Stroke Subject

Barber M, Stott DJ. Validity of the telephone interview for cognitive status (TICS) in post-stroke subjects. Int J Geriatr Psychiatry 2004 19 75-79. 

Treatment of cerebral stroke patients with selective serotonin reuptake inhibitor antidepressant showed difference in improvement with respect to laterality. The post-stroke major depressive disorder improved much more in right stroke subjects in comparison with the left stroke ones (Spalletta el al., 2003). In case of unilateral brain injury due to stroke or parkinsonism, the intact hemisphere plays an important role in recovery and compensation for the lost motor function (Schallert el al., 2003). A well-selected homeopathic potency may facilitate recovery by acting on the intact hemisphere. It has been demonstrated that the brain can asymmetrically... 

While electrodes may be integrated as detectors, another possibility is to use the electrodes to stimulate muscles. Electrodes for functional electrical stimulation have been integrated into fabrics to provide actuation stimuli to muscles of the spinal cord of injured and stroke subjects in order to generate or improve lost motor function. 

Lum, P.S., Burgar, C.G., Van der Loos, M., Shor, P.C., Majmundar, M., Yap, R. MIME robotic device for upper-limb neurorehabihtation in subacute stroke subjects A follow-up study. Journal of Rehabilitation Research and Development 43(5), 631-642 (2006)... 

A therapy study of the MIME device has produced similar results with chronic stroke patients. In this study, the robot was position controlled so as to drive the subject s arm through a desired trajectory, as specified either by the trajectory of the contralateral (unimpaired) arm in real time (bimanual mode) or as measured previously (unimanual mode). Chronic stroke subjects exercised 3 hours per week, performing reaching exercises and tracing shapes. At the end of 2 months, the robot exercise group exhibited enhanced movement ability, as measured by clinical scales similar to those used in the MIT-MANUS study, as well as in terms of measurements of active range of motion and... 

The NAS researchers longitudinally studied 860 subjects for Pb exposure versus patellar bone levels at three baseline terciles <22, 22—35, >35 pg Pb/g bone (Weisskopf et al., 2009). Three mortality classifications were all cause, all cardiovascular, and cancer. The adjusted HR for all cardiovascular mortality versus highest tercile was 5.63, excluding baseline of existing cardiovascular disease or stroke subjects. Trend significance level for all cardiovascular mortahty was p < 0.003. 

Knock is caused by unwanted chemical reactions in the combustion chamber. These reactions are a function of the specific chemical species which make up the fuel and the environmental conditions to which the fuel is subjected during the compression and power stroke in the engine. Therefore, both the chemical makeup of the fuel and the engine design parameters must be considered when trying to understand knock. 

Jaw crushers take lumps of several feet in diameter down to 4 in. Stroke rates are 100-300/min. The average feed is subjected to 8-10 strokes before it becomes small enough to escape. Gyratory crushers are suited to slabby feeds and make a more rounded product. 

Expert opinion is a source, frequently elicited by survey, that is used to obtain information where no or few data are available. For example, in our experience with a multicountry evaluation of health care resource utilization in atrial fibrillation, very few country-specific published data were available on this subject. Thus the decision-analytic model was supplemented with data from a physician expert panel survey to determine initial management approach (rate control vs. cardioversion) first-, second-, and third-line agents doses and durations of therapy type and frequency of studies that would be performed to initiate and monitor therapy type and frequency of adverse events, by body system and the resources used to manage them place of treatment and adverse consequences of lack of atrial fibrillation control and cost of these consequences, for example, stroke, congestive heart failure. This method may also be used in testing the robustness of the analysis [30]. 

The second hypothesis, that patients should be selected for thrombolysis depending on whether or not they exhibit a diffusion-perfusion mismatch, may have enormous implications for stroke therapy in the near future, and is one of the most actively investigated and debated subjects in neuroimaging. 

ECASS-II was designed to test a lower dose of rt-PA (0.9 mg/kg) during the same 0-6-hours time period after stroke onset, using similar inclusion criteria as in ECASS-I. ° The primary endpoint was the proportion with a favorable outcome on the mRS scale (defined as a score of 0 or 1). There was no difference in this outcome between rt-PA-treated and placebo controls (40% vs. 37%, p = 0.28). A separate analysis of the 158 subjects enrolled within 3 hours of stroke onset also showed no difference in the proportion with a favorable outcome (42% vs. 38%, p = 0.63) this result, however, must be treated with caution because in ECASS-II there was a substantially lower number of patients treated within 3 hours of stroke onset, compared to the 1995 NINDS rt-PA study. Parenchymal hematoma on post-treatment CT was seen in 12% of rt-PA-treated and 3% of placebo patients (p < 0.001). The 90-day mortality rate was 11 % for the rt-PA group and 11 % for the placebo group (p = 0.54). Protocol violations were much less frequent in ECASS-II compared to ECASS-I (9% vs. 18%), probably because of standardized training in CT interpretation at the study sites. 

A combined analysis of the ATLANTIS, ECASS-11, and NINDS rt-PA study data found that females had a greater benefit from rt-PA than males (p = 0.04), despite similar initial stroke severity and rates of slCH." This finding may not be relevant to the clinical, FDA-approved use of rt-PA, because most of the analyzed subjects from ATLANTIS and ECASS-11 were randomized greater than 3 hours after stroke onset. Therefore, sex should not be a criterion for patient selection for thrombolysis. 

The Stroke-Thrombolytic Predictive Instrument (Stroke-TPI) has recently been developed in order to provide patient-specific estimates of the probability of a more favorable outcome with rt-PA, and has been proposed as a decision-making aid to patient selection for rt-PA." The estimates from this tool should, however, be treated with caution. The prediction rule is dependent on post hoc mathematical modeling, uses clinical trial data from subjects randomized beyond 3 hours who are not rt-PA-eligible according to FDA labeling and current best practice, and has not been externally validated. It is, therefore, not appropriate to exclude patients from rt-PA treatment based solely on Stroke-TPI predictions. 

Lisboa et al. analyzed the safety and efficacy of lAT on the basis of current published data. They found a total of 27 studies (10 patients minimum) with a total of 852 patients who received lAT and 100 control subjects. There were more favorable outcomes in the lAT than in the control group (41.5% vs. 23%), with a lower mortality rate for lAT (27.2% vs. 40%). The lAT group had an OR of 2.4 for favorable outcomes, despite a higher frequency of symptomatic ICH (9.5% vs. 3%). In addition, they found a trend toward better outcomes with combined IV rt-PA and lAT than with lAT alone. They also remarked that lAT-treated supratentorial strokes are more likely to have favorable outcomes than infratentorial ones (42.2% vs. 25.6%). 

A reversed bridging approach has been proposed by Keris et al. In this study, 12 patients (three ICA occlusions and nine MCA occlusions) out of the 45 enrolled (all with an NIHSS score >20) were randomized to receive an initial lA infusion of 25 mg of rt-PA over 5-10 minutes, followed by IV infusion of another 25 mg over 60 minutes, within 6 hours of stroke onset (total combined dose 50 mg with a maximum dose of 0.7 mg/kg). The remaining 33 patients were assigned to a control group and did not undergo any thrombolysis. TIMI 2 and 3 recanalization occurred in 1 of 12 and 5 of 12 of the patients, respectively. There were no symptomatic ICHs. At 12 months, 83% of the patients in the thrombolysis group were functionally independent, whereas only 33% of the control subjects had a good outcome. 

The Interventional Management of Stroke (IMS I) Study was a multicenter, open-labeled, single-arm pilot study in which 80 patients (median NIHSS 18) were enrolled to receive IV rt-PA (0.6 mg/kg, 60 mg maximum, 15% of the dose as a bolus with the remainder administered over 30 minutes) within 3 hours of stroke onset (median time to initiation 140 minutes). " Additional rt-PA was subsequently administered via a microcatheter at the site of the thrombus in 62 of the 80 patients, up to a total dose of 22 mg over 2 hours of infusion or until complete recanalization. Primary comparisons were with similar subsets of the placebo and rt-PA-treated subjects from the NINDS rt-PA Stroke Trial. The 3-month mortality in IMS I subjects (16%) was numerically lower but not statistically different than the mortality of the placebo (24%) or rt-PA-treated subjects (21%) in the NINDS rt-PA Stroke Trial. The rate of symptomatic ICH (6.3%) in IMS I subjects was similar to that of the rt-PA-treated subjects (6.6%) but higher than the rate in the... 

Hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins) have been shown to improve vascular outcomes due to their cholesterol-lowering effects as well as multiple pleiotropic effects. In high-risk populations, statin therapy is known to reduce the risk of vascular events such as myocardial infarction and stroke. A meta-analysis of 10 trials involving 79,494 subjects showed that statin therapy reduced the incidence of stroke by 18%, major coronary events by 27%, and all-cause mortality by 15%. The SPARCL trial recently showed that high-dose HMG-CoA reductase inhibitors prevent recurrent stroke and transient ischemic attacks. ... 

Li PA, Shuaib A, Miyashita H, He QP, Siesjo BK, Warner DS. Hyperglycemia enhances extracellular glutamate accumulation in rats subjected to forebrain ischemia. Stroke 2000 31 183-192. 

The reasons for the observed differences in mortality between aspirin-treated patients in 1ST and CAST are unclear. The findings may relate to baseline differences between the treated groups. CAST had a younger age profile (72% under 70 compared to 38% in 1ST), excluded some patients with severe stroke, and likely included more subjects with lacunar stroke, an etiology associated with lower mortality and less disability. 

The CAPRIE trial found that compared to aspirin (325 mg daily), clopidogrel (75 mg daily) was associated with RRR of 8.7% p = 0.043) for the composite endpoint of ischemic stroke, Ml, or vascular death among 19,185 subjects with stroke, MI, or peripheral arterial disease, but no significant reduction in the composite endpoint in the subgroup with stroke (RRR 7.3%, p = 0.26). No comparison of clopidogrel with aspirin in the acute stroke period was performed. Furthermore, stroke as an endoint was not significantly reduced in the stroke patients entered in this trial (RRR 8.0%, p = NS). 

An effect on blood pressure was shown in the study by Clark and Litchfield (1969) in which subcutaneous injections of PGDN to anesthetized rats at 5, 10, 20, 40, 80, or 160 mg/kg resulted in a dose-related fall in mean arterial blood pressure (measured in the cannulized femoral artery) within 30 min with recovery over the next 12 h. The maximum drop in blood pressure correlated with the maximum concentration of PGDN in the blood. However, a drop in blood pressure did not occur in human volunteers who inhaled 0.5 ppm PGDN for 7.3 h. Rather, a mean elevation of diastolic blood pressure of 12 mm Hg was associated with severe and throbbing headaches (Stewart et al. 1974). A drop in blood pressure and decreasing stroke volume can result in brain ischemia, causing the dizziness and weakness reported by one subject after exposure at 0.5 ppm for 6 h in the Stewart et al. (1974) study as well as in occupationally exposed workers (Horvath et al. 1981). 

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