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45 papers 1000+ followers Questioning Medicine upcoming podcast #FOAMed #MedQuestioning
By Joe Weatherly FM/Hospitalist-CoFounder of QuestioningMedicine and PCRAP contributor.
https://www.readbyqxmd.com/read/27161018/low-dose-versus-standard-dose-intravenous-alteplase-in-acute-ischemic-stroke
#1
RANDOMIZED CONTROLLED TRIAL
Craig S Anderson, Thompson Robinson, Richard I Lindley, Hisatomi Arima, Pablo M Lavados, Tsong-Hai Lee, Joseph P Broderick, Xiaoying Chen, Guofang Chen, Vijay K Sharma, Jong S Kim, Nguyen H Thang, Yongjun Cao, Mark W Parsons, Christopher Levi, Yining Huang, Verónica V Olavarría, Andrew M Demchuk, Philip M Bath, Geoffrey A Donnan, Sheila Martins, Octavio M Pontes-Neto, Federico Silva, Stefano Ricci, Christine Roffe, Jeyaraj Pandian, Laurent Billot, Mark Woodward, Qiang Li, Xia Wang, Jiguang Wang, John Chalmers
BACKGROUND: Thrombolytic therapy for acute ischemic stroke with a lower-than-standard dose of intravenous alteplase may improve recovery along with a reduced risk of intracerebral hemorrhage. METHODS: Using a 2-by-2 quasi-factorial open-label design, we randomly assigned 3310 patients who were eligible for thrombolytic therapy (median age, 67 years; 63% Asian) to low-dose intravenous alteplase (0.6 mg per kilogram of body weight) or the standard dose (0.9 mg per kilogram); patients underwent randomization within 4...
June 16, 2016: New England Journal of Medicine
https://www.readbyqxmd.com/read/23648949/management-strategies-for-asymptomatic-carotid-stenosis-a-systematic-review-and-meta-analysis
#2
REVIEW
Gowri Raman, Denish Moorthy, Nira Hadar, Issa J Dahabreh, Thomas F O'Donnell, David E Thaler, Edward Feldmann, Joseph Lau, Georgios D Kitsios
BACKGROUND: Adults with asymptomatic carotid artery stenosis are at increased risk for ipsilateral carotid territory ischemic stroke. PURPOSE: To examine comparative evidence on management strategies for asymptomatic carotid stenosis and the incidence of ipsilateral stroke with medical therapy alone. DATA SOURCES: MEDLINE, Cochrane Central Register of Controlled Trials, U.S. Food and Drug Administration documents, and review of references through 31 December 2012...
May 7, 2013: Annals of Internal Medicine
https://www.readbyqxmd.com/read/24076337/high-dose-albumin-treatment-for-acute-ischaemic-stroke-alias-part-2-a-randomised-double-blind-phase-3-placebo-controlled-trial
#3
RANDOMIZED CONTROLLED TRIAL
Myron D Ginsberg, Yuko Y Palesch, Michael D Hill, Renee H Martin, Claudia S Moy, William G Barsan, Bonnie D Waldman, Diego Tamariz, Karla J Ryckborst
BACKGROUND: In animal models of ischaemic stroke, 25% albumin reduced brain infarction and improved neurobehavioural outcome. In a pilot clinical trial, albumin doses as high as 2 g/kg were safely tolerated. We aimed to assess whether albumin given within 5 h of the onset of acute ischaemic stroke increased the proportion of patients with a favourable outcome. METHODS: We did a randomised, double-blind, parallel-group, phase 3, placebo-controlled trial between Feb 27, 2009, and Sept 10, 2012, at 69 sites in the USA, 13 sites in Canada, two sites in Finland, and five sites in Israel...
November 2013: Lancet Neurology
https://www.readbyqxmd.com/read/24816974/the-protective-arms-of-the-renin-angiontensin-system-in-stroke
#4
REVIEW
Claudia A McCarthy, Lachlan J Facey, Robert E Widdop
It is quite well established that activation of the so-called protective arms of the renin-angiotensin system (RAS), involving both AT2 and Mas receptors, provides a counter-regulatory role to AT1 receptor overactivity that may drive pathological changes in the cardiovascular system. In this brief review, we will focus on recent evidence that identifies at least three different pathways that may be effective in the setting of stroke and may be complementary with AT1 receptor blockade. Such mechanisms include AT2 receptor stimulation, Mas receptor stimulation and insulin-regulated aminopeptidase blockade...
July 2014: Current Hypertension Reports
https://www.readbyqxmd.com/read/24908220/early-decompressive-surgery-after-combined-intra-venous-thrombolysis-and-endovascular-stroke-treatment
#5
COMPARATIVE STUDY
Ozcan Ozdemir, Zuhtu Ozbek, Murat Vural, Ramazan Durmaz, Erhan Cosan, Ali Arslantas, Metin Ant Atasoy
BACKGROUND AND PURPOSE: The prognosis of malignant middle cerebral artery infarctions (MCA) is poor. The poor prognosis is attributable to the severe cerebral edema that causes a brain herniation and death. Decompressive surgery reduces mortality and may further improve patient outcomes. However, the safety and effectiveness of decompressive surgery in patients who underwent combined intravenous (IV) thrombolysis and endovascular stroke treatment are not certain. Moreover, the evidence on the timing of decompressive surgery is lacking...
July 2014: Clinical Neurology and Neurosurgery
https://www.readbyqxmd.com/read/24909195/a-new-paradigm-for-primary-prevention-strategy-in-people-with-elevated-risk-of-stroke
#6
Valery L Feigin, Bo Norrving
Existing methods of primary stroke prevention are not sufficiently effective. Based on the recently developed Stroke Riskometer app, a new 'mass-elevated risk stroke/cardiovascular disease prevention' approach as an addition to the currently adopted absolute risk stroke/cardiovascular disease prevention approach is being advocated. We believe this approach is far more appealing to the individuals concerned and could be as efficient as the conventional population-based approach because it allows identification and engagement in prevention of all individuals who are at an increased (even slightly increased) risk of stroke and cardiovascular disease...
July 2014: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/24909197/update-protocol-preventive-antibiotics-in-stroke-study-pass
#7
RANDOMIZED CONTROLLED TRIAL
Paul J Nederkoorn, Diederik van de Beek
No abstract text is available yet for this article.
July 2014: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/24593194/statin-treatment-in-patients-with-acute-ischemic-stroke
#8
MULTICENTER STUDY
Mohamed Al-Khaled, Christine Matthis, Jürgen Eggers
BACKGROUND AND PURPOSE: We aimed to investigate the association of statin treatment with outcomes in patients with acute ischemic stroke. METHODS: Over a 4.5-year period (starting November 2007), 12 781 patients (mean age, 72·8 ± 12·6 years; 48·6% women) with acute ischemic stroke from 15 hospitals in Schleswig-Holstein, Germany, were enrolled in a population-based study and prospectively evaluated. The primary outcomes were the mortality during hospitalization and the disability (modified Rankin Scale score ≥2) at discharge from hospital...
July 2014: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/23130938/solitaire%C3%A2-with-the-intention-for-thrombectomy-swift-trial-design-of-a-randomized-controlled-multicenter-study-comparing-the-solitaire%C3%A2-flow-restoration-device-and-the-merci-retriever-in-acute-ischaemic-stroke
#9
RANDOMIZED CONTROLLED TRIAL
J L Saver, R Jahan, E I Levy, T G Jovin, B Baxter, R Nogueira, W Clark, R Budzik, O O Zaidat
RATIONALE: Self-expanding stent retrievers are a promising new device class designed for rapid flow restoration in acute cerebral ischaemia. The SOLITAIRE™ Flow Restoration device (SOLITAIRE) has shown high rates of recanalization in preclinical models and in uncontrolled clinical series. AIMS: (1) To demonstrate non-inferiority of SOLITAIRE compared with a legally marketed device, the MERCI Retrieval System®; (2) To demonstrate safety, feasibility, and efficacy of SOLITAIRE in subjects requiring mechanical thrombectomy diagnosed with acute ischaemic stroke...
July 2014: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/23231528/risk-factor-management-in-survivors-of-stroke-a-double-blind-cluster-randomized-controlled-trial
#10
RANDOMIZED CONTROLLED TRIAL
Amanda G Thrift, Velandai K Srikanth, Mark R Nelson, Joosup Kim, Sharyn M Fitzgerald, Richard P Gerraty, Christopher F Bladin, Thanh G Phan, Dominique A Cadilhac
BACKGROUND: Comprehensive community care has the potential to improve risk factor management of patients with stroke or transient ischaemic attack. AIM: The primary aim is to determine the effectiveness of an individualized management program on risk factor management for patients discharged from hospital after stroke. DESIGN: Multicentre, cluster-randomized, controlled trial, with clusters by general practice. Participants are randomized to receive intervention or control after a baseline assessment undertaken after discharge from hospital...
July 2014: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/24025084/short-duration-hypothermia-after-ischemic-stroke-prevents-delayed-intracranial-pressure-rise
#11
L A Murtha, D D McLeod, S K McCann, D Pepperall, S Chung, C R Levi, M B Calford, N J Spratt
BACKGROUND: Intracranial pressure elevation, peaking three to seven post-stroke is well recognized following large strokes. Data following small-moderate stroke are limited. Therapeutic hypothermia improves outcome after cardiac arrest, is strongly neuroprotective in experimental stroke, and is under clinical trial in stroke. Hypothermia lowers elevated intracranial pressure; however, rebound intracranial pressure elevation and neurological deterioration may occur during rewarming. HYPOTHESES: (1) Intracranial pressure increases 24 h after moderate and small strokes...
July 2014: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/24621343/renal-dysfunction-in-stroke-patients-a-hospital-based-cohort-study-and-systematic-review
#12
REVIEW
Anne Rowat, Catriona Graham, Martin Dennis
BACKGROUND AND PURPOSE: Renal dysfunction (i.e. a reduced estimated glomerular filtration rate, eGFR) is commonly found in hospitalized stroke patients but its associations with patients' characteristics and outcome require further investigation. METHODS: We linked clinical data from stroke patients enrolled between 2005 and 2008 into two prospective hospital registers with routine laboratory eGFR data. The eGFR was calculated using the Modification of Diet in Renal Disease method and renal dysfunction was defined as <60 ml/min/1·73 m(2) ...
July 2014: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/24828363/eurohyp-1-european-multicenter-randomized-phase-iii-clinical-trial-of-therapeutic-hypothermia-plus-best-medical-treatment-vs-best-medical-treatment-alone-for-acute-ischemic-stroke
#13
RANDOMIZED CONTROLLED TRIAL
H Bart van der Worp, Malcolm R Macleod, Philip M W Bath, Jacques Demotes, Isabelle Durand-Zaleski, Bernd Gebhardt, Christian Gluud, Rainer Kollmar, Derk W Krieger, Kennedy R Lees, Carlos Molina, Joan Montaner, Risto O Roine, Jesper Petersson, Dimitre Staykov, Istvan Szabo, Joanna M Wardlaw, Stefan Schwab
RATIONALE: Cooling reduced infarct size and improved neurological outcomes in animal studies modeling ischemic stroke, and also improved outcome in randomized clinical trials in patients with hypoxic-ischemic brain injury after cardiac arrest. Cooling awake patients with ischemic stroke has been shown feasible in phase II clinical trials. PRIMARY AIM: To determine whether systemic cooling to a target body temperature between 34·0 and 35·0°C, started within six-hours of symptom onset and maintained for 24 h, improves functional outcome at three-months in patients with acute ischemic stroke...
July 2014: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/24447527/chads2-score-cha2-ds2-vasc-score-and-major-artery-occlusion-in-cardioembolic-stroke-patients-with-nonvalvular-atrial-fibrillation
#14
Ichiro Deguchi, Takeshi Hayashi, Yasuko Ohe, Yuji Kato, Takuya Fukuoka, Hajime Maruyama, Yohsuke Horiuchi, Hiroyasu Sano, Yuito Nagamine, Norio Tanahashi
OBJECTIVE: The associations between the CHADS2 score/CHA2 DS2 -VASc score, and the presence of cerebral vessel occlusion on admission were examined in cardioembolic stroke patients with nonvalvular atrial fibrillation. METHODS: The subjects were 546 consecutive patients hospitalized between April 2007 and December 2012 with onset of cardioembolic stroke associated with nonvalvular atrial fibrillation within 24 h. The associations between the CHADS2 score/CHA2 DS2 -VASc score and the presence of occluded cerebral vessels on magnetic resonance angiography were evaluated retrospectively...
July 2014: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/24360934/priming-sensorimotor-cortex-to-enhance-task-specific-training-after-subcortical-stroke
#15
RANDOMIZED CONTROLLED TRIAL
Suzanne J Ackerley, Cathy M Stinear, P Alan Barber, Winston D Byblow
OBJECTIVE: This double-blind sham-controlled crossover study investigated the interactions between primary sensory and motor cortex after stroke and their response to Theta Burst Stimulation (TBS). METHODS: Thirteen chronic subcortical stroke patients with upper limb impairment performed standardised dexterity training primed with ipsilesional M1 intermittent TBS (iTBSiM1), contralesional M1 continuous TBS (cTBScM1) or sham TBS. The effects on sensorimotor integration, corticomotor excitability, sensation and grip-lift kinetics were examined...
July 2014: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
https://www.readbyqxmd.com/read/24493127/influence-of-the-%C3%AE-s-haplotype-and-%C3%AE-thalassemia-on-stroke-development-in-a-brazilian-population-with-sickle-cell-anaemia
#16
Igor F Domingos, Diego A Falcão, Betania L Hatzlhofer, Anderson F Cunha, Magnun N Santos, Dulcinéia M Albuquerque, Kleber Y Fertrin, Fernando F Costa, Renata C Azevedo, Cíntia G Machado, Aderson S Araújo, Antonio R Lucena-Araujo, Marcos A Bezerra
Stroke is a catastrophic complication of sickle cell anaemia (SCA) and is one of the leading causes of death in both adults and children with SCA. Evidence suggests that some genetic polymorphisms could be related to stroke development, but their association remains controversial. Here, we performed genotyping of five published single nucleotide polymorphisms, the α-thalassemia genotype, the G6PD A (-) variant deficiency, and the β(S) haplotype in a large series of SCA patients with well-defined stroke phenotypes...
July 2014: Annals of Hematology
https://www.readbyqxmd.com/read/24607857/biodegradable-gelatin-microspheres-enhance-the-neuroprotective-potency-of-osteopontin-via-quick-and-sustained-release-in-the-post-ischemic-brain
#17
Yinchuan Jin, In-Yong Kim, Il-Doo Kim, Hye-Kyung Lee, Jin-Young Park, Pyung-Lim Han, Kyekyoon Kevin Kim, Hyungsoo Choi, Ja-Kyeong Lee
Gelatin microspheres (GMSs) are widely used as drug carriers owing to their excellent biocompatibilities and toxicologically safe degradation products. The drug release profile is easily tailored by controlling the cross-linking density and surface-to-volume ratio, i.e. size, of the GMS. In this study, we employed GMSs which are 25 μm in diameter and cross-linked with 0.03125% glutaraldehyde, to enable rapid initial and a subsequent sustained release. Therapeutic potency of human recombinant osteopontin (rhOPN) with or without encapsulation into GMSs was investigated after administrating them to rat stroke model (Sprague-Dawley; middle cerebral artery occlusion, MCAO)...
July 2014: Acta Biomaterialia
https://www.readbyqxmd.com/read/24841111/daytime-sleepiness-and-risk-of-coronary-heart-disease-and-stroke-results-from-the-nurses-health-study-ii
#18
James E Gangwisch, Kathryn Rexrode, John P Forman, Kenneth Mukamal, Dolores Malaspina, Diane Feskanich
OBJECTIVE: The objective of this study was to determine whether daytime sleepiness is independently associated with coronary heart disease (CHD) and stroke or whether the positive association is explained by short sleep duration, disturbed sleep, and circadian disruption, conditions that are associated with cardiometabolic risk factors for vascular events. METHODS: Longitudinal analyses of data from the Nurses' Health Study II comprising 84,003 female registered nurses aged 37-54 at baseline were conducted in 2001 with follow-up until 2009...
July 2014: Sleep Medicine
https://www.readbyqxmd.com/read/24444610/the-disability-burden-associated-with-stroke-emerges-before-stroke-onset-and-differentially-affects-blacks-results-from-the-health-and-retirement-study-cohort
#19
Benjamin D Capistrant, Nicte I Mejia, Sze Y Liu, Qianyi Wang, M Maria Glymour
BACKGROUND: Few longitudinal studies compare changes in instrumental activities of daily living (IADLs) among stroke-free adults to prospectively document IADL changes among adults who experience stroke. We contrast annual declines in IADL independence for older individuals who remain stroke free to those for individuals who experienced stroke. We also assess whether these patterns differ by sex, race, or Southern birthplace. METHODS: Health and Retirement Study participants who were stroke free in 1998 (n = 17,741) were followed through 2010 (average follow-up = 8...
July 2014: Journals of Gerontology. Series A, Biological Sciences and Medical Sciences
https://www.readbyqxmd.com/read/24768488/severity-of-spontaneous-echo-contrast-in-the-jugular-vein-associated-with-ischemic-stroke
#20
Hung-Yi Hsu, Yu-Shan Lee, Ming-Che Ou, Chih-Ping Chung, Su-Yi Chen, Yu-Ping Ho, Han-Hwa Hu
This study evaluated the relationship between spontaneous echo contrast (SEC) in the internal jugular vein (JV), atherosclerotic markers and ischemic stroke. One hundred twenty patients with acute ischemic stroke and 120 controls were recruited. SEC score correlated with plasma level of fibrinogen (coefficient: 0.105, p = 0.022), hemoglobin (coefficient: 0.122, p = 0.008) and presence of JV reflux (coefficient: 0.314, p < 0.001) and peak flow velocity (coefficient: -0.244, p < 0.001) in the corresponding JV, but did not correlate with carotid plaque score (coefficient: 0...
July 2014: Ultrasound in Medicine & Biology
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