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
Title: The influence of elements of synchronized swimming on technique of the selected swimming strokes Objectives: The objective of the thesis is to assess the effect of the elements of synchronized swimming at improving the techniques of swimming. Methods: The results were detected by overt observation with active participation and subsequent scaling on the ordinal scale 1 to 5. Results: The results show that the influence of the elements of synchronized swimming on improving the technique ...
Full Text Available The aim of this study is to explain in the best way possible the nature and significance of basic hand strokes in modern karate and the importance of their sensible application in combat as a means of achieving greater effectiveness. The object of the study is a theoretical demonstration of elementary techniques of performing basic hand strokes fit for use in combat with special attention to their practical application. The subject matter itself requires the use of a descriptive method. The paper will give a brief summary of the development of karate in our country and abroad, as well as a concise overview of the key principles of practicing karate techniques upon which the philosophy of karate as a martial art and sports discipline is based. The paper will also provide a systematization of hand techniques which are based on elementary hand strokes used most commonly owing to their effectiveness and practicability in karate combat, just one of the disciplines of modern karate.
Runitz, K.; Jensen, T.H.
We describe a case of severe heat stroke resulting from exposure to extreme heat in a sauna for an unknown period of time. The patient sustained 20% 2nd degree burns. On arrival at the emergency department, the patient's temperature was 40.5 degrees C. At the critical care unit, the patient...... developed severe multi-organ failure and critical polyneuropathy. Severe heat stroke is a rare diagnosis in Denmark. The treatment is symptomatic and the prognosis is grave, especially in combination with severe burns Udgivelsesdato: 2009/1/26...
Ramos-Cabrer, Pedro; Agulla, Jesús; Rodríguez-González, Raquel; Sobrino, Tomás; Castillo, José
Many patients that survive stroke have to face serious functional disabilities for the rest of their lives, which is a personal drama for themselves and their relatives, and an elevated charge for society. Thus, functional recovery after stroke must be a key aspect of the development of new therapeutic approaches. This is the second of a series of two works on which we review the strategies and tools available nowadays for the assessment of multiple aspects related to brain function (both in humans and research animals) and that are helping neuroscientist to better understand the processes of functional restoration and reorganization of the brain, that are triggered following stroke. We have assumed that a multidisciplinary approach is able to provide us with a wider perspective of the underlying mechanisms behind tissue repair, plastic reorganization of the brain and compensatory mechanisms, that can be triggered after stroke. In the second of the works of this series we are focusing in a series of techniques, complementary to the already discussed in the first work, and that are based on MR. These techniques are discussed separately from those ones, because they tackle with aspects not directly related to brain function, although they somehow do in indirect ways, or because they are based on physicochemical or physiological principles different from those discussed on the first work of this series.
Daniel Maxwell Bernad
Full Text Available Noninvasive techniques such as functional magnetic resonance imaging (fMRI and transcranial magnetic stimulation (TMS have provided insight into understanding how neural connections are altered in consequence to cerebrovascular injury. The first part of this review will briefly survey some of the methodological issues and limitations related to noninvasive poststroke motor recovery studies. The second section will investigate some of the different neural mechanisms that underlie neurorehabilitation in stroke patients. The third part will explore our current understanding of motor memory processing, describe the neural structures that subserve motor memory consolidation, and discuss the current literature related to memory reconsolidation in healthy adults. Lastly, this paper will suggest the potential therapeutic applications of integrating noninvasive tools with memory consolidation and reconsolidation theories to enhance motor recovery. The overall objective of this work is to demonstrate how noninvasive technologies have been utilized in the multidisciplinary field of clinical behavioral neuroscience and to highlight their potential to be employed as clinical tools to promote individualized motor recovery in stroke patients.
Lang, Clemens; Seyfang, Leonhard; Ferrari, Julia; Gattringer, Thomas; Greisenegger, Stefan; Willeit, Karin; Toell, Thomas; Krebs, Stefan; Brainin, Michael; Kiechl, Stefan; Willeit, Johann; Lang, Wilfried; Knoflach, Michael
Ischemic strokes associated with atrial fibrillation (AF) are more severe than those of other cause. We aim to study potential sex effects in this context. In this cross-sectional study, 74 425 adults with acute ischemic stroke from the Austrian Stroke Unit Registry were included between March 2003 and January 2016. In 63 563 patients, data on the National Institutes of Health Stroke Scale on admission to the stroke unit, presence of AF, vascular risk factors, and comorbidities were complete. Analysis was done by a multivariate regression model. Stroke severity in general increased with age. AF-related strokes were more severe than strokes of other causes. Sex-related differences in stroke severity were only seen in stroke patients with AF. Median (Q 25 , 75 ) National Institutes of Health Stroke Scale score points were 9 (4,17) in women and 6 (3,13) in men ( P stroke severity was independent of age, previous functional status, vascular risk factors, and vascular comorbidities and remained significant in various subgroups. Women with AF do not only have an increased risk of stroke when compared with men but also experience more severe strokes. © 2017 American Heart Association, Inc.
Amarenco, Pierre; Benavente, Oscar; Goldstein, Larry B
BACKGROUND AND PURPOSE: The SPARCL trial showed that atorvastatin 80 mg/d reduces the risk of stroke and other cardiovascular events in patients with recent stroke or transient ischemic attack (TIA). We tested the hypothesis that the benefit of treatment varies according to index event stroke sub...
Zietemann, Vera; Wollenweber, Frank Arne; Bayer-Karpinska, Anna; Biessels, Geert Jan; Dichgans, Martin
Introduction: The relationship between glucose metabolism and stroke outcome is likely to be complex. We examined whether there is a linear or non-linear relationship between glucose measures in the acute phase of stroke and post-stroke cognition, and whether altered glucose metabolism at different
Kerse, Ngaire; Parag, Varsha; Feigin, Valery L; McNaughton, Harry; Hackett, Maree L; Bennett, Derrick A; Anderson, Craig S
Falls are an important issue in older people. We aimed to determine the incidence, circumstances, and predictors of falls in patients with recent acute stroke. The Auckland Regional Community Stroke (ARCOS) study was a prospective population-based stroke incidence study conducted in Auckland, New Zealand (NZ) during 2002 to 2003. Among 6-month survivors, the location and consequences of any falls were ascertained by self-report as part of a structured interview. Multivariable logistic regression was used to establish associations between risk factors and "any" and "injurious" falls. Of 1104 stroke survivors who completed an interview, 407 (37%) reported at least 1 fall, 151 (37% of fallers, 14% of stroke survivors) sustained an injury that required medical treatment, and 31 (8% of fallers, 3% of stroke survivors) sustained a fracture. The majority of falls occurred indoors at home. Independent factors associated with falls were depressive symptoms, disability, previous falls, and older age. For injurious falls, the positively associated factors were female sex and NZ/European ethnicity and dependence before the stroke, whereas higher levels of activity and normal cognition were negatively associated factors. Falls are common after stroke, and their predictive factors are similar to those for older people in general. Falls prevention programs require implementation in stroke services.
Leslie Ecker Ferreira
Full Text Available ABSTRACT Aiming to contribute to studies that use detailed clinical and genomic information of biobanks, we present the initial results of the first Latin American Stroke Biobank. Methods: Blood samples were collected from patients included in the Joinville Stroke Registry and four Brazilian cities. Demographic socio-economic data, cardiovascular risk factors, Causative Classification System for Ischemic Stroke, Trial of Org 10172 in Acute Stroke Treatment and National Institutes of Health scores, functional stroke status (modified Rankin and brain images were recorded. Additionally, controls from both geographic regions were recruited. High-molecular-weight genomic DNA was obtained from all participants. Results: A total of 2,688 patients and 3,282 controls were included. Among the patients, 76% had ischemic stroke, 12% transient ischemic attacks, 9% hemorrhagic stroke and 3% subarachnoid hemorrhage. Patients with undetermined ischemic stroke were most common according the Trial of Org 10172 in Acute Stroke Treatment (40% and Causative Classification System for Ischemic Stroke (47% criteria. A quarter of the patients were under 55 years of age at the first-ever episode. Conclusions: We established the Joinville Stroke Biobank and discuss its potential for contributing to the understanding of the risk factors leading to stroke.
Kostakos, Vassilis; O'Neill, Eamonn
This paper presents a common gestural interface to mobile and pervasive computing devices. We report our development of a novel technique for recognizing input strokes on a range of mobile and pervasive devices, ranging from small devices with low processing capabilities and limited input area to computers with wall-sized displays and an input area as large as can be accommodated by motion-sensing technologies such as cameras. Recent work has included implementing and testing our stroke recog...
Engels, Thomas; Baglione, Quentin; Audibert, Martine; Viallefont, Anne; Mourji, Fouzi; El Alaoui Faris, Mustapha
Background Stroke is a growing public health concern in low- and middle- income countries. Improved knowledge about the association between socioeconomic status and stroke in these countries would enable the development of effective stroke prevention and management strategies. This study presents the association between socioeconomic status and the prevalence of stroke in Morocco, a lower middle-income country. Methods Data on the prevalence of stroke and stroke-related risk factors were collected during a large population-based survey. The diagnosis of stroke in surviving patients was confirmed by neurologists while health, demographic, and socioeconomic characteristics of households were collected using structured questionnaires. We used Multiple Correspondence Analysis to develop a wealth index based on characteristics of the household dwelling as well as ownership of selected assets. We used logistic regressions controlling for multiple variables to assess the statistical association between socioeconomic status and stroke. Findings Our results showed a significant association between household socioeconomic status and the prevalence of stroke. This relationship was non-linear, with individuals from both the poorest (mainly rural) and richest (mainly urban) households having a lower prevalence of stroke as compared to individuals with medium wealth level. The latter belonged mainly to urban households with a lower socioeconomic status. When taking into account the urban population only, we observed that a third of poorest households experienced a significantly higher prevalence of stroke compared to the richest third (OR = 2.06; CI 95%: 1.09; 3.89). Conclusion We conclude that individuals from the most deprived urban households bear a higher risk of stroke than the rest of the population in Morocco. This result can be explained to a certain extent by the higher presence of behavioral risk factors in this specific category of the population, which leads in
Full Text Available BACKGROUND: Stroke is a growing public health concern in low- and middle- income countries. Improved knowledge about the association between socioeconomic status and stroke in these countries would enable the development of effective stroke prevention and management strategies. This study presents the association between socioeconomic status and the prevalence of stroke in Morocco, a lower middle-income country. METHODS: Data on the prevalence of stroke and stroke-related risk factors were collected during a large population-based survey. The diagnosis of stroke in surviving patients was confirmed by neurologists while health, demographic, and socioeconomic characteristics of households were collected using structured questionnaires. We used Multiple Correspondence Analysis to develop a wealth index based on characteristics of the household dwelling as well as ownership of selected assets. We used logistic regressions controlling for multiple variables to assess the statistical association between socioeconomic status and stroke. FINDINGS: Our results showed a significant association between household socioeconomic status and the prevalence of stroke. This relationship was non-linear, with individuals from both the poorest (mainly rural and richest (mainly urban households having a lower prevalence of stroke as compared to individuals with medium wealth level. The latter belonged mainly to urban households with a lower socioeconomic status. When taking into account the urban population only, we observed that a third of poorest households experienced a significantly higher prevalence of stroke compared to the richest third (OR = 2.06; CI 95%: 1.09; 3.89. CONCLUSION: We conclude that individuals from the most deprived urban households bear a higher risk of stroke than the rest of the population in Morocco. This result can be explained to a certain extent by the higher presence of behavioral risk factors in this specific category of the population
... 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 ...
Smith, H K; Montpetit, R R; Perrault, H
Few studies have examined the aerobic demand of backstroke swimming, and its relation to body morphology, technique, or performance. The aims of this study were thus to: i) describe the aerobic demand of backstroke swimming in proficient swimmers at high velocities; ii) assess the effects of body size and stroke technique on submaximal and maximal O2 costs, and; iii) test for a relationship between submaximal O2 costs and maximal performance. Sixteen male competitive swimmers were tested during backstroke swimming at velocities from 1.0 to 1.4 m.s-1. Results showed that VO2 increased linearly with velocity (m.s-1) following the equation VO2 = 6.28v - 3.81 (r = 0.77, SEE/Y = 14.9%). VO2 was also related to the subjects' body mass, height, and armspan. Longer distances per stroke were associated with lower O2 costs, and better maximal performances. A significant relation was found between VO2 at 1.1 m.s-1, adjusted for body mass, and 400 m performance (r = -0.78). Submaximal VO2 was also related to reported times for 100 m and 200 m races. Multiple correlation analyses indicated that VO2 at 1.1 m.s-1 and VO2max accounted for up to 78% of the variance in maximal performances. These results suggest that the assessment of submaximal and maximal VO2 during backstroke swimming may be of value in the training and testing programs of competitive swimmers.
Darcourt, J.; Migneco, O.; Mahagne, M.H.
Perfusion SPECT allows immediate evaluation of cerebral ischaemia during the acute phase of stroke. Its prognostic value has been demonstrated by several studies. This prognostic value increases in comparison to clinical evaluation alone when injection is performed early after the first neurological signs. The classical three patterns fist described on PET studies by Marchal and Baron are also seen using SPECT: (pattern I) severe irreversible ischaemia with poor prognosis, (pattern III) normal study due to spontaneous reperfusion with complete clinical recovery and (pattern II) ischaemic penumbra with unpredictable prognosis. Two recent studies prove that SPECT can identify with high accuracy the extreme hemodynamic situations which are on one hand spontaneous re-perfusions (100 % sensitivity and specificity) and on the other hand the 'malignant middle cerebral artery infarctions' (82 % sensitivity and 98 % specificity). Therefore early SPECT is a valid tool to select stroke patients for thrombolytic therapy. (author)
Angres, G G
Cosmetic enhancement of the upper and lower eyelids by implantation of various colored pigments is one of the fastest growing procedures in ophthalmic practice. A new procedure, called Natural Brows, involves implantation of pigment in the brow line with a brush stroke technique in order to simulate brow hair. This procedure is particularly useful in patients with sparse brow hair caused by "overplucking." Burn victims and patients suffering from scarring after basal cell carcinoma removal will benefit from the camouflaging effect of the procedure. To achieve optimum cosmetic results, certain guidelines must be followed, and a complete evaluation of the patient's ocular morphology must be undertaken before surgery. A "paint-by-number" approach to the blepharopigmentation procedure is presented that is designed to reduce the risk of patient dissatisfaction.
Ramos-Cabrer, P; Agulla, J; Argibay, B; Brea, D; Campos, F; Castillo, J
Many patients that survive stroke have to face serious functional disabilities for the rest of their lives, which is a personal drama for themselves and their relatives, and an elevated charge for society. Thus functional recovery following stroke should be a key objective for the development of new therapeutic approaches. In this series of two works we review the strategies and tools available nowadays for the evaluation of multiple aspects related to brain function (both in humans and research animals), and how they are helping neuroscientist to better understand the processes of restoration and reorganization of brain function that are triggered following stroke. We have mainly focused on magnetic resonance applications, probably the most versatile neuroimaging technique available nowadays, and that everyday surprises us with new and exciting applications. But we tackle other alternative and complementary techniques, since a multidisciplinary approach allows a wider perspective over the underlying mechanisms behind tissue repair, plastic reorganization of the brain and compensatory mechanisms that are triggered after stroke. The first of the works of this series is focused on methodological aspects that will help us to understand how it is possible to assess brain function based on different physical and physiological principles. In the second work we will focus on different practical issues related to the application of the techniques here discussed.
Full Text Available Background: Rat is the most frequently used animal for ischemic stroke studies. Recently, middle cerebral artery occlusion (MCAO by introducing various types of surgical monofilament intraluminally has been widely used, with their advantages and disadvantages. For permanent occlusion, problems with mortality in rats are higher than transient. In this study, we used permanent occlusion using modified monofilament by flaming on its tip which may reduce mortality rate, so that chronic phase of stroke can be learned extensively.Methods: Three male Sprague-Dawley rats underwent permanent MCAO. The flame-blunted monofilament was introduced through common carotid artery. Hematoxylin eosin histopathology confirmation and functional assessment post-stroke induction were then evaluated.Results: Evaluation was conducted on 3 rats in different time post-stroke induction (48 hours, 72 hours, and 3 weeks. Using histopathological examination, the infarction was proved in all 3 rats showing red neurons, perivascular edema and neutrophil spongiosis, in infarct and peri-infarct area. The changes in histopathology showed spongiosis were more dominant in 3 week-post-MCAO rats. On the other hand, red neurons and perivascular edema were less compared to 48 and 72-hour-post-MCAO rats.Conclusion: Flame–blunted monofilament showed its efficacy in producing infarct area. The advantages of this technique are easy to perform with simple and less expensive modification of the monofilament. Conducting successful permanent occlusion with less mortality rate will give chances to do further research on stroke in chronic phase and its effect on novel treatment.
Samar M Hatem
Full Text Available Stroke is one of the leading causes for disability worldwide. Motor function deficits due to stroke affect the patients’ mobility, their limitation in daily life activities, their participation in society and their odds of returning to professional activities. All of these factors contribute to a low overall quality of life. Rehabilitation training is the most effective way to reduce motor impairments in stroke patients. This multiple systematic review focuses both on standard treatment methods and on innovating rehabilitation techniques used to promote upper extremity motor function in stroke patients. A total number of 5712 publications on stroke rehabilitation was systematically reviewed for relevance and quality with regards to upper extremity motor outcome. This procedure yielded 270 publications corresponding to the inclusion criteria of the systematic review. Recent technology-based interventions in stroke rehabilitation including non-invasive brain stimulation, robot-assisted training and virtual reality immersion are addressed. Finally, a decisional tree based on evidence from the literature and characteristics of stroke patients is proposed.At present, the stroke rehabilitation field faces the challenge to tailor evidence-based treatment strategies to the needs of the individual stroke patient. Interventions can be combined in order to achieve the maximal motor function recovery for each patient. Though the efficacy of some interventions may be under debate, motor skill learning and some new technological approaches give promising outcome prognosis in stroke motor rehabilitation.
Hatem, Samar M.; Saussez, Geoffroy; della Faille, Margaux; Prist, Vincent; Zhang, Xue; Dispa, Delphine; Bleyenheuft, Yannick
Stroke is one of the leading causes for disability worldwide. Motor function deficits due to stroke affect the patients' mobility, their limitation in daily life activities, their participation in society and their odds of returning to professional activities. All of these factors contribute to a low overall quality of life. Rehabilitation training is the most effective way to reduce motor impairments in stroke patients. This multiple systematic review focuses both on standard treatment methods and on innovating rehabilitation techniques used to promote upper extremity motor function in stroke patients. A total number of 5712 publications on stroke rehabilitation was systematically reviewed for relevance and quality with regards to upper extremity motor outcome. This procedure yielded 270 publications corresponding to the inclusion criteria of the systematic review. Recent technology-based interventions in stroke rehabilitation including non-invasive brain stimulation, robot-assisted training, and virtual reality immersion are addressed. Finally, a decisional tree based on evidence from the literature and characteristics of stroke patients is proposed. At present, the stroke rehabilitation field faces the challenge to tailor evidence-based treatment strategies to the needs of the individual stroke patient. Interventions can be combined in order to achieve the maximal motor function recovery for each patient. Though the efficacy of some interventions may be under debate, motor skill learning, and some new technological approaches give promising outcome prognosis in stroke motor rehabilitation. PMID:27679565
Pilar, Avinash; Gupta, Meetakshi; Ghosh Laskar, Sarbani; Laskar, Siddhartha
Intraoperative radiotherapy (IORT) is a technique that involves precise delivery of a large dose of ionising radiation to the tumour or tumour bed during surgery. Direct visualisation of the tumour bed and ability to space out the normal tissues from the tumour bed allows maximisation of the dose to the tumour while minimising the dose to normal tissues. This results in an improved therapeutic ratio with IORT. Although it was introduced in the 1960s, it has seen a resurgence of popularity with the introduction of self-shielding mobile linear accelerators and low-kV IORT devices, which by eliminating the logistical issues of transport of the patient during surgery for radiotherapy or building a shielded operating room, has enabled its wider use in the community. Electrons, low-kV X-rays and HDR brachytherapy are all different methods of IORT in current clinical use. Each method has its own unique set of advantages and disadvantages, its own set of indications where one may be better suited than the other, and each requires a specific kind of expertise. IORT has demonstrated its efficacy in a wide variety of intra-abdominal tumours, recurrent colorectal cancers, recurrent gynaecological cancers, and soft-tissue tumours. Recently, it has emerged as an attractive treatment option for selected, early-stage breast cancer, owing to the ability to complete the entire course of radiotherapy during surgery. IORT has been used in a multitude of roles across these sites, for dose escalation (retroperitoneal sarcoma), EBRT dose de-escalation (paediatric tumours), as sole radiation modality (early breast cancers) and as a re-irradiation modality (recurrent rectal and gynaecological cancers). This article aims to provide a review of the rationale, techniques, and outcomes for IORT across different sites relevant to current clinical practice.
This study is an experimental investigation of the dynamics of the aurora, describing both the systems developed for the optical measurements and the results obtained. It is found that during a auroral arc deformation, a fold travelling eastward along the arc is associated with an enhanced F-region ion temperature of 2700 K, measured by EISCAT, indicative of enhanced ionspheric electric fields. It is shown that for an auroral break-up, the large-scale westward travelling surge (WTS) is the last developed spiral in a sequence of spiral formations. It is proposed that the Kelvin-Helmholtz instability is the responsible process. In another event it is shown that large-amplitude long-lasting pulsations, observed both in ground-based magnetic field and photometer recordings, correspond to strong modulations of the particle intensity at the equatorial orbit (6.6 Re). In this event a gradual transition occurs between pulses classified as Ps6/auroral torches toward pulses with characteristics of substorms. The observations are explained by the Kelvin-Helmholtz instability in a magnetospheric boundary layer. The meridional neutral wind, at about 240 km altitude, is found to be reduced prior to or at the onset of auroral activity. These findings are suggestive of large-scale reconfigurations of the ionspheric electric fields prior to auroral onsets. A new real time triangulation technique developed to determine the altitude of auroral arcs is presented, and an alternative method to analyze incoherent scatter data is discussed. (With 46 refs.) (author)
... 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, ...
Sensitivity analysis techniques may be required to examine the sensitivity of SYVAC model predictions to the input parameter values, the subjective probability distributions assigned to the input parameters and to the relationship between dose and the probability of fatal cancers plus serious hereditary disease in the first two generations of offspring of a member of the critical group. This report mainly considers techniques for determining the sensitivity of dose and risk to the variable input parameters. The performance of a sensitivity analysis technique may be improved by decomposing the model and data into subsets for analysis, making use of existing information on sensitivity and concentrating sampling in regions the parameter space that generates high doses or risks. A number of sensitivity analysis techniques are reviewed for their application to the SYVAC model including four techniques tested in an earlier study by CAP Scientific for the SYVAC project. This report recommends the development now of a method for evaluating the derivative of dose and parameter value and extending the Kruskal-Wallis technique to test for interactions between parameters. It is also recommended that the sensitivity of the output of each sub-model of SYVAC to input parameter values should be examined. (author)
Mazzoleni, Stefano; Turchetti, Giuseppe; Palla, Ilaria; Posteraro, Federico; Dario, Paolo
During the last decade, different robotic devices have been developed for motor rehabilitation of stroke survivors. These devices have been shown to improve motor impairment and contribute to the understanding of mechanisms underlying motor recovery after a stroke. The assessment of the robotic technology for rehabilitation assumes great importance. The aim of this study is to present preliminary results on the assessment of the acceptability of the robotic technology for rehabilitation on a group of thirty-four chronic stroke patients. The results from questionnaires on the patients' acceptability of two different robot-assisted rehabilitation scenarios show that the robotic approach was well accepted and tolerated by the patients. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
Blanc, Raphaël; Redjem, Hocine; Ciccio, Gabriele; Smajda, Stanislas; Desilles, Jean-Philippe; Orng, Eliane; Taylor, Guillaume; Drumez, Elodie; Fahed, Robert; Labreuche, Julien; Mazighi, Mikael; Lapergue, Bertrand; Piotin, Michel
A direct aspiration first pass technique (ADAPT) has been reported to be fast, safe, and effective for the treatment of acute ischemic stroke. The aim of this study is to determine the preoperative factors that affect success of the aspiration component of the technique in ischemic stroke patients with large vessel occlusion in the anterior circulation. We enrolled all 347 consecutive patients with anterior circulation acute ischemic stroke admitted for mechanical thrombectomy at our institution from August 2013 to October 2015 and treated by ADAPT for the endovascular treatment of stroke. Baseline and procedural characteristics, modified thrombolysis in cerebral infarction scores, and 3-month modified Rankin Scale were captured and analyzed. Among the 347 patients (occlusion sites: middle cerebral artery=200, 58%; internal carotid artery Siphon=89, 25%; Tandem=58, 17%), aspiration component led to successful reperfusion (modified thrombolysis in cerebral infarction 2b/3 scores) in 55.6% (193/347 patients), stent retrievers were required in 40%, and a total successful final reperfusion rate of 83% (288/347) was achieved. Overall, procedural complications occurred in 13.3% of patients (48/347). Modified Rankin Scale score of 0 to 2 at 90 days was reported in 45% (144/323). Only 2 factors positively influenced the success of the aspiration component: an isolated middle cerebral artery occlusion ( P stroke onset to clot contact ( P =0.018). In this large retrospective study, ADAPT was shown to be safe and effective for anterior circulation acute ischemic stroke with a final successful reperfusion achieved in 83%. The site of arterial occlusion and delay of the procedure were predictors for reperfusion. URL: http://www.clinicaltrials.gov. Unique identifier: NCT02523261, NCT02678169, and NCT02466893. © 2017 American Heart Association, Inc.
van der Kooij, Herman; Prange, Grada Berendina; Prange, G.B.; Krabben, T.; Krabben, T.; Renzenbrink, G.H.; Boer, J.; Hermens, Hermanus J.; Jannink, M.J.A.
After stroke, arm function can be limited by a reduction in the selectivity of movements, due to involuntary coupling of shoulder abduction and elbow flexion, limiting the ability to reach. Gravity compensation of the arm reduces the required active shoulder abduction torques, which results in a
Comai, Alessio; Haglmüller, Thomas; Ferro, Federica; Dall'Ora, Elisa; Currò Dossi, Roberto; Bonatti, Giampietro
We report the preliminary results of a single-centre experience in the endovascular treatment (ET) of acute ischemic stroke (AIS) with a sequential endovascular thrombectomy approach (SETA), which comprehends a direct aspiration first-pass technique (ADAPT) eventually followed by stent retriever thrombectomy. We prospectively analyzed data from 16 patients with severe to moderate AIS and CT angiography demonstration of large intracranial vessel occlusion treated with SETA between July 2013 and March 2014. We evaluated recanalization rate, clinical outcome after 90 days as well as differential costs of aspiration and stent-assisted thrombectomy. A group of 16 patients met the eligibility criteria to undergo ET with a baseline NIHSS score of 22 (range 12-39). In 15/16 cases, we obtained target vessel recanalization, 11 cases with ADAPT technique alone. Modified rankin score (mRS) at 90 days follow-up was ≤2 in 9/16 patients (56%). ADAPT technique had a lower device-related cost than stent-assisted thrombectomy leading to an overall saving of -2,747.28 . Our preliminary data suggest that a SETA beginning with direct aspiration could be useful to optimize ET of stroke in terms of invasiveness, safety and cost-effectiveness allowing recanalization with low complication rate.
Soares-Oliveira, Miguel; Araújo, Fernando
Implementing integrated systems for emergency care of patients with acute ischemic stroke helps reduce morbidity and mortality. We describe the process of organizing and implementing a regional system to cover around 3.7 million people and its main initial results. We performed a descriptive analysis of the implementation process and a retrospective analysis of the following parameters: number of patients prenotified by the pre-hospital system; number of times thrombolysis was performed; door-to-needle time; and functional assessment three months after stroke. The implementation process started in November 2005 and ended in December 2009, and included 11 health centers. There were 3574 prenotifications from the prehospital system. Thrombolysis was performed in 1142 patients. The percentage of patients receiving thrombolysis rose during the study period, with a maximum of 16%. Median door-to-needle time was 62 min in 2009. Functional recovery three months after stroke was total or near total in 50% of patients. The regional system implemented for emergency care of patients with acute ischemic stroke has led to health gains, with progressive improvements in patients' access to thrombolysis, and to greater equity in the health care system, thus helping to reduce mortality from cerebrovascular disease in Portugal. Our results, which are comparable with those of international studies, support the strategy adopted for implementation of this system. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.
Fan, C W
Most patients with acute stroke are admitted to hospital. If stroke services in this country are to be improved, we need accurate and reliable information about the types of stroke patients being admitted, their present management and outcome.
Bijoy K Menon
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.
Full Text Available Purpose: to investigate the influence of indicators of morpho-functional development of highly trained swimmers on the result of overcoming different length distances by means of the butterfly stroke. Material & Methods: analysis of scientific and methodical literature, timing, measurement of morphological and functional indicators using individual techniques, methods of mathematical statistics. Contingent surveyed accounted for athletes who specialize in the distances of 50, 100 and 200 meters by means of the butterfly stroke and had a level of sports qualification: master of sports, international class master of sports. Results: the authors determined the relationship between the degree of correlation of morphological and functional performance highly trained swimmers and sports results at distances of 50, 100 and 200 meters by means butterfly stroke; investigated the significance of morpho-functional indicators, depending on the length of the competitive distance. Conclusion: significance of the indicators of anthropometric development and the functional state of athletes who specialize in swimming by means butterfly stroke differs depending on the length of the competitive distance. The definition of distance specialization of athletes by means butterfly stroke should be carried out taking into account the indicators of morpho-functional development, which most significantly affect the result of overcoming the distances of 50, 100 and 200 meters.
Kapetanakis, Vasilis; Jacob, Kristina; Klauschie, Jennifer; Kho, Rosanne; Magrina, Javier
The feasibility, safety and outcomes of robotic presacral neurectomy were evaluated. A retrospective analysis was performed of 33 patients with midline chronic pelvic pain, who underwent robotic presacral neurectomy. Data were collected during the period March 2004-March 2010. All patients underwent robotic presacral neurectomy and additional robotic procedures. Mean operating time for robotic presacral neurectomy was 5.8 (range 4.4-6.9) min. Mean blood loss, including concomitant procedures, was 39 (range 15-150) ml. Most patients were discharged the same day (60%) and mean hospital stay was 0.39 (range 0-2) days. There were no conversions or intra-operative complications. There were two postoperative complications: one pelvic abscess and one Clostridium difficile colitis. Pain improvement was reported by 73% (22/30) of patients. Robotic presacral neurectomy is safe and feasible, resulting in improvement of pelvic pain in selected patients. Copyright © 2011 John Wiley & Sons, Ltd.
Full Text Available Abstract Background The Pierre Robin Sequence features were first described by Robin in 1923 and include micrognathia, glossoptosis and respiratory distress with an incidence estimated as 1:8,500 to 1:20,000 newborns. Upper airway obstruction and feeding difficulties are the main concerns related to the pathology. Mandibular distraction should be considered a treatment option (when other treatments result inadequate. Patiants and methods Ten patients between the ages of 1 month and 2 years with severe micrognathia and airway obstruction were treated with Mandibular Distraction Osteogenesis (MDO. All patients underwent fibroscopic examination of the upper airway and a radiographic imaging and/or computed tomography scans to detect malformations and to confirm that the obstruction was caused by posterior tongue displacement. All patients were evaluated by a multidisciplinary team. Indications for surgery included frequent apneic episodes with severe desaturation (70%. Gavage therapy was employed in all patients since oral feeding was not possible. The two tracheotomy patients were 5 months and 2 years old respectively, and the distraction procedure was performed to remove the tracheotomy tube. All patients were treated with bilateral mandibular distraction: two cases with an external multivector distraction device, six cases with an internal non-resorbable device and two cases with an internal resorbable device. In one case, the patient with Goldenhar's Syndrome, the procedure was repeated. Results The resolution of symptoms was obtained in all patients, and, when present, tracheotomy was removed without complications. Of the two patients with pre-existing tracheotomies, in the younger patient (5 months old the tracheotomy was removed 7 days postoperatively. In the Goldenhar's syndrome case (2 years old a Montgomery device was necessary for 6 months due to the presence of tracheotomy-inducted tracheomalacia. Patients were discharged when the
Dorado, Laura; Ahmed, Niaz; Thomalla, Götz; Lozano, Manuel; Malojcic, Branko; Wani, Mushtaq; Millán, Mònica; Tomek, Ales; Dávalos, Antoni
Stroke patients with unknown onset (UKO) are excluded from thrombolytic therapy. We aim to study the safety and efficacy of intravenous alteplase in ischemic stroke patients with UKO of symptoms compared with those treated within 4.5 hours in a large cohort. Data were analyzed from 47 237 patients with acute ischemic stroke receiving intravenous tissue-type plasminogen activator in hospitals participating in the Safe Implementation of Treatment in Stroke-International Stroke Thrombolysis Registry between 2010 and 2014. Two groups were defined: (1) patients with UKO (n=502) and (2) patients treated within 4.5 hours of stroke onset (n=44 875). Outcome measures were symptomatic intracerebral hemorrhage per Safe Implementation of Treatment in Stroke on the 22 to 36 hours post-treatment neuroimaging and mortality and functional outcome assessed by the modified Rankin Scale at 3 months. Patients in UKO group were significantly older, had more severe stroke at baseline, and longer door-to-needle times than patients in the ≤4.5 hours group. Logistic regression showed similar risk of symptomatic intracerebral hemorrhage (adjusted odds ratio, 1.09; 95% confidence interval, 0.44-2.67) and no significant differences in functional independency (modified Rankin Scale score of 0-2; adjusted odds ratio, 0.79; 95% confidence interval, 0.56-1.10), but higher mortality (adjusted odds ratio, 1.58; 95% confidence interval, 1.04-2.41) in the UKO group compared with the ≤4.5 hours group. Patients treated within 4.5 hours showed reduced disability over the entire range of modified Rankin Scale compared with the UKO group (common adjusted odds ratio, 1.29; 95% confidence interval, 1.01-1.65). Our data suggest no excess risk of symptomatic intracerebral hemorrhage but increased mortality and reduced favorable outcome in patients with UKO stroke compared with patients treated within the approved time window. © 2017 American Heart Association, Inc.
Hemmen, Thomas M; Raman, Rema; Guluma, Kama Z; Meyer, Brett C; Gomes, Joao A; Cruz-Flores, Salvador; Wijman, Christine A; Rapp, Karen S; Grotta, James C; Lyden, Patrick D
Induced hypothermia is a promising neuroprotective therapy. We studied the feasibility and safety of hypothermia and thrombolysis after acute ischemic stroke. Intravenous Thrombolysis Plus Hypothermia for Acute Treatment of Ischemic Stroke (ICTuS-L) was a randomized, multicenter trial of hypothermia and intravenous tissue plasminogen activator in patients treated within 6 hours after ischemic stroke. Enrollment was stratified to the treatment time windows 0 to 3 and 3 to 6 hours. Patients presenting within 3 hours of symptom onset received standard dose intravenous alteplase and were randomized to undergo 24 hours of endovascular cooling to 33°C followed by 12 hours of controlled rewarming or normothermia treatment. Patients presenting between 3 and 6 hours were randomized twice: to receive tissue plasminogen activator or not and to receive hypothermia or not. Results- In total, 59 patients were enrolled. One patient was enrolled but not treated when pneumonia was discovered just before treatment. All 44 patients enrolled within 3 hours and 4 of 14 patients enrolled between 3 to 6 hours received tissue plasminogen activator. Overall, 28 patients randomized to receive hypothermia (HY) and 30 to normothermia (NT). Baseline demographics and risk factors were similar between groups. Mean age was 65.5±12.1 years and baseline National Institutes of Health Stroke Scale score was 14.0±5.0; 32 (55%) were male. Cooling was achieved in all patients except 2 in whom there were technical difficulties. The median time to target temperature after catheter placement was 67 minutes (Quartile 1 57.3 to Quartile 3 99.4). At 3 months, 18% of patients treated with hypothermia had a modified Rankin Scale score of 0 or 1 versus 24% in the normothermia groups (nonsignificant). Symptomatic intracranial hemorrhage occurred in 4 patients (68); all were treated with tissue plasminogen activator <3 hours (1 received hypothermia). Six patients in the hypothermia and 5 in the normothermia
Caimmi, Marco; Chiavenna, Andrea; Scano, Alessandro; Gasperini, Giulio; Giovanzana, Chiara; Molinari Tosatti, Lorenzo; Molteni, Franco
Robotic rehabilitation is promising to promote function in stroke patients. The assist as needed training paradigm has shown to stimulate neuroplasticity but often cannot be used because stroke patients are too impaired to actively control the robot against gravity. To verify whether a rehabilitation intervention based on robot fully assisted reaching against gravity (RCH) and hand-to-mouth (HTM) can promote upper-limb function in chronic stroke. Cohort study. Chronic stroke outpatients referring to the robotic rehabilitation lab of a rehabilitation centre. Ten chronic stroke patients with mild to moderate upper-limb hemiparesis. Patients underwent 12 sessions (3 per week) of robotic treatment using an end-effector robot Every session consisted of 20 minutes each of RCH and HtM; movements were fully assisted, but patients were asked to try to actively participate. The Fugl-Meyer Assessment (FMA) was the primary outcome measure; Medical Research Council and Modified Ashworth Scale were the secondary outcome measures. All patients, but one, show functional improvements (FMA section A-D, mean increment 7.2±3.9 points, Probotic intervention based on functional movements, fully assisted, can be effective in promoting function in chronic stroke patients. These results are promising considering the short time of the intervention (1 month) and the time from the stroke event, which was large (27±20 months). A larger study, comprehensive of objective instrumental measures, is necessary to confirm the results. This intervention could be extended even to subacute stroke and other neurological disorders.
Full Text Available Abstract Background Stroke is a major cause of mortality and morbidity with potential for improved care and prevention through general practice. A national survey was undertaken to determine current resources and needs for optimal stroke prevention and care. Methods Postal survey of random sample of general practitioners undertaken (N = 204; 46% response. Topics included practice organisation, primary prevention, acute management, secondary prevention, long-term care and rehabilitation. Results Service organisation for both primary and secondary prevention was poor. Home management of acute stroke patients was used at some stage by 50% of responders, accounting for 7.3% of all stroke patients. Being in a structured cardiovascular management scheme, a training practice, a larger practice, or a practice employing a practice nurse were associated with structures and processes likely to support stroke prevention and care. Conclusion General practices were not fulfilling their potential to provide stroke prevention and long-term management. Systems of structured stroke management in general practice are essential to comprehensive national programmes of stroke care.
Whitford, David L
BACKGROUND: Stroke is a major cause of mortality and morbidity with potential for improved care and prevention through general practice. A national survey was undertaken to determine current resources and needs for optimal stroke prevention and care. METHODS: Postal survey of random sample of general practitioners undertaken (N = 204; 46% response). Topics included practice organisation, primary prevention, acute management, secondary prevention, long-term care and rehabilitation. RESULTS: Service organisation for both primary and secondary prevention was poor. Home management of acute stroke patients was used at some stage by 50% of responders, accounting for 7.3% of all stroke patients. Being in a structured cardiovascular management scheme, a training practice, a larger practice, or a practice employing a practice nurse were associated with structures and processes likely to support stroke prevention and care. CONCLUSION: General practices were not fulfilling their potential to provide stroke prevention and long-term management. Systems of structured stroke management in general practice are essential to comprehensive national programmes of stroke care.
van Hartingsveld, Frank; Lucas, Cees; Kwakkel, Gert; Lindeboom, Robert
Attempts have been made to provide guidelines for interpreting Barthel scores. We used a Rasch analysis to improve the measurement properties and clinical interpretability of the Barthel index score. A specific extension of Rasch model was used to identify items that preclude the summation of items and to improve the item rating scale by examining the scores on the Barthel of 559 stroke patients scored 3 weeks (n=89) and 6 months (n=470) after stroke. The clinical interpretation of the revised Rasch modeled Barthel was illustrated by re-examining the results of a previously published trial on the effectiveness of leg and arm training after stroke. Most rating scales could be improved by collapsing nondiscriminating rating categories. Two items showed misfit: Bladder and Bowel. The remaining Barthel showed an excellent fit to the extended Rasch model (R1c Goodness-of-Fit P=0.35). Both items and patients could be placed on a common logit unit scale, allowing a clearer interpretation of the trial effect. Using the modeled activities of daily living difficulty/ability scale, we could express the differences between treatment arms in modeled probabilities of a positive score to each Barthel item for the treatment arms not conveyed by the original ordinal Barthel sum scores. We improved the psychometric properties and clinical interpretation of the Barthel index.
Full Text Available Abstract Background Physical rehabilitation is an area where robotics could contribute significantly to improved motor return for individuals following a stroke. This paper presents the results of a preliminary randomized controlled trial (RCT of a robot system used in the rehabilitation of the paretic arm following a stroke. Methods The study's objectives were to explore the efficacy of this new type of robotic therapy as compared to standard physiotherapy treatment in treating the post-stroke arm; to evaluate client satisfaction with the proposed robotic system; and to provide data for sample size calculations for a proposed larger multicenter RCT. Twenty clients admitted to an inpatient stroke rehabilitation unit were randomly allocated to one of two groups, an experimental (robotic arm therapy group or a control group (conventional therapy. An occupational therapist blinded to patient allocation administered two reliable measures, the Chedoke Arm and Hand Activity Inventory (CAHAI-7 and the Chedoke McMaster Stroke Assessment of the Arm and Hand (CMSA at admission and discharge. For both groups, at admission, the CMSA motor impairment stage of the affected arm was between 1 and 3. Results Data were compared to determine the effectiveness of robot-assisted versus conventional therapy treatments. At the functional level, both groups performed well, with improvement in scores on the CAHAI-7 showing clinical and statistical significance. The CAHAI-7 (range7-49 is a measure of motor performance using functional items. Individuals in the robotic therapy group, on average, improved by 62% (95% CI: 26% to 107% while those in the conventional therapy group changed by 30% (95% CI: 4% to 61%. Although performance on this measure is influenced by hand recovery, our results showed that both groups had similar stages of motor impairment in the hand. Furthermore, the degree of shoulder pain, as measured by the CMSA pain inventory scale, did not worsen for
Background Physical rehabilitation is an area where robotics could contribute significantly to improved motor return for individuals following a stroke. This paper presents the results of a preliminary randomized controlled trial (RCT) of a robot system used in the rehabilitation of the paretic arm following a stroke. Methods The study's objectives were to explore the efficacy of this new type of robotic therapy as compared to standard physiotherapy treatment in treating the post-stroke arm; to evaluate client satisfaction with the proposed robotic system; and to provide data for sample size calculations for a proposed larger multicenter RCT. Twenty clients admitted to an inpatient stroke rehabilitation unit were randomly allocated to one of two groups, an experimental (robotic arm therapy) group or a control group (conventional therapy). An occupational therapist blinded to patient allocation administered two reliable measures, the Chedoke Arm and Hand Activity Inventory (CAHAI-7) and the Chedoke McMaster Stroke Assessment of the Arm and Hand (CMSA) at admission and discharge. For both groups, at admission, the CMSA motor impairment stage of the affected arm was between 1 and 3. Results Data were compared to determine the effectiveness of robot-assisted versus conventional therapy treatments. At the functional level, both groups performed well, with improvement in scores on the CAHAI-7 showing clinical and statistical significance. The CAHAI-7 (range7-49) is a measure of motor performance using functional items. Individuals in the robotic therapy group, on average, improved by 62% (95% CI: 26% to 107%) while those in the conventional therapy group changed by 30% (95% CI: 4% to 61%). Although performance on this measure is influenced by hand recovery, our results showed that both groups had similar stages of motor impairment in the hand. Furthermore, the degree of shoulder pain, as measured by the CMSA pain inventory scale, did not worsen for either group over the
Andersen, Klaus Kaae; Olsen, Tom Skyhøj
severity (according to the Scandinavian Stroke Scale), computed tomography scan, and an evaluation for cardiovascular risk factors. Follow-up duration was 4 years (mean, 1.2 years). RESULTS: Of all patients, 22 179 (89.4%) experienced an ischemic stroke. In total, 3670 (16.5%) had AF, and 1909 had....... METHODS: A nationwide registry that was started in 2001 with the aim of registering all hospitalized stroke patients in Denmark now includes 24 791 patients. We studied the survival of patients with ischemic stroke and AF with respect to anticoagulation treatment. All underwent an evaluation for stroke......BACKGROUND AND PURPOSE: The preventive effect of anticoagulation in patients with stroke and atrial fibrillation (AF) is documented only in trials of minor stroke. Although anticoagulation reduced stroke recurrence, those trials did not demonstrate an influence of anticoagulation on survival...
Wang Ziliang; Xu Haowen; Li Tianxiao; Zhu Liangfu; Li Zhaoshuo; Xue Jiangyu; Bai Weixing; Li Li; Guan Sheng
Objective: To evaluate the incidence, potential hazards and effective countermeasure for perforator stroke (PS) resulting from stent angioplasty of symptomatic intracranial artery stenosis. Methods: Peri-operation PS complications of 258 patients receiving Gateway balloon-Wingspan stenting for severe symptomatic intracranial stenosis were analyzed. The incidence, clinical course, and prognosis of PS resulting from stenting were recorded. Special attention was given to the anatomical features, clinical manifestation and video materials of patients with PS. χ 2 test was used for statistics. Results: Two hundred and fifty-five patients received stent angioplasty successfully and 7 patients had PS (incidence rate 2.7%). The patients with basilar artery stenosis had a higher incidence of PS resulting from intracranial stenting (6.1%, 4/66) than patients with middle cerebral artery stenosis (2.5%, 3/118) (χ 2 =2.320, P= 0.025). The potential hazards for PS included preoperative perforator stroke adjacent to the stenotic segment and prominent dissection during operation. Six patients presented symptoms after awake from general anaesthesia and one had symptoms 3 hours after stenting. One deteriorated gradually and the others reached the maximum deficit almost at once. At the follow-up of 3 months, 3 patients were disabled and scored one, two, two by mRS respectively. Conclusion: The incidence of PS resulting from intracranial stenting was low and the prognosis was not disastrous. Stenosis at basilar artery and preoperative perforator stroke adjacent to the stenotic segment were potential risk factors for PS complication. Proper maneuver of angioplasty may decrease the incidence of PS and improve the prognosis. (authors)
Roosink, M.; Renzenbrink, G.J.; Buitenweg, J.R.; Dongen, R.T. van; Geurts, A.C.H.; IJzerman, M.J.
OBJECTIVE: To identify factors associated with persistent poststroke shoulder pain (pPSSP) in the first 6 months after stroke. DESIGN: Prospective inception cohort study. SETTING: Stroke units of 2 teaching hospitals. PARTICIPANTS: Patients (N=31) with a clinical diagnosis of stroke. INTERVENTIONS:
Roosink, M.; Renzenbrink, Gerbert J.; Buitenweg, Jan R.; van Dongen, Robert T.; Geurts, Alexander C.; IJzerman, Maarten Joost
OBJECTIVE: To identify factors associated with persistent poststroke shoulder pain (pPSSP) in the first 6 months after stroke. DESIGN: Prospective inception cohort study. SETTING: Stroke units of 2 teaching hospitals. PARTICIPANTS: Patients (N=31) with a clinical diagnosis of stroke. INTERVENTIONS:
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.
Jauch, Edward C; Holmstedt, Christine; Nolte, Justin
The past 15 years have witnessed significant strides in the management of acute stroke. The most significant advance, reperfusion therapy, has changed relatively little, but the integrated healthcare systems-stroke systems-established to effectively and safely administer stroke treatments have evolved greatly. Driving change is the understanding that "time is brain." Data are compelling that the likelihood of improvement is directly tied to time of reperfusion. Regional stroke systems of care ensure patients arrive at the most appropriate stroke-capable hospital in which intrahospital systems have been created to process the potential stroke patient as quickly as possible. The hospital-based systems are comprised of prehospital care providers, emergency department physicians and nurses, stroke team members, and critical ancillary services such as neuroimaging and laboratory. Given their complexity, these systems of care require maintenance. Through teamwork and ownership of the process, more patients will be saved from potential death and long-term disability. © 2012 New York Academy of Sciences.
Uchiyama, Shinichiro; Sakai, Nobuyuki; Toi, Sono; Ezura, Masayuki; Okada, Yasushi; Takagi, Makoto; Nagai, Yoji; Matsubara, Yoshihiro; Minematsu, Kazuo; Suzuki, Norihiro; Tanahashi, Norio; Taki, Waro; Nagata, Izumi; Matsumoto, Masayasu
to the adequate control of risk factors, and because patients with stroke within 2 weeks after the onset were excluded. The results of the CATHARSIS trial suggest a potential utility of pharmacotherapies with cilostazol plus aspirin as well as of strict control of risk factors for the management of symptomatic IAS. Larger studies with higher statistical power are required to obtain conclusive results.
Smith, Wade S; Sung, Gene; Saver, Jeffrey; Budzik, Ronald; Duckwiler, Gary; Liebeskind, David S; Lutsep, Helmi L; Rymer, Marilyn M; Higashida, Randall T; Starkman, Sidney; Gobin, Y Pierre; Frei, Donald; Grobelny, Thomas; Hellinger, Frank; Huddle, Dan; Kidwell, Chelsea; Koroshetz, Walter; Marks, Michael; Nesbit, Gary; Silverman, Isaac E
Endovascular mechanical thrombectomy may be used during acute ischemic stroke due to large vessel intracranial occlusion. First-generation MERCI devices achieved recanalization rates of 48% and, when coupled with intraarterial thrombolytic drugs, recanalization rates of 60% have been reported. Enhancements in embolectomy device design may improve recanalization rates. Multi MERCI was an international, multicenter, prospective, single-arm trial of thrombectomy in patients with large vessel stroke treated within 8 hours of symptom onset. Patients with persistent large vessel occlusion after IV tissue plasminogen activator treatment were included. Once the newer generation (L5 Retriever) device became available, investigators were instructed to use the L5 Retriever to open vessels and could subsequently use older generation devices and/or intraarterial tissue plasminogen activator. Primary outcome was recanalization of the target vessel. One hundred sixty-four patients received thrombectomy and 131 were initially treated with the L5 Retriever. Mean age+/-SD was 68+/-16 years, and baseline median (interquartile range) National Institutes of Health Stroke Scale score was 19 (15 to 23). Treatment with the L5 Retriever resulted in successful recanalization in 75 of 131 (57.3%) treatable vessels and in 91 of 131 (69.5%) after adjunctive therapy (intraarterial tissue plasminogen activator, mechanical). Overall, favorable clinical outcomes (modified Rankin Scale 0 to 2) occurred in 36% and mortality was 34%; both outcomes were significantly related to vascular recanalization. Symptomatic intracerebral hemorrhage occurred in 16 patients (9.8%); 4 (2.4%) of these were parenchymal hematoma type II. Clinically significant procedural complications occurred in 9 (5.5%) patients. Higher rates of recanalization were associated with a newer generation thrombectomy device compared with first-generation devices, but these differences did not achieve statistical significance. Mortality
Pan, R.; Hobbs, K.; Minnis, M.; Graham, K.
The use of various decontamination techniques and equipment has become a critical part of Fuel Handling maintenance work at the Pickering Nuclear Station, an eight unit CANDU station located about 30 km east of Toronto. This paper presents an overview of the set up and techniques used for cleaning in the PND Fuel Handling Maintenance Facility, and the results achieved. (author)
van Spronsen, Erik; Ebbens, Fenna A.; Mirck, Peter G. B.; van Wettum, Cathelijne H. M.; van der Baan, Sieberen
To describe the technique for canalplasty as performed in the Academic Medical Center, Amsterdam, the Netherlands and to present the results of this technique. Retrospective chart analysis. Charts of patients who underwent a canalplasty prodedure between 2001 and 2010 were reviewed for indication
Leker, Ronen R; Hur, Tamir Ben; Gomori, John M; Paniri, R; Eichel, Roni; Cohen, Jose E
Acute vertigo may be secondary to stroke or to non-ischemic causes. Accurate identification of vertigo secondary to ischemia may lead to appropriate timely intervention that can minimize stroke-related damage and can help in tailoring the most appropriate individual therapy for affected patients. Diffusion weighted MRI (DWI) is very accurate for diagnosing stroke and we therefore aimed to test whether it can aid in making a correct diagnosis of vertigo secondary to stroke. All patients presenting with vertigo in which the diagnosis of stroke was considered underwent DWI only MRI. Data regarding the symptoms and neurological deficits, vascular risk factors, imaging findings, and outcomes was accrued. Patients with stroke on DWI were compared with those without ischemia. Between June 2010 and August 2011, 28 patients fulfilling the entry criteria were identified with a mean age of 62·2±12·8 (60% male). The final diagnosis was stroke in 11 patients (39%). Patients with stroke did not differ from those without stroke in their risk factor profile. However, patients with stroke more often tended to present with vertigo accompanied by other neurological symptoms (73% versus 12% respectively, P = 0·001). After adjusting for age and the presence of diabetes, the presence of multiple symptoms remained the only variable that was associated with a positive DWI scan (odds ratio: 30: 95% confidence interval: 2·6-349). Most patients with stroke had very mild strokes with a median admission NIHSS score of 3 and DWI lesion volumes >2 cm were found in only three patients. Most stroke patients made a good recovery (modified Rankin score ≤2 in seven of nine patients with 90 day data). The most common diagnosis in patients without stroke was of vertigo of peripheral origin (14/17). DWI only MRI can be used to rapidly screen patients presenting with vertigo and suspected vertebrobasilar stroke. The occurrence of vertigo in combination with other focal neurological symptoms may
Juan, Juan; Liu, Gang; Willett, Walter C; Hu, Frank B; Rexrode, Kathryn M; Sun, Qi
Higher intake of whole grains may exert cardiometabolic benefits, although findings on stroke risk are inconclusive. The potentially differential effects of individual whole grain foods on ischemic stroke have not been examined. We analyzed whole grain consumption in relation to ischemic stroke among 71 750 women from the Nurses' Health Study and 42 823 men from the Health Professionals Follow-up Study who were free of cardiovascular disease, diabetes mellitus, and cancer at baseline (1984 and 1986, respectively) through 2010 using a Cox proportional hazards model. Validated semiquantitative food frequency questionnaires were used to assess consumption of whole grain intake, including whole grain cold breakfast cereal, dark bread, oatmeal, brown rice, popcorn, bran, and germ. Self-reported incident cases of ischemic stroke were confirmed through medical record review. During 2 820 128 person-years of follow-up in the 2 cohorts, 2458 cases of ischemic stroke were identified and confirmed. Intake of total whole grains was not associated with risk of ischemic stroke after adjustment for covariates: the pooled hazard ratio (95% confidence interval) comparing extreme intake levels was 1.04 (0.91-1.19). However, intake of whole grain cold breakfast cereal and total bran was inversely associated with ischemic stroke after multivariate adjustment: the pooled hazard ratios (95% confidence intervals) were 0.88 (0.80-0.96; P trend =0.008) and 0.89 (0.79-1.00; P trend =0.004), respectively. Other whole grain foods were not associated with a lower risk of ischemic stroke. Although overall consumption of whole grains was not associated with lower risk of ischemic stroke, greater consumption of whole grain cold breakfast cereal and bran was significantly associated with a lower risk of ischemic stroke. More studies are needed to replicate these associations between individual whole grain foods and risk of ischemic stroke among other populations. © 2017 American Heart
Pasternak Maria M.
Full Text Available The article is aimed at generalizing the theoretical approaches to the structure and elements of the technique for analysis of the Financial results report (Cumulative income report and providing suggestions for its improvement. The current methods have been analyzed, relevance of the application of a common technique for such analysis has been substantiated. A common technique for analyzing the Financial results report has been proposed, which includes definition of the objectives and tasks of analysis, subjects and objects of analysis, sources of its information. Stages of such an analysis were allocated and described. The findings of the article can be used to theoretically substantiate and to practically develop a technique for analyzing the Financial results report in the branches of Ukrainian economy.
Impact of the New American Heart Association/American Stroke Association Definition of Stroke on the Results of the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis Trial.
Al Kasab, Sami; Lynn, Michael J; Turan, Tanya N; Derdeyn, Colin P; Fiorella, David; Lane, Bethany F; Janis, L Scott; Chimowitz, Marc I
An American Heart Association/American Stroke Association (AHA/ASA) writing committee has recently recommended that tissue evidence of cerebral infarction associated with temporary symptoms (CITS) lasting Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial. We compared outcomes in the medical (n = 227) and stenting (n = 224) groups in SAMMPRIS using the following primary end point (new components in bold): any stroke, CITS, or death within 30 days after enrollment or within 30 days after a revascularization procedure for the qualifying lesion during follow-up; or ischemic stroke or CITS in the territory of the qualifying artery beyond 30 days. We also compared the use of brain magnetic resonance imaging (MRI) after transient ischemic attacks (TIAs) in both treatment groups. By considering CITS as equivalent to stroke, the number of primary end points increased from 34 to 43 in the medical group and from 52 to 66 in the stenting group of SAMMPRIS. The Kaplan-Meier curves for the primary end points in the 2 groups were significantly different (P = .009). The percentage of patients with reported TIAs who underwent brain MRI was 69% in the medical group and 61% in the stenting group (P = .40). Using the AHA/ASA definition of stroke resulted in a substantially higher primary end point rate in both treatment groups and an even higher benefit from medical therapy over stenting than originally shown in SAMMPRIS. The higher rate of CITS in the stenting group was not due to ascertainment bias. Published by Elsevier Inc.
Aries, M.J.H.; Elting, Jan Willem; Stewart, Roy E.; de Keyser, Jacques; Thien, Theo; Kremer, Berry P.; Vroomen, Patrick C. A. J.
Background: Blood pressure (BP) is one of the major vital parameters monitored in the stroke unit. The accuracy of indirect BP measurement is strongly influenced by the position of both patient and arm during the measurement. Acute stroke patients are often nursed in lateral decubitus positions. The
Proietti, Riccardo; Joza, Jacqueline; Arensi, Andrea; Levi, Michael; Russo, Vincenzo; Tzikas, Apostolos; Danna, Paolo; Sagone, Antonio; Viecca, Maurizio; Essebag, Vidal
Atrial fibrillation (AF), the most common cardiac arrhythmia, confers a 5-fold risk of stroke that increases to 17-fold when associated with mitral stenosis. At this time, the most effective long-term solution to protect patients from stroke and thromboembolism is oral anticoagulation, either with vitamin K antagonists (VKAs) or a novel oral anticoagulant (NOAC). Despite the significant benefits they confer, both VKAs and NOACs are underused because of their increased potential for bleeding, and VKAs are underused because of their narrow therapeutic range, need for regular international normalized ratio checks, and interactions with food or medications. In patients with nonvalvular AF, approximately 90% of strokes originate from the left atrial appendage (LAA); in patients with rheumatic mitral valve disease, many patients (60%) have strokes that originate from the left atrium itself. Surgical LAA amputation or closure, although widely used to reduce stroke risk in association with cardiac surgery, is not currently performed as a stand-alone operation for stroke risk reduction because of its invasiveness. Percutaneous LAA closure, as an alternative to anticoagulation, has been increasingly used during the last decade in an effort to reduce stroke risk in nonvalvular AF. Several devices have been introduced during this time, of which one has demonstrated noninferiority compared with warfarin in a randomized controlled trial. This review describes the available technologies for percutaneous LAA closure, as well as a summary of the published trials concerning their safety and efficacy in reducing stroke risk in AF.
Atmuri, Kiran; Hughes, Andrew; Coles, David; Ahmad, Omar; Neeman, Teresa; Lueck, Christian
There is limited evidence supporting the routine use of Holter monitoring (HM) in patients with acute ischaemic stroke. This study aimed to assess the diagnostic yield of HM and determine whether any cardiac disease parameter(s) would permit more focused targeting of HM. We performed a retrospective evaluation of HM in patients with acute ischaemic stroke admitted to our hospital over a one-year period to assess diagnostic yield and whether certain cardiac disease parameters were correlated with HM results. The diagnostic yield was 9%, the number needed to screen was 11, and the cost to detect one clinically significant case was AUS$1,300. Apart from age, stratifying patients by cardiac disease parameters did not predict HM result. This strengthens the use of HM in all patients presenting with acute ischaemic stroke of unknown aetiology. Copyright © 2011 Elsevier Ltd. All rights reserved.
Leys, Didier; Ringelstein, E Bernd; Kaste, Markku; Hacke, Werner
Stroke units decrease mortality, handicap and need for institutional care, but there are only sparse evidence-based data showing which components make the difference over general wards. The aim of this survey was to identify from expert opinions what should be the major components of stroke units. A questionnaire was sent to 83 European stroke experts, to ask their opinion on what should be the components of comprehensive stroke centres (CSC), primary stroke centres (PSC) and any hospital ward (AHW) admitting acute stroke patients routinely. It consisted of a list of 107 components (personnel, diagnostic procedures, monitoring, invasive treatments provided, infrastructures, protocols and procedures and their availability for 24 h a day for 7 days a week, 24/7) to be classified as irrelevant, useful but not necessary, desirable, important but not absolutely necessary, or absolutely necessary. 42 questionnaires (50.6%) were returned. Four components were excluded because of a poor level of agreement between experts. Eight components were considered as absolutely necessary by more than 75% of the experts for both CSC and PSC: multidisciplinary team, stroke-trained nurses, brain CT scan 24/7, CT priority for stroke patients, extracranial Doppler sonography, automated electrocardiographic monitoring, intravenous rt-PA protocols 24/7 and in-house emergency department. Eleven other components (in the fields of vascular surgery, neurosurgery, interventional radiology and clinical research) were considered as necessary in CSC by more than 75% of the experts. Only 8 components were considered as important but not absolutely necessary by more than 50% of the experts for AHW. The experts showed a high level of agreement about the essential components of organized acute stroke care, providing useful information to health authorities for the allocation of resources. Copyright 2007 S. Karger AG, Basel.
Bersano, Anna; Markus, Hugh Stephen; Quaglini, Silvana; Arbustini, Eloisa; Lanfranconi, Silvia; Micieli, Giuseppe; Boncoraglio, Giorgio B; Taroni, Franco; Gellera, Cinzia; Baratta, Silvia; Penco, Silvana; Mosca, Lorena; Grasso, Maurizia; Carrera, Paola; Ferrari, Maurizio; Cereda, Cristina; Grieco, Gaetano; Corti, Stefania; Ronchi, Dario; Bassi, Maria Teresa; Obici, Laura; Parati, Eugenio A; Pezzini, Alessando; De Lodovici, Maria Luisa; Verrengia, Elena P; Bono, Giorgio; Mazucchelli, Francesca; Zarcone, Davide; Calloni, Maria Vittoria; Perrone, Patrizia; Bordo, Bianca Maria; Colombo, Antonio; Padovani, Alessandro; Cavallini, Anna; Beretta, Simone; Ferrarese, Carlo; Motto, Cristina; Agostoni, Elio; Molini, Graziella; Sasanelli, Francesco; Corato, Manuel; Marcheselli, Simona; Sessa, Maria; Comi, Giancarlo; Checcarelli, Nicoletta; Guidotti, Mario; Uccellini, Davide; Capitani, Erminio; Tancredi, Lucia; Arnaboldi, Marco; Incorvaia, Barbara; Tadeo, Carlo Sebastiano; Fusi, Laura; Grampa, Giampiero; Merlini, Giampaolo; Trobia, Nadia; Comi, Giacomo Pietro; Braga, Massimiliano; Vitali, Paolo; Baron, Pierluigi; Grond-Ginsbach, Caspar; Candelise, Livia
Lombardia GENS is a multicentre prospective study aimed at diagnosing 5 single-gene disorders associated with stroke (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, Fabry disease, MELAS [mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes], hereditary cerebral amyloid angiopathy, and Marfan syndrome) by applying diagnostic algorithms specific for each clinically suspected disease We enrolled a consecutive series of patients with ischemic or hemorrhagic stroke or transient ischemic attack admitted in stroke units in the Lombardia region participating in the project. Patients were defined as probable when presenting with stroke or transient ischemic attack of unknown etiopathogenic causes, or in the presence of young age at onset, or positive familial history or of specific clinical features. Patients fulfilling diagnostic algorithms specific for each monogenic disease (suspected) were referred for genetic analysis. In 209 patients (57.4±14.7 years), the application of the disease-specific algorithm identified 227 patients with possible monogenic disease. Genetic testing identified pathogenic mutations in 7% of these cases. Familial history of stroke was the only significant specific feature that distinguished mutated patients from nonmutated ones. The presence of cerebrovascular risk factors did not exclude a genetic disease. In patients prescreened using a clinical algorithm for monogenic disorders, we identified monogenic causes of events in 7% of patients in comparison to the 1% to 5% prevalence reported in previous series. © 2016 American Heart Association, Inc.
Bustamante, Alejandro; López-Cancio, Elena; Pich, Sara; Penalba, Anna; Giralt, Dolors; García-Berrocoso, Teresa; Ferrer-Costa, Carles; Gasull, Teresa; Hernández-Pérez, María; Millan, Mónica; Rubiera, Marta; Cardona, Pedro; Cano, Luis; Quesada, Helena; Terceño, Mikel; Silva, Yolanda; Castellanos, Mar; Garces, Moisés; Reverté, Silvia; Ustrell, Xavier; Marés, Rafael; Baiges, Joan Josep; Serena, Joaquín; Rubio, Francisco; Salas, Eduardo; Dávalos, Antoni; Montaner, Joan
Stroke diagnosis could be challenging in the acute phase. We aimed to develop a blood-based diagnostic tool to differentiate between real strokes and stroke mimics and between ischemic and hemorrhagic strokes in the hyperacute phase. The Stroke-Chip was a prospective, observational, multicenter study, conducted at 6 Stroke Centers in Catalonia. Consecutive patients with suspected stroke were enrolled within the first 6 hours after symptom onset, and blood samples were drawn immediately after admission. A 21-biomarker panel selected among previous results and from the literature was measured by immunoassays. Outcomes were differentiation between real strokes and stroke mimics and between ischemic and hemorrhagic strokes. Predictive models were developed by combining biomarkers and clinical variables in logistic regression models. Accuracy was evaluated with receiver operating characteristic curves. From August 2012 to December 2013, 1308 patients were included (71.9% ischemic, 14.8% stroke mimics, and 13.3% hemorrhagic). For stroke versus stroke mimics comparison, no biomarker resulted included in the logistic regression model, but it was only integrated by clinical variables, with a predictive accuracy of 80.8%. For ischemic versus hemorrhagic strokes comparison, NT-proBNP (N-Terminal Pro-B-Type Natriuretic Peptide) >4.9 (odds ratio, 2.40; 95% confidence interval, 1.55-3.71; P 4.7 (odds ratio, 2.02; 95% confidence interval, 1.19-3.45; P =0.010), together with age, sex, blood pressure, stroke severity, atrial fibrillation, and hypertension, were included in the model. Predictive accuracy was 80.6%. The studied biomarkers were not sufficient for an accurate differential diagnosis of stroke in the hyperacute setting. Additional discovery of new biomarkers and improvement on laboratory techniques seem necessary for achieving a molecular diagnosis of stroke. © 2017 American Heart Association, Inc.
Ajaj, Waleed; Goyen, Mathias
In the last few years virtual colonography using MR imaging has shown a proceeding development regarding detection and quantification of colorectal pathologies. Dark-lumen MR colonography (MRC) has been a leading tool for the diagnosis of the entire colon and their pathologies. This review article describes some of the underlying techniques of MRC concerning data acquisition, the need for intravenously applied paramagnetic contrast agent, as well as indications, results and limitations of MRC for the detection of colorectal pathologies. In addition, new techniques to improve patient acceptance are discussed
Minni, E; Margiotta, A; Guerra, E; Marrano, N; Ricci, C; Grottola, T; Pagogna, S
The improvement of results and patients quality life is the aim of surgical technique. Mini-laparoscopic cholecystectomy brings not only to a better cosmetic results, but also to a decrease of post operative pain, analgesic use, hospital stay and an early return to normal activities. In this study, Authors report their own experience about mini-laparoscopic cholecystectomy using 5 mm and 3 mm trocar. Patients suffering from biliary sludge, microscopic lithiasis and mild or moderate gallbladder inflammation can undergo this procedure.
Fil, Ayla; Armutlu, Kadriye; Atay, Ahmet Ozgur; Kerimoglu, Ulku; Elibol, Bulent
To examine the efficiency of electrical stimulation in combination with Bobath techniques in the prevention of inferior and anterior shoulder subluxation in acute stroke patients. A prospective randomized controlled trial. Intensive care unit and inpatient clinics of neurology in a university hospital. Forty-eight patients with acute stroke, divided equally into control and study groups. Subjects in both groups were treated in accordance with the Bobath concept during the early hospitalization period. In addition to Bobath techniques, electrical stimulation was also applied to the supraspinatus muscle, mid and posterior portions of the deltoid muscle of patients in the study group. Two radiological methods were used to measure the horizontal, vertical and total asymmetry and vertical distance values of the shoulder joint. Motor functions of the arm were evaluated with the Motor Assessment Scale. The hospitalization period was 12.62 ± 2.24 days for the control group and 11.66 ± 1.88 days for the study group. Shoulder subluxation occurred in 9 (37.5%) subjects in the control group, whereas it was not observed in the study group. All shoulder joint displacement values were higher in the control group than in the study group (horizontal asymmetry P = 0.0001, vertical asymmetry P = 0.0001, total asymmetry P = 0.0001, vertical range P = 0.002). Application of electrical stimulation combined with the Bobath approach proved to be efficient in preventing inferior and anterior shoulder subluxation in the acute stages of stroke.
Söderholm, M; Almgren, P; Jood, K; Stanne, T M; Olsson, M; Ilinca, A; Lorentzen, E; Norrving, B; Engström, G; Melander, O; Jern, C; Lindgren, A
Genome-wide association (GWA) studies have identified a few risk loci for ischaemic stroke, but these variants explain only a small part of the genetic contribution to the disease. Coding variants associated with amino acid substitutions or premature termination of protein synthesis could have a large effect on disease risk. We performed an exome array analysis for ischaemic stroke. Patients with ischaemic stroke (n = 2385) and control subjects (n = 6077) from three Swedish studies were genotyped with the Illumina HumanOmniExpressExome BeadChip. Single-variant association analysis and gene-based tests were performed of exome variants with minor allele frequency of ischaemic stroke after Bonferroni correction (all P > 1.8 × 10 -6 for single-variant and >4.15 × 10 -6 for gene-based analysis). The strongest association in single-variant analysis was found for a missense variant in the DNAH11 gene (rs143362381; P = 5.01 × 10 -6 ). In gene-based tests, the strongest association was for the ZBTB20 gene (P = 7.9 × 10 -5 ). The GWA analysis showed that the sample was homogenous (median genomic inflation factor = 1.006). No genome-wide significant association with overall ischaemic stroke risk was found. However, previously reported associations for the PITX2 and ZFHX3 gene loci with cardioembolic stroke subtype were replicated (P = 7 × 10 -15 and 6 × 10 -3 ). This exome array analysis did not identify any single variants or genes reaching the pre-defined significance level for association with ischaemic stroke. Further studies on exome variants should be performed in even larger, well-defined and subtyped samples. © 2016 EAN.
Larsson, Susanna C; Wallin, Alice; Wolk, Alicja
High adherence to the Dietary Approaches to Stop Hypertension (DASH) diet is associated with lower risk of hypertension, the major risk factor for stroke. We examined whether adherence to the DASH diet is inversely associated with the incidence of stroke. The study population comprised 74 404 men and women (45-83 years of age), without stroke at baseline, from the Cohort of Swedish Men and the Swedish Mammography Cohort. Diet was assessed with a food-frequency questionnaire. A modified DASH diet score was created based on consumption of vegetables, fruits, legumes and nuts, whole grains, low-fat dairy, red meat and processed meat, and sweetened beverages. Stroke cases were identified through linkage to the Swedish National Patient and Cause of Death Registers. Relative risks and 95% confidence intervals were estimated using Cox proportional hazards regression model. During 882 727 person-years (mean, 11.9 years) of follow-up, 3896 ischemic strokes, 560 intracerebral hemorrhages, and 176 subarachnoid hemorrhages were ascertained. The modified DASH diet score was statistically significantly inversely associated with the risk of ischemic stroke (P for trend=0.002), with a multivariable relative risk of 0.86 (95% confidence interval, 0.78-0.94) for the highest versus the lowest quartile of the score. The modified DASH diet score was nonsignificantly inversely associated with intracerebral hemorrhage (corresponding relative risk=0.81; 95% confidence interval, 0.63-1.05) but was not associated with subarachnoid hemorrhage. These findings indicate that high adherence to the DASH diet is associated with a reduced risk of ischemic stroke. URL: http://www.clinicaltrials.gov. Unique identifiers: NCT01127698 and NCT01127711 for the Swedish Mammography Cohort and the Cohort of Swedish Men, respectively. © 2016 American Heart Association, Inc.
Mirkowski, Magdalena; Pereira, Shelialah; Janzen, Shannon; Mehta, Swati; Meyer, Matthew; McClure, Andrew; Speechley, Mark; Teasell, Robert
To evaluate the predictive capacity of caregiver availability on functional ability at time of discharge from inpatient rehabilitation in individuals with severe first-time stroke. A retrospective chart review was conducted of severe stroke inpatients admitted to a stroke rehabilitation unit between April 2005 and December 2009. Follow-up telephone interviews were conducted with patients to determine caregiver availability at time of discharge. Hierarchical linear regression analysis was performed to assess the predictive capacity of caregiver availability on functional ability at discharge from an inpatient rehabilitation unit after controlling for covariates. Data from 180 individuals were included in the analysis. Individuals with a caregiver had significantly higher levels of functional ability at discharge compared to those without (85.8 ± 23.6 versus 72.9 ± 20.3; p availability explained 1.3% of additional variance, with the final model explaining 41.3% of total variance for functional ability at discharge (F (5,174) = 26.21, p availability of a caregiver at time of discharge from inpatient rehabilitation is predictive of improved functional ability at discharge in individuals with severe stroke. The presence of an available caregiver positively influences the functional recovery of individuals with severe stroke and may be an important element to successful rehabilitation.
The surgical rehabilitation of patients with Graves disease involves orbital decompression and various lid and extraocular muscle procedures. We have reviewed the literature and include a presentation of our own results. The indications for orbital decompression include not only functional reasons (optic neuropathy, keratopathy, glaucoma, pain) but also aesthetic and psychosocial reasons without visual problems. Current techniques for orbital decompression (bone versus fat removal) are described and discussed. Results demonstrating a mean reduction of proptosis (4 - 6 mm) and complications (mainly diplopia in 3 - 12 %) are presented for coronal and transconjunctival approaches and compared with other methods. Current techniques of orbital decompression are effective and safe and are therefore increasingly used not only for functional but also for aesthetic or "rehabilitative" indications.
Viña Soria, L; Martín Iglesias, L; López Amor, L; Astola Hidalgo, I; Rodríguez García, R; Forcelledo Espina, L; Gonzalo Guerra, J A; de Cima Iglesias, S; Murias Quintana, E; Vega Valdés, P; Calleja Puerta, S; Escudero Augusto, D
To study the results and complications of endovascular treatment (EVT) in acute ischemic stroke patients admitted to Intensive Care Unit (ICU). To analyse the possible factors related to mortality and level of disability at ICU discharge and one year after stroke. Observational prospective study. Mixed ICU. Third level hospital. Sixty adult patients. Consecutive sample. None. Epidemiological data, time from symptom onset to EVT, angiographic result, length of stay, days on mechanical ventilation, neurological complications, National Institutes of Health Stroke Scale (NIHSS) at ICU admission and discharge, modified Rankin scale score (mRS) at one year. Mean age 68,90±8,84years. Median time from symptom onset to EVT: 180minutes. Median NIHSS at admission: 17,5; at discharge: 3. Distal flow was achieved in 90% of cases. Median ICU stay: 3 days. Mechanical ventilation: 81,7.%. Functional independence (mRS≤2) 50% at one year. Deaths: 22 (36,6%) of which 8 (13,3%) died during UCI stay and the rest during the first year. The factors relating to a worse functional outcome were symptomatic hemorrhage transformation, lack of recanalization and complications during EVT. The factors relating to mortality were symptomatic hemorrhage and hydrocephalus. Distal flow was achieve in most cases with a low complication rate. Half of the patients presented functional independence one year after the stroke. Copyright © 2017 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.
Wiener, R Constance
Strokes are common events of significant morbidity and mortality. Poor oral conditions may share or exacerbate pathways that lead to stroke. This study was a cross-sectional study of 410,939 participants from the 2010 Behavioral Risk Factor Surveillance System. Stroke was defined as the participant's response (yes/no) to the survey's question, "Has a doctor, nurse or other health professional ever told you that you had a stroke?" The definition for tooth loss was based upon participant's response to the survey's question, "How many of your permanent teeth have been removed because of tooth decay or gum disease?" Descriptive, Chi Square and logistic regression analyses were conducted. Other variables that are known etiologic factors were also included in the analysis. The participants with increasing numbers of teeth lost had increasing adjusted odds ratios for stroke independent of the other factors. In adjusted logistic regression analysis, the participants who had 1 to 5 missing teeth had an adjusted odds ratio (AOR) of 1.29 (95% Confidence Interval (CI): 1.17, 1.42), participants who had 6 or more, but not all missing teeth had an AOR of 1.68 (95% CI: 1.50, 1.88), and participants who were edentulous had an AOR of 1.86 (95% CI: 1.63, 2.11). Evidence from this cross-sectional study indicates that tooth loss had a potential, although weak positive association as an independent factor in multivariable analysis with stroke. Copyright © 2014 The American Dental Hygienists’ Association.
Cohen, H; Rossignol, M
Stroke is a rare event during pregnancy (10/100,000) and can be ischemic (24%), hemorrhagic (74%) or both (2%). Pregnancy probably increases the risk even if it is discussed for arteriovenous malformation (AVM), aneurismal subarachnoid hemorrhage (SAH) and cavernomas. Between 2010 and 2012, 31 maternal deaths were associated with stroke. In 22 cases, stroke was the direct cause of death giving a maternal mortality ratio of 0,9/100,000 witch is not different from the former report (2007-2009). There were 2 cerebral thrombophlebitis, 2 ischemic strokes and 18 hemorrhagic strokes (4 SAH, 2 AVM). These deaths occurred during ongoing pregnancy in 5 cases (25%), after miscarriage in 1 case (5%) and in the post-partum period in 14 cases (70%). In this last situation, stroke occurred before delivery in 4 cases and during the post-partum period in 9 cases (1 to 9 days) (1 unknown). There were 7 vaginal deliveries (50%) and 6 emergency cesarean sections (43%) (1 unknown). Most of those deaths were considered to be unavoidable (13/17, 76%). Four deaths were considered by the experts as being possibly avoidable (delay diagnosis, diagnostic error, inadequate treatment, lake of interruption of the pregnancy). Analyzing those deaths remind that any sudden, severe and unusual headache must be explored and that pregnancy does not contraindicate any of the diagnostic examinations (TDM, angio-TDM, MRI) or invasive treatments (surgery, arterio-embolization, fibrinolysis) necessary for its management. Furthermore, the diagnosis of postdural puncture headache should not be establishedwithout imaging when the symptomatology is not absolutely typical. Copyright © 2017 Elsevier Masson SAS. All rights reserved.
Roosink, Meyke; Renzenbrink, Gerbert J; Buitenweg, Jan R; Van Dongen, Robert T; Geurts, Alexander C; IJzerman, Maarten J
To identify factors associated with persistent poststroke shoulder pain (pPSSP) in the first 6 months after stroke. Prospective inception cohort study. Stroke units of 2 teaching hospitals. Patients (N=31) with a clinical diagnosis of stroke. Not applicable. The development of pPSSP within the first 6 months after stroke. Clinical assessment of motor, somatosensory, cognitive, emotional, and autonomic functions, undertaken within 2 weeks (t0), at 3 months (t1), and at 6 months (t2) after stroke. Patients with pPSSP (n=9) were compared with patients without pPSSP (n=22). Bivariate logistic regression analyses showed that pPSSP was significantly associated with impaired voluntary motor control (t0, t1, t2), diminished proprioception (t0, t1), tactile extinction (t0), abnormal sensation (t1, t2), spasticity of the elbow flexor muscles (t1, t2), restricted range of motion (ROM) for both shoulder abduction (t2) and shoulder external rotation (t1, t2), trophic changes (t1), and type 2 diabetes mellitus (t0). These findings suggest a multifactorial etiology of pPSSP. The association of pPSSP with restricted, passive, pain-free ROM and signs indicative of somatosensory sensitization may implicate a vicious cycle of repetitive (micro)trauma that can establish itself rapidly after stroke. Intervention should therefore be focused on maintaining and restoring joint ROM as well as preventing injury and somatosensory sensitization. In this perspective, strategies that aim to intervene simultaneously at various levels of function can be expected to be more effective than treatment directed at merely 1 level. Copyright © 2011 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
Jacova, Claudia; Pearce, Lesly A; Roldan, Ana M; Arauz, Antonio; Tapia, Jorge; Costello, Raymond; McClure, Leslie A; Hart, Robert G; Benavente, Oscar R
Cognitive impairment is frequent in lacunar stroke patients. The prevalence and pattern among Spanish-speaking patients are unknown and have not been compared across regions or with English-speaking patients. The aim of this study was to characterize cognitive impairment in Spanish-speaking patients and compare it with English-speaking patients. The baseline neuropsychological test performance and the prevalence of mild cognitive impairment, defined as a z-score ≤ -1.5 on memory and/or non-memory tests, were evaluated in Spanish-speaking patients in the Secondary Prevention of Small Subcortical Strokes trial. Out of 3020 participants, 1177 were Spanish-speaking patients residing in Latin America (n = 693), the United States (n = 121), and Spain (n = 363). Low education (zero- to eight-years) was frequent in Spanish-speaking patients (49-57%). Latin American Spanish-speaking patients had frequent post-stroke upper extremity motor impairment (83%). Compared with English-speaking patients, all Spanish-speaking patient groups had smaller memory deficits and larger non-memory/motor deficits, with Latin American Spanish-speaking patients showing the largest deficits median z-score -1.3 to -0.6 non-memory tests; ≤5.0 for Grooved Pegboard; -0.7 to -0.3 for memory tests). The prevalence of mild cognitive impairment was high and comparable with English-speaking patients in the United States and Latin American Spanish-speaking patients but not the Spanish group: English-speaking patients = 47%, Latin American Spanish-speaking patients = 51%, US Spanish-speaking patients = 40%, Spanish Spanish-speaking patients = 29%, with >50% characterized as non-amnestic in Spanish-speaking patient groups. Older age [odds ratio per 10 years = 1.52, confidence interval = 1.35-1.71), lower education (odds ratio 0-4 years = 1.23, confidence interval = 0.90-1.67), being a Latin American resident (odds ratio = 1.31, confidence interval = 0
Full Text Available Riccardo Proietti,1,2 Jacqueline Joza,1 Andrea Arensi,2 Michael Levi,1 Vincenzo Russo,3 Apostolos Tzikas,4 Paolo Danna,2 Antonio Sagone,2 Maurizio Viecca,2 Vidal Essebag1,5 1McGill University Health Center, Montreal, QC, Canada; 2Cardiology Department, Luigi Sacco Hospital, Milano, Italy; 3Cardiology Department, Second University of Naples, Monaldi Hospital, Naples, Italy; 4Interbalkan European Medical Centre, Thessaloniki, Greece; 5Hôpital Sacré-Coeur de Montréal, Montreal, QC, Canada Abstract: Atrial fibrillation (AF, the most common cardiac arrhythmia, confers a 5-fold risk of stroke that increases to 17-fold when associated with mitral stenosis. At this time, the most effective long-term solution to protect patients from stroke and thromboembolism is oral anticoagulation, either with vitamin K antagonists (VKAs or a novel oral anticoagulant (NOAC. Despite the significant benefits they confer, both VKAs and NOACs are underused because of their increased potential for bleeding, and VKAs are underused because of their narrow therapeutic range, need for regular international normalized ratio checks, and interactions with food or medications. In patients with nonvalvular AF, approximately 90% of strokes originate from the left atrial appendage (LAA; in patients with rheumatic mitral valve disease, many patients (60% have strokes that originate from the left atrium itself. Surgical LAA amputation or closure, although widely used to reduce stroke risk in association with cardiac surgery, is not currently performed as a stand-alone operation for stroke risk reduction because of its invasiveness. Percutaneous LAA closure, as an alternative to anticoagulation, has been increasingly used during the last decade in an effort to reduce stroke risk in nonvalvular AF. Several devices have been introduced during this time, of which one has demonstrated noninferiority compared with warfarin in a randomized controlled trial. This review describes the
S. V. Kotov
Full Text Available Background: Efficacy of physical exercise and movement imagination for restoration of motor dysfunction after a stroke is seen as proven. However, the use of movement imagination is complicated by impossibility of objective and subjective control over the exercise, as well as by the absence of their motor support. The brain-computer interface based on electroencephalography is a technique that enables a feedback during movement imagination.Materials and methods: We assessed 10 patients (6 men and 4 women aged from 30 to 66 years (mean age, 47 ± 7.7 years with an ischemic (n = 9 and hemorrhagic (n = 1 stroke during the last 2 months to 4 years. Online recognition of movement imagination was done by a classifier with a brain computer interface. An exo-skeleton supported passive movements in a paretic hand managed by the brain-computer interface. During 2 weeks the patients had 10 sessions of 45–90 minute duration each. For control, we used data from 5 stroke patients who, in addition to their standard treatment, underwent an imitation of rehabilitation procedures without movement imagination and feedback. To assess efficacy of treatment, we used a modified Ashworth scale, Fugl-Meyer scale, test for evaluation of hand functions ARAT, British scale for assessment of muscle force MRC-SS. Level of everyday activity and working ability was measured with a modified Rankin scale and Bartel index. Cognitive functions were assessed with Schulte tables.Results: Online recognition of movement imagination according to desynchronization of μ rhythm was registered in 50–75% of patients. All patients reported a subjective improvement of motor functions and working ability. Positive results for at least one parameter were observed in all patients; however, there were no significant difference between the parameters before and after rehabilitation procedures, excluding cognitive functions (degree of warming-up, p < 0.02.Conclusion: In post stroke patients
Association of Osteopontin, Neopterin, and Myeloperoxidase With Stroke Risk in Patients With Prior Stroke or Transient Ischemic Attacks: Results of an Analysis of 13 Biomarkers From the Stroke Prevention by Aggressive Reduction in Cholesterol Levels Trial.
Ganz, Peter; Amarenco, Pierre; Goldstein, Larry B; Sillesen, Henrik; Bao, Weihang; Preston, Gregory M; Welch, K Michael A
Established risk factors do not fully identify patients at risk for recurrent stroke. The SPARCL trial (Stroke Prevention by Aggressive Reduction in Cholesterol Levels) evaluated the effect of atorvastatin on stroke risk in patients with a recent stroke or transient ischemic attack and no known coronary heart disease. This analysis explored the relationships between 13 plasma biomarkers assessed at trial enrollment and the occurrence of outcome strokes. We conducted a case-cohort study of 2176 participants; 562 had outcome strokes and 1614 were selected randomly from those without outcome strokes. Time to stroke was evaluated by Cox proportional hazards models. There was no association between time to stroke and lipoprotein-associated phospholipase A 2 , monocyte chemoattractant protein-1, resistin, matrix metalloproteinase-9, N-terminal fragment of pro-B-type natriuretic peptide, soluble vascular cell adhesion molecule-1, soluble intercellular adhesion molecule-1, or soluble CD40 ligand. In adjusted analyses, osteopontin (hazard ratio per SD change, 1.362; P strokes. After adjustment for the Stroke Prognostic Instrument-II and treatment, osteopontin, neopterin, and myeloperoxidase remained independently associated with outcome strokes. The addition of these 3 biomarkers to Stroke Prognostic Instrument-II increased the area under the receiver operating characteristic curve by 0.023 ( P =0.015) and yielded a continuous net reclassification improvement (29.1%; P stroke and improved risk classification when added to a clinical risk algorithm. URL: http://www.clinicaltrials.gov. Unique Identifier: NCT00147602. © 2017 American Heart Association, Inc.
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.
Jayes, Mark J; Palmer, Rebecca L
The process of obtaining informed consent from people with communication difficulties is challenging. An online survey was conducted to explore the experiences of stroke research staff in seeking consent from this population. To identify how stroke research staff seek consent from people with communication difficulties, potential barriers to effective practice, and ways to improve practice. All research staff working for the National Institute for Health Research Stroke Research Network in England were invited to complete an online questionnaire. Data were collected anonymously between March and June 2013. Quantitative data were analyzed using descriptive statistics, and qualitative data were coded using thematic analysis. Seventy-five research staff responded, corresponding to a response rate of 10%. There were 97% who had sought consent from people with communication difficulties and 52% did this regularly; 65% had received training in consenting this population. Most staff were aware of appropriate methods for supporting communication needs, but only 18% regularly used accessible information and 35% regularly used augmentative communication techniques. Lack of specific training and lack of access to ethically approved materials were suggested barriers to using these methods. Respondents indicated that people with impaired communication may be excluded from the consent process because they are not eligible for inclusion in studies or because assent is obtained from third parties. For research staff to work more effectively with this population, study protocols need to be more inclusive of people with communication difficulties, and staff need better access to ethically approved, accessible communication resources and appropriate training.
Full Text Available Background and purposeStroke has been scarcely studied in Latin America (LA. The Mexican Institute of Neurology Stroke Registry was established in 1990 as a prospective computer-based database to register data obtained from patients admitted with stroke. Using this data, we attempted to define the profile of risk factors and outcomes.MethodsThe demographic data, stroke description, ancillary tests, vascular risk factors, and modified Rankin scale (mRs were registered. Ischemic stroke subtyping was based on the Trial of Org 10,172 of the Acute Stroke Treatment classification. We followed-up patients using multiple overlapping methods. Primary outcomes included mRs, recurrence, and death at 30 days and at the end of follow-up.ResultsWe included 4,481 patients with a median follow-up of 27 months, (17,281 person-years follow-up. The mean age was 52.8 ± 18 years. There were 2,229 males (50% included in the study. CI was present in 64.9%, intracerebral hemorrhage (ICH in 25.6%, and cerebral venous thrombosis (CVT in 6.3%. Hypertension was the major risk factor (46.5%. The most common cause of CI was atherosclerosis (27%. ICH was mainly hypertensive (58%, and 60% of CVT were puerperal. Overall, the mortality rate was 24.5%. The recurrence rate was 16.9%. Poor outcome (mRs ≥ 3 was found in 56.2% of patients. The best outcomes were observed in CVT patients (74.5% mRs ≤ 2, whereas 72.1% ICH patients had mRs ≥3.ConclusionThis is one of the largest hospital-based registries in LA and shows significant differences with other previously published registries, including a younger age, relatively less hypertension, and larger proportion of CVT. Poor functional outcome was common. This study adds to the understanding of geographic differences in stroke characteristics and outcomes.
Arts, S.E.J.; Francke, A.L.; Hutten, J.B.F.
Liaison nurses, employed by a home care organization, were introduced into two Dutch hospitals to improve discharge planning for stroke patients. The main aim of the study presented was to gain insight into the effects of liaison nursing on the quality of the discharge process and related
Mocco, J.; Fargen, Kyle M.; Goyal, Mayank; Levy, Elad I.; Mitchell, Peter J.; Campbell, Bruce C. V.; Majoie, Charles B. L. M.; Dippel, Diederik W. J.; Khatri, Pooja; Hill, Michael D.; Saver, Jeffery L.
The overwhelming benefit demonstrated in the four recent randomized trials comparing intra-arterial therapies to medical management alone will have a transformative effect on the emergent management of strokes throughout the world. New generation neurothrombectomy devices were critical to trial
Read, A L
I describe a framework for the presentation of search results which is motivated by frequentist statistics. The most well-known use of this framework is for the combined search for the Higgs boson at LEP. A toy neutrino oscillations experiment is used to illustrate the rich information available in the framework for exclusion and discovery. I argue that the so-called CL/sub s/ technique for setting limits is appropriate for determining exclusion intervals while the determination of confidence intervals advocated by Feldman and Cousins' method is more appropriate for treating established signals, i.e. going beyond discovery to measurement. (17 refs).
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)
Full Text Available Background: Avaialable minimal invasive arthro/endoscopic techniques are not compatible with 30 degree arthroscope which orthopedic surgeons uses in knee and shoulder arthroscopy. Minimally invasive “Arthrospine assisted percutaneous technique for lumbar discectomy” is an attempt to allow standard familiar microsurgical discectomy and decompression to be performed using 30° arthroscope used in knee and shoulder arthroscopy with conventional micro discectomy instruments. Materials and Methods: 150 patients suffering from lumbar disc herniations were operated between January 2004 and December 2012 by indiginously designed Arthrospine system and were evaluated retrospectively. In lumbar discectomy group, there were 85 males and 65 females aged between 18 and 72 years (mean, 38.4 years. The delay between onset of symptoms to surgery was between 3 months to 7 years. Levels operated upon included L1-L2 (n = 3, L2-L3 (n = 2, L3-L4 (n = 8, L4-L5 (n = 90, and L5-S1 (n = 47. Ninety patients had radiculopathy on right side and 60 on left side. There were 22 central, 88 paracentral, 12 contained, 3 extraforaminal, and 25 sequestrated herniations. Standard protocol of preoperative blood tests, x-ray LS Spine and pre operative MRI and pre anaesthetic evaluation for anaesthesia was done in all cases. Technique comprised localization of symptomatic level followed by percutaneous dilatation and insertion of a newly devised arthrospine system devise over a dilator through a 15 mm skin and fascial incision. Arthro/endoscopic discectomy was then carried out by 30° arthroscope and conventional disc surgery instruments. Results: Based on modified Macnab's criteria, of 150 patients operated for lumbar discectomy, 136 (90% patients had excellent to good, 12 (8% had fair, and 2 patients (1.3% had poor results. The complications observed were discitis in 3 patients (2%, dural tear in 4 patients (2.6%, and nerve root injury in 2 patients (1.3%. About 90% patients
Mitochondrial disorders result from dysfunctional mitochondria that are unable to generate sufficient energy to meet the needs of various organs. Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome is one of the most frequent maternally inherited mitochondrial...
Sun, Runjie; Tian, Liang; Fang, Xiaoli; Du, Xiaozheng; Zhu, Bowen; Song, Zhongyang; Xu, Xuan; Qin, Xiaoguang
To compare the difference in the clinical efficacy on post-stroke upper limb spasmodic hemiplegia between the combined therapy of jingou diaoyu needling technique and Bobath technology and simple Bobath technology. Sixty patients were randomized into an observation group and a control group, 30 cases in each one. The usual medication of neurological internal medicine was used in the two groups. In the control group, Bobath facilitation technology was applied to the rehabilitation training. In the observation group, on the basis of the treatment as the control group, jingou diaoyu needling technique was used to stimulate Zhongfu (LU 1), Tianfu (LU 3), Chize (LU 5), Quchi (LI 11), Jianshi (PC 5) and Daling (PC 7). The treatment was given once a day; 5 treatments made one session and totally 4-week treatment was required in the two groups. The modified Ashworth scale, the modified Fugle-Meyer assessment (FMA) and the Barthel index (BI) were adopted to evaluate the muscular tension, the upper limb motor function and the activities of daily living (ADL) before and after treatment in the two groups. The clinical efficacy was compared between the two groups. Compared with those before treatment, the modified Ashworth scale, Fugl-Meyer score and BI score were all improved after treatment in the two groups (all P Bobath therapy achieve the superior efficacy on post-stroke upper limb spasmodic hemiplegia as compared with the simple application Bobath therapy. This combined treatment effectively relieve spasmodic state and improve the upper limb motor function and the activities of daily living.
Ethan A. Benardete
Full Text Available Background: The requirements for a comprehensive stroke center (CSC include the capability to perform endovascular stroke therapy (EST. EST is a complex process requiring early identification of appropriate patients and effective delivery of intervention. In order to provide prompt intervention for stroke, CSCs have been established away from large academic centers in community-based hospitals. We hypothesized that quantifiable improvements would occur during the first 2 years of a community-based CSC as the processes and personnel evolved. We report the results over time of EST at a new community-based CSC. Methods: We have retrospectively analyzed demographic data and outcome metrics of EST from the initiation phase of a new community-based CSC. Data was divided into year 1 and year 2. Statistical analysis (Student's t test and Fisher's exact test was performed to compare the patient population and outcomes across the two time periods. Outcome variables included the thrombolysis in cerebral infarction (TICI score, a change in the NIH stroke scale score and the modified Rankin Scale (mRS score. Analysis of variance (ANOVA was used to statistically analyze the relationship between population variables and outcome. Computed tomography (CT angiography and CT perfusion analysis were used to select patients for EST. Approximately half of the patients undergoing EST were excluded from receiving intravenous recombinant tissue plasminogen activator (IV rt-PA by standard criteria, while the other half showed no sign of improvement following 1 h of IV rt-PA treatment. Mechanical thrombolysis with a stentriever was performed in the majority of cases with or without intra-arterial medication. The majority of treated occlusions were in the middle cerebral artery. Results: A total of 18 patients underwent EST during year 1 and year 2. A statistically significant increase in good outcomes (mRS score ≤2 at discharge was seen from year 1 to year 2 (p = 0
Fasola, Elena; Gazzola, Riccardo
External female genitalia lose elasticity and volume with age. In the literature several techniques address the redundancy of the labia minora, but only few reports describe the augmentation of labia majora with fat grafting. At present, no studies describe the augmentation of the labia majora with hyaluronic acid. This study aims to present our technique of infiltration of hyaluronic acid filler, analyzing effectiveness, patient satisfaction, and complications. We retrospectively analyzed 54 patients affected by hypotrophy of the labia majora; they were treated with hyaluronic acid filler between November 2010 and December 2014. The Global Aesthetic Improvement Scale (GAIS) filled out by the doctor and the patients was used to evaluate the results 12 months after the infiltration. Complications were recorded. A total of 31 patients affected by mild to moderate labia majora hypotrophy were treated with 19 mg/mL HA filler; 23 patients affected by severe labia majora hypotrophy were treated with 21 mg/mL HA filler. Among the first group of patients, one underwent a second infiltration 6 months later with 19 mg/mL HA filler (maximum 1 mL). A significant improvement (P labia majora is able to provide a significant rejuvenation with a simple outpatient procedure. We achieved significant improvements with one infiltration in all cases. The treatment is repeatable, has virtually no complications and it is reversible. 4 Therapeutic. © 2016 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: email@example.com.
Lyden, Patrick; Hemmen, Thomas; Grotta, James; Rapp, Karen; Ernstrom, Karin; Rzesiewicz, Teresa; Parker, Stephanie; Concha, Mauricio; Hussain, Syed; Agarwal, Sachin; Meyer, Brett; Jurf, Julie; Altafullah, Irfan; Raman, Rema
Therapeutic hypothermia is a potent neuroprotectant approved for cerebral protection after neonatal hypoxia-ischemia and cardiac arrest. Therapeutic hypothermia for acute ischemic stroke is safe and feasible in pilot trials. We designed a study protocol to provide safer, faster therapeutic hypothermia in stroke patients. Safety procedures and 4°C saline infusions for faster cooling were added to the ICTuS trial (Intravascular Cooling in the Treatment of Stroke) protocol. A femoral venous intravascular cooling catheter after intravenous recombinant tissue-type plasminogen activator in eligible patients provided 24 hours cooling followed by a 12-hour rewarm. Serial safety assessments and imaging were performed. The primary end point was 3-month modified Rankin score 0,1. Of the intended 1600 subjects, 120 were enrolled before the study was stopped. Randomly, 63 were to receive hypothermia plus antishivering treatment and 57 normothermia. Compared with previous studies, cooling rates were improved with a cold saline bolus, without fluid overload. The intention-to-treat primary outcome of 90-day modified Rankin Score 0,1 occurred in 33% hypothermia and 38% normothermia subjects, odds ratio (95% confidence interval) of 0.81 (0.36-1.85). Serious adverse events occurred equally. Mortality was 15.9% hypothermia and 8.8% normothermia subjects, odds ratio (95% confidence interval) of 1.95 (0.56-7.79). Pneumonia occurred in 19% hypothermia versus 10.5% in normothermia subjects, odds ratio (95% confidence interval) of 1.99 (0.63-6.98). Intravascular therapeutic hypothermia was confirmed to be safe and feasible in recombinant tissue-type plasminogen activator-treated acute ischemic stroke patients. Protocol changes designed to reduce pneumonia risk appeared to fail, although the sample is small. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01123161. © 2016 American Heart Association, Inc.
León-Jiménez, C; Ruiz-Sandoval, J L; Chiquete, E; Vega-Arroyo, M; Arauz, A; Murillo-Bonilla, L M; Ochoa-Guzmán, A; Carrillo-Loza, K; Ramos-Moreno, A; Barinagarrementeria, F; Cantú-Brito, C
Information regarding hospital arrival times after acute ischaemic stroke (AIS) has mainly been gathered from countries with specialised stroke units. Little data from emerging nations is available. We aim to identify factors associated with achieving hospital arrival times of less than 1, 3, and 6 hours, and analyse how arrival times are related to functional outcomes after AIS. We analysed data from patients with AIS included in the PREMIER study (Primer Registro Mexicano de Isquemia Cerebral) which defined time from symptom onset to hospital arrival. The functional prognosis at 30 days and at 3, 6, and 12 months was evaluated using the modified Rankin Scale. Among 1096 patients with AIS, 61 (6%) arrived in <1 hour, 250 (23%) in <3 hours, and 464 (42%) in <6 hours. The factors associated with very early (<1 hour) arrival were family history of ischemic heart disease and personal history of migraines; in <3 hours: age 40-69 years, family history of hypertension, personal history of dyslipidaemia and ischaemic heart disease, and care in a private hospital; in <6 hours: migraine, previous stroke, ischaemic heart disease, care in a private hospital, and family history of hypertension. Delayed hospital arrival was associated with lacunar stroke and alcoholism. Only 2.4% of patients underwent thrombolysis. Regardless of whether or not thrombolysis was performed, arrival time in <3 hours was associated with lower mortality at 3 and 6 months, and with fewer in-hospital complications. A high percentage of patients had short hospital arrival times; however, less than 3% underwent thrombolysis. Although many factors were associated with early hospital arrival, it is a priority to identify in-hospital barriers to performing thrombolysis. Copyright © 2013 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.
Greenway, Anthea; Ware, Russell E; Thornburg, Courtney D
Children with sickle cell anemia (SCA) and a primary overt stroke are at high risk of recurrent (secondary) stroke. Chronic transfusion therapy dramatically reduces but does not eliminate this high risk, and inevitably results in transfusion-related hemosiderosis. We previously reported the use of hydroxyurea/phlebotomy as an alternative to transfusions to reduce the risk of secondary stroke and improve management of iron overload in 35 children with SCA. To report long-term results, we retrospectively reviewed clinical and laboratory data through October 2008. With a median of 5.6 years and total of 219 patient-years of follow-up, 10 of 35 patients (29%) had recurrent stroke after switching to hydroxyurea; seven were previously reported and three new strokes occurred during extended follow-up. The overall secondary stroke event rate was 4.6 per 100 patient-years. Children on hydroxyurea received serial phlebotomy and had lower mean serum ferritin values than children on transfusions (591 ng/mL vs. 3410 ng/mL, P = 0.02). In this cohort, long-term hydroxyurea treatment reduced but did not eliminate the risk of stroke recurrence and, uniquely, allowed phlebotomy to reduce iron overload. Long-term assessments of this therapy should evaluate risk factors for secondary stroke and assessments of hemosiderosis, neurocognitive outcome, and health-related quality of life. Copyright © 2011 Wiley-Liss, Inc.
Putnam, T. W.; Burcham, F. W.
Operational techniques for reducing approach noise from business jet aircraft were evaluated in flight by measuring the noise generated by five such aircraft during modified approaches. Approaches with 4-deg glide slopes were approximately 4.0 EPNdB quieter than approaches with standard 3-deg glide slopes. Noise reductions for low-drag 3-deg approaches varied widely among the airplanes tested; the fleet-weighted reduction was 8.5 EPNdB. Two-segment approaches resulted in noise reductions of 7.0 EPNdB to 8.5 EPNdB 3 nautical miles and 5 nautical miles from touchdown. Pilot workload increased progressively for the 4-deg, low-drag 3-deg, and two-segment approach.
Ziegler, V; Rashid, A; Müller-Gorchs, M; Kippnich, U; Hiermann, E; Kögerl, C; Holtmann, C; Siebler, M; Griewing, B
Telemedical networks that apply innovative mobile information technologies (IT) are an innovative approach to improve stroke care in community settings. Within the German Stroke Angel initiative and the research project PerCoMed (Pervasive Computing in Medical Care, funded by the Federal Ministry of Education and Research, http://www.percomed.de) the effects of such a solution were assessed by an interdisciplinary research approach. The main goal of the team of researchers and practitioners was to provide clear evidence of improvements in intersectional processes of the stroke chain survival, namely in the acute stroke processes between prehospital rescue services and hospital stroke units. Between October 2005 and October 2007 the paramedical staff of five rescue service transporters in a rural area of northern Bavaria was included in a network with the stroke unit of the Neurological Clinic Bad Neustadt. Telemedical support by the Stroke Angel computing system - a software running on a personal digital assistant (PDA) to transmit patient data from the rescue team to the hospital during patient transporting time - was established. As procedural guidance, the Stroke Angel system suggests a predefined path through the necessary emergency procedures according to the structure of the mandatory protocol and the implemented Los Angeles Prehospital Stroke Screen (LAPSS). In the empirical study the authors obtained a complete data set of 226 consecutively admitted patients for analysis in Bad Neustadt and LAPSS data of 217 patients from a second scenario in Düsseldorf. Medical, economic and technical analyses were applied. The technological robustness of the Stroke Angel system could be proven and information entered was transmitted fully and correctly. Concerning medical research questions, for both scenario locations LAPSS with a sensitivity of 68.3% and a specificity of 85.1% has to be deemed insufficient. Hence, alternative algorithms will have to be used in the next
Cogollor, José M; Rojo-Lacal, Javier; Hermsdörfer, Joachim; Ferre, Manuel; Arredondo Waldmeyer, Maria Teresa; Giachritsis, Christos; Armstrong, Alan; Breñosa Martinez, Jose Manuel; Bautista Loza, Doris Anabelle; Sebastián, José María
Neurological patients after stroke usually present cognitive deficits that cause dependencies in their daily living. These deficits mainly affect the performance of some of their daily activities. For that reason, stroke patients need long-term processes for their cognitive rehabilitation. Considering that classical techniques are focused on acting as guides and are dependent on help from therapists, significant efforts are being made to improve current methodologies and to use eHealth and Web-based architectures to implement information and communication technology (ICT) systems that achieve reliable, personalized, and home-based platforms to increase efficiency and level of attractiveness for patients and carers. The goal of this work was to provide an overview of the practices implemented for the assessment of stroke patients and cognitive rehabilitation. This study puts together traditional methods and the most recent personalized platforms based on ICT technologies and Internet of Things. A literature review has been distributed to a multidisciplinary team of researchers from engineering, psychology, and sport science fields. The systematic review has been focused on published scientific research, other European projects, and the most current innovative large-scale initiatives in the area. A total of 3469 results were retrieved from Web of Science, 284 studies from Journal of Medical Internet Research, and 15 European research projects from Community Research and Development Information Service from the last 15 years were reviewed for classification and selection regarding their relevance. A total of 7 relevant studies on the screening of stroke patients have been presented with 6 additional methods for the analysis of kinematics and 9 studies on the execution of goal-oriented activities. Meanwhile, the classical methods to provide cognitive rehabilitation have been classified in the 5 main techniques implemented. Finally, the review has been finalized with
Full Text Available Ofer N Gofrit,1 Amos Shapiro,1 Ran Katz,1 Mordechai Duvdevani,1 Vladimir Yutkin,1 Ezekiel H Landau,1 Kevin C Zorn,2 Guy Hidas,1 Dov Pode1 1Department of Urology, Hadassah Hebrew University Hospital, Jerusalem, Israel; 2Department of Surgery, Section of Urology, Montreal, Canada Background: Partial cystectomy provides oncological results comparable with those of radical cystectomy in selected patients with invasive bladder cancer without the morbidity associated with radical cystectomy and urinary diversion. We describe a novel technique of partial cystectomy that allows accurate identification of tumor margins while minimizing damage to the rest of the bladder. Methods: During the study period, 30 patients underwent partial cystectomy for invasive high-grade cancer. In 19 patients, the traditional method of tumor identification was used, ie, identifying the tumor by palpation and cystotomy. In eleven patients, after mobilization of the bladder, flexible cystoscopy was done and the light of the cystoscope was pointed toward one edge of the planned resected ellipse around the tumor, thus avoiding cystotomy. Results: Patients who underwent partial cystectomy using the novel method were similar in all characteristics to patients operated on using the traditional technique except for tumor diameter which was significantly larger in patients operated on using the novel method (4.3±1.5 cm versus 3.11±1.18 cm, P=0.032. Complications were rare in both types of surgery. The 5-year local recurrence-free survival was marginally superior using the novel method (0.8 versus 0.426, P=0.088. Overall, disease-specific and disease-free survival rates were similar. Conclusion: The use of a flexible cystoscope during partial cystectomy is a simple, low-cost maneuver that assists in planning the bladder incision and minimizes injury to the remaining bladder by avoiding the midline cystotomy. Initial oncological results show a trend toward a lower rate of local
Lyden, Patrick; Hemmen, Thomas; Grotta, James; Rapp, Karen; Ernstrom, Karin; Rzesiewicz, Teresa; Parker, Stephanie; Concha, Mauricio; Syed, Hussain; Agarwal, Sachin; Meyer, Brett; Jurf, Julie; Altafullah, Irfan; Raman, Rema
Background and Purpose Therapeutic hypothermia (TH) is a potent neuroprotectant approved for cerebral protection after neonatal hypoxia-ischemia and cardiac arrest. TH for acute ischemic stroke is safe and feasible in pilot trials. We designed a study protocol to provide safer, faster TH in stroke patients. Methods Safety procedures and 4°C saline infusions for faster cooling were added to the Intravascular Cooling Treatment in Acute Stroke (ICTuS) trial protocol. A femoral venous intravascular cooling catheter following intravenous rt-PA in eligible patients provided 24 hours cooling followed by a 12 hour re-warm. Serial safety assessments and imaging were performed. The primary endpoint was 3-month modified Rankin score 0,1. Results Of the intended 1600 subjects, 120 were enrolled before the study was stopped. Randomly, 63 were to receive hypothermia (HY) plus anti-shivering treatment and 57 normothermia (NT). Compared to prior studies, cooling rates were improved with a cold saline bolus, without fluid overload. The intention-to-treat primary outcome of 90-day mRS 0,1 occurred in 33% HY and 38% NT subjects, OR (95% CL) of 0.81 (0.36, 1.85). Serious adverse events occurred equally. Mortality was 15.9% HY and 8.8% NT subjects, OR (95% CL) of 1.95 (0.56, 7.79). Pneumonia occurred in 19% HY vs. 10.5% in NT subjects, OR (95% CL) of 1.99 (0.63, 6.98). Conclusion Intravascular TH was confirmed to be safe and feasible in rt-PA treated acute ischemic stroke patients. Protocol changes designed to reduce pneumonia risk appeared to fail, although the sample is small. Clinical trial registration clinicaltrials.gov NCT 01123161. PMID:27834742
Struffert, Tobias; Engelhorn, Tobias; Richter, Gregor; Doerfler, Arnd; Koehrmann, Martin; Nowe, Tim; Schellinger, Peter D.; Schwab, Stefan
The Penumbra Stroke System (PSS) was cleared for use in patients with ischemic stroke by the FDA in January 2008. We describe our experience of using this new system in acute large vessel occlusive disease following thrombolysis. Fifteen consecutive patients (mean age 60 years) suffering from acute ischemic stroke were treated with the PSS after intravenous or intra-arterial standard treatment with tissue plasminogen activator (n = 14) or ReoPro (n = 1). All patients presented with TIMI 3 before use of the PSS. Carotid stenting (n = 3) and intracranial balloon angioplasty or stenting (n = 2) were performed if indicated. Neurological evaluation was performed using the NIHSS score and the mRS score. Initial median NIHSS score in 12 patients with occlusions in the anterior circulation was 15; three patients with basilar artery occlusion presented with coma. Median symptom to procedure start time was 151 min. In the anterior circulation, 9 of the 12 target vessels were recanalised successfully (TIMI 2 and 3). The rate of patients with independent clinical outcome (mRS ≤ 2) was 42%. One patient died 5 days after unsuccessful treatment, one after 28 days and one after 85 days owing to heart attack. Basilar artery occlusions could be recanalised in all cases to TIMI 3. The clinical result after 90 days was mRS 4 in two cases and mRS 5 in one case. Symptomatic haemorrhage did not occur. The PSS can safely be used for recanalisation in patients with acute ischemic stroke due to large vessel occlusion, who have already received thrombolysis treatment. The recanalisation rate was 80%. Symptomatic haemorrhage did not occur. Randomized trials may demonstrate that endovascular mechanical thrombectomy improves patient outcome. (orig.)
Guilherme Pereira Corrêa Meyer
Full Text Available OBJECTIVE: Retrospective analyses of 216 patients undergoing foraminal decompression with transcorporeal approach and review of the surgical technique. METHOD: 216 patients with minimum follow-up of 2 years and an average of 41.8 months were included in the study. The clinical records of these patients were reviewed for complications, NDI (neck disability index and VAS (visual analogue scale. Pre and post-operative radiographs were used to evaluate the disc height. RESULTS: At the end of follow-up patients had significant clinical improvement with reduction of NDI of 88.3% and 86.5% and 68.3% of the VAS for neck and upper limb, respectively (p<0.05. A reduction of 8.8% of the disc height was observed without other complications associated (p<0.05. CONCLUSION: Radicular decompression through a transcorporeal approach is an alternative that provides good clinical results without the need for a fusion and with few complications.
Arshad, Saaid H.; Murphy, Ethan K.; Halter, Ryan J.
Telemonitoring is becoming increasingly important as the proportion of the population living with cardiovascular disease (CVD) increases. Currently used health parameters in the suite of telemonitoring tools lack the sensitivity and specificity to accurately predict heart failure events, forcing physicians to play a reactive versus proactive role in patient care. A novel cardiac output (CO) monitoring device is proposed that leverages a custom smart phone application and a wearable electrical impedance tomography (EIT) system. The purpose of this work is to explore the potential of using respiratory-gated EIT to quantify stroke volume (SV) and assess its feasibility using real data. Simulations were carried out using the 4D XCAT model to create anatomically realistic meshes and electrical conductivity profiles representing the human thorax and the intrathoracic tissue. A single 5-second period respiration cycle with chest/lung expansion was modeled with end-diastole (ED) and end-systole (ES) heart volumes to evaluate how effective EIT-based conductivity changes represent clinically significant differences in SV. After establishing a correlation between conductivity changes and SV, the applicability of the respiratory-gated EIT was refined using data from the PhysioNet database to estimate the number of useful end-diastole (ED) and end-systole (ES) heart events attained over a 3.3 minute period. The area associated with conductivity changes was found to correlate to SV with a correlation coefficient of 0.92. A window of 12.5% around peak exhalation was found to be the optimal phase of the respiratory cycle from which to record EIT data. Within this window, ~47 useable ED and ES were found with a standard deviation of 28 using 3.3 minutes of data for 20 patients.
Steiner, Thorsten; Vincent, Catherine; Morris, Stephen; Davis, Stephen; Vallejo-Torres, Laura; Christensen, Michael C
The value of neurosurgical interventions after spontaneous intracerebral hemorrhage (SICH) is uncertain. We evaluated clinical outcomes in patients diagnosed with SICH within 3 hours of symptom onset who underwent hematoma evacuation or external ventricular drainage (EVD) of the hematoma in the Factor Seven for Acute Hemorrhagic Stroke Trial (FAST). FAST was a randomized, multicenter, double-blind, placebo-controlled trial conducted between May 2005 and February 2007 at 122 sites in 22 countries. Neurosurgical procedures (hematoma evacuation and external ventricular drainage) performed at any point after hospital admission were prospectively recorded. Clinical outcomes evaluated were post-SICH disability, as assessed by the modified Rankin Scale; neurologic impairment, as assessed by the National Institutes of Health Stroke Scale; and mortality at 90 days after SICH onset. The impact of neurosurgical procedures on clinical outcomes was evaluated using multivariate logistic regression analysis, controlling for relevant baseline characteristics. Fifty-five of 821 patients underwent neurosurgery. Patients who underwent hematoma evacuation or EVD were on average younger, had greater baseline neurologic impairment, and lower levels of consciousness compared with patients who did not undergo neurosurgery. After adjusting for these differences and other relevant baseline characteristics, we found that neurosurgery was generally associated with unfavorable outcomes at day 90. Among the patients who underwent hematoma evacuation, those with lobar ICH had less ICH expansion than those with deep gray matter ICH, and the smaller expansion was associated with lower mortality. ICH volume was substantially decreased in patients who underwent hematoma evacuation between 24 and 72 hours after hospital admission, and this was associated with better clinical outcome. In conclusion, a small number of patients who underwent neurosurgery in FAST exhibited no overall clinical benefit
... 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 ...
Malizia, A., E-mail: firstname.lastname@example.org [Associazione EURATOM-ENEA, Department of Industrial Engineering, University of Rome “Tor Vergata”, Via del Politecnico 1, 00133 Rome (Italy); Camplani, M. [Grupo de Tratamiento de Imágenes, E.T.S.I de Telecomunicación, Universidad Politécnica de Madrid (Spain); Gelfusa, M. [Associazione EURATOM-ENEA, Department of Industrial Engineering, University of Rome “Tor Vergata”, Via del Politecnico 1, 00133 Rome (Italy); Lupelli, I. [Associazione EURATOM-ENEA, Department of Industrial Engineering, University of Rome “Tor Vergata”, Via del Politecnico 1, 00133 Rome (Italy); EURATOM/CCFE Association, Culham Science Centre, Abingdon (United Kingdom); Richetta, M.; Antonelli, L.; Conetta, F.; Scarpellini, D.; Carestia, M.; Peluso, E.; Bellecci, C. [Associazione EURATOM-ENEA, Department of Industrial Engineering, University of Rome “Tor Vergata”, Via del Politecnico 1, 00133 Rome (Italy); Salgado, L. [Grupo de Tratamiento de Imágenes, E.T.S.I de Telecomunicación, Universidad Politécnica de Madrid (Spain); Video Processing and Understanding Laboratory, Universidad Autónoma de Madrid (Spain); Gaudio, P. [Associazione EURATOM-ENEA, Department of Industrial Engineering, University of Rome “Tor Vergata”, Via del Politecnico 1, 00133 Rome (Italy)
Highlights: •Use of an experimental facility, STARDUST, to analyze the dust resuspension problem inside the tokamak in case of loss of vacuum accident. •PIV technique implementation to track the dust during a LOVA reproduction inside STARDUST. •Data imaging techniques to analyze dust velocity field: first results and data discussion. -- Abstract: An important issue related to future nuclear fusion reactors fueled with deuterium and tritium is the creation of large amounts of dust due to several mechanisms (disruptions, ELMs and VDEs). The dust size expected in nuclear fusion experiments (such as ITER) is in the order of microns (between 0.1 and 1000 μm). Almost the total amount of this dust remains in the vacuum vessel (VV). This radiological dust can re-suspend in case of LOVA (loss of vacuum accident) and these phenomena can cause explosions and serious damages to the health of the operators and to the integrity of the device. The authors have developed a facility, STARDUST, in order to reproduce the thermo fluid-dynamic conditions comparable to those expected inside the VV of the next generation of experiments such as ITER in case of LOVA. The dust used inside the STARDUST facility presents particle sizes and physical characteristics comparable with those that created inside the VV of nuclear fusion experiments. In this facility an experimental campaign has been conducted with the purpose of tracking the dust re-suspended at low pressurization rates (comparable to those expected in case of LOVA in ITER and suggested by the General Safety and Security Report ITER-GSSR) using a fast camera with a frame rate from 1000 to 10,000 images per second. The velocity fields of the mobilized dust are derived from the imaging of a two-dimensional slice of the flow illuminated by optically adapted laser beam. The aim of this work is to demonstrate the possibility of dust tracking by means of image processing with the objective of determining the velocity field values
Full Text Available The objective of this pilot study was to objectively assess electroacupuncture for motor function recovery in patients with acute ischemic stroke using the triple-stimulation technique (TST. The patients received either electroacupuncture plus western conventional medication (WCM (n=32 or single WCM (n=31 for 14 days. The total clinical effective rate was statistically significantly superior in electroacupuncture group to that in WCM group (P0.05. In conclusion, electroacupuncture was beneficial for the motor function recovery of patients with acute ischemic stroke and was generally safe. TST can be used for quantitative evaluation of electroacupuncture for motor function recovery in patients with acute ischemic stroke because it can objectively analyze the injury and recovery of corticospinal tract impairments.
Sallustio, Fabrizio; Pampana, Enrico; Davoli, Alessandro; Merolla, Stefano; Koch, Giacomo; Alemseged, Fana; Panella, Marta; D'Agostino, Vittoria Carla; Mori, Francesco; Morosetti, Daniele; Konda, Daniel; Fabiano, Sebastiano; Diomedi, Marina; Gandini, Roberto
To report clinical and procedural outcomes of acute ischemic stroke patients after endovascular treatment with the new thromboaspiration catheter AXS Catalyst 6. Patients with anterior and posterior circulation stroke were selected. Successful reperfusion defined as a Thrombolysis in Cerebral Infarction (TICI) score ≥2 b and 3-month functional independence defined as a modified Rankin Scale (mRS) ≤2 were the main efficacy outcomes. Symptomatic intracranial hemorrhage and mortality were the main safety outcomes. 107 patients were suitable for analysis. Mean age was 73.18±12.62 year and median baseline NIHSS was 17 (range: 3-32). The most frequent site of occlusion was the middle cerebral artery (MCA) (60.7%). 76.6% of patients were treated with AXS Catalyst 6 alone without the need for rescue devices or thromboaspiration catheters. Successful reperfusion was achieved in 84.1%, functional independence in 47.6%, symptomatic intracranial hemorrhage occurred in 3.7%, and mortality in 21.4%. Endovascular treatment with AXS Catalyst 6 proved to be safe, technically feasible, and effective. Comparison analyses with other devices for mechanical thrombectomy are needed. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Full Text Available Abstract Background It has been shown that intense training can significantly improve post-stroke upper-limb functionality. However, opportunities for stroke survivors to practice rehabilitation exercises can be limited because of the finite availability of therapists and equipment. This paper presents a haptic-enabled exercise platform intended to assist therapists and moderate-level stroke survivors perform upper-limb reaching motion therapy. This work extends on existing knowledge by presenting: 1 an anthropometrically-inspired design that maximizes elbow and shoulder range of motions during exercise; 2 an unobtrusive upper body postural sensing system; and 3 a vibratory elbow stimulation device to encourage muscle movement. Methods A multi-disciplinary team of professionals were involved in identifying the rehabilitation needs of stroke survivors incorporating these into a prototype device. The prototype system consisted of an exercise device, postural sensors, and a elbow stimulation to encourage the reaching movement. Eight experienced physical and occupational therapists participated in a pilot study exploring the usability of the prototype. Each therapist attended two sessions of one hour each to test and evaluate the proposed system. Feedback about the device was obtained through an administered questionnaire and combined with quantitative data. Results Seven of the nine questions regarding the haptic exercise device scored higher than 3.0 (somewhat good out of 4.0 (good. The postural sensors detected 93 of 96 (97% therapist-simulated abnormal postures and correctly ignored 90 of 96 (94% of normal postures. The elbow stimulation device had a score lower than 2.5 (neutral for all aspects that were surveyed, however the therapists felt the rehabilitation system was sufficient for use without the elbow stimulation device. Conclusion All eight therapists felt the exercise platform could be a good tool to use in upper-limb rehabilitation as
Stummer, C.A.; Verheyden, G.; Putman, K.; Jenni, W.; Schupp, W.; Wit, L. De
PURPOSE: To develop prognostic models and equations for predicting participation at six months after stroke. METHODS: This European prospective cohort study recruited 532 consecutive patients from four rehabilitation centers. Participation was assessed at six months after stroke with the Sickness
Broeks, J.G.; Lankhorst, G.J.; Rumping, K.; Prevo, A.J.H.
Purpose: To assess the long-term motor and functional recovery of arm function after stroke. Design: Cohort study. Subjects: Fifty-four patients with a first stroke, who underwent inpatient rehabilitation, were measured early after stroke, after 16 weeks and after 4 years. Measures: Fugl-Meyer Motor
Nemade, Sanjana Vijay; Shinde, Kiran Jaywant; Naik, Chetana Shivadas; Qadri, Haris
Surgical repair of the tympanic membrane, termed a type one tympanoplasty is a tried and tested treatment modality. Overlay or underlay technique of tympanoplasty is common. Sandwich tympanoplasty is the combined overlay and underlay grafting of tympanic membrane. To describe and evaluate the modified sandwich graft (mediolateral graft) tympanoplasty using temporalis fascia and areolar fascia. To compare the clinical and audiological outcome of modified sandwich tympanoplasty with underlay tympanoplasty. A total of 88 patients of chronic otitis media were studied. 48 patients (Group A) underwent type one tympanoplasty with modified sandwich graft. Temporalis fascia was underlaid and the areolar fascia was overlaid. 48 patients (Group B) underwent type one tympanoplasty with underlay technique. We assessed the healing and hearing results. Successful graft take up was accomplished in 47 patients (97.9%) in Group A and in 40 patients (83.3%) Group B. The average Air-Bone gap closure achieved in Group A was 24.4±1.7dB while in Group B; it was 22.5±3.5dB. Statistically significant difference was found in graft healing rate. Difference in hearing improvement was not statistically significant. Double layered graft with drum-malleus as a 'meat' of sandwich maintains a perfect balance between sufficient stability and adequate acoustic sensitivity. Copyright © 2017 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.
Arvind G Kulkarni
Full Text Available Background: Discectomy performed open or with an operating microscope remains the standard surgical management. Tubular retractor system is being increasingly used. Potential benefits include less muscle and local damage, better cosmesis, decreased pain and operative time and faster recovery after surgery. We have evaluated the outcome of micro endoscopic discectomy (MED utilizing tubular retractors in terms of safety and efficacy of the technique. Materials and Methods: 188 consecutive patients who underwent surgery for herniated disc using the tubular retractors between April 2007 and April 2012 are reported. All patients had a preoperative MRI (Magnetic Resonance Imaging and were operated by a single surgeon with the METRx system (Medtronic, Sofamor-Danek, Memphis, TN using 18 and 16 mm ports. All patients were mobilized as soon as pain subsided and discharged within 24-48 hours post surgery. The results were evaluated by using VAS (Visual Analog Scale 0-5 for back and leg pain and ODI (Oswestry Disability Index. Patients were followed up at intervals of 1 week, 6 weeks, 3 months, 6 months, 12 months and 2 years. Results: The mean age of patients was 46 years (range 16-78 years and the sex ratio was 1.5 males to 1 female. The mean followup was 22 months (range 8-69 months. The mean VAS scale for leg pain improved from 4.14 to 0.76 ( P < 0.05 and the mean VAS scale for back pain improved from 4.1 to 0.9 ( P < 0.05. The mean ODI changed from 59.5 to 22.6 ( P < 0.05. The mean operative time per level was about 50 minutes (range 20-90 minutes. Dural punctures occurred in 11 (5% cases. Average blood loss was 30 ml (range 10-500 ml. A wrong level was identified and later corrected in a case of revision discectomy. Four patients with residual disc-herniation had revision MED and three patients with recurrent disc herniation later underwent fusion. One patient had wound infection which needed a debridement. Conclusion: MED for herniated discs
Full Text Available Image processing technique (IPT is a computational technique which is a simple, wide and great for many purposes. In this paper, we used IPT to obtain plasma source such as sun and sunspot temperatures. Sun image was taken by a telescope and DSLR camera and imported to MATLAB software. Using the IPT, we cropped two areas and evaluated their RGB values, using a code which was written according to Python software. We computed wavelengths and then by substituting wavelengths in Wien’s law, we obtained sun’s surface and sunspot temperature’s. The temperature errors for surface and sunspot were 0.57% and 13% respectively. Keywords: Image processing technique, Plasma temperature
Mahdavipour, B.; Hatami, A.; Salar Elahi, A.
Image processing technique (IPT) is a computational technique which is a simple, wide and great for many purposes. In this paper, we used IPT to obtain plasma source such as sun and sunspot temperatures. Sun image was taken by a telescope and DSLR camera and imported to MATLAB software. Using the IPT, we cropped two areas and evaluated their RGB values, using a code which was written according to Python software. We computed wavelengths and then by substituting wavelengths in Wien's law, we obtained sun's surface and sunspot temperature's. The temperature errors for surface and sunspot were 0.57% and 13% respectively.
Melendez-Calderon, A; Rodrigues, E; Thielbar, K; Patton, J L
This study explores the use of isometric movement training for arm rehabilitation after stroke. The aim of this approach is to enhance movement skill even when the person training is not moving. This is accomplished by deceptively displaying virtual motions, exploiting known cross-modal sensory interactions between vision and proprioception. This approach can be advantageous in situations where actual movement is prohibitive due to weakness, spasticity, instability, or unsafe conditions. We present early insights on usability of and tolerance to this training approach and quantitative results that can power future clinical trials.
Romanowsky, AJ; Douglas, NG; Kuijken, K; Arnaboldi, M; Gerssen, J; Merrifield, MR; Kwok, S; Dopita, M; Sutherland, R
We have observed planetary nebulae (PNe) in several early-type galaxies using new techniques on 4- to 8-meter-class telescopes. We obtain the first large data sets (greater than or similar to 100 velocities each) of PN kinematics in galaxies at greater than or similar to 15 Mpc, and present some
Clua-Espuny, Josep Ll; Piñol-Moreso, Josep Ll; Gil-Guillén, Vicente F; Orozco-Beltrán, Domingo; Panisello-Tafalla, Anna; Lucas-Noll, Jorgina; Queralt-Tomás, M Lluïssa; Pla-Farnós, Roger
The prevalence and cardiovascular risk factors control (CVRF) are determining to suffer a stroke and its relapse which arise the mortality and disability. To estimate the incidence of the first episode of ictus and describe the results in primary and secondary cardiovascular prevention. Observational and prospective study of a fix cohort of 130,649 people, 15-90-year-old assigned to participants centers between 01/04/2006 and 31/03/2008. Community based register. Analyses were performed with the use of time-to-event methods, included Cox's multivariate on survival, risk of it's relapse; the CVRF diagnosed and it's relative risk (RR); cardiovascular risk. 553 patients were enrolled (48,8% female), average age 73.3 ± 11.6 years with the first episode of stroke. After the episode, the hypertension (74.9% vs 88.7%), atrial fibrillation (9.9% vs 16%) and dislipemia (37.8% vs 49.8%) increased significantly as well its control. The 47% (95% CI = 42.8-51.2) of the cases had high risk of relapsing. In the 15.7% of the patients happened relapse of cardiovascular event, 48.3% of which were stroke. The main predictors variables were history of recurrent cardiovascular event (RR = 6.7; 95% CI = 2.2-21.7) and the aging (RR = 1,08; 95% CI = 1.01-1.2). The cardiovascular secondary prevention seems to be more effective both in CVRF's detection and its control and is extremely important to get better results of survival.
Cai, Bin; Wang, Ning
Stroke is a leading cause of serious long-term disability worldwide and the second leading cause of death in many countries. Long-time attempts to salvage dying neurons via various neuroprotective agents have failed in stroke translational research, owing in part to the huge gap between animal stroke models and stroke patients, which also suggests that rodent models have limited predictive value and that alternate large animal models are likely to become important in future translational research. The genetic background, physiological characteristics, behavioral characteristics, and brain structure of large animals, especially nonhuman primates, are analogous to humans, and resemble humans in stroke. Moreover, relatively new regional imaging techniques, measurements of regional cerebral blood flow, and sophisticated physiological monitoring can be more easily performed on the same animal at multiple time points. As a result, we can use large animal stroke models to decrease the gap and promote translation of basic science stroke research. At the same time, we should not neglect the disadvantages of the large animal stroke model such as the significant expense and ethical considerations, which can be overcome by rodent models. Rodents should be selected as stroke models for initial testing and primates or cats are desirable as a second species, which was recommended by the Stroke Therapy Academic Industry Roundtable (STAIR) group in 2009.
Grob, D.; Humke, T.
Translaminar screw fixation of the lumbar spine represents a simple and effective technique for short segment fusion in the degenerative spine. Clinical experience with 173 patients who underwent translaminar screw fixation revealed a fusion rate of 94%. The indications for translaminar screw fixation as a primary fixation procedure are: segmental dysfunction, lumbar spinal stenosis with painful degenerative changes, segmental revision surgery after discectomies, and painful disc-related synd...
Mueller-Kronast, Nils H; Zaidat, Osama O; Froehler, Michael T; Jahan, Reza; Aziz-Sultan, Mohammad Ali; Klucznik, Richard P; Saver, Jeffrey L; Hellinger, Frank R; Yavagal, Dileep R; Yao, Tom L; Liebeskind, David S; Jadhav, Ashutosh P; Gupta, Rishi; Hassan, Ameer E; Martin, Coleman O; Bozorgchami, Hormozd; Kaushal, Ritesh; Nogueira, Raul G; Gandhi, Ravi H; Peterson, Eric C; Dashti, Shervin R; Given, Curtis A; Mehta, Brijesh P; Deshmukh, Vivek; Starkman, Sidney; Linfante, Italo; McPherson, Scott H; Kvamme, Peter; Grobelny, Thomas J; Hussain, Muhammad S; Thacker, Ike; Vora, Nirav; Chen, Peng Roc; Monteith, Stephen J; Ecker, Robert D; Schirmer, Clemens M; Sauvageau, Eric; Abou-Chebl, Alex; Derdeyn, Colin P; Maidan, Lucian; Badruddin, Aamir; Siddiqui, Adnan H; Dumont, Travis M; Alhajeri, Abdulnasser; Taqi, M Asif; Asi, Khaled; Carpenter, Jeffrey; Boulos, Alan; Jindal, Gaurav; Puri, Ajit S; Chitale, Rohan; Deshaies, Eric M; Robinson, David H; Kallmes, David F; Baxter, Blaise W; Jumaa, Mouhammad A; Sunenshine, Peter; Majjhoo, Aniel; English, Joey D; Suzuki, Shuichi; Fessler, Richard D; Delgado Almandoz, Josser E; Martin, Jerry C; Haussen, Diogo C
Mechanical thrombectomy with stent retrievers has become standard of care for treatment of acute ischemic stroke patients because of large vessel occlusion. The STRATIS registry (Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke) aimed to assess whether similar process timelines, technical, and functional outcomes could be achieved in a large real world cohort as in the randomized trials. STRATIS was designed to prospectively enroll patients treated in the United States with a Solitaire Revascularization Device and Mindframe Capture Low Profile Revascularization Device within 8 hours from symptom onset. The STRATIS cohort was compared with the interventional cohort of a previously published SEER patient-level meta-analysis. A total of 984 patients treated at 55 sites were analyzed. The mean National Institutes of Health Stroke Scale score was 17.3. Intravenous tissue-type plasminogen activator was administered in 64.0%. The median time from onset to arrival in the enrolling hospital, door to puncture, and puncture to reperfusion were 138, 72, and 36 minutes, respectively. The Core lab-adjudicated modified Thrombolysis in Cerebral Infarction ≥2b was achieved in 87.9% of patients. At 90 days, 56.5% achieved a modified Rankin Scale score of 0 to 2, all-cause mortality was 14.4%, and 1.4% suffered a symptomatic intracranial hemorrhage. The median time from emergency medical services scene arrival to puncture was 152 minutes, and each hour delay in this interval was associated with a 5.5% absolute decline in the likelihood of achieving modified Rankin Scale score 0 to 2. This largest-to-date Solitaire registry documents that the results of the randomized trials can be reproduced in the community. The decrease of clinical benefit over time warrants optimization of the system of care. URL: http://www.clinicaltrials.gov. Unique identifier: NCT02239640. © 2017 American Heart Association, Inc.
In patients after a stroke there are variable disorders. These patients often need rehabilitation in more than one area beceause of multiple limitations of the ability to perform everyday activities. The aim of the study was to assess correlations - statistical relationships between observed gait parameters, ADL and hand functions - results of rehabilitation of patients after ischaemic stroke according to the NDTBobath method for adults. The investigated group consisted of 60 patients after ischaemic stroke, who participated in the rehabilitation programme. 10 sessions of the NDT-Bobath therapy were provided in 2 weeks (10 days of the therapy). The calculation of correlations was made based on changes of parameters: Bobath Scale (to assess hand functions), Barthel Index (to assess ADL), gait velocity, cadence and stride lenght. Measurements were performed in every patient twice: on admission (before the therapy) and after last session of the therapy to assess rehabilitation effects. The main statistically relevant corellations observed in the study were as follows: in the whole group of patients: poor and moderate (negative) correlation between changes of gait parameters and Bobath Scale and Barthel Index, moderate and severe (negative) correlation between changes of gait parameters and Bobath Scale and Barthel Index in the group of women, correlation between changes in Bobath Scale and Barthel Index in the group of patients with left side of paresis, (negative) correlation between changes of gait parameters and Bobath Scale in group of patients younger than 68 years, moderate, high and very high correlations between changes in gait parameters in groups of women, men, younger than 68 years and older than 68 years. There have been observed statistically significant and favourable changes in the health status of patients, described by gait parameters, changes in hand functions and ADL. Based on the presented correlations there is an assumption that it is hard to
Buschfort, R; Brocke, J; Hess, A; Werner, C; Waldner, A; Hesse, Stefan
To assess the acceptance, utilization and clinical results of an arm studio designed to intensify treatment of the severely to moderately affected arm after stroke. In line with a distal bilateral approach, the equipment comprised 4 workstations, 1 finger trainer, and 3 machines for bilateral training of selected distal and proximal movements. Open study. Of 119 treated patients after subacute stroke, 30 completed a questionnaire and 24 were assessed. All patients completed 15 sessions, each of 30-45 min duration, on each of 2 workstations. Based on the patients' impairment level they were divided into 3 groups, as follows: group A, plegic; group B, proximal and distal movements but hand non-functional; and group C, able to grasp and release an object. Motor functions were assessed with the Fugl-Meyer Score (FM, 0-66) for groups A (n = 6) and B (n = 6), and the Action Arm Research Test (ARAT, 0-57) for group C (n = 12). No side-effects occurred. The patients regarded the training positively. The initial FM was 8.5 (standard deviation (SD) 3.3) and final FM 21.2 (SD 4.4) for group A, initial FM 25.3 (SD 6.9) and final FM 44.3 (SD 9.1) for group B, and initial ARAT 33.3 (SD 11.2) and final ARAT 43.5 (SD 10.7) for group C. The use of the arm studio to intensify upper limb rehabilitation after stroke is promising, and a controlled study is warranted.
Hemmen, Thomas M; Raman, Rema; Guluma, Kama Z; Meyer, Brett C; Gomes, Joao A; Cruz-Flores, Salvador; Wijman, Christine A; Rapp, Karen S; Grotta, James C; Lyden, Patrick D
Background Induced hypothermia is a promising neuroprotective therapy. We studied the feasibility and safety of hypothermia and thrombolysis after acute ischemic stroke. Methods ICTuS-L was a randomized, multi-center trial of hypothermia and intravenous t-PA in patients treated within 6 hours after ischemic stroke. Enrollment was stratified to the treatment time windows 0–3 and 3–6 hours. Patients presenting within 3 hours of symptom onset received standard dose intravenous alteplase (IV tPA) and were randomized to undergo 24 hours of endovascular cooling to 33°C followed by 12 hours of controlled re-warming or normothermia treatment. Patients presenting between 3 and 6 hours were randomized twice: to receive t-PA or not and to receive hypothermia or not. Results In total, 59 patients were enrolled. One patient was enrolled but not treated when pneumonia was discovered just prior to treatment. All 44 patients enrolled within 3 hours and 4 of 14 patients enrolled between 3–6 hours received t-PA. Overall, 28 patients randomized to receive hypothermia (HY) and 30 to normothermia (NT). Baseline demographics and risk factors were similar between groups. Mean age was 65.5±12.1 years and baseline NIHSS was 14.0±5.0; 32 (55%) were male. Cooling was achieved in all patients except 2 in whom there were technical difficulties. The median time to target temperature after catheter placement was 67min (Q1 57.3 –Q3 99.4). At 3 months, 18% of patients treated with HY had a modified Rankin Scale (mRS) of 0 or 1, versus 24% in the NT groups (NS). Symptomatic intracranial hemorrhage occurred in 4 patients (68), all were treated with tPA less than 3 hours (1 received HY). Six patients in the HY and 5 in the NT groups died within 90 days (NS). Pneumonia occurred in 14 patients in the HY and in 3 of the NT groups (p=0.001). The pneumonia rate did not significantly adversely affect 3 month mRS (p=0.32). Conclusion This study demonstrates the feasibility and preliminary safety
Full Text Available Background. During the past decade, virtual reality (VR has become a new component in the treatment of patients after stroke. Therefore aims of the study were (a to get an insight into experiences and expectations of physiotherapists and occupational therapists in using a VR training system and (b to investigate relevant facilitators, barriers, and risks for implementing VR training in clinical practice. Methods. Three focus groups were conducted with occupational therapists and physiotherapists, specialised in rehabilitation of patients after stroke. All data were audio-recorded and transcribed verbatim. The study was analysed based on a phenomenological approach using qualitative content analysis. Results. After code refinements, a total number of 1289 codes emerged out of 1626 statements. Intercoder reliability increased from 53% to 91% until the last focus group. The final coding scheme included categories on a four-level hierarchy: first-level categories are (a therapists and VR, (b VR device, (c patients and VR, and (d future prospects and potential of VR developments. Conclusions. Results indicate that interprofessional collaboration is needed to develop future VR technology and to devise VR implementation strategies in clinical practice. In principal, VR technology devices were seen as supportive for a general health service model.
Ben Hamouda, Mohamed; Bergaoui, Naceur; Douik, Mongi; Ladeb, Fethi
Imaging is necessary in the diagnosis of musculoskeletal diseases and X rays is the first step of this morphological exploration. Ultrasonography is cost effectiveness, without radiation and have to constitute the second step of the exploration of the smooth tissue (tendon, muscle, sheath, synovium and superficial ligaments). Computed tomography with its new technological progress is very effective in the study of the cortical bone. Magnetic resonance imaging, a non irradiating but costly technique, becomes inevitable in several osteo-articular affections. It often makes the examination of last intention to compensate for the inadequacy of ultrasonography and computed tomography.
Hachinski, Vladimir; Donnan, Geoffrey A.; Gorelick, Philip B.; Hacke, Werner; Cramer, Steven C.; Kaste, Markku; Fisher, Marc; Brainin, Michael; Buchan, Alastair M.; Lo, Eng H.; Skolnick, Brett E.; Furie, Karen L.; Hankey, Graeme J.; Kivipelto, Miia; Morris, John; Rothwell, Peter M.; Sacco, Ralph L.; Smith, Jr., Sidney C.; Wang, Yulun; Bryer, Alan; Ford, Gary A.; Iadecola, Costantino; Martins, Sheila C.O.; Saver, Jeff; Skvortsova, Veronika; Bayley, Mark; Bednar, Martin M.; Duncan, Pamela; Enney, Lori; Finklestein, Seth; Jones, Theresa A.; Kalra, Lalit; Kleim, Jeff; Nitkin, Ralph; Teasell, Robert; Weiller, Cornelius; Desai, Bhupat; Goldberg, Mark P.; Heiss, Wolf-Dieter; Saarelma, Osmo; Schwamm, Lee H.; Shinohara, Yukito; Trivedi, Bhargava; Wahlgren, Nils; Wong, Lawrence K.; Hakim, Antoine; Norrving, Bo; Prudhomme, Stephen; Bornstein, Natan M.; Davis, Stephen M.; Goldstein, Larry B.; Leys, Didier; Tuomilehto, Jaakko
Background and Purpose The aim of the Synergium was to devise and prioritize new ways of accelerating progress in reducing the risks, effects, and consequences of stroke. Methods Preliminary work was performed by 7 working groups of stroke leaders followed by a synergium (a forum for working synergistically together) with approximately 100 additional participants. The resulting draft document had further input from contributors outside the synergium. Results Recommendations of the Synergium are: Basic Science, Drug Development and Technology: There is a need to develop: (1) New systems of working together to break down the prevalent ‘silo’ mentality; (2) New models of vertically integrated basic, clinical, and epidemiological disciplines; and (3) Efficient methods of identifying other relevant areas of science. Stroke Prevention: (1) Establish a global chronic disease prevention initiative with stroke as a major focus. (2) Recognize not only abrupt clinical stroke, but subtle subclinical stroke, the commonest type of cerebrovascular disease, leading to impairments of executive function. (3) Develop, implement and evaluate a population approach for stroke prevention. (4) Develop public health communication strategies using traditional and novel (e.g., social media/marketing) techniques. Acute Stroke Management: Continue the establishment of stroke centers, stroke units, regional systems of emergency stroke care and telestroke networks. Brain Recovery and Rehabilitation: (1) Translate best neuroscience, including animal and human studies, into poststroke recovery research and clinical care. (2) Standardize poststroke rehabilitation based on best evidence. (3) Develop consensus on, then implementation of, standardized clinical and surrogate assessments. (4) Carry out rigorous clinical research to advance stroke recovery. Into the 21st Century: Web, Technology and Communications: (1) Work toward global unrestricted access to stroke-related information. (2) Build
Orsi, Franco; Grasso, Rosario Francesco; Bonomo, Guido; Marinucci, Irene [Division of Radiology, European Institute of Oncology, Milan (Italy); Monti, Cinzia [Institute of Radiology, University of Milan (Italy); Bellomi, Massimo [Division of Radiology, European Institute of Oncology, Milan (Italy); Institute of Radiology, University of Milan (Italy)
Nine peritoneovenous shunts were positioned by percutaneous technique in seven patients with advanced malignancy causing severe refractory ascites, and in two patients with hepatic cirrhosis (one with hepatocarcinoma). In all patients the shunts were percutaneously placed through the subclavian vein in the angiographic suite under digital fluoroscopic guide. No complications directly related to the procedure occurred. The shunt was successfully positioned in all patients in 60 min average time. No patient showed symptoms related to pulmonary overload or to disseminated intravascular coagulation. All patients had a significant improvement of the objective symptoms related to ascites such as respiratory symptoms, dyspepsia, and functional impairment to evacuation describing an improvement of their quality of life. Maximum shunt patency was 273 days. Percutaneous placement of peritoneovenous shunt is a safe, fast, and inexpensive procedure, extremely useful in resolution of refractory ascites, reducing symptoms, and allowing effective palliation, with a great improvement in quality of life. (orig.)
Werry, E.V.; Gates, T.E.; Cabbage, K.S.; Eklund, J.D.
This report covers the investigation of fabrication techniques associated with the development of suitable materials and methods to provide a prefabricated packing for waste packages for the Basalt Waste Isolation Project (BWIP). The principal functions of the packing are to minimize container corrosion during the 300 to 1000 years following repository closure and provide long-term control of the release of radionuclides from the waste package. The investigative work, discussed in this report, was specifically conceived to develop the design criteria for production of full-scale prototypical packing rings. The investigative work included the preparation of procedures, the preparation of fabrication materials, physical properties, and the determination of the engineering properties. The principal activities were the preparation of the materials and the determination of the physical properties. 21 refs., 20 figs., 14 tabs
Lee, Eun-Jae; Kim, Yong-Hwan; Kim, Namkug; Kang, Dong-Wha
Artificial intelligence (AI), a computer system aiming to mimic human intelligence, is gaining increasing interest and is being incorporated into many fields, including medicine. Stroke medicine is one such area of application of AI, for improving the accuracy of diagnosis and the quality of patient care. For stroke management, adequate analysis of stroke imaging is crucial. Recently, AI techniques have been applied to decipher the data from stroke imaging and have demonstrated some promising results. In the very near future, such AI techniques may play a pivotal role in determining the therapeutic methods and predicting the prognosis for stroke patients in an individualized manner. In this review, we offer a glimpse at the use of AI in stroke imaging, specifically focusing on its technical principles, clinical application, and future perspectives.
Hachinski, Vladimir; Donnan, Geoffrey A; Gorelick, Philip B; Hacke, Werner; Cramer, Steven C; Kaste, Markku; Fisher, Marc; Brainin, Michael; Buchan, Alastair M; Lo, Eng H; Skolnick, Brett E; Furie, Karen L; Hankey, Graeme J; Kivipelto, Miia; Morris, John; Rothwell, Peter M; Sacco, Ralph L; Smith, Sidney C; Wang, Yulun; Bryer, Alan; Ford, Gary A; Iadecola, Costantino; Martins, Sheila C O; Saver, Jeff; Skvortsova, Veronika; Bayley, Mark; Bednar, Martin M; Duncan, Pamela; Enney, Lori; Finklestein, Seth; Jones, Theresa A; Kalra, Lalit; Kleim, Jeff; Nitkin, Ralph; Teasell, Robert; Weiller, Cornelius; Desai, Bhupat; Goldberg, Mark P; Heiss, Wolf-Dieter; Saarelma, Osmo; Schwamm, Lee H; Shinohara, Yukito; Trivedi, Bhargava; Wahlgren, Nils; Wong, Lawrence K; Hakim, Antoine; Norrving, Bo; Prudhomme, Stephen; Bornstein, Natan M; Davis, Stephen M; Goldstein, Larry B; Leys, Didier; Tuomilehto, Jaakko
The aim of the Synergium was to devise and prioritize new ways of accelerating progress in reducing the risks, effects, and consequences of stroke. Preliminary work was performed by seven working groups of stroke leaders followed by a synergium (a forum for working synergistically together) with approximately 100 additional participants. The resulting draft document had further input from contributors outside the synergium. Recommendations of the Synergium are: Basic Science, Drug Development and Technology: There is a need to develop: (1) New systems of working together to break down the prevalent 'silo' mentality; (2) New models of vertically integrated basic, clinical, and epidemiological disciplines; and (3) Efficient methods of identifying other relevant areas of science. Stroke Prevention: (1) Establish a global chronic disease prevention initiative with stroke as a major focus. (2) Recognize not only abrupt clinical stroke, but subtle subclinical stroke, the commonest type of cerebrovascular disease, leading to impairments of executive function. (3) Develop, implement and evaluate a population approach for stroke prevention. (4) Develop public health communication strategies using traditional and novel (eg, social media/marketing) techniques. Acute Stroke Management: Continue the establishment of stroke centers, stroke units, regional systems of emergency stroke care and telestroke networks. Brain Recovery and Rehabilitation: (1) Translate best neuroscience, including animal and human studies, into poststroke recovery research and clinical care. (2) Standardize poststroke rehabilitation based on best evidence. (3) Develop consensus on, then implementation of, standardized clinical and surrogate assessments. (4) Carry out rigorous clinical research to advance stroke recovery. Into the 21st Century: Web, Technology and Communications: (1) Work toward global unrestricted access to stroke-related information. (2) Build centralized electronic archives and
Sikdar, Siddhartha; Beach, Kirk W; Vaezy, Shahram; Kim, Yongmin
We propose an ultrasound (US)-based technique for imaging vibrations in the blood vessel walls and surrounding tissue caused by eddies produced during flow through narrowed or punctured arteries. Our approach is to utilize the clutter signal, normally suppressed in conventional color flow imaging, to detect and characterize local tissue vibrations. We demonstrate the feasibility of visualizing the origin and extent of vibrations relative to the underlying anatomy and blood flow in real-time and their quantitative assessment, including measurements of the amplitude, frequency and spatial distribution. We present two signal-processing algorithms, one based on phase decomposition and the other based on spectral estimation using eigen decomposition for isolating vibrations from clutter, blood flow and noise using an ensemble of US echoes. In simulation studies, the computationally efficient phase-decomposition method achieved 96% sensitivity and 98% specificity for vibration detection and was robust to broadband vibrations. Somewhat higher sensitivity (98%) and specificity (99%) could be achieved using the more computationally intensive eigen decomposition-based algorithm. Vibration amplitudes as low as 1 mum were measured accurately in phantom experiments. Real-time tissue vibration imaging at typical color-flow frame rates was implemented on a software-programmable US system. Vibrations were studied in vivo in a stenosed femoral bypass vein graft in a human subject and in a punctured femoral artery and incised spleen in an animal model.
Actis, Eloy Vicente; Huang, Dongping; Márquez, Raúl; Adarvez, Sonia; Flores, Matías; Brizuela, Diego; Nievas, Jesica; Podestá, Ricardo; Pacheco, Ana M.; Rojas, Hernán Alvis; Yin, Zhiqiang; Li, Jinzeng; Han, Yanben; Liu, Weidong; Wang, Rui
Along the late 30 years spatial geodetic techniques enable us to measure horizontal and vertical deformations of the Earth’s surface with a very high precision. Performing this task we made Satellite Laser Ranging (SLR), and Global Positioning System (GPS) observations in South America ILRS 7406 Station placed at Observatorio Astronómico Félix Aguilar (OAFA) in San Juan, Argentina, accomplishing a Cooperation Agreement between CAS - NAOC and OAFA - UNSJ. Trough LAGEOS II Satellite observations we obtain rectangular coordinates of San Juan ILRS Station in the Terrestrial Reference Frame (ITR 2000), standing out that Argentine Station data were included in the late arrangements ITRF given by International Earth Rotation and Reference System Service (IERS). Spatial and temporary variations of the epoch 2010 - 2011 were evaluated finding out remarkable displacements, of about a half meter, related with seismic events on the region. We confirm these deformations by means of GP S determinations referred to Permanent GPS Station placed nearby the SLR Station.
Hubert, Dominique; Patrat, Catherine; Guibert, Juliette; Thiounn, Nicolas; Bienvenu, Thierry; Viot, Géraldine; Jouannet, Pierre; Epelboin, Sylvie
Sterility in men with cystic fibrosis (CF) raises the question of the use of assisted reproductive techniques (ART). A multidisciplinary network including adult CF centre and reproductive medicine units was set up to answer requests for ART. This retrospective study included 25 men with CF between 1994 and 2004. Clinical status, semen analysis, CF mutations analysis and artificial insemination by donor (AID) or ICSI after surgical retrieval of sperm were monitored. All CF men had azoospermia. Two chose AID first (one delivery); 23 chose ICSI. Sperm were surgically retrieved in 21 cases, and ICSI was performed in 19. Pregnancies occurred in 12 of these 19 couples (63%) (two ectopic pregnancies, two spontaneous abortions, one termination of pregnancy for polymalformed twins and 11 single deliveries in nine couples). Two couples tried AID after ICSI failed; one had twins. Another adopted a child, and two had a spontaneous pregnancy. After a follow-up of 4.1+/-2.3 years, two patients died, two underwent lung transplantation and 21 remained stable. ART can help men with CF to become a father, but their health status and short survival need careful counselling and multidisciplinary medical care.
Full Text Available In order to determine the impact of flexibility on the results in swimming, we conducted a study on a sample of 50 female patients aged 11-14 years of age who are in the training process in the swimming clubs „Nis 2005“ and „Sveti Nikola“ in Nis. The study is applied to 14 measuring instruments that were divided into three groups: Measuring instruments for the assessment of flexibility (11; Measuring instruments for assessing the results of swimming (1; Measuring instruments for evaluation of morphological characteristics (2. The regression analysis determined the impact of flexibility on the results in swimming. The regression analysis didn't confirmed the assumption that there is a statistically significant effect of flexibility variables on results in swimming for female swimmers
Molenaar, P.A.; Straten, P. van der; Heideman, H.G.M.; Metcalf, H.
We have developed a new diagnostic tool for the study of Zeeman-compensated slowing of an alkali atomic beam. Our time-of-flight technique measures the longitudinal veloc- ity distribution of the slowed atoms with a resolution below the Doppler limit of 30 cm/s. Furthermore, it can map the position and velocity distribution of atoms in either ground hyperfine level inside the solenoid without any devices inside the solenoid. The technique reveals the optical pumping ef- fects, and shows in de...
Full Text Available We aimed at comparing the sensitivity of magnetic resonance (MR susceptibility-weighted imaging (SWI with computed tomography angiography (CTA in the detection of middle cerebral artery (MCA thrombus in acute stroke. Seventy-nine patients with acute MCA stroke was selected using our search engine software; only the ones showing restricted diffusion in the MCA territory on diffusion-weighted images were included. We finally selected 35 patients who had done both MRI (including SWI and CTA. Twenty random subjects with completely normal MRI (including SWI exam were selected as control. Two neuroradiologists (blinded to the presence or absence of stroke reviewed the SW images and then compared the findings with CT angiogram (in patients with stroke. The number of MCA segments showing thrombus in each patient was tabulated to estimate the thrombus burden. Thrombus was detected on SWI in one or more MCA segments in 30 out of 35 patients, on the first review. Of the 30, SWI showed thrombus in more than one MCA segments in 7 patients. CTA depicted branch occlusion in 31 cases. Thrombus was seen on both SWI and CTA in 28 patients. Thrombus was noted in two patients on SWI only, with no corresponding abnormality seen on CTA. Two patients with acute MCA showed no vascular occlusion or thrombus on either CTA or SWI. Only two case of false-positive thrombus was reported in normal control subjects. Susceptibility-weighted images had sensitivity and specificity of 86% and 90% respectively, with positive predictive value 94%. Sensitivity was 86% for SWI, compared with 89% for CTA, and this difference was statistically insignificant (P>0.05. Of all the positive cases on CTA (31 corresponding thrombus was seen on SWI in 90% of subjects (28 of 31. Susceptibility-weighted imaging has high sensitivity for detection of thrombus in acute MCA stroke. Moreover, SWI is a powerful technique for estimation of thrombus burden, which can be challenging on CTA.
Molenaar, P.A.; Straten, P. van der; Heideman, H.G.M.; Metcalf, H.
We have developed a new diagnostic tool for the study of Zeeman-compensated slowing of an alkali atomic beam. Our time-of-flight technique measures the longitudinal veloc- ity distribution of the slowed atoms with a resolution below the Doppler limit of 30 cm/s. Furthermore, it can map
The weather conditions and crop seasons seem not to be associated with monkeys' crop raiding behaviour in Uluguru Mountains. Therefore, the preliminary results suggest that the use of trained dogs in farms is cheap and can save up to 61.5 % of the current crop losses.al, 1998). The Mountains have outstanding various ...
Rotter, R; Gierer, P
The anatomical reconstruction of tibial pilon fractures is a major challenge with respect to preoperative planning, time management and the intraoperative procedure. Presentation of the various surgical procedures available and the clinical outcome. The established open reduction and internal plate fixation procedures form the basis for new minimally invasive treatment concepts. The current results of comparative studies and basic literature are discussed. The treatment result depends on the severity of the initial fracture and accompanying soft tissue damage. Essential is an anatomical reduction with an articular displacement of less than 2 mm. Overall, only approximately half of all patients return to work within 1 year. The fixation procedure used is not relevant for this purpose. Both plate fixation and the combination of external fixator plus minimally invasive articular reconstruction with and without arthroscopy achieve equivalent results. Good clinical results can be achieved by an accurate preoperative planning with respect to the surgical procedure, time of surgery and the surgical steps. In cases of disregarding these points and inadequate surgical expertise, loss of function and reduced quality of life are impending.
Steen-Banasik, E.M. van der; Visser, A.G.; Reinders, J.G.; Heijbroek, R.P.; Idema, J.G.; Janssen, T.G.; Leer, J.W.H.
PURPOSE: To analyze and report the treatment results of brachytherapy for solitary bladder cancer in the Arnhem Radiotherapy Institute. METHODS AND MATERIALS: Between January 1983 and October 1998, 63 patients with a solitary bladder tumor were treated with a combination of transurethral resection,
Andersen, H E; Schultz-Larsen, K; Kreiner, S
the completion of inpatient rehabilitation, were discharged to their homes. The patients were randomized to 1 of 2 follow-up interventions provided in addition to standard care or to standard aftercare. Fifty-four received follow-up home visits by a physician (INT1-HVP), 53 were provided instructions......BACKGROUND AND PURPOSE: About 50% of stroke survivors are discharged to their homes with lasting disability. Knowledge, however, of the importance of follow-up services that targets these patients is sparse. The purpose of the present study was to evaluate 2 models of follow-up intervention after...... that the effect of intervention was strongest for patients with a prolonged inpatient rehabilitation. CONCLUSIONS: Readmission is common among disabled stroke survivors. Follow-up intervention after discharge seems to be a way of preventing readmission, especially for patients with long inpatient rehabilitation....
Maurice, N; Delol, J; Makeieff, M; Arnoux, A; Crampette, L; Guerrier, B
In this article, we advocate supraglottic laryngectomy with bilateral neck dissection for the treatment of supraglottic carcinomas with preserved laryngeal mobility. Post-operative results and follow-up of 87 patients are discussed. This technique allows an excellent loco-regional control of the disease with preservation of laryngeal function. Radiation therapy is preserved for treatment of metachronous (2nd primary) in cases with satisfactory local control without neck metastases. All stage 5-year overall survival rate was 55% with a 68.5% disease survival rate. Five-year local control of the disease and regional control of neck nodes were respectively 94% and 92%. Five-year disease survival rate for N- population was 71% Vs 61% for N+ population. Five-year disease survival rate according to the tumor classification was 70% for T1, 75% for T2, 69% for T3 and 54% for T4. In the post-operative follow-up, the median of time to decanulation was 17 days, that of nasogastric tube removal was 19 days, that of hospital stay 38 days.
Montaner, Joan; Bustamante, Alejandro; García-Matas, Silvia; Martínez-Zabaleta, Maite; Jiménez, Carmen; de la Torre, Javier; Rubio, Francisco R; Segura, Tomás; Masjuán, Jaime; Cánovas, David; Freijo, Mar; Delgado-Mederos, Raquel; Tejada, Javier; Lago, Aida; Bravo, Yolanda; Corbeto, Natália; Giralt, Dolors; Vives-Pastor, Bárbara; de Arce, Anna; Moniche, Francisco; Delgado, Pilar; Ribó, Marc
The STARS trial (Stroke Treatment With Acute Reperfusion and Simvastatin) was conducted to demonstrate the efficacy and safety of simvastatin treatment in acute stroke. STARS07 was a multicentre, phase IV, prospective, randomized, double-blind, placebo-controlled trial. Patients with Acute ischemic stroke recruited within 12 hours from symptom onset were randomized to oral simvastatin 40 mg or placebo, once daily for 90 days. Primary outcome was proportion of independent patients (modified Rankin Scale score of ≤2) at 90 days. Safety end points were hemorrhagic transformation, hemorrhagic events, death, infections, and serious adverse events. From April 2009 to March 2014, 104 patients were included. Fifty-five patients received intravenous tissue-type plasminogen activator. No differences were found between treatment arms regarding the primary outcome (adjusted odds ratio, 0.99 [0.35-2.78]; P=0.98). Concerning safety, no significant differences were found in the rate of hemorrhagic transformation of any type, nor symptomatic hemorrhagic transformation. There were no differences in other predefined safety outcomes. In post hoc analyses, for patients receiving tissue-type plasminogen activator, a favorable effect for simvastatin treatment was noted with higher proportion of patients experiencing major neurological recovery (adjusted odds ratio, 4.14 [1.18-14.4]; P=0.02). Simvastatin plus tissue-type plasminogen activator combination seems safe in acute stroke, with low rates of bleeding complications. Because of the low recruitment, the STARS trial was underpowered to detect differences in simvastatin efficacy. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01073007. © 2016 American Heart Association, Inc.
Blood Pressure Control and Risk of Stroke or Systemic Embolism in Patients With Atrial Fibrillation: Results From the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) Trial.
Rao, Meena P; Halvorsen, Sigrun; Wojdyla, Daniel; Thomas, Laine; Alexander, John H; Hylek, Elaine M; Hanna, Michael; Bahit, M Cecilia; Lopes, Renato D; De Caterina, Raffaele; Erol, Cetin; Goto, Shinya; Lanas, Fernando; Lewis, Basil S; Husted, Steen; Gersh, Bernard J; Wallentin, Lars; Granger, Christopher B
Patients with atrial fibrillation (AF) and hypertension are at high risk for stroke. Previous studies have shown elevated risk of stroke in patients with AF who have a history of hypertension (regardless of blood pressure [BP] control) and in patients with elevated BP. We assessed the association of hypertension and BP control on clinical outcomes. In ARISTOTLE (n=18 201), BP was evaluated as history of hypertension requiring treatment and elevated BP (systolic ≥140 and/or diastolic ≥90 mm Hg) at study entry and any point during the trial. Hazard ratios (HRs) were derived from Cox proportional hazards models including BP as a time-dependent covariate. A total of 15 916 (87.5%) patients had a history of hypertension requiring treatment. In patients with elevated BP measurement at any point during the trial, the rate of stroke or systemic embolism was significantly higher (HR, 1.53; 95% confidence interval [CI], 1.25-1.86), as was hemorrhagic stroke (HR 1.85; 95% CI, 1.26-2.72) and ischemic stroke (HR, 1.50; 95% CI, 1.18-1.90). Rates of major bleeding were lower in patients with a history of hypertension (HR, 0.80; 95% CI, 0.66-0.98) and nonsignificantly lower in patients with elevated BP at study entry (HR, 0.89; 95% CI, 0.77-1.03). The benefit of apixaban versus warfarin on preventing stroke or systemic embolism was consistent among patients with and without a history of hypertension (P interaction=0.27), BP control at baseline (P interaction=0.43), and BP control during the trial (P interaction=0.97). High BP measurement at any point during the trial was independently associated with a substantially higher risk of stroke or systemic embolism. These results strongly support efforts to treat elevated BP as an important strategy to optimally lower risk of stroke in patients with AF. URL: https://ClinicalTrials.gov/. Unique identifier: NCT00412984. © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.
van Mierlo, Maria; van Heugten, Caroline; Post, Marcel W M; Hoekstra, Trynke; Visser-Meily, Anne
PURPOSE: To identify trajectories of physical and psychosocial health-related quality of life (HRQoL) from two months to one-year post stroke and to determine the factors that are associated with trajectory membership. METHOD: Multicenter prospective cohort study in which 351 stroke patients were
Biermann, K; Hungerbühler, S; Kästner, S B R
The aim of this study was to assess agreement and repeatability of four ultrasound methods for measuring stroke volume (SV) and cardiac output (CO) in cats. Measurement of SV and CO was performed by the Teichholz method, the Simpson's method (SM), the area length method (ALM) and a volumetric flow method across the aorta (Trace method). For each method, the coefficient of variation (CV) was calculated and agreement was determined by Bland-Altman analysis. The CV was acceptable (parameters, except for SV and CO obtained by SM (28.8% and 22.4%, respectively) and ALM (21.6% and 22.6%, respectively). Narrow limits of agreement were observed between both planimetric methods (SM and ALM). The Trace method was the most repeatable, followed by the Teichholz method. Despite excellent inter-method agreement, neither of the planimetric methods produced results with adequate repeatability. As the Teichholz and Trace methods were acceptably repeatable, and probably gave the most representative values, they appear to be the most useful methods for the measurement of SV and CO in cats. Further investigations are needed to compare the echocardiographic methods described here with a standard technique such as thermodilution. Copyright © 2012. Published by Elsevier Ltd.
Karul, M.; Regier, M.; Heuer, R.
The diagnosis of acute urolithiasis results from unenhanced multidetector computed tomography (MDCT). This test analyses the functional and anatomical possibility for passing an ureteral calculi, the localization and dimension of which are important parameters for further therapy. Alternatively chronic urolithiasis could be ruled out by magnetic resonance urography (MRU). MRU is the first choice especially in pregnant women and children because of radiation hygiene. Enhanced MDCT must be emphasized as an alternative to intravenous urography (IVU) for diagnosis of complex drainage of urine and suspected disorder of the involved kidney. This review illustrates the principles of different tests and the clinical relevance thereof. (orig.)
Wendt, Matthias; Ebinger, Martin; Kunz, Alexander; Rozanski, Michal; Waldschmidt, Carolin; Weber, Joachim E; Winter, Benjamin; Koch, Peter M; Freitag, Erik; Reich, Jenrik; Schremmer, Daniel; Audebert, Heinrich J
Specialized management of patients with stroke is not available in all hospitals. We evaluated whether prehospital management in the Stroke Emergency Mobile (STEMO) improves the triage of patients with stroke. STEMO is an ambulance staffed with a specialized stroke team and equipped with a computed tomographic scanner and point-of-care laboratory. We compared the prehospital triage of patients with suspected stroke at dispatcher level who either received STEMO care or conventional care. We assessed transport destination in patients with different diagnoses. Status at hospital discharge was used as short-term outcome. From May 2011 to January 2013, 1804 of 6182 (29%) patients received STEMO care and 4378 of 6182 (71%) patients conventional care. Two hundred forty-five of 2110 (11.6%) patients with cerebrovascular events were sent to hospitals without Stroke Unit in conventional care when compared with 48 of 866 (5.5%; Pstroke, STEMO care reduced transport to hospitals without Stroke Unit from 10.1% (151 of 1497) to 3.9% (24 of 610; P<0.01). The delivery rate of patients with intracranial hemorrhage to hospitals without neurosurgery department was 43.0% (65 of 151) in conventional care and 11.3% (7 of 62) in STEMO care (P<0.01). There was a slight trend toward higher rates of patients discharged home in neurological patients when cared by STEMO (63.5% versus 60.8%; P=0.096). The triage of patients with cerebrovascular events to specialized hospitals can be improved by STEMO ambulances. http://www.clinicaltrials.gov. Unique identifier: NCT01382862. © 2015 American Heart Association, Inc.
Kober, G.; Lang, H.; Vallbracht, C.; Bussmann, W.D.; Hopf, R.; Kunkel, B.; Kaltenbach, M.
Transluminal coronary angioplasty (TCA) was introduced in 1977 for dilatation of coronary stenoses. From October 1977 to December 1984 1087 procedures have been performed in Frankfurt. The mean success rate was 77% with an increase from 58% to 84% since 1977. Recurrences were seen within the first year in 15% of the patients, which could be treated successfully in a high percentage with a second TCA. Emergency bypass operations were necessary in 5.2%. Four patients (fatality rate 0.37%) died as the consequence of the intervention. Within few years TCA has become an established procedure for myocardial revascularisation, with a high success rate. Major progress has been possible in the last few years due to technical developments, which are still going on. They may lead to further improvement of the results and enlargement of the indication for TCA. (orig.) [de
Qureshi, Adnan I; Chaudhry, Saqib A; Rodriguez, Gustavo J; Suri, M Fareed K; Lakshminarayan, Kamakshi; Ezzeddine, Mustapha A
BACKGROUND: The 'drip-and-ship' paradigm denotes a treatment regimen in patients in whom intravenous (IV) recombinant tissue plasminogen activator (rt-PA) is initiated at the emergency department (ED) of a community hospital, followed by transfer within 24 h to a comprehensive stroke center. Although the drip-and-ship paradigm has the potential to increase the number of patients who receive IV rt-PA, comparative outcomes have not been assessed at a population-based level. METHODS: Statewide estimates of thrombolysis, associated in-hospital outcomes, and hospitalization charges were obtained from 2008-2009 Minnesota Hospital Association data for all patients hospitalized with a primary diagnosis of ischemic stroke. Patients who were assigned the drip-and-ship code [International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) V45.88] were classified under the drip-and-ship paradigm. Patients who underwent thrombolysis (ICD-9-CM code 99.10) without drip-and-ship code were classified as primary ED arrival. Patient outcomes were analyzed after stratification into patients treated with IV rt-PA through primary ED arrival or drip-and-ship paradigm. RESULTS: Of the 21,024 admissions, 602 (2.86%) received IV rt-PA either through primary ED arrival (n = 473) or the drip-and-ship paradigm (n = 129). IV rt-PA was administered in 30 hospitals, of which 13 hospitals used the drip-and-ship paradigm; the number of patients treated with the drip-and-ship paradigm varied from 1 to 40 between the 13 hospitals. The rates of secondary intracerebral or subarachnoid hemorrhage were higher in patients treated with IV rt-PA through primary ED arrival compared with those treated with the drip-and-ship paradigm (8.5 vs. 3.1%, respectively; p = 0.038). The in-hospital mortality rate was similar among ischemic stroke patients receiving IV rt-PA through primary ED arrival or the drip-and-ship paradigm (5.9 vs. 7.0%, respectively). The mean hospital charges were USD
Triay, I.R.; Furlano, A.C.; Weaver, S.C.; Chipera, S.J.; Bish, D.L.
We used crushed-rock columns to study the sorption retardation of neptunium by zeolitic, devitrified, and vitric tuffs typical of those at the site of the potential high-level nuclear waste repository at Yucca Mountain, Nevada. We used two sodium bicarbonate waters (groundwater from Well J-13 at the site and water prepared to simulate groundwater from Well UE-25p No. 1) under oxidizing conditions. It was found that values of the sorption distribution coefficient, Kd, obtained from these column experiments under flowing conditions, regardless of the water or the water velocity used, agreed well with those obtained earlier from batch sorption experiments under static conditions. The batch sorption distribution coefficient can be used to predict the arrival time for neptunium eluted through the columns. On the other hand, the elution curves showed dispersivity, which implies that neptunium sorption in these tuffs may be nonlinear, irreversible, or noninstantaneous. As a result, use of a batch sorption distribution coefficient to calculate neptunium transport through Yucca Mountain tuffs would yield conservative values for neptunium release from the site. We also noted that neptunium (present as the anionic neptunyl carbonate complex) never eluted prior to tritiated water, which implies that charge exclusion does not appear to exclude neptunium from the tuff pores. The column experiments corroborated the trends observed in batch sorption experiments: neptunium sorption onto devitrified and vitric tuffs is minimal and sorption onto zeolitic tuffs decreases as the amount of sodium and bicarbonate/carbonate in the water increases
Full Text Available Purpose: This article considers the question if measurable improvements are achieved in the quality of care in stroke services by using a Breakthrough collaborative quality improvement model. Context of case: Despite the availability of explicit criteria, evidence based guidelines, national protocols and examples of best practices; stroke care in the Netherlands did not improve substantially yet. For that reason a national collaborative started in 2002 to improve integrated stroke care in 23 self selected stroke services. Data sources: Characteristics of sites, teams, aims and changes were assessed by using a questionnaire and monthly self-reports of teams. Progress in achieving significant quality improvement has been assessed on a five point Likert scale (IHI score. Case description: The stroke services (n=23 formed multidisciplinary teams, which worked together in a collaborative based on the IHI Breakthrough Series Model. Teams received instruction in quality improvement, reviewed self reported performance data, identified bottlenecks and improvement goals, and implemented “potentially better practices” based on criteria from the Edisse study, evidence based guidelines, own ideas and expert opinion. Conclusion and discussion: Quality of care has been improved in most participating stroke services. Eighty-seven percent of the teams have improved their care significantly on at least one topic. About 34% of the teams have achieved significant improvement on all aims within the time frame of the project. The project has contributed to the further development and spread of integrated stroke care in the Netherlands.
Gioia, Laura C; Kate, Mahesh; Sivakumar, Leka; Hussain, Dulara; Kalashyan, Hayrapet; Buck, Brian; Bussiere, Miguel; Jeerakathil, Thomas; Shuaib, Ashfaq; Emery, Derek; Butcher, Ken
Early anticoagulation after cardioembolic stroke remains controversial because of the potential for hemorrhagic transformation (HT). We tested the safety and feasibility of initiating rivaroxaban ≤14 days after cardioembolic stroke/transient ischemic attack. A prospective, open-label study of patients with atrial fibrillation treated with rivaroxaban ≤14 days of transient ischemic attack or ischemic stroke (National Institute of Health Stroke Scale stroke/18% transient ischemic attack) were enrolled. Median (interquartile range) time from onset to rivaroxaban was 3 (5) days. At treatment initiation, median National Institute of Health Stroke Scale was 2 (4), and median diffusion-weighted imaging volume was 7.9 (13.7) mL. At baseline, HT was present in 25 (42%) patients (hemorrhagic infarct [HI]1=19, HI2=6). On follow-up magnetic resonance imaging, no patients developed symptomatic HT. New asymptomatic HI1 developed in 3 patients, and asymptomatic progression from HI1 to HI2 occurred in 5 patients; otherwise, HT remained unchanged at day 7. These data support the safety of rivaroxaban initiation ≤14 days of mild-moderate cardioembolic stroke/transient ischemic attack. Magnetic resonance imaging evidence of petechial HT, which is common, does not appear to increase the risk of symptomatic HT. © 2016 American Heart Association, Inc.
Arboix, Adrià; Cartanyà, Anna; Lowak, Michael; García-Eroles, Luís; Parra, Olga; Oliveres, Montserrat; Massons, Joan
We assessed gender differences and women-specific secular trends in stroke. Data from 2318 women and 2274 men with first-ever stroke collected from the Sagrat Cor Hospital Stroke Registry of Barcelona between 1986 and 2009 were analyzed. Patient's age increased significantly from a mean of 74.5 years in 1986-1992 to 81.2 years in 2004-2009 (P 12 days) from 59.7% to 33.7% (P = 0.0001). Lacunar infarction was more frequent in men (21.5% vs. 16.2%, P = 0.0003) and cardioembolic infarction in women (26% vs. 15.6%, P = 0.0001). Acute stroke in women continues to be a severe disease with high risk of death in the immediate post-stroke phase (13.5%) and low probability of early full neurological recovery (13.9% vs. 11.8%, P = 0.029). Women differ from men in the distribution of risk factors and stroke subtype, stroke severity, and outcome. An increase in the patient's age, hypertension, atrial fibrillation and cardioembolic infarction, as well as a decrease mortality and length of hospitalization over a 24-year period was recorded. Copyright © 2014 Elsevier B.V. All rights reserved.
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.
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
Full Text Available Ischemic stroke (IS is a multifactorial disorder caused by both genetic and environmental factors. The combined effects of multiple susceptibility genes might result in a higher risk for IS than a single gene. Therefore, we investigated whether interactions among multiple susceptibility genes were associated with an increased risk of IS by evaluating gene polymorphisms identified in previous meta-analyses, including methylenetetrahydrofolate reductase (MTHFR C677T, beta fibrinogen (FGB, β-FG A455G and T148C, apolipoprotein E (APOE ε2-4, angiotensin-converting enzyme (ACE insertion/deletion (I/D, and endothelial nitric oxide synthase (eNOS G894T. In order to examine these interactions, 712 patients with IS and 774 controls in a Chinese Han population were genotyped using the SNaPshot method, and multifactor dimensionality reduction analysis was used to detect potential interactions among the candidate genes. The results of this study found that ACE I/D and β-FG T148C were significant synergistic contributors to IS. In particular, the ACE DD + β-FG 148CC, ACE DD + β-FG 148CT, and ACE ID + β-FG 148CC genotype combinations resulted in higher risk of IS. After adjusting for potential confounding IS risk factors (age, gender, family history of IS, hypertension history and history of diabetes mellitus using a logistic analysis, a significant correlation between the genotype combinations and IS patients persisted (overall stroke: adjusted odds ratio [OR] = 1.57, 95% confidence interval [CI]: 1.22-2.02, P < 0.001, large artery atherosclerosis subtype: adjusted OR = 1.50, 95% CI: 1.08-2.07, P = 0.016, small-artery occlusion subtype: adjusted OR = 2.04, 95% CI: 1.43-2.91, P < 0.001. The results of this study indicate that the ACE I/D and β-FG T148C combination may result in significantly higher risk of IS in this Chinese population.
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
Doig, D.; Turner, E. L.; Dobson, J.; Featherstone, R. L.; de Borst, G. J.; Stansby, G.; Beard, J. D.; Engelter, S. T.; Richards, T.; Brown, M. M.; Algra, A.; Bamford, J.; Beard, J.; Bland, M.; Bradbury, A. W.; Clifton, A.; Gaines, P.; Collins, R.; Molyneux, A.; Naylor, R.; Warlow, C.; Ferro, J. M.; Thomas, D.; Bonati, L. H.; Coward, L.; Ederle, J.; Featherstone, R. F.; Tindall, H.; McCabe, D. J.; Wallis, A.; Brooks, M.; Chambers, B.; Chan, A.; Chu, P.; Clark, D.; Dewey, H.; Donnan, G.; Fell, G.; Hoare, M.; Molan, M.; Roberts, A.; Roberts, N.; Beiles, B.; Bladin, C.; Clifford, C.; Grigg, M.; New, G.; Bell, R.; Bower, S.; Chong, W.; Holt, M.; Saunder, A.; Than, P. G.; Gett, S.; Leggett, D.; McGahan, T.; Quinn, J.; Ray, M.; Wong, A.; Woodruff, P.; Foreman, R.; Schultz, D.; Scroop, R.; Stanley, B.; Allard, B.; Atkinson, N.; Cambell, W.; Davies, S.; Field, P.; Milne, P.; Mitchell, P.; Tress, B.; Yan, B.; Beasley, A.; Dunbabin, D.; Stary, D.; Walker, S.; Cras, P.; d'Archambeau, O.; Hendriks, J. M.; van Schil, P.; St Blasius, A. Z.; Bosiers, M.; Deloose, K.; van Buggenhout, E.; de Letter, J.; Devos, V.; Ghekiere, J.; Vanhooren, G.; Astarci, P.; Hammer, F.; Lacroix, V.; Peeters, A.; Verbist, J.; Blair, J. F.; Caron, J. L.; Daneault, N.; Giroux, M. F.; Guilbert, F.; Lanthier, S.; Lebrun, L. H.; Oliva, V.; Raymond, J.; Roy, D.; Soulez, G.; Weill, A.; Hill, M.; Hu, W.; Hudion, M.; Morrish, W.; Sutherland, G.; Wong, J.; Albäck, A.; Harno, H.; Ijäs, P.; Kaste, M.; Lepäntalo, M.; Mustanoja, S.; Paananen, T.; Porras, M.; Putaala, J.; Railo, M.; Sairanen, T.; Soinne, L.; Vehmas, A.; Vikatmaa, P.; Goertler, M.; Halloul, Z.; Skalej, M.; Brennan, P.; Kelly, C.; Leahy, A.; Moroney, J.; Thornton, J.; Koelemay, M. J.; Nederkoorn, P. J.; Reekers, J. A.; Roos, Y. B.; Koudstaal, P. J.; Pattynama, P. M.; van der Lugt, A.; van Dijk, L. C.; van Sambeek, M. R.; van Urk, H.; Verhagen, H. J.; Bruijninckx, C. M.; de Bruijn, S. F.; Keunen, R.; Knippenberg, B.; Mosch, A.; Treurniet, F.; van Dijk, L.; van Overhagen, H.; Wever, J.; de Beer, F. C.; van den Berg, J. S.; van Hasselt, B. A.; Zeilstra, D. J.; Boiten, J.; van Otterloo, J. C.; de Vries, A. C.; Lycklama a Nijeholt, G. J.; van der Kallen, B. F.; Blankensteijn, J. D.; de Leeuw, F. E.; Kool, L. J.; van der Vliet, J. A.; de Kort, G. A.; Kapelle, L. J.; Lo, T. H.; Mali, W. P.; Moll, F.; van der Worp, H. B.; Verhagen, H.; Barber, P. A.; Bourchier, R.; Hill, A.; Holden, A.; Stewart, J.; Bakke, S. J.; Krohg-Sørensen, K.; Skjelland, M.; Tennøe, B.; Bialek, P.; Biejat, Z.; Czepiel, W.; Czlonkowska, A.; Dowzenko, A.; Jedrzejewska, J.; Kobayashi, A.; Lelek, M.; Polanski, J.; Kirbis, J.; Milosevic, Z.; Zvan, B.; Blasco, J.; Chamorro, A.; Macho, J.; Obach, V.; Riambau, V.; San Roman, L.; Branera, J.; Canovas, D.; Estela, J.; Gaibar, A. G.; Perendreu, J.; Björses, K.; Gottsater, A.; Ivancev, K.; Maetzsch, T.; Sonesson, B.; Berg, B.; Delle, M.; Formgren, J.; Gillgren, P.; Kall, T. B.; Konrad, P.; Nyman, N.; Takolander, R.; Andersson, T.; Malmstedt, J.; Soderman, M.; Wahlgren, C.; Wahlgren, N.; Binaghi, S.; Hirt, L.; Michel, P.; Ruchat, P.; Fluri, F.; Guerke, L.; Jacob, A. L.; Kirsch, E.; Lyrer, P. A.; Radue, E. W.; Stierli, P.; Wasner, M.; Wetzel, S.; Bonvin, C.; Kalangos, A.; Lovblad, K.; Murith, M.; Ruefenacht, D.; Sztajzel, R.; Higgins, N.; Kirkpatrick, P. J.; Martin, P.; Varty, K.; Adam, D.; Bell, J.; Crowe, P.; Gannon, M.; Henderson, M. J.; Sandler, D.; Shinton, R. A.; Scriven, J. M.; Wilmink, T.; D'Souza, S.; Egun, A.; Guta, R.; Punekar, S.; Seriki, D. M.; Thomson, G.; Brennan, J. A.; Enevoldson, T. P.; Gilling-Smith, G.; Gould, D. A.; Harris, P. L.; McWilliams, R. G.; Nahser, H. C.; White, R.; Prakash, K. G.; Serracino-Inglott, F.; Subramanian, G.; Symth, J. V.; Walker, M. G.; Clarke, M.; Davis, M.; Dixit, S. A.; Dorman, P.; Dyker, A.; Ford, G.; Golkar, A.; Jackson, R.; Jayakrishnan, V.; Lambert, D.; Lees, T.; Louw, S.; Macdonald, S.; Mendelow, A. D.; Rodgers, H.; Rose, J.; Wyatt, M.; Baker, T.; Baldwin, N.; Jones, L.; Mitchell, D.; Munro, E.; Thornton, M.; Baker, D.; Davis, N.; Hamilton, G.; McCabe, D.; Platts, A.; Tibballs, J.; Cleveland, T.; Dodd, D.; Lonsdale, R.; Nair, R.; Nassef, A.; Nawaz, S.; Venables, G.; Belli, A.; Cloud, G.; Halliday, A.; Markus, H.; McFarland, R.; Morgan, R.; Pereira, A.; Thompson, A.; Chataway, J.; Cheshire, N.; Gibbs, R.; Hammady, M.; Jenkins, M.; Malik, I.; Wolfe, J.; Adiseshiah, M.; Bishop, C.; Brew, S.; Brookes, J.; Jäger, R.; Kitchen, N.; Ashleigh, R.; Butterfield, S.; Gamble, G. E.; McCollum, C.; Nasim, A.; O'Neill, P.; Edwards, R. D.; Lees, K. R.; MacKay, A. J.; Moss, J.
Objectives: Carotid endarterectomy (CEA) is standard treatment for symptomatic carotid artery stenosis but carries a risk of stroke, myocardial infarction (MI), or death. This study investigated risk factors for these procedural complications occurring within 30 days of endarterectomy in the
Choe, C.-U.; Atzler, D.; Wild, P.S.; Carter, A.M.; B\\"oger, R.H.; Ojeda, F.; Simova, O.; Stockebrand, M.; Lackner, K.; Nabuurs, C.; Marescau, B.; Streichert, T.; M\\"uller, C.; L\\"uneburg, N.; Deyn, P.P. de; Benndorf, R.A.; Baldus, S.; Gerloff, C.; Blankenberg, S.; Heerschap, A.; Grant, P.J.; Magnus, T.; Zeller, T.; Isbrandt, D.; Schwedhelm, E.
Endogenous arginine homologues, including homoarginine, have been identified as novel biomarkers for cardiovascular disease and outcomes. Our studies of human cohorts and a confirmatory murine model associated the arginine homologue homoarginine and its metabolism in stroke pathology and
Willems, Mia; Schroder, Carin; van der Weijden, Trudy; Post, Marcel W.; Visser-Meily, Anne M.
Purpose: Although physical activity and exercise for stroke patients is highly recommended for fast recovery, patients in hospitals and rehabilitation centres are insufficiently encouraged to be physically active. In this study, we investigated the impact of knowledge brokers (KBs), enterprising
Abd. Rahni, Ashrani Aizzuddin; Arka, Israna Hossain; Chellappan, Kalaivani; Mukari, Shahizon Azura; Law, Zhe Kang; Sahathevan, Ramesh
In this paper we present preliminary results of comparison of automatic segmentations of the infarct core, between that obtained from CT perfusion (based on time to peak parameter) and diffusion weighted imaging (DWI). For each patient, the two imaging volumes were automatically co-registered to a common frame of reference based on an acquired CT angiography image. The accuracy of image registration is measured by the overlap of the segmented brain from both images (CT perfusion and DWI), measured within their common field of view. Due to the limitations of the study, DWI was acquired as a follow up scan up to a week after initial CT based imaging. However, we found significant overlap of the segmented brain (Jaccard indices of approximately 0.8) and the percentage of infarcted brain tissue from the two modalities were still fairly highly correlated (correlation coefficient of approximately 0.9). The results are promising with more data needed in future for clinical inference.
... 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 ...
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 ...
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.
Badr, Kamal F; Boudia, Khereddine M Merad; Alami, Mohamed; Khoja, Waleed A; Belhani, Ali B; Nawar, Moustafa; Ragy, Hany; Ishaq, Mohammad; Baron, J M Muscat; Hammoudeh, Ayman J; De Mar Youssef, Suzan S; Nakhle, Reine M; Chalfoun, Amale G
In the absence of reliable, contemporary national data, the ACTION survey was designed to: a) provide preliminary data on stroke risk in the MEA (Middle East and Africa); b) describe the contribution of specific cardiovascular risk factors; 3) assess blood pressure (BP) control. This was a multi-center observational study in nine countries in the MEA region. From 2003 to 2005, 562 physicians from a variety of specialties recorded observations of cardiovascular risk factors in 4,747 hypertensive patients, aged 54-80 years. The 10-year absolute stroke risk was calculated using a scoring system based on the Framingham Heart Study observations, and comparisons made with an age-matched cohort. The mean 10-year stroke risk was estimated at 22.7% and was significantly higher for men (25.4%) than for women (19.5%) (P age-matched Framingham cohort, the estimated stroke risk in our population was almost double, and was significantly higher for females (212%) than for males (192%) (P < .001). Hypertension, diabetes, left ventricular hypertrophy, and smoking were major contributing risk factors, as were physical inactivity and elevated cholesterol. Blood pressure was controlled in only 18% of the population and in 12% of diabetics. Physicians of all specialties were willing to participate in stroke risk assessment. The risk of stroke in hypertensive patients in the MEA region is high, and is higher than would be predicted using Framingham data, particularly for females. Hypertension appears to be poorly controlled in more than 80% of hypertensive patients in the MEA region.
Lebach, D. E.; Ratner, M. I.; Shapiro, I. I.; Bartel, N.; Bietenholz, M. F.; Lederman, J. I.; Ransom, R. R.; Campbell, R. M.; Gordon, D.; Lestrade, J.-F.
When very long baseline interferometry (VLBI) observations are used to determine the position or motion of a radio source relative to reference sources nearby on the sky, the astrometric information is usually obtained via (1) phase-referenced maps or (2) parametric model fits to measured fringe phases or multiband delays. In this paper, we describe a 'merged' analysis technique which combines some of the most important advantages of these other two approaches. In particular, our merged technique combines the superior model-correction capabilities of parametric model fits with the ability of phase-referenced maps to yield astrometric measurements of sources that are too weak to be used in parametric model fits. We compare the results from this merged technique with the results from phase-referenced maps and from parametric model fits in the analysis of astrometric VLBI observations of the radio-bright star IM Pegasi (HR 8703) and the radio source B2252+172 nearby on the sky. In these studies we use central-core components of radio sources 3C 454.3 and B2250+194 as our positional references. We obtain astrometric results for IM Peg with our merged technique even when the source is too weak to be used in parametric model fits, and we find that our merged technique yields astrometric results superior to the phase-referenced mapping technique. We used our merged technique to estimate the proper motion and other astrometric parameters of IM Peg in support of the NASA/Stanford Gravity Probe B mission.
Ozcan, Hakan; Yamin, Jehad A.A.
A computer simulation of a variable stroke length, LPG fuelled, four stroke, single cylinder, water cooled spark ignition engine was done. The engine capacity was varied by varying the stroke length of the engine, which also changed its compression ratio. The simulation model developed was verified with experimental results from the literature for both constant and variable stroke engines. The performance of the engine was simulated at each stroke length/compression ratio combination. The simulation results clearly indicate the advantages and utility of variable stroke engines in fuel economy and power issues. Using the variable stroke technique has significantly improved the engine's performance and emission characteristics within the range studied. The brake torque and power have registered an increase of about 7-54% at low speed and 7-57% at high speed relative to the original engine design and for all stroke lengths and engine speeds studied. The brake specific fuel consumption has registered variations from a reduction of about 6% to an increase of about 3% at low speed and from a reduction of about 6% to an increase of about 8% at high speed relative to the original engine design and for all stroke lengths and engine speeds studied. On the other hand, an increase of pollutants of about 0.65-2% occurred at low speed. Larger stroke lengths resulted in a reduction of the pollutants level of about 1.5% at higher speeds. At lower stroke lengths, on the other hand, an increase of about 2% occurred. Larger stroke lengths resulted in increased exhaust temperature and, hence, make the exhaust valve work under high temperature
Hacke, Werner; Schellinger, Peter D; Albers, Gregory W; Bornstein, Natan M; Dahlof, Bjorn L; Fulton, Rachael; Kasner, Scott E; Shuaib, Ashfaq; Richieri, Steven P; Dilly, Stephen G; Zivin, Justin; Lees, Kennedy R
On the basis of phase II trials, we considered that transcranial laser therapy could have neuroprotective effects in patients with acute ischemic stroke. We studied transcranial laser therapy in a double-blind, sham-controlled randomized clinical trial intended to enroll 1000 patients with acute ischemic stroke treated ≤24 hours after stroke onset and who did not undergo thrombolytic therapy. The primary efficacy measure was the 90-day functional outcome as assessed by the modified Rankin Scale, with hierarchical Bayesian analysis incorporating relevant previous data. Interim analyses were planned after 300 and 600 patients included. The study was terminated on recommendation by the Data Monitoring Committee after a futility analysis of 566 completed patients found no difference in the primary end point (transcranial laser therapy 140/282 [49.6%] versus sham 140/284 [49.3%] for good functional outcome; modified Rankin Scale, 0-2). The results remained stable after inclusion of all 630 randomized patients (adjusted odds ratio, 1.024; 95% confidence interval, 0.705-1.488). Once the results of the interim futility analysis became available, all study support was immediately withdrawn by the capital firms behind PhotoThera, and the company was dissolved. Proper termination of the trial was difficult but was finally achieved through special efforts by former employees of PhotoThera, the CRO Parexel and members of the steering and the safety committees. We conclude that transcranial laser therapy does not have a measurable neuroprotective effect in patients with acute ischemic stroke when applied within 24 hours after stroke onset. http://www.clinicaltrials.gov. Unique identifier: NCT01120301. © 2014 American Heart Association, Inc.
Li, Qi; Tian, Fu-Ling; Liu, Guo-Rong; Zheng, De-Song; Chen, Jin-Ming; Ma, Shu-Riang; Cui, Jian-Mei; Wang, Hong-Bin; Li, Xue-Qing
To compare the difference in the efficacy on gait time cycle of ischemic stroke between yin-yang respiratory reinforcing and reducing needling technique (yin-yang needling) and the conventional acupuncture. Sixty cases of ischemic stroke were randomized into a conventional acupuncture group and a yin-yang needling group, 30 cases in each one. The basic treatment (the control of blood pressure, blood sugar and blood lipid, the intravenous drops of ginkgo leaf extract and dipyridamole injection and vinpocetine injection) were applied in the two groups. Additionally, in the conventional acupuncture group, the acupoints of the Stomach Meridian of Foot-Yangming [Biguan (ST 31), Liangqiu (ST 34), Zusanli (ST 36), Shangjuxu (ST 37), Xiajuxu (ST 39), etc.] were selected and stimulated with the even needling technique. In the yin-yang needling group, the acupoints of yin meridians such as Zuwuli (LR 10), Xuehai (SP 10), Yinlingquan (SP 9) and Sanyinjiao (SP 6), etc. and the acupoints of yang meridians such as Biguan (ST 31), Liangqiu (ST 34) and Yanglingquan (GB 34), etc. were selected. The reducing manipulation of respiratory reinforcing and reducing technique was applied to the acupoints of yin meridians and the reinforcing manipulation was applied to the acupoints of yang meridians. The kinematics time parameters were determined and compared before and 4 weeks after treatment. After treatment, the differences in the gait cycle, the phase time of standing (%), the phase time of single support (%), the phase time of unilateral sway (%) on the affected (healthy) foot and phase time of double support (%) were significant as compared with those before treatment in the patients of the two groups (all P yin-yang needling group were improved much obviously after treatment as compared with those in the conventional acupuncture group. The differences in support phase time (%), single support phase time (%) and sway phase time (%) were significant between the affected limb and
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.
Full Text Available Stavroula Raptis,1,* Jia Ning Chen,2,* Florencia Saposnik,2 Roman Pelyavskyy,2 Andrew Liuni,3 Gustavo Saposnik2,4 On behalf of the Stroke Outcomes Research Canada Working Group (SORCan- www.sorcan.ca 1Applied Health Research Centre, Li Ka Shing Knowledge Institute, 2Stroke Outcomes and Decision Neuroscience Research Unit, Department of Medicine, St. Michael’s Hospital, University of Toronto, Toronto, 3Medical Department, Boehringer Ingelheim (Canada Ltd., Burlington, ON, Canada; 4Neuroeconomics and Decision Neuroscience, Department of Economics, University of Zurich, Zurich, Switzerland *These authors contributed equally to this work Background: Anticoagulation is the therapeutic paradigm for stroke prevention in patients with atrial fibrillation (AF. It is unknown how physicians make treatment decisions in primary stroke prevention for patients with AF. Objectives: To evaluate the association between family physicians’ risk preferences (aversion risk and ambiguity and therapeutic recommendations (anticoagulation in the management of AF for primary stroke prevention by applying concepts from behavioral economics. Methods: Overall, 73 family physicians participated and completed the study. Our study comprised seven simulated case vignettes, three behavioral experiments, and two validated surveys. Behavioral experiments and surveys incorporated an economic framework to determine risk preferences and biases (e.g., ambiguity aversion, willingness to take risks. The primary outcome was making the correct decision of anticoagulation therapy. Secondary outcomes included medical errors in the management of AF for stroke prevention. Results: Overall, 23.3% (17/73 of the family physicians elected not to escalate the therapy from antiplatelets to anticoagulation when recommended by best practice guidelines. A total of 67.1% of physicians selected the correct therapeutic options in two or more of the three simulated case vignettes. Multivariate
Full Text Available This study examines which therapists are involved in the rehabilitation of stroke survivors in Belgium at different points in time. A nationwide registration of stroke patients was provided by 199 and 189 family physicians working in sentinel practices for the years 2009 and 2010 respectively. 326 patients who were diagnosed with stroke were included. Patients with paralysis/paresis received significant more physiotherapy after one month (63% compared to non-paralysed patients (38% (P=0.005. Residing in a nursing home was associated with higher proportions of patients receiving physiotherapy, both after one (P=0.003 and six (P=0.002 months. 31% of patients with aphasia were treated by a speech and language therapist after one month, which decreased after six months to 20%. After six months, the patients in a nursing home received significant more often speech and language therapy (P=0.004, compared to patients living at home. The proportion of patients receiving stroke rehabilitation services provided by physiotherapists, speech/language therapists and occupational therapists is rather low, especially 6 months after the critical event.
Street, Alexander J; Magee, Wendy L; Bateman, Andrew; Parker, Michael; Odell-Miller, Helen; Fachner, Jorg
To assess the feasibility of a randomized controlled trial to evaluate music therapy as a home-based intervention for arm hemiparesis in stroke. A pilot feasibility randomized controlled trial, with cross-over design. Randomization by statistician using computer-generated, random numbers concealed in opaque envelopes. Participants' homes across Cambridgeshire, UK. Eleven people with stroke and arm hemiparesis, 3-60 months post stroke, following discharge from community rehabilitation. Each participant engaged in therapeutic instrumental music performance in 12 individual clinical contacts, twice weekly for six weeks. Feasibility was estimated by recruitment from three community stroke teams over a 12-month period, attrition rates, completion of treatment and successful data collection. Structured interviews were conducted pre and post intervention to establish participant tolerance and preference. Action Research Arm Test and Nine-hole Peg Test data were collected at weeks 1, 6, 9, 15 and 18, pre and post intervention by a blinded assessor. A total of 11 of 14 invited participants were recruited (intervention n = 6, waitlist n = 5). In total, 10 completed treatment and data collection. It cannot be concluded whether a larger trial would be feasible due to unavailable data regarding a number of eligible patients screened. Adherence to treatment, retention and interview responses might suggest that the intervention was motivating for participants. ClinicalTrials.gov identifier NCT 02310438.
Steinberg, Benjamin A.; Hellkamp, Anne S.; Lokhnygina, Yuliya; Patel, Manesh R.; Breithardt, Günter; Hankey, Graeme J.; Becker, Richard C.; Singer, Daniel E.; Halperin, Jonathan L.; Hacke, Werner; Nessel, Christopher C.; Berkowitz, Scott D.; Mahaffey, Kenneth W.; Fox, Keith A.A.; Califf, Robert M.; Piccini, Jonathan P.
Aim Anticoagulation prophylaxis for stroke is recommended for at-risk patients with either persistent or paroxysmal atrial fibrillation (AF). We compared outcomes in patients with persistent vs. paroxysmal AF receiving oral anticoagulation. Methods and results Patients randomized in the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET-AF) trial (n = 14 264) were grouped by baseline AF category: paroxysmal or persistent. Multivariable adjustment was performed to compare thrombo-embolic events, bleeding, and death between groups, in high-risk subgroups, and across treatment assignment (rivaroxaban or warfarin). Of 14 062 patients, 11 548 (82%) had persistent AF and 2514 (18%) had paroxysmal AF. Patients with persistent AF were marginally older (73 vs. 72, P = 0.03), less likely female (39 vs. 45%, P < 0.0001), and more likely to have previously used vitamin K antagonists (64 vs. 56%, P < 0.0001) compared with patients with paroxysmal AF. In patients randomized to warfarin, time in therapeutic range was similar (58 vs. 57%, P = 0.94). Patients with persistent AF had higher adjusted rates of stroke or systemic embolism (2.18 vs. 1.73 events per 100-patient-years, P = 0.048) and all-cause mortality (4.78 vs. 3.52, P = 0.006). Rates of major bleeding were similar (3.55 vs. 3.31, P = 0.77). Rates of stroke or systemic embolism in both types of AF did not differ by treatment assignment (rivaroxaban vs. warfarin, Pinteraction = 0.6). Conclusion In patients with AF at moderate-to-high risk of stroke receiving anticoagulation, those with persistent AF have a higher risk of thrombo-embolic events and worse survival compared with paroxysmal AF. PMID:25209598
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
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...
Cassoudesalle, H; Nozères, A; Petit, H; Cressot, V; Muller, F; Rouanet, F; Sibon, I; Joseph, P-A; Dehail, P
The main objective of this study was to describe the distribution of referrals offered to patients assessed in the "Post-Acute Stroke program" of Bordeaux University Hospital (France). This program was developed in 2008 to organize the dispensation of care in rehabilitation units specialized in neurological diseases. This was a single-centre observational study. Between July 2008 and December 2012, data on the number of stroke patients hospitalized at the Bordeaux University Hospital and their post-acute referral were collected from the local hospital discharge database. Some of these patients were assessed by Physical Rehabilitation and Medicine physicians participating in the program. Proposed and actual referrals, time from admission to assessment and functional status were also collected. Among 4189 stroke patients, 1465 (35%) survivors were assessed, of whom 932 (22.2%) were discharged to inpatient rehabilitation facilities. There were no patients discharged to this type of unit without an assessment. Among the 1465 patients who were assessed, 57.2% were referred to specialized rehabilitation units, 6.3% were discharged to non-specialized rehabilitation units and 26% returned home directly. The median total length of stay in acute units varied from 10 to 15days depending on referral orientation. Patients that were assessed were more likely to be transferred to specialized rehabilitation units than to non-specialized rehabilitation units. The Post-Acute Stroke program has the particularity of combining private and public specialized rehabilitation units in a common collaborative referral system while retaining the control and flexibility of personalised referral for each patient in the light of local care availability. Copyright © 2016 Elsevier Masson SAS. All rights reserved.
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.
Molteni, Franco; Gasperini, Giulio; Gaffuri, Marina; Colombo, Maria; Giovanzana, Chiara; Lorenzon, Chiara; Farina, Nico; Cannaviello, Giovanni; Scarano, Stefano; Proserpio, Davide; Liberali, Davide; Guanziroli, Eleonora
Recovery of therapeutic or functional ambulatory capacity in post-stroke patients is a primary goal of rehabilitation. Wearable powered exoskeletons allow patients with gait dysfunctions to perform over-ground gait training, even immediately after the acute event. To investigate the feasibility and the clinical effects of an over-ground walking training with a wearable powered exoskeleton in sub-acute and chronic stroke patients. Prospective, pilot pre-post, open label, non-randomized experimental study. A single neurological rehabilitation center for inpatients and outpatients. Twenty-three post-stroke patients were enrolled: 12 sub-acute (mean age: 43.8±13.3 years, 5 male and 7 female, 7 right hemiparesis and 5 left hemiparesis) and 11 chronic (mean age: 55.5±15.9 years, 7 male and 4 female, 4 right hemiparesis and 7 left hemiparesis) patients. Patients underwent 12 sessions (60 min/session, 3 times/week) of walking rehabilitation training using Ekso™, a wearable bionic suit that enables individuals with lower extremity disabilities and minimal forearm strength to stand up, sit down and walk over a flat hard surface with a full weight-bearing reciprocal gait. Clinical evaluations were performed at the beginning of the training period (t0), after 6 sessions (t1) and after 12 sessions (t2) and were based on the Ashworth scale, Motricity Index, Trunk Control Test, Functional Ambulation Scale, 10-Meter Walking Test, 6-Minute Walking Test, and Walking Handicap Scale. Wilcoxon's test (PScale, 10-meter walking test, and 6-minute walking test. Sub-acute patients achieved statistically significant improvement in Trunk Control Test and Walking Handicap Scale at t0-t2. Sub-acute and chronic patient did not achieve significant improvement in Ashworth scale at t0-t2. Twelve sessions of over-ground gait training using a powered wearable robotic exoskeleton improved ambulatory functions in sub-acute and chronic post-stroke patients. Large, randomized multicenter studies are
Cassidy, J David; Boyle, Eleanor; Côté, Pierre; He, Yaohua; Hogg-Johnson, Sheilah; Silver, Frank L; Bondy, Susan J
Population-based, case-control and case-crossover study. To investigate associations between chiropractic visits and vertebrobasilar artery (VBA) stroke and to contrast this with primary care physician (PCP) visits and VBA stroke. Chiropractic care is popular for neck pain and headache, but may increase the risk for VBA dissection and stroke. Neck pain and headache are common symptoms of VBA dissection, which commonly precedes VBA stroke. Cases included eligible incident VBA strokes admitted to Ontario hospitals from April 1, 1993 to March 31, 2002. Four controls were age and gender matched to each case. Case and control exposures to chiropractors and PCPs were determined from health billing records in the year before the stroke date. In the case-crossover analysis, cases acted as their own controls. There were 818 VBA strokes hospitalized in a population of more than 100 million person-years. In those aged VBA stroke in those older than 45 years. Positive associations were found between PCP visits and VBA stroke in all age groups. Practitioner visits billed for headache and neck complaints were highly associated with subsequent VBA stroke. VBA stroke is a very rare event in the population. The increased risks of VBA stroke associated with chiropractic and PCP visits is likely due to patients with headache and neck pain from VBA dissection seeking care before their stroke. We found no evidence of excess risk of VBA stroke associated chiropractic care compared to primary care.
Full Text Available Background and Purpose. BM-MNC transplantation improves recovery in experimental models of ischemic stroke. Clinical trials are ongoing to test efficacy in stroke patients. However, whether cell dose is related to outcomes is not known. Methods. We performed a pooling data analysis of two pilot clinical trials with autologous BM-MNCs transplantation in ischemic stroke patients. Cell dose and route were analyzed to evaluate their relation to good outcome (m-Rankin scale [mRS] score 0–2 at 6 months. Results. Twenty-two patients were included. A median of 153 × 106 (±121 × 106 BM-MNCs was injected. Intra-arterial route was used in 77.3% of cases. A higher number of cells injected were associated with better outcomes at 180 days (390 × 106 [320–422] BM-MNCs injected in those patients with mRS of 0–2 at 6 months versus 130 × 106 [89–210] in those patients with mRS 3–6, p=0.015. In the intra-arterially treated patients, a strong correlation between dose of cells and disability was found (r=-0.63, p=0.006. A cut point of 310 × 106 injected cells predicted good outcome with 80% sensitivity and 88.2% specificity. Conclusions. Similar to preclinical studies, a higher dose of autologous BM-MNC was related to better outcome in stroke patients, especially when more than 310 × 106 cells are injected. Further interventional studies are warranted to confirm these data.
Full Text Available BACKGROUND: Regenerative strategies in the treatment of acute stroke may have great potential. Hematopoietic growth factors mobilize hematopoietic stem cells and may convey neuroprotective effects. We examined the safety, potential functional and structural changes, and CD34(+ cell-mobilization characteristics of G-CSF treatment in patients with acute ischemic stroke. METHODS AND RESULTS: Three cohorts of patients (8, 6, and 6 patients per cohort were treated subcutaneously with 2.5, 5, or 10 µg/kg body weight rhG-CSF for 5 consecutive days within 12 hrs of onset of acute stroke. Standard treatment included i.v. thrombolysis. Safety monitoring consisted of obtaining standardized clinical assessment scores, monitoring of CD34(+ stem cells, blood chemistry, serial neuroradiology, and neuropsychology. Voxel-guided morphometry (VGM enabled an assessment of changes in the patients' structural parenchyma. 20 patients (mean age 55 yrs were enrolled in this study, 5 of whom received routine thrombolytic therapy with r-tPA. G-CSF treatment was discontinued in 4 patients because of unrelated adverse events. Mobilization of CD34(+ cells was observed with no concomitant changes in blood chemistry, except for an increase in the leukocyte count up to 75,500/µl. Neuroradiological and neuropsychological follow-up studies did not disclose any specific G-CSF toxicity. VGM findings indicated substantial atrophy of related hemispheres, a substantial increase in the CSF space, and a localized increase in parenchyma within the ischemic area in 2 patients. CONCLUSIONS: We demonstrate a good safety profile for daily administration of G-CSF when begun within 12 hours after onset of ischemic stroke and, in part in combination with routine i.v. thrombolysis. Additional analyses using VGM and a battery of neuropsychological tests indicated a positive functional and potentially structural effect of G-CSF treatment in some of our patients. TRIAL REGISTRATION: German
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Miyoshi, Tasuku; Takahashi, Yoshiyuki; Lee, Hokyoo; Suzuki, Tadashi; Komeda, Takashi
Muscular co-contraction resulted in corrected elbow and shoulder joint stiffness; however, this correction neither ameliorated endpoint oscillation nor assisted in the execution of smooth two-joint arm movements. We hypothesised that the reacquisition of smooth arm movements became synonymous with the restoration of time-domain reciprocal electromyographic (EMG) activities in biarticular arm muscles. The purpose of this study was to investigate whether or not the restored reciprocal EMG activities in biarticular arm muscles reflected improved smooth motor performance in patients with stroke after 10 days of two-joint arm-movement training. Three male patients with sub-acute stroke with left-arm paralysis performed circle-drawing tasks using a haptic device system for upper limb neuromuscular rehabilitation. After the training, the movement velocities and achievement periods increased with the enhancement of the reciprocal EMG activities in biarticular arm muscles, and there was less jerkness in movement after training for the same duration. Patients with stroke could achieve smooth motor performance with the restoration of the reciprocal EMG activities in biarticular arm muscles. Therefore, the reciprocal EMG activities in biarticular arm muscles in response to circle drawing would be an index for the progressive improvements of smooth motor functions in the upper limbs.
Picelli, Alessandro; Lobba, Davide; Midiri, Alessandro; Prandi, Paolo; Melotti, Camilla; Baldessarelli, Silvia; Smania, Nicola
To compare the outcome of manual needle placement, electrical stimulation and ultrasonography-guided techniques for botulinum toxin injection into the forearm muscles of adults with arm spasticity. Randomized controlled trial. University hospital. Sixty chronic stroke patients with wrist and fingers spasticity. After randomization into three groups, each patient received botulinum toxin type A in at least two of these muscles: flexor carpi radialis and ulnaris, flexor digitorum superficialis and profundus (no fascicles selection). The manual needle placement group underwent injections using palpation; the electrical stimulation group received injections with electrical stimulation guidance; the ultrasonography group was injected under sonographic guidance. A sole injector was used. All patients were evaluated at baseline and four weeks after injection. Modified Ashworth Scale; Tardieu Scale; wrist and fingers passive range of motion. One month after injection, Modified Ashworth Scale scores improved more in the electrical stimulation group than the manual needle placement group (wrist: P = 0.014; fingers: P = 0.011), as well as the Tardieu angle (wrist: P = 0.008; fingers: P = 0.015) and passive range of motion (wrist: P = 0.004). Furthermore, Modified Ashworth Scale scores improved more in the ultrasonography group than in the manual needle placement group (wrist: P = 0.001; fingers: P = 0.003), as well as the Tardieu angle (wrist: P = 0.010; fingers: P = 0.001) and passive range of motion (wrist: P < 0.001; proximal interphalangeal joints: P = 0.009). No difference was found between the ultrasonography and electrical stimulation groups. Instrumental guidance may improve the outcome of botulinum toxin injections into the spastic forearm muscles of stroke patients.
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
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
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.
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.
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
Tattersall, R.B.; Small, V.G.; MacBean, I.J.; Howe, W.D.
The techniques used in making reactivity change measurements on HECTOR are described and discussed. Pile period measurements were used in the majority of oases, though the pile oscillator technique was used occasionally. These two methods are compared. Flux determinations were made in the vicinity of the fuel element samples using manganese foils, and the techniques used are described and an error assessment made. Results of both reactivity change and flux measurements on 1.2 in. diameter uranium and plutonium-uranium alloy fuel elements are presented, these measurements being carried out in a variety of graphite moderated lattices at temperatures up to 450 deg. C. (author)
Vogl, T.J.; Mueller, P.K.; Mack, M.G.; Straub, R.; Engelmann, K. [Dept. of Radiology, Univ. of Frankfurt (Germany); Neuhaus, P. [Dept. of Surgery, Humboldt University of Berlin (Germany)
The liver is the most common site of metastatic tumour deposits. Hepatic metastases are the major cause of morbidity and mortality in patients with gastrointestinal carcinomas and other malignant tumours. The rationale and results for interventional therapeutic techniques in the treatment of liver metastases are presented. For the treatment of patients with irresectable liver metastases, alternative local ablative therapeutic modalities have been developed. Technique and results of local interventional therapies are presented such as microwave-, radiofrequency (RF)- and ultrasound ablation, and laser-induced interstitial therapy (LITT), cryotherapy and local drug administration such as alcohol injection, endotumoral chemotherapy and regional chemoembolisation. In addition to cryotherapy, all ablative techniques can be performed percutaneously with low morbidity and mortality. Cryotherapy is an effective and precise technique for inducing tumour necrosis, but it is currently performed via laparotomy. Percutaneous local alcohol injection results in an inhomogeneous distribution in liver metastases with unreliable control rates. Local chemotherapeutic drug instillation and regional chemoembolisation produces relevant but non-reproducible lesions. Laser-induced interstitial thermotherapy (LITT) performed under MRI guidance results in precise and reproducible areas of induced necrosis with a local control of 94 %, and with an improved survival rate. Interventional therapeutic techniques of liver metastases do result in a remarkable local tumour control rate with improved survival results. (orig.) With 5 figs., 1 tab., 43 refs.
Vogl, T.J.; Mueller, P.K.; Mack, M.G.; Straub, R.; Engelmann, K.; Neuhaus, P.
The liver is the most common site of metastatic tumour deposits. Hepatic metastases are the major cause of morbidity and mortality in patients with gastrointestinal carcinomas and other malignant tumours. The rationale and results for interventional therapeutic techniques in the treatment of liver metastases are presented. For the treatment of patients with irresectable liver metastases, alternative local ablative therapeutic modalities have been developed. Technique and results of local interventional therapies are presented such as microwave-, radiofrequency (RF)- and ultrasound ablation, and laser-induced interstitial therapy (LITT), cryotherapy and local drug administration such as alcohol injection, endotumoral chemotherapy and regional chemoembolisation. In addition to cryotherapy, all ablative techniques can be performed percutaneously with low morbidity and mortality. Cryotherapy is an effective and precise technique for inducing tumour necrosis, but it is currently performed via laparotomy. Percutaneous local alcohol injection results in an inhomogeneous distribution in liver metastases with unreliable control rates. Local chemotherapeutic drug instillation and regional chemoembolisation produces relevant but non-reproducible lesions. Laser-induced interstitial thermotherapy (LITT) performed under MRI guidance results in precise and reproducible areas of induced necrosis with a local control of 94 %, and with an improved survival rate. Interventional therapeutic techniques of liver metastases do result in a remarkable local tumour control rate with improved survival results. (orig.)
Dabigatran etexilate is licensed for use in prevention of deep venous thromboembolism and in prevention of stroke and systemic embolism in nonvalvular atrial fibrillation (AF). It has also been used in patients for other indications as a substitute for warfarin therapy because it requires no monitoring; one group being patients undergoing radiofrequency (RF), ablation for AF, although there have been no consensus guidelines with regards to dosage and timing of dose. We report the case of a patient with documentary evidence of left atrial appendage (LAA) thrombus formation and neurological sequelae post-RF ablation despite being on dabigatran. This case highlights the concern that periprocedural dabigatran may not provide adequate protection from development of LAA thrombus and that a standardised protocol will need to be developed and undergo large multicentre trials before dabigatran can be safely used for patients undergoing RF-ablation.
Ramírez-Fernández, Cristina; Morán, Alberto L; García-Canseco, Eloísa; Gómez-Montalvo, Jorge R
1) To enhance the content of an ontology for designing virtual environments (VEs) for upper limb motor rehabilitation of stroke patients according to the suggestions and comments of rehabilitation specialists and software developers, 2) to characterize the perceived importance level of the ontology, 3) to determine the perceived usefulness of the ontology, and 4) to identify the safety characteristics of the ontology for VEs design according to the rehabilitation specialists. Using two semi-structured Web questionnaires, we asked six rehabilitation specialists and six software developers to provide us with their perception regarding the level of importance and the usability of the ontology. From their responses we have identified themes related to perceived and required safety characteristics of the ontology. Significant differences in the importance level were obtained for the Stroke Disability, VE Configuration, Outcome Measures, and Safety Calibration classes, which were perceived as highly important by rehabilitation specialists. Regarding usability, the ontology was perceived by both groups with high usefulness, ease of use, learnability and intention of use. Concerning the thematic analysis of recommendations, eight topics for safety characteristics of the ontology were identified: adjustment of therapy strategies; selection and delimitation of movements; selection and proper calibration of the interaction device; proper selection of measuring instruments; gradual modification of the difficulty of the exercise; adaptability and variability of therapy exercises; feedback according to the capabilities of the patient; and real-time support for exercise training. The rehabilitation specialists and software developers confirmed the importance of the information contained in the ontology regarding motor rehabilitation of the upper limb. Their recommendations highlight the safety features and the advantages of the ontology as a guide for the effective design of VEs.
Full Text Available The sample of the tested people involves 128 swimmers, who were 11-18-year-old and who took part in the fi nal at SAD national competition in 2004-2005. The sample of the variables relates to the result realization of the swimming the techniques: freestyle-crawl, butterfl y, backstroke and breaststroke at 100 and 200 m. The aim of the study is to defi ne the comparison of the results of 11-18-yearold swimmers swimming the techniques: freestyle-crawl, butterfl y, backstroke and breaststroke at 100 and 200 m.
Walsh, Mary Elizabeth; Galvin, Rose; Loughnane, Cliona; Macey, Chris; Horgan, N Frances
Acute stroke care continues to improve but the later stroke recovery phase remains less well understood. The aim of this study was to document self-reported need in relation to stroke recovery and community re-integration among community-dwelling persons up to five years post-stroke. A national survey was carried out in Ireland. Participants were recruited through stroke advocacy organisations and health professionals. Existing validated questionnaires were adapted with permission. The final questionnaire assessed respondents' perceptions of their community re-integration and on-going needs. A total of 196 stroke survivors, aged 24-89 years responded. Over 75% of respondents reported experiencing mobility, emotional, fatigue and concentration difficulties post-stroke. Emotional problems and fatigue demonstrated the highest levels of unmet need. Families provided much support with 52% of people needing help with personal care post-stroke. Forty-two per cent of respondents in a relationship felt that it was significantly affected by their stroke. In addition, 60% of respondents reported negative financial change. Only 23% of those <66 years had worked since their stroke, while 60% of drivers returned to driving. Stroke had a personal, social and economic impact. Emotional distress and fatigue were common and satisfaction with the help available for these problems was poor. Implications for Rehabilitation Professionals should recognise that family members provide high levels of support post-stroke while dealing with changes to personal relationships. Emotional, concentration and fatigue problems post-stroke require recognition by health professionals. A greater focus on return-to-work as part of stroke rehabilitation may be of value for patients of working age.
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.
Hansson, B.M.; Bleichrodt, R.P.; Hingh, I.H.J.T. de
INTRODUCTION: Parastomal herniation is a common complication of stoma formation, and its operative treatment is notoriously difficult. Recently we have reported the promising short-term results of a keyhole technique in which a Gore-Tex Dual Mesh with a central keyhole is laparoscopically fashioned
Abu Hilal, M.; Richardson, J. R. C.; de Rooij, T.; Dimovska, E.; Al-Saati, H.; Besselink, M. G.
Laparoscopic left pancreatectomy has been well described for benign pancreatic lesions, but its role in pancreatic adenocarcinoma remains open to debate. We report our results adopting a laparoscopic technique that obeys established oncologic principles of open distal pancreatosplenectomy. This is a
Turtzo, L Christine; McCullough, Louise D
Stroke is a sexually dimorphic disease, with differences between males and females observed both clinically and in the laboratory. While males have a higher incidence of stroke throughout much of the lifespan, aged females have a higher burden of stroke. Sex differences in stroke result from a combination of factors, including elements intrinsic to the sex chromosomes as well as the effects of sex hormone exposure throughout the lifespan. Research investigating the sexual dimorphism of stroke...
Frazee, Bradley W; Enriquez, Kayla; Ng, Valerie; Alter, Harrison
Voided urinalysis to test for urinary tract infection (UTI) is prone to false-positive results for a number of reasons. Specimens are often collected at triage from women with any abdominal complaint, creating a low UTI prevalence population. Improper collection technique by the patient may affect the result. At least four indices, if positive, can indicate UTI. We examine the impact of voided specimen collection technique on urinalysis indicators of UTI and on urine culture contamination in disease-free women. In this crossover design, 40 menstrual-age female emergency department staff without UTI symptoms collected urine two ways: directly in a cup ("non-clean") and midstream clean catch ("ideal"). Samples underwent standard automated urinalysis and culture. Urinalysis indices and culture contamination were compared. The proportion of abnormal results from samples collected by "non-clean" vs. "ideal" technique, respectively, were: leukocyte esterase (>trace) 50%, 35% (95% confidence interval for difference -6% to 36%); nitrites (any) 2.5%, 2.5% (difference -2.5 to 2.5%); white blood cells (>5/high-powered field [HPF]) 50%, 27.5% (difference 4 to 41%); bacteria (any/HPF) 77.5%, 62.5%, (difference -7 to 37%); epithelial cells (>few) 65%, 30% (difference 13 to 56%); culture contamination (>1000 colony-forming units of commensal or >2 species) 77%, 63% (difference -5 to 35%). No urinalysis index was positively correlated with culture contamination. Contemporary automated urinalysis indices were often abnormal in a disease-free population of women, even using ideal collection technique. In clinical practice, such false-positive results could lead to false-positive UTI diagnosis. Only urine nitrite showed a high specificity. Culture contamination was common regardless of collection technique and was not predicted by urinalysis results. Copyright © 2015 Elsevier Inc. All rights reserved.
Huh, Gil Cha; Suh, Hyun Suk; Lee, Hyuk Sang; Kim, Re Hwe; Kim, Chul Soo; Kim, Hong Yong; Kim, Sung Rok
Purpose : To evaluate the potential advantage for 'sandwich' technique radiotherapy compared to postoperative radiotherapy in respectable rectal cancer. Between January 1989 and May 1994, 60 patients with respectable rectal cancer were treated at Inje University Seoul and Sanggye Paik Hospital.Fifty one patients were available for analysis : 20 patients were treated with sandwich technique radiotherapy and 31 patients were treated with postoperative radiotherapy. In sandwich technique radiotherapy(RT), patients were treated with preoperative RT 1500 cGy/5fx followed by immediate curative resection. Patients staged as Astler-Coller B2, C were considered for postoperative RT with 2500-4500 cGy. In postoperative RT, total radiation dose of 4500-6120 cGy, 180 cGy daily at 4-6 weeks was delivered. Patients were followed for median period of 25 months. Results : The overall 5-year survival rates for sandwich technique RT group and postoperative RT group were 60% and 71%, respectively(p>0.05). The 5-year disease free survival rates for each group were 63%. There was no difference in local failure rate between two groups(11% versus 7%). Incidence of distant metastasis was 11%(2/20) in the sandwich technique RT group and 20%(6/31) in the postoperative RT group(p>0.05). The frequencies of acute and chronic complications were comparable in both groups. Conclusion : The sandwich technique radiotherapy group shows local recurrence and survival similar to those of postoperative RT alone group but reduced distant metastasis compared to postoperative RT group. But long term follow-up and large number of patients is needed to make an any firm conclusion regarding the value of this sandwich technique RT
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 ...
Bruners, P.; Penzkofer, T. [Lehrstuhl fuer Angewandte Medizintechnik, Helmholtz Inst. fuer Biomedizinische Technik, RWTH Aachen (Germany); Guenther, R. W.; Mahnken, A. [Klinik fuer Radiologische Diagnostik, Universitaetsklinikum RWTH Aachen (Germany)
Purpose: Osteoid osteoma is a benign primary bone tumor that typically occurs in children and young adults. Besides local pain, which is often worse at night, prompt relief due to medication with acetylsalicylic acid (ASS) is characteristic for this bone lesion. Because long-term medication with ASS does not represent an alternative treatment strategy due to its potentially severe side effects, different minimally invasive image-guided techniques for the therapy of osteoid osteoma have been developed. In this context radiofrequency (RF) ablation in particular has become part of the clinical routine. The technique and results of image-guided RF ablation are compared to alternative treatment strategies. Materials and Methods: Using this technique, an often needle-shaped RF applicator is percutaneously placed into the tumor under image guidance. Then a high-frequency alternating current is applied by the tip of the applicator which leads to ionic motion within the tissue resulting in local heat development and thus in thermal destruction of the surrounding tissue including the tumor. Results: The published primary and secondary success rates of this technique are 87 and 83%, respectively. Surgical resection and open curettage show comparable success rates but are associated with higher complication rates. In addition image-guided RF ablation of osteoid osteomas is associated with low costs. (orig.)
Ozyürekoğlu, Tuna; Tsai, Tsu-Min
The results of three different surgical techniques used for the treatment of 46 ruptures of the distal biceps brachii tendon in 45 patients were evaluated and compared. Mean follow-up time was 14 months. The 46 ruptures were categorised according to the surgical technique used for treatment. In Group I, 17 arms were treated using two incisions and transosseous suture fixation; in Group II, 19 patients were treated using bone-anchor fixation; and in Group III, ten patients were treated using a tie-on-button technique. After treatment, 41 patients (89.1%) had full active range of motion (ROM) and 38 patients (82.6%) had excellent or good strength. The results after treatment in all three groups were satisfactory. Though the outcomes of these techniques were similar, operative time, time to return to regular activity, and time to return to work was shorter in the bone-anchor and tie-on-button groups than that in the two-incision transosseous fixation group.
Full Text Available The Emilia Romagna Region (N-E Italy and in particular the Adriatic Sea coastline of Ravenna, is affected by a noticeable subsidence that started in the 1950s, when the exploitation of on and off-shore methane reservoirs began, along with the pumping of groundwater for industrial uses. In such area the current subsidence rate, even if lower than in the past, reaches the -2 cm/y. Over the years, local Authorities have monitored this phenomenon with different techniques: spirit levelling, GPS surveys and, more recently, Differential Interferometric Synthetic Aperture Radar (DInSAR techniques, confirming the critical situation of land subsidence risk. In this work, we present the comparison between the results obtained with DInSAR and GPS techniques applied to the study of the land subsidence in the Ravenna territory. With regard to the DInSAR, the Small Baseline Subset (SBAS and the Coherent Pixel Technique (CPT techniques have been used. Different SAR datasets have been exploited: ERS-1/2, ENVISAT, TerraSAR-X and Sentinel-1. Some GPS campaigns have been also carried out in a subsidence prone area. 3D vertices have been selected very close to existing persistent scatterers in order to link the GPS measurement results to the SAR ones. GPS data were processed into the International reference system and the comparisons between the coordinates, for the first 6 months of the monitoring, provided results with the same trend of the DInSAR data, even if inside the precision of the method.
Clinical Effectiveness of Statin Therapy After Ischemic Stroke: Primary Results From the Statin Therapeutic Area of the Patient-Centered Research Into Outcomes Stroke Patients Prefer and Effectiveness Research (PROSPER) Study.
O'Brien, Emily C; Greiner, Melissa A; Xian, Ying; Fonarow, Gregg C; Olson, DaiWai M; Schwamm, Lee H; Bhatt, Deepak L; Smith, Eric E; Maisch, Lesley; Hannah, Deidre; Lindholm, Brianna; Peterson, Eric D; Pencina, Michael J; Hernandez, Adrian F
In patients with ischemic stroke, data on the real-world effectiveness of statin therapy for clinical and patient-centered outcomes are needed to better inform shared decision making. Patient-Centered Research Into Outcomes Stroke Patients Prefer and Effectiveness Research (PROSPER) is a Patient-Centered Outcomes Research Institute-funded research program designed with stroke survivors to evaluate the effectiveness of poststroke therapies. We linked data on patients ≥65 years of age enrolled in the Get With The Guidelines-Stroke Registry to Medicare claims. Two-year to postdischarge outcomes of those discharged on a statin versus not on a statin were adjusted through inverse probability weighting. Our coprimary outcomes were major adverse cardiovascular events and home time (days alive and out of a hospital or skilled nursing facility). Secondary outcomes included all-cause mortality, all-cause readmission, cardiovascular readmission, and hemorrhagic stroke. From 2007 to 2011, 77 468 patients who were not taking statins at the time of admission were hospitalized with ischemic stroke; of these, 71% were discharged on statin therapy. After adjustment, statin therapy at discharge was associated with a lower hazard of major adverse cardiovascular events (hazard ratio, 0.91; 95% confidence interval, 0.87-0.94), 28 more home-time days after discharge (PStatin therapy at discharge was not associated with increased risk of hemorrhagic stroke (hazard ratio, 0.94; 95% confidence interval, 0.72-1.23). Among statin-treated patients, 31% received a high-intensity dose; after risk adjustment, these patients had outcomes similar to those of recipients of moderate-intensity statin. In older ischemic stroke patients who were not taking statins at the time of admission, discharge statin therapy was associated with lower risk of major adverse cardiovascular events and nearly 1 month more home time during the 2-year period after hospitalization. © 2015 American Heart Association
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.
... 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 ...
... 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. ...
Murayama, Haruo; Hitosugi, Masahito; Motozawa, Yasuki; Ogino, Masahiro; Koyama, Katsuhiro
Most severe head injuries in judo are reported as acute subdural hematoma. It is thus necessary to examine the rotational acceleration of the head to clarify the mechanism of head injuries. We determined the rotational acceleration of the head when the subject is thrown by judo techniques. One Japanese male judo expert threw an anthropomorphic test device using two throwing techniques, Osoto-gari and Ouchi-gari. Rotational and translational head accelerations were measured with and without an under-mat. For Osoto-gari, peak resultant rotational acceleration ranged from 4,284.2 rad/s(2) to 5,525.9 rad/s(2) and peak resultant translational acceleration ranged from 64.3 g to 87.2 g; for Ouchi-gari, the accelerations respectively ranged from 1,708.0 rad/s(2) to 2,104.1 rad/s(2) and from 120.2 g to 149.4 g. The resultant rotational acceleration did not decrease with installation of an under-mat for both Ouchi-gari and Osoto-gari. We found that head contact with the tatami could result in the peak values of translational and rotational accelerations, respectively. In general, because kinematics of the body strongly affects translational and rotational accelerations of the head, both accelerations should be measured to analyze the underlying mechanism of head injury. As a primary preventative measure, throwing techniques should be restricted to participants demonstrating ability in ukemi techniques to avoid head contact with the tatami.
Alberto Naoki Miyazaki
Full Text Available ABSTRACT OBJECTIVE: To evaluate the results of arthroscopic treatment of large and extensive rotator cuff injuries (RCI that involved the supra and infraspinatus muscles using the suture bridge (SB technique. METHODS: Between July 2010 and November 2014, 37 patients with RCI who were treated with SB technique were evaluated. The study included all patients with a minimum follow-up of 12 months who underwent primary surgery of the shoulder. Twenty-four patients were male and 13 were female. The mean age was 60 years (45-75. The dominant side was affected in 32 cases. The most common cause of injury was trauma (18 cases. The mean preoperative motion was 123°, 58°, T11. Through magnetic resonance imaging, 36 fatty degenerations were classified according to Goutallier. Patients underwent rotator cuff repair with SB technique, which consists of using a medial row anchor with two Corkscrew(r fibertape(r or fiberwire(r at the articular margin, associated with lateral fixation without stitch using PushLocks(r or SwiveLocks(r. RESULTS: The mean age was 60 years and mean fatty degeneration was 2.6. The mean range of motion (following the AAOS in the postoperative evaluation was 148° of forward elevation, 55° in lateral rotation and medial rotation in T9. Using the criteria of the University of California at Los Angeles (UCLA, 35 (94% patients had excellent and good results; one (2.7%, fair; and one (2.7%, poor. CONCLUSION: Arthroscopic repair of a large and extensive RCI using SB technique had good and excellent results in 94% of the patients.
Feldman, Evan M; Koshy, John C; Chike-Obi, Chuma J; Hatef, Daniel A; Bullocks, Jamal M; Stal, Samuel
Nasal airway obstruction is a frequently-encountered problem, often secondary to inferior turbinate hypertrophy. Medical treatment can be beneficial but is inadequate for many individuals. For these refractory cases, surgical intervention plays a key role in management. The authors evaluate the current trends in surgical management of inferior turbinate hypertrophy and review the senior author's (SS) preferred technique. A questionnaire was devised and sent to members of the American Society for Aesthetic Plastic Surgery (ASAPS) to determine their preferred methods for assessment and treatment of inferior turbinate hypertrophy. One hundred and twenty-seven physicians responded to the survey, with 85% of surveys completed fully. Of the responses, 117 (92%) respondents were trained solely in plastic surgery and 108 (86.4%) were in private practice. Roughly 81.6% of respondents employ a clinical exam alone to evaluate for airway issues. The most commonly-preferred techniques to treat inferior turbinate hypertrophy were a limited turbinate excision (61.9%) and turbinate outfracture (35.2%). Based on the results of this study, it appears that limited turbinate excision and turbinate outfracture are the most commonly-used techniques in private practice by plastic surgeons. Newer techniques such as radiofrequency coblation have yet to become prevalent in terms of application, despite their current prevalence within the medical literature. The optimal method of management for inferior turbinate reduction should take into consideration the surgeon's skill and preference, access to surgical instruments, mode of anesthesia, and the current literature.
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
Cash, David M.; Frost, Chris; Iheme, Leonardo O.; Ünay, Devrim; Kandemir, Melek; Fripp, Jurgen; Salvado, Olivier; Bourgeat, Pierrick; Reuter, Martin; Fischl, Bruce; Lorenzi, Marco; Frisoni, Giovanni B.; Pennec, Xavier; Pierson, Ronald K.; Gunter, Jeffrey L.; Senjem, Matthew L.; Jack, Clifford R.; Guizard, Nicolas; Fonov, Vladimir S.; Collins, D. Louis; Modat, Marc; Cardoso, M. Jorge; Leung, Kelvin K.; Wang, Hongzhi; Das, Sandhitsu R.; Yushkevich, Paul A.; Malone, Ian B.; Fox, Nick C.; Schott, Jonathan M.; Ourselin, Sebastien
Structural MRI is widely used for investigating brain atrophy in many neurodegenerative disorders, with several research groups developing and publishing techniques to provide quantitative assessments of this longitudinal change. Often techniques are compared through computation of required sample size estimates for future clinical trials. However interpretation of such comparisons is rendered complex because, despite using the same publicly available cohorts, the various techniques have been assessed with different data exclusions and different statistical analysis models. We created the MIRIAD atrophy challenge in order to test various capabilities of atrophy measurement techniques. The data consisted of 69 subjects (46 Alzheimer's disease, 23 control) who were scanned multiple (up to twelve) times at nine visits over a follow-up period of one to two years, resulting in 708 total image sets. Nine participating groups from 6 countries completed the challenge by providing volumetric measurements of key structures (whole brain, lateral ventricle, left and right hippocampi) for each dataset and atrophy measurements of these structures for each time point pair (both forward and backward) of a given subject. From these results, we formally compared techniques using exactly the same dataset. First, we assessed the repeatability of each technique using rates obtained from short intervals where no measurable atrophy is expected. For those measures that provided direct measures of atrophy between pairs of images, we also assessed symmetry and transitivity. Then, we performed a statistical analysis in a consistent manner using linear mixed effect models. The models, one for repeated measures of volume made at multiple time-points and a second for repeated “direct” measures of change in brain volume, appropriately allowed for the correlation between measures made on the same subject and were shown to fit the data well. From these models, we obtained estimates of the
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.
Full Text Available Introduction: The use of cartilage as a grafting material has been advocated in cases where there is a high risk of graft failure, such as subtotal perforations, adhesive processes, and residual defects after primary tympanoplasties. The purpose of this study was to compare the graft acceptance rates and auditory outcomes of cartilage tympanoplasty operations using a palisade technique with those of primary tympanoplasty using temporalis fascia in a homogenous group of patients. Study Design: Prospective study. Materials and Methods:The study population included 54 patients who were operated on in two groups (palisade technique & temporalis fascia technique with each group containing 27 patients. Patients with pure subtotal perforations (perforation of >50% of the whole tympanic membrane [TM] area, an intact ossicular chain, at least a one month dry period, and normal middle ear mucosa were included in the study. Grafts acceptance rates and pre- and post-operative audiograms were compared. The follow-up time was six months. Results: Graft acceptance was achieved in all patients (100% in the palisade cartilage tympanoplasty group and in 25 patients (92.5% in the temporalis fascia group. This difference was not statistically significant (P= 0.15. Comparison of the increases in mean speech reception threshold, air–bone gap, and pure-tone average scores between both techniques showed no significant changes. Conclusion: Our experience with the palisade cartilage technique demonstrates that subtotal or total perforation at high risk for graft failure can be treated efficiently, and that a durable and resistant reconstruction of the TM with reasonable auditory function can be achieved.
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
Victoria Louise Barbour
Full Text Available Background. Fatigue after stroke is common and distressing to patients. Aims. Our aims were to explore patients' perceptions of post-stroke fatigue, including the causes of fatigue and the factors that alleviate fatigue, in a mixed methods study. Results. We interviewed 15 patients who had had a stroke and were inpatients on stroke rehabilitation wards. A substantial proportion of patients reported that their fatigue started at the time of their stroke. Various different factors were reported to improve fatigue, including exercise, good sleep, rehabilitation and rest. Fatigue influences patients' sense of “control” after their stroke. Conclusion. Our results are consistent with the possibility that poststroke fatigue might be triggered by factors that occur at the time of the stroke (e.g., the stroke lesion itself, or admission to hospital and then exacerbated by poor sleep and boredom. These factors should be considered when developing complex interventions to improve post-stroke fatigue.
R. M. Tikhilov
Full Text Available The purpose of the study was to analyze the medium- and long-term results of hip arthroplasty using Paavilainen technique in patients with the congenitally dislocated hip. Methods: From 2001 to 2012 180 operations were carried out were using the Paavilainen technique in 140 patients with high dislocation of the hip (Crowe IV. All patients were clinically evaluated using the Harris Hip Score (HHS, VAS and radiography. Statistical analysis was performed using the Pearson correlation coefficients, multiple regression analysis and classification trees analysis. Results: The average Harris score improved from preoperative 41.6 (40,3-43,5 to 79.3 (77,9-82,7 at final follow-up, and the difference was significant. Early complications were 9% (the most frequent were fractures of the proximal femur, later - 16.7% (pseudoarthrosis of the greater trochanter, 13.9%; disclocations-1,1%, aseptic loosening of the components - 1.7%, reoperation performed in 8.3% of cases. Such factors as age and limb length has statistically significant effect on functional outcomes. Established predictive model allows to get the best possible functional outcome in such patients with severe dysplasia. Conclusions: Total Hip arthroplasty using the Paavilainen technique is an effective method of surgical treatment in patients with the congenitally dislocated hip, but it is technically difficult operation with a high incidence of complications in comparison with standard primary total hip replacement.
Singh, Gurpreet; Kohli, Pavneet Singh; Bagaria, Dinesh
We present a new approach for BCS which we have named as the Lateral Oncoplastic Breast Surgery (LOBS) approach. Patients with biopsy proven breast cancer or phyllodes tumors in the outer quadrants of the breast were selected. The patients were operated in the lateral position using the principles of a Level 1 oncoplastic technique. 106 patients (93 breast cancer; 13 phyllodes tumor) were operated using this technique. For patients with breast cancer the mean tumor size was 2.7 cms. 3 patients had a positive margin. The mean tumor size for phyllodes tumors was 6.7 cms. Surgical site infections (15 patients), marginal skin necrosis (2 patients) and superficial NAC necrosis (1 patient) were observed. Although the mean follow up was only 355.8 days there were no early detected recurrences. LOBS is a new approach for BCS which offers distinct advantages. The short term results, both oncological and aesthetic, are encouraging. A new approach for performing oncoplastic breast conserving surgery (BCS) is described and the short term results of our first 106 cases are presented. Advantages of this approach over conventional techniques are reviewed. Copyright © 2017 Elsevier Inc. All rights reserved.
Luís Eduardo Carelli Teixeira da Silva
Full Text Available ABSTRACT Objective: Analysis of the use of polyetheretherketone (PEEK cages for atlantoaxial facet realignment and distraction for treatment of basilar invagination by Goel technique. Method: Retrospective descriptive statistical analysis of the neurological status, pain, presence of subsidence and bone fusion with the use of PEEK cages in 8 atlantoaxial joints of 4 patients with basilar invagination. All patients were treated with atlantoaxial facet distraction and realignment and subsequent arthrodesis C1-C2 by the technique of Goel modified by the use of PEEK cage. Results: All patients showed improvement in Nurick neurological assessment scale and Visual Analogue Scale (VAS of pain. There were no cases of subsidence, migration, or damage to the vertebral artery during the insertion of the cage. All joints evolved with bone fusion, assessed by dynamic radiographs, and computed tomography. Two patients developed neuropathic pain in dermatome of C2 and one patient had unilateral vertebral artery injury during C2 instrumentation treated with insertion of pedicle screw to control the bleeding. Conclusion: The results of the treatment of basilar invagination by the Goel technique with the use of PEEK cages shown to be effective and safe although further studies are needed to confirm this use.
Kats, J; van Kampen, A; de Waal-Malefijt, M C
We retrospectively assessed time until consolidation, complications, and functional results according to Morgan from the clinical charts and radiographs of 15 arthroscopic ankle fusions. In 11 patients unilateral distraction and crossed screw placement over the fusion area through tibia and fibula were used (group A); in 4 patients a technique of bilateral distraction and parallel screw placement from the dorsal side of the tibia into the neck of the talus was used (group B). In group A there were two cases of insufficient compression at the arthrodesis site, three cases of suboptimal compression, and five cases of malposition of the screws. In all cases in group B good compression and fixation was achieved, and no case of malpositioning of screws occurred. There was nonunion in 3 of 11 patients in group A and in none of the four patients in group B. Time until fusion was 23.3 in group A and 12.5 weeks in group B. Functional results were better in group B. The initial experiences with our technique of bilateral distraction and parallel screw placement are therefore promising. Screw placement is easier and optimal compression and fixation are achieved. We feel that this technique should be considered when performing an arthroscopic ankle fusion.
Kornerup, Henriette; Marott, Jacob Louis; Schnohr, Peter
Several studies have indicated an association between depression and the development of stroke, but few studies have focused on gender differences, although both depression and stroke are more common in women than in men. The aim of the present study was to describe whether vital exhaustion...
Salameh, Pascale; Farah, Rita; Hallit, Souheil; Zeidan, Rouba Karen; Chahine, Mirna N; Asmar, Roland; Hosseini, Hassan
Stroke is a disease related to high mortality and morbidity, particularly in developing countries. Some studies have linked self-reported indoor and outdoor pollution to stroke and mini-stroke, while some others showed no association. Our objective was to assess this association in Lebanon, a Middle Eastern developing country. A national cross-sectional study was conducted all over Lebanon. In addition to self-reported items of pollution exposure, we assessed potential predictors of stroke and mini-stroke, including sociodemographic characteristics, self-reported health information, and biological measurements. Moreover, we assessed dose-effect relationship of pollution items in relation with stroke. Self-reported indoor pollution exposure was associated with stroke and mini-stroke, with or without taking biological values into account. Moreover, we found a dose-effect relationship of exposure with risk of disease, but this effect did not reach statistical significance after adjustment for sociodemographics and biological characteristics. No association was found for any outdoor pollution item. Although additional studies would be necessary to confirm these findings, sensitizing the population about the effect of pollution on chronic diseases, working on reducing pollution, and improving air quality should be implemented to decrease the burden of the disease on the population and health system.
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.
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.
Adams, Harold P; Effron, Mark B; Torner, James; Dávalos, Antoni; Frayne, Judith; Teal, Philip; Leclerc, Jacques; Oemar, Barry; Padgett, Lakshmi; Barnathan, Elliot S; Hacke, Werner
A previous randomized, placebo-controlled, double-blind study suggested that abciximab may be safe and effective in treatment of acute ischemic stroke. The current phase 3 study was planned to test the relative efficacy and safety of abciximab in patients with acute ischemic stroke with planned treatment within 5 hours since symptoms onset. An international, randomized, placebo-controlled, double-blind phase 3 trial tested intravenous administration of abciximab in 2 study cohorts using stratification variables of time since onset and stroke severity. The planned enrollment was 1800 patients. The primary cohort enrolled those patients who could be treated within 5 hours of onset of stroke. A companion cohort enrolled patients that were treated 5 to 6 hours after stroke as well as a smaller cohort of patients who could be treated within 3 hours of stroke present on awakening. The primary efficacy measure was the dichotomous modified Rankin Scale score at 3 months as adjusted to the baseline severity of stroke among subjects in the primary cohort. The primary safety outcome was the rate of symptomatic or fatal intracranial hemorrhage that occurred within 5 days of stroke. The trial was terminated prematurely after 808 patients in all cohorts were enrolled by recommendation of an independent safety and efficacy monitoring board due to an unfavorable benefit-risk profile. At 3 months, approximately 33% of patients assigned placebo (72/218) and 32% of patients assigned abciximab (71/221; P=0.944) in the primary cohort were judged to have a favorable response to treatment. The distributions of outcomes on the modified Rankin Scale were similar between the treated and control groups. Within 5 days of enrollment, approximately 5.5% of abciximab-treated and 0.5% of placebo-treated patients in the primary cohort had symptomatic or fatal intracranial hemorrhage (P=0.002). The trial also did not demonstrate an improvement in outcomes with abciximab among patients in the
Kornerup, Henriette; Marott, Jacob Louis; Schnohr, Peter
Several studies have indicated an association between depression and the development of stroke, but few studies have focused on gender differences, although both depression and stroke are more common in women than in men. The aim of the present study was to describe whether vital exhaustion, a me......, a measure of fatigue and depression, prospectively predicts ischemic and hemorrhagic strokes in a large cohort, with particular focus on gender differences.......Several studies have indicated an association between depression and the development of stroke, but few studies have focused on gender differences, although both depression and stroke are more common in women than in men. The aim of the present study was to describe whether vital exhaustion...
Matsumoto, Hiroyuki; Nishiyama, Hirokazu; Tetsuo, Yoshiaki; Takemoto, Hideki; Nakao, Naoyuki
Our initial experience using the two-stage aspiration technique (TSAT) with proximal flow arrest by a balloon guiding catheter is presented. In TSAT, aspiration is applied with the 5MAX ACE and also with the 3MAX catheter with a Penumbra aspiration pump, while arresting proximal flow by balloon inflation. In patients treated with TSAT, clinical data including National Institutes of Health Stroke Scale (NIHSS) score at admission and the modiﬁed Rankin Scale (mRS) score at discharge, as well as procedural data including the Thrombolysis in Cerebral Infarction (TICI) score, procedural time, and complications were analyzed. Thirty-four consecutive patients (19 men (56%); mean age 73 years) were treated with TSAT using a balloon guiding catheter. The patients presented with a mean NIHSS score of 17.4 and 23 (68%) patients received IV tissue plasminogen activator. Median time from groin puncture to successful recanalization was 41 min (range 15-160 min). All patients were successfully revascularized; TICI 2b or better recanalization was achieved in 30 (88%) patients. No patient required an additional procedure such as use of a stent retriever. Procedure-related complications occurred in two (5.9%) patients (vessel injury and guidewire perforation). Symptomatic intracranial hemorrhage occurred in one patient and asymptomatic hemorrhagic infarction occurred in two patients. There were no cases of embolization to new territory (ENT). The mean NIHSS score at discharge improved to 6.1. Sixteen patients (47%) achieved a good outcome with an mRS score of 0-2 at discharge (mean hospitalization period 20 days). TSAT with proximal flow arrest by a balloon guiding catheter is an effective and safe method to achieve good clinical and angiographic outcomes. This method may reduce ENT in the direct aspiration first-pass thrombectomy (ADAPT) technique. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to
Haeusler, Karl Georg; Gerth, Andrea; Limbourg, Tobias; Tebbe, Ulrich; Oeff, Michael; Wegscheider, Karl; Treszl, András; Ravens, Ursula; Meinertz, Thomas; Kirchhof, Paulus; Breithardt, Günter; Steinbeck, Gerhard; Nabauer, Michael
Anticoagulation using vitamin K antagonists (VKAs) significantly reduces the risk of recurrent stroke in stroke patients with atrial fibrillation (AF) and is recommended by guidelines. The German Competence NETwork on Atrial Fibrillation established a nationwide prospective registry including 9,574 AF patients, providing the opportunity to analyse AF management according to German healthcare providers. On enrolment, 896 (9.4 %) patients reported a prior ischaemic stroke or transient ischaemic attack. Stroke patients were significantly older, more likely to be female, had a higher rate of cardiovascular risk factors, and more frequently received anticoagulation (almost exclusively VKA) than patients without prior stroke history. Following enrolment, 76.4 % of all stroke patients without VKA contraindications received anticoagulation, which inversely associated with age (OR 0.95 per year; 95 % CI 0.92-0.97). General practitioners/internists (OR 0.40; 95 % CI 0.21-0.77) and physicians working in regional hospitals (OR 0.47; 95 % CI 0.29-0.77) prescribed anticoagulation for secondary stroke prevention less frequently than physicians working at university hospitals (reference) and office-based cardiologists (OR 1.40; 95 % CI 0.76-2.60). The impact of the treating healthcare provider was less evident in registry patients without prior stroke. In the AFNET registry, anticoagulation for secondary stroke prevention was prescribed in roughly three-quarters of AF patients, a significantly higher rate than in primary prevention. We identified two factors associated with withholding oral anticoagulation in stroke survivors, namely higher age and-most prominently-treatment by a general practitioner/internist or physicians working at regional hospitals.
Savvidou, Christiana; Tsai, Tsu-Min
The purpose of this study is to report the clinical results after repair of flexor tendon zone II injuries utilizing a 6-strand double-loop technique and early post-operative active rehabilitation. We retrospectively reviewed 22 patients involving 51 cases with zone II flexor tendon repair using a six strand double loop technique from September 1996 to December 2012. Most common mechanism of injuries was sharp lacerations (86.5 %). Tendon injuries occurred equally in manual and non-manual workers and were work-related in 33 % of the cases. The Strickland score for active range of motion (ROM) postoperatively was excellent and good in the majority of the cases (81 %). The rupture rate was 1.9 %. The six strand double loop technique for Zone II flexor tendon repair leads to good and excellent motion in the majority of patients and low re- rupture rate. It is clinically effective and allows for early postoperative active rehabilitation.
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.; Köhrmann, 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; Wu, Ona; 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 (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 neuroimaging in acute stroke treatment. The goals of the meeting were to assess state-of-the-art practice in terms of acute stroke imaging research and to propose specific recommendations regarding: (1) the standardization of perfusion and penumbral imaging techniques, (2) the validation of the accuracy and clinical utility of imaging markers of the ischemic penumbra, (3) the validation of imaging biomarkers relevant to clinical outcomes, and (4) the creation of a central repository to achieve these goals. The present article summarizes these recommendations and examines practical steps to achieve them. PMID:18477656
Hoggard, Nigel; Wilkinson, Iain D.; Griffiths, Paul D.
Stroke is a clinical syndrome of a rapidly developing focal neurological deficit that may be classified for practical purposes into ischaemic and haemorrhagic. The role of imaging is to exclude mimics of ischaemic stroke or intracranial haemorrhage and confirm the presence of an ischaemic stroke. Computed tomography (CT) remains the investigation of choice to exclude acute intracranial haemorrhage but diffusion weighted magnetic resonance (MR) has proved to be a sensitive method of detecting early ischaemic infarction. Perfusion weighted MR allows further assessment at the same examination that could help guide the clinician in the risk/benefit analysis of treatment with thrombolytics or neuroprotective agents under evaluation. This can also be achieved with CT. This review article discusses the imaging of ischaemic stroke, relating the pathophysiology of stroke to it. It deals separately in more detail with these newer MR techniques. Hoggard, N. et al. (2001)
Sivakumar, Brahman S; Wong, Peter; Dick, Charles G; Steer, Richard A; Tetsworth, Kevin
To highlight a technique combining fluoroscopy and arthroscopy to aid percutaneous reduction and internal fixation of selected displaced intra-articular calcaneal fractures, assess outcome scores, and compare this method with other previously reported percutaneous methods. Retrospective review of all patients treated by this technique between June 2009 and June 2012. A tertiary care center located in Brisbane, Queensland, Australia. Thirteen consecutive patients were treated by this method during this period. All patients had a minimum of 13 months follow-up and were available for radiological checks and assessment of complications; functional outcome scores were available for 9 patients. The patient was placed in a lateral decubitus position. Reduction was achieved with the aid of both intraoperative fluoroscopy and subtalar arthroscopy and held with cannulated screws in orthogonal planes. The patient was mobilized non-weight bearing for 10 weeks. Outcomes measured were improvement in Bohler angle, postoperative complications, and 3 functional outcome scores (American Orthopaedic Foot and Ankle Society ankle-hindfoot score, Foot Function Index, and Calcaneal Fracture Scoring System). Mean postoperative improvement in Bohler angle was 18.3 degrees, with subsidence of 1.7 degrees. Functional outcome scores compared favorably with the prior literature. Based on available postoperative computed tomography scans (8/13), maximal residual articular incongruity measured 2 mm or less in 87.5% of our cases. Early results indicate that this technique, when combined with careful patient selection, offers a valid therapeutic option for the treatment of a distinct subset of displaced intra-articular calcaneal fractures, with diminished risk of wound complications. Large, prospective multicenter studies will be necessary to better evaluate the potential benefits of this technique. Level IV Therapeutic. See Instructions for Authors for a complete description of levels of evidence.
Clayton, Dwight; Barker, Alan; Albright, Austin; Santos-Villalobos, Hector
A multitude of concrete-based structures are typically part of a light water reactor (LWR) plant to provide the foundation, support, shielding, and containment functions. This use has made its long-term performance crucial for the safe operation of commercial nuclear power plants (NPPs). Extending reactor life to 60 years and beyond will likely increase susceptibility and severity of known forms of degradation. We seek to improve and extend the usefulness of results produced using the synthetic aperture focusing technique (SAFT) on ultrasonic data collected from thick, complex concrete structures such as in NPPs. Towards these goals, we apply the time-frequency technique of wavelet packet decomposition and reconstruction using a mother wavelet that possesses the exact reconstruction property. However, instead of analyzing the coefficients of each decomposition node, we select and reconstruct specific nodes based on the frequency band it contains to produce a frequency band specific time-series representation. SAFT is then applied to these frequency specific reconstructions allowing SAFT to be used to visualize the reflectivity of a frequency band and that band's interaction with the contents of the concrete structure. Specially designed and fabricated test specimens can provide realistic flaws that are similar to actual flaws in terms of how they interact with a particular NDE technique. Artificial test blocks allow the isolation of certain testing problems as well as the variation of certain parameters. Because conditions in the laboratory are controlled, the number of unknown variables can be decreased, making it possible to focus on specific aspects, investigate them in detail, and gain further information on the capabilities and limitations of each method. To minimize artifacts caused by boundary effects, the dimensions of the specimens should not be too compact. In this paper, we apply this enhanced SAFT technique to a 2.134 m × 2.134 m × 1.016 m concrete
Full Text Available This paper focuses on radiological approach in pediatric stroke including both ischemic stroke (Arterial Ischemic Stroke and Cerebral Sinovenous Thrombosis and hemorrhagic stroke. Etiopathology and main clinical findings are examined as well. Magnetic Resonance Imaging could be considered as the first-choice diagnostic exam, offering a complete diagnostic set of information both in the discrimination between ischemic/hemorrhagic stroke and in the identification of underlying causes. In addition, Magnetic Resonance vascular techniques supply further information about cerebral arterial and venous circulation. Computed Tomography, for its limits and radiation exposure, should be used only when Magnetic Resonance is not available and on unstable patients.
Shabani, Farzin; Kumar, Lalit; Solhjouy-fard, Samaneh
The aim of this study was to have a comparative investigation and evaluation of the capabilities of correlative and mechanistic modeling processes, applied to the projection of future distributions of date palm in novel environments and to establish a method of minimizing uncertainty in the projections of differing techniques. The location of this study on a global scale is in Middle Eastern Countries. We compared the mechanistic model CLIMEX (CL) with the correlative models MaxEnt (MX), Boosted Regression Trees (BRT), and Random Forests (RF) to project current and future distributions of date palm ( Phoenix dactylifera L.). The Global Climate Model (GCM), the CSIRO-Mk3.0 (CS) using the A2 emissions scenario, was selected for making projections. Both indigenous and alien distribution data of the species were utilized in the modeling process. The common areas predicted by MX, BRT, RF, and CL from the CS GCM were extracted and compared to ascertain projection uncertainty levels of each individual technique. The common areas identified by all four modeling techniques were used to produce a map indicating suitable and unsuitable areas for date palm cultivation for Middle Eastern countries, for the present and the year 2100. The four different modeling approaches predict fairly different distributions. Projections from CL were more conservative than from MX. The BRT and RF were the most conservative methods in terms of projections for the current time. The combination of the final CL and MX projections for the present and 2100 provide higher certainty concerning those areas that will become highly suitable for future date palm cultivation. According to the four models, cold, hot, and wet stress, with differences on a regional basis, appears to be the major restrictions on future date palm distribution. The results demonstrate variances in the projections, resulting from different techniques. The assessment and interpretation of model projections requires reservations
Pascarelli, Luciano; Righi, Lúcio César Silva; Bongiovanni, Roberto Rangel; Imoto, Rogério Sano; Teodoro, Renato Loureiro; Ferro, Hemanoel Fernando dos Anjos
OBJECTIVE: Evaluation of postoperative results of repair of distal biceps brachii ruptures through a two anterior mini-incisions. METHODS: Nine patients with clinical and imaging (MRI) diagnosis of total lesion of the biceps brachii at its insertion were operated with a surgical technique with two mini-incisions between 2008 and 2011. The patients were evaluated after three months of evolution and all of them recovered the fully flexion-extension arch. RESULTS: Two patients (22.2%) presented a limitation of 20 degrees of supination. One patient (11.1%) had radial nerve palsy, but was totally recovered after five months. In one patient (11.1%) the muscle remained retracted, but the insertion was recovered. In three patients (33.3%) adhesion was observed on the proximal scar. There was no clinical or radiographic evidence of radioulnar synostosis after six months of evolution. All patients reported satisfaction with the treatment. CONCLUSIONS: We conclude that the presented method shows good results as well as other techniques, with less risk of adhesion on the flexor fold of the elbow. Level of Evidence IV, Case Series. PMID:24453647
Juan Antonio Castro Flores
Full Text Available ABSTRACT Mesial temporal sclerosis creates a focal epileptic syndrome that usually requires surgical resection of mesial temporal structures. Objective: To describe a novel operative technique for treatment of temporal lobe epilepsy and its clinical results. Methods: Prospective case-series at a single institution, performed by a single surgeon, from 2006 to 2012. A total of 120 patients were submitted to minimally-invasive keyhole transtemporal amygdalohippocampectomy. Results: Of the patients, 55% were male, and 85% had a right-sided disease. The first 70 surgeries had a mean surgical time of 2.51 hours, and the last 50 surgeries had a mean surgical time of 1.62 hours. There was 3.3% morbidity, and 5% mild temporal muscle atrophy. There was no visual field impairment. On the Engel Outcome Scale at the two-year follow-up, 71% of the patients were Class I, 21% were Class II, and 6% were Class III. Conclusion: This novel technique is feasible and reproducible, with optimal clinical results.
Calvitti, M.; Remotti, P.C.; Pasquali, A.; Cirio, U.
Trials for the evaluation of the effectiveness of the sterile insect technique for the suppression of greenhouse whitefly, Trialeurodes vaporariorum (Westwood), both in cage and in greenhouse conditions are described. The results show a significant reduction of the reproductive capacity of the untreated whitefly populations interacting with sterile insects. Untreated whiteflies, co-existing in a mixed population together with sterile insects, attained less than the half (44%) of their potential reproductive capacity. This trend was also evident in the cage test where the untreated whitefly population, crossed with the sterile whiteflies, increased without exceeding 2/3 of the density recorded in the control cages. These results may be based on 2 joint sterile insect technique effects: primarily a drastic reduction of the progeny of normal untreated females, when mating with sterile males, carriers of dominant lethal mutations, and secondarily a progressive reduction of the females in the population due to an increasing rate of unsuccessful matings resulting in a condition of forced arrhenotoky. No deleterious effects, on plant health and fruit quality, were observed on plants exposed to high sterile whitefly pressures
Full Text Available Introduction - Observing stroke patients with hemiplegia we can easily identify one of the problems they face –inability to use affected upper limb. On a closer analysis we can see that this incapacity is determined, at many of them, by the incapacity to open the hand and grasp. They follow therapies for months and the results are often mediocre therefore respectively upper limb is neglected and forgotten and its activities are taken up by the healthy upper limb. These observations have prompted the search for other type of solutions to help / assist them and facilitate participation. In this way were created twodynamic devices/orthotics that assists finger extension, facilitates grasping and increase, at least in theory, the possibilities of participation. Objective - The main purpose of this study is to test the effectiveness of using these devices on short and medium term. Material and method - For this study we will select 60 patients with single stroke. Patients will be randomized into two groups. Patients in the control group will receive a physical therapy session per day for 10 days. Patients in the experimental group will receive in addition a functional workout (20-30 minutes of handling small objects and few simple functional gestures of the "activities of daily living" using one of the two devices –the one that will allow the patient to best accomplish the given tasks. We will perform an initial assessment, one final and one to three months. The initiation of this study will be made after obtaining the opinion of the ethics committee, and the inclusion of patients will occur only after obtaining informed consent. Conclusions - Creation of two dynamic devices/orthotics witch assist finger extension and facilitate prehension opened the possibility of carrying out a clinical trial to test the effectiveness of their use. To what extent that this will happen remains to be seen.
What causes disability after transient ischemic attack and minor stroke?: Results from the CT and MRI in the Triage of TIA and minor Cerebrovascular Events to Identify High Risk Patients (CATCH) Study.
Coutts, Shelagh B; Modi, Jayesh; Patel, Shiel K; Aram, Heidi; Demchuk, Andrew M; Goyal, Mayank; Hill, Michael D
Minor stroke and transient ischemic attack portend a significant risk of disability. Three possible mechanisms for this include disability not captured by the National Institutes of Health Stroke Scale, symptom progression, or recurrent stroke. We sought to assess the relative impact of these mechanisms on disability in a population of patients with transient ischemic attack and minor stroke. Five hundred ten consecutive minor stroke (National Institutes of Health Stroke Scalefour of 499 (15%; 95% CI, 12%-18%) patients had a disabled outcome. Baseline factors predicting disability were: age≥60 years, diabetes mellitus, premorbid modified Rankin Scale 1, ongoing symptoms, baseline National Institutes of Health Stroke Scale, CT/CT angiography-positive metric, and diffusion-weighted imaging positivity. In the multivariable analysis ongoing symptoms (OR, 2.4; 95% CI, 1.3-4.4; P=0.004), diabetes mellitus (OR, 2.3; 95% CI, 1.2-4.3; P=0.009), female sex (OR, 1.8; 95% CI, 1.1-3; P=0.025), and CT/CT angiography-positive metric (OR, 2.4; 95% CI, 1.4-4; P=0.001) predicted disability. Of the 463 patients who did not have a recurrent event, 55 were disabled (12%). By contrast 19 of 36 (53%) patients were disabled after a recurrent event (risk ratio, 4.4; 95% CI, 3-6.6; Pstroke become disabled. In terms of absolute numbers, most patients have disability as a result of their presenting event; however, recurrent events have the largest relative impact on outcome.
Senaran, Hakan; Yilmaz, Guney; Nagai, Mary K; Thacker, Mihir; Dabney, Kirk W; Miller, Freeman
Valgus deformity of the hindfoot in cerebral palsy (CP) patients is common and causes functional deterioration and shoe fitting problems together with skin ulcerations. Our aims in this study are, to present an intra-articular technique of subtalar fusion using allograft and internal fixation to achieve stabilization and second to report the results and clinical outcome of a series of intra-articular subtalar arthrodesis performed in CP children. We performed a retrospective review of radiographs and medical records of 145 children with CP who underwent intra-articular subtalar fusion from January 1994 to December 2004. The subtalar joint was fixed through the anterior facet with a cannulated screw whereas the anterior aspect of the calcaneus was parallel to the anterior aspect of the head of the talus. Tricortical iliac crest allograft was placed into the sinus tarsi and the denuded posterior facet area. Results are grouped as good, satisfactory, and poor according to the radiographic and clinical outcomes. The mean age at the time of surgery was 12.7 years (range: 5 to 20 y) and the average follow-up was 4.8 years (range: 2 to 11 y). Good results were obtained in 242 feet (96%). Satisfactory results were obtained in 6 feet (2%) which were painless pseudoarthrosis of subtalar joint in 2 feet and screw removal was required in 4 feet because of pain. Nonunion of thesubtalar joint together with recurrence of deformity was observed in 5 feet (2%) which is accepted as poor result and required revision surgery. No deep infections, implant failure, allograft failure were observed in a mean of 4.8 years. Our described technique of intra-articular subtalar joint fusion is safe and reliable in CP children with high rate of satisfactory results. Therapeutic studies-Level IV.
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
Numerical modelling is a powerful tool for studies of soil gas and radon-222 entry into houses. It is the purpose of this paper to review some main techniques and results. In the past, modelling has focused on Darcy flow of soil gas (driven by indoor–outdoor pressure differences) and combined......, fractures, moisture, non-uniform soil temperature, non-Darcy flow of gas, and flow caused by changes in the atmospheric pressure. Numerical models can be used to estimate the importance of specific factors for radon entry. Models are also helpful when results obtained in special laboratory or test structure...... experiments need to be extrapolated to more general situations (e.g. to real houses or even to other soil–gas pollutants). Finally, models provide a cost-effective test bench for improved designs of radon prevention systems. The paper includes a summary of transport equations and boundary conditions...
Rose, Jessica F.; Colen, Jessica Suarez; Ellsworth, Warren A.
Breast conservation therapy has emerged as an important option for select cancer patients as survival rates are similar to those after mastectomy. Large tumor size and the effect of radiation create cosmetic deformities in the shape of the breast after lumpectomy alone. Volume loss, nipple displacement, and asymmetry of the contralateral breast are just a few concerns. Reconstruction of lumpectomy defects with local tissue rearrangement in concert with reduction and mastopexy techniques have allowed for outstanding aesthetic results. In patients who have a reasonable tumor- to breast-size ratio, this oncoplastic surgery can successfully treat the patient's cancer while often improving upon preoperative breast shape. Specific surgical guidelines in reduction and mastopexy help achieve predictable aesthetic results, despite the effects of radiation, and can allow for a single surgical procedure for cancer removal, reconstruction, and contralateral symmetry in one stage. PMID:26528086
Jerosch, J; Sokkar, S; Dücker, M; Donner, A
Posterior calcaneal exostosis treatment modalities have given rise to many controversial opinions. After failure of the conservative treatment, surgical bursectomy and resection of the calcaneal exostosis are indicated by many authors. But clinical studies also show a high rate of unsatisfactory results with a relative high incidence of complications. The minimally invasive surgical technique by an endoscopic calcaneoplasty (ECP) could be an option to overcome some of these problems. Between 1999 und 2010 we operated 164 patients with an age range between 16 and 67 years, 81 males and 83 females. The radiological examination prior to surgery documented in all cases a posterior superior calcaneal exostosis that showed friction to the Achilles tendon. All patients included in the study had no clinical varus of the hind foot, nor cavus deformities. All patients had undergone a trial of conservative treatment for at least 6 months and did not show a positive response. The average follow-up was 46.3 (range: 8-120) months. According to the Ogilvie-Harris score 71 patients presented good and 84 patients excellent results, while 5 patients showed fair results, and 4 patients only poor results. All the post-operative radiographs showed sufficient resection of the calcaneal spur. In 61 patients the preoperative MRI showed a partial rupture of the Achilles tendon close to the insertion side. In no case could we observe a complete tear at the time of follow-up. Only minor postoperative complications were observed. In many patients we could observe a chondral layer at the posterior aspect of the calcaneus. Close to the intersion the Achilles tendon showed also in many patients a chondroide metaplasia. ECP is an effective and minimally invasive procedure for the treatment of patients with calcaneal exostosis. After a short learning curve the endoscopic exposure is superior to the open technique, has less morbidity, less operating time, and nearly no complications. Moreover, the
Atalar, Ata Can; Demirhan, Mehmet; Salduz, Ahmet; Kiliçoğlu, Onder; Seyahi, Aksel
We evaluated functional results of patients treated with open reduction and internal fixation with the parallel-plate technique for complex distal humerus fractures. Twenty-one patients (14 males, 7 females; mean age 47 years; range 16 to 85) underwent open reduction with olecranon osteotomy and internal fixation with the parallel-plate technique for distal humerus fractures accompanied by highly intra-articular or metaphyseal comminution (n=10), intra-articular comminution and osteoporosis (n=7), and intra-articular and metaphyseal comminution with bone loss (n=4). According to the AO classification, there were 12 C3, six C2, and three C1 type fractures. Eight patients had open fractures. The mean time to surgery was six days (range 1 to 17 days). Functional results were evaluated using the Mayo elbow performance score, Jupiter elbow score, and DASH (Disabilities of the Arm, Shoulder and Hand) score. The mean follow-up was 28 months (range 12 to 48 months). The mean total range of motion was 90.2+/-31.1 degrees, flexion was 118.1+/-17.4 degrees, and extension was 27.8+/-17.4 degrees. The mean Mayo elbow performance score and DASH score were 86.1+/-12.6 and 7.6+/-9.5, respectively. According to the Jupiter elbow scores, the results were excellent in seven patients, good in 11 patients, moderate in two patients, and poor in one patient. Radiographically, solid union was achieved in all the patients. Heterotopic ossification of varying degrees was seen in seven patients, two of whom underwent resection of heterotopic ossification due to severe limitation of movement. Debridement was performed in one patient due to the development of deep infection. Chondrolysis of the elbow occurred in one patient. Patients with open fractures had significantly lower range of motion than those with closed fractures (p0.05). Functional results are satisfactory in distal humerus fractures treated with stable osteosynthesis and parallel-plate technique that allow early active motion.
Grosse, Christian U. [Technische Univ. Muenchen (Germany). Chair of Non-destructive Testing; Goldammer, Matthias; Grager, Jan-Carl [Siemens AG Corporate Technology, Muenchen (Germany); and others
Fiber reinforced polymeric materials are used for lightweight constructions and are an integral part of cars, airplanes or rotor blades of wind turbines. Nondestructive testing (NDT) methods play an increasing role concerning the manufacturing process and the inspection during lifetime. The selection of the best NDT technique for a certain application depends - of course - on many factors including the type, position and size of the defect to be detected but also on secondary issues like accessibility, automation, testing costs, reliability and resolution to mention only some. For the more technical-scientific part of these issues, the determination of the probability of detection (PoD) plays a significant role. Early in the design process questions should be raised concerning the probability with which certain attribute of interest (a defect that has an effect on the structural behavior) can be detected (and localized) in a certain construction. Several defect types have been identified to be critical like impact damages, undulations and porosity. Test samples out of differently processed Carbon Fiber-Reinforced Polymers (CFRP) as used in the automotive or aeronautical industry have been produced including defects of different type and size. In order to determine the PoD and to check whether a technique is applicable the different partners applied a broad variety of selected NDT techniques including Micro CT, Ultrasound (including phased-array and air-coupled UT), Active Thermography, Eddy Current, Vibration and Visual Analysis and Local Acoustic Resonance Spectroscopy (LARS). The presentation will summarize some of the results of the experiments and ongoing data analysis.
Franca, M. J.; Battisacco, E.; Schleiss, A. J.
The transport of sediments by water throughout the river basins, from the steep slopes of the upstream regions to the sea level, is recognizable important to keep the natural conditions of rivers with a role on their ecology processes. Over the last decades, a reduction on the supply of sand and gravel has been observed downstream dams existing in several alpine rivers. Many studies highlight that the presence of a dam strongly modifies the river behavior in the downstream reach, in terms of morphology and hydrodynamics, with consequences on local ecology. Sediment deficit, bed armoring, river incision and bank instability are the main effects which affect negatively the aquatic habitats and the water quality. One of the proposed techniques to solve the problem of sediment deficit downstream dams, already adopted in few Japanese and German rivers although on an unsatisfactory fashion, is the artificial replenishment of these. Generally, it was verified that the erosion of the replenishments was not satisfactory and the transport rate was not enough to move the sediments to sufficient downstream distances. In order to improve and to provide an engineering answer to make this technique more applicable, a series of laboratory tests are ran as preparatory study to understand the hydrodynamics of the river flow when the replenishment technique is applied. Erodible volumes, with different lengths and submergence conditions, reproducing sediment replenishments volumes, are positioned along a channel bank. Different geometrical combinations of erodible sediment volumes are tested as well on the experimental flume. The first results of the experimental research, concerning erosion time evolution, the influence of discharge and the distance travelled by the eroded sediments, will be presented and discussed.
Grosse, Christian U.
Fiber reinforced polymeric materials are used for lightweight constructions and are an integral part of cars, airplanes or rotor blades of wind turbines. Nondestructive testing (NDT) methods play an increasing role concerning the manufacturing process and the inspection during lifetime. The selection of the best NDT technique for a certain application depends - of course - on many factors including the type, position and size of the defect to be detected but also on secondary issues like accessibility, automation, testing costs, reliability and resolution to mention only some. For the more technical-scientific part of these issues, the determination of the probability of detection (PoD) plays a significant role. Early in the design process questions should be raised concerning the probability with which certain attribute of interest (a defect that has an effect on the structural behavior) can be detected (and localized) in a certain construction. Several defect types have been identified to be critical like impact damages, undulations and porosity. Test samples out of differently processed Carbon Fiber-Reinforced Polymers (CFRP) as used in the automotive or aeronautical industry have been produced including defects of different type and size. In order to determine the PoD and to check whether a technique is applicable the different partners applied a broad variety of selected NDT techniques including Micro CT, Ultrasound (including phased-array and air-coupled UT), Active Thermography, Eddy Current, Vibration and Visual Analysis and Local Acoustic Resonance Spectroscopy (LARS). The presentation will summarize some of the results of the experiments and ongoing data analysis.
Algara, Manuel; Arenas, Meritxell; De las Peñas Eloisa Bayo, Dolores; Muñoz, Julia; Carceller, José Antonio; Salinas, Juan; Moreno, Ferran; Martínez, Francisco; González, Ezequiel; Montero, Ángel
Aim To evaluate the resources and techniques used in the irradiation of patients with breast cancer after lumpectomy or mastectomy and the status of implementation of new techniques and therapeutic schedules in our country. Background The demand for cancer care has increased among the Spanish population, as long as cancer treatment innovations have proliferated. Radiation therapy in breast cancer has evolved exponentially in recent years with the implementation of three-dimensional conformal radiotherapy, intensity modulated radiotherapy, image guided radiotherapy and hypofractionation. Material and Methods An original survey questionnaire was sent to institutions participating in the SEOR-Mama group (GEORM). In total, the standards of practice in 969 patients with breast cancer after surgery were evaluated. Results The response rate was 70% (28/40 centers). In 98.5% of cases 3D conformal treatment was used. All the institutions employed CT-based planning treatment. Boost was performed in 56.4% of patients: electrons in 59.8%, photons in 23.7% and HDR brachytherapy in 8.8%. Fractionation was standard in 93.1% of patients. Supine position was the most frequent. Only 3 centers used prone position. The common organs of risk delimited were: homolateral lung (80.8%) and heart (80.8%). In 84% histograms were used. An 80.8% of the centers used isocentric technique. In 62.5% asymmetric fields were employed. CTV was delimited in 46.2%, PTV in 65% and both in 38.5%. A 65% of the centers checked with portal films. IMRT and hypofractionation were used in 1% and in 5.5% respectively. Conclusion In most of centers, 3D conformal treatment and CT-based planning treatment were used. IMRT and hypofractionation are currently poorly implemented in Spain. PMID:24377012
Full Text Available Stroke imposes significant burdens on health services and society, and as such there is a growing need to assess the cost-effectiveness of stroke treatment to ensure maximum benefit is derived from limited resources. This study compared the cost-effectiveness of treating post-stroke upper limb spasticity with botulinum toxin type A plus an upper limb therapy programme against the therapy programme alone. Data on resource use and health outcomes were prospectively collected for 333 patients with post-stroke upper limb spasticity taking part in a randomized trial and combined to estimate the incremental cost per quality adjusted life year (QALY gained of botulinum toxin type A plus therapy relative to therapy alone. The base case incremental cost-effectiveness ratio (ICER of botulinum toxin type A plus therapy was £93,500 per QALY gained. The probability of botulinum toxin type A plus therapy being cost-effective at the England and Wales cost-effectiveness threshold value of £20,000 per QALY was 0.36. The point estimates of the ICER remained above £20,000 per QALY for a range of sensitivity analyses, and the probability of botulinum toxin type A plus therapy being cost-effective at the threshold value did not exceed 0.39, regardless of the assumptions made.
Mueller, Sabine, E-mail: email@example.com [Department of Neurology, University of California, San Francisco, California (United States); Department of Pediatrics, University of California, San Francisco, California (United States); Department of Neurosurgery, University of California, San Francisco, California (United States); Sear, Katherine [Department of Neurology, University of California, San Francisco, California (United States); Hills, Nancy K. [Department of Neurology, University of California, San Francisco, California (United States); Department of Epidemiology and Biostatistics, University of California, San Francisco, California (United States); Chettout, Nassim [Department of Neurology, University of California, San Francisco, California (United States); Afghani, Shervin [Undergraduate Program, University of California, Berkeley, California (United States); Gastelum, Erica [School of Medicine, University of California, San Francisco, California (United States); Haas-Kogan, Daphne [Department of Radiation Oncology, University of California, San Francisco, California (United States); Fullerton, Heather J. [Department of Neurology, University of California, San Francisco, California (United States); Department of Pediatrics, University of California, San Francisco, California (United States)
Purpose: To assess, in a retrospective cohort study, rates and predictors of first and recurrent stroke in patients treated with cranial irradiation (CRT) and/or cervical irradiation at ≤18 years of age. Methods and Materials: We performed chart abstraction (n=383) and phone interviews (n=104) to measure first and recurrent stroke in 383 patients who received CRT and/or cervical radiation at a single institution between 1980 and 2009. Stroke was defined as a physician diagnosis and symptoms consistent with stroke. Incidence of first stroke was number of first strokes per person-years of observation after radiation. We used survival analysis techniques to determine cumulative incidence of first and recurrent stroke. Results: Among 325 subjects with sufficient follow-up data, we identified 19 first strokes (13 ischemic, 4 hemorrhagic, 2 unknown subtype) occurring at a median age of 24 years (interquartile range 17-33 years) in patients treated with CRT. Imaging was reviewed when available (n=13), and the stroke was confirmed in 12. Overall rate of first stroke was 625 (95% confidence interval [CI] 378-977) per 100,000 person-years. The cumulative incidence of first stroke was 2% (95% CI 0.01%-5.3%) at 5 years and 4% (95% CI 2.0%-8.4%) at 10 years after irradiation. With each 100-cGy increase in the radiation dose, the stroke hazard increased by 5% (hazard ratio 1.05; 95% CI 1.01-1.09; P=.02). We identified 6 recurrent strokes; 5 had available imaging that confirmed the stroke. Median time to recurrence was 15 months (interquartile range 6 months-3.2 years) after first stroke. The cumulative incidence of recurrent stroke was 38% (95% CI 17%-69%) at 5 years and 59% (95% CI 27%-92%) at 10 years after first stroke. Conclusion: Cranial irradiation puts childhood cancer survivors at high risk of both first and recurrent stroke. Stroke prevention strategies for these survivors are needed.
Mueller, Sabine; Sear, Katherine; Hills, Nancy K.; Chettout, Nassim; Afghani, Shervin; Gastelum, Erica; Haas-Kogan, Daphne; Fullerton, Heather J.
Purpose: To assess, in a retrospective cohort study, rates and predictors of first and recurrent stroke in patients treated with cranial irradiation (CRT) and/or cervical irradiation at ≤18 years of age. Methods and Materials: We performed chart abstraction (n=383) and phone interviews (n=104) to measure first and recurrent stroke in 383 patients who received CRT and/or cervical radiation at a single institution between 1980 and 2009. Stroke was defined as a physician diagnosis and symptoms consistent with stroke. Incidence of first stroke was number of first strokes per person-years of observation after radiation. We used survival analysis techniques to determine cumulative incidence of first and recurrent stroke. Results: Among 325 subjects with sufficient follow-up data, we identified 19 first strokes (13 ischemic, 4 hemorrhagic, 2 unknown subtype) occurring at a median age of 24 years (interquartile range 17-33 years) in patients treated with CRT. Imaging was reviewed when available (n=13), and the stroke was confirmed in 12. Overall rate of first stroke was 625 (95% confidence interval [CI] 378-977) per 100,000 person-years. The cumulative incidence of first stroke was 2% (95% CI 0.01%-5.3%) at 5 years and 4% (95% CI 2.0%-8.4%) at 10 years after irradiation. With each 100-cGy increase in the radiation dose, the stroke hazard increased by 5% (hazard ratio 1.05; 95% CI 1.01-1.09; P=.02). We identified 6 recurrent strokes; 5 had available imaging that confirmed the stroke. Median time to recurrence was 15 months (interquartile range 6 months-3.2 years) after first stroke. The cumulative incidence of recurrent stroke was 38% (95% CI 17%-69%) at 5 years and 59% (95% CI 27%-92%) at 10 years after first stroke. Conclusion: Cranial irradiation puts childhood cancer survivors at high risk of both first and recurrent stroke. Stroke prevention strategies for these survivors are needed
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Full Text Available Aim: Partial patellectomy and patellotibial cerclage technique used in comminuted inferior pole patellar fractures were evaluated and the results were discussed. Methods: Thirteen patients who have undergone partial distal patellar excision were evaluated in the study. In all patients, the inferior pole of the patella was resected, patellar tendon was sutured to the proximal patellar fragment and patellotibial cerclage was performed. At the last visit, the patients were evaluated using measurement of the distance between the superior pole of the patella and the tibial tubercle, the Lysholm knee scoring scale, knee range of motion and thigh circumference measurement. Results: The mean flexion value was 131.10 (±4.6 in normal knees and 117.20 (±8.0 in operated knees. The mean thigh diameter was 49.5 (±3.7 cm and 46.4 (±4.5 cm in normal knees and in operated knees, respectively. The mean Lysholm knee score in the patient group was 84.3 (±17.1 points. The mean distance between the superior pole of the patella and the tibial tubercle was 10.6 (±1.0 cm in normal knees and 10.1 (±1.2 cm in operated knees. The exstensor mechanism was intact in all patients and no revision surgery was performed. Conclusion: Patellotibial cerclage technique performed after partial patellectomy permits early motion and protects patients from harmful effects of immobilization; and good functional results are obtained if patients start early knee motion.
Smyth, P.; Mellstrom, J.
Initial results obtained from an investigation using pattern recognition techniques for identifying fault modes in the Deep Space Network (DSN) 70 m antenna control loops are described. The overall background to the problem is described, the motivation and potential benefits of this approach are outlined. In particular, an experiment is described in which fault modes were introduced into a state-space simulation of the antenna control loops. By training a multilayer feed-forward neural network on the simulated sensor output, classification rates of over 95 percent were achieved with a false alarm rate of zero on unseen tests data. It concludes that although the neural classifier has certain practical limitations at present, it also has considerable potential for problems of this nature.
Full Text Available Spasticity is one of many consequences after stroke. It is characterized by a velocity-dependent increase in resistance during passive stretch, resulting from hyperexcitability of the stretch reflex. The underlying mechanism of the hyperexcitable stretch reflex, however, remains poorly understood. Accumulated experimental evidence has supported supraspinal origins of spasticity, likely from an imbalance between descending inhibitory and facilitatory regulation of spinal stretch reflexes secondary to cortical disinhibition after stroke. The excitability of reticulospinal and vestibulospinal tracts has been assessed in stroke survivors with spasticity using non-invasive indirect measures. There are strong experimental findings that support the reticulospinal hyperexcitability as a prominent underlying mechanism of post-stroke spasticity. This mechanism can at least partly account for clinical features associated with spasticity and provide insightful guidance for clinical assessment and management of spasticity. However, the possible role of VST hyperexcitability can not be ruled out from indirect measures. In vivo measure of individual brainstem nuclei in stroke survivors with spasticity using advanced fMRI techniques in the future is probably able to provide direct evidence of pathogenesis of post-stroke spasticity.
BACKGROUND: Robust international data support the effectiveness of stroke unit (SU) care. Despite this, most stroke care in Ireland are provided outside of this setting. Limited data currently exist on the quality of care provided. AIM: The aim of this study is to examine the quality of care for patients with stroke in two care settings-Regional General Hospital (RGH) and Stroke Rehabilitation Unit (SRU). METHODS: A retrospective analysis of the stroke records of consecutive patients admitted to the SRU between May-November 2002 and April-November 2004 was performed applying the UK National Sentinel Audit of Stroke (NSAS) tool. RESULTS: The results of the study reveal that while SRU processes of care was 74% compliant with standards; compliance with stroke service organisational standards was only 15 and 43% in the RGH and SRU, respectively. CONCLUSION: The quality of stroke care in our area is deficient. Comprehensive reorganisation of stroke services is imperative.
Granulocyte Colony Stimulating Factor and Physiotherapy after Stroke: Results of a Feasibility Randomised Controlled Trial: Stem Cell Trial of Recovery EnhanceMent after Stroke-3 (STEMS-3 ISRCTN16714730).
Sprigg, Nikola; O'Connor, Rebecca; Woodhouse, Lisa; Krishnan, Kailash; England, Timothy J; Connell, Louise A; Walker, Marion F; Bath, Philip M
Granulocyte-colony stimulating factor (G-CSF) mobilises endogenous haematopoietic stem cells and enhances recovery in experimental stroke. Recovery may also be dependent on an enriched environment and physical activity. G-CSF may have the potential to enhance recovery when used in combination with physiotherapy, in patients with disability late after stroke. A pilot 2 x 2 factorial randomised (1:1) placebo-controlled trial of G-CSF (double-blind), and/or a 6 week course of physiotherapy, in 60 participants with disability (mRS >1), at least 3 months after stroke. Primary outcome was feasibility, acceptability and tolerability. Secondary outcomes included death, dependency, motor function and quality of life measured 90 and 365 days after enrolment. Recruitment to the trial was feasible and acceptable; of 118 screened patients, 92 were eligible and 32 declined to participate. 60 patients were recruited between November 2011 and July 2013. All participants received some allocated treatment. Although 29 out of 30 participants received all 5 G-CSF/placebo injections, only 7 of 30 participants received all 18 therapy sessions. G-CSF was well tolerated but associated with a tendency to more adverse events than placebo (16 vs 10 patients, p = 0.12) and serious adverse events (SAE) (9 vs 3, p = 0.10). On average, patients received 14 (out of 18 planned) therapy sessions, interquartile range [12, 17]. Only a minority (23%) of participants completed all physiotherapy sessions, a large proportion of sessions (114 of 540, 21%) were cancelled due to patient (94, 17%) and therapist factors (20, 4%). No significant differences in functional outcomes were detected in either the G-CSF or physiotherapy group at day 90 or 365. Delivery of G-CSF is feasible in chronic stroke. However, the study failed to demonstrate feasibility for delivering additional physiotherapy sessions late after stroke therefore a definitive study using this trial design is not supported. Future work should
Intensive versus Guideline Blood Pressure and Lipid Lowering in Patients with Previous Stroke: Main Results from the Pilot 'Prevention of Decline in Cognition after Stroke Trial' (PODCAST Randomised Controlled Trial.
Philip M Bath
Full Text Available Stroke is associated with the development of cognitive impairment and dementia. We assessed the effect of intensive blood pressure (BP and/or lipid lowering on cognitive outcomes in patients with recent stroke in a pilot trial.In a multicentre, partial-factorial trial, patients with recent stroke, absence of dementia, and systolic BP (SBP 125-170 mmHg were assigned randomly to at least 6 months of intensive (target SBP <125 mmHg or guideline (target SBP <140 mmHg BP lowering. The subset of patients with ischaemic stroke and total cholesterol 3.0-8.0 mmol/l were also assigned randomly to intensive (target LDL-cholesterol <1.3 mmol/l or guideline (target LDL-c <3.0 mmol/l lipid lowering. The primary outcome was the Addenbrooke's Cognitive Examination-Revised (ACE-R.We enrolled 83 patients, mean age 74.0 (6.8 years, and median 4.5 months after stroke. The median follow-up was 24 months (range 1-48. Mean BP was significantly reduced with intensive compared to guideline treatment (difference -10·6/-5·5 mmHg; p<0·01, as was total/LDL-cholesterol with intensive lipid lowering compared to guideline (difference -0·54/-0·44 mmol/l; p<0·01. The ACE-R score during treatment did not differ for either treatment comparison; mean difference for BP lowering -3.6 (95% CI -9.7 to 2.4, and lipid lowering 4.4 (95% CI -2.1 to 10.9. However, intensive lipid lowering therapy was significantly associated with improved scores for ACE-R at 6 months, trail making A, modified Rankin Scale and Euro-Qol Visual Analogue Scale. There was no difference in rates of dementia or serious adverse events for either comparison.In patients with recent stroke and normal cognition, intensive BP and lipid lowering were feasible and safe, but did not alter cognition over two years. The association between intensive lipid lowering and improved scores for some secondary outcomes suggests further trials are warranted.ISRCTN ISRCTN85562386.
Ferretto, Luca; Piazza, Michele; Bonvini, Stefano; Battocchio, Piero; Grego, Franco; Ricotta, Joseph J
To describe early results of a novel technique (ViPS, Viabahn Padova Sutureless) that connects a vascular prosthetic graft to a target artery in a sutureless fashion. A consecutive series of five patients with peripheral arterial occlusive disease (Rutherford class IV and V) underwent six ViPS procedures (one bilateral) for limb revascularization. Angiography in all cases demonstrated complete superficial femoral artery (SFA) occlusion with reconstitution of a circumferentially calcified above-knee popliteal artery. Ultrasonography revealed no adequate vein for autogenous bypass creation. In all cases, a previous attempt of SFA endovascular recanalization was unsuccessful. A Viabahn (W.L. Gore, Flagstaff, AZ) endoprosthesis was partially deployed, and its proximal end was sutured to a polytetrafluoroethylene graft. After surgical exposure, the circumferentially calcified popliteal artery, which could not be safely sutured, was transected and the undeployed distal portion of the Viabahn was inserted into the popliteal artery supported by a stiff guidewire. The distal portion of the Viabahn graft was then deployed 2.5 cm into the popliteal artery with optimal apposition. The proximal end of the polytetrafluoroethylene graft was then sutured to the common femoral artery. The distal portion of the Viabahn was ballooned to ensure apposition with the popliteal artery. The mean time for surgical modification of the device was 6.6 minutes with a mean time for ViPS anastomosis deployment of 7 seconds. Mean operative time for ViPS procedure was 61 minutes (range: 48-74). Completion angiogram in all cases demonstrated a patent graft with no sign of dissection. The patients' symptoms resolved in all cases, with complete ulcer healing occurring in five patients within 3 weeks. Follow-up imaging (mean = 2.6 months, range: 1-5) with eco-color-Doppler and computed tomography angiogram demonstrated a patent graft with no loss of device integrity in all cases. The ViPS technique is
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)
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.
Full Text Available Varicocele repair is mainly indicated in young adult patients with clinical palpable varicocele and abnormal semen parameters. Varicocele treatment is associated with a significant improvement in sperm concentration, motility, morphology, and pregnancy rate. Antegrade scrotal sclerotherapy (ASS represented one of the main alternatives to the traditional inguinal or suprainguinal surgical ligation. This article reviews the use of ASS for varicocele treatment. We provide a brief overview of the history of the procedure and present our methods used in ASS. In addition, we review complication and success of ASS, including our own retrospective data of treating 674 patients over the last 17 years. Herein, we analyzed step by step the ASS technique and described our results with an original modified technique with a long follow-up. Between December 1997 and December 2014, we performed 674 ASS. Mean operative time was 14 min (range 9 to 50 min. No significant intraoperative complications were reported. Within 90 days from the procedure, postoperative complications were recorded in overall 49 (7.2% patients. No major complications were recorded. A persistent/recurrent varicocele was detected in 40 (5.9% cases. In 32/40 (80% cases, patients showed preoperative grade III varicoceles. In patients with a low sperm number before surgery, sperm count improved from 13 × 10 6 to 21 × 10 6 ml−1 (P < 0.001. The median value of the percentage of progressive motile forms at 1 h improved from 25% to 45% (P < 0.001. Percentage of normal forms increased from 17% before surgery to 35% 1 year after the procedure (P < 0.001. In the subgroup of the 168 infertile patients, 52 (31% fathered offspring at a 12-month-minimum follow-up. Therefore, ASS is an effective minimal invasive treatment for varicocele with low recurrence/persistence rate.
Lee, Byung Ho; Lee, Hwan-Mo; Kim, Tae-Hwan; Kim, Hak-Sun; Moon, Eun-Soo; Park, Jin-Oh; Chong, Hyun-Soo; Moon, Seong-Hwan
Infective spondylodiscitis usually occurs in patients of older age, immunocompromisation, co-morbidity, and individuals suffering from an overall poor general condition unable to undergo reconstructive anterior and posterior surgeries. Therefore, an alternative, less aggressive surgical method is needed for these select cases of infective spondylodiscitis. This retrospective clinical case series reports our novel surgical technique for the treatment of infective spondylodiscitis. Between January 2005 and July 2011, among 48 patients who were diagnosed with pyogenic lumbar spondylodiscitis or tuberculosis lumbar spondylodiscitis, 10 patients (7 males and 3 females; 68 years and 48 to 78 years, respectively) underwent transpedicular curettage and drainage. The mean postoperative follow-up period was 29 months (range, 7 to 61 months). The pedicle screws were inserted to the adjacent healthy vertebrae in the usual manner. After insertion of pedicle screws, the drainage pedicle holes were made through pedicles of infected vertebra(e) in order to prevent possible seeding of infective emboli to the healthy vertebra, as the same instruments and utensils are used for both pedicle screws and the drainage holes. A minimum of 15,000 mL of sterilized normal saline was used for continuous irrigation through the pedicular pathways until the drained fluid looked clear. All patients' symptoms and inflammatory markers significantly improved clinically between postoperative 2 weeks and postoperative 3 months, and they were satisfied with their clinical results. Radiologically, all patients reached the spontaneous fusion between infected vertebrae and 3 patients had the screw pulled-out but they were clinically tolerable. We suggest that our method of transpedicular curettage and drainage is a useful technique in regards to the treatment of infectious spondylodiscitic patients, who could not tolerate conventional combined anterior and posterior surgery due to multiple co
Relevance of Electrical Remodeling in Human Atrial Fibrillation Results of the Asymptomatic Atrial Fibrillation and Stroke Evaluation in Pacemaker Patients and the Atrial Fibrillation Reduction Atrial Pacing Trial Mechanisms of Atrial Fibrillation Study
Healey, Jeff S.; Israel, Carsten W.; Connolly, Stuart J.; Hohnloser, Stefan H.; Nair, Girish M.; Divakaramenon, Syamkumar; Capucci, Alessandro; Van Gelder, Isabelle C.; Lau, Chu-Pak; Gold, Michael R.; Carlson, Mark; Themeles, Ellison; Morillo, Carlos A.
Background-In animal models of atrial fibrillation (AF), changes in atrial electrophysiological properties are associated with the development of AF. Their relevance to human AF is unclear. Methods and Results-The Asymptomatic Atrial Fibrillation and Stroke Evaluation in Pacemaker Patients and the
K. C. Clemitshaw
Full Text Available An intercomparison of different radiometric techniques measuring atmospheric photolysis frequencies j(NO2, j(HCHO and j(O1D was carried out in a two-week field campaign in June 2005 at Jülich, Germany. Three double-monochromator based spectroradiometers (DM-SR, three single-monochromator based spectroradiometers with diode-array detectors (SM-SR and seventeen filter radiometers (FR (ten j(NO2-FR, seven j(O1D-FR took part in this comparison. For j(NO2, all spectroradiometer results agreed within ±3%. For j(HCHO, agreement was slightly poorer between −8% and +4% of the DM-SR reference result. For the SM-SR deviations were explained by poorer spectral resolutions and lower accuracies caused by decreased sensitivities of the photodiode arrays in a wavelength range below 350 nm. For j(O1D, the results were more complex within +8% and −4% with increasing deviations towards larger solar zenith angles for the SM-SR. The direction and the magnitude of the deviations were dependent on the technique of background determination. All j(NO2-FR showed good linearity with single calibration factors being sufficient to convert from output voltages to j(NO2. Measurements were feasible until sunset and comparison with previous calibrations showed good long-term stability. For the j(O1D-FR, conversion from output voltages to j(O1D needed calibration factors and correction functions considering the influences of total ozone column and elevation of the sun. All instruments showed good linearity at photolysis frequencies exceeding about 10% of maximum values. At larger solar zenith angles, the agreement was non-uniform with deviations explainable by insufficient correction functions. Comparison with previous calibrations for some j(O1D-FR indicated
Koo, Laura W.; Horowitz, Alice M.; Radice, Sarah D.; Wang, Min Q.; Kleinman, Dushanka V.
Objectives We examined nurse practitioners? use and opinions of recommended communication techniques for the promotion of oral health as part of a Maryland state-wide oral health literacy assessment. Use of recommended health-literate and patient-centered communication techniques have demonstrated improved health outcomes. Methods A 27-item self-report survey, containing 17 communication technique items, across 5 domains, was mailed to 1,410 licensed nurse practitioners (NPs) in Maryland in 2...
Rozier, R Gary; Horowitz, Alice M; Podschun, Gary
The authors conducted a national survey to determine the communication techniques that dentists use routinely and variations in their use. American Dental Association Survey Center staff members mailed an 86-item questionnaire to a random sample of 6,300 U.S. dentists in private practice. Participants reported routine use ("most of the time" or "always") during a typical week of 18 communication techniques, of which seven are basic techniques. The authors used analysis of variance and ordinary least squares regression models to test the association of communication, provider and practice characteristics with the number of techniques. Dentists routinely use an average of 7.1 of the 18 techniques and 3.1 of the seven basic techniques. Two-thirds or more of dentists used four of the techniques (hand out printed materials, speak slowly, use models or radiographs to explain, use simple language). Less than one-fourth of dentists used any of the techniques in the teach-back method or patient-friendly practice domains. A dentist's age, race/ethnicity, education outside the United States and area of dentistry affected use. Health literacy variables (awareness, education in communication, practice-level change, outcome expectancy) and lack of time were associated with the number of techniques used. Routine use of all of the communication techniques is low among dentists, including some techniques thought to be most effective with patients with low literacy skills. Professional education is needed to improve knowledge about communication techniques and to ensure that they are used effectively. A firm foundation for these efforts requires the development, evaluation and dissemination of communication guidelines for dental care professionals.
Ohl, Jeanine; Partisani, Marialuisa; Wittemer, Christiane; Lang, Jean-Marie; Viville, Stéphane; Favre, Romain
Assisted reproduction technologies can treat infertility for human immunodeficiency virus (HIV) seropositive women. We assessed the efficacy of these techniques in the results and difficulties encountered while conducting our assisted reproduction programme for 49 couples in which at least the woman had HIV infection that was currently under control. Treatments included intrauterine insemination (IUI), IVF and ICSI, with ovarian stimulation. Embryos were transferred on day 3 after oocyte retrieval. An elective single transfer was performed, except for patients aged > or = 40 years. The median age of the women was 36 years. Ten IUI, nine IVF, 53 ICSI and 10 frozen-thawed embryo transfers have been performed. No pregnancy occurred following the IUI trials but for the couples with IVF and ICSI attempts the clinical pregnancy rate per embryo transfer was 23.9%. Eight babies have been born leading to a 22.2% take home baby rate per treated couple. Contamination was not observed in any newborn. Assisted reproduction technologies and particularly ICSI can provide HIV seropositive women with a safe means of mothering children. Results are encouraging when considering the age of the patients and a preferential single embryo transfer.
Full Text Available Organ motion leads to dosimetric uncertainties during a patient’s treatment. Much work has been done to quantify the dosimetric effects of lung movement during radiation treatment. There is a particular need for a good description and prediction of organ motion. To describe lung motion more precisely, we have examined the possibility of using a computer technique: a morphing algorithm. Morphing is an iterative method which consists of blending one image into another image. To evaluate the use of morphing, Four Dimensions Computed Tomography (4DCT acquisition of a patient was performed. The lungs were automatically segmented for different phases, and morphing was performed using the end-inspiration and the end-expiration phase scans only. Intermediate morphing files were compared with 4DCT intermediate images. The results showed good agreement between morphing images and 4DCT images: fewer than 2 % of the 512 by 256 voxels were wrongly classified as belonging/not belonging to a lung section. This paper presents preliminary results, and our morphing algorithm needs improvement. We can infer that morphing offers considerable advantages in terms of radiation protection of the patient during the diagnosis phase, handling of artifacts, definition of organ contours and description of organ motion.
Hofmayer, C.H.; Park, Y.J.; Costello, J.F.
As part of a cooperative study between the United States and Japan, the US Nuclear Regulatory Commission and the Ministry of International Trade and Industry of Japan agreed to perform a test program that would subject a large scale piping model to significant plastic strains under excitation conditions much greater than the design condition for nuclear power plants. The objective was to compare the results of the tests with state-of-the-art analyses. Comparisons were done at different excitation levels from elastic to elastic-plastic to levels where cracking was induced in the test model. The program was called the high Level Vibration Test (HLVT). The HLVT was performed on the seismic table at the Tadotsu Engineering Laboratory of Nuclear Power Engineering Test Center in Japan. The test model was constructed by modifying the 1/2.5 scale model of one loop of a PWR primary coolant system which was previously tested by NUPEC as part of their seismic proving test program. A comparison of various analysis techniques with test results shows a higher prediction error in the detailed strain values than in the overall response values. This prediction error is magnified as the plasticity in the test model increases. There is no significant difference in the peak responses between the simplified and the detailed analyses. A comparison between various detailed finite element model runs indicates that the material properties and plasticity modeling have a significant impact on the plastic strain responses under dynamic loading reversals. 5 refs., 12 figs
Maréchal, L; Barthod, C; Jeulin, J C
This study provides an important contribution to the definition of the expiratory flow increase technique (EFIT). So far, no measuring means were suited to assess the manual EFIT performed on infants. The proposed method aims at objectively defining the EFIT based on the quantification of pertinent cognitive parameters used by physiotherapists when practicing. We designed and realized customized instrumented gloves endowed with pressure and displacement sensors, and the associated electronics and software. This new system is specific to the manoeuvre, to the user and innocuous for the patient. Data were collected and analysed on infants with bronchiolitis managed by an expert physiotherapist. The analysis presented is realized on a group of seven subjects (mean age: 6.1 months, SD: 1.1; mean chest circumference: 44.8 cm, SD: 1.9). The results are consistent with the physiotherapist's tactility. In spite of inevitable variability due to measurements on infants, repeatable quantitative data could be reported regarding the manoeuvre characteristics: the magnitudes of displacements do not exceed 10 mm on both hands; the movement of the thoracic hand is more vertical than the movement of the abdominal hand; the maximum applied pressure with the thoracic hand is about twice higher than with the abdominal hand; the thrust of the manual compression lasts (590 ± 62) ms. Inter-operators measurements are in progress in order to generalize these results
Goyal, Mayank; Jadhav, Ashutosh P; Bonafe, Alain; Diener, Hans; Mendes Pereira, Vitor; Levy, Elad; Baxter, Blaise; Jovin, Tudor; Jahan, Reza; Menon, Bijoy K; Saver, Jeffrey L
Purpose To study the relationship between functional independence and time to reperfusion in the Solitaire with the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke (SWIFT PRIME) trial in patients with disabling acute ischemic stroke who underwent endovascular therapy plus intravenous tissue plasminogen activator (tPA) administration versus tPA administration alone and to investigate variables that affect time spent during discrete steps. Materials and Methods Data were analyzed from the SWIFT PRIME trial, a global, multicenter, prospective study in which outcomes were compared in patients treated with intravenous tPA alone or in combination with the Solitaire device (Covidien, Irvine, Calif). Between December 2012 and November 2014, 196 patients were enrolled. The relation between time from (a) symptom onset to reperfusion and (b) imaging to reperfusion and clinical outcome was analyzed, along with patient and health system characteristics that affect discrete steps in patient workflow. Multivariable logistic regression was used to assess relationships between time and outcome; negative binomial regression was used to evaluate effects on workflow. The institutional review board at each site approved the trial. Patients provided written informed consent, or, at select sites, there was an exception from having to acquire explicit informed consent in emergency circumstances. Results In the stent retriever arm of the study, symptom onset to reperfusion time of 150 minutes led to 91% estimated probability of functional independence, which decreased by 10% over the next hour and by 20% with every subsequent hour of delay. Time from arrival at the emergency department to arterial access was 90 minutes (interquartile range, 69-120 minutes), and time to reperfusion was 129 minutes (interquartile range, 108-169 minutes). Patients who initially arrived at a referring facility had longer symptom onset to groin puncture times compared with
Muntner, Paul; Woodward, Mark; Carson, April P; Judd, Suzanne E; Levitan, Emily B; Mann, Devin; McClellan, William; Warnock, David G
Background The prevalence of albuminuria in the general population is high, but awareness of it is low. Therefore, we sought to develop and validate a self-assessment tool that allows individuals to estimate their probability of having albuminuria. Study Design Cross-sectional study Setting & Participants The population-based REasons for Geographic And Racial Differences in Stroke (REGARDS) study for model development and the National Health and Nutrition Examination Survey 1999-2004 (NHANES 1999-2004) for model validation. US adults ≥ 45 years of age in the REGARDS study (n=19,697) and NHANES 1999-2004 (n=7,168) [nijsje 1]Factor Candidate items for the self-assessment tool were collected using a combination of interviewer- and self-administered questionnaires. Outcome Albuminuria was defined as a urinary albumin to urinary creatinine ratio ≥ 30 mg/g in spot samples. Results Eight items were included in the self-assessment tool (age, race, gender, current smoking, self-rated health, and self-reported history of diabetes, hypertension, and stroke). These items provided a c-statistic of 0.709 (95% CI, 0.699 – 0.720) and a good model fit (Hosmer-Lemeshow chi-square p-value = 0.49). In the external validation data set, the c-statistic for discriminating individuals with and without albuminuria using the self-assessment tool was 0.714. Using a threshold of ≥ 10% probability of albuminuria from the self-assessment tool, 36% of US adults ≥ 45 years of age in NHANES 1999-2004 would test positive and be recommended screening. The sensitivity, specificity, and positive and negative predictive values for albuminuria associated with a probability ≥ 10% were 66%, 68%, 23% and 93%, respectively. Limitations Repeat urine samples were not available to assess the persistency of albuminuria. Conclusions Eight self-report items provide good discrimination for the probability of having albuminuria. This tool may encourage individuals with a high probability to request
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...
Comiso, Josefino C.; Meier, Walter N.; Gersten, Robert
Variability and trend studies of sea ice in the Arctic have been conducted using products derived from the same raw passive microwave data but by different groups using different algorithms. This study provides consistency assessment of four of the leading products, namely, Goddard Bootstrap (SB2), Goddard NASA Team (NT1), EUMETSAT Ocean and Sea Ice Satellite Application Facility (OSI-SAF 1.2), and Hadley HadISST 2.2 data in evaluating variability and trends in the Arctic sea ice cover. All four provide generally similar ice patterns but significant disagreements in ice concentration distributions especially in the marginal ice zone and adjacent regions in winter and meltponded areas in summer. The discrepancies are primarily due to different ways the four techniques account for occurrences of new ice and meltponding. However, results show that the different products generally provide consistent and similar representation of the state of the Arctic sea ice cover. Hadley and NT1 data usually provide the highest and lowest monthly ice extents, respectively. The Hadley data also show the lowest trends in ice extent and ice area at -3.88%/decade and -4.37%/decade, respectively, compared to an average of -4.36%/decade and -4.57%/decade for all four. Trend maps also show similar spatial distribution for all four with the largest negative trends occurring at the Kara/Barents Sea and Beaufort Sea regions, where sea ice has been retreating the fastest. The good agreement of the trends especially with updated data provides strong confidence in the quantification of the rate of decline in the Arctic sea ice cover.Plain Language SummaryThe declining Arctic sea ice cover, especially in the summer, has been the center of attention in recent years. Reports on the sea ice cover have been provided by different institutions using basically the same set of satellite data but different techniques for estimating key parameters such as ice concentration, ice extent, and ice area. In
Thomsen, Barbara Blicher; Gredal, Hanne; Wirenfeldt, Martin
Background Dogs develop spontaneous ischaemic stroke with a clinical picture closely resembling human ischaemic stroke patients. Animal stroke models have been developed, but it has proved difficult to translate results obtained from such models into successful therapeutic strategies in human....../macrophages and astrocytes. Conclusions The neuropathological changes reported in the present study were similar to findings in human patients with ischaemic stroke. The dog with spontaneous ischaemic stroke is of interest as a complementary spontaneous animal model for further neuropathological studies....... stroke patients. In order to face this apparent translational gap within stroke research, dogs with ischaemic stroke constitute an opportunity to study the neuropathology of ischaemic stroke in an animal species. Case presentation A 7 years and 8 months old female neutered Rottweiler dog suffered...
Lourdes R. Hernández Santos
Full Text Available Se realizó un estudio sensorial y motor preoperatorio y posoperatorio a 84 pacientes que acudieron a la consulta de Visión Binocular con el diagnóstico de estrabismo horizontal a partir de los 13 años de edad. El método estadístico utilizado fue "t" o Chi cuadrado. Nos trazamos como objetivo determinar los resultados posoperatorios de la cirugía de estrabismo realizada con la técnica de suturas ajustables, que fueron los siguientes: el 61 % de los pacientes con exotropía y el 71,4 % con el diagnóstico de exotropía se encontraban en ortotropía a los 6 meses de la intervención. El 71,4 % de los pacientes con esotropía y el 83,3 % con el diagnóstico de esotropía se encontraban en ortotropía al año de la intervención. Esta técnica quirúrgica permite la modificación de la desviación en el posoperatorio inmediato.A preoperative and postoperative sensorial and motor study was conducted among 84 patients who received attention at the consultation room of Binocular Vision with the diagnosis of horizontal strabismus from the age of 13 years old on. The statistical method used was "t" or chi square test. Our objective was to determine the postoperative results of the strabismus surgery performed by the technique of adjustable sutures. The results were as follows: 61 % of the patients with exotropia and 71.4 % with the diagnosis of exotropia were in orthotropia 6 months after the operation. 71.4 % of the patients with exotropia and 83.3 % with the diagnosis of exotropia were in orthotropia a year after the operation. This surgical technique allows the modification of the deviation in the immediate postoperative.
This paper presents three simple techniques for fusing observations and numerical model predictions. The techniques rely on model/observation bias being considered either as error free, or containing some uncertainty, the latter mitigated with a Kalman filter approach or a spati...
Brown, Nicholas J. L.; Heathers, James A. J.
We present a simple mathematical technique that we call granularity-related inconsistency of means (GRIM) for verifying the summary statistics of research reports in psychology. This technique evaluates whether the reported means of integer data such as Likert-type scales are consistent with the
Mueller, P.R.; Brown, A.; Saini, S.; Hahn, P.F.; Steiner, E.; Ferrucci, J.T.; Forman, B.H.; Silverman, S.G.
Percutaneous radiologic gastrostomy is a well-described method that has not been widely adopted by radiologists. The authors reviewed their experience to highlight technical points and clinical results. Direct percutaneous gastrostomy was performed in 51 patients and percutaneous jejunostomy in four. Indications for gastrostomy procedures were the need for general nutrition (n = 31), complications of use of a nasogastric feeding tube (n = 7), gastric or small bowel decompression (n = 4) and endoscopic failure (n = 5). The major indication for percutaneous jejunostomy was decompression of small bowel obstruction. Key technical aspects include the use of a novel needle device that tacks the abdominal wall to the stomach, thus assuring a seal between the two structures. In the percutaneous gastrostomies, 18-F Foley catheters were introduced through the tacked portion of the stomach with a Seldinger technique and dilators. For percutaneous jejunostomy, 18-F feeding tubes were placed. All procedures were performed under local anesthesia. The authors conclude that a radiologic percutaneous gastrostomy is a safe and effective procedure and should be pursued aggressively by interventional radiologists
Full Text Available Aim: The aim of this study was to evaluate the functional outcomes of arthroscopic all-inside meniscal repair at an average 5-year follow-up. Methods: Thirty-two patients (29 males 3 females; 19 right knees, 13 left knees, who underwent arthroscopic all-inside meniscal repair, were included in the study. Clinical examination and magnetic resonance imaging were the main diagnostic tools. The mean age of the patients was 28 years (23-41 years. ACL reconstruction was performed in the same session in 12 patients with meniscal injury associated with ACL tear. Preoperative and postoperative functional knee scores of the patients were assessed by modified Marshall functional knee scores in their last follow-up. Results: The mean follow-up period was 58 months (range 49- 81. Marshall knee scores in the last follow-up were found to be excellent in 23 patients, good - in 8 patients, and moderate in 1 patient. ACL reconstruction was performed in the same session in 12 patients with meniscal injury associated with ACL tear. A statistically significant functional improvement was detected in patients with meniscal repair after 5 years. Conclusion: This study showed that all-inside meniscal repair technique is an easy and reliable method for the treatment of meniscus tears. (The Medical Bulletin of Haseki 2015; 53:47-51
Abel, Taylor J; Rhone, Ariane E; Nourski, Kirill V; Oya, Hiroyuki; Kawasaki, Hiroto; Howard, Matthew A III; Granner, Mark A; Tranel, Daniel T; Griffiths, Timothy D
Temporopolar cortex plays a crucial role in the pathogenesis of temporal lobe epilepsy and subserves important cognitive functions. Because of its shape and position in the middle cranial fossa, complete electrode coverage of the temporal pole (TP) is difficult to achieve using existing devices. We designed a novel TP electrode array that conforms to the surface of temporopolar cortex and achieves dense electrode coverage of this important brain region. A multi-pronged electrode array was designed that can be placed over the surface of the TP using a straightforward insertion technique. Twelve patients with medically intractable epilepsy were implanted with the TP electrode array for purposes of seizure localization. Select patients underwent cognitive mapping by electrocorticographic (ECoG) recording from the TP during a naming task. Use of the array resulted in excellent TP electrode coverage in all patients. High quality ECoG data were consistently obtained for purposes of delineating seizure activity and functional mapping. During a naming task, significant increases in ECoG power were observed within localized subregions of the TP. One patient developed a transient neurological deficit thought to be related to the mass effect of multiple intracranial recording arrays, including the TP array. This deficit resolved following removal of all electrodes. The TP electrode array overcomes limitations of existing devices and enables clinicians and researchers to obtain optimal multi-site recordings from this important brain region. (paper)
Fish that pass through a hydroelectric turbine may not be killed directly, but may nonetheless experience sublethal stresses that will increase their susceptibility to predators (indirect mortality). There is a need to develop reliable tests for indirect mortality so that the full consequences of passage through turbines (and other routes around a hydroelectric dam) can be assessed. We evaluated a new technique for assessing indirect mortality, based on a behavioral response to a startling stimulus (akin to perceiving an approaching predator). We compare this technique to the standard predator preference test. The behavioral response is a rapid movement commonly referred to as a startle response, escape response, or C-shape, based on the characteristic body position assumed by the fish. When viewed from above, a startled fish bends into a C-shape, then springs back and swims away in a direction different from its original orientation. This predator avoidance (escape) behavior can be compromised by sublethal stresses that temporarily stun or disorient the fish. We subjected striped shiners and fathead minnows to varying intensities of either turbulence (10-, 20- or 30-min) or 2-min exposures to a fish anesthetic (100 or 200 mg/L of tricaine methanesulfonate), and evaluated their subsequent behavior. Individual fish were given a startle stimulus and filmed with a high-speed video camera. Each fish was startled and filmed twice before being stressed, and then at 1-, 5-, 15-, and 30-min post-exposure. The resulting image files were analyzed for a variety of behavioral measures including: presence of a response, time to first reaction, duration of reaction, time to formation of maximum C-shape, time to completion of C-shape, and completeness of C-shape. The most immediate measure of potential changes in fish behavior was whether stressed fish exhibited a startle response. For striped shiners, the number of fish not responding to the stimulus was significantly different
Philipp, Carsten M.; Berlien, Hans-Peter; Poetke, Margitta; Waldschmidt, Juergen
During the period of January 1984 - July 1993, we have treated 611 children with more than 2000 lesions of congenital vascular disorders (CVD) such as hemangiomas and vascular malformations. This number does not include the patients with port wine stains, which also have been treated by means of laser. Most of the CVD patients (n equals 467) presented hemangiomas of the face, the anogenital region, and the extremities, some were located in the trachea or mouth or in the urogenital tract. All of these hemangiomas were growing prior to intervention or showed complications such as bleeding, ulceration, superinfection, or obstruction. Nearly a quarter (n equals 144) of the patients presented vascular malformations, either of singular vessel type involvement or of mixed vascular genesis (venous, arterio- venous, veno-lymphatic or lymphatic) with various complications like tracheal obstruction or recurrent thrombophlebitis. According to our step program, which is based on a clinical classification, the hemangiomas were treated as early as possible, while the vascular malformations were only treated with laser when no other therapeutic technique (embolization, resection) was suitable. All patients were referred for laser treatment from other centers. The lasers used were Nd:YAG and Argon lasers with transcutaneous application with or without continuous ice-cube surface cooling or interstitial laser application. The treatments were performed either on in- or outpatient basis according to age, localization and with good to excellent results in most cases and a complication rate of less than 2%.
Akmansu, M.; Dirican, Bahar; Oeztuerk, Berrin; Egehan, Ibrahim; Subasi, Mahmut; Or, Meral
Purpose: This study was performed to determine the toxicity and efficacy of external-beam radiotherapy in patients with age-related subfoveal neovascularization. Methods and Materials: Between January 1996 and September 1996, 25 patients with a mean age of 70.5 (60-84) years were enrolled. All patients underwent fluorescein angiographic evaluation and documentation of their neovascular disease prior to irradiation. A total of 25 patients were treated with a total dose of 12 Gy in 6 fractions over 8 days. We used a lens-sparing technique and patients were treated with a single lateral 6-MV photon beam. To assess the risk of radiation carcinogenesis after treatment of age-related subfoveal neovascularization, we estimated the effective dose for a standard patient on the basis of tissue-weighting factors as defined by the International Commission on Radiological Protection (ICRP). The calculations were made with TLD on a male randophantom. The lens dose was found to be 0.217 Gy per fraction. Results: No significant acute morbidity was noted. Visual acuity was maintained or improved in 76% and 80% of treated patients at their 1- and 3-month follow-up examinations, respectively. On angiographic imaging, there was stabilization of subfoveal neovascular membranes in 23 patients (92%) at 3 months after irradiation. Conclusion: Our observations on these 25 patients in this study indicate that many patients will have improved or stable vision after radiotherapy treatment with low-dose irradiation
Gillett, Sarah R; Boyle, Rebekah H; Zakai, Neil A; McClure, Leslie A; Jenny, Nancy S; Cushman, Mary
The REasons for Geographic and Racial Differences in Stroke (REGARDS) study is a prospective cohort of 30,239 Americans in the contiguous United States; the first of this scale to use home visits to obtain, process, and ship biologic samples to a core laboratory. Pre-analytical factors resulting from this study design may affect the results of some laboratory assays. We investigated the impact of REGARDS processing on a variety of analytes. In REGARDS, blood samples were processed in the field by technicians who were trained on standardized methods for phlebotomy and sample processing. Field processing included centrifugation using varying non-uniform equipment and shipping overnight on ice to the University of Vermont, where samples were re-centrifuged for 30,000 ×g-minutes and stored at -80 °C. We assessed the effects of REGARDS sample handling by processing split samples from 20 volunteers using either ideal procedures or simulated REGARDS procedures. Assays for 19 analytes for potential study in REGARDS were then run on both samples and results compared. Spearman correlation coefficients for analytes measured in ideal versus REGARDS processed samples ranged from 0.11 to 1.0. Thirteen of 19 analytes were highly correlated (>0.75), but platelet proteins were more variable. Simulation of non-optimal field processing and shipment to a central laboratory showed high variability in analytes released by platelets. The majority of other analytes produced valid results, but platelet contamination in REGARDS samples makes measurement of platelet proteins unadvisable in these samples. Future analytes considered by REGARDS or similar studies should undergo similar pilot testing. Copyright © 2014. Published by Elsevier Inc.
Dewey, M.; Hamm, B.
Multislice computed tomography (MSCT) after intravenous contrast agent administration enables visualization of the coronary arteries with high spatial resolution (voxel sizes down to 0.5 x 0.35 x 0.35 mm3) and a short scan time. Magnetic resonance imaging (MRI) is also intensively studied with respect to the noninvasive detection of coronary artery stenosis and thus the detection of coronary artery disease (CAD) without radiation exposure but is not equal to MSCT at present. This article provides an overview of the historical development of CT coronary angiography from 4-slice CT to 16-slice CT and 64-slice CT. A crucial aspect of this development is the improvement in image quality resulting from shorter breath-hold periods and the reduced gantry rotation time. Other techniques that appear to considerably improve image quality and accuracy and make CT independent of patient heart rates are multisegment reconstruction and dual-source CT. Sublingual nitroglycerin as well as oral or intravenous betablocker administration should be considered in relation to the diagnostic question to be answered and the patient's heart rate. In the studies available CT coronary angiography with at least 12 simultaneous detector rows has a sensitivity of 96.9 % and a specificity of 75.3 % at the patient level. Especially the negative predictive value of CT (94.6 %) emphasizes the idea that this technique may reliably exclude CAD in patients with intermediate pretest likelihood. In the near future, 256-slice CT will allow examination of the entire heart during one heartbeat or even 4D CT scanning with simultaneous assessment of myocardial perfusion. Automatic or semiautomatic software tools will assume a central place in detecting and quantifying coronary artery stenoses and plaques as well as in the analysis of cardiac function in the clinical setting over the next years. Prior to its routine clinical use, the cost-effectiveness of CT coronary angiography must be determined and the
Nery, Caio; Fonseca, Lucas; Raduan, Fernando; Moreno, Marcus; Baumfeld, Daniel
Lateral ankle ligament injury is among the most common orthopedic injuries. The objective of this study is to present the preliminary prospective results of treatment using the "Inside-Out" variant of the fully arthroscopic Broström-Gould technique. Twenty six patients were included: 20 male and 6 female, aged 19-60 years, mean 41 years. All patients had positive "anterior drawer" and "talar tilt" tests. When necessary, cartilage injuries were treated with microfracture and arthroscopic resection for anterior impingement; three patients had hindfoot varus, on whom Dwyer osteotomy was performed; one patient had peroneal tendinopathy and was treated with tendoscopic debridement and another one had partial injury of the deltoid ligament, which was treated by direct repair. Two arthroscopic surgery portals were used; the anteromedial and anterolateral. After careful inspection of the joint, the anterior surface of the fibula was cleaned to resect the remains of the anterior talo-fibular ligament. An anchor with two sutures was placed on the anterior aspect of the fibula, 1cm from the distal apex of the malleolus. The sutures were passed through the remnant of the anterior talo-fibular ligament as well as the extensor retinaculum using special curved needles. Duncan knots were used to tie the ligament and the inferior extensor retinaculum while the ankle was kept in a neutral position. Patients were kept immobilized non-weight bearing for 2 weeks and were then allowed to start weight bearing in a removable protective boot for 4 weeks. The patients were able to return to sporting activities 6 months after surgery. After a mean follow-up of 27 months (range 21-36 months), patients were functionally evaluated using the American Orthopedics Foot and Ankle Society (AOFAS) ankle score. The mean preoperative value was 58 points, while the mean postoperative value increased to 90 points. One patient had paresthesia in the superficial fibular nerve area, which resolved
Huang, Chen [Affiliated Hospital of Nantong University, Department of General Surgery (China); Tang, Hanfei; Qiao, Tong; Liu, Changjian; Zhou, Min, E-mail: firstname.lastname@example.org [The Affiliated Hospital of Nanjing University Medical School, Department of Vascular Surgery, Nanjing Drum Tower Hospital (China)
ObjectiveTo summarize our early experience gained from the chimney technique for type B aortic dissection (TBAD) extending to the aortic arch and to evaluate the aortic remodeling in the follow-up period.MethodsFrom September 2011 to July 2014, 27 consecutive TBAD patients without adequate proximal landing zones were retrograde analyzed. Chimney stent-grafts were deployed parallel to the main endografts to reserve flow to branch vessels while extending the landing zones. In the follow-up period, aortic remodeling was observed with computed tomography angiography.ResultsThe technical success rate was 100 %, and endografts were deployed in zone 0 (n = 3, 11.1 %), zone 1 (n = 18, 66.7 %), and zone 2 (n = 6, 22.2 %). Immediately, proximal endoleaks were detected in 5 patients (18.5 %). During a mean follow-up period of 17.6 months, computed tomography angiography showed all the aortic stent-grafts and chimney grafts to be patent. Favorable remodeling was observed at the level of maximum descending aorta and left subclavian artery with expansion of true lumen (from 18.4 ± 4.8 to 25 ± 0.86 mm, p < 0.001 and 27.1 ± 0.62 to 28.5 ± 0.37 mm, p < 0.001) and depressurization of false lumen (from 23.7 ± 2.7 to 8.7 ± 3.8 mm, p < 0.001, from 5.3 ± 1.2 to 2.1 ± 2.1 mm, p < 0.001). While at the level of maximum abdominal aorta, suboptimal remodeling of the total aorta (from 24.1 ± 0.4 to 23.6 ± 1.5 mm, p = 0.06) and true lumen (from 13.8 ± 0.6 to 14.5 ± 0.4 mm, p = 0.08) was observed.ConclusionBased on our limited experience, the chimney technique with thoracic endovascular repair is demonstrated to be promising for TBAD extending to the arch with favorable aortic remodeling.
De Coninck, Carina; Frid, Anders; Gaspar, Ruth; Hicks, Debbie; Hirsch, Larry; Kreugel, Gillian; Liersch, Jutta; Letondeur, Corinne; Sauvanet, Jean-Pierre; Tubiana, Nadia; Strauss, Kenneth
The efficacy of injection therapy in diabetes depends on correct injection technique and, to provide patients with guidance in this area, we must understand how they currently inject. From September 2008 to June 2009, 4352 insulin-injecting Type 1 and Type 2 diabetic patients from 171 centers in 16 countries were surveyed regarding their injection practices. Overall, 3.6% of patients use the 12.7-mm needle, 1.8% use the 12-mm needle, 1.6% use the 10-mm needle, 48.6% use the 8-mm needle, 15.8% use the 6-mm needle, and 21.6% use the 5-mm needle; 7% of patients do not know what length of needle they use. Twenty-one percent of patients admitted injecting into the same site for an entire day, or even a few days, a practice associated with lipohypertrophy. Approximately 50% of patients have or have had symptoms suggestive of lipohypertrophy. Abdominal lipohypertrophy seems to be more frequent in those using the two smaller injection size areas, and less frequent in those using larger areas. Nearly 3% of patients reported always injecting into lipohypertrophic lesions and 26% inject into them sometimes. Of the 65% of patients using cloudy insulins (e.g. NPH), 35% do not remix it before use. It is clear from the latest survey that we have improved in certain areas, but that, in others, we have either not moved at all or our efforts have not yielded the results we expected. The results of the present survey are available online on a country-by-country and question-by-question basis at http://www.titan-workshop.org. © 2010 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and Blackwell Publishing Asia Pty Ltd.
Koo, Laura W; Horowitz, Alice M; Radice, Sarah D; Wang, Min Q; Kleinman, Dushanka V
We examined nurse practitioners' use and opinions of recommended communication techniques for the promotion of oral health as part of a Maryland state-wide oral health literacy assessment. Use of recommended health-literate and patient-centered communication techniques have demonstrated improved health outcomes. A 27-item self-report survey, containing 17 communication technique items, across 5 domains, was mailed to 1,410 licensed nurse practitioners (NPs) in Maryland in 2010. Use of communication techniques and opinions about their effectiveness were analyzed using descriptive statistics. General linear models explored provider and practice characteristics to predict differences in the total number and the mean number of communication techniques routinely used in a week. More than 80% of NPs (N = 194) routinely used 3 of the 7 basic communication techniques: simple language, limiting teaching to 2-3 concepts, and speaking slowly. More than 75% of respondents believed that 6 of the 7 basic communication techniques are effective. Sociodemographic provider characteristics and practice characteristics were not significant predictors of the mean number or the total number of communication techniques routinely used by NPs in a week. Potential predictors for using more of the 7 basic communication techniques, demonstrating significance in one general linear model each, were: assessing the office for user-friendliness and ever taking a communication course in addition to nursing school. NPs in Maryland self-reported routinely using some recommended health-literate communication techniques, with belief in their effectiveness. Our findings suggest that NPs who had assessed the office for patient-friendliness or who had taken a communication course beyond their initial education may be predictors for using more of the 7 basic communication techniques. These self-reported findings should be validated with observational studies. Graduate and continuing education for NPs
Gran, Fredrik; Jakobsson, Andreas; Udesen, Jesper
spectral Capon (BPC) method is based on a standard minimum variance technique adapted to account for both averaging over slowtime and depth. The Blood Amplitude and Phase Estimation technique (BAPES) is based on finding a set of matched filters (one for each velocity component of interest) and filtering......Adaptive spectral estimation techniques are known to provide good spectral resolution and contrast even when the observation window(OW) is very sbort. In this paper two adaptive techniques are tested and compared to the averaged perlodogram (Welch) for blood velocity estimation. The Blood Power...... the blood process over slow-time and averaging over depth to find the power spectral density estimate. In this paper, the two adaptive methods are explained, and performance Is assessed in controlled steady How experiments and in-vivo measurements. The three methods were tested on a circulating How rig...
Hernández-Orgaz, A; López-Alonso, M
The Boix-Ochoa technique enable hipercorrection of the gastroesophageal reflux (GER), avoiding the disphagia and allowing the eructing capability as a consequence of the fundoplication procedure. During the last decade 102 children were surgically treated using the Boix-Ochoa technique. The age range was 4.93 +/- 3.80 years. All patients have previously been studied with Xray, esophageal manometry, pHmetry during 24 h, and eventually with medical treatment. Failure of the medical treatment lead to the surgical treatment with the Boix-Ochoa technique. After surgery, 24 h controls of esophageal pHmetry showed reflux indexes greater than 5 in six patients. Two of them had neurological pathology and one of them suffered peptic stenosis previously treated by means of mechanical dilatation. The rest of patients showed normal value of reflux indexes after surgery. Excluding the esophageal atresia and caustic stenosis, the Boix-Ochoa technique is the best choice for the surgical treatment of GER.
Ku, Elaine; Scherzer, Rebecca; Odden, Michelle C; Shlipak, Michael; White, Carole L; Field, Thalia S; Benavente, Oscar; Pergola, Pablo E; Peralta, Carmen A
We applied cluster analysis to identify discrete patterns of concomitant responses of systolic (SBP), diastolic (DBP) and pulse pressure (PP) during intensive BP lowering; and to evaluate their clinical relevance and association with risk of mortality, major vascular events (MVEs), and stroke. We used an unsupervised cluster procedure to identify distinct patterns of BP change during the first 9 months of anti-hypertensive therapy intensification among 1,331 participants in the Secondary Prevention of Small Subcortical Strokes Trial who were previously randomized to lower BP target (SBP < 130 mm Hg) after lacunar stroke. The cluster procedure partitioned participants into three groups in the lower SBP target arm, persons with: 1) mildly elevated baseline SBP and minimal visit-to-visit BP variability (mild reducers); 2) moderately elevated baseline SBP and moderate visit-to-visit BP variability (moderate reducers); and 3) very elevated baseline SBP with very large visit-to-visit BP variability during intensification (large reducers). In the lower SBP target group, moderate reducers had a higher risk of death (adjusted HR 1.6 [95% CI 1.0-2.7]), MVE (adjusted HR 2.1 [95% CI 1.4-3.2]), and stroke (adjusted HR 2.6[95% CI 1.7-4.1]) compared to mild reducers. Large reducers had the highest risk of death (adjusted HR 2.3 [95% CI 1.2-4.4]), but risk of MVE (HR = 1.7 [95%CI 0.9-3.1]) and stroke (HR = 1.6 [95%CI: 0.8-3.5]) were not statistically significantly different compared to mild reducers. Among persons with prior lacunar stroke, baseline BP levels, and BP variability in the setting of intensive BP lowering can identify discrete groups of persons at higher risk of adverse outcomes.
Wang, Yu-Tsai; Kent, Ray D.; Kent, Jane Finley; Duffy, Joseph R.; Thomas, Jack E.
Although perceptual studies indicate the likelihood of voice disorders in persons with stroke, there have been few objective instrumental studies of voice dysfunction in dysarthria following stroke. This study reports automatic analysis of sustained vowel phonation for 61 speakers with stroke. The results show: (1) men with stroke and healthy…
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.
Onuminya, J E; Onuminya, D S
Severe chronic osteomyelitis with variable outcomes is still common among children in developing nations. There has been no consensus on the optimal method of treatment. We therefore prospectively evaluated the rates of wound healing and recurrence following open wound treatment of post-sequestrectomy dead spaces in 30 patients with haematogenous chronic osteomyelitis of the tibial shaft at the King Orthopaedic Clinic, Ekpoma, Edo State, Nigeria, between January 2001 and December 2005. Thirty similar patients whose post-sequestrectomy dead spaces were treated by closed wound technique formed the control group. Both groups were subjected to standard methods of perioperative management. Saucerisation, sequestrectomy and curettage were the cornerstones of surgical therapy. The wounds were primarily either left open (study group) or closed (control group). The rates of wound healing and recurrence were used to assess the outcome of treatment. The chi-square test was used for statistical analysis. The median age was 13 years, with a range of 6 - 60 years. Staphylococcus aureus was the organism most commonly associated with chronic osteomyelitis. Rates of wound healing and recurrence in the study group were significantly better than in the control group (p<0.05), even though it took a relatively longer period to achieve healing with the open method of treatment. The follow-up period ranged from 1 to 5 years, with a median of 2 years. We observed that the results of the open method of treating post-sequestrectomy dead spaces were good, and we advocate its use in resource-poor settings.
Kozlov, Yury; Novogilov, Vladimir; Rasputin, Andrey; Podkamenev, Alexey; Krasnov, Pavel; Weber, Irina; Solovjev, Alexey
Inguinal hernia repair is the most common procedure in pediatric surgery. Suture techniques for laparoscopic inguinal hernia repair in children are easy to perform and popular with a low recurrence rate. The aim of this study was to evaluate the effect of laparoscopic preperitoneal injection of three-dimensional gel on closing of the inguinal hernia sac (IHS) in laboratory animals. With the animals under general anesthesia, we performed peritoneoscopy in 12 male Chinchilla rabbits weighing 1200-1400 g. The endoscope was introduced into the abdominal cavity, and bilateral deep inguinal rings were identified. A Tuohy needle with the injectable polymeric bulking agent DAM+™ (three-dimensional polyacrylamide gel with silver ions [Argiform(®) from Bioform(®)]) was introduced preperitoneally. The implant was then injected across the entire orifice of the deep inguinal rings and draped over the cord structures. After completion of bilateral repairs, the rabbits were extubated and observed in the animal laboratory. Then the second laparoscopy was performed 6 months later, and the deep inguinal rings were inspected. The postoperative course was uneventful in all the animals. At the second laparoscopy no reopening of the entire orifice of the deep inguinal rings was noted. Accurate placement of the polymeric agent and adequate coverage of the vas deferens were accomplished in all the animals. This study demonstrates that the biopolymeric implant gives good postoperative results and a stable trend of closing the IHS in long-term follow-up. In conclusion, we hope that injectable polymeric bulking agents can be used for treatment of inguinal hernias of pediatric patients after additional animal and human research.
Durner, Wolfgang; Huber, Magdalena; Yangxu, Li; Steins, Andi; Pertassek, Thomas; Göttlein, Axel; Iden, Sascha C.; von Unold, Georg
The particle-size distribution (PSD) is one of the main properties of soils. To determine the proportions of the fine fractions silt and clay, sedimentation experiments are used. Most common are the Pipette and Hydrometer method. Both need manual sampling at specific times. Both are thus time-demanding and rely on experienced operators. Durner et al. (Durner, W., S.C. Iden, and G. von Unold (2017): The integral suspension pressure method (ISP) for precise particle-size analysis by gravitational sedimentation, Water Resources Research, doi:10.1002/2016WR019830) recently developed the integral suspension method (ISP) method, which is implemented in the METER Group device PARIOTM. This new method estimates continuous PSD's from sedimentation experiments by recording the temporal evolution of the suspension pressure at a certain measurement depth in a sedimentation cylinder. It requires no manual interaction after start and thus no specialized training of the lab personnel. The aim of this study was to test the precision and accuracy of new method with a variety of materials, to answer the following research questions: (1) Are the results obtained by PARIO reliable and stable? (2) Are the results affected by the initial mixing technique to homogenize the suspension, or by the presence of sand in the experiment? (3) Are the results identical to the one that are obtained with the Pipette method as reference method? The experiments were performed with a pure quartz silt material and four real soil materials. PARIO measurements were done repetitively on the same samples in a temperature-controlled lab to characterize the repeatability of the measurements. Subsequently, the samples were investigated by the pipette method to validate the results. We found that the statistical error for silt fraction from replicate and repetitive measurements was in the range of 1% for the quartz material to 3% for soil materials. Since the sand fractions, as in any sedimentation method, must
Recinos, Pablo F; Pindrik, Jonathan A; Bedri, Mazen I; Ahn, Edward S; Jallo, George I; Recinos, Violette Renard
low infection rates, and has cosmetically appealing results. It may be considered as an alternative option to standard VP shunt placement techniques.
Feng, Rui; Badgeley, Marcus; Mocco, J; Oermann, Eric K
Stroke is a leading cause of long-term disability, and outcome is directly related to timely intervention. Not all patients benefit from rapid intervention, however. Thus a significant amount of attention has been paid to using neuroimaging to assess potential benefit by identifying areas of ischemia that have not yet experienced cellular death. The perfusion-diffusion mismatch, is used as a simple metric for potential benefit with timely intervention, yet penumbral patterns provide an inaccurate predictor of clinical outcome. Machine learning research in the form of deep learning (artificial intelligence) techniques using deep neural networks (DNNs) excel at working with complex inputs. The key areas where deep learning may be imminently applied to stroke management are image segmentation, automated featurization (radiomics), and multimodal prognostication. The application of convolutional neural networks, the family of DNN architectures designed to work with images, to stroke imaging data is a perfect match between a mature deep learning technique and a data type that is naturally suited to benefit from deep learning's strengths. These powerful tools have opened up exciting opportunities for data-driven stroke management for acute intervention and for guiding prognosis. Deep learning techniques are useful for the speed and power of results they can deliver and will become an increasingly standard tool in the modern stroke specialist's arsenal for delivering personalized medicine to patients with ischemic stroke. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
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....
Koyamada, K. [University of Iwate Prefecture, Iwate (Japan)
In this paper, we propose a new technique for visualizing volume datasets using VRML. In general, a visualization algorithm generates tens thousands of geometric triangles with numerical data, when it is visualized. They are huge in number, if we transfer them through the Internet. To solve the problem, we restrict the visualization on a slice plane and represent triangle mesh as a single quadrateral with a texture image. The texture image are constructed at a server side. We apply the technique to some volume datasets and confirm the effectiveness. (author)
Leys, D; Englund, E; Del Ser, T
or white matter lesions or leukoencephalopathy or leukoaraiosis' and 'stroke or cerebral infarct or cerebral hemorrhage or cerebrovascular disease or transient ischemic attack (TIA)'. WMC, as defined radiologically, are present in up to 44% of patients with stroke or TIA and in 50% of patients...... of death or dependency, recurrent stroke of any type, cerebral bleeding under anticoagulation, myocardial infarction, and poststroke dementia. WMC in stroke patients are often associated with small-vessel disease and lead to a higher risk of death, and poor cardiac and neurological outcome. However......White matter changes (WMC), detected by imaging techniques, are frequent in stroke patients. The aim of the study was to determine how WMC relate to stroke subtypes and to stroke outcome. We made a systematic Medline search for articles appearing with two of the following key words: either 'WMC...
Siegerink, Bob; Meltzer, Mirjam E.; de Groot, Philip G.; Algra, Ale; Lisman, Ton; Rosendaal, Frits R.
Reduced overall fibrinolytic capacity increases the risk of myocardial infarction (MI), as demonstrated in studies with predominantly male participants. We determined the influence of altered fibrinolysis on the risk of MI and ischaemic stroke (IS) in young women. The RATIO (Risk of Arterial
van Wijk, Renske; Cumming, T.; Churilov, L.; Donnan, G.; Bernhardt, J.
Background: The optimal physical therapy dose in acute stroke care is unknown. The authors hypothesized that physical therapy would be significantly different between treatment arms in a trial of very early and frequent mobilization (VEM) and that immobility-related adverse events would be
Mueller, C.; Huebner, F.; Bisdas, S.; Herzog, C.; Hammerstingl, R.M.; Vogl, T.J.; Ackermann, H.; Vorbuchner, M.
Purpose: To analyze the proton magnetic resonance spectroscopic data ( 1 H MRS) of normal liver parenchyma with regard to age, sex, body mass index and location in the liver. Materials and Methods: 45 healthy volunteers age 24 to 65 years were examined with an optimized single-voxel 1 H MRS using a 1.5-T scanner. A spin echo sequence with a TR of 1500 ms and a TE of 135 ms was used, allowing in-phase detection of the choline signal. Weak water suppression was achieved using a chemical shift selective suppression (CHESS) technique. Each examination included the measurement of three voxels with a voxel size of 18 x 18 x 18 mm 3 in different areas of the liver. The volunteers were divided into different age-based groups (young: ≤44 years; older: ≥44 years), BMI (normal weighted: 2 ; obese: >25 kg/m 2 ) and sex. Results: In the acquired spectra different lipid (e.g. [CH 2 ] n ), choline, glutamine, glutamate and glycogenglucose-complex reasonances were detected. The analysis of the spectra, however, only focused on the concentrations of choline and (CH 2 ) n and the relative concentrations of the choline-to-(CH 2 ) n -ratios. In the older volunteers the relative concentration of the choline-to-(CH 2 ) n -ratio was significantly decreased by 0.213±0.193 in comparison to the younger subjects (p=0,031). Further statistical analysis confirmed a significant decrease of the choline-to-(CH 2 ) n -ratio by 0.223±0.180 in obese volunteers compared to volunteers of a standard weight (p=0,016). The significant difference between the choline-to-(CH 2 ) n -ratio female versus male volunteers was calculated with an increase of 0.483±0.172 (p=0,000). The location of the voxel in the liver parenchyma did not yield a signficant difference in the choline-to-(CH 2 ) n -ratio. (orig.)
Kan, Lisheng; Kang, Jian; Gao, Rui; Chen, Xiongsheng; Jia, Lianshun
To date, formulation of the optimal surgical protocol for noncontiguous multilevel cervical spondylosis remains controversial, and the corresponding clinical data continue to be limited. The purpose of this study was to compare the clinical and radiological outcomes of two hybrid reconstructive techniques in noncontiguous 3-level cervical spondylosis (2 contiguous disc levels and 1 "skip" disc level [nonoperated level between 2 operated levels]). The incidence of adjacent-segment degeneration (ASD) was also evaluated. Sixty-three consecutive patients with noncontiguous 3-level cervical spondylosis who underwent two different hybrid methods of treatment were retrospectively reviewed. The patients were divided into 2 groups, the fusion group and the arthroplasty group. A titanium mesh cage and an anterior cervical plate were used after the anterior cervical corpectomy, and then a stand-alone cage (the fusion group) or an artificial cervical disc (the arthroplasty group) was used after the discectomy. Clinical outcomes were assessed using the Japanese Orthopaedic Association (JOA) scale score and the JOA scale score improvement rate preoperatively and during follow-up. Radiological results were assessed using global angle and global range of motion (ROM) of the cervical spine. The ASD was also evaluated. The JOA scores of the patients significantly improved postoperatively and were well maintained within the follow-up period, as did the JOA scale score improvement rate. The mean global angle of the cervical spine of the patients significantly increased postoperatively. At the last follow-up evaluation, the mean global ROM was retained by patients in the arthroplasty group (p > 0.05) but not by patients in the fusion group (p = 0.00). There was no significant difference in the incidence of ASD between the 2 groups (p = 0.114). However, at the skip levels, patients in the fusion group had a higher incidence of ASD than patients in the arthroplasty group (p = 0
Litner, Jason A; Adamson, Peter A
To compare the intraoperative outcomes of superficial musculoaponeurotic system plication, imbrication, and deep-plane rhytidectomy techniques. Thirty-two patients undergoing primary deep-plane rhytidectomy participated. Each hemiface in all patients was submitted sequentially to 3 progressively more extensive lifts, while other variables were standardized. Four major outcome measures were studied, including the extent of skin redundancy and the repositioning of soft tissues along the malar, mandibular, and cervical vectors of lift. The amount of skin excess was measured without tension from the free edge to a point over the intertragal incisure, along a plane overlying the jawline. Using a soft tissue caliper, repositioning was examined by measurement of preintervention and immediate postintervention distances from dependent points to fixed anthropometric reference points. The mean skin excesses were 10.4, 12.8, and 19.4 mm for the plication, imbrication, and deep-plane lifts, respectively. The greatest absolute soft tissue repositioning was noted along the jawline, with the least in the midface. Analysis revealed significant differences from baseline and between lift types for each of the studied techniques in each of the variables tested. These data support the use of the deep-plane rhytidectomy technique to achieve a superior intraoperative lift relative to comparator techniques.
Aliakseyeu, D.V.; Mason, J.D.; Meerbeek, B.W.; Van Essen, H.; Offermans, S.; Alessandrini, A.; Sanesi, V.; Carreira, P.; Eby, C.
Technological advances in lighting lead towards the development of intelligent LED systems and require reconsidering the way we interactwith lighting systems. In this paper, we report on the workshop User Interaction Techniques for Future Lighting System that was heldin conjunction with INTERACT
De Coninck, Carina; Frid, Anders; Gaspar, Ruth; Hicks, Debbie; Hirsch, Larry; Kreugel, Gillian; Liersch, Jutta; Letondeur, Corinne; Sauvanet, Jean-Pierre; Tubiana, Nadia; Strauss, Kenneth
Background: The efficacy of injection therapy in diabetes depends on correct injection technique and, to provide patients with guidance in this area, we must understand how they currently inject. Methods: From September 2008 to June 2009, 4352 insulin-injecting Type 1 and Type 2 diabetic patients
Gardiner, Chris; Di Vizio, Dolores; Sahoo, Susmita; Théry, Clotilde; Witwer, Kenneth W; Wauben, Marca; Hill, Andrew F
Extracellular vesicles (EVs) represent an important mode of intercellular communication. Research in this field has grown rapidly in the last few years, and there is a plethora of techniques for the isolation and characterization of EVs, many of which are poorly standardized. EVs are heterogeneous
Ruiz-Sandoval, José Luis; Briseño-Godínez, María Eugenia; Chiquete-Anaya, Erwin; Arauz-Góngora, Antonio; Troyo-Sanromán, Rogelio; Parada-Garza, Juan Didier; Ramos-Moreno, Alma; Barinagarrementería, Fernando; Murillo-Bonilla, Luis Manuel; Cantú-Brito, Carlos
Mortality and bad outcome by stroke are higher in developing countries than in industrialized countries. Health-care system efficiency could explain these disparities. Our objective was to identify the impact on short- and middle-term outcomes of patients with acute ischemic stroke (AIS) among public and private Mexican medical care. We analyzed data from patients with AIS included in the Primer Registro Mexicano de Isquemia Cerebral (PREMIER) study. Transient ischemic attacks (TIAs) and ambulatory patients were excluded. Mortality and good outcome were assessed by the modified Rankin Scale (mRS) and analyzed at 1, 3, and 12 months of follow-up. From 1246 patients with AIS included in the registry, 1123 were hospitalized, either in public (n = 881) or in private (n = 242) hospitals. There were no significant differences regarding age and gender. In private settings, patients had a higher educational level, a major frequency of dyslipidemia, a previous stroke and TIA, less overweight and obesity, a sedentary lifestyle, and diabetes; stroke severity, the rate of systemic complications, the length of stay, and in-hospital mortality were also lower; a major frequency of thrombolysis was observed when compared with public hospitals. Our study showed a better outcome (mRS score ≤2) in private scenarios and a higher mortality in patients treated in public hospitals at short- and middle-term follow-ups. A polarized medical practice was observed in the AIS care in this large multicenter cohort of Mexico. There is evidence of an advantage for private scenarios, possibly related with an optimal infrastructure or with a strong patient's economic status. Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.
Steinberg, Benjamin A; Hellkamp, Anne S; Lokhnygina, Yuliya; Patel, Manesh R; Breithardt, Günter; Hankey, Graeme J; Becker, Richard C; Singer, Daniel E; Halperin, Jonathan L; Hacke, Werner; Nessel, Christopher C; Berkowitz, Scott D; Mahaffey, Kenneth W; Fox, Keith A A; Califf, Robert M; Piccini, Jonathan P
Anticoagulation prophylaxis for stroke is recommended for at-risk patients with either persistent or paroxysmal atrial fibrillation (AF). We compared outcomes in patients with persistent vs. paroxysmal AF receiving oral anticoagulation. Patients randomized in the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET-AF) trial (n = 14 264) were grouped by baseline AF category: paroxysmal or persistent. Multivariable adjustment was performed to compare thrombo-embolic events, bleeding, and death between groups, in high-risk subgroups, and across treatment assignment (rivaroxaban or warfarin). Of 14 062 patients, 11 548 (82%) had persistent AF and 2514 (18%) had paroxysmal AF. Patients with persistent AF were marginally older (73 vs. 72, P = 0.03), less likely female (39 vs. 45%, P < 0.0001), and more likely to have previously used vitamin K antagonists (64 vs. 56%, P < 0.0001) compared with patients with paroxysmal AF. In patients randomized to warfarin, time in therapeutic range was similar (58 vs. 57%, P = 0.94). Patients with persistent AF had higher adjusted rates of stroke or systemic embolism (2.18 vs. 1.73 events per 100-patient-years, P = 0.048) and all-cause mortality (4.78 vs. 3.52, P = 0.006). Rates of major bleeding were similar (3.55 vs. 3.31, P = 0.77). Rates of stroke or systemic embolism in both types of AF did not differ by treatment assignment (rivaroxaban vs. warfarin, Pinteraction = 0.6). In patients with AF at moderate-to-high risk of stroke receiving anticoagulation, those with persistent AF have a higher risk of thrombo-embolic events and worse survival compared with paroxysmal AF. © The Author 2014. Published by Oxford University Press on behalf of the European Society of Cardiology.
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.
Kissela, Brett M.; Kleindorfer, Dawn O.; McClure, Leslie A.; Soliman, Elsayed Z.; Judd, Suzanne E.; Rhodes, J. David; Cushman, Mary; Moy, Claudia S.; Sands, Kara A.; Howard, Virginia J.
Objectives: To assess whether black race and other cerebrovascular risk factors have a differential effect on first vs recurrent stroke events. Methods: Estimate the differences in the magnitude of the association of demographic (age, back race, sex) or stroke risk factors (hypertension, diabetes, cigarette smoking, atrial fibrillation, left ventricular hypertrophy, or heart disease) for first vs recurrent stroke from a longitudinal cohort study of 29,682 black or white participants aged 45 years and older. Results: Over an average 6.8 years follow-up, 301 of 2,993 participants with a previous stroke at baseline had a recurrent stroke, while 818 of 26,689 participants who were stroke-free at baseline had a first stroke. Among those stroke-free at baseline, there was an age-by-race interaction (p = 0.0002), with a first stroke risk 2.70 (95% confidence interval: 1.86–3.91) times greater for black than white participants at age 45, but no racial disparity at age 85 (hazard ratio = 0.91; 95% confidence interval: 0.70–1.18). In contrast, there was no evidence of a higher risk of recurrent stroke at any age for black participants (p > 0.05). The association of traditional stroke risk factors was generally similar for first and recurrent stroke. Conclusion: The association of age and black race differs substantially on first vs recurrent stroke risk, with risk factors playing a similar role. PMID:26791153
The aim of this study was to analyze the error structure in propulsive movements with regard to its influence on monofin swimming speed. The random cycles performed by six swimmers were filmed during a progressive test (900m). An objective method to estimate errors committed in the area of angular displacement of the feet and monofin segments was employed. The parameters were compared with a previously described model. Mutual dependences between the level of errors, stroke frequency, stroke length and amplitude in relation to swimming velocity were analyzed. The results showed that proper foot movements and the avoidance of errors, arising at the distal part of the fin, ensure the progression of swimming speed. The individual stroke parameters distribution which consists of optimally increasing stroke frequency to the maximal possible level that enables the stabilization of stroke length leads to the minimization of errors. Identification of key elements in the stroke structure based on the analysis of errors committed should aid in improving monofin swimming technique. Key points The monofin swimming technique was evaluated through the prism of objectively defined errors committed by the swimmers. The dependences between the level of errors, stroke rate, stroke length and amplitude in relation to swimming velocity were analyzed. Optimally increasing stroke rate to the maximal possible level that enables the stabilization of stroke length leads to the minimization of errors. Propriety foot movement and the avoidance of errors arising at the distal part of fin, provide for the progression of swimming speed. The key elements improving monofin swimming technique, based on the analysis of errors committed, were designated. PMID:24149742
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.
Maximilian Jonas Wessel
Full Text Available Stroke is the leading cause of disability among adults. Motor deficit is the most common impairment after stroke. Especially, deficits in fine motor skills impair numerous activities of daily life. Re-acquisition of motor skills resulting in improved or more accurate motor performance is paramount to regain function, and is the basis of behavioral motor therapy after stroke. Within the past years, there has been a rapid technological and methodological development in neuroimaging leading to a significant progress in the understanding of the neural substrates that underlie motor skill acquisition and functional recovery in stroke patients. Based on this and the development of novel non-invasive brain stimulation techniques, new adjuvant interventional approaches that augment the response to behavioral training have been proposed. Transcranial direct current (tDCS, transcranial magnetic (TMS and paired associative (PAS stimulation are noninvasive brain stimulation techniques that can modulate cortical excitability, neuronal plasticity and interact with learning and memory in both healthy individuals and stroke patients. These techniques can enhance the effect of practice and facilitate the retention of tasks that mimic daily life activities. The purpose of the present review is to provide a comprehensive overview of neuroplastic phenomena in the motor system during learning of a motor skill, recovery after brain injury, and of interventional strategies to enhance the beneficial effects of customarily used neurorehabilitation after stroke.
Full Text Available Abstract Background Dysphagia is a major complication in hemispheric as well as brainstem stroke patients causing aspiration pneumonia and increased mortality. Little is known about the recovery from dysphagia after stroke. The aim of the present study was to determine the different patterns of cortical swallowing processing in patients with hemispheric and brainstem stroke with and without dysphagia in the early subacute phase. Methods We measured brain activity by mean of whole-head MEG in 37 patients with different stroke localisation 8.2 +/- 4.8 days after stroke to study changes in cortical activation during self-paced swallowing. An age matched group of healthy subjects served as controls. Data were analyzed by means of synthetic aperture magnetometry and group analyses were performed using a permutation test. Results Our results demonstrate strong bilateral reduction of cortical swallowing activation in dysphagic patients with hemispheric stroke. In hemispheric stroke without dysphagia, bilateral activation was found. In the small group of patients with brainstem stroke we observed a reduction of cortical activation and a right hemispheric lateralization. Conclusion Bulbar central pattern generators coordinate the pharyngeal swallowing phase. The observed right hemispheric lateralization in brainstem stroke can therefore be interpreted as acute cortical compensation of subcortically caused dysphagia. The reduction of activation in brainstem stroke patients and dysphagic patients with cortical stroke could be explained in terms of diaschisis.
... 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 ...
... 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 ...
... 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 ...
Behzadi, Gry N; Fjetland, Lars; Advani, Rajiv; Kurz, Martin W; Kurz, Kathinka D
Our purpose was to evaluate the safety and efficacy of endovascular treatment (EVT) of stroke caused by large vessel occlusions (LVO) performed by general interventional radiologists in cooperation with stroke neurologists and neuroradiologists at a center with a limited annual number of procedures. We aimed to compare our results with those previously reported from larger stroke centers. A total of 108 patients with acute stroke due to LVO treated with EVT were included. Outcome was measured using the modified Rankin scale (mRS) at 90 days. Efficacy was classified according to the modified thrombolysis in cerebral infarction (mTICI) scoring system. Safety was evaluated according to the incidence of procedural complications and symptomatic intracranial hemorrhage (sICH). Mean age of the patients was 67.5 years. The median National Institutes of Health Stroke Scale (NIHSS) on hospital admission was 17. Successful revascularization was achieved in 76%. 39.4% experienced a good clinical outcome (mRS<3). Intraprocedural complications were seen in 7.4%. 7.4% suffered a sICH. 21.3% died within 3 months after EVT. The use of general interventional radiologists in EVT of LVO may be a possible approach for improving EVT coverage where availability of specialized neurointerventionalists is challenging. EVT for LVO stroke performed by general interventional radiologists in close cooperation with diagnostic neuroradiologists and stroke neurologists can be safe and efficacious despite the low number of annual procedures.
Ceccarelli, Graziano; Marano, Luigi; Codacci-Pisanelli, Massimo; Andolfi, Enrico; Biancafarina, Alessia; Fabozzi, Massimiliano; Caruso, Stefano; Patriti, Alberto
Laparoscopic surgery for gastric tumor is considered a demanding procedure because of lymph node dissection and reconstruction. Billroth-I (B-I) reconstruction after laparoscopic distal gastrectomy is commonly performed extracorporeally because of the complexity of an intracorporeal procedure. Robotic surgery overcomes some limitations of laparoscopy, allowing to reproduce the basic maneuvers of open surgery. We describe a new technique to perform robotic B-I anastomosis. Between January 2012 and February 2015, 5 patients underwent distal gastrectomy with intracorporeal B-I-stapled anastomosis. Patient demographics, tumor characteristics, histopathologic features, and perioperative data were analyzed. Median operative time was 170 minutes (145 to 180 min). There were no conversions. Contrast swallow was routinely performed on the third postoperative day. Median postoperative hospitalization was 7 days (range: 6 to 8). No major complications or mortality were observed. Robotic distal gastrectomy with intracorporeal B-I anastomosis is a safe and promising technique in selected cases of gastric tumors.
Full Text Available We report the surgical technique and outcome of planned posterior assisted levitation (P-PAL in four cases of subluxated cataract. P-PAL was planned as the preferred approach in all cases. A spatula was inserted via the pars plana, the whole lens was lifted to the anterior chamber and then removed through a scleral tunnel incision. Anterior chamber intraocular lenses were implanted in all cases. All four eyes had severe subluxation of the crystalline lenses with marked phacodonesis. Two eyes had history of blunt trauma, and the other two eyes had severe pseudoexfoliation with spontaneous lens subluxation. Follow-up ranged from 1 to 2 years in three cases. The postoperative visual acuity was 20/80 or better. No intraoperative complications were observed. In conclusion, the P-PAL technique was successfully performed during cataract surgery in four eyes with severe subluxated cataracts. There were no complications over the long-term follow-up.
Naresh K Yadav
Full Text Available Scleral fixated intraocular lens (SFIOL is a safe and effective option for managing optical aphakia. Suture related complications like suture erosion, suture breakage, endophthalmitis, etc. are unique to SFIOL. The knots can be covered by partial thickness flaps or they can be rotated into scleral tissues without flaps to reduce the complications. We performed a recently described novel technique which obviates the need for knot and scleral flaps in securing the SFIOL. This novel 2-point Ab externo knotless technique may reduce the knot related problems. Twenty-three eyes undergoing this knotless SFIOL procedure were analyzed for intraoperative and postoperative complications. Twenty-two eyes either maintained or improved on their preoperative vision. All patients had a minimum follow-up of 24 months.
Campbell, Scott Ayers; Daley, Catherine A
Interest in noninvasive feeding tube placement in companion animals led to the adaption of a human technique utilizing endoscopy to place nasojejunal feeding tubes. Data from medical records in which nasojejunal feeding tubes were attempted were reviewed. Feeding tubes were attempted and successfully placed in five dogs within a median of 35 min. Feeding tubes remained in place for approximately 7 days. Complications included facial irritation (5/5), sneezing (5/5), fractured facial sutures (4/5), vomiting (3/5), diarrhea (3/5), crimping of feeding tube (3/5), regurgitation (1/5), epistaxis (1/5), clogging of the feeding tube (2/5), and oral migration with premature removal of the feeding tube (1/5). The deployment technique used in this study was found to be cumbersome. Despite minor complications, endoscopy can be used to rapidly and accurately place nasoenteric feeding devices.
Gardiner, Chris; Vizio, Dolores Di; Sahoo, Susmita; Théry, Clotilde; Witwer, Kenneth W.; Wauben, Marca; Hill, Andrew F.
Extracellular vesicles (EVs) represent an important mode of intercellular communication. Research in this field has grown rapidly in the last few years, and there is a plethora of techniques for the isolation and characterization of EVs, many of which are poorly standardized. EVs are heterogeneous in size, origin and molecular constituents, with considerable overlap in size and phenotype between different populations of EVs. Little is known about current practices for the isolation, purification and characterization of EVs. We report here the first large, detailed survey of current worldwide practices for the isolation and characterization of EVs. Conditioned cell culture media was the most widely used material (83%). Ultracentrifugation remains the most commonly used isolation method (81%) with 59% of respondents use a combination of methods. Only 9% of respondents used only 1 characterization method, with others using 2 or more methods. Sample volume, sample type and downstream application all influenced the isolation and characterization techniques employed. PMID:27802845
Giuliani, Mario; Orasch, Oliver; Gattringer, Christof
We use the complex ø4 field at finite density as a model system for developing further techniques based on worldline formulations of lattice field theories. More specifically we: 1) Discuss new variants of the worm algorithm for updating the ø4 theory and related systems with site weights. 2) Explore the possibility of canonical simulations in the worldline formulation. 3) Study the connection of 2-particle condensation at low temperature to scattering parameters of the theory.
Gardiner, Chris; Vizio, Dolores Di; Sahoo, Susmita; Th?ry, Clotilde; Witwer, Kenneth W.; Wauben, Marca; Hill, Andrew F.
Extracellular vesicles (EVs) represent an important mode of intercellular communication. Research in this field has grown rapidly in the last few years, and there is a plethora of techniques for the isolation and characterization of EVs, many of which are poorly standardized. EVs are heterogeneous in size, origin and molecular constituents, with considerable overlap in size and phenotype between different populations of EVs. Little is known about current practices for the isolation, purificat...
Shanahan, E; Keenan, R; Cunningham, N; O'Malley, G; O'Connor, M; Lyons, D; Peters, C
The Irish Heart Foundation carried out the Irish National Audit of Stroke Care (INASC) in 2008. Management practices were significantly poorer than those in the UK Sentinel audits. Since then an acute stroke unit has been established in University Hospital Limerick. A stroke database was established. 12 key indicators of stroke management audited by INASC were identified. Results were compared to those in INASC. 89 stroke patients were admitted. 8 of the 12 key indicators scored significantly better than in INASC. 92.5% had a brain scan within 24hrs (INASC-40%, p = strokes received anti-thrombotics (INASC-85%, p = 0.001). 94% had rehab goals agreed by MDT (22% in INASC p = 0.0000). 55% were treated in stroke unit (2% in INASC, p = 0.0000). MDT input improved with regard to physiotherapy (87% vs 43% in INASC, p = Stroke management has significantly improved from 2008, however some deficiencies remain.
Net, P; Karnycheff, F; Vasse, M; Bourdain, F; Bonan, B; Lapergue, B
Urinary catheterization and acute urinary retention increase the risk of urinary tract infection (UTI). Our study aimed to investigate the incidence of UTI following acute stroke at our stroke center (SC) and to assess urinary catheter-care practices among French SCs. Stroke patients hospitalized within 24h of stroke onset were prospectively enrolled between May and September 2013. Neurological deficit level was assessed on admission using the US National Institutes of Health Stroke Scale (NIHSS). Patients were followed-up until discharge. Indwelling urinary catheterization (IUC) was the only technique authorized during the study. An electronic survey was also conducted among French SCs to assess their practices regarding urinary catheterization in acute stroke patients. A total of 212 patients were included, with 45 (21.2%) receiving indwelling urinary catheters. The overall estimated incidence of UTI was 14.2%, and 18% among patients receiving IUC. On univariate analysis, IUC was significantly associated with older age, longer hospital stays and higher NIHSS scores. Of the 30 SCs that responded to our survey, 19 (63.3%) declared using IUC when urinary catheterization was needed. The main argument given to justify its use was that it was departmental policy to adopt this technique. Also, 27 participants (90%) stated that conducting a study to assess the impact of urinary catheterization techniques on UTI rates in acute stroke patients would be relevant. Our results are in accord with previously reported data and confirm the high burden of UTI among acute stroke subjects. However, no association was found between IUC and UTI on univariate analysis due to a lack of statistical power. Also, our survey showed high heterogeneity in catheter-use practices among French SCs, but offered no data to help determine the best urinary catheterization technique. Urinary catheterization is common after acute stroke and a well-known risk factor of UTI. However, as high
Wang, Wenqing; Wang, Aihui; Yu, Limin; Han, Xuesong; Jiang, Guiyun; Weng, Changshui; Zhang, Hongwei; Zhou, Zhiqiang
Stroke patients with hemiplegia exhibit flexor spasms in the upper limb and extensor spasms in the lower limb, and their movement patterns vary greatly. Constraint-induced movement therapy is an upper limb rehabilitation technique used in stroke patients with hemiplegia; however, studies of lower extremity rehabilitation are scarce. In this study, stroke patients with lower limb hemiplegia underwent conventional Bobath therapy for 4 weeks as baseline treatment, followed by constraint-induced movement therapy for an additional 4 weeks. The 10-m maximum walking speed and Berg balance scale scores significantly improved following treatment, and lower extremity motor function also improved. The results of functional MRI showed that constraint-induced movement therapy alleviates the reduction in cerebral functional activation in patients, which indicates activation of functional brain regions and a significant increase in cerebral blood perfusion. These results demonstrate that constraint-induced movement therapy promotes brain functional reorganization in stroke patients with lower limb hemiplegia.
Wang, Wenqing; Wang, Aihui; Yu, Limin; Han, Xuesong; Jiang, Guiyun; Weng, Changshui; Zhang, Hongwei; Zhou, Zhiqiang
Stroke patients with hemiplegia exhibit flexor spasms in the upper limb and extensor spasms in the lower limb, and their movement patterns vary greatly. Constraint-induced movement therapy is an upper limb rehabilitation technique used in stroke patients with hemiplegia; however, studies of lower extremity rehabilitation are scarce. In this study, stroke patients with lower limb hemiplegia underwent conventional Bobath therapy for 4 weeks as baseline treatment, followed by constraint-induced movement therapy for an additional 4 weeks. The 10-m maximum walking speed and Berg balance scale scores significantly improved following treatment, and lower extremity motor function also improved. The results of functional MRI showed that constraint-induced movement therapy alleviates the reduction in cerebral functional activation in patients, which indicates activation of functional brain regions and a significant increase in cerebral blood perfusion. These results demonstrate that constraint-induced movement therapy promotes brain functional reorganization in stroke patients with lower limb hemiplegia. PMID:25337108
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...
Lazar, Ronald M; Boehme, Amelia K
Aphasia is a common feature of stroke, affecting 21-38% of acute stroke patients and an estimated 1 million stroke survivors. Although stroke, as a syndrome, is the leading cause of disability in the USA, less is known about the independent impact of aphasia on stroke outcomes. During the acute stroke period, aphasia has been found to increase length of stay, inpatient complications, overall neurological disability, mortality, and to alter discharge disposition. Outcomes during the sub-acute and chronic stroke periods show that aphasia is associated with lower Functional Independence Measures (FIM) scores, longer stays in rehabilitation settings, poorer function in activities of daily living, and mortality. Factors that complicate the analysis of aphasia on post-stroke outcomes, however, include widely different systems of care across international settings that result in varying admission patterns to acute stroke units, allowable length of stays based on reimbursement, and criteria for rehabilitation placement. Aphasia arising from stroke is associated with worse outcomes both in the acute and chronic periods. Future research will have to incorporate disparate patterns in analytic models, and to take into account specific aphasia profiles and evolving methods of post-stroke speech-language therapy.
Samaee, Milad; Kasoju, Vishwa; Lai, Hong Kuan; Santhanakrishnan, Arvind
Crustaceans such as shrimp and krill use a drag-based technique for propulsion, in which multiple pairs of limbs are paddled rhythmically from the tail to the head. Each limb is phase-shifted in time relative to its neighbor. Most studies of this type of metachronal swimming have focused on the jet formed in the animal's wake. However, synergistic hydrodynamic interactions between adjacent limbs in metachrony have received minimal attention. We used a dynamically scaled robotic model to experimentally investigate how variations in stroke kinematics impact inter-paddle hydrodynamic interactions and thrust generation. Physical models of limbs were fitted to the robot and paddled with two different motion profiles (MPs)-1) MP1: metachronal power stroke (PS) and metachronal recovery stroke (RS); and 2) MP2: metachronal PS and synchronous RS. Stroke frequency and amplitude were maintained constant across both MPs. Our results show that MP2 produced faster jets in the thrust-generating direction as compared to MP1. The necessity for a pause in MP2 after completion of PS by the paddles leading the motion, prior to executing the synchronous RS, aided in further downstream flow propagation. The effect of using asymmetric stroke kinematics on thrust generated will be discussed.
José Rafael Romero
Full Text Available Recent advances in research are modifying our view of recovery after nervous system damage. New findings are changing previously held concepts and providing promising avenues for treatment of patients after stroke. This review discusses mechanisms of neuronal injury after brain ischemia and the attempts to study neuroprotection options based on such mechanisms. It also considers measures available at present to improve outcome after stroke and presents new areas of research, particularly stimulation techniques, neurogenesis and trophic factors to enhance recovery. In order to improve outcomes, medications that may be detrimental to recovery should be avoided, while symptomatic therapy of problems such as depression, pain syndromes and spasticity may contribute to better results. Continued surveillance and early treatment of complications associated with acute stroke, along with supportive care remain the mainstay of treatment for stroke patients in the recovery phase. Present research on limiting brain damage and improving recovery and plasticity enhance the prospects for better clinical treatments to improve recovery after stroke.
Maria Gabriela R. Ferreira
Full Text Available Cognitive impairment after stroke affects the patient recovery process. Therefore, the identification of factors associated with cognitive outcomes is important since it allows risk profiles of stroke survivors to be determined. OBJECTIVE: To assess cognitive outcome of stroke outpatients and investigate associations among clinical and demographic variables, vascular risk factors, depression symptoms and functional ability; and to describe the neuropsychological profile of these patients. METHODS: A cross-sectional design study was conducted. Subjects who suffered a first-ever ischaemic stroke 6 to 10 months prior to data collection underwent neuropsychological assessment and screening for depressive symptoms and functional ability. The outcome "cognitive performance" was analyzed considering two groups: "cognitive impairment" and "no cognitive impairment". RESULTS: There was a statistically significant association between cognitive impairment and female gender, age, stroke severity and functional ability. Regarding neuropsychological profile, the cognitive impairment group exhibited more generalized deficits in attention, visuospatial organization, verbal functions and verbal memory domains compared to the community control group. CONCLUSION: The occurrence of cognitive impairment among patients was high, especially in women, older participants, individuals with more severe stroke, and greater impairment in functional ability. Multiple cognitive domains are affected and this may hamper recovery and negatively impact independence and quality of life after stroke.
Rohde, S; Bösel, J; Hacke, W; Bendszus, M
Stent retrievers are increasingly used for flow restoration and thrombectomy in acute embolic stroke. First clinical results support the potential of these new devices, in particular the ability to rapidly restore flow and effectively retrieve clots from large intracranial arteries, with favorable clinical results in preliminary patient series. This article reviews the concept and technical aspects of this new technique of endovascular stroke treatment and summarizes the first clinical results.
Maubert, H.; Jouve, A.; Mary, N.
After a major nuclear accident, decontamination of agricultural soils would be necessary in order to reclaim the land. Specific techniques were studied in the framework of the European program for Rehabilitation of Soils and Surfaces after an Accident (RESSAC). Different ways to remove the top layer of soils are described, and especially the use of Decontaminating Vegetal Network (D.V.N.) combined with spraying of organic polymers. Real scale tests in the 30 km zone around the Chernobyl nuclear power plant showed that it is possible to achieve an excellent decontamination of agricultural fields (decontamination factor greater than 95%. (author)
Avignone, F.T. III; Creswick, R.J.; Farach, H.A.; Abriola, D.; Di Gregorio, D.E.; Gattone, A.O.; Hasenbalg, F.; Huck, H.; Brodzinski, R.L.; Miley, H.S.; Reeves, J.H.; Collar, J.I.; Guerard, C.K.; Morales, A.; Morales, J.; Ortiz de Solorzano, A.; Villar, J.A.; Nussinov, S.; Zioutas, K.
A new technique has been used to seek solar axions with a single-crystal germanium detector. It exploits the coherent conversion of axions into photons when their angle of incidence satisfies the Bragg condition with a crystalline plane. The analysis of approximately 1.94 kg yr of data from the 1-kg DEMOS detector in Sierra Grande, Argentina, yields a new laboratory bound on the axion-photon coupling constant (g aγγ -9 GeV -1 ), irrespective of the axion mass up to ∼1 keV
Hankey, Graeme J; Eikelboom, John W; Yi, Qilong; Lees, Kennedy R; Chen, Christopher; Xavier, Denis; Navarro, Jose C; Ranawaka, Udaya K; Uddin, Wasim; Ricci, Stefano; Gommans, John; Schmidt, Reinhold
To determine the effect of B vitamin treatment on the incidence of cancer among patients with stroke or transient ischemic attack. A total of 8164 patients with recent stroke or transient ischemic attack were randomly allocated to double-blind treatment with 1 tablet daily of placebo or B vitamins (2 mg folic acid, 25 mg vitamin B(6), 500 μg vitamin B(12)) and followed for a median of 3.4 years for any cancer as an adverse event. There was no significant difference in the incidence of any cancer among participants assigned B vitamins compared with placebo (4.04% versus 4.59%; risk ratio, 0.86; 95% CI, 0.70-1.07) and no difference in cancer mortality (2.35% versus 2.09%; risk ratio, 1.09; 0.81-1.46). Among 1899 patients with diabetes, the incidence of cancer was higher among participants assigned B vitamins compared with placebo (5.35% versus 3.28%; adjusted risk ratio, 2.21; 1.31-3.73), whereas among 6168 patients without diabetes, the incidence of cancer was lower among participants assigned B vitamins compared with placebo (3.66% versus 5.03%; adjusted risk ratio, 0.67; 0.51-0.87; P for interaction=0.0001). Daily administration of folic acid, vitamin B(6), and vitamin B(12) to 8164 patients with recent stroke or transient ischemic attack for a median of 3.4 years had no significant effect, compared with placebo, on cancer incidence or mortality. However, a post hoc subgroup analysis raises the hypothesis that folic acid treatment may increase the incidence of cancer among diabetics and reduce the incidence of cancer among nondiabetics with a history of stroke or transient ischemic attack.
Full Text Available Urethrocutaneous fistula is a common complication of urethroplasty for severe hypospadias, even when a microsurgical technique is applied, the closure of the fistula is a challenging problem. We present a simple surgical procedure, posterior urethral incision technique [PUIT] to close the fistula in our department. Between February 2001 and December 2004 we prospectively evaluated 32 patients, 26 patients with initial hypospadias fistulas and 6 with recurrent fistulas who underwent closure of urethrocutaneous fistula after hypospadias repair. The mean age of patients was 5 years, the operation consisted of trimming the fistula edge after mobilization of the skin all-around then a midline posterior urethral incision was done 2 mm above and 2 mm below the fistula opening then re-approximation of the urethral edges using 6/0 vicryl sutures with loop magnification. The timing of fistula repair was between 6 and 13 months after it was formed, all of these were effectively closed except three cases with stricture and fistula. Of these, two were completely relieved after repeated urethral dilatation, three times a week for 2 weeks. The third failed case will need another sitting after 6 months. The posterior midline urethral incision gives a good opportunity for repair without tension with a good cosmetic outcome. This may be done under local anesthesia in adults. The procedure is considered simple rapid and easy to be done for variable fistulas types whatever of its site and the age.
Video-assisted thoracic surgery (VATS) is a minimally invasive approach with several advantages over open thoracotomy for the surgery of lung cancer but also some limitations like rigid instruments and suboptimal vision. Robot technology is an evolution of manual videothoracoscopy introduced to overcome these limitations maintaining the advantages related to low invasiveness. More intuitive movements, greater flexibility and high definition three-dimensional vision are advantages of the robotic approach. Different studies demonstrate that robotic lobectomy and segmentectomy are feasible and safe with long term outcome similar to that of open/VATS approaches, however no randomised comparison are available and benefits in terms of quality of life (QOL) and pain need to be demonstrated yet. Several different robotic techniques are currently employed and differ for number of robotic arms (three versus four), the use of CO2 insufflation, timing of utility incision and the port positioning. The four arms robotic approach with anterior utility incision is the technique described by the authors. Indications to perform robotic lung resections may be more extensive than those of traditional videothoracoscpic approach and includes patients with locally advanced disease after chemotherapy or those requiring anatomical segmentectomy. Learning curve of vats and robotic lung resection is similar. High capital and running costs are the most important disadvantages. Entry of competitor companies should drive down costs.
Block, Michael; Finger, Israel; Castellon, Paulino; Lirettle, Denise
Patients desire efficient restoration of missing teeth. Immediate provisionalization of implants at the time of placement can provide the patient with a tooth-like restoration. Our hypothesis is that preoperative fabrication of the implant abutment and provisional restoration can provide successful immediate provisionalization of implants, if specific diagnostic criteria are used for patient selection. This hypothesis is evaluated by prospectively following 74 implants thus treated for 6 months to 2 years. A technique is presented to illustrate a simple and reliable method to provisionally restore a single tooth restoration. The method involves preoperative placement of an implant analog into a model, preparation of the abutment on the model, and fabrication of a provisional crown out of occlusion. At the time of surgery, the implant is placed according to the prescription of the restorative dentist, the surgeon places the abutment and provisional crown, and the final restoration is fabricated after the implant integrates. Seventy of 74 (94.6%) restorations have been successful with up to 2-year follow-up, which is similar to single tooth implants treated using a 2-stage protocol. Single tooth immediate provisionalization implants are effective techniques when specific diagnostic criteria are used.
Ambrosini, E; Ferrante, S; Zajc, J; Bulgheroni, M; Baccinelli, W; d'Amico, E; Schauer, T; Wiesener, C; Russold, M; Gfoehler, M; Puchinger, M; Weber, M; Becker, S; Krakow, K; Rossini, M; Proserpio, D; Gasperini, G; Molteni, F; Ferrigno, G; Pedrocchi, A
The combined use of Functional Electrical Stimulation (FES) and robotic technologies is advocated to improve rehabilitation outcomes after stroke. This work describes an arm rehabilitation system developed within the European project RETRAINER. The system consists of a passive 4-degrees-of-freedom exoskeleton equipped with springs to provide gravity compensation and electromagnetic brakes to hold target positions. FES is integrated in the system to provide additional support to the most impaired muscles. FES is triggered based on the volitional EMG signal of the same stimulated muscle; in order to encourage the active involvement of the patient the volitional EMG is also monitored throughout the task execution and based on it a happy or sad emoji is visualized at the end of each task. The control interface control of the system provides a GUI and multiple software tools to organize rehabilitation exercises and monitor rehabilitation progress. The functionality and the usability of the system was evaluated on four stroke patients. All patients were able to use the system and judged positively its wearability and the provided support. They were able to trigger the stimulation based on their residual muscle activity and provided different levels of active involvement in the exercise, in agreement with their level of impairment. A randomized controlled trial aimed at evaluating the effectiveness of the RETRAINER system to improve arm function after stroke is currently ongoing.
Pujadas Capmany, Ramón; Arboix, Adrià; Casañas-Muñoz, Roser; Anguera-Ferrando, Nuria
To determine the cardiological substrate in acute stroke patients presenting with a cardioembolic stroke subtype. Data of 402 consecutive patients with cardioembolic stroke (cerebral infarction, n=347; transient ischaemic attack, n=55) were collected from a prospective hospital-based stroke registry in which data on 2000 stroke patients over a 10-year period were included. In all patients, specific cardiac disorders were identified by physical examination and results of electrocardiography and transthoracic echocardiography. Holter monitoring and more sensitive techniques of cardiac imaging were used in selected cases. Cardioembolic cerebral ischaemia accounted for 20% of all acute strokes (25% of ischaemic cerebrovascular events). Cardiac sources of embolism included the following: (a) structural cardiac disorders associated with arrhythmia (n=232), the most frequent being left ventricular hypertrophic hypertensive disease (n=120) and rheumatic mitral valve disease (n=49); (b) structural cardiac disease with sustained sinus rhythm (n=81), the most frequent being systolic left ventricular dysfunction of both ischaemic (n=35) or non-ischaemic (n=24) aetiology; and (c) isolated atrial dysrhythmia (atrial fibrillation, n=88 and atrial flutter, n=1). Hypertrophic hypertensive cardiac disease complicated with atrial fibrillation was the most frequent cardiac source of emboli in cardioembolic stroke. Other important cardiac sources were isolated atrial fibrillation, rheumatic mitral valve disease, and systolic left ventricular dysfunction of ischaemic and non-ischaemic cause. The incidence of traditional emboligenous-prone cardiac disorders, such as mitral valve prolapse and mitral annular calcification was low.
Ohsawa, Masaki; Okamura, Tomonori; Tanno, Kozo; Ogasawara, Kuniaki; Itai, Kazuyoshi; Yonekura, Yuki; Konishi, Kazuki; Omama, Shinichi; Miyamatsu, Naomi; Turin, Tanvir Chowdhury; Morino, Yoshihiro; Itoh, Tomonori; Onoda, Toshiyuki; Sakata, Kiyomi; Ishibashi, Yasuhiro; Makita, Shinji; Nakamura, Motoyuki; Tanaka, Fumitaka; Kuribayashi, Toru; Ohta, Mutsuko; Okayama, Akira
The relative and absolute risks of stroke and heart failure attributable to atrial fibrillation (AF) have not been sufficiently examined. A prospective study of 23,731 community-dwelling Japanese individuals was conducted. Participants were divided into two groups based on the presence or absence of prevalent AF (n = 338 and n = 23,393, respectively). Excess events (EE) due to AF and relative risks (RRs) determined using the non-AF group as the reference for incident stroke and heart failure were estimated using Poisson regression stratified by age groups (middle-aged: 40-69 years old; elderly: 70 years of age or older) after adjustment for sex and age. There were 611 cases of stroke and 98 cases of heart failure during the observation period (131,088 person-years). AF contributed to a higher risk of stroke both in middle-aged individuals (EE 10.4 per 1000 person-years; RR 4.88; 95% confidence interval [CI], 2.88-8.29) and elderly individuals (EE 18.3 per 1000 person-years; RR 3.05; 95% CI, 2.05-4.54). AF also contributed to a higher risk of heart failure in middle-aged individuals (EE 3.7 per 1000 person-years; RR 8.18; 95% CI, 2.41-27.8) and elderly individuals (EE 15.4 per 1000 person-years; RR 7.82; 95% CI, 4.11-14.9). Results obtained from multivariate-adjusted analysis were similar (stroke: EE 8.9 per 1000 person-years; RR 4.40; 95% CI, 2.57-7.55 in middle-aged and EE 17.4 per 1000 person-years; RR 2.97; 95% CI, 1.99-4.43 in elderly individuals; heart failure: EE 3.1 per 1000 person-years; RR 7.22; 95% CI, 2.06-25.3 in middle-aged and EE 14.1 per 1000 person-years; RR 7.41; 95% CI, 3.86-14.2 in elderly individuals). AF increased the risk of stroke by the same magnitude as that reported previously in Western countries. AF increased the RR of heart failure more than that in Western populations. Copyright © 2017 The Authors. Production and hosting by Elsevier B.V. All rights reserved.
Moghaddam, A; Ermisch, C; Fischer, C; Zietzschmann, S; Schmidmaier, G
The treatment of non-unions with large bone defects or osteitis is a major challenge in orthopedic and trauma surgery. A new concept of therapy is a two-step procedure: Masquelet technique according to the diamond concept. Between February 2010 and June 2014, 55 patients with tibia non-unions or infections were treated in a two-step Masquelet technique in our center. The patients' average age was 48 (median 50; minimum 15-maximum 72) with an average BMI (body mass index) of 28 (27; 18-52). There were 10 (18 %) female and 45 (82 %) male patients in the group. All study patients went through a follow up. Bone healing and clinical functional data were collected, as well as data according to subjective patient statements about pain and everyday limitations. In 42 cases (76.4 %) the outcome was a sufficient bony consolidation. On average, the time to heal was 10.3 (8, 5; 3-40) months, defect gaps were 4 cm (3 cm; 0,6-26 cm), and on average the patients had had 6 (median 4; range 1-31) previous operations . In all cases patients received osteosynthesis as well as a defect filling with RIA (reamer-irrigator-aspirator), and growth factor BMP-7 (bone morphogenetic protein-7). In 13 cases (23.6 %) there was no therapeutic success. In the evaluation of the SF12 questionnaire the mental health score increased from 47.4 (49.1; 27.6-65.7) to 49.8 (53.0; 28.7-69.4) and the well-being score from 32.7 (32.7;16.9-55.7) to 36.6 (36.5; 24.6-55.9). The two-step bone grafting method in the Masquelet technique used for tibia non-unions according to the diamond concept is a promising treatment option. Its application for tibia shaft non-unions with large bone defects or infections means a high degree of safety for the patient.
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.
Page, W F; Brass, L M
For the first 30 years after repatriation, former American prisoners of war (POWs) of World War II and the Korean Conflict had lower death rates for heart disease and stroke than non-POW veteran controls and the U.S. population, but subsequent morbidity data suggested that this survival advantage may have disappeared. We used U.S. federal records to obtain death data through 1996 and used proportional hazards analysis to compare the mortality experience of POWs and controls. POWs aged 75 years and older showed a significantly higher risk of heart disease deaths than controls (hazard ratio = 1.25; 95% confidence interval, 1.01-1.56), and their stroke mortality was also increased, although not significantly (hazard ratio = 1.13; 95% confidence interval, 0.66-1.91). These results suggest that circulatory disease sequelae of serious, acute malnutrition and the stresses associated with imprisonment may not appear until after many decades.
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.
Amongst all the methods used to explore the bile function of the liver, isotopic cholangio-cysto scintigraphy should be ideally placed because of its harmlessness and ease of application and the importance of the information supplied. By this technique the bile function may be explored in its various aspects. Functional kinetics: - uptake and excretion by the hepatocytes, - storage and motivity (spontaneous or activated), - spontaneous vesicular rhythm. Morphological: - size and permeability of the bile ducts. The purpose of this study is to define the practical details involved in sup(99mTc)-HIDA cholangio-cysto scintigraphy and to estimate its reliability, advantages and limits. It covers the first 20 patients subjected to this examination in the biophysics service of the Lyon-Sud Faculty of Medicine [fr
Tene, Oren; Shenhar-Tsarfaty, Shani; Korczyn, Amos D; Kliper, Efrat; Hallevi, Hen; Shopin, Ludmila; Auriel, Eitan; Mike, Anat; Bornstein, Natan M; Assayag, Einor Ben
To examine whether depressive symptoms after a stroke or a transient ischemic attack (TIA) increase the risk of cognitive impairment and functional deterioration at 2-year follow-up. Participants were survivors of first-ever, mild-to-moderate ischemic stroke or TIA from the TABASCO prospective cohort study who underwent 3T magnetic resonance imaging and were examined by a multiprofessional team 6, 12, and 24 months after the event using direct interviews, depression scales, and neurologic, neuropsychological, and functional evaluations. The main outcome was the development of cognitive impairment, either mild cognitive impairment (MCI) or dementia. MCI was diagnosed by a decline on at least 1 cognitive domain (≥ 1.5 SD) of the Montreal Cognitive Assessment score and/or on the computerized neuropsychological battery, as compared with age- and education-matched published norms. Dementia was diagnosed by a consensus forum that included senior neurologists specializing in memory disorders and a neuropsychologist. Data were obtained from 306 consecutive eligible patients (mean age: 67.1 ± 10.0 years) who were admitted to the department of emergency medicine at the Tel Aviv Medical Center from April 1, 2008, to December 1, 2011, within 72 hours from onset of symptoms of TIA or stroke. Of these patients, 51 (16.7%) developed cognitive impairment during a 2-year follow-up. Multivariate regression analysis showed that a Geriatric Depression Scale (GDS) score ≥ 6 at admission and at 6 months after the event was a significant independent marker of cognitive impairment 2 years after the stroke/TIA (OR = 3.62, 95% CI, 1.01-13.00; OR = 3.68, 95% CI, 1.03-13.21, respectively). A higher GDS score at 6 months was also related to a worse functional outcome (P depression screening among stroke and TIA survivors as a tool to identify patients who are prone to have a worse cognitive and functional outcome. These patients may benefit from closer medical surveillance and a more
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.
Rollandi, Gian Andrea; Biscaldi, Ennio; DeCicco, Enzo
The double contrast barium enema of the colon continues to be a diffused conventional radiological technique and allows for the diagnosis of neoplastic and inflammatory pathology. After the '70s, a massive initiative is undertaken to simplify, perfect and encode the method of the double contrast barium enema: Altaras from Germany, Miller from USA and Cittadini from Italy are responsible for the perfection of this technique in the last 30 years. The tailored patient preparation, a perfect technique of execution and a precise radiological documentation are essentials steps to obtain a reliable examination. The main limit of double contrast enema is that it considers the pathology only from the mucosal surface. In neoplastic pathology evaluation the main limit is the "T" parameter staging, but more limited are the "N" and "M" parameters evaluation. Today the double contrast technique continues to be a refined, sensitive and specific diagnostic method, moreover, diagnostic results cannot compete with the new CT multislice techniques (CT-enteroclysis and virtual colonoscopy) which can examine both the lumen and the wall of the colon. The double contrast is a cheap and simple examination but in the next future is predictably a progressive substitution of conventional radiology from new multislice techniques, because the cross sectional imaging is more frequently able to detect causes of the symptoms whether resulting both from colonic or non colonic origin.
Rollandi, Gian Andrea; Biscaldi, Ennio; DeCicco, Enzo
The double contrast barium enema of the colon continues to be a diffused conventional radiological technique and allows for the diagnosis of neoplastic and inflammatory pathology. After the '70s, a massive initiative is undertaken to simplify, perfect and encode the method of the double contrast barium enema: Altaras from Germany, Miller from USA and Cittadini from Italy are responsible for the perfection of this technique in the last 30 years. The tailored patient preparation, a perfect technique of execution and a precise radiological documentation are essentials steps to obtain a reliable examination. The main limit of double contrast enema is that it considers the pathology only from the mucosal surface. In neoplastic pathology evaluation the main limit is the 'T' parameter staging, but more limited are the 'N' and 'M' parameters evaluation. Today the double contrast technique continues to be a refined, sensitive and specific diagnostic method, moreover, diagnostic results cannot compete with the new CT multislice techniques (CT-enteroclysis and virtual colonoscopy) which can examine both the lumen and the wall of the colon. The double contrast is a cheap and simple examination but in the next future is predictably a progressive substitution of conventional radiology from new multislice techniques, because the cross sectional imaging is more frequently able to detect causes of the symptoms whether resulting both from colonic or non colonic origin
Kyung Cho Kim
Full Text Available The Korea Institute of Nuclear Safety, as a representative organization of Korea, in February 2012 participated in an international Program to Assess the Reliability of Emerging Nondestructive Techniques initiated by the U.S. Nuclear Regulatory Commission. The goal of the Program to Assess the Reliability of Emerging Nondestructive Techniques is to investigate the performance of emerging and prospective novel nondestructive techniques to find flaws in nickel-alloy welds and base materials. In this article, Korean round-robin test results were evaluated with respect to the test blocks and various nondestructive examination techniques. The test blocks were prepared to simulate large-bore dissimilar metal welds, small-bore dissimilar metal welds, and bottom-mounted instrumentation penetration welds in nuclear power plants. Also, lessons learned from the Korean round-robin test were summarized and discussed.
Hee-Young Song, RN, PhD
Conclusions: Our preliminary results indicate that the stroke risk self-management intervention is feasible and associated with improvement in self-management of stroke risk factors for primary stroke prevention among a prehypertensive population.
Tondu, Thierry; Thiessen, Filip; Tjalma, Wiebren A.A.
More high-risk women with breast cancer are identified using genetic testing at a younger age. These young women often opt for prophylactic surgery. Most patients are reluctant for extra donor-site scars besides infections and necrosis. In order to reduce these risks, a two-stage breast reconstruction technique is used for high-risk women with large or ptotic breasts. We presume that this procedure will reduce the risk of skin envelope and nipple–areola complex (NAC) necrosis to less than 1%. In the first stage, an inferior pedicle reduction is performed to obtain large volume reduction with maximal safety for the NAC. The ptosis, skin excess, and malpositioning of the NAC are corrected safely at this stage. In the second stage, the skin-sparing mastectomy is performed with or without nipple sparing. During this procedure, the areola is never removed. A bilateral breast reconstruction is then performed with an immediate subpectoral prothesis or delayed with the use of a subpectoral tissue expander. In this way, we aim to meet the patient’s wish to undergo bilateral risk reducing mastectomy in breasts that need ptosis correction without donor-site scarring. This article describes the procedure and reports the preliminary data. PMID:27867298
Full Text Available More high-risk women with breast cancer are identified using genetic testing at a younger age. These young women often opt for prophylactic surgery. Most patients are reluctant for extra donor-site scars besides infections and necrosis. In order to reduce these risks, a two-stage breast reconstruction technique is used for high-risk women with large or ptotic breasts. We presume that this procedure will reduce the risk of skin envelope and nipple–areola complex (NAC necrosis to less than 1%. In the first stage, an inferior pedicle reduction is performed to obtain large volume reduction with maximal safety for the NAC. The ptosis, skin excess, and malpositioning of the NAC are corrected safely at this stage. In the second stage, the skin-sparing mastectomy is performed with or without nipple sparing. During this procedure, the areola is never removed. A bilateral breast reconstruction is then performed with an immediate subpectoral prothesis or delayed with the use of a subpectoral tissue expander. In this way, we aim to meet the patient's wish to undergo bilateral risk reducing mastectomy in breasts that need ptosis correction without donor-site scarring. This article describes the procedure and reports the preliminary data.
Desai, Janak D
Stone disease has afflicted mankind since centuries; records from ancient civilisations of India and Egypt have shown stones in human bodies. The scientific mind of humans has always made smart endeavours to remove the kidney stones. From large instruments made like the beaks of different animals and birds in 600 BC (Indian civilisation) to extremely sophisticated and miniaturised endoscopic intruments of today the human race has travelled a long way. The theme has always been to remove the stones with minimal morbidity and mortality and with minimum pain to the patient. The article takes you through the journey of instruments used in 600 BC until today. The story of instrumentation is a symbiosis of the medical minds along with engineering advances. The story of miniaturisation could not have moved further without the development of lasers, fiberoptics and sophisticated cameras. As the field stands today, we remove more complex stones by larger endoscopic intervention and smaller stones by miniaturised instruments. The article discusses all the merits and shortcomings of various techniques: from open surgery to standard PCNL to Mini PCNL to Ultra- Mini PCNL to Micro-PCNL.
Lidar, Zvi; Salame, Khalil
Retrospective analysis of data of all patients treated by minimally invasive posterior discectomy for cervical radiculopathy between January 2004 and February 2008. To describe our technique and report the outcome of minimally invasive posterior cervical discectomy using the MetRx tubular retractor system and surgical microscope. Although several studies have been published on posterior minimally invasive approaches to cervical radiculopathy, most have focused on decompression of the nerve root by laminoforaminotomy only without the removal of the offending disc. The hospital charts, magnetic resonance imaging studies, and follow-up records of all the patients were reviewed. Outcome was assessed by neurological status, visual analog scale (VAS) for neck and arm pain, and by the short form-36 health survey questionnaire. Thirty-two patients were included in this study. The follow-up time was 20 to 67 months (mean, 39 mo). Muscle weakness improved in all patients; sensory deficits resolved in 21 patients and improved in 7 patients. Analysis of the mean VAS for radicular pain, VAS for neck pain, and all 8 domains of the short form-36 health survey questionnaire showed significant improvement. Complications included 1 case of incidental dural tear without postoperative cerebrospinal fluid leakage and 1 case of longstanding neck pain. Minimally invasive posterior cervical discectomy is safe and effective in the management of lateral cervical disc herniation manifested by radiculopathy. In addition to eliminating some of the disadvantages of open surgical approaches, it may also have swifter symptoms resolution compared with laminoforaminotomy without discectomy.
Full Text Available Stroke is the third leading cause of death. The role of genetics in the etiology and development of this disease is undeniable. As a result of inadequate previous research, more and more studies in the field of genetics are necessary to identify pathways involved in the pathogenesis of stroke, which in turn, may lead to new therapeutic approaches. However, due to the multifactorial nature of stroke and the few studies conducted in this field, genetic diversity is able to predict only a small fraction of the risk of disease. On the other hand, studies have shown genetically different architecture for different types of stroke, and finally pharmacogenomics as an important part of personalized medicine approach, is influenced by genetic studies, all of which confirm the need of addressing the topic by researchers.
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...
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 ...
Conclusion: The results of our study show that RASP with UVA is a feasible, secure, and reproducible procedure with low morbidity. Additional series with larger patient cohorts are needed to validate this approach.
Hagrey, S. A. Al; Strahser, M. H. P.; Rabbel, W.
The research project "CO2 MoPa" (modelling and parameterisation of CO2 storage in deep saline formations for dimensions and risk analysis) has been initiated in 2008 by partners from different disciplines (e.g. geology, hydrogeology, geochemistry, geophysics, geomechanics, hydraulic engineering and law). It deals with the parameterisation of virtual subsurface storage sites to characterise rock properties, with high pressure-temperature experiments to determine in situ hydro-petrophysical and mechanical parameters, and with modelling of processes related to CCS in deep saline reservoirs. One objective is the estimation of the sensitivity and the resolution of reflection seismic and geoelectrical time-lapse measurements in order to determine the underground distribution of CO2. Compared with seismic, electric resistivity tomography (ERT) has lower resolution, but its permanent installation and continuous monitoring can make it an economical alternative or complement. Seismic and ERT (in boreholes) applications to quantify changes of intrinsic aquifers properties with time are justified by the velocity and resistivity decrease related to CO2 injection. Our numerical 2D/3D modelling reveals the capability of the techniques to map CO2 plumes and changes as a function of thickness, concentration, receiver/electrode configuration, aspect ratio and modelling and inversion constraint parameters. Depending on these factors, some configurations are favoured due to their better spatial resolution and lower artefacts. Acknowledgements This work has been carried out in the framework of "CO2 MoPa" research project funded by the Federal German Ministry of Education and Research (BMBF) and a consortium of energy companies (E.ON Energy, EnBW AG, RWE Dea AG, Stadtwerke Kiel AG, Vattenfall Europe Technology Research GmbH and Wintershall Holding AG).
... 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 ...
Langhammer, Birgitta; Stanghelle, Johan K
The primary aim of the present study was to investigate, based on data from our study in 2000, whether the Bobath approach enhanced quality of movement better than the Motor Relearning Programme (MRP) during rehabilitation of stroke patients. A randomized controlled stratified trial of acute stroke patients. The patients were treated according to Motor Relearning Programme and Bobath approach and assessed with Motor Assessment Scale, Sødring Motor Evaluation Scale, Nottingham Health Profile and the Barthel Index. A triangulation of the test scores was made in reference to the Movement Quality Model and biomechanical, physiological, psycho-socio-cultural, and existential themes. The items arm (p = 0.02-0.04) sitting (p = 0.04) and hand (p = 0.01-0.03) were significantly better in the Motor Relearning Programme group than in the Bobath group, in both Sødring Motor Evaluation Scale and Motor Assessment Scale. Leg function, balance, transfer, walking and stair climbing did not differ between the groups. The Movement Quality Model and the movement qualities biomechanical, physiological and psycho-socio-cultural showed higher scoring in the Motor Relearning Programme group, indicating better quality of movement in all items. Regression models established the relationship with significant models of motor performance and self reported physical mobility (adjusted R(2) 0.30-0.68, p < 0.0001), energy (adjusted R(2) 0.13-0.14, p = 0.03-0.04, emotion (adjusted R(2) 0.30-0.38, p < 0.0001) and social interaction (arm function, adjusted R(2) 0.25, p = 0.0001). These analyses confirm that task oriented exercises of the Motor Relearning Programme type are preferable regarding quality of movement in the acute rehabilitation of patients with stroke. Copyright © 2010 John Wiley & Sons, Ltd.
Kai Keng eAng
Full Text Available The objective of this study was to investigate the efficacy of an Electroencephalography (EEG-based Motor Imagery (MI Brain-Computer Interface (BCI coupled with a Haptic Knob (HK robot for arm rehabilitation in stroke patients. In this three-arm, single-blind, randomized controlled trial; 21 chronic hemiplegic stroke patients (Fugl-Meyer Motor Assessment (FMMA score 10-50, recruited after pre-screening for MI BCI ability, were randomly allocated to BCI-HK, HK or Standard Arm Therapy (SAT groups. All groups received 18 sessions of intervention over 6 weeks, 3 sessions per week, 90 minutes per session. The BCI-HK group received 1 hour of BCI coupled with HK intervention, and the HK group received 1 hour of HK intervention per session. Both BCI-HK and HK groups received 120 trials of robot-assisted hand grasping and knob manipulation followed by 30 minutes of therapist-assisted arm mobilization. The SAT group received 1.5 hours of therapist-assisted arm mobilization and forearm pronation-supination movements incorporating wrist control and grasp-release functions. In all, 14 males, 7 females, mean age 54.2 years, mean stroke duration 385.1 days, with baseline FMMA score 27.0 were recruited. The primary outcome measure was upper-extremity FMMA scores measured mid-intervention at week 3, end-intervention at week 6, and follow-up at weeks 12 and 24. Seven, 8 and 7 subjects underwent BCI-HK, HK and SAT interventions respectively. FMMA score improved in all groups, but no intergroup differences were found at any time points. Significantly larger motor gains were observed in the BCI-HK group compared to the SAT group at weeks 3, 12 and 24, but motor gains in the HK group did not differ from the SAT group at any time point. In conclusion, BCI-HK is effective, safe, and may have the potential for enhancing motor recovery in chronic stroke when combined with therapist-assisted arm mobilization.
Ang, Kai Keng; Guan, Cuntai; Phua, Kok Soon; Wang, Chuanchu; Zhou, Longjiang; Tang, Ka Yin; Ephraim Joseph, Gopal J; Kuah, Christopher Wee Keong; Chua, Karen Sui Geok
The objective of this study was to investigate the efficacy of an Electroencephalography (EEG)-based Motor Imagery (MI) Brain-Computer Interface (BCI) coupled with a Haptic Knob (HK) robot for arm rehabilitation in stroke patients. In this three-arm, single-blind, randomized controlled trial; 21 chronic hemiplegic stroke patients (Fugl-Meyer Motor Assessment (FMMA) score 10-50), recruited after pre-screening for MI BCI ability, were randomly allocated to BCI-HK, HK or Standard Arm Therapy (SAT) groups. All groups received 18 sessions of intervention over 6 weeks, 3 sessions per week, 90 min per session. The BCI-HK group received 1 h of BCI coupled with HK intervention, and the HK group received 1 h of HK intervention per session. Both BCI-HK and HK groups received 120 trials of robot-assisted hand grasping and knob manipulation followed by 30 min of therapist-assisted arm mobilization. The SAT group received 1.5 h of therapist-assisted arm mobilization and forearm pronation-supination movements incorporating wrist control and grasp-release functions. In all, 14 males, 7 females, mean age 54.2 years, mean stroke duration 385.1 days, with baseline FMMA score 27.0 were recruited. The primary outcome measure was upper extremity FMMA scores measured mid-intervention at week 3, end-intervention at week 6, and follow-up at weeks 12 and 24. Seven, 8 and 7 subjects underwent BCI-HK, HK and SAT interventions respectively. FMMA score improved in all groups, but no intergroup differences were found at any time points. Significantly larger motor gains were observed in the BCI-HK group compared to the SAT group at weeks 3, 12, and 24, but motor gains in the HK group did not differ from the SAT group at any time point. In conclusion, BCI-HK is effective, safe, and may have the potential for enhancing motor recovery in chronic stroke when combined with therapist-assisted arm mobilization.
Scheeren, BA; Adema, EH
A low-cost, accurate and sensitive passive measurement method for ozone has been developed and tested. The method is based on the reaction of ozone with indigo carmine which results in colourless reaction products which are detected spectrophotometrically after exposure. Coated glass filters are
Rathmel, Angela; Mobley, Liisa; Pennington, Buddy; Chandler, Adam
A primary role of any e-resources librarian or staff is troubleshooting electronic resources (e-resources). While much progress has been made in many areas of e-resources management (ERM) to understand the ERM lifecycle and to manage workflows, troubleshooting access remains a challenge. This collaborative study is the result of the well-received…
Kats, J.; Kampen, A. van; Waal Malefijt, M.C. de
We retrospectively assessed time until consolidation, complications, and functional results according to Morgan from the clinical charts and radiographs of 15 arthroscopic ankle fusions. In 11 patients unilateral distraction and crossed screw placement over the fusion area through tibia and fibula
Capanna, R.; Totti, F.; Geest, I.C.M. van der; Muller, D.A.
HYPOTHESIS: Scapular allograft reconstruction after total scapulectomy preserving the rotator cuff muscles is an oncologically safe procedure and results in good functional outcome with a low complication rate. METHODS: The data of 6 patients who underwent scapular allograft reconstruction after a
Rocksmith, Eugenio R; Reding, Michael J
There is increasing evidence that environmental and neuropharmacologic treatments enhance stroke recovery. Functional magnetic resonance imaging and transcranial magnetic stimulation have significantly broadened our understanding of the neuroanatomic relationships involved in recovery from brain injury due to stroke. These tools have also demonstrated the role for pharmacologic enhancement of cortical plasticity coupled with behavioral interventions. Robot-assisted therapy and partial body weight-supported treadmill gait training have demonstrated the role for technologic intervention in the modern neuro-rehabilitation setting. Current research using hemi-field ocular prisms and patching techniques suggest a role in the rehabilitation of hemianopsia and visual neglect. Finally, many advances have been made in the understanding of common stroke complications, such as depression, dysphagia, venous thromboembolic disease, incontinence, and spasticity.
Background Pyrexia after stroke (temperature ≥37.5°C) is associated with poor prognosis, but information on timing of body temperature changes and relationship to stroke severity and subtypes varies. Methods We recruited patients with acute ischemic stroke, measured stroke severity, stroke subtype and recorded four-hourly tympanic (body) temperature readings from admission to 120 hours after stroke. We sought causes of pyrexia and measured functional outcome at 90 days. We systematically summarised all relevant previous studies. Results Amongst 44 patients (21 males, mean age 72 years SD 11) with median National Institute of Health Stroke Score (NIHSS) 7 (range 0–28), 14 had total anterior circulation strokes (TACS). On admission all patients, both TACS and non-TACS, were normothermic (median 36.3°C vs 36.5°C, p=0.382 respectively) at median 4 hours (interquartile range, IQR, 2–8) after stroke; admission temperature and NIHSS were not associated (r2=0.0, p=0.353). Peak temperature, occurring at 35.5 (IQR 19.0 to 53.8) hours after stroke, was higher in TACS (37.7°C) than non-TACS (37.1°C, ptemperatures. Sixteen (36%) patients became pyrexial, in seven (44%) of whom we found no cause other than the stroke. Conclusions Normothermia is usual within the first 4 hours of stroke. Peak temperature occurs at 1.5 to 2 days after stroke, and is related to stroke severity/subtype and more closely associated with poor outcome than admission temperature. Temperature-outcome associations after stroke are complex, but normothermia on admission should not preclude randomisation of patients into trials of therapeutic hypothermia. PMID:23075282
Amouyal, Gregory, E-mail: email@example.com; Thiounn, Nicolas, E-mail: firstname.lastname@example.org; Pellerin, Olivier, E-mail: email@example.com [Université Paris Descartes - Sorbonne - Paris - Cité, Faculté de Médecine (France); Yen-Ting, Lin, E-mail: firstname.lastname@example.org [Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Interventional Radiology Department (France); Giudice, Costantino Del, E-mail: email@example.com [Université Paris Descartes - Sorbonne - Paris - Cité, Faculté de Médecine (France); Dean, Carole, E-mail: firstname.lastname@example.org [Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Interventional Radiology Department (France); Pereira, Helena, E-mail: email@example.com [Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit (France); Chatellier, Gilles, E-mail: firstname.lastname@example.org; Sapoval, Marc, E-mail: email@example.com [Université Paris Descartes - Sorbonne - Paris - Cité, Faculté de Médecine (France)
BackgroundProstatic artery embolization (PAE) has been performed for a few years, but there is no report on PAE using the PErFecTED technique outside from the team that initiated this approach.ObjectiveThis single-center retrospective open label study reports our experience and clinical results on patients suffering from symptomatic BPH, who underwent PAE aiming at using the PErFecTED technique.Materials and MethodsWe treated 32 consecutive patients, mean age 65 (52–84 years old) between December 2013 and January 2015. Patients were referred for PAE after failure of medical treatment and refusal or contra-indication to surgery. They were treated using the PErFecTED technique, when feasible, with 300–500 µm calibrated microspheres (two-night hospital stay or outpatient procedure). Follow-up was performed at 3, 6, and 12 months.ResultsWe had a 100 % immediate technical success of embolization (68 % of feasibility of the PErFecTED technique) with no immediate complications. After a mean follow-up of 7.7 months, we observed a 78 % rate of clinical success. Mean IPSS decreased from 15.3 to 4.2 (p = .03), mean QoL from 5.4 to 2 (p = .03), mean Qmax increased from 9.2 to 19.2 (p = .25), mean prostatic volume decreased from 91 to 62 (p = .009) mL. There was no retrograde ejaculation and no major complication.ConclusionPAE using the PErFecTED technique is a safe and efficient technique to treat bothersome LUTS related to BPH. It is of interest to note that the PErFecTED technique cannot be performed in some cases for anatomical reasons.
Barry, S.; Nieswand, C.; Prunty,, S. L.; Mansfield, H. M.; O'Leary, P
The results of bench tests performed on a new method of combined interferometry/polarimetry for the magnetic-field reconstruction of tokamak plasmas is presented. In particular, the sensitivity obtained in the polarimetric measurement shows the feasibility of Faraday rotation determination approaching a precision of ±0.2°. The method is based on an optically pumped far-infrared laser with a rotating polarization where both the interferometric and polarimetric information is determined from ph...
Donadille, L.; Tagnard-Merat, F.; Rehel, J.L.; Gauron, C.
The authors evoke different surveys made among interventional imagery operators to assess the doses received by their hands. The operators had a local dosimeter on their middle finger nail during a single procedure, and had then to fill in a questionnaire. At least ten measurements per operator are required for the survey. The survey started in 2008 and is planned to end in December 2009. Some results are already briefly discussed
Teasdale, T W; Engberg, A W
PRIMARY OBJECTIVE: This study aimed to establish prevalence levels of disability pensions among stroke patients within a national population. RESEARCH DESIGN: From a Danish National register of hospitalizations, 72 673 patients were identified who had a discharge diagnosis of stroke between the y...... of stroke units and post-acute rehabilitation programmes may justify greater optimism.......PRIMARY OBJECTIVE: This study aimed to establish prevalence levels of disability pensions among stroke patients within a national population. RESEARCH DESIGN: From a Danish National register of hospitalizations, 72 673 patients were identified who had a discharge diagnosis of stroke between...... OUTCOMES AND RESULTS: Being in possession of a disability pension prior to stroke (n = 8565, 12%), rarely at the highest level, was not associated with elevated risk for stroke, or with elevated stroke mortality. It was, however, associated with a greater mortality subsequent to stroke. Disability pensions...
Karul, M.; Regier, M. [Universitaetsklinikum Hamburg-Eppendorf, Hamburg (Germany). Zentrum fuer Radiologie und Endoskopie; Heuer, R. [Universitaetsklinikum Hamburg-Eppendorf, Hamburg (Germany). Zentrum fuer Operative Medizin
The diagnosis of acute urolithiasis results from unenhanced multidetector computed tomography (MDCT). This test analyses the functional and anatomical possibility for passing an ureteral calculi, the localization and dimension of which are important parameters for further therapy. Alternatively chronic urolithiasis could be ruled out by magnetic resonance urography (MRU). MRU is the first choice especially in pregnant women and children because of radiation hygiene. Enhanced MDCT must be emphasized as an alternative to intravenous urography (IVU) for diagnosis of complex drainage of urine and suspected disorder of the involved kidney. This review illustrates the principles of different tests and the clinical relevance thereof. (orig.)
van Leeuwen, Barbara L; Huisman, Monique G; Audisio, Riccardo A
Recent developments in oncogeriatric surgery focus on several items - preoperative risk estimation and identification of frail patients and optimalization of perioperative care. New screening tools are being evaluated and show promising results. There is increasing evidence that preoperative training of frail patients might decrease the rate of postoperative complications and increase survival. The recent trend towards individualized treatment schemes will certainly be of benefit for the elderly population. More tools are becoming available to answer the most difficult question of all, namely whether surgery is the optimal treatment in this individual frail elderly oncogeriatric patient. Copyright © 2013 S. Karger AG, Basel.
Barry, S.; Nieswand, C.; Prunty, S.L.; Mansfield, H.M.; O'Leary, P.
The results of bench tests performed on a new method of combined interferometry/polarimetry for the magnetic field reconstruction of tokamak plasmas is presented. In particular, the sensitivity obtained in the polarimetric measurement shows the feasibility of Faraday rotation determination approaching a precision of ±0.2 o . The method is based on an optically pumped far-infrared (FIR) laser with a rotating polarization where both the interferometric and polarimetric information is determined from phase measurements. Specific sources which introduce disturbances in the optical arrangement and which can limit the attainment of the polarimetric precision, mentioned above, are discussed. (author) 4 figs., 6 refs
Larraga-Gutierrez, J. M.; Ballesteros-Zebadua, P.; Garcia-Garduno, O. A.; Martinez-Davalos, A.; Rodriguez-Villafuerte, M.; Moreno-Jimenez, S.; Celis, M. A.
Radiation transmission, leakage and beam penumbra are essential dosimetric parameters related to the commissioning of a multileaf collimation system. This work shows a comparative analysis of commonly used film detectors: X-OMAT V2 and EDR2 radiographic films, and GafChromic EBT registered radiochromic film. The results show that X-OMAT over-estimates radiation leakage and 80-20% beam penumbra. However, according to the reference values reported by the manufacturer for these dosimetric parameters, all three films are adequate for MLC dosimetric characterization, but special care must be taken when X-OMAT V2 film is used due to its low energy photon dependence
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
Nowakowski, Michał; Czapla-Masztafiak, Joanna; Kozak, Maciej; Zhukov, Igor; Zhukova, Lilia; Szlachetko, Jakub; Kwiatek, Wojciech M.
Neurodegenerative diseases are one of the malfunctions of human nervous system, being a class of complex and prominent pathologies. The human prion Protease Resistant Protein (PrP) is protein regulating copper metabolism in mammalian cells through binding of Cu(II) ions to specific fragments. Nowadays misfolding of this protein is associated with development of prion diseases. Therefore, it is crucial to obtain structural information about coordination of Cu(II) by PrP protein. Herein, we report X-ray absorption spectroscopy (XAS) measurements, carried out on SuperXAS beamline (SLS, PSI Villigen) on PrPC-Cu(II) complexes. Obtained results were compared with theoretical predictions done by FEFF 9.6 software. Complementary to XAS data, Atomic Force Microscopy (AFM) measurements were conducted to obtain low resolution structural information about prepared sample that allow to develop protocol of fixing PrPC molecules on solid substrate used for further experiments. It has been established that folded C-terminal domain of PrPC protein has around 5 nm in diameter. Presented results showed that both XAS and AFM methods are useful tools in detailed examination of complexes of human PrPC either with Cu(II) or with other divalent metal ions.
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.
Merritt, Wyndell H
There is no consensus regarding etiology or best surgical technique for severe Raynaud syndrome in patients with connective tissue disease. Observations after 30 years' experience in more than 100 cases led to the conclusion that an extended periarterial sympathectomy (with or without vein-graft reconstruction) and adjunctive use of Botox topically will offer benefits that exceed palliation and reduce recurrent ulcerations. In this article the rationale for this approach is reviewed, techniques and results are outlined, and a hypothesis for the mechanism of Raynaud attacks is offered. Copyright © 2015 Elsevier Inc. All rights reserved.
Henry B. Wilson, MD, FACS
Full Text Available Summary: Infection is a common complication of immediate breast reconstruction that often leads to device removal, a result emotionally devastating to the patient and frustrating for her surgeon. “No-touch” techniques have been used in other surgical disciplines and plastic surgery, but they have not been reported for breast reconstruction with tissue expanders or implants and acellular dermis. We report a novel technique of tissue expander and acellular dermis placement using no-touch principles with a self-retaining retractor system that holds promise to decrease infectious complications of breast reconstruction.
Anjail Zarinah Sharrief
Full Text Available AbstractBackground: There are significant racial disparities in stroke incidence and mortality. Health fairs and outreach programs can be used to increase stroke literacy, but they often fail to reach those at highest risk, including African American males. Methods: We conducted a stroke outreach and screening program at an inner city market in order to attract a high-risk group for a stroke education intervention. A modified Framingham risk tool was used to estimate stroke risk and a 10-item quiz was developed to assess stroke literacy among 80 participants. We report results of the demographic and stroke risk analyses and stroke knowledge assessment. Results: The program attracted a majority male (70% and African American (95% group of participants. Self-reported hypertension (57.5%, tobacco use (40%, and diabetes (23.8% were prevalent. Knowledge of stroke warning signs, risk factors, and appropriate action to take for stroke symptoms was not poor when compared to the literature. Conclusions: Stroke outreach and screening in an inner city public market may be an effective way to target a high-risk population for stroke prevention interventions. Stroke risk among participants was high despite adequate stroke knowledge.
Clamp, Philip J; Briggs, Robert J S
Bone conduction implant systems utilize osseointegrated fixtures to transmit sound through the bones of the skull. They allow patients with hearing loss to receive acoustic signals directly to the inner ear, bypassing the outer and middle ear. The new Cochlear™ Baha(®) Attract System (Cochlear Bone Anchored Solutions AB, Mölnlycke, Sweden) has been designed as a non-skin penetration hearing implant. The system uses magnetic coupling to hold the external sound processor in place and transmit acoustic energy. An implantable magnet is anchored to the skull via a single osseointegrated fixture, maximizing the efficiency of energy sound transfer. The interposed soft tissue is protected by a SoftWear pad that evenly distributes pressure in order to minimize the risk of pressure necrosis. This article summarizes the design features and early clinical results of the Baha 4 Attract System and provides context as to its place in the broader hearing aid market.
Chen, Chung-Yen; Lee, Wei-Jei; Lee, Hui-Ming; Chen, Jung-Chien; Ser, Kong-Han; Lee, Yi-Chih; Chen, Shu-Chun
Laparoscopic gastric bypass is a commonly performed bariatric surgery for the treatment of morbid obesity. Revision surgery for patients who have gastric bypass complications is a challenge for bariatric surgeon. Our aim is to present the early results of the conversions of gastric bypass complications to sleeve gastrectomies. From January 2001 to April 2015, 49 of 2382 gastric bypasses underwent revisional surgery to convert gastric bypasses to sleeve gastrectomies. The demographic data, surgical parameters, and outcomes were studied. The mean age of the study group was 35.0 years (range 20 to 55), and the average body mass index (BMI) prior to the reoperation was 25.3 kg/m(2). Seven patients had previous laparoscopic Roux-en-Y gastric bypasses (LRYGBs), and 42 had laparoscopic single anastomosis (mini-) gastric bypasses (LSAGBs). The main reasons for the revisions were malnutrition (58 %), weight regain (10 %), intolerance (18 %), and others (14 %). The revisional surgeries had longer operative times, greater blood loss, and longer flatus passage times than the primary gastric bypass surgeries. Four patients (8.1 %) developed major complications during revisional surgery, including three (6.1 %) cases of leakage and one (2.0 %) case of internal bleeding. No mortality was noted. After conversion to sleeve gastrectomy, the body weights of the patients remained stable, and all patients improved in terms of malnutrition, including anemia, hypoalbuminemia, and secondary hyperparathyroidism. Conversion to sleeve gastrectomy is an effective and safe option for patients with gastric bypass complications. The conversions to sleeve gastrectomy resulted in significant improvements in malnutrition and maintained weight loss at the early follow-ups.
Seegenschmiedt, M.H.; Keilholz, L.; Stecken, A.; Katalinic, A.; Sauer, R.
From 1.1.1984 through 1.3.1994, 182 patients with refractory painful heel symptoms and radiologically proven plantar heel spur received radiotherapy. A total of 141 patients and 170 heels (due to double-sided symptoms) were completely documented in long-term follow-up. Clearly defined semi-quantitative criteria (9-point score) were used to analyze heel pain and ankle function prior to RT, 6 to 12 weeks post-radiation, and at last follow-up. The treatment outcome, i.e. (un)favourable response, of 3 radiation dose concepts were compared: Group A (n=72 heels) received 12 Gy total radiation dose in 3 fractions per week and 2 series (6x1 Gy per series) separated by 6 weeks; group B (n=98 heels) received 3 Gy total radiation dose in 10 fractions of 0.3 Gy (n=50) or 5 Gy (10x0.5 Gy) (n=48) with conventiona fraction in 1 series. Radiotherapy was very effective: At last follow-up 67% (group A) and 71% (group B) remained completely free of pain. The rate of 'complete pain relief' (i.e. free of any pain symptoms) was not different between the 3 radiation concepts. However, significant differences were observed with regard to 'incomplete or insufficient pain relief', i.e. a subjective pain relief of less than 80%, a delayed pain relief after more than 4 weeks or a relapse of pain symptoms in long-term follow-up. More favourable results were achieved in patients receiving 5 Gy or 12 Gy total dose, while patients with 3 Gy total dose had significantly worse results. Prognostic factors for 'complete pain relief' were short duration of pain symptoms and acute pain symptoms prior to radiotherapy; with regard to 'incomplete or insufficient pain relief' the total dose was found to be a prognostic parameter. (orig./MG) [de
Wang, Yuming; Zhou, Zhenjun; Zhang, Jie; Liu, Kai; Liu, Rui; Shen, Chenglong; Chamberlin, Phillip C.
The Solar Dynamics Observatory (SDO)/EUV Variability Experiment (EVE) provides rich information on the thermodynamic processes of solar activities, particularly on solar flares. Here, we develop a method to construct thermodynamic spectrum (TDS) charts based on the EVE spectral lines. This tool could potentially be useful for extreme ultraviolet (EUV) astronomy to learn about the eruptive activities on distant astronomical objects. Through several cases, we illustrate what we can learn from the TDS charts. Furthermore, we apply the TDS method to 74 flares equal to or greater than the M5.0 class, and reach the following statistical results. First, EUV peaks are always behind the soft X-ray (SXR) peaks and stronger flares tend to have faster cooling rates. There is a power-law correlation between the peak delay times and the cooling rates, suggesting a coherent cooling process of flares from SXR to EUV emissions. Second, there are two distinct temperature drift patterns, called Type I and Type II. For Type I flares, the enhanced emission drifts from high to low temperature like a quadrilateral, whereas for Type II flares the drift pattern looks like a triangle. Statistical analysis suggests that Type II flares are more impulsive than Type I flares. Third, for late-phase flares, the peak intensity ratio of the late phase to the main phase is roughly correlated with the flare class, and the flares with a strong late phase are all confined. We believe that the re-deposition of the energy carried by a flux rope, which unsuccessfully erupts out, into thermal emissions is responsible for the strong late phase found in a confined flare. Furthermore, we show the signatures of the flare thermodynamic process in the chromosphere and transition region in the TDS charts. These results provide new clues to advance our understanding of the thermodynamic processes of solar flares and associated solar eruptions, e.g., coronal mass ejections.
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.
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.
Neff, K.P.; Baldwin, A.H.
Although seed dispersal is assumed to be a major factor determining plant community development in restored wetlands, little research exists on density and species richness of seed available through dispersal in these systems. We measured composition and seed dispersal rates at a restored tidal freshwater marsh in Washington, DC, USA by collecting seed dispersing through water and wind. Seed dispersal by water was measured using two methods of seed collection: (1) stationary traps composed of coconut fiber mat along an elevation gradient bracketing the tidal range and (2) a floating surface trawl net attached to a boat. To estimate wind dispersal rates, we collected seed from stationary traps composed of coconut fiber mat positioned above marsh vegetation. We also collected a small number of samples of debris deposited along high tide lines (drift lines) and feces of Canada Goose to explore their seed content. We used the seedling emergence method to determine seed density in all samples, which involved placing the fiber mats or sample material on top of potting soil in a greenhouse misting room and enumerating emerging seedlings. Seedlings from a total of 125 plant species emerged during this study (including 82 in river trawls, 89 in stationary water traps, 21 in drift lines, 39 in wind traps, and 10 in goose feces). The most abundant taxa included Bidens frondosa, Boehmeria cylindrica, Cyperus spp., Eclipta prostrata, and Ludwigia palustris. Total seedling density was significantly greater for the stationary water traps (212 + 30.6 seeds/m2/month) than the equal-sized stationary wind traps (18 + 6.0 seeds/m(2)/month). Lower-bound estimates of total species richness based on the non-parametric Chao 2 asymptotic estimators were greater for seeds in water (106 + 1.4 for stationary water traps and 104 + 5.5 for trawl samples) than for wind (54 + 6.4). Our results indicate that water is the primary source of seeds dispersing to the site and that a species-rich pool
Full Text Available Background. Comprehensive stroke unit care, incorporating acute care and rehabilitation, may promote early physical activity after stroke. However, previous information regarding physical activity specific to the acute phase of stroke and the comprehensive stroke unit setting is limited to one stroke unit. This study describes the physical activity undertaken by patients within 14 days after stroke admitted to a comprehensive stroke unit. Methods. This study was a prospective observational study. Behavioural mapping was used to determine the proportion of the day spent in different activities. Therapist reports were used to determine the amount of formal therapy received on the day of observation. The timing of commencement of activity out of bed was obtained from the medical records. Results. On average, patients spent 45% (SD 25 of the day in some form of physical activity and received 58 (SD 34 minutes per day of physiotherapy and occupational therapy combined. Mean time to first mobilisation out of bed was 46 (SD 32 hours post-stroke. Conclusions. This study suggests that commencement of physical activity occurs earlier and physical activity is at a higher level early after stroke in this comprehensive stroke unit, when compared to studies of other acute stroke models of care.
Full Text Available The cytology study is effective and reliable technique in intraoperative consultation. This study was performed to evaluate the accuracy of the cytology study in intraoperative consultation of the breast lesions. 125 specimens of the breast lesions were examined and studied in Imam Khomeini Hospital during the years 1998-99. The sensitivity, specificity and accuracy for cytological method were 87.5% , 95%, 90.5% and for the frozen section 92.4%, 100% and 95.4% respectively. The false positive reports were 2% in the cytology technique and the most important source of error and false postivie reports was fibroadenoma in this method. By reviewing the results. It could be concluded that combination of these two techniques is beneficial and more reliable in intraoperative consultation resports of the breast lesions
Ryan, R.S.; McGrath, F P.; Haslam, P.J.; Varghese, J.C.; Lee, M.J.
AIM: To evaluate the experience in our institution with ultrasound-guided transrectal and transvaginal (endocavitary) drainage of pelvic abscesses. MATERIALS AND METHODS: Eighteen patients (four male, 14 female; mean age 55 years, range 30-78 years) presenting with pelvic abscesses were referred to our institution for therapeutic drainage over a 4 year period. Patients received broad-spectrum antibiotics prior to drainage, which was performed by either the transvaginal or transrectal route under ultrasound guidance. Patients were given sedo-analgesia in the form of midazolam and fentanyl and local anaesthesia was also employed. Eight French catheters were inserted into the abscess cavities, and patients were subsequently monitored on a daily basis by a member of the interventional radiology team until such time as it was deemed appropriate to remove the catheter. RESULTS: Eighteen catheters were placed in 17 patients, and transvaginal aspiration alone was performed in one patient. Drainage was successful in 16 of 17 patients, but a transgluteal approach was ultimately required in the remaining patient to enable passage of a larger catheter into an infected haematoma. The mean duration of drainage was 5 days, mean time to defervesce 2 days. Spontaneous catheter dislodgement occurred in four patients associated with straining, but this did not have any adverse effect in three of the four patients. CONCLUSION: Endocavitary drainage is an effective method of treatment for pelvic abscesses. Spontaneous catheter dislodgement does not affect patient outcome
Ryan, R.S.; McGrath, F P.; Haslam, P.J.; Varghese, J.C.; Lee, M.J
AIM: To evaluate the experience in our institution with ultrasound-guided transrectal and transvaginal (endocavitary) drainage of pelvic abscesses. MATERIALS AND METHODS: Eighteen patients (four male, 14 female; mean age 55 years, range 30-78 years) presenting with pelvic abscesses were referred to our institution for therapeutic drainage over a 4 year period. Patients received broad-spectrum antibiotics prior to drainage, which was performed by either the transvaginal or transrectal route under ultrasound guidance. Patients were given sedo-analgesia in the form of midazolam and fentanyl and local anaesthesia was also employed. Eight French catheters were inserted into the abscess cavities, and patients were subsequently monitored on a daily basis by a member of the interventional radiology team until such time as it was deemed appropriate to remove the catheter. RESULTS: Eighteen catheters were placed in 17 patients, and transvaginal aspiration alone was performed in one patient. Drainage was successful in 16 of 17 patients, but a transgluteal approach was ultimately required in the remaining patient to enable passage of a larger catheter into an infected haematoma. The mean duration of drainage was 5 days, mean time to defervesce 2 days. Spontaneous catheter dislodgement occurred in four patients associated with straining, but this did not have any adverse effect in three of the four patients. CONCLUSION: Endocavitary drainage is an effective method of treatment for pelvic abscesses. Spontaneous catheter dislodgement does not affect patient outcome.
Thompson, Shelby; Litaker, Harry; Howard, Robert
A natural component to driving any type of vehicle, be it Earth-based or space-based, is visibility. In its simplest form visibility is a measure of the distance at which an object can be seen. With the National Aeronautics and Space Administration s (NASA) Space Shuttle and the International Space Station (ISS), there are human factors design guidelines for windows. However, for planetary exploration related vehicles, especially land-based vehicles, relatively little has been written on the importance of windows. The goal of the current study was to devise a proper methodology and to obtain preliminary human-in-the-loop data on window placement and location for the small pressurized rover (SPR). Nine participants evaluated multiple areas along the vehicle s front "nose", while actively maneuvering through several lunar driving simulations. Subjective data was collected on seven different aspects measuring areas of necessity, frequency of views, and placement/configuration of windows using questionnaires and composite drawings. Results indicated a desire for a large horizontal field-of-view window spanning the front of the vehicle for most driving situations with slightly reduced window areas for the lower front, lower corners, and side views.
The International Atomic Energy Agency has regarded the creation of adequate facilities for training in nuclear science and technology as an essential step towards the development of the peaceful uses of atomic energy throughout the world. It has also been clear that this is one of the fields in which the Agency an give most fruitful assistance to its Member States: by awarding fellowships for training at advanced centres of study and research, by instituting visiting professorships to train scientific and technical personnel in their home countries, by organizing international and regional training courses or training centres. The Agency has made use of all these methods and more than 60 countries have benefited from its training programme. A part of the programme is financed out of voluntary contributions by Member States to the Agency's General Fund and some of it financed out of funds made available to the Agency under the UN Expanded Programme of Technical Assistance (EPTA). In addition, use is made of training facilities provided free by several Member States. In an attempt to assess some of the concrete results of the training programme, the Agency recently sent a special questionnaire to 151 former Agency fellows who had completed their training at least two years earlier. By the end of last year, replies had been received from 121 former fellows from 31 countries. They provide an encouraging picture, as can be seen from the numerical analysis
Full Text Available Alexander R Meldrum,1 Jeremy R Reed,2 Megan D Dash3 1Department of Surgery, Section of Orthopedic Surgery, University of Calgary, Calgary, AB, Canada; 2Department of Surgery, University of Saskatchewan College of Medicine, Regina, SK, Canada; 3Department of Family Medicine, College of Medicine, University of Saskatchewan, Regina, SK, Canada Purpose: To present two cases of intractable patellofemoral pain syndrome treated with a novel procedure, arthroscopic medial release, and lateral imbrication of the patellar retinaculum. Patients and methods: This case series presents the treatment of three knees in two patients (one bilateral in whom an all-inside arthroscopic medial release and lateral imbrication of the patellar retinaculum was performed. Subjective measurement of pain was the primary outcome measurement, and subjective patellofemoral instability was the secondary outcome measurement. Results: Subjectively the two patients had full resolution of their pain, without any patellofemoral instability. Conclusion: Medial release and lateral imbrication of the patellar retinaculum is a new surgical procedure that has been used in the treatment of intractable patellofemoral pain syndrome. This is the first report of its kind in the literature. While outcome measurements were less than ideal, the patients had positive outcomes, both functionally and in terms of pain. Keywords: anterior knee pain syndrome, chondromalacia patellae, runners knee, patellar chondropathy, patellofemoral dysfunction, patellofemoral tracking disorder
Heintz, A; Braunstein, S; Menke, H
Between January 1986 and October 1991 255 patients with rectal tumors were treated by local excision. In 239 patients local excision was performed by transanal endoscopic microsurgery, 16 tumors were removed with the retractor developed by Parks. Operative mortality was 1% in 189 local removed adenomas, complications were observed in two patients (2.1%), local recurrences in seven patients (3.7%). 66 rectal carcinomas were treated by local excision (operative mortality 1%, complication rate 3%). In one of 28 local excised "low risk" T1-carcinomas a recurrence was observed. Five of eleven local treated patients with "high risk" tumors developed a recurrence. Endosonography was of utmost importance in preoperative staging of rectal tumors. Between June 1987 and October 1991 204 patients with rectal tumors (92 sessile adenomas, 30 T1-carcinomas and 82 advanced carcinomas) were examined preoperatively by endosonography. The diagnosis of an adenoma or a T1-carcinoma was made with a sensitivity of 0.9, although no differentiation was possible between adenomas and T1-carcinomas. Results of digital examination were comparable to endosonography, under condition that digital examination was complete. Insufficient information was obtained from the endosonographic detection of lymph-node metastatic spread.
Inamasu, Joji; Nakatsukasa, Masashi; Tomiyasu, Kazuhiro; Mayanagi, Keita; Nishimoto, Masaaki; Oshima, Takeo; Yoshii, Masami; Miyatake, Satoru; Imai, Akira
Background Cardiovascular events while driving have occasionally been reported. In contrast, there have been few studies on stroke while driving. Aim The objectives of this study were to (1) report the frequency of stroke while driving and (2) evaluate its association with automobile accidents. Methods Clinical data prospectively acquired between January 2011 and December 2016 on 2145 stroke patients (1301 with ischemic stroke, 585 with intracerebral hemorrhage, and 259 with subarachnoid hemorrhage) were reviewed to identify patients who sustained a stroke while driving. The ratio of driving to performing other activities was evaluated for each stroke type. Furthermore, the drivers' response to stroke was reviewed to understand how automobile accidents occurred. Results Among the 2145 patients, 85 (63 ischemic stroke, 20 intracerebral hemorrhage, and 2 subarachnoid hemorrhage) sustained a stroke while driving. The ratio of driving to performing other activities was significantly higher in ischemic stroke (4.8%) than in intracerebral hemorrhage (3.4%) or subarachnoid hemorrhage (0.8%). A majority of drivers either continued driving or pulled over to the roadside after suffering a stroke. However, 14 (16%) patients were involved in automobile accidents. In most patients, an altered mental status due to severe stroke was the presumed cause of the accident. Conclusion Stroke occurred while driving in 4.0% of all strokes and accidents occurred in 16% of these instances.
David, Tirone E; Armstrong, Susan; Manlhiot, Cedric; McCrindle, Brian W; Feindel, Christopher M
Aortic valve sparing is frequently performed to treat patients with aortic root aneurysm, but there is an inadequate amount of information regarding its long-term durability. This study examines the long-term results of reimplantation of the aortic valve in patients with aortic root aneurysms. From August 1989 to December 2010, 296 consecutive patients had reimplantation of the aortic valve into a tubular Dacron graft. Their mean age was 45 years (range, 11-79 years), and 78% were men. Of the patients, 36% had Marfan syndrome and 11% had bicuspid aortic valve. Patients were followed prospectively with periodic images of the aortic root and remaining aorta. The mean follow-up was 6.9 ± 4.5 years. There were 21 patients at risk at 15 years. There were 4 operative and 18 late deaths. The survival at 5, 10, and 15 years was 95.1% ± 3.5%, 93.1% ± 4.4%, and 76.5% ± 18%, respectively. Only 3 patients required reoperation on the aortic valve; all 3 patients had the Bentall procedure. Freedom from reoperation at 5, 10, and 15 years was 99.7% ± 2.0%, 97.8% ± 5.3%, and 97.8% ± 5.3%, respectively. During follow-up, moderate aortic insufficiency developed in 9 patients, and severe aortic insufficiency developed in 2 patients. Freedom from moderate or severe aortic insufficiency at 5, 10, and 15 years was 98.3% ± 3.5%, 92.9% ± 6.5%, and 89.4% ± 12%, respectively. The function of the aortic valve implanted inside a tubular Dacron graft remains normal at 15 years in most patients after this type of aortic valve-sparing operation. Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
Bransgrove, Ashley; Levin, Yuri; Beloborodov, Andrei
In this work we explore the evolution of magnetic fields inside strongly magnetized neutron stars in axisymmetry. We model numerically the coupled field evolution in the core and the crust. Our code models the Hall drift and Ohmic effects in the crust, the back-reaction on the field from magnetically induced elastic deformation of the crust, the magnetic twist exchange between the crust and the core, and the drift of superconducting flux tubes inside the core. The correct hydromagnetic equilibrium is enforced in the core. We find that (i) The Hall attractor found by Gourgouliatos and Cumming in the crust exists also for configurations when the B-field penetrates into the core. However, the evolution time-scale for the core-penetrating fields is dramatically different from that of the fields confined to the crust. (ii) The combination of Jones' flux tube drift and Ohmic dissipation in the crust can deplete the pulsar magnetic fields on the time-scale of 150 Myr if the crust is hot (T ∼ 2 × 108 K), but acts on much slower time-scales for cold neutron stars, such as recycled pulsars (∼1.8 Gyr, depending on impurity levels). (iii) The outward motion of superfluid vortices during the rapid spin-down of a young highly magnetized pulsar can result in a partial expulsion of flux from the core when B ≲ 1013 G. However for B ≳ 2 × 1013 G, the combination of a stronger magnetic field and a longer spin period implies that the core field cannot be expelled.
Pavone, P. [Ist. di Radiologia - 2 Cattedra, Univ. degli Studi di Roma `La Sapienza`, Policlinico Umberto I (Italy); Laghi, A. [Ist. di Radiologia - 2 Cattedra, Univ. degli Studi di Roma `La Sapienza`, Policlinico Umberto I (Italy); Catalano, C. [Ist. di Radiologia - 2 Cattedra, Univ. degli Studi di Roma `La Sapienza`, Policlinico Umberto I (Italy); Broglia, L. [Ist. di Radiologia - 2 Cattedra, Univ. degli Studi di Roma `La Sapienza`, Policlinico Umberto I (Italy); Messina, A. [Ist. di Radiologia - 2 Cattedra, Univ. degli Studi di Roma `La Sapienza`, Policlinico Umberto I (Italy); Scipioni, A. [Ist. di Radiologia - 2 Cattedra, Univ. degli Studi di Roma `La Sapienza`, Policlinico Umberto I (Italy); Di Girolamo, M. [Ist. di Radiologia - 2 Cattedra, Univ. degli Studi di Roma `La Sapienza`, Policlinico Umberto I (Italy); Passariello, R. [Ist. di Radiologia - 2 Cattedra, Univ. degli Studi di Roma `La Sapienza`, Policlinico Umberto I (Italy)
The aim of our study was to evaluate the feasibility of MR cholangiopancreatography (MRCP) at 0.5 T. To our knowledge no previous studies of MRCP have been performed at mid-field strength. Thirty-one patients with dilated biliary systems were examined with three-dimensional MRCP. All patients were studied with a 0.5 T superconducting magnet. A three-dimensional turbo spin-echo (TSE) sequence was acquired (TR=5000 ms, TE=244 ms, echo train length=45; acquisition time=14 min 10 s). Coronal images were post-processed with the MIP algorithm. Recently, the parameters have been optimised (TR=3000 ms, TE=700 ms, echo train length=128), reducing the acquisition time to 3 min. Endoscopic retrograde cholangiopancreatography (ERCP) was performed in 26 cases; 5 patients underwent percutaneous transhepatic cholangiography PTC. MRCP and ERCP images were evaluated by an experienced radiologist and an endoscopist. MRCP of diagnostic quality was acquired in all patients. Choledocholithiasis was correctly evaluated by MRCP in 12 of 12 patients, compared with 11 correct diagnoses by ERCP. The Presence and the level of the stricture were accurately shown in 16 of 16 patients with MRCP and in 13 of 16 patients with ERCP. The peripheral biliary tree above the obstruction and pancreatic duct were better evaluated by MRCP in all cases. In 3 of 3 patients who had undergone bilio-enteric surgery, a correct evaluation of the site of the anastomosis was possible with MRCP. It is concluded that MRCP performed at mid-field strength allows good visualisation of the dilated biliary system. Excellent results have been obtained on comparison with ERCP. MRCP performed at mit-field strength could have the same clinical value as high field strength MRCP. (orig.)
Kunert, Przemysław; Janowski, Mirosław; Zakrzewska, Agnieszka; Marchel, Andrzej
A variety of approaches are employed for treatment of Chiari I malformation. They differ in extent of cranio-c ervical decompression. A technique based on arachnoid preservation and duroplasty was introduced in our department in 2001. The aim of the study is to compare between the previous and the present technique. Retrospective analysis of 38 patients with Chiari I malformation treated between 1998 and 2004 was performed. The previous technique including arach- noid incision, coagulation of cerebellar tonsils, and fourth ventricle exploration without duroplasty was used to treat 21 patients (group 1). A further 17 patients were treated with the present technique consisting of arachnoid preservation and duroplasty (group 2). Complication rates as well as early and late results of treatment were evaluated. Karnofsky (KPS), Rankin (RS) and Bidziński (BS) scales were used for evaluation of results. Post-operative complications were detected in 9 patients in group 1 (43%). They included liquorrhoea (5 cases), meningitis (1 case), and symptoms progression (3 cases). There were no surgical complications in group 2 (p = 0.002). Neurological improvement in the early period (until discharge from hospital) occurred in 10 (48%) patients in group 1 and in 13 (76%) in group 2 (p = NS). Further improvement or lack of symptoms progression was found in 58% in group 1 and 82% in group 2 (p = NS). Assessment in KPS, RS and BS showed slightly better results of group 2 but the difference was statistically insignificant. Results of both techniques are comparable. The risk of post-operative complications after extra-arachnoid cranio-cervical decompression with duroplasty is, however, significantly lower.
Lee, Ching-Chih; Su, Yu-Chieh; Ho, Hsu-Chueh; Hung, Shih-Kai; Lee, Moon-Sing; Chiou, Wen-Yen; Chou, Pesus; Huang, Yung-Sung
Purpose: Radiation/chemoradiotherapy-induced carotid stenosis and cerebrovascular events in patients with nasopharyngeal carcinoma (NPC) can cause severe disability and even death. This study aimed to estimate the risk of ischemic stroke in this patient population over more than 10 years of follow-up. Methods and Materials: The study cohorts consisted of all patients hospitalized with a principal diagnosis of NPC (n = 1094), whereas patients hospitalized for an appendectomy during 1997 and 1998 (n = 4376) acted as the control group and surrogate for the general population. Cox proportional hazard model was performed as a means of comparing the stroke-free survival rate between the two cohorts after adjusting for possible confounding and risk factors. Results: Of the 292 patients with ischemic strokes, 62 (5.7%) were from the NPC cohort and 230 (5.3%) were from the control group. NPC patients ages 35–54 had a 1.66 times (95% CI, 1.16–2.86; p = 0.009) higher risk of ischemic stroke after adjusting for patient characteristics, comorbidities, geographic region, urbanization level of residence, and socioeconomic status. There was no statistical difference in ischemic stroke risk between the NPC patients and appendectomy patients ages 55–64 years (hazard ratio = 0.87; 95% CI, 0.56–1.33; p = 0.524) after adjusting for other factors. Conclusions: Young NPC patients carry a higher risk for ischemic stroke than the general population. Besides regular examinations of carotid duplex, different irradiation strategies or using new technique of radiotherapy, such as intensity modulated radiation therapy or volumetric modulated arc therapy, should be considered in young NPC patients.
Ramalho, Adriana Teixeira
Following the Goiania radiation accident, which occurred in September of 1987, peripheral lymphocytes from 129 exposed or potentially exposed individuals were analyzed for the frequency of unstable chromosomal aberrations (dicentrics and centric rings) to estimate absorbed radiation dose. During the emergency period, the doses were assessed to help immediate medical treatment. After this initial estimation, doses were reassessed using in vitro calibration curves produced after the accident, more suitable for the conditions prevailing in Goiania. Dose estimates for 24 subjects exceeded 0,5 Gy. Among those, 15 individuals exceeded 1,0 Gy and 5 exceeded 3,0 Gy. None of the estimates exceeded 6,0 Gy. Four of the subjects died. During the emergency period, a cytogenetic follow-up of 14 of the exposed patients was started, aiming to observe the mean lifetime of lymphocytes containing dicentric and ring aberrations. The results suggest that for the highly exposed individuals the disappearance rate of unstable aberrations follows a two- term exponential function. Up to 470 days after the exposure, there is a rapid fall in the aberration frequency. After 470 days, the disappearance rate is very slow, almost constant. The estimated average half-time of elimination of dicentrics and rings among the highly exposed group (> 1 Gy) was 140 days for the initial period after the exposure (up to 470 days). This value is significantly shorter than the usually accepted value of 3 years reported in the literature. Mean disappearance functions of unstable chromosome aberrations were inferred, to be applied in accident situations in which there is a blood sampling delay. Statistical analysis of possible correlations between the individual half-times and biological parameters, such as sex, age, leukopenia level shown during the critical period, absorbed dose (initial frequency of chromosomal aberrations) and the administration of the bone marrow stimulating factor (rHuGM-CSF) was
Comparison between clinical and audiological results of tympanoplasty with double layer graft (modified sandwich fascia) technique and single layer graft (underlay fascia and underlay cartilage) technique.
Nemade, Sanjana Vijay; Shinde, Kiran Jaywant; Sampate, Pratibha Bharat
Surgical repair of the tympanic membrane, termed a type one tympanoplasty is a tried and tested treatment modality. Overlay or underlay technique of tympanoplasty is common. Sandwich Tympanoplasty is the combined overlay and underlay grafting of tympanic membrane. To describe and evaluate the modified sandwich graft (mediolateral double layer graft) tympanoplasty using temporalis fascia and areolar fascia. To compare the clinical and audiological outcome of modified sandwich tympanoplasty with underlay tympanoplasty. A total of 88 patients of chronic otitis media were studied. 48 patients (Group A) underwent type one tympanoplasty with modified sandwich graft. Temporalis fascia was underlaid and the areolar fascia was overlaid. 48 patients (Group B) underwent type one tympanoplasty with underlay fascia technique. 48 patients (Group C) underwent type one tympanoplasty with underlay cartilage technique. We assessed the healing and hearing results. Successful graft take up was accomplished in 47 patients (97.9%) in Group A, in 40 patients (83.3%) Group B, and in 46 (95.8%) patients in Group C. The average Air-Bone gap closure achieved in Group A was 24.4±1.7dB, in Group B, it was 22.5±3.5dB and in group C, it was 19.8±2.6dB. Statistically significant difference was found in graft healing rate. Difference in hearing improvement was not statistically significant. Double layered graft with drum-malleus as a 'meat' of sandwich maintains a perfect balance between sufficient stability and adequate acoustic sensitivity. Copyright © 2017 Elsevier B.V. All rights reserved.
Kawaguchi, Naoki; Murakami, Masato; Mikami, Taishi; Kamoshita, Hiroshi
Diffusion-weighted imaging (DWI) and perfusion-imaging (PI) MRI are powerful new techniques for the assessment of early ischemic changes in acute stroke patients. We aimed to determine whether the results of these acute phase DWI and PI MRI are useful to predict their neurological outcomes. DWI, PI and fluid-attenuated inversion recovery imaging (FLAIR) MRI lesion volumes were compared with neurological deficit as determined by Japan Stroke Scale (JSS) and Barthel index in 12 patients with acute stroke at two time points. Patients were scanned and their clinical severity was measured first at their admission and two weeks after the initial scan. We could perform MRI within 5 days (mean: 2.6 days), and detect the latest ischemic lesions with initial DWI in all cases. Most patients showed decreased DWI lesion volumes, increased FLAIR volumes and decreased JSS scores reflecting their neurological improvements. Initial DWI volumes correlated with follow-up FLAIR volumes (p=0.0047, r 2 =0.976). The results seem to indicate that lesion volumes determined by DWI in the acute phase may be predictive of irreversible ischemic lesion, although the initial MRI study did not correlate with JSS, BI and patients' age. (author)
Kalowska, E.; Rostrup, E.; Rosenbaum, S.
aimed to assess if acute MRI findings could be used for the prediction of stroke in progression (SIP). METHODS: Prospectively 41 patients, 13 with lacunar infarcts and 28 with territorial infarcts, were admitted to an acute stroke unit within 24 h of stroke onset (median 11 h, range 3- 22). Diffusion...... the modified Rankin Scale, Barthel Index and SSS score. Patients with and without SIP were compared using both clinical and MRI data obtained on admission, on day 7 and after 3 months. RESULTS: Fifteen patients (37%) developed SIP. Increased DWI lesion volume on day 7 in all strokes was associated with SIP...
Correia Pinto, Oriana Horta Rendeiro; Ribeiro, Lúcia
Introduction: Several behavioural changes can occur as a consequence of stroke. A large number of studies have evaluated the frequency and severity of post-stroke depression, apathy and alexithymia that result from stroke, however the published data is contradictory.Aims: The aim of this article is to present a literature review of the concepts of depression, apathy and alexithymia and post-stroke neuroanatomical findings that support these psychopathological observations.Methods:...
Fransson, Eleonor I; Nyberg, Solja T; Heikkilä, Katriina
studies to investigate the association between job strain, a measure of work-related stress, and incident stroke. RESULTS: In 1.8 million person-years at risk (mean follow-up 9.2 years), 2023 first-time stroke events were recorded. The age- and sex-adjusted hazard ratio for job strain relative to no job....... CONCLUSION: Job strain may be associated with an increased risk of ischemic stroke, but further research is needed to determine whether interventions targeting job strain would reduce stroke risk beyond existing preventive strategies....
M.A. Koopmanschap (Marc); W.J.M. Scholte op Reimer (Wilma); J.D.H. van Wijngaarden (Jeroen); N.J.A. van Exel (Job)
textabstractBACKGROUND: Stroke is a major cause of death and long-term disability in Western societies and constitutes a major claim on health care budgets. Organising stroke care in a stroke service has recently been demonstrated to result in better health effects for patients.
N.J.A. van Exel (Job); M.A. Koopmanschap (Marc); J.D.H. van Wijngaarden (Jeroen); W.J.M. Scholte op Reimer (Wilma)
textabstractBackground. Stroke is a major cause of death and long-term disability in Western societies and constitutes a major claim on health care budgets. Organising stroke care in a stroke service has recently been demonstrated to result in better health effects for patients. This paper discusses
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.
Sivan, Manoj; Gallagher, Justin; Makower, Sophie; Keeling, David; Bhakta, Bipin; O'Connor, Rory J; Levesley, Martin
Home-based robotic technologies may offer the possibility of self-directed upper limb exercise after stroke as a means of increasing the intensity of rehabilitation treatment. The current literature has a paucity of robotic devices that have been tested in a home environment. The aim of this research project was to evaluate a robotic device Home-based Computer Assisted Arm Rehabilitation (hCAAR) that can be used independently at home by stroke survivors with upper limb weakness. hCAAR device comprises of a joystick handle moved by the weak upper limb to perform tasks on the computer screen. The device provides assistance to the movements depending on users ability. Nineteen participants (stroke survivors with upper limb weakness) were recruited. Outcome measures performed at baseline (A0), at end of 8-weeks of hCAAR use (A1) and 1 month after end of hCAAR use (A2) were: Optotrak kinematic variables, Fugl Meyer Upper Extremity motor subscale (FM-UE), Action Research Arm Test (ARAT), Medical Research Council (MRC) and Modified Ashworth Scale (MAS), Chedoke Arm and Hand Activity Inventory (CAHAI) and ABILHAND. Two participants were unable to use hCAAR: one due to severe paresis and the other due to personal problems. The remaining 17 participants were able to use the device independently in their home setting. No serious adverse events were reported. The median usage time was 433 minutes (IQR 250 - 791 min). A statistically significant improvement was observed in the kinematic and clinical outcomes at A1. The median gain in the scores at A1 were by: movement time 19%, path length 15% and jerk 19%, FM-UE 1 point, total MAS 1.5 point, total MRC 2 points, ARAT 3 points, CAHAI 5.5 points and ABILHAND 3 points. Three participants showed clinically significant improvement in all the clinical outcomes. The hCAAR feasibility study is the first clinical study of its kind reported in the current literature; in this study, 17 participants used the robotic device independently
Mehl, S.; Hill, M.C.
Five common numerical techniques for solving the advection-dispersion equation (finite difference, predictor corrector, total variation diminishing, method of characteristics, and modified method of characteristics) were tested using simulations of a controlled conservative tracer-test experiment through a heterogeneous, two-dimensional sand tank. The experimental facility was constructed using discrete, randomly distributed, homogeneous blocks of five sand types. This experimental model provides an opportunity to compare the solution techniques: the heterogeneous hydraulic-conductivity distribution of known structure can be accurately represented by a numerical model, and detailed measurements can be compared with simulated concentrations and total flow through the tank. The present work uses this opportunity to investigate how three common types of results - simulated breakthrough curves, sensitivity analysis, and calibrated parameter values - change in this heterogeneous situation given the different methods of simulating solute transport. The breakthrough curves show that simulated peak concentrations, even at very fine grid spacings, varied between the techniques because of different amounts of numerical dispersion. Sensitivity-analysis results revealed: (1) a high correlation between hydraulic conductivity and porosity given the concentration and flow observations used, so that both could not be estimated; and (2) that the breakthrough curve data did not provide enough information to estimate individual values of dispersivity for the five sands. This study demonstrates that the choice of assigned dispersivity and the amount of numerical dispersion present in the solution technique influence estimated hydraulic conductivity values to a surprising degree.
Sharrief, Anjail Zarinah; Johnson, Brenda; Urrutia, Victor Cruz
There are significant racial disparities in stroke incidence and mortality. Health fairs and outreach programs can be used to increase stroke literacy, but they often fail to reach those at highest risk, including African American males. We conducted a stroke outreach and screening program at an inner city market in order to attract a high-risk group for a stroke education intervention. A modified Framingham risk tool was used to estimate stroke risk and a 10-item quiz was developed to assess stroke literacy among 80 participants. We report results of the demographic and stroke risk analyses and stroke knowledge assessment. The program attracted a majority male (70%) and African American (95%) group of participants. Self-reported hypertension (57.5%), tobacco use (40%), and diabetes (23.8%) were prevalent. Knowledge of stroke warning signs, risk factors, and appropriate action to take for stroke symptoms was not poor when compared to the literature. Stroke outreach and screening in an inner city public market may be an effective way to target a high-risk population for stroke prevention interventions. Stroke risk among participants was high despite adequate stroke knowledge.
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.
Tian, Liang; Wang, Jin-hai; Sun, Run-jie; Zhang, Xing-hua; Yuan, Bo; Du, Xiao-zheng
Ischemic stroke is one of the commonly met diseases in clinical practice nowadays. Acupuncture therapy is widly used in the treatment of sequela of ischemic stroke in China and its mechanisms have been extensively studied in recen years. In the present paper, the authors focus on the development of studies on the mechanism of scalp acupuncture therapy in the treatment of ischemic stroke. Results indicate that scalp acupuncture intervention can 1) improve cerebral blood circulation to promote regional energy metabolism, 2) up-regulate expression of glial cell-line derived neurotrophic factor (GDNF), etc., possibly promoting proliferation and differentiation of neural stem cells in the focal cerebral cortex and hippocampus, 3) reduce contents of excitatory amino acid and increase level of gamma-aminobutyric acid (GABA) to lower neurogenic toxicity, and relieve cerebral injury, 4) ease cerebral vascular immunoinflammatory reactions, 5) regulate blood lipid metabolism to resist cerebral free radical damage, and 6) inhibit cerebral cortical apoptosis. However, these results only revealed very limited intrinsic mechanisms of scalp acupuncture in improving ischemic stroke. Further studies using comprehensive techniques of multi-disciplines as molecular biology, electrophysiology, etc. are definitely needed.
P R Srijithesh
Full Text Available The outcome of randomized controlled trials can vary depending on the eligibility criteria of the patients entering into the trial, as well as the heterogeneity of the eligible population and/or the interventions. If the subject population and/or interventions are heterogeneous, the final outcome of the trial depends on the degree of concordance of effects of the subgroups of interventions on the subgroups of the subject population. The considerations that go into the calculation of sample size and determination of the study stopping rules also would affect the nature of the outcome of the study. In this paper we try to examine these phenomena with respect to the recent trials on endovascular therapy in acute ischemic stroke.
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.
... 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 ...
Mudholkar, A.V.; Pattan, J.N.; Sudhakar, M.
India Ltd (EIL) and Metallurgical and Engineering Consultants (MECON) were involved in the database management R & D efforts in the extraction of metallurgy of the nodules was started by various leading research centres in the country Efforts to develop...
Aragao de Carvalho, C.; Froehlich, J.
We investigate the approach to the critical point and the scaling limit of a variety of models on a four-dimensional lattice, including gvertical strokephivertical stroke 4 4 theory and the self-avoiding random walk. Our results, both theoretical and numerical, provide strong evidence for the triviality of the scaling limit and for logarithmic corrections to mean field scaling laws, as predicted by the perturbative renormalization group. We relate logarithmic corrections to scaling to the triviality of the scaling limit. Our numerical analysis is based on a novel, high-precision Monte Carlo technique. (orig.)
Bateman, Mathew; Slater, Lee-Anne; Leslie-Mazwi, Thabele M
Magnetic resonance (MR) diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) offer unique insight into acute ischemic stroke pathophysiology. These techniques may offer the ability to apply pathophysiology to accurately individualize acute stroke reperfusion treatment, including ...
Effects of Adjuvant Mental Practice on Affected Upper Limb Function Following a Stroke: Results of Three-Dimensional Motion Analysis, Fugl-Meyer Assessment of the Upper Extremity and Motor Activity Logs.
Oh, Hyun Seung; Kim, Eun Joo; Kim, Doo Young; Kim, Soo Jeong
To investigate the effects of adjuvant mental practice (MP) on affected upper limb function following a stroke using three-dimensional (3D) motion analysis. In this AB/BA crossover study, we studied 10 hemiplegic patients who had a stroke within the past 6 months. The patients were randomly allocated to two groups: one group received MP combined with conventional rehabilitation therapy for the first 3 weeks followed by conventional rehabilitation therapy alone for the final 3 weeks; the other group received the same therapy but in reverse order. The MP tasks included drinking from a cup and opening a door. MP was individually administered for 20 minutes, 3 days a week for 3 weeks. To assess the tasks, we used 3D motion analysis and three additional tests: the Fugl-Meyer Assessment of the upper extremity (FMA-UE) and the motor activity logs for amount of use (MAL-AOU) and quality of movement (MAL-QOM). Assessments were performed immediately before treatment (T0), 3 weeks into treatment (T1), and 6 weeks into treatment (T2). Based on the results of the 3D motion analysis and the FMA-UE index (p=0.106), the MAL-AOU scale (p=0.092), and MAL-QOM scale (p=0.273), adjuvant MP did not result in significant improvements. Adjuvant MP had no significant effect on upper limb function following a stroke, according to 3D motion analysis and three clinical assessment tools (the FMA-UE index and the two MAL scales). The importance of this study is its use of objective 3D motion analysis to evaluate the effects of MP. Further studies will be needed to validate these findings.
Jabbur, Nada S; Akpek, Esen Karamursel; Stark, Walter J
To describe subluxation of iris-fixated intraocular lenses (IOLs) after penetrating keratoplasty (PK) as a postoperative complication and report the long-term outcomes of a closed-chamber refixation technique used in the management. This was a retrospective, noncomparative interventional case series in which 19 consecutive patient charts with a subluxated iris-fixated IOL after PK were retrospectively reviewed. Fourteen of the patients underwent surgery using a closed-chamber refixation technique. These patients were evaluated for visual outcome and surgical complications associated with the procedure. In 13 patients, postoperative follow-up was available. In all 13 cases, the fixated IOL appeared stable and remained well positioned during a follow-up period of 56 months (range, 6-122). All patients (100%) achieved improved uncorrected visual acuity. The postoperative visual acuity ranged from 20/20 to 20/100 with a mean of 20/40. Vitreous hemorrhage occurred in 1 patient, and an additional patient required a second surgery using the same technique. Both of these patients did well with a final visual acuity of 20/40 and 20/50, respectively. Subluxation of iris-fixated IOL after PK can occur as a postoperative complication. The technique that we herein describe enables secure refixation of subluxated IOLs and yields favorable long-term results.
Karampalis, Christos; Grevitt, Michael; Shafafy, Masood; Webb, John
To report the results of a cohort of patients treated with this technique high lighting radiological and functional outcomes, discussing also benefits arising from a gradual reduction procedure compared with other techniques. We evaluated nine patients who have undergone high-grade listhesis reduction and circumferential fusion at our institution from 1988 to 2006. Average length of follow-up was 11 years (5-19). Functional outcomes and radiological measurements were recorded and reported. Slip magnitude was reduced by an average of 2.9 grades (Meyerding classification). Slip angle improved by an average of 66% (p = 0.0001), lumbosacral angle by 47% (p = 0.0002), sacral rotation by 51% (p = 0.0068) and sacral inclination by 47% (p = 0.0055). At the latest follow-up 88.9% had achieved solid fusion. Post-operative 10-point Visual Analogue Score (VAS) for back pain had improved by 70% (p Average postoperative Oswestry Disability Index for all patients was 8% (range 0-16%) and that for Low Back Outcome Scores was 56.6 (range 44-70). All components of Short Form 36 Health Survey were greater than 80%. Overall patients' expectations were met in 100%. This is an effective and safe technique which addresses the lumbosacral kyphosis and cosmetic deformity without the neurological complications which accompany other reduction and fusion techniques for high-grade spondylolisthesis.
Zhang, Hui; Liu, Wei; Hu, Jin-Ju; Liu, Rui-Zhi
Abstract This study constructed a technique effectiveness evaluation formula for table tennis players based on the relationship between the scoring rate and usage rate of techniques and established evaluation criteria through the examination of 224 matches of the world's top 35 players. It also built a competition performance formula with the score difference theory for the exploration of the correlation between player technique effectiveness and competition performance. The results showed the three indices - the technique effectiveness of the first and third strokes (TE₁,₃), the second and fourth strokes (TE₂,₄) and the after fourth strokes (TE>₄) - could help better evaluate the technique effectiveness of elite players. The comparative analysis of Chinese elite table tennis players and players from other countries and regions revealed that Chinese players as a whole were 'excellent' in all the examined techniques except in the male's 'first and third strokes'; while players from other countries and regions were overall 'general'. The case analysis of two of the world's top players further indicated that correlation analysis of technique effectiveness and competition performance could help identify the technique indices highly correlated with player competition performance.
Xu, Na; Sun, Mao
Many insects hover with their wings beating in a horizontal plane (‘normal hovering’), while some insects, e.g., hoverflies and dragonflies, hover with inclined stroke-planes. Here, we investigate the lateral dynamic flight stability of a hovering model hoverfly. The aerodynamic derivatives are computed using the method of computational fluid dynamics, and the equations of motion are solved by the techniques of eigenvalue and eigenvector analysis. The following is shown: The flight of the insect is unstable at normal hovering (stroke-plane angle equals 0) and the instability becomes weaker as the stroke-plane angle increases; the flight becomes stable at a relatively large stroke-plane angle (larger than about 24°). As previously shown, the instability at normal hovering is due to a positive roll-moment/side-velocity derivative produced by the ‘changing-LEV-axial-velocity’ effect. When the stroke-plane angle increases, the wings bend toward the back of the body, and the ‘changing-LEV-axial-velocity’ effect decreases; in addition, another effect, called the ‘changing-relative-velocity’ effect (the ‘lateral wind’, which is due to the side motion of the insect, changes the relative velocity of its wings), becomes increasingly stronger. This causes the roll-moment/side-velocity derivative to first decrease and then become negative, resulting in the above change in stability as a function of the stroke-plane angle. (paper)
Full Text Available Background: Children with osteogenesis imperfecta (OI can suffer from frequent fractures and limb deformities, resulting in impaired ambulation. Osteopenia and thin cortices complicate orthopedic treatment in this group. This study evaluates the clinical results of a bone splint technique for the treatment of lower limb deformities in children with type I OI. The technique consists of internal plating combined with cortical strut allograft fixation. Materials and Methods: We prospectively followed nine children (five boys, four girls with lower limb deformities due to type I OI, who had been treated with the bone splint technique (11 femurs, four tibias between 2003 and 2006. The fracture healing time, deformity improvement, ambulation ability and complications were recorded to evaluate treatment effects. Results: At the time of surgery the average age in our study was 7.7 years (range 5-12 years. The average length of followup was 69 months (range 60-84 months. All patients had good fracture healing with an average healing time of 14 weeks (range 12-16 weeks and none experienced further fractures, deformity, or nonunion. The fixation remained stable throughout the procedure in all cases, with no evidence of loosening or breakage of screws and the deformity and mobility significantly improved after surgery. Of the two children confined to bed before surgery, one was able to walk on crutches and the other needed a wheelchair. The other seven patients could walk without walking aids or support like crutches. Conclusions: These findings suggest that the bone splint technique provides good mechanical support and increases the bone mass. It is an effective treatment for children with OI and lower limb deformities.
Kumbha Thulasi Ram
Full Text Available NTRIDUCTION : Stroke is one of the important causes of morbidity and mortality all over the world. Incidence of stroke steadily increases with age. Experts are concerned of the emerging stroke epidemic in India. Stroke affecting the young has potentially devastating consequence son the individual and his family. Certain risk factors are unique to the young. I t needs more studies for identification and modification of risk factors. The study aims to evaluate clinical features, risk factors, etiology and mortality of stroke in young patients. METHODS : 74 young patients satisfying the inclusion criteria were included in this study. A detailed history was taken from young stroke patients, systemic examination and required investigations were done. Data was collected in standardized proforma and analysed. RESULTS: Stroke in young accounts for 7.95% of stroke cases of all age groups. The mean age of the patients was 34.66 ± 7.48 years. Among 74 patients, 47(63.51% were male and 27(36.49% were female. Seizures, decreased consciousness, speech involvement and motor deficit were observed in 33.78%, 44.59%, 22.97% and 100% of cases respectively. 82.43% patients had ischemic and 17.57% patients had hemorrhagic stroke. Among ischemic stroke, large artery atherosclerosis was 16.21%, tuberculous meningoencephalitis with vasculitis was 16.21%, lacunar stroke was 10.81%, CVT was 10.81% and cardio embolic stroke was 6.76%. Smoking (59.45%, alcoholism (58.10%, hypertension (43.24%, coronary artery disease (8.10%, diabetes mellitus (10.81%, elevated total cholesterol (25.67%, elevated low density lipo proteins (22.97%, elevated triglycerides (27.02% and low HDL (22.97% were important risk factors. Carotid doppler was abnormal in 9.45% of patients. 6.76% patients had mitral stenosis in echocardiogram. Low protein C and protein S were found in 1.35% of patients. Eight (10.81% patients died during the hospital stay. INTERPRETATION AND CONCLUSIONS: The major risk
... 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 ...
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Full Text Available Background : Though described long back, there has been a renewed interest towards Ponseti method of conservative treatment of clubfoot recently. Methods : Forty children with idiopathic clubfeet were treated by Ponseti technique. The median age at presentation was 9 days. Twenty-six children with bilateral and 12 children with unilateral clubfeet were graded by the Pirani method at the commencement of treatment and then at the final follow-up. Feet were graded as excellent if the Pirani score was zero, fair, if the sum of mid-foot and hind-foot score was one or less and poor, if the score was more than one. Thirty four children need a heel cord tenotomy and all children received conventional ankle-foot orthosis (AFO and foot-abduction orthosis (FAO to maintain correction. Results : Twenty-eight children had excellent correction, four had a fair outcome and eight cases had relapse in their deformity. Poor splint compliance and fitting along with incomplete correction of the deformity were identified as the chief causes leading to a poor result. Conclusion : A strict protocol and parent education can improve the outcome for all cases with the Ponseti technique. Key-words: Clubfoot; Congenital talipes equinovarus; Ponseti technique.
Angelo V. Vasiliadis
Full Text Available Background: Stroke is a leading cause of death and acquired disability worldwide. In Europe, strokes account for almost 1.1 million death per year. In particular, countries in Southern Europe constitute populations with a different lifestyle and dietary habits from those in Northern Europe and that may influence stroke incidence, type and risk factors.Aim: The objective of this study was to review and summarise the trends of the incidence of stroke in Southern Europe, as well as,to mention stroke subtypes and recognise the risk factors for stroke.Methods: A systematic review in PubMed was conducted.Results: Therefore, twenty-three articles, representing seven countries, related to incidence, type and risk factors of stroke in this specific geographical area of Europe were identified. The annual stroke incidence varied from approximately 1.41 to 3.73 per 1000 population per year. Currently, in all the countries studied, ischemic stroke was the commonest stroke type in all series. Hypertension remains the main risk factor for both ischemic andhemorrhagic strokes, followed by diabetes mellitus, hyperlipidemia and other factors.Conclusions: A wide range of stroke incidence may be due to the different lifestyle and behavioural factors among countries. Further research that uses the best possible methods to study the incidence, type and risk factors of stroke are urgently needed in Balkan Peninsula.
This TECDOC summarizes the results of a Co-ordinated Research Programme on The Use of Nuclear and Related Techniques in Assessment of Irrigation Schedules of Field Crops to Increase Effective Use of Water in Irrigation Projects. The programme was carried out between 1990 and 1995 through the technical co-ordination of the Soil Fertility, Irrigation and Crop Production Section of the Joint FAO/IAEA Division of Nuclear Techniques in Food and Agriculture of the International Atomic Energy Agency. Fourteen Member States of the IAEA and FAO carried out a series of field experiments aimed at improving irrigation water use efficiency through a type of irrigation scheduling known as deficit irrigation. Refs, figs, tabs
Full Text Available Background: Cell transplantation is a ‘hype and hope’ in the current scenario. It is in the early stage of development with promises to restore function in chronic diseases. Mesenchymal stem cell (MSC transplantation in stroke patients has shown significant improvement by reducing clinical and functional deficits. They are feasible and multipotent and have homing characteristics. This study evaluates the safety, feasibility and efficacy of autologous MSC transplantation in patients with chronic stroke using clinical scores and functional imaging (blood oxygen level-dependent and diffusion tensor imaging techniques. Methods: Twelve chronic stroke patients were recruited; inclusion criteria were stroke lasting 3 months to 1 year, motor strength of hand muscles of at least 2, and NIHSS of 4–15, and patients had to be conscious and able to comprehend. Fugl Meyer (FM, modified Barthel index (mBI, MRC, Ashworth tone grade scale scores and functional imaging scans were assessed at baseline, and after 8 and 24 weeks. Bone marrow was aspirated under aseptic conditions and expansion of MSC took 3 weeks with animal serum-free media (Stem Pro SFM. Six patients were administered a mean of 50–60 × 106 cells i.v. followed by 8 weeks of physiotherapy. Six patients served as controls. This was a non-randomized experimental controlled trial. Results: Clinical and radiological scanning was normal for the stem cell group patients. There was no mortality or cell-related adverse reaction. The laboratory tests on days 1, 3, 5 and 7 were also normal in the MSC group till the last follow-up. The FM and mBI showed a modest increase in the stem cell group compared to controls. There was an increased number of cluster activation of Brodmann areas BA 4 and BA 6 after stem cell infusion compared to controls, indicating neural plasticity. Conclusion: MSC therapy aiming to restore function in stroke is safe and feasible. Further randomized controlled trials are needed
Diringer, Michael N; Skolnick, Brett E; Mayer, Stephan A; Steiner, Thorsten; Davis, Stephen M; Brun, Nikolai C; Broderick, Joseph P
Patients with intracerebral hemorrhage have a high risk of thromboembolic events (TEs) due to advanced age, hypertension, atherosclerosis, diabetes, and immobility. Use of recombinant activated factor VII (rFVIIa) could increase TEs in high-risk patients. Factor Seven for Acute Hemorrhagic Stroke (FAST) trial data were reviewed to define the frequency of and risk factors for TE with rFVIIa. Eight hundred forty-one patients presenting hemorrhage were randomized to 20 or 80 microg/kg of rFVIIa or placebo. Those with Glasgow Coma Scale score surgery, coagulopathy, or recent TE were excluded. Myocardial, cerebral, or venous TEs were subject to detailed reporting and expedited local review. Additionally, a blinded Data Monitoring Committee reviewed all electrocardiograms, centrally analyzed troponin I values, and CT scans. There were 178 arterial and 47 venous TEs. Venous events were similar across groups. There were 49 (27%) arterial events in the placebo group, 47 (26%) in the 20-microg/kg group, and 82 (46%) in the 80 microg/kg group (P=0.04). Of the myocardial events, 38 were investigator-reported and 103 identified by the Data Monitoring Committee. They occurred in 17 (6.3%) placebo and 57 (9.9%) rFVIIa patients (P=0.09). Arterial TEs were associated with: receiving 80 microg/kg rFVIIa (OR=2.14; P=0.031), signs of cardiac or cerebral ischemia at presentation (OR=4.19; P=0.010), age (OR=1.14/5 years; P=0.0123), and prior use of antiplatelet agents (OR=1.83; P=0.035). Ischemic strokes possibly related to study drug occurred in 7, 5, and 8 patients in the placebo, 20 microg/kg, and 80-microg/kg groups, respectively. Higher doses of rFVIIa in a high-risk population are associated with a small increased risk of what are usually minor cardiac events. Demonstration of the ability of rFVIIa to improve outcome in future studies should be driven by its effectiveness in slowing bleeding outweighting the risk of a small increase in arterial TEs.
Krarup, L-H; Sandset, E C; Sandset, P M
Krarup L-H, Sandset EC, Sandset PM, Berge E. D-dimer levels and stroke progression in patients with acute ischemic stroke and atrial fibrillation. Acta Neurol Scand: 2011: 124: 40-44. © 2010 John Wiley & Sons A/S. Background - Patients with acute ischemic stroke and atrial fibrillation are at in......Krarup L-H, Sandset EC, Sandset PM, Berge E. D-dimer levels and stroke progression in patients with acute ischemic stroke and atrial fibrillation. Acta Neurol Scand: 2011: 124: 40-44. © 2010 John Wiley & Sons A/S. Background - Patients with acute ischemic stroke and atrial fibrillation.......96), and the combined endpoint of stroke progression, recurrent stroke, and death (D-dimer: 991 ng/ml vs 970 ng/ml, P = 0.91). Multivariable analyses did not alter the results. Conclusion - D-dimer and other markers of hemostatic activation were not associated with stroke progression, recurrent stroke, or death...
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.
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 ...
Tutuarima, J. A.; van der Meulen, J. H.; de Haan, R. J.; van Straten, A.; Limburg, M.
Patients with stroke are at a high risk for falling. We assessed the fall incidence and risk factors for patients hospitalized as the result of an acute stroke. We studied a cohort of 720 stroke patients from 23 hospitals in The Netherlands. The data were abstracted from the medical and nursing
Stroke is one of the leading causes of severe handicap. Deficiencies in walking may present significant challenges to mobility, resulting in abnormal and inefficient gait patterns in stroke survivors. This study compared the gait characteristics of hemiparetic stroke survivors and those of healthy individuals and determined the ...
Prange, Grada Berendina
A cerebrovascular accident, or stroke, is major cause of mortality or permanent disability. Stroke can be defined as a neurological deficit due to damage to the blood supply of the brain. A stroke causes a destruction of brain tissue in areas that are subjected to blood deprivation. This can result
Fiaschi, Simone; Di Martire, Diego; Tessitore, Serena; Achilli, Vladimiro; Ahmed, Ahmed; Borgstrom, Sven; Calcaterra, Domenico; Fabris, Massimo; Ramondini, Massimo; Serpelloni, Enrico; Siniscalchi, Valeria; Floris, Mario
Land subsidence affecting the Ravenna Municipality (Emilia Romagna Region, NE Italy) is one of the best example on how the exploitation of natural resources can affect the environment and the territory. In fact, the pumping of groundwater and the extraction of gas from both on and off-shore reservoirs, started in the 1950s, have caused a strong land subsidence affecting most of the Emilia Romagna territory but in particular the Adriatic Sea coastline near Ravenna. In such area the current subsidence rate, even if lower than in the past, can reach the -2cm/y. Local Authorities have monitored this phenomenon over the years with different techniques: spirit levelling, GPS surveys and, more recently, Interferometric Synthetic Aperture Radar (InSAR) techniques, confirming the critical situation of land subsidence risk. In this work, we present the comparison between the results obtained with two different DInSAR techniques applied to the study of the land subsidence in the Ravenna territory: the Small Baseline Subset (SBAS) and the Coherent Pixel Technique (CPT) techniques. The SBAS works on SARscape software and is based on the Berardino et al., 2002 algorithm. This technique relies on the combination of differential interferograms created from stacks of SAR image pairs that have small temporal and perpendicular baselines. Thanks to the application of several interferograms for every single image, it is possible to obtain high spatial coherence, high data density and more effective error reduction. This allows us to obtain mean velocity maps with good data density even over non-urbanized territories. For the CPT we used the SUBsoft processor based on the algorithm implemented by Mora et al., 2003. CPT is able to extract from a stack of differential interferograms the deformation evolution over wide areas during large time spans. The processing scheme is composed of three main steps: a) the generation of the best interferogram set among all the available images of the
Phillips, L Alison; Tuhrim, Stanley; Kronish, Ian M; Horowitz, Carol R
Perceptions that stress causes and stress-reduction controls hypertension have been associated with poorer blood pressure (BP) control in hypertension populations. The current study investigated these "stress-model perceptions" in stroke survivors regarding prevention of recurrent stroke and the influence of these perceptions on patients' stroke risk factor control. Stroke and transient ischemic attack survivors (N=600) participated in an in-person interview in which they were asked about their beliefs regarding control of future stroke; BP and cholesterol were measured directly after the interview. Counter to expectations, patients who endorsed a "stress-model" but not a "medication-model" of stroke prevention were in better control of their stroke risk factors (BP and cholesterol) than those who endorsed a medication-model but not a stress-model of stroke prevention (OR for poor control=.54, Wald statistic=6.07, p=.01). This result was not explained by between group differences in patients' reported medication adherence. The results have implications for theory and practice, regarding the role of stress belief models and acute cardiac events, compared to chronic hypertension.
Glaydson Gomes Godinho
Full Text Available ABSTRACTOBJECTIVE: To demonstrate the clinical and functional results from treatment of humeral diaphysis fractures using Ender nails. METHODS: Eighteen patients who underwent osteosynthesis of humeral diaphysis fractures using Ender nails were evaluated