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Background Race-ethnic differences may influence postthrombolysis outcomes in acute ischemic stroke patients. Guidelines for thrombolytic therapy to treat Asian stroke patients are based mostly on extrapolated western data. Aims We undertook to examine outcomes among Asians by comparing a propensity-matched cohort of thrombolyzed patients from a tertiary center in Singapore with nonthrombolyzed Asian comparators collated from Virtual International Stroke Trials Archives (control). Methods We identified propensity scores-matched patients between thrombolyzed and control Asian patients lodged in the Virtual International Stroke Trials Archives by employing propensity scores method. We compared matched patients for their distributions of three-month functional (modified Rankin scores) and neurological outcomes ( National Institute of Health Stroke Scale) by employing Cochran- Mantel- Haenszel test and proportional odds logistic regression analysis. We report odds ratio and 95% confidence interval for improved outcomes on day 90. Results Virtual International Stroke Trials Archives and National University Hospital, Singapore, contributed 517 and 133 patients of Asian race-ethnicity ( n = 650), respectively. After propensity matching, sample size reduced to 237 patients; 104 were from Virtual International Stroke Trials Archives. Age (59·7 vs. 61·5 years, P = 0·2) and mean baseline National Institute of Health Stroke Scale scores were similar (14) between thrombolyzed and control. The odds ratio for shift toward improved modified Rankin scores and National Institute of Health Stroke Scale distributions after tissue plasminogen activator therapy were 2·8 (95% confidence interval 1·8-4·5, P < 0·0001, n = 233; Cochran- Mantel- Haenszel P < 0·0001) and 2·8 (95% confidence interval 1·7-4·7, P = 0·0008, n = 201; Cochran- Mantel- Haenszel P = 0·0001). Conclusions Our data indicate that Asian patients derive benefit from thrombolytic therapy. [ABSTRACT FROM AUTHOR]

Abstract: Background: Although peak torque has shown acceptable reproducibility, this may not be the case with two other often used parameters: time to peak torque (TPT) and the angle of peak torque (APT). Those two parameters should be used for the characterization of muscular adaptations in athletes. Methods: The isokinetic performance of the knee extensors and flexors in both limbs was measured in 29 male athletes. The experimental protocol consisted of three consecutive identical paradigms separated by 45min breaks. Each test consisted of four maximal concentric efforts performed at 60 and 180°/s. Reproducibility was quantified by the standard error measurement (SEM), the coefficient of variation (CV) and by means of intra-class correlation coefficients (ICCs) with the calculation of 6 forms of ICCs. Results: Using ICC as the indicator of reproducibility, the correlations for TPT of both limbs showed a range of 0.51–0.65 in extension and 0.50–0.63 in flexion. For APT, the values were 0.46–0.60 and 0.51–0.81, respectively. In addition, the calculated standard error of measurement (SEM) and CV scores confirmed the low level of absolute reproducibility. Conclusions: Due to their low reproducibility, neither TPT nor APT can serve as independent isokinetic parameters of knee flexor and extensor performance. So, given its reproducibility level, TPT and APT should not be used for the characterization of muscular adaptations in athletes. [Copyright &y& Elsevier]

Abstract: Introduction: The aim of this study was to assess the influence of sport discipline and age on maximal torque, mean power output and balance of the knee joint muscles. Isokinetic data was evaluated for 58 athletic males, separated into two groups of 38 soccer and 20 gymnasts players. Results: They demonstrated the influence of soccer activity on muscle capacities and the specific development of the flexors when body mass was taken into account. Our study showed the different adaptations in the three age sub-groups of the soccer and gymnast groups. Conclusion: Values were significantly higher in the soccer players for flexor muscles, but no significant differences were demonstrated between the two groups of athletes for the extensor muscles. Analysis also showed the different adaptations in the three age sub-groups of the soccer and gymnast groups. The analysis of peak torque and power demonstrated that gymnastic activity led to a specific development of extensor muscles with age. In a future study, longitudinal analysis will be used to assess the changes in isokinetic characteristics of knee muscles. [Copyright &y& Elsevier]

Abstract: Objective: We aimed to examine the effect of a physical activity program on postural sway and on the attentional control of postural abilities in elderly frail adults. Method: Twelve older adults (age 81.4±9 years) institutionalised in a geriatric care institution participated in the physical activity program posture–balance–mobility (PBM) twice a week (1 hour per session) for 12 weeks. We analysed stabilometric data for surface and length of the center of pressure (COP) sway, with eyes open and eyes closed, under single-task and dual-task conditions on a firm floor before and after the training program. During the static postural evaluation and under the dual-task condition, subjects performed an attention-demanding cognitive task, the random number generation task. Results: Only the length of COP sway was more important under the dual-task condition than under the single-task condition (p =0.05). At baseline, cognitive performance was significantly weaker under the dual-task condition (standing) than under the single-task condition (seated), with eyes closed but not eyes open (p <0.05). However, after the training program, the performance of the cognitive task did not significantly differ between the dual-task condition with eyes closed and the single-task condition with eyes closed. Conclusion: The training program allowed elderly subjects to improve their ability to perform an attention-demanding cognitive task while standing still, in particular with their eyes closed. Although balance seemed to be less stable under the dual-task condition than under the single-task condition, these results could be interpreted as an improvement of the attentional control of postural stability. [Copyright &y& Elsevier]

OBJECTIVES:: To assess the influence of wheelchair propulsion and neurological level on isokinetic shoulder rotational strength. SETTING:: University of Montpellier, France METHODS:: Data were evaluated in three groups of subjects as follows: 12 nonathletes, 15 tennis players and 21 wheelchair athletes. We then compared 12 high paraplegic athletes (HPA) and nine low paraplegic athletes (LPA) within the group of 21 wheelchair athletes: The isokinetic tests were performed in the seated 45° abducted test position in the scapular plane at 60, 180 and 300°?s-1 for both shoulders. Peak torque and mean power values were gathered and, from these values, the internal/external rotation ratios were calculated. RESULTS:: Intergroup comparison showed an influence of lesion and sport on peak torque at 180 and 300°?s-1 for the internal rotators and significantly higher values of the internal/external ratios in the wheelchair athlete group. For mean power, we observed significant differences under all test conditions and significant differences for ratio only on the dominant side at 180°?s-1 and on the dominant side at 300°?s-1. Comparison of the two groups of paraplegic athletes showed significantly higher values of peak torque and mean power of the external rotators in the LPA for all test conditions. CONCLUSIONS:: Neurological level of lesion does not systematically influence the development of internal rotator muscles; in contrast, the participation of the external rotators appears strongly correlated to neurological level. The comparison of the two sides in the two paraplegic groups showed that in two-thirds of the cases the values of the external rotators were significantly higher than those of the internal rotators on the nondominant side for peak torque and mean power. Ratios on the dominant side were systematically higher than on the nondominant side, with significant differences also noted in two-thirds of the cases. These results raise questions about the influence of neurological level and wheelchair propulsion on the muscular adaptations of the shoulder in wheelchair athletes.Spinal Cord (2004) 42, 222-229. doi:10.1038/sj.sc.3101556 [ABSTRACT FROM AUTHOR]

Objectives: To characterize the influence of neurological lesion level on the cardiorespiratory and ventilatory responses of two groups of paraplegic athletes during incremental exercise on a treadmill and in the usual conditions for wheelchair exercise.METHODS:&EMSP;:Cardioventilatory responses evaluated in two groups of paraplegic wheelchair sportsmen designated as high paraplegic athletes (HPA) and low paraplegic athletes (LPA). After 2 min of data collection at rest and 3 min of warm-up at 4 km.h-1, treadmill speed was increased by 1 km.h-1 every minute until exhaustion. During this test, ventilation and its components, as well as respiratory exchanges, were measured breath by breath (C.P.X. Medical Graphics) every minute by taking the mean of the last 20 s of each increment. RESULTS:&EMSP;:Spirometric values presented no significant differences between groups. At rest, no significant difference was observed between the two groups for all cardiorespiratory and ventilatory values obtained during the treadmill test. At submaximal exercise, all variables increased with the augmentation in workload. With the exception of R, there were no significant differences in the classic cardiorespiratory parameters (V˙O2, V˙CO2, HR, V˙E) between the two groups of paraplegics. For the ventilatory parameters, we observed significant differences between the two groups, with values of f and It/Trf significantly higher (0.01

A letter to the editor is presented in response to an article on the changes in calcium levels associated with catheter-based cerebral angiography, published in a previous issue.

A letter to the editor is presented in response to a commentary article "Is Transcranial Doppler for the Detection of Venous-to-Arterial Circulation Shunts Reproducible?, " by Sanjay Sastry.

A letter to the editor is presented in response to the article "Assessment of intra-cranial pressure after severe traumatic brain injury by trancranial Doppler ultrasonography," by B. Splavski and colleagues in the 2006 issue.

The article explains the association of the recurrent artery of Heubner to the contralateral middle cerebral artery infarction in an 86-year-old Chinese woman suffering from subfalcine herniation. According to the researchers, the patient's subfalcine herniation has caused compression of the right anterior cerebral artery (ACA), which affected the left recurrent artery of Heubner. It is noted that the recurrent artery of Heubner is an inconsistent branch of ACA.

The Fibrosis (FIB)-4 index is an established non-invasive test to detect liver fibrosis. Liver fibrosis is postulated to be one of the predictors of the risk of symptomatic Intracranial Haemorrhage (SICH) after intravenous tissue plasminogen activator (IV tPA) therapy, the mainstay of treatment following acute ischemic stroke (AIS). However, SICH is a feared complication of thrombolytic therapy. We aimed to evaluate the association of FIB-4 with outcomes of AIS after IV tPA. Consecutive AIS patients receiving IV tPA from 2006 to 2018 at a single stroke centre were studied in a retrospective cohort study. Multivariable adjusted logistic regression was performed to assess associations of FIB-4 with outcomes. The primary outcome was SICH, and secondary outcomes included functional independence (mRS of 0–2) and mortality measured at 90 days. Among 887 patients (median age: 67 (IQR: 57–77)), 342 had FIB-4 < 1.3 and 161 had FIB-4 > 2.67. A greater proportion of moderate to severe strokes (NIHSS ≥10) occurred in the FIB-4 > 2.67 group (n = 142, 88.8%) compared to the FIB-4 < 1.3 group (n = 208, 61.2%). Amongst the different stroke subtypes, median FIB-4 was highest in cardioembolic stroke (CES) compared to the 3 other non-CES stroke subtypes (1.90 (IQR: 1.41–2.69)). Following IV tPA, having FIB-4 > 2.67 was associated with an increased rate of SICH (adjusted OR: 4.09, 95% CI: 1.04–16.16, p = 0.045) and increased mortality (adjusted OR 3.05, 95% CI: 1.28–7.26, p = 0.012). Advanced liver fibrosis was associated with an increased rate of SICH and increased 90-day mortality after IV tPA. The FIB-4 score may be useful for prognostication after IV tPA. [ABSTRACT FROM AUTHOR]

Background frailty has been shown to be a better predictor of clinical outcomes than age alone across many diseases. Few studies have examined the relationship between frailty, stroke and stroke interventions such as endovascular thrombectomy (EVT). Objective we aimed to investigate the impact of frailty measured by clinical frailty scale (CFS) on clinical outcomes after EVT for acute ischemic stroke (AIS) in older patients ≥70 years. Methods in this retrospective cohort study, we included all consecutive AIS patients age ≥ 70 years receiving EVT at a single comprehensive stroke centre. Patients with CFS of 1–3 were defined as not frail, and CFS > 3 was defined as frail. The primary outcome was modified Rankin Score (mRS) at 90 days. The secondary outcomes included duration of hospitalisation, in-hospital mortality, carer requirement, successful reperfusion, symptomatic intracranial haemorrhage and haemorrhagic transformation. Results a total of 198 patients were included. The mean age was 78.1 years and 52.0% were female. Frail patients were older, more likely to be female, had more co-morbidities. CFS was significantly associated with poor functional outcome after adjustment for age, NIHSS and time to intervention (adjusted odds ratio [aOR] 1.54, 95% confidence interval [CI] 1.04–2.28, P  = 0.032). There was trend towards higher mortality rate in frail patients (frail: 18.3%; non-frail: 9.6%; P  = 0.080). There were no significant differences in other secondary outcomes except increased carer requirement post discharge in frail patients (frail: 91.6%; non-frail: 72.8%; P  = 0.002). Conclusions frailty was associated with poorer functional outcome at 90 days post-EVT in patients ≥ 70 years. [ABSTRACT FROM AUTHOR]

There have been reports of de novo or relapse of acquired thrombotic thrombocytopenic purpura (aTTP) after coronavirus disease 2019 (COVID-19) messenger ribonucleic acid (mRNA) vaccinations. Additional controls employed to confirm assay specificity: (1) I Negative Control 1 i : plasma from a previous TTP patient collected in 2016, thus predates SARS-CoV-2 emergence and mRNA COVID-19 vaccines and lacking the necessary anti-Spike S1 antibody. All three patients had significant levels of neutralizing IgG antibodies against the SARS-CoV-2 Spike S1 protein after COVID-19 vaccinations. In the validation experiment, all readings were also negative (Table 2), demonstrating that while these samples have significant levels of IgG antibodies against SARS-CoV-2 Spike S1 protein, no cross-binding was observed to ADAMTS-13 proteins based on a lack of anti-ADAMTS-13 conjugate interaction. [Extracted from the article]

Intravenous tissue plasminogen activator (tPA) remains the cornerstone of recanalization therapy for acute ischemic stroke (AIS), albeit with varying degrees of response. The triglyceride-glucose (TyG) index is a novel marker of insulin resistance, but association with outcomes among AIS patients who have received tPA has not been well elucidated. We studied 698 patients with AIS who received tPA from 2006 to 2018 in a comprehensive stroke centre. TyG index was calculated using the formula: ln[fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. TyG index was significantly lower in patients that survived at 90-days than those who died (8.61 [Interquartile Range: 8.27–8.99] vs 8.76 [interquartile range: 8.39–9.40], p = 0.007). In multivariate analysis, TyG index was significantly associated with 90-day mortality (OR: 2.12, 95% CI: 1.39–3.23, p = 0.001), poor functional outcome (OR: 1.41 95% CI: 1.05–1.90, p = 0.022), and negatively associated with early neurological improvement (ENI) (OR: 0.68, 95% CI: 0.52–0.89, p = 0.004). There was no association between TyG index and symptomatic intracranial hemorrhage. 'High TyG' (defined by TyG index ≥ 9.15) was associated with mortality, poor functional outcomes and no ENI. In conclusion, the TyG index, a measure of insulin resistance, was significantly associated with poorer clinical outcomes in AIS patients who received tPA. [ABSTRACT FROM AUTHOR]

STUDY DESIGN:: This study analyzed the reproducibility of a field test. In a previous study, we showed that this test, the Adapted Leger and Boucher Test (ALBT), was progressive and maximal. The Leger and Boucher predictive equation for able-bodied subjects was not accurate for WD athletes, however, and a new predictive equation is needed. OBJECTIVES:: To determine the reproducibility of an adapted incremental field test for wheelchair-dependent (WD) athletes. SETTING:: France at Montpellier. METHODS:: The proposed protocol was conducted on a 400 m track. Eight male paraplegics (mean age: 30.8±5.1 years) performed the test three times in the same conditions, ie same time of day, same wheelchair, same material. Maximal heart rate (HRmax) and maximal speed (Smax) were measured. RESULTS:: We found no significant differences (P>0.05) between tests for either variable. The Bland and Altman graphic analyses showed a good reproducibility for both variables. Lastly, the reproducibility coefficients of HRmax and Smax were very low (2% and 1%, respectively). CONCLUSION:: The ALBT is reproducible concerning measurements of HRmax and Smax. A valid predictive equation of maximal oxygen uptake from the Smax is now needed for WD athletes during this field test. [ABSTRACT FROM AUTHOR]

Endothelial dysfunction has been implicated in atherosclerosis, ischemic heart disease, and stroke. Endothelial progenitor cells (EPCs), found in the bone marrow and peripheral blood as rare cell population, demonstrated a high proliferation and differentiation capacity. Understanding how such diseases influence the quantity and functionality of EPCs is essential for the development of novel therapies. This study aims to investigate the factors that affect the quantity and functionality of circulating EPCs in stroke patients and healthy controls. Blood samples were collected once from healthy donors (n = 30) and up to 3 times (within 7 days (baseline), 3 and 12 months post-stroke) from stroke patients (n = 207). EPC subpopulations were isolated with flow cytometry for characterization. The Matrigel tubular formation assay was performed as a measure of functionality. An increased amount of circulating EPCs was observed in stroke patients over 45 years when compared to age-matched healthy individuals. EPCs showed a rising trend in stroke patients over the 12-month post-stroke period, reaching statistical significance at 12 months post-stroke. Isolated CD34+KDR+ cells from stroke patients showed impairment in tubular formation capability when compared to cells from healthy donors. The quantity and vasculogenic function of circulating EPCs in peripheral blood have been effectively evaluated in stroke patients and healthy control donors in this study. Age and stroke are found to be 2 influencing factors on the angiogenic capacity. It is suggested that the increase in EPC number is triggered by the recovery response following ischemic stroke. [ABSTRACT FROM AUTHOR]

Aim We sought to evaluate the relationship of urine levels of soluble cellular adhesion molecules s VCAM-1 (vascular) and s ICAM-1 (intercellular) in systemic lupus erythematosus ( SLE) patients with or without lupus nephritis, and to explore their correlation with renal disease activity. Methods Paired serum and urine samples of 121 Asian SLE patients, and urine samples of 19 normal healthy controls were collected. Demographic data, disease activity and damage scores, and selected laboratory parameters, including levels of anti-double stranded DNA antibody, complements C3, C4, and creatinine were captured. Renal disease activity was scored with renal SLE Activity Measure revised (r SLAM- R). Serum and urine s VCAM-1 and s ICAM-1 levels were assayed by enzyme-linked immunosorbent assay. Results Urinary s VCAM-1 and s ICAM-1 were elevated in SLE patients compared to controls. Significantly higher levels of urine s VCAM-1 found in patients with active lupus nephritis correlated with r SLAM- R. In addtion, significantly more patients with active lupus nephritis had detectable levels of urine s ICAM-1, but no correlation with renal activity was observed. Conclusion Urinary s VCAM-1 may serve as a potential biomarker for early diagnosis of lupus nephritis as levels correlated with even mild abnormalities of urine sediment. In addition, both urine s VCAM-1 and s ICAM-1 levels may be useful in identifying patients at risk of lupus nephritis. [ABSTRACT FROM AUTHOR]

Background Data regarding thrombolysis for acute ischemic stroke in Asia are scarce and only a small percentage of patients are thrombolysed. The dose of intravenous tissue plasminogen activator (IV-tPA) in Asia remains controversial. Case-controlled observation studies in Asia included only Japanese patients and suggested the clinical efficacy and safety of low-dose IV-tPA (0·6 mg/kg body weight; max 60 mg) comparable to standard dose (0·9 mg/kg body weight; max. 90 mg). Reduced treatment cost, lower symptomatic intracerebral hemorrhage risk and comparable efficacy encouraged many Asian centers to adopt low-dose or even variable-dose IV-tPA regimens. We evaluated various Asian thrombolysis studies and compared with SITS-MOST registry and NINDS trial. Methods We included the published studies on acute ischemic stroke thrombolysis in Asia. Unadjusted relative risks and 95% Confidence intervals were calculated for each study. Pooled estimates from random effects models were used because the tests for heterogeneity were significant. Results We found only 18 publications regarding acute ischemic stroke thrombolysis in Asia that included total of 9300 patients. Owing to ethnic differences, stroke severity, small number of cases in individual reports, outcome measures and tPA dose regimes, it is difficult to compare these studies. Functional outcomes were almost similar (to Japanese studies) when lower-dose IV-tPA was used in non-Japanese populations across Asia. Interestingly, with standard dose IV-tPA, considerably better functional outcomes were observed, without increasing symptomatic intracerebral hemorrhage rates. Conclusions Variable dose regimens of IV-tPA are used across Asia without any reliable or established evidence. Establishing a uniform IV-tPA regimen is essential since the rapid improvements in health-care facilities and public awareness are expected to increase the rates of thrombolysis in Asia. [ABSTRACT FROM AUTHOR]

Background: Previous clinical trials have shown that Neuroaid® (MLC601), a traditional Chinese medicine, shows good tolerability and superiority over another traditional Chinese medicine in terms of neurological disability and functional outcome and thus may be beneficial as part of a poststroke rehabilitation program. The safety of MLC601 on hemostasis, hematology and biochemistry has been established in normal subjects and patients with nonacute stroke over a short treatment period. We assessed the safety of Neuroaid in patients with acute stroke treated for 3 months in a substudy of an ongoing randomized placebo-controlled trial. Methods: Laboratory tests (biochemical, hematological and electrocardiogram) were conducted at the month 3 follow-up, in addition to baseline tests. A total of 114 patients were recruited. As there were 13 dropouts, a total of 52 patients on MLC601 and 49 on placebo were available for analysis. Serious adverse events (SAEs) were also analyzed. Results: There were no statistically or clinically significant differences between treatment groups in biochemical, hematological or electrocardiogram tests at month 3, nor any statistically or clinically significant differences in the absolute and relative changes of the various parameters between baseline and 3 months. SAEs were similar and were those commonly seen in stroke patients. Conclusions: Longer-term laboratory safety data show no differences between MLC601 and placebo, confirming the safety of MLC601 in acute stroke patients receiving a 3-month treatment. Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The primary aim of thrombolysis in acute ischemic stroke is recanalization of an occluded intracranial artery. Recanalization is an important predictor of stroke outcome as timely restoration of regional cerebral perfusion helps salvage threatened ischemic tissue. At present, intravenously administered tissue plasminogen activator (IV-TPA) remains the only FDA-approved therapeutic agent for the treatment of ischemic stroke within 3 hours of symptom onset. Recent studies have demonstrated safety as well as efficacy of IV-TPA even in an extended therapeutic window. However, the short therapeutic window, low rates of recanalization, and only modest benefits with IV-TPA have prompted a quest for alternative approaches to restore blood flow in an occluded artery in acute ischemic stroke. Although intra-arterial delivery of the thrombolytic agent seems effective, various logistic constraints limit its routine use and as yet no lytic agent have not received full regulatory approval for intra-arterial therapy. Mechanical devices and approaches can achieve higher rates of recanalization but their safety and efficacy still need to be established in larger clinical trials. The field of acute revascularization is rapidly evolving, and various combinations of pharmacologic agents, mechanical devices, and novel microbubble/ultrasound technologies are being tested in multiple clinical trials. [ABSTRACT FROM AUTHOR]

The demographic and laboratory predictors of long-stay patients with ischemic stroke were sought in this retrospective hospital-based study. In the univariate and multivariate analysis, advanced age, male gender, leukocytosis, elevated creatinine, low-serum albumin, elevated alkaline transaminases, and lactate dehydrogenase were identified as independent predictors of “long” stayers. At an optimal probability cut-offs, the receiver operating curve incorporating these variables was 0.70, sensitivity 68%, specificity 80%, positive-predictive value 39% and negative-predictive value 95%. Application of this information may assist physicians to triage patients at risk of severe stroke for early therapy and care. [ABSTRACT FROM AUTHOR]

Background and Objective: Previous studies on Danqi Piantan Jiaonang (DPJ, NeuroAid®), a traditional Chinese medicine, in stroke patients showed promising results. Our aim was to determine the safety of DPJ in normal subjects and stroke patients through a series of studies assessing its immediate and long-term effects, alone and in combination with aspirin, on hematological, hemostatic, and biochemical parameters. Methods: We conducted 3 studies from December 2004 to May 2006. Study 1 was a case series which recruited 32 healthy volunteers who were given 2 oral doses of 4 DPJ capsules (0.4 g/capsule) 6 h apart. Study 2 was a randomized controlled trial of 22 healthy volunteers who received either 1 oral dose of aspirin 300 mg alone or a combination of 1 dose of aspirin 300 mg and 2 doses of 4 DPJ capsules taken 6 h apart. For both studies 1 and 2, hemostatic parameters (prothrombin time, activated partial thromboplastin time, fibrinogen, platelet aggregation, D-dimer) were tested at baseline, and after 2 and 8 h. Study 3 was a case series which recruited 10 patients with recent ischemic stroke (within 7 days) who were given 4 DPJ capsules taken orally 3 times a day for 1 month. Blood tests for hemostatic, hematological (complete blood count), and biochemical parameters (glucose, creatinine, alanine aminotransferase, aspartate transaminase, C-reactive protein) were performed at baseline, and after 1 and 4 weeks. Results: Apart from the expected changes in platelet aggregation in subjects taking aspirin, no significant differences were detected in hemostatic parameters at baseline, and 2 and 8 h after oral intake of DPJ alone or in combination with aspirin. Likewise, no significant differences were observed in hematological, hemostatic, and biochemical parameters at baseline, and after 1 and 4 weeks of oral intake of DPJ. Conclusion: DPJ does not significantly modify hematological, hemostatic, and biochemical parameters in normal subjects and stroke patients. Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Proposes a predictive peak oxygen uptake equation in wheelchair-dependent athletes using the Adapted Léger and Boucher test. Findings of a clinical examination on anthropometric characteristics; Application of a deceleration field test; Correlation of the muscular volume of the arm and arm length.

A letter to the editor is presented in response to the article "Cerebral Vasomotor Reactivity in Epilepsy Patients," by S. Bek and colleagues that was published in the May 2010 issue.

Background and purpose A recent retrospective study using an online list service established by the American Academy of Neurology has suggested that ischaemic cerebrovascular events may occur in patients who undergo 'bubble studies' (BS) with either transcranial Doppler (TCD) or transoesophageal echocardiography (TOE). The safety of TCD-BS for right to left shunt (RLS) identification was evaluated prospectively in an international multicentre study. Methods Consecutive patients with cerebral ischaemia (ischaemic stroke or transient ischaemic attack (TIA)) were screened for potential ischaemic cerebrovascular events following injection of microbubbles during TCD-BS for identification of RLS at three tertiary care stroke centres. TCD-BS was performed according to the standardised International Consensus Protocol. TOE-BS was performed in selected cases for confirmation of Results 508 patients hospitalised with acute cerebral ischaemia (mean age 46±12 years, 59% men; 63% ischaemic stroke, 37% TIA) were investigated with TCDBS within 1 week of ictus. RLS was identified in 151 cases (30%). TOE-BS was performed in 101 out of 151 patients with RLS identified on TCD-BS (67%). It was positive in 99 patients (98%). The rate of ischaemic cerebrovascular complications during or after TCD-BS was 0% (95% CI by the adjusted Wald method: 0e0.6%). Structural cardiac abnormalities were identified in 38 patients, including atrial septal aneurysm (n&equals;23), tetralogy of Fallot (n&equals;1), intracardiac thrombus (n&equals;2), ventricular septal defect (n&equals;3) and atrial myxoma (n&equals;1). Conclusion TCD-BS is a safe screening test for identification of RLS, independent of the presence of cardiac structural abnormalities [ABSTRACT FROM AUTHOR]

Background: The treatment of ischaemic stroke with neuroprotective drugs has been unsuccessful, and whether these compounds can be used to reduce disability after recurrent stroke is unknown. The putative neuroprotective effects of antiplatelet compounds and the angiotensin II receptor antagonist telmisartan were investigated in the Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) trial.Methods: Patients who had had an ischaemic stroke were randomly assigned in a two by two factorial design to receive either 25 mg aspirin (ASA) and 200 mg extended-release dipyridamole (ER-DP) twice a day or 75 mg clopidogrel once a day, and either 80 mg telmisartan or placebo once per day. The predefined endpoints for this substudy were disability after a recurrent stroke, assessed with the modified Rankin scale (mRS) and Barthel index at 3 months, and cognitive function, assessed with the mini-mental state examination (MMSE) score at 4 weeks after randomisation and at the penultimate visit. Analysis was by intention to treat. The study was registered with ClinicalTrials.gov, number NCT00153062.Findings: 20,332 patients (mean age 66 years) were randomised and followed-up for a median of 2.4 years. Recurrent strokes occurred in 916 (9%) patients randomly assigned to ASA with ER-DP and 898 (9%) patients randomly assigned to clopidogrel; 880 (9%) patients randomly assigned to telmisartan and 934 (9%) patients given placebo had recurrent strokes. mRS scores were not statistically different in patients with recurrent stroke who were treated with ASA and ER-DP versus clopidogrel (p=0.38), or with telmisartan versus placebo (p=0.61). There was no significant difference in the proportion of patients with recurrent stroke with a good outcome, as measured with the Barthel index, across all treatment groups. Additionally, there was no significant difference in the median MMSE scores, the percentage of patients with an MMSE score of 24 points or less, the percentage of patients with a drop in MMSE score of 3 points or more between 1 month and the penultimate visit, and the number of patients with dementia among the treatment groups. There were no significant differences in the proportion of patients with cognitive impairment or dementia among the treatment groups.Interpretation: Disability due to recurrent stroke and cognitive decline in patients with ischaemic stroke were not different between the two antiplatelet regimens and were not affected by the preventive use of telmisartan. [ABSTRACT FROM AUTHOR]