Pub Date : 2019-12-03eCollection Date: 2019-01-01DOI: 10.1155/2019/4360787
Ali M Al Khathaami, Bayan Al Bdah, Abdulmjeed Alnosair, Abdulkarim Alturki, Rayan Alrebdi, Shorug Alwayili, Sulaiman Alhamzah, Fahad A M AlKhathaami, Nasser Alotaibi
Introduction: Embolic stroke of undetermined source (ESUS) in younger adults may have different risk factors compared with ESUS in elderly, and the approach to ESUS in young adults may require new therapies. We aimed to investigate the characteristics and outcomes in younger adults with ESUS at a single centre in Saudi Arabia.
Patients and methods: A retrospective study was conducted using the medical records of younger adults with ESUS according to the criteria of the Cryptogenic Stroke/ESUS International Working Group. Younger adults (aged ≤50 years) with ESUS were compared with older patients, on admission and discharge from hospital, using the modified Rankin scale (mRS) and the National Institute of Health Stroke Scale (NIHSS).
Results: Among 147 patients with ESUS, 39 (26.5%) were younger adults. Younger adults compared with older adults with ESUS had fewer vascular risk factors, including lower rates of hypertension (43.6% vs. 70.3%; P = 0.004), diabetes (35.9% vs. 57.4%; P = 0.03), and dyslipidaemia (12.8% vs. 28.7%; P = 0.05). There was no significant difference in poor outcome at discharge (defined as mRS > 2), which was observed in 17.9% of younger adults and 28.7% of older adults. Further, there were no significant differences in stroke severity at discharge (NIHSS score ≤5) or median length of stay.
Discussion: Although the outcomes of ESUS do not differ between younger and older patients, younger patients have fewer identified risk factors.
Conclusion: This study showed that 26.5% of patients with ESUS were aged ≤50 years. Although younger adults with ESUS had fewer risk factors, there were no significant differences in neurologic disability or mortality at discharge, stroke severity, or median length of stay.
与老年人的ESUS相比，年轻人的不明来源栓塞性卒中(ESUS)可能有不同的危险因素，年轻人的ESUS可能需要新的治疗方法。我们的目的是在沙特阿拉伯的一个中心调查年轻成人ESUS的特征和结果。患者和方法:根据隐源性卒中/ESUS国际工作组的标准，使用年轻ESUS患者的医疗记录进行回顾性研究。采用改良Rankin量表(mRS)和美国国立卫生研究院卒中量表(NIHSS)对ESUS患者(年龄≤50岁)与老年患者在入院和出院时进行比较。结果:147例ESUS患者中，39例(26.5%)为年轻人。与患有ESUS的老年人相比，年轻人的血管危险因素更少，包括高血压发病率更低(43.6%比70.3%;P = 0.004)，糖尿病(35.9% vs. 57.4%;P = 0.03)，血脂异常(12.8% vs. 28.7%;P = 0.05)。出院时不良预后(定义为mRS > 2)无显著差异，17.9%的年轻人和28.7%的老年人出现不良预后。此外，两组在出院时卒中严重程度(NIHSS评分≤5)或中位住院时间方面无显著差异。讨论:尽管ESUS的结果在年轻患者和老年患者之间没有差异，但年轻患者确定的危险因素较少。结论:26.5%的ESUS患者年龄≤50岁。虽然患有ESUS的年轻成人的危险因素较少，但在神经功能障碍或出院时死亡率、中风严重程度或中位住院时间方面没有显著差异。
{"title":"Characteristics and Outcomes of Younger Adults with Embolic Stroke of Undetermined Source (ESUS): A Retrospective Study.","authors":"Ali M Al Khathaami, Bayan Al Bdah, Abdulmjeed Alnosair, Abdulkarim Alturki, Rayan Alrebdi, Shorug Alwayili, Sulaiman Alhamzah, Fahad A M AlKhathaami, Nasser Alotaibi","doi":"10.1155/2019/4360787","DOIUrl":"https://doi.org/10.1155/2019/4360787","url":null,"abstract":"<p><strong>Introduction: </strong>Embolic stroke of undetermined source (ESUS) in younger adults may have different risk factors compared with ESUS in elderly, and the approach to ESUS in young adults may require new therapies. We aimed to investigate the characteristics and outcomes in younger adults with ESUS at a single centre in Saudi Arabia.</p><p><strong>Patients and methods: </strong>A retrospective study was conducted using the medical records of younger adults with ESUS according to the criteria of the Cryptogenic Stroke/ESUS International Working Group. Younger adults (aged ≤50 years) with ESUS were compared with older patients, on admission and discharge from hospital, using the modified Rankin scale (mRS) and the National Institute of Health Stroke Scale (NIHSS).</p><p><strong>Results: </strong>Among 147 patients with ESUS, 39 (26.5%) were younger adults. Younger adults compared with older adults with ESUS had fewer vascular risk factors, including lower rates of hypertension (43.6% vs. 70.3%; <i>P</i> = 0.004), diabetes (35.9% vs. 57.4%; <i>P</i> = 0.03), and dyslipidaemia (12.8% vs. 28.7%; <i>P</i> = 0.05). There was no significant difference in poor outcome at discharge (defined as mRS > 2), which was observed in 17.9% of younger adults and 28.7% of older adults. Further, there were no significant differences in stroke severity at discharge (NIHSS score ≤5) or median length of stay.</p><p><strong>Discussion: </strong>Although the outcomes of ESUS do not differ between younger and older patients, younger patients have fewer identified risk factors.</p><p><strong>Conclusion: </strong>This study showed that 26.5% of patients with ESUS were aged ≤50 years. Although younger adults with ESUS had fewer risk factors, there were no significant differences in neurologic disability or mortality at discharge, stroke severity, or median length of stay.</p>","PeriodicalId":22054,"journal":{"name":"Stroke Research and Treatment","volume":"2019 ","pages":"4360787"},"PeriodicalIF":1.5,"publicationDate":"2019-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2019/4360787","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37499215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. D. de Havenon, Lee S Chung, Jaleen Smith, Kirby Taylor, J. Majersik, N. Chauhan
Background Stroke telemedicine (telestroke) increases tPA availability and administration. However, the effective use of telestroke requires training, which is not a standard component of vascular neurology training. As a result, many providers learn telestroke skills “on the job” after finishing their training. Aims We sought to explore if providers with more telestroke experience would be more efficient in the utilization of telemedicine, compared to providers with less experience. Methods We prospectively collected data on telestrokes between July 2014 and July 2017 at a Comprehensive Stroke Center. Telestrokes are initiated on the telephone and typically, but not always, followed by an on-camera consult. Decision to do a phone-only versus on-camera consult is at the provider's discretion. Results There were 1,029 telestrokes, of which 807 were on-camera (74%). Of the 8 telestroke providers, 4 had less experience, having just finished stroke fellowship, and 4 had more experience (mean = 7.8 years of telestroke experience at the beginning of the study). Providers with less experience were more likely to go on camera than providers with more experience (79% vs. 67% of consults, p = 0.021), but were less likely to give tPA when on-camera (25% vs. 33%, p = 0.023). The absolute rate of tPA administration, combining phone and camera administration, or the frequency of technical difficulties were not different. Conclusions Telestroke consultants with less experience do not triage as many cases by phone and are less likely to administer tPA on-camera, suggesting their use of telemedicine is not optimized. This supports the introduction of telestroke didactics during vascular neurology training.
{"title":"Less Experienced Telestroke Consultants Are More Likely to Go On-Camera, but Less Likely to Give tPA","authors":"A. D. de Havenon, Lee S Chung, Jaleen Smith, Kirby Taylor, J. Majersik, N. Chauhan","doi":"10.1155/2019/1059369","DOIUrl":"https://doi.org/10.1155/2019/1059369","url":null,"abstract":"Background Stroke telemedicine (telestroke) increases tPA availability and administration. However, the effective use of telestroke requires training, which is not a standard component of vascular neurology training. As a result, many providers learn telestroke skills “on the job” after finishing their training. Aims We sought to explore if providers with more telestroke experience would be more efficient in the utilization of telemedicine, compared to providers with less experience. Methods We prospectively collected data on telestrokes between July 2014 and July 2017 at a Comprehensive Stroke Center. Telestrokes are initiated on the telephone and typically, but not always, followed by an on-camera consult. Decision to do a phone-only versus on-camera consult is at the provider's discretion. Results There were 1,029 telestrokes, of which 807 were on-camera (74%). Of the 8 telestroke providers, 4 had less experience, having just finished stroke fellowship, and 4 had more experience (mean = 7.8 years of telestroke experience at the beginning of the study). Providers with less experience were more likely to go on camera than providers with more experience (79% vs. 67% of consults, p = 0.021), but were less likely to give tPA when on-camera (25% vs. 33%, p = 0.023). The absolute rate of tPA administration, combining phone and camera administration, or the frequency of technical difficulties were not different. Conclusions Telestroke consultants with less experience do not triage as many cases by phone and are less likely to administer tPA on-camera, suggesting their use of telemedicine is not optimized. This supports the introduction of telestroke didactics during vascular neurology training.","PeriodicalId":22054,"journal":{"name":"Stroke Research and Treatment","volume":"4 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2019-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80700751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Iyad Ali, Mahmoud Abuissa, A. Alawneh, Omar Subeh, Ahmad Abu Sneineh, Sabreen Mousa, Israa' Deeb, Hiba Rayyan
Background/Aim Stroke or cerebrovascular accident is defined as sudden or sub acute onset of focal neurologic deficit, caused by the interruption of blood flow to parts of the brain. In this study, we aimed to investigate the prevalence of dyslipidemia and hyperglycemia among stroke patients in Palestine. Materials and Methods A total of 70 patients with stroke were included in a cross-sectional study between November 2017 and February 2018. Stroke patients were diagnosed based on a CT scan reviewed by a neurologist. Fasting venous blood samples were collected to measure the lipid profile (cholesterol, low-density lipoproteins (LDL), triacylglycerol (TAG), high-density lipoproteins (HDL)), fasting blood glucose (FBG), and glycosylated hemoglobin (HbA1c) levels. An interview-based questionnaire, included background data, past medical history, family history, and other risk factors for stroke, was filled for each patient. Results Based on our results, 28.57% of patients had high LDL, 17.1% had high cholesterol, 15.7% had high TAG and 61.3% had low HDL. About half of the patients (51.4%) had abnormal HbA1c and abnormal FBG (52.8%). The majority (67.1%) of patients were males, whereas, 11% of patients were obese (BMI of more than 30 kg/m2) and 51.4% were smokers. Regarding the family history of diseases, 81% of patients had a family history of hypertension, 50% had a family history of stroke, and 58% had a family history of diabetes mellitus. Conclusion Male gender and smoking were most likely to increase the risk of stroke. Risk factors like low HDL, high LDL, high FBG, high HbA1c, and hypertension contribute substantially to the incidence of stroke. A family history of stroke, hypertension and diabetes were significant risk factors for stroke.
{"title":"The Prevalence of Dyslipidemia and Hyperglycemia among Stroke Patients: Preliminary Findings","authors":"Iyad Ali, Mahmoud Abuissa, A. Alawneh, Omar Subeh, Ahmad Abu Sneineh, Sabreen Mousa, Israa' Deeb, Hiba Rayyan","doi":"10.1155/2019/8194960","DOIUrl":"https://doi.org/10.1155/2019/8194960","url":null,"abstract":"Background/Aim Stroke or cerebrovascular accident is defined as sudden or sub acute onset of focal neurologic deficit, caused by the interruption of blood flow to parts of the brain. In this study, we aimed to investigate the prevalence of dyslipidemia and hyperglycemia among stroke patients in Palestine. Materials and Methods A total of 70 patients with stroke were included in a cross-sectional study between November 2017 and February 2018. Stroke patients were diagnosed based on a CT scan reviewed by a neurologist. Fasting venous blood samples were collected to measure the lipid profile (cholesterol, low-density lipoproteins (LDL), triacylglycerol (TAG), high-density lipoproteins (HDL)), fasting blood glucose (FBG), and glycosylated hemoglobin (HbA1c) levels. An interview-based questionnaire, included background data, past medical history, family history, and other risk factors for stroke, was filled for each patient. Results Based on our results, 28.57% of patients had high LDL, 17.1% had high cholesterol, 15.7% had high TAG and 61.3% had low HDL. About half of the patients (51.4%) had abnormal HbA1c and abnormal FBG (52.8%). The majority (67.1%) of patients were males, whereas, 11% of patients were obese (BMI of more than 30 kg/m2) and 51.4% were smokers. Regarding the family history of diseases, 81% of patients had a family history of hypertension, 50% had a family history of stroke, and 58% had a family history of diabetes mellitus. Conclusion Male gender and smoking were most likely to increase the risk of stroke. Risk factors like low HDL, high LDL, high FBG, high HbA1c, and hypertension contribute substantially to the incidence of stroke. A family history of stroke, hypertension and diabetes were significant risk factors for stroke.","PeriodicalId":22054,"journal":{"name":"Stroke Research and Treatment","volume":"67 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2019-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79544143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Marlena Schnieder, Anneki von Glasenapp, A. Hesse, M. Psychogios, M. Bähr, G. Hasenfuss, M. R. Schroeter, J. Liman
The impact of heart failure on outcome in stroke patients is not fully understood. There is evidence for an increased mortality and morbidity, but it remains uncertain whether thrombectomy in patients with large vessel occlusion (LVO) in the anterior circulation is less effective in patients with heart failure compared to patients without. Retrospectively, we analyzed echocardiographic data of all patients in our stroke database, who underwent mechanical thrombectomy (n=668) for the presence of heart failure. Furthermore, we collected baseline characteristics and neurological and neuroradiological parameters. In the analysis, 373 of the 668 patients of our stroke database underwent echocardiography. Of these 373 patients, 90 patients (24%) suffered from heart failure with reduced left ventricular ejection fraction measured by echocardiography according to the current guidelines. After adjustment for age, the Alberta stroke program early CT score (ASPECTS), and time from symptom onset to recanalization, the analysis revealed that thrombectomy in patients with heart failure and LVO is not associated with less favorable outcome measured by the modified Rankin Scale after 90 days (3 (0-6) vs. 3 (1-5); p=0.380). Moreover, we could not find a significant difference in mortality compared to patients without heart failure (11.0% vs. 7.4%; p=0.313).
{"title":"Heart Failure Is Not Associated with a Poor Outcome after Mechanical Thrombectomy in Large Vessel Occlusion of Cerebral Arteries","authors":"Marlena Schnieder, Anneki von Glasenapp, A. Hesse, M. Psychogios, M. Bähr, G. Hasenfuss, M. R. Schroeter, J. Liman","doi":"10.1155/2019/4695414","DOIUrl":"https://doi.org/10.1155/2019/4695414","url":null,"abstract":"The impact of heart failure on outcome in stroke patients is not fully understood. There is evidence for an increased mortality and morbidity, but it remains uncertain whether thrombectomy in patients with large vessel occlusion (LVO) in the anterior circulation is less effective in patients with heart failure compared to patients without. Retrospectively, we analyzed echocardiographic data of all patients in our stroke database, who underwent mechanical thrombectomy (n=668) for the presence of heart failure. Furthermore, we collected baseline characteristics and neurological and neuroradiological parameters. In the analysis, 373 of the 668 patients of our stroke database underwent echocardiography. Of these 373 patients, 90 patients (24%) suffered from heart failure with reduced left ventricular ejection fraction measured by echocardiography according to the current guidelines. After adjustment for age, the Alberta stroke program early CT score (ASPECTS), and time from symptom onset to recanalization, the analysis revealed that thrombectomy in patients with heart failure and LVO is not associated with less favorable outcome measured by the modified Rankin Scale after 90 days (3 (0-6) vs. 3 (1-5); p=0.380). Moreover, we could not find a significant difference in mortality compared to patients without heart failure (11.0% vs. 7.4%; p=0.313).","PeriodicalId":22054,"journal":{"name":"Stroke Research and Treatment","volume":"154 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78001752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Thunyakamon Phusuttatam, Jittima Saengsuwan, P. Kittipanya-ngam
Objective The aim of the current study was to develop and then to determine preliminary validity of a physical activity questionnaire specifically designed for ambulatory, chronic stroke patients. Methods This cross-sectional study recruited 92 chronic stroke patients. In Phase I, the SPAQ was developed and its content validity index (CVI) determined. In Phase II, we examined (1) the concurrent validity of SPAQ vs. the International Physical Activity Questionnaire-Short Form (IPAQ-SF); (2) the convergent validity of SPAQ vs. the Functional Ambulation Category (FAC), vs. the six-minute walk test (6-MWT), vs. the timed up and go test (TUGT), vs. the Motricity Index, vs. the National Institutes of Health Stroke Scale (NIHSS), and vs. the Modified Rankin Scale (MRS); and (3) the discriminant validity of the SPAQ vs. the Montreal Cognitive Assessment (MoCA). The concurrent validity and convergent and divergent validity were analysed using Spearman's rank correlation coefficient. The agreement between the SPAQ and IPAQ-SF was assessed using the Kappa statistic. Results The SPAQ has 12 items in 3 main components which covers low (7 items), moderate (3 items), and vigorous (2 items) physical activity. The SPAQ had a CVI of 0.93. Spearman's correlation coefficient (rs) for SPAQ vs. IPAQ-SF was 0.53 (p < 0.001). The SPAQ yielded substantial agreement with the IPAQ-SF (Kappa = 0.65). For convergent validity, the SPAQ had a moderate correlation with the 6-MWT, MI, NIHSS, FAC, TUGT, and MRS (p < 0.05). For discriminant validity, the SPAQ was not correlated with the MoCA (rs = 0.061, p = 0.68). Conclusion The SPAQ can be used to practically assess physical activity in chronic stroke patients, and it has acceptable psychometric properties which are comparable to other standard physical activity questionnaires. Future work should determine the validity of the SPAQ using an objective device such as an accelerometer.
{"title":"Development and Preliminary Validation of a Stroke Physical Activity Questionnaire","authors":"Thunyakamon Phusuttatam, Jittima Saengsuwan, P. Kittipanya-ngam","doi":"10.1155/2019/6764834","DOIUrl":"https://doi.org/10.1155/2019/6764834","url":null,"abstract":"Objective The aim of the current study was to develop and then to determine preliminary validity of a physical activity questionnaire specifically designed for ambulatory, chronic stroke patients. Methods This cross-sectional study recruited 92 chronic stroke patients. In Phase I, the SPAQ was developed and its content validity index (CVI) determined. In Phase II, we examined (1) the concurrent validity of SPAQ vs. the International Physical Activity Questionnaire-Short Form (IPAQ-SF); (2) the convergent validity of SPAQ vs. the Functional Ambulation Category (FAC), vs. the six-minute walk test (6-MWT), vs. the timed up and go test (TUGT), vs. the Motricity Index, vs. the National Institutes of Health Stroke Scale (NIHSS), and vs. the Modified Rankin Scale (MRS); and (3) the discriminant validity of the SPAQ vs. the Montreal Cognitive Assessment (MoCA). The concurrent validity and convergent and divergent validity were analysed using Spearman's rank correlation coefficient. The agreement between the SPAQ and IPAQ-SF was assessed using the Kappa statistic. Results The SPAQ has 12 items in 3 main components which covers low (7 items), moderate (3 items), and vigorous (2 items) physical activity. The SPAQ had a CVI of 0.93. Spearman's correlation coefficient (rs) for SPAQ vs. IPAQ-SF was 0.53 (p < 0.001). The SPAQ yielded substantial agreement with the IPAQ-SF (Kappa = 0.65). For convergent validity, the SPAQ had a moderate correlation with the 6-MWT, MI, NIHSS, FAC, TUGT, and MRS (p < 0.05). For discriminant validity, the SPAQ was not correlated with the MoCA (rs = 0.061, p = 0.68). Conclusion The SPAQ can be used to practically assess physical activity in chronic stroke patients, and it has acceptable psychometric properties which are comparable to other standard physical activity questionnaires. Future work should determine the validity of the SPAQ using an objective device such as an accelerometer.","PeriodicalId":22054,"journal":{"name":"Stroke Research and Treatment","volume":"274 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2019-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83041660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-06-02eCollection Date: 2019-01-01DOI: 10.1155/2019/8264502
George A Kelley, Kristi S Kelley
Objective: Apply more robust and additional analyses to a previous meta-analysis that reported statistically significant associations between leisure time physical activity (LTPA) and stroke.
Methods: A reanalysis of a previous meta-analysis that included nine prospective cohort studies representing 269,594 men and women 25-84 years of age and in which the association between LTPA and incident stroke was examined. Follow-up periods ranged from 7.7 to 32.0 years. Relative risks (RR) from each study were pooled using the inverse-heterogeneity model. Heterogeneity was examined using the Q statistic, inconsistency using I2, and small-study effects using Doi plots and the LFK index. Influence and cumulative meta-analysis were also conducted.
Results: Using low LTPA as the reference, moderate LTPA was associated with a statistically significant reduction in the risk for stroke in men (RR = 0.79, 95% CI = 0.65 to 0.95) and a trend in women (RR = 0.88, 95% CI = 0.78 to 1.0). High LTPA was associated with a statistically significant reduction in the risk for stroke in both men (RR = 0.72, 95% CI = 0.60 to 0.86) and women (RR = 0.78, 95% CI = 0.66 to 0.92). No statistically significant heterogeneity was observed and inconsistency was low. However, potential small-study effects were observed. With each study deleted once, results remained statistically significant. Cumulative meta-analysis demonstrated stability in results since at least 2005.
Conclusions: Leisure time physical activity is associated with a reduced risk of stroke in both men and women. However, the small-study effects observed suggest the possibility that results may be exaggerated.
目的:对先前的一项荟萃分析进行更有力和额外的分析，该荟萃分析报告了闲暇时间身体活动(LTPA)与中风之间的统计学显著关联。方法:对先前的荟萃分析进行再分析，该荟萃分析包括9项前瞻性队列研究，涉及269,594名25-84岁的男性和女性，其中检查了LTPA与事件性卒中之间的关系。随访时间从7.7到32.0年不等。使用逆异质性模型汇总各研究的相对风险(RR)。使用Q统计量检验异质性，使用i2检验不一致性，使用Doi图和LFK指数检验小研究效应。并进行了影响和累积meta分析。结果:以低LTPA为参照，中度LTPA与男性卒中风险降低有统计学意义(RR = 0.79, 95% CI = 0.65 ~ 0.95)相关，在女性中也有这种趋势(RR = 0.88, 95% CI = 0.78 ~ 1.0)。在男性(RR = 0.72, 95% CI = 0.60 ~ 0.86)和女性(RR = 0.78, 95% CI = 0.66 ~ 0.92)中，高LTPA与卒中风险的统计学显著降低相关。未观察到统计学上显著的异质性，不一致性较低。然而，观察到潜在的小型研究效应。每项研究删除一次，结果仍然具有统计学意义。累积荟萃分析显示，至少从2005年起，结果稳定。结论:无论是男性还是女性，休闲时间的体育活动都与中风风险降低有关。然而，观察到的小型研究效应表明，结果可能被夸大了。
{"title":"Leisure Time Physical Activity Reduces the Risk for Stroke in Adults: A Reanalysis of a Meta-Analysis Using the Inverse-Heterogeneity Model.","authors":"George A Kelley, Kristi S Kelley","doi":"10.1155/2019/8264502","DOIUrl":"https://doi.org/10.1155/2019/8264502","url":null,"abstract":"<p><strong>Objective: </strong>Apply more robust and additional analyses to a previous meta-analysis that reported statistically significant associations between leisure time physical activity (LTPA) and stroke.</p><p><strong>Methods: </strong>A reanalysis of a previous meta-analysis that included nine prospective cohort studies representing 269,594 men and women 25-84 years of age and in which the association between LTPA and incident stroke was examined. Follow-up periods ranged from 7.7 to 32.0 years. Relative risks (RR) from each study were pooled using the inverse-heterogeneity model. Heterogeneity was examined using the Q statistic, inconsistency using <i>I</i> <sup>2</sup>, and small-study effects using Doi plots and the LFK index. Influence and cumulative meta-analysis were also conducted.</p><p><strong>Results: </strong>Using low LTPA as the reference, moderate LTPA was associated with a statistically significant reduction in the risk for stroke in men (RR = 0.79, 95% CI = 0.65 to 0.95) and a trend in women (RR = 0.88, 95% CI = 0.78 to 1.0). High LTPA was associated with a statistically significant reduction in the risk for stroke in both men (RR = 0.72, 95% CI = 0.60 to 0.86) and women (RR = 0.78, 95% CI = 0.66 to 0.92). No statistically significant heterogeneity was observed and inconsistency was low. However, potential small-study effects were observed. With each study deleted once, results remained statistically significant. Cumulative meta-analysis demonstrated stability in results since at least 2005.</p><p><strong>Conclusions: </strong>Leisure time physical activity is associated with a reduced risk of stroke in both men and women. However, the small-study effects observed suggest the possibility that results may be exaggerated.</p>","PeriodicalId":22054,"journal":{"name":"Stroke Research and Treatment","volume":"2019 ","pages":"8264502"},"PeriodicalIF":1.5,"publicationDate":"2019-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2019/8264502","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37395820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-05-02eCollection Date: 2019-01-01DOI: 10.1155/2019/2642458
Ismail Setyopranoto, Halwan Fuad Bayuangga, Andre Stefanus Panggabean, Sarastiti Alifaningdyah, Lutfan Lazuardi, Fatwa Sari Tetra Dewi, Rusdy Ghazali Malueka
Background: Stroke remains one of the most common noncommunicable diseases among Indonesian populations. This study aimed to identify the prevalence of stroke and its associated risk factors in the Sleman District of Yogyakarta Special Region, Indonesia.
Method: This study was a secondary analysis of community-based data collected by the Sleman Health and Demographic Surveillance System (HDSS) in 2016. Basic demographic and socioeconomic data were collected. Additional questions about history of stroke and other chronic diseases were interviewed as a self-reported diagnosis. History of hormonal contraceptives use and dietary patterns were also collected. We examined the association between the prevalence of stroke and risk factors, namely, age, gender, self-reported history of chronic diseases, hormonal contraceptives use, and high-risk dietary patterns.
Results: The survey included 4,996 households composed of 20,465 individuals. Data regarding stroke incidents were available from 13,605 subjects aged ≥20 years old. Among them, a total of 4,884 subjects also have data regarding stroke risk factors. The overall prevalence of stroke in Sleman District was 1.4% (0.5% men and 0.90% women). The prevalence increased with additional decades of age (p<0.001). In a multivariable model, increasing age, self-reported history of hypertension (OR=8.37, 95%CI: 4.76 to 14.69), and self-reported history of diabetes mellitus (OR=2.87, 95%CI: 1.54 to 5.35) were significantly associated with stroke.
Conclusions: A community-based survey in Indonesia showed a high prevalence of stroke which was associated with increasing age, hypertension, and diabetes mellitus. These findings suggest that preventive actions against the aforementioned modifiable risk factors should be prioritized.
{"title":"Prevalence of Stroke and Associated Risk Factors in Sleman District of Yogyakarta Special Region, Indonesia.","authors":"Ismail Setyopranoto, Halwan Fuad Bayuangga, Andre Stefanus Panggabean, Sarastiti Alifaningdyah, Lutfan Lazuardi, Fatwa Sari Tetra Dewi, Rusdy Ghazali Malueka","doi":"10.1155/2019/2642458","DOIUrl":"10.1155/2019/2642458","url":null,"abstract":"<p><strong>Background: </strong>Stroke remains one of the most common noncommunicable diseases among Indonesian populations. This study aimed to identify the prevalence of stroke and its associated risk factors in the Sleman District of Yogyakarta Special Region, Indonesia.</p><p><strong>Method: </strong>This study was a secondary analysis of community-based data collected by the Sleman Health and Demographic Surveillance System (HDSS) in 2016. Basic demographic and socioeconomic data were collected. Additional questions about history of stroke and other chronic diseases were interviewed as a self-reported diagnosis. History of hormonal contraceptives use and dietary patterns were also collected. We examined the association between the prevalence of stroke and risk factors, namely, age, gender, self-reported history of chronic diseases, hormonal contraceptives use, and high-risk dietary patterns.</p><p><strong>Results: </strong>The survey included 4,996 households composed of 20,465 individuals. Data regarding stroke incidents were available from 13,605 subjects aged ≥20 years old. Among them, a total of 4,884 subjects also have data regarding stroke risk factors. The overall prevalence of stroke in Sleman District was 1.4% (0.5% men and 0.90% women). The prevalence increased with additional decades of age (<i>p</i><0.001). In a multivariable model, increasing age, self-reported history of hypertension (OR=8.37, 95%CI: 4.76 to 14.69), and self-reported history of diabetes mellitus (OR=2.87, 95%CI: 1.54 to 5.35) were significantly associated with stroke.</p><p><strong>Conclusions: </strong>A community-based survey in Indonesia showed a high prevalence of stroke which was associated with increasing age, hypertension, and diabetes mellitus. These findings suggest that preventive actions against the aforementioned modifiable risk factors should be prioritized.</p>","PeriodicalId":22054,"journal":{"name":"Stroke Research and Treatment","volume":"2019 ","pages":"2642458"},"PeriodicalIF":1.8,"publicationDate":"2019-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6521526/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37323257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-01eCollection Date: 2019-01-01DOI: 10.1155/2019/2527384
Åse Hagen Morsund, Hanne Ellekjær, Arne Gramstad, Magnus Tallaksen Reiestad, Rune Midgard, Sigrid Botne Sando, Egil Jonsbu, Halvor Næss
Aim: To study the prevalence of cognitive and emotional impairment following a minor ischemic stroke compared to an age-matched group with non-ST-elevation myocardial infarction (NSTEMI).
Methods: We included patients aged 18-70 years with a minor ischemic stroke defined as modified Rankin Scale (mRS) 0-2 at day 7 or at discharge if before and age-matched NSTEMI patients with the same functional mRS. We applied a selection of cognitive tests and the patients completed a questionnaire comprising of Hospital Anxiety and Depression scale (HADS) and Fatigue Severity Scale (FSS) at follow-up 12 months after the vascular event. Results of cognitive tests were also compared to normative data.
Results: 325 ischemic stroke and 144 NSTEMI patients were included. There was no significant difference in cognitive functioning between ischemic stroke and NSTEMI patients. Minor stroke patients and to a lesser extent NSTEMI patients scored worse on more complex cognitive functions including planning and implementation of activities compared to validated normative data. For the minor stroke patients the location of the ischemic lesion had no influence on the result. The prevalence of anxiety, depression, and fatigue was significantly higher in the stroke group compared to the NSTEMI group. Depression was independently associated with reduced cognitive function.
Discussion and conclusion: Minor ischemic stroke patients, and to lesser degree NSTEMI patients, had reduced cognitive function compared to normative data, especially executive functioning, on 12-month follow-up. The difference in cognitive function between stroke and NSTEMI patients was not significant. Depression was associated with low scores on cognitive tests highlighting the need to adequately address emotional sequelae when considering treatment options for cognitive disabilities.
{"title":"Cognitive and Emotional Impairment after Minor Stroke and Non-ST-Elevation Myocardial Infarction (NSTEMI): A Prevalence Study.","authors":"Åse Hagen Morsund, Hanne Ellekjær, Arne Gramstad, Magnus Tallaksen Reiestad, Rune Midgard, Sigrid Botne Sando, Egil Jonsbu, Halvor Næss","doi":"10.1155/2019/2527384","DOIUrl":"https://doi.org/10.1155/2019/2527384","url":null,"abstract":"<p><strong>Aim: </strong>To study the prevalence of cognitive and emotional impairment following a minor ischemic stroke compared to an age-matched group with non-ST-elevation myocardial infarction (NSTEMI).</p><p><strong>Methods: </strong>We included patients aged 18-70 years with a minor ischemic stroke defined as modified Rankin Scale (mRS) 0-2 at day 7 or at discharge if before and age-matched NSTEMI patients with the same functional mRS. We applied a selection of cognitive tests and the patients completed a questionnaire comprising of Hospital Anxiety and Depression scale (HADS) and Fatigue Severity Scale (FSS) at follow-up 12 months after the vascular event. Results of cognitive tests were also compared to normative data.</p><p><strong>Results: </strong>325 ischemic stroke and 144 NSTEMI patients were included. There was no significant difference in cognitive functioning between ischemic stroke and NSTEMI patients. Minor stroke patients and to a lesser extent NSTEMI patients scored worse on more complex cognitive functions including planning and implementation of activities compared to validated normative data. For the minor stroke patients the location of the ischemic lesion had no influence on the result. The prevalence of anxiety, depression, and fatigue was significantly higher in the stroke group compared to the NSTEMI group. Depression was independently associated with reduced cognitive function.</p><p><strong>Discussion and conclusion: </strong>Minor ischemic stroke patients, and to lesser degree NSTEMI patients, had reduced cognitive function compared to normative data, especially executive functioning, on 12-month follow-up. The difference in cognitive function between stroke and NSTEMI patients was not significant. Depression was associated with low scores on cognitive tests highlighting the need to adequately address emotional sequelae when considering treatment options for cognitive disabilities.</p>","PeriodicalId":22054,"journal":{"name":"Stroke Research and Treatment","volume":"2019 ","pages":"2527384"},"PeriodicalIF":1.5,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2019/2527384","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37212721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-03-17eCollection Date: 2019-01-01DOI: 10.1155/2019/7292304
Naoki Kato, Vincent Prinz, Julius Dengler, Peter Vajkoczy
Intraoperative indocyanine green (ICG) videoangiography is widely used in patients undergoing neurosurgery. FLOW800 is a recently developed analytical tool for ICG videoangiography to assess semi-quantitative flow dynamics; however, its efficacy is unknown. In this study, we evaluated its functionality in the assessment of flow dynamics of arteriovenous malformation (AVM) through ICG videoangiography under clinical settings. ICG videoangiography was performed in the exposed AVM in eight patients undergoing surgery. FLOW800 analysis was applied directly, and gray-scale and color-coded maps of the surgical field were obtained. After surgery, a region of interest was placed on the individual vessels to obtain time-intensity curves. Parameters of flow dynamics, including the maximum intensity, transit time, and cerebral blood flow index, were calculated using the curves. The color-coded maps provided high-resolution images; however, reconstruction of colored images was restricted by the depth, approach angle, and brain swelling. Semi-quantitative parameters were similar among the feeders, niduses, and drainers. However, a higher cerebral blood flow index was observed in the feeders of large AVM (>3 cm) than in those of small AVM (P < 0.05). Similarly, the cerebral blood flow index values were positively correlated with the nidus volume (P < 0.01). FLOW800 enabled visualization of the AVM structure and safer resection, except in case of deep-seated AVM. Moreover, semi-quantitative values in the individual vessels through using ICG intensity diagram showed different patterns according to size of the AVM. ICG videoangiography showed good performance in evaluating flow dynamics of the AVM in patients undergoing surgery.
{"title":"Blood Flow Assessment of Arteriovenous Malformations Using Intraoperative Indocyanine Green Videoangiography.","authors":"Naoki Kato, Vincent Prinz, Julius Dengler, Peter Vajkoczy","doi":"10.1155/2019/7292304","DOIUrl":"https://doi.org/10.1155/2019/7292304","url":null,"abstract":"<p><p>Intraoperative indocyanine green (ICG) videoangiography is widely used in patients undergoing neurosurgery. FLOW800 is a recently developed analytical tool for ICG videoangiography to assess semi-quantitative flow dynamics; however, its efficacy is unknown. In this study, we evaluated its functionality in the assessment of flow dynamics of arteriovenous malformation (AVM) through ICG videoangiography under clinical settings. ICG videoangiography was performed in the exposed AVM in eight patients undergoing surgery. FLOW800 analysis was applied directly, and gray-scale and color-coded maps of the surgical field were obtained. After surgery, a region of interest was placed on the individual vessels to obtain time-intensity curves. Parameters of flow dynamics, including the maximum intensity, transit time, and cerebral blood flow index, were calculated using the curves. The color-coded maps provided high-resolution images; however, reconstruction of colored images was restricted by the depth, approach angle, and brain swelling. Semi-quantitative parameters were similar among the feeders, niduses, and drainers. However, a higher cerebral blood flow index was observed in the feeders of large AVM (>3 cm) than in those of small AVM (P < 0.05). Similarly, the cerebral blood flow index values were positively correlated with the nidus volume (P < 0.01). FLOW800 enabled visualization of the AVM structure and safer resection, except in case of deep-seated AVM. Moreover, semi-quantitative values in the individual vessels through using ICG intensity diagram showed different patterns according to size of the AVM. ICG videoangiography showed good performance in evaluating flow dynamics of the AVM in patients undergoing surgery.</p>","PeriodicalId":22054,"journal":{"name":"Stroke Research and Treatment","volume":"2019 ","pages":"7292304"},"PeriodicalIF":1.5,"publicationDate":"2019-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2019/7292304","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37171751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-02-03eCollection Date: 2019-01-01DOI: 10.1155/2019/4650104
Ginenus Fekadu, Hunduma Wakassa, Firew Tekle
Background: The fact that the majority of patients come late creates management difficulties as these first hours are important to avoid secondary insults to the brain and preserve the ischemic penumbra. Although thrombolytic treatments are currently not available in our hospital, significant delays during the prehospital or in-hospital phases of care create management difficulties and would make such advanced treatments impossible in the future in Ethiopia.
Methods: Prospective observational study was carried at stroke unit of Jimma University Medical Center for 4 consecutive months from March 10 to July 10, 2017. Data was cleaned and entered to Epidata version 3.1 and then exported and analyzed using SPSS version 20.0.
Results: A total of 116 eligible stroke patients were recruited during the study period with mean age of 55.1±14.0 years, ranging from 23 to 96 years. The majority of stroke patients were males (62.9%) and from rural areas (72.4%). The median time elapsed between the onset of stroke symptoms and arrival to the hospital was 27 hours. Almost half (47.4%) of the patients presented within 24 hours and 26 (22.4%) patients presented to hospital beyond 72 hours. Majority of patients (40.5%) showed severe neurological deficit on admission and the mean National Institute of health stroke scale (NIHSS) was 15.71 ± 7.52. The mean Glasgow coma scale (GCS) was moderate (12.12±3.35). On hospital arrival systolic blood pressure (SBP) was highly elevated (≥140 mm Hg) in 65.5% of the patients. The circadian pattern showed a significant peak in morning for hemorrhagic stroke (35.7%) and afternoon for ischemic stroke (38.3%).
Conclusions: The delay of hospital arrival was a challenge similar to other high income countries for early management of the patients. Studies that attempt to determine some of the factors that impede timely presentation in patients with strokes are advisable to address those issues further.
背景:事实上，大多数患者来晚造成了管理困难，因为这最初的几个小时是重要的，以避免对大脑的继发性损伤和保存缺血半暗带。虽然我们医院目前无法提供溶栓治疗，但院前或院内护理阶段的严重延误造成了管理困难，并将使这种先进治疗今后在埃塞俄比亚不可能实现。方法:于2017年3月10日至7月10日，在吉马大学医学中心脑卒中单元连续4个月进行前瞻性观察研究。数据清理后输入Epidata 3.1版本，然后导出并使用SPSS 20.0版本进行分析。结果:研究期间共纳入116例符合条件的脑卒中患者，平均年龄55.1±14.0岁，年龄从23岁到96岁不等。卒中患者以男性(62.9%)和农村(72.4%)居多。从出现中风症状到到达医院的中位时间为27小时。近一半(47.4%)患者在24小时内就诊，26(22.4%)患者超过72小时就诊。大多数患者(40.5%)入院时表现出严重的神经功能缺损，美国国立卫生研究院卒中量表(NIHSS)平均为15.71±7.52。平均格拉斯哥昏迷评分(GCS)为中等(12.12±3.35)。到达医院时，65.5%的患者收缩压(SBP)高升高(≥140 mm Hg)。昼夜节律模式显示出血性卒中的高峰在上午(35.7%)和缺血性卒中的高峰在下午(38.3%)。结论:与其他高收入国家一样，延迟到院是患者早期管理的挑战。试图确定一些阻碍中风患者及时就诊的因素的研究建议进一步解决这些问题。
{"title":"Stroke Event Factors among Adult Patients Admitted to Stroke Unit of Jimma University Medical Center: Prospective Observational Study.","authors":"Ginenus Fekadu, Hunduma Wakassa, Firew Tekle","doi":"10.1155/2019/4650104","DOIUrl":"https://doi.org/10.1155/2019/4650104","url":null,"abstract":"<p><strong>Background: </strong>The fact that the majority of patients come late creates management difficulties as these first hours are important to avoid secondary insults to the brain and preserve the ischemic penumbra. Although thrombolytic treatments are currently not available in our hospital, significant delays during the prehospital or in-hospital phases of care create management difficulties and would make such advanced treatments impossible in the future in Ethiopia.</p><p><strong>Methods: </strong>Prospective observational study was carried at stroke unit of Jimma University Medical Center for 4 consecutive months from March 10 to July 10, 2017. Data was cleaned and entered to Epidata version 3.1 and then exported and analyzed using SPSS version 20.0.</p><p><strong>Results: </strong>A total of 116 eligible stroke patients were recruited during the study period with mean age of 55.1±14.0 years, ranging from 23 to 96 years. The majority of stroke patients were males (62.9%) and from rural areas (72.4%). The median time elapsed between the onset of stroke symptoms and arrival to the hospital was 27 hours. Almost half (47.4%) of the patients presented within 24 hours and 26 (22.4%) patients presented to hospital beyond 72 hours. Majority of patients (40.5%) showed severe neurological deficit on admission and the mean National Institute of health stroke scale (NIHSS) was 15.71 ± 7.52. The mean Glasgow coma scale (GCS) was moderate (12.12±3.35). On hospital arrival systolic blood pressure (SBP) was highly elevated (≥140 mm Hg) in 65.5% of the patients. The circadian pattern showed a significant peak in morning for hemorrhagic stroke (35.7%) and afternoon for ischemic stroke (38.3%).</p><p><strong>Conclusions: </strong>The delay of hospital arrival was a challenge similar to other high income countries for early management of the patients. Studies that attempt to determine some of the factors that impede timely presentation in patients with strokes are advisable to address those issues further.</p>","PeriodicalId":22054,"journal":{"name":"Stroke Research and Treatment","volume":"2019 ","pages":"4650104"},"PeriodicalIF":1.5,"publicationDate":"2019-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2019/4650104","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37042342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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