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Objective: The primary objective is to evaluate the use of colchicine as an anti-inflammatory agent for stroke prevention in patients with coronary artery disease. Background: There has been a rising number of randomized controlled trials conducted in patients with coronary artery disease on the use of colchicine in reducing cardiovascular complications. Recent publications suggest colchicine reduces the risk of stroke and other cardiovascular events. Methods: We performed a systematic review of known trials in the current literature to characterize the clinical characteristics and outcomes of colchicine treatment in patients with coronary artery disease. A literature search was performed in PubMed, Embase and SCOPUS using a suitable keyword search strategy from inception to 4 June 2021. All studies evaluating cardiovascular outcomes of colchicine treatment in patients with coronary artery disease were included. Results: The systemic review included 5 randomized controlled trials assessing a total of 11,790 patients. Majority of studies used a colchicine dosing regimen of 0.5 mg once daily, with the median follow-up duration ranging from 6 to 36 months. Meta-analytic estimates for stroke incidence highlighted a statistically significant benefit for patients that were administered colchicine compared to placebo (OR 0.47, 95% CI 0.27–0.81, p = 0.006), and a non-significant benefit for myocardial infarction. There was no significant association between colchicine treatment and the adverse effects of gastrointestinal symptoms and myopathy/myalgia. Conclusions: The use of colchicine reduces the risk of stroke in patients with a history of coronary artery disease, without a significant increase in gastrointestinal and myopathy/myalgia adverse effects. [ABSTRACT FROM AUTHOR]

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]

Purpose: Conventional predictive models are based on a combination of clinical and neuroimaging parameters using traditional statistical approaches. Emerging studies have shown that the machine learning (ML) prediction models with multiple pretreatment clinical variables have the potential to accurately prognosticate the outcomes in acute ischemic stroke (AIS) patients undergoing thrombectomy, and hence identify patients suitable for thrombectomy. This article summarizes the published studies on ML models in large vessel occlusion AIS patients undergoing thrombectomy. Methods: We searched electronic databases including PubMed from 1 January 2000 up to 14 October 2019 for studies that evaluated ML algorithms for the prediction of outcomes in stroke patients undergoing thrombectomy. We then used random-effects bivariate meta-analysis models to summarize the studies. Results: We retained a total of five studies that evaluated ML (4 support vector machine, 1 decision tree model) with a combined cohort of 802 patients. The prevalence of good functional outcome defined by 90-day mRS of 0–2 when available. Random effects model demonstrated that the AUC was 0.846 (95% confidence interval, CI 0.686–0.902). A pooled diagnostic odds ratio of 12.6 was computed. The pooled sensitivity and specificity were 0.795 (95% CI 0.651–0.889) and 0.780 (95% CI 0.634–0.879), respectively. Conclusion: ML may be useful as an adjunct to clinical assessment to predict functional outcomes in AIS patients undergoing thrombectomy, and hence identify suitable patients for treatment. Further studies validating ML models in large multicenter cohorts are necessary to explore this further. [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]

Background: Analysis of the health profile of participants aged over 65 has been initiated in balneotherapy. Aims: To determine the benefits of a 3-week outpatient balneotherapy program on patient-reported outcomes. Methods: Our sample consisted of 1471 people. The average age of the study population was 72.5 years (± 5.1) and 67% of the participants were females. Symptoms intensity was measured by visual analogue scale, and health-related quality of life (HRQL) with the EQ5D questionnaire before and after the program. Changes of perceived functional status were rated using a 3-point Likert scale. Results: The results indicated a significant increase in the fear of falling and a decrease in fatigue. EQ5D reveals a significant improvement after the program. The perceived change scores remained stable, except for anxiety/depression. Conclusions: The study indicated significant improvements of HRQL and a decrease of perception of fatigue and anxiety in elderly people participants in a 3-week balneological programme. [ABSTRACT FROM AUTHOR]

Intravenously administered tissue plasminogen activator (IV-tPA), dose determined by patients' body-weight, remains the only approved drug treatment for acute ischemic stroke (AIS). Since a shorter onset-to-treatment time results in better functional outcome, treatment is often initiated according to the estimated or last-known body-weight of the patient. This approach may result in underdosing or overdosing of tPA. In this multicenter retrospective study, we evaluated the extent of error in tPA dosing in our AIS cohort and its impact on functional outcome and symptomatic intracranial hemorrhage (SICH). Consecutive AIS patients, receiving IV-tPA, dose determined by the estimated body-weight, at three tertiary centers between January and December 2017 were included. Collected data included information about demographics, cardiovascular risk factors, stroke subtype and National Institute of Health Stroke Scale (NIHSS) score. Estimated and measured body-weights were recorded. Modified Rankin scale (mRS) of 2 or more defined unfavorable outcome. The study included 150 patients. Median age was 64 -years (IQR 55–75) with male preponderance (67%) and median NIHSS score of 9 points (IQR 6–17). Mean measured weight of our study population was 58 (SD 13) kg. Median difference between actual and estimated body-weight was 3 kg (IQR 1.5–6). Difference was more than 10% in 35 (23.3%) patients. Good functional outcome (mRS 0–1) was achieved by 74 (49.3%) patients and 10 (6.8%) developed SICH. NIHSS (OR 1.288; 95% CI 1.157–1.435, p < 0.001) and large artery atherosclerosis (OR 5.878; 95% CI 1.929–17.910, p = 0.002) were independent predictors of unfavorable functional outcome. Our finding of the statistically insignificant 2.5-fold increase in poor outcomes among patients where the estimated and actual weight differed by more than 10% should be interpreted with caution due to the limited sample size. Significant difference occurs between estimated and actual body-weight in a considerable proportion of thrombolysed AIS patients. However, this discrepancy does not affect functional outcome or the risk of SICH. [ABSTRACT FROM AUTHOR]

Acute ischemic stroke (AIS) is a life-threatening complication of coronavirus disease 2019 (COVID-19) infection. Increasing reports suggest an association between COVID-19 and AIS, although the underlying mechanism remains uncertain. We performed a systematic review to characterize the clinical characteristics, neuroimaging findings, and outcomes of AIS in COVID-19 patients. A literature search was performed in PubMed and Embase using a suitable keyword search strategy from 1st December 2019 to 29th May 2020. All studies reporting AIS occurrence in COVID-19 patients were included. A total of 39 studies comprising 135 patients were studied. The pooled incidence of AIS in COVID-19 patients from observational studies was 1.2% (54/4466) with a mean age of 63.4 ± 13.1 years. The mean duration of AIS from COVID-19 symptoms onset was 10 ± 8 days, and the mean NIHSS score was 19 ± 8. Laboratory investigations revealed an elevated mean d-dimer (9.2 ± 14.8 mg/L) and fibrinogen (5.8 ± 2.0 g/L). Antiphospholipid antibodies were detected in a significant number of cases. The majority of AIS neuroimaging patterns observed was large vessel thrombosis, embolism or stenosis (62.1%, 64/103), followed by multiple vascular territory (26.2%, 27/103). A high mortality rate was reported (38.0%, 49/129). We report the pooled incidence of AIS in COVID-19 patients to be 1.2%, with a high mortality rate. Elevated d-dimer, fibrinogen and the presence of antiphospholipid antibodies appear to be prominent in COVID-19 patients with concomitant AIS, but further mechanistic studies are required to elucidate their role in pathogenesis. [ABSTRACT FROM AUTHOR]

Cerebral venous thrombosis (CVT) causes significant disability and mortality. Current guidelines for CVT management support the initial use of unfractionated heparin or low molecular weight heparin followed by longer-term oral vitamin K antagonist (VKA). There has been increasing, albeit limited, evidence for the use of direct oral anticoagulants (DOAC) as an alternative to VKA. We performed a systematic review and meta-analysis of studies that compared the safety and efficacy of DOACs to VKA in treating CVT. A comprehensive literature search was carried out in Medline, Embase and Cochrane Stroke Group Trials Register using a suitable keyword/MeSH term search strategy. All studies published in English comparing outcomes of patients with CVT treated with DOAC or VKA were included. In total, 6 studies (5 observational studies and 1 randomized clinical trial) comprising 412 patients (age range 16–83 years) were analyzed. DOAC was used in 151 patients, while 261 received VKA. The follow-up period was 3–11 months. The efficacy of DOACs was comparable with VKA in terms of partial or full thrombus recanalization (RR 1.02, 95% CI 0.89–1.16) and excellent functional recovery with modified Rankin scale < 2 (RR 1.02, 95% CI 0.93–1.13). Patients treated with DOAC developed lower major bleeding events when compared to VKA, although this did not reach statistical significance (RR 0.44, 95% CI 0.12–1.59). We provide preliminary evidence to support DOAC as effective and safe alternatives to VKA in CVT treatment. We await the results of upcoming randomized trials to further support our results and validate the use of DOAC. [ABSTRACT FROM AUTHOR]

Background: A falls prevention programme has been initiated in balneotherapy at Balaruc-les-Bains. Aims: To determine the health profiles of subjects who are at risk of falls, over 65 years of age and attending balneotherapy. Methods: Questionnaires were used to evaluate people on their fear of falling. Fatigue was assessed by visual analog scale as well as by functional status over the past 12 months. EQ-5D-3L, the IPAQ questionnaire and Fried's frailty scale were all used. Patients' functional capabilities were tested using the Unipedal stance test, the TUG test, the SPPB, the Tandem walking test and the isometric manual grip strength test. Results: Out of the 1471 patients (72.45 years ± 5.10), the women (67%) were tested. In the last 12 months, 485 of these 1471 patients fell (33%) and 37% of them suffered a severe injury. 45–50% of these subjects are now in good health. Women had a significantly higher impaired perception of their health than men (0.02 < p < 0.0001). According to Fried's criteria, 10.2% of the population is considered frail, with a significantly greater number of women (p < 0.0001). Static equilibrium was subnormal (less than 12 s during the TUG). The number of steps in tandem position discriminates individuals and gender as does the speed of moving from A to B and muscular strength. Conclusions: More than one-third of the subjects (more women than men) aged 65 or older visiting the Balaruc-les-Bains health resort are pre-frail or frail. They all have a recent history of falls, suffer from impaired muscle strength, and have balance and gait disorders. [ABSTRACT FROM AUTHOR]

This study analyzes the evolution in kinematic and non-linear stabilometric parameters in elderly sedentary women selected to participate in a brisk walking program. Ninety-four women were randomly selected for a program of 78 sessions over 6 months, with three sessions of 60 min per week. On the force platform, participants were assessed with both eyes opened as well as eyes closed during a period of 51.2 s and the sampling frequency was 40 Hz. The main dependent kinematic variables were the length, stabilogram surface, and the mean position in anteroposterior as well as medio-lateral directions. For the dynamic approach, we have selected the parameters of recurrence quantification analysis, sample entropy, and multiscale entropy. The kinematic and the time series analysis of group × time interactions demonstrated that 6 months of walk-training lacked influence on kinematic postural responses and on dynamical measurements. The weekly brisk walking program was situated on flat ground and consisted of three 60-min weekly sessions lasting 6 months, leading to no significant effect on postural responses. In regards to international recommendations brisk walking is a pertinent exercise. However, in older sedentary women, our study indicated a systemic lack of influence of 6 months’ walk-training on flat ground on kinematic postural responses and on dynamical measures obtained by time series analysis. [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 AIMS: Complex interactions between visual, vestibular and somatosensory information and the cerebellar system are involved in the maintenance of upright posture. Previous studies have shown that normal aging and pathologies may lead to deterioration of the control of upright standing posture. METHODS: In order to investigate postural control during quiet standing in the elderly, the center of pressure (CoP) was analysed on two force platforms in three different groups. The first group was composed of 13 healthy older adults (O), the second consisted of 9 older adults with plantar sole deficit (OD), and the third (control) group was composed of 8 young healthy subjects (Y). All subjects were tested with eyes closed, before and after tactile plantar stimulation lasting ten minutes. Center of pressure displacements were analyzed in terms of sway area, mean velocity, and mean root mean square (RMS) along both mediolateral and antero-posterior axes. RESULTS: Results showed that, before tactile plantar stimulation, the sway area and mean RMS were greater in O and OD subjects compared with Y ones. After tactile plantar stimulation, a decrease in the mean RMS was observed in OD subjects, this effect being significant only for the medio-lateral axis. CONCLUSIONS: These results suggest that application of tactile plantar stimulation may compensate a loss of superficial plantar sensitivity. [ABSTRACT FROM AUTHOR]

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]

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.

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

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]

The aims of the present study were: (1) to assess aerobic metabolism in paraplegic (P) athletes (spinal lesion level, T4–L3) by means of peak oxygen uptake ( V˙O2peak) and ventilatory threshold (VT), and (2) to determine the nature of exercise limitation in these athletes by means of cardioventilatory responses at peak exercise. Eight P athletes underwent conventional spirographic measurements and then performed an incremental wheelchair exercise on an adapted treadmill. Ventilatory data were collected every minute using an automated metabolic system: ventilation (l · min−1), oxygen uptake ( V˙O2, l · min−1, ml · min−1 · kg−1), carbon dioxide production ( V˙CO2, ml · min−1), respiratory exchange ratio, breathing frequency and tidal volume. Heart rate (HR, beats · min−1) was collected with the aid of a standard electrocardiogram. V˙O2peak was determined using conventional criteria. VT was determined by the breakpoint in the V˙CO2− V˙O2 relationship, and is expressed as the absolute VT ( V˙O2, ml · min−1 · kg−1) and relative VT (percentage of V˙O2peak). Spirometric values and cardioventilatory responses at rest and at peak exercise allowed the measurement of ventilatory reserve (VR), heart rate reserve (HRr), heart rate response (HRR), and O2 pulse (O2 P). Results showed a V˙O2peak value of 40.6 (2.5) ml · min−1 · kg−1, an absolute VT detected at 23.1 (1.5) ml · min−1 · kg−1 V˙O2 and a relative VT at 56.4 (2.2)% V˙O2peak. HRr [15.8 (3.2) beats · min−1], HRR [48.6 (4.3) beat · l−1], and O2 P [0.23 (0.02) ml · kg−1 · beat−1] were normal, whereas VR at peak exercise [42.7 (2.4)%] was increased. As wheelchair exercise excluded the use of an able-bodied (AB) control group, we compared our V˙O2peak and VT results with those for other P subjects and AB controls reported in the literature, and we compared our cardioventilatory responses with those for respiratory and cardiac patients. The low V˙O2peak values obtained compared with subject values obtained during an arm-crank exercise may be due to a reduced active muscle mass. Absolute VT was somewhat comparable to that of AB subjects, mainly due to the similar muscle mass involved in wheelchair and arm-crank exercise by P and AB subjects, respectively. The increased VR, as reported in patients with chronic heart failure, suggested that P athletes exhibited cardiac limitation at peak exercise, and this contributed to the lower V˙O2peak measured in these subjects. [ABSTRACT FROM AUTHOR]

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.