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https://www.readbyqxmd.com/read/29458135/porcine-heart-interatrial-septum-anatomy
#1
Mateusz K Hołda, Mateusz Koziej, Katarzyna Piątek, Wiesława Klimek-Piotrowska
BACKGROUND: The left-sided atrial septal pouch (SP), a recently re-discovered anatomical structure within the human interatrial septum, has emerged as a possible source of thrombi formation and a trigger for atrial fibrillation, thereby potentially increasing the risk for ischemic stroke. In many studies, the swine interatrial septum has been used as model of the human heart. Also, possible new strategies and devices for management of the SPs may first be tested in this pig model. Therefore, in this study, we aimed to evaluate swine interatrial septum morphology and to compare it with the human analog, especially in the light of SP occurrence...
February 16, 2018: Annals of Anatomy, Anatomischer Anzeiger: Official Organ of the Anatomische Gesellschaft
https://www.readbyqxmd.com/read/29457261/angiography-vs-transesophageal-echocardiography-guided-patent-foramen-ovale-closure-a-propensity-score-matched-analysis-of-a-two-center-registry
#2
Paolo Scacciatella, Ilaria Meynet, Mauro Giorgi, Lorenza M Biava, Ivana Matranga, Luigi Biasco, Pierluigi Omedè, Fulvio Orzan, Fiorenzo Gaita
OBJECTIVES: The purpose of this study is to compare the long-term outcomes of patent foramen ovale (PFO) closure using angiography or transesophageal echocardiography as procedural guidance. BACKGROUND: The interventional treatment is emerging as a safe and efficient option for patients with high likelihood of PFO-related cryptogenic stroke and high risk of recurrence. The "gold-standard" guidance technique remains an issue. METHODS: Two cohorts of patients undergoing PFO closure for cryptogenic stroke in two catheterization laboratories of the same institution, using similar inclusion criteria but different guidance, were compared with propensity score matching...
February 19, 2018: Echocardiography
https://www.readbyqxmd.com/read/29450524/effect-of-a-quality-improvement-intervention-on-clinical-outcomes-in-patients-in-india-with-acute-myocardial-infarction-the-acs-quik-randomized-clinical-trial
#3
Mark D Huffman, Padinhare P Mohanan, Raji Devarajan, Abigail S Baldridge, Dimple Kondal, Lihui Zhao, Mumtaj Ali, Mangalath N Krishnan, Syam Natesan, Rajesh Gopinath, Sunitha Viswanathan, Joseph Stigi, Johny Joseph, Somanathan Chozhakkat, Donald M Lloyd-Jones, Dorairaj Prabhakaran
Importance: Wide heterogeneity exists in acute myocardial infarction treatment and outcomes in India. Objective: To evaluate the effect of a locally adapted quality improvement tool kit on clinical outcomes and process measures in Kerala, a southern Indian state. Design, Setting, and Participants: Cluster randomized, stepped-wedge clinical trial conducted between November 10, 2014, and November 9, 2016, in 63 hospitals in Kerala, India, with a last date of follow-up of December 31, 2016...
February 13, 2018: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/29448967/facial-nerve-stimulation-in-normal-pigs-and-healthy-human-volunteers-transitional-development-of-a-medical-device-for-the-emergency-treatment-of-ischemic-stroke
#4
Olivia Sanchez, Andrea García, Fernando Castro-Prado, Miriam Perez, Rafael Lara-Estrada, Martin Ramirez-Meza, Montserrat Godinez, Michael L Coco, Joaquín Azpiroz, Mark K Borsody, Emilio Sacristán
BACKGROUND: Magnetic stimulation of the facial nerve has been tested in preclinical studies as a new, non-invasive emergency treatment of ischemic stroke that acts by increasing cerebral blood flow (CBF). The objective of the studies reported herein was to identify minimal stimulation parameters that increase CBF in large animals and then test those stimulation parameters in healthy volunteers for safety, tolerability, and effectiveness at increasing CBF. This translational research is necessary preparation for clinical studies in ischemic stroke patients...
February 15, 2018: Journal of Translational Medicine
https://www.readbyqxmd.com/read/29441421/diagnostic-error-in-stroke-reasons-and-proposed-solutions
#5
REVIEW
Ekaterina Bakradze, Ava L Liberman
PURPOSE OF REVIEW: We discuss the frequency of stroke misdiagnosis and identify subgroups of stroke at high risk for specific diagnostic errors. In addition, we review common reasons for misdiagnosis and propose solutions to decrease error. RECENT FINDINGS: According to a recent report by the National Academy of Medicine, most people in the USA are likely to experience a diagnostic error during their lifetimes. Nearly half of such errors result in serious disability and death...
February 13, 2018: Current Atherosclerosis Reports
https://www.readbyqxmd.com/read/29440586/national-practice-patterns-of-obtaining-informed-consent-for-stroke-thrombolysis
#6
Scott J Mendelson, D Mark Courtney, Elisa J Gordon, Leena F Thomas, Jane L Holl, Shyam Prabhakaran
BACKGROUND AND PURPOSE: No standard approach to obtaining informed consent for stroke thrombolysis with tPA (tissue-type plasminogen activator) currently exists. We aimed to assess current nationwide practice patterns of obtaining informed consent for tPA. METHODS: An online survey was developed and distributed by e-mail to clinicians involved in acute stroke care. Multivariable logistic regression analyses were performed to determine independent factors contributing to always obtaining informed consent for tPA...
February 12, 2018: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29440034/subclinical-compromise-in-cardiac-strain-relates-to-lower-cognitive-performances-in-older-adults
#7
Hailey A Kresge, Omair A Khan, Madison A Wagener, Dandan Liu, James G Terry, Sangeeta Nair, Francis E Cambronero, Katherine A Gifford, Katie E Osborn, Timothy J Hohman, Kimberly R Pechman, Susan P Bell, Thomas J Wang, John Jeffrey Carr, Angela L Jefferson
BACKGROUND: Global longitudinal strain (GLS), reflecting total shortening of the myocardium during the cardiac cycle, has emerged as a more precise myocardial function measure than left ventricular ejection fraction (LVEF). Longitudinal strain may be selectively affected in subclinical heart disease, even in the presence of normal LVEF. This study examines subclinical cardiac dysfunction, assessed by GLS and LVEF, and cognition among older adults. METHODS AND RESULTS: Vanderbilt Memory and Aging Project participants who were free of clinical dementia, stroke, and heart failure (n=318, 73±7 years, 58% male) completed neuropsychological assessment and cardiac magnetic resonance to quantify GLS and LVEF...
February 13, 2018: Journal of the American Heart Association
https://www.readbyqxmd.com/read/29439542/update-on-the-non-pharmacological-management-of-stroke-prevention-in-patients-with-atrial-fibrillation
#8
REVIEW
Aneesh Tolat, Neal Lippman
Non-surgical left atrial appendage occlusion has emerged as an alternative to anticoagulant therapy in the management of stroke risk in patients with atrial fibrillation. This review reports on some of the more common devices that are currently being used to manage patients in this challenging group.
February 12, 2018: Journal of Clinical Medicine
https://www.readbyqxmd.com/read/29439477/a-practical-review-of-the-emerging-direct-anticoagulants-laboratory-monitoring-and-reversal-agents
#9
REVIEW
Stephanie A Joppa, Justin Salciccioli, Jill Adamski, Salma Patel, Waldemar Wysokinski, Robert McBane, Farah Al-Saffar, Heidi Esser, Fadi Shamoun
Millions of patients in the United States use anticoagulation for a variety of indications, such as the prevention of stroke in those with atrial fibrillation (AF) and the treatment and prevention of venous thrombosis. For over six decades warfarin was the only available oral anticoagulant, but now several DOACs are available and their use has become more prevalent in recent years. In spite of this increased use, many physicians remain reluctant to prescribe DOACs due to concerns about bleeding and reversibility...
February 11, 2018: Journal of Clinical Medicine
https://www.readbyqxmd.com/read/29434631/transcatheter-aortic-valve-replacement-and-stroke-a-comprehensive-review
#10
REVIEW
Periklis A Davlouros, Virginia C Mplani, Ioanna Koniari, Grigorios Tsigkas, George Hahalis
Transcatheter aortic valve implantation (TAVR) has emerged as an alternative, rapidly evolving treatment option for patients with severe aortic stenosis and high surgical risk. Stroke is a devastating complication being confined mainly in the periprocedural and 30-day period following TAVR, with a lower and relatively constant frequency thereafter. Early stroke is mainly due to debris embolization during the procedure, whereas later events are associated with patient specific factors. Despite the fact that the rate of clinical stroke has been constantly decreasing compared to initial TAVR experience, modern neuro-imaging with MRI suggests that new ischemic lesions post-TAVR are almost universal...
January 2018: Journal of Geriatric Cardiology: JGC
https://www.readbyqxmd.com/read/29431856/cerebral-embolization-silent-cerebral-infarction-and-neurocognitive-decline-after-thoracic-endovascular-aortic-repair
#11
A H Perera, N Rudarakanchana, L Monzon, C D Bicknell, B Modarai, O Kirmi, T Athanasiou, M Hamady, R G Gibbs
BACKGROUND: Silent cerebral infarction is brain injury detected incidentally on imaging; it can be associated with cognitive decline and future stroke. This study investigated cerebral embolization, silent cerebral infarction and neurocognitive decline following thoracic endovascular aortic repair (TEVAR). METHODS: Patients undergoing elective or emergency TEVAR at Imperial College Healthcare NHS Trust and Guy's and St Thomas' NHS Foundation Trust between January 2012 and April 2015 were recruited...
February 12, 2018: British Journal of Surgery
https://www.readbyqxmd.com/read/29430622/prehospital-stroke-scales-and-large-vessel-occlusion-a-systematic-review
#12
S Vidale, E Agostoni
BACKGROUND AND PURPOSE: Time sensitivity for pharmacological and mechanical arterial recanalization in acute ischemic stroke influences the choice of the reference hospital. The accurate selection and identification of patients with high probability of a large vessel occlusion (LVO) in the prehospital setting improve the rationalization of the transport in the more suitable centers. Aim of this analysis was to determine the diagnostic accuracy of prehospital stroke scales detecting LVO...
February 11, 2018: Acta Neurologica Scandinavica
https://www.readbyqxmd.com/read/29430236/idiopathic-thrombocytopenia-purpura-masking-hodgkin-disease-a-paraneoplastic-syndrome-or-simply-a-mere-association
#13
Nicholas Poponea, Mohanad Suede, Mohammad Muhsin Chisti
We report a 74-year-old female who presented to the emergency department complaining of bruising and stroke-like symptoms. She underwent a negative stroke work-up but was found to have profoundly low platelets and splenomegaly on examination. An abdominal CT scan was ordered, showing pelvic lymphadenopathy. Lymphoma was suspected. However, subsequent bone marrow and lymph node biopsies showed no evidence of this. She was treated for immune thrombocytopenia purpura (ITP) to no avail while a lymphoma work-up continued...
September 2017: Case Reports in Oncology
https://www.readbyqxmd.com/read/29429783/pediatric-stroke-and-its-mimics-limitations-of-a-pediatric-stroke-clinical-pathway
#14
Amy M DeLaroche, Lalitha Sivaswamy, Ahmad Farooqi, Nirupama Kannikeswaran
BACKGROUND: Acute stroke protocols improve delivery of care but it is unclear whether these resource intensive protocols are able to differentiate stroke from mimics in children. The aim of this study is to describe our institution's experience with stroke mimics identified through our pediatric stroke clinical pathway (PSCP). METHODS: The PSCP was implemented in our level 1 pediatric emergency department in June 2014 for children aged one month to 18 years. For patients managed using the PSCP from June 2014 to December 2016, demographic and clinical data were compared for patients diagnosed with stroke or a stroke mimic...
October 31, 2017: Pediatric Neurology
https://www.readbyqxmd.com/read/29428832/long-term-efficacy-and-safety-of-proprotein-convertase-subtilisin-kexin-9-monoclonal-antibodies-a-meta-analysis-of-11-randomized-controlled-trials
#15
REVIEW
Jie Bai, Li-Lin Gong, Qi-Fu Li, Zhi-Hong Wang
BACKGROUND: Monoclonal antibodies targeting proprotein convertase subtilisin/kexin type 9 (PCSK9) have been shown to significantly reduce low-density lipoprotein cholesterol (LDL-C) levels. OBJECTIVE: The purpose of this study was to assess the long-term efficacy and safety of PCSK9 antibodies. METHODS: PubMed, EMBASE, the Cochrane Library, and ClinicalTrials.gov were searched for relevant studies. RESULTS: A total of 11 studies including 38,235 participants who were treated for at least 48 weeks were included in this meta-analysis...
January 12, 2018: Journal of Clinical Lipidology
https://www.readbyqxmd.com/read/29428327/the-effect-of-being-found-with-stroke-symptoms-on-predictors-of-hospital-arrival
#16
Mellanie V Springer, Daniel L Labovitz
BACKGROUND: Studies examining predictors of delay in hospital arrival after stroke symptom onset have not accounted for patients who are found with their symptoms and cannot seek help independently. Our objective is to show that inclusion of patients who are "found down" in studies of prehospital delay biases the estimated association of sociodemographic and clinical variables with time of hospital arrival. METHODS: We performed a retrospective analysis of sociodemographic and clinical characteristics of patients with acute ischemic stroke presenting to a tertiary care hospital in the Bronx, New York...
February 8, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29427478/from-ruling-out-to-ruling-in-putting-pocus-in-focus
#17
Arjun K Venkatesh, Charles D Scales, Marta E Heilbrun
Over the past twenty years, the Emergency Department (ED) has transformed from a location that managed patients with acute life-threatening illness or injury to an acute diagnostic center. The advent of rapid and accurate imaging, novel biomarkers, and other innovations concurrent with effects from financial and social forces has supported the development of an acute care system focused on "ruling out" low-frequency, high-mortality events such as acute myocardial infarction, stroke, pulmonary embolism, and aortic dissection...
February 10, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29427026/wearable-sensors-for-clinical-applications-in-epilepsy-parkinson-s-disease-and-stroke-a-mixed-methods-systematic-review
#18
REVIEW
Dongni Johansson, Kristina Malmgren, Margit Alt Murphy
OBJECTIVES: Wearable technology is increasingly used to monitor neurological disorders. The purpose of this systematic review was to synthesize knowledge from quantitative and qualitative clinical researches using wearable sensors in epilepsy, Parkinson's disease (PD), and stroke. METHODS: A systematic literature search was conducted in PubMed and Scopus spanning from 1995 to January 2017. A synthesis of the main findings, reported adherence to wearables and missing data from quantitative studies, is provided...
February 9, 2018: Journal of Neurology
https://www.readbyqxmd.com/read/29427025/telemedicine-in-general-neurology-use-of-audiovisual-consultation-for-on-call-back-up-service-in-an-acute-care-hospital
#19
Frank Janssen, Mohammed Awadallah, Awed Alhalabi, Barbara Körber, Reinhard Lang, Mateusz Scibor, René Handschu
OBJECTIVE: While telemedicine is in expanding use in acute stroke care, little is known about its use in general neurology, especially in acute care. We sought to investigate the feasibility and possible effects of a telemedicine device within the neurological back-up service of an acute care hospital. METHODS: In a 450 bed academic teaching hospital an experienced neurologist (EN) is on call to support the junior doctor at the hospital. Support was possible whether by standard telephone advice (TA) or by audiovisual consultations (AVC)...
February 9, 2018: Journal of Neurology
https://www.readbyqxmd.com/read/29427013/assessment-of-fluid-responsiveness-in-spontaneously-breathing-patients-a-systematic-review-of-literature
#20
REVIEW
Renato Carneiro de Freitas Chaves, Thiago Domingos Corrêa, Ary Serpa Neto, Bruno de Arruda Bravim, Ricardo Luiz Cordioli, Fabio Tanzillo Moreira, Karina Tavares Timenetsky, Murillo Santucci Cesar de Assunção
Patients who increase stoke volume or cardiac index more than 10 or 15% after a fluid challenge are usually considered fluid responders. Assessment of fluid responsiveness prior to volume expansion is critical to avoid fluid overload, which has been associated with poor outcomes. Maneuvers to assess fluid responsiveness are well established in mechanically ventilated patients; however, few studies evaluated maneuvers to predict fluid responsiveness in spontaneously breathing patients. Our objective was to perform a systematic review of literature addressing the available methods to assess fluid responsiveness in spontaneously breathing patients...
February 9, 2018: Annals of Intensive Care
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