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Stroke

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https://read.qxmd.com/read/32227791/act-fast-a-quality-improvement-project-to-increase-the-percentage-of-acute-stroke-patients-receiving-intravenous-thrombolysis-within-60-minutes-of-arrival-at-the-emergency-department
#1
Li Qi Chiu, Daniel Yong Jing Quek, Roslin Binte Salihan, Wai May Ng, Rozana Binte Othman, Chiao-Hao Lee, Daniel Chia Theng Oh
INTRODUCTION: Stroke is a leading cause of death and disability, with the administration of reverse transcriptase-plasminogen activator (rtPA) improving outcomes in a time-dependent manner. Only 52.3% of our eligible stroke patients received rtPA within 60 minutes of arrival. We aimed to better the percentage of acute stroke patients receiving rtPA within 60 minutes of arrival at the emergency department (ED). METHODS: Results from the first year of a clinical practice improvement project, where quality improvement interventions were implemented, are presented...
March 31, 2020: Singapore Medical Journal
https://read.qxmd.com/read/32227772/effectiveness-of-xinglou-chengqi-decoction-on-constipation-in-patients-with-acute-ischemic-stroke-a-randomized-controlled-trial
#2
Pei Chen, Lan Jiang, Hualei Geng, Xiao Han, Shuang Wu, Yahui Wang, Ruyu Yan, Yi Ren, Yihuai Zou, Pei Chen, Yinping Xu, Yan Chen, Jinbin Guo, Ruyu Yan
OBJECTIVE: To evaluate the effectiveness of traditional Chinese herbal Xinglouchengqi (XLCQ) decoction for the treatment of constipation in acute ischemic stroke patients, and figure out the role that bowel movements play in the treatment of acute ischemic stroke. METHODS: A total of 317 eligible patients were recruited and randomized to the XLCQ group (211 patients) or the control group (106 patients). In addition to conventional standard medical care and rehabilitation, participants in the XLCQ group received XLCQ decoction, while the control group received clysis therapy using glycerin enemas or lactulose oral solution...
February 2020: Journal of Traditional Chinese Medicine
https://read.qxmd.com/read/32227756/management-of-coronary-disease-in-patients-with-advanced-kidney-disease
#3
Sripal Bangalore, David J Maron, Sean M O'Brien, Jerome L Fleg, Evgeny I Kretov, Carlo Briguori, Upendra Kaul, Harmony R Reynolds, Tomasz Mazurek, Mandeep S Sidhu, Jeffrey S Berger, Roy O Mathew, Olga Bockeria, Samuel Broderick, Radoslaw Pracon, Charles A Herzog, Zhen Huang, Gregg W Stone, William E Boden, Jonathan D Newman, Ziad A Ali, Daniel B Mark, John A Spertus, Karen P Alexander, Bernard R Chaitman, Glenn M Chertow, Judith S Hochman
BACKGROUND: Clinical trials that have assessed the effect of revascularization in patients with stable coronary disease have routinely excluded those with advanced chronic kidney disease. METHODS: We randomly assigned 777 patients with advanced kidney disease and moderate or severe ischemia on stress testing to be treated with an initial invasive strategy consisting of coronary angiography and revascularization (if appropriate) added to medical therapy or an initial conservative strategy consisting of medical therapy alone and angiography reserved for those in whom medical therapy had failed...
March 30, 2020: New England Journal of Medicine
https://read.qxmd.com/read/32227723/role-of-the-nurse-in-acute-stroke-care
#4
Christopher Stephen Clare
The recognition of stroke as a medical emergency, provision of specialist services and advances in treatments have contributed to a decrease in stroke-related mortality, but the incidence and burden of stroke continue to rise. A stroke is a life-threatening and life-limiting event, but prompt identification and early treatment can reduce mortality and disability, and enhance the recovery and rehabilitation potential of survivors. Nurses working in acute stroke services have a wide-ranging role that includes assessment, identification and monitoring, as well as rehabilitation, psychological support and end of life care...
March 23, 2020: Nursing Standard
https://read.qxmd.com/read/32227638/different-mismatch-concepts-for-mri-guided-thrombolysis-in-unknown-onset-stroke
#5
Lauranne Scheldeman, Anke Wouters, Florent Boutitie, Patrick Dupont, Soren Christensen, Bastian Cheng, Martin Ebinger, Matthias Endres, Jochen B Fiebach, Christian Gerloff, Keith W Muir, Norbert Nighoghossian, Salvador Pedraza, Claus Z Simonsen, Vincent Thijs, Götz Thomalla, Robin Lemmens
OBJECTIVE: To explore the prevalence of the perfusion-weighted imaging (PWI) - diffusion-weighted imaging (DWI) mismatch and response to intravenous thrombolysis in the WAKE-UP trial. METHODS: We performed a prespecified post-hoc analysis of ischemic stroke patients screened for DWI - fluid-attenuated inversion recovery (FLAIR) mismatch in WAKE-UP who underwent PWI. We defined PWI-DWI mismatch as ischemic core volume < 70 ml, mismatch volume > 10 ml and mismatch ratio > 1...
March 30, 2020: Annals of Neurology
https://read.qxmd.com/read/32227466/greater-macrovascular-and-microvascular-morbidity-from-type-2-diabetes-in-northern-compared-with-southern-china-a-cross-sectional-study
#6
Li Wang, Ying Xing, Xinwen Yu, Jie Ming, Xiangyang Liu, Xiaomiao Li, Jianfang Fu, Jie Zhou, Bin Gao, Dayi Hu, Changyu Pan, Linong Ji, Qiuhe Ji
INTRODUCTION: There are substantial differences in genes, diet, culture, and environment between the Northern and Southern Chinese populations, which may influence treatment strategy and screening policy. We studied the differences in type 2 diabetes (T2D) and diabetic complications between Northern and Southern China. METHODS: We did a cross-sectional survey using data from the China Cardiometabolic Registries on blood pressure, blood lipids, and blood glucose in 25,398 Chinese T2D patients...
March 29, 2020: Journal of Diabetes Investigation
https://read.qxmd.com/read/32227432/empagliflozin-reduces-the-risk-of-mortality-and-hospitalization-for-heart-failure-across-thrombolysis-in-myocardial-infarction-risk-score-for-heart-failure-in-diabetes-categories-post-hoc-analysis-of-the-empa-reg-outcome-trial
#7
Subodh Verma, Abhinav Sharma, Bernard Zinman, Anne Pernille Ofstad, David Fitchett, Martina Brueckmann, Christoph Wanner, Isabella Zwiener, Jyothis T George, Silvio E Inzucchi, Javed Butler, C David Mazer
AIM: To investigate the association of the Thrombolysis In Myocardial Infarction (TIMI) Risk Score for Heart Failure in Diabetes (TRS-HFDM ) with mortality using data from the EMPA-REG OUTCOME trial. MATERIALS AND METHODS: In EMPA-REG OUTCOME, patients with type 2 diabetes and atherosclerotic cardiovascular (CV) disease (N = 7020) received the sodium-glucose co-transporter-2 inhibitor, empagliflozin, 10 or 25 mg or placebo. Post hoc, patients were stratified into risk categories (low-intermediate, high, very-high risk scores) using baseline TRS-HFDM ...
March 29, 2020: Diabetes, Obesity & Metabolism
https://read.qxmd.com/read/32227427/feasibility-of-real-time-cardiac-mri-in-mice-using-tiny-golden-angle-radial-sparse
#8
Hao Li, Patrick Metze, Alireza Abaei, Wolfgang Rottbauer, Steffen Just, Qinghua Lu, Volker Rasche
Cardiovascular magnetic resonance imaging has proven valuable for the assessment of structural and functional cardiac abnormalities. Even although it is an established imaging method in small animals, the long acquisition times of gated or self-gated techniques still limit its widespread application. In this study, the application of tiny golden angle radial sparse MRI (tyGRASP) for real-time cardiac imaging was tested in 12 constitutive nexilin (Nexn) knock-out (KO) mice, both heterozygous (Het, N = 6) and wild-type (WT, N = 6), and the resulting functional parameters were compared with a well-established self-gating approach...
March 29, 2020: NMR in Biomedicine
https://read.qxmd.com/read/32227294/guidelines-for-the-acute-treatment-of-cerebral-edema-in-neurocritical-care-patients
#9
Aaron M Cook, G Morgan Jones, Gregory W J Hawryluk, Patrick Mailloux, Diane McLaughlin, Alexander Papangelou, Sophie Samuel, Sheri Tokumaru, Chitra Venkatasubramanian, Christopher Zacko, Lara L Zimmermann, Karen Hirsch, Lori Shutter
BACKGROUND: Acute treatment of cerebral edema and elevated intracranial pressure is a common issue in patients with neurological injury. Practical recommendations regarding selection and monitoring of therapies for initial management of cerebral edema for optimal efficacy and safety are generally lacking. This guideline evaluates the role of hyperosmolar agents (mannitol, HTS), corticosteroids, and selected non-pharmacologic therapies in the acute treatment of cerebral edema. Clinicians must be able to select appropriate therapies for initial cerebral edema management based on available evidence while balancing efficacy and safety...
March 29, 2020: Neurocritical Care
https://read.qxmd.com/read/32227247/isradipine-versus-placebo-in-early-parkinson-disease-a-randomized-trial
#10
(no author information available yet)
Background: Studies suggest that dihydropyridine calcium-channel blockers may be associated with reduced risk for Parkinson disease (PD). Objective: To assess the effect of isradipine, a dihydropyridine calcium-channel blocker, on the rate of clinical progression of PD. Design: Multicenter, randomized, parallel-group, double-blind, placebo-controlled trial. (ClinicalTrials.gov: NCT02168842). Setting: 57 Parkinson Study Group sites in North America...
March 31, 2020: Annals of Internal Medicine
https://read.qxmd.com/read/32227212/a-murine-photothrombotic-stroke-model-with-an-increased-fibrin-content-and-improved-responses-to-tpa-lytic-treatment
#11
Yu-Yo Sun, Yi-Min Kuo, Hong-Ru Chen, Jonah C Short-Miller, Marchelle R Smucker, Chia-Yi Kuan
The Rose Bengal (RB) dye-based photothrombotic stroke (PTS) model has many methodological advantages including consistent location and size of infarct, low mortality, and relatively simple surgical procedures. However, the standard PTS has the caveat of poor responses to tissue-type plasminogen activator (tPA)-mediated lytic treatment, likely as a result of the platelet-rich, fibrin-poor content of the blood clots. Here we tested whether the admixture of thrombin (80 U/kg) and RB dye (50 mg/kg) in the proximal middle cerebral artery (MCA)-targeted PTS will modify the clot composition and elevate the responsiveness to tPA-lytic treatment (Alteplase, 10 mg/kg)...
April 14, 2020: Blood Advances
https://read.qxmd.com/read/32227172/2019-vs-2016-esc-eas-statin-guidelines-for-primary-prevention-of-atherosclerotic-cardiovascular-disease
#12
Martin Bødtker Mortensen, Børge Grønne Nordestgaard
AIMS : The 2019 vs. 2016 European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) dyslipidaemia guidelines contains new recommendations for primary prevention with statins; however, the potential impact of these changes is unclear. We compared the 2019 and 2016 guidelines regarding statin eligibility and potential impact on prevention of atherosclerotic cardiovascular disease (ASCVD) in the general population. METHODS AND RESULTS : We examined 45 750 individuals aged 40-75 from the Copenhagen General Population Study, all free of ASCVD and statin use at baseline...
March 30, 2020: European Heart Journal
https://read.qxmd.com/read/32227165/long-term-effectiveness-of-catheter-ablation-in-patients-with-atrial-fibrillation-and-heart-failure
#13
Michelle Samuel, Michal Abrahamowicz, Jacqueline Joza, Marie-Eve Beauchamp, Vidal Essebag, Louise Pilote
AIMS: Randomized trials suggest reductions in all-cause mortality and heart failure (HF) rehospitalizations with catheter ablation (CA) in patients with atrial fibrillation (AF) and HF. Whether these results can be replicated in a real-world population with long-term follow-up or varies over time is unknown. We sought to evaluate the long-term effectiveness of CA in reducing the incidence of all-cause mortality, HF hospitalizations, stroke, and major bleeding in AF-HF patients. METHODS AND RESULTS: In a cohort of patients newly diagnosed with AF-HF in Quebec, Canada (2000-2017), CA patients were matched 1:2 to controls on time and frequency of hospitalizations...
March 30, 2020: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://read.qxmd.com/read/32227157/effect-of-in-hospital-remote-ischemic-perconditioning-on-brain-infarction-growth-and-clinical-outcomes-in-patients-with-acute-ischemic-stroke-the-rescue-brain-randomized-clinical-trial
#14
Fernando Pico, Bertrand Lapergue, Marc Ferrigno, Charlotte Rosso, Elena Meseguer, Marie-Laure Chadenat, Frederic Bourdain, Michael Obadia, Catherine Hirel, Duc Long Duong, Sandrine Deltour, Philippe Aegerter, Julien Labreuche, Amina Cattenoy, Didier Smadja, Hassan Hosseini, Benoit Guillon, Valérie Wolff, Yves Samson, Charlotte Cordonnier, Pierre Amarenco
Importance: Treatment with remote ischemic perconditioning has been reported to reduce brain infarction volume in animal models of stroke. Whether this neuroprotective effect was observed in patients with acute ischemic stroke remains unknown. Objective: To determine whether treatment with remote ischemic perconditioning administered to the leg of patients with acute ischemic stroke can reduce brain infarction volume growth. Design, Setting, and Participants: This proof-of-concept multicenter prospective randomized open-label with blinded end point clinical trial was performed from January 12, 2015, to May 2, 2018...
March 30, 2020: JAMA Neurology
https://read.qxmd.com/read/32227140/association-between-cardiovascular-disease-and-long-term-exposure-to-air-pollution-with-the-risk-of-dementia
#15
Giulia Grande, Petter L S Ljungman, Kristina Eneroth, Tom Bellander, Debora Rizzuto
Importance: Emerging yet contrasting evidence associates air pollution with incident dementia, and the potential role of cardiovascular disease (CVD) in this association is unclear. Objective: To investigate the association between long-term exposure to air pollution and dementia and to assess the role of CVD in that association. Design, Setting, and Participants: Data for this cohort study were extracted from the ongoing Swedish National Study on Aging and Care in Kungsholmen (SNAC-K), a longitudinal population-based study with baseline assessments from March 21, 2001, through August 30, 2004...
March 30, 2020: JAMA Neurology
https://read.qxmd.com/read/32226699/chorea-as-the-first-manifestation-of-cerebral-infarction
#16
Otto Jesus Hernandez Fustes, Renato Puppi Munhoz, Carlos Arteaga Rodriguez, Olga Judith Hernandez Fustes
Cerebrovascular disease (CVD), which usually manifests as a focal neurological deficit, is presented here as a movement disorder. This unusual manifestation corresponds to 1% of the CVDs and 8% of the striatal lesions. We report a 37-year-old right-handed woman who developed choreic movements as the first manifestation of an acute stroke. The computed tomography (CT) scan revealed a cortical/subcortical hypodense lesion in the right middle cerebral artery territory. This picture slowly improved and remitted completely after six weeks...
March 24, 2020: Curēus
https://read.qxmd.com/read/32226634/lifestyle-counselling-as-secondary-prevention-in-patients-with-minor-stroke-and-transient-ischemic-attack-study-protocol-for-a-randomized-controlled-pilot-study
#17
Jacob Liljehult, Stig Molsted, Tom Møller, Dorthe Overgaard, Lis Adamsen, Mary Jarden, Thomas Christensen
Background: Most patients with minor stroke or transient ischemic attack (TIA) are discharged with little or no specialised follow-up. Nonetheless, these patients have a high prevalence of cognitive impairments and a considerable risk of recurrent stroke. Smoking cessation, physical activity, and adherence to antihypertensive and antithrombotic medication are highly recommended in patients with minor stroke and TIA. Evidence suggests that simple encouragement to change lifestyle is ineffective...
2020: Pilot and Feasibility Studies
https://read.qxmd.com/read/32226566/novel-hybrid-brain-computer-interface-system-based-on-motor-imagery-and-p300
#18
Cili Zuo, Jing Jin, Erwei Yin, Rami Saab, Yangyang Miao, Xingyu Wang, Dewen Hu, Andrzej Cichocki
Motor imagery (MI) is a mental representation of motor behavior and has been widely used in electroencephalogram based brain-computer interfaces (BCIs). Several studies have demonstrated the efficacy of MI-based BCI-feedback training in post-stroke rehabilitation. However, in the earliest stage of the training, calibration data typically contain insufficient discriminability, resulting in unreliable feedback, which may decrease subjects' motivation and even hinder their training. To improve the performance in the early stages of MI training, a novel hybrid BCI paradigm based on MI and P300 is proposed in this study...
April 2020: Cognitive Neurodynamics
https://read.qxmd.com/read/32226552/nir-ii-fluorescence-microscopic-imaging-of-cortical-vasculature-in-non-human-primates
#19
Zhaochong Cai, Liang Zhu, Mengqi Wang, Anna Wang Roe, Wang Xi, Jun Qian
Vasculature architecture of the brain can provide revealing information about mental and neurological function and disease. Fluorescence imaging in the second near-infrared (NIR-II) regime with less light scattering is a more promising method for detecting cortical vessels than traditional visible and NIR-I modes. Methods : Clinically approved dye indocyanine green (ICG) was used for NIR-II fluorescence imaging. Here, for the first time, we developed two NIR-II fluorescence microscopy systems for brain vasculature imaging in macaque monkeys...
2020: Theranostics
https://read.qxmd.com/read/32226394/angiotensin-1-7-receptor-mas-deficiency-does-not-exacerbate-cardiac-atrophy-following-high-level-spinal-cord-injury-in-mice
#20
Anne Järve, Fatimunnisa Qadri, Mihail Todiras, Shirley Schmolke, Natalia Alenina, Michael Bader
Experimental spinal cord injury (SCI) causes a morphological and functional deterioration of the heart, in which the renin-angiotensin system (RAS) might play a role. The recently discovered non-canonical axis of RAS with angiotensin-(1-7) and its receptor Mas, which is associated with cardioprotection could be essential to prevent damage to the heart following SCI. We investigated the cardiac consequences of SCI and the role of Mas in female wild-type (WT, n = 22) and mice deficient of Mas ( Mas-/- , n = 25) which underwent spinal cord transection at thoracic level T4 (T4-Tx) or sham-operation by echocardiography (0, 7, 21, and 28 days post-SCI), histology and gene expression analysis at 1 or 2 months post-SCI...
2020: Frontiers in Physiology
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