modified Rankin Scale (mRS scores on admission and mRS scores at discharge, brain imaging findings, stroke etiology and risk factors of the patients were recorded. Patients were classified into three groups according to ESR values on admission and compared in terms of severity of clinical symptoms on admission, short-term prognosis, risk factors and etiology of stroke. RESULTS: A total 158 patients with acute ischemic stroke including 89 women and 69 men were enrolled in the study. Patients with ESR≤10 mm/h were included in group 1 (n=49, ESR levels between 11-25 mm/h were included in group 2 (n=69 and ESR≥26 mm/h were included in group 3 (n=40. No significant difference was determined between the groups in terms of NIHSS and mRS scores on admission and mRS scores at discharge and etiology of stroke. While coronary artery disease was found more frequently in group 1 and 2 than group 3 (p=0.018, valvular heart disease was more frequently in group 2 than group 1 (p=0.037. CONCLUSION: The results of our study revealed that ESR levels on admission do not reflect the severity of stroke and can not be accepted as a useful predictor of short-term prognosis in patients with acute ischemic stroke.

  8. Addition of 24 hour heart rate variability parameters to the cardiovascular health study stroke risk score and prediction of incident stroke : The cardiovascular health study

    NARCIS (Netherlands)

    Bodapati, R.K.; Kizer, J.R.; Kop, W.J.; Stein, P.K.


    Background Heart rate variability (HRV) characterizes cardiac autonomic functioning. The association of HRV with stroke is uncertain. We examined whether 24‐hour HRV added predictive value to the Cardiovascular Health Study clinical stroke risk score (CHS‐SCORE), previously developed at the baseline

  9. Informed Consent: the Rate-Limiting Step in Acute Stroke Trials

    Directory of Open Access Journals (Sweden)

    David Z Rose


    Full Text Available Successful implementation of a randomized clinical trial (RCT for neuro-vascular emergencies such as cerebral infarction, intracerebral hemorrhage (ICH, or subarachnoid hemorrhage (SAH is difficult. Besides establishing an accurate, hyper-expedited diagnosis among many mimics in a person with acute neurological deficits, informed consent must be obtained from this vulnerable group of patients who may be unable to convey their own wishes, grasp the gravity of their situation, or give a complete history or examination. We review the influences, barriers, and factors investigators encounter when providing established and putative stroke therapies, and focus on informed consent, the most important research protector of human subjects, as the rate-limiting step for enrollment into acute stroke RCTs. The informed consent process has received relatively little attention in the stroke literature, but is especially important for stroke victims with acute cognitive, aural, lingual, motor, or visual impairments. Consent by a surrogate may not accurately reflect the patient’s wishes. Further, confusion about trial methodology, negative opinions of placebo-controlled studies, and therapeutic misconception by patients or surrogates may impede trial enrollment and requires further study. Exception From Informed Consent (EFIC offers an opportunity that is rarely if ever utilized for stroke RCTs. Ultimately, advancing the knowledge base and treatment paradigms for acute stroke is essential but autonomy, beneficence (non-malfeasance, and justice must also be carefully interwoven into any well-designed RCT.

  10. The Disability Rate of 5-Year Post-Stroke and Its Correlation Factors: A National Survey in China. (United States)

    Yang, Yang; Shi, Yu-Zhi; Zhang, Ning; Wang, Shuo; Ungvari, Gabor S; Ng, Chee H; Wang, Yi-Long; Zhao, Xing-Quan; Wang, Yong-Jun; Wang, Chun-Xue; Xiang, Yu-Tao


    Few studies on long-term functional outcome have been conducted in post-stroke patients in China. The objective of this study was to conduct a nationwide survey in China to investigate the 5-year prevalence of post-stroke disability and its correlation factors. A total of 893 patients with ischemic stroke were included. Demographic, clinical and neuro-imaging information were collected with standardized instruments that assessed stroke severity, depression, cognitive impairment, stroke recurrence and physical disability. Disability was assessed with the modified Ranking Score (mRS), of which a cutoff score ≥2 indicates disability. Statistical analysis included chi-square tests, two independent samples t-tests, Mann-Whitney U test and multiple logistic regression analysis. The frequency of disability in this study population was 45%. Multivariate analyses revealed that older age, lower education level, previous history of stroke, stroke severity at admission, depression, cognitive impairment at 3 months, and stroke recurrence within 5 years follow up were all significantly associated with post-stroke disability. The disability rate in 5-year post-stroke was high in Chinese patients. Treatment of depression, secondary prevention of stroke and rehabilitation may benefit disabled patients with stroke in China.

  11. Changes of deceleration and acceleration capacity of heart rate in patients with acute hemispheric ischemic stroke

    Directory of Open Access Journals (Sweden)

    Xu YH


    Full Text Available Yan-Hong Xu,1 Xing-De Wang,2 Jia-Jun Yang,1 Li Zhou,2 Yong-Chao Pan1 1Department of Neurology, 2Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, People’s Republic of China Background and purpose: Autonomic dysfunction is common after stroke, which is correlated with unfavorable outcome. Phase-rectified signal averaging is a newly developed technique for assessing cardiac autonomic function, by detecting sympathetic and vagal nerve activity separately through calculating acceleration capacity (AC and deceleration capacity (DC of heart rate. In this study, we used this technique for the first time to investigate the cardiac autonomic function of patients with acute hemispheric ischemic stroke. Methods: A 24-hour Holter monitoring was performed in 63 patients with first-ever acute ischemic stroke in hemisphere and sinus rhythm, as well as in 50 controls with high risk of stroke. DC, AC, heart rate variability parameters, standard deviation of all normal-to-normal intervals (SDNN, and square root of the mean of the sum of the squares of differences between adjacent normal-to-normal intervals (RMSSD were calculated. The National Institutes of Health Stroke Scale (NIHSS was used to assess the severity of stroke. We analyzed the changes of DC, AC, SDNN, and RMSSD and also studied the correlations between these parameters and NIHSS scores. Results: The R–R (R wave to R wave on electrocardiogram intervals, DC, AC, and SDNN in the cerebral infarction group were lower than those in controls (P=0.003, P=0.002, P=0.006, and P=0.043, but the difference of RMSSD and the D-value and ratio between absolute value of AC (|AC| and DC were not statistically significant compared with those in controls. The DC of the infarction group was significantly correlated with |AC|, SDNN, and RMSSD (r=0.857, r=0.619, and r=0.358; P=0.000, P=0.000, and P=0.004. Correlation analysis also showed that DC, |AC|, and SDNN

  12. Rates and correlates of suicidal ideation among stroke survivors: a meta-analysis. (United States)

    Bartoli, Francesco; Pompili, Maurizio; Lillia, Nicoletta; Crocamo, Cristina; Salemi, Giuseppe; Clerici, Massimo; Carrà, Giuseppe


    A better understanding of the epidemiological impact of suicidal ideation after stroke is required to identify subjects needing personalised interventions. The aim of this meta-analysis was to estimate rates and correlates of suicidal ideation among stroke survivors. We searched via Ovid, Medline, Embase and PsycInfo from database inception until August 2016. Predefined outcomes were (1) rates of suicidal ideation based on random-effects pooled proportion and (2) relevant sociodemographic and clinical correlates, using random-effects odds ratio (OR) or standardised mean difference (SMD) for categorical and continuous variables, respectively. Fifteen studies and 13 independent samples, accounting for 10 400 subjects, were included in meta-analyses. The pooled proportion of suicidal ideation among stroke survivors was 11.8% (7.4% to 16.2%), with high heterogeneity across studies (I 2 =97.3%). Current (OR=11.50; psuicidal ideation. Moreover, suicidal ideation was less likely in stroke survivors who were married (OR=0.63; psuicidal ideation. Thus, there is enough evidence to support the use of routine screening and early interventions to prevent and treat suicidal ideation after stroke, especially among subjects carrying specific correlates. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  13. Muscle energy stores and stroke rates of emperor penguins: implications for muscle metabolism and dive performance. (United States)

    Williams, Cassondra L; Sato, Katsufumi; Shiomi, Kozue; Ponganis, Paul J


    In diving birds and mammals, bradycardia and peripheral vasoconstriction potentially isolate muscle from the circulation. During complete ischemia, ATP production is dependent on the size of the myoglobin oxygen (O(2)) store and the concentrations of phosphocreatine (PCr) and glycogen (Gly). Therefore, we measured PCr and Gly concentrations in the primary underwater locomotory muscle of emperor penguin and modeled the depletion of muscle O(2) and those energy stores under conditions of complete ischemia and a previously determined muscle metabolic rate. We also analyzed stroke rate to assess muscle workload variation during dives and evaluate potential limitations on the model. Measured PCr and Gly concentrations, 20.8 and 54.6 mmol kg(-1), respectively, were similar to published values for nondiving animals. The model demonstrated that PCr and Gly provide a large anaerobic energy store, even for dives longer than 20 min. Stroke rate varied throughout the dive profile, indicating muscle workload was not constant during dives as was assumed in the model. The stroke rate during the first 30 s of dives increased with increased dive depth. In extremely long dives, lower overall stroke rates were observed. Although O(2) consumption and energy store depletion may vary during dives, the model demonstrated that PCr and Gly, even at concentrations typical of terrestrial birds and mammals, are a significant anaerobic energy store and can play an important role in the emperor penguin's ability to perform long dives.

  14. Assessing quality of life after stroke. The value and limitations of proxy ratings

    NARCIS (Netherlands)

    Sneeuw, K. C.; Aaronson, N. K.; de Haan, R. J.; Limburg, M.


    Because many stroke survivors have cognitive and communication disorders, self-reported information on a patient's quality of life (QL) cannot always be obtained. Proxy ratings may be used to prevent exclusion of this highly relevant subgroup of patients from QL studies. The purpose of this study

  15. Diurnal Variation of Intravenous Thrombolysis Rates for Acute Ischemic Stroke and Associated Quality Performance Parameters

    Directory of Open Access Journals (Sweden)

    Björn Reuter


    Full Text Available IntroductionBased on data from the Baden-Wuerttemberg stroke registry, we aimed to explore the diurnal variation of acute ischemic stroke (IS care delivery.Materials and methods92,530 IS patients were included, of whom 37,471 (40% presented within an onset-to-door time ≤4.5 h. Daytime was stratified in 3-h time intervals and working vs. non-working hours. Stroke onset and hospital admission time, rate of door-to-neurological examination time ≤30 min, onset-/door-to-imaging time IV thrombolysis (IVT rates, and onset-/door-to-needle time were determined. Multivariable regression models were used stratified by stroke onset and hospital admission time to assess the relationship between IVT rates, quality performance parameters, and daytime. The time interval 0:00 h to 3:00 h and working hours, respectively, were taken as reference.ResultsThe IVT rate of the whole study population was strongly associated with the sleep–wake cycle. In patients presenting within the 4.5-h time window and potentially eligible for IVT stratification by hospital admission time identified two time intervals with lower IVT rates. First, between 3:01 h and 6:00 h (IVT rate 18% and likely attributed to in-hospital delays with the lowest diurnal rate of door-to-neurological examination time ≤30 min and the longest door-to-needle time Second, between 6:01 h and 15:00 h (IVT rate 23–25% compared to the late afternoon and evening hours (IVT rate 27–29% due to a longer onset-to-imaging time and door-to-imaging time. No evidence for a compromised stroke service during non-working hours was observed.ConclusionThe analysis provides evidence that acute IS care is subject to diurnal variation which may affect stroke outcome. An optimization of IS care aiming at constantly high IVT rates over the course of the day therefore appears desirable.

  16. Population-Based Incidence Rates of First-Ever Stroke in Central Vietnam. (United States)

    Yamanashi, Hirotomo; Ngoc, Mai Quang; Huy, Tran Van; Suzuki, Motoi; Tsujino, Akira; Toizumi, Michiko; Takahashi, Kensuke; Thiem, Vu Dinh; Anh, Dang Duc; Anh, Nguyen Thi Hien; Tho, Le Huu; Maeda, Takahiro; Cox, Sharon E; Yoshida, Lay-Myint; Ariyoshi, Koya


    Stroke incidence data with methodologically acceptable design in Southeast Asia countries is limited. This study aimed to determine incidence of age-, sex- and subtype-specific first-ever stroke (FES) in Vietnam. We conducted a hospital-based retrospective study, targeting all stroke cases hospitalized at a solo-provider hospital in our study site of Nha Trang from January 2009 to December 2011 with International Classification of Diseases, 10th revision (ICD-10) codes I60-69. We calculated positive predictive values (PPVs) of each ICD-10-coded stroke by conducting a detailed case review of 190 randomly selected admissions with ICD-10 codes of I60-I69. These PPVs were then used to estimate annual incident stroke cases from the computerized database. National census data in 2009 was used as a denominator. 2,693 eligible admissions were recorded during the study period. The crude annual incidence rate of total FES was 90.2 per 100,000 population (95% CI 81.1-100.2). The age-adjusted incidence of FES was 115.7 (95% CI 95.9-139.1) when adjusted to the WHO world populations. Importantly, age-adjusted intracerebral hemorrhage was as much as one third of total FES: 36.9 (95% CI 26.1-51.0). We found a considerable proportion of FES in Vietnam to be attributable to intracerebral hemorrhage, which is as high or exceeding levels seen in high-income countries. A high prevalence of improperly treated hypertension in Vietnam may underlie the high prevalence of intracerebral hemorrhagic stroke in this population.

  17. Early Dysphagia Screening by Trained Nurses Reduces Pneumonia Rate in Stroke Patients: A Clinical Intervention Study. (United States)

    Palli, Christoph; Fandler, Simon; Doppelhofer, Kathrin; Niederkorn, Kurt; Enzinger, Christian; Vetta, Christian; Trampusch, Esther; Schmidt, Reinhold; Fazekas, Franz; Gattringer, Thomas


    Dysphagia is a common stroke symptom and leads to serious complications such as aspiration and pneumonia. Early dysphagia screening can reduce these complications. In many hospitals, dysphagia screening is performed by speech-language therapists who are often not available on weekends/holidays, which results in delayed dysphagia assessment. We trained the nurses of our neurological department to perform formal dysphagia screening in every acute stroke patient by using the Gugging Swallowing Screen. The impact of a 24/7 dysphagia screening (intervention) over swallowing assessment by speech-language therapists during regular working hours only was compared in two 5-month periods with time to dysphagia screening, pneumonia rate, and length of hospitalization as outcome variables. Overall, 384 patients (mean age, 72.3±13.7 years; median National Institutes of Health Stroke Scale score of 3) were included in the study. Both groups (pre-intervention, n=198 versus post-intervention, n=186) were comparable regarding age, sex, and stroke severity. Time to dysphagia screening was significantly reduced in the intervention group (median, 7 hours; range, 1-69 hours) compared with the control group (median, 20 hours; range, 1-183; P =0.001). Patients in the intervention group had a lower rate of pneumonia (3.8% versus 11.6%; P =0.004) and also a reduced length of hospital stay (median, 8 days; range, 2-40 versus median, 9 days; range, 1-61 days; P =0.033). 24/7 dysphagia screening can be effectively performed by nurses and leads to reduced pneumonia rates. Therefore, empowering nurses to do a formal bedside screening for swallowing dysfunction in stroke patients timely after admission is warranted whenever speech-language therapists are not available. © 2017 American Heart Association, Inc.

  18. Targets and self-management for the control of blood pressure in stroke and at risk groups (TASMIN-SR): protocol for a randomised controlled trial. (United States)

    O'Brien, Claire; Bray, Emma P; Bryan, Stirling; Greenfield, Sheila M; Haque, M Sayeed; Hobbs, F D Richard; Jones, Miren I; Jowett, Sue; Kaambwa, Billingsley; Little, Paul; Mant, Jonathan; Penaloza, Cristina; Schwartz, Claire; Shackleford, Helen; Varghese, Jinu; Williams, Bryan; McManus, Richard J


    Self-monitoring of hypertension with self-titration of antihypertensives (self-management) results in lower systolic blood pressure for at least one year. However, few people in high risk groups have been evaluated to date and previous work suggests a smaller effect size in these groups. This trial therefore aims to assess the added value of self-management in high risk groups over and above usual care. The targets and self-management for the control of blood pressure in stroke and at risk groups (TASMIN-SR) trial will be a pragmatic primary care based, unblinded, randomised controlled trial of self-management of blood pressure (BP) compared to usual care. Eligible patients will have a history of stroke, coronary heart disease, diabetes or chronic kidney disease and will be recruited from primary care. Participants will be individually randomised to either usual care or self-management. The primary outcome of the trial will be difference in office SBP between intervention and control groups at 12 months adjusted for baseline SBP and covariates. 540 patients will be sufficient to detect a difference in SBP between self-management and usual care of 5 mmHg with 90% power. Secondary outcomes will include self-efficacy, lifestyle behaviours, health-related quality of life and adverse events. An economic analysis will consider both within trial costs and a model extrapolating the results thereafter. A qualitative analysis will gain insights into patients' views, experiences and decision making processes. The results of the trial will be directly applicable to primary care in the UK. If successful, self-management of blood pressure in people with stroke and other high risk conditions would be applicable to many hundreds of thousands of individuals in the UK and beyond. ISRCTN87171227.

  19. Combined effects of family history of CVD and heart rate on ischemic stroke incidence among Inner Mongolians in China. (United States)

    Zhou, Yipeng; Tian, Yunfan; Zhong, Chongke; Batu, Buren; Xu, Tian; Li, Hongmei; Zhang, Mingzhi; Wang, Aili; Zhang, Yonghong


    This study aimed to evaluate the combined effects of family history of cardiovascular diseases (FHCVD) and heart rate on ischemic stroke incidence among Inner Mongolians in China. A prospective cohort study was conducted among 2589 participants aged 20 years and older from Inner Mongolia, China. The participants were divided into four groups according to status of FHCVD and heart rate and followed up from June 2002 to July 2012. Cox proportional hazards models were used to evaluate the combined effects of FHCVD and heart rate on the incidence of ischemic stroke. A total of 76 ischemic stroke occurred during the follow-up period. The observed ischemic stroke cases tended to be older and male, and had higher prevalence of smoking, drinking, hypertension and FHCVD as well as higher systolic and diastolic blood pressures at baseline compared with those who did not experience ischemic stroke. Age- and gender-adjusted hazard ratio (95% confidence interval) of ischemic stroke in the participants with both FHCVD and heart rate ≥ 80 were 2.89 (1.51-5.53), compared with those without FHCVD and heart rate < 80. After multiple adjustment, the association between ischemic stroke risk and both FHCVD and heart rate ≥ 80 remained statistically significant (hazard ratio, 2.47; 95% confidence interval: 1.22-5.01). Our main finding that participants with both FHCVD and faster heart rate have the highest risk of ischemic stroke suggests that faster heart rate may increase the risk of ischemic stroke among people with FHCVD.

  20. The Correlation Between Rates of Falling, Balance, Quality of Life and Fear of Falling in Patients With Chronic Stroke

    Directory of Open Access Journals (Sweden)

    Hamid Azadeh


    Conclusion The findings of the present study demonstrated the correlation between balance, physical dimensions of quality of life and fear of falling in patients with stroke; however, the rate of falling has no association with fear of falling.

  1. Relationship of Self-Rated Health to Stroke Incidence and Mortality in Older Individuals with and without a History of Stroke: A Longitudinal Study of the MRC Cognitive Function and Ageing (CFAS) Population. (United States)

    Mavaddat, Nahal; van der Linde, Rianne; Parker, Richard; Savva, George; Kinmonth, Ann Louise; Brayne, Carol; Mant, Jonathan


    Poor self-rated health (SRH) has been associated with increased risk of death and poor health outcomes even after adjusting for confounders. However its' relationship with disease-specific mortality and morbidity has been less studied. SRH may also be particularly predictive of health outcomes in those with pre-existing conditions. We studied whether SRH predicts new stroke in older people who have never had a stroke, or a recurrence in those with a prior history of stroke. MRC CFAS I is a multicentre cohort study of a population representative sample of people in their 65th year and older. A comprehensive interview at baseline included questions about presence of stroke, self-rated health and functional disability. Follow-up at 2 years included self-report of stroke and stroke death obtained from death certificates. Multiple logistical regression determined odds of stroke at 2 years adjusting for confounders including disability and health behaviours. Survival analysis was performed until June 2014 with follow-up for up to 13 years. 11,957 participants were included, of whom 11,181 (93.8%) had no history of stroke and 776 (6.2%) one or more previous strokes. Fewer with no history of stroke reported poor SRH than those with stroke (5 versus 21%). In those with no history of stroke, poor self-rated health predicted stroke incidence (OR 1.5 (1.1-1.9)), but not stroke mortality (OR 1.2 (0.8-1.9)) at 2 years nor for up to 13 years (OR 1.2(0.9-1.7)). In those with a history of stroke, self-rated health did not predict stroke incidence (OR 0.9(0.6-1.4)), stroke mortality (OR 1.1(0.5-2.5)), or survival (OR 1.1(0.6-2.1)). Poor self-rated health predicts risk of stroke at 2 years but not stroke mortality among the older population without a previous history of stroke. SRH may be helpful in predicting who may be at risk of developing a stroke in the near future.

  2. Stroke rates and diving air volumes of emperor penguins: implications for dive performance. (United States)

    Sato, Katsufumi; Shiomi, Kozue; Marshall, Greg; Kooyman, Gerald L; Ponganis, Paul J


    Emperor penguins (Aptenodytes forsteri), both at sea and at an experimental dive hole, often have minimal surface periods even after performance of dives far beyond their measured 5.6 min aerobic dive limit (ADL: dive duration associated with the onset of post-dive blood lactate accumulation). Accelerometer-based data loggers were attached to emperor penguins diving in these two different situations to further evaluate the capacity of these birds to perform such dives without any apparent prolonged recovery periods. Minimum surface intervals for dives as long as 10 min were less than 1 min at both sites. Stroke rates for dives at sea were significantly greater than those for dives at the isolated dive hole. Calculated diving air volumes at sea were variable, increased with maximum depth of dive to a depth of 250 m, and decreased for deeper dives. It is hypothesized that lower air volumes for the deepest dives are the result of exhalation of air underwater. Mean maximal air volumes for deep dives at sea were approximately 83% greater than those during shallow (emperor penguins, (b) stroke rate at sea is greater than at the isolated dive hole and, therefore, a reduction in muscle stroke rate does not extend the duration of aerobic metabolism during dives at sea, and (c) a larger diving air volume facilitates performance of deep dives by increasing the total body O(2) store to 68 ml O(2) kg(-1). Although increased O(2) storage and cardiovascular adjustments presumably optimize aerobic metabolism during dives, enhanced anaerobic capacity and hypoxemic tolerance are also essential for longer dives. This was exemplified by a 27.6 min dive, after which the bird required 6 min before it stood up from a prone position, another 20 min before it began to walk, and 8.4 h before it dived again.

  3. Expert versus proxy rating of verbal communicative ability of people with aphasia after stroke. (United States)

    de Jong-Hagelstein, Marjolein; Kros, Lieke; Lingsma, Hester F; Dippel, Diederik W J; Koudstaal, Peter J; Visch-Brink, Evy G


    In randomized clinical trials of aphasia treatment, a functional outcome measure like the Amsterdam-Nijmegen Everyday Language Test (ANELT), administered by speech-language therapists, is often used. However, the agreement between this expert rating and the judgment of the proxy about the quality of the daily life communication of the person with aphasia is largely unknown. We examined the association between ANELT scores by speech-language therapists and proxy judgments on the Partner Communication Questionnaire both at 3 and 6 months in 39 people with aphasia after stroke. We also determined which factors affected the level of agreement between expert and proxy judgment of the communicative ability at 6 months in 53 people with aphasia. We found moderate agreement (at 3 months r = .662; p = aphasia, measured with the Aphasia Severity Rating Scale, was associated with better agreement. In conclusion, although proxies were slightly more positive than experts, we found moderate agreement between expert and proxy rating of verbal communicative ability of people with aphasia after stroke, especially in milder cases.

  4. Relationship between Kidney Dysfunction and Ischemic Stroke Outcomes: Albuminuria, but Not Estimated Glomerular Filtration Rate, Is Associated with the Risk of Further Vascular Events and Mortality after Stroke. (United States)

    Lee, Seung-Jae; Lee, Dong-Geun


    Estimated glomerular filtration rate (eGFR) and albuminuria are known to be associated with ischemic stroke outcomes. In this study, we investigated the longitudinal relationships of the two markers with mortality, vascular events and functional outcomes in a stroke cohort. A total of 295 patients with acute ischemic stroke were prospectively recruited in a single center between May 2012 and February 2015. Renal dysfunction was defined as a decreased eGFR (albuminuria (urine albumin-to-creatinine ratio ≥ 30 mg/g). Good functional outcome at 6 months was defined as a modified Rankin scale score ≤ 2, and the occurrence of major vascular events (stroke, acute coronary syndrome or peripheral artery occlusion) or death was monitored. The associations between renal dysfunction and mortality, major vascular events, and 6-month functional outcome were evaluated by the Cox proportional hazards model and logistic regression analysis. Unadjusted and adjusted hazards ratios (HRs), odds ratios (ORs), and 95% confidence intervals (CIs) were obtained. A Kaplan-Meier survival curve for composite adverse events (major vascular events or death) was also computed according to the presence or absence of albuminuria. Albuminuria, not eGFR, was significantly associated with mortality (P = 0.028; HR 2.15; 95% CI 1.09-4.25) and major vascular events (P = 0.044; HR 2.24; 95% CI 1.02-4.94) in the multivariate Cox proportional hazards models adjusting for age, sex, diabetes, hypertension, current smoking, atrial fibrillation, previous stroke, alcohol history, initial National Institutes of Health Stroke Scale (NIHSS) score and eGFR. In addition, albuminuria was negatively associated with 6-month functional outcome in the multivariate logistic regression analysis adjusting for age, sex, diabetes, hypertension, current smoking, atrial fibrillation, previous stroke, alcohol history and eGFR (P = 0.001; OR 0.36; 95% CI 0.20-0.65), but the association disappeared when NIHSS score was

  5. Impact of heart rate on admission on mortality and morbidity in acute ischaemic stroke patients - results from VISTA. (United States)

    Nolte, C H; Erdur, H; Grittner, U; Schneider, A; Piper, S K; Scheitz, J F; Wellwood, I; Bath, P M W; Diener, H-C; Lees, K R; Endres, M


    Elevated heart rate (HR) is associated with worse outcomes in patients with cardiovascular disease. Its predictive value in acute stroke patients is less well established. We investigated the effects of HR on admission in acute ischaemic stroke patients. Using the Virtual International Stroke Trials Archive (VISTA) database, the association between HR in acute stroke patients without atrial fibrillation and the pre-defined composite end-point of (recurrent) ischaemic stroke, transient ischaemic attack (TIA), myocardial infarction (MI) and vascular death within 90 days was analysed. Pre-defined secondary outcomes were the composite end-point components and any death, decompensated heart failure and degree of functional dependence according to the modified Rankin Scale after 90 days. HR was analysed as a categorical variable (quartiles). In all, 5606 patients were available for analysis (mean National Institutes of Health Stroke Scale 13; mean age 67 years; mean HR 77 bpm; 44% female) amongst whom the composite end-point occurred in 620 patients (11.1%). Higher HR was not associated with the composite end-point. The frequencies of secondary outcomes were 3.2% recurrent stroke (n = 179), 0.6% TIA (n = 35), 1.8% MI (n = 100), 6.8% vascular death (n = 384), 15.0% any death (n = 841) and 2.2% decompensated heart failure (n = 124). Patients in the highest quartile (HR> 86 bpm) were at increased risk for any death [adjusted hazard ratio (95% confidence interval) 1.40 (1.11-1.75)], decompensated heart failure [adjusted hazard ratio 2.20 (1.11-4.37)] and worse modified Rankin Scale [adjusted odds ratio 1.29 (1.14-1.52)]. In acute stroke patients, higher HR (>86 bpm) is linked to mortality, heart failure and higher degree of dependence after 90 days but not to recurrent stroke, TIA or MI. © 2016 EAN.

  6. Effect of cooling rate on the transition temperature in Bi-Pb-Sr-Ca-Cu-O system

    International Nuclear Information System (INIS)

    Wang Yugui; Wang Jinsong; Wang Nanlin; Jiao Xinping; Han Guchang; Chen Zhaojia; Wang Keqin; Wu Xiaoguang


    The resistance and a.c. susceptibility measurement show that cooling rate of the cast-annealing samples in heat treatment process has some effect on the 110K superconducting phase in Bi-Pb-Sr-Ca-Cu-O system. Rapid quenching of the sample in air from 845 deg C causes oxygen deficiency in lattice and brings about a trifling change of unit cell size along c-axis direction. The d.c. magnetization and specific heat anomaly Δc measurements demostrate that fast cooling rate can reduce the transition temperature of high-T c phase and the lower critical field, and weaken the pinning forces for vertex lines. The peak value of specific heat anomaly of the sample with nominal composition of Bi 1.7 Pb 0.3 Sr 2 Ca 2 Cu 4.5 O v is still small in comparison with YBa 2 Cu 3 O 7 . From the magnetization curve the authors estimate that the superconducting volume fraction is about 20%

  7. estimated glomerular filtration rate and risk of survival in acute stroke

    African Journals Online (AJOL)


    Mar 3, 2014 ... independence and the common odds ratio with stroke severity as a layering variable. Results: No significant ... Conclusion: Independent of stroke severity, GFR is a surrogate in the assessment of the risk of survival in acute ..... outcome of acute stroke in the University College. Hospital Ibadan, Nigeria.

  8. Association between polyvascular atherosclerosis and estimated glomerular filtration rate in patients with ischaemic stroke: data analysis of the patients in the Chinese National Stroke Registry. (United States)

    Meng, Xia; Chen, Yu; Jing, Jing; Zhao, Xingquan; Wang, Chunxue; Liu, Liping; Wang, Anxin; Pan, Yuesong; Li, Chao; Wang, Yilong


    This study evaluated the prevalence of chronic kidney disease (CKD) in ischemic stroke (IS) patients with polyvascular disease (PolyVD) and analysed the relationship between PolyVD and estimated glomerular filtration rate (eGFR) in IS patients. Data from 9152 consecutive IS patients from the China National Stroke Registry were analysed. PolyVD was defined as patients with IS and coronary artery disease (CAD) and/or peripheral arterial disease (PAD). Chronic kidney disease was defined as eGFR stroke, and National Institutes of Health Stroke Scale scores. PolyVD was observed in 1387 of 9152 patients (15.16%). Among these patients, 1351 (14.76%) had CAD, 56 (0.61%) had PAD, and 20 (0.22%) had CAD and PAD in addition to IS. The prevalence of CKD in IS patients with PolyVD and IS alone was 29.56 and 16.28%, respectively (P < 0.0001). The PolyVD group had a significantly higher risk of lower eGFR (OR: 1.414, 95% CI: 1.202-1.665, P < 0.0001) compared with patients with IS alone. IS patients with PolyVD had a high prevalence of CKD, and PolyVD was independently associated with a low eGFR.

  9. 90Sr content in the Black Sea bottom sediments after the Chernobyl NPP accident and its use as a radiotracer for an assessment of bottom settlement rate

    International Nuclear Information System (INIS)

    Mirzoyeva, N. Y.; Egorov, V. N.; Polikarpov, G. G.


    radioactive fall outs, connected with nuclear weapon tests in the environments, as well as a radioactive pollution of water ecosystems after the Chernobyl NPP accident. These obtained results allow us to supply the dating on 9 0Sr the 1 37Cs method on estimation of the Black Sea bottom sediments settlement rate, which is developed earlier in RChBD (Radiation and Chemical Biology Department)

  10. Addition of 24-Hour Heart Rate Variability Parameters to the Cardiovascular Health Study Stroke Risk Score and Prediction of Incident Stroke: The Cardiovascular Health Study (United States)

    Bodapati, Rohan K.; Kizer, Jorge R.; Kop, Willem J.; Kamel, Hooman; Stein, Phyllis K.


    Background Heart rate variability (HRV) characterizes cardiac autonomic functioning. The association of HRV with stroke is uncertain. We examined whether 24-hour HRV added predictive value to the Cardiovascular Health Study clinical stroke risk score (CHS-SCORE), previously developed at the baseline examination. Methods and Results N=884 stroke-free CHS participants (age 75.3 ± 4.6), with 24-hour Holters adequate for HRV analysis at the 1994–1995 examination, had 68 strokes over ≤8 year follow-up (median 7.3 [interquartile range 7.1–7.6] years). The value of adding HRV to the CHS-SCORE was assessed with stepwise Cox regression analysis. The CHS-SCORE predicted incident stroke (HR=1.06 per unit increment, P=0.005). Two HRV parameters, decreased coefficient of variance of NN intervals (CV%, P=0.031) and decreased power law slope (SLOPE, P=0.033) also entered the model, but these did not significantly improve the c-statistic (P=0.47). In a secondary analysis, dichotomization of CV% (LOWCV% ≤12.8%) was found to maximally stratify higher-risk participants after adjustment for CHS-SCORE. Similarly, dichotomizing SLOPE (LOWSLOPE <− 1.4) maximally stratified higher-risk participants. When these HRV categories were combined (eg, HIGHCV% with HIGHSLOPE), the c-statistic for the model with the CHS-SCORE and combined HRV categories was 0.68, significantly higher than 0.61 for the CHS-SCORE alone (P=0.02). Conclusions In this sample of older adults, 2 HRV parameters, CV% and power law slope, emerged as significantly associated with incident stroke when added to a validated clinical risk score. After each parameter was dichotomized based on its optimal cut point in this sample, their composite significantly improved prediction of incident stroke during ≤8-year follow-up. These findings will require validation in separate, larger cohorts. PMID:28396041

  11. First-Ever Stroke and Transient Ischemic Attack Incidence and 30-Day Case-Fatality Rates in a Population-Based Study in Argentina

    DEFF Research Database (Denmark)

    Bahit, M Cecilia; Coppola, Mariano L; Riccio, Patricia M


    BACKGROUND AND PURPOSE: Epidemiological data about stroke are scarce in low- and middle-income Latin-American countries. We investigated annual incidence of first-ever stroke and transient ischemic attack (TIA) and 30-day case-fatality rates in a population-based setting in Tandil, Argentina....... METHODS: We prospectively identified all first-ever stroke and TIA cases from overlapping sources between January 5, 2013, and April 30, 2015, in Tandil, Argentina. We calculated crude and standardized incidence rates. We estimated 30-day case-fatality rates. RESULTS: We identified 334 first-ever strokes.......1% (95% CI, 14.2-36.6) for intracerebral hemorrhage, and 1.9% (95% CI, 0.4-5.8) for TIA. CONCLUSIONS: This study provides the first prospective population-based stroke and TIA incidence and case-fatality estimate in Argentina. First-ever stroke incidence was lower than that reported in previous Latin...

  12. Preventing Stroke Deaths (United States)

    ... die within minutes. Strokes happen more in some populations and geographic areas. Stroke death declines have stalled in 3 out of every 4 states. Blacks have the highest stroke death rates among all ...

  13. Cohort-specific trends in stroke mortality in seven European countries were related to infant mortality rates

    NARCIS (Netherlands)

    Amiri, M.; Kunst, A. E.; Janssen, F.; Mackenbach, J. P.


    Objectives: To assess, in a population-based study, whether secular trends in cardiovascular disease mortality in seven European countries were correlated with past trends in infant mortality rate (IMR) in these countries. Study Design and Setting: Data on ischemic heart disease (IHD) and stroke

  14. Cortical bone resorption rate in elderly persons: Estimates from long-term in vivo measurements of 90Sr in the skeleton

    International Nuclear Information System (INIS)

    Shagina, N.B.; Tolstykh, E.I.; Degteva, M.O.; Anspaugh, L.R.; Napier, Bruce A.


    The rate of cortical bone resorption was assessed from long-term in vivo measurements of 90Sr content in the skeleton for men aged 50-80 years and for women 0-30 years after menopause. Measurements of 90Sr were conducted with a whole body counter for residents of the Techa Riverside communities (Southern Urals, Russia), who ingested large amounts of 90Sr as a result of releases of liquid radioactive wastes into the river from the Mayak plutonium facility in early 1950s. The results of this study showed an increase in the rate of cortical bone resorption in both men and women, as based on the use of accidentally ingested 90Sr as a tracer for bone metabolism. In men there was a continuous gradual increase in the rate of cortical bone resorption after 55 years from 2.8 to 4.5%/year by the age of 75 years. In women, there was a doubled increase in the rate of cortical bone resorption after menopause of up to 6%/year; then the rate remained unchanged for 10-12 years with a subsequent gradual decline down to 5-5.5%/year. Comparison of the rate of cortical bone resorption in men and women older than 55 years showed that women expressed significantly higher levels of cortical bone resorption.

  15. Cortical bone resorption rate in elderly persons: Estimates from long-term in vivo measurements of 90Sr in the skeleton

    Energy Technology Data Exchange (ETDEWEB)

    Shagina, N. B.; Tolstykh, E. I.; Degteva, M. O.; Anspaugh, L. R.; Napier, Bruce A.


    The rate of cortical bone resorption was assessed from long-term in vivo measurements of 90Sr content in the skeleton for men aged 50-80 years and for women 0-30 years after menopause. Measurements of 90Sr were conducted with a whole body counter for residents of the Techa Riverside communities (Southern Urals, Russia), who ingested large amounts of 90Sr as a result of releases of liquid radioactive wastes into the river from the Mayak plutonium facility in early 1950s. The results of this study showed an increase in the rate of cortical bone resorption in both men and women, as based on the use of accidentally ingested 90Sr as a tracer for bone metabolism. In men there was a continuous gradual increase in the rate of cortical bone resorption after 55 years from 2.8 to 4.5%/year by the age of 75 years. In women, there was a doubled increase in the rate of cortical bone resorption after menopause of up to 6%/year; then the rate remained unchanged for 10-12 years with a subsequent gradual decline down to 5-5.5%/year. Comparison of the rate of cortical bone resorption in men and women older than 55 years showed that women expressed significantly higher levels of cortical bone resorption.

  16. Self-rated health, symptoms of depression and general symptoms at 3 and 12 months after a first-ever stroke: a municipality-based study in Sweden

    Directory of Open Access Journals (Sweden)

    Hassler Ejda


    Full Text Available Abstract Background Self-rated health is an important indicator of quality of life as well as a good predictor of future health. The purpose of the study was to follow up the self-rated health and the prevalence of symptoms of depression and general symptoms in a population of first-ever stroke patients 3 and 12 months after stroke. Methods All patients surviving their first-ever stroke and residing in Nacka municipality in Stockholm County Council were included using a multiple overlapping search strategy during an 18-month period (n = 187. Our study group comprised the 145 patients who survived the first 3 months after stroke. Three and 12 months after their stroke, the patients were assessed regarding self-rated health and general symptoms using parts of the Göteborg Quality of Life Instrument (GQLI, and regarding symptoms of depression using the Montgomery Asberg Depression Scale (MADRS-S. Results Self-rated health was rated as very good or rather good by 62% at 3 months after stroke and by 78% at 12 months after stroke. More than half of the patients suffered from symptoms of depression, with no significant improvement at 12 months. The most common general symptoms at 3 months after stroke were fatigue, sadness, pain in the legs, dizziness and irritability. Fatigue and sadness were still common at 12 months. Twelve months after stroke the prevalences of crying easily, irritability, impaired concentration, nausea and loss of weight were significantly lower. Conclusion The majority of patients rated their health as rather good or very good at 3 and 12 months after stroke. However, the majority suffered from fatigue and from symptoms of depression after both 3 and 12 months. In continued care of stroke survivors, it is important to consider the fact that many patients who rate their health as good may nevertheless have symptoms of depression, and some of them may benefit from anti-depressive treatment.

  17. Impact of proteinuria and glomerular filtration rate on risk of ischaemic and intracerebral hemorrhagic stroke: a result from the Kailuan study. (United States)

    Li, Z; Wang, A; Cai, J; Gao, X; Zhou, Y; Luo, Y; Wu, S; Zhao, X


    Persons with chronic kidney disease, defined by a reduced estimated glomerular filtration rate and proteinuria, have an increased risk of cardiovascular disease including stroke. However, data from developing countries are limited. Our aim was to assess the relationship between chronic kidney disease and risk of stroke and its subtypes in a community-based population in China. The study was based on 92,013 participants (18-98 years old; 73,248 men and 18,765 women) of the Kailuan study who at baseline were free from stroke and myocardial infarction and had undergone tests for serum creatinine or proteinuria. Glomerular filtration rate was estimated using the Chronic Kidney Disease Epidemiology Collaboration formula and proteinuria by the urine dipstick result in laboratory databases. The primary outcome was the first occurrence of stroke. Data were analyzed using Cox proportional hazards models adjusted for relevant confounders and results are presented as hazard ratios (HRs) with 95% confidence intervals (CIs). During a follow-up of 4 years, 1575 stroke events (1128 ischaemic, 406 intracerebral hemorrhagic and 41 subarachnoid hemorrhagic strokes) occurred. After adjustment for variable confounders, patients with proteinuria were found to have increased HRs for the total and subtypes of stroke events (HR 1.61; 95% CI 1.35-1.92 for total stroke; HR 1.53; 95% CI 1.24-1.89 for ischaemic stroke; and HR 1.90; 95% CI 1.35-2.67 for hemorrhagic stroke). However, estimated glomerular filtration rate was not associated with incident stroke after adjustment for established cardiovascular risk factors. Proteinuria increased the risk of stroke in a general Chinese population. © 2014 EAN.

  18. Comorbid Psychiatric Disease Is Associated With Lower Rates of Thrombolysis in Ischemic Stroke. (United States)

    Bongiorno, Diana M; Daumit, Gail L; Gottesman, Rebecca F; Faigle, Roland


    Intravenous thrombolysis (IVT) improves outcomes after acute ischemic stroke but is underused in certain patient populations. Mental illness is pervasive in the United States, and patients with comorbid psychiatric disease experience inequities in treatment for a range of conditions. We aimed to determine whether comorbid psychiatric disease is associated with differences in IVT use in acute ischemic stroke. Acute ischemic stroke admissions between 2007 and 2011 were identified in the Nationwide Inpatient Sample. Psychiatric disease was defined by International Classification of Diseases , Ninth Revision, Clinical Modification codes for secondary diagnoses of schizophrenia or other psychoses, bipolar disorder, depression, or anxiety. Using logistic regression, we tested the association between IVT and psychiatric disease, controlling for demographic, clinical, and hospital factors. Of the 325 009 ischemic stroke cases meeting inclusion criteria, 12.8% had any of the specified psychiatric comorbidities. IVT was used in 3.6% of those with, and 4.4% of those without, psychiatric disease ( P disease was associated with lower odds of receiving IVT (adjusted odds ratio, 0.80; 95% confidence interval, 0.76-0.85). When psychiatric diagnoses were analyzed separately individuals with schizophrenia or other psychoses, anxiety, or depression each had significantly lower odds of IVT compared to individuals without psychiatric disease. Acute ischemic stroke patients with comorbid psychiatric disease have significantly lower odds of IVT. Understanding barriers to IVT use in such patients may help in developing interventions to increase access to evidence-based stroke care. © 2018 American Heart Association, Inc.

  19. Influence of annealing temperature and doping rate on the magnetic properties of Zr-Mn substituted Sr-hexaferrite nanoparticles

    Energy Technology Data Exchange (ETDEWEB)

    Iqbal, Muhammad Javed [Department of Chemistry, Quaid-i-Azam University, Islamabad 45320 (Pakistan); Ashiq, Muhammad Naeem [Department of Chemistry, Bahauddin Zakariya University, Multan (Pakistan); Hernandez-Gomez, Pablo, E-mail: pabloher@ee.uva.e [Dpt. Electricidad y Electronica, University of Valladolid, 47071 Valladolid (Spain); Munoz, Jose Maria Munoz; Cabrera, Carlos Torres [Dpt. Electricidad y Electronica, University of Valladolid, 47071 Valladolid (Spain)


    A series of M-type strontium hexaferrite samples having nominal composition SrZr{sub x}Mn{sub x}Fe{sub 12-2x}O{sub 19} (where x = 0.0-0.8) has been synthesized by the co-precipitation method. All the samples synthesized were of single magnetoplumbite phase. The particle size was found to be in the 40-65 nm range for the samples annealed at 1193 K while the samples annealed at 1443 K were in the 100-200 nm range. The saturation magnetization increase with temperature and reached maxima for the samples annealed at 1393 K and then start to decrease while the coercivity decreases regularly with temperature. The decrease in coercivity is due to the increase in the particle size of the sample with temperature. The saturation magnetization increase for the samples doped with Zr-Mn up to x = 0.4 doping rate and higher substitution lead to decrease in saturation magnetization. The coercivity decrease with the increase in Zr-Mn substitution. The behavior of saturation magnetization has been explained on the basis of occupation of the substituted cations at different iron sites. The increase in saturation magnetization and decrease in coercivity suggest that the synthesized materials can be used for the application of recording media.

  20. Declining stroke and vascular event recurrence rates in secondary prevention trials over the past 50 years and consequences for current trial design. (United States)

    Hong, Keun-Sik; Yegiaian, Sharon; Lee, Meng; Lee, Juneyoung; Saver, Jeffrey L


    It is widely supposed, but not well-demonstrated, that cumulative advances in standard care have reduced recurrent stroke and cardiovascular events in secondary prevention trials. Systematic search identified all randomized, controlled trials of medical secondary stroke prevention therapies published from 1960 to 2009. Randomized, controlled trials narrowly focused on single stroke mechanisms, including atrial fibrillation, cervical carotid stenosis, and intracranial stenosis, were excluded. From control arms of individual trials, we extracted data for baseline characteristics and annual event rates for recurrent stroke, fatal stroke, and major vascular events and analyzed trends over time. Fifty-nine randomized controlled trials were identified, enrolling 66 157 patients in control arms. Over the 5 decade periods, annual event rates declined, per decade, for recurrent stroke by 0.996% (P=0.001), fatal stroke by 0.282% (P=0.003), and major vascular events by 1.331% (P=0.001). Multiple regression analyses identified increasing antithrombotic use and lower blood pressures as major contributors to the decline in recurrent stroke. For recurrent stroke, annual rates fell from 8.71% in trials launched in the 1960s to 6.10% in the 1970s, 5.41% in the 1980s, 4.04% in the 1990s, and 4.98% in the 2000s. The sample size required for a trial to have adequate power to detect a 20% reduction in recurrent stroke increased 2.2-fold during this period. Recurrent stroke and vascular event rates have declined substantially over the last 5 decades, with improved blood pressure control and more frequent use of antiplatelet therapy as the leading causes. Considerably larger sample sizes are now needed to demonstrate incremental improvements in medical secondary prevention.

  1. Effects of Transferring to the Rehabilitation Ward on Long-Term Mortality Rate of First-Time Stroke Survivors: A Population-Based Study. (United States)

    Chen, Chien-Min; Yang, Yao-Hsu; Chang, Chia-Hao; Chen, Pau-Chung


    To assess the long-term health outcomes of acute stroke survivors transferred to the rehabilitation ward. Long-term mortality rates of first-time stroke survivors during hospitalization were compared among the following sets of patients: patients transferred to the rehabilitation ward, patients receiving rehabilitation without being transferred to the rehabilitation ward, and patients receiving no rehabilitation. Retrospective cohort study. Patients (N = 11,419) with stroke from 2005 to 2008 were initially assessed for eligibility. After propensity score matching, 390 first-time stroke survivors were included. None. Cox proportional hazards regression model was used to assess differences in 5-year poststroke mortality rates. Based on adjusted hazard ratios (HRs), the patients receiving rehabilitation without being transferred to the rehabilitation ward (adjusted HR, 2.20; 95% confidence interval [CI], 1.36-3.57) and patients receiving no rehabilitation (adjusted HR, 4.00; 95% CI, 2.55-6.27) had significantly higher mortality risk than the patients transferred to the rehabilitation ward. Mortality rate of the stroke survivors was affected by age ≥65 years (compared with age stroke (adjusted HR, 1.55), stroke severity (Stroke Severity Index [SSI] score≥20, compared with SSI scorestroke survivors transferred to the rehabilitation ward had a 5-year mortality rate 2.2 times lower than those who received rehabilitation without transfer to the rehabilitation ward and 4 times lower than those who received no rehabilitation. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  2. Autonomic Nervous System and Stress to Predict Secondary Ischemic Events after Transient Ischemic Attack or Minor Stroke: Possible Implications of Heart Rate Variability. (United States)

    Guan, Ling; Collet, Jean-Paul; Mazowita, Garey; Claydon, Victoria E


    Transient ischemic attack (TIA) and minor stroke have high risks of recurrence and deterioration into severe ischemic strokes. Risk stratification of TIA and minor stroke is essential for early effective treatment. Traditional tools have only moderate predictive value, likely due to their inclusion of the limited number of stroke risk factors. Our review follows Hans Selye's fundamental work on stress theory and the progressive shift of the autonomic nervous system (ANS) from adaptation to disease when stress becomes chronic. We will first show that traditional risk factors and acute triggers of ischemic stroke are chronic and acute stress factors or "stressors," respectively. Our first review shows solid evidence of the relationship between chronic stress and stroke occurrence. The stress response is tightly regulated by the ANS whose function can be assessed with heart rate variability (HRV). Our second review demonstrates that stress-related risk factors of ischemic stroke are correlated with ANS dysfunction and impaired HRV. Our conclusions support the idea that HRV parameters may represent the combined effects of all body stressors that are risk factors for ischemic stroke and, thus, may be of important predictive value for the risk of subsequent ischemic events after TIA or minor stroke.

  3. Autonomic Nervous System and Stress to Predict Secondary Ischemic Events after Transient Ischemic Attack or Minor Stroke: Possible Implications of Heart Rate Variability (United States)

    Guan, Ling; Collet, Jean-Paul; Mazowita, Garey; Claydon, Victoria E.


    Transient ischemic attack (TIA) and minor stroke have high risks of recurrence and deterioration into severe ischemic strokes. Risk stratification of TIA and minor stroke is essential for early effective treatment. Traditional tools have only moderate predictive value, likely due to their inclusion of the limited number of stroke risk factors. Our review follows Hans Selye’s fundamental work on stress theory and the progressive shift of the autonomic nervous system (ANS) from adaptation to disease when stress becomes chronic. We will first show that traditional risk factors and acute triggers of ischemic stroke are chronic and acute stress factors or “stressors,” respectively. Our first review shows solid evidence of the relationship between chronic stress and stroke occurrence. The stress response is tightly regulated by the ANS whose function can be assessed with heart rate variability (HRV). Our second review demonstrates that stress-related risk factors of ischemic stroke are correlated with ANS dysfunction and impaired HRV. Our conclusions support the idea that HRV parameters may represent the combined effects of all body stressors that are risk factors for ischemic stroke and, thus, may be of important predictive value for the risk of subsequent ischemic events after TIA or minor stroke. PMID:29556209

  4. Association between resting heart rate and coronary artery disease, stroke, sudden death and noncardiovascular diseases: a meta-analysis. (United States)

    Zhang, Dongfeng; Wang, Weijing; Li, Fang


    Resting heart rate is linked to risk of coronary artery disease, stroke, sudden death and noncardiovascular diseases. We conducted a meta-analysis to assess these associations in general populations and in populations of patients with hypertension or diabetes mellitus. We searched PubMed, Embase and MEDLINE from inception to Mar. 5, 2016. We used a random-effects model to combine study-specific relative risks (RRs). We used restricted cubic splines to assess the dose-response relation. We included 45 nonrandomized prospective cohort studies in the meta-analysis. The multivariable adjusted RR with an increment of 10 beats/min in resting heart rate was 1.12 (95% confidence interval [CI] 1.09-1.14) for coronary artery disease, 1.05 (95% CI 1.01-1.08) for stroke, 1.12 (95% CI 1.02-1.24) for sudden death, 1.16 (95% CI 1.12-1.21) for noncardiovascular diseases, 1.09 (95% CI 1.06-1.12) for all types of cancer and 1.25 (95% CI 1.17-1.34) for noncardiovascular diseases excluding cancer. All of these relations were linear. In an analysis by category of resting heart rate ( 80 beats/min), the RRs were 0.99 (95% CI 0.93-1.04), 1.08 (95% CI 1.01-1.16) and 1.30 (95% CI 1.19-1.43), respectively, for coronary artery disease; 1.08 (95% CI 0.98-1.19), 1.11 (95% CI 0.98-1.25) and 1.08 (95% CI 0.93-1.25), respectively, for stroke; and 1.17 (95% CI 0.94-1.46), 1.31 (95% CI 1.12-1.54) and 1.57 (95% CI 1.39-1.77), respectively, for noncardiovascular diseases. After excluding studies involving patients with hypertension or diabetes, we obtained similar results for coronary artery disease, stroke and noncardiovascular diseases, but found no association with sudden death. Resting heart rate was an independent predictor of coronary artery disease, stroke, sudden death and noncardiovascular diseases over all of the studies combined. When the analysis included only studies concerning general populations, resting heart rate was not associated with sudden death. © 2016 Canadian Medical

  5. Mineralogic Residence and Desorption Rates of Sorbed 90Sr in Contaminated Subsurface Sediments: Implications to Future Behavior and In-Ground Stability

    International Nuclear Information System (INIS)

    Peter C. Lichtner


    90Sr desorption process will be quantified in coarse-textured Hanford sediments contaminated by different waste types and a reaction-based reactive transport model developed to forecast 90Sr concentration dynamics in Hanford's 100-N plume. Previous research has addressed 137Cs desorption from HLW-contaminated sediment providing results critical for HLW tank farm closure decisions. This renewal focuses on 90Sr with the objective of providing fundamental knowledge to predict future in-ground behavior as required for sound remedial decisions. Preliminary observations that suggest that 10-y sorbed 90Sr in coarse-textured sediment resides in the interiors of basaltic lithic fragments. This intraparticle retention defines a new conceptual model for 90Sr retardation that is tentatively attributed to internal domains of phyllosilicates formed from the weathering of basaltic glass. Research will characterize the spatial locations, composition, and reactivity of these intragrain phyllosilicate domains using spectroscopic, microscopic, and wet chemical methods. Intragrain porosity, diffusivity, and tortuosity will be estimated using emersion experiments coupled with particle imaging (using electron, X-ray, and NMR techniques). Desorption rates and extent will be measured from contaminated Hanford sediments of different waste impact in electrolytes that promote isotopic exchange, ion exchange, and/or dissolution. Desorption results will be interpreted with a geochemical-physical model that incorporates aqueous speciation, mass transfer, and other important factors. Batch and column experiments will be performed with sediments from Hanfords 100-N plume to quantify factors controlling long-term release rates and river stage effects. Newfound understanding and geochemical parameters will be incorporated into the FLOTRAN reactive transport code for simulation of 100-N plume dynamics

  6. The analysis of hyper-homocysteine incidence rate and multi-risk factors in 200 patients with cerebral stroke

    International Nuclear Information System (INIS)

    Ding Xiudong; Yang Jianghui; Huo Aimei; Wang Yan; Chu Yanchuang; Dong Mei


    To investigate the hyperhomocysteine incidence rate and clinical significance in 200 patients with cerebral stroke, the serum homocysteine, fibrinogen, C-reaction protein, cholesterol, triglyceride, LDL-cholesterol and HDL-cholesterol levels in 200 patients with cerebral stroke and 100 normal healthy controls were detected. The results showed that both serum homocysteine and plasma FIB levels in patients with cerebral infarction and intracerebral hemorrhage were significantly higher than those in controls (P 0.05). The hyper-homocysteinemia is an independent risk factor for cerebral stoke, and hyperhomocysteine may lead to the increase of Fibrinogen level, which is one of the important reasons for the high blood viscosity in the cerebral infarction patients. (authors)

  7. Similar Secondary Stroke Prevention and Medication Persistence Rates among Rural and Urban Patients (United States)

    Rodriguez, Daniel; Cox, Margueritte; Zimmer, Louise O.; Olson, DaiWai M.; Goldstein, Larry B.; Drew, Laura; Peterson, Eric D.; Bushnell, Cheryl D.


    Purpose: Rural residents are less likely to obtain optimal care for many serious conditions and have poorer health outcomes than those residing in more urban areas. We determined whether rural vs urban residence affected postdischarge medication persistence and 1 year outcomes after stroke. Methods: The Adherence eValuation After Ischemic…

  8. Increasing rate of atrial fibrillation from 2003 to 2011 in patients with ischaemic stroke

    DEFF Research Database (Denmark)

    Jespersen, S F; Christensen, L. M.; Christensen, A


    identified. Frequency analysis and linear regression were used to assess trends in atrial fibrillation diagnosis and oral anticoagulation therapy prescription. RESULTS: A total of 17.1% (n = 9482) of ischaemic stroke patients had atrial fibrillation. The relative frequency of atrial fibrillation increased...

  9. Correlation between critical force and critical velocity and their respective stroke rates

    Directory of Open Access Journals (Sweden)

    Eduardo Kokubun


    Full Text Available The critical power model has been utilized to estimate the anaerobic and aerobic capacities in swimming. There are studies which evidence the applicability of swimming velocity, force during tethered swimming and stroke rate data to the critical power model. However, the relationship among these estimates derived from freestyle and tethered swimming needs to be established. Therefore, the aim of this study was to evaluate the relationship between critical force (FCRIT obtained from tethered swimming and critical velocity (VCRIT during freestyle swimming (VCRIT, and their respective critical stroke rates (FBrCRIT. Eleven swimmers of both sexes (16.6 ± 1.3 years, 60 ± 10 kg, 172 ± 8 cm underwent maximal tests to exhaustion in the tethered system and to as fast as possible trials during 200 and 400 m freestyle swimming. There were estimates of: 1 FCRIT and CIAnaer fi tting the three known equations derived from the critical power model (hyperbolic forcetime F-t, linear force-1/time F-1/t, linear impulse-time I-t; 2 VCRIT and CNAnaer during the freestyle tests using the linear distance-time relationship (d-t and; 3 FBrCRIT and CBrAnaer during both kinds of tests (tethered and freestyle. The tethered performance data presented a good fi tting to the critical power model: FCRIT (R2 of 0.98, 0.97 and 0.99 and FBrCRIT-TETHERED (R2 of 0.96, 0.90 and 0.99. There was a high correlation between VCRIT and FCRIT (r= 0.89-0.91. Nevertheless, there was no signifi cant correlation among the estimates of FBrCRIT-TETHERED and FBrCRIT-FREESTYLE, neither among the anaerobic variables. These results indicate that FCRIT can be considered a reliable aerobic capacity index. However, the FBrCRIT-TETHERED did not approach this capacity, despite the good fi tting to the critical power model. RESUMO O modelo da potência crítica tem sido utilizado para estimar a capacidade anaeróbia e aeróbia na natação. Há estudos demonstrando que a velocidade de nado livre, for

  10. The Inventory of Depressive Symptomatology, Clinician Rating (IDS-C) and Self-Report (IDS-SR), and the Quick Inventory of Depressive Symptomatology, Clinician Rating (QIDS-C) and Self-Report (QIDS-SR) in public sector patients with mood disorders: a psychometric evaluation. (United States)

    Trivedi, M H; Rush, A J; Ibrahim, H M; Carmody, T J; Biggs, M M; Suppes, T; Crismon, M L; Shores-Wilson, K; Toprac, M G; Dennehy, E B; Witte, B; Kashner, T M


    The present study provides additional data on the psychometric properties of the 30-item Inventory of Depressive Symptomatology (IDS) and of the recently developed Quick Inventory of Depressive Symptomatology (QIDS), a brief 16-item symptom severity rating scale that was derived from the longer form. Both the IDS and QIDS are available in matched clinician-rated (IDS-C30; QIDS-C16) and self-report (IDS-SR30; QIDS-SR16) formats. The patient samples included 544 out-patients with major depressive disorder (MDD) and 402 out-patients with bipolar disorder (BD) drawn from 19 regionally and ethnicically diverse clinics as part of the Texas Medication Algorithm Project (TMAP). Psychometric analyses including sensitivity to change with treatment were conducted. Internal consistencies (Cronbach's alpha) ranged from 0.81 to 0.94 for all four scales (QIDS-C16, QIDS-SR16, IDS-C30 and IDS-SR30) in both MDD and BD patients. Sad mood, involvement, energy, concentration and self-outlook had the highest item-total correlations among patients with MDD and BD across all four scales. QIDS-SR16 and IDS-SR30 total scores were highly correlated among patients with MDD at exit (c = 0.83). QIDS-C16 and IDS-C30 total scores were also highly correlated among patients with MDD (c = 0.82) and patients with BD (c = 0.81). The IDS-SR30, IDS-C30, QIDS-SR16, and QIDS-C16 were equivalently sensitive to symptom change, indicating high concurrent validity for all four scales. High concurrent validity was also documented based on the SF-12 Mental Health Summary score for the population divided in quintiles based on their IDS or QIDS score. The QIDS-SR16 and QIDS-C16, as well as the longer 30-item versions, have highly acceptable psychometric properties and are treatment sensitive measures of symptom severity in depression.

  11. Estimation of Sparkover Rate of Medium-Voltage Line due to Direct Lightning Hit Taking Account of Statistics on Observed Return-Stroke Current (United States)

    Hongo, Yasuji; Michishita, Koji

    The overvoltage associated with direct lightning hits has been the important factor for the insulation design of a distribution line. In this paper, the sparkover rate of a medium-voltage line associated with direct lightning hits is investigated based on numerical calculations obtained by using EMTP and statistical analysis by taking account of the correlation between the peak value and the front duration of return-stroke current waveform. When the line is equipped with surge arresters at the interval of 100m in addition to the overhead ground wire, the sparkover rate associated with subsequent strokes is higher than that associated with first strokes. This demonstrates the importance of the study of current parameters for subsequent strokes.

  12. Ventilatory Threshold may be a More Specific Measure of Aerobic Capacity than Peak Oxygen Consumption Rate in Persons with Stroke (United States)

    Boyne, Pierce; Reisman, Darcy; Brian, Michael; Barney, Brian; Franke, Ava; Carl, Daniel; Khoury, Jane; Dunning, Kari


    Background After stroke, aerobic deconditioning can have a profound impact on daily activities. This is usually measured by the peak oxygen consumption rate achieved during exercise testing (VO2-peak). However, VO2-peak may be distorted by motor function. The oxygen uptake efficiency slope (OUES) and VO2 at the ventilatory threshold (VO2-VT) could more specifically assess aerobic capacity after stroke, but this has not been tested. Objectives To assess the differential influence of motor function on three measures of aerobic capacity (VO2-peak, OUES and VO2-VT) and to evaluate the inter-rater reliability of VO2-VT determination post-stroke. Methods Among 59 persons with chronic stroke, cross-sectional correlations with motor function (comfortable gait speed [CGS] and lower extremity Fugl-Meyer [LEFM]) were compared between the different aerobic capacity measures, after adjustment for covariates, in order to isolate any distorting effect of motor function. Reliability of VO2-VT determination between 3 raters was assessed with intra-class correlation (ICC). Results CGS was moderately correlated with VO2-peak (r=0.52, p<0.0001) and weakly correlated with OUES (r=0.41, p=0.002) and VO2-VT (r=0.37, p=0.01). LEFM was weakly correlated with VO2-peak (r=0.26, p=0.055) and very weakly correlated with OUES (r=0.19, p=0.17) and VO2-VT (r=0.14, p=0.31). Compared to VO2-peak, VO2-VT was significantly less correlated with CGS (r difference = -0.16, p=0.02). Inter-rater reliability of VO2-VT determination was high (ICC: 0.93, 95%CI: 0.89 to 0.96). Conclusions Motor dysfunction appears to artificially lower measured aerobic capacity. VO2-VT seemed to be less distorted than VO2-peak and had good inter-rater reliability, so it may provide more specific assessment of aerobic capacity post-stroke. PMID:27454553

  13. The use of the TL and OSL phenomena for determination of absorbed dose rates of 90Sr + 90Y sources by a postal method

    International Nuclear Information System (INIS)

    Antonio, Patrícia L.; Pinto, Teresa C.N.O.; Silva, Rogério M.V.; Souza, Divanizia N.; Caldas, Linda V.E.


    International recommendations establish that 90 Sr + 90 Y clinical applicators have to be calibrated in order to determine the absorbed dose rates in the case of the sources that do not have original calibration certificates, or to update the absorbed dose rates presented in the source certificates. Following these recommendations, a postal dosimetric system was developed to calibrate clinical applicators using two luminescent techniques: thermoluminescence (TL) and optically stimulated luminescence (OSL). In this work, Al 2 O 3 :C commercial detectors were characterized and their TL and OSL responses were analyzed. The results showed the efficiency and the optimal behavior of this material in beta radiation beams. After characterization, the system was sent to the Federal University of Sergipe (UFS), Brazil, for calibration of five 90 Sr + 90 Y clinical applicators, where the detectors were irradiated and returned to IPEN, for their evaluation and determination of the absorbed dose rates. A comparison between these absorbed dose rates and those adopted by the UFS as original was made; the differences obtained were within those of other studies, and they demonstrated the usefulness of the system. - Highlights: • A postal dosimetric system was developed to calibrate clinical applicators. • Al 2 O 3 :C samples were characterized in relation to their TL and OSL response. • The clinical applicators from UFS were calibrated. • The absorbed dose rates were compared with those provided on the certificates

  14. Effect of cooling rate on the microstructure and luminescence properties of Sr2MgSi2O7:Eu2+,Dy3+materials. (United States)

    Hai, Ou; Jiang, Hongyi; Zhang, Qiang; Ren, Qiang; Wu, Xiulan; Hu, Jieliang


    Sr 2 MgSi 2 O 7 :Eu 2+ ,Dy 3+ long afterglow materials were prepared by a high-temperature solid-state reaction method with different cooling rates. The cooling rate had a slight effect on X-ray diffraction patterns and photoluminescence performance, but significantly modified the grain boundaries and long afterglow properties of the Sr 2 MgSi 2 O 7 :Eu 2+ ,Dy 3+ materials. When the cooling rate was 1°C/min, grains remained intact with clear grain boundaries. As the cooling rate increased from 1°C/min to 5°C/min, some grain boundaries became indistinguishable. The afterglow properties were optimized, presenting best performance at the cooling rate of 3°C/min. The trap state was investigated and illustrated through thermoluminescence curves. The depths of the traps of all the samples were unchanged, whereas densities changed to a large extent, leading to different afterglow properties. The retrapping process is discussed based on the afterglow curves. Copyright © 2017 John Wiley & Sons, Ltd.

  15. 30-Year Trends in Stroke Rates and Outcome in Auckland, New Zealand (1981-2012: A Multi-Ethnic Population-Based Series of Studies.

    Directory of Open Access Journals (Sweden)

    Valery L Feigin

    Full Text Available Insufficient data exist on population-based trends in morbidity and mortality to determine the success of prevention strategies and improvements in health care delivery in stroke. The aim of this study was to determine trends in incidence and outcome (1-year mortality, 28-day case-fatality in relation to management and risk factors for stroke in the multi-ethnic population of Auckland, New Zealand (NZ over 30-years.Four stroke incidence population-based register studies were undertaken in adult residents (aged ≥15 years of Auckland NZ in 1981-1982, 1991-1992, 2002-2003 and 2011-2012. All used standard World Health Organization (WHO diagnostic criteria and multiple overlapping sources of case-ascertainment for hospitalised and non-hospitalised, fatal and non-fatal, new stroke events. Ethnicity was consistently self-identified into four major groups. Crude and age-adjusted (WHO world population standard annual incidence and mortality with corresponding 95% confidence intervals (CI were calculated per 100,000 people, assuming a Poisson distribution.5400 new stroke patients were registered in four 12 month recruitment phases over the 30-year study period; 79% were NZ/European, 6% Māori, 8% Pacific people, and 7% were of Asian or other origin. Overall stroke incidence and 1-year mortality decreased by 23% (95% CI 5%-31% and 62% (95% CI 36%-86%, respectively, from 1981 to 2012. Whilst stroke incidence and mortality declined across all groups in NZ from 1991, Māori and Pacific groups had the slowest rate of decline and continue to experience stroke at a significantly younger age (mean ages 60 and 62 years, respectively compared with NZ/Europeans (mean age 75 years. There was also a decline in 28-day stroke case fatality (overall by 14%, 95% CI 11%-17% across all ethnic groups from 1981 to 2012. However, there were significant increases in the frequencies of pre-morbid hypertension, myocardial infarction, and diabetes mellitus, but a reduction in

  16. 30-Year Trends in Stroke Rates and Outcome in Auckland, New Zealand (1981-2012): A Multi-Ethnic Population-Based Series of Studies. (United States)

    Feigin, Valery L; Krishnamurthi, Rita V; Barker-Collo, Suzanne; McPherson, Kathryn M; Barber, P Alan; Parag, Varsha; Arroll, Bruce; Bennett, Derrick A; Tobias, Martin; Jones, Amy; Witt, Emma; Brown, Paul; Abbott, Max; Bhattacharjee, Rohit; Rush, Elaine; Suh, Flora Minsun; Theadom, Alice; Rathnasabapathy, Yogini; Te Ao, Braden; Parmar, Priya G; Anderson, Craig; Bonita, Ruth


    Insufficient data exist on population-based trends in morbidity and mortality to determine the success of prevention strategies and improvements in health care delivery in stroke. The aim of this study was to determine trends in incidence and outcome (1-year mortality, 28-day case-fatality) in relation to management and risk factors for stroke in the multi-ethnic population of Auckland, New Zealand (NZ) over 30-years. Four stroke incidence population-based register studies were undertaken in adult residents (aged ≥15 years) of Auckland NZ in 1981-1982, 1991-1992, 2002-2003 and 2011-2012. All used standard World Health Organization (WHO) diagnostic criteria and multiple overlapping sources of case-ascertainment for hospitalised and non-hospitalised, fatal and non-fatal, new stroke events. Ethnicity was consistently self-identified into four major groups. Crude and age-adjusted (WHO world population standard) annual incidence and mortality with corresponding 95% confidence intervals (CI) were calculated per 100,000 people, assuming a Poisson distribution. 5400 new stroke patients were registered in four 12 month recruitment phases over the 30-year study period; 79% were NZ/European, 6% Māori, 8% Pacific people, and 7% were of Asian or other origin. Overall stroke incidence and 1-year mortality decreased by 23% (95% CI 5%-31%) and 62% (95% CI 36%-86%), respectively, from 1981 to 2012. Whilst stroke incidence and mortality declined across all groups in NZ from 1991, Māori and Pacific groups had the slowest rate of decline and continue to experience stroke at a significantly younger age (mean ages 60 and 62 years, respectively) compared with NZ/Europeans (mean age 75 years). There was also a decline in 28-day stroke case fatality (overall by 14%, 95% CI 11%-17%) across all ethnic groups from 1981 to 2012. However, there were significant increases in the frequencies of pre-morbid hypertension, myocardial infarction, and diabetes mellitus, but a reduction in frequency

  17. Stroke Treatments (United States)

    ... Month Infographic Stroke Hero F.A.S.T. Quiz Stroke Treatment Stroke used to rank fourth in leading causes of ... type of treatment depends on the type of stroke. Ischemic stroke happens when a clot blocks a ...

  18. A lower baseline glomerular filtration rate predicts high mortality and newly cerebrovascular accidents in acute ischemic stroke patients. (United States)

    Dong, Kai; Huang, Xiaoqin; Zhang, Qian; Yu, Zhipeng; Ding, Jianping; Song, Haiqing


    Chronic kidney disease (CKD) is gradually recognized as an independent risk factor for cardiovascular and cardio-/cerebrovascular disease. This study aimed to examine the association of the estimated glomerular filtration rate (eGFR) and clinical outcomes at 3 months after the onset of ischemic stroke in a hospitalized Chinese population.Totally, 972 patients with acute ischemic stroke were enrolled into this study. Modified of Diet in Renal Disease (MDRD) equations were used to calculate eGFR and define CKD. The site and degree of the stenosis were examined. Patients were followed-up for 3 months. Endpoint events included all-cause death and newly ischemic events. The multivariate logistic model was used to determine the association between renal dysfunction and patients' outcomes.Of all patients, 130 patients (13.4%) had reduced eGFR (<60 mL/min/1.73 m), and 556 patients had a normal eGFR (≥90 mL/min/1.73 m). A total of 694 patients suffered from cerebral artery stenosis, in which 293 patients only had intracranial artery stenosis (ICAS), 110 only with extracranial carotid atherosclerotic stenosis (ECAS), and 301 with both ICAS and ECAS. The patients with eGFR <60 mL/min/1.73m had a higher proportion of death and newly ischemic events compared with those with a relatively normal eGFR. Multivariate analysis revealed that a baseline eGFR <60 mL/min/1.73 m increased the risk of mortality by 3.089-fold and newly ischemic events by 4.067-fold. In further analysis, a reduced eGFR was associated with increased rates of mortality and newly events both in ICAS patients and ECAS patients. However, only an increased risk of newly events was found as the degree of renal function deteriorated in ICAS patients (odds ratio = 8.169, 95% confidence interval = 2.445-14.127).A low baseline eGFR predicted a high mortality and newly ischemic events at 3 months in ischemic stroke patients. A low baseline eGFR was also a strong independent predictor for newly

  19. Recanalization and Mortality Rates of Thrombectomy With Stent-Retrievers in Octogenarian Patients with Acute Ischemic Stroke

    International Nuclear Information System (INIS)

    Parrilla, G.; Carreón, E.; Zamarro, J.; Espinosa de Rueda, M.; García-Villalba, B.; Marín, F.; Hernández-Fernández, F.; Morales, A.; Fernández-Vivas, M.; Núñez, R.; Moreno, A.


    BackgroundOur objective was to evaluate the effect of treatment with stent-retrievers in octogenarians suffering an acute ischemic stroke.MethodsA total of 150 consecutive patients with acute stroke who were treated with stent-retrievers between April 2010 and June 2012 were retrospectively reviewed. Patients were divided into those <80 years old (n = 116) and those ≥80 (n = 34). Baseline characteristics, procedure data, and endpoints (postprocedural NIHSS, death, and mRS at 3 months) were compared.ResultsHigh blood pressure, atrial fibrillation, and anticoagulation were more frequent in octogenarians (p = 0.01, 0.003, and 0.04 respectively). There were no differences between both groups regarding previous intravenous thrombolysis (32.4 vs. 48.3 %, p = 0.1), preprocedural NIHSS (18.1 vs. 16.8, p = 0.3), procedure time (74.5 (40–114) min vs. 63 (38–92) min, p = 0.2), revascularization time (380.5 (298–526.3) min vs. 350 (296.3–452.8), p = 0.3), TICI ≥ 2B (88.2 vs. 93.9 %, p = 0.1), and symptomatic haemorrhage (5.9 vs. 2.6 %, p = 0.3). Discharge NIHSS was higher in octogenarians (9.7 vs. 6.5, p = 0.03). Death and 3-month mRS ≥3 were more frequent in octogenarians (35.3 vs. 17.2 %, p = 0.02 and 73.5 vs. 37.1 %, p = 0.02). ICA-involvement and prolonged revascularization involved higher mortality (66.7 vs. 27.6 %, p = 0.03) and worse mRS (50 vs. 24.4 %, p = 0.06) in octogenarians.ConclusionsIn our series, treatment with stent-retrievers in octogenarians with acute ischemic stroke achieved good rates of recanalization but with a high mortality rate. ICA involvement and revascularization times beyond 6 hours associated to a worse prognosis. These data might be of value in the design of prospective studies evaluating the clinical efficacy of the endovascular treatments in octogenarians

  20. Recanalization and Mortality Rates of Thrombectomy With Stent-Retrievers in Octogenarian Patients with Acute Ischemic Stroke

    Energy Technology Data Exchange (ETDEWEB)

    Parrilla, G., E-mail: [Hospital Clínico Universitario Virgen de la Arrixaca, Service of Interventional Neuroradiology (Spain); Carreón, E. [Service of Neurology Hospital Clínico Universitario Virgen de la Arrixaca (Spain); Zamarro, J.; Espinosa de Rueda, M.; García-Villalba, B. [Hospital Clínico Universitario Virgen de la Arrixaca, Service of Interventional Neuroradiology (Spain); Marín, F. [Hospital Clínico Universitario Virgen de la Arrixaca, Department of Cardiology (Spain); Hernández-Fernández, F. [Hospital Clínico Universitario Virgen de la Arrixaca, Service of Interventional Neuroradiology (Spain); Morales, A. [Service of Neurology Hospital Clínico Universitario Virgen de la Arrixaca (Spain); Fernández-Vivas, M.; Núñez, R. [Hospital Clínico Universitario Virgen de la Arrixaca, Intensive Care Unit (Spain); Moreno, A. [Hospital Clínico Universitario Virgen de la Arrixaca, Service of Interventional Neuroradiology (Spain)


    BackgroundOur objective was to evaluate the effect of treatment with stent-retrievers in octogenarians suffering an acute ischemic stroke.MethodsA total of 150 consecutive patients with acute stroke who were treated with stent-retrievers between April 2010 and June 2012 were retrospectively reviewed. Patients were divided into those <80 years old (n = 116) and those ≥80 (n = 34). Baseline characteristics, procedure data, and endpoints (postprocedural NIHSS, death, and mRS at 3 months) were compared.ResultsHigh blood pressure, atrial fibrillation, and anticoagulation were more frequent in octogenarians (p = 0.01, 0.003, and 0.04 respectively). There were no differences between both groups regarding previous intravenous thrombolysis (32.4 vs. 48.3 %, p = 0.1), preprocedural NIHSS (18.1 vs. 16.8, p = 0.3), procedure time (74.5 (40–114) min vs. 63 (38–92) min, p = 0.2), revascularization time (380.5 (298–526.3) min vs. 350 (296.3–452.8), p = 0.3), TICI ≥ 2B (88.2 vs. 93.9 %, p = 0.1), and symptomatic haemorrhage (5.9 vs. 2.6 %, p = 0.3). Discharge NIHSS was higher in octogenarians (9.7 vs. 6.5, p = 0.03). Death and 3-month mRS ≥3 were more frequent in octogenarians (35.3 vs. 17.2 %, p = 0.02 and 73.5 vs. 37.1 %, p = 0.02). ICA-involvement and prolonged revascularization involved higher mortality (66.7 vs. 27.6 %, p = 0.03) and worse mRS (50 vs. 24.4 %, p = 0.06) in octogenarians.ConclusionsIn our series, treatment with stent-retrievers in octogenarians with acute ischemic stroke achieved good rates of recanalization but with a high mortality rate. ICA involvement and revascularization times beyond 6 hours associated to a worse prognosis. These data might be of value in the design of prospective studies evaluating the clinical efficacy of the endovascular treatments in octogenarians.

  1. Single motor unit firing rate after stroke is higher on the less-affected side during stable low-level voluntary contractions

    Directory of Open Access Journals (Sweden)

    Penelope A Mcnulty


    Full Text Available Muscle weakness is the most common outcome after stroke and a leading cause of adult-acquired motor disability. Single motor unit properties provide insight into the mechanisms of post-stroke motor impairment. Motor units on the more-affected side are reported to have lower peak firing rates, reduced discharge variability and a more compressed dynamic range than healthy subjects. The activity of 169 motor units was discriminated from surface EMG in 28 stroke patients during sustained voluntary contractions 10% of maximal and compared to 110 units recorded from 16 healthy subjects. Motor units were recorded in three series: ankle dorsiflexion, wrist flexion and elbow flexion. Mean firing rates after stroke were significantly lower on the more-affected than the less-affected side (p< 0.001 with no between-side differences for controls. When data were combined, firing rates on the less-affected side were significantly higher than those either on the more-affected side or healthy subjects (p< 0.001. Motor unit mean firing rate was higher in the upper-limb than the lower-limb (p< 0.05. The coefficient of variation of motor unit discharge rate was lower for motor units after stroke compared to controls for wrist flexion (p< 0.05 but not ankle dorsiflexion. However, the dynamic range of motor units was compressed only for motor units on the more-affected side during wrist flexion. Our results show that the pathological change in motor unit firing rate occurs on the less-affected side after stroke and not the more-affected side as previously reported, and suggest that motor unit behavior recorded in a single muscle after stroke cannot be generalized to muscles acting on other joints even within the same limb. These data emphasize that the less-affected side does not provide a valid control for physiological studies on the more-affected side after stroke and that both sides should be compared to data from age- and sex-matched healthy subjects.

  2. Low stroke rate and few thrombo-embolic events after HeartMate II implantation under mild anticoagulation. (United States)

    Menon, Ares K; Götzenich, Andreas; Sassmannshausen, Helena; Haushofer, Marcus; Autschbach, Rüdiger; Spillner, Jan W


    Bleeding and thrombo-embolism are two of the most threatening adverse events associated with the use of continuous flow left ventricular assist devices (LVADs) in the treatment of severe heart failure. We analysed our LVAD patients treated with the HeartMate II (HM II) device by following a low anticoagulation regimen. Between 2008 and February 2011, we implanted 40 HM II LVADs in our institution. Intention to treat was bridge to transplant in 25, destination therapy in 9, bridge to candidacy in 5 cases and bridge to recovery in 1 case. Heparin was started only after 24 h postoperatively, and Phenprocumon (Phen) was started after removal of all chest drains. International normalized ratio (INR) target in the years 2008-2009 was 2.5, and 2.0-2.5 since 2010. Acetyl salicylic acid (ASA) was prescribed 50-100 mg/day only in patients <55 years or in case of severe atherosclerotic disease of the right coronary artery. All data were analysed consecutively concerning thrombo-embolic and bleeding events. Fifty-two percent of the patients were in INTERMACS level 1 or 2 at the time of implantation. The mean age was 58 ± 11 years, and the mean days under LVAD was 241 days (maximum: 1052 days). The survival rate was 87.5% after 30 years and 75% in the long term. Early postoperatively, no strokes or thrombo-embolic events occurred. In the long term, two patients suffered from ischaemic strokes, but recovered well. In both of these index events, the INR was lasting below 1.4. One of these two patients developed pump thrombosis additionally. Only three patients (ASA + Phen) developed gastrointestinal bleeding (7.5%). Two patients were withdrawn from Phen + ASA because of multiple angiodysplasia. Compared with the literature, even a mild anticoagulation protocol does not increase the risk of thrombotic events, but reduces bleeding events in the use of an HM II LVAD.

  3. Lowering bronchoaspiration rate in an acute stroke unit by means of a 2 volume/3 texture dysphagia screening test with pulsioximetry. (United States)

    Cocho, D; Sagales, M; Cobo, M; Homs, I; Serra, J; Pou, M; Perez, G; Pujol, G; Tantinya, S; Bao, P; Aloy, A; Sabater, R; Gendre, J; Otermin, P

    During acute stroke, 30% of all patients present dysphagia and 50% of that subgroup will experience bronchoaspiration. Our aim was to compare mortality and bronchoaspiration rates associated with the water test compared to those associated with a 2 volume/3 texture test controlled with pulse oximetry (2v/3t-P test) in our stroke unit. Over a 5-year period, we performed a prospective analysis of all consecutive acute ischaemic stroke patients hospitalised in the Stroke Unit. Dysphagia was evaluated using the water test between 2008 and 2010 (group 0 or G0), and the 2v/3t-P test (group 1 or G1) between 2011 and 2012. We analysed demographic data, vascular risk factors, neurological deficit on the NIHSS, aetiological subtype according to TOAST criteria, clinical subtype according to the Oxfordshire classification, prevalence of dysphagia, percentage of patients with bronchoaspiration, and mortality. We examined 418 patients with acute stroke (G0=275, G1=143). There were significant differences between the 2 groups regarding the percentage of patients with TACI (17% in G0 vs. 29% in G1, P=.005) and median NIHSS score (4 points in G0 vs. 7 points in G1, P=.003). Since adopting the new swallowing test, we detected a non-significant increase in the percentage of dysphagia (22% in G0 vs. 25% in G1, P=.4), lower mortality (1.7% in G0 vs. 0.7% in G1, P=.3) and a significant decrease in the bronchoaspiration rate (6.2% in G0 vs. 2.1% in G1, P=.05). Compared to the water test used for dysphagia screening, the new 2v/3t-P test lowered bronchoaspiration rates in acute stroke patients. Copyright © 2014 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  4. Explaining failure through success: a critical analysis of reduction in road and stroke deaths as an explanation for Australia's low deceased organ donation rates. (United States)

    Bendorf, A; Kerridge, I H; Kelly, P J; Pussell, B; Guasch, X


    During the past two decades, Australian federal and state governments have funded many initiatives to bolster organ donation. Despite large investments of time, effort and money, Australia's deceased donation rate is in the bottom half of the Organisation for Economic Co-operation and Development countries and has only marginally increased from 11.9 donors per million people (pmp) in 1990 to 14.9 donors pmp in 2011. An often-cited explanation for this situation is that Australia's success in increasing levels of public health and safety through reduced traffic and stroke fatalities has reduced its number of potential deceased organ donors. We refer to this as the 'Failure Because of Success' hypothesis. Although commonly accepted, this hypothesis is largely untested. By analysing data from international donation and transplantation organisations and international public health and safety organisations, we compared historical deceased organ donation rates with traffic and stroke fatality rates in Australia and the seven countries with the world's highest deceased organ donation rates (Spain, Portugal, France, USA, Belgium, Austria and Italy). Traffic fatality rates across all countries in the study have fallen dramatically during the time period, with Spain having the lowest traffic fatality rates. Stroke fatality rates demonstrate similar reductions, with France showing the lowest cerebral vascular accident mortality rates. When compared with countries with the world's highest deceased donation rates, Australia's improvements to public health and safety through reductions in traffic and stroke fatalities were neither unique nor exemplary and do not provide an adequate explanation for its low organ donor rates. © 2012 The Authors. Internal Medicine Journal © 2012 Royal Australasian College of Physicians.

  5. Determination of the CKM matrix element vertical stroke V{sub cb} vertical stroke, the B {yields} X{sub s}{gamma} decay rate, and the b-quark mass

    Energy Technology Data Exchange (ETDEWEB)

    Bernlochner, Florian Urs


    vertical stroke V{sub cb} vertical stroke. The b-quark mass is determined by analyzing measured B {yields} X{sub s}{gamma} photon energy spectra from BABAR and Belle. Due to the sizeable background contributions from other processes which produce high energetic photons, the B {yields} X{sub s}{gamma} decay rate is best measured near the kinematic limit where the photon recoils against a light jet-like hadronic state. Unfortunately, the heavy quark expansion breaks down in this kinematic limit and non-perturbative corrections arise. This behaviour in the theory can be remedied by summing the most divergent contributions of the heavy quark expansion into a single function, the shape function. At the time being, the shape function cannot be determined by first principles. This work includes the first direct measurement of the shape function with absorbed 1/m{sub b} corrections, and uses the applied framework for a precision test of the Standard Model prediction for the B {yields} X{sub s}{gamma} decay by determining the absolute value of the leading Wilson coefficient C{sup incl.}{sub 7}. The b-quark mass is related to the first, second, and third moment of the shape function. For vertical stroke C{sup incl.}{sub 7} vertical stroke and the b-quark mass we find, vertical stroke C{sup incl.}{sub 7} V{sub tb} V*{sub ts} vertical stroke x 10{sup 3} = 15.003{+-}0.537{sub exp.}{+-}0.303{sub theo.}, m{sup 1S}{sub b} = 4.764{+-}0.027{sub exp.}{+-}0.016{sub theo.} GeV/c{sup 2}, where the uncertainties are experimental, and theoretical, respectively. The extracted value of vertical stroke C{sup incl.}{sub 7} vertical stroke is in excellent agreement with the Standard Model expectation and the precision on the b quark mass in the 1S scheme, m{sup 1S}{sub b}, is of the same order as the uncertainties on m{sup 1S}{sub b} from global B {yields} X{sub c}l{nu}{sub l} moment fits.

  6. A spatial and vertical comparison of coral Sr/Ca variations and growth rates in Montastraea faveolata colonies in Veracruz, Mexico (United States)

    Cobb, R. M.; DeLong, K. L.; Richey, J. N.; Flannery, J. A.; Kilbourne, K. H.; Smith, J. M.; Quinn, T. M.; Hudson, J. H.


    The massive coral genera Montastraea spp. is ubiquitous in modern and fossil coral reefs in the Gulf of Mexico and Caribbean Sea making this genus a potential archive for paleoclimate reconstructions. Interpretation of modern and fossil coral records requires understanding the origins of variability in coral geochemical variations on scales ranging from intracolony to regional as well as differing water depths. In 1991, the U.S. Geological Survey recovered cores from five Montastraea faveolata colonies offshore of Veracruz, Mexico (19.06°N, 96.93°W) in water depths from 2.7 m to 12.2 m. The average linear extension per year based on x-radiograph analysis is similar (8.1 and 8.6, ×1.9 mm/yr, 1σ; n=31) for colonies at water depths of 2.7 and 4.3 m, respectively, for the interval from 1963 to 1991. Progressively slower extension rates are observed for deeper colonies (7.6 × 1.8, 7.5 × 1.9, and 4.5 × 1.5 mm/yr, 1σ; n=31) for 5.8, 6.1 and 12.2 m, respectively. Correlation coefficients among annual linear extension records vary between 0.00 and 0.40 (n=31) with the lowest correlation between colonies in close proximity (~1 km) and highest between colonies furthest apart (~250 km). We analyzed coral Sr/Ca at approximately 18 samples per year (0.5 mm/sample) along corallite thecal walls parallel to the slab surface for the interval from 1982 to 1991. This geochemical proxy for SST reveals seasonal variations within the coral skeleton that correspond to the high- and low-density bands in the coral slab, which represent one year of growth. Our linear regression of coral Sr/Ca from a single core (5.8 m water depth) to the Optimum Interpolation sea surface temperature (OISST; Reynolds et al., 2002) results in a slope of -0.049 (×0.024 mmol/mol/°C, 1σ; n=100; r2=0.52), which is slightly greater than the slope of other published Montastraea calibrations, but less than those reported for Porites spp. An alternative calibration method is to examine mean coral Sr/Ca with

  7. Neural Network for Determining Risk Rate of Post-Heart Stroke Patients

    Directory of Open Access Journals (Sweden)

    Oldřich Trenz


    Full Text Available The ischemic heart disease presents an important health problem that affects a great part of the population and is the cause of one third of all deaths in the Czech Republic. The availability of data describing the patients’ prognosis enables their further analysis, with the aim of lowering the patients’ risk, by proposing optimum treatment. The main reason for creating the neural network model is not only to automate the process of establishing the risk rate of patients suffering from ischemic heart disease, but also to adapt it for practical use in clinical conditions. Our aim is to identify especially the specific group of risk-rate patients whose well-timed preventive care can improve the quality and prolong the length of their lives.The aim of the paper is to propose a patient-parameter structure, using which we could create a suitable model based on a self-taught neural network. The emphasis is placed on identifying key descriptive parameters (in the form of a reduction of the available descriptive parameters that are crucial for identifying the required patients, and simultaneously to achieve a portability of the model among individual clinical workplaces (availability of parameters.

  8. Analysis of the power saturation method and using SR-ELDOR and global analysis to extract multiple rates from recovery curves. [SR-ELDOR (Saturation Recovery - Electron Electron Double Resonance)

    Energy Technology Data Exchange (ETDEWEB)

    Haas, D.A.


    The possibility is investigated to extending the method of extracting the spin-lattice relaxation rate (R[sub 1e]) from Continuous Wave Electron Paramagnetic Resonance (CW-EPR) lineshapes under saturating conditions beyond the very fast motional region. The signal intensities of simulated [sup 14]N lineshapes under progressive saturation are analyzed for a wide range of motional rates. An adjustable parameter is included in the analysis to account for the changing degree of homogeneity of the EPR spectrum as the motion slows from the fast- to the slow-motion regime. The quantity R[sub 2], determined from the lineshape analysis, is shown to be a valid description of the homogeneous linewidth under saturation. Theoretical models for R[sub 2], constructed from spectral density functions, are compared. The standard theory works very well for motions faster than 5 ns; and, for slower motions, the modified theories qualitatively reproduce R[sub 2]. In the motional range of 10 to 200 ns, R[sub 2] remains roughly constant. This should therefore be the optimal range for obtaining relative values of R[sub 1e]. The electron and nuclear relaxation rates R[sub 1e] and R[sub 1n] have been measured, for the spin label TEMPOL in glycerol-water solutions, over a wide range of motion, from 10[sup [minus]11] to longer than 10[sup [minus]4] seconds. In the range 10[sup [minus]7] to 10[sup [minus]5] seconds, the motional correlation time is measured directly as one component of the SR-ELDOR relaxation curve. The functional dependence of R[sub 1e] and R[sub 1n] on the correlation time is clarified, based on the Electron Nuclear Dipolar effect, spin diffusion, and spin rotation. CW- and Saturation Transfer (ST-) EPR spectra provide independent measures of the correlation time. There is good agreement between simulations and ST-EPR spectra up to 5 [mu]s; for slower motions the simulations require additional convolution to quantitatively fit the data.

  9. Effect of the racket mass and the rate of strokes on kinematics and kinetics in the table tennis topspin backhand. (United States)

    Iino, Yoichi; Kojima, Takeji


    The purpose of this study was to investigate the effect of the racket mass and the rate of strokes on the kinematics and kinetics of the trunk and the racket arm in the table tennis topspin backhand. Eight male Division I collegiate table tennis players hit topspin backhands against topspin balls projected at 75 balls · min(-1) and 35 balls · min(-1) using three rackets varying in mass of 153.5, 176 and 201.5 g. A motion capture system was used to obtain trunk and racket arm motion data. The joint torques of the racket arm were determined using inverse dynamics. The racket mass did not significantly affect all the trunk and racket arm kinematics and kinetics examined except for the wrist dorsiflexion torque, which was significantly larger for the large mass racket than for the small mass racket. The racket speed at impact was significantly lower for the high ball frequency than for the low ball frequency. This was probably because pelvis and upper trunk axial rotations tended to be more restricted for the high ball frequency. The result highlights one of the advantages of playing close to the table and making the rally speed fast.

  10. What determines the self-rated health of older individuals with stroke compared to other older individuals? A cross-sectional analysis of the Medical Research Council Cognitive Function and Aging Study. (United States)

    Mavaddat, Nahal; Van der Linde, Rianne; Savva, George M; Brayne, Carol; Mant, Jonathan


    Poor self-rated health has been associated with poorer objective health outcomes across a range of conditions including stroke. Identification of factors associated with poor self-rated health in stroke survivors has received little attention compared to that in other older individuals. This study identifies determinants of self-rated health in older individuals with or without a history of stroke participating in the population-representative MRC Cognitive Function and Aging Study (MRC CFAS). The MRC CFAS is a multicentred longitudinal survey of a population representative sample of people in their 65th year and older at baseline. Baseline interview included questions about functional disability, psychiatric history, independent living status, social interactions, and cognitive function. Multiple logistic regression was used to determine associations between demographic, physical, cognitive, psychological and social factors with poor self-rated health among those with and without stroke. After excluding those with impaired cognitive function, 776 individuals out of 11,957 reported a stroke. Factors associated with self-rated health were similar between those with or without a stroke in older individuals. Poorer self-rated health in those who had suffered a stroke was associated predominantly with the presence of comorbidity with diabetes (OR 3.5; 95% CI 1.5-8.1) and not "getting out and about" (OR 2.6; 95% CI 1.7-4.1) even after adjustment for disability levels and for depression. In those without a stroke the most important determinants were disability (OR 3.9; 95% CI 3.2-4.8) and not "getting out and about" (OR 2.9; 95% CI 2.5-3.3). The presence of disability was less strongly associated with poor self-rated health in those with a history of stroke than those without due to a substantially higher reporting of poor self-rated health in the non-disabled stroke group than the non-disabled stroke-free group, while those with disabilities reported poor self-rated

  11. Investigation of the Temperature Dependence of the Acceptor Center Relaxation Rate in Silicon by the mu^-SR-Method

    CERN Document Server

    Mamedov, T N; Stojkov, A V; Andrianov, D G; Gerlach, D; Zimmermann, U; Gorelkin, V N; Kormann, O; Major, J V; Shevchik, M


    Results on the temperature dependence of the residual polarization of negative muons in silicon with phosphorus (3.2 cdot 10^12, 2.3 cdot 10^15 and 4.5 cdot 10^18 cm^-3) and aluminium (2 cdot 10^14 and 2.4 cdot 10^18 cm^-3) impurities are presented. The measurements were carried out in a transverse to the direction of the muon spin magnetic field of 2000 Oe in the temperature range 4.2-300 K. The temperature dependence of the relaxation rate of the magnetic moment of the Al shallow acceptor centre in undeformed silicon is determined for the first time. The constant of the hyperfine interaction between the magnetic moment of the muon and that of the electron shell of the muonic atom A_hf/2pi approx 3 cdot 10^7 s^-1) and the coefficient for capture of free electrons by a neutral aluminium atom in silicon (beta (Al^0) approx 7 cdot 10^-14 cm^3 s^-1 at 30 K) are estimated.

  12. Preventing stroke (United States)

    ... A.M. Editorial team. Related MedlinePlus Health Topics Hemorrhagic Stroke Ischemic Stroke Stroke Browse the Encyclopedia A.D. ... any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should ...

  13. Stroke Rehabilitation (United States)

    A stroke can cause lasting brain damage. People who survive a stroke need to relearn skills they lost because of ... them relearn those skills. The effects of a stroke depend on which area of the brain was ...

  14. Child-Mediated Stroke Communication: Findings from Hip Hop Stroke (United States)

    Williams, Olajide; DeSorbo, Alexandra; Noble, James; Gerin, William


    Background and Purpose Low thrombolysis rates for acute ischemic stroke is linked to delays in seeking immediate treatment due to low public stroke awareness. We aimed to assess whether “Child-Mediated Stroke Communication” (CMSC) could improve stroke literacy parents of children enrolled in a school-based stroke literacy program called Hip Hop Stroke (HHS). Methods Parents of children aged 9 to 12 years from two public schools in Harlem, NYC, were recruited to participate in stroke literacy questionnaires before and after their child’s participation in HHS, a novel CMSC intervention delivered in school auditoriums. Parental recall of stroke information communicated through their child was assessed 1-week following the intervention. Results Fifth and Sixth grade students (n =182) were enrolled into HHS. 102 parents were approached in person to participate; 75 opted to participate and 71 completed both pretest and post-test (74% response rate and 95% retention rate). Parental stroke literacy improved after the program: before the program, 3 parents of 75 (3.9%) were able to identify the five cardinal stroke symptoms, distracting symptom (chest pains), and had an urgent action plan (calling 911), compared to 21 of 71 parents (29.6%) post-intervention (pstroke signs and symptoms remains low among residents of this high-risk population. The use of Child-Mediated Stroke Communication suggests that schoolchildren aged 9-12 may be effective conduits of critical stroke knowledge to their Parents. PMID:22033995

  15. Child-Mediated Stroke Communication: findings from Hip Hop Stroke. (United States)

    Williams, Olajide; DeSorbo, Alexandra; Noble, James; Gerin, William


    Low thrombolysis rates for acute ischemic stroke are linked to delays in seeking immediate treatment due to low public stroke awareness. We aimed to assess whether "Child-Mediated Stroke Communication" could improve stroke literacy of parents of children enrolled in a school-based stroke literacy program called Hip Hop Stroke. Parents of children aged 9 to 12 years from 2 public schools in Harlem, New York City, were recruited to participate in stroke literacy questionnaires before and after their child's participation in Hip Hop Stroke, a novel Child-Mediated Stroke Communication intervention delivered in school auditoriums. Parental recall of stroke information communicated through their child was assessed 1-week after the intervention. Fifth and sixth grade students (n=182) were enrolled into Hip Hop Stroke. One hundred two parents were approached in person to participate; 75 opted to participate and 71 completed both the pretest and post-test (74% response rate and 95% retention rate). Parental stroke literacy improved after the program; before the program, 3 parents of 75 (3.9%) were able to identify the 5 cardinal stroke symptoms, distracting symptom (chest pains), and had an urgent action plan (calling 911) compared with 21 of 71 parents (29.6%) postintervention (P<0.001). The FAST mnemonic was known by 2 (2.7%) of participants before the program versus 29 (41%) after program completion (P<0.001). Knowledge of stroke signs and symptoms remains low among residents of this high-risk population. The use of Child-Mediated Stroke Communication suggests that school children aged 9 to 12 years may be effective conduits of critical stroke knowledge to their parents.

  16. Paediatric stroke

    African Journals Online (AJOL)


    Apr 2, 2011 ... Ischemic Stroke Registry yielded an incidence of 3.3 cases per 100 000 children per year, of ... Neonatal stroke. The newborn period confers the highest risk period for childhood ischaemic stroke. Focal patterns of ischaemic brain injury to the perinatal brain are .... family history of young stroke/ thrombosis.

  17. Differences in coronary heart disease, stroke and cancer mortality rates between England, Wales, Scotland and Northern Ireland: the role of diet and nutrition. (United States)

    Scarborough, Peter; Morgan, Robert David; Webster, Premila; Rayner, Mike


    Introduction It is unclear how much of the geographical variation in coronary heart disease (CHD), stroke and cancer mortality rates within the UK is associated with diet. The aim of this study is to estimate how many deaths from CHD, stroke and cancer would be delayed or averted if Wales, Scotland and Northern Ireland adopted a diet equivalent in nutritional quality to the English diet. Methods Mortality data for CHD, stroke and 10 diet-related cancers for 2007-2009 were used to calculate the mortality gap (the difference between actual mortality and English mortality rates) for Wales, Scotland and Northern Ireland. Estimates of mean national consumption of 10 dietary factors were used as baseline and counterfactual inputs in a macrosimulation model (DIETRON). An uncertainty analysis was conducted using a Monte Carlo simulation with 5000 iterations. Results The mortality gap in the modelled scenario (achieving the English diet) was reduced by 81% (95% credible intervals: 62% to 108%) for Wales, 40% (33% to 51%) for Scotland and 81% (67% to 99%) for Northern Ireland, equating to approximately 3700 deaths delayed or averted annually. For CHD only, the mortality gap was reduced by 88% (69% to 118%) for Wales, 58% (47% to 72%) for Scotland, and 88% (70% to 111%) for Northern Ireland. Conclusion Improving the average diet in Wales, Scotland and Northern Ireland to a level already achieved in England could have a substantial impact on reducing geographical variations in chronic disease mortality rates in the UK. Much of the mortality gap between Scotland and England is explained by non-dietary risk factors.

  18. Does current oral antiplatelet agent or subtherapeutic anticoagulation use have an effect on tissue-plasminogen-activator-mediated recanalization rate in patients with acute ischemic stroke? (United States)

    Ibrahim, Mohamed M; Sebastian, Joseph; Hussain, Muhammad; Al-Hussain, Fawaz; Uchino, Ken; Molina, Carlos; Khan, Khurshid; Demchuk, Andrew M; Alexandrov, Andrei V; Saqqur, Maher


    Our goal is to assess if current antiplatelet (AP) use has an effect on recanalization rate and outcome in acute stroke patients. We conducted a retrospective analysis of acute stroke patients who received intravenous (IV) recombinant tissue plasminogen activator (rt-PA) and had transcranial Doppler examination within 3 h of symptom onset. The TCD findings were interpreted using the Thrombolysis in Brain Ischemia flow grading system as persistent arterial occlusion, reocclusion or complete recanalization. Complete recanalization was defined as established Thrombolysis in Brain Ischemia 4 or 5 within 2 h of IV rt-PA. The patients were divided based on their current use of AP agents. Comparisons were made between the different groups based on recanalziation rate, reocclusion and good long-term outcome (mRS ≤ 2) using χ(2) test. Multiple regression analysis was used to identify AP use as a predictor for recanalization and outcome including symptomatic intracranial hemorrhage after controlling for age, baseline NIHSS score, time to treatment, previous vascular event, hypertension and diabetes mellitus. Two hundred and eighty-four patients were included; 154 (54%) males, 130 (46%) females, with a mean age of 69.5 ± 13 years. The median baseline NIHSS score was 16 ± 5. The median time to TCD examination was 131 ± 38 min from symptom onset. The median time to IV rt-PA was 140 ± 34 min. One hundred eighty patients were not on AP prior to their stroke, 76 were on aspirin, 15 were on clopidogrel, 2 were on aspirin-dipyridamole combination, 2 were on both aspirin and clopidogrel, and 9 patients on subtherapeutic coumadin. In patients who were naïve to AP, 68/178 (38.2%) had complete recanalization, whereas in the AP group, 25/91 (28%) had complete recanalization. Patients on aspirin alone had a lower recanalization rate (16/72) as compared to those not on AP (22 vs. 39%) (p = 0.017), while those on clopidogrel had higher rates of complete recanalization (9/19, 60

  19. Heart rate variability and stroke volume variability to detect central hypovolemia during spontaneous breathing and supported ventilation in young, healthy volunteers

    International Nuclear Information System (INIS)

    Elstad, Maja; Walløe, Lars


    Cardiovascular oscillations exist in many different variables and may give important diagnostic and prognostic information in patients. Variability in cardiac stroke volume (SVV) is used in clinical practice for diagnosis of hypovolemia, but currently is limited to patients on mechanical ventilation. We investigated if SVV and heart rate variability (HRV) could detect central hypovolemia in spontaneously breathing humans: We also compared cardiovascular variability during spontaneous breathing with supported mechanical ventilation.Ten subjects underwent simulated central hypovolemia by lower body negative pressure (LBNP) with >10% reduction of cardiac stroke volume. The subjects breathed spontaneously and with supported mechanical ventilation. Heart rate, respiratory frequency and mean arterial blood pressure were measured. Stroke volume (SV) was estimated by ModelFlow (Finometer). Respiratory SVV was calculated by: 1) SVV% = (SVmax − SVmin)/SVmean during one respiratory cycle, 2) SVIntegral from the power spectra (Fourier transform) at 0.15–0.4 Hz and 3) SVV-norm = (√SVIntegral)/SVmean. HRV was calculated by the same methods.During spontaneous breathing two measures of SVV and all three measures of HRV were reduced during hypovolemia compared to baseline. During spontaneous breathing SVIntegral and HRV% were best to detect hypovolemia (area under receiver operating curve 0.81). HRV% ≤ 11% and SVIntegral ≤ 12 ml 2 differentiated between hypovolemia and baseline during spontaneous breathing.During supported mechanical ventilation, none of the three measures of SVV changed and two of the HRV measures were reduced during hypovolemia. Neither measures of SVV nor HRV were classified as a good detector of hypovolemia.We conclude that HRV% and SVIntegral detect hypovolemia during spontaneous breathing and both are candidates for further clinical testing. (paper)

  20. Cerebrorenal interaction and stroke. (United States)

    Toyoda, Kazunori


    Beyond the original meaning of chronic kidney disease (CKD) as high-risk state for future dialysis, CKD is now known as an established risk factor for cardiovascular diseases. Stroke is a major player of cardiovascular disease and has deep two-way relationships with CKD. CKD is an evident risk factor for stroke. Meta-analyses of cohort studies and trials indicate that proteinuria/albuminuria increases the risk of stroke by 71-92%, and reduced glomerular filtration rate increases the risk by 43%. In addition, CKD has a strong relationship with subclinical brain damage including white matter changes, microbleeds, cognitive impairment, and carotid atherosclerosis. CKD is prevalent in acute stroke patients; patients with estimated glomerular filtration rate stroke patients and 39% of total intracerebral hemorrhage patients in our institute. Acute and chronic management of stroke are influenced by CKD. Therapeutic effects of several antithrombotic and thrombolytic agents, including recently-developed novel oral anticoagulants, are affected by renal function. Moreover, reduced glomerular filtration rate is independently associated with increased 1- and 10-year mortalities in the end. Stroke also has deep relationships with end-stage kidney disease. Stroke occurs much more commonly in dialysis patients than general population or CKD patients without need for dialysis. The triggers of ischemic and hemorrhagic stroke in patients with end-stage kidney disease include special characteristics unique to dialysis, such as drastic hemodynamic change, dialysate and anticoagulants, and vascular calcification. As cohorts of dialysis patients become older, more hypertensive, and more diabetic than before, stroke become more prevalent and more serious events in dialysis clinics. Now, clinicians should have much interest in the association between CKD and cerebrovascular diseases, so-called the cerebro-renal interaction. Copyright © 2013 S. Karger AG, Basel.

  1. Towards an objective assessment of motor function in sub-acute stroke patients: Relationship between clinical rating scales and instrumental gait stability indexes. (United States)

    Tamburini, P; Mazzoli, D; Stagni, R


    The assessment of walking function alterations is a key issue to design effective rehabilitative interventions in sub-acute stroke patients. Nevertheless, the objective quantification of these alterations remains a challenge. Clinical rating scales are commonly used in clinical practice, but have been proven prone to errors associated to the evaluator subjective perception. On the other hand, instrumental measurement of trunk acceleration can be exploited for an objective quantitative characterization of gait function, but it is not applied in routine clinical practice, because the resulting quantitative indexes have not been related to the clinically information, conventionally provided by the rating scales. To overcome this limitation, the relationship between the indexes, in specific clinical conditions, and rating scale must be better investigated, to support their exploitability in the clinical practice as a fast and reliable screening tool. Thirty-one sub-acute stroke patients (17 with and 14 without cane) participated in the study. All were assessed with 6 rating scales (MI, TCT, MRI, FAC, WHS, CIRS) and 2 functional tests (2MWT and TUG). Sample Entropy (SEN) and Recurrence Quantification Analysis (RQA) in AP, ML and V directions were calculated over 2MWT and walking section of TUG. The influence of assessment task and cane was analysed, as well as correlation of SEN and RQA indexes with clinical rating scales. SEN and RQA on the medio-lateral plane resulted influenced by the use of the cane, while the correlations between indexes and clinical scales showed that SEN and RQA for antero-posterior direction correlate positively with WHS. Copyright © 2017 Elsevier B.V. All rights reserved.

  2. Ischemic Stroke (United States)

    ... Workplace Giving Fundraise Planned Giving Corporate Giving Cause Marketing Join your team, your way! The Stroke Challenge ... Your Technology Guide High Blood Pressure and Stroke Importance of Physical Activity See More Multimedia Las minorías ...

  3. Stroke - slideshow (United States)

    ... this page: // Stroke - series—Part 1 To use the sharing features ... M. Editorial team. Related MedlinePlus Health Topics Ischemic Stroke A.D.A.M., Inc. is accredited by ...

  4. Estimations of direct release rate of 137Cs and 90Sr to the ocean from the Fukushima Dai-ichi Nuclear Power Plant for five-and-a-half years (United States)

    Tsumune, Daisuke; Aoyama, Michio; Tsubono, Takaki; Misumi, Kazuhiro; Tateda, Yutaka


    A series of accidents at the Fukushima Dai-ichi Nuclear Power Plant (1F NPP) following the earthquake and tsunami of 11 March 2011 resulted in the release of radioactive materials to the ocean by two major pathways, direct release from the accident site and atmospheric deposition. Additional release pathways by river input and runoff from 1F NPP site with precipitation and were also effective for coastal zone in the specific periods before starting direct release on March 26 2011. Direct release from 1F NPP site is dominant one year after the accident. We estimated the direct release rate of 137Cs and 90Sr for more than five-and-a-half years after the accident by the Regional Ocean Model System (ROMS). Direct release rate of 137Cs were estimated for five-and-a-half years after the accident by comparing simulated results and measured activities adjacent to the 1F NPP site(at 5,6 discharge and south discharge). Directly release rate of 137Cs was estimated to be the order of magnitude of 1014 Bq/day and decreased exponentially with time to be the order of magnitude of 109 Bq/day by the end of September 2016. Estimated direct release rate have exponentially reduced with constant rate since November 2011. Apparent half-life of direct release rate was estimated to be 346 days. The estimated total amounts of directly released 137Cs was 3.7±0.7 PBq for five and a half years. Simulated 137Cs activities attributable to direct release were in good agreement with observed activities, a result that implies the estimated direct release rate was reasonable. Simulated 137Cs activity affected off coast in the Fukushima prefecture. We used the measured 137Cs activities by the Tokyo Electric Power Company (TEPCO) for the estimation of direct release. The sea water samples were corrected from the coast. The averaged 137Cs activities from November 2013 to June 2016 were 391 and 383 Bq/m3 at 5,6 discharge and south discharge, respectively. The averaged 137Cs activities measured by the

  5. Partial body weight support treadmill training speed influences paretic and non-paretic leg muscle activation, stride characteristics, and ratings of perceived exertion during acute stroke rehabilitation. (United States)

    Burnfield, Judith M; Buster, Thad W; Goldman, Amy J; Corbridge, Laura M; Harper-Hanigan, Kellee


    Intensive task-specific training is promoted as one approach for facilitating neural plastic brain changes and associated motor behavior gains following neurologic injury. Partial body weight support treadmill training (PBWSTT), is one task-specific approach frequently used to improve walking during the acute period of stroke recovery (training parameters and physiologic demands during this early recovery phase. To examine the impact of four walking speeds on stride characteristics, lower extremity muscle demands (both paretic and non-paretic), Borg ratings of perceived exertion (RPE), and blood pressure. A prospective, repeated measures design was used. Ten inpatients post unilateral stroke participated. Following three familiarization sessions, participants engaged in PBWSTT at four predetermined speeds (0.5, 1.0, 1.5 and 2.0mph) while bilateral electromyographic and stride characteristic data were recorded. RPE was evaluated immediately following each trial. Stride length, cadence, and paretic single limb support increased with faster walking speeds (p⩽0.001), while non-paretic single limb support remained nearly constant. Faster walking resulted in greater peak and mean muscle activation in the paretic medial hamstrings, vastus lateralis and medial gastrocnemius, and non-paretic medial gastrocnemius (p⩽0.001). RPE also was greatest at the fastest compared to two slowest speeds (ptraining at the slowest speeds. Copyright © 2016 Elsevier B.V. All rights reserved.

  6. Interobserver agreement between senior radiology resident, neuroradiology fellow, and experienced neuroradiologist in the rating of Alberta Stroke Program Early Computed Tomography Score (ASPECTS). (United States)

    Kobkitsuksakul, Chai; Tritanon, Oranan; Suraratdecha, Vichan


    The distribution of ischemic changes caused by infarction of the middle cerebral artery (MCA) territories is usually measured using the Alberta Stroke Program Early Computed Tomography Score (ASPECTS). The first interpreter of the brain computed tomography (CT) in the emergency department is the on-call radiology resident. The primary objective of this study was to describe the agreement of the ASPECTS performed retrospectively by the resident compared with expert raters. The second objective was to ascertain the appropriate window setting for early detection of acute ischemic stroke and good interobserver agreement between the interpreters. We identified consecutive patients presenting with hemiparesis or aphasia at the emergency department who underwent brain CT and CT angiography. Each scan was rated using ASPECTS by senior radiology resident, neuroradiology fellow, and later by consensus between two expert raters. Statistical analysis included determination of Cohen's kappa (κ) coefficient and intraclass correlation coefficient (ICC). A total of 43 patients met our study criteria. Interobserver agreements for ASPECTS varied from 0.486 to 0.678 in Cohen's κ coefficient between consensus of two neuroradiologists and a neuroradiology fellow, and from 0.198 to 0.491 for consensus between two neuroradiologists and a senior radiology resident. ICC among three raters (expert consensus, neuroradiology fellow, and senior radiology resident), was very good when 8 HU window width and 32 HU center level setting was used. ASPECTS varied among raters. However, when using a narrowed window setting for interpretation, interobserver agreement improved.

  7. The effect of adipose tissue-derived stem cells in a middle cerebral artery occlusion stroke model depends on their engraftment rate. (United States)

    Grudzenski, Saskia; Baier, Sebastian; Ebert, Anne; Pullens, Pim; Lemke, Andreas; Bieback, Karen; Dijkhuizen, Rick M; Schad, Lothar R; Alonso, Angelika; Hennerici, Michael G; Fatar, Marc


    In the field of experimental stem cell therapy, intra-arterial (IA) delivery yields the best results concerning, for example, migrated cell number at the targeted site. However, IA application also appears to be associated with increased mortality rates and infarction. Since many rodent studies systemically apply 1 × 10 6 cells, this could also be a consequence of engrafted cell number. The aim of this study was therefore to investigate the effect of different doses of adipose tissue-derived stem cells (ASCs) on engraftment rates and stroke outcome measured in vivo using 9.4-T high-field magnetic resonance imaging (MRI). Male Wistar rats (n = 43) underwent a middle cerebral artery occlusion (MCAo) for 45 or 90 min, followed by IA delivery of either saline or 1 × 10 6 , 3 × 10 5 , or 5 × 10 4 ASCs pre-labelled with very small superparamagnetic iron oxide particles (VSOPs). MRI (9.4-T) analysis was performed 48 h and 9 days post-MCAo. Lesion volumes were assessed by analysis of T2-weighted images and cell signal tracking showing cell engraftment and active cell migration by an improved T2*-analysis. The ASC-derived signal intensity increased in the affected hemisphere 48 h post MCAo with injected cell number (p cell numbers between both MRI examinations but showed active ASC migration to the site of infarction. Our results confirm that IA injection is an efficient way of targeting damaged brain tissue but its usefulness strongly depends on the right dose of delivered stem cells since this factor has a strong influence on migration rate and infarct volume, with better results for doses below 1 × 10 6 cells. Future challenges will include the determination of therapeutic doses for best cellular engraftment and stroke outcome.

  8. Cryptogenic Stroke

    Directory of Open Access Journals (Sweden)

    Mohammad Saadatnia


    Full Text Available Cryptogenic stroke is defined as brain infarction that is not attributable to a source of definite embolism, large artery atherosclerosis, or small artery disease despite a thorough vascular, cardiac, and serologic evaluation. Despite many advances in our understanding of ischemic stroke, cryptogenic strokes remain a diagnostic and therapeutic challenge. The pathophysiology of cryptogenic stroke is likely various. Probable mechanisms include cardiac embolism secondary to occult paroxysmal atrial fibrillation, aortic atheromatous disease or other cardiac sources, paradoxical embolism from atrial septal abnormalities such as patent foramen ovale, hypercoagulable states, and preclinical or subclinical cerebrovascular disease.  Cryptogenic stroke is one-fourth among cerebral infarction, but most of them could be ascribed to embolic stroke. A significant proportion of cryptogenic strokes adhere to embolic infarct topography on brain imaging and improvement in our ability to detect paroxysmal atrial fibrillation in patients with cryptogenic stroke has strengthened the idea that these strokes are embolic in nature. a significant proportion of cryptogenic strokes adhere to embolic infarct topography on brain imaging.embolic stroke of undetermined sources(ESUS was planned for unifying embolic stroke of undetermined source.  The etiologies underlying ESUS included minor-risk potential cardioembolic sources, covert paroxysmal atrial fibrillation, cancer-associated coagulopathy and embolism, arteriogenic emboli, and paroxysmal embolism. Extensive evaluation including transesophageal echocardiography and cardiac monitoring for long time could identify the etiology of these patients. Therefore cryptogenic stroke is a diagnosis of exclusion. Compared with other stroke subtypes, cryptogenic stroke tends to have a better prognosis and lower long-term risk of recurrence.

  9. Sudden unexpected death caused by stroke

    DEFF Research Database (Denmark)

    Ågesen, Frederik Nybye; Risgaard, Bjarke; Zachariasardóttir, Sára


    Background Stroke is the fifth leading cause of death in young individuals globally. Data on the burden of sudden death by stroke are sparse in the young. Aims The aim of this study was to report mortality rates, cause of death, stroke subtype, and symptoms in children and young adults who suffered...... contacted the healthcare system because of neurological symptoms, whereof one was suspected of having a stroke (6%). Conclusions Sudden death by stroke in children and young adults occurs primarily due to hemorrhagic stroke. We report a high frequency of neurological symptoms prior to sudden death by stroke....... Increased awareness among healthcare professionals towards stroke symptoms in children and young adults may lead to earlier detection of stroke, and thereby potentially lowering the incidence of sudden death by stroke....

  10. Excited state dynamics and energy transfer rates in Sr3Tb0.90Eu0.10(PO4)3

    International Nuclear Information System (INIS)

    Bettinelli, Marco; Piccinelli, Fabio; Speghini, Adolfo; Ueda, Jumpei; Tanabe, Setsuhisa


    The emission spectrum of neat Sr 3 Tb(PO 4 ) 3 upon excitation at 337 nm in the levels above 5 D 3 is dominated by 5 D 4 emission and no significant emission from 5 D 3 is observed due to efficient cross relaxation involving the Tb 3+ levels. On the other hand, the emission spectrum of the same host containing 10 mol% Eu 3+ upon excitation at the same wavelength (in the Tb 3+ levels) is dominated by strong emission bands from the 5 D 0 level of Eu 3+ . This clearly indicates that Tb 3+ →Eu 3+ energy transfer is present. The excitation spectrum of the Eu 3+5 D 0 emission is dominated by Tb 3+ bands extending in the UV region. The presence of 10 mol% Eu 3+ in Sr 3 Tb(PO 4 ) 3 very strongly shortens the 5 D 4 decay time. The decay curve is not far from exponential, indicating that the energy transfer to Eu 3+ is accompanied by fast energy migration. The transfer regimes are identified and the donor-donor and donor-acceptor transfer microparameters are quantified under the assumption of electric dipole-electric dipole interactions. - Highlights: → Tb 3+ →Eu 3+ energy transfer in Sr 3 Tb 0.90 Eu 0.10 (PO 4 ) 3 is evidenced and investigated. → The energy migration in the 5 D 4 level of Tb 3+ is faster than the transfer to the Eu 3+ ion. → The fast migration among the Tb 3+ ions greatly enhances the transfer efficiency.

  11. Mapping of cerebral metabolic rate of oxygen using dynamic susceptibility contrast and blood oxygen level dependent MR imaging in acute ischemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Gersing, Alexandra S.; Schwaiger, Benedikt J. [Technical University Munich, Klinikum rechts der Isar, Department of Neuroradiology, Munich (Germany); University of California, Department of Radiology and Biomedical Imaging, San Francisco, CA (United States); Ankenbrank, Monika; Toth, Vivien; Bauer, Jan S.; Zimmer, Claus [Technical University Munich, Klinikum rechts der Isar, Department of Neuroradiology, Munich (Germany); Janssen, Insa [Technical University Munich, Department of Neurosurgery, Munich (Germany); Kooijman, Hendrik [Philips Healthcare, Hamburg (Germany); Wunderlich, Silke [Technical University Munich, Department of Neurology, Munich (Germany); Preibisch, Christine [Technical University Munich, Klinikum rechts der Isar, Department of Neuroradiology, Munich (Germany); Technical University Munich, Department of Neurology, Munich (Germany)


    MR-derived cerebral metabolic rate of oxygen utilization (CMRO{sub 2}) has been suggested to be analogous to PET-derived CMRO{sub 2} and therefore may be used for detection of viable tissue at risk for infarction. The purpose of this study was to evaluate MR-derived CMRO{sub 2} mapping in acute ischemic stroke in relation to established diffusion- and perfusion-weighted imaging. In 23 patients (mean age 63 ± 18.7 years, 11 women) with imaging findings for acute ischemic stroke, relative oxygen extraction fraction was calculated from quantitative transverse relaxation times (T2, T2*) and relative cerebral blood volume using a quantitative blood oxygenation level dependent (BOLD) approach in order to detect a local increase of deoxyhemoglobin. Relative CMRO{sub 2} (rCMRO{sub 2}) maps were calculated by multiplying relative oxygen extraction fraction (rOEF) by cerebral blood flow, derived from PWI. After co-registration, rCMRO{sub 2} maps were evaluated in comparison with apparent diffusion coefficient (ADC) and time-to-peak (TTP) maps. Mean rCMRO{sub 2} values in areas with diffusion-restriction or TTP/ADC mismatch were compared with rCMRO{sub 2} values in the contralateral tissue. In tissue with diffusion restriction, mean rCMRO{sub 2} values were significantly decreased compared to perfusion-impaired (17.9 [95 % confidence interval 10.3, 25.0] vs. 58.1 [95 % confidence interval 50.1, 70.3]; P < 0.001) and tissue in the contralateral hemisphere (68.2 [95 % confidence interval 61.4, 75.0]; P < 0.001). rCMRO{sub 2} in perfusion-impaired tissue showed no significant change compared to tissue in the contralateral hemisphere (58.1 [95 % confidence interval 50.1, 70.3] vs. 66.7 [95 % confidence interval 53.4, 73.4]; P = 0.34). MR-derived CMRO{sub 2} was decreased within diffusion-restricted tissue and stable within perfusion-impaired tissue, suggesting that this technique may be adequate to reveal different pathophysiological stages in acute stroke. (orig.)

  12. Studies on the radioactive contamination due to nuclear detonations V. The radioactive contamination of human body by Sr90 and Cs137 and its correlation with the fallout rate and ground deposition

    International Nuclear Information System (INIS)

    Nishiwaki, Yasushi


    About 60 bone samples were analysed for Sr 90 during the period from January 1957 to July 1959. The highest average concentration was found to be about 1 S.U for the age group of 5 to 10 years old. However since most of the cases are more or less pathological ones after long period of hospitalization the results may not be considered to be the representative values for the average normal person. The highest concentration among the cases whose past history is known was 175 S.U. or roughly, about 2 S.U. During the period of observation occasionally we have found higher concentration than 2 S.U, in the bone samples of a few cases obtained from the crematory. However, since the past history of these cases is not known, it is not clear whether they depended on the rainwater or on the brown ice with much higher contamination than the white rice. In view of these findings it may not be to, much to assume that the concentration of Sr 90 in te bones of the average normal children might reach 2 S.U c corresponding to the cumulative ground deposition and the fallout rate. The concentration of Cs whose physical half-life is very much similar to Sr 90 was in the range of about 30 - 100 cesium unit in 1957 to early 1958. However, during the period from 1958 to early 1959 the concentration of Cs 137 in come of the organs of the human body has been reported to be about two to three times higher on the average in Tokyo than the above value in 1957

  13. Growth Rates, Stable Oxygen Isotopes (18O), and Strontium (Sr/Ca) Composition in Two Species of Pacific Sclerosponges (Acanthocheatetes wellsi and Astrosclera willeyana) with 18O Calibration and Application to Paleoceanography

    Energy Technology Data Exchange (ETDEWEB)

    Grottoli, A.; Adkins, J; Panero, W; Reaman, D; Moots, K


    The isotopic and elemental composition of sclerosponge skeletons is used to reconstruct paleoceanographic records. Yet few studies have systematically examined the natural variability in sclerosponge skeletal {delta}{sup 18}O, growth, and Sr/Ca, and how that may influence the interpretation of sclerosponge proxy records. Here, we analyzed short records in seven specimens of Acanthocheatetes wellsi (high-Mg calcite, 21 mol% Mg) from Palau, four A. wellsi (high-Mg calcite, 21 mol% Mg) from Saipan, and three Astrosclera willeyana (aragonite) sclerosponges from Saipan, as well as one long record in an A. wellsi specimen from Palau spanning 1945-2001.5. In Saipan, species-specific and mineralogical effects appear to have a negligible effect on sclerosponge {delta}{sup 18}O, facilitating the direct comparison of {delta}{sup 18}O records between species at a given location. At both sites, A. wellsi {delta}{sup 18}O and growth rates were sensitive to environmental conditions, but Sr/Ca was not sensitive to the same conditions. High-resolution {delta}{sup 18}O analyses confirmed this finding as both A. wellsi and A. willeyana deposited their skeleton in accordance with the trends in isotopic equilibrium with seawater, though with a 0.27{per_thousand} offset in the case of A. willeyana. In the high-Mg-calcite species A. wellsi, Mg may be interfering with Sr incorporation into the skeleton. On multidecadal timescales, A. wellsi sclerosponge {delta}{sup 18}O in Palau tracked the Southern Oscillation Index variability post-1977, but not pre-1977, coincident with the switch in the Pacific Decadal Oscillation (PDO) at {approx}1976. This suggests that water mass circulation in the region is influenced by El Nino-Southern Oscillation variability during positive PDO phases, but not during negative ones.

  14. Recovering after stroke (United States)

    Stroke rehabilitation; Cerebrovascular accident - rehabilitation; Recovery from stroke; Stroke - recovery; CVA - recovery ... LIVE AFTER A STROKE Most people will need stroke rehabilitation (rehab) to help them recover after they leave ...

  15. Post-stroke urinary incontinence. (United States)

    Mehdi, Z; Birns, J; Bhalla, A


    To provide a comprehensive review of the current evidence on post-stroke urinary incontinence. An electronic database search was performed to identify relevant studies and review articles related to Urinary Incontinence (UI) in the stroke population between the years 1966 and 2012. Urinary incontinence following stroke is a common problem affecting more than one-third of acute stroke patients and persisting in up to a quarter at 1 year. It is well established that this condition is a strong marker of stroke severity and is associated with poorer functional outcomes and increased institutionalisation and mortality rates compared with those who remain continent. Despite evidence linking better outcomes to those patients who regain continence, the results of national audits have demonstrated that the management of UI following stroke is suboptimal, with less than two-thirds of stroke units having a documented plan to promote continence. Current evidence supports a thorough assessment to categorise the type and severity of post-stroke urinary incontinence. An individually tailored, structured management strategy to promote continence should be employed. This has been associated with better stroke outcomes and should be the aim of all stroke health professionals. © 2013 John Wiley & Sons Ltd.

  16. Chondrite chronology by initial Sr-87/Sr-86 in phosphates? (United States)

    Podosek, Frank A.; Brannon, Joyce C.


    New data are presented on Rb-Sr isotope analyses of phosphates from nine ordinary chondrites, including accurate identification of initial Sr-87/Sr-86. The initial Sr-87/Sr-86 ratios found in this study were generally significantly higher than the more primitive initial Sr-87/Sr-86 ratios inferred for carbonaceous chondrite refractory inclusions, basaltic achondrites, or bulk ordinary chondrites. Such elevation of initial Sr-87/Sr-86 is generally considered to reflect isotopic redistribution during metamorphism. However, in this study, no evident correlation was found between the phosphate initial Sr-87/Sr-86 compositions and the metamorphic grade. Two possible alternative hypotheses for high initial Sr-87/Sr-86 ratios are considered.

  17. Stroke Rehabilitation (United States)

    ... unique for each person. Although a majority of functional abilities may be restored soon after a stroke, recovery is an ongoing process. Effects of a Stroke Weakness (hemiparesis) or paralysis (hemiplegia) on one side of the body that may affect the whole ...

  18. Pediatric Stroke (United States)

    ... of 3 and 10. In those with SCD, ischemic strokes most often occur in children under the age of 15 and adults over the age of 30, while hemorrhagic strokes most often occur in young adults between the ages of 20 and 30. ...

  19. Stroke and Cerebrovascular Diseases Registry (United States)


    Stroke; Acute Stroke; Acute Brain Injury; Ischemic Stroke; Hemorrhagic Stroke; Transient Ischemic Attack; Subarachnoid Hemorrhage; Cerebral Ischemia; Cerebral Infarction; Cerebral Stroke; Venous Sinus Thrombosis, Cranial

  20. Environmental 90Sr measurements (United States)

    Paul, M.; Berkovits, D.; Cecil, L.D.; Feldstein, H.; Hershkowitz, A.; Kashiv, Y.; Vogt, S.


    90Sr (T1/2 = 28.5 years) is a long-lived radionuclide produced in nuclear fission. Fast radiochemical detection of 90Sr in environmental samples is not feasible using current analytical methods. Accelerator Mass Spectrometry (AMS) measurements of 90Sr were made with the Rehovot 14UD Pelletron accelerator at a terminal voltage of 11 or 12 MV using our standard detection system. Injection of hydride ions (SrH3-) was chosen owing to high beam intensity and low Coulomb explosion effects. 90Sr ions were identified and discriminated from isobaric 90Zr by measuring time of flight, total energy and three independent energy-loss signals in an ionization chamber. A reference sample and a ground-water sample were successfully measured. The detection limit determined for a laboratory blank by the residual counts in the 90Sr region is 90Sr/Sr = 3 ?? 10-13, corresponding in practice to (2-4) ?? 10790Sr atoms or about 0.5-1 pCi/L in environmental water samples.

  1. British Association of Stroke Physicians: benchmarking survey of stroke services. (United States)

    Rodgers, Helen; Dennis, Martin; Cohen, David; Rudd, Anthony


    the National Service Framework for Older People requires every general hospital which cares for stroke patients to introduce a specialist stroke service by 2004. to describe the organisation and staffing of specialist hospital-based stroke services in the UK. a national postal survey of consultant members of the British Association of Stroke Physicians (BASP) seeking details of the provision of neurovascular clinics, acute stroke units (ASUs), stroke rehabilitation units (SRUs), and the organisation and staffing of these services. the response rate was 91/126 (72%). Fifty-four neurovascular clinics, 40 ASUs and 68 SRUs were identified. Neurovascular clinics used a number of strategies to maintain rapid access and 30 (56%) were run by a single consultant. Only 50% ASUs usually admitted patients within 24 h of stroke. As the number of beds available on ASUs and SRUs did not reflect the total number of stroke in-patients, 21 (53%) ASUs and 45 (79%) SRUs had admission criteria. Training opportunities were limited: 37% ASUs and 82% SRUs had no specialist registrar. The therapy sessions (1 session=half a day) available per bed per week on a SRU were: physiotherapy 0.8; occupational therapy 0.6; speech and language therapy 0.25. significant development is needed to achieve the NSF target for hospital-based stroke services as few Trusts currently have all components in place and even when available not all stroke patients have access to specialist care. Stroke specialists will be required to run these services but training opportunities are currently limited. Stroke unit therapy staffing levels were lower than was available in randomised controlled trials.

  2. Stroke Care 2: Stroke rehabilitation

    NARCIS (Netherlands)

    Langhorne, P.; Bernhardt, J.; Kwakkel, G.


    Stroke is a common, serious, and disabling global health-care problem, and rehabilitation is a major part of patient care. There is evidence to support rehabilitation in well coordinated multidisciplinary stroke units or through provision of early supported provision of discharge teams. Potentially

  3. Early diastolic strain rate in relation to systolic and diastolic function and prognosis in acute myocardial infarction

    DEFF Research Database (Denmark)

    Ersbøll, Mads; Andersen, Mads J; Valeur, Nana


    AIMS: Diastolic dysfunction in acute myocardial infarction (MI) is associated with adverse outcome. Recently, the ratio of early mitral inflow velocity (E) to global diastolic strain rate (e'sr) has been proposed as a marker of elevated LV filling pressure. However, the prognostic value...... of this measure has not been demonstrated in a large-scale setting when existing parameters of diastolic function are known. We hypothesized that the E/e'sr ratio would be independently associated with an adverse outcome in patients with MI. METHODS AND RESULTS: We prospectively included patients with MI...... and performed echocardiography with comprehensive diastolic evaluation including E/e'sr. The relationship between E/e'sr and the primary composite endpoint (all-cause mortality, hospitalization for heart failure (HF), stroke, and new onset atrial fibrillation) was analysed with Cox models. A total of 1048...

  4. The role of polarity in antonym and synonym conceptual knowledge: evidence from stroke aphasia and multidimensional ratings of abstract words. (United States)

    Crutch, Sebastian J; Williams, Paul; Ridgway, Gerard R; Borgenicht, Laura


    This study describes an investigation of different types of semantic relationship among abstract words: antonyms (e.g. good-bad), synonyms (e.g. good-great), non-antonymous, non-synonymous associates (NANSAs; e.g. good-fun) and unrelated words (e.g. good-late). The comprehension and semantic properties of these words were examined using two distinct methodologies. Experiment 1 tested the comprehension of pairs of abstract words in three patients with global aphasia using a spoken word to written word matching paradigm. Contrary to expectations, all three patients showed superior antonym comprehension compared with synonyms or NANSAs, discriminating antonyms with a similar level of accuracy as unrelated words. Experiment 2 aimed to explore the content or semantic attributes of the abstract words used in Experiment 1 through the generation of control ratings across nine cognitive dimensions (sensation, action, thought, emotion, social interaction, space, time, quantity and polarity). Discrepancy analyses revealed that antonyms were as or more similar to one another than synonyms on all but one measure: polarity. The results of Experiment 2 provide a possible explanation for the novel pattern of neuropsychological data observed in Experiment 1, namely that polarity information is more important than other semantic attributes when discriminating the meaning of abstract words. It is argued that polarity is a critical semantic attribute of abstract words, and that simple 'dissimilarity' metrics mask fundamental consistencies in the semantic representation of antonyms. It is also suggested that mapping abstract semantic space requires the identification and quantification of the contribution made to abstract concepts by not only sensorimotor and emotional information but also a host of other cognitive dimensions. Copyright © 2012 Elsevier Ltd. All rights reserved.

  5. Pediatric stroke

    International Nuclear Information System (INIS)

    Hoermann, M.


    Stroke in childhood has gained increasingly more attention and is accepted as an important disease in childhood. The reasons for this severe event and the consequences for the rest of the life are totally different than for adults. This is also true for the diagnosis and therapy. This paper gives a comprehensive overview on the characteristics of pediatric stroke to assist radiologists in making a rapid and safe diagnosis in order to identify the underlying disease. (orig.) [de

  6. Specific antismoking advice after stroke

    DEFF Research Database (Denmark)

    Hornnes, Nete; Larsen, Klaus; Brink-Kjær, Tove


    INTRODUCTION: Many stroke survivors would benefit from modification of their lifestyle in order to reduce their risk of recurrent stroke. We investigated if tailored smoking cessation advice would yield a higher smoking cessation rate and a higher rate with sustained abstinence in ex......-smokers in the intervention group than among controls. MATERIAL AND METHODS: Patients admitted with an acute stroke or a transient ischaemic attack were included in a randomised controlled trial focusing on control of lifestyle risk factors and hypertension. Here, we report the intervention focused on smoking cessation. We...

  7. Identification of stroke mimics among clinically diagnosed acute strokes. (United States)

    Tuntiyatorn, Lojana; Saksornchai, Pichaya; Tunlayadechanont, Supoch


    Stroke is a clinically syndrome of a sudden onset of neurological deficit in a vascular cause. Stroke mimics is the non-vascular disorders with stroke-like clinical symptoms. It is important to distinguish true stroke from mimics since treatment plan may differ To determine the incidence of the stroke mimics and identify their etiologies. All non-contrast head CT of the patients with clinically diagnosed stroke who immediately received imaging upon arrival at the emergency department of the university hospital were retrospectively reviewed in 12-month period between January 1 and December 31, 2008. Medical records, laboratory results, MRI, and 6-month clinical follow-up records were reviewed for final diagnosis. Seven hundred four patients were included in this study, including 363 (51.5%) men and 341 (48.5%) women with range in age from 24 to 108 years. Amongst those, 417 (59.2%) were ischemic stroke, 80 (11.40%) were hemorrhagic stroke, 186 (26.4%) were stroke-mimics, and 21 (3%) were inconclusive. The etiologies among stroke-mimics were metabolic/intoxication (35, 18.8%), sepsis (28, 15.0%), seizure (21, 11.3%), syncope (20, 10.8%), subdural hemorrhage (14, 7.5%), vertigo (11, 6.0%), brain tumor (10, 5.30%), central nervous system infection (5, 2.7%), others (26, 14.0%), and unspecified (16, 8.6%). Incidence rates and etiologies of the stroke mimics were similar to the western reports. However the frequency of each mimic was not.

  8. Wen Dan Decoction for hemorrhagic stroke and ischemic stroke. (United States)

    Xu, Jia-Hua; Huang, Yan-Mei; Ling, Wei; Li, Yang; Wang, Min; Chen, Xiang-Yan; Sui, Yi; Zhao, Hai-Lu


    The use of traditional Chinese medicine (TCM) in stroke is increasing worldwide. Here we report the existing clinical evidence of the Pinellia Ternata containing formula Wen Dan Decoction (WDD) for the treatment of ischemic stroke and hemorrhagic stroke. PubMed, CNKI, Wan Fang database, Cochrane Library and online Clinical Trial Registry were searched up to 26 February 2013 for randomized, controlled clinical trials (RCTs) using WDD as intervention versus Western conventional medicine as control to treat stroke. Clinical outcomes were improvement of the Neurological Functional Deficit Scores (NFDS) and overall therapeutic efficacy rates including rate of cure. Meta-regression analysis using Hedges'g was performed for RCTs with significant heterogeneity. A total of 22 RCTs of ischemic stroke and 4 RCTs of hemorrhagic stroke, involving 2214 patients (1167 used WDD), met our inclusion criteria. Meta-analysis of the 13 RCTs reporting NFDS improvement favored WDD over the control (mean difference=-3.40, 95% confidence intervals [CI]=[-4.64, -2.15]). Rate of overall therapeutic efficacy (odds ratio [OR]=3.39, 95%CI=[1.81, 6.37]) for hemorrhagic stroke were significantly higher in WDD treated patients than the control subjects. In the 1898 patients with ischemic stroke, WDD medication also achieved higher rates of cure (OR=2.22, 95%CI=[1.66, 2.97]) and overall therapeutic efficacy (OR=3.31, 95%CI=[2.54, 4.31]) than the conventional treatment. WDD displays benefits on improvement of neurological function and overall therapeutic efficacy in post-stroke patients. TCM such as WDD may serve as a therapeutic tool of dual actions to explore the common mechanisms underlying cerebral hemorrhage and ischemia. Copyright © 2015 Elsevier Ltd. All rights reserved.

  9. Construction of the seawater 87Sr/86Sr curve for the Cenozoic and Cretaceous: supporting data

    International Nuclear Information System (INIS)

    Koepnick, R.B.; Burke, W.H.; Denison, R.E.; Hetherington, E.A.; Nelson, H.F.; Otto, J.B.; Waite, L.E.


    We present the data used to construct the Cenozoic and Cretaceous portion of the Phanerozoic curve of seawater 87 Sr/ 86 Sr that had been given in summary form by W.H. Burke and coworkers. All Cenozoic samples (128) and 22 Cretaceous samples are foram-nannofossil oozes and limestones from DSDP cores distributed among 13 sites in the Atlantic, Pacific and Indian Oceans, and the Caribbean Sea. Non-DSDP Cretaceous samples (126) include limestone, anhydrite and phosphate samples from North America, Europe and Asia. Determination of the 87 Sr/ 86 Sr value of seawater at particular times in the past is based on comparison of ratios derived from coeval marine samples from widely separated geographic areas. The general configuration of the Cenozoic and Cretaceous curve appears to be strongly influenced by the history of plate interactions and sea-floor spreading. Specific rises and falls in the 87 Sr/ 86 Sr of seawater, however, may be caused by a variety of factors such as variation in lithologic composition of the crust exposed to weathering, configuration and topographic relief of continents, volcanic activity, rate of sea-floor spreading, extent of continental inundation by epeiric seas, and variations in both climate and paleo-oceanographic conditions. Many or all of these factors are probably related to global tectonic processes, yet their combined effect on the temporal variation of seawater 87 Sr/ 86 Sr can complicate a direct plate-tectonic interpretation for portions of the seawater curve. (Auth.)

  10. Driving After a Stroke (United States)

    ... Stroke Professionals for Stroke Shop for Stroke Support for Stroke Association. ... a wheelchair accessible or modified van, truck or car can provide the assurance you need to feel ...

  11. Rating


    Karas, Vladimír


    Charakteristika ratingu. Dělení a druhy ratingu (rating emise × rating emitenta; dlouhodobý rating × krátkodobý rating; mezinárodní rating × lokální rating). Obecné požadavky kladené na rating. Proces tvorby ratingu. Vyžádaný rating. Nevyžádaný rating. Ratingový proces na bázi volně přístupných informací. Uplatňované ratingové systémy. Ratingová kriteria. Využití a interpretace ratingové známky. Funkce ratingu. Rating v souvislosti s BASEL II. Rating v souvislosti s hospodářskými krizemi....

  12. National Trends in Patients Hospitalized for Stroke and Stroke Mortality in France, 2008 to 2014. (United States)

    Lecoffre, Camille; de Peretti, Christine; Gabet, Amélie; Grimaud, Olivier; Woimant, France; Giroud, Maurice; Béjot, Yannick; Olié, Valérie


    Stroke is the leading cause of death in women and the third leading cause in men in France. In young adults (ie, stroke was observed at a local scale between 1985 and 2011. After the implementation of the 2010 to 2014 National Stroke Action Plan, this study investigates national trends in patients hospitalized by stroke subtypes, in-hospital mortality, and stroke mortality between 2008 and 2014. Hospitalization data were extracted from the French national hospital discharge databases and mortality data from the French national medical causes of death database. Time trends were tested using a Poisson regression model. From 2008 to 2014, the age-standardized rates of patients hospitalized for ischemic stroke increased by 14.3% in patients stroke was stable (+2.0%), irrespective of age and sex. The proportion of patients hospitalized in stroke units substantially increased. In-hospital mortality decreased by 17.1% in patients with ischemic stroke. From 2008 to 2013, stroke mortality decreased, except for women between 45 and 64 years old and for people aged ≥85 years. An increase in cardiovascular risk factors and improved stroke management may explain the increase in the rates of patients hospitalized for ischemic stroke. The decrease observed for in-hospital stroke mortality may be because of recent improvements in acute-phase management. © 2017 American Heart Association, Inc.

  13. In-hospital stroke recurrence and stroke after transient ischemic attack: frequency and risk factors. (United States)

    Erdur, Hebun; Scheitz, Jan F; Ebinger, Martin; Rocco, Andrea; Grittner, Ulrike; Meisel, Andreas; Rothwell, Peter M; Endres, Matthias; Nolte, Christian H


    We aimed to assess the risk of recurrent ischemic events during hospitalization for stroke or transient ischemic attack (TIA) with optimal current management and to identify associated risk factors. We performed a retrospective analysis of all patients treated for acute ischemic stroke or TIA in 3 stroke units between 2010 and 2013. Recurrent stroke was defined as new persisting (≥24 hours) neurological deficit occurring >24 hours after the index event and not attributable to other causes of neurological deterioration. Cox proportional hazard regression identified risk factors associated with recurrent stroke. The study included 5106 patients. During a median length of stay of 5 days (interquartile range, 4-8), stroke recurrence (or stroke after TIA) occurred in 40 patients (0.8%) and was independently associated with history of TIA, symptomatic carotid stenosis (≥70%), or other determined etiology. Patients with recurrent stroke and other determined etiology had cervical arterial dissection (n=2), primary angiitis of the central nervous system (n=1), giant cell arteritis (n=1), and lung cancer with nonbacterial thrombotic endocarditis (n=1). In patients with initial TIA or minor stroke (National Institutes of Health Stroke Scale ≤5) recurrence was associated additionally with pneumonia after the inciting ischemic event but before stroke recurrence. Patients with initial stroke and aphasia had a lower stroke recurrence rate and there were no recurrences in patients with lacunar stroke. Recurrence was associated with significantly higher in-hospital mortality (17.5% versus 3.1%; Pstroke recurrence was low with optimal current management. Patients with a history of TIA, severe symptomatic carotid stenosis, or uncommon causes of stroke were at higher risk. Pneumonia was associated with a higher risk of stroke recurrence in patients with initial TIA or minor stroke but not in the overall population studied. Aphasia may bias the detection rate by concealing new

  14. Age trajectories of stroke case fatality

    DEFF Research Database (Denmark)

    Olsen, Tom Skyhøj; Andersen, Zorana Jovanovic; Andersen, Klaus Kaae


    Mortality rates level off at older ages. Age trajectories of stroke case-fatality rates were studied with the aim of investigating prevalence of this phenomenon, specifically in case-fatality rates at older ages....

  15. mStroke: "Mobile Stroke"-Improving Acute Stroke Care with Smartphone Technology. (United States)

    Andrew, Benjamin Y; Stack, Colleen M; Yang, Julian P; Dodds, Jodi A


    This study aimed to evaluate the effect of method and time of system activation on clinical metrics in cases utilizing the Stop Stroke (Pulsara, Inc.) mobile acute stroke care coordination application. A retrospective cohort analysis of stroke codes at 12 medical centers using Stop Stroke from March 2013 to May 2016 was performed. Comparison of metrics (door-to-needle time [DTN] and door-to-CT time [DTC], and rate of DTN ≤ 60 minutes [goal DTN]) was performed between subgroups based on method (emergency medical service [EMS] versus emergency department [ED]) and time of activation. Effects were adjusted for confounders (age, sex, National Institutes of Health Stroke Scale [NIHSS] score) using multiple linear and logistic regression. The final dataset included 2589 cases. Cases activated by EMS were more severe (median NIHSS score 8 versus 4, P smartphone technology provides unique insight into acute stroke codes. Activation of mobile electronic stroke coordination in the field appears to promote a more expedited and successful care process. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  16. Radiative rates for E1, E2, M1, and M2 transitions in the Br-like ions Sr IV, Y V, Zr VI, Nb VII, and Mo VIII

    International Nuclear Information System (INIS)

    Aggarwal, Kanti M.; Keenan, Francis P.


    Energies and lifetimes are reported for the lowest 375 levels of five Br-like ions, namely Sr IV, Y V, Zr VI, Nb VII, and Mo VIII, mostly belonging to the 4s 2 4p 5 , 4s 2 4p 4 4ℓ, 4s4p 6 , 4s 2 4p 4 5ℓ, 4s 2 4p 3 4d 2 , 4s4p 5 4ℓ, and 4s4p 5 5ℓ configurations. Extensive configuration interaction has been included and the general-purpose relativistic atomic structure package (GRASP) has been adopted for the calculations. Additionally, radiative rates are listed among these levels for all E1, E2, M1, and M2 transitions. From a comparison with the measurements, the majority of our energy levels are assessed to be accurate to better than 2%, although discrepancies between theory and experiment for a few are up to 6%. An accuracy assessment of the calculated radiative rates (and lifetimes) is more difficult, because no prior results exist for these ions

  17. Can we derive an 'exchange rate' between descriptive and preference-based outcome measures for stroke? Results from the transfer to utility (TTU) technique. (United States)

    Mortimer, Duncan; Segal, Leonie; Sturm, Jonathan


    Stroke-specific outcome measures and descriptive measures of health-related quality of life (HRQoL) are unsuitable for informing decision-makers of the broader consequences of increasing or decreasing funding for stroke interventions. The quality-adjusted life year (QALY) provides a common metric for comparing interventions over multiple dimensions of HRQoL and mortality differentials. There are, however, many circumstances when--because of timing, lack of foresight or cost considerations--only stroke-specific or descriptive measures of health status are available and some indirect means of obtaining QALY-weights becomes necessary. In such circumstances, the use of regression-based transformations or mappings can circumvent the failure to elicit QALY-weights by allowing predicted weights to proxy for observed weights. This regression-based approach has been dubbed 'Transfer to Utility' (TTU) regression. The purpose of the present study is to demonstrate the feasibility and value of TTU regression in stroke by deriving transformations or mappings from stroke-specific and generic but descriptive measures of health status to a generic preference-based measure of HRQoL in a sample of Australians with a diagnosis of acute stroke. Findings will quantify the additional error associated with the use of condition-specific to generic transformations in stroke. We used TTU regression to derive empirical transformations from three commonly used descriptive measures of health status for stroke (NIHSS, Barthel and SF-36) to a preference-based measure (AQoL) suitable for attaching QALY-weights to stroke disease states; based on 2570 observations drawn from a sample of 859 patients with stroke. Transformations from the SF-36 to the AQoL explained up to 71.5% of variation in observed AQoL scores. Differences between mean predicted and mean observed AQoL scores from the 'severity-specific' item- and subscale-based SF-36 algorithms and from the 'moderate to severe' index- and item

  18. Heat Stroke

    DEFF Research Database (Denmark)

    Mørch, Sofie Søndergaard; Andersen, Johnny Dohn Holmgren; Bestle, Morten Heiberg


    and mortality. This case report describes two Danish patients diagnosed with heat stroke syndrome during a heat wave in the summer of 2014. Both patients were morbidly obese and had several predisposing illnesses. However since heat stroke is a rare condition in areas with temperate climate, they were...... not diagnosed until several days after admittance; hence treatment with cooling was delayed. Both patients were admitted to the intensive care unit, where they were treated with an external cooling device and received treatment for complications. Both cases ended fatally. As global warming continues, more heat...

  19. Stroke awareness among inpatient nursing staff at an academic medical center. (United States)

    Adelman, Eric E; Meurer, William J; Nance, Dorinda K; Kocan, Mary Jo; Maddox, Kate E; Morgenstern, Lewis B; Skolarus, Lesli E


    Because 10% of strokes occur in hospitalized patients, we sought to evaluate stroke knowledge and predictors of stroke knowledge among inpatient and emergency department nursing staff. Nursing staff completed an online stroke survey. The survey queried outcome expectations (the importance of rapid stroke identification), self-efficacy in recognizing stroke, and stroke knowledge (to name 3 stroke warning signs or symptoms). Adequate stroke knowledge was defined as the ability to name ≥2 stroke warning signs. Logistic regression was used to identify the association between stroke symptom knowledge and staff characteristics (education, clinical experience, and nursing unit), stroke self-efficacy, and outcome expectations. A total of 875 respondents (84% response rate) completed the survey and most of the respondents were nurses. More than 85% of respondents correctly reported ≥2 stroke warning signs or symptoms. Greater self-efficacy in identifying stroke symptoms (odds ratio, 1.13; 95% confidence interval, 1.01-1.27) and higher ratings for the importance of rapid identification of stroke symptoms (odds ratio, 1.23; 95% confidence interval, 1.002-1.51) were associated with stroke knowledge. Clinical experience, educational experience, nursing unit, and personal knowledge of a stroke patient were not associated with stroke knowledge. Stroke outcome expectations and self-efficacy are associated with stroke knowledge and should be included in nursing education about stroke.

  20. Teleneurology to improve stroke care in rural areas: The Telemedicine in Stroke in Swabia (TESS) Project. (United States)

    Wiborg, Andreas; Widder, Bernhard


    Assessing both stroke patients and their CT scans by using a conventional videoconference system offers an interesting opportunity to improve stroke care in rural areas. However, until now there have been no studies to suggest whether this method is feasible in routine stroke management. Seven rural hospitals in the southern part of Germany in Swabia were connected to the stroke unit of Günzburg with the use of a videoconference link (Telemedicine in Stroke in Swabia [TESS] Project). The local physicians are free to present every admitted stroke patient to the Günzburg stroke expert, who can assess the clinical status and CT images, thereafter giving therapeutic recommendations. All teleconsultations are rated concerning transmission quality and relevance of telemedicine for stroke management. A total of 153 stroke patients were examined by teleconsultation. Mean age was 67.5 years. Eighty-seven patients had suffered an ischemic stroke, 9 had an intracerebral hemorrhage, and 17 suffered a transient ischemic attack. Forty patients were revealed to have a diagnosis other than stroke. Duration of teleconsultation was 15 minutes on average. User satisfaction was good concerning imaging and audio quality, and patient satisfaction was very good or good in all cases. Relevant contributions could be made in >75% of the cases concerning diagnostic workup, CT assessment, and therapeutic recommendations. Teleconsultation using a videoconference system seems to be a feasible and promising method to improve stroke care in rural areas where management in a stroke unit is hindered by long transportation distances.

  1. Stroke etiology and collaterals: atheroembolic strokes have greater collateral recruitment than cardioembolic strokes. (United States)

    Rebello, L C; Bouslama, M; Haussen, D C; Grossberg, J A; Dehkharghani, S; Anderson, A; Belagaje, S R; Bianchi, N A; Grigoryan, M; Frankel, M R; Nogueira, R G


    Chronic hypoperfusion from athero-stenotic lesions is thought to lead to better collateral recruitment compared to cardioembolic strokes. It was sought to compare collateral flow in stroke patients with atrial fibrillation (AF) versus stroke patients with cervical atherosclerotic steno-occlusive disease (CASOD). This was a retrospective review of a prospectively collected endovascular database. Patients with (i) anterior circulation large vessel occlusion stroke, (ii) pre-treatment computed tomography angiography (CTA) and (iii) intracranial embolism from AF or CASOD were included. CTA collateral patterns were evaluated and categorized into two groups: absent/poor collaterals (CTA collateral score 0-1) versus moderate/good collaterals (CTA collateral score 2-4). CT perfusion was also utilized for baseline core volume and evaluation of infarct growth. A total of 122 patients fitted the inclusion criteria, of whom 88 (72%) had AF and 34 (27%) CASOD. Patients with AF were older (P Collateral scores were lower in the AF group (P = 0.01) with patients having poor collaterals in 28% of cases versus 9% in the CASOD group (P = 0.03). Mortality rates (20% vs. 0%; P = 0.02) were higher in the AF patients whilst rates of any parenchymal hemorrhage (6% vs. 26%; P collaterals (odds ratio 4.70; 95% confidence interval 1.17-18.79; P = 0.03). Atheroembolic strokes seem to be associated with better collateral flow compared to cardioembolic strokes. This may in part explain the worse outcomes of AF-related stroke. © 2017 EAN.

  2. Embolic stroke of undetermined source: a retrospective analysis from an Italian Stroke Unit

    Directory of Open Access Journals (Sweden)

    Marco Masina


    Full Text Available The new clinical construct of embolic stroke of undetermined source (ESUS suggests that many cryptogenic strokes are related to minor-risk covert embolic cardiac sources or to embolus from non-occlusive plaques in the aortic arch or in the cerebral arteries. The authors analyzed the prevalence of ESUS in a real-life condition in Italy and compared the recurrence rates in cryptogenic strokes, cardioembolic strokes, and ESUS. The authors retrospectively reassessed according to ESUS criteria 391 consecutive admissions in a stroke unit where extensive diagnostic search was routinely performed. Recurrences in each stroke type within a 3-year follow-up period (mean time: 25.44 months - standard deviation: 9.42 were also compared. The prevalence of ESUS in the aforementioned cohort was 10.5%. All ESUS patients received antiplatelet agents. Warfarin was prescribed in 56.9% of cardioembolic strokes. The recurrence rate in ESUS patients was 4.4% per year, slightly higher than in cardioembolic strokes (3.5% and significantly higher than in cryptogenic non-ESUS (1.2% (P<0.0001. This is the first description of a cohort of ESUS patients in an Italian stroke unit. Patients with ESUS have a significantly higher risk of recurrence than in those with non-ESUS cryptogenic strokes, and slightly higher than in those with cardioembolic strokes. Results support the hypothesis of a more extensive diagnostic evaluation in cryptogenic strokes and the feasibility of such approach.

  3. Association between atherogenic dyslipidemia and recurrent stroke risk in patients with different subtypes of ischemic stroke. (United States)

    Zhao, Lu; Wang, Ruihao; Song, Bo; Tan, Song; Gao, Yuan; Fang, Hui; Lu, Jie; Xu, Yuming


    The association between atherogenic dyslipidemia and stroke recurrence remains unclear, and may be influenced by different subtypes of ischemic stroke. We aimed to investigate whether atherogenic dyslipidemia contributed to stroke recurrence in ischemic stroke patients and in those with certain subtypes of ischemic stroke. We conducted a prospective hospital-based study enrolling patients with acute ischemic stroke. Atherogenic dyslipidemia was defined as high-density lipoprotein cholesterol dyslipidemia and stroke recurrence was analyzed by using multivariable Cox regression model. In the 510 ischemic stroke patients, 64 patients (12·5%) had atherogenic dyslipidemia, and 66 patients (12·9%) experienced stroke recurrence events within 24 months. Kaplan-Meier analysis revealed that stroke recurrence rate was significantly higher in patients with atherogenic dyslipidemia than those without in all the stroke patients (20·3% vs. 11·9%; P = 0·048), and more evident in those of large-artery atherosclerosis subtype (31·0% vs. 14·1%; P = 0·014), but not in the other subtypes. Multivariable Cox regression analysis revealed that atherogenic dyslipidemia was associated with higher stroke recurrence risk among stroke patients of large-artery atherosclerosis subtype (hazard ratio, 2·79; 95% confidence interval, 1·24-6·28), but not significant in all the stroke patients (hazard ratio, 1·69; 95% confidence interval, 0·85-3·37). Atherogenic dyslipidemia is associated with higher risk of stroke recurrence in ischemic stroke patients. Such association might be more pronounced in large-artery atherosclerosis subtype and needs further investigation to establish such relationship. © 2015 World Stroke Organization.

  4. Stroke awareness in Denmark

    DEFF Research Database (Denmark)

    Truelsen, Thomas; Krarup, Lars-Henrik


    This is the first study to examine the awareness of major stroke symptoms and stroke risk factors among the general population in Denmark. Early recognition of stroke warning signs and means of reducing stroke occurrence could improve the treatment and prevention of stroke....

  5. Thrombolysis in Postoperative Stroke. (United States)

    Voelkel, Nicolas; Hubert, Nikolai Dominik; Backhaus, Roland; Haberl, Roman Ludwig; Hubert, Gordian Jan


    Intravenous thrombolysis (IVT) is beneficial in reducing disability in selected patients with acute ischemic stroke. There are numerous contraindications to IVT. One is recent surgery. The aim of this study was to analyze the safety of IVT in patients with postoperative stroke. Data of consecutive IVT patients from the Telemedical Project for Integrative Stroke Care thrombolysis registry (February 2003 to October 2014; n=4848) were retrospectively searched for keywords indicating preceding surgery. Patients were included if surgery was performed within the last 90 days before stroke. The primary outcome was defined as surgical site hemorrhage. Subgroups with major/minor surgery and recent/nonrecent surgery (within 10 days before IVT) were analyzed separately. One hundred thirty-four patients underwent surgical intervention before IVT. Surgery had been performed recently (days 1-10) in 49 (37%) and nonrecently (days 11-90) in 85 patients (63%). In 86 patients (64%), surgery was classified as major, and in 48 (36%) as minor. Nine patients (7%) developed surgical site hemorrhage after IVT, of whom 4 (3%) were serious, but none was fatal. One fatal bleeding occurred remotely from surgical area. Rate of surgical site hemorrhage was significantly higher in recent than in nonrecent surgery (14.3% versus 2.4%, respectively, odds ratio adjusted 10.73; 95% confidence interval, 1.88-61.27). Difference between patients with major and minor surgeries was less distinct (8.1% and 4.2%, respectively; odds ratio adjusted 4.03; 95% confidence interval, 0.65-25.04). Overall in-hospital mortality was 8.2%. Intracranial hemorrhage occurred in 9.7% and was asymptomatic in all cases. IVT may be administered safely in postoperative patients as off-label use after appropriate risk-benefit assessment. However, bleeding risk in surgical area should be taken into account particularly in patients who have undergone surgery shortly before stroke onset. © 2017 American Heart Association, Inc.

  6. Imaging of Hemorrhagic Stroke. (United States)

    Hakimi, Ryan; Garg, Ankur


    Hemorrhagic stroke comprises approximately 15% to 20% of all strokes. This article provides readers with an understanding of the indications and significance of various neuroimaging techniques available for patients presenting with hemorrhagic strokes of distinct causes. The most common initial neuroimaging study is a noncontrast head CT, which allows for the identification of hemorrhage. Once an intracranial hemorrhage has been identified, the pattern of blood and the patient's medical history, neurologic examination, and laboratory studies lead the practitioner to pursue further neuroimaging studies to guide the medical, surgical, and interventional management. Given that hemorrhagic stroke constitutes a heterogeneous collection of diagnoses, the subsequent neuroimaging pathway necessary to better evaluate and care for these patients is variable based on the etiology.With an increasing incidence and prevalence of atrial fibrillation associated with the aging population and the introduction of three new direct factor Xa inhibitors and one direct thrombin inhibitor to complement vitamin K antagonists, oral anticoagulant use continues to increase. Patients on oral anticoagulants have a sevenfold to tenfold increased risk for intracerebral hemorrhage (ICH). Furthermore, patients who have an ICH associated with oral anticoagulant use have a higher mortality rate than those with primary ICH. Despite the reduced incidence of hypertension-related ICH over the past decade, it is expected that the incidence of ICH will continue to increase. Neuroimaging studies are integral to the identification of hemorrhagic stroke, determination of the underlying etiology, prevention of hematoma expansion, treatment of acute complications, and treatment of the underlying etiology, if indicated. Neuroimaging is essential for prognostication and thus directly impacts patient care.

  7. Stroke rehabilitation. (United States)

    Langhorne, Peter; Bernhardt, Julie; Kwakkel, Gert


    Stroke is a common, serious, and disabling global health-care problem, and rehabilitation is a major part of patient care. There is evidence to support rehabilitation in well coordinated multidisciplinary stroke units or through provision of early supported provision of discharge teams. Potentially beneficial treatment options for motor recovery of the arm include constraint-induced movement therapy and robotics. Promising interventions that could be beneficial to improve aspects of gait include fitness training, high-intensity therapy, and repetitive-task training. Repetitive-task training might also improve transfer functions. Occupational therapy can improve activities of daily living; however, information about the clinical effect of various strategies of cognitive rehabilitation and strategies for aphasia and dysarthria is scarce. Several large trials of rehabilitation practice and of novel therapies (eg, stem-cell therapy, repetitive transcranial magnetic stimulation, virtual reality, robotic therapies, and drug augmentation) are underway to inform future practice. Copyright © 2011 Elsevier Ltd. All rights reserved.

  8. Multiple Strokes

    Directory of Open Access Journals (Sweden)

    Obododimma Oha


    Full Text Available This poem playfully addresses the slippery nature of linguistic signification, employing humour and sarcasm in presenting a wide range of human experience. It ironical twists -- and "strokes" (read ambiguously as both a giving a punishment and erotic pleasuring -- move from the naming of location through international discourse of capital to the crumbling relationships between nation states. It reading of the signs of language is tied to the unease and fracture in cultural and political experience.

  9. Two Kinds of Stroke (United States)

    ... Issue Past Issues Special Section Two Kinds of Stroke Past Issues / Summer 2007 Table of Contents For ... are often a warning sign for future strokes. Stroke Can Affect Anyone Award-winning actress Julie Harris ...

  10. Healthy Living after Stroke (United States)

    ... Stories Stroke Heroes Among Us Healthy Living After Stroke Nutrition Good nutrition is one way to reduce ... the hospital. Thank goodness, she did. Subscribe to Stroke Connection Get quarterly digital issues plus our monthly ...

  11. Impact of Libido at 2 Weeks after Stroke on Risk of Stroke Recurrence at 1-Year in a Chinese Stroke Cohort Study


    Jing-Jing Li; Huai-Wu Yuan; Chun-Xue Wang; Ben-Yan Luo; Jie Ruan; Ning Zhang; Yu-Zhi Shi; Yong Zhou; Yi-Long Wang; Tong Zhang; Juan Zhou; Xing-Quan Zhao; Yong-Jun Wang


    Background: There were few studies on the relation between changes in libido and incidence of stroke recurrence. The aim of this study was to investigate the relationship between libido decrease at 2 weeks after stroke and recurrent stroke at 1-year. Methods: It is a multi-centered, prospective cohort study. The 14 th item of the Hamilton Depression Rating Scale-17 was used to evaluate changes of libido in poststroke patients at 2 weeks. Stroke recurrence was defined as an aggravation of ...

  12. Understanding Life After Stroke


    Hjelmblink, Finn


    Stroke is an acute, neurological dysfunction of vascular origin with sudden occurrence and it influences physical, cognitive and psychological functions. Initial treatment aims at eliminating or reducing the brain damage. Soon, however, the influence of the stroke on the entire life of stroke survivors has to be considered. This thesis explores the meaning of life after stroke to 19 elderly stroke survivors during the first year post stroke. Survivors were interviewed twice and the interviews...

  13. Difficulty Swallowing After Stroke (Dysphagia) (United States)

    ... Simple Techniques Can Help Memory after a Stroke Self-Esteem after Stroke Cognitive Challenges After Stroke Depression Trumps ... spasticity), fatigue and more. Let's Talk About Stroke Fact Sheets Our stroke fact sheets cover treatments, recovery, ...

  14. A temible complication of ischemic stroke: pulmonary embolism

    Directory of Open Access Journals (Sweden)

    Linda Iurato


    Pulmonary embolism is a major contributor to in-hospital death after stroke. Although the rate of clinically overt pulmonary embolism after stroke has been estimated to be less than 1%, pulmonary emboli account for up to 50% of early deaths after stroke. In daily practice, the clinical burden of pulmonary embolism in patient with stroke is, however, underestimated since the clinical symptoms of stroke may obscure the recognition of this complication. The aim of this article is to describe the clinical and therapeutic aspects of pulmonary embolism as complication after stroke.

  15. Risk Factors, Subtypes, and Outcome of Ischemic Stroke in Kuwait: A National Study. (United States)

    Al-Hashel, Jasem Y; Al-Sabah, Al-Alya; Ahmed, Samar F; Al-Enezi, Maha; Al-Tawheid, Nour; Al Mesailekh, Zainab; Eliwa, Jasmine; Alroughani, Raed


    Epidemiological studies of stroke burden in Kuwait are scarce. We aimed to identify the risk factors, subtypes, and outcome of ischemic stroke in the 6 major hospitals in Kuwait between 2008 and 2013. A cross-sectional survey was carried out using randomly selected ischemic stroke patients. It included data of sociodemographic status, stroke risk factors, stroke subtypes, treatment, and outcomes. A total of 1257 ischemic stroke patients (811 men and 446 women; mean age 60.2 ± 13.1) were included. Small-artery ischemic stroke was the most common stroke subgroup (69.8%) whereas hypertension was the most prevalent risk factor (80.9%). History of heart disease was significantly associated (P strokes (58.3%) compared to large-artery stroke (37.5%) and small-artery stroke (32.5%). Atrial fibrillation was significantly prevalent (P stroke (54.2%) compared to large-artery stroke (13%) and small-artery stroke (7.6%). Presentation at ages less than 45 years was significantly (P stroke was significantly associated with higher mortality rates (25% versus 12.4% and 6.8%; P strokes, respectively. Small-artery ischemic stroke was the most common stroke subgroup, and hypertension was the most common risk factor. The outcome was better in younger patients. Cardioembolic stroke was associated with worse outcome. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  16. Endovascular therapy for acute stroke: Quo vadis?

    Directory of Open Access Journals (Sweden)

    Venkatesh S Madhugiri


    Full Text Available Endovascular therapy (EVT has gained vogue in the management of patients with acute stroke. Newer stent-retriever devices have led to better recanalization rates. In many centers, EVT is slowly being used as an add on to or in some instances, even as an alternative to intravenous tissue plasminogen activator (IV tPA. The publication of the results of the SYNTHESIS expansion, Interventional Management of Stroke III and Mechanical Retrieval Recanalization of Stroke Clots Using Embolectomy trials in 2013 has questioned the enthusiastic use of EVT in acute stroke. They demonstrate that EVT (using a variety of devices is no superior to IV tPA in the management of acute stroke. In the light of these controversial findings, we review the current status of EVT in the management of acute stroke.

  17. Update on the Global Burden of Ischemic and Hemorrhagic Stroke in 1990-2013: The GBD 2013 Study

    NARCIS (Netherlands)

    Feigin, V.L.; Krishnamurthi, R.V.; Parmar, P.; Norrving, B.; Mensah, G.A.; Bennett, D.; Barker-Collo, S.; Moran, A.E.; Sacco, R.L.; Truelsen, T.; Davis, S.C.; Pandian, J.D.; Naghavi, M.R.; Forouzanfar, M.H.; Nguyen, G.; Johnson, C.; Vos, T.; Meretoja, A.; Murray, C.J.; Roth, G.A.; Geleijnse, J.M.


    Background: Global stroke epidemiology is changing rapidly. Although age-standardized rates of stroke mortality have decreased worldwide in the past 2 decades, the absolute numbers of people who have a stroke every year, and live with the consequences of stroke or die from their stroke, are

  18. Protein consumptions in stroke patients

    Directory of Open Access Journals (Sweden)

    Zahra Maghsoudi


    Full Text Available Background : Stroke is one of the most common causes of disabilities and death all over the world. The mortality rate of stroke is predicted to be doubled by 2030 in the Middle East countries. Nutrition is an effective strategy in prevention and management of stroke. This study assessed the relationship between various protein types and stroke risk. Materials and Methods: This hospital-based case-control study was performed in a University hospital. The data regarding consumption of usual food intake of 69 cases (46 men and 23 women and 60 controls (30 men and 30 women was collected with a food frequency questionnaire (FFQ. The mean consumption of red and white meat and vegetable and processed proteins consumption were compared between two groups. Results: The percent of total of daily protein intake were lower in patients with stroke in both sexes (25.92% vs 30.55% in men and 30.7% vs 31.14% in women. Conclusion: Lower protein consumption may be observed in patients with stroke patients in both sex.

  19. Prevention Of Stroke

    Directory of Open Access Journals (Sweden)

    Nagaraja D


    Full Text Available Stroke is an important cause for neurological morbidity and mortality. Prevention of ischemic stroke involves identification and prevention of risk factors and optimal use of pharmacotherapy. Risk factors have been classified as modifiable and non-modifiable; control of modifiable factors should prevent stroke occurrence. Stroke prevention has been described at three levels: primary, secondary and tertiary. Prolonged hypertension increases an individual′s risk for developing fatal or nonfatal stroke by three times and its control has been shown to prevent stroke. Diabetes mellitus is an important cause for microangiopathy and predisposes to stroke. Statin trials have shown significant reduction in stroke in those who were treated with statins. Stroke risk can be reduced by avoiding tobacco use, control of obesity and avoiding sedentary life style. Anti platelet medications are effective for secondary prevention of stroke. Educating society regarding modifiable risk factors and optimal use of pharmacotherapy form the cornerstone for the prevention of stroke.

  20. Telmisartan to prevent recurrent stroke and cardiovascular events

    NARCIS (Netherlands)

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


    Background: Prolonged lowering of blood pressure after a stroke reduces the risk of recurrent stroke. In addition, inhibition of the renin-angiotensin system in high-risk patients reduces the rate of subsequent cardiovascular events, including stroke. However, the effect of lowering of blood

  1. Characterization of Hospitalized Ischemic Stroke Patients in Palestine

    African Journals Online (AJOL)

    Objective: Stroke is a major health problem, yet no studies on stroke have been reported from Palestine. This one-year, hospital-based study was conducted to determine the prevalence of risk factors and the in-hospital mortality rate in patients with ischemic stroke. Method: All patients admitted to Al-Watani government ...

  2. Decay of 83Sr

    International Nuclear Information System (INIS)

    Yu Xiaohan; Shi Shuanghui; Gu Jiahui


    The decay of 83 Sr was reinvestigated using γ singles and γ-γ-t coincidence measurement. A new level scheme of Rb, which contains 41 excited levels and about 180 transitions, is constructed. 19 new levels were added to the old level scheme and 8 formerly adopted levels were denied. A new data set of branching ratio, log(ft) value and spin parity was obtained

  3. Study on sorption capacity and characterization of Sr2+ on synthetic zeolite

    International Nuclear Information System (INIS)

    Wang Jinming; Yi Facheng


    Sr 2+ adsorption capacity of synthetic zeolite(ZF) are studied with the intermittence method, and ZF adsorbed the Sr 2+ is characterized and analyzed by XRD, as a reference for the evaluation of the disposal effectiveness of low and medium radwastes. The results show that Sr 2+ adsorption capacity of ZF is good, and the equilibrium time for ZF to adsorb Sr 2+ is in range of 5-14 days. Sr 2+ concentration has the greatest effect on ZF adsorption capacity,and the medium,temperature and pH value of the solution also have effect on ZF adsorption capacity. With the augment of Sr 2+ concentration,the Sr 2+ equilibrium adsorption quantity of ZF increases,but the equilibrium adsorption rate and equilibrium adsorption ratio decreases. Sr 2+ adsorption capacity of ZF improves with the augment of pH value. Sr 2+ adsorption capacity of ZF is complicate and varies with the different ion, concentration and other components in the medium solution. Sr 2+ adsorption capacity of ZF increases with the augment of temperature. As a whole, when Sr 2+ concentration in the solution is 0.005mol/L, the pH value of the solution, and the temperature of medium and solution have less effect on the Sr 2+ adsorption capacity of ZF, and the unit cell parameter of ZF adsorbed Sr 2+ decreases. (authors)

  4. Leukocytosis in acute stroke

    DEFF Research Database (Denmark)

    Kammersgaard, L P; Jørgensen, H S; Nakayama, H


    Leukocytosis is a common finding in the acute phase of stroke. A detrimental effect of leukocytosis on stroke outcome has been suggested, and trials aiming at reducing the leukocyte response in acute stroke are currently being conducted. However, the influence of leukocytosis on stroke outcome has...

  5. Stroke: First Aid (United States)

    First aid Stroke: First aid Stroke: First aid By Mayo Clinic Staff A stroke occurs when there's bleeding into your brain or when blood flow to your ... cells start dying. Seek immediate medical assistance. A stroke is a true emergency. The sooner treatment is ...

  6. Adapting the Home After a Stroke (United States)

    ... News About Neurology Image Library Search The Internet Stroke Center Patients & Families About Stroke Stroke Diagnosis Stroke ... after a Stroke Adapting the Home after a Stroke Caregiver Introduction What is Aphasia? Stroke Recovery Guides ...

  7. Reducing recurrent stroke: methodology of the motivational interviewing in stroke (MIST) randomized clinical trial. (United States)

    Krishnamurthi, Rita; Witt, Emma; Barker-Collo, Suzanne; McPherson, Kathryn; Davis-Martin, Kelly; Bennett, Derrick; Rush, Elaine; Suh, Flora; Starkey, Nicola; Parag, Varsha; Rathnasabapathy, Yogini; Jones, Amy; Brown, Paul; Te Ao, Braden; Feigin, Valery L


    Recurrent stroke is prevalent in both developed and developing countries, contributing significantly to disability and death. Recurrent stroke rates can be reduced by adequate risk factor management. However, adherence to prescribed medications and lifestyle changes recommended by physicians at discharge after stroke is poor, leading to a large number of preventable recurrent strokes. Using behavior change methods such as Motivational Interviewing early after stroke occurrence has the potential to prevent recurrent stroke. The overall aim of the study is to determine the effectiveness of motivational interviewing in improving adherence to medication and lifestyle changes recommended by treating physicians at and after hospital discharge in stroke patients 12 months poststroke to reduce risk factors for recurrent stroke. Recruitment of 430 first-ever stroke participants will occur in the Auckland and Waikato regions. Randomization will be to intervention or usual care groups. Participants randomized to intervention will receive four motivational interviews and five follow-up assessments over 12 months. Nonintervention participants will be assessed at the same time points. Primary outcome measures are changes in systolic blood pressure and low-density lipoprotein levels 12 months poststroke. Secondary outcomes include self-reported adherence and barriers to prescribed medications, new cardiovascular events (including stroke), changes in quality of life, and mood. The results of the motivational interviewing in stroke trial will add to our understanding of whether motivational interviewing may be potentially beneficial in the management of stroke and other diseases where similar lifestyle factors or medication adherence are relevant. © 2013 The Authors. International Journal of Stroke © 2013 World Stroke Organization.


    Directory of Open Access Journals (Sweden)

    Rebecca M. Sealey


    Full Text Available This study aimed to identify the effect of different stroke rates on various kinematic parameters during 1000 m outrigger canoeing. Sixteen, experienced female outrigger canoeists completed three 1000 m outrigger ergometer time trials, one trial each using a self-selected, a Hawaiian ( 65 strokes·min-1 stroke rate. Stroke rate, stroke length, stroke time, proportion of time spent in propulsion and recovery, torso flexion angle and 'twist' were measured and compared with repeated measures ANOVAs. Stroke rate, stroke length and stroke time were significantly different across all interventions (p < 0.05 despite no difference in the percentage of time spent in the propulsive and recovery phases of the stroke. Stroke length and stroke time were negatively correlated to stroke rate for all interventions (r = -0.79 and -0.99, respectively. Female outrigger canoeists maintain consistent stroke kinematics throughout a 1000 m time trial, most likely as a learned skill to maximize crew paddling synchrony when paddling on-water. While the Hawaiian stroke rate resulted in the greatest trunk flexion movement and 'twist' action, this potential increased back injury risk may be offset by the slow stroke rate and long stroke length and hence slow rate of force development.

  9. Stroke in Asia: a global disaster. (United States)

    Kim, Jong S


    Although stroke is a world-wide problem, the burden of stroke is particularly serious in Asia; its mortality is higher than in Europe or North America. The situation in Asia is dichotomized. Stroke mortality and case fatality has been declining in northern-eastern countries such as Korea, Japan, Taiwan, and urbanized areas of China. This is attributed to both the risk factor control and stroke care improvement. However, declining stroke incidence is rarely observed, which is in part due to rapidly aging population. As a result, there is an increase in the number of stroke survivors who require long-term, costly care. The extremely low birth rate and relatively insecure social health system markedly increases the caregiver burden. The problem in southern Asian countries, such as India, Pakistan, Bangladesh, and Indonesia is more fundamental. With the improving control of infectious diseases, life expectancy is prolonged. However, risk factors such as hypertension, diabetes, obesity and cigarette smoking become prevalent, and are poorly controlled. Stroke neurologists, organized stroke centers, and diagnostic tools are insufficient, which has resulted in high stroke fatality and mortality. Throughout Asia, the most urgent priority should be the primary stroke prevention through promoting a healthy lifestyle, e.g. low salt intake, regular physical exercise, stopping smoking, government sectors should take a stronger initiative to accomplish this. The rapidly aging populations and stroke burden will shrink the economy and destabilize the society, not only in Asia but also globally unless appropriate efforts are promptly initiated, this may result in a global disaster. © 2014 World Stroke Organization.

  10. Recanalization rate and clinical outcome of intravenous tissue plasminogen activator at 0.6 mg/kg and intra-arterial urokinase in acute ischemic stroke with large vessel occlusion

    International Nuclear Information System (INIS)

    Nakashima, Kazuya; Ohnishi, Hideyuki; Taomoto, Katsushi


    We evaluated the recanalization rate and clinical outcome of intravenous tissue plasminogen activator (t-PA) and intra-arterial urokinase (PTA) in acute ischemic stroke with large vessel occlusion. The recanalization of the occlusion site and the ischemic change were evaluated with pre-and post-treated MRI and MR angiography (MRA). Total recanalization rates after the intravenous (IV) t-PA and the PTA therapy were 35.6 and 21.9%, respectively. These rates were 50.0 and 16.7% in the distal middle cerebral artery (MCA), 52.6 and 25.0% in the proximal MCA, 6.3 and 5.3% in the internal carotid artery (ICA), 25.0 and 26.3% in the basilar artery (BA), respectively. The rates of the symptomatic intracerebral hemorrhage after IV t-PA and PTA were 0 and 5.2%, respectively. The proportion of modified Rankin Scale (mRS) of 0 to 1 at 3 months after treatments were 17.4% in IV t-PA and 12.5% in PTA. Our results indicated better recanalization rate and outcome of MCA with t-PA than that of PTA. However, the recanalization rate of ICA and BA were very poor in both t-PA and PTA as yet. It is necessary to investigate newly strategies and/or modality for ICA and BA occlusion. (author)

  11. The coprecipitation of Sr2+ with calcite at 250C and 1 atm

    International Nuclear Information System (INIS)

    Pingitore, N.E. Jr.; Eastman, M.P.


    The incorporation of Sr 2+ into calcite at earth surface aqueous conditions is affected by the absolute concentration of Sr 2+ , the presence of Ba 2+ and NaCl in the solution and the rate of precipitation. At solution ratios (molar) of Sr 2+ to Ca 2+ in the low 10 -3 range, which yield calcites with several hundred ppm Sr 2+ , kappasub(calcite) sup(Sr) typically assumes a value between 0.10 and 0.20. Above these concentrations the value of kappasub(calcite) sup(Sr) drops to approximately 0.06. Furthermore, if minor amounts of Ba 2+ or large amounts of Na + (0.48 M) are added to a dilute Sr 2+ solution, a value around 0.06 for kappasub(calcite)sup(Sr) is found. This 'strontium concentration effect' and the associated 'competitive cation effect' suggest that small amounts of Sr 2+ may be incorporated into a limited number of nonlattice sites in calcite. Incorporation of Sr 2+ into these sites, presumably defects, noticeably affects kappasub(calcite)sup(Sr) only at low Sr 2+ concentrations and in the absence of competition from other large cations. An increase in kappasub(calcite)sup(Sr) with rate of precipitation, qualitatively similar to that found in other studies, was observed only when precipitation times were decreased from days to hours. For many geologic settings a partition coefficient for Sr 2+ into calcite of 0.06 appears appropriate, but there are situations - very low Sr 2+ concentrations, the presence of Mg 2+ , and fast precipitation rates - in which a larger value might better approximate natural partitioning. (author)

  12. Adsorption behavior of 90Sr on montmorillonite or vermiculite

    International Nuclear Information System (INIS)

    Liao Jiali; Li Bing; Wu Jiaojiao; Yang Yuanyou; Liu Ning; Zhang Dong; Zhao Jun; Cheng Qiong


    The adsorption of 90 Sr from aqueous solution by montmorillonite or vermiculite, and the effect of experimental conditions on the adsorption were investigated. The preliminary results showed that montmorillonite and vermiculite were both efficient absorbent for 90 Sr and more than 96% or 98% of the total 90 Sr could be removed by montmorillonite or vermiculite of 20 g/L from 90 Sr solution of 20 kBq/L(Co). The adsorption equilibrium was achieved within 30 min and 2h, and the suitable pH ranged 2-12 and 3-12. No significant differences on 90 Sr adsorption were observed at 0-50℃ by these two natural absorbents. In this time, the adsorption rate decreased with the increase of 90 Sr concentration in the range of 1-200 kBq/L and the adsorption behavior accorded to Langmuir isothermal adsorption. Furthermore, the adsorption rate both increased efficiently on montmorillonite and vermiculite modified by 1-2 mol/L HCl. About 98% of adsorbed 90 Sr could be desorbed by 10 mL of 2 mol/L HNO 3 . (authors)

  13. Deposition of 90Sr in bone and the relevant dose

    International Nuclear Information System (INIS)

    Kawamura, Hisao


    The deposition of fallout 90 Sr in bone and radiation dose from the nuclide in Japan is reviewed with special reference to (i) the intraskeletal distribution of 90 Sr and reference bone, (ii) bone models for predicting 90 Sr level and (iii) possible problems in applying dose rate factors to Japanese, especially to infants and adolescents. An evidence is presented for the assumption that the ratio of the 90 Sr concentration in a particular bone to that in vertebra will reach the ratio observed for stable strontium under the virtually constant intake of 90 Sr. The importance of surveying 90 Sr levels in different bones is stressed. Observed Ratios (bone/diet) found for Japanese are noticeably lower than those reported for Europeans and Americans. The recently presented model for the retention of alkaline earth elements in man by ICRP will be useful if only adults are concerned. Dose rate factors for 90 Sr in bone should be given as a function of age for the purpose of better estimation of dose commitments. The cumulative absorbed doses to bone tissues calculated with the Palmley-Mays model and with the Spiers model show remarkably higher levels in school children and young adults than the mean level. (auth.)

  14. Stroke Risk Perception in Atrial Fibrillation Patients is not Associated with Clinical Stroke Risk. (United States)

    Fournaise, Anders; Skov, Jane; Bladbjerg, Else-Marie; Leppin, Anja


    Clinical risk stratification models, such as the CHA2DS2-VASc, are used to assess stroke risk in atrial fibrillation (AF) patients. No study has yet investigated whether and to which extent these patients have a realistic perception of their personal stroke risk. The purpose of this study was to investigate and describe the association between AF patients' stroke risk perception and clinical stroke risk. In an observational cross-sectional study design, we surveyed 178 AF patients with a mean age of 70.6 years (SD 8.3) in stable anticoagulant treatment (65% treatment duration >12 months). Clinical stroke risk was scored through the CHA2DS2-VASc, and patients rated their perceived personal stroke risk on a 7-point Likert scale. There was no significant association between clinical stroke risk assessment and patients' stroke risk perception (rho = .025; P = .741). Approximately 60% of the high-risk patients had an unrealistic perception of their own stroke risk, and there was no significant increase in risk perception from those with a lower compared with a higher risk factor load (χ(2) = .010; P = .522). Considering possible negative implications in terms of lack of motivation for lifestyle behavior change and adequate adherence to the treatment and monitoring of vitamin K antagonist, the apparent underestimation of risk by large subgroups warrants attention and needs further investigation with regard to possible behavioral consequences. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  15. Preparation of Sr adsorptive fiber by impregnating with crown ether derivative for 90Sr measurement

    International Nuclear Information System (INIS)

    Horita, Takuma; Asai, Shiho; Hanzawa, Yukiko; Kitatsuji, Yoshihiro; Konda, Miki; Saito, Kyoichi; Fujiwara, Kunio; Sugo, Takanobu


    A Sr adsorption fiber was prepared for rapid analysis of 90 Sr content in the fiber using radiation-induced emulsion graft polymerization and subsequent chemical modification. A polyethylene fiber with a diameter of 13 μm was first immersed in a methanol solution of an epoxy-group-containing vinyl monomer, glycidyl methacrylate (GMA), and polyoxyethylene sorbitol ester (Tween20) as a surfactant for the graft-polymerization of GMA. Octadecylamine was then bound to a polymer chain extending from the fiber surface, providing hydrophobicity to the polymer chain. Dicyclohexano-18-crown-6 (DCH18C6) was finally impregnated onto the polymer chain via a hydrophobic interaction between the octadecyl moiety of the polymer chain and the cyclohexyl moiety of DCH18C6. The fiber surface structure, characterized by DCH18C6 molecules loosely entangled with polymer chains, allowed for the rapid adsorption of Sr ions at an adsorption rate of approximately 100-times higher than that of a commercially available Sr-selective resin (Sr Resin ® ). (author)

  16. Airplane stroke syndrome. (United States)

    Humaidan, Hani; Yassi, Nawaf; Weir, Louise; Davis, Stephen M; Meretoja, Atte


    Only 37 cases of stroke during or soon after long-haul flights have been published to our knowledge. In this retrospective observational study, we searched the Royal Melbourne Hospital prospective stroke database and all discharge summaries from 1 September 2003 to 30 September 2014 for flight-related strokes, defined as patients presenting with stroke within 14days of air travel. We hypothesised that a patent foramen ovale (PFO) is an important, but not the only mechanism, of flight-related stroke. We describe the patient, stroke, and flight characteristics. Over the study period, 131 million passengers arrived at Melbourne airport. Our centre admitted 5727 stroke patients, of whom 42 (0.73%) had flight-related strokes. Flight-related stroke patients were younger (median age 65 versus 73, p<0.001), had similar stroke severity, and received intravenous thrombolysis more often than non-flight-related stroke patients. Seven patients had flight-related intracerebral haemorrhage. The aetiology of the ischaemic strokes was cardioembolic in 14/35 (40%), including seven patients with confirmed PFO, one with atrial septal defect, four with atrial fibrillation, one with endocarditis, and one with aortic arch atheroma. Paradoxical embolism was confirmed in six patients. Stroke related to air travel is a rare occurrence, less than one in a million. Although 20% of patients had a PFO, distribution of stroke aetiologies was diverse and was not limited to PFO and paradoxical embolism. Copyright © 2016 Elsevier Ltd. All rights reserved.

  17. Relevance of prehospital stroke code activation for acute treatment measures in stroke care: a review. (United States)

    Baldereschi, Marzia; Piccardi, Benedetta; Di Carlo, Antonio; Lucente, Giuseppe; Guidetti, Donata; Consoli, Domenico; Provinciali, Leandro; Toni, Danilo; Sacchetti, Maria Luisa; Polizzi, Bianca Maria; Inzitari, Domenico


    The use of emergency services with prehospital stroke assessment and early notification to the treatment hospital (stroke code) is a crucial determinant of delay time for acute stroke treatment. We reviewed and summarized the literature on prehospital stroke code system implementation. Two databases were explored (last update June 20, 2011) with 3 key words (stroke code, stroke prehospital management and stroke prehospital services). Inclusion criteria were: randomized and quasirandomized controlled trials, cohort and case-control studies, and hospital- and emergency-based registers, with no year or language restrictions. We examined the reference lists of all included articles. All potentially relevant reports and abstracts were transcribed into a specifically designed data abstraction form. Only 19 of the 680 studies which were initially retrieved, published from 1999 to 2011, fulfilled our inclusion criteria. One clinical trial was identified. Large differences in stroke code procedures and study designs within and across countries prohibited the pooling of the data. Most studies were carried out in urban areas. Assuming the rate of tissue-plasminogen activator treatment as the performance measure, most studies report a significant increase in the rate of treatment (increase between 3.2 and 16%) with only 1 study not reporting any increase. Despite its limitations, this review suggests that the use of prehospital stroke code is an important intervention to improve the accessibility of the benefits of thrombolysis, especially when implemented together with educational campaigns to optimize the awareness and behavior of patients and bystanders. Copyright © 2012 S. Karger AG, Basel.

  18. Gait stability in stroke survivors : The assessment and training of gait stability in chronic stroke survivors

    NARCIS (Netherlands)

    Michiel Punt


    In order to achieve a level of community involvement and physical independence, being able to walk is the primary aim of many stroke survivors. It is therefore one of the most important goals during rehabilitation. Falls are common in all stages after stroke. Reported fall rates in the chronic stage

  19. Risks for Heart Disease & Stroke (United States)

    ... Risks for Heart Disease & Stroke Risks for Heart Disease & Stroke About 1.5 million heart attacks and strokes ... the Centers for Disease Control and Prevention: Heart Disease Stroke High Blood Pressure Cholesterol Salt Video: Know Your ...

  20. Stroke Incidence and Outcomes in Northeastern Greece: The Evros Stroke Registry. (United States)

    Tsivgoulis, Georgios; Patousi, Athanasia; Pikilidou, Maria; Birbilis, Theodosis; Katsanos, Aristeidis H; Mantatzis, Michalis; Asimis, Aristeidis; Papanas, Nikolaos; Skendros, Panagiotis; Terzoudi, Aikaterini; Karamanli, Aikaterini; Kouroumichakis, Ioannis; Zebekakis, Pantelis; Maltezos, Efstratios; Piperidou, Charitomeni; Vadikolias, Konstantinos; Heliopoulos, Ioannis


    Data are scarce on both stroke incidence rates and outcomes in Greece and in rural areas in particular. We performed a prospective population-based study evaluating the incidence of first-ever stroke in the Evros prefecture, a region of a total 147 947 residents located in North Eastern Greece. Adult patients with first-ever stroke were registered during a 24-month period (2010-2012) and followed up for 12 months. To compare our stroke incidence with that observed in other studies, we standardized our incidence rate data according to the European Standard Population, World Health Organization, and Segi population. We also applied criteria of data quality proposed by the Monitoring Trends and Determinants in Cardiovascular Disease project. Stroke diagnosis and classification were performed using World Health Organization criteria on the basis of neuroimaging and autopsy data. We prospectively documented 703 stroke cases (mean age: 75±12 years; 52.8% men; ischemic stroke: 80.8%; intracerebral hemorrhage: 11.8%; subarachnoid hemorrhage: 4.4%; undefined: 3.0%) with a total follow-up time of 119 805 person-years. The unadjusted and European Standard Population-adjusted incidences of all strokes were 586.8 (95% confidence interval [CI], 543.4-630.2) and 534.1 (95% CI, 494.6-573.6) per 100 000 person-years, respectively. The unadjusted incidence rates for ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage were 474.1 (95% CI, 435-513), 69.3 (95% CI, 54-84), and 25.9 (95% CI, 17-35) per 100 000 person-years, respectively. The corresponding European Standard Population-adjusted incidence rates per 100 000 person-years were 425.9 (95% CI, 390.9-460.9), 63.3 (95% CI, 49.7-76.9), and 25.8 (95% CI, 16.7-34.9) for ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage, respectively. The overall 28-day case fatality rate was 21.3% (95% CI, 18.3%-24.4%) for all strokes and was higher in hemorrhagic strokes than ischemic stroke (40

  1. A review of post-stroke urinary incontinence. (United States)

    Tuong, Nicole E; Klausner, Adam P; Hampton, Lance J


    Cerebrovascular accidents, or strokes, are a common cause of morbidity and mortality in the United States. Urinary incontinence is a prevalent morbidity experienced by post-stroke patients that is associated with long term disability and institutionalization effects on these patients. An extensive literature review was conducted using multiple academic search engines using the keywords: 'stroke,' 'CVA,' 'urinary incontinence,' 'urodynamics,' 'pharmacologic treatments,' and 'conservative treatments.' Articles were reviewed and summarized to explain incidence, assessment, and treatments of urinary incontinence in post-stroke individuals. Twenty-eight percent to seventy-nine percent of stroke survivors experience urinary incontinence with detrusor overactivity being the most common type of incontinence assessed by urodynamic studies. There continues to be insufficient data studying the effects and benefits of non-pharmacologic and pharmacologic treatments in post-stroke patients. Similarly, urinary incontinence remains an indicator of increased morbidity, disability, and institutionalization rates in the post-stroke patient. Stroke is a debilitating disease which causes urinary incontinence in many patients. As a result, patients have increased rates of hospitalization and disability compared to post-stroke patients without urinary incontinence. The history and physical exam are key in diagnosing the type of urinary incontinence with urodynamic studies being an adjunctive study. Non-pharmacologic treatment, such as behavioral therapy, and pharmacologic agents including antimuscarinics and beta adrenergic medications, are not well studied in the post-stroke patient. Urinary incontinence in stroke patients needs to be further studied to help decrease morbidity and mortality rates within this population.

  2. Recurrent Stroke: The Value of the CHA2DS2VASc Score and the Essen Stroke Risk Score in a Nationwide Stroke Cohort

    DEFF Research Database (Denmark)

    Andersen, Søren Due; Gorst-Rasmussen, Anders; Lip, Gregory Y H


    Background and Purpose—The CHA2DS2VASc score and the Essen Stroke Risk Score are respectively used for risk stratification in patients with atrial fibrillation and in patients with cerebrovascular incidents. We aimed to test the ability of the 2 scores to predict stroke recurrence, death...... and no atrial fibrillation. Patients were stratified according to the CHA2DS2VASc score and the Essen Stroke Risk Score and were followed up until stroke recurrence or death. We estimated stratified incidence rates and hazard ratios and calculated the cumulative risks. Results—42 182 patients with incident...... ischemic stroke with median age 70.1 years were included. The overall 1-year incidence rates of recurrent stroke, death, and cardiovascular events were 3.6%, 10.5%, and 6.7%, respectively. The incidence rates, the hazard ratios, and the cumulative risk of all outcomes increased with increasing risk scores...

  3. Stroke in Saudi children

    International Nuclear Information System (INIS)

    Salih, Mustafa A.; Al-Jarallah, Ahmed A.; Kentab, Anal Y.; Al-Nasser, Mohammad N.; Bahakim, Hassan M.; Kurban, Khadija M.; Zahraa, Jihad N.; Nasir, Ali A.; Abdel-Gader, Abdel-Galil M.; Alorainy, Ibrahim A.; Hassan, Hamdy H.; Kabiraj, Mohammad M.; Khoja, Waleed A.


    To describe the epidemiology and clinical features of stroke in a prospective and retrospective cohort of Saudi children and ascertain the causes, pathogenesis, and risk factors. The Retrospective Study Group (RSG) included children with stroke who were evaluated at the Division of Pediatric Neurology, or admitted to King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia during the period July 1992 to February 2001. The Prospective Study Group (PSG) included those seen between February 2001 and March 2003. During the combined study periods of 10 years and 7 months, 117 children (61 males and 56 females, aged one month-12 years) were evaluated; the majority (89%) of these were Saudis. The calculated annual hospital frequency rate of stroke was 27.1/100,000 of the pediatric (1month-12 years) population The mean age at onset of the initial stroke in the 104 Saudi children was 27.1 months (SD=39.3 months) median and median was 6 months. Ischemic strokes accounted for the majority of cases (76%). Large-vessel infarcts (LVI, 51.9%) were more common than small-vessel lacunar lesions (SVLL, 19.2%). Five patients (4.8%) had combined LVI and SVLL. Intracranial hemorrhage was less common (18.2%), whereas sinovenous thrombosis was diagnosed in 6 (5.8%) patients. A major risk factor was identified in 94 of 104 (89.4%) Saudi children. Significantly more hematologic disorders and coagulopathies were identified in the PSG compared to the RSG (p=0.001), reflecting a better yield following introduction of more comprehensive hematologic and cogulation laboratory tests during the prospective study period. Hematologic disorders were the most common risk factor (46.2%); presumed perinatal ischemic cerebral injury was risk factor in 23 children (22.1) and infectious and inflammatory disorders of the circulatory system in 18 (17.3%). Congenital and genetic cerebrovascular anomalies were the underlying cause in 7 patients (6.7%) and

  4. Sickle Cell Disease and Stroke: Diagnosis and Management. (United States)

    Lawrence, Courtney; Webb, Jennifer


    Both adult and pediatric patients with sickle cell disease face a higher risk of stroke than the general population. Given the different underlying pathophysiology predisposing these patients to stroke, providers should be aware of differences in guidelines for stroke management. This paper reviews diagnostic considerations and recommendations during the evaluation and acute management of patients with sickle cell disease presenting with stroke, focusing on recent updates in the literature. Given the high recurrence rate of stroke in these patients, secondary prevention and curative measures will also be reviewed.

  5. Suicide after a stroke: a population study

    DEFF Research Database (Denmark)

    Teasdale, T W; Engberg, A W


    STUDY OBJECTIVE: To establish whether there are increased rates of suicide after a stroke and the degree to which any increase is related to gender, age at stroke, diagnosis, duration of hospitalisation, and time since stroke. DESIGN: Cross linkage of national registers for hospitalisations...... cases of suicide were identified. MAIN RESULTS: Annual incidence rates, both observed and expected, together with standardised mortality ratios (SMR) were computed based on annual population and suicide statistics, stratified by age and gender. The overall annual incidence rate of suicide in the cohort.......76) for patients under 50 years of age group and were least for patients 80 years or older (1.3; 0.95, 1.79). There was no clear relation to stroke diagnosis. Suicides were negatively related to duration of hospitalisation, being lowest for those hospitalised for more than three months (0.88; 0.65, 1...

  6. Electron-density distribution in cubic SrTiO{sub 3}: a comparative {gamma}-ray diffraction study

    Energy Technology Data Exchange (ETDEWEB)

    Jauch, W. [Hahn-Meitner-Inst., Berlin (Germany); Reehuis, M. [Max-Planck-Institut fuer Festkoerperforschung, Stuttgart (Germany)


    The electron density and atomic displacements in the perovskite SrTiO{sub 3} have been studied using extensive and accurate {gamma}-ray diffraction data ({lambda}=0.0392 Aa) at room temperature. The six strongest low-order structure factors have been determined under extinction-free conditions. Gram-Charlier series expansion of the thermal parameters have revealed no evidence for anharmonicity. The population of the 3d subshell on Ti is found to be close to zero, in agreement with the observed magnetic behaviour. The electronic properties at the bond critical points indicate ionic Ti-O and Sr-O interactions of different strengths, which is corroborated by the net charges of the atomic basins [q(Sr)=1.18 vertical stroke e vertical stroke, q(Ti)=3.10 vertical stroke e vertical stroke, q(O)=1.42 vertical stroke e vertical stroke ]. A critical comparison is made with earlier experimental results from laboratory X-ray, synchrotron X-ray, electron and neutron diffraction studies. Agreement and discrepancies are identified and resolved. (orig.)

  7. Stroke Management: An Emerging Role of Nanotechnology

    Directory of Open Access Journals (Sweden)

    Deepaneeta Sarmah


    Full Text Available Stroke is among the leading causes of mortality and morbidity worldwide. Stroke incidences and associated mortality are expected to rise to 23 million and 7.8 million, respectively, by 2030. Further, the aging population, imbalanced lifestyles, and environmental factors continue to shift the rate of stroke incidence, particularly in developing countries. There is an urgent need to develop new therapeutic approaches for treating stroke. Nanotechnology is a growing field, offering an encouraging future prospect for medical research in the management of strokes. The world market for nanotechnology derived products is expected to rise manyfold in the coming decades. Different types of nanomaterials such as perfluorocarbon nanoparticles, iron oxide nanoparticles, gold nanoparticles, polymeric nanoparticles, quantum dots, nanospheres, etc. have been developed for the diagnosis as well as therapy of strokes. Today, nanotechnology has also been integrated with stem cell therapy for treating stroke. However several obstacles remain to be overcome when using such nanomaterials for treating stroke and other neurological diseases.

  8. National data on stroke outcomes in Thailand. (United States)

    Kongbunkiat, Kannikar; Kasemsap, Narongrit; Thepsuthammarat, Kaewjai; Tiamkao, Somsak; Sawanyawisuth, Kittisak


    Stroke is a major public health problem worldwide. There are limited data on national stroke prevalence and outcomes after the beginning of the thrombolytic therapy era in Thailand. This study aimed to investigate the prevalence and factors associated with mortality in stroke patients in Thailand using the national reimbursement databases. Clinical data retrieved included individuals under the universal coverage, social security, and civil servant benefit systems between 1 October 2009 and 30 September 2010. The stroke diagnosis code was based on the International Classification of Diseases 10th revision system including G45 (transient cerebral ischemic attacks and related syndromes), I61 (intracerebral hemorrhage), and I63 (cerebral infarction). The prevalence and stroke outcomes were calculated from these coded data. Factors associated with death were evaluated by multivariable logistic regression analysis. We found that the most frequent stroke subtype was cerebral infarction with a prevalence of 122 patients per 100,000 of population, an average length of hospital stay of 6.8 days, an average hospital charge of 20,740 baht (∼$USD 691), a mortality rate of 7%, and thrombolytic prescriptions of 1%. The significant factors associated with stroke mortality were septicemia, pulmonary embolism, pneumonia, myocardial infarction, status epilepticus, and heart failure. In conclusion, the prevalence and outcomes of stroke in Thailand were comparable with other countries. The era of thrombolytic therapy has just begun in Thailand. Copyright © 2014 Elsevier Ltd. All rights reserved.

  9. Racial Differences by Ischemic Stroke Subtype: A Comprehensive Diagnostic Approach

    Directory of Open Access Journals (Sweden)

    Sarah Song


    Full Text Available Background. Previous studies have suggested that black populations have more small-vessel and fewer cardioembolic strokes. We sought to analyze racial differences in ischemic stroke subtype employing a comprehensive diagnostic workup with magnetic resonance-imaging-(MRI- based evaluation including diffusion-weighted imaging (DWI. Methods. 350 acute ischemic stroke patients admitted to an urban hospital with standardized comprehensive diagnostic evaluations were retrospectively analyzed. Ischemic stroke subtype was determined by three Trial of Org 10172 in Acute Stroke Treatment (TOAST classification systems. Results. We found similar proportions of cardioembolic and lacunar strokes in the black and white cohort. The only subtype category with a significant difference by race was “stroke of other etiology,” more common in whites. Black stroke patients were more likely to have an incomplete evaluation, but this did not reach significance. Conclusions. We found similar proportions by race of cardioembolic and lacunar strokes when employing a full diagnostic evaluation including DWI MRI. The relatively high rate of cardioembolism may have been underappreciated in black stroke patients when employing a CT approach to stroke subtype diagnosis. Further research is required to better understand the racial differences in frequency of “stroke of other etiology” and explore disparities in the extent of diagnostic evaluations.

  10. Test Your Stroke Knowledge (United States)

    ... 9-1-1. Which of the following are risk factors for stroke? High blood pressure Heart disease Smoking High cholesterol Diabetes Show Answer All of these are risk factors for stroke. If you smoke - quit. If you have high ...

  11. Heart and Stroke Encyclopedia (United States)

    ... Thromboembolism Aortic Aneurysm More The Heart and Stroke Encyclopedia Click a letter below to get a brief ... of cardiovascular terms from our Heart and Stroke Encyclopedia and get links to in-depth information. A ...

  12. Stroke Connection Magazine (United States)

    ... Resources Submit A Story Edit Module Show Tags Stroke Rehabilitation Two-Part Series Making the Best Decisions at ... first part of a two-part series on stroke rehab, we offer guidance for the decision-making process ...

  13. Stroke (For Kids) (United States)

    ... your friend. Being around friends can help with healing. Preventing Strokes Some strokes can be prevented in ... Why Does Hair Turn Gray? What Are Wrinkles? Alzheimer Disease Your Brain & Nervous System Why Exercise Is ...

  14. Stroke Trials Registry (United States)

    ... News About Neurology Image Library Search The Internet Stroke Center Trials Registry Clinical Trials Interventions Conditions Sponsors ... a clinical trial near you Welcome to the Stroke Trials Registry Our registry of clinical trials in ...

  15. [Genetics of ischemic stroke]. (United States)

    Gschwendtner, A; Dichgans, M


    Stroke is one of the most widespread causes of mortality und disability worldwide. Around 80 % of strokes are ischemic and different forms of intracranial bleeding account for the remaining cases. Monogenic stroke disorders are rare but the diagnosis may lead to specific therapeutic consequences for the affected patients who are predominantly young. In common sporadic stroke, genetic factors play a role in the form of susceptibility genes. Their discovery may give rise to new therapeutic options in the future.

  16. Hemorrhagic Stroke in Children


    Jordan M.D., Lori C.; Hillis M.D., Argye E.


    Hemorrhagic stroke accounts for approximately half of stroke in childhood. Unlike arterial ischemic stroke, there are no consensus guidelines to assist in the evaluation and treatment of these children. We review the literature on the evaluation, treatment, etiology and neurologic outcome of hemorrhagic stroke in children. Important differences between pediatric and adult hemorrhage are highlighted, as treatment guidelines for adults may not be applicable in all cases. Needed future research ...

  17. Ethnic disparities in incidence of stroke subtypes: Auckland Regional Community Stroke Study, 2002-2003. (United States)

    Feigin, Valery; Carter, Kristie; Hackett, Maree; Barber, P Alan; McNaughton, Harry; Dyall, Lorna; Chen, Mei-hua; Anderson, Craig


    Limited population-based data exist on differences in the incidence of major pathological stroke types and ischaemic stroke subtypes across ethnic groups. We aimed to provide such data within the large multi-ethnic population of Auckland, New Zealand. All first-ever cases of stroke (n=1423) in a population-based register in 940 000 residents (aged 15 years) in Auckland, New Zealand, for a 12-month period in 2002-2003, were classified into ischaemic stroke, primary intracerebral haemorrhage (PICH), subarachnoid haemorrhage, and undetermined stroke, according to standard definitions and results of neuroimaging/necropsy (in over 90% of cases). Ischaemic stroke was further classified into five subtypes. Ethnicity was self-identified and grouped as New Zealand (NZ)/European, Maori/Pacific, and Asian/other. Incidence rates were standardised to the WHO world population by the direct method, and differences in rates between ethnic groups expressed as rate ratios (RRs), with NZ/European as the reference group. In NZ/European people, ischaemic stroke comprised 73%, PICH 11%, and subarachnoid haemorrhage 6%, but PICH was higher in Maori/Pacific people (17%) and in Asian/other people (22%). Compared with NZ/European people, age-adjusted RRs for PICH were 2.7 (95% CI 1.8-4.0) and 2.3 (95% CI 1.4-3.7) among Maori/Pacific and Asian/other people, respectively. The corresponding RR for ischaemic stroke was greater for Maori/Pacific people (1.7 [95% CI 1.4-2.0]), particularly embolic stroke, and for Asian/other people (1.3 [95% CI 1.0-1.7]). The onset of stroke in Maori/Pacific and Asian/other people began at significantly younger ages (62 years and 64 years, respectively) than in NZ/Europeans (75 years; p<0.0001). There were ethnic differences in the risk factor profiles (such as age, sex, hypertension, cardiac disease, diabetes, hypercholesterolaemia, smoking status, overweight) for the stroke types and subtypes. Compared to NZ/Europeans, Maori/Pacific and Asian/other people are

  18. Recurrent Stroke: The Value of the CHA2DS2VASc Score and the Essen Stroke Risk Score in a Nationwide Stroke Cohort. (United States)

    Andersen, Søren Due; Gorst-Rasmussen, Anders; Lip, Gregory Y H; Bach, Flemming W; Larsen, Torben Bjerregaard


    The CHA2DS2VASc score and the Essen Stroke Risk Score are respectively used for risk stratification in patients with atrial fibrillation and in patients with cerebrovascular incidents. We aimed to test the ability of the 2 scores to predict stroke recurrence, death, and cardiovascular events (stroke, transient ischemic attack, myocardial infarction, or arterial thromboembolism) in a nationwide Danish cohort study, among patients with incident ischemic stroke and no atrial fibrillation. We conducted a registry-based study in patients with incident ischemic stroke and no atrial fibrillation. Patients were stratified according to the CHA2DS2VASc score and the Essen Stroke Risk Score and were followed up until stroke recurrence or death. We estimated stratified incidence rates and hazard ratios and calculated the cumulative risks. 42 182 patients with incident ischemic stroke with median age 70.1 years were included. The overall 1-year incidence rates of recurrent stroke, death, and cardiovascular events were 3.6%, 10.5%, and 6.7%, respectively. The incidence rates, the hazard ratios, and the cumulative risk of all outcomes increased with increasing risk scores. C-statistics for both risk scores were around 0.55 for 1-year stroke recurrence and cardiovascular events and correspondingly for death around 0.67 for both scores. In this cohort of non-atrial fibrillation patients with incident ischemic stroke, increasing CHA2DS2VASc score and Essen Stroke Risk Score was associated with increasing risk of recurrent stroke, death, and cardiovascular events. Their discriminatory performance was modest and further refinements are required for clinical application. © 2015 American Heart Association, Inc.

  19. Heart rate is a prognostic risk factor for myocardial infarction: a post hoc analysis in the PERFORM (Prevention of cerebrovascular and cardiovascular Events of ischemic origin with teRutroban in patients with a history oF ischemic strOke or tRansient ischeMic attack) study population. (United States)

    Fox, Kim; Bousser, Marie-Germaine; Amarenco, Pierre; Chamorro, Angel; Fisher, Marc; Ford, Ian; Hennerici, Michael G; Mattle, Heinrich P; Rothwell, Peter M


    Elevated resting heart rate is known to be detrimental to morbidity and mortality in cardiovascular disease, though its effect in patients with ischemic stroke is unclear. We analyzed the effect of baseline resting heart rate on myocardial infarction (MI) in patients with a recent noncardioembolic cerebral ischemic event participating in PERFORM. We compared fatal or nonfatal MI using adjusted Cox proportional hazards models for PERFORM patients with baseline heart rate heart rate was analyzed as a continuous variable. Other cerebrovascular and cardiovascular outcomes were also explored. Heart rate ≥70 bpm was associated with increased relative risk for fatal or nonfatal MI (HR 1.32, 95% CI 1.03-1.69, P=0.029). For every 5-bpm increase in heart rate, there was an increase in relative risk for fatal and nonfatal MI (11.3%, P=0.0002). Heart rate ≥70 bpm was also associated with increased relative risk for a composite of fatal or nonfatal ischemic stroke, fatal or nonfatal MI, or other vascular death (excluding hemorrhagic death) (Pheart rate, there were increases in relative risk for fatal or nonfatal ischemic stroke, fatal or nonfatal MI, or other vascular death (4.7%, Pheart rate ≥70 bpm places patients with a noncardioembolic cerebral ischemic event at increased risk for MI. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  20. Stroke Burden in Rwanda: A Multicenter Study of Stroke Management and Outcome. (United States)

    Nkusi, Agabe Emmy; Muneza, Severien; Nshuti, Steven; Hakizimana, David; Munyemana, Paulin; Nkeshimana, Menelas; Rudakemwa, Emmanuel; Amendezo, Etienne


    Cerebrovascular accidents or stroke constitute the second leading cause of mortality worldwide. Low- and middle-income countries bear most of the stroke burden worldwide. The main objective of this study is to determine the burden of stroke in Rwanda. This was a prospective observational study in 2 parts: 6 months baseline data collection and outcome assessment sessions at 1 year. A total of 96 patients were enrolled in our series. Stroke constituted 2100 per 100,000 population. Of all patients, 55.2% were male and most (60%) were 55 years and older. Of all patients and/or caretakers, 22% were not aware of their previous health status and 53.5% of hypertensive patients were not on treatment by the time of the event. Median presentation delay was 72 hours for patients with ischemic stroke and 24 hours for patients with hemorrhagic stroke. Most patients had hemorrhagic stroke (65% vs. 35%), and more patients with hemorrhagic stroke presented with loss of consciousness (80% vs. 51%). Many patients (62% ischemic group and 44% hemorrhagic group) presented with severe stroke scores, and this was associated with worst outcome (P = 0.004). At 1 year follow-up, 24.7% had no or mild disability, 14.3% were significantly disabled, and 61% had died. Our results show that stroke is a significant public health concern in Rwanda. Risk factor awareness and control are still low and case fatality of stroke is significantly high. The significant delay in presentation to care and presentation with severe stroke are major contributors for the high mortality and severe disability rates. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Enhancing the Oxygen Permeation Rate of Zr0.84Y0.16O1.92 - La0.8Sr0.2Cr0.5Fe0.5O3-δ Dual-Phase Hollow Fiber Membrane by Coating with Ce0.8Sm0.2O1.9 Nanoparticles

    NARCIS (Netherlands)

    Liu, Tong; Wang, Yao; Yuan, Ronghua; Gao, Jianfeng; Chen, Chusheng; Bouwmeester, Henricus J.M.


    Zr0.84Y0.16O1.92−La0.8Sr0.2Cr0.5Fe0.5O3−δ (YSZ-LSCrF) dual-phase composite hollow fiber membranes were prepared by a combined phase-inversion and sintering method. The shell surface of the hollow fiber membrane was modified with Ce0.8Sm0.2O1.9 (SDC) via a drop−coating method. As the rate of oxygen

  2. Trends in the incidence of ischaemic stroke in young adults between 1985 and 2011: the Dijon Stroke Registry. (United States)

    Béjot, Yannick; Daubail, Benoit; Jacquin, Agnès; Durier, Jérôme; Osseby, Guy-Victor; Rouaud, Olivier; Giroud, Maurice


    Recent data have suggested that stroke incidence in young people may be rising. In this population-based study, we aimed to determine whether the incidence of stroke in people aged stroke (ischaemic stroke, spontaneous intracerebral haemorrhage, and undetermined stroke) occurring in Dijon, France, from 1985 to 2011 were prospectively collected from a population-based registry. Incidence rates were calculated and temporal trends were analysed by age groups and stroke subtypes using a Poisson regression to estimate incidence rate ratios (IRR). Risk factors and premorbid treatments were analysed. Over the 27-year study period, 4506 patients were recorded (53% women, mean age 74.6±14.4, 10.1% aged stroke incidence was noted, as was a rise in ischaemic stroke in individuals aged ischaemic stroke in people aged disease and treatment options in the population and among practitioners leading to more frequent referrals for specialised care, and improvements in stroke diagnosis. Stroke prevention must be encouraged even in young adults.

  3. Temporal Trends in Sex Differences With Regard to Stroke Incidence: The Dijon Stroke Registry (1987-2012). (United States)

    Giroud, Marie; Delpont, Benoit; Daubail, Benoit; Blanc, Christelle; Durier, Jérôme; Giroud, Maurice; Béjot, Yannick


    We evaluated temporal trends in stroke incidence between men and women to determine whether changes in the distribution of vascular risk factors have influenced sex differences in stroke epidemiology. Patients with first-ever stroke including ischemic stroke, spontaneous intracerebral hemorrhage, subarachnoid hemorrhage, and undetermined stroke between 1987 and 2012 were identified through the population-based registry of Dijon, France. Incidence rates were calculated for age groups, sex, and stroke subtypes. Sex differences and temporal trends (according to 5-year time periods) were evaluated by calculating incidence rate ratios (IRRs) with Poisson regression. Four thousand six hundred and fourteen patients with a first-ever stroke (53.1% women) were recorded. Incidence was lower in women than in men (112 versus 166 per 100 000/y; IRR, 0.68; P stroke and intracerebral hemorrhage. From 1987 to 2012, the lower incidence of overall stroke in women was stable (IRR ranging between 0.63 and 0.72 according to study periods). When considering stroke subtype, a slight increase in the incidence of ischemic stroke was observed in both men (IRR, 1.011; 95% confidence interval, 1.005-1.016; P =0.001) and women (IRR, 1.013; 95% confidence interval, 1.007-1.018; P =0.001). The sex gap in incidence remained unchanged in ischemic stroke and intracerebral hemorrhage. Conversely, the lower subarachnoid hemorrhage incidence in women vanished with time because of an increasing incidence. The sex gap in stroke incidence did not change with time except for subarachnoid hemorrhage. Despite lower rates, more women than men experience an incident stroke each year because of a longer life expectancy. © 2017 American Heart Association, Inc.

  4. Changes in risk factor profile after ischemic stroke

    DEFF Research Database (Denmark)

    Hornnes, Nete

    Background and aims. Adherence to preventive medication and to a healthy life style reduces stroke survivors’ risk of recurrent stroke. We investigated risk factor management in patients admitted to 3 Copenhagen hospitals with ischemic stroke (IS) Methods. 320 patients with acute IS were followed...... up 1 year after stroke. We constructed a baseline risk factor profile (RFP) of 6 variables: smoking, excessive drinking, physical inactivity, untreated hypertension, no cholesterol-lowering, and no antithrombotic treatment/warfarin at discharge from hospital. Each item was rated 0 or 1 giving......-fatal recurrent stroke or myocardial infarction Conclusions. We suggest the organisation of secondary prevention clinics within the stroke units for life style modification and treatment to target of risk factors immediately after discharge, thus extending the success of TIA clinics to all stroke survivors...

  5. Functional Gain After Inpatient Stroke Rehabilitation: Correlates and Impact on Long-Term Survival. (United States)

    Scrutinio, Domenico; Monitillo, Vincenzo; Guida, Pietro; Nardulli, Roberto; Multari, Vincenzo; Monitillo, Francesco; Calabrese, Gianluigi; Fiore, Pietro


    Prediction of functional outcome after stroke rehabilitation (SR) is a growing field of interest. The association between SR and survival still remains elusive. We sought to investigate the factors associated with functional outcome after SR and whether the magnitude of functional improvement achieved with rehabilitation is associated with long-term mortality risk. The study population consisted of 722 patients admitted for SR within 90 days of stroke onset, with an admission functional independence measure (FIM) score of stroke onset to rehabilitation admission (PStroke Scale score at rehabilitation admission (P<0.001), and aphasia (P=0.021) were independently associated with FIM gain. The R2 of the model was 0.275. During a median follow-up of 6.17 years, 36.9% of the patients died. At multivariable Cox analysis, age (P<0.0001), coronary heart disease (P=0.018), atrial fibrillation (P=0.042), total cholesterol (P=0.015), and total FIM gain (P<0.0001) were independently associated with mortality. The adjusted hazard ratio for death significantly decreased across tertiles of increasing FIM gain. Several factors are independently associated with functional gain after SR. Our findings strongly suggest that the magnitude of functional improvement is a powerful predictor of long-term mortality in patients admitted for SR. © 2015 American Heart Association, Inc.

  6. Sex Disparities in Stroke

    DEFF Research Database (Denmark)

    Dehlendorff, Christian; Andersen, Klaus Kaae; Olsen, Tom Skyhøj


    between 2003 and 2012 (N=79 617), and the Danish Register of Causes of Death. Information was available on age, sex, marital status, stroke severity, stroke subtype, socioeconomic status, and cardiovascular risk profile. We studied only deaths due to the index stroke, with the assumption that death.......5%) or 1 month (6.9%), respectively. After the age of 60 years, women had more severe strokes than men. Up to ages in the mid-60s, no difference in the risk of death from stroke was seen between the 2 sexes. For people aged >65 years, however, the risk gradually became greater in men than in women...

  7. The influence of Sr on the microstructure, degradation and stress corrosion cracking of the Mg alloys - ZK40xSr. (United States)

    Chen, Lianxi; Bin, Yuanhong; Zou, Wenqi; Wang, Xiaojian; Li, Wei


    In the present work, new magnesium (Mg) alloys (Mg-4Zn-0.6Zr-xSr, x=0, 0.4, 0.8, 1.2, 1.6wt%; ZK40xSr) were prepared and studied as potential biodegradable materials. The influence of strontium (Sr) addition on the properties of the new Mg alloys was investigated, which included microstructure, corrosion degradation, and the stress corrosion cracking (SCC) susceptibility. The average grain size of the ZK40Sr was approximately 100µm, which was significantly smaller than that of ZK40 alloy without Sr (402.3±40.2µm). The size of grain boundaries precipitates in the ZK40xSr alloys gradually increased with the increase of Sr content. The grain boundaries finally showed a continuously distribution and net-like shape. The degradation test showed that the average degradation rate of the ZK40xSr alloys increased with the increase of Sr addition. In the case of Mg-4Zn-0.6Zr, the degradation rate was 2.2mgcm -2 day -1 , which was lower than that of Mg-4Zn-0.6Zr-1.6Sr (4.93mgcm -2 day -1 ). When the ZK40xSr alloys were immersed in m-SBF, the rod-like Sr-contained hydroxyapatite (HA) substance was detected, which was known to enhance cell growth around bone implants. The fracture surfaces of the as-cast Mg-4Zn-0.6Zr-1.6Sr were shown intergranular stress corrosion cracking (IGSCC) patterns. The increase of SCC susceptibility of the higher Sr ZK40xSr alloys was attributed to the increase of micro-galvanic corrosion between the α-Mg and the grain boundaries precipitates. The SCC susceptibility values were ≈0.13 and ≈0.41 for the Mg-4Zn-0.6Zr-0.4Sr and the Mg-4Zn-0.6Zr-1.6Sr, respectively. Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. Clinical Epidemiology Of Stroke

    Directory of Open Access Journals (Sweden)

    Nagaraja D


    Full Text Available Stroke is a huge public health problem because of its high morbidity and disability. The epidemiology of stroke is of relevance to construct practical paradigms to tackle this major health issue in the community. Recent data have shown that about 72-86% of strokes are ischemic, 9-18% are due to hemorrhage (intracerebral of subarachnoid and the rest are undefined. The risk factors for stroke are multiple and combined. At present, stroke is no more considered as unavoidable and untreatable. It is an emergency and specialized units and teams improve outcome and lower costs. Death related to stroke is declining in many countries and in both sexes. This decrease in multifactorial. The detection and more effective treatment of hypertension may play an important factor, as well as the improved medical care and improvement in diagnostic procedures. While stroke incidence appears stable and stroke mortality is slowly declining, the absolute magnitude of stroke is likely to grow over the next 30 years. as the population ages, the absolute number of stroke victims and demands on healthcare and other support systems is likely to increase substantially in the future. Keeping this in perspective, this chapter shall focus on the epidemiology of stroke in the world and in Indian, in particular.

  9. Registration of acute stroke

    DEFF Research Database (Denmark)

    Wildenschild, Cathrine; Mehnert, Frank; Thomsen, Reimar Wernich


    BACKGROUND: The validity of the registration of patients in stroke-specific registries has seldom been investigated, nor compared with administrative hospital discharge registries. The objective of this study was to examine the validity of the registration of patients in a stroke-specific registry...... (The Danish Stroke Registry [DSR]) and a hospital discharge registry (The Danish National Patient Registry [DNRP]). METHODS: Assuming that all patients with stroke were registered in either the DSR, DNRP or both, we first identified a sample of 75 patients registered with stroke in 2009; 25 patients...... in the DSR, 25 patients in the DNRP, and 25 patients registered in both data sources. Using the medical record as a gold standard, we then estimated the sensitivity and positive predictive value of a stroke diagnosis in the DSR and the DNRP. Secondly, we reviewed 160 medical records for all potential stroke...

  10. Sleep and Stroke

    Directory of Open Access Journals (Sweden)

    M V Padma Srivastav


    Full Text Available Circadian variations in conjunction with sleep-related heart rhythm changes and sleepdisordered breathing (SDB are contributing risk factors for stroke. Strong scientificevidence now exists indicating that SDB contributes to systemic hypertension, aprominent risk factor for stroke, and compelling circumstantial evidence is presentsuggesting that SDB raises the risk for development of stroke through other circulatorymechanisms as well. Preliminary evidence indicates that post-stroke patients have ahigher prevalence of SDB, which is likely to compromise their rehabilitation outcomes.Since SDB is modifiable with the application of CPAP and other treatment modalities,there is practical value in investigating patients at risk of stroke or post stroke forpresence of SDB. Successful application of CPAP or BiPAP therapy may improve theoutcome in both instances.Key words : Sleep, Stroke, SDB, CPAP

  11. Management Of Post Stroke Seizures

    Directory of Open Access Journals (Sweden)

    Kavian Ghandehari


    Full Text Available The incidence of seizures in relation to stroke is 8.9%, with a frequency of 10.6 and 8.6% in haemorrhagic and ischaemic stroke, respectively. In subarachnoid haemorrhage the incidence is 8.5%. Due to the fact that infarcts are significantly more frequent than haemorrhages, seizures are mainly related to occlusive vascular disease of the brain. The general view is to consider stroke-related seizures as harmless complications in the course of a prolonged vascular disease involving the heart and brain. Seizures can be classified as those of early and those of late onset in a paradigm comparable to post-traumatic epilepsy, with an arbitrary dividing point of two weeks after the event. Most early-onset seizures occur during the first day after the stroke. Late-onset seizures occur three times more often than early-onset ones. A first late-onset epileptic event is most likely to take place between six months and two years after the stroke. However, up to 28% of patients develop their first seizure several years later. Simple partial seizures, with or without secondary generalisation, account for about 50% of total seizures, while complex partial spells, with or without secondary generalisation, and primary generalised tonic–clonic insults account for approximately 25% each. Status epilepticus occurs in 12% of stroke patients, but the recurrence rate after an initial status epilepticus is not higher than after a single seizure. Inhibitory seizures, mimicking transient ischaemic attacks, are observed in 7.1% of cases. The only clinical predictor of late-onset seizures is the initial presentation of partial anterior circulation syndrome due to a territorial infarct. Patients with total anterior circulation syndrome have less chance of developing epileptic spells, not only due to their shorter life expectancy but also due to the fact that the large infarcts are sharply demarcated in these patients. The optimal timing and type of antiepileptic drug

  12. The effect of adipose tissue-derived stem cells in a middle cerebral artery occlusion stroke model depends on their engraftment rate

    NARCIS (Netherlands)

    Grudzenski, Saskia; Baier, Sebastian; Ebert, Anne; Pullens, Pim; Lemke, Andreas; Bieback, Karen; Dijkhuizen, Rick M.; Schad, Lothar R.; Alonso, Angelika; Hennerici, Michael G.; Fatar, Marc


    Background: In the field of experimental stem cell therapy, intra-arterial (IA) delivery yields the best results concerning, for example, migrated cell number at the targeted site. However, IA application also appears to be associated with increased mortality rates and infarction. Since many rodent

  13. Thirty-Day Case Fatality of Stroke at the Lagos University Teaching ...

    African Journals Online (AJOL)

    Background: There is some evidence that the case fatality rate of stroke has declined in recent years, although it is not certain that this reduction has been caused by changes in stroke management. There has been no recent review of the case fatality rate of stroke at the Lagos University Teaching Hospital [LUTH].

  14. Stroke in rural South Africa - contributing to the little known about a ...

    African Journals Online (AJOL)

    CVA) in a rural South African population. Design. Annual demographic and health surveillance with verbal autopsy of all deaths, 1992 - 1995. Outcome measures. Stroke mortality rate by age and sex. Results. Stroke mortality increased with age ...

  15. Professionals’ views on interprofessional stroke team functioning

    Directory of Open Access Journals (Sweden)

    Jane Murray Cramm


    Full Text Available Introduction: The quality of integrated stroke care depends on smooth team functioning but professionals may not always work well together. Professionals' perspectives on the factors that influence stroke team functioning remain largely unexamined. Understanding their experiences is critical to indentifying measures to improve team functioning. The aim of this study was to identify the factors that contributed to the success of interprofessional stroke teams as perceived by team members.  Methods: We distributed questionnaires to professionals within 34 integrated stroke care teams at various health care facilities in 9 Dutch regions. 558 respondents (response rate: 39% completed the questionnaire. To account for the hierarchical structure of the study design we fitted a hierarchical random-effects model. The hierarchical structure comprised 558 stroke team members (level 1 nested in 34 teams (level 2.  Results: Analyses showed that personal development, social well-being, interprofessional education, communication, and role understanding significantly contributed to stroke team functioning. Team-level constructs affecting interprofessional stroke team functioning were communication and role understanding. No significant relationships were found with individual-level personal autonomy and team-level cohesion.  Discussion and conclusion: Our findings suggest that interventions to improve team members' social well-being, communication, and role understanding will improve teams' performance. To further advance interprofessional team functioning, healthcare organizations should pay attention to developing professionals' interpersonal skills and interprofessional education.        

  16. Professionals’ views on interprofessional stroke team functioning

    Directory of Open Access Journals (Sweden)

    Jane Murray Cramm


    Full Text Available Introduction: The quality of integrated stroke care depends on smooth team functioning but professionals may not always work well together. Professionals' perspectives on the factors that influence stroke team functioning remain largely unexamined. Understanding their experiences is critical to indentifying measures to improve team functioning. The aim of this study was to identify the factors that contributed to the success of interprofessional stroke teams as perceived by team members. Methods: We distributed questionnaires to professionals within 34 integrated stroke care teams at various health care facilities in 9 Dutch regions. 558 respondents (response rate: 39% completed the questionnaire. To account for the hierarchical structure of the study design we fitted a hierarchical random-effects model. The hierarchical structure comprised 558 stroke team members (level 1 nested in 34 teams (level 2. Results: Analyses showed that personal development, social well-being, interprofessional education, communication, and role understanding significantly contributed to stroke team functioning. Team-level constructs affecting interprofessional stroke team functioning were communication and role understanding. No significant relationships were found with individual-level personal autonomy and team-level cohesion. Discussion and conclusion: Our findings suggest that interventions to improve team members' social well-being, communication, and role understanding will improve teams' performance. To further advance interprofessional team functioning, healthcare organizations should pay attention to developing professionals' interpersonal skills and interprofessional education.       

  17. Stroke care: Experiences and clinical research in stroke units in Chennai

    Directory of Open Access Journals (Sweden)

    Gobindram Arjundas


    Full Text Available Background: S troke is the second commonest cause of death in India with crude overall prevalence rate of 220 per 100,000. With an increasing aging population at risk, the stroke burden in India can be expected to reach epidemic proportions. Materials and Methods: The first protocol-based prospective studies, funded by private agencies was conducted in Madras Institute of Neurology in 1984-86. The results led to establishment of the first stroke unit in Tamil Nadu state, in the institute. The first all-India hospital-based studies in acute stroke was completed as INDIAN COOPERATIVE ACUTE STROKE STUDIES (ICASS I and ICASS II with WHO STEP ONE by members of the Indian Stroke Association between 2000-2005. This has generated very useful data for our country. Results: Mortality in 1984-86 was 40%. Stroke unit in the institute dropped it to 12%. About 10 years later, ICASS studies showed a further fall of mortality to 8%, which is the current international figure in the west. Morbidity pattern showed about half return to their original activities. But about one third are left totally disabled needing prolonged care, for which fiscal, social and rehab provisions have to be done on a national basis. Conclusions: The progress and success of care of Stroke in the last three decades, from treatment in medical and neurology wards to specialized stroke units is presented. The main risk factors are hypertension, diabetes and ischemic heart disease across the country. Hypertension alone or with the other two diseases was present in 72% of cases. Prevention and treatment of these factors will reduce the stroke burden, mortality and morbidity of strokes. The Stroke-team concept can be extended to the smallest hospitals in our country.

  18. Age and ethnic disparities in incidence of stroke over time: the South London Stroke Register. (United States)

    Wang, Yanzhong; Rudd, Anthony G; Wolfe, Charles D A


    Data on continuous monitoring of stroke risk among different age and ethnic groups are lacking. We aimed to investigate age and ethnic disparities in stroke incidence over time from an inner-city population-based stroke register. Trends in stroke incidence and before-stroke risk factors were investigated with the South London Stroke Register, a population-based register covering a multiethnic population of 357 308 inhabitants. Age-, ethnicity-, and sex-specific incidence rates with 95% confidence intervals were calculated, assuming a Poisson distribution and their trends over time tested by the Cochran-Armitage test. Four thousand two hundred forty-five patients with first-ever stroke were registered between 1995 and 2010. Total stroke incidence reduced by 39.5% during the 16-year period from 247 to 149.5 per 100 000 population (Pstroke incidence were observed in men, women, white groups, and those aged>45 years, but not in those aged 15 to 44 years (12.6-10.1; P=0.2034) and black groups (310.1-267.5; P=0.3633). The mean age at stroke decreased significantly from 71.7 to 69.6 years (P=0.0001). The reduction in prevalence of before-stroke risk factors was mostly seen in white patients aged>55 years, whereas an increase in diabetes mellitus was observed in younger black patients aged 15 to 54 years. Total stroke incidence decreased during the 16-year time period. However, this was not seen in younger age groups and black groups. The advances in risk factor reduction observed in white groups aged>55 years failed to be transferred to younger age groups and black groups.

  19. Impact of libido at 2 weeks after stroke on risk of stroke recurrence at 1-year in a chinese stroke cohort study. (United States)

    Li, Jing-Jing; Yuan, Huai-Wu; Wang, Chun-Xue; Luo, Ben-Yan; Ruan, Jie; Zhang, Ning; Shi, Yu-Zhi; Zhou, Yong; Wang, Yi-Long; Zhang, Tong; Zhou, Juan; Zhao, Xing-Quan; Wang, Yong-Jun


    There were few studies on the relation between changes in libido and incidence of stroke recurrence. The aim of this study was to investigate the relationship between libido decrease at 2 weeks after stroke and recurrent stroke at 1-year. It is a multi-centered, prospective cohort study. The 14 th item of the Hamilton Depression Rating Scale-17 was used to evaluate changes of libido in poststroke patients at 2 weeks. Stroke recurrence was defined as an aggravation of former neurological functional deficit, new local or overall symptoms, or stroke diagnosed at re-admission. Among 2341 enrolled patients, 1757 patients had completed follow-up data, 533 (30.34%) patients had decreased libido at 2 weeks, and 166 (9.45%) patients had recurrent stroke at 1-year. Multivariate logistic regression analysis showed that, compared with patients with normal libido, the odds ratio (OR) of recurrent stroke in patients with decreased libido was reduced by 41% (OR = 0.59, 95% confidence interval [CI]: 0.40-0.87). The correlation was more prominent among male patients (OR = 0.52, 95% CI: 0.31-0.85) and patients of ≥60 years of age (OR = 0.57, 95% CI: 0.35-0.93). One out of three stroke patients in mainland China has decreased libido at 2 weeks after stroke. Decreased libido is a protective factor for stroke recurrence at 1-year, which is more prominent among older male patients.

  20. Effects of stroke education of junior high school students on stroke knowledge of their parents: Tochigi project. (United States)

    Matsuzono, Kosuke; Yokota, Chiaki; Takekawa, Hidehiro; Okamura, Tomonori; Miyamatsu, Naomi; Nakayama, Hirofumi; Nishimura, Kunihiro; Ohyama, Satoshi; Ishigami, Akiko; Okumura, Kosuke; Toyoda, Kazunori; Miyamoto, Yoshihiro; Minematsu, Kazuo


    Educating the youth about stroke is a promising approach for spreading stroke knowledge. The aim of this study was to verify communication of stroke knowledge to parents by educating junior high school students about stroke. We enrolled 1127 junior high school students (age, 13-15 years) and their parents in the Tochigi prefecture, Japan. All students received a stroke lesson, watched an animated cartoon, and read the related Manga comic as educational aids. The students took back home the Manga and discussed what they learned with their parents. Questionnaires on stroke knowledge were given to all at baseline and immediately after the lesson. A total of 1125 students and 915 parents answered the questionnaires. In the students, the frequency of correct answers increased significantly for all questions on stroke symptoms except for headache, and for all questions on risk factors after the lesson. In the parents, the correct answer rates increased for stroke symptoms except for headache and numbness in one side of the body, and for all questions on risk factors except for hypertension. Ninety-one percent of students and 92.7% of parents correctly understood the Face, Arm, Speech, and Time (FAST) mnemonic after the lesson. Improvement of stroke knowledge immediately after the stroke lesson was observed in parents as well as their children, which indicated that our teaching materials using the Manga was effective in delivering the stroke knowledge to parents through their children. © 2014 American Heart Association, Inc.

  1. Quantitative measures of spasticity in post-stroke patients. (United States)

    Pisano, F; Miscio, G; Del Conte, C; Pianca, D; Candeloro, E; Colombo, R


    Quantitative evaluation of muscle tone in post-stroke patients; correlation of biomechanical indices with conventional clinical scales and neurophysiological measures; characterization of passive and neural components of muscle tone. Mechanical stretches of the wrist flexor muscles of 53 post-stroke patients were imposed by means of a torque motor at constant speed. Patients were clinically studied using the Ashworth scale for spasticity and the Medical Research Council score for residual muscle strength. The neurophysiological measures were Hoffmann reflex latency, Hmax/Mmax ratio, stretch reflex threshold speed (SRTS), stretch reflex (SR) latency and area, passive (ISI) and total (TSI) stiffness indices. Hmax/Mmax ratio, SR area, ISI and TSI values were significantly higher in patients, while SRTS was significantly lower. TSI, SRTS and SR area were highly correlated to the Ashworth score. This EMG-biomechanical technique allows an objective evaluation of changes in muscle tone in post-stroke patients, providing easily measurable, quantitative indices of muscle stiffness. The linear distribution of these measures is particularly indicated for monitoring changes induced by treatment. The apparatus seems suitable to characterize neural stiffness, while difficulties were found in isolating the passive components, because of the occurrence of tonic EMG activity in most spastic patients.

  2. Stroke in Commercial Flights. (United States)

    Álvarez-Velasco, Rodrigo; Masjuan, Jaime; DeFelipe, Alicia; Corral, Iñigo; Estévez-Fraga, Carlos; Crespo, Leticia; Alonso-Cánovas, Araceli


    Stroke on board aircraft has been reported in retrospective case series, mainly focusing on economy class stroke syndrome. Data on the actual incidence, pathogenesis, and prognosis of stroke in commercial flights are lacking. A prospective registry was designed to include all consecutive patients referred from an international airport (40 million passengers a year) to our hospital with a diagnosis of ischemic stroke or transient ischemic attack and onset of symptoms during a flight or immediately after landing. Forty-four patients (32 ischemic strokes and 12 transient ischemic attacks) were included over a 76-month period (January 2008 to April 2014). The estimated incidence of stroke was 1 stroke in 35 000 flights. Pathogeneses of stroke or transient ischemic attack were atherothrombotic in 16 (36%), economy class stroke syndrome in 8 (18%), cardioembolic in 7 (16%), arterial dissection in 4 (9%), lacunar stroke in 4 (9%), and undetermined in 5 (12%) patients. Carotid stenosis >70% was found in 12 (27%) of the patients. Overall prognosis was good, and thrombolysis was applied in 44% of the cases. The most common reason for not treating patients who had experienced stroke onset midflight was the delay in reaching the hospital. Only 1 patient with symptom onset during the flight prompted a flight diversion. We found a low incidence of stroke in the setting of air travel. Economy class stroke syndrome and arterial dissection were well represented in our sample. However, the main pathogenesis was atherothrombosis with a high proportion of patients with high carotid stenosis. © 2016 American Heart Association, Inc.

  3. Stroke And Substance Abuse

    Directory of Open Access Journals (Sweden)

    A Chitsaz


    Full Text Available Introduction: stroke in recreational substance users can be an indirect complication, like endocarditis and cardio embolism in parenteral drug users. With some drug like cocaine, stroke appear to be the result of a direct effect. In young subjects without other risk factors provide persuasive evidence for causality . OPIATES: Heroine is the most abused opiate drug, which is administered by injection, by snorting or by smoking. Stroke affects heroin users by diverse mechanisms,. Injectors are at risk of infections endocarditis, which carries risk for both ischemic and hemorrhagic stroke. Cerebral or subarachnoid hemorrhage usually occurs after rupture of a septic (mycotic aneurysm. Heroine users can are also at risk for hemorrhagic stroke secondary to liver failure with deranged clotting and to heroin nephropathy with uremia or malignant hypertension. In some heroin users the drug it self is directly causal due to vasculitis, hypersensitivity and immunologic changes. Embolization of foreign material to brain due to mixed of heroine with quinine can cause cerebral embolism. AMPHETAMINE AND other psychostimulants: In abuser of amphetamine hemorrhagic stroke can occur, oral, intravenous, nasal, and inhalational routes of administration have been reported. Most were chronic user, but in several patients, stroke followed a first exposure. Some of amphetamine induced intracranial hemorrhages are secondary to acute hypertension, some to cerebral vacuities, and some to a combination of two. Decongestants and diet pills: Phenylpropanolamine (PPA, an amphetamine – like drug, in decongestants and diet pills, induce acute hypertension, sever headache, psychiatric symptoms, seizures and hemorrhagic stroke. Ephedrine and pseudo ephedrine are present in decongestants and bronchodilators and induce headache, tachyarrhythmia, hypertensive emergency, and hemorrhagic and occlusive stroke. Ecstasy, 3,4 Methylenedioxymethamphetamin (MDMA with amphetamine like can

  4. Emergency Medical Services Support for Acute Ischemic Stroke Patients Receiving Thrombolysis at a Primary Stroke Center

    Directory of Open Access Journals (Sweden)

    Byron R. Spencer


    Full Text Available Background Emergency Medical Services (EMS is a vital link in the overall chain of stroke survival. A Primary Stroke Center (PSC relies heavily on the 9-1-1 response system along with the ability of EMS personnel to accurately diagnose acute stroke. Other critical elements include identifying time of symptom onset, providing pre-hospital care, selecting a destination PSC, and communicating estimated time of arrival (ETA. Purpose Our purpose was to evaluate the EMS component of thrombolysed acute ischemic stroke patient care at our PSC. Methods In a retrospective manner we retrieved electronic copies of the EMS incident reports for every thrombolysed ischemic stroke patient treated at our PSC from September 2001 to August 2005. The following data elements were extracted: location of victim, EMS agency, times of dispatch, scene, departure, emergency department (ED arrival, recordings of time of stroke onset, blood pressure (BP, heart rate (HR, cardiac rhythm, blood glucose (BG, Glasgow Coma Scale (GCS, Cincinnati Stroke Scale (CSS elements, emergency medical personnel field assessment, and transport decision making. Results Eighty acute ischemic stroke patients received thrombolysis during the study interval. Eighty-one percent arrived by EMS. Two EMS agencies transported to our PSC. Mean dispatch-to-scene time was 6 min, on-scene time was 16 min, transport time was 10 min. Stroke onset time was recorded in 68%, BP, HR, and cardiac rhythm each in 100%, BG in 81%, GCS in 100%, CSS in 100%, and acute stroke diagnosis was made in 88%. Various diagnostic terms were employed: cerebrovascular accident in 40%, unilateral weakness or numbness in 20%, loss of consciousness in 16%, stroke in 8%, other stroke terms in 4%. In 87% of incident reports there was documentation of decision-making to transport to the nearest PSC in conjunction with pre-notification. Conclusion The EMS component of thrombolysed acute ischemic stroke patients care at our PSC appeared

  5. Sequential strokes in a hyperacute stroke unit. (United States)

    Ganesalingam, Jeban; Buddha, Sandeep; Carlton-Jones, Anoma L; Nicholas, Richard


    Vasculitis is a rare, but treatable condition that can present to hyperacute stroke units. Thrombolysis does not treat the underlying pathology, and a rapidly evolving clinical picture drives clinical decision often before all the investigation results are available.

  6. Antithrombotic therapy for secondary stroke prevention. (United States)

    Alberts, Mark J


    : Antithrombotic therapy is a key component of any strategy for the secondary prevention of ischemic stroke. A better understanding of the various therapeutic options will lead to improved stroke prevention, better medication adherence, and fewer complications. : Antiplatelet agents and anticoagulants are the two major classes of antithrombotic therapy used for stroke prevention. The etiology and mechanism of the stroke must be considered in order to make the best decision regarding which agent(s) to use for secondary stroke prevention. The recent Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) study showed that clopidogrel and aspirin plus extended-release dipyridamole had similar event rates in terms of recurrent stroke, but clopidogrel was better tolerated, with fewer bleeding events. Several new anticoagulants are poised to replace warfarin for stroke prevention in the setting of atrial fibrillation. These include dabigatran (a new oral direct thrombin inhibitor) and possibly apixaban (a new oral factor Xa inhibitor). These new medications are much easier to use than warfarin and may be more effective and safer, with fewer drug and food interactions and no need for routine blood monitoring. Thus, these new medications may improve adherence as well as clinicians' inclination to treat with anticoagulation. : Because each antiplatelet agent or anticoagulant has certain advantages and disadvantages, clinicians must choose an agent that the patient can afford and tolerate in terms of side effects and adherence. The hope and expectation is that the proper use of these medications in accordance with current guidelines will reduce the risk of a recurrent stroke.

  7. The Christchurch earthquake stroke incidence study. (United States)

    Wu, Teddy Y; Cheung, Jeanette; Cole, David; Fink, John N


    We examined the impact of major earthquakes on acute stroke admissions by a retrospective review of stroke admissions in the 6 weeks following the 4 September 2010 and 22 February 2011 earthquakes. The control period was the corresponding 6 weeks in the previous year. In the 6 weeks following the September 2010 earthquake there were 97 acute stroke admissions, with 79 (81.4%) ischaemic infarctions. This was similar to the 2009 control period which had 104 acute stroke admissions, of whom 80 (76.9%) had ischaemic infarction. In the 6 weeks following the February 2011 earthquake, there were 71 stroke admissions, and 61 (79.2%) were ischaemic infarction. This was less than the 96 strokes (72 [75%] ischaemic infarction) in the corresponding control period. None of the comparisons were statistically significant. There was also no difference in the rate of cardioembolic infarction from atrial fibrillation between the study periods. Patients admitted during the February 2011 earthquake period were less likely to be discharged directly home when compared to the control period (31.2% versus 46.9%, p=0.036). There was no observable trend in the number of weekly stroke admissions between the 2 weeks leading to and 6 weeks following the earthquakes. Our results suggest that severe psychological stress from earthquakes did not influence the subsequent short term risk of acute stroke, but the severity of the earthquake in February 2011 and associated civil structural damages may have influenced the pattern of discharge for stroke patients. Copyright © 2013 Elsevier Ltd. All rights reserved.

  8. Coral Sr-U Thermometry (United States)

    DeCarlo, T. M.; Gaetani, G. A.; Cohen, A. L.; Foster, G. L.; Alpert, A.; Stewart, J.


    Coral skeletons archive the past two millennia of climate variability in the oceans with unrivaled temporal resolution. However, extracting accurate temperature information from coral skeletons is confounded by "vital effects", which often override the temperature dependence of geochemical proxies. Here, we present a new approach to coral paleothermometry based on results of abiogenic precipitation experiments interpreted within a framework provided by a quantitative model of the coral biomineralization process. We conducted laboratory experiments to test the temperature and carbonate chemistry controls on abiogenic partitioning of Sr/Ca and U/Ca between aragonite and seawater, and we modeled the sensitivity of skeletal composition to processes occurring at the site of calcification. The model predicts that temperature can be accurately reconstructed from coral skeleton by combining Sr/Ca and U/Ca ratios into a new proxy, Sr-U. We tested the model predictions with measured Sr/Ca and U/Ca ratios of fourteen Porites sp. corals collected from the tropical Pacific Ocean and the Red Sea, with a subset also analyzed using the boron isotope (δ11B) pH proxy. Observed relationships among Sr/Ca, U/Ca, and δ11B agree with model predictions, indicating that the model accounts for the key features of the coral biomineralization process. We calibrated Sr-U to instrumental temperature records and found that it captures 93% of mean annual variability (26-30 °C) and predicts temperature within 0.5 °C (1 σ). Conversely, Sr/Ca alone has an error of prediction of 1 °C and often diverges from observed temperature by 3 °C or more. Many of the problems afflicting Sr/Ca - including offsets among neighboring corals and decouplings from temperature during coral stress events - are reconciled by Sr-U. By accounting for the influence of the coral biomineralization process, the Sr-U thermometer may offer significantly improved reliability for reconstructing ocean temperatures from coral

  9. Investigations into Brain-Computer Interfacing for Stroke Rehabilitation


    Leamy, Darren J.


    A stroke is the loss of brain function following the cessation of blood supply to a region of the brain caused by either a blockage or haemorrhage in the vasculature. It is a leading cause of death worldwide but survival rates have increased significantly in the past 25 years with recent estimates putting the number of worldwide stroke survivors at 33 million. Stroke survivors live with lasting effects such as limb weakness, limb paralysis, loss of speech, loss of comprehens...

  10. Atlas of the Global Burden of Stroke (1990-2013)

    DEFF Research Database (Denmark)

    Feigin, Valery L; Mensah, George A; Norrving, Bo


    BACKGROUND: World mapping is an important tool to visualize stroke burden and its trends in various regions and countries. OBJECTIVES: To show geographic patterns of incidence, prevalence, mortality, disability-adjusted life years (DALYs) and years lived with disability (YLDs) and their trends....... CONCLUSIONS: Global burden of stroke has continued to increase in spite of dramatic declines in age-standardized incidence, prevalence, mortality rates and disability. Population growth and aging have played an important role in the observed increase in stroke burden....

  11. Burden and outcome of prevalent ischemic brain disease in a national acute stroke registry. (United States)

    Koton, Silvia; Tsabari, Rakefet; Molshazki, Noa; Kushnir, Moshe; Shaien, Radi; Eilam, Anda; Tanne, David


    Previous overt stroke and subclinical stroke are frequent in patients with stroke; yet, their clinical significance and effects on stroke outcome are not clear. We studied the burden and outcome after acute ischemic stroke by prevalent ischemic brain disease in a national registry of hospitalized patients with acute stroke. Patients with ischemic stroke in the National Acute Stroke Israeli prospective hospital-based registry (February to March 2004, March to April 2007, and April to May 2010) with information on previous overt stroke and subclinical stroke per computed tomography/MRI (n=3757) were included. Of them, a subsample (n=787) was followed up at 3 months. Logistic regression models were computed for outcomes in patients with prior overt stroke or subclinical stroke, compared with patients with first stroke, adjusting for age, sex, vascular risk factors, stroke severity, and clinical classification. Two-thirds of patients had a prior overt stroke or subclinical stroke. Death rates were similar for patients with and without prior stroke. Adjusted odds ratios (OR; 95% confidence interval [CI]) for disability were increased for patients with prior overt stroke (OR, 1.31; 95% CI, 1.03-1.66) and subclinical stroke (OR, 1.45; 95% CI, 1.16-1.82). Relative odds of Barthel Index≤60 for patients with prior overt stroke (OR, 2.04; 95% CI, 1.14-3.68) and with prior subclinical stroke (OR, 2.04; 95% CI, 1.15-3.64) were twice higher than for patients with a first stroke. ORs for dependency were significantly increased for patients with prior overt stroke (OR, 1.95; 95% CI, 1.19-3.20) but not for those with subclinical stroke (OR, 1.36; 95% CI, 0.84-2.19). In our national cohort of patients with acute ischemic stroke, nearly two thirds had a prior overt stroke or subclinical stroke. Risk of poor functional outcomes was increased for patients with prior stroke, both overt and subclinical.

  12. Blood Pressure Control: Stroke and Stroke Prevention

    Directory of Open Access Journals (Sweden)

    Hans-Christoph Diener


    Full Text Available Hypertension is the most important modifiable risk factor for primary and secondary stroke prevention.All antihypertensive drugs are effective in primary prevention: the risk reduction for stroke is 30—42%. However, not all classes of drugs have the same effects: there is some indication that angiotensin receptor blockers may be superior to other classes of antihypertensive drugs in stroke prevention.Seventy-five percent of patients who present to hospital with acute stroke have elevated blood pressure within the first 24—48 hours. Extremes of systolic blood pressure (SBP increase the risk of death or dependency. The aim of treatment should be to achieve and maintain the SBP in the range 140—160 mmHg. However, fast and drastic blood pressure lowering can have adverse consequences.The PROGRESS trial of secondary prevention with perindopril + indapamide versus placebo + placebo showed a decrease in numbers of stroke recurrences in patients given both active antihypertensive agents, more impressive for cerebral haemorrhage.There were also indications that active treatment might decrease the development of post-stroke dementia.


    Directory of Open Access Journals (Sweden)



    Full Text Available Introduction: Cerebrovascular disease is the third most common cause of death in the developed world after cancer and ischemic heart disease. In India, community surveys have shown a crude prevalence rate of 200 per 100000 population for hemiplegia. Aims and objectives: Identification of risk factors for c erebrovascular disease. Materials and Methods: Inclusion Criteria: Cases of acute stroke admitted in S.V.R.R.G.G.H, Tirupati were taken for the study. Exclusion Criteria: Head injury cases, neoplasm cases producing cerebrovascular disease were excluded. Re sults: Stroke was more common in male, 54% patients were male 46% were female. It was more common in 6 th and 7 th decade. More common risk factors were hypertension followed by smoking, diabetes mellitus. More common pathology was infarction. Conclusion: Com mon risk factors for acute stroke are hypertension, smoking, diabetes mellitus, alcoholism, obesity, cardiac disease. Stroke was confirmed by CT scan of brain.


    Directory of Open Access Journals (Sweden)

    Harmayetty Harmayetty


    Full Text Available Introduction: Biological, physical and phsycosocial changes in stroke patient could be a stressor that induced a depression state. There would be an emotional disturbance in stroke patient and stroke attack would be recurrent, if it was not treated. One of the alternative techniques to reduce depression is musical therapy especially memory songs. Method: This study was used a quasy experimental pre-post test purposive sampling design. The population was stroke patients who treated in Neurological Ward A and Stroke Unit Dr Soetomo Hospital Surabaya. There were 12 respondents divided into 6 respondents for treatment group and 6 respondents for control group. The independent variable was music (memory song and dependent variable was depression. Data were collected by using questionnaire which adapted from Hamilton Depression Rating Scale and Geriatric Depression Rating Scale, then analyzed by using Wilcoxon Signed Rank Test and Mann Whitney U Test with significance level α≤0.05. Result: The result showed that there was a difference between pre test and post test in depression (p=0.0196 and there was a difference in the depression between treatment group and control group (p=0.002. Discussion: It can be concluded that music (memory songs has an effect to the depression of stroke patient. Further studies are needed to concerning other factors that may affect the relaxation technique especially in listening music.

  15. Knowledge of Stroke Risk Factors among Stroke Survivors in Nigeria


    Grace Vincent-Onabajo; Taritei Moses


    Background. Knowledge of stroke risk factors is expected to reduce the incidence of stroke?whether first-ever or recurrent. This study examined knowledge of stroke risk factors and its determinants among stroke survivors. Methods. A cross-sectional survey of consenting stroke survivors at two physiotherapy facilities in Nigeria was carried out. Sociodemographic and clinical data were obtained and knowledge of stroke risk factors (defined as the ability to mention at least one correct risk fac...

  16. European Stroke Science Workshop (United States)

    Mattle, Heinrich P.; Brainin, Michael; Chamorro, Angel; Diener, Hans Christoph; Hacke, Werner; Leys, Didier; Norrving, Bo; Ward, Nick


    The European Stroke Organisation (ESO) held its first European Stroke Science Workshop in Garmisch-Partenkirchen, Germany (15-17 December 2011). Stroke experts based in Europe were invited to present and discuss their current research. The scope of the workshop was to review the most recent findings of selected topics in stroke, to exchange ideas, to stimulate new research and to enhance collaboration between European stroke research groups. Seven scientific sessions were held, each starting with a keynote lecture to review the state of the art of the given topic, followed by 4 or 5 short presentations by experts. They were asked to limit their presentations to 10 slides containing only recent information. The meeting was organized by the executive committee of the ESO (Heinrich Mattle, chairman, Michael Brainin, Angel Chamorro, Werner Hacke, Didier Leys) and supported by the European Stroke Conference (Michael Hennerici). In this article we summarize the main contents of this successful workshop. PMID:22836350

  17. Delivering Knowledge of Stroke to Parents Through Their Children Using a Manga for Stroke Education in Elementary School. (United States)

    Ishigami, Akiko; Yokota, Chiaki; Nishimura, Kunihiro; Ohyama, Satoshi; Tomari, Shinya; Hino, Tenyu; Arimizu, Takuro; Wada, Shinichi; Toyoda, Kazunori; Minematsu, Kazuo


    School-based intervention would be promising to spread stroke knowledge widely. This study aimed to clarify the effectiveness of our new educational aids that were developed for elementary school children to impart information about stroke to children and their parents in 2 different ways: with or without stroke lessons by a neurologist. We enrolled 562 children (aged 11 to 12 years) and their parents (n = 485). The students were divided into 2 groups: 323 received a lesson on stroke by a stroke neurologist without watching an animated cartoon (Group I), and 239 watched an animated cartoon without the lesson (Group II). All of the children took the manga home, and talked about stroke with their parents. Questionnaires on stroke knowledge were administered at baseline (BL), immediately after the lesson (IL), and 3 months (3M) after the lesson. There were significant increases in the adjusted mean scores for risk factors as well as stroke symptoms at 3M in both groups compared with BL scores, although the children in Group I scored significantly better than those in Group II at IL and 3M (P < .05). In both children and parents, the correct answer rates of the FAST mnemonic at 3M were around 90%, with no significant differences between groups. Stroke education for elementary school children using our educational aids provided knowledge of stroke symptoms to the children as well as their parents even without lessons on stroke, although a better understanding of stroke was obtained from lessons led by stroke neurologists. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  18. Changes in memory before and after stroke differ by age and sex, but not by race. (United States)

    Wang, Qianyi; Mejía-Guevara, Iván; Rist, Pamela M; Walter, Stefan; Capistrant, Benjamin D; Glymour, M Maria


    Post-stroke memory impairment is more common among older adults, women and blacks. It is unclear whether post-stroke differences reflect differential effects of stroke per se or differences in prestroke functioning. We compare memory trajectories before and after stroke by age, sex and race. Health and Retirement Study participants aged ≥50 years (n = 17,341), with no stroke history at baseline, were interviewed biennially up to 10 years for first self- or proxy-reported stroke (n = 1,574). Segmented linear regression models were used to compare annual rates of memory change before and after stroke among 1,169 stroke survivors, 405 stroke decedents and 15,767 stroke-free participants. Effect modification was evaluated with analyses stratified by baseline age (≤70 vs. >70), sex and race (white vs. nonwhite), and using interaction terms between age/sex/race indicators and annual memory change. Older (>70 years) adults experienced a faster memory decline before stroke (-0.19 vs. -0.10 points/year for survivors, -0.24 vs. -0.13 points/year for decedents, p memory decrements (-0.64 vs. -0.26 points, p memory decline (-0.15 vs. -0.07 points/year, p = 0.003) after stroke onset, compared to younger adults. Female stroke survivors experienced a faster prestroke memory decline than male stroke survivors (-0.14 vs. -0.10 points/year, p memory scores than nonwhites, race was not associated with rate of memory decline during any period of time; i.e. race did not significantly modify the rate of decline before or after stroke or the immediate effect of stroke on memory. Older age predicted worse memory change before, at and after stroke onset. Sex and race differences in post-stroke memory outcomes might be attributable to prestroke disparities, which may be unrelated to cerebrovascular disease. © 2014 S. Karger AG, Basel.

  19. Predictors of stroke - associated mortality in Africans. (United States)

    Longo-Mbenza, B; Tonduangu, K; Muyeno, K; Phanzu, M; Kebolo Baku, A; Muvova, D; Lelo, T; Odio, W; Lukoki, L; Bikangi Nkiabungu, F; Kilembe, M; Tshiamala, P; Katalay, L; Mwema, M; Muyembe, T


    The objective of the study was to examine the association of the stroke-related mortality with gender, age, ethnicity, social class, blood pressure, fibrinogen, selected clinical data and meteorologic parameters in hospitalized Africans. A series of 1032 consecutively hospitalized incident cases of acute stroke between 1987 and 1991 was studied. Univariate and multivariate analyses were used to estimate the risk (odds ratio=OR) of stroke mortality for meteorologic parameters on the month before the accident onset and selected sociodemophysiological variables on the day of admission. The variables significantly associated with stroke mortality in multivariate analysis were male sex (OR= 2.3 [1.3 - 4.1]), low social class (OR= 2.0 [1.2 - 4.0]), migrant tribes (OR= 1.7 [1.5 - 1.8]), ischemic stroke (OR= 1.4 [1.2 - 1.6]), heart rate >=100 bpm (OR= 1.1 [1.0 - 1.2]), age > or =60 years (OR= 1.03 [1.01 - 1.06]), systolic blood pressure> 160 mmHg (OR= 1. 02 [1.01 - 1.03]), and fibrinogen > or =400 mg/dl (OR= 1.01 [1.002 - 1. 02]). However, diastolic blood pressure > 90 mmHg and global radiation< 340 Cal/cm(2)/day were significantly (p< 0.05) and inversely associated with stroke mortality. Our results indicate that male sex, older age, low social class, migration, ischemic stroke and higher baseline levels of heart rate, systolic blood pressure and fibrinogen are significant predictors of stroke mortality, but lower global radiation and higher diastolic blood pressure are inversely linked.

  20. Acute stroke imaging research roadmap

    NARCIS (Netherlands)

    Wintermark, Max; Albers, Gregory W.; Alexandrov, Andrei V.; Alger, Jeffry R.; Bammer, Roland; Baron, Jean-Claude; Davis, Stephen; Demaerschalk, Bart M.; Derdeyn, Colin P.; Donnan, Geoffrey A.; Eastwood, James D.; Fiebach, Jochen B.; Fisher, Marc; Furie, Karen L.; Goldmakher, Gregory V.; Hacke, Werner; Kidwell, Chelsea S.; Kloska, Stephan P.; Koehrmann, Martin; Koroshetz, Walter; Lee, Ting-Yim; Lees, Kennedy R.; Lev, Michael H.; Liebeskind, David S.; Ostergaard, Leif; Powers, William J.; Provenzale, James; Schellinger, Peter; Silbergleit, Robert; Sorensen, Alma Gregory; Wardlaw, Joanna; Warach, Steven

    The recent "Advanced Neuroimaging for Acute Stroke Treatment" meeting on September 7 and 8, 2007 in Washington DC, brought together stroke neurologists, neuroradiologists, emergency physicians, neuroimaging research scientists, members of the National Institute of Neurological Disorders and Stroke

  1. Body Mass Index and Stroke

    DEFF Research Database (Denmark)

    Andersen, Klaus Kaae; Olsen, Tom Skyhøj


    Although obesity is associated with excess mortality and morbidity, mortality is lower in obese than in normal weight stroke patients (the obesity paradox). Studies now indicate that obesity is not associated with increased risk of recurrent stroke in the years after first stroke. We studied the ...... the association between body mass index (BMI) and stroke patient's risk of having a history of previous stroke (recurrent stroke)....

  2. Spontaneous ischaemic stroke in dogs

    DEFF Research Database (Denmark)

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


    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....

  3. Computational investigation of 99Mo, 89Sr, and 131I production rates in a subcritical UO2(NO32 aqueous solution reactor driven by a 30-MeV proton accelerator

    Directory of Open Access Journals (Sweden)

    Z. Gholamzadeh


    Full Text Available The use of subcritical aqueous homogenous reactors driven by accelerators presents an attractive alternative for producing 99Mo. In this method, the medical isotope production system itself is used to extract 99Mo or other radioisotopes so that there is no need to irradiate common targets. In addition, it can operate at much lower power compared to a traditional reactor to produce the same amount of 99Mo by irradiating targets. In this study, the neutronic performance and 99Mo, 89Sr, and 131I production capacity of a subcritical aqueous homogenous reactor fueled with low-enriched uranyl nitrate was evaluated using the MCNPX code. A proton accelerator with a maximum 30-MeV accelerating power was used to run the subcritical core. The computational results indicate a good potential for the modeled system to produce the radioisotopes under completely safe conditions because of the high negative reactivity coefficients of the modeled core. The results show that application of an optimized beam window material can increase the fission power of the aqueous nitrate fuel up to 80%. This accelerator-based procedure using low enriched uranium nitrate fuel to produce radioisotopes presents a potentially competitive alternative in comparison with the reactor-based or other accelerator-based methods. This system produces ∼1,500 Ci/wk (∼325 6-day Ci of 99Mo at the end of a cycle.

  4. Post-stroke depression: Prevalence and relationship with disability in chronic stroke survivors

    Directory of Open Access Journals (Sweden)

    Srivastava Abhishek


    Full Text Available Objectives: To evaluate (1 the prevalence of operationally defined depressive disorder (ICD-10 in chronic stroke subjects and (2 the relationship of post-stroke depression (PSD with disability. Design: Cross-sectional, descriptive study. Setting: Neurological rehabilitation unit of a tertiary care university research center. Materials and Methods: Participants were those with first episode of supratentorial stroke of more than 3 months′ duration with impaired balance and gait who had been referred for rehabilitation. Data were collected on demographic data, stroke data (side and type of lesion and post-stroke duration, cognition (mini mental state examination, depressive ideation (Hamilton Depression Rating Scale - HRDS, impairment (Scandinavian Stroke Scale, balance (Berg Balance Scale, ambulatory status (Functional Ambulation Category, walking ability (speed, and independence in activities of daily living (Barthel Index. Statistical analysis was done using SPSS 13.0. We carried out the chi-square test for ordinal variables and the independent t test for continuous variables. Results: Fifty-one patients (M:F: 41:10 of mean age 46.06 ± 11.19 years and mean post-stroke duration of 467.33 ± 436.39 days were included in the study. Eighteen of the 51 participants (35.29% met the criteria for depression. Demographic variables like male gender, being married, living in a nuclear family, urban background, and higher HRDS score were significantly correlated with PSD (P < 0.05. Depression was related to functional disability after stroke but to a statistically insignificant level (P > 0.05 and was unrelated to lesion-related parameters. Conclusion: Depression occurs in one-third of chronic stroke survivors and is prevalent in subjects referred for rehabilitation. PSD is related primarily to demographic variables and only to a lesser extent to functional disability following stroke.

  5. A method to determine 89Sr and 90Sr when they are in mixture

    International Nuclear Information System (INIS)

    Baha Al-Deen, A.H.; Baha Al-Deen, B.K. de


    89 Sr and 90 Sr are among the most dangerous types of radioactive fallout from biological view point. Particular concern about 89 Sr and 90 Sr is due to their chemical similarity to calcium. These radionuclides in water soluble form are absorbed by rain and they are eventually incorporated into human bones and teeth causing a potential danger to human life. Because of the great need for accurate measurement of 90 Sr in environmental samples which also contain 89 Sr and because no specific method has been published for the determination of 90 Sr and 89 Sr when they are in mixture, the following method was established: (1) enough time is allowed for the sample to reach the steady state between 90 Sr and its daughter 90 Y then the 90 Y is milked; (2) 90 Y is counted separately to determine the activity of 90 Sr; (3) the solution, after 90 Y is milked, is purified by hidroxide scavenging and counted for the combined 89 Sr and 90 Sr activity; (4) 89 Sr activity is determined by substracting the 90 Sr activity from the combined activity. The method has been applied by the authors to analyse an unknown solution of 89 Sr and 90 Sr at approximately environmental levels of activity obtaining the following results: (154+-19) dpm 90 Sr and (1210+-260) dpm 89 Sr per gram of original solution

  6. Predictors of Stroke After Transient Ischemic Attack in Children. (United States)

    Lehman, Laura L; Watson, Christopher G; Kapur, Kush; Danehy, Amy R; Rivkin, Michael J


    Transient ischemic attack (TIA) in children has received far less attention compared with TIA in adults. The risk factors of stroke after TIA in children are relatively unknown. We aimed to determine the percentage of children who have stroke after TIA and the risk factors associated with stroke after TIA. We searched the medical records at Boston Children's Hospital for the year 2010 to find children who were evaluated for TIA to determine associated risk factors of stroke after TIA. We included children who were evaluated in 2009 through 2010 for TIA and had magnetic resonance imaging. We examined follow-up imaging through August 2014 for subsequent stroke. Logistic regression was used to calculate odds ratios for factors in our cohort who are associated with stroke after presentation with TIA. We identified 63 children who experienced a TIA. The mean time of imaging follow-up was 4.5 years after TIA presentation. Of the 63 children, 10 (16%) developed radiological evidence of ischemic cerebral injury within the follow-up period. Four of the 10 (6%) demonstrated diffusion abnormalities on magnetic resonance imaging at TIA presentation, whereas 8 (13%) had a stroke after their TIA. Arteriopathy, female sex, and autoimmune disorders were significantly associated with stroke after TIA. In our cohort of children, stroke occurred after TIA at a rate similar to that seen in adults, but the risk factors for stroke after TIA in children are different. © 2015 American Heart Association, Inc.

  7. The Sr/Ca-temperature relationship in coralline aragonite: Influence of variability in (Sr/Ca)[sub seawater] and skeletal growth parameters

    Energy Technology Data Exchange (ETDEWEB)

    de Villiers, S.; Shen, G.T.; Nelson, B.K. (Univ. of Washington, Seattle, WA (United States))


    This paper provides an evaluation of two of the most likely pitfalls of Sr/Ca thermometry, i.e., the effect of biogenic cycling of Sr vs. Ca in the surface ocean and the effect of variable extension rate on Sr incorporation in coralline aragonite. The authors also report calibration of the Sr/Ca-temperature relationship for three coral species, Porites lobata, Pocillopora eydouxi, and Pavona clavus, collected for the Hawaiian and Galapagos islands. Analyses of seawater samples show significant spatial and depth variability in the Sr:Ca ratio. The uncertainty introduced by this effect is estimated to be <0.2[degrees]C for corals located in tropical oligotrophic waters, and potentially larger for corals located in upwelling areas. Sr/Ca along two different growth axes of a Galapagos Pavona clavus, with annual extension rates of [approximately]6 and 12 mm/y, respectively, indicate an offset of 1-2[degrees]C, with higher Sr/Ca values associated with slower extension rates. The offset observed between the two growth axes may be the result of variations in extension and/or calcification rate. These results are important in determining past sea surface temperatures for reconstruction of paleoclimates.

  8. Risk factors and strategies for stroke prevention in low to middle-income countries

    Directory of Open Access Journals (Sweden)

    В. Л. Фейгин


    Full Text Available A recent meta-analysis of the population-based stroke incidence studies showed a significant trend towards almost 2-fold increasing of stroke incidence rates in low to middle-income countries over the last 4 decades. The study also demonstrated that stroke incidence rates in low to middle-income countries currently exceed the level of stroke incidence in the developed (high income countries by 20%. Compared with people in high-income countries, people in low to middle-income countries also experience a higher stroke mortality rate and greater proportions of hemorrhagic strokes. Should the current trends in stroke incidence and aging of the population continue, deaths from stroke in the developing countries will increase over the next decade by 20% and the overall burden of stroke may soon become unbearable for the economy of these countries. The way to stop the stroke pandemic and reduce stroke incidence is effective stroke prevention. In this review, we summarize current evidence for stroke risk factors and prevention in low to middle-income countries and outline possible promising strategies for tackling the problem.

  9. Splicing factor SR34b mutation reduces cadmium tolerance in Arabidopsis by regulating iron-regulated transporter 1 gene

    International Nuclear Information System (INIS)

    Zhang, Wentao; Du, Bojing; Liu, Di; Qi, Xiaoting


    Highlights: • Arabidopsis splicing factor SR34b gene is cadmium-inducible. • SR34b T-DNA insertion mutant is sensitive to cadmium due to high cadmium uptake. • SR34b is a regulator of cadmium transporter IRT1 at the posttranscription level. • These results highlight the roles of splicing factors in cadmium tolerance of plant. - Abstract: Serine/arginine-rich (SR) proteins are important splicing factors. However, the biological functions of plant SR proteins remain unclear especially in abiotic stresses. Cadmium (Cd) is a non-essential element that negatively affects plant growth and development. In this study, we provided clear evidence for SR gene involved in Cd tolerance in planta. Systemic expression analysis of 17 Arabidopsis SR genes revealed that SR34b is the only SR gene upregulated by Cd, suggesting its potential roles in Arabidopsis Cd tolerance. Consistent with this, a SR34b T-DNA insertion mutant (sr34b) was moderately sensitive to Cd, which had higher Cd 2+ uptake rate and accumulated Cd in greater amounts than wild-type. This was due to the altered expression of iron-regulated transporter 1 (IRT1) gene in sr34b mutant. Under normal growth conditions, IRT1 mRNAs highly accumulated in sr34b mutant, which was a result of increased stability of IRT1 mRNA. Under Cd stress, however, sr34b mutant plants had a splicing defect in IRT1 gene, thus reducing the IRT1 mRNA accumulation. Despite of this, sr34b mutant plants still constitutively expressed IRT1 proteins under Cd stress, thereby resulting in Cd stress-sensitive phenotype. We therefore propose the essential roles of SR34b in posttranscriptional regulation of IRT1 expression and identify it as a regulator of Arabidopsis Cd tolerance

  10. Splicing factor SR34b mutation reduces cadmium tolerance in Arabidopsis by regulating iron-regulated transporter 1 gene

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Wentao; Du, Bojing; Liu, Di; Qi, Xiaoting, E-mail:


    Highlights: • Arabidopsis splicing factor SR34b gene is cadmium-inducible. • SR34b T-DNA insertion mutant is sensitive to cadmium due to high cadmium uptake. • SR34b is a regulator of cadmium transporter IRT1 at the posttranscription level. • These results highlight the roles of splicing factors in cadmium tolerance of plant. - Abstract: Serine/arginine-rich (SR) proteins are important splicing factors. However, the biological functions of plant SR proteins remain unclear especially in abiotic stresses. Cadmium (Cd) is a non-essential element that negatively affects plant growth and development. In this study, we provided clear evidence for SR gene involved in Cd tolerance in planta. Systemic expression analysis of 17 Arabidopsis SR genes revealed that SR34b is the only SR gene upregulated by Cd, suggesting its potential roles in Arabidopsis Cd tolerance. Consistent with this, a SR34b T-DNA insertion mutant (sr34b) was moderately sensitive to Cd, which had higher Cd{sup 2+} uptake rate and accumulated Cd in greater amounts than wild-type. This was due to the altered expression of iron-regulated transporter 1 (IRT1) gene in sr34b mutant. Under normal growth conditions, IRT1 mRNAs highly accumulated in sr34b mutant, which was a result of increased stability of IRT1 mRNA. Under Cd stress, however, sr34b mutant plants had a splicing defect in IRT1 gene, thus reducing the IRT1 mRNA accumulation. Despite of this, sr34b mutant plants still constitutively expressed IRT1 proteins under Cd stress, thereby resulting in Cd stress-sensitive phenotype. We therefore propose the essential roles of SR34b in posttranscriptional regulation of IRT1 expression and identify it as a regulator of Arabidopsis Cd tolerance.

  11. Stroke awareness decreases prehospital delay after acute ischemic stroke in korea

    Directory of Open Access Journals (Sweden)

    Lee Su-Ho


    Full Text Available Abstract Background Delayed arrival at hospital is one of the major obstacles in enhancing the rate of thrombolysis therapy in patients with acute ischemic stroke. Our study aimed to investigate factors associated with prehospital delay after acute ischemic stroke in Korea. Methods A prospective, multicenter study was conducted at 14 tertiary hospitals in Korea from March 2009 to July 2009. We interviewed 500 consecutive patients with acute ischemic stroke who arrived within 48 hours. Univariate and multivariate analyses were performed to evaluate factors influencing prehospital delay. Results Among the 500 patients (median 67 years, 62% men, the median time interval from symptom onset to arrival was 474 minutes (interquartile range, 170-1313. Early arrival within 3 hours of symptom onset was significantly associated with the following factors: high National Institutes of Health Stroke Scale (NIHSS score, previous stroke, atrial fibrillation, use of ambulance, knowledge about thrombolysis and awareness of the patient/bystander that the initial symptom was a stroke. Multivariable logistic regression analysis indicated that awareness of the patient/bystander that the initial symptom was a stroke (OR 4.438, 95% CI 2.669-7.381, knowledge about thrombolysis (OR 2.002, 95% CI 1.104-3.633 and use of ambulance (OR 1.961, 95% CI 1.176-3.270 were significantly associated with early arrival. Conclusions In Korea, stroke awareness not only on the part of patients, but also of bystanders, had a great impact on early arrival at hospital. To increase the rate of thrombolysis therapy and the incidence of favorable outcomes, extensive general public education including how to recognize stroke symptoms would be important.

  12. Stroke outcome in clinical trial patients deriving from different countries. (United States)

    Ali, Myzoon; Atula, Sari; Bath, Philip M W; Grotta, James; Hacke, Werner; Lyden, Patrick; Marler, John R; Sacco, Ralph L; Lees, Kennedy R


    Stroke incidence and outcome vary widely within and across geographical locations. We examined whether differences in index stroke severity, stroke risk factors, mortality, and stroke outcome across geographical locations remain after adjusting for case mix. We analyzed 3284 patients from the Virtual International Stroke Trials Archive (VISTA). We used logistic regression to examine the incidence of mild index stroke, functional, and neurological outcomes after accounting for age, medical history, year of trial recruitment, and initial stroke severity in the functional and neurological outcome analyses. We examined mortality between geographical regions using a Cox proportional hazards model, accounting for age, initial stroke severity, medical history, and year of trial recruitment. Patients enrolled in the USA and Canada had the most severe index strokes. Those recruited in Austria and Switzerland had the best functional and neurological outcomes at 90 days (P<0.05), whereas those enrolled in Germany had the worst functional outcome at 90 days (P=0.013). Patients enrolled in Austria, Switzerland, Belgium, Netherlands, Finland, Germany, Greece, Israel, Spain, and Portugal had a significantly better survival rate when compared with those enrolled in USA and Canada. Patients enrolled in trials after 1998 had more severe index strokes, with no significant difference in outcome compared with those enrolled before 1998. We identified regional variations in index stroke severity, outcome, and mortality for patients enrolled in ischemic stroke clinical trials over the past 13 years that were not fully explained by case mix. Index stroke severity was greater in patients enrolled after 1998, with no significant improvement in outcomes compared to those enrolled before 1998.

  13. Early management and outcome of acute stroke in Auckland

    International Nuclear Information System (INIS)

    Anderson, N.E.; Bonita, R.; Broad, J.B.


    Studies of acute stroke management in stroke units and tertiary referral hospitals may not accurately reflect practice within the population. Reliable information on the management of stroke within a population is sparse. The aims of this study was to compare clinical practice in acute stroke management in Auckland with guidelines for the management and treatment of stroke in other countries; to provide a baseline measure against which future changes in management can be evaluated. All new stroke events in Auckland residents in 12 months were traced through multiple case finding sources. For each patient, a record of investigations and treatment during the first week of hospital admission was kept. One thousand eight hundred and three stroke events (including subarachnoid haemorrhages) occurred in 1761 patients in one year. Twenty-seven per cent of all events were managed outside hospital and 73% of the stroke events were treated in an acute hospital. Of the 1242 stroke events admitted to an acute hospital in the first week, only 6% were managed on the neurology and neurosurgery ward, 83% were managed by a general physician or geriatrician and 42% had computed tomography (CT). Of 376 validated ischaemic strokes, 44% were treated with aspirin and 12% with intravenous heparin. Of the 690 unspecified strokes (no CT or autopsy), 38% received aspirin and 0.5% heparin. The 28 day in-hospital case fatality for all stroke events admitted to an acute hospital during the first week was 25%. It was concluded that in Auckland, management of acute stroke differed from clinical guidelines in the high proportion of patients managed in the community, the low rate of neurological consultation, and the low frequency of CT scanning. Despite these deficiencies in management, the 28 day hospital case fatality in Auckland was similar to other comparable studies which had a high proportion of cases evaluated by a neurologist and CT. (authors)

  14. Lumbar spine fusion surgery and stroke: a national cohort study. (United States)

    Wu, Jau-Ching; Chen, Yu-Chun; Liu, Laura; Huang, Wen-Cheng; Thien, Peck-Foong; Chen, Tzeng-Ji; Cheng, Henrich; Lo, Su-Shun


    To investigate the incidence and risk of stroke after lumbar spinal fusion surgery. Study subjects were identified from a nationwide cohort of 1 million people from 2000 to 2005 and were divided into the lumbar spinal fusion group (n = 2,015), who received posterior lumbar spinal fusion surgery, and the comparison group (n = 16,120) composed of age-, sex-, and propensity score-matched control subjects. The matching process was intended to adjust for demographics, comorbidities, and other immeasurable covariates to minimize selection bias. All subjects were followed up for 3 years for stroke, including hemorrhagic and ischemic strokes. Kaplan-Meier and Cox regression analyses were performed. The overall incidence rate of stroke in the cohort was 9.99 per 1,000 person-year. The lumbar spinal fusion group was less likely to have any stroke (adjusted hazard ratio (HR) = 0.83, p = 0.293), hemorrhagic stroke (adjusted HR = 0.74, p = 0.739) and ischemic stroke (adjusted HR = 0.81, p = 0.250) than the comparison group, but without significance. Three years post-operatively, patients who received lumbar spinal fusion had stroke incidence rates similar to those without surgery. Posterior lumbar spinal fusion surgery is not associated with increased risks for any kind of stroke.

  15. Proteinuria and clinical outcomes after ischemic stroke. (United States)

    Kumai, Y; Kamouchi, M; Hata, J; Ago, T; Kitayama, J; Nakane, H; Sugimori, H; Kitazono, T


    The impact of chronic kidney disease (CKD) on clinical outcomes after acute ischemic stroke is still not fully understood. The aim of the present study was to elucidate how CKD and its components, proteinuria and low estimated glomerular filtration rate (eGFR), affect the clinical outcomes after ischemic stroke. The study subjects consisted of 3,778 patients with first-ever ischemic stroke within 24 hours of onset from the Fukuoka Stroke Registry. CKD was defined as proteinuria or low eGFR (Stroke Scale during hospitalization), in-hospital mortality, and poor functional outcome (modified Rankin Scale score at discharge of 2 to 6). The effects of CKD, proteinuria, and eGFR on these outcomes were evaluated using a multiple logistic regression analysis. CKD was diagnosed in 1,320 patients (34.9%). In the multivariate analyses after adjusting for confounding factors, patients with CKD had significantly higher risks of neurologic deterioration, in-hospital mortality, and poor functional outcome (p relationship between the eGFR level and each outcome was found. CKD is an important predictor of poor clinical outcomes after acute ischemic stroke. Proteinuria independently contributes to the increased risks of neurologic deterioration, mortality, and poor functional outcome, but the eGFR may not be relevant to these outcomes.

  16. Demographic Characteristics of Strokes Types in Sanliurfa

    Directory of Open Access Journals (Sweden)

    Yusuf Ižnanc


    Full Text Available Aim: Sanliurfa training and research hospital for diagnosis and treatment of patients with stroke admitted demographic features planned. We aimed to study demographic feature of stroke patient who admitted to Sanliurfa training and research hospital for diagnosis and treatment. Material and Method: 01/10/2011 and 01/9/2012, ischemic and hemorrhagic brain training and research hospital in Sanliurfa vascular disease diagnosis and treatment without any exclusion criteria, patient sequential 454 retrospectively.Results: 366%u2019si 88 were ischemic, hemorrhagic stroke. 54.6% by sex male,% 45.4 were women. Average age: 67.86 di.56.3% radiologically roaming the front circulation infarct brain infarct% found the rear 23.2. Hospital stay duration: 9.27 day.. Hemorrhagic stroke was longer this Sura in the group. Mortality rate 4.6% in all in packaging (21 patients, ischemic in boots in 1.9% (7 patients, hemorrhagic of boots were found at 15.9% (14 patients.Discussion: our study of Sanliurfa province stroke data in terms of the region together, although a portion of their valuable results. In the summer, the ischemic stroke incidence is higher.

  17. Immune interventions in stroke (United States)

    Fu, Ying; Liu, Qiang; Anrather, Josef


    Inflammatory and immune responses in the brain can shape the clinical presentation and outcome of stroke. Approaches for effective management of acute stroke are sparse and many measures for brain protection fail, but our ability to modulate the immune system and modify the disease progression of multiple sclerosis is increasing. As a result, immune interventions are currently being explored as therapeutic interventions in acute stroke. In this Review, we compare the immunological features of acute stroke with those of multiple sclerosis, identify unique immunological features of stroke, and consider the evidence for immune interventions. In acute stroke, microglia activation and cell death products trigger an inflammatory cascade that damages vessels and the parenchyma within minutes to hours of the ischaemia or haemorrhage. Immune interventions that restrict brain inflammation, vascular permeability and tissue oedema must be administered rapidly to reduce acute immune-mediated destruction and to avoid subsequent immunosuppression. Preliminary results suggest that the use of drugs that modify disease in multiple sclerosis might accomplish these goals in ischaemic and haemorrhagic stroke. Further elucidation of the immune mechanisms involved in stroke is likely to lead to successful immune interventions. PMID:26303850

  18. Relational Processing Following Stroke (United States)

    Andrews, Glenda; Halford, Graeme S.; Shum, David; Maujean, Annick; Chappell, Mark; Birney, Damian


    The research examined relational processing following stroke. Stroke patients (14 with frontal, 30 with non-frontal lesions) and 41 matched controls completed four relational processing tasks: sentence comprehension, Latin square matrix completion, modified Dimensional Change Card Sorting, and n-back. Each task included items at two or three…

  19. National Stroke Association (United States)

    ... Event Join a Stroke Challenge Team Comeback Trail Tell Your Story Community Presentations Faces of Stroke Volunteer With Us ... in a video presentation. Watch Video ... to feel the right side of her body. Kathryn’s friends performed the FAST exam and soon ...

  20. Diagnostic neuroimaging in stroke

    International Nuclear Information System (INIS)

    Jarenwattananon, A.; Khandji, A.; Brust, J.C.M.


    Since the development of cerebral angiography 60 years ago, there has been a proliferation of increasingly sophisticated, expensive, and, fortunately, safe imaging techniques for patients with cerebrovascular disease. In addition, occlusive and hemorrhagic stroke are now recognized as having a wide variety of possible causes. This chapter addresses the different imaging options available for particular kinds of stroke

  1. The Optimal Golf Stroke

    DEFF Research Database (Denmark)

    Buchinger, Mikael; Durigen, Susan; Dahl, Johan Rambech


    The paper presents a preliminary investigation into aspects of the game of golf. A series of models is proposed for the golf stroke, the momentum transfer between club and ball and the flight of the ball.Numerical and asymptotic solutions are presented reproducing many of the features observed...... in the golf stroke of a professional golfer....

  2. Motivational interviewing for improving recovery after stroke. (United States)

    Cheng, Daobin; Qu, Zhanli; Huang, Jianyi; Xiao, Yousheng; Luo, Hongye; Wang, Jin


    Psychological problems are common complications following stroke that can cause stroke survivors to lack the motivation to take part in activities of daily living. Motivational interviewing provides a specific way for enhancing intrinsic motivation, which may help to improve activities of daily living for stroke survivors. To investigate the effect of motivational interviewing for improving activities of daily living after stroke. We searched the Cochrane Stroke Group's Trials Register (November 2014), the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 1), MEDLINE (1948 to March 2015), EMBASE (1980 to March 2015), CINAHL (1982 to March 2015), AMED (1985 to March 2015), PsycINFO (1806 to March 2015), PsycBITE (March 2015) and four Chinese databases. In an effort to identify further published, unpublished and ongoing trials, we searched ongoing trials registers and conference proceedings, checked reference lists, and contacted authors of relevant studies. Randomised controlled trials (RCTs) comparing motivational interviewing with no intervention, sham motivational interviewing or other psychological therapy for people with stroke were eligible. Two review authors independently selected studies for inclusion, extracted eligible data and assessed risk of bias. Outcome measures included activities of daily living, mood and death. One study involving a total of 411 participants, which compared motivational interviewing with usual care, met our inclusion criteria. The results of this review did not show significant differences between groups receiving motivational interviewing or usual stroke care for participants who were not dependent on others for activities of daily living, nor on the death rate after three-month and 12-month follow-up, but participants receiving motivational interviewing were more likely to have a normal mood than those who received usual care at three-months and 12-months follow-up. There is insufficient evidence to support

  3. Stable and Radiogenic Sr Isotopes in Barite - Clues on the Links Between Weathering, Climate and the C Cycle (United States)

    Paytan, A.; Eisenhauer, A.; Wallmann, K. J. G.; Griffith, E. M.; Ridgwell, A.


    The radiogenic Sr-isotopic signature (87Sr/86Sr) of seawater fluctuates primarily in response to changes in the inputs of Sr from weathering and hydrothermal activity, which have distinct 87Sr/86Sr values. Changes in the isotopic ratio of the weathered terrain also contribute to observed changes in 87Sr/86Sr. The stable Sr-isotope ratios in seawater (mass dependent isotopic fractionation; δ88/86Sr) fluctuate primarily in response to the rate of calcium carbonate (CaCO3) accumulation at the seafloor. Together the radiogenic and stable Sr can constrain the coupling between weathering and sedimentation and shed light on the relation between weathering, CaCO3 deposition, the global carbon (C) cycle and climate. Reconstruction of the coupled stable and radiogenic Sr seawater curves over the past 35 Ma of Earth history indicates that the location and rate of CaCO3 burial in the ocean fluctuated considerably over the past 35 Ma. Between 35 to 18 Ma a reduction in neritic CaCO3 burial and increased burial in pelagic settings is observed. The trend was reversed between 20 and 3 Ma and finally over the last 3 million years a rapid change from neritic to pelagic burial is seen. The lack of continues increase of pelagic CaCO3 burial rates suggests that silicate weathering rates have not increased monotonically over the past 35 Ma implying strong feedbacks operating in the climate system - lower atmospheric pCO2 and cooling trends (which control chemical weathering as seen from carbonate deposition in the ocean) countered the effects of uplift (which controls physical weathering) - modulating weathering rates and preventing a runaway ice-house. In addition the data suggests considerable fluctuations in seawater Sr concentrations over time. These data demonstrate how using multiple isotope proxies can help constrain interpretations of the geological record.

  4. Acute ischemic stroke update. (United States)

    Baldwin, Kathleen; Orr, Sean; Briand, Mary; Piazza, Carolyn; Veydt, Annita; McCoy, Stacey


    Stroke is the third most common cause of death in the United States and is the number one cause of long-term disability. Legislative mandates, largely the result of the American Heart Association, American Stroke Association, and Brain Attack Coalition working cooperatively, have resulted in nationwide standardization of care for patients who experience a stroke. Transport to a skilled facility that can provide optimal care, including immediate treatment to halt or reverse the damage caused by stroke, must occur swiftly. Admission to a certified stroke center is recommended for improving outcomes. Most strokes are ischemic in nature. Acute ischemic stroke is a heterogeneous group of vascular diseases, which makes targeted treatment challenging. To provide a thorough review of the literature since the 2007 acute ischemic stroke guidelines were developed, we performed a search of the MEDLINE database (January 1, 2004-July 1, 2009) for relevant English-language studies. Results (through July 1, 2009) from clinical trials included in the Internet Stroke Center registry were also accessed. Results from several pivotal studies have contributed to our knowledge of stroke. Additional data support the efficacy and safety of intravenous alteplase, the standard of care for acute ischemic stroke since 1995. Due to these study results, the American Stroke Association changed its recommendation to extend the time window for administration of intravenous alteplase from within 3 hours to 4.5 hours of symptom onset; this recommendation enables many more patients to receive the drug. Other findings included clinically useful biomarkers, the role of inflammation and infection, an expanded role for placement of intracranial stents, a reduced role for urgent carotid endarterectomy, alternative treatments for large-vessel disease, identification of nontraditional risk factors, including risk factors for women, and newly published pediatric stroke guidelines. In addition, new devices for

  5. Post-stroke infection: a systematic review and meta-analysis

    NARCIS (Netherlands)

    Westendorp, Willeke F.; Nederkoorn, Paul J.; Vermeij, Jan-Dirk; Dijkgraaf, Marcel G.; van de Beek, Diederik


    stroke is the main cause of disability in high-income countries, and ranks second as a cause of death worldwide. Patients with acute stroke are at risk for infections, but reported post-stroke infection rates vary considerably. We performed a systematic review and meta-analysis to estimate the

  6. 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


    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...

  7. The Danish Stroke Registry

    DEFF Research Database (Denmark)

    Johnsen, Søren Paaske; Ingeman, Annette; Hundborg, Heidi Holmager


    AIM OF DATABASE: The aim of the Danish Stroke Registry is to monitor and improve the quality of care among all patients with acute stroke and transient ischemic attack (TIA) treated at Danish hospitals. STUDY POPULATION: All patients with acute stroke (from 2003) or TIA (from 2013) treated...... at Danish hospitals. Reporting is mandatory by law for all hospital departments treating these patients. The registry included >130,000 events by the end of 2014, including 10,822 strokes and 4,227 TIAs registered in 2014. MAIN VARIABLES: The registry holds prospectively collected data on key processes...... of care, mainly covering the early phase after stroke, including data on time of delivery of the processes and the eligibility of the individual patients for each process. The data are used for assessing 18 process indicators reflecting recommendations in the national clinical guidelines for patients...

  8. Identification of Barriers to Stroke Awareness and Risk Factor Management Unique to Hispanics

    Directory of Open Access Journals (Sweden)

    Marina Martinez


    Full Text Available Barriers to risk factor control may differ by race/ethnicity. The goal of this study was to identify barriers to stroke awareness and risk factor management unique to Hispanics as compared to non-Hispanic whites (NHWs. We performed a prospective study of stroke patients from an academic Stroke Center in Arizona and surveyed members of the general community. Questionnaires included: the Duke Social Support Index (DSSI, the Multidimensional Health Locus of Control (MHLC Scale, a stroke barriers questionnaire, and a Stroke Awareness Test. Of 145 stroke patients surveyed (72 Hispanic; 73 NHW, Hispanics scored lower on the Stroke Awareness Test compared to NHWs (72.5% vs. 79.1%, p = 0.029. Hispanic stroke patients also reported greater barriers related to medical knowledge, medication adherence, and healthcare access (p < 0.05 for all. Hispanics scored higher on the “powerful others” sub-scale (11.3 vs. 10, p < 0.05 of the MHLC. Of 177 members of the general public surveyed, Hispanics had lower stroke awareness compared to NHWs and tended to have lower awareness than Hispanic stroke patients. These results suggest that Hispanic stroke patients perceive less control over their health, experience more healthcare barriers, and demonstrate lower rates of stroke literacy. Interventions for stroke prevention and education in Hispanics should address these racial/ethnic differences in stroke awareness and barriers to risk factor control.

  9. Stroke mimic diagnoses presenting to a hyperacute stroke unit. (United States)

    Dawson, Ang; Cloud, Geoffrey C; Pereira, Anthony C; Moynihan, Barry J


    Stroke services have been centralised in several countries in recent years. Diagnosing acute stroke is challenging and a high proportion of patients admitted to stroke units are diagnosed as a non-stroke condition (stroke mimics). This study aims to describe the stroke mimic patient group, including their impact on stroke services. We analysed routine clinical data from 2,305 consecutive admissions to a stroke unit at St George's Hospital, London. Mimic groupings were derived from 335 individual codes into 17 groupings. From 2,305 admissions, 555 stroke mimic diagnoses were identified (24.2%) and 72% of stroke mimics had at least one stroke risk factor. Common mimic diagnoses were headache, seizure and syncope. Medically unexplained symptoms and decompensation of underlying conditions were also common. Median length of stay was 1 day; a diagnosis of dementia (p=0.028) or needing MRI (p=0.006) was associated with a longer stay. Despite emergency department assessment by specialist clinicians and computed tomography brain, one in four suspected stroke patients admitted to hospital had a non-stroke diagnosis. Stroke mimics represent a heterogeneous patient group with significant impacts on stroke services. Co-location of stroke and acute neurology services may offer advantages where service reorganisation is being considered. © Royal College of Physicians 2016. All rights reserved.

  10. Post-stroke depression among stroke survivors attending two ...

    African Journals Online (AJOL)

    Background: The burden of stroke worldwide is increasing rapidly. There is paucity of data on post-stroke depression (PSD) among stroke survivors in Uganda, despite the high prevalence of PSD reported elsewhere. Methods: In a cross-sectional study, we assessed adult participants with confirmed first stroke with a ...

  11. Perception of stroke among patients with stroke | Ajayi | Nigerian ...

    African Journals Online (AJOL)

    The perception of patients to stroke is variable. The aim of this study was to determine the perception of stroke among stroke patients. The study was carried out between January 2004 - December 2004 on all the patients presenting with features of stroke at the Federal Medical Center Ido, Nigeria. Data were collected by ...

  12. Delay in presentation after acute ischemic stroke: the Careggi Hospital Stroke Registry. (United States)

    Eleonora, Innocenti; Patrizia, Nencini; Ilaria, Romani; Alessandra, Del Bene; Francesco, Arba; Benedetta, Piccardi; Giovanni, Pracucci


    Intravenous thrombolysis with recombinant tissue-type plasminogen activator is the approved treatment for acute ischemic stroke within 4.5 h from symptoms onset. Evidence suggests the earlier treatment was given, the greater the chance of a favorable outcome. We investigated if the delay in hospital presentation has been modified in the past 8 years. Acute ischemic strokes admitted to the Emergency Department of the Careggi Hospital, Florence from March 2004 to December 2012 were prospectively collected in the Careggi Hospital Stroke Registry. Proportion of patients presenting ≤ 2 h, 2-3.5, 3.5-6, and >6 h from symptom onset or with awakening stroke were compared. From March 2004 to December 2012, 3,856 patients with acute ischemic stroke arrived to the Careggi Emergency Department. During the period, 28.3 % of patients arrived ≤ 2 h from symptoms onset and 9.8 % between 2 and 3.5 h. The proportion of time-eligible patients is steady in the first years with a slight increase in 2011 and 2012. Early presentation is significantly associated with younger age, intracerebral hemorrhage, and stroke severity. In this study, about one-third of acute ischemic strokes arrived at the Emergency Department within the therapeutic time-window for intravenous thrombolysis. There is only a slight increase in early presentation through the period, mainly in the last 2 years. Additional efforts are required to impact deeply on the rates of time-eligible patients.

  13. Effects of Dy, Sr and Die Casting on Microstructure, Mechanical and Corrosion Properties of Mg-Dy-Sr-Nd-Zr Alloys (United States)

    Liu, Dexue; Yin, Xunyan; Pang, Xin; Hu, Shiwen; Ding, Yutian


    By adding 2, 6 and 10 wt.% Dy and 0.5, 1.5 and 2 wt.% Sr elements to Mg-2.4Nd-0.5Zr alloys and adopting die-casting process for biomedical Mg-10Dy-0.5Sr-2.4Nd-0.5Zr alloys, the effects of Dy and Sr elements and die-casting process on the microstructure, mechanical properties and corrosion resistance of Mg-Dy-Sr-Nd-Zr alloys were investigated. The new biomedical Mg-10Dy-0.5Sr-2.4Nd-0.5Zr alloys were designed, and the grain size of the as-cast new alloy was refined to 70 μm and distributed equably. The ultimate tensile strength increased with increasing Dy content and decreasing Sr content. The corrosion rate decreased firstly and then increased with increasing Dy content and decreased with increasing Sr content. By adjusting the content of Sr and Dy, the ultimate tensile strength of as-cast new Mg-10Dy-0.5Sr-2.4Nd-0.5Zr alloys increased to 203 MPa, elongation was 7.4%, and the corrosion rate decreased to 0.48 mm/a. The elongation rate increased to 10.2% after the new biomedical alloys were processed by die casting with an refine-grained microstructure of 18 μm, meanwhile the ultimate tensile strength decreased to 180 MPa, and the corrosion rate was 1.29 mm/a.

  14. Sodium Valproate, a Histone Deacetylase Inhibitor, Is Associated With Reduced Stroke Risk After Previous Ischemic Stroke or Transient Ischemic Attack. (United States)

    Brookes, Rebecca L; Crichton, Siobhan; Wolfe, Charles D A; Yi, Qilong; Li, Linxin; Hankey, Graeme J; Rothwell, Peter M; Markus, Hugh S


    A variant in the histone deacetylase 9 ( HDAC9 ) gene is associated with large artery stroke. Therefore, inhibiting HDAC9 might offer a novel secondary preventative treatment for ischemic stroke. The antiepileptic drug sodium valproate (SVA) is a nonspecific inhibitor of HDAC9. We tested whether SVA therapy given after ischemic stroke was associated with reduced recurrent stroke rate. Data were pooled from 3 prospective studies recruiting patients with previous stroke or transient ischemic attack and long-term follow-up: the South London Stroke Register, The Vitamins to Prevent Stroke Study, and the Oxford Vascular Study. Patients receiving SVA were compared with patients who received antiepileptic drugs other than SVA using survival analysis and Cox Regression. A total of 11 949 patients with confirmed ischemic event were included. Recurrent stroke rate was lower in patient taking SVA (17 of 168) than other antiepileptic drugs (105 of 530; log-rank survival analysis P =0.002). On Cox regression, controlling for potential cofounders, SVA remained associated with reduced stroke (hazard ratio=0.44; 95% confidence interval: 0.3-0.7; P =0.002). A similar result was obtained when patients taking SVA were compared with all cases not taking SVA (Cox regression, hazard ratio=0.47; 95% confidence interval: 0.29-0.77; P =0.003). These results suggest that exposure to SVA, an inhibitor of HDAC, may be associated with a lower recurrent stroke risk although we cannot exclude residual confounding in this study design. This supports the hypothesis that HDAC9 is important in the ischemic stroke pathogenesis and that its inhibition, by SVA or a more specific HDAC9 inhibitor, is worthy of evaluation as a treatment to prevent recurrent ischemic stroke. © 2017 The Authors.

  15. Smoking Cessation Intervention After Ischemic Stroke or Transient Ischemic Attack. A Randomized Controlled Pilot Trial

    DEFF Research Database (Denmark)

    Brunner Frandsen, Nicole; Sørensen, Margit; Hyldahl, Tanja Kirstine


    BACKGROUND: Smoking cessation is widely recommended for secondary stroke prevention. However, little is known about the efficacy of smoking cessation intervention after stroke or transient ischemic attack (TIA). METHODS: Ninety-four smokers under age 76, admitted with ischemic stroke or TIA were...... to the results from other studies. Intensive smoking cessation intervention was not superior to short smoking cessation intervention. Thus, other factors than intensity of smoking cessation intervention might influence the smoking cessation rates after stroke or TIA....

  16. Meta-Analysis of Perioperative Stroke and Mortality in Transcatheter Aortic Valve Implantation. (United States)

    Muralidharan, Aditya; Thiagarajan, Karthy; Van Ham, Raymond; Gleason, Thomas G; Mulukutla, Suresh; Schindler, John T; Jeevanantham, Vinodh; Thirumala, Parthasarathy D


    Transcatheter aortic valve implantation (TAVI) is a rapidly evolving safe method with decreasing incidence of perioperative stroke. There is a void in literature concerning the impact of stroke after TAVI in predicting 30-day stroke-related mortality. The primary aim of this meta-analysis was to determine whether perioperative stroke increases risk of stroke-related mortality after TAVI. Online databases, using relevant keywords, and additional related records were searched to retrieve articles involving TAVI and stroke after TAVI. Data were extracted from the finalized studies and analyzed to generate a summary odds ratio (OR) of stroke-related mortality after TAVI. The stroke rate and stroke-related mortality rate in the total patient population were 3.07% (893 of 29,043) and 12.27% (252 of 2,053), respectively. The all-cause mortality rate was 7.07% (2,053 of 29,043). Summary OR of stroke-related mortality after TAVI was estimated to be 6.45 (95% confidence interval 3.90 to 10.66, p York Heart Association class III/IV status, previous stroke, valve type, and implantation route. All failed to exhibit any significant associations with the OR. In conclusion, perioperative strokes after TAVI are associated with >6 times greater risk of 30-day stroke-related mortality. Transapical TAVI is not associated with increased stroke-related mortality in patients who suffer from perioperative stroke. Preventative measures need to be taken to alleviate the elevated rates of stroke after TAVI and subsequent direct mortality. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Intestinal SR-BI does not impact cholesterol absorption or transintestinal cholesterol efflux in mice. (United States)

    Bura, Kanwardeep S; Lord, Caleb; Marshall, Stephanie; McDaniel, Allison; Thomas, Gwyn; Warrier, Manya; Zhang, Jun; Davis, Matthew A; Sawyer, Janet K; Shah, Ramesh; Wilson, Martha D; Dikkers, Arne; Tietge, Uwe J F; Collet, Xavier; Rudel, Lawrence L; Temel, Ryan E; Brown, J Mark


    Reverse cholesterol transport (RCT) can proceed through the classic hepatobiliary route or through the nonbiliary transintestinal cholesterol efflux (TICE) pathway. Scavenger receptor class B type I (SR-BI) plays a critical role in the classic hepatobiliary route of RCT. However, the role of SR-BI in TICE has not been studied. To examine the role of intestinal SR-BI in TICE, sterol balance was measured in control mice and mice transgenically overexpressing SR-BI in the proximal small intestine (SR-BI(hApoCIII-ApoAIV-Tg)). SR-BI(hApoCIII-ApoAIV-Tg) mice had significantly lower plasma cholesterol levels compared with wild-type controls, yet SR-BI(hApoCIII-ApoAIV-Tg) mice had normal fractional cholesterol absorption and fecal neutral sterol excretion. Both in the absence or presence of ezetimibe, intestinal SR-BI overexpression had no impact on the amount of cholesterol excreted in the feces. To specifically study effects of intestinal SR-BI on TICE we crossed SR-BI(hApoCIII-ApoAIV-Tg) mice into a mouse model that preferentially utilized the TICE pathway for RCT (Niemann-Pick C1-like 1 liver transgenic), and likewise found no alterations in cholesterol absorption or fecal sterol excretion. Finally, mice lacking SR-BI in all tissues also exhibited normal cholesterol absorption and fecal cholesterol disposal. Collectively, these results suggest that SR-BI is not rate limiting for intestinal cholesterol absorption or for fecal neutral sterol loss through the TICE pathway.

  18. The Rb-Sr system

    International Nuclear Information System (INIS)

    Graham, I.J.


    This manual is intended to serve as a guide to the chemical procedures involved in Rb-Sr isotopic analysis as conducted at the Institute of Nuclear Sciences. Included are notes on the experimental developments made over the last 2.5 years, especially those involving rock dissolution and cation exchange chromatography

  19. Third European Stroke Science Workshop

    NARCIS (Netherlands)

    Dichgans, Martin; Planas, Anna M.; Biessels, Geert Jan|info:eu-repo/dai/nl/165576367; van der Worp, Bart|info:eu-repo/dai/nl/189855010; Sudlow, Cathie; Norrving, B.; Lees, Kennedy; Mattle, Heinrich P.


    Lake Eibsee, Garmisch-Partenkirchen, November 19 to 21, 2015: The European Stroke Organization convened >120 stroke experts from 27 countries to discuss latest results and hot topics in clinical, translational, and basic stroke research. Since its inception in 2011, the European Stroke Science

  20. Model of hospital-supported discharge after stroke

    DEFF Research Database (Denmark)

    Torp, Claus Rydahl; Vinkler, Sonja; Pedersen, Kirsten Damgaard


    BACKGROUND AND PURPOSE: Readmission rate within 6 months after a stroke is 40% to 50%. The purpose of the project was to evaluate whether an interdisciplinary stroke team could reduce length of hospital stay, readmission rate, increase patient satisfaction and reduce dependency of help. METHODS......: One hundred and ninety-eight patients with acute stroke were randomized into 103 patients whose discharge was supported by an interdisciplinary stroke team and 95 control patients who received standard aftercare. Baseline characteristics were comparable in the 2 groups. The patients were evaluated...... services. Furthermore, there was no significant difference in functional scores or patient satisfaction. CONCLUSIONS: In this setting we could not show benefit of an interdisciplinary stroke team supporting patients at discharge perhaps because standard aftercare was very efficient already....

  1. Dizziness in stroke

    Directory of Open Access Journals (Sweden)

    M. V. Zamergrad


    Full Text Available Differential diagnosis of new-onset acute vestibular vertigo is chiefly made between vestibular neuronitis and stroke. Dizziness in stroke is usually accompanied by other focal neurological symptoms of brainstem and cerebellar involvement. However, stroke may appear as isolated vestibular vertigo in some cases. An analysis of history data and the results of neurovestibular examination and brain magnetic resonance imaging allows stroke to be diagnosed in patients with acute isolated dizziness. The treatment of patients with stroke-induced dizziness involves a wide range of medications for the reduction of the degree of dizziness and unsteadiness and for the secondary prevention of stroke. Vestibular rehabilitation is an important component of treatment. The paper describes an observation of a patient with poorly controlled hypertension, who developed new-onset acute systemic dizziness. Vestibular neuronitis might be presumed to be a peripheral cause of vestibular disorders, by taking into account the absence of additional obvious neurological symptoms (such as pareses, defective sensation, diplopia, etc. and the nature of nystagmus. However, intention tremor in fingernose and heel-knee tests on the left side, a negative Halmagyi test, and results of Romberg’s test could suggest that stroke was a cause ofdizziness.

  2. One-Year Outcomes After Minor Stroke or High-Risk Transient Ischemic Attack: Korean Multicenter Stroke Registry Analysis. (United States)

    Park, Hong-Kyun; Kim, Beom Joon; Han, Moon-Ku; Park, Jong-Moo; Kang, Kyusik; Lee, Soo Joo; Kim, Jae Guk; Cha, Jae-Kwan; Kim, Dae-Hyun; Nah, Hyun-Wook; Park, Tai Hwan; Park, Sang-Soon; Lee, Kyung Bok; Lee, Jun; Hong, Keun-Sik; Cho, Yong-Jin; Lee, Byung-Chul; Yu, Kyung-Ho; Oh, Mi-Sun; Kim, Joon-Tae; Choi, Kang-Ho; Kim, Dong-Eog; Ryu, Wi-Sun; Choi, Jay Chol; Johansson, Saga; Lee, Su Jin; Lee, Won Hee; Lee, Ji Sung; Lee, Juneyoung; Bae, Hee-Joon


    Patients with minor ischemic stroke or transient ischemic attack are at high risk of recurrent stroke and vascular events, which are potentially disabling or fatal. This study aimed to evaluate contemporary subsequent vascular event risk after minor ischemic stroke or transient ischemic attack in Korea. Patients with minor ischemic stroke or high-risk transient ischemic attack admitted within 7 days of symptom onset were identified from a Korean multicenter stroke registry database. We estimated 3-month and 1-year event rates of the primary outcome (composite of stroke recurrence, myocardial infarction, or all-cause death), stroke recurrence, a major vascular event (composite of stroke recurrence, myocardial infarction, or vascular death), and all-cause death and explored differences in clinical characteristics and event rates according to antithrombotic strategies at discharge. Of 9506 patients enrolled in this study, 93.8% underwent angiographic assessment and 72.7% underwent cardiac evaluations; 25.1% had symptomatic stenosis or occlusion of intracranial arteries. At discharge, 95.2% of patients received antithrombotics (antiplatelet polytherapy, 37.1%; anticoagulation, 15.3%) and 86.2% received statins. The 3-month cumulative event rate was 5.9% for the primary outcome, 4.3% for stroke recurrence, 4.6% for a major vascular event, and 2.0% for all-cause death. Corresponding values at 1 year were 9.3%, 6.1%, 6.7%, and 4.1%, respectively. Patients receiving nonaspirin antithrombotic strategies or no antithrombotic agent had higher baseline risk profiles and at least 1.5× higher event rates for clinical event outcomes than those with aspirin monotherapy. Contemporary secondary stroke prevention strategies based on thorough diagnostic evaluation may contribute to the low subsequent vascular event rates observed in real-world clinical practice in Korea. © 2017 American Heart Association, Inc.

  3. The High Prevalence of Anxiety Disorders After Stroke. (United States)

    Cumming, Toby B; Blomstrand, Christian; Skoog, Ingmar; Linden, Thomas


    Previous studies indicate that post-stroke anxiety is common and persistent. We aimed to determine whether point prevalence of anxiety after stroke is higher than in the population at large, and whether the profile of anxiety symptoms is different. This case-control study was conducted in Göteborg, Sweden, with stroke patients recruited from the Sahlgrenska University Hospital and a comparison group selected from local population health studies. We included 149 stroke survivors (assessed at 20 months post-stroke) and 745 participants from the general population matched for age and sex. A comprehensive psychiatric interview was conducted, with anxiety and depressive disorders diagnosed according to DSM-III-R criteria. Those in the stroke group were significantly more likely than those in the comparison group to have generalized anxiety disorder (GAD) (27% versus 8%), phobic disorder (24% versus 8%) and obsessive-compulsive disorder (9% versus 2%). Multivariate regression indicated that being in the stroke group, female sex, and having depression were all significant independent associates of having an anxiety disorder. In terms of symptom profile, stroke survivors with GAD were significantly more likely to report vegetative disturbance than those in the comparison group with GAD but less likely to have observable muscle tension or reduced sleep. Point prevalence of anxiety disorders is markedly higher after stroke than in the general population, and this cannot be attributed to higher rates of comorbid depression. Copyright © 2016. Published by Elsevier Inc.

  4. Risk of ischemic stroke after atrial fibrillation diagnosis: A national sample cohort.

    Directory of Open Access Journals (Sweden)

    Mi Kyoung Son

    Full Text Available Atrial fibrillation (AF is a major risk factor for ischemic stroke and associated with a 5-fold higher risk of stroke. In this retrospective cohort study, the incidence of and risk factors for ischemic stroke in patients with AF were identified. All patients (≥30 years old without previous stroke who were diagnosed with AF in 2007-2013 were selected from the National Health Insurance Service-National Sample Cohort. To identify factors that influenced ischemic stroke risk, Cox proportional hazard regression analysis was conducted. During a mean follow-up duration of 3.2 years, 1022 (9.6% patients were diagnosed with ischemic stroke. The overall incidence rate of ischemic stroke was 30.8/1000 person-years. Of all the ischemic stroke that occurred during the follow-up period, 61.0% occurred within 1-year after AF diagnosis. Of the patients with CHA2DS2-VASc score of ≥2, only 13.6% were receiving warfarin therapy within 30 days after AF diagnosis. Relative to no antithrombotic therapy, warfarin treatment for >90 days before the index event (ischemic stroke in stroke patients and death/study end in non-stroke patients associated with decreased ischemic stroke risk (Hazard Ratio = 0.41, 95%confidence intervals = 0.32-0.53. Heart failure, hypertension, and diabetes mellitus associated with greater ischemic stroke risk. AF patients in Korea had a higher ischemic stroke incidence rate than patients in other countries and ischemic stroke commonly occurred at early phase after AF diagnosis. Long-term (>90 days continuous warfarin treatment may be beneficial for AF patients. However, warfarin treatment rates were very low. To prevent stroke, programs that actively detect AF and provide anticoagulation therapy are needed.

  5. Clinical neurogenetics: stroke. (United States)

    Rost, Natalia S


    Understanding the genetic architecture of cerebrovascular disease holds promise of novel stroke prevention strategies and therapeutics that are both safe and effective. Apart from a few single-gene disorders associated with cerebral ischemia or intracerebral hemorrhage, stroke is a complex genetic phenotype that requires careful ascertainment and robust association testing for discovery and validation analyses. The recently uncovered shared genetic contribution between clinically manifest stroke syndromes and closely related intermediate cerebrovascular phenotypes offers effective and efficient approaches to complex trait analysis. Copyright © 2013 Elsevier Inc. All rights reserved.

  6. Cost of stroke

    DEFF Research Database (Denmark)

    Jennum, Poul; Iversen, Helle K; Ibsen, Rikke


    . The attributable cost of direct net health care costs after the stroke (general practitioner services, hospital services, and medication) and indirect costs (loss of labor market income) were €10,720, €8,205 and €7,377 for patients, and €989, €1,544 and €1.645 for their partners, over and above that of controls......BACKGROUND: To estimate the direct and indirect costs of stroke in patients and their partners. DESCRIPTION: Direct and indirect costs were calculated using records from the Danish National Patient Registry from 93,047 ischemic, 26,012 hemorrhagic and 128,824 unspecified stroke patients...

  7. Determinan Penyakit Stroke

    Directory of Open Access Journals (Sweden)

    Woro Riyadina


    Full Text Available Penyakit stroke merupakan penyebab kematian dan kecacatan kronik yang paling tinggi pada kelompok umur diatas usia 45 tahun terbanyak di Indonesia. Tujuan penelitian ini untuk mengidentifikasi determinan utama yang berhubungan dengan penyakit stroke pada masyarakat di kelurahan Kebon Kalapa Bogor. Analisis lanjut terhadap 1.912 responden subset baseline data penelitian “Studi Kohort Faktor Risiko Penyakit Tidak Menular” Data dikumpulkan dengan metode wawancara pada penduduk tetap di kelurahan Kebon Kalapa, Kecamatan Bogor Tengah, Bogor tahun 2012. Diagnosis stroke berdasarkan anamnesis dan pemeriksaan dokter spesialis syaraf. Variabel independen meliputi karakteristik sosiodemografi, status kesehatan dan perilaku berisiko. Data dianalisis dengan uji regresi logistik ganda. Penyakit stroke ditemukan pada 49 (2,6% orang. Determinan utama stroke meliputi hipertensi (OR = 4,20; IK 95% = 2,20 – 8,03, penyakit jantung koroner (OR = 2,74; IK 95% = 1,51 – 4,99, diabetes melitus (OR = 2,89; IK 95% = 1,47 – 5,64, dan status ekonomi miskin (OR = 1,83 ; IK 95% = 1,03 – 3,33. Pencegahan penyakit stroke dilakukan dengan peningkatan edukasi (kampanye/penyuluhan melalui pengendalian faktor risiko utama yaitu hipertensi dan pencegahan terjadinya penyakit degeneratif lain yaitu penyakit jantung koroner dan diabetes melitus. Stroke disease is the leading cause of death and chronic disabi lity in most over the age of 45 years in Indonesia. The aim of study was to identify the major determinants of stroke disease in Kebon Kalapa community in Bogor. A deep analyze was conducted in 1.912 respondents based on the subset of baseline data “Risk Factors Cohort Study of Non Communicable Diseases.” Data was collected by interviews on Kebon Kalapa community, Bogor in 2012. Stroke diagnosis was determined by anamnesis and neu-rological examination with specialist. Independent variables were sociodemographic characteristics, health status and risk behavior

  8. The Migraine?Stroke Connection


    Lee, Mi Ji; Lee, Chungbin; Chung, Chin-Sang


    Migraine and stroke are common neurovascular disorders which share underlying physiological processes. Increased risks of ischemic stroke, hemorrhagic stroke, and subclinical ischemic lesions have been consistently found in migraineurs. Three possible associations are suggested. One is that underlying pathophysiology of migraine can lead to ischemic stroke. Second, common comorbidities between migraine and stroke can be present. Lastly, some syndromes can manifest with both migraine-like head...

  9. Persistence of locomotor-related interlimb reflex networks during walking after stroke. (United States)

    Zehr, E Paul; Loadman, Pamela M


    Cutaneous nerve stimulation evokes coordinated and phase-modulated reflex output widely distributed to muscles of all four limbs during walking. Accessibility to this distributed network after stroke offers insight into the pathological changes and suggests utility for therapeutic applications. Here we examined muscles in both the more (MA) and less affected (LA) legs evoked by stimulation at the ankle and wrist during walking in chronic (>6 months post CVA) stroke. Stroke and control participants walked on a treadmill with a harness support system. Reflexes were evoked with trains of electrical stimuli delivered separately to the cutaneous superficial peroneal (SP; at the ankle) and superficial radial (SR; at the wrist) nerves. Background locomotor and reflex EMG were phase-averaged across the gait cycle and analyzed off line. Locomotor background muscle activation patterns were altered bilaterally in stroke, as compared with control. Phase-dependent modulation of interlimb cutaneous reflexes was found in both stroke and control subjects with stimulation of each nerve, but responses were blunted in stroke. Reflex reversal in tibialis anterior (TA) at heel strike with SP nerve stimulation was present in both groups. Notably, SR nerve stimulation produced facilitation during the swing-to-stance transition in the TA and suppression of MG in the MA leg during stance. Interlimb cutaneous inputs may access coordinated reflex pathways in the MA limb during walking after stroke. Importantly activation in these pathways could provoke responses to counter foot drop during swing phase of walking. Additionally, our data support the perspective that there is no "unaffected" side after stroke and that caution should be used when interpreting the LA side as "control" after stroke. The presence of functionally-relevant interlimb cutaneous reflexes in the MA leg presents a substrate that may be strengthened by rehabilitation. Copyright © 2011 International Federation of Clinical

  10. Rapid method for determining Sr-89 and Sr-90 using Cherenkov and proportional counting; Schnellmethode zur Bestimmung von SR-89 und SR-90 durch Cerenkov- und Proportionalzaehlermessungen

    Energy Technology Data Exchange (ETDEWEB)

    Lange, S.; Wende, C.; Schwokowski, R.; Alisch-Mark, M.; Abraham, A.; Heinrich, T. [Staatliche Betriebsgesellschaft fuer Umwelt und Landwirtschaft, Radebeul (Germany)


    A rapid method for determining Sr-89 and Sr-90 in water, milk and biological samples has been developed and tested. After sample preparation strontium is separated by extraction chromatography using Sr resin. Eluate is divided and transfered to LSC vial and filter paper by SrCO{sub 3} precipitation. A Hidex 300 SL TDCR liquid scintillation counter and Thermo Fisher low level proportional counter have been used. Chemical yield of Sr-85 tracer is determined by Gamma spectroscopy. Uncertainty budget, decision threshold and detection limit are calculated in accordance with GUM and ISO 11929.

  11. Stroke awareness in the general population: knowledge of stroke risk factors and warning signs in older adults.

    LENUS (Irish Health Repository)

    Hickey, Anne


    BACKGROUND: Stroke is a leading cause of death and functional impairment. While older people are particularly vulnerable to stroke, research suggests that they have the poorest awareness of stroke warning signs and risk factors. This study examined knowledge of stroke warning signs and risk factors among community-dwelling older adults. METHODS: Randomly selected community-dwelling older people (aged 65+) in Ireland (n = 2,033; 68% response rate). Participants completed home interviews. Questions assessed knowledge of stroke warning signs and risk factors, and personal risk factors for stroke. RESULTS: Of the overall sample, 6% had previously experienced a stroke or transient ischaemic attack. When asked to identify stroke risk factors from a provided list, less than half of the overall sample identified established risk factors (e.g., smoking, hypercholesterolaemia), hypertension being the only exception (identified by 74%). Similarly, less than half identified established warning signs (e.g., weakness, headache), with slurred speech (54%) as the exception. Overall, there were considerable gaps in awareness with poorest levels evident in those with primary level education only and in those living in Northern Ireland (compared with Republic of Ireland). CONCLUSION: Knowledge deficits in this study suggest that most of the common early symptoms or signs of stroke were recognized as such by less than half of the older adults surveyed. As such, many older adults may not recognise early symptoms of stroke in themselves or others. Thus, they may lose vital time in presenting for medical attention. Lack of public awareness about stroke warning signs and risk factors must be addressed as one important contribution to reducing mortality and morbidity from stroke.

  12. Sex differences in stroke: a socioeconomic perspective

    Directory of Open Access Journals (Sweden)

    Delbari A


    Full Text Available Ahmad Delbari,1 Farzane Keyghobadi,2 Yadollah Abolfathi Momtaz,1,3 Fariba Keyghobadi,2 Reza Akbari,2 Houman Kamranian,2 Mohammad Shouride Yazdi,2 Sayed Shahaboddin Tabatabaei,1 Seyed-Mohammad Fereshtehnejad4 1Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; 2Research Center on Healthy Aging, Sabzevar University of Medical Sciences, Sabzevar, Khorasan, Iran; 3Malaysian Research Institute on Ageing (MyAgeing™, Universiti Putra Malaysia, Serdang, Selangor, Malaysia; 4Department of Neurobiology, Division of Clinical Geriatrics, Care Sciences and Society (NVS, Karolinska Institutet, Stockholm, Sweden Background: A number of studies have explored the issue of sex differences in stroke from biomedical perspective; however, there are still large gaps in the existing knowledge. The purpose of this study was to assess whether the differences in socioeconomic status and living conditions between men and women may explain the part of the sex differences in incidence and outcomes of stroke. Methods: All stroke participants aged ≥60 years admitted in Vaseie Hospital in Sabzevar, Iran, from March 21, 2013, until March 20, 2014, were included in this study. Computerized tomography and magnetic resonance imaging were used to confirm stroke. A series of χ2 tests were performed and Statistical Program for Social Sciences, Version 21.0, was used to investigate the potential differences between older men and women in stroke incidence and outcomes. Results: A total of 159 incident stroke cases were documented during 1 year. The annual rate of stroke was statistically significantly higher in elderly women than in elderly men (401 vs 357 per 100,000; P<0.001. Female elderly participants had significantly lower socioeconomic status, poorer living conditions, and higher lifetime history of depression, hypertension, and diabetes mellitus than their male counterparts. Conclusion: The findings from this study

  13. Sr Isotopes at the Onset of the Ice Ages at the Northern Apennines (United States)

    Fuchs, Rita; Lazar, Boaz; Angiolini, Lucia; Crippa, Gaia; Stein, Mordechai


    show normal late Pliocene - early Pleistocene marine values of 87Sr/86Sr ratios (˜ 0.709). On the other hand, the calcite skeleton organisms from the same bed, Ostrea edulis (bivalve) and Terebratula scillae (brachiopod), show continental effect on the 87Sr/86Sr isotopes (values ranging from 0.7084 to 0.7089). It should be noted that these two groups of organisms have also different life styles and metabolic rates. Measuring the δ88/86Sr values on the fossils with "normal" marine radiogenic Sr composition and those with continental radiogenic Sr signal may provide additional constraints on the sources and processes that affected the geochemistry of these species and yield a reliable marine δ88/86Sr value for that period.

  14. Stroke - risk factors (United States)

    ... Brain cells can die, causing lasting damage. Risk factors are things that increase your chance of getting ... disease or condition. This article discusses the risk factors for stroke and things you can do to ...

  15. Post-Stroke Rehabilitation (United States)

    ... negotiate the provision of reasonable accommodations in the workplace. When can a stroke patient begin rehabilitation? Rehabilitation ... at home gives people the advantage of practicing skills and developing compensatory strategies in the context of ...

  16. A Stroke of Language (United States)

    Blaisdell, Bob


    The author reflects on foreign-language learning by his EFL students as well as his own foreign-language learning. He concludes by musing on the possible and fantastical devastation on language-ability wrought by strokes.

  17. Epilepsy after stroke

    DEFF Research Database (Denmark)

    Olsen, T S; Høgenhaven, H; Thage, O


    Development of epilepsy was studied prospectively in a group of 77 consecutive stroke patients. Included were stroke patients less than 75 years old admitted within the first 3 days after the stroke. Excluded were patients with subarachnoid hemorrhage, vertebrobasilar stroke, and patients...... with other severe diseases. Cerebral angiography, CT, and EEG were performed in all patients. The patients were followed clinically for 2 to 4 years. Seven patients (9%) developed epilepsy. Of 23 patients with lesions involving the cortex, 6 (26%) developed epilepsy. Of 54 patients in whom the cortex...... was not involved, only 1 (2%) developed epilepsy. Patients with persisting paresis and cortical involvement seem to be at particularly high risk of developing epilepsy, as 50% of such patients (6 of 12) developed the disease....

  18. The "Know Stroke" Campaign (United States)

    ... Issue Past Issues Special Section The "Know Stroke" Campaign Past Issues / Summer 2007 Table of Contents For ... Javascript on. NINDS is conducting a public awareness campaign across the United States to educate people about ...

  19. Communication disorders after stroke in Aboriginal Australians. (United States)

    Armstrong, Elizabeth; Hersh, Deborah; Hayward, Colleen; Fraser, Joan


    Limited research exists on acquired communication disorders (ACD) in Aboriginal Australians despite their high rates of stroke. Their uptake of rehabilitation services is low, and little information is available on functional consequences for this population. This pilot study explored consequences of ACD for Aboriginal Australians after stroke, including their experiences of services received. Semi-structured interviews were collected with 13 Aboriginal people with ACD, and family members, in Perth. Ages ranged from 30 to 78 years and time post stroke from 0.5 to 29 years. A qualitative, thematic analysis of interview transcripts was undertaken. The key themes which emerged were "getting on with life", coping with change, independence/interdependence, the importance of communication for maintaining family and community connection, role and identity issues and viewing the stroke consequences within the broader context of co-morbidities. While similar life disruptions were found to those previously reported in the general stroke population, this study highlighted differences, which reflect the particular context of ACD for Aboriginal people and which need to be considered when planning future services. While implications are limited due to small numbers, the findings emphasise the importance of a holistic approach, and integration of communication treatments into community-led social activities. Implications for Rehabilitation Aboriginal Australians frequently experience a range of concurrent and complex co-morbidities and demanding social or family circumstances at the same time as coping with communication disorders post-stroke. A holistic approach to post stroke rehabilitation may be appropriate with services that accommodate communication disorders, delivered in collaboration with Aboriginal organisations, emphasising positive attitudes and reintegration into community as fully as possible. Communication and yarning are important for maintaining family and

  20. Cognitive impairment and stroke in elderly patients

    Directory of Open Access Journals (Sweden)

    Lo Coco D


    Full Text Available Daniele Lo Coco,1 Gianluca Lopez,1 Salvatore Corrao,2,31Neurology and Stroke Unit, 2Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, 3Centre of Research for Effectiveness and Appropriateness in Medicine (C.R.E.A.M., Di.Bi.M.I.S., University of Palermo, Palermo, Italy Abstract: We reviewed current knowledge about the interaction between stroke and vascular risk factors and the development of cognitive impairment and dementia. Stroke is increasingly recognized as an important cause of cognitive problems and has been implicated in the development of both Alzheimer's disease and vascular dementia. The prevalence of cognitive impairment after stroke is high, and their combined effects significantly increase the cost of care and health resource utilization, with reflections on hospital readmissions and increased mortality rates. There is also substantial evidence that vascular risk factors (such as hypertension, diabetes, obesity, dyslipidemia, and tobacco smoking are independently associated with an increased risk of cognitive decline and dementia. Thus, a successful management of these factors, as well as optimal acute stroke management, might have a great impact on the development of cognitive impairment. Notwithstanding, the pathological link between cognitive impairment, stroke, and vascular risk factors is complex and still partially unclear so that further studies are needed to better elucidate the boundaries of this relationship. Many specific pharmacological treatments, including anticholinergic drugs and antihypertensive medications, and nonpharmacological approaches, such as diet, cognitive rehabilitation, and physical activity, have been studied for patients with vascular cognitive impairment, but the optimal care is still far away. Meanwhile, according to the most recent knowledge, optimal stroke care should also include cognitive assessment in the

  1. In vitro and in vivo studies on a Mg-Sr binary alloy system developed as a new kind of biodegradable metal. (United States)

    Gu, X N; Xie, X H; Li, N; Zheng, Y F; Qin, L


    Magnesium alloys have shown potential as biodegradable metallic materials for orthopedic applications due to their degradability, resemblance to cortical bone and biocompatible degradation/corrosion products. However, the fast corrosion rate and the potential toxicity of their alloying element limit the clinical application of Mg alloys. From the viewpoint of both metallurgy and biocompatibility, strontium (Sr) was selected to prepare hot rolled Mg-Sr binary alloys (with a Sr content ranging from 1 to 4 wt.%) in the present study. The optimal Sr content was screened with respect to the mechanical and corrosion properties of Mg-Sr binary alloys and the feasibility of the use of Mg-Sr alloys as orthopedic biodegradable metals was investigated by in vitro cell experiments and intramedullary implantation tests. The mechanical properties and corrosion rates of Mg-Sr alloys were dose dependent with respect to the added Sr content. The as-rolled Mg-2Sr alloy exhibited the highest strength and slowest corrosion rate, suggesting that the optimal Sr content was 2 wt.%. The as-rolled Mg-2Sr alloy showed Grade I cytotoxicity and induced higher alkaline phosphatase activity than the other alloys. During the 4 weeks implantation period we saw gradual degradation of the as-rolled Mg-2Sr alloy within a bone tunnel. Micro-computer tomography and histological analysis showed an enhanced mineral density and thicker cortical bone around the experimental implants. Higher levels of Sr were observed in newly formed peri-implant bone compared with the control. In summary, this study shows that the optimal content of added Sr is 2 wt.% for binary Mg-Sr alloys in the rolled state and that the as-rolled Mg-2Sr alloy in vivo produces an acceptable host response. Copyright © 2012 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

  2. Acute ischemic stroke--from symptom recognition to thrombolysis. (United States)

    Kurz, M W; Kurz, K D; Farbu, E


    The understanding of stroke has changed in the recent years from rehabilitation to an emergency approach. We review existing data from symptom recognition to thrombolysis and identify challenges in the different phases of patient treatment. Implementation of treatment in dedicated stroke units with a multidisciplinary team exclusively treating stroke patients has led to significant reduction of stroke morbidity and mortality. Yet, first the introduction of treatment with intravenous rtPA (IVT) has led to the 'time is brain' concept where stroke is conceived as an emergency. As neuronal death in stroke is time dependent, all effort should be laid on immediate symptom recognition, rapid transport to the nearest hospital with a stroke treatment facility and diagnosis and treatment as soon as possible. The main cause of prehospital delay is that patients do not recognize that they suffered a stroke or out of other reasons do not call the Emergency Medical Services immediately. Educational stroke awareness campaigns may have an impact in increasing the number of patients eligible for rtPA treatment and can decrease the prehospital times if they are directed both to the public and to the medical divisions treating stroke. Stroke transport times can be shortened by the use of helicopter and a stroke mobile--an ambulance equipped with a CT scanner--may be helpful to decrease time from onset to treatment start in the future. Yet, IVT has several limitations such as a narrow time window and a weak effect in ischemic strokes caused by large vessel occlusions. In these cases, interventional procedures and the concept of bridging therapy, a combined approach of IVT and intraarterial thrombolysis or mechanical thrombectomy, might improve recanalization rates and patient outcome. As neuronal death in stroke patients occurs in a time-dependent fashion, all effort should be made to decrease time from symptom onset to treatment start with rtPA: major challenges are stroke

  3. Report on the assessment of the heat stress in working places, underground in the mines. Part 3: An examination of the extent to which metabolic rate is taken into account by the P4SR index

    CSIR Research Space (South Africa)

    Wyndham, CH


    Full Text Available In this report for the Transvaal and Orange Free State Chamber of Mines Research Organization, a detailed analysis is made of the effect of different metabolic rates, corresponding to light, moderate and hard work, on the rectal temperatures, heart...

  4. Access to expert stroke care with telemedicine: REACH MUSC

    Directory of Open Access Journals (Sweden)

    Abby Swanson Kazley


    Full Text Available Stroke is a leading cause of death and disability, and rtPA can significantly reduce the long-term impact of acute ischemic stroke (AIS if given within 3 hours of symptom onset. South Carolina is located in the stroke belt and has a high rate of stroke and stroke mortality. Many small rural SC hospitals do not maintain the expertise needed to treat AIS patients with rtPA. MUSC is an academic medical center using REACH MUSC telemedicine to deliver stroke care to 15 hospitals in the state, increasing the likelihood of timely treatment with rtPA. The purpose of this study is to determine the increase in access to rtPA through the use of telemedicine for AIS in the general population and in specific segments of the population based on age, gender, race, ethnicity, education, urban/rural residence, poverty, and stroke mortality.We used a retrospective cross-sectional design examining Census data from 2000 and Geographic Information Systems (GIS analysis to identify South Carolina residents that live within 30 or 60 minutes of a Primary Stroke Center (PSC or a REACH MUSC site. We include all South Carolina citizens in our analysis and specifically examine the population’s age, gender, race, ethnicity, education, urban/rural residence, poverty, and stroke mortality. Our sample includes 4,012,012 South Carolinians. The main measure is access to expert stroke care at a Primary Stroke Center (PSC or a REACH MUSC hospital within 30 or 60 minutes. We find that without REACH MUSC, only 38% of the population has potential access to expert stroke care in SC within sixty minutes given that most PSCs will maintain expert stroke coverage. REACH MUSC allows 76% of the population to be within sixty minutes of expert stroke care, and 43% of the population to be within 30 minute drive time of expert stroke care. These increases in access are especially significant for groups that have faced disparities in care and high rates of AIS. The use of telemedicine can

  5. Increase of Meningitis Risk in Stroke Patients in Taiwan

    Directory of Open Access Journals (Sweden)

    Chie-Hong Wang


    Full Text Available Background and purposeThe blood–brain barrier (BBB not only provides a physical obstruction but also recruits and activates neutrophils in cases of infection. Hemorrhagic or ischemic stroke reportedly induces the disruption of the BBB. However, few studies have reported a correlation between the incidence of meningitis in patients with a history of stroke. This study tested the hypothesis that patients with a history of stroke may be more vulnerable to meningitis.MethodsStroke and age-matched comparison (n = 29,436 and 87,951, respectively cohorts were recruited from the Taiwan National Health Insurance database (2000–2011. Correlations between the two cohorts were evaluated by Cox proportional hazard regression model, Kaplan–Meier curve, and log-rank tests.ResultsThe incidence of meningitis was higher in the stroke cohort compared to that in the comparison cohort [hazard ratio (HR, 2.89; 95% confidence interval (CI, 2.23–3.74, p < 0.001]. After adjusting for age, sex, and comorbidities, the estimated HR in the stroke cohort was 2.55-fold higher than that in the comparison cohort (CI, 1.94–3.37; p < 0.001. Notably, patients who had experienced hemorrhagic stroke had a higher incidence rate of meningitis than those with a history of ischemic stroke, except for patients older than 75 years (incidence rates in hemorrhagic/ischemic stroke patients, 3.14/1.48 in patients younger than 45 years, 1.52/0.41 in 45- to 64-year group, 1.15/0.90 in 65- to 74-year group, 0.74/0.93 in patients older than 75 years. Moreover, stroke patients who had undergone head surgery had the highest meningitis risk (adjusted HR, 8.66; 95% CI, 5.55–13.5; p < 0.001 followed by stroke patients who had not undergone head surgery (adjusted HR, 2.11; 95% CI, 1.57–2.82; p < 0.001.ConclusionOur results indicated that stroke patients have higher risks of meningitis. Compromised BBB integrity in stroke patients may lead to increased

  6. Telestroke in stroke survivors. (United States)

    Joubert, Jacques; Joubert, Lynette B; de Bustos, Elizabeth Medeiros; Ware, Dallas; Jackson, David; Harrison, Terrence; Cadilhac, Dominique


    Stroke is a high-frequency disorder placing a significant burden on the health care systems, being the foremost cause of complex chronic disability in adults. Devising systems that can enhance the prevention of stroke recurrence is an important priority and challenge in both the developed and the developing world. The potential for recurrent stroke can be substantially reduced by effective management of vascular risk factors. Telestroke is a tool with potential application to improve risk management of stroke survivors. Lack of acknowledgment of existing practices as well as lack of awareness of potential financial barriers to diffusion of telestroke can lead to limited implementation. Telestroke offers service providers the opportunity to access large numbers of stroke survivors targeting secondary prevention. The ideal 'telestroke model' provides service support, education for the patient and caregiver, as well as integration of specialist and primary care services. Effective use of technological advances, with adequate recognition of the importance of human interaction in the long-term management of a largely elderly population of stroke survivors is challenging but possible. Telestroke should be systems- and not technology-driven. Barriers in the implementation of telestroke have been identified as insufficient planning of IT infrastructure, lack of long-term vision for sustainability, a lack of contextual perspective as well as poor communication across domains. Future telestroke models should provide effective action in an integrated model of care recognizing and involving all existing players and practices. (c) 2009 S. Karger AG, Basel.

  7. Autopsy approach to stroke. (United States)

    Love, Seth


    Stroke is a major cause of morbidity and mortality but the brain and other relevant tissues are often examined only cursorily when stroke patients come to autopsy. The pathological findings and clinical implications vary according to the type of stroke and its location and cause. Large ischaemic strokes are usually associated with atherosclerosis of extracranial or major intracranial arteries but can be caused by dissection. Most small cerebral infarcts are caused by arteriosclerosis or, in the elderly, cerebral amyloid angiopathy (CAA). However, vasculitides and coagulopathies can cause a range of different patterns of ischaemic (and, occasionally, haemorrhagic) stroke. Global brain ischaemia, caused by severe hypotension or raised intracranial pressure, produces damage that is accentuated in certain regions and neuronal populations and may be confused with hypoglycaemic injury. The main cause of subarachnoid haemorrhage is a ruptured berry aneurysm but CAA, arteriovenous malformations and infective aneurysms are occasionally responsible. These can also cause parenchymal brain haemorrhage, although this most often complicates hypertensive small vessel disease. Sometimes the haemorrhage arises from a neoplasm. Performing an adequate autopsy in stroke requires proper preparation, awareness of the likely pathological processes, familiarity with intracranial vascular anatomy, careful gross examination and dissection, and appropriate use of histology. © 2010 Blackwell Publishing Limited.

  8. Post-stroke dyskinesias

    Directory of Open Access Journals (Sweden)

    Nakawah MO


    Full Text Available Mohammad Obadah Nakawah, Eugene C Lai Stanely H. Appel Department of Neurology, Houston Methodist Neurological Institute, Houston, TX, USA Abstract: Strokes, whether ischemic or hemorrhagic, are among the most common causes of secondary movement disorders in elderly patients. Stroke-related (vascular movement disorders, however, are uncommon complications of this relatively common disease. The spectrum of post-stroke movement disorders is broad and includes both hypo- and hyperkinetic syndromes. Post-stroke dyskinesias are involuntary hyperkinetic movements arising from cerebrovascular insults and often present with mixed phenotypes of hyperkinesia which can sometimes be difficult to classify. Nevertheless, identification of the most relevant motor phenotype, whenever possible, allows for a more specific phenomenological categorization of the dyskinesia and thus helps guide its treatment. Fortunately, post-stroke dyskinesias are usually self-limiting and resolve within 6 to 12 months of onset, but a short-term pharmacotherapy might sometimes be required for symptom control. Functional neurosurgical interventions targeting the motor thalamus or globus pallidus interna might be considered for patients with severe, disabling, and persistent dyskinesias (arbitrarily defined as duration longer than 12 months. Keywords: vascular dyskinesia, stroke, movement disorders

  9. Improving Outcomes Achieved by a New Stroke Program in Hungary

    Directory of Open Access Journals (Sweden)

    Csilla Égi


    Full Text Available Background: Stroke is a devastating disease with increasing incidence and prevalence due to population aging. Even with the best care, a proportion of patients dies or is left with significant neurological and cognitive disability. Organization of stroke centers markedly improved outcomes worldwide. We initiated a ‘lysis alarm' program in September 2013 at our medical center. Methods: This is a retrospective review of electronic data from patients with acute ischemic stroke before (October 2012-June 2013 and after (October 2013-June 2014 the ‘lysis alarm' program was introduced at our medical center. Results: Prior to the introduction of the stroke program, there were only 19 thrombolysis procedures in 777 acute stroke patients in 9 months, while this figure rose to 32 thrombolysis procedures in 737 acute stroke patients after the initiation of the program. The ‘door-to-needle' time decreased from 88 to 71 min when the two study periods were compared. These changes were associated with decreased stroke mortality in patients receiving thrombolytic treatment (16% prior to the program and 9% during the program. In 2013, there were 1,439 thrombolysis procedures, representing 3.2% of all stroke cases throughout Hungary. After the introduction of the ‘lysis alarm' program, we have reached a 4% thrombolysis rate at our medical center. Conclusions: Our thrombolysis rate is higher than the national average, but still low compared to the rates of Western European countries. We are continuously working to enhance our stroke program. Here, we discuss those components that need to be further refined in order to improve stroke intervention and outcome.

  10. Fraction of stroke mortality attributable to alcohol consumption in Russia. (United States)

    Y E, Razvodovsky


    Stroke is an international health problem with high associated human and economic costs. The mortality rate from stroke in Russia is one of the highest in the world. Risk factors identification is therefore a high priority from the public health perspective. Epidemiological evidence suggests that binge drinking is an important determinant of high stroke mortality rate in Russia. The aim of the present study was to estimate the premature stroke mortality attributable to alcohol abuse in Russia on the basis of aggregate-level data of stroke mortality and alcohol consumption. Age-standardized sex-specific male and female stroke mortality data for the period 1980-2005 and data on overall alcohol consumption were analyzed by means ARIMA time series analysis. The results of the analysis suggest that 26.8% of all male stroke deaths and 18.4% female stroke deaths in Russia could be attributed to alcohol. The estimated alcohol-attributable fraction for men ranged from 16.2% (75+ age group) to 57,5% (30-44 age group) and for women from 21.7% (60-74 age group) and 43.5% (30- 44 age group). The outcomes of this study provide support for the hypothesis that alcohol is an important contributor to the high stroke mortality rate in Russian Federation. Therefore prevention of alcohol-attributable harm should be a major public health priority in Russia. Given the distribution of alcohol-related stroke deaths, interventions should be focused on the young and middle-aged men and women.

  11. Effect of Sr Additive Amount and Holding Time on Microstructure of A390 Aluminum Alloy (United States)

    Zhang, J. H.; Xing, S. M.; Han, Q. Y.; Guo, Q.; Wang, R. F.


    The microstructure of A390 alloy under different Sr additive amounts and holding times was studied by means of direct reading spectrum analysis, energy spectrum analysis, optical microscope and electron microscope. The results show that Sr has a good modification to eutectic Si, while it has a negative effect on primary silicon. The Sr addition will increase the size of primary silicon. When the addition amount of Al-10Sr alloy is 0.6%, the modification of eutectic silicon is the optimum. The Sr has a short incubation period and a fine modification at 10min, but it is more serious burning rate in small furnace smelting, and the modification effect disappears basically after 100min.

  12. Nursing care for stroke patients

    DEFF Research Database (Denmark)

    Tulek, Zeliha; Poulsen, Ingrid; Gillis, Katrin


    AIMS AND OBJECTIVES: To conduct a survey of the clinical nursing practice in European countries in accordance with the European Stroke Strategies (ESS) 2006, and to examine to what extent the ESS have been implemented in stroke care nursing in Europe. BACKGROUND: Stroke is a leading cause of death...... comprising 61 questions based on the ESS and scientific evidence in nursing practice was distributed to representatives of the European Association of Neuroscience Nurses, who sent the questionnaire to nurses active in stroke care. The questionnaire covered the following areas of stroke care: Organization...... of stroke services, Management of acute stroke and prevention including basic care and nursing, and Secondary prevention. RESULTS: Ninety-two nurses in stroke care in 11 European countries participated in the survey. Within the first 48 hours after stroke onset, 95% monitor patients regularly, 94% start...

  13. Improving public education about stroke. (United States)

    Alberts, Mark J


    Stroke is a common and serious disease. Most studies have shown that basic public knowledge about what a stroke is, symptoms of a stroke, and the proper reaction to a stroke is quite deficient. The fact that a stroke affects cognitive, communicative, and motor functions may partially explain the poor reaction to acute stroke symptoms. Several educational studies, using diverse formats and messaging paradigms, have been shown to positively affect public knowledge of stroke symptoms. Such efforts have often used mass media public education campaigns with an emphasis on recognizing symptoms of an acute stroke. Some have been able to demonstrate an increase in the chance of patients (or by-standers) calling 911 and seeking emergency care. However, many programs were of brief duration, and their long-term benefits are uncertain. Continual educational efforts will be needed to improve stroke knowledge and increase the percentage of patients who seek emergency care. © 2012 New York Academy of Sciences.

  14. Communication activity in stroke patients with aphasia. (United States)

    Mazaux, Jean-Michel; Lagadec, Tiphaine; de Sèze, Mathieu Panchoa; Zongo, Drissa; Asselineau, Julien; Douce, Emmanuelle; Trias, Joel; Delair, Marie-France; Darrigrand, Bénédicte


    To study communication disability in stroke patients with aphasia. Prospective, multicentric cohort study of patients with aphasia, consecutively included after a first stroke, and examined 1 year later at home. Assessment included a stroke severity scale, the Barthel Index, the boston diagnostic aphasia examination, a communication questionnaire, and the aphasia depression rating scale. A total of 164 patients were included. Among the 100 survivors assessed at follow-up, 24% had severe aphasia, 12% moderate aphasia and 64% mild aphasia according to the Boston diagnostic aphasia examination severity score. Patients mainly reported difficulties in conversation with strangers and/or on abstract topics, using a phone, reading and writing administrative documents, dealing with money and outdoor communication activities. Communication was strongly related to aphasia severity. Age, gender, education level, residence status and type of stroke had no influence on communication activity. On multivariate analysis, severity of stroke and severity of aphasia on inclusion were found to account for 58% of variance and were independent predictors of the communication questionnaire score at follow-up. Documenting the most impaired communication skills may help to set priority goals for speech and language therapy in aphasia.

  15. Bioactive SrO-SiO2 glass with well-ordered mesopores: characterization, physiochemistry and biological properties. (United States)

    Wu, Chengtie; Fan, Wei; Gelinsky, Michael; Xiao, Yin; Simon, Paul; Schulze, Renate; Doert, Thomas; Luo, Yongxiang; Cuniberti, Gianaurelio


    For a biomaterial to be considered suitable for bone repair it should ideally be both bioactive and have a capacity for controllable drug delivery; as such, mesoporous SiO(2) glass has been proposed as a new class of bone regeneration material by virtue of its high drug-loading ability and generally good biocompatibility. It does, however, have less than optimum bioactivity and controllable drug delivery properties. In this study, we incorporated strontium (Sr) into mesoporous SiO(2) in an effort to develop a bioactive mesoporous SrO-SiO(2) (Sr-Si) glass with the capacity to deliver Sr(2+) ions, as well as a drug, at a controlled rate, thereby producing a material better suited for bone repair. The effects of Sr(2+) on the structure, physiochemistry, drug delivery and biological properties of mesoporous Sr-Si glass were investigated. The prepared mesoporous Sr-Si glass was found to have an excellent release profile of bioactive Sr(2+) ions and dexamethasone, and the incorporation of Sr(2+) improved structural properties, such as mesopore size, pore volume and specific surface area, as well as rate of dissolution and protein adsorption. The mesoporous Sr-Si glass had no cytotoxic effects and its release of Sr(2+) and SiO(4)(4-) ions enhanced alkaline phosphatase activity - a marker of osteogenic cell differentiation - in human bone mesenchymal stem cells. Mesoporous Sr-Si glasses can be prepared to porous scaffolds which show a more sustained drug release. This study suggests that incorporating Sr(2+) into mesoporous SiO(2) glass produces a material with a more optimal drug delivery profile coupled with improved bioactivity, making it an excellent material for bone repair applications. Copyright © 2010 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

  16. Impact of emergency medical services stroke routing protocols on Primary Stroke Center certification in California. (United States)

    Schuberg, Sam; Song, Sarah; Saver, Jeffrey L; Mack, William J; Cen, Steven Y; Sanossian, Nerses


    Organized stroke systems of care include Primary Stroke Center (PSC) certification and preferential emergency medical services (EMS) routing of suspected patients with stroke to designated PSCs. Stroke EMS routing is not nationally governed; in California, routing is determined by county. EMS routing policies might provide an incentive for PSC accreditation. We evaluated the relationship between independent adoption of EMS routing protocols and PSC designation acquisition in California. Dates of PSC certification were obtained through The Joint Commissions Website and confirmatory calls to stroke coordinators. Starting date of county EMS PSC routing policies was obtained from county EMS agencies. We provide descriptive analysis of number of hospitals achieving PSC designation relative to implementation of EMS routing policies for all counties with PSCs. By June 2012, there were 131 California PSCs in 27 counties, and 22 of 58 counties had implemented EMS routing policies. The greatest number of PSCs was in Los Angeles (30) followed by San Diego (11), Orange (9), and Santa Clara (9) counties. Achievement of PSC designation occurred more frequently immediately before and after EMS routing: 51 PSCs (39%) within 1 year; 85 PSCs (65%) within 2 years. The yearly rate of eligible hospital conversion to PSC designation accelerated concurrent with EMS diversion policy adoption from 3.8% before to 16.2% during and decelerated afterward to 7.6%. Implementation of EMS routing policies may be an important factor driving PSC certification. National adoption of stroke routing policies may lead to more PSCs, positively impacting patient care.

  17. Toxicity of inhaled 90SrCl2 in Beagle dogs. XIII

    International Nuclear Information System (INIS)

    Muggenburg, B.A.; Hahn, F.F.; Boecker, B.B.; Jones, R.K.; McClellan, R.O.; Pickrell, J.A.


    The metabolism, dosimetry and biological effects of inhaled 90 SrCl 2 in the Beagle dog are being studied to provide a basis for assessing the consequences of inhaling 90 Sr such as might be released in certain nuclear accidents. Seventy-two dogs were exposed to aerosols containing 90 Sr resulting in initial body burdens ranging from 2.5 to 250 μCi 90 Sr/kg body weight. To date, 60 90 Sr-exposed dogs have died or have been euthanized, six during the first 31 days after inhalation of 90 Sr with bone marrow aplasia and 54 between 585 and 5109 days after inhalation of 90 Sr. The latter group includes 32 dogs with bone-related neoplasms, two with upper respiratory tract carcinomas and five dogs with various diseases of the lower respiratory tract and heart. The other 15 dogs and diseases in organs that received little or no radiation dose, such as the gastrointestinal tract, urinary tract and the central nervous system. The skeletons of the dogs dying with bone-related neoplasms received initial radiation dose rates of 3.2 to 55 rads/day and cumulative doses to death of 2800 to 22 000 rads. Fourteen control dogs have died or been euthanized, two during the last year with mammary carcinoma and intestinal lymphosarcoma. Serial observations are continuing on the six surviving 90 Sr dogs and six controls

  18. Relearning the Basics: Rehabilitation after a Stroke (United States)

    ... of this page please turn Javascript on. Feature: Stroke Rehabilitation Relearning the Basics: Rehabilitation After a Stroke Past ... to help them recover successfully. What is post-stroke rehabilitation? Rehab helps stroke survivors relearn skills lost to ...

  19. Stroke of a cardiac myxoma origin. (United States)

    Yuan, Shi-Min; Humuruola, Gulimila


    The clinical features of cardiac myxoma stroke have not been sufficiently described. Debates remain concerning the options and timing of treatment and the clinical outcomes are unknown. This article aims to highlight the pertinent aspects of this rare condition. Data source of the present study came from a comprehensive literature collection of cardiac myxoma stroke in PubMed, Google search engine and Highwire Press for the year range 2000-2014. Young adults, female predominance, single cerebral vessel (mostly the middle cerebral artery), multiple territory involvements and solitary left atrial myxoma constituted the outstanding characteristics of this patient setting. The most common affected cerebral vessel (the middle cerebral artery) and areas (the basal ganglion, cerebellum and parietal and temporal regions) corresponded well to the common manifestations of this patient setting, such as conscious alteration, ataxia, hemiparesis and hemiplegia, aphasia and dysarthria. Initial computed tomography scan carried a higher false negative rate for the diagnosis of cerebral infarction than magnetic resonance imaging did. A delayed surgical resection of cardiac myxoma was associated with an increased risk of potential consequences in particular otherwise arterial embolism. The mortality rate of this patient population was 15.3%. Cardiac myxoma stroke is rare. Often does it affect young females. For an improved diagnostic accuracy, magnetic resonance imaging of the brain and echocardiography are imperative for young stroke patients in identifying the cerebral infarct and determining the stroke of a cardiac origin. Immediate thrombolytic therapy may completely resolve the cerebral stroke and improve the neurologic function of the patients. An early surgical resection of cardiac myxoma is recommended in patients with not large territory cerebral infarct.

  20. Stroke of a cardiac myxoma origin

    Directory of Open Access Journals (Sweden)

    Shi-Min Yuan


    Full Text Available AbstractObjective:The clinical features of cardiac myxoma stroke have not been sufficiently described. Debates remain concerning the options and timing of treatment and the clinical outcomes are unknown. This article aims to highlight the pertinent aspects of this rare condition.Methods:Data source of the present study came from a comprehensive literature collection of cardiac myxoma stroke in PubMed, Google search engine and Highwire Press for the year range 2000-2014.Results:Young adults, female predominance, single cerebral vessel (mostly the middle cerebral artery, multiple territory involvements and solitary left atrial myxoma constituted the outstanding characteristics of this patient setting. The most common affected cerebral vessel (the middle cerebral artery and areas (the basal ganglion, cerebellum and parietal and temporal regions corresponded well to the common manifestations of this patient setting, such as conscious alteration, ataxia, hemiparesis and hemiplegia, aphasia and dysarthria. Initial computed tomography scan carried a higher false negative rate for the diagnosis of cerebral infarction than magnetic resonance imaging did. A delayed surgical resection of cardiac myxoma was associated with an increased risk of potential consequences in particular otherwise arterial embolism. The mortality rate of this patient population was 15.3%.Conclusion:Cardiac myxoma stroke is rare. Often does it affect young females. For an improved diagnostic accuracy, magnetic resonance imaging of the brain and echocardiography are imperative for young stroke patients in identifying the cerebral infarct and determining the stroke of a cardiac origin. Immediate thrombolytic therapy may completely resolve the cerebral stroke and improve the neurologic function of the patients. An early surgical resection of cardiac myxoma is recommended in patients with not large territory cerebral infarct.

  1. Neighborhood cohesion is associated with reduced risk of stroke mortality. (United States)

    Clark, Cari Jo; Guo, Hongfei; Lunos, Scott; Aggarwal, Neelum T; Beck, Todd; Evans, Denis A; Mendes de Leon, Carlos; Everson-Rose, Susan A


    Greater social cohesion is related to lower rates of coronary heart disease, but its relation to stroke risk is unstudied. This study examined whether neighborhood social cohesion was protective against stroke mortality and incidence. Data come from 5789 participants (60% female; 62% black; mean age, 74.7 years) in a longitudinal study of chronic diseases in the elderly. Stroke mortality, ascertained through December 31, 2007, was verified through the National Death Index; 186 stroke deaths were identified in 11 years of follow-up. Stroke incidence was determined in a subset (N=3816) with linkage to Medicare claims files; 701 first-ever strokes were identified. Cohesion was measured by 6 items assessing frequency of contact and social interactions with neighbors; items were z-scored and averaged. Individual scores were averaged across 82 census block groups, forming a neighborhood-level measure of social cohesion. Marginal Cox proportional hazard models tested the association of neighborhood-level cohesion with stroke mortality and incidence. Each 1-point increase in cohesion related to a 53% reduced risk of stroke mortality (hazard ratio, 0.47; 95% CI, 0.24 to 0.90), adjusting for relevant covariates, including sociodemographics, known stroke risk factors, and neighborhood-level socioeconomic status. A race×cohesion interaction (P=0.04) revealed cohesion was protective in whites (hazard ratio, 0.34; 95% CI, 0.17 to 0.67) but not blacks (hazard ratio, 1.17; 95% CI, 0.35 to 3.86). Cohesion was unrelated to stroke incidence (P>0.5). Neighborhood-level social cohesion was independently protective against stroke mortality. Research is needed to further examine observed race differences and pathways by which cohesion is health-protective.

  2. Clinically significant change in stroke volume in pulmonary hypertension. (United States)

    van Wolferen, Serge A; van de Veerdonk, Marielle C; Mauritz, Gert-Jan; Jacobs, Wouter; Marcus, J Tim; Marques, Koen M J; Bronzwaer, Jean G F; Heymans, Martijn W; Boonstra, Anco; Postmus, Pieter E; Westerhof, Nico; Vonk Noordegraaf, Anton


    Stroke volume is probably the best hemodynamic parameter because it reflects therapeutic changes and contains prognostic information in pulmonary hypertension (PH). Stroke volume directly reflects right ventricular function in response to its load, without the correction of compensatory increased heart rate as is the case for cardiac output. For this reason, stroke volume, which can be measured noninvasively, is an important hemodynamic parameter to monitor during treatment. However, the extent of change in stroke volume that constitutes a clinically significant change is unknown. The aim of this study was to determine the minimal important difference (MID) in stroke volume in PH. One hundred eleven patients were evaluated at baseline and after 1 year of follow-up with a 6-min walk test (6MWT) and cardiac MRI. Using the anchor-based method with 6MWT as the anchor, and the distribution-based method, the MID of stroke volume change could be determined. After 1 year of treatment, there was, on average, a significant increase in stroke volume and 6MWT. The change in stroke volume was related to the change in 6MWT. Using the anchor-based method, an MID of 10 mL in stroke volume was calculated. The distribution-based method resulted in an MID of 8 to 12 mL. Both methods showed that a 10-mL change in stroke volume during follow-up should be considered as clinically relevant. This value can be used to interpret changes in stroke volume during clinical follow-up in PH.

  3. Global and regional burden of stroke during 1990-2010

    DEFF Research Database (Denmark)

    Feigin, Valery L; Forouzanfar, Mohammad H; Krishnamurthi, Rita


    -years (DALYs) lost by age group (income level (high-income, and low-income and middle-income) for 1990, 2005, and 2010. FINDINGS: We included 119 studies (58 from high-income countries and 61 from low-income and middle-income countries). From 1990 to 2010......, the age-standardised incidence of stroke significantly decreased by 12% (95% CI 6-17)in high-income countries, and increased by 12% (-3 to 22) in low-income and middle-income countries, albeit nonsignificantly. Mortality rates decreased significantly in both high income (37%, 31-41) and low-income......, respectively), with most of the burden (68・6% incident strokes, 52・2% prevalent strokes, 70・9% stroke deaths, and 77・7% DALYs lost) in low-income and middle-income countries. In 2010, 5・2 million (31%) strokes were in children (aged aged adults(20-64 years), to which...

  4. Determinants of social inequalities in stroke incidence across Europe

    DEFF Research Database (Denmark)

    Ferrario, Marco M.; Veronesi, Giovanni; Kee, Frank


    Europe. Materials and methods: The MORGAM (MOnica Risk, Genetics, Archiving and Monograph) Study comprises 48 cohorts recruited mostly in the 1980s and 1990s in four European regions using standardised procedures for baseline risk factor assessment and fatal and non-fatal stroke ascertainment......Background: Knowledge on the origins of the social gradient in stroke incidence in different populations is limited. This study aims to estimate the burden of educational class inequalities in stroke incidence and to assess the contribution of risk factors in determining these inequalities across...... and adjudication during follow-up. Among the 126 635 middle-aged participants, initially free of cardiovascular diseases, generating 3788 first stroke events during a median follow-up of 10 years, we estimated differences in stroke rates and HRs for the least versus the most educated individuals. Results: Compared...


    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


    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

  6. Effect of SR manipulation on conduit artery dilation in humans. (United States)

    Carter, Howard H; Dawson, Ellen A; Birk, Gurpreet K; Spence, Angela L; Naylor, Louise H; Cable, N Timothy; Thijssen, Dick H J; Green, Daniel J


    The impact of manipulating shear stress on conduit artery vasodilation has not been comprehensively described in vivo. We hypothesized that manipulation of SR through the brachial and radial arteries would be associated with corresponding changes in diameter. We performed a series of studies involving the following: (1) leg cycle exercise at increasing intensities (≈70 and 85% maximum heart rate [HRmax]) with simultaneous bilateral measurement of SR in the radial arteries; (2) leg cycle exercise for 30 minutes at 80% HRmax with simultaneous bilateral measurement of velocity and diameter in the brachial arteries; and (3) bilateral forearm heating for 30 minutes with simultaneous bilateral measurement of brachial artery diameter and blood velocity. Cycling and forearm heating interventions were performed in the presence of unilateral cuff inflation throughout the experiment, or starting during the intervention (15 minutes), to manipulate SR responses. Cuff placement was associated with lower radial artery SR responses (cuffed versus uncuffed, 248±49 versus 349±105 L/s 85% HRmax; P<0.01), and diameter responses were similarly attenuated (2.45±0.30 versus 2.78±0.20 mm 85% HRmax; P<0.05). Exercise performed at 80% HRmax in the presence of unilateral cuff inflation also reduced brachial artery SR (cuffed versus uncuffed; 258±107 versus 454±157 L/s; P<0.01) and diameter (3.96±0.39 versus 4.20±0.45 mm). Finally, cuff inflation decreased the impact of forearm heating on brachial SR (cuffed versus uncuffed; 262±97 versus 440±106 L/s; P<0.01) and diameter (4.35±0.54 versus 4.87±0.47 mm; P<0.05). Similar significant differences between the cuffed and uncuffed limbs in SR and diameter were observed when cuff inflation occurred during exercise or heating. Our findings strongly implicate SR as an important stimulus to increase conduit artery diameter in humans.

  7. Examining vertebrobasilar artery stroke in two Canadian provinces. (United States)

    Boyle, Eleanor; Côté, Pierre; Grier, Alexander R; Cassidy, J David


    Ecological study. To determine the annual incidence of hospitalized vertebrobasilar artery (VBA) stroke and chiropractic utilization in Saskatchewan and Ontario between 1993 and 2004. To determine whether at an ecological level, the incidence of VBA stroke parallels the incidence of chiropractic utilization. Little is known about the incidence and time trends of VBA stroke diagnoses in the population. Chiropractic manipulation to the neck is believed to be a risk factor for VBA stroke. No study has yet found an association between chiropractic utilization and VBA diagnoses at the population level. All hospitalizations with discharge diagnoses of VBA stroke were extracted from administrative databases for Saskatchewan and Ontario. We included incident cases that were diagnosed between January 1993 and December 2004 for Saskatchewan and from April 1993 to March 2002 for Ontario. VBA cases that had previously been hospitalized for any stroke or transient ischemic attack (TIA) were excluded. Chiropractic utilization was measured using billing data from Saskatchewan Health and Ontario Health Insurance Plan. Denominators were derived from Statistics Canada's annual population estimates. The incidence rate of VBA stroke was 0.855 per 100,000 person-years for Saskatchewan and 0.750 per 100,000 person-years for Ontario. The annual incidence rate spiked dramatically with a 360% increase for Saskatchewan in 2000. There was a 38% increase for the 2000 incidence rate in Ontario. The rate of chiropractic utilization did not increase significantly during the study period. In Saskatchewan, we observed a dramatic increase in the incidence rate in 2000 and there was a corresponding relatively small increase in chiropractic utilization. In Ontario, there was a small increase in the incidence rate; however, chiropractic utilization decreased. At the ecological level, the increase in VBA stroke does not seem to be associated with an increase in the rate of chiropractic utilization.

  8. Pattern of hospitalized-stroke patients in ASEAN countries an ASNA stroke epidemiological study

    Directory of Open Access Journals (Sweden)

    Jusuf Misbach


    discharged from the hospital were alive improved (57% and mean death rate was 22%, highest in Thailand (45% and lowest in Brunei (8%. This hospital based stroke data showed the recent characteristics of stroke pattern in seven ASEAN member countries and it will be very important data for health policy maker in these countries and for further cooperative researches in the future. (Med J Indones 2001; 10: 48-56Keywords: Stroke, clinical pattern, risk factor

  9. Mini-Stroke vs. Regular Stroke: What's the Difference? (United States)

    ... How is a ministroke different from a regular stroke? Answers from Jerry W. Swanson, M.D. When ... brain, spinal cord or retina, which may cause stroke-like symptoms but does not damage brain cells ...

  10. Dysphagia in Patients with Acute Ischemic Stroke: Early Dysphagia Screening May Reduce Stroke-Related Pneumonia and Improve Stroke Outcomes. (United States)

    Al-Khaled, Mohamed; Matthis, Christine; Binder, Andreas; Mudter, Jonas; Schattschneider, Joern; Pulkowski, Ulrich; Strohmaier, Tim; Niehoff, Torsten; Zybur, Roland; Eggers, Juergen; Valdueza, Jose M; Royl, Georg


    Dysphagia is associated with poor outcome in stroke patients. Studies investigating the association of dysphagia and early dysphagia screening (EDS) with outcomes in patients with acute ischemic stroke (AIS) are rare. The aims of our study are to investigate the association of dysphagia and EDS within 24 h with stroke-related pneumonia and outcomes. Over a 4.5-year period (starting November 2007), all consecutive AIS patients from 15 hospitals in Schleswig-Holstein, Germany, were prospectively evaluated. The primary outcomes were stroke-related pneumonia during hospitalization, mortality, and disability measured on the modified Rankin Scale ≥2-5, in which 2 indicates an independence/slight disability to 5 severe disability. Of 12,276 patients (mean age 73 ± 13; 49% women), 9,164 patients (74%) underwent dysphagia screening; of these patients, 55, 39, 4.7, and 1.5% of patients had been screened for dysphagia within 3, 3 to 72 h following admission. Patients who underwent dysphagia screening were likely to be older, more affected on the National Institutes of Health Stroke Scale score, and to have higher rates of neurological symptoms and risk factors than patients who were not screened. A total of 3,083 patients (25.1%; 95% CI 24.4-25.8) had dysphagia. The frequency of dysphagia was higher in patients who had undergone dysphagia screening than in those who had not (30 vs. 11.1%; p dysphagia had a higher rate of pneumonia than those without dysphagia (29.7 vs. 3.7%; p dysphagia was associated with increased risk of stroke-related pneumonia (OR 3.4; 95% CI 2.8-4.2; p dysphagia was independently correlated with an increase in mortality (OR 3.2; 95% CI 2.4-4.2; p Dysphagia exposes stroke patients to a higher risk of pneumonia, disability, and death, whereas an EDS seems to be associated with reduced risk of stroke-related pneumonia and disability. © 2016 S. Karger AG, Basel.

  11. PO-06 - Cancer and the risk of venous thromboembolism in stroke patients

    DEFF Research Database (Denmark)

    Corraini, P; Ording, A G; Henderson, V W


    was matched to the stroke patients by date of diagnosis, year of birth, sex, and specific comorbidities using the Charlson Comorbidity Index and other VTE risk factors. We computed VTE cumulative risks, rates and rate ratios, as well as the interaction with comorbidity (as the excess VTE rates not explained......INTRODUCTION: The impact of comorbidity and in particular cancer on the risk of venous thromboembolism (VTE) after stroke is poorly understood. AIM: We aimed to determine the impact of comorbidity, in particular cancer, on the risk of venous thromboembolism in stroke patients as the excess VTE...... by stroke and comorbidity alone) during five years of follow-up. RESULTS: Five-year VTE risks were 2.16% and 1.85% in the stroke and general population comparison cohorts, respectively. Three-month VTE rate ratios peaked at a 6-fold increase (95% confidence interval: 4.9;6.2) in stroke patients and remained...

  12. Post-stroke cognitive impairments: diagnosis and therapeutic approaches

    Directory of Open Access Journals (Sweden)

    Natalia Vyacheslavovna Pizova


    Full Text Available Stroke is a leading cause of disability not only due to its impact on motor or sensory functions, but also to post-stroke cognitive impairments (CI. Within the first year after stroke, the rate of CI may be as high as 80-90% and 7-23% of patients develop dementia. The most important risk factors for CI are strokes, their extent, site, and number. Old age, low education level, severe previous pathological changes in the brain parenchyma, diabetes mellitus, atrial fibrillations, and recurrent strokes in particular, are associated with an increased risk of CI. Examining cognitive functions, monitoring the evolution of cognitive deficit, and post-stroke rehabilitation are indicated in patients who have had stroke. The main treatments in patients with CI are secondary stroke prevention, including lifestyle modification and symptomatic therapy. Sermion is one of the promising agents for the prevention and treatment of CI in these patients.

  13. Risk factors for swallowing dysfunction in stroke patients

    Directory of Open Access Journals (Sweden)

    Anna Flávia Ferraz Barros Baroni


    Full Text Available CONTEXT: Stroke is a frequent cause of dysphagia. OBJECTIVE: To evaluate in a tertiary care hospital the prevalence of swallowing dysfunction in stroke patients, to analyze factors associated with the dysfunction and to relate swallowing dysfunction to mortality 3 months after the stroke. METHODS: Clinical evaluation of deglutition was performed in 212 consecutive patients with a medical and radiologic diagnosis of stroke. The occurrence of death was determined 3 months after the stroke. RESULTS: It was observed that 63% of the patients had swallowing dysfunction. The variables gender and specific location of the lesion were not associated with the presence or absence of swallowing dysfunction. The patients with swallowing dysfunction had more frequently a previous stroke, had a stroke in the left hemisphere, motor and/or sensitivity alterations, difficulty in oral comprehension, alteration of oral expression, alteration of the level of consciousness, complications such as fever and pneumonia, high indexes on the Rankin scale, and low indexes on the Barthel scale. These patients had a higher mortality rate. CONCLUSIONS: Swallowing evaluation should be done in all patients with stroke, since swallowing dysfunction is associated with complications and an increased risk of death.

  14. Explicit memory and implicit memory in occipital lobe stroke patients. (United States)

    Gong, Liang; Wang, JiHua; Feng, Lei; Wang, MeiHong; Li, Xiu; Hu, JiaYun; Wang, Kai


    Occipital stroke patients mainly showed cortical blindness and unilateral vision loss; memory is generally reserved. Recent reports from neuroimaging show the occipital lobe may be involved in the processing of implicit memory (IM), especially the perception type of IM processing. In this study, we explored the explicit memory (EM) and IM damage in occipital lobe stroke patients. A total of 25 occipital strokes and 29 years of age, educational level equivalent healthy controls (HCs), evaluated by using immediate recall, delayed recall, recognition for EM tasks, picture identification, and category exemplar generation for IM tasks. There was no significant difference between occipital stroke patients and HCs in EM tasks and category exemplar generation task. In the picture identification task, occipital lobe stroke group score was poorer than HC group, the results were statistically significant, but in the pictures identify rate, occipital stroke patients and normal control group had no significant difference. The occipital stroke patients may have IM damage, primarily damage the perception type of IM priming effects, which was unrelated with their cortical blindness. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  15. Risk Factors and Stroke Characteristic in Patients with Postoperative Strokes. (United States)

    Dong, Yi; Cao, Wenjie; Cheng, Xin; Fang, Kun; Zhang, Xiaolong; Gu, Yuxiang; Leng, Bing; Dong, Qiang


    Intravenous thrombolysis and intra-arterial thrombectomy are now the standard therapies for patients with acute ischemic stroke. In-house strokes have often been overlooked even at stroke centers and there is no consensus on how they should be managed. Perioperative stroke happens rather frequently but treatment protocol is lacking, In China, the issue of in-house strokes has not been explored. The aim of this study is to explore the current management of in-house stroke and identify the common risk factors associated with perioperative strokes. Altogether, 51,841 patients were admitted to a tertiary hospital in Shanghai and the records of those who had a neurological consult for stroke were reviewed. Their demographics, clinical characteristics, in-hospital complications and operations, and management plans were prospectively studied. Routine laboratory test results and risk factors of these patients were analyzed by multiple logistic regression model. From January 1, 2015, to December 31, 2015, over 1800 patients had neurological consultations. Among these patients, 37 had an in-house stroke and 20 had more severe stroke during the postoperative period. Compared to in-house stroke patients without a procedure or operation, leukocytosis and elevated fasting glucose levels were more common in perioperative strokes. In multiple logistic regression model, perioperative strokes were more likely related to large vessel occlusion. Patients with perioperative strokes had different risk factors and severity from other in-house strokes. For these patients, obtaining a neurological consultation prior to surgery may be appropriate in order to evaluate the risk of perioperative stroke. Copyright © 2017. Published by Elsevier Inc.

  16. Stroke risk perception among participants of a stroke awareness campaign


    Kraywinkel, Klaus; Heidrich, Jan; Heuschmann, Peter U; Wagner, Markus; Berger, Klaus


    Abstract Background Subjective risk factor perception is an important component of the motivation to change unhealthy life styles. While prior studies assessed cardiovascular risk factor knowledge, little is known about determinants of the individual perception of stroke risk. Methods Survey by mailed questionnaire among 1483 participants of a prior public stroke campaign in Germany. Participants had been informed about their individual stroke risk based on the Framingham stroke risk score. S...

  17. World Stroke Organization Global Stroke Services Guidelines and Action Plan


    Lindsay, Patrice; Furie, Karen L.; Davis, Stephen M.; Donnan, Geoffrey A.; Norrving, Bo


    Every two seconds, someone across the globe suffers a symptomatic stroke. 'Silent' cerebrovascular disease insidiously contributes to worldwide disability by causing cognitive impairment in the elderly. The risk of cerebrovascular disease is disproportionately higher in low to middle income countries where there may be barriers to stroke care. The last two decades have seen a major transformation in the stroke field with the emergence of evidence-based approaches to stroke prevention,...

  18. The incidence of pregnancy-related stroke: A systematic review and meta-analysis. (United States)

    Swartz, Richard H; Cayley, Megan L; Foley, Norine; Ladhani, Noor Niyar N; Leffert, Lisa; Bushnell, Cheryl; McClure, J A; Lindsay, M Patrice


    Background Stroke risk is increased during pregnancy, but estimates of pregnancy-related stroke incidence vary widely. Aims A systematic review and meta-analysis was conducted to assess the incidence of stroke during pregnancy and the puerperium. Ovid Medline, EMBASE, and ISI Web of Science were searched for studies published between 1990 and January 2017 reporting stroke incidence during pregnancy and postpartum, from defined pregnancy populations. Pooled analyses were conducted using a random effects approach and expressed as an incidence rate per 100,000 pregnancies, with 95% confidence intervals. Subgroup analyses of stroke type and timing were conducted. Summary of review Eleven studies met inclusion criteria. Variation in estimated rates was noted based on geography and study methodology. The pooled crude rate of pregnancy-related stroke was 30.0 per 100,000 pregnancies (95% confidence interval 18.8-47.9). The pooled crude rates from nonhemorrhagic stroke (arterial and cerebral venous sinus thrombosis) were 19.9 (95% confidence interval 10.7-36.9) and from hemorrhage 12.2 (95% confidence interval 6.4-23.2) per 100,000 pregnancies. For studies separately reporting cerebral venous sinus thrombosis, the rates were roughly equal between ischemic stroke (12.2, 95% confidence interval 6.7-22.2), cerebral venous sinus thrombosis (9.1, 95% confidence interval 4.3-18.9), and hemorrhage (12.2, 95% confidence interval 6.4-23.2). The crude stroke rate for antenatal/perinatal stroke was 18.3 (95% confidence interval 11.9-28.2), and for postpartum stroke was 14.7 (95% confidence interval 8.3-26.1). Conclusions Stroke affects 30.0 per 100,000 pregnancies, with ischemia, cerebral venous sinus thrombosis, and hemorrhage causing roughly equal numbers and with highest risk peripartum and postpartum. Organized approaches to the management of this high-risk population, informed by existing evidence from stroke and obstetrical care are needed.

  19. Incorporating Stroke Severity Into Hospital Measures of 30-Day Mortality After Ischemic Stroke Hospitalization. (United States)

    Schwartz, Jennifer; Wang, Yongfei; Qin, Li; Schwamm, Lee H; Fonarow, Gregg C; Cormier, Nicole; Dorsey, Karen; McNamara, Robert L; Suter, Lisa G; Krumholz, Harlan M; Bernheim, Susannah M


    The Centers for Medicare & Medicaid Services publicly reports a hospital-level stroke mortality measure that lacks stroke severity risk adjustment. Our objective was to describe novel measures of stroke mortality suitable for public reporting that incorporate stroke severity into risk adjustment. We linked data from the American Heart Association/American Stroke Association Get With The Guidelines-Stroke registry with Medicare fee-for-service claims data to develop the measures. We used logistic regression for variable selection in risk model development. We developed 3 risk-standardized mortality models for patients with acute ischemic stroke, all of which include the National Institutes of Health Stroke Scale score: one that includes other risk variables derived only from claims data (claims model); one that includes other risk variables derived from claims and clinical variables that could be obtained from electronic health record data (hybrid model); and one that includes other risk variables that could be derived only from electronic health record data (electronic health record model). The cohort used to develop and validate the risk models consisted of 188 975 hospital admissions at 1511 hospitals. The claims, hybrid, and electronic health record risk models included 20, 21, and 9 risk-adjustment variables, respectively; the C statistics were 0.81, 0.82, and 0.79, respectively (as compared with the current publicly reported model C statistic of 0.75); the risk-standardized mortality rates ranged from 10.7% to 19.0%, 10.7% to 19.1%, and 10.8% to 20.3%, respectively; the median risk-standardized mortality rate was 14.5% for all measures; and the odds of mortality for a high-mortality hospital (+1 SD) were 1.51, 1.52, and 1.52 times those for a low-mortality hospital (-1 SD), respectively. We developed 3 quality measures that demonstrate better discrimination than the Centers for Medicare & Medicaid Services' existing stroke mortality measure, adjust for

  20. From stroke unit care to stroke care unit

    NARCIS (Netherlands)

    De Keyser, J; Sulter, G.


    In some stroke units continuous monitoring of blood pressure, electrocardiogram, body temperature, and oxygen saturation has become an integral part of the management of acute stroke. In addition, regular measurements of blood glucose are performed. Stroke units equipped with such monitoring

  1. 90Sr liquid scintillation urine analysis utilizing different approaches for tracer recovery.

    Energy Technology Data Exchange (ETDEWEB)

    Piraner, Olga; Preston, Rose T.; Shanks, Sonoya Toyoko; Jones, Robert


    90Sr is one of the isotopes most commonly produced by nuclear fission. This medium lived isotope presents serious challenges to radiation workers, the environment, and following a nuclear event, the general public. Methods of identifying this nuclide have been in existence for a number of years (e.g. Horwitz, E.P. [1], Maxwell, S.L.[2], EPA 905.0 [3]) which are time consuming, requiring a month or more for full analysis. This time frame is unacceptable in the present security environment. It is therefore important to have a dependable and rapid method for the determination of Sr. The purposes of this study are to reduce analysis time to less than half a day by utilizing a single method of radiation measurement while continuing to yield precise results. This paper presents findings on three methods that can meet this criteria; (1) stable Sr carrier, (2) 85Sr by gamma spectroscopy, and (3) 85Sr by LSC. Two methods of analyzing and calculating the 85Sr tracer recovery were investigated (gamma spectroscopy and a low energy window-Sr85LEBAB by LSC) as well as the use of two different types of Sr tracer (85Sr and stable Sr carrier). Three separate stock blank urine samples were spiked with various activity levels of 239Pu, 137Cs, 90Sr /90Y to determine the effectiveness of the Eichrome Sr-spec resin 2mL extractive columns. The objective was to compare the recoveries of 85Sr versus a stable strontium carrier, attempt to compare the rate at which samples can be processed by evaluating evaporation, neutralization, and removing the use of another instrument (gamma spectrometer) by using the LSC spectrometer to obtain 85Sr recovery. It was found that when using a calibration curve comprised of a different cocktail and a non-optimum discriminator setting reasonable results (bias of « 25%) were achieved. The results from spiked samples containing 85Sr demonstrated that a higher recovery is obtained when using gamma spectroscopy (89-95%) than when using the LEB window

  2. Comparison of tissue plasminogen activator administration management between Telestroke Network hospitals and academic stroke centers: the Telemedical Pilot Project for Integrative Stroke Care in Bavaria/Germany. (United States)

    Audebert, Heinrich J; Kukla, Christian; Vatankhah, Bijan; Gotzler, Berthold; Schenkel, Johannes; Hofer, Stephan; Fürst, Andrea; Haberl, Roman L


    Systemic thrombolysis is the only therapy proven to be effective for ischemic stroke. Telemedicine may help to extend its use. However, concerns remain whether management and safety of tissue plasminogen activator (tPA) administration after telemedical consultation are equivalent in less experienced hospitals compared with tPA administration in academic stroke centers. During the second year of the ongoing Telemedical Pilot Project for Integrative Stroke Care, all systemic thrombolyses in stroke patients of the 12 regional clinics and the 2 stroke centers were recorded prospectively. Patients' demographics, stroke severity (National Institutes of Health Stroke Scale), frequency of administration, time management, protocol violations, and safety were included in the analysis. In 2004, 115 of 4727 stroke or transient ischemic attack patients (2.4%) in the community hospitals and 110 of 1889 patients in the stroke centers (5.8%) received systemic thrombolysis. Prehospital latencies were shorter in the regional hospitals despite longer distances. Door to needle times were shorter in the stroke centers. Although blood pressure was controlled more strictly in community hospitals, symptomatic intracerebral hemorrhage rate (7.8%) was higher (P=0.14) than in stroke centers (2.7%) but still within the range of the National Institute of Neurological Disorders and Stroke trial. In-hospital mortality rate was low in community hospitals (3.5%) and in stroke centers (4.5%). Although with a lower rate of systemic thrombolysis, there was no evidence of lower treatment quality in the remote hospitals. With increasing numbers of tPA administration and growing training effects, the telestroke concept promises better coverage of systemic thrombolysis in nonurban areas.

  3. Estimates of outcomes up to ten years after stroke: analysis from the prospective South London Stroke Register.

    Directory of Open Access Journals (Sweden)

    Charles D A Wolfe


    Full Text Available Although stroke is acknowledged as a long-term condition, population estimates of outcomes longer term are lacking. Such estimates would be useful for planning health services and developing research that might ultimately improve outcomes. This burden of disease study provides population-based estimates of outcomes with a focus on disability, cognition, and psychological outcomes up to 10 y after initial stroke event in a multi-ethnic European population.Data were collected from the population-based South London Stroke Register, a prospective population-based register documenting all first in a lifetime strokes since 1 January 1995 in a multi-ethnic inner city population. The outcomes assessed are reported as estimates of need and included disability (Barthel Index 10, and mental and physical domain scores of the Medical Outcomes Study 12-item short form (SF-12 health survey. Estimates were stratified by age, gender, and ethnicity, and age-adjusted using the standard European population. Plots of outcome estimates over time were constructed to examine temporal trends and sociodemographic differences. Between 1995 and 2006, 3,373 first-ever strokes were registered: 20%-30% of survivors had a poor outcome over 10 y of follow-up. The highest rate of disability was observed 7 d after stroke and remained at around 110 per 1,000 stroke survivors from 3 mo to 10 y. Rates of inactivity and cognitive impairment both declined up to 1 y (280/1,000 and 180/1,000 survivors, respectively; thereafter rates of inactivity remained stable till year eight, then increased, whereas rates of cognitive impairment fluctuated till year eight, then increased. Anxiety and depression showed some fluctuation over time, with a rate of 350 and 310 per 1,000 stroke survivors, respectively. SF-12 scores showed little variation from 3 mo to 10 y after stroke. Inactivity was higher in males at all time points, and in white compared to black stroke survivors, although black

  4. Diabetes, Heart Disease, and Stroke (United States)

    ... Disease, & Other Dental Problems Diabetes & Sexual & Urologic Problems Diabetes, Heart Disease, and Stroke Having diabetes means that ... help to stop. What is the link between diabetes, heart disease, and stroke? Over time, high blood ...

  5. The obesity paradox in stroke

    DEFF Research Database (Denmark)

    Andersen, Klaus Kaae; Olsen, Tom Skyhøj


    . Data include age, gender, civil status, stroke severity, computed tomography, and cardiovascular risk factors. Patients were followed up to 9·8 years (median 2·6 years). We used Cox regression models to compare risk of death and readmission for recurrent stroke in the four body mass index groups......BACKGROUND: Although associated with excess mortality and morbidity, obesity is associated with lower mortality after stroke. The association between obesity and risk of recurrent stroke is unclear. AIMS: The study aims to investigate the association in stroke patients between body mass index...... and risk of death and readmission for recurrent stroke. METHODS: An administrative Danish quality-control registry designed to collect a predefined dataset on all hospitalized stroke patients in Denmark 2000–2010 includes 45 615 acute first-ever stroke patients with information on body mass index in 29 326...

  6. Preventable Pediatric Stroke via Vaccination?

    Directory of Open Access Journals (Sweden)

    Craig A. Press


    Full Text Available Investigators from the Vascular Effects of Infection in Pediatric Stroke (VIPS group studied the risk of arterial ischemic stroke (AIS associated with minor infection and routine childhood vaccinations.

  7. Epidemiology of stroke in the elderly in the Nordic countries. Incidence, survival, prevalence and risk factors

    Directory of Open Access Journals (Sweden)

    Torgeir Engstad


    Full Text Available Objective: To review what is known at present with respect to incidence, survival, risk factors and prevalence among the elderly stroke patients in the Nordic countries.Method: This article is based mainly on literature identified through search engines (Mc Master Plus, Cochrane Library, Medline and PubMed, restricted to first-ever stroke in Nordic population-based studies and having applied to the standard WHO definition, a prospective study design and no upper age limit.Results: Data from the Nordic countries show an incidence rate of 1250 to 1796/100 000 in the age group 75-84, and 1628 to 2234 in those above 85 years. The incidence rates are higher among men, but women are expected to contribute more to incident cases due to their higher life expectancy. If the age-specific incidence of stroke remains stable, the proportion of stroke patients aged 80 years and older may reach 50% in a few decades. The elderly stroke patients have a higher 30-days case fatality, and a higher risk of dependency. Better treatment of stroke patients has improved the survival over the last two decades. The prevalence is expected to increase due to the decrease in lethality, a slower fall in incidence and a higher proportion of elderly. Cardiovascular risk factors increase with age. Hypertension is a major risk factor for stroke mortality in the elderly. Cardioembolic stroke due to atrial fibrillation is the most common stroke subtype in the elderly. Lifestyle risk factors are less prevalent in the older stroke patients.Conclusion: The growing proportion of elderly stroke patients is a major challenge for future stroke care. The elderly stroke patients have a different risk factor profile compared to younger stroke patients. Treatment should focus on regaining independency. The age-specific epidemiology of stroke needs to be studied further in large studies in order to plan for future health care.

  8. Early Operation in Patients With Mitral Valve Infective Endocarditis and Acute Stroke Is Safe. (United States)

    Ghoreishi, Mehrdad; Foster, Nate; Pasrija, Chetan; Shah, Aakash; Watkins, A Claire; Evans, Charlie F; Maghami, Sam; Quinn, Rachael; Wehman, Brody; Taylor, Bradley S; Dawood, Murtaza Y; Griffith, Bartley P; Gammie, James S


    To determine if preoperative embolic stroke is associated with an increased risk of postoperative stroke among patients undergoing early operation for mitral valve (MV) infective endocarditis (IE), we compared outcomes among patients presenting with and without acute stroke. From 2003 to 2015, 243 consecutive patients underwent surgery for active MV IE. Patients were categorized into 2 groups: 72% (174 of 243 patients) with no preoperative acute stroke (clinical, radiographic or both) and 28% (69 of 243 patients) with stroke. Both preoperative and postoperative strokes were confirmed in all patients with brain computed tomography or magnetic resonance imaging and comprehensive examination by a neurologist. Among patients presenting with stroke, 33% (23 of 69 patients) were asymptomatic and had only positive imaging findings. The median time from admission to operation was 5 days. The overall rate of new postoperative stroke was 4% (10 of 243 patients). The rate of postoperative stroke was not different between the 2 groups: 4% (7 of 174 patients) among patients with no preoperative stroke and 4% (3 of 69 patients) with stroke (p = 0.9). One patient developed a hemorrhagic conversion of an acute infarct. Operative mortality was 7% (13 of 174 patients) among patients with no preoperative stroke and 7% (5 of 69 patients) among patients with stroke (p = 0.9). MV surgery for IE and acute stroke can be performed early with a low risk of postoperative neurologic complications. When indicated, surgical intervention for MV IE complicated by acute stroke should not be delayed. Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  9. Cigarette smoking is an independent risk factor for post-stroke delirium. (United States)

    Lim, Tae Sung; Lee, Jin Soo; Yoon, Jung Han; Moon, So Young; Joo, In Soo; Huh, Kyoon; Hong, Ji Man


    Post-stroke delirium is a common problem in the care of stroke patients, and is associated with longer hospitalization, high short-term mortality, and an increased need for long-term care. Although post-stroke delirium occurs in approximately 10 ~ 30% of patients, little is known about the risk factors for post-stroke delirium in patients who experience acute stroke. A total of 576 consecutive patients who experienced ischemic stroke (mean age, 65.2 years; range, 23-93 years) were screened for delirium over a 2-year period in an acute stroke care unit of a tertiary referral hospital. We screened for delirium using the Confusion Assessment Method. Once delirium was suspected, we evaluated the symptoms using the Korean Version of the Delirium Rating Scale-Revised-98. Neurological deficits were assessed using the National Institutes of Health Stroke Scale at admission and discharge, and functional ability was assessed using the Barthel Index and modified Rankin Scale at discharge and 3 months after discharge. Thirty-eight (6.7%) patients with stroke developed delirium during admission to the acute stroke care unit. Patients with delirium were significantly older (70.6 vs. 64.9 years of age, P = .001) and smoked cigarettes more frequently (40% vs. 24%, P = .033) than patients without delirium. In terms of clinical features, the delirium group experienced a significantly higher rate of major hemispheric stroke (55% vs. 26%, P delirium were older age, history of cigarette smoking, and major hemispheric stroke. Abrupt cessation of cigarette smoking may be a risk factor for post-stroke delirium in ischemic stroke patients. The development of delirium after stroke is associated with worse outcome and longer hospitalization.

  10. Rapid determination of 90Sr in seawater

    International Nuclear Information System (INIS)

    Pavlotskaya, F.I.; Moskin, A.I.


    A method for determining 90 Sr in seawater that is based on direct isolation and radiochemical purification of daughter 90 Y is proposed. The analysis time is 6-8 h. The chemical yield of the Y-carrier during the 90 Sr determination from 35 liters of seawater varies in the range 37-69%. The analysis uncertainty is 90 Sr from seawater and subsequent isolation of 90 Y

  11. Perfusion CT in acute stroke

    International Nuclear Information System (INIS)

    Eckert, Bernd; Roether, Joachim; Fiehler, Jens; Thomalla, Goetz


    Modern multislice CT scanners enable multimodal protocols including non-enhanced CT, CT angiography, and CT perfusion. A 64-slice CT scanner provides 4-cm coverage. To cover the whole brain, a 128 - 256-slice scanner is needed. The use of perfusion CT requires an optimized scan protocol in order to reduce exposure to radiation. As compared to non-enhanced CT and CT angiography, the use of CT perfusion increases detection rates of cerebral ischemia, especially small cortical ischemic lesions, while the detection of lacunar and infratentorial stroke lesions remains limited. Perfusion CT enables estimation of collateral flow in acute occlusion of large intra- or extracranial arteries. Currently, no established reliable thresholds are available for determining infarct core and penumbral tissue by CT perfusion. Moreover, perfusion parameters depend on the processing algorithms and the software used for calculation. However, a number of studies point towards a reduction of cerebral blood volume (CBV) below 2 ml/100 g as a critical threshold that identifies infarct core. Large CBV lesions are associated with poor outcome even in the context of recanalization. The extent of early ischemic signs on non-enhanced CT remains the main parameter from CT imaging to guide acute reperfusion treatment. Nevertheless, perfusion CT increases diagnostic and therapeutic certainty in the acute setting. Similar to stroke MRI, perfusion CT enables the identification of tissue at risk of infarction by the mismatch between infarct core and the larger area of critical hypoperfusion. Further insights into the validity of perfusion parameters are expected from ongoing trials of mechanical thrombectomy in stroke.

  12. Characteristics of stroke in tibet autonomous region in china: a hospital-based study of acute stroke. (United States)

    Fang, Jiajia; Zhuo-Ga, Cidan; Zhao, Yuhua; Kong, Fanyi; Si, Yang; Liu, Ming; Zhou, Dong


    We know little of the current status of stroke in Tibet Autonomous Region in China. This study was designed to investigate the characteristics of acute stroke in Tibet. We conducted a hospital-based study on acute first-ever stroke in the People's Hospital of Tibet Autonomous Region (PHOTAR), and then compared the data collected to that from West China Hospital (WCH). The study included 301 inpatients from PHOTAR and 3,334 from WCH. The peak age group in PHOTAR was one decade younger than in WCH. Intracerebral hemorrhage (ICH) was the main stroke subtype in PHOTAR (74.1%). The prevalence of hypertension and heavy alcohol consumption prior to stroke were the most important vascular risk factors. Treatments for stroke in PHOTAR lacked standardization and in-hospital mortality was higher for each subtype. ICH is the dominant stroke subtype in Tibet Autonomous Region, and can be attributed to high rates of hypertension and heavy alcohol consumption. Greater public awareness of stroke and effective management of risk factors should be implemented immediately in Tibet. Copyright © 2011 S. Karger AG, Basel.

  13. Isotope ratio 87Sr/86Sr in limestones from Bambui group, Brazil (MG)

    International Nuclear Information System (INIS)

    Kawashita, K.; Mizusaki, A.M.P.; Kiang, C.H.


    The Sr composition of ancient seawater can be estimated from the analysis of carbonate rocks and, in some cases, used to estimate the age of the analyzed carbonate. The normalized 87Sr/86Sr ratios in calcium carbonate fractions from 14 core samples in the Bambui Group near Montalvania, MG, were found to range between .7077 and .7280. The higher values are attributable to Sr isotopic exchange between silicate and carbonate phases during diagenesis. The ratio of .7077 obtained in two pure calcium carbonate samples is here suggested as the best aproximation for the 87Sr/86Sr value for the Bambui sea. This ratio is compatible with an age of about 700 Ma., estimated from the published 87Sr/86Sr curve of Veizer and others, an age in accordance with Quadros recent (1987, in preparation) identification of marine acritarchs from the latest Precambrian (Vendian). (author) [pt

  14. beta decay of (78)Sr


    Pérez-Cerdán, Ana Belén; Rubio, Berta; Gelletly, W.; Algora, Alejandro; Agramunt, Jorge; Burkard, K.; Huller W.; Nácher, Enrique; Sarriguren, Pedro; Caballero Ontanaya, Luis; Molina Palacios, Francisco Gabriel; Fraile, Luis M.; Reillo, E.; García Borge, María José; Dessagne, Ph.


    The gamma rays and conversion electrons emitted in the beta decay of (78)Sr to levels in (78)Rb have been studied using Ge detectors and a mini-orange spectrometer. A reliable level scheme based on the results of these experiments has been established. The properties of the levels in (78)Rb have been compared with calculations based on deformed Hartree-Fock with Skyrme interactions and pairing correlations in the BCS approximation. This has allowed an interpretation of the nature of the obser...

  15. Chernobyl 90Sr in bilberries from Poland

    International Nuclear Information System (INIS)

    Mietelski, J.W.; Vajda, N.


    As part of a detailed survey on the contamination of Polish forests 90 Sr activity concentrations were determined in bilberries. Elevated 90 Sr levels were found in several samples from north-eastern Poland. The calculated maximum 90 Sr surface contamination was 2 kBq*m -2 . The correlation between 90 Sr and 137 Cs concentrations in bilberries was good for two sets of samples originating from two geographical areas of Poland indicating the local differences in radionuclide depositions from Chernobyl fallout. (author)

  16. Experiences with the determination of Sr-89 and Sr-90 using fast methods; Erfahrungen bei der Bestimmung von {sup 89}Sr und {sup 90}Sr mittels Schnellmethoden

    Energy Technology Data Exchange (ETDEWEB)

    Kowalik, C.; Fueger, J. [Thueringer Landesanstalt fuer Umwelt und Geologie, Jena (Germany). Landesmessstelle fuer Umweltradioaktivaet


    Quick methods of the measurement of {sup 89}Sr and {sup 90}Sr have a great importance in the supervision of the environmental radioactivity. It is necessary to receive in short time dependable analytical data to be able to carry out suitable assessments or to give recommendations. The aim of the investigations was to be guaranteed the demands for these methods (test preparation, measurement and evaluation). The use of the solid phase extraction by means of commercial Sr Resin trademark columns (4.4' (5')-Di-tert-butylcyclohexanol-18-kronen-6-aether) (Triskem) to the radiochemical separation of the Sr isotopes was suitable. The measurements occurred to the FHT 770 T12 - Multi Low Level Alpha/Beta Sample Counter (Thermo Scientific). The results contain the summary activities of all available Sr isotopes, as for example {sup 89}Sr and {sup 90}Sr. The calculations of the single activities occur about the mathematical algorithm of the linear development on the basis of the works of G. Kanisch. The first results show, this method is suitable for the analysis of {sup 89}Sr and {sup 90}Sr and is used therefore in future in Thuringia.

  17. Preparation of 90Sr-90Y generator

    International Nuclear Information System (INIS)

    Jin Xiaohai; Yu Haibin; Zhang Jinming; Zhang Peixin; Lin Qiongfang


    In recent years, 90 Y has been considered as one of the best radionuclides for tumor radioimmunotherapy when chelated to tumor-associated antibodies. This evaluation is based on the superior properties of this radionuclide (suitable half-life, pure β-ray emitter of intermediate energy, stable daughters, and suitable chemical properties) and because it is available as a radionuclide generator product by decay of its 28a parent 90 Sr. The experimental conditions of 90 Sr- 90 Y generator are described. The elution efficiency of 90 Sr- 90 Y generator reaches 98%. One of the most important problems is the 90 Sr contamination breakthrough from the generator. The level of 90 Sr contamination must be controlled to the clinical standard. The cation exchange resin 732 (100-150 mesh) was successfully used for the separation of 90 Y from 90 Sr. The method used by the authors provides a 90 Y-HAc solution which is very simple and safe for administration to the patients. 90 Y was separated from 90 Sr almost completely, the level of the 90 Sr contamination per 740 MBq 90 Y product was only 0.74 kBq. However the toxicity of 90 Sr is extremely high, the human life-time permissible dose is 74 kBq, then 740 MBq of 90 Y is allowed to be administrated to a patient for 50-100 times



    Sujatha; Ramalingam; Vinodkumar; Vasumathi; Valarmathi; Anu


    BACKGROUND Ischemic strokes account for >80% of total stroke events. Biochemical modalities like serum uric acid, ESR, CRP, Serum Fibrinogen will be a low cost and useful way to predict functional outcome after ischemic stroke. The Barthel ADL index it is an ordinal scale helping us to measure performances in ADL-activities in daily living. The present study aims to study the Biochemical parameters Uric Acid, CRP, ESR and Fibrinogen in Ischemic Stroke patients and to assess fu...

  19. Stroke-related mortality in a tertiary care hospital in Andalusia: Analysis and reflections. (United States)

    Maestre-Moreno, J F; Fernández-Pérez, M D; Triguero-Cueva, L; Gutiérrez-Zúñiga, R; Herrera-García, J D; Espigares-Molero, A; Mínguez-Castellanos, A

    Stroke is a very common cause of death, especially in southern Spain. The present study analyses in-hospital mortality associated with stroke in an Andalusian tertiary care hospital. We gathered the files of all patients who had died at Hospital Universitario Virgen de las Nieves in Granada in 2013 and whose death certificates indicated stroke as the cause of death. We also gathered stroke patients discharge data and compared them to that of patients with acute coronary syndrome (ACS). A total of 825 patients had a diagnosis of stroke (96 deaths, 11.6%); of these, 562 had ischaemic stroke (44 deaths, 7.8%) and 263 haemorrhagic stroke (52 deaths, 19.7%). Patients with haemorrhagic stroke therefore showed greater mortality rate (OR=2.9). Patients in this group died after a shorter time in hospital (median, 4 vs 7 days; mean, 6 days). However, patients with ischaemic stroke were older and presented with more comorbidities. On the other hand, 617 patients had a diagnosis of ACS (36 deaths, 5.8%). The mortality odds ratio (MOR) was 2.1 (stroke/SCA). Around 23% of the patients who died from stroke were taking anticoagulants. 60% of the deceased patients with ischaemic stroke and 20% of those with haemorrhagic stroke had atrial fibrillation (AF); 35% of the patients with ischaemic stroke and AF were taking anticoagulants. Stroke is associated with higher admission and in-hospital mortality rates than SCA. Likewise, patients with haemorrhagic stroke showed higher mortality rates than those with ischaemic stroke. Patients with fatal stroke usually had a history of long-term treatment with anticoagulants; 2 thirds of the patients with fatal ischaemic stroke and atrial fibrillation were not receiving anticoagulants. According to our results, optimising prevention in patients with AF may have a positive impact on stroke-related in-hospital mortality. Copyright © 2016 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  20. SAR: Stroke Authorship Recognition

    KAUST Repository

    Shaheen, Sara


    Are simple strokes unique to the artist or designer who renders them? If so, can this idea be used to identify authorship or to classify artistic drawings? Also, could training methods be devised to develop particular styles? To answer these questions, we propose the Stroke Authorship Recognition (SAR) approach, a novel method that distinguishes the authorship of 2D digitized drawings. SAR converts a drawing into a histogram of stroke attributes that is discriminative of authorship. We provide extensive classification experiments on a large variety of data sets, which validate SAR\\'s ability to distinguish unique authorship of artists and designers. We also demonstrate the usefulness of SAR in several applications including the detection of fraudulent sketches, the training and monitoring of artists in learning a particular new style and the first quantitative way to measure the quality of automatic sketch synthesis tools. © 2015 The Eurographics Association and John Wiley & Sons Ltd.

  1. Preadmission Use of Glucocorticoids and 30-Day Mortality After Stroke. (United States)

    Sundbøll, Jens; Horváth-Puhó, Erzsébet; Schmidt, Morten; Dekkers, Olaf M; Christiansen, Christian F; Pedersen, Lars; Bøtker, Hans Erik; Sørensen, Henrik T


    The prognostic impact of glucocorticoids on stroke mortality remains uncertain. We, therefore, examined whether preadmission use of glucocorticoids is associated with short-term mortality after ischemic stroke, intracerebral hemorrhage (ICH), or subarachnoid hemorrhage (SAH). We conducted a nationwide population-based cohort study using medical registries in Denmark. We identified all patients with a first-time inpatient diagnosis of stroke between 2004 and 2012. We categorized glucocorticoid use as current use (last prescription redemption ≤90 days before admission), former use, and nonuse. Current use was further classified as new or long-term use. We used Cox regression to compute 30-day mortality rate ratios with 95% confidence intervals (CIs), controlling for confounders. We identified 100 042 patients with a first-time stroke. Of these, 83 735 patients had ischemic stroke, 11 779 had ICH, and 4528 had SAH. Absolute mortality risk was higher for current users compared with nonusers for ischemic stroke (19.5% versus 10.2%), ICH (46.5% versus 34.4%), and SAH (35.0% versus 23.2%). For ischemic stroke, the adjusted 30-day mortality rate ratio was increased among current users compared with nonusers (1.58, 95% CI: 1.46-1.71), driven by the effect of glucocorticoids among new users (1.80, 95% CI: 1.62-1.99). Current users had a more modest increase in the adjusted 30-day mortality rate ratio for hemorrhagic stroke (1.26, 95% CI: 1.09-1.45 for ICH and 1.40, 95% CI: 1.01-1.93 for SAH) compared with nonusers. Former use was not substantially associated with mortality. Preadmission use of glucocorticoids was associated with increased 30-day mortality among patients with ischemic stroke, ICH, and SAH. © 2016 American Heart Association, Inc.

  2. Death caused by heat stroke: Case report

    Directory of Open Access Journals (Sweden)

    Savić Slobodan


    Full Text Available Introduction. Heat stroke is the most dangerous among numerous disorders caused by elevated environmental temperature. It is characterized by an increased body temperature of over 40°C, the dysfunction of the central nervous system and the development of multiple organ failure. The aim of this paper was to highlight problems in the clinical and post-mortal diagnosis of fatal heat stroke. Case Outline. A 20-year-old male was found unconscious on the street; on admission at the Emergency Center, Clinical Center of Serbia, Belgrade, he was in a coma. The body temperature of 40°C was maintained despite the applied therapy, meningeal signs were negative, tachycardia with gallop rhythm, hypotension, bleeding from the nose and mouth, and presence of skin bruises. Laboratory findings: highly elevated LDH and creatine kinase, elevated serum creatinine, AST, and signs of DIC. Lethal outcome occurred 6 hours after admission, and the case remained clinically unsolved. Autopsy showed signs of hemorrhagic diathesis, brain and pulmonary edema, and microscopic examination revealed general congestion, internal bleeding in various organs, cerebral edema, massive blood aspiration and pulmonary edema. Toxicological and bacteriological examinations were negative. Based on these findings and subsequently obtained data on the conditions at the workplace where the young man had a part-time job, it was concluded that the violent death was caused by heat stroke. Conclusion. Since heat stroke is associated with a high mortality rate and high incidence of serious and permanent organ damage in survivors, it is important to make the diagnosis of heat stroke as quickly as possible and apply appropriate treatment. Misdiagnosis of heat stroke, and consequently inadequate treatment, with a potential fatal outcome for the patient, can be the reason for blaming doctors for the legal offense of medical malpractice in failing to administer first aid.

  3. Personal accounts of stroke experiences

    NARCIS (Netherlands)

    Wachters-Kaufmann, CSM


    As there appeared to be a need for personal accounts of stroke experiences, a book called "Speaking about Stroke" was written for stroke patients and their caregivers. For the past two years, a questionnaire was sent to the people who had ordered the book, to gain an insight into the characteristics

  4. Questions and Answers about Stroke (United States)

    ... stroke. High blood pressure increases your risk of stroke four to six times. Heart disease, especially a condition ... leading cause of serious, long-term adult disability. Four million Americans are living with the effects of stroke. The length of time to recover from a ...

  5. Stroke and Episodic Memory Disorders (United States)

    Lim, Chun; Alexander, Michael P.


    Memory impairments are common after stroke, and the anatomical basis for impairments may be quite variable. To determine the range of stroke-related memory impairment, we identified all case reports and group studies through the Medline database and the Science Citation Index. There is no hypothesis about memory that is unique to stroke, but there…

  6. Young ischaemic stroke in South Auckland: a hospital-based study. (United States)

    Wu, Teddy Y; Kumar, Ajay; Wong, Edward H


    To analyse the risk factors, trends in incidence and aetiology of stroke in young adults in a hospital-based population in South Auckland, New Zealand. A retrospective review of patients aged 15 years to 45 years with a discharge diagnosis of ischaemic stroke (ICD 10 Codes I63 - I65, G46, I672, I675-I679, I694- I694) from June 1 2004 to December 31, 2009. Vascular risk factors, demographic factors, stroke severity, stroke subtype, results of investigations and stroke outcome were determined from review of the hospital record (paper copy and electronic record). A total of 131 patients were identified, representing 4.6% of all stroke discharges. Over one-half of the patients were of "underdetermined cause" (Trial of Org 10172 in Acute Stroke Treatment [TOAST] criteria), (1) mainly due to incomplete investigation. Cardioembolism (16%) was the second most common cause of stroke, followed by small vessel disease and stroke of other determined aetiology (both 12.2%). Confirmed large vessel atherosclerosis (6.1%) was the least common cause of stroke in this study population. The most common risk factors were hyperlipidaemia (45.8%), hypertension (42.7%), current tobacco smoking (42.7%) and obesity (36.6%). The indigenous Maori and Pacific Island people had a higher rate of stroke, at least double of other ethnicities. The in-hospital fatality rate was 3.1%. All surviving patients were discharged home. Eighty-six percent of the survivors were independent. Our study demonstrates strokes of undetermined aetiology and cardioembolism were the most common cause of stroke in young people in South Auckland, and that Māori and Pacific Island people have a higher rate of stroke.

  7. Stroke prevention: an update. (United States)

    Bousser, Marie-Germaine


    Stroke is a personal, familial, and social disaster. It is the third cause of death worldwide, the first cause of acquired disability, the second cause of dementia, and its cost is astronomic. The burden of stroke is likely to increase given the aging of the population and the growing incidence of many vascular risk factors. Prevention of stroke includes--as for all other diseases--a "mass approach" aiming at decreasing the risk at the society level and an individual approach, aiming at reducing the risk in a given subject. The mass approach is primarily based on the identification and treatment of vascular risk factors and, if possible, in the implementation of protective factors. These measures are the basis of primary prevention but most of them have now been shown to be also effective in secondary prevention. The individual approach combines a vascular risk factor modification and various treatments addressing the specific subtypes of stroke, such as antiplatelet drugs for the prevention of cerebral infarction in large and small artery diseases of the brain, carotid endarterectomy or stenting for tight carotid artery stenosis, and oral anticoagulants for the prevention of cardiac emboli. There is a growing awareness of the huge evidence-to-practice gap that exists in stroke prevention largely due to socio-economic factors. Recent approaches include low cost intervention packages to reduce blood pressure and cheap "polypills" combining in a single tablet aspirin and several drugs to lower blood pressure and cholesterol. Polypill intake should however not lead to abandon the healthy life-style measures which remain the mainstay of stroke prevention.

  8. Stroke in Trinidad and Tobago: burden of illness and risk factors

    Directory of Open Access Journals (Sweden)

    Mahabir Deepak


    Full Text Available This study describes the burden of stroke on hospital services in a Caribbean community. The settings are the two main acute general hospitals in Trinidad observed over a 12-month period. All subjects were admitted with a clinical diagnosis of acute stroke. The measures were hospital admission rates, length of hospital stay, case-fatality rates, disability at discharge, and risk factors for stroke. There were 1 105 hospital admissions with a diagnosis of stroke. The median length of stay was 4 days, with an interquartile range of 2 to 9, and stroke accounted for approximately 9 478 bed days per annum. The hospital admission fatality rate was 29%. Among surviving patients, 437 (56% were severely disabled at discharge. Age-standardized admission rates for first strokes in persons aged 35_64 years were 114 (95%CI: 83 to 145 per 100 000 in Afro-Trinidadian men and 144 (109 to 179 in Indo-Trinidadian men. The equivalent rates for women were 115 (84 to 146 and 152 (118 to 186. Among patients with first strokes, 348/531 (66% reported physician-diagnosed hypertension, but only 226 (65% of these reported being on antihypertensives at admission. Stroke in Trinidad and Tobago is associated with a high case-fatality rate and severe disability in survivors. Modifiable risk factors were reported in a majority of stroke cases, and there is a need to develop effective preventive strategies.

  9. Stroke in Trinidad and Tobago: burden of illness and risk factors

    Directory of Open Access Journals (Sweden)

    Deepak Mahabir


    Full Text Available This study describes the burden of stroke on hospital services in a Caribbean community. The settings are the two main acute general hospitals in Trinidad observed over a 12-month period. All subjects were admitted with a clinical diagnosis of acute stroke. The measures were hospital admission rates, length of hospital stay, case-fatality rates, disability at discharge, and risk factors for stroke. There were 1 105 hospital admissions with a diagnosis of stroke. The median length of stay was 4 days, with an interquartile range of 2 to 9, and stroke accounted for approximately 9 478 bed days per annum. The hospital admission fatality rate was 29%. Among surviving patients, 437 (56% were severely disabled at discharge. Age-standardized admission rates for first strokes in persons aged 35_64 years were 114 (95%CI: 83 to 145 per 100 000 in Afro-Trinidadian men and 144 (109 to 179 in Indo-Trinidadian men. The equivalent rates for women were 115 (84 to 146 and 152 (118 to 186. Among patients with first strokes, 348/531 (66% reported physician-diagnosed hypertension, but only 226 (65% of these reported being on antihypertensives at admission. Stroke in Trinidad and Tobago is associated with a high case-fatality rate and severe disability in survivors. Modifiable risk factors were reported in a majority of stroke cases, and there is a need to develop effective preventive strategies.

  10. Effect of Wood Aging on Wine Mineral Composition and87Sr/86Sr Isotopic Ratio. (United States)

    Kaya, Ayse D; Bruno de Sousa, Raúl; Curvelo-Garcia, António S; Ricardo-da-Silva, Jorge M; Catarino, Sofia


    The evolution of mineral composition and wine strontium isotopic ratio 87 Sr/ 86 Sr (Sr IR) during wood aging were investigated. A red wine was aged in stainless steel tanks with French oak staves (Quercus sessiliflora Salisb.), with three industrial scale replicates. Sampling was carried out after 30, 60, and 90 days of aging, and the wines were evaluated in terms of general analysis, phenolic composition, total polysaccharides, multielement composition, and Sr IR. Li, Be, Mg, Al, Sc, Ti, V, Mn, Co, Ni, Cu, Zn, Ga, Ge, As, Rb, Sr, Y, Zr, Mo, Sb, Cs, Ba, Pr, Nd, Sm, Eu, Dy, Ho, Er, Yb, Lu, Tl, and Pb elements and 87 Sr/ 86 Sr were determined by quadrupole inductively coupled plasma mass spectrometry (Q-ICP-MS) and Na, K, Ca, and Fe by flame atomic absorption spectrometry (FAAS). Two-way ANOVA was applied to assess wood aging and time effect on Sr IR and mineral composition. Wood aging resulted in significantly higher concentrations of Mg, V, Co, Ni, and Sr. At the end of the aging period, wine exhibited statistically identical Sr IR compared to control. Study suggests that wood aging does not affect 87 Sr/ 86 Sr, not precluding the use of this parameter for wine traceability purposes.

  11. Micron SR Studies of High Critical Temperature Superconductor Lead (United States)

    Wu, Wei-Dong


    Flux depinning phenomena in the rm Bi_2Sr_2CaCu_2O_8 (Bi2212) and rm Pb_{0.7}Bi_ {1.3}Sr_2CaCu_2O_8 (Pb-Bi2212) systems have been studied using the technique of transverse field (TF) muSR. Comparison of field-cooled (FC) and zero-field-cooled (ZFC) results defines an irreversibility (depinning) temperature T _{rm irr}: the ZFC and FC relaxation rates are essentially identical above T _{rm irr}, while the ZFC relaxation rate is larger than the FC relaxation rate below T_{rm irr}, reflecting the increased inhomogeneity of the local fields in the ZFC measurements due to flux pinning. The irreversibility line T_{irr}(H) of Bi2212 obtained by muSR measurements is compared with those from dc and ac-susceptibility, and mechanical oscillator measurements. I show that the results from muSR and these other techniques can be explained consistently within a framework of the flux creep model. The irreversibility temperature in Pb -Bi2212, determined by muSR measurements, is significantly higher than that in the pure Bi2212 system. This result, together with the larger critical current and the higher activation energy U_0 in the Pb-Bi2212 crystals as found by the dc-susceptibility measurements, suggests an enhancement of flux pinning by the Pb doping. In order to fit the muSR asymmetry measured in Y_{1-x} U_{x}Pd _3, I have performed Monte Carlo simulations for spin glasses with impurity concentration x between 0 and 1; I found that the stretched exponential decay of muon polarisation found empirically in many spin glasses above the spin freezing temperature T_{g } is consistent with a lognormal distribution of the fluctuation rate nu. Our muSR measurements of Y_ {1-x}U_{x}Pd _3 and UPd_4 demonstrate the disappearance of magnetic order with decreasing U concentration x with a threshold U concentration x _{rm th} ~ 0.2. I show that the behavior is consistent with Sherrington's induced spin glass model based on the competition between exchange interaction coupling {cal T } and the

  12. Ischemic Stroke and Cancer: Stroke Severely Impacts Cancer Patients, While Cancer Increases the Number of Strokes


    Bang, Oh Young; Seok, Jin Myoung; Kim, Seon Gyeong; Hong, Ji Man; Kim, Hahn Young; Lee, Jun; Chung, Pil-Wook; Park, Kwang-Yeol; Kim, Gyeong-Moon; Chung, Chin-Sang; Lee, Kwang Ho


    Background Cancer and ischemic stroke are two of the most common causes of death among the elderly, and associations between them have been reported. However, the main pathomechanisms of stroke in cancer patients are not well known, and can only be established based on accurate knowledge of the characteristics of cancer-related strokes. We review herein recent studies concerning the clinical, laboratory, and radiological features of patients with cancer-related stroke. Main Contents This revi...

  13. The relationship between stroke survivors' perceived identity and mood, self-esteem and quality of life. (United States)

    Lapadatu, Irina; Morris, Reg


    To examine change in identity after stroke and to elucidate its relationship with mood and quality of life. To test Higgins' theory of the impact of identity (self-discrepancy) on anxiety and depression. To examine the role of self-esteem in mediating the relationship between identity and outcomes. Sixty-five community-living first-time stroke survivors, mean age 61.58 and time since stroke 5.60 years, were recruited from stroke charities. A cross-sectional study used the Head Injury Semantic Differential Scale, the Hospital Anxiety and Depression Scale, the Rosenberg Self-Esteem Scale, the Stroke-Specific Quality of Life Questionnaire (adapted) and the Barthel Index. Identity was rated more negatively after stroke than before (t(64) = 6.46, p self-esteem (r = -.48, p self-esteem (β = .30, p self-esteem are associated with important outcomes for stroke survivors.

  14. Family History in Young Patients With Stroke. (United States)

    Thijs, Vincent; Grittner, Ulrike; Dichgans, Martin; Enzinger, Christian; Fazekas, Franz; Giese, Anne-Katrin; Kessler, Christof; Kolodny, Edwin; Kropp, Peter; Martus, Peter; Norrving, Bo; Ringelstein, Erich Bernd; Rothwell, Peter M; Schmidt, Reinhold; Tanislav, Christian; Tatlisumak, Turgut; von Sarnowski, Bettina; Rolfs, Arndt


    Family history of stroke is an established risk factor for stroke. We evaluated whether family history of stroke predisposed to certain stroke subtypes and whether it differed by sex in young patients with stroke. We used data from the Stroke in Fabry Patients study, a large prospective, hospital-based, screening study for Fabry disease in young patients (aged stroke in whom cardiovascular risk factors and family history of stroke were obtained and detailed stroke subtyping was performed. A family history of stroke was present in 1578 of 4232 transient ischemic attack and ischemic stroke patients (37.3%). Female patients more often had a history of stroke in the maternal lineage (P=0.027) than in the paternal lineage. There was no association with stroke subtype according to Trial of Org 10172 in Acute Stroke Treatment nor with the presence of white matter disease on brain imaging. Patients with dissection less frequently reported a family history of stroke (30.4% versus 36.3%; P=0.018). Patients with a parental history of stroke more commonly had siblings with stroke (3.6% versus 2.6%; P=0.047). Although present in about a third of patients, a family history of stroke is not specifically related to stroke pathogenic subtypes in patients with young stroke. Young women with stroke more often report stroke in the maternal lineage. URL: Unique identifier: NCT00414583. © 2015 American Heart Association, Inc.

  15. Trends in stroke incidence. The Copenhagen City Heart Study

    DEFF Research Database (Denmark)

    Truelsen, T; Prescott, E; Grønbaek, M


    in men, whose annual rate ratio was 0.97 (95% CI, 0.95 to 0.99), but not in women, whose annual rate ratio was 0.98 (95% CI, 0.95 to 1.00). Throughout four observed periods the stroke incidence among men remained significantly higher than that for women. CONCLUSIONS: During the period from 1976 to 1993......BACKGROUND AND PURPOSE: Stroke incidence has increased in some countries and decreased in others. After 20 years of intensive antihypertensive treatment the latter could be expected, and we have evaluated the sex-specific temporal trends in stroke incidence using 17 years of follow...... at least one of the two first examinations as well as the total cohort including nonresponders. Subjects between 45 and 84 years of age were followed from March 1, 1976 until March 1, 1993. Changes in age-specific stroke incidence were calculated by means of Poisson regression analysis. RESULTS...

  16. Pediatric abusive head trauma and stroke. (United States)

    Khan, Nickalus R; Fraser, Brittany D; Nguyen, Vincent; Moore, Kenneth; Boop, Scott; Vaughn, Brandy N; Klimo, Paul


    stroke cohort (25%) died as a direct result of their AHT, whereas only 2 children in the nonstroke cohort died (1%). There was a 30% readmission rate within the first 180-day postinjury period for patients in the stroke cohort, and of these, approximately 50% required additional neurosurgical intervention(s). CONCLUSIONS One or more strokes in a child with AHT indicate a particularly severe injury. These children have longer hospital stays, greater hospital charges, and a greater likelihood of needing a neurosurgical intervention (i.e., bedside procedure or surgery). Stroke is such an important predictor of health care utilization and outcome that it warrants a subcategory for both Grade II and Grade III injuries. It should be noted that the word "stroke" or "CVA" should not automatically imply arterial compromise in this population.

  17. Determinants and Time Trends for Ischaemic and Haemorrhagic Stroke in a Large Chinese Population (United States)

    Guo, Yutao; Wang, Hao; Tao, Tao; Tian, Yingchun; Wang, Yutang; Chen, Yundai; Lip, Gregory Y. H.


    Background The clinical epidemiology of stroke has been widely investigated in Caucasian populations, but the changes over time in the proportion of ischaemic to haemorrhagic strokes is less clear, especially in the Chinese population. Aims Our objective was to study the determinants and time trends for ischaemic and haemorrhagic stroke, in relation to age, in a large Chinese population cohort. Methods Using a medical insurance database in the southwest of China from 2001 to 2012, time trends in age-adjusted ischaemic and haemorrhagic stroke incidence and the contributing risk factors associated with age were investigated. Results Among 425,901 individuals without prior stroke (52.4% male, median age 54), the rate of ischaemic stroke (per 1000 patient-years) decreased between 2002–2007, then remained broadly similar between 2008–2012. The rate of haemorrhagic stroke showed a similar trend, being approximately 1.3–1.9 from 2008–2012. Compared to patients ageischaemic and haemorrhagic stroke incidences (rate, 95% confidential interval, CI) were higher in the elderly population (age ischaemic: 3.64, 3.33–4.00, vs 14.33, 14.01–14.60; haemorrhagic: 1.09, 1.00–1.10 vs 2.52,2.40–2.70, respectively, both pstroke rates between the elderly and the very elderly population. Ischaemic and haemorrhagic stroke shared similar risk factors (age, hypertension, coronary artery disease (CAD), vascular disease, and diabetes mellitus) (all pstroke (all pdisease (2.24, 1.49–3.37) was an additional major risk factor for haemorrhagic stroke, together with CAD and diabetes mellitus (all pischaemic stroke compared to haemorrhagic stroke with ageing. CAD, vascular disease, diabetes mellitus, and hypertension were major contributors to the development of hemorrhagic stroke in the very elderly Chinese population. PMID:27685332

  18. Stroke subtypes and comorbidity among ischemic stroke patients in Brasilia and Cuenca: a Brazilian-Spanish cross-cultural study. (United States)

    Carod-Artal, Francisco Javier; Casanova Lanchipa, Jardiel Omar; Cruz Ramírez, Luis Miguel; Pérez, Noelia Sánchez; Siacara Aguayo, Fátima M; Moreno, Isabel Gómez; Romero, Lourdes Gómez; Coral, Luciene Ferreira; Trizotto, Daniele Stieven; Moreira, Clarissa Menezes


    With the increase in life expectancy worldwide, changes in stroke subtypes and burden of stroke population are expected in both developing and developed countries. Prevalence of stroke subtypes and comorbidity in ischemic stroke patients was assessed in Brasilia, Brazil, and Cuenca, Spain. This was an international (Brazilian-Spanish) cross-sectional study. Stroke subtypes were assessed by means of Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification. Modified Rankin scale was used to measure functional recovery and the Cumulative Illness Rating Scale for Geriatrics (CIRS-G) was used to assess comorbidity. A total of 500 patients (mean age 66.2 ± 16.4 years; 48% female; 48.2% Spanish) were included in the study. Spanish patients were significantly older than Brazilian ones (76.4 ± 11.2 versus 56.7 ± 14.6 years; P < .0001). Prevalence of ischemic cardiopathy (20.3% versus 6.2%) and atrial fibrillation (25.7% versus 6.6%) was significantly higher in Spanish stroke patients, whereas they less frequently used tobacco (28.3% versus 52.9%); P less than .0001. Prevalence of stroke subtypes in Spanish and Brazilian stroke patients was: stroke of undetermined etiology (58.1% versus 32.4%), cardioembolism (24.5% versus 11.6%), lacunar infarct (11.6% versus 25.5%), atherothrombotic (3.7% versus 19.7%), and other causes (2.1% versus 10.8%); P less than .0001. The Spanish sample had a significantly higher frequency of comorbidities. The CIRS-G total score and CIRS-G mean number of affected organs significantly increased with age, and correlated with the level of functional dependence as measured by Rankin scale (rS = 0.50; P = .0005). Spanish stroke people had a higher frequency of comorbid conditions, atrial fibrillation, and cardioembolism and these facts were associated with age. Atherothrombotic and lacunar strokes were more common in the younger Brazilian stroke population. Copyright © 2014 National Stroke Association. Published by Elsevier

  19. Trends in Stroke Incidence and 28-Day Case Fatality in a Nationwide Stroke Registry of a Multiethnic Asian Population. (United States)

    Tan, Chuen Seng; Müller-Riemenschneider, Falk; Ng, Sheryl Hui Xian; Tan, Pei Zheng; Chan, Bernard P L; Tang, Kok-Foo; Ahmad, Aftab; Kong, Keng He; Chang, Hui Meng; Chow, Khuan Yew; Koh, Gerald Choon-Huat; Venketasubramanian, Narayanaswamy


    This study investigated trends in stroke incidence and case fatality overall and according to sex, age, ethnicity, and stroke subtype in a multiethnic Asian population. The Singapore Stroke Registry identifies all stroke cases in all public hospitals using medical claims, hospital discharge summaries, and death registry data. Age-standardized incidence rates and 28-day case-fatality rates were calculated for individuals aged ≥15 years between 2006 and 2012. To estimate the annual percentage change of the rates, a linear regression model was fitted to the log rates, and a Wald test was performed to test for trend. P values Chinese (-2.64; 95% CI, -3.15 to -2.13), Indians (-3.78; 95% CI, -5.93 to -1.58), and others (-12.73; 95% CI, -18.93 to -6.06) compared with Malays (2.58; 95% CI, 1.17 to 4.02); and in ischemic stroke subtype (ischemic: -2.43; 95% CI, -3.13 to -1.73; hemorrhagic: -1.02; 95% CI, -2.04 to 0.01). Subgroup-specific findings for case fatality were similar. This is the first countrywide hospital-based registry study in a multiethnic Asian population, and it revealed marked overall reductions in stroke incidence and case fatality. However, it also identified important population groups with less favorable trends, especially younger adults and those of Malay ethnicity. © 2015 American Heart Association, Inc.

  20. Effect of Visual Art School-Based Stroke Intervention for Middle School Students. (United States)

    Johnson, Ashleigh B; Montgomery, Chelsea M; Dillard, Wesley A; Morrill, Kenneth; Hoesli, Coral; Gillette, Wesley M; Johnson, Brandon K; Nathaniel, Thomas I


    Community stroke awareness initiatives have traditionally been used to expand knowledge of stroke signs and risk factors to high-risk adult populations. Here, we use a novel unfettered, visual art-based approach for an elementary school initiative to raise stroke awareness. Seventh graders in a middle school art class received stroke awareness training during the course of the 2015 to 2016 school year through their teacher in the visual arts class. In turn, they used this training to develop their own artistic interpretations of key stroke awareness concepts via project-based learning and then present their projects to raise awareness about stroke. We evaluated our predata and postdata to determine whether the visual art school-based stroke intervention was effective in both educating students about stroke and enabling them to effectively disseminate this information to parents and other adults in their community. The pretest evaluation indicates a fair or good knowledge about stroke, and no student indicated an "outstanding" or "excellent" knowledge. The posttest evaluation indicated a higher degree of stroke awareness because students were rated as having an "outstanding," "excellent," or "very good" performance especially in the ability to translate knowledge of stroke awareness lessons learned in their art class into a well-articulated stroke-related project and presentation. Pearson χ test reveals significant difference (P art teacher to lead the educational component in the intervention indicates that expertise in neurology or stroke is not necessary to facilitate understanding of stroke and highlights the importance of creativeness in stroke education for children.

  1. Hypertension unawareness among Chinese patients with first-ever stroke

    Directory of Open Access Journals (Sweden)

    Qinqin Cao


    Full Text Available Abstract Background The low rates of hypertension treatment and control, partly due to its unawareness, are the main causes of the high stroke incidence in China. The purpose of this study was to evaluate hypertension unawareness amongst patients with first-ever stroke and to detect factors associated with its unawareness. Methods We selected those diagnosed with hypertension from patients with first-ever stroke registered in the Nanjing Stroke Registry Program between 2004 and 2014. These hypertensives were divided as being aware or unaware of their hypertension by using a brief questionnaire conducted shortly after the stroke. Multivariate logistic regression analysis was performed to identify potential factors associated with hypertension unawareness. Results Of the 5309 patients with first-ever stroke, 3732 (70.3 % were diagnosed with hypertension. Among which, 593 (15.9 % were unaware of their hypertension at the time of stroke onset. Lower-level of education (primary school or illiteracy and smoking were associated positively with hypertension unawareness; while advanced age, overweight, diabetes mellitus, heart diseases and family history of stroke were associated negatively with hypertension unawareness. Annual data analyzed indicated that the rate of hypertension awareness increased during the past 11 years (r = 0.613, P = 0.045 for trends. Conclusions A substantial proportion (15.9 % of Chinese patients with hypertension had not been aware of this covert risk until an overt stroke occurred. Hypertension unawareness was associated with lower educational levels and smoking, which address the importance of health education especially in these individuals.

  2. Ageism in stroke rehabilitation studies. (United States)

    Gaynor, Eva Joan; Geoghegan, Sheena Elizabeth; O'Neill, Desmond


    stroke is predominantly a disease of older people. While age bias has been demonstrated in studies of pharmacological therapeutic interventions in stroke, the extent of discrimination by age in stroke rehabilitation studies is unknown. The aim of this study was to systematically review the literature to assess the extent of ageism in stroke rehabilitation studies. all randomised control trials (RCT) on stroke rehabilitation entered in the Cochrane database which reported mean age were included. Patient gender and exclusion criteria were also recorded. of 241 RCT's identified, 182 were eligible for inclusion. The mean age of all patients was 64.3, almost a decade younger than those seen by stroke physicians in daily practice in global terms, and 11-12 years younger than encountered in hospital practice in the British Isles. Almost half (46%) of trials excluded patients with cognitive impairment, almost one-quarter (23%) patients with dysphasia and one-eighth (13%) excluded patients with multiple strokes. we have identified a clear difference in the mean age of those included in stroke rehabilitation studies compared with the international mean age of stroke. In addition, a quarter of trials excluded dysphasic patients which may indicate omission of more severe strokes. This means that the evidence base for stroke rehabilitation is deficient in terms of matching the characteristics of patients encountered in clinical practice, and a more representative sample of older people and those with significant disability must be included in future trials.

  3. Stroke? Localized, otogenic meningitis!

    DEFF Research Database (Denmark)

    Ingolfsdottir, Harpa Maria; Thomasen, Per Caye


    We report the case of a patient admitted with aphasia, treated for a stroke. Subsequently, it was revealed that the symptoms were caused by complicated otitis media with localized meningitis. This case draws attention to the possible intracranial spread of infection when neurological symptoms occur...

  4. Ischemic strokes and migraine

    International Nuclear Information System (INIS)

    Bousser, M.G.; Baron, J.C.; Chiras, J.


    Lasting neurological deficits, though most infrequent, do occur in migrainous subjects and are well documented by clinical angiographic computed tomographic (CT scan) and even pathological studies. However the mechanism of cerebral ischemia in migraine remains widely unknown and the precise role of migraine in the pathogenesis of ischemic strokes is still debated. (orig./MG)

  5. Stroke while jogging.


    Kelly, W. F.; Roussak, J.


    Jogging is a form of physical exercise that has stimulated the imagination of the public as shown by recent appearance of its own journal (Jogging Magazine, Editor J. Bryant). We wish to report the unusual complication of an acute stroke sustained during jogging.

  6. Stroke while jogging. (United States)

    Kelly, W. F.; Roussak, J.


    Jogging is a form of physical exercise that has stimulated the imagination of the public as shown by recent appearance of its own journal (Jogging Magazine, Editor J. Bryant). We wish to report the unusual complication of an acute stroke sustained during jogging. Images p229-a Fig. 1 PMID:7448490

  7. Sex differences in stroke.

    NARCIS (Netherlands)

    Haast, R.A.M.; Gustafson, D.R.; Kiliaan, A.J.


    Sex differences in stroke are observed across epidemiologic studies, pathophysiology, treatments, and outcomes. These sex differences have profound implications for effective prevention and treatment and are the focus of this review. Epidemiologic studies reveal a clear age-by-sex interaction in

  8. Stroke Incidence in Victoria, Australia—Emerging Improvements

    Directory of Open Access Journals (Sweden)

    Benjamin B. Clissold


    Full Text Available BackgroundEvidence of a decline in the incidence of stroke has emerged from population-based studies. These have included retrospective and prospective cohorts. However, in Australia and other countries, government bodies and stroke foundations predict a rise in the prevalence of stroke that is anticipated to increase the burden of stroke across the entire domain of care. This increase in prevalence must be viewed as different from the decline in incidence being observed, a measure of new stroke cases. In Victoria, all public emergency department visits and public and private hospital admissions are reported to the Department of Health and Human Services and include demographic, diagnostic, and procedural/treatment information.MethodsWe obtained data from financial years 1997/1998 to 2007/2008 inclusive, for all cases with a primary stroke diagnosis (ICD-10-AM categories with associated data fields. Incident cases were established by using a 5-year clearance period.ResultsFrom 2003/2004 to 2007/2008 inclusive, there were 53,425 patients with a primary stroke or TIA diagnosis. The crude incident stroke rate for first ever stroke was 211 per 100,000 per year (95% CI 205–217 [females—205 per 100,000 per year (95% CI 196–214 and males—217 per 100,000 per year (95% CI 210–224]. The overall stroke rates were seen to significantly decline over the period [males (per 100,000 per year 227 in 2003/2004 to 202 in 2007/2008 (p = 0.0157 and females (per 100,000 per year 214 in 2003/2004 to 188 in 2007/2008 (p = 0.0482]. Ischemic stroke rates also appeared to decline; however, this change was not significant.ConclusionThese results demonstrate a significant decline in stroke incidence during the study period and may suggest evidence for effectiveness of primary and secondary prevention strategies in cerebrovascular risk factor management.

  9. Design and validation of a clinical scale for prehospital stroke recognition, severity grading and prediction of large vessel occlusion: the shortened NIH Stroke Scale for emergency medical services. (United States)

    Purrucker, Jan Christoph; Härtig, Florian; Richter, Hardy; Engelbrecht, Andreas; Hartmann, Johannes; Auer, Jonas; Hametner, Christian; Popp, Erik; Ringleb, Peter Arthur; Nagel, Simon; Poli, Sven


    To develop an NIH Stroke Scale (NIHSS)-compatible, all-in-one scale for rapid and comprehensive prehospital stroke assessment including stroke recognition, severity grading and progression monitoring as well as prediction of large vessel occlusion (LVO). Emergency medical services (EMS) personnel and stroke physicians (n=326) rated each item of the NIHSS regarding suitability for prehospital use; best rated items were included. Stroke recognition was evaluated retrospectively in 689 consecutive patients with acute stroke or stroke mimics, prediction of LVO in 741 consecutive patients with ischaemic stroke with acute vessel imaging independent of admission NIHSS score. Nine of the NIHSS items were rated as 'suitable for prehospital use.' After excluding two items in order to increase specificity, the final scale (termed shortened NIHSS for EMS, sNIHSS-EMS) consists of 'level of consciousness', 'facial palsy', 'motor arm/leg', 'sensory', 'language' and 'dysarthria'. Sensitivity for stroke recognition of the sNIHSS-EMS is 91% (95% CI 86 to 94), specificity 52% (95% CI 47 to 56). Receiver operating curve analysis revealed an optimal cut-off point for LVO prediction of ≥6 (sensitivity 70% (95% CI 65 to 76), specificity 81% (95% CI 76 to 84), positive predictive value 70 (95% CI 65 to 75), area under the curve 0.81 (95% CI 0.78 to 0.84)). Test characteristics were non-inferior to non-comprehensive scales. The sNIHSS-EMS may overcome the sequential use of multiple emergency stroke scales by permitting parallel stroke recognition, severity grading and LVO prediction. Full NIHSS-item compatibility allows for evaluation of stroke progression starting at the prehospital phase. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  10. Citation Classics in Stroke: The Top-100 Cited Articles on Hemorrhagic Stroke. (United States)

    Kim, Yerim; Yoon, Dae Young; Kim, Jee-Eun; Park, Kang Min; Lee, Ju-Hun; Song, Hong-Ki; Bae, Jong Seok


    Stroke is a disastrous disease and a major health burden worldwide, especially in Korea. Hemorrhagic stroke (HS) accounts for approximately 20% of all the types of strokes. It is important to be able to evaluate stroke diagnoses and evolving treatments. We aimed to identify the top-100 cited articles and assess a paradigm shift that occurred in the field of HS. We searched all articles that had been cited more than 100 times using the Web of Science citation search tool during January 2016. Among a total of 2,651 articles, we identified the top-100 cited articles on HS. The number of citations for the articles analyzed in this study ranged from 1,746 to 211, and the number of annual citations ranged from 125.6 to 5.5. Most of the articles that were published in Stroke (35%) and Journal of Neurosurgery (22%), originated in the United States (n = 56), were original articles (64%), and dealt with the natural history or etiology (n = 37) and vasospasm in subarachnoid hemorrhage (n = 8). We analyzed the top-100 cited articles in the field of HS based on citation rates. The results provide a unique perspective on historical and academic developments in this field. © 2017 S. Karger AG, Basel.

  11. Coexistence of spin frozen state and persistent spin dynamics in NaSrCo{sub 2}F{sub 7} as probed by μSR and NMR

    Energy Technology Data Exchange (ETDEWEB)

    Dengre, Shanu; Sarkar, Rajib; Braeuninger, Sascha Albert; Brueckner, Felix; Materne, Philipp; Klauss, Hans-Henning [Institute for Solid State Physics, TU Dresden (Germany); Krizan, Jason W.; Cava, Robert J. [Department of Chemistry, Princeton University, Princeton, NJ (United States); Luetkens, Hubertus; Baines, Chris [Laboratory for Muon-Spin Spectroscopy, Paul Scherrer Institute, Villigen (Switzerland)


    {sup 23}Na -and {sup 19}F NMR, and μSR experiments are performed to explore the microscopic properties of NaSrCo{sub 2}F{sub 7}, which is a newly discovered magnetically frustrated pyrochlore with weak bond disorder and with a frustration index of f = 42. While {sup 23}Na and {sup 19}F NMR experiments clearly suggest the presence of quasi static field distribution below ∝3 K as reflected in the huge NMR line broadening and wipe out effect of NMR signal intensity, μSR experiments on the other hand remains passive to this spin frozen state. Both NMR and μSR results indicate the slowing down of the magnetic (spin) fluctuations upon cooling towards the NMR spin frozen state. μSR relaxation rate increases slightly below ∝ 3 K, and remains not only constant down to 20 mK, but also stands independent in longitudinal magnetic field upto 4000 G implying that the spin fluctuations are dynamic. These observations suggest the coexistence of partial spin frozen state and persistent spin dynamics in NaSrCo{sub 2}F{sub 7}.

  12. Rehabilitating the Stroke Collection

    Directory of Open Access Journals (Sweden)

    Mary Grimmond


    Full Text Available Objective The aim of this project was to complete an analysis of monograph and audiovisual items held in the Central Coast Health Service (CCHS Libraries and containing information relevant to the treatment of acute stroke. Acute stroke is treated by multidisciplinary teams of clinicians based at two hospitals within the CCHS. The adequacy of the library collection was measured by subject coverage and age. Methods The methodology used consisted of three main steps: a literature review; design, administration, and analysis of a questionnaire to members of the CCHS Acute Stroke Team; and an analysis of the libraries’ collections. The research project utilised project management methodology and an evidence based librarianship framework. Results The questionnaire revealed that electronic resources were by far the most frequently used by participants, followed in order by print journals, books, interlibrary loan articles, and audiovisual items. Collection analysis demonstrated that the monograph and audiovisual collections were adequate in both scope and currency to support the information needs of Acute Stroke Team members, with the exception of resources to support patient education. Conclusion The researchers developed recommendations for future collection development in the area of acute stroke resources. Conducting this project within the evidence based librarianship framework helped to develop library staff members’ confidence in their ability to make future collection development decisions, informed by the target group’s information needs and preferences. The collection analysis methodology was designed to be replicated, and new specialist groups within the client base of the library will be targeted to repeat the collection analysis process.

  13. Formation and function of acute stroke-ready hospitals within a stroke system of care recommendations from the brain attack coalition. (United States)

    Alberts, Mark J; Wechsler, Lawrence R; Jensen, Mary E Lee; Latchaw, Richard E; Crocco, Todd J; George, Mary G; Baranski, James; Bass, Robert R; Ruff, Robert L; Huang, Judy; Mancini, Barbara; Gregory, Tammy; Gress, Daryl; Emr, Marian; Warren, Margo; Walker, Michael D


    Many patients with an acute stroke live in areas without ready access to a Primary or Comprehensive Stroke Center. The formation of care facilities that meet the needs of these patients might improve their care and outcomes and guide them and emergency responders to such centers within a stroke system of care. The Brain Attack Coalition conducted an electronic search of the English medical literature from January 2000 to December 2012 to identify care elements and processes shown to be beneficial for acute stroke care. We used evidence grading and consensus paradigms to synthesize recommendations for Acute Stroke-Ready Hospitals (ASRHs). Several key elements for an ASRH were identified, including acute stroke teams, written care protocols, involvement of emergency medical services and emergency department, and rapid laboratory and neuroimaging testing. Unique aspects include the use of telemedicine, hospital transfer protocols, and drip and ship therapies. Emergent therapies include the use of intravenous tissue-type plasminogen activator and the reversal of coagulopathies. Although many of the care elements are similar to those of a Primary Stroke Center, compliance rates of ≥67% are suggested in recognition of the staffing, logistical, and financial challenges faced by rural facilities. ASRHs will form the foundation for acute stroke care in many settings. Recommended elements of an ASRH build on those proven to improve care and outcomes at Primary Stroke Centers. The ASRH will be a key component for patient care within an evolving stroke system of care.

  14. Assessing response of local moisture conditions in central Brazil to variability in regional monsoon intensity using speleothem 87Sr/86Sr values (United States)

    Wortham, Barbara E.; Wong, Corinne I.; Silva, Lucas C. R.; McGee, David; Montañez, Isabel P.; Troy Rasbury, E.; Cooper, Kari M.; Sharp, Warren D.; Glessner, Justin J. G.; Santos, Roberto V.


    Delineating the controls on hydroclimate throughout Brazil is essential to assessing potential impact of global climate change on water resources and biogeography. An increasing number of monsoon reconstructions from δ18O records provide insight into variations in regional monsoon intensity over the last millennium. The strength, however, of δ18O as a proxy of regional climate limits its ability to reflect local conditions, highlighting the need for comparable reconstructions of local moisture conditions. Here, speleothem 87Sr/86Sr values are developed as a paleo-moisture proxy in central Brazil to complement existing δ18O-based reconstructions of regional monsoon intensity. Speleothem 87Sr/86Sr values are resolved using laser ablation and conventional solution mass spectrometry at high resolution relative to existing (non-δ18O-based) paleo-moisture reconstructions to allow comparisons of centennial variability in paleo-monsoon intensity and paleo-moisture conditions. Variations in speleothem 87Sr/86Sr values from Tamboril Cave are interpreted to reflect varying extents of water interaction with the carbonate host rock, with more interaction resulting in greater evolution of water isotope values from those initially acquired from the soil to those of the carbonate bedrock. Increasing speleothem 87Sr/86Sr values over the last millennium suggest progressively less interaction with the carbonate host rock likely resulting from higher infiltration rates, expected under wetter conditions. Increasingly wetter conditions over the last millennium are consistent with an overall trend of increasing monsoon intensity (decreasing δ18O values) preserved in many existing δ18O records from the region. Such a trend, however, is absent in δ18O records from our site (central Brazil) and Cristal Cave (southeast Brazil), suggesting the existence of divergent (relevant to δ18Oprecip) shifts in the climate patterns within and outside the core monsoon region.

  15. Stroke treatment outcomes in hospitals with and without Stroke Units. (United States)

    Masjuan, J; Gállego Culleré, J; Ignacio García, E; Mira Solves, J J; Ollero Ortiz, A; Vidal de Francisco, D; López-Mesonero, L; Bestué, M; Albertí, O; Acebrón, F; Navarro Soler, I M


    Organisational capacity in terms of resources and care circuits to shorten response times in new stroke cases is key to obtaining positive outcomes. This study compares therapeutic approaches and treatment outcomes between traditional care centres (with stroke teams and no stroke unit) and centres with stroke units. We conducted a prospective, quasi-experimental study (without randomisation of the units analysed) to draw comparisons between 2 centres with stroke units and 4 centres providing traditional care through the neurology department, analysing a selection of agreed indicators for monitoring quality of stroke care. A total of 225 patients participated in the study. In addition, self-administered questionnaires were used to collect patients' evaluations of the service and healthcare received. Centres with stroke units showed shorter response times after symptom onset, both in the time taken to arrive at the centre and in the time elapsed from patient's arrival at the hospital to diagnostic imaging. Hospitals with stroke units had greater capacity to respond through the application of intravenous thrombolysis than centres delivering traditional neurological care. Centres with stroke units showed a better fit to the reference standards for stroke response time, as calculated in the Quick study, than centres providing traditional care through the neurology department. Copyright © 2017 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  16. Secular trends in ischemic stroke subtypes and stroke risk factors. (United States)

    Bogiatzi, Chrysi; Hackam, Daniel G; McLeod, A Ian; Spence, J David


    Early diagnosis and treatment of a stroke improves patient outcomes, and knowledge of the cause of the initial event is crucial to identification of the appropriate therapy to maximally reduce risk of recurrence. Assumptions based on historical frequency of ischemic subtypes may need revision if stroke subtypes are changing as a result of recent changes in therapy, such as increased use of statins. We analyzed secular trends in stroke risk factors and ischemic stroke subtypes among patients with transient ischemic attack or minor or moderate stroke referred to an urgent transient ischemic attack clinic from 2002 to 2012. There was a significant decline in low-density lipoprotein cholesterol and blood pressure, associated with a significant decline in large artery stroke and small vessel stroke. The proportion of cardioembolic stroke increased from 26% in 2002 to 56% in 2012 (Prisk factors was observed, with a significant decline in stroke/transient ischemic attack caused by large artery atherosclerosis and small vessel disease. As a result, cardioembolic stroke/transient ischemic attack has increased significantly. Our findings suggest that more intensive investigation for cardiac sources of embolism and greater use of anticoagulation may be warranted. © 2014 American Heart Association, Inc.

  17. Outcome Determinants of Stroke in a Brazilian Primary Stroke Center

    Directory of Open Access Journals (Sweden)

    Gustavo W. Kuster


    Full Text Available Background. Stroke mortality in Brazil is one of the highest among Western countries. Nonetheless, stroke outcome determinants are still poorly known in this country. In this study we evaluate outcome determinants of stroke in a primary stroke center in São Paulo, Brazil. Methods. We evaluated demographic, clinical, and outcome data of patients with ischemic stroke (IS, transient ischemic attack (TIA, and intracerebral hemorrhage (ICH admitted at “Hospital Paulistano,” São Paulo, Brazil. In-hospital mortality and functional outcome determinants were assessed. Univariate and binary logistic regression analysis were performed. Results. Three hundred forty-one patients were included in the study, 52.2% being male with 66.8±15.7 years. The stroke type distribution was IS: 59.2%, TIA: 29.6%, and ICH: 11.1%. ICH was associated with greater severity and poorer functional outcome. The determinants of poorer functional outcome were higher NIHSS, lower Glasgow score, and lower oxygen saturation level. The most important mortality determinant was the presence of visual symptoms. Conclusions. The stroke mortality and stroke outcome determinants found in the present study do not remarkably differ from studies carried out in developed countries. Stroke prognosis studies are crucial to better understand the high burden of stroke in Brazil.

  18. Thermodynamic Modeling of Sr/TRU Removal

    International Nuclear Information System (INIS)

    Felmy, A.R.


    This report summarizes the development and application of a thermodynamic modeling capability designed to treat the Envelope C wastes containing organic complexants. A complete description of the model development is presented. In addition, the model was utilized to help gain insight into the chemical processes responsible for the observed levels of Sr, TRU, Fe, and Cr removal from the diluted feed from tank 241-AN-107 which had been treated with Sr and permanganate. Modeling results are presented for Sr, Nd(III)/Eu(III), Fe, Cr, Mn, and the major electrolyte components of the waste (i.e. NO 3 , NO 2 , F,...). On an overall basis the added Sr is predicted to precipitate as SrCO 3 (c) and the MnO 4 - reduced by the NO 2 - and precipitated as a Mn oxide. These effects result in only minor changes to the bulk electrolyte chemistry, specifically, decreases in NO 2 - and CO 3 2- , and increases in NO 3 - and OH - . All of these predictions are in agreement with the experimental observations. The modeling also indicates that the majority of the Sr, TRU's (or Nd(III)/Eu(III)) analogs, and Fe are tied up with the organic complexants. The Sr and permanganate additions are not predicted to effect these chelate complexes significantly owing to the precipitation of insoluble Mn oxides or SrCO 3 . These insoluble phases maintain low dissolved concentrations of Mn and Sr which do not affect any of the other components tied up with the complexants. It appears that the removal of the Fe and TRU'S during the treatment process is most likely as a result of adsorption or occlusion on/into the Mn oxides or SrCO 3 , not as direct displacement from the complexants into precipitates. Recommendations are made for further studies that are needed to help resolve these issues

  19. Automated Speech Rate Measurement in Dysarthria (United States)

    Martens, Heidi; Dekens, Tomas; Van Nuffelen, Gwen; Latacz, Lukas; Verhelst, Werner; De Bodt, Marc


    Purpose: In this study, a new algorithm for automated determination of speech rate (SR) in dysarthric speech is evaluated. We investigated how reliably the algorithm calculates the SR of dysarthric speech samples when compared with calculation performed by speech-language pathologists. Method: The new algorithm was trained and tested using Dutch…

  20. Understanding Stroke - Know Stroke • Know the Signs • Act in Time (United States)

    ... Home Current Issue Past Issues Special Section Understanding Stroke Know Stroke • Know the Signs • Act in Time Past Issues / ... Julie Harris, and motivational speaker David Layton. Preventing Stroke "Until I had my stroke, I didn't ...

  1. Polygenic overlap between kidney function and large artery atherosclerotic stroke (United States)

    Holliday, Elizabeth G.; Traylor, Matthew; Malik, Rainer; Bevan, Stephen; Maguire, Jane; Koblar, Simon A.; Sturm, Jonathan; Hankey, Graeme J.; Oldmeadow, Christopher; McEvoy, Mark; Sudlow, Cathie; Rothwell, Peter M.; Coresh, Josef; Hamet, Pavel; Tremblay, Johanne; Turner, Stephen T.; de Andrade, Mariza; Rao, Madhumathi; Schmidt, Reinhold; Crick, Peter A.; Robino, Antonietta; Peralta, Carmen A.; Jukema, J. Wouter; Mitchell, Paul; Rosas, Sylvia E.; Wang, Jie Jin; Scott, Rodney J.; Dichgans, Martin; Mitchell, Braxton D.; Linda Kao, W. H.; Fox, Caroline S.; Levi, Christopher; Attia, John; Markus, Hugh S


    Background and Purpose Epidemiological studies show strong associations between kidney dysfunction and risk of ischaemic stroke, the mechanisms of which are incompletely understood. We investigated whether these associations may reflect shared heritability due to a common polygenic basis and whether this differed for ischaemic stroke subtypes. Methods Polygenic models were derived using GWAS meta-analysis results for three kidney traits: estimated glomerular filtration rate using serum creatinine (eGFRcrea: N=73,998), eGFR using cystatin C (eGFRcys: N=22,937) and urinary albumin to creatinine ratio (UACR: N=31,580). For each, SNPs passing ten P-value thresholds were used to form profile scores in 4,561 ischaemic stroke cases and 7,094 controls from the UK, Germany and Australia. Scores were tested for association with ischaemic stroke and its three aetiological subtypes: large artery atherosclerosis (LAA), cardioembolism (CE) and small vessel disease (SVD). Results Polygenic scores correlating with higher eGFRcrea were associated with reduced risk of LAA, with five scores reaching Pischaemic stroke. The shared genetic components may be specific to stroke subtypes, particularly large artery atherosclerotic stroke. Further study of the genetic relationships between these disorders appears merited. PMID:25352485

  2. Current clinical practices in stroke rehabilitation: regional pilot survey. (United States)

    Natarajan, Pradeep; Oelschlager, Ashley; Agah, Arvin; Pohl, Patricia S; Ahmad, S Omar; Liu, Wen


    This study was aimed at understanding the current physical and occupational therapy practices in stroke rehabilitation in the Midwest. The insights gained from this pilot study will be used in a future study aimed at understanding stroke rehabilitation practices across the nation. Researchers and clinicians in the field of stroke rehabilitation were interviewed, and past studies in the literature were analyzed. Through these activities, we developed a 37-item questionnaire that was sent to occupational and physical therapists practicing in Kansas and Missouri who focus on the care of people who have had a stroke (n = 320). A total of 107 respondents returned a com pleted questionnaire, which gives a response rate of about 36%. The majority of respondents had more than 12 years of experience treating patients with stroke. Consensus of 70% or more was found for 80% of the items. The preferred approaches for the rehabilitation of people who have had a stroke are the Bobath and Brunnstrom methods, which are being used by 93% and 85% of the physical and occupational therapists, respectively. Even though some variability existed in certain parts of the survey, in general clinicians agreed on different treatment approaches in issues dealing with muscle tone, weakness, and limited range of motion in stroke rehabilitation. Some newer treatment approaches that have been proven to be effective are practiced only by a minority of clinicians. The uncertainty among clinicians in some sections of the survey reveals that more evidence on clinical approaches is needed to ensure efficacious treatments.

  3. Stroke occurring in patients with cognitive impairment or dementia

    Directory of Open Access Journals (Sweden)

    Solène Moulin

    Full Text Available ABSTRACT One in six patients admitted for stroke was previously demented. These patients have less access to appropriate stroke care, although little is known about their optimal management. Objective To determine how pre-stroke cognitive impairment can be detected, its mechanism, and influence on outcome and management. Methods Literature search. Results (i A systematic approach with the Informant Questionnaire of Cognitive Decline in the Elderly is recommended; (ii Pre-stroke cognitive impairment may be due to brain lesions of vascular, degenerative, or mixed origin; (iii Patients with pre-stroke dementia, have worse outcomes, more seizures, delirium, and depression, and higher mortality rates; they often need to be institutionalised after their stroke; (iv Although the safety profile of treatment is not as good as that of cognitively normal patients, the risk:benefit ratio is in favour of treating these patients like others. Conclusion Patients with cognitive impairment who develop a stroke have worse outcomes, but should be treated like others.

  4. 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. (United States)

    Guo, Yutao; Wang, Hao; Tian, Yingchun; Wang, Yutang; Lip, Gregory Y H


    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 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 stroke rates were 2.07 (0.86-4.76) and 4.29 (4.08-4.51) in non-AF and AF populations, respectively. The non-AF population age ≥ 65 years with ≥ 2 additional comorbidities (hypertension, vascular disease, diabetic, or heart failure) had ischaemic stroke rates similar to an AF population with CHA2DS2-VASc ≥ 4. In both non-AF and AF populations, those with CHA2DS2-VASc =1 had a 1.9 fold increase in stroke risk, and those with CHA2DS2-VASc ≥ 2 had more than four-fold increased risk for stroke, compared with those with CHA2DS2-VASc=0. In conclusion, an increasing cluster of multiple cardiovascular 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

  5. The Effect of Anemia on the Functional Outcomes of the Stroke Patients and the Efficiency of their Stroke Rehabilitation. (United States)

    Chan, Tik; Ganasekaran, Ganesh


    There has been limited study focusing on the functional outcomes of stroke patients' after rehabilitation, such as functional improvement and discharge destination, length of stay (LOS), and complication rate. A retrospective study was conducted on 123 consecutive patients who were admitted to The Prince Charles Hospital Rehabilitation Unit from January 2011 to December 2012 with clinically defined stroke syndromes. Functional Independence Measure (FIM) score was used to measure the functional improvement. Anemia is defined by using the World Health Organization's criteria (hemoglobin concentration in men types of stroke were all comparable in both anemic and nonanemic groups. It was found that, when selecting only the patients with ischemic stroke for comparison (103 patients), there was a significantly higher FIM score improvement (discharge FIM - admission FIM) in nonanemic group (P = .042). FIM efficiency (FIM change/LOS) was also significantly higher in the nonanemic group (P = .027). Higher percentage of patients were discharged home in nonanemic group (94.3% versus 73.3%, P = .006). In addition, higher rate of complications was found in anemic group (60% versus 39%, P = .049). Anemia appears to have a significant effect on the functional improvement and discharge outcomes for patients who had an ischemic stroke. Anemia may also increase the complication rate and affect the efficiency of stroke rehabilitation for those patients. Crown Copyright © 2015. Published by Elsevier Inc. All rights reserved.

  6. Electronic parameters of Sr2M2O7 (M = V, Nb, Ta) and Sr-O chemical bonding

    DEFF Research Database (Denmark)

    Atuchin, Victor V.; Grivel, Jean-Claude; Zhang, Zhaoming


    on the formation of the Sr-O bonds. The chemical bonding effects were considered on the basis of our XPS results for Sr2Nb2O7 and Sr2Ta2O7 and the previously published structural and XPS data for other Sr-oxide compounds. A new empirical relationship between Δ(O-Sr) and L(Sr-O) was obtained. Possible applications...

  7. Translation and validation of the Malay version of the Stroke Knowledge Test. (United States)

    Sowtali, Siti Noorkhairina; Yusoff, Dariah Mohd; Harith, Sakinah; Mohamed, Monniaty


    To date, there is a lack of published studies on assessment tools to evaluate the effectiveness of stroke education programs. This study developed and validated the Malay language version of the Stroke Knowledge Test research instrument. This study involved translation, validity, and reliability phases. The instrument underwent backward and forward translation of the English version into the Malay language. Nine experts reviewed the content for consistency, clarity, difficulty, and suitability for inclusion. Perceived usefulness and utilization were obtained from experts' opinions. Later, face validity assessment was conducted with 10 stroke patients to determine appropriateness of sentences and grammar used. A pilot study was conducted with 41 stroke patients to determine the item analysis and reliability of the translated instrument using the Kuder Richardson 20 or Cronbach's alpha. The final Malay version Stroke Knowledge Test included 20 items with good content coverage, acceptable item properties, and positive expert review ratings. Psychometric investigations suggest that Malay version Stroke Knowledge Test had moderate reliability with Kuder Richardson 20 or Cronbach's alpha of 0.58. Improvement is required for Stroke Knowledge Test items with unacceptable difficulty indices. Overall, the average rating of perceived usefulness and perceived utility of the instruments were both 72.7%, suggesting that reviewers were likely to use the instruments in their facilities. Malay version Stroke Knowledge Test was a valid and reliable tool to assess educational needs and to evaluate stroke knowledge among participants of group-based stroke education programs in Malaysia.

  8. [Optimized logistics in the prehospital management of acute stroke]. (United States)

    Luiz, T; Moosmann, A; Koch, C; Behrens, S; Daffertshofer, M; Ellinger, K


    Current management of acute stroke is characterised by an aggressive approach including specific therapy i. e. reperfusion therapy. However currently stroke patients often arrive too late in hospitals offering adequate treatment. Therefore optimized logistics play a predominant role in modern stroke management. 1. Does teaching of EMS staff and the public result in reduced prehospital latencies 2. Will EMS personnel be able to effectively screen patients potentially suitable for thrombolysis? During a six week-period all EMS patients presenting with possible signs of an acute stroke were prospectively registered (period 1). Data of interest were age, mode of primary contact, prehospital latencies, mode of transportation, destination and final diagnosis. Next an algorithm was established allowing EMS personnel to transfer patients with an assumed stroke to the best suitable hospital. Teaching comprised clinical signs, indication of CT scanning, pathophysiology, specific therapeutic options (thrombolysis), and criteria to identify patients suitable for thrombolysis. In a second step the public was continuously taught about stroke symptoms and the necessity to instantly seek EMS assistance. After 12 months data were compared to baseline (period 2). (period 2 vs. Period 1): Rate of patients transferred to a stroke center: 60 % vs. 54 %; rate of those transported to hospitals not offering CT scans: 17 % vs. 26 % (p < 0.05). Percentage of patients primarily contacting the EMS system: 33 % vs. 24 %. Median interval between onset of symptoms and emergency call: 54 vs. 263 minutes Median interval between the emergency call and arrival at the emergency department: 44 vs. 58 minutes (p < 0.01). Rate of patients admitted with a diagnosis other than stroke: 18 % vs. 25 % (n. s.). Median interval between onset of symptoms and hospital admission: 140 vs. 368 minutes (p < 0.001). Median age: 69 vs. 75 years (p < 0.01). This study demonstrates the efficacy of educational efforts in

  9. Application of the World Stroke Organization health system indicators and performance in Australia, Singapore, and the USA. (United States)

    Tse, Tamara; Carey, Leeanne; Cadilhac, Dominique; Koh, Gerald Choon-Huat; Baum, Carolyn


    Aim To examine how Australia, Singapore and the United States of America (USA) match to the World Stroke Organization Global Stroke Services health system monitoring indicators (HSI). Design Descriptive comparative study Participants The health systems of Australia, Singapore, the USA. Outcome measures Published data available from each country were mapped to the 10 health system monitoring indicators proposed by the World Stroke Organization. Results Most health system monitoring indicators were at least partially met in each country. Thrombolytic agents were available for use in acute stroke. Stroke guidelines and stroke registry data were available in all three countries. Stroke incidence, prevalence, and mortality rates were available but at non-uniform times post-stroke. The International Classification of Disease 9 or 10 coding systems are used in all three countries. Standardized clinical audits are routine in Australia and the USA, but not in Singapore. The use of the modified Rankin Scale is collected sub-acutely but not at one year post-stroke in all three countries. Conclusions The three developed countries are performing well against the World Stroke Organization health system monitoring indicators for acute and sub-acute stroke care. However, improvements in stroke risk assessment and at one-year post-stroke outcome measurement are needed.

  10. A normalised seawater strontium isotope curve. Possible implications for Neoproterozoic-Cambrian weathering rates and the further oxygenation of the Earth

    International Nuclear Information System (INIS)

    Shields, G.A.


    The strontium isotope composition of seawater is strongly influenced on geological time scales by changes in the rates of continental weathering relative to ocean crust alteration. However, the potential of the seawater 87 Sr/ 86 Sr curve to trace globally integrated chemical weathering rates has not been fully realised because ocean 87 Sr/ 86 Sr is also influenced by the isotopic evolution of Sr sources to the ocean. A preliminary attempt is made here to normalise the seawater 87 Sr/ 86 Sr curve to plausible trends in the 87 Sr/ 86 Sr ratios of the three major Sr sources: carbonate dissolution, silicate weathering and submarine hydrothermal exchange. The normalised curve highlights the Neoproterozoic-Phanerozoic transition as a period of exceptionally high continental influence, indicating that this interval was characterised by a transient increase in global weathering rates and/or by the weathering of unusually radiogenic crustal rocks. Close correlation between the normalised 87 Sr/ 86 Sr curve, a published seawater δ 34 S curve and atmospheric pCO 2 models is used here to argue that elevated chemical weathering rates were a major contributing factor to the steep rise in seawater 87 Sr/ 86 Sr from 650 Ma to 500 Ma. Elevated weathering rates during the Neoproterozoic-Cambrian interval led to increased nutrient availability, organic burial and to the further oxygenation of Earth's surface environment. Use of normalised seawater 87 Sr/ 86 Sr curves will, it is hoped, help to improve future geochemical models of Earth System dynamics. (orig.)

  11. Challenging comparison of stroke scales

    Directory of Open Access Journals (Sweden)

    Kavian Ghandehari


    Full Text Available Stroke scales can be classified as clinicometric scales and functional impairment, handicap scales. All studies describing stroke scales were reviewed by internet searching engines with the final search performed on January 1, 2013. The following string of keywords was entered into search engines; stroke, scale, score and disability. Despite advantages of modified National Institute of Health Stroke Scale and Scandinavian stroke scale comparing to the NIHSS, including their simplification and less inter-rater variability; most of the stroke neurologists around the world continue using the NIHSS. The modified Rankin scale (mRS and Barthel index (BI are widely used functional impairment and disability scales. Distinction between grades of mRS is poorly defined. The Asian stroke disability scale is a simplified functional impairment, handicap scale which is as valid as mRS and BI. At the present time, the NIHSS, mRS and BI are routine stroke scales because physicians have used to work with these scales for more than two decades, although it could not be an acceptable reason. On the other side, results of previous stroke trials, which are the basis of stroke management guidelines are driven using these scales.

  12. Assessment and provision of rehabilitation among patients hospitalized with acute ischemic stroke in China: Findings from the China National Stroke Registry II. (United States)

    Bettger, Janet Prvu; Li, Zixiao; Xian, Ying; Liu, Liping; Zhao, Xingquan; Li, Hao; Wang, Chunxue; Wang, Chunjuan; Meng, Xia; Wang, Anxin; Pan, Yuesong; Peterson, Eric D; Wang, Yilong; Wang, Yongjun


    Background Stroke rehabilitation improves functional recovery among stroke patients. However, little is known about clinical practice in China regarding the assessment and provision of rehabilitation among patients with acute ischemic stroke. Aims We examined the frequency and determinants of an assessment for rehabilitation among acute ischemic stroke patients from the China National Stroke Registry II. Methods Data for 19,294 acute ischemic stroke patients admitted to 219 hospitals from June 2012 to January 2013 were analyzed. The multivariable logistic regression model with the generalized estimating equation method accounting for in-hospital clustering was used to identify patient and hospital factors associated with having a rehabilitation assessment during the acute hospitalization. Results Among 19,294 acute ischemic stroke patients, 11,451 (59.4%) were assessed for rehabilitation. Rates of rehabilitation assessment varied among 219 hospitals (IQR 41.4% vs 81.5%). In the multivariable analysis, factors associated with increased likelihood of a rehabilitation assessment ( p stroke, higher NIHSS on admission, receipt of a dysphagia screen, deep venous thrombosis prophylaxis, carotid vessel imaging, longer length of stay, and treatment at a hospital with a higher number of hospital beds (per 100 units). In contrast, patients with a history of atrial fibrillation and hospitals with higher number of annual stroke discharges (per 100 patients) were less likely to receive rehabilitation assessment during the acute stroke hospitalization. Conclusions Rehabilitation assessment among acute ischemic stroke patients was suboptimal in China. Rates varied considerably among hospitals and support the need to improve adherence to recommended care for stroke survivors.

  13. Prediction models for 90Sr in shed deciduous teeth and infant bone

    DEFF Research Database (Denmark)

    Aarkrog, Asker


    Shed deciduous teeth were collected in 1966-69 in Denmark, the Faroes and Greenland from children born in the period 1953-63. 235 samples of crowns were analysed for 90Sr. The 90Sr levels in deciduous tooth crowns were related to the fall-out rate and the accumulated fall-out. The tooth levels...... in children born in 1950-62 could be described with the same equation as the 90Sr bone levels in 1-yr-old infants born in 1962-68. The prediction models for 90Sr in teeth and bones showed that for given amount of fall-out the Faroese levels became nearly twice as high as the Danish. The maximum teeth and bone...

  14. Autoradiography of 90Sr in developing rats

    International Nuclear Information System (INIS)

    Olsen, I.; Jonsen, J.


    The distribution patterns of 90 Sr in five littermate, 8-day-old Wistar rats were studied by whole body autoradiography. Rats were killed 15 min, 1, 4, 24, and 72 h after a single intraperitoneal injection of the isotope. Immediately after administration, 90 Sr was distributed throughout most of the soft tissues of the body. The soft tissue deposits had practically disappeared after 4 h. In the hard tissues of the body 90 Sr accumulated up to 24-72 h. Fifteen minutes after injection the uptake of 90 Sr in the enamel of the teeth was highest in the occlusal and incisal regions. 90 Sr gradually accumulated throughout the enamel and after 72 h its distribution in this layer was fairly uniform. Immediately after injection a narrow zone of radioactivity appeared in the dentin near the pulp. This zone broadened with time towards the dentinoenamel junction and included the intire dentin layer 72 h after injection. Initially, the uptake of 90 Sr was higher in the dentin than in the enamel, particularly in the cervical areas of the crown. This difference became less apparent with time. There was good correlation between the uptake in the teeth and bones, supporting the use of teeth as indicators of the 90 Sr body burden. (author)

  15. Maxdose-SR and popdose-SR routine release atmospheric dose models used at SRS

    Energy Technology Data Exchange (ETDEWEB)

    Jannik, G. T. [Savannah River Site (SRS), Aiken, SC (United States). Savannah River National Lab. (SRNL); Trimor, P. P. [Savannah River Site (SRS), Aiken, SC (United States). Savannah River National Lab. (SRNL)


    MAXDOSE-SR and POPDOSE-SR are used to calculate dose to the offsite Reference Person and to the surrounding Savannah River Site (SRS) population respectively following routine releases of atmospheric radioactivity. These models are currently accessed through the Dose Model Version 2014 graphical user interface (GUI). MAXDOSE-SR and POPDOSE-SR are personal computer (PC) versions of MAXIGASP and POPGASP, which both resided on the SRS IBM Mainframe. These two codes follow U.S. Nuclear Regulatory Commission (USNRC) Regulatory Guides 1.109 and 1.111 (1977a, 1977b). The basis for MAXDOSE-SR and POPDOSE-SR are USNRC developed codes XOQDOQ (Sagendorf et. al 1982) and GASPAR (Eckerman et. al 1980). Both of these codes have previously been verified for use at SRS (Simpkins 1999 and 2000). The revisions incorporated into MAXDOSE-SR and POPDOSE-SR Version 2014 (hereafter referred to as MAXDOSE-SR and POPDOSE-SR unless otherwise noted) were made per Computer Program Modification Tracker (CPMT) number Q-CMT-A-00016 (Appendix D). Version 2014 was verified for use at SRS in Dixon (2014).

  16. Effect of new and conventional technological processes on the terroir marker 87Sr/86Sr

    Directory of Open Access Journals (Sweden)

    Catarino Sofia


    Full Text Available Aiming to use the strontium isotopic ratio 87Sr/86Sr for traceability and authentication of wine, it is crucial to understand the impacts of anthropogenic factor and technological processes on this parameter. In this study the effect of two technologies: nanofiltration (NF, applied for wine dealcoholisation (1, and ageing with oak wood staves (2, on 87Sr/86Sr ratio of wines from Portuguese Designations of Origin (DO, was assessed. Control wines, NF processed wines and wooden aged wines were evaluated for chemical composition, multi-elemental composition and 87Sr/86Sr ratio by Q-ICP-MS. Regarding NF experiments, high rejections to mineral elements, including heavy metals, were observed. Bearing in mind the several roles played by these elements in wine, this knowledge is of strategic importance in order to guarantee that NF process does not adversely affect product quality. Concerning wood ageing experiment, results indicate the influence of this technological process on metal physical-chemical stability. In the experimental conditions of this study, no significant effect of NF process and wood ageing on 87Sr/86Sr ratio was observed, suggesting that the application of these technologies in wine production is not a limitative factor for the use of 87Sr/86Sr ratio as a geographical origin marker.

  17. Guidelines for acute ischemic stroke treatment: part II: stroke treatment

    Directory of Open Access Journals (Sweden)

    Sheila Cristina Ouriques Martins


    Full Text Available The second part of these Guidelines covers the topics of antiplatelet, anticoagulant, and statin therapy in acute ischemic stroke, reperfusion therapy, and classification of Stroke Centers. Information on the classes and levels of evidence used in this guideline is provided in Part I. A translated version of the Guidelines is available from the Brazilian Stroke Society website (

  18. For whom the desert bell tolls: heat stroke or stroke

    Directory of Open Access Journals (Sweden)

    Mustafa Bolatkale


    Full Text Available Heat stroke is the most complicated and dangerous amongst heat injuries that can lead to irreversible injury and even death with itself or with creating predisposibility to different diseases. The following case report depicts a patient who presented primarily with impairment of consciousness after walking 45 km in the summer heat to cross the Syria-Turkey border and later syncope. This case report aims to highlight the possibility of higher co-incidence with heat stroke and stroke.

  19. Cs+ and Sr2+ adsorption selectivity of zeolites in relation to radioactive decontamination

    Directory of Open Access Journals (Sweden)

    M.W. Munthali


    Full Text Available Zeolites are used as adsorbents of cationic elements in the radioactive decontamination process of water, soil and others. We determined Cs+ and Sr2+ adsorption selectivity of some zeolites to know effective zeolite species for the decontamination of radioactive Cs and Sr. A 30 mL mixed solution containing up to 15 mg L−1 of non-radioactive Cs+ or Sr+ and up to 0.50 M of Na+ or K+ was mixed with 0.5 g of Linde-type A, Na-P1, faujasite X, faujasite Y and mordenite. Among the zeolites, mordenite had the highest Cs+ adsorption selectivity, and the selectivity had no correlation to the cation exchange capacity (CEC of the zeolites. In contrast, Sr2+ adsorption selectivity of the zeolites positively correlated with the CEC of the zeolites; Linde-type A with the highest CEC showed the highest adsorption selectivity, and its adsorption rate was more than 99.9% even in the presence of 0.5 M K+. A simulated soil decontamination experiment of Cs from a Cs-retaining vermiculite by using mordenite and that of Sr from a Sr-retaining vermiculite by using Linde-type A showed decontamination rates of more than 90%.

  20. Diagnostic value of prehospital ECG in acute stroke patients. (United States)

    Bobinger, Tobias; Kallmünzer, Bernd; Kopp, Markus; Kurka, Natalia; Arnold, Martin; Heider, Stefan; Schwab, Stefan; Köhrmann, Martin


    To investigate the diagnostic yield of prehospital ECG monitoring provided by emergency medical services in the case of suspected stroke. Consecutive patients with acute stroke admitted to our tertiary stroke center via emergency medical services and with available prehospital ECG were prospectively included during a 12-month study period. We assessed prehospital ECG recordings and compared the results to regular 12-lead ECG on admission and after continuous ECG monitoring at the stroke unit. Overall, 259 patients with prehospital ECG recording were included in the study (90.3% ischemic stroke, 9.7% intracerebral hemorrhage). Atrial fibrillation (AF) was detected in 25.1% of patients, second-degree or greater atrioventricular block in 5.4%, significant ST-segment elevation in 5.0%, and ventricular ectopy in 9.7%. In 18 patients, a diagnosis of new-onset AF with direct clinical consequences for the evaluation and secondary prevention of stroke was established by the prehospital recordings. In 2 patients, the AF episodes were limited to the prehospital period and were not detected by ECG on admission or during subsequent monitoring at the stroke unit. Of 126 patients (48.6%) with relevant abnormalities in the prehospital ECG, 16.7% received medical antiarrhythmic therapy during transport to the hospital, and 6.4% were transferred to a cardiology unit within the first 24 hours in the hospital. In a selected cohort of patients with stroke, the in-field recordings of the ECG detected a relevant rate of cardiac arrhythmia. The results can add to the in-hospital evaluation and should be considered in prehospital care of acute stroke. © 2017 American Academy of Neurology.

  1. Risk factors of outcomes in elderly patients with acute ischemic stroke in China. (United States)

    Wu, Qi; Zou, Chunying; Wu, Chengji; Zhang, Shuping; Huang, Zuoyi


    Stroke results in poor outcomes among elderly patients. However, the factors associated with outcome over different follow-up periods in this population are unknown. To evaluate the outcomes and risk factors of outcomes in elderly patients after stroke. Outcomes, including mortality, dependency (defined as a mRS >2), and recurrence rates, and associated risk factors were assessed at 3 and 12 months after stroke in patients aged ≥80 years. There were 419 acute ischemic stroke patients aged ≥80 years at 3 months, and 309 patients at 12 months; outcomes and relevant risk factors were assessed in these patients. Hypertension was more prevalent in women than in men. At 3 months, the mortality, dependency, and recurrence rates were 13.8, 54.2, and 18.1 %, respectively; the corresponding rates at 12 months were 26.9, 58.0, and 32.6 %, respectively. In the multivariate analysis, after adjusting by confounding factors, TOAST classification and stroke severity were associated with mortality and recurrence, while stroke severity was associated with dependency at 3 months. The mortality and dependency rates at 12 months were significantly associated with moderate and severe stroke, but severe stroke was an independent factor associated with recurrence. Stroke subtype and severity were associated with stroke outcomes among elderly patients in northern China. These findings suggest that it is crucial to highlight the affected factors of stroke outcome among elderly patients for reduce the burden of stroke in China.

  2. Red cell distribution width and neurological scoring systems in acute stroke patients

    Directory of Open Access Journals (Sweden)

    Kara H


    Full Text Available Hasan Kara,1 Selim Degirmenci,1 Aysegul Bayir,1 Ahmet Ak,1 Murat Akinci,1 Ali Dogru,1 Fikret Akyurek,2 Seyit Ali Kayis3 1Department of Emergency Medicine, Faculty of Medicine, Selcuk University, Konya, Turkey; 2Department of Biochemistry, Faculty of Medicine, Selcuk University, Konya, Turkey; 3Department of Biostatistics, Faculty of Medicine, Karabuk University, Karabuk, Turkey Objectives: The purpose of the present study was to evaluate the association between the red blood cell distribution width (RDW and the Glasgow Coma Scale (GCS, Canadian Neurological Scale (CNS, and National Institutes of Health Stroke Scale (NIHSS scores in patients who had acute ischemic stroke. Methods: This prospective observational cohort study included 88 patients who have had acute ischemic stroke and a control group of 40 patients who were evaluated in the Emergency Department for disorders other than acute ischemic stroke. All subjects had RDW determined, and stroke patients had scoring with the GCS, CNS, and NIHSS scores. The GCS, CNS, and NIHSS scores of the patients were rated as mild, moderate, or severe and compared with RDW. Results: Stroke patients had significantly higher median RDW than control subjects. The median RDW values were significantly elevated in patients who had more severe rather than milder strokes rated with all three scoring systems (GCS, CNS, and NIHSS. The median RDW values were significantly elevated for patients who had moderate rather than mild strokes rated by GCS and CNS and for patients who had severe rather than mild strokes rated by NIHSS. The area under the receiver operating characteristic curve was 0.760 (95% confidence interval, 0.676–0.844. Separation of stroke patients and control groups was optimal with RDW 14% (sensitivity, 71.6%; specificity, 67.5%; accuracy, 70.3%. Conclusion: In stroke patients who have symptoms <24 hours, the RDW may be useful in predicting the severity and functional outcomes of the stroke

  3. Incidence, Causative Mechanisms, and Anatomic Localization of Stroke in Pituitary Adenoma Patients Treated With Postoperative Radiation Therapy Versus Surgery Alone

    Energy Technology Data Exchange (ETDEWEB)

    Sattler, Margriet G.A., E-mail: [Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen (Netherlands); Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON (Canada); Vroomen, Patrick C. [Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen (Netherlands); Sluiter, Wim J. [Department of Endocrinology and Metabolic Diseases, University of Groningen, University Medical Center Groningen, Groningen (Netherlands); Schers, Henk J. [Department of Primary and Community Care, Radboud University Nijmegen Medical Centre (Netherlands); Berg, Gerrit van den [Department of Endocrinology and Metabolic Diseases, University of Groningen, University Medical Center Groningen, Groningen (Netherlands); Langendijk, Johannes A. [Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen (Netherlands); Wolffenbuttel, Bruce H.R. [Department of Endocrinology and Metabolic Diseases, University of Groningen, University Medical Center Groningen, Groningen (Netherlands); Bergh, Alphons C.M. van den [Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen (Netherlands); Beek, André P. van [Department of Endocrinology and Metabolic Diseases, University of Groningen, University Medical Center Groningen, Groningen (Netherlands)


    Purpose: To assess and compare the incidence of stroke and stroke subtype in pituitary adenoma patients treated with postoperative radiation therapy (RT) and surgery alone. Methods and Materials: A cohort of 462 pituitary adenoma patients treated between 1959 and 2008 at the University Medical Center Groningen in The Netherlands was studied. Radiation therapy was administered in 236 patients. The TOAST (Trial of ORG 10172 in Acute Stroke Treatment) and the Oxfordshire Community Stroke Project classification methods were used to determine causative mechanism and anatomic localization of stroke. Stroke incidences in patients treated with RT were compared with that observed after surgery alone. Risk factors for stroke incidence were studied by log–rank test, without and with stratification for other significant risk factors. In addition, the stroke incidence was compared with the incidence rate in the general Dutch population. Results: Thirteen RT patients were diagnosed with stroke, compared with 12 surgery-alone patients. The relative risk (RR) for stroke in patients treated with postoperative RT was not significantly different compared with surgery-alone patients (univariate RR 0.62, 95% confidence interval [CI] 0.28-1.35, P=.23). Stroke risk factors were coronary or peripheral artery disease (univariate and multivariate RR 10.4, 95% CI 4.7-22.8, P<.001) and hypertension (univariate RR 3.9, 95% CI 1.6-9.8, P=.002). There was no difference in TOAST and Oxfordshire classification of stroke. In this pituitary adenoma cohort 25 strokes were observed, compared with 16.91 expected (standard incidence ratio 1.48, 95% CI 1.00-1.96, P=.049). Conclusions: In pituitary adenoma patients, an increased incidence of stroke was observed compared with the general population. However, postoperative RT was not associated with an increased incidence of stroke or differences in causative mechanism or anatomic localization of stroke compared with surgery alone. The primary stroke risk

  4. μ+SR Investigation of the Shastry-Sutherland Compound SrCu2(BO3)2 (United States)

    Sassa, Y.; Wang, S.; Sugiyama, J.; Amato, A.; Rønnow, H. M.; Rüegg, C.; Månsson, M.

    In this study we have investigated the low-dimensional correlated spin system SrCu2(BO3)2 using ambient-pressure muon spin rotation/relaxation (μ+SR). The zero-field data are similar to previously published data, but in addition, they give an even clearer sign of the two low-temperature transitions (T1 ≈ 3 and T2 ≈ 7 K), which is fully consistent with inelastic neutron scattering (INS) measurements. Longitudinal field (LF) data clearly show that the copper spins are highly dynamic and a saturation of the low-temperature relaxation rate indicate that these are indeed two-dimensional (2D) quantum spin fluctuations.

  5. Risk factor and etiology analysis of ischemic stroke in young adult patients. (United States)

    Renna, Rosaria; Pilato, Fabio; Profice, Paolo; Della Marca, Giacomo; Broccolini, Aldobrando; Morosetti, Roberta; Frisullo, Giovanni; Rossi, Elena; De Stefano, Valerio; Di Lazzaro, Vincenzo


    Approximately 10%-14% of ischemic strokes occur in young adults. To investigate risk factors and etiologies of strokes of young adults admitted to the "stroke unit" of Policlinico "Gemelli" of Rome from December 2005 to January 2013. In all, 150 consecutive patients younger than 50 years diagnosed with ischemic stroke were enrolled. Clinical evaluation consisted of a complete neurologic examination and the National Institutes of Health Stroke Scale. Diagnostic workup consisted of anamnesis, extensive laboratory, radiologic, and cardiologic examination. Stroke etiologies were classified according to the Trial of Org 10172 in Acute Stroke Treatment. Patients' mean age was 41 ± 8.0 years. The most common risk factors were dyslipidemia (52.7%), smoking (47.3%), hypertension (39.3%), and patent foramen ovale (PFO, 32.8%). Large-artery atherosclerosis was diagnosed as the cause of stroke in 17 patients (11.3%). Cardioembolism was presumed in 36 patients (24%), most of them presented a PFO at transesophageal echocardiography. Small-vessel occlusion was diagnosed in 12 patients (8%); all of them were hypertensive and most of them presented additional risk factors. Forty-one patients (27.3%) presented a stroke of other determined etiology and 44 (29.3%) presented a stroke of undetermined etiology. The 3-year survival was 96.8% and recurrent strokes occurred in only 3 cases. Traditional vascular risk factors are also very common in young adults with ischemic stroke, but such factors increase the susceptibility to stroke dependent to other causes as atherosclerosis and small-artery occlusion represent less than 20% of cases. Prognosis quoadvitam is good, being characterized by low mortality and recurrence rate. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  6. Weakness of Eye Closure with Central Facial Paralysis after Unilateral Hemispheric Stroke Predicts a Worse Outcome. (United States)

    Lin, Jianwen; Chen, Yicong; Wen, Hongmei; Yang, Zhiyun; Zeng, Jinsheng


    Upper facial dysfunction is not generally considered a feature of central facial paralysis after unilateral hemispheric stroke; however, weakness of eye closure (WEC) has been observed in some cases. We aimed to investigate the frequency and characteristics of WEC in unilateral stroke and its association with stroke prognosis. Patients with unilateral stroke and central facial paralysis were prospectively recruited within 7 days of onset. Facial paralysis was evaluated via the fourth item in the National Institute of Health Stroke Scale (NIHSS-4) and the Japan Facial Score (JFS) on admission, and at days 7, 14, 21, and 30 after stroke. Eye closure strength was measured daily using an ergometer for 30 days after stroke. Primary outcome was assessed using the modified Rankin Scale (mRS) at 90 and 180 days. Univariate and multivariate analyses were performed to investigate risk factors of WEC. WEC was identified in 16 of 242 patients (6.6%). Baseline characteristics, stroke risk factors, and lesion volume were not significantly different between patients with and patients without WEC. Patients with WEC featured higher NIHSS-4 scores and lower JFS between admission and at 21 days after stroke. Severe central facial paralysis (odds ratio [OR] = 8.1, 95% confidence interval [CI] = 2.3-28.6, P = .001) and right hemispheric stroke (OR = 13.7, 95% CI = 3.7-51.2, P WEC. At 180 days after stroke, patients with WEC demonstrated a lower rate of functional independence (mRS = 0-2: 37.5% versus 72.1%, P WEC, which predicts a worse functional outcome at 180 days after unilateral stroke, demonstrates an association with severe central facial paralysis and right hemispheric stroke. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  7. Anemia and stroke: Where do we stand? (United States)

    Kaiafa, G; Savopoulos, C; Kanellos, I; Mylonas, K S; Tsikalakis, G; Tegos, T; Kakaletsis, N; Hatzitolios, A I


    Anemia seems to have a clear relationship with cerebrovascular events (CVEs), as there is a direct connection between central nervous system, blood supply, and tissue oxygen delivery. Anemia is considered a hyperkinetic state which disturbs endothelial adhesion molecule genes that may lead to thrombus formation. Furthermore, blood flow augmentation and turbulence may result in the migration of this thrombus, thus producing artery-to-artery embolism. It is for this reason that anemia is characterized as "the fifth cardiovascular risk factor." Anemia is consistently present in patients with acute stroke, ranging from 15% to 29%, while the mortality rate was significantly higher in patients suffering from anemia at the time of admission. Different types of anemia (sickle cell disease, beta thalassemia, iron deficiency anemia [IDA]) have been associated with increased cardiovascular and CVE risk. The relation between hemoglobin level and stroke would require further investigation. Unfortunately, treatment of anemia in cardiovascular and cerebrovascular disease still lacks clear targets and specific therapy has not developed. However, packed red blood cell transfusion is generally reserved for therapy in patients with CVEs. What is more, treatment of IDA prevents thrombosis and the occurrence of stroke; although iron levels should be checked, chronic administration favors thrombosis. Regarding erythropoietin (EPO), as there is lack of studies in anemic stroke patients, it would be desirable to utilize both neuroprotective and hematopoietic properties of EPO in anemic stroke patients. This review aims to clarify the poorly investigated and defined issues concerning the relation of anemia and CVEs. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  8. Hemichorea after ischemic stroke

    Directory of Open Access Journals (Sweden)

    Sadullah Saglam


    Full Text Available The deterioration of the balance between direct and indirect ways in the basal ganglia causes chorea. The lesions of contralateral basal ganglia, thalamus or the connection of them all together are responsible for this. Chorea can be observed during the course of metabolic and vascular diseases, neurodegenerative or hereditary diseases. Hyperkinetic movement disorders after acute ischemic stroke are reported as rare; however, hemichorea is the most frequent developing disorder of hyperkinetic movement as a result of cerebrovascular disease. In this case report, we presented two case who applied us with choreiform movements in his left half of the body after acute thalamic stroke. [Cukurova Med J 2016; 41(0.100: 29-32

  9. [Smoking and stroke]. (United States)

    Hashimoto, Yoichiro


    Cigarette smoking is a risk factor for the brain infarction (lacunar and atherothrombotic brain infarction) and subarachnoid hemorrhage. Not only active smoking but also passive smoking and smokeless tobacco products pose a risk. The risk after smoking cessation for 5-10 years is equal to that faced by a non-smoker. Many patients continue smoking even after an attack of stroke; therefore, support measures to enforce nonsmoking are required in this high-risk population. We offer nonsmoking support using the 5A approach, and assess the nonsmoking stage (precontemplation, contemplation, preparation, action, and maintenance). We also administer medical therapy for smoking cessation when the patients find it difficult to quit smoking on their own accord. Nicotine dependency needs a follow-up like that required for other risk factors in the primary and secondary prevention of the stroke because smoking is a chronic disease that tends to recur.

  10. The Female Stroke Survival Advantage: Relation to Age

    DEFF Research Database (Denmark)

    Olsen, Tom Skyhøj; Dehlendorff, Christian; Andersen, Klaus Kaae


    Background: Age-related hormonal factors are thought to be related to the gender gap in longevity. Testing the hypothesis that survival is best in young premenopausal women we studied the effect of age on 1-week mortality in stroke patients. Methods: A registry was started in 2001 with the aim...... logistic regression. Results: The probability of death within 1 week adjusted for stroke severity, stroke type and risk factors was highly age-dependent in both men and women. Up to the age of 50 years, the 1-week female/male mortality rates paralleled being slightly (15%) but insignificantly better...... in women. While mortality increased almost linearly in women over the entire age range, it increased steeply in men from the age of 50 and at the age of 80 years survival was 80% better in women. Conclusion: The female stroke survival advantage applies to all ages. It increases with age due to a steeply...

  11. Thrombectomy assisted by carotid stenting in acute ischemic stroke management

    DEFF Research Database (Denmark)

    Steglich-Arnholm, Henrik; Holtmannspötter, Markus; Kondziella, Daniel


    Extracranial carotid artery occlusion or high-grade stenosis with concomitant intracranial embolism causes severe ischemic stroke and shows poor response rates to intravenous thrombolysis (IVT). Endovascular therapy (EVT) utilizing thrombectomy assisted by carotid stenting was long considered risky......-center analysis of 47 consecutive stroke patients with carotid occlusion or high-grade stenosis and concomitant intracranial embolus treated between September 2011 and December 2014. Benefits included early improvement of stroke severity (NIHSS ≥ 10) or complete remission within 72 h and favorable long......-term outcome (mRS ≤ 2). Harms included complications during and following EVT. Mean age was 64.3 years (standard deviation ±12.5), 40 (85%) patients received IVT initially. Median NIHSS was 16 (inter-quartile range 14-19). Mean time from stroke onset to recanalization was 311 min (standard deviation ±78...

  12. Women Sex Importance in Stroke Patients with Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Cemile Handan Mısırlı


    Full Text Available OBJECTIVE: It was shown the differences in age, risk factors and treatment between women and men in stroke patients with atrial fibrillation METHODS: The stroke patients with atrial fibrillation who were hospitalized in our department at the last 2 years were seperated into 2 groups of aged above 75 and below 75, investigated with CHADS2 and CHA2DS2VASc scores and looked at the sex differences of women and men. RESULTS: Stroke ratio according to sex was statistically meaningful especially in women above the age of 75. Risc factors also were founded in elderly women and CHA2DS2VASc scores were higher in women than men so more anticoagulan treatment were begun. No differences were shown between sexes at lone atrial fibrillation and no treatment were begun. CONCLUSION: Women with atrial fibrillation had more risk factors, higher stroke rate and higher anticoagulation treatment.

  13. Report on nuclear energy in SR Slovenia

    International Nuclear Information System (INIS)


    Currently Yugoslavia has one 632 MWe nuclear power plant (NPP) of PWR design, located at Krsko in the Socialist Republic (SR) of Slovenia. Krsko NPP, which is a two-loop plant, started power operation in 1981. In general, reactor safety activities in the SR of Slovenia are mostly related to upgrading the safety of our Krsko NPP and to developing capabilities for use in future units. This report presents the nuclear safety related legislation and organization of the corresponding regulatory body, and the activities related to nuclear safety of the participating organizations in the SR of Slovenia in 1987.

  14. High dietary fiber intake prevents stroke at a population level. (United States)

    Casiglia, Edoardo; Tikhonoff, Valérie; Caffi, Sandro; Boschetti, Giovanni; Grasselli, Carla; Saugo, Mario; Giordano, Nunzia; Rapisarda, Valentina; Spinella, Paolo; Palatini, Paolo


    This research was aimed at clarifying whether high dietary fiber intake has an impact on incidence and risk of stroke at a population level. In 1647 unselected subjects, dietary fiber intake (DFI) was detected in a 12-year population-based study, using other dietary variables, anagraphics, biometrics, blood pressure, heart rate, blood lipids, glucose, insulin, uricaemia, fibrinogenaemia, erytrosedimentation rate, diabetes, insulin resistance, smoking, pulmonary disease and left ventricular hypertrophy as covariables. In adjusted Cox models, high DFI reduced the risk of stroke. In analysis based on quintiles of fiber intake adjusted for confounders, HR for incidence of stroke was lower when the daily intake of soluble fiber was >25 g or that of insoluble fiber was >47 g. In multivariate analyses, using these values as cut-off of DFI, the risk of stroke was lower in those intaking more that the cut-off of soluble (HR 0.31, 0.17-0.55) or insoluble (HR 0.35, 0.19-0.63) fiber. Incidence of stroke was also lower (-50%, p < 0.003 and -46%, p < 0.01, respectively). Higher dietary DFI is inversely and independently associated to incidence and risk of stroke in general population. Copyright © 2012 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  15. New possibilities in the prevention of stroke in atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Vladimir Anatolyevich Parfenov


    Full Text Available The paper reviews the data available in the literature on the prevention of stroke in atrial fibrillation (AF. Until recently, mainly warfarin was noted to be used to prevent stroke in AF, which required regulatory laboratory (hematological control. The authors give the results of the RE-LY trial that compared the efficacy of the new thrombin inhibitor dabigatran (pradax in a dose of 150 or 110 mg twice daily and warfarin. The trial has indicated that the use of dabigatran in a dose of 150 mg twice daily results in a reduction in the rate of stroke and systemic embolism as compared to that with warfarin treatment. The administration of dabigatran in a dose of 150 or 110 mg twice daily decreases the rate of deaths from all cases, life-threatening hemorrhages, and hemorrhagic stroke as compared to that of warfarin. The prospects for using different doses of dabigatran in AF patients with prior ischemic stroke (IS or transient ischemic attack (TIA are discussed. In our country, most patients with prior IS or TIA in the presence of AF do not take warfarin due to the difficulty of regulatory laboratory control, the introduction of dabigatran into neurological care may increase the number of patients receiving effective anticoagulant therapy to prevent re-stroke.

  16. Knowledge, perceptions and thoughts of stroke among Arab-Muslim Israelis. (United States)

    Itzhaki, Michal; Koton, Silvia


    Age-adjusted stroke mortality rates in Israel are higher among Arabs compared with Jews; therefore, knowledge of stroke signs and prevention strategies is especially important in the Arab population. Data on stroke knowledge among Arabs in Israel are lacking. We aimed to examine knowledge, perceptions and thoughts of stroke among Arab-Muslim Israelis. A complementary mixed method design was used. Ninety-nine Arab Muslims living in Israel, older than 40 years, with no history of stroke, were personally interviewed. Knowledge of stroke was assessed using quantitative analysis by a semi-structured interview. Information on perceptions and thoughts evoked by stroke was analyzed using qualitative analysis by the constant comparative method. Rates of reported knowledge-related variables were presented. Mean (SD) age of participants was 50.1 (8.0) years, 52.5% were women. Most of the participants (84.8%) knew the causes of stroke but only 29.3% mentioned sudden weakness or paralysis in one side of the body as a warning sign and other warning signs were even less known. The main known risk factor was hypertension (43.3%). Although knowledge of stroke prevention was poor, 89% were interested in learning about stroke and its prevention. The qualitative findings showed that stroke evokes negative thoughts of mental and physical burden and is associated with death, disability, dependence and depression. Levels of stroke knowledge among Arab-Muslim Israelis are low to moderate. Healthcare professionals should assist high risk populations in controlling and treating risk factors in order to reduce mortality and disability following a stroke.

  17. Detrusor Hyperreflexia in Stroke


    AYBEK, Zafer


    In this study detrusor hyperreflexia was investigated by urodynamic study during the acute phase of stroke in patients who became incontinent after a cerebrovascular accident. Urodynamic studies reveal physiopathological findings of incontinence while the acute period of cerebrovascular accident do not cover neurogenic bladder features. In our study it was observed that most of the patients (60%) had normal bladder functions and detrusor hyperreflexia was a rare rindings. This res...

  18. Stroke Management: Nursing Roles


    Maryam Esmaeili


    Introduction: The subacute and long-term assessment and management of patients who have suffered a stroke includes physical therapy and testing to determine the precise etiology of the event so as to prevent recurrence. The acute management differs. Immediate goals include minimizing brain injury, treating medical complications, and moving toward uncovering the pathophysiologic basis of the patient's symptoms. Methods: This is a review paper that report up to date finding with review some...

  19. Recurrent Stroke in Minor Ischemic Stroke or Transient Ischemic Attack With Metabolic Syndrome and/or Diabetes Mellitus. (United States)

    Chen, Weiqi; Pan, Yuesong; Jing, Jing; Zhao, Xingquan; Liu, Liping; Meng, Xia; Wang, Yilong; Wang, Yongjun


    We aimed to determine the risk conferred by metabolic syndrome (METS) and diabetes mellitus (DM) to recurrent stroke in patients with minor ischemic stroke or transient ischemic attack from the CHANCE (Clopidogrel in High-risk patients with Acute Non-disabling Cerebrovascular Events) trial. In total, 3044 patients were included. Patients were stratified into 4 groups: neither, METS only, DM only, or both. METS was defined using the Chinese Diabetes Society (CDS) and International Diabetes Foundation (IDF) definitions. The primary outcome was new stroke (including ischemic and hemorrhagic) at 90 days. A multivariable Cox regression model was used to assess the relationship of METS and DM status to the risk of recurrent stroke adjusted for potential covariates. Using the CDS criteria of METS, 53.2%, 17.2%, 19.8%, and 9.8% of patients were diagnosed as neither, METS only, DM only, and both, respectively. After 90 days of follow-up, there were 299 new strokes (293 ischemic, 6 hemorrhagic). Patients with DM only (16.1% versus 6.8%; adjusted hazard ratio 2.50, 95% CI 1.89-3.39) and both (17.1% versus 6.8%; adjusted hazard ratio 2.76, 95% CI 1.98-3.86) had significantly increased rates of recurrent stroke. No interaction effect of antiplatelet therapy by different METS or DM status for the risk of recurrent stroke ( P =0.82 for interaction in the fully adjusted model of CDS) was observed. Using the METS (IDF) criteria demonstrated similar results. Concurrent METS and DM was associated with an increased risk of recurrent stroke in patients with minor stroke and transient ischemic attack. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  20. Early rehabilitation after stroke. (United States)

    Bernhardt, Julie; Godecke, Erin; Johnson, Liam; Langhorne, Peter


    Early rehabilitation is recommended in many guidelines, with limited evidence to guide practice. Brain neurobiology suggests that early training, at the right dose, will aid recovery. In this review, we highlight recent trials of early mobilization, aphasia, dysphagia and upper limb treatment in which intervention is commenced within 7 days of stroke and discuss future research directions. Trials in this early time window are few. Although the seminal AVERT trial suggests that a cautious approach is necessary immediately (stroke, early mobility training and mobilization appear well tolerated, with few reasons to delay initiating some rehabilitation within the first week. The results of large clinical trials of early aphasia therapy are on the horizon, and examples of targeted upper limb treatments with better patient selection are emerging. Early rehabilitation trials are complex, particularly those that intervene across acute and rehabilitation care settings, but these trials are important if we are to optimize recovery potential in the critical window for repair. Concerted efforts to standardize 'early' recruitment, appropriately stratify participants and implement longer term follow-up is needed. Trial standards are improving. New recommendations from a recent Stroke Recovery and Rehabilitation Roundtable will help drive new research.

  1. Detection of Atrial Fibrillation Among Patients With Stroke Due to Large or Small Vessel Disease: A Meta-Analysis. (United States)

    Demeestere, Jelle; Fieuws, Steffen; Lansberg, Maarten G; Lemmens, Robin


    Recent trials have demonstrated that extended cardiac monitoring increases the yield of paroxysmal atrial fibrillation (AF) detection in patients with cryptogenic stroke. The utility of extended cardiac monitoring is uncertain among patients with stroke caused by small and large vessel disease. We conducted a meta-analysis to estimate the yield of AF detection in this population. We searched PubMed, Cochrane, and SCOPUS databases for studies on AF detection in stroke patients and excluded studies restricted to patients with cryptogenic stroke or transient ischemic attack. We abstracted AF detection rates for 3 populations grouped by stroke etiology: large vessel stroke, small vessel stroke, and stroke of undefined etiology (a mixture of cryptogenic, small vessel, large vessel, and other stroke etiologies). Our search yielded 30 studies (n=5687). AF detection rates were similar in patients with large vessel (2.2%, 95% CI 0.3-5.5; n=830) and small vessel stroke (2.4%, 95% CI 0.4-6.1; n=520). No studies had a monitoring duration longer than 7 days. The yield of AF detection in the undefined stroke population was higher (9.2%; 95% CI 7.1-11.5) compared to small vessel stroke (P=0.02) and large vessel stroke (P=0.02) populations. AF detection rate is similar in patients with small and large vessel strokes (2.2-2.4%). Because no studies reported on extended monitoring (>7 days) in these stroke populations, we could not estimate the yield of AF detection with long-term cardiac monitoring. Randomized controlled trials are needed to examine the utility of AF detection with long-term cardiac monitoring (>7 days) in this patient population. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  2. Global and regional burden of stroke during 1990–2010: findings from the Global Burden of Disease Study 2010 (United States)

    Feigin, Valery L; Forouzanfar, Mohammad H; Krishnamurthi, Rita; Mensah, George A; Connor, Myles; Bennett, Derrick A; Moran, Andrew E; Sacco, Ralph L; Anderson, Laurie; Truelsen, Thomas; O’Donnell, Martin; Venketasubramanian, Narayanaswamy; Barker-Collo, Suzanne; Lawes, Carlene M M; Wang, Wenzhi; Shinohara, Yukito; Witt, Emma; Ezzati, Majid; Naghavi, Mohsen; Murray, Christopher


    Summary Background Although stroke is the second leading cause of death worldwide, no comprehensive and comparable assessment of incidence, prevalence, mortality, disability, and epidemiological trends has been estimated for most regions. We used data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) to estimate the global and regional burden of stroke during 1990–2010. Methods We searched Medline, Embase, LILACS, Scopus, PubMed, Science Direct, Global Health Database, the WHO library, and WHO regional databases from 1990 to 2012 to identify relevant studies published between 1990 and 2010. We applied the GBD 2010 analytical technique (DisMod-MR), based on disease-specific, pre-specified associations between incidence, prevalence, and mortality, to calculate regional and country-specific estimates of stroke incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) lost by age group (stroke significantly decreased by 12% (95% CI 6–17) in high-income countries, and increased by 12% (–3 to 22) in low-income and middle-income countries, albeit non-significantly. Mortality rates decreased significantly in both high income (37%, 31–41) and low-income and middle-income countries (20%, 15–30). In 2010, the absolute numbers of people with first stroke (16·9 million), stroke survivors (33 million), stroke-related deaths (5·9 million), and DALYs lost (102 million) were high and had significantly increased since 1990 (68%, 84%, 26%, and 12% increase, respectively), with most of the burden (68·6% incident strokes, 52·2% prevalent strokes, 70·9% stroke deaths, and 77·7% DALYs lost) in low-income and middle-income countries. In 2010, 5·2 million (31%) strokes were in children (aged stroke burden between GBD regions and countries. More than 62% of new strokes, 69·8% of prevalent strokes, 45·5% of deaths from stroke, and 71·7% of DALYs lost because of stroke were in people younger than 75 years

  3. Blood glucose in acute stroke

    DEFF Research Database (Denmark)

    Olsen, Tom Skyhøj


    Blood glucose is often elevated in acute stroke, and higher admission glucose levels are associated with larger lesions, greater mortality and poorer functional outcome. In patients treated with thrombolysis, hyperglycemia is associated with an increased risk of hemorrhagic transformation...... to the risk of inducing potentially harmful hypoglycemia has been raised. Still, basic and observational research is overwhelmingly in support of a causal relationship between blood glucose and stroke outcome and further research on glucose-lowering therapy in acute stroke is highly warranted....

  4. Acute Stroke Imaging Research Roadmap


    Wintermark, Max; Albers, Gregory W.; Alexandrov, Andrei V.; Alger, Jeffry R.; Bammer, Roland; Baron, Jean-Claude; Davis, Stephen; Demaerschalk, Bart M.; Derdeyn, Colin P.; Donnan, Geoffrey A.; Eastwood, James D.; Fiebach, Jochen B.; Fisher, Marc; Furie, Karen L.; Goldmakher, Gregory V.


    The recent “Advanced Neuroimaging for Acute Stroke Treatment” meeting on September 7 and 8, 2007 in Washington DC, brought together stroke neurologists, neuroradiologists, emergency physicians, neuroimaging research scientists, members of the National Institute of Neurological Disorders and Stroke (NINDS), the National Institute of Biomedical Imaging and Bioengineering (NIBIB), industry representatives, and members of the US Food and Drug Administration (FDA) to discuss the role of advanced n...

  5. Problematising risk in stroke rehabilitation. (United States)

    Egan, Mary Y; Kessler, Dorothy; Ceci, Christine; Laliberté-Rudman, Debbie; McGrath, Colleen; Sikora, Lindsey; Gardner, Paula


    Following stroke, re-engagement in personally valued activities requires some experience of risk. Risk, therefore, must be seen as having positive as well as negative aspects in rehabilitation. Our aim was to identify the dominant understanding of risk in stroke rehabilitation and the assumptions underpinning these understandings, determine how these understandings affect research and practise, and if necessary, propose alternate ways to conceptualise risk in research and practise. Alvesson and Sandberg's method of problematisation was used. We began with a historical overview of stroke rehabilitation, and proceeded through five steps undertaken in an iterative fashion: literature search and selection; data extraction; syntheses across texts; identification of assumptions informing the literature and; generation of alternatives. Discussion of risk in stroke rehabilitation is largely implicit. However, two prominent conceptualisations of risk underpin both knowledge development and clinical practise: the risk to the individual stroke survivor of remaining dependent in activities of daily living and the risk that the health care system will be overwhelmed by the costs of providing stroke rehabilitation. Conceptualisation of risk in stroke rehabilitation, while implicit, drives both research and practise in ways that reinforce a focus on impairment and a generic, decontextualised approach to rehabilitation. Implications for rehabilitation Much of stroke rehabilitation practise and research seems to centre implicitly on two risks: risk to the patient of remaining dependent in ADL and risk to the health care system of bankruptcy due to the provision of stroke rehabilitation. The implicit focus on ADL dependence limits the ability of clinicians and researchers to address other goals supportive of a good life following stroke. The implicit focus on financial risk to the health care system may limit access to rehabilitation for people who have experienced either milder or

  6. Mechanical properties, corrosion, and biocompatibility of Mg-Zr-Sr-Dy alloys for biodegradable implant applications. (United States)

    Ding, Yunfei; Lin, Jixing; Wen, Cuie; Zhang, Dongmei; Li, Yuncang


    This study investigates the microstructure, mechanical properties, corrosion behavior, and biocompatibility of magnesium (Mg)-based Mg1Zr2SrxDy (x = 0, 1, 1.63, 2.08 wt %) alloys for biodegradable implant applications. The corrosion behavior of the Mg-based alloys has been evaluated in simulated body fluid using an electrochemical technique and hydrogen evolution. The biocompatibility of the Mg-based alloys has been assessed using SaSO2 cells. Results indicate that the addition of Dy to Mg-Zr-Sr alloy showed a positive impact on the corrosion behavior and significantly decreased the degradation rates of the alloys. The degradation rate of Mg1Zr2Sr1.0Dy decreased from 17.61 to 12.50 mm year -1 of Mg1Zr2Sr2.08Dy based on the hydrogen evolution. The ultimate compressive strength decreased from 270.90 MPa for Mg1Zr2Sr1Dy to 236.71 MPa for Mg1Zr2Sr2.08Dy. An increase in the addition of Dy to the Mg-based alloys resulted in an increase in the volume fraction of the Mg 2 Dy phase, which mitigated the galvanic effect between the Mg 17 Sr 2 phase and the Mg matrix, and led to an increase in the corrosion resistance of the base alloy. The biocompatibility of the Mg-based alloys was enhanced with decreasing corrosion rates. Mg1Zr2Sr2.08Dy exhibited the lowest corrosion rate and the highest biocompatibility compared with the other Mg-based alloys. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2017. © 2017 Wiley Periodicals, Inc.

  7. Guide to Choosing Stroke Rehabilitation Services (United States)

    National Stroke Association’s Guide to Choosing Stroke Rehabilitation Services Rehabilitation, often referred to as rehab, is an important part of stroke recovery. Through rehab, you:  Re-learn basic skills such ...

  8. What You Need to Know about Stroke (United States)

    ... the brain. The other kind of stroke, called hemorrhagic stroke, is caused by a blood vessel that breaks ... are very common among African Americans. The best treatment for stroke is prevention. You can reduce your ...

  9. Epidermoid Causing Ischemic Stroke in the Brainstem

    Directory of Open Access Journals (Sweden)

    Raghvendra Ramdasi


    Full Text Available Intracranial tumors may rarely cause stroke. We report an epidermoid cyst causing stroke in a pediatric patient. We have also reviewed the literature and pathogenesis of stroke caused by intracranial tumors.

  10. What Are the Warning Signs of Stroke? (United States)

    ... Cardiovascular Conditions What Are the Warning Signs of Stroke? Brain tissue affected by blockage Stroke is the fifth leading cause of death in ... over 55 years old have more chance of stroke, and the risk gets greater as you get ...

  11. Frequency and predictors of stroke after acute myocardial infarction: specific aspects of in-hospital and postdischarge events. (United States)

    Hachet, Olivier; Guenancia, Charles; Stamboul, Karim; Daubail, Benoit; Richard, Carole; Béjot, Yannick; Yameogo, Valentin; Gudjoncik, Aurélie; Cottin, Yves; Giroud, Maurice; Lorgis, Luc


    Stroke is a serious complication after acute myocardial infarction (AMI) and is closely associated with decreased survival. This study aimed to investigate the frequency, characteristics, and factors associated with in-hospital and postdischarge stroke in patients with AMI. Eight thousand four hundred eighty-five consecutive patients admitted to a cardiology intensive care unit for AMI, between January 2001 and July 2010. Stroke/transient ischemic attack were collected during 1-year follow-up. One hundred twenty-three in-hospital strokes were recorded: 65 (52.8%) occurred on the first day after admission for AMI, and 108 (87%) within the first 5 days. One hundred six patients (86.2%-incidence rate 1.25%) experienced in-hospital ischemic stroke, and 14 patients (11.4%-incidence rate 0.16%) were diagnosed with an in-hospital hemorrhagic stroke. In-hospital ischemic stroke subtypes according to the Trial of Org 10 172 in Acute Stroke Treatment (TOAST) classification showed that only 2 types of stroke were identified more frequently. As expected, the leading subtype of in-hospital ischemic stroke was cardioembolic stroke (n=64, 60%), the second was stroke of undetermined pathogenesis (n=38, 36%). After multivariable backward regression analysis, female sex, previous transient ischemic attack (TIA)/stroke, new-onset atrial fibrillation, left ventricular ejection fraction (odds ratio per point of left ventricular ejection fraction), and C-reactive protein were independently associated with in-hospital ischemic stroke. When antiplatelet and anticoagulation therapy within the first 48 hours was introduced into the multivariable model, we found that implementing these treatments (≥1) was an independent protective factor of in-hospital stroke. In-hospital hemorrhagic stroke was dramatically increased (5-fold) when thrombolysis was prescribed as the reperfusion treatment. However, the different parenteral anticoagulants were not predictors of risk in univariable analysis

  12. Burden of stroke in Cambodia. (United States)

    Loo, Keat Wei; Gan, Siew Hua


    In Cambodia, stroke is not ranked among the top 10 leading causes of death, but infectious disease are among the top three leading causes of death. This finding could be attributed to a lack of awareness among Cambodians of the signs and symptoms of stroke or to poor reporting, incomplete data, lack of neurologists and neurosurgeons, or low accessibility to the hospitals. The only study of stroke in Cambodia is the Prevalence of Non-Communicable Disease Risk Factors in Cambodia survey, which identified several stroke-related risk factors in the population. Tobacco chewing or smoking is the main risk factor for stroke in Cambodia. Traditional therapies, such as oyt pleung (moxibustion) and jup (cupping), are widely practiced for stroke rehabilitation. In Cambodia, there are few neurologists and few important equipment, such as magnetic resonance imaging machines and computed tomography scanners. The Cambodian government should cooperate with the World Health Organization and the United Nations Children's Fund to attract foreign expertise and technologies to treat stroke patients. © 2012 The Authors. International Journal of Stroke © 2012 World Stroke Organization.

  13. Infections and Ischemic Stroke Outcome


    Grabska, Katarzyna; Gromadzka, Grażyna; Członkowska, Anna


    Background. Infections increase the risk of ischemic stroke (IS) and may worsen IS prognosis. Adverse effects of in-hospital infections on stroke outcome were also reported. We aimed to study the prevalence of pre- and poststroke infections and their impact on IS outcome. Methods. We analysed clinical data of 2066 IS patients to assess the effect of pre-stroke and post-stroke infections on IS severity, as well as short-term (up to 30 days) and long-term (90 days) outcome. The independent i...

  14. Stroke scale score and early prediction of outcome after stroke

    International Nuclear Information System (INIS)

    Ahmed, R.; Zuberi, F.Z.; Afsar, S.


    Objective: To evaluate the baseline National Institute of Health Stroke Scale (NIHSS) score as a predictor of functional outcome after ischemic stroke. Subjects and Methods: The study included 50 patients who presented to Civil Hospital, Karachi, during the study period with acute stroke and were evaluated with CT scan of brain. Only those patients were enrolled in the study that had acute ischemic stroke. The enrolled subjects were then evaluated for the neurological impairment using National Institute of Health Stroke Scale (NIHSS). The subjects were followed-up and their functional outcome was assessed using Barthel index (BI) on the 7th day of their admission. Results: Of the fifty patients enrolled in the study, 31 (62%) were males and 19 (38%) were females, with age ranging from 45 years to 95 years and a mean age of 59.9 years. Neurological impairment at presentation was assessed by NIHSS. The score ranged between 2 and 28. The functional outcome was evaluated on the 7th day using Barthel index (BI), which ranged from 0 to 80. NIHSS score was found to be a good predictor of functional outcome in patients with ischemic stroke (p<0.001). Other factors like gender, hypertension and heart disease did not affect the functional recovery in such patients. Various factors were found to be significant for early prediction of stroke recovery. The NIHSS score was the strongest predictor of outcome after ischemic stroke. Age at the time of the event was also found to be an important predictor for stroke recovery. Conclusion: The NIHSS score is a good predictor of patient's recovery after stroke. Assessing the patient's neurological impairment at first presentation of ischemic stroke can guide the physician regarding the prognosis and management plan. (author)

  15. Addition to the analysis of the Sr VI and Sr VII spectra

    International Nuclear Information System (INIS)

    Wyart, J.F.


    Fifty-six lines of multicharged strontium are measured with an improved wavelength accuracy, or interpreted for the first time. They are 4p-4s, 4p-5s and 4p-4d transitions in Sr VII and 4p-5s transitions in Sr VI. The revision of the singlet-triplet connection in Sr VII is supported by theoretical survey of the ground configuration in Ge-like ions. (orig.)

  16. Exploring the Role of La Codoping beyond Charge Compensation for Enhanced Hydrogen Evolution by Rh-SrTiO3. (United States)

    Modak, Brindaban; Ghosh, Swapan K


    In this theoretical study, we investigate recent observation of enhancement of hydrogen evolution efficiency of Rh-doped SrTiO3 due to codoping with La at the Sr lattice site. Using hybrid density functional theory, we have systematically studied the electronic structure of (Rh, La)-codoped SrTiO3 and compared with that of Rh-doped SrTiO3, La-doped SrTiO3, and undoped SrTiO3. The aim of the present study has been to explore the role of different factors toward the observed enhanced photoactivity of (Rh, La)-codoped SrTiO3. Doping with only Rh significantly reduces the photoabsorption energy by introducing localized acceptor states between the valence band and conduction band. Unfortunately, these states act as efficient sources for charge carrier trapping. Besides, the oxygen vacancy found to be present in the Rh-doped SrTiO3 as a charge compensating defect also accelerates the electron-hole recombination rate. We have shown that codoping with La and Rh leads to the formation of clean band structure without encountering any midgap states. Introduction of La into the Rh-doped SrTiO3 not only reduces the quantity of Rh(4+) species but also suppresses the oxygen vacancy due to formation of a charge-compensated system. The presence of La favors Rh doping into the crystal structure of SrTiO3 by reducing the formation energy. Moreover, the conduction band minima are found to be shifted in the upward direction significantly due to codoping with Rh and La, thereby increasing the reducing behavior at the conduction band. This leads to enhancement of hydrogen evolution activity of SrTiO3 during photocatalytic water splitting under visible light.

  17. Effects of self-made 90Sr applicator retainer on radiation protection in treatment of skin disease

    International Nuclear Information System (INIS)

    Zheng Yuming; Cheng Xia; Zheng Bang


    Objective: To investigate the effects of self-made 90 Sr applicator retainer on reducing radiation doses to medical personnel and improving their health status. Methods: Self-made 90 Sr applicator retainer was used in radiation therapy instead of traditionally holding the applicator in hand. The individual annual dose equivalent, peripheral white blood cell count and lymphocyte chromosome aberration rate of medical personnel before and after the application of 90 Sr applicator retainer were analyzed comparatively. Results: The individual annual dose equivalent was significantly reduced after the application of 90 Sr applicator retainer (t=11.40, P<0.01). The peripheral white blood cell count was significantly improved after the application (t=-3.75, P<0.01). Conclusion: The application of 90 Sr applicator retainer significantly reduced individual radiation doses, improved peripheral white blood cell count and effectively protected the health of medical personnel. (authors)

  18. External Validation of the Prestroke Independence, Sex, Age, National Institutes of Health Stroke Scale Score for Predicting Pneumonia After Stroke Using Data From the China National Stroke Registry. (United States)

    Zhang, Runhua; Ji, Ruijun; Pan, Yuesong; Jiang, Yong; Liu, Gaifen; Wang, Yilong; Wang, Yongjun


    Pneumonia is an important risk factor for mortality and morbidity after stroke. The Prestroke Independence, Sex, Age, National Institutes of Health Stroke Scale (ISAN) score was shown to be a useful tool for predicting stroke-associated pneumonia based on UK multicenter cohort study. We aimed to externally validate the score using data from the China National Stroke Registry (CNSR). Eligible patients with acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH) in the CNSR from 2007 to 2008 were included. The area under the receiver operating characteristic (AUC) curve was used to evaluate discrimination. The Hosmer-Lemeshow goodness of fit test and Pearson correlation coefficient were performed to assess calibration of the model. A total of 19,333 patients (AIS = 14400; ICH = 4933) were included and the overall pneumonia rate was 12.7%. The AUC was .76 (95% confidence interval [CI]: .75-.78) for the subgroup of AIS and .70 (95% CI: .68-.72) for the subgroup of ICH. The Hosmer-Lemeshow test showed the ISAN score with the good calibration for AIS and ICH (P = .177 and .405, respectively). The plot of observed versus predicted pneumonia rates suggested higher correlation for patients with AIS than with ICH (Pearson correlation coefficient = .99 and .83, respectively). The ISAN score was a useful tool for predicting in-hospital pneumonia after acute stroke, especially for patients with AIS. Further validations need to be done in different populations. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.


    Directory of Open Access Journals (Sweden)

    Wagih El-Shouny


    Full Text Available The bacteriocin bound to the cells and that secreted into the culture filtrate of Lactobacillus plantarum SR18 were precipitated by 75% ammomium sulphate, dialysed and further purified by Gel filtration on Sephadex G-100. Bacteriocins were purified from proteins bound to the cell of L. plantarum SR18 (plantarcin SR18 a and culture filtrate proteins (plantarcin SR18 b, respectively. The SDS-PAGE of partially purified Plantarcin SR18a showed a molecular weight of 3.5 KDa. While, plantarcin SR18 b had a molecular weight of 10.3 KDa. The antibacterial activity of the tested plantarcin SR18 preparations suffered no measurable loss after 45 min at 80ºC. Whereas, At 100ºC, significant decrease in the activity of bacteriocin preparations (60- 80 % took place by the end of 45 min. At pH ranged from 5-8, the activity of the plantarcin SR18 preparations suffered no measurable loss. Dissociating agents significantly affected the bacteriocin activity. Thus, tween 80 and mercaptoethanol increased the activity of bacteriocin preparations to 1.2-1.4 fold. Sodium dodecyl sulphate (SDS increased the activity of the tested bacteriocin preparations by about 20%.The lowest residual activity (60% was recorded after treatment with Triton X100 for 45 min. Protease completely inhibited the activities of all forms of plantarcin SR18 after 45 min at 37ºC.

  20. Metastable honeycomb SrTiO3/SrIrO3 heterostructures

    International Nuclear Information System (INIS)

    Anderson, T. J.; Ryu, S.; Podkaminer, J. P.; Ma, Y.; Eom, C. B.; Zhou, H.; Xie, L.; Irwin, J.; Rzchowski, M. S.; Pan, X. Q.


    Recent theory predictions of exotic band topologies in (111) honeycomb perovskite SrIrO 3 layers sandwiched between SrTiO 3 have garnered much attention in the condensed matter physics and materials communities. However, perovskite SrIrO 3 film growth in the (111) direction remains unreported, as efforts to synthesize pure SrIrO 3 on (111) perovskite substrates have yielded films with monoclinic symmetry rather than the perovskite structure required by theory predictions. In this study, we report the synthesis of ultra-thin metastable perovskite SrIrO 3 films capped with SrTiO 3 grown on (111) SrTiO 3 substrates by pulsed laser deposition. The atomic structure of the ultra-thin films was examined with scanning transmission electron microscopy (STEM), which suggests a perovskite layering distinct from the bulk SrIrO 3 monoclinic phase. In-plane 3-fold symmetry for the entire heterostructure was confirmed using synchrotron surface X-ray diffraction to measure symmetry equivalent crystal truncation rods. Our findings demonstrate the ability to stabilize (111) honeycomb perovskite SrIrO 3 , which provides an experimental avenue to probe the phenomena predicted for this material system.

  1. Suicidal ideation at 1-year post-stroke: A nationwide survey in China. (United States)

    Yang, Yang; Shi, Yu-Zhi; Zhang, Ning; Wang, Shuo; Ungvari, Gabor S; Ng, Chee H; Wang, Yi-Long; Zhao, Xing-Quan; Wang, Yong-Jun; Wang, Chun-Xue; Xiang, Yu-Tao

    Few studies on suicidal ideation have been conducted in post-stroke patients in China. This national study examined suicidal ideation at 1-year post-stroke and explored its demographic and clinical correlates. A total of 1418 patients with ischemic stroke were included in 56 hospitals nationwide. Demographic, clinical characteristics and neuro-imaging information were collected with standardized instruments, including assessment of stroke severity, depression, cognitive impairment, stroke recurrence, physical disability and insomnia. Suicidal ideation was measured using item 3 of the Hamilton Rating Scale for Depression. The frequency of suicidal ideation in this study was 6.6%. Multivariate analyses revealed that disability (OR=2.07, 95% CI=1.09-3.05), stroke recurrence (OR=4.13, 95% CI=1.74-9.77) and insomnia early (OR=1.87, 95% CI=1.03-3.39), middle (OR=2.66, 95% CI=1.46-4.85) and late (OR=2.35, 95% CI=1.31-4.19) at the 1-year follow-up and post-stroke depression (OR=2.16, 95% CI=1.23-3.82) were significantly associated with post-stroke suicidal ideation. Post-stroke depression, disability, insomnia and stroke recurrence are possible risk factors of suicidal ideation that warrant attention in clinical practice. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. An Investigation of the Use of Traditional Chinese Medicine in Stroke Patients in Taiwan

    Directory of Open Access Journals (Sweden)

    Chien-Chang Liao


    Full Text Available Background. The use of complementary and alternative medicine in critical illness is increasing worldwide. This study investigates how traditional Chinese medicine (TCM is used in stroke patients. Methods. Using Taiwan National Health Insurance reimbursement claims, we compared the annual use of TCM between stroke patients and general population, identifying 15,330 patients with a new onset of stroke in 2000–2009. The sociodemographic status and medical comorbidities between stroke patients receiving TCM services and those without using the service were compared. Results. The use of TCM was higher in stroke patients than in the general population, 27.9% versus 25.4% in 2000 and 32.7% versus 27.8% in 2009, respectively, and grew consistently from 2000 to 2009. Among stroke patients, women, younger patients, white-collar employees, higher-income residents, and those living in areas with more TCM physicians were more likely to use TCM. Stroke patients using rehabilitation services were more likely to have more TCM visits (OR = 2.28, 95% CI = 1.96–2.66 and higher expenditure on TCM (OR = 2.67, 95% CI = 2.29–3.12 compared with stroke patients without rehabilitation. Conclusion. TCM is popular and well accepted in Taiwan. Patients with stroke have a higher TCM utilization rate than people without stroke.

  3. Stroke Prevalence, Mortality and Disability-Adjusted Life Years in Children and Youth Aged 0-19 Years

    DEFF Research Database (Denmark)

    Krishnamurthi, Rita V; deVeber, Gabrielle; Feigin, Valery L


    research and the resulting evidence-based strategies for stroke prevention and management. OBJECTIVES: To estimate the prevalence, mortality and disability-adjusted life years (DALYs) for ischemic stroke (IS), hemorrhagic stroke (HS) and all stroke types combined globally from 1990 to 2013. METHODOLOGY...... and consistent estimates of prevalence and mortality. Stroke-specific disability weights were used to estimate years lived with disability and DALYs. Means and 95% uncertainty intervals (UIs) were calculated for prevalence, mortality and DALYs. The median of the percent change and 95% UI were determined...... increases in the global prevalence rates of childhood IS, as well as significant decreases in the global death rate and DALYs rate of all strokes in those of age 0-19 years. While prevalence rates for childhood IS and HS decreased significantly in developed countries, a decline was seen only in HS...

  4. Ischemic Stroke: MedlinePlus Health Topic (United States)

    ... Clots) (American Stroke Association) Let's Talk about Ischemic Stroke (American Heart Association) Also in Spanish Prevention and Risk Factors Carotid Endarterectomy (National Heart, Lung, and Blood Institute) ...

  5. Stroke subtypes and factors associated with ischemic stroke in ...

    African Journals Online (AJOL)

    Stroke subtypes assessed four OCSP (Oxfordshire Communi-. African Health Sciences Vol 15 Issue 1, March 2015. 68. 69 ty Stroke Project Classification) subtypes classification. 13 was used with lacunar circulation infarct (LACI) and total anterior (TACI), partial anterior (PACI), posterior. (POCI) circulation infarcts as non ...

  6. 'This stroke was sent…': Stroke-related illness concepts and ...

    African Journals Online (AJOL)

    Though there is evidence that stroke incidence is increasing even in low and middle income countries, there is no study of stroke-related illness concepts and HSB in Nigerians. Data from 960 educated Nigerians were analysed. Eight hundred and fifty four respondents (431 aged 20-40 years and 423 aged 41 years or ...

  7. Thromboxane biosynthesis in stroke and post-stroke dementia

    NARCIS (Netherlands)

    F. van Kooten (Fop)


    textabstractWith 25 to 30 thousand new patients per year and an incidence of 170/100.000, stroke is a major health problem in the Netherlands, as it is in other western countries. It accounts for almost I 0% of the annual death in the Netherlands. Approximately 80% of stroke is of ischemic

  8. Thromboxane biosynthesis in stroke and post-stroke dementia

    NARCIS (Netherlands)

    F. van Kooten (Fop)


    textabstractWith 25 to 30 thousand new patients per year and an incidence of 170/100.000, stroke is a major health problem in the Netherlands, as it is in other western countries. It accounts for almost I 0% of the annual death in the Netherlands. Approximately 80% of stroke is of ischemic origin,

  9. Improving Stroke Management through Specialized Stroke Units in ...

    African Journals Online (AJOL)

    ... rehabilitation of the stroke patient. The establishment of stroke units has been found to improve the survival of patients and significantly reduce disability by rendering holistic care. Early intervention to rapidly restore and maintain blood supply to the ischemic area in the brain, minimize brain damage and hence impairment ...

  10. Atomic layer deposited ZrO2 nanofilm on Mg-Sr alloy for enhanced corrosion resistance and biocompatibility. (United States)

    Yang, Qiuyue; Yuan, Wei; Liu, Xiangmei; Zheng, Yufeng; Cui, Zhenduo; Yang, Xianjin; Pan, Haobo; Wu, Shuilin


    The biodegradability and good mechanical property of magnesium alloys make them potential biomedical materials. However, their rapid corrosion rate in the human body's environment impairs these advantages and limits their clinical use. In this work, a compact zirconia (ZrO 2 ) nanofilm was fabricated on the surface of a magnesium-strontium (Mg-Sr) alloy by the atomic layer deposition (ALD) method, which can regulate the thickness of the film precisely and thus also control the corrosion rate. Corrosion tests reveal that the ZrO 2 film can effectively reduce the corrosion rate of Mg-Sr alloys that is closely related to the thickness of the film. The cell culture test shows that this kind of ZrO 2 film can also enhance the activity and adhesion of osteoblasts on the surfaces of Mg-Sr alloys. The significance of the current work is to develop a zirconia nanofilm on biomedical MgSr alloy with controllable thickness precisely through atomic layer deposition technique. By adjusting the thickness of nanofilm, the corrosion rate of Mg-Sr alloy can be modulated, thereafter, the degradation rate of Mg-based alloys can be controlled precisely according to actual clinical requirement. In addition, this zirconia nanofilm modified Mg-Sr alloys show excellent biocompatibility than the bare samples. Hence, this work provides a new surface strategy to control the degradation rate while improving the biocompatibility of substrates. Copyright © 2017 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

  11. Sex-related time-dependent variations in post-stroke survival-evidence of a female stroke survival advantage

    DEFF Research Database (Denmark)

    Olsen, Tom Skyhøj; Dehlendorff, Christian; Andersen, Klaus Kaae


    of stroke and remained so during the first month suggesting a female survival advantage. Throughout the second month the rate reversed in favour of men suggesting that women in that period are paying a 'toll' for their initial survival advantage. Hereafter, the rate steadily decreased, and after 4 months...

  12. Increased risk of treatment with antidepressants in stroke compared with other chronic illness

    DEFF Research Database (Denmark)

    Dam, Henrik; Harhoff, Mette; Andersen, Per Kragh


    The prevalence of depression and anxiety is higher in patients with stroke than in the general population but it is unclear whether patients with stroke are at an increased risk of being treated for depression and anxiety compared with patients with other chronic illness. The objective...... of the present study was to investigate whether the rate of treatment with antidepressants is increased in patients with stroke compared with patients with other chronic illness and compared with the general population. By linkage of nationwide case registers, all patients who received a main diagnosis of stroke...

  13. Diagnosis in stroke - an uptake

    International Nuclear Information System (INIS)

    Aichner, F.T.


    In practical day-to-day terms, most patients have one of the common causes of stroke: ischemic stroke caused by the complications of atherothrombosis, intracranial small vessel disease, embolism from the heart, primary intracerebral hemorrhage caused by hypertension, or subarachnoid hemorrhage as a result of a ruptured saccular aneurysm. There are three issues to be considered in assessing the reliability of the clinical diagnosis of stroke: the diagnosis of stroke itself: is it a stroke or not; whether the stroke is caused by an infarct or a hemorrhage and particular in ischemic stroke the site and size of the lesion (anterior vs. posterior circulation, lacunar vs. cortical, etc.). No clinical scoring method can differentiate with absolute reliability ischemic stroke from primary intracerebral hemorrhage. To do this brain computed tomography or magnetic resonance imaging is required. For vascular diagnosis ultrasound and magnetic resonance angiography are ideal and complementary non-invasive techniques. Both have no risks and are reasonably sensitive. Catheterangiography is only reserved for patients with subarachnoid hemorrhage with a view to surgical or endovascular treatment or in exceptional cases to establish a more firm prognosis. The diagnosis of ischemic stroke caused by embolism from the heart can only be considered at all if there is an identifiable cardioembolic source which is the case in about 30 % of ischemic stroke, a higher proportion in recent studies using transoesophageal echocardiography. It is not clear that transoesophageal echocardiography provides much more information for clinical decision-making than transthoracic echocardiography, although it certainly provides more anatomical information in selected patients. This article summarizes the diagnostic armamentarium which is used for the diagnosis of stroke and gives an overview of clinically reliable and relevant measures. Refs. 23 (author)

  14. Prospects of measuring the CKM matrix element vertical stroke Vts vertical stroke at the LHC

    International Nuclear Information System (INIS)

    Ali, Ahmed; Barreiro, Fernando; Lagouri, Theodota


    We study the prospects of measuring the CKM matrix element vertical stroke V ts vertical stroke at the LHC with the top quarks produced in the processes pp→t anti tX and pp→t/ anti tX, and the subsequent decays t→W + s and anti t→W - anti s. To reduce the jet activity in top quark decays, we insist on tagging the W ± leptonically, W ± →l ± ν l (l = e,μ,τ), and analyse the anticipated jet profiles in the signal process t→Ws and the dominant background from the decay t→Wb. To that end, we analyse the V 0 (K 0 and Λ) distributions in the s- and b-quark jets concentrating on the energy and transverse momentum distributions of these particles. The V 0 s emanating from the t→Wb branch have displaced decay vertexes from the interaction point due to the weak decays b→c→s and the b-quark jets are rich in charged leptons. Hence, the absence of secondary vertexes and of the energetic charged leptons in the jet prov