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Stroke clinical outcomes

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https://www.readbyqxmd.com/read/29161693/long-term-outcomes-of-ischemic-stroke-of-undetermined-mechanism-a-population-based-prospective-cohort
#1
Negar Morovatdar, Amanda G Thrift, Moira K Kapral, Réza Behrouz, Hamidreza Saber, Amin Amiri, Mohammad Taghi Farzadfard, Naghmeh Mokhber, Saverio Stranges, Mahmoud Reza Azarpazhooh
BACKGROUND AND PURPOSE: Little is known about the short- and long-term outcomes of ischemic stroke of undetermined mechanism (ISUM). METHODS: Subjects were recruited from the Mashhad Stroke Incidence Study. Ischemic stroke (IS) was classified on the basis of the TOAST criteria. We further categorized patients with ISUM into ISUMneg (negative clinical/test results for large artery, small artery) and ISUMinc (incomplete investigations). Cox proportional hazard models and the competing-risk regression model were used to compare 1 and 5 years mortality (all-causes) and recurrent rate among IS subtypes...
November 21, 2017: Neuroepidemiology
https://www.readbyqxmd.com/read/29160390/left-atrial-appendage-closure-with-amplatzer-cardiac-plug-in-nonvalvular-atrial-fibrillation-safety-and-long-term-outcome
#2
Marcio José Montenegro da Costa, Esmeralci Ferreira, Edgard Freitas Quintella, Bernardo Amorim, Alexandre Fuchs, Ricardo Zajdenverg, Hugo Sabino, Denilson Campos de Albuquerque
BACKGROUND: Atrial fibrillation (AF) is a cardiac arrhythmia with high risk for thromboembolic events, specially stroke. OBJECTIVE: To assess the safety of left atrial appendage closure (LAAC) with the Amplatzer Cardiac Plug for the prevention of thromboembolic events in patients with nonvalvular AF. METHODS: This study included 15 patients with nonvalvular AF referred for LAAC, 6 older than 75 years (mean age, 69.4 ± 9.3 years; 60% of the male sex)...
November 13, 2017: Arquivos Brasileiros de Cardiologia
https://www.readbyqxmd.com/read/29160168/cerebral-blood-volume-lesion-extent-predicts-functional-outcome-in-patients-with-vertebral-and-basilar-artery-occlusion
#3
Fana Alemseged, Darshan G Shah, Andrew Bivard, Timothy J Kleinig, Nawaf Yassi, Marina Diomedi, Francesca Di Giuliano, Gagan Sharma, Roy Drew, Bernard Yan, Richard J Dowling, Steven Bush, Fabrizio Sallustio, Carlo Caltagirone, Nicola B Mercuri, Roberto Floris, Mark W Parsons, Christopher R Levi, Peter J Mitchell, Stephen M Davis, Bruce Cv Campbell
Background CT perfusion may improve diagnostic accuracy in posterior circulation stroke. The posterior circulation Acute Stroke Prognosis Early CT score (pc-ASPECTS) on Computed Tomography Angiography source images (CTA-SI) predicts functional outcome in patients with basilar artery occlusion. Aims We assessed the prognostic value of pc-ASPECTS on CT perfusion in patients with vertebral and basilar artery occlusion (VBAO) in comparison with CTA-SI. Methods Whole-brain CT perfusion from consecutive stroke patients with VBAO at four stroke centers was retrospectively analyzed...
January 1, 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/29159410/use-of-health-care-databases-to-support-supplemental-indications-of-approved-medications
#4
Michael Fralick, Aaron S Kesselheim, Jerry Avorn, Sebastian Schneeweiss
Importance: Manufacturers of US Food and Drug Administration-approved prescription drugs often apply for additional indications based on randomized clinical trials. Real-world database analyses on a medication's use and outcomes in routine settings of care might help to inform decision making regarding such supplemental indications. Objective: To examine whether longitudinal data from a health care database can support the results of a randomized clinical trial that led to a supplemental indication for telmisartan...
November 20, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/29159193/prep2-a-biomarker-based-algorithm-for-predicting-upper-limb-function-after-stroke
#5
Cathy M Stinear, Winston D Byblow, Suzanne J Ackerley, Marie-Claire Smith, Victor M Borges, P Alan Barber
Objective: Recovery of motor function is important for regaining independence after stroke, but difficult to predict for individual patients. Our aim was to develop an efficient, accurate, and accessible algorithm for use in clinical settings. Clinical, neurophysiological, and neuroimaging biomarkers of corticospinal integrity obtained within days of stroke were combined to predict likely upper limb motor outcomes 3 months after stroke. Methods: Data from 207 patients recruited within 3 days of stroke [103 females (50%), median age 72 (range 18-98) years] were included in a Classification and Regression Tree analysis to predict upper limb function 3 months poststroke...
November 2017: Annals of Clinical and Translational Neurology
https://www.readbyqxmd.com/read/29157734/usefulness-of-the-cha2ds2-vasc-score-to-predict-outcome-in-patients-who-underwent-transcatheter-aortic-valve-implantation
#6
Katia Orvin, Amos Levi, Uri Landes, Tamir Bental, Alexander Sagie, Yaron Shapira, Hana Vaknin-Assa, Abid Assali, Ran Kornowski
Risk assessment for transcatheter aortic valve implantation (TAVI) patients remains challenging, especially in elderly and high-risk candidates. Although several risk factors contribute to increased morbidity and mortality after TAVI, simple risk scores for routine use are lacking. Applying the CHA2DS2-VASC (congestive heart failure, hypertension, age ≥ 75 years, diabetes, prior stroke, vascular disease, age 65-74 years, sex [female] category) score as a novel risk stratification tool for conditions other than atrial fibrillation and stroke prevention has been previously examined; however, its usefulness in a population of patients with aortic stenosis after TAVI has not been established...
October 19, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/29157263/ldl-receptor-blockade-reduces-mortality-in-a-mouse-model-of-ischaemic-stroke-without-improving-tissue-type-plasminogen-activator-induced-brain-haemorrhage-towards-pre-clinical-simulation-of-symptomatic-ich
#7
Be'eri Niego, Brad R S Broughton, Heidi Ho, Christopher G Sobey, Robert L Medcalf
BACKGROUND: Symptomatic intracerebral haemorrhage (sICH) following tissue-type plasminogen activator (rt-PA) administration is the most feared and lethal complication of thrombolytic therapy for ischaemic stroke, creating a significant obstacle for a broader uptake of this beneficial treatment. rt-PA also undermines cerebral vasculature stability in a multimodal process which involves engagement with LDL receptor-related protein 1 (LRP-1), potentially underlying the development of sICH...
November 21, 2017: Fluids and Barriers of the CNS
https://www.readbyqxmd.com/read/29156493/virtual-reality-for-stroke-rehabilitation
#8
REVIEW
Kate E Laver, Belinda Lange, Stacey George, Judith E Deutsch, Gustavo Saposnik, Maria Crotty
BACKGROUND: Virtual reality and interactive video gaming have emerged as recent treatment approaches in stroke rehabilitation with commercial gaming consoles in particular, being rapidly adopted in clinical settings. This is an update of a Cochrane Review published first in 2011 and then again in 2015. OBJECTIVES: Primary objective: to determine the efficacy of virtual reality compared with an alternative intervention or no intervention on upper limb function and activity...
November 20, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29155982/economic-and-survival-burden-of-dysphagia-among-inpatients-in-the-united-states
#9
D A Patel, S Krishnaswami, E Steger, E Conover, M F Vaezi, M R Ciucci, D O Francis
The inpatient burden of dysphagia has primarily been evaluated in patients with stroke. It is unclear whether dysphagia, irrespective of cause, is associated with worse clinical outcomes and higher costs compared to inpatients with similar demographic, hospital, and clinical characteristics without dysphagia. The aim of this study is to assess how a dysphagia diagnosis affects length of hospital stay (LOS), costs, discharge disposition, and in-hospital mortality among adult US inpatients. Annual and overall dysphagia prevalence, LOS, hospital charges, inpatient care costs, discharge disposition, and in-hospital mortality were measured using the AHRQ Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (2009-2013)...
November 16, 2017: Diseases of the Esophagus: Official Journal of the International Society for Diseases of the Esophagus
https://www.readbyqxmd.com/read/29155938/cerebral-autoregulation-in-cardiopulmonary-bypass-surgery-a-systematic-review
#10
Juliana R Caldas, Victoria J Haunton, Ronney B Panerai, Ludhmila A Hajjar, Thompson G Robinson
Cardiopulmonary bypass surgery is associated with a high incidence of neurological complications, including stroke, delirium and cognitive impairment. The development of strategies to reduce the incidence of such neurological events has been hampered by the lack of a clear understanding of their pathophysiology. Cerebral autoregulation (CA), which describes the ability of the brain to maintain a stable cerebral blood flow over a wide range of cerebral perfusion pressures despite changes in blood pressure, is known to be impaired in various neurological disorders...
November 16, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/29155848/an-electronic-health-record-based-model-predicts-statin-adherence-ldl-cholesterol-and-cardiovascular-disease-in-the-united-states-military-health-system
#11
Joseph E Lucas, Taylor C Bazemore, Celan Alo, Patrick B Monahan, Deepak Voora
HMG-CoA reductase inhibitors (or "statins") are important and commonly used medications to lower cholesterol and prevent cardiovascular disease. Nearly half of patients stop taking statin medications one year after they are prescribed leading to higher cholesterol, increased cardiovascular risk, and costs due to excess hospitalizations. Identifying which patients are at highest risk for not adhering to long-term statin therapy is an important step towards individualizing interventions to improve adherence. Electronic health records (EHR) are an increasingly common source of data that are challenging to analyze but have potential for generating more accurate predictions of disease risk...
2017: PloS One
https://www.readbyqxmd.com/read/29154131/impact-of-age-sex-therapeutic-intent-race-and-severity-of-advanced-heart-failure-on-short-term-principal-outcomes-in-the-momentum-3-trial
#12
Daniel J Goldstein, Mandeep R Mehra, Yoshifumi Naka, Christopher Salerno, Nir Uriel, David Dean, Akinobu Itoh, Francis D Pagani, Eric R Skipper, Geetha Bhat, Nirav Raval, Brian A Bruckner, Jerry D Estep, Rebecca Cogswell, Carmelo Milano, Lahn Fendelander, John B O'Connell, Joseph Cleveland
BACKGROUND: Primary outcomes analysis of the Multicenter Study of MagLev Technology in Patients Undergoing MCS Therapy With HeartMate 3 (MOMENTUM 3) trial short-term cohort demonstrated a higher survival rate free of debilitating stroke and reoperation to replace/remove the device (primary end-point) in patients receiving the HeartMate 3 (HM3) compared with the HeartMate (HMII). In this study we sought to evaluate the individual and interactive effects of pre-specified patient subgroups (age, sex, race, therapeutic intent [bridge to transplant/bridge to candidacy/destination therapy] and severity of illness) on primary end-point outcomes in MOMENTUM 3 patients implanted with HM3 and HMII devices...
November 3, 2017: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/29153636/early-intervention-for-lactate-dehydrogenase-elevation-improves-clinical-outcomes-in-patients-with-the-heartmate-ii-left-ventricular-assist-device-insights-from-the-prevent-study
#13
Thenappan Thenappan, John M Stulak, Richa Agarwal, Simon Maltais, Palak Shah, Peter Eckman, Sitaramesh Emani, Jason N Katz, Igor Gregoric, Mary E Keebler, Nir Uriel, Eric Adler, Joyce Chuang, David J Farrar, Kartik S Sundareswaran, Ranjit John
BACKGROUND: Hemolysis, assessed by elevated serum lactate dehydrogenase (LDH), is strongly associated with HeartMate II pump thrombosis (PT). However, it is unknown whether early intervention for elevated LDH circumvents the risk of serious PT requiring pump exchange. We sought to evaluate the relationship between elevated LDH and clinical outcomes, the effectiveness of early medical intervention, and risk factors for elevated LDH. METHODS: We studied 268 patients in the prospective, multicenter PREVENT study who had 2 or more LDH measurements at ≥30 days post-implant...
October 24, 2017: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/29153576/coronary-artery-calcium-and-long-term%C3%A2-risk-of-death-myocardial%C3%A2-infarction-and-stroke-the-walter-reed-cohort-study
#14
Joshua D Mitchell, Robert Paisley, Patrick Moon, Eric Novak, Todd C Villines
OBJECTIVES: This study aimed to assess the long-term risk of death and atherosclerotic cardiovascular disease (ASCVD) outcomes, including stroke, in a real-world cohort that underwent coronary artery calcium (CAC) scoring. BACKGROUND: Large-scale, long-term studies assessing the independent relationship of CAC for prediction of ASCVD events, to include stroke, in young, low-risk patients are uncommon outside of the clinical trial setting. METHODS: A total of 23,637 consecutive subjects without ASCVD who underwent CAC scoring from 1997 to 2009 were studied...
November 10, 2017: JACC. Cardiovascular Imaging
https://www.readbyqxmd.com/read/29151151/long-term-treatment-of-diabetic-rats-with-vanadyl-sulfate-or-insulin-attenuate-acute-focal-cerebral-ischemia-reperfusion-injury-via-their-antiglycemic-effect
#15
Hossein Ahmadi-Eslamloo, Gholam Abbas Dehghani, Seyed Mostafa Shid Moosavi
It is well-known that patients with diabetes mellitus have worse clinical outcomes following acute ischemic stroke. The intensifying effects of diabetes on ischemic brain injury have been shown to be mostly due to hyperglycemia, rather than the lack of insulin direct effects on brain. It is also well-approved that vanadium compounds have insulin-like and anti-diabetic effects, and the present study was designed to compare the protective effects of diabetes treatment with vanadium or insulin on ischemic/reperfused brain injury...
November 19, 2017: Metabolic Brain Disease
https://www.readbyqxmd.com/read/29151041/assessment-of-thrombus-length-in-acute-ischemic-stroke-by-post-contrast-magnetic-resonance-angiography
#16
Ramanan Ganeshan, Alexander H Nave, Jan F Scheitz, Katharina A Schindlbeck, Karl Georg Haeusler, Christian H Nolte, Kersten Villringer, Jochen B Fiebach
OBJECTIVES: Post-contrast magnetic resonance angiography (PC-MRA) enables visualization of vessel segments distal to an intra-arterial thrombus in acute ischemic stroke. We hypothesized that PC-MRA also allows clot length measurement in different intracranial vessels. METHODS: Patients with MRI-confirmed ischemic stroke and intracranial artery occlusion within 24 hours of symptom onset were prospectively evaluated. PC-MRA was added to a standard stroke MRI protocol...
November 18, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/29150739/cell-therapy-in-stroke-cautious-steps-towards-a-clinical-treatment
#17
REVIEW
Olivier Detante, Keith Muir, Jukka Jolkkonen
In the future, stroke patients may receive stem cell therapy as this has the potential to restore lost functions. However, the development of clinically deliverable therapy has been slower and more challenging than expected. Despite recommendations by STAIR and STEPS consortiums, there remain flaws in experimental studies such as lack of animals with comorbidities, inconsistent approaches to experimental design, and concurrent rehabilitation that might lead to a bias towards positive results. Clinical studies have typically been small, lacking control groups as well as often without clear biological hypotheses to guide patient selection...
November 17, 2017: Translational Stroke Research
https://www.readbyqxmd.com/read/29149815/stroke-and-hypertension-an-appraisal-from-pathophysiology-to-clinical-practice
#18
Agata Buonacera, Benedetta Stancanelli, Lorenzo Malatino
Stroke as a cause of long-term disability is a growing public health burden. Therefore, focusing on prevention is important. The most prominent aim of this strategy is to treat modifiable risk factors, such as arterial hypertension, the leading modifiable contributor to stroke. Thus, efforts to adequately reduce blood pressure (BP) among hypertensives are mandatory. In this respect, although safety and benefits of BP control related to long-term outcome have been largely demonstrated, there are open questions that remain to be addressed, such as optimal timing to initiate BP reduction and BP goals to be targeted...
November 16, 2017: Current Vascular Pharmacology
https://www.readbyqxmd.com/read/29147858/community-interventions-to-increase-stroke-preparedness-and-acute-stroke-treatment-rates
#19
REVIEW
Kathleen M Kelly, Kathryn T Holt, Gina M Neshewat, Lesli E Skolarus
PURPOSE OF REVIEW: Acute stroke treatments reduce the risk of post-stroke disability. These treatments, tissue plasminogen activator (tPA) and intra-arterial treatment, are highly time-dependent; thus, one of the main barriers to treatment is pre-hospital delay. Stroke preparedness is defined as the ability to recognize stroke symptoms and the intent to activate emergency medical services (EMS). This review describes types of acute stroke treatment and preparedness interventions, including recent mass media interventions to increase acute stroke treatment rates, and adult and youth community interventions to increase stroke preparedness...
November 16, 2017: Current Atherosclerosis Reports
https://www.readbyqxmd.com/read/29147661/an-eeg-tool-for-monitoring-patient-engagement-during-stroke-rehabilitation-a-feasibility-study
#20
Gadi Bartur, Katherin Joubran, Sara Peleg-Shani, Jean-Jacques Vatine, Goded Shahaf
Objective: Patient engagement is of major significance in neural rehabilitation. We developed a real-time EEG marker for attention, the Brain Engagement Index (BEI). In this work we investigate the relation between the BEI and temporary functional change during a rehabilitation session. Methods: First part: 13 unimpaired controls underwent BEI monitoring during motor exercise of varying levels of difficulty. Second part: 18 subacute stroke patients underwent standard motor rehabilitation with and without use of real-time BEI feedback regarding their level of engagement...
2017: BioMed Research International
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