Pub Date : 2024-02-08DOI: 10.3389/fstro.2024.1350825
D. Jayaraman, Stephanie Kjelstrom, Georgia Montone, Divya Rajasekaran
Stroke is one of the leading causes of death and disability worldwide. Every year, about 795,000 strokes are reported in the United States, of which around 23% are recurrent. We analyzed the national inpatient sample to assess the outcomes in patient with pulmonary hypertension and ischemic stroke. Our study included 7 million inpatient discharge encounters among which 553,085 patients had ischemic stroke. Among this, 16,830 had PH and 536,255 did not have PH.female (63.8% vs. 48.8%; p < 0.0001). A higher proportion of stroke patients with PH died in the hospital (5.7% vs. 3.7%; p < 0.0001) as well as had a longer average length of stay (LOS) [6.3 days (SD 6.2) vs. 5.0 days (SD 6.8); p < 0.0001]. Our study noted that black patients with PH were younger [70.5 years (SD 13.8)]. Black patients had the longest length of stay compared to Caucasians (7.8 days SD 8.3) (p < 0.0001).
{"title":"Pulmonary hypertension leads to poor inpatient outcome in non-white patients admitted with stroke: an analysis of national inpatient sample","authors":"D. Jayaraman, Stephanie Kjelstrom, Georgia Montone, Divya Rajasekaran","doi":"10.3389/fstro.2024.1350825","DOIUrl":"https://doi.org/10.3389/fstro.2024.1350825","url":null,"abstract":"Stroke is one of the leading causes of death and disability worldwide. Every year, about 795,000 strokes are reported in the United States, of which around 23% are recurrent. We analyzed the national inpatient sample to assess the outcomes in patient with pulmonary hypertension and ischemic stroke. Our study included 7 million inpatient discharge encounters among which 553,085 patients had ischemic stroke. Among this, 16,830 had PH and 536,255 did not have PH.female (63.8% vs. 48.8%; p < 0.0001). A higher proportion of stroke patients with PH died in the hospital (5.7% vs. 3.7%; p < 0.0001) as well as had a longer average length of stay (LOS) [6.3 days (SD 6.2) vs. 5.0 days (SD 6.8); p < 0.0001]. Our study noted that black patients with PH were younger [70.5 years (SD 13.8)]. Black patients had the longest length of stay compared to Caucasians (7.8 days SD 8.3) (p < 0.0001).","PeriodicalId":504975,"journal":{"name":"Frontiers in Stroke","volume":"7 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139851283","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 : 2024-01-19DOI: 10.3389/fstro.2023.1241649
Louis R. Caplan
Some argue that the term transient ischemic attack (TIA) has become obsolete in the current age of advanced modern technology. Let us look back and analyze the term, its support and detraction, and its potential continued usefulness. The best way to begin is a review of the history of the term.
{"title":"Transient ischemic attack in the twenty first century: is it still a useful construct?","authors":"Louis R. Caplan","doi":"10.3389/fstro.2023.1241649","DOIUrl":"https://doi.org/10.3389/fstro.2023.1241649","url":null,"abstract":"Some argue that the term transient ischemic attack (TIA) has become obsolete in the current age of advanced modern technology. Let us look back and analyze the term, its support and detraction, and its potential continued usefulness. The best way to begin is a review of the history of the term.","PeriodicalId":504975,"journal":{"name":"Frontiers in Stroke","volume":"78 18","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139613006","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 : 2024-01-17DOI: 10.3389/fstro.2023.1339331
Maged Elsayed Hassanein, Jaber Fayad, Jilan Ali Shabana, Esraa M. AlEdani, M. Hefnawy, Hazem. S Ghaith, A. Negida
Clinical trials have evaluated the efficacy of intravenous mesenchymal stem cells (MSCs) for acute and subacute ischemic stroke. Therefore, we conducted this meta-analysis to investigate the efficacy and safety of intravenous MSC treatments compared to placebo for acute and subacute ischemic stroke patients.We searched PubMed, SCOPUS, Web of Science, and Cochrane CENTRAL for randomized controlled trials evaluating any clinical trials of intravenous MSCs for acute and subacute ischemic stroke patients. The efficacy outcomes of this study were the rates of improvement in National Institutes of Health Stroke Scale (NIHSS) scores, good scores on the modified Rankin Scale (mRS), and Barthel Index (BI) scores, while the safety outcomes were the rates of mortality and stroke recurrence. We compared intravenous MSC and placebo treatments on a fixed-effect meta-analysis model in R software.Four randomized controlled studies involving 97 patients were included in the analysis. In the meta-analysis, MSC treatments were superior to placebo treatments in good mRS (MD −0.95, 95% CI [−1.39, −0.52]) or BI (MD 21.36, 95% CI [9.96, 32.75]) scores, and MSC treatments were not superior to placebo treatments in the rate of improvement of the NIHSS scores (MD −1.81, 95% CI [−4.123, 0.494]). MSCs were associated with neither decreased mortality nor stroke recurrence (risk ratio 0.58 and 0.59, respectively; p-value = 0.51 and p-value = 0.533, respectively).For patients with acute and subacute ischemic stroke who are eligible for further damage to neural tissue, MSCs achieve high efficacy and acceptable safety.Prospero, unique ID: CRD42023457655.
临床试验评估了静脉间充质干细胞（MSCs）治疗急性和亚急性缺血性中风的疗效。因此，我们进行了这项荟萃分析，研究急性和亚急性缺血性中风患者静脉注射间充质干细胞治疗与安慰剂相比的疗效和安全性。我们检索了PubMed、SCOPUS、Web of Science和Cochrane CENTRAL的随机对照试验，以评估急性和亚急性缺血性中风患者静脉注射间充质干细胞的任何临床试验。本研究的疗效指标是美国国立卫生研究院卒中量表（NIHSS）评分、改良Rankin量表（mRS）良好评分和Barthel指数（BI）评分的改善率，而安全性指标是死亡率和卒中复发率。我们利用 R 软件中的固定效应荟萃分析模型对静脉间充质干细胞和安慰剂治疗进行了比较。在荟萃分析中，间充质干细胞治疗在改善 mRS（MD -0.95，95% CI [-1.39，-0.52]）或 BI（MD 21.36，95% CI [9.96，32.75]）评分方面优于安慰剂治疗，而在改善 NIHSS 评分方面，间充质干细胞治疗不优于安慰剂治疗（MD -1.81，95% CI [-4.123，0.494]）。间充质干细胞既不会降低死亡率，也不会降低中风复发率（风险比分别为 0.58 和 0.59；P 值分别为 0.51 和 0.533）。对于符合神经组织进一步损伤条件的急性和亚急性缺血性中风患者，间充质干细胞具有很高的疗效和可接受的安全性。Prospero，唯一 ID：CRD42023457655。
{"title":"Efficacy and safety of intravenous mesenchymal stem cells for ischemic stroke patients, a systematic review and meta-analysis","authors":"Maged Elsayed Hassanein, Jaber Fayad, Jilan Ali Shabana, Esraa M. AlEdani, M. Hefnawy, Hazem. S Ghaith, A. Negida","doi":"10.3389/fstro.2023.1339331","DOIUrl":"https://doi.org/10.3389/fstro.2023.1339331","url":null,"abstract":"Clinical trials have evaluated the efficacy of intravenous mesenchymal stem cells (MSCs) for acute and subacute ischemic stroke. Therefore, we conducted this meta-analysis to investigate the efficacy and safety of intravenous MSC treatments compared to placebo for acute and subacute ischemic stroke patients.We searched PubMed, SCOPUS, Web of Science, and Cochrane CENTRAL for randomized controlled trials evaluating any clinical trials of intravenous MSCs for acute and subacute ischemic stroke patients. The efficacy outcomes of this study were the rates of improvement in National Institutes of Health Stroke Scale (NIHSS) scores, good scores on the modified Rankin Scale (mRS), and Barthel Index (BI) scores, while the safety outcomes were the rates of mortality and stroke recurrence. We compared intravenous MSC and placebo treatments on a fixed-effect meta-analysis model in R software.Four randomized controlled studies involving 97 patients were included in the analysis. In the meta-analysis, MSC treatments were superior to placebo treatments in good mRS (MD −0.95, 95% CI [−1.39, −0.52]) or BI (MD 21.36, 95% CI [9.96, 32.75]) scores, and MSC treatments were not superior to placebo treatments in the rate of improvement of the NIHSS scores (MD −1.81, 95% CI [−4.123, 0.494]). MSCs were associated with neither decreased mortality nor stroke recurrence (risk ratio 0.58 and 0.59, respectively; p-value = 0.51 and p-value = 0.533, respectively).For patients with acute and subacute ischemic stroke who are eligible for further damage to neural tissue, MSCs achieve high efficacy and acceptable safety.Prospero, unique ID: CRD42023457655.","PeriodicalId":504975,"journal":{"name":"Frontiers in Stroke","volume":" 546","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139617914","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 : 2024-01-15DOI: 10.3389/fstro.2023.1353566
Ana Catarina Fonseca
{"title":"Editorial: Pushing the frontiers of stroke care and research - where are we heading?","authors":"Ana Catarina Fonseca","doi":"10.3389/fstro.2023.1353566","DOIUrl":"https://doi.org/10.3389/fstro.2023.1353566","url":null,"abstract":"","PeriodicalId":504975,"journal":{"name":"Frontiers in Stroke","volume":" 16","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139623031","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 : 2024-01-12DOI: 10.3389/fstro.2023.1265702
Aravind Nehrujee, A. T. Prabhakar, Sathish Balaraman, Rasika Bombatkar, H. Prakash, Selvaraj Samuelkamaleshkumar, Sanjith Aaron, Suranjan Bhattacharji, S. Sujatha, Sivakumar Balasubramanian
Robot-assisted rehabilitation has emerged as a promising approach for enhancing motor function in stroke survivors. However, the feasibility and effectiveness of home-based robotic training in this population are underexplored, especially in low/middle-income countries.This feasibility study aimed to address this gap by examining the feasibility and effectiveness of independent home-based training using PLUTO, a robotic device for hand training. A total of 7 chronic stroke survivors were recruited, with 5 completing the study.The results revealed high engagement and adherence to the home-based training program, with participants averaging 1659.8 min of training over 24.8 days. The PLUTO system demonstrated excellent usability and elicited positive user perceptions. Significant improvements were observed in functional outcomes, as evidenced by a noteworthy increase in Fugl-Meyer Assessment scores (mean increase of 6.2 points, exceeding the minimal clinically important difference (MCID) of 5.35 points). Furthermore, participants showed improvements in the ABILHAND measure (mean improvement of 1.24 logits, surpassing the MCID of 0.2 logits) and the Barthel Index (mean increase of 8.8 points).These findings demonstrate the feasibility and effectiveness of home-based robotic rehabilitation for chronic stroke survivors. This has implications for expanding access to rehabilitation services in low- and middle-income countries, enhancing patient engagement and adherence, and improving functional outcomes. Larger controlled studies are warranted to evaluate the effectiveness of home-based robotic rehabilitation programs.
{"title":"The facilitators and barriers to home-based robotic rehabilitation in India: a pilot feasibility study","authors":"Aravind Nehrujee, A. T. Prabhakar, Sathish Balaraman, Rasika Bombatkar, H. Prakash, Selvaraj Samuelkamaleshkumar, Sanjith Aaron, Suranjan Bhattacharji, S. Sujatha, Sivakumar Balasubramanian","doi":"10.3389/fstro.2023.1265702","DOIUrl":"https://doi.org/10.3389/fstro.2023.1265702","url":null,"abstract":"Robot-assisted rehabilitation has emerged as a promising approach for enhancing motor function in stroke survivors. However, the feasibility and effectiveness of home-based robotic training in this population are underexplored, especially in low/middle-income countries.This feasibility study aimed to address this gap by examining the feasibility and effectiveness of independent home-based training using PLUTO, a robotic device for hand training. A total of 7 chronic stroke survivors were recruited, with 5 completing the study.The results revealed high engagement and adherence to the home-based training program, with participants averaging 1659.8 min of training over 24.8 days. The PLUTO system demonstrated excellent usability and elicited positive user perceptions. Significant improvements were observed in functional outcomes, as evidenced by a noteworthy increase in Fugl-Meyer Assessment scores (mean increase of 6.2 points, exceeding the minimal clinically important difference (MCID) of 5.35 points). Furthermore, participants showed improvements in the ABILHAND measure (mean improvement of 1.24 logits, surpassing the MCID of 0.2 logits) and the Barthel Index (mean increase of 8.8 points).These findings demonstrate the feasibility and effectiveness of home-based robotic rehabilitation for chronic stroke survivors. This has implications for expanding access to rehabilitation services in low- and middle-income countries, enhancing patient engagement and adherence, and improving functional outcomes. Larger controlled studies are warranted to evaluate the effectiveness of home-based robotic rehabilitation programs.","PeriodicalId":504975,"journal":{"name":"Frontiers in Stroke","volume":" 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139623951","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}
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