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1. Low-Density Lipoprotein Cholesterol and Mortality in Patients With Intracerebral Hemorrhage in Taiwan

Author

Chi-Pang Wen, Yi-Che Lee, Yuan-Ting Sun, Chih-Yuan Huang, Chon-Haw Tsai, Po-Lin Chen, Wei-Lun Chang, Po-Yen Yeh, Cheng-Yu Wei, Ming-Jun Tsai, Yu Sun, Chih-Hao Lin, Jiunn-Tay Lee, Ta-Chang Lai, Li-Ming Lien, Mei-Chen Lin, Cheng-Li Lin, June-Han Lee, Hao-Kuang Wang, Chung Y. Hsu, Taiwan Stroke Registry Investigators, Chung-Hsiang Liu, Wei-Shih Huang, Chung-Ta Lu, Tzung-Chang Tsai, Chun-Hung Tseng, Kang-Hsu Lin, Woei-Cherng Shyn, Yu-Wan Yang, Yen-Liang Liu, Der-Yang Cho, Chun-Chung Chen, Shih-Pin Hsu, Han-Jung Chen, Cheng-Sen Chang, Hung-Chang Kuo, Lian-Hui Lee, Huan-Wen Tsui, Jung-Chi Tsou, Yan-Tang Wang, Yi-Cheng Tai, Kun-Chang Tsai, Yen-Wen Chen, Kang Lu, Po-Chao Liliang, Yu-Tun Tsai, Cheng-Loong Liang, Kuo-Wei Wang, Jui-Sheng Chen, Po-Yuan Chen, Cien-Leong Chye, Wei-Jie Tzeng, Pei-Hua Wu, Chih-Hung Chen, Han-Chieh Hsieh, Hui-Chen Su, Yu-Shan Lee, Hsin-Yi Chi, Chou-Hsiung Pan, Po-Chi Chan, Min-Hsien Hsu, Ya-Ying Wu, Zhi-Zang Huang, Hai-Ming Shoung, Yi-Chen Lo, Fu-Hwa Wang, Chien-Chung Chen, Yu-Tai Tsai, Ko-Yi Wang, Tzu-Hsuan Huang, Chao-Nan Yang, Chao-Hsien Hung, Ian Shih, Hsin-Yi Kao, Chien-Jung Lu, Cheng-Huai Lin, Chieh-Cheng Huang, Chang-Hsiu Liu, Hoi-Fong Chan, Ping-Kun Chen, Pai-Yi Chiu, Jiann-Chyun Lin, Yaw-Don Hsu, Jong-Chyou Denq, Giia-Sheun Peng, Chang-Hung Hsu, Chun-Chieh Lin, Che-Hung Yen, Chun-An Cheng, Yueh-Feng Sung, Yuan-Liang Chen, Ming-Tung Lien, Chung-Hsing Chou, Chia-Chen Liu, Fu-Chi Yang, Yi-Chung Wu, An-Chen Tso, Yu-Hua Lai, Chun-I Chiang, Chia-Kuang Tsai, Meng-Ta Liu, Ying-Che Lin, Yu-Chuan Hsu, Jiu-Haw Yin, Chung-JenWang, Kai-ChenWang, Li-Mei Chen, Hou-Chang Chiu, Wei-Hung Chen, Chyi-Huey Bai, Chi-Ieong Lau, Hsu-Ling Yeh, Anna Chang, Jiann-Shing Jeng, Sung-Chun Tang, Li-Kai Tsai, Shin-Joe Yeh, Ching-Huang Lin, Cheng-Chang Yen, Ruey-Tay Lin, Chun-Hung Chen, Gim-Thean Khor, A-Ching Chao, Hsiu-Fen Lin, Poyin Huang, Huey-Juan Lin, Der-Shin Ke, Chia-Yu Chang, Poh-Shiow Yeh, Kao-Chang Lin, Tain-Junn Cheng, Chih-Ho Chou, Chun-Ming Yang, Hsiu-Chu Shen, An-Chih Chen, Shih-Jei Tsai, Tsong-Ming Lu, Sheng-Ling Kung, Mei-Ju Lee, Hsi-Hsien Chou, Siu-Pak Lee, Ming-Hui Sun, Li-Ying Ke, Sheng-Feng Sung, Cheung-Ter Ong, Chi-Shun Wu, Yu-Hsiang Su, Ling-Chien Hung, Tsuey-Ru Chiang, Mei-Ching Lee, Pai-Hao Huang, Sian-King Lie, Pin-Wen Liao, Jen-Tse Chen, Mu-Chien Sun, Tien-Pao Lai, Wei-Liang Chen, Yen-Chun Chen, Ta-Cheng Chen, Wen-Fu Wang, Kwo-Whei Lee, Chen-Shu Chang, Chien-Hsu Lai, Siao-Ya Shih, Chieh-Sen Chuang, Yen-Yu Chen, Chien-Min Chen, Shinn-Kuang Lin, Yu-Chin Su, Cheng-Lun Hsiao, Fu-Yi Yang, Chih-Yang Liu, Han-Lin Chiang, Ser-Chen Fu, Chun-Yuan Chang, I-sheng Lin, Chung-Hsien Chien, Yang-Chuang Chang, Yu-Jen Hsiao, Chen-Wen Fang, Yu-Wei Chen, Kuo-Ying Lee, Yun-Yu Lin, Chen-Hua Li, Hui-Fen Tsai, Chuan-Fa Hsieh, Chih-Dong Yang, Shiumn-Jen Liaw, How-Chin Liao, Shoou-Jeng Yeh, Liang-Po Hsieh, Yong-Hui Lee, Chung-Wen Chen, Chih-Shan Hsu, Ye-Jian-Jhih, Hao-Yu Zhuang, Yan-Hong Pan, Shin-An Shih, Chin-I Chen, Jia-Ying Sung, Hsing-Yu Weng, Hao-Wen Teng, Jing-Er Lee, Chih-Shan Huang, Shu-Ping Chao, Rey-Yue Yuan, Jau-Jiuan Sheu, Jia-Ming Yu, Chun-Sum Ho, Ting-Chun Lin, Shih-Chieh Yu, Jiunn-Rong Chen, Song-Yen Tsai, Hung-Pin Tseng, Chin-Hsiung Liu, Chun-Liang Lin, Hung-Chih Lin, Pi-Tzu Chen, Chaur-Jong Hu, Nai-Fang Chi, Lung Chan, Chang-Ming Chern, Chun-Jen Lin, Shuu-Jiun Wang, Li-Chi Hsu, Wen-Jang Wong, I-Hui Lee, Der-Jen Yen, Ching-Piao Tsai, Shang-Yeong Kwan, Bing-Wen Soong, Shih-Pin Chen, Kwong-Kum Liao, Kung-Ping Lin, Chien Chen, Din-E Shan, Jong-Ling Fuh, Pei-Ning Wang, Yi-Chung Lee, Yu-Hsiang Yu, Hui-Chi Huang, Jui-Yao Tsai, Ming-Hsiu Wu, Shi-Cheng Chen, Chiung-Yao Wang, Ming-Chin Hsu, Tsang-Shan Chen, Ping-Keung Yip, Vinchi Wang, Kaw-ChenWang, Chung-Fen Tsai, Chao-Ching Chen, Chih-Hao Chen, Yi-Chien Liu, Shao-Yuan Chen, Zi-Hao Zhao, Zhi-Peng Wei, Shey-Lin Wu, Ching-Kuan Liu, Ryh-Huei Lin, Ching-Hua Chu, Sui-Hing Yan, Yi-Chun Lin, Pei-Yun Chen, Sheng-Huang Hsiao, Bak-Sau Yip, Pei-Chun Tsai, Ping-Chen Chou, Tsam-Ming Kuo, Yi-Chen Lee, Yi-Pin Chiu, and Yi-Sheng Liao

Subjects
stroke, ICH, LDL, Taiwan Stroke Registry, mortality, proportional hazards regression analysis, Neurology. Diseases of the nervous system, RC346-429
Abstract

Objective: Lower serum low-density lipoprotein cholesterol (LDL-C) levels are associated with increased intracerebral hemorrhage (ICH) risk. However, reverse causality and residual confounding has not attracted public attention. Therefore, we assessed whether people with LDL-C have increased risk of mortality adjusting for potential confounders using two large Taiwan cohorts.Methods: The Mei-Jhao (MJ) cohort has 414,372 adults participating in a medical screening program with 378 ICH deaths within 15 years of follow-up (1994–2008). Cox proportional hazards regressions estimated hazard death ratios according to LDL-C levels. We identified 4,606 ICH patients from the Taiwan Stroke Registry (TSR) and analyzed the impact of LDL-C on 3-month mortality.Results: Low cholesterol (LDL-C

Published
2022
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2. 10th Anniversary of Asia Pacific Stroke Organization: State of Stroke Care and Stroke Research in the Asia Pacific

Author

Kay-Sin Tan, Byung-Woo Yoon, Ruey-Tay Lin, Man Mohan Mehndiratta, Nijasri C. Suwanwela, and Narayanaswamy Venketasubramanian

Subjects
Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

The Asia Pacific Stroke Organization is the largest international and professional stroke group in the region. It has worked consistently over the last 10 years to gain visibility and reliability across the Asia Pacific and beyond. The 10 year journey will be reviewed in the background of many internal and external developments including changes in Asia Pacific stroke epidemiology, stroke care systems, stroke service developments as well as major research studies in the Asia Pacific.

Published
2021
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3. Early functional improvement after stroke correlates with cardiovascular fitness

Author

Chun-Kai Chen, Mao-Hsiung Huang, Wen-Lung Liang, Ruey-Tay Lin, and Suh-Hang H. Juo

Subjects
Medicine (General), R5-920
Abstract

Cardiovascular fitness exerts directly beneficial effects on functional and cognitive outcomes in patients of chronic stroke. However, the effect of early rehabilitation on cardiovascular function has not yet been thoroughly examined. We tested whether complementary rehabilitation program could influence cardiovascular fitness in an early stage of stroke patients. The associations for post-acute stroke functional recovery with cardiovascular fitness were explored. Thirty-seven patients with mean poststroke interval of 8.6 ± 3.8 days underwent inpatient rehabilitation of 22.8 ± 3.8 days. Functional outcomes of 15.3 points (17.2%) in functional independence measure improved after rehabilitation program. The therapeutic cardiovascular fitness was determined in ramp exercise test on a cycling ergometer. Peak oxygen uptake (V˙O2peak) significantly increased by 24.8% after early stroke rehabilitation. Multivariate regression analysis was performed to assess for associations of functional improvement with respect to change in V˙O2peak and extremities motor impairment. V˙O2peak gain accounted for more functional recovery than extremities motor improvement (R2 = 0.42). In conclusion, these results suggest that cardiovascular fitness appears to increase after complementary program in early stroke rehabilitation, and better cardiovascular fitness may be associated with greater functional improvement. Keywords: Fitness, Oxygen uptake, Rehabilitation, Stroke

Published
2018
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4. Impact of MCA stenosis on the early outcome in acute ischemic stroke patients.

Author

Jiann-Shing Jeng, Fang-I Hsieh, Hsu-Ling Yeh, Wei-Hung Chen, Hou-Chang Chiu, Sung-Chun Tang, Chung-Hsiang Liu, Huey-Juan Lin, Shih-Pin Hsu, Yuk-Keung Lo, Lung Chan, Chih-Hung Chen, Ruey-Tay Lin, Yu-Wei Chen, Jiunn-Tay Lee, Chung-Hsin Yeh, Ming-Hui Sun, Ta-Chang Lai, Yu Sun, Mu-Chien Sun, Po-Lin Chen, Tsuey-Ru Chiang, Shinn-Kuang Lin, Bak-Sau Yip, Chin-I Chen, Chi-Huey Bai, Sien-Tsong Chen, Hung-Yi Chiou, Li-Ming Lien, Chung Y Hsu, and Taiwan Stroke Registry Investigators

Subjects
Medicine, Science
Abstract

BACKGROUND:Asians have higher frequency of intracranial arterial stenosis. The present study aimed to compare the clinical features and outcomes of ischemic stroke patients with and without middle cerebral artery (MCA) stenosis, assessed by transcranial sonography (TCS), based on the Taiwan Stroke Registry (TSR). METHODS:Patients with acute ischemic stroke or transient ischemic attack registered in the TSR, and received both carotid duplex and TCS assessment were categorized into those with stenosis (≥50%) and without (

Published
2017
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5. Effects of metabolic syndrome, apolipoprotein E, and CYP46 on cognition among Taiwanese Chinese

Author

Chiou-Lian Lai, Li-Min Liou, Ching-Kuan Liu, Yuan-Han Yang, and Ruey-Tay Lin

Subjects
Apolipoprotein E, Cognition, CYP46, Metabolic syndrome, Medicine (General), R5-920
Abstract

The combined effects of metabolic syndrome and the apolipoprotein E and CYP46 genotypes on the risk of cognitive decline has yet to be determined among Taiwanese Chinese. Two hundred and nine mentally healthy middle-aged and older adults were assessed for metabolic syndrome, cognitive function using the Cognitive Abilities Screening Instrument, Mini-Mental State Examination, ApoE, and CYP46 polymorphisms. There were no differences in cognitive performance, ApoE epsilon4 (ε4) carrier status, or CYP46 genotypes between participants with and those without metabolic syndrome. The ε4 carriers and participants with the AA allele of CYP46 had significantly lower mental manipulation score. Metabolic syndrome and ε4 had synergistic effects on cognitive decline. Therefore, the ε4 carriers and participants with the AA allele of CYP46 have decreased mental manipulation ability. The metabolic syndrome may play a role in subtle cognitive dysfunction in ε4 carriers among Taiwanese Chinese.

Published
2014
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6. Predictive value of vertebral artery extracranial color-coded duplex sonography for ischemic stroke-related vertigo

Author

Li-Min Liou, Hsiu-Fen Lin, I-Fang Huang, Yang-Pei Chang, Ruey-Tay Lin, and Chiou-Lian Lai

Subjects
Ischemic stroke, Posterior circulation, Sonography, Vertebral artery, Vertigo, Medicine (General), R5-920
Abstract

Vertigo can be a major presentation of posterior circulation stroke and can be easily misdiagnosed because of its complicated presentation. We thus prospectively assessed the predictive value of vertebral artery extracranial color-coded duplex sonography (ECCS) for the prediction of ischemic stroke-related vertigo. The inclusion criteria were: (1) a sensation of whirling (vertigo); (2) intractable vertigo for more than 1 hour despite appropriate treatment; and (3) those who could complete cranial magnetic resonance imaging (MRI) and vertebral artery (V2 segment) ECCS studies. Eventually, 76 consecutive participants with vertigo were enrolled from Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan between August 2010 and August 2011. Demographic data, neurological symptoms, neurologic examinations, and V2 ECCS were assessed. We chose the parameters of peak systolic velocity (PSV), end diastolic velocity (EDV), PSV/EDV, mean velocity (MV), resistance index (RI), and pulsatility index (PI) to represent the hemodynamics. Values from both sides of V2 segments were averaged. We then calculated the average RI (aRI), average PI (aPI), average PSV (aPSV)/EDV, and average (aMV). Axial and coronal diffusion-weighted MRI findings determined the existence of acute ischemic stroke. We grouped and analyzed participants in two ways (way I and way II analyses) based on the diffusion-weighted MRI findings (to determine whether there was acute stroke) and neurological examinations. Using way I analysis, the “MRI (+)” group had significantly higher impedance (aRI, aPI, and aPSV/EDV ratio) and lower velocity (aPSV, aEDV, and aMV(PSV + EDV/2)), compared to the “MRI (–)” group. The cutoff value/sensitivity/specificity of aPSV, aEDV, aMV, aPI, aRI, and aPSV/EDV between the MRI (+) and MRI (–) groups were 41.15/61.5/66.0 (p = 0.0101), 14.55/69.2/72.0 (p = 0.0003), 29.10/92.1/38.0 (p = 0.0013), 1.07/76.9/64.0 (p = 0.0066), 0.62/76.9/64.0 (p = 0.0076), and 2.69/80.8/66.0 (p = 0.0068), respectively. Using way II analysis, lower aEDV and aMV, and higher aRI, aPI, and aPSV/EDV ratio could determine the “MRI (+) without focal signs” group. The cutoff value/sensitivity/specificity of aEDV, aMV, aPI, aRI, and aPSV/EDV between the MRI (+) without focal signs and MRI (–) groups were 9.10/71.4/96.0 (p = 0.0005), 15.65/57.1/96.0 (p = 0.0124), 1.10/100/70.0 (p = 0.0002), 0.64/100/70.0 (p = 0.0023), and 2.80/100/70.0 (p = 0.0017), respectively. In conclusion, using demographic data and clinical symptoms, it was difficult to determine the patients with ischemic stroke-related vertigo. Although neurological examinations still have diagnostic value, the high impedance and low velocity pattern of V2 ECCS can be an add-on method for the screening of acute ischemic stroke-related vertigo, even for those without focal neurological signs.

Published
2013
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7. The role of cognitive event-related potentials in executive dysfunction

Author

Chiou-Lian Lai, Ruey-Tay Lin, Li-Min Liou, Yuan-Han Yang, and Ching-Kuan Liu

Subjects
Event-related potential, Executive function, Frontal lesion, P300, Medicine (General), R5-920
Abstract

Frontal lobes are great and are a late-developing region of the neocortex that play a critical role in human behavior and executive function. The aim of this study was to clarify the role of event-related potentials (ERPs) in executive dysfunction and its relationship between generator mechanism and cognitive significance. We recruited 20 patients with frontal lobe lesion (FLL) and 27 age-matched controls. All patients submitted to comprehensive Frontal Test Battery and auditory ERPs measurement. In comparison with controls, the patients with FLL had significantly decreased executive function and manifested the delay of P300 latency, which reflected a delay of mental processing speed in these patients. Our findings suggest that patients with FLL may have prolonged P300 latency, which has a good correlation with executive dysfunction, poor performance, and longer P300 latencies. P300 ERPs are considered to be a useful method to identify the alteration of frontal-parietal connection.

Published
2013
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8. Timing of stroke onset determines discharge-functional status but not stroke severity: A hospital-based study

Author

Li-Min Liou, Hsiu-Fen Lin, Chin-Ling Tsai, Ruey-Tay Lin, and Chiou-Lian Lai

Subjects
Circadian variation, Functional outcome, Stroke onset, Medicine (General), R5-920
Abstract

Circadian variation of the onset time of acute ischemic stroke has been well studied. However, little is mentioned about the circadian variation of discharge-stroke severity and discharge-functional status. This study evaluated the impact of onset time on discharge-stroke severity and the functional status of acute ischemic stroke. Brain magnetic resonance imaging was performed on 274 acute ischemic stroke patients (66.42% male; mean age = 64.81 ± 12.80 years). All times of onset were assigned to 4-hourly periods (six groups) starting from midnight. Stroke severity/functional status was evaluated on admission and discharge using the National Institute of Health Stroke Scale (NIHSS) score/modified Rankin Scale (mRS) and Barthel Index (BI), respectively. Using mRS, but not NIHSS score and BI, it was possible to differentiate the best and worst groups on discharge. Patients in group 2 (4 to

Published
2013
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10. Reappraisal of heart rate variability in acute ischemic stroke

Author

Chien-Fu Chen, Chiou-Lian Lai, Hsiu-Fen Lin, Li-Min Liou, Ruey-Tay Lin, 陳建甫, 賴秋蓮, 林秀芬, 劉立民, and 林瑞泰

Subjects
Acute ischemic stroke, Cardiac autonomic function, Heart rate variability, Large-artery atherosclerosis, Small-vessel occlusion, Medicine (General), R5-920
Abstract

Cardiac autonomic dysfunction is a common complication after acute ischemic stroke (IS). Prior investigators have emphasized that infarction of brain stem or hemispheres with insular involvement is related to this dysfunction and may predict poor clinical outcome. From the viewpoint of stroke physicians, however, all stroke patients, particularly large-artery atherosclerosis (LAA) should be monitored for possible cardiac complications after acute IS. This study aimed to investigate cardiac autonomic impaction in patients with acute IS and to make the comparison between LAA and small-vessel occlusion (SVO) subtypes. Of the 126 acute IS patients prospectively enrolled in this study, 32 had LAA, 56 had SVO, and 38 had undetermined etiology according to the Trial of Org 10172 in Acute Stroke Treatment criteria. Cardiac autonomic function of all patients was assessed by measuring heart rate variability (HRV). The low- and high-frequency components of HRV in all stroke patients were significantly lower than those of control subjects after comparing multivariable models, including additional adjustments for age, gender, and all risk factors. There were no significant differences on HRV between LAA and SVO although post hoc comparisons showed that stroke patients of SVO had increased sympathetic modulation and reduced vagal activity. In conclusion, in acute IS patients, both LAA and SVO are predisposed to have cardiac autonomic dysfunction, manifesting as abnormalities in HRV, whether in hemispheric or brain stem lesions. Stroke patients of SVO are at higher risks of cardiac abnormalities, which might suggest an early cardiac dysfunction because of long-term hypertension. The HF component of HRV thought to be for vagal control might be a cardinal marker for predicting cardiac autonomic dysfunction after acute IS. Short-term HRV spectral analysis is a convenient approach for stroke clinicians to assess autonomic function in acute stroke. Long-term follow-up for HRV and clinical outcome relative to LAA and SVO stroke subtypes is warranted, particularly when an abnormal HRV is found at admission.

Published
2011
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11. Potential Risk and Protective Factors for In-Hospital Mortality in Hyperacute Ischemic Stroke Patients

Author

Chien-Hsun Li, Gim-Thean Khor, Chun-Hung Chen, Poyin Huang, and Ruey-Tay Lin

Subjects
hyperacute ischemic stroke, mortality, protective factor, risk factor, survival, Medicine (General), R5-920
Abstract

In the era of thrombolytic therapy for hyperacute ischemic stroke, most investigators have focused their attention on the factors influencing mortality and functional outcomes in patients treated with thrombolysis, but very few have focused on these factors among patients not receiving thrombolysis. The aim of this study was to investigate the prognostic factors for mortality in all hyperacute stroke patients with or without thrombolysis. In 2005, we enrolled 101 ischemic stroke patients (43 females, 58 males; mean age, 68 years) who were transported to the emergency department (ED) within 4 hours of symptom onset. The overall in-hospital mortality rate was 17.8% (18/101). According to t test analysis, age (p = 0.034), time interval from neurologist consultation (p < 0.0001) and ED to ward admission (p = 0.001), Glasgow coma scale (GCS) (p = 0.001), National Institutes of Health Stroke Scale (NIHSS) (p < 0.0001) and the sum of major risk factors of cerebrovascular disease (CVD) (p < 0.0001) were significantly different between mortality and survivor groups. Further χ2 test analysis revealed significant differences in the presenting consciousness disturbance (p = 0.001), place of attack (p = 0.04), and referral transportation (p = 0.008) between these groups. In conclusion, old age, delay between neurologist consultation and ward admission, severity of stroke, and multiple risk factors of CVD are significant risk factors for in-hospital mortality. Conversely, being free of initial consciousness disturbance, living in an urban area, and having direct transportation to a stroke center are protective factors in survivors. The concept of “brain attack” should be re-emphasized among ED physicians. The interconnection between stroke centers and emergency medical systems (EMS) should be more tightly built to promote timely management for hyperacute stroke care.

Published
2008
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12. Pre‐hospital and In‐hospital Delays After Onset of Acute Ischemic Stroke—A Hospital‐based Study in Southern Taiwan

Author

Chun‐Hung Chen, Poyin Huang, Yuan‐Han Yang, Ching‐Kuan Liu, Tzeng‐Jih Lin, and Ruey‐Tay Lin

Subjects
acute ischemic stroke, standardized pathway, stroke team, time lag, Medicine (General), R5-920
Abstract

The biggest hurdle for early hospital presentation is the narrow therapeutic window after stroke. The aims of our study were to investigate the time lags and the factors causing pre‐hospital and emergency department (ED) delay during acute ischemic stroke attack. Between June 2004 and October 2005, we prospectively studied 129 acute ischemic stroke patients who presented to the ED of the study hospital within 4 hours after symptom onset. Chi‐square testing for trend, uni‐variate and multiple logistic regression analyses was performed to evaluate the factors influencing delays in the ED presentation of acute ischemic stroke patients. The median time from symptom onset to ED arrival was 71 (mean ± SD, 82.7 ± 57.7) minutes. The median times from ED arrival to neurologic consultation, computed tomography scan, electrocardiogram, and laboratory data completion were 10 (11.3±9.9) minutes, 17 (9.6±11.3) minutes, 14 (23.3±55) minutes, and 39 (44.4±24.5) minutes, respectively. Univariate and multiple logistic regression models revealed that age < 65 years, illiteracy and awakening with symptoms were the most significant factors related to a delay in ED presentation. This study indicates that 2 hours of pre‐hospital delay is the cutoff point for thrombolytic therapy. Organization of a stroke team and standardized stroke pathways may help to shorten in‐hospital time consumption. Educational efforts should not only focus on the public, but also on the training of ED physicians and other medical personnel.

Published
2007
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13. Association of Apolipoprotein E Polymorphism with Ischemic Stroke Subtypes in Taiwan

Author

Chiou-Lian Lai, Ching-Kuan Liu, Ruey-Tay Lin, and Chih-Ta Tai

Subjects
apolipoprotein E, ischemic stroke, Taiwan, Medicine (General), R5-920
Abstract

The aim of this study was to clarify whether the apolipoprotein E gene (APOE) is related to ischemic stroke subtypes in Taiwan's Chinese population. Using the classification of Cerebrovascular Diseases III, 143 patients with lacunar infarction, 114 patients with atherothrombotic infarction, and 112 healthy controls were enrolled. APOE genotype was determined using polymerase chain reaction. Regarding the distribution of APOE genotypes, the frequency of ϵ3/ϵ4 genotypes in lacunar patients was significantly different from that in control subjects, by logistic regression, using ϵ3/ϵ3 as a reference group. There was no significant difference between atherothrombotic patients and the control group in the distribution of APOE genotypes or alleles. The present finding suggests that there is a probable association between ϵ3/ϵ4 genotype and lacunar infarcts, but not atherothrombotic infarcts. This indicates that genetic factors may play a role, at least partially, in lacunar infarction in Taiwan's Chinese population.

Published
2007
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14. Mechanisms of Cough Syncope as Evaluated by Valsalva Maneuver

Author

A-Ching Chao, Ruey-Tay Lin, Ching-Kuan Liu, Pao-Yu Wang, and Hung-Yi Hsu

Subjects
cough syncope, hypotension, intrathoracic pressure, valsalva maneuver, Medicine (General), R5-920
Abstract

Successful treatment of cough syncope depends on the correction of various pathogenetic mechanisms among different patients. The valsalva maneuver (VM), which elicits hemodynamic responses mimicking coughs, has potential for investigating the individual pathogenesis of cough syncope. Eighteen consecutive patients suffering from cough-induced syncope were examined. All patients were asked to cough and to perform VM several times under continuous cerebral blood-flow velocity and blood pressure (BP) monitoring by transcranial Doppler and finger plethysmography. Eight patients demonstrated abnormal VM characterized by the absent BP overshoot following the relief of straining. Patients demonstrating abnormal VM had delayed BP recovery after cough (median, 16.4; range, 8.7–25.6 seconds) compared to those demonstrating normal VM (2.6, 1.3–3.8 seconds, p < 0.001). Seven of the 10 patients exhibiting normal BP overshoot during VM had stenotic arterial lesions in the cerebral or coronary circulation, whereas only one of the eight patients demonstrating absent BP overshoot had coronary artery disease (70% vs. 12.5%, p = 0.025). Other clinical profiles, body mass index, frequency of obstructive pulmonary disease and valsalva ratio did not differ between patients featuring normal and absent BP overshoot. In conclusion, the pathogenesis of cough syncope could be different between patients with normal and abnormal VM responses. Patients who had no BP overshoot during VM sustained prolonged hypotension after cough. The VM helps in discriminating among pathogenic mechanisms and guiding investigation and treatment for cough syncope patients.

Published
2007
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15. Demethylation of Circulating Estrogen Receptor Alpha Gene in Cerebral Ischemic Stroke.

Author

Hsiu-Fen Lin, Edward Hsi, Yi-Chu Liao, Brian Chhor, Jessica Hung, Suh-Hang H Juo, and Ruey-Tay Lin

Subjects
Medicine, Science
Abstract

Estrogen is involved in neuron plasticity and can promote neuronal survival in stroke. Its actions are mostly exerted via estrogen receptor alpha (ERα). Previous animal studies have shown that ERα is upregulated by DNA demethylation following ischemic injury. This study investigated the methylation levels in the ERα promoter in the peripheral blood of ischemic stroke patients.The study included 201 ischemic stroke patients, and 217 age- and sex-comparable healthy controls. The quantitative methylation level in the 14 CpG sites of the ERα promoter was measured by pyrosequencing in each participant. Multivariate regression model was used to adjust for stroke traditional risk factors. Stroke subtypes and sex-specific analysis were also conducted.The results demonstrated that the stroke cases had a lower ERα methylation level than controls in all 14 CpG sites, and site 13 and site 14 had significant adjusted p-values of 0.035 and 0.026, respectively. Stroke subtypes analysis showed that large-artery atherosclerosis and cardio-embolic subtypes had significantly lower methylation levels than the healthy controls at CpG site 5, site 9, site 12, site 13 and site 14 with adjusted p = 0.039, 0.009, 0.025, 0.046 and 0.027 respectively. However, the methylation level for the patients with small vessel subtype was not significant. We combined the methylation data from the above five sites for further sex-specific analysis. The results showed that the significant association only existed in women (adjusted p = 0.011), but not in men (adjusted p = 0.300).Female stroke cases have lower ERα methylation levels than those in the controls, especially in large-artery and cardio-embolic stroke subtypes. The study implies that women suffering from ischemic stroke of specific subtype may undergo different protective mechanisms to reduce the brain injury.

Published
2015
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16. Postmalaria Neurologic Syndrome: A Case Report

Author

Cheng-Fang Hsieh, Pang-Ying Shih, and Ruey-Tay Lin

Subjects
glucocorticoid, malaria, postmalaria neurologic syndrome, single photon emission computed tomography, Medicine (General), R5-920
Abstract

Neurologic signs and symptoms are common in acute malarial infection. However, after the parasites have been cleared from the blood and patients recover full consciousness, neurologic or psychiatric symptoms may occur or recur within 2 months after the acute illness. This phenomenon is called “postmalaria neurologic syndrome” (PMNS). We present a 50-year-old man who returned from the Republic of Malawi and soon developed Plasmodium falciparum malaria. Cerebral malaria, renal failure, hepatic failure, diffuse intravascular coagulation with thrombocytopenia, and upper gastrointestinal bleeding were noted during the acute stage. He was admitted to the infectious diseases ward and treated for 3 weeks. He was free from clinical general symptoms and parasites in blood smear when discharged. However, 2 weeks after discharge, he began to experience severe headache, dizziness, diplopia, mild hand tremor, unsteady gait, and easy falling. When readmitted to the neurologic ward, he presented with irritability, delirium, visual hallucination, and strange behavior. Neurologic examination was normal except for mild general weakness and evident truncal ataxia when walking. Brain magnetic resonance imaging revealed no structural lesions, and electroencephalography showed diffuse cortical dysfunction. Cerebral spinal fluid profile exhibited cytoalbuminologic dissociation. Brain single photon emission computed tomography showed diffuse cerebral parenchymal disorder. Nerve conduction studies revealed early sensory predominant polyneuropathy. The unsteadiness persisted for the initial 2 weeks of hospitalization until corticosteroid was administered. Intravenous methylprednisolone (80 mg/day) was continued for 3 days, followed by oral prednisolone (45 mg/day). His unsteadiness improved gradually after medication, and he absconded from the hospital on the 9th day of corticosteroid treatment with clear consciousness and free ambulation. The manifestation of PMNS is diverse and may present as an acute confusional state or psychosis, generalized seizure, fine tremors, cerebellar syndromes, postural hypotension, or malarial polyneuritis. Although the neurologic syndrome is primarily self-limited in most cases, corticosteroid may be beneficial in reversing PMNS.

Published
2006
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17. Status Epilepticus as an Initial Manifestation of Neurosyphilis: A Case Report

Author

Chien-Hsun Li and Ruey-Tay Lin

Subjects
CNS disease, neurosyphilis, status epilepticus, Medicine (General), R5-920
Abstract

Seizures and focal neurologic deficits may be the complications of neurosyphilis, but status epilepticus as a presenting picture of neurosyphilis is rare. We describe a 41-year-old man with an acute onset of expressive dysphasia, followed by persistent seizure state and severe complications of systemic medical problems. An extensive laboratory evaluation confirmed the diagnosis of neurosyphilis and diabetes mellitus. Brain magnetic resonance imaging showed edematous change in the left cingulate gyrus, left temporal lobe, and peri-Rolandic area, which suggested an inflammatory process. Due to varied clinical manifestations of neurosyphilis, we underscore the importance of considering neurosyphilis among the possible causes of status epilepticus and any central nervous system diseases.

Published
2006
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18. Cut-off Values of Blessed Dementia Rating Scale and Its Clinical Application in Elderly Taiwanese

Author

Yuan-Han Yang, Chiou-Lian Lai, Ruey-Tay Lin, Chih-Ta Tai, and Ching-Kuan Liu

Subjects
Blessed Dementia Rating Scale, Clinical Dementia Rating Scale, dementia, mild cognitive impairment, Mini Mental State Examination, Medicine (General), R5-920
Abstract

Although the Blessed Dementia Rating Scale (BDRS), a clinical screening instrument, has been applied extensively, no suitable cut-off values and clinical application have been proposed, particularly in mild cognitive impairment (MCI), the precursor of dementia. The BDRS, Mini Mental State Examination (MMSE), and Clinical Dementia Rating Scale (CDR) were administrated in people aged 65 years and above, who were enrolled from southern Taiwan with multistep stratified random sampling and followed-up for 2 years. All subjects (total number = 3,027), with new onset of MCI (defined as CDR = 0.5) in the first year and dementia (defined as CDR ≥ 1) in the second and third years were subjected to statistical analysis. In distinguishing normal from MCI, except in the literate group aged 65-74 years, MMSE was superior to BDRS, with cut-off values of 1 in both literate groups aged 65-74 years and ≥ 75 years, and 1.5 and 2 in less educated groups aged 65-74 and ≥ 75 years, respectively. In distinguishing MCI from dementia, BDRS had cut-off values of 2.5 in both literate groups aged 65-74 and ≥ 75 years, and 2.5 and 3 in less educated groups aged 65-74 and ≥ 75 years, respectively. These values were better than those for MMSE in all groups. BDRS might be considered as a better tool than MMSE to screen for MCI and dementia in the increasing proportion of literate elderly aged 65-74 years in the aging population.

Published
2006
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19. Successful Treatment of Cerebral Venous Thrombosis Associated with Bilateral Internal Jugular Vein Stenosis Using Direct Thrombolysis and Stenting: A Case Report

Author

Poyin Huang, Yuan-Han Yang, Chun-Hung Chen, and Ruey-Tay Lin

Subjects
cerebral venous thrombosis, internal jugular vein stenosis, thrombolysis, stenting, Medicine (General), R5-920
Abstract

Cerebral venous thrombosis (CVT) is not uncommon, but CVT associated with bilateral internal jugular vein stenosis (BIJVS) is rare. Bilateral internal jugular vein stenting is also a rare procedure. We report on a patient with CVT associated with BIJVS, who was treated successfully using direct thrombolysis and bilateral internal jugular vein stenting.

Published
2005
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20. MicroRNA-152 mediates DNMT1-regulated DNA methylation in the estrogen receptor α gene.

Author

Yung-Song Wang, Wen-Wen Chou, Ku-Chung Chen, Hsin-Yun Cheng, Ruey-Tay Lin, and Suh-Hang Hank Juo

Subjects
Medicine, Science
Abstract

BackgroundEstrogen receptor α (ERα) has been shown to protect against atherosclerosis. Methylation of the ERα gene can reduce ERα expression leading to a higher risk for cardiovascular disease. Recently, microRNAs have been found to regulate DNA methyltransferases (DNMTs) and thus control methylation status in several genes. We first searched for microRNAs involved in DNMT-associated DNA methylation in the ERα gene. We also tested whether statin and a traditional Chinese medicine (San-Huang-Xie-Xin-Tang, SHXXT) could exert a therapeutic effect on microRNA, DNMT and ERα methylation.Methodology/principal findingsThe ERα expression was decreased and ERα methylation was increased in LPS-treated human aortic smooth muscle cells (HASMCs) and the aorta from rats under a high-fat diet. MicroRNA-152 was found to be down regulated in the LPS-treated HASMCs. We validated that microRNA-152 can knock down DNMT1 in HASMCs leading to hypermethylation of the ERα gene. Statin had no effect on microRNA-152, DNMT1 or ERα expression. On the contrary, SHXXT could restore microRNA-152, decrease DNMT1 and increase ERα expression in both cellular and animal studies.Conclusions/significanceThe present study showed that microRNA-152 decreases under the pro-atherosclerotic conditions. The reduced microRNA-152 can lose an inhibitory effect on DNA methyltransferase, which leads to hypermethylation of the ERα gene and a decrease of ERα level. Although statin can not reverse these cascade proatherosclerotic changes, the SHXXT shows a promising effect to inhibit this unwanted signaling pathway.

Published
2012
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21. Sex differential genetic effect of chromosome 9p21 on subclinical atherosclerosis.

Author

Hsiu-Fen Lin, Pei-Chien Tsai, Ruey-Tay Lin, Gim-Thean Khor, Sheng-Hsiung Sheu, and Suh-Hang Hank Juo

Subjects
Medicine, Science
Abstract

BACKGROUND: Chromosome 9p21 has recently been shown to be a risk region for a broad range of vascular diseases. Since carotid intima-media thickness (IMT) and plaque are independent predictors for vascular diseases, the association between 9p21 and these two phenotypes was investigated. METHODOLOGY/PRINCIPAL FINDINGS: Carotid segment-specific IMT and plaques were obtained in 1083 stroke- and myocardial infarction-free volunteers. We tested the genotypes and haplotypes of key single nucleotide polymorphisms (SNPs) on chromosome 9p21 for the associations with carotid IMT and plaque. Multivariate permutation analyses demonstrated that carriers of the T allele of SNP rs1333040 were significantly associated with thicker common carotid artery (CCA) IMT (p=0.021) and internal carotid artery (ICA) IMT (p=0.033). The risk G allele of SNP rs2383207 was associated with ICA IMT (p=0.007). Carriers of the C allele of SNP rs1333049 were found to be significantly associated with thicker ICA IMT (p=0.010) and the greater risk for the presence of carotid plaque (OR=1.57 for heterozygous carriers; OR=1.75 for homozygous carriers). Haplotype analysis showed a global p value of 0.031 for ICA IMT and 0.115 for the presence of carotid plaque. Comparing with the other haplotypes, the risk TGC haplotype yielded an adjusted p value of 0.011 and 0.017 for thicker ICA IMT and the presence of carotid plaque respectively. Further analyzing the data separated by sex, the results were significant only in men but not in women. CONCLUSIONS: Chromosome 9p21 had a significant association with carotid atherosclerosis, especially ICA IMT. Furthermore, such genetic effect was in a gender-specific manner in the Han Chinese population.

Published
2010
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22. 10th Anniversary of the Asia Pacific Stroke Organization: State of Stroke Care and Stroke Research in the Asia-Pacific

Author

Kay Sin Tan, Nijasri C. Suwanwela, Ruey-Tay Lin, Man Mohan Mehndiratta, Narayanaswamy Venketasubramanian, and Byung-Woo Yoon

Subjects
Economic growth, Asia, business.industry, media_common.quotation_subject, education, Stroke care, medicine.disease, Stroke, Anniversaries and Special Events, Asia pacific, Neurology, State (polity), RC666-701, medicine, Research studies, Diseases of the circulatory (Cardiovascular) system, Humans, cardiovascular diseases, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, media_common
Abstract

The Asia Pacific Stroke Organization is the largest international and professional stroke group in the region. It has worked consistently over the last 10 years to gain visibility and consistency across the Asia-Pacific and beyond. The 10-year journey will be reviewed in the background of many internal and external developments including changes in Asia-Pacific stroke epidemiology, stroke care systems, and stroke service developments as well as major research studies in the Asia-Pacific.

Published
2021

23. Asia Pacific Stroke Organization

Author

Ruey-Tay Lin, Narayanaswamy Venketasubramanian, Man Mohan Mehndiratta, Nijasri C. Suwanwela, Kay Sin Tan, and Byung-Woo Yoon

Subjects
Advanced and Specialized Nursing, Asia, business.industry, Organizations, Nonprofit, medicine.disease, Pacific Islands, Stroke, Asia pacific, medicine, Humans, Neurology (clinical), Cardiology and Cardiovascular Medicine, Socioeconomics, business, Health policy, Societies, Medical
Published
2021

24. Low Cholesterol Levels Increase Symptomatic Intracranial Hemorrhage Rates After Intravenous Thrombolysis: A Multicenter Cohort Validation Study

Author

Lung Chan, Sheng-Feng Lin, Shinn-Kuang Lin, Yu-Te Lin, Han-Hwa Hu, Jiunn-Tay Lee, Yu Sun, Ruey-Tay Lin, Chyi Huey Bai, Cheng-Yu Wei, Yung-Yang Lin, Chih Hung Chen, Huey-Juan Lin, Po Lin Chen, and A-Ching Chao

Subjects
Male, medicine.medical_specialty, Validation study, medicine.medical_treatment, Intracranial hemorrhage, 030204 cardiovascular system & hematology, Gastroenterology, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Internal medicine, Hyperlipidemia, Internal Medicine, medicine, Humans, Thrombolytic Therapy, Longitudinal Studies, Stroke, Aged, Cholesterol, business.industry, Low cholesterol levels, Cholesterol, HDL, Biochemistry (medical), Thrombolysis, Prognosis, medicine.disease, chemistry, Low-density lipoprotein cholesterol (LDL-C), Cohort, Administration, Intravenous, Female, Original Article, Cardiology and Cardiovascular Medicine, business, Intracranial Hemorrhages, Biomarkers, 030217 neurology & neurosurgery, Follow-Up Studies, Cohort study
Abstract

Aim: Although a lower level of non-high-density lipoprotein cholesterol (HDL-C) was reported to be inversely associated with spontaneous intracranial hemorrhage (ICH), no enough evidence has verified whether lipid profiles modify hemorrhagic transformation and functional outcomes in patients with acute ischemic treated with thrombolysis. Methods: This multicenter cohort study included 2373 patients with acute ischemic stroke treated with intravenous thrombolysis between December 2004 and December 2016. Of these, 1845 patients were categorized into either the hyperlipidemia or non-hyperlipidemia group. Symptomatic ICH (SICH) rates within 24–36 h of thrombolytic onset and functional outcomes at 30 and 90 days were longitudinally surveyed. Models of predicting hemorrhagic transformation were used to validate our findings. Results: For enrolled 1845 patients, SICH rates were ≥ 2-fold reduced for the hyperlipidemia group by the NINDS (adjusted RR: 0.488 [0.281–0.846], p = 0.0106), the ECASS II (adjusted RR: 0.318 [0.130–0.776], p = 0.0119), and SITS-MOST standards (adjusted RR: 0.214 [0.048–0.957], p = 0.0437). The favorable functional rates between the two groups were not significantly different. Lower levels of LDL-C were showed in robust association with SICH. With a cut-off LDL-C value of < 130 mg/dL, new models are more robust and significant in predicting hemorrhagic transformation within 24–36 h. Conclusions: This study supports the strong association between reduced LDL-C and increased SICH, but not for functional outcomes in patients with acute ischemic stroke treated with intravenous thrombolysis. LDL-C level of < 130 mg/dL is supposed to a candidate marker for predicting SICH within 24–36 h.

Published
2019

25. Statins and the risk of bleeding in patients taking dabigatran

Author

Chien-Fu Chen, A-Ching Chao, Bo-Lin Ho, Sheng-Feng Lin, Han-Hwa Hu, Ping-Song Chou, Ruey-Tay Lin, and Ya-Ju Lin

Subjects
Male, medicine.medical_specialty, Statin, medicine.drug_class, Hemorrhage, Kaplan-Meier Estimate, Lower risk, Antithrombins, Dabigatran, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, Atrial Fibrillation, medicine, Humans, Prospective Studies, cardiovascular diseases, 030212 general & internal medicine, Stroke, Aged, Proportional Hazards Models, Aged, 80 and over, Aspirin, business.industry, Anticoagulant, Hazard ratio, General Medicine, Middle Aged, medicine.disease, Neurology, Direct thrombin inhibitor, Polypharmacy, Female, Neurology (clinical), Hydroxymethylglutaryl-CoA Reductase Inhibitors, business, 030217 neurology & neurosurgery, medicine.drug
Abstract

OBJECTIVES Dabigatran etexilate is a direct thrombin inhibitor that clinicians increasingly prescribe to prevent stroke in patients with non-valvular atrial fibrillation (NVAF). Clinicians also commonly prescribe statins for primary and secondary prevention of cardiovascular diseases. Little is known about the bleeding risk in patients taking a statin and dabigatran together. The aim of this study was to evaluate the safety and persistence of dabigatran after co-medication with statins. MATERIALS AND METHODS We performed a prospective, multicenter registry study of stroke patients with NVAF who initiated dabigatran therapy within 3 months after a clinically evident ischemic cerebrovascular event between 2013 and 2017. The main outcome measure was symptomatic bleeding after 90, 180, and 360 days. RESULTS In total, 652 patients (336 statin users, 316 non-users) were followed for 1 year after dabigatran therapy. Cox multivariate analysis demonstrated that male sex, prior use of aspirin, and concurrent use of an antiarrhythmic drug were associated with a higher risk of bleeding at 360 days. After adjusting time-dependent covariates, statin users had a significantly lower bleeding risk (adjusted hazard ratio: 0.11, P

Published
2019

26. Effect of the Interaction Between Hypertension and Cerebral White Matter Changes on the Progression of Alzheimer Disease

Author

Yi-Hui Kao, Mei-Chuan Chou, Ping-Song Chou, Yuan-Han Yang, Ruey-Tay Lin, Chun-Hung Chen, and Meng-Ni Wu

Subjects
Male, medicine.medical_specialty, Longitudinal study, Tomography Scanners, X-Ray Computed, Psychometrics, Neuropsychological Tests, 03 medical and health sciences, 0302 clinical medicine, Alzheimer Disease, Leukoencephalopathies, Rating scale, Internal medicine, medicine, Humans, Dementia, In patient, Longitudinal Studies, Aged, Retrospective Studies, Aged, 80 and over, Cerebral Cortex, Cerebral white matter, business.industry, Confounding, medicine.disease, Magnetic Resonance Imaging, 030227 psychiatry, Neurology, Hypertension, Disease Progression, Cardiology, Female, Neurology (clinical), Alzheimer's disease, Mental Status Schedule, business, 030217 neurology & neurosurgery
Abstract

Background: Cerebrovascular pathologies and hypertension could play a vital role in Alzheimer disease (AD) progression. However, whether cerebrovascular pathologies and hypertension accelerate the AD progression through an independent or interaction effect is unknown. Objective: To investigate the effect of the interactions of cerebrovascular pathologies and hypertension on AD progression. Method: A retrospective longitudinal study was conducted to compare AD courses in patients with different severities of cerebral White Matter Changes (WMCs) in relation to hypertension. Annual comprehensive psychometrics were performed. WMCs were rated using a rating scale for Age-related WMCs (ARWMC). Results: In total, 278 patients with sporadic AD were enrolled in this study. The mean age of the patients was 76.6 ± 7.4 years, and 166 patients had hypertension. Among AD patients with hypertension, those with deterioration in clinical dementia rating-sum of box (CDR-SB) and CDR had significantly severe baseline ARWMC scales in total (CDR-SB: 5.8 vs. 3.6, adjusted P = 0.04; CDR: 6.4 vs. 4.4, adjusted P = 0.04) and frontal area (CDR-SB: 2.4 vs. 1.2, adjusted P = 0.01; CDR: 2.4 vs. 1.7, adjusted P < 0.01) compared with those with no deterioration in psychometrics after adjustment for confounders. By contrast, among AD patients without hypertension, no significant differences in ARWMC scales were observed between patients with and without deterioration. Conclusion: The effect of cerebrovascular pathologies on AD progression between those with and without hypertension might differ. An interaction but not independent effect of hypertension and WMCs on the progression of AD is possible.

Published
2018

27. Early functional improvement after stroke correlates with cardiovascular fitness

Author

Ruey Tay Lin, Mao Hsiung Huang, Suh Hang H. Juo, Chun-Kai Chen, and Wen Lung Liang

Subjects
Male, medicine.medical_specialty, Stroke patient, medicine.medical_treatment, 030204 cardiovascular system & hematology, Cardiovascular System, 03 medical and health sciences, 0302 clinical medicine, Physical medicine and rehabilitation, medicine, Humans, Chronic stroke, Cardiovascular fitness, Stroke, Aged, lcsh:R5-920, Rehabilitation, Anthropometry, business.industry, Stroke Rehabilitation, VO2 max, Cognition, General Medicine, Recovery of Function, Middle Aged, medicine.disease, Functional Independence Measure, Female, business, lcsh:Medicine (General), 030217 neurology & neurosurgery
Abstract

Cardiovascular fitness exerts directly beneficial effects on functional and cognitive outcomes in patients of chronic stroke. However, the effect of early rehabilitation on cardiovascular function has not yet been thoroughly examined. We tested whether complementary rehabilitation program could influence cardiovascular fitness in an early stage of stroke patients. The associations for post-acute stroke functional recovery with cardiovascular fitness were explored. Thirty-seven patients with mean poststroke interval of 8.6 ± 3.8 days underwent inpatient rehabilitation of 22.8 ± 3.8 days. Functional outcomes of 15.3 points (17.2%) in functional independence measure improved after rehabilitation program. The therapeutic cardiovascular fitness was determined in ramp exercise test on a cycling ergometer. Peak oxygen uptake (V˙O2peak) significantly increased by 24.8% after early stroke rehabilitation. Multivariate regression analysis was performed to assess for associations of functional improvement with respect to change in V˙O2peak and extremities motor impairment. V˙O2peak gain accounted for more functional recovery than extremities motor improvement (R2 = 0.42). In conclusion, these results suggest that cardiovascular fitness appears to increase after complementary program in early stroke rehabilitation, and better cardiovascular fitness may be associated with greater functional improvement. Keywords: Fitness, Oxygen uptake, Rehabilitation, Stroke

Published
2018

28. Ticagrelor Added to Aspirin in Acute Nonsevere Ischemic Stroke or Transient Ischemic Attack of Atherosclerotic Origin

Author

Pierre Amarenco, Hans Denison, Scott R. Evans, Anders Himmelmann, Stefan James, Mikael Knutsson, Per Ladenvall, Carlos A. Molina, Yongjun Wang, S. Claiborne Johnston, Kenneth Butcher, Shuya Li, Huaguang Zheng, David Skoloudik, Lawrence Wong, Ketevana Meshkova, Nijasri C. Suwanwela, Sebastian Ameriso, Leonardo Gonzalez, Pablo Ioli, Lorena Jure, Guillermo Povedano, Guadalupe Bruera, Gustavo Herrera, Juan Jose Martin Artesi, Virginia A. Pujol Lereis, Conrado J. Estol, Maia Gomez Schneider, Santiago Pigretti, Fernando Lipovestky, María Cristina Zurru, Stephen Davis, Andrew Wong, Tissa Wijeratne, Arman Sabet, Andrew Lee, Vincent Thijs, Robin Lemmens, Laetitia Yperzeele, Geert Vanhooren, Peter Vanacker, Iris Vansteenkiste, Vicky Maqueda, André Peeters, Marie-Christine Hasenbroekx, Van Daele, Wendy Hasenbroekx, Adinda De Pauw, Regilio Oedit, Wouter De Vooght, Philippe Desfontaines, Yves Vandermeeren, Marianna D.A. Dracoulakis, Rodrigo Bazan, Octavio M. Pontes Neto, Daniel D.C. Bezerra, Luiz C. Marrone, Pedro A. Kowacs, Carla H.C. Moro, Paulo C.O. Macelino, Marco Tulio A. Pedatella, Ekaterina Titianova, Ivan Staikov, Dimitar Maslarov, Plamen Petkov, Tanya Beleva, Borislav Kralev, Nikolay Sotirov, Dimcho Hristov, Rumeliya M. Ivanova, Margarita V. Mihailova, Ashfaq M. Shuaib, Andrew Demchuk, Michel Beaudry, Anthony R. Winder, Sumiti Nayar, Xingquan Zhao, Guoqiang Wen, Xueshuang Dong, Guozhong Li, Zhaohui Zhang, Huisheng Chen, Dong Wang, Xiaohong Li, Yuncheng Wu, Xu Zhang, Baorong Zhang, Wenke Hong, Xiaogang Li, Lijuan Wang, Li Liu, Xiaolin Xu, Peifu Wang, Weihong Zheng, Jinsheng Zeng, Yukai Wang, Yan Jia, Yongqiu Li, Bo Hu, Wei Shen, Zhi Song, Zhiping Hu, Yunhai Liu, Kaifu Ke, Deqin Geng, Shigang Zhao, Runxiu Zhu, Qiumin Qu, Xiuli Zhao, Qi Wan, Yunhua Yue, Huishan Du, Meiyun Zhang, Yan Wang, Dongfang Li, Dongyu Wang, Yongqiang Li, Xufang Xie, Tingmin Yu, Qi Liu, Mingxiu Yang, Xiaoping Pan, Lijun Xu, Deen Xu, Gang Li, Anding Xu, Martin Roubec, Petr Geier, Daniel Vaclavik, Jiri Neumann, Jana Bednarova, Robert Mikulik, David Hlinovsky, Charlotte Cordonnier, Igor Sibon, Caroline Arquizan, Sonia Alamowitch, Bertrand Lapergue, Jean-Marc Olivot, Nicolas Raposo, Marie-Hélène Mahagne, Emmanuel Touze, Gilles Rodier, Stéphane Vannier, Yves Samson, Michael Obadia, Emmanuel Ellie, Benoît Guillon, Serge Timsit, Yannick Bejot, Valérie Wolff, Didier Smadja, Aude Bagan-Triquenot, Pierre Garnier, Xavier Ducrocq, Peggy Reiner, Thierry Moulin, Frédéric Philippeau, Fernando Pico, Sébastien Richard, Joachim Röther, Jörg Berrouschot, Hassan Soda, Carsten Pohlmann, Christoph Terborg, Darius G. Nabavi, Rainer Dziewas, Martin Köhrmann, Jörg Glahn, Lars Marquardt, Bernd Kallmünzer, Karin Weißenborn, Yannie Oi-Yan Soo, Richard Li, Wing Chi Fong, Siu Hung Li, Raymond Cheung, Kin Keung Yip, Joshua Wai Ming Fok, Michael Y.P. Fu, Norbert Szegedi, Krisztián Pozsegovits, Attila Valikovics, Gyula Pánczél, Csilla Rózsa, Péter Diószeghy, Attila Csányi, Levente Kerényi, Valéria Nagy, László Szapáry, Dániel Bereczki, Sándor Molnár, Gyula Timár, András G. Folyovich, Mária Sátori, Ildikó Vastagh, Praveen S. Kumar, Rajnish Kumar, Atul Prasad, Vikram Sharma, Alok Verma, Indraneel Basu, Abu Z. Ansari, Vijaya Pamidimukkala, Raghavendra B, null S, Vivek D. Junewar, Sumit Singh, Advait Prakash Kulkarni, Padma M.V. Srivastava, K. Pramod, Sanjay G. Ramteke, Jaideep Bansal, Kewal Krishan, Hrishikesh Kumar, Priyanka V. Kashyap, T.C.R. Ramakrishnan, Gopal R. Adrasetty, Amit Yeole, Rahul B. Baviskar, Giancarlo Agnelli, Danilo Toni, Stefano Ricci, Rossana Tassi, Giuseppe Micieli, Michelangelo Mancuso, Giovanni Orlandi, Alberto Chiti, Marialuisa Delodovici, Federico Carimati, Alessandro De Vito, Francesco Perini, Cinzia Finocchi, Tiziana Tassinari, Massimo Del Sette, Luisa Roveri, Andrea Zini, Guido Bigliardi, Francesca R. Pezzella, Letizia Cupini, Alessandro Adami, Giampaolo Tomelleri, Carla Zanferrari, Angel A. Arauz Góngora, Minerva López Ruíz, Angelica Ruíz Franco, José O.J. Chacon Romero, Fernando Cruz Castillo, Jose L. Ruiz-Sandoval, Jesús D. López Tapia, Edgar A. Castillo Vargas, Juan F. Gongora Rivera, Guillermo Rivera Martinez, Jorge Villarreal Careaga, Nilton Custodio, Oscar G. Pamo Reyna, Cesar A. Castañeda, Edwin J. Pretell, Nestor Najar, Julio C. Perez, Luisa Cardoza, Carlos Chavez, Maria Reyes, Anna Członkowska, Waldemar Fryze, Piotr Sobolewski, Ryszard Nowak, Dorota Szkopek, Zbigniew Bąk, Sławomir Brzozowski, Waldemar Brola, Marek Zalisz, Konrad Rejdak, Marta Bilik, Małgorzata Fudala, Andrzej Tutaj, Anetta Lasek-Bal, Jan Kochanowicz, Bartosz Karaszewski, Tomasz Berkowicz, Beata Zwiernik, Dorota Różański, Jan P. Mejnartowicz, Szymon Jurga, Jacek Rożniecki, Maciej Świat, Ovidiu A. Bajenaru, Cristina A. Panea, Mihaela A. Simu, Rodica Balasa, Dan I. Cuciureanu, Bogdan O. Popescu, Monica Sabau, Corina Roman-Filip, Liudmila Odnopozova, Oleg Artyukov, Anna Milto, Liudmila V. Stakhovskaya, Sergei Aksentiev, Svetlana E. Chuprina, Elena B. Kuznetsova, Ilya I. Sholomov, Alexander Malygin, Elena Mordvintseva, Rostislav Y. Nilk, Inna Ershova, Dina Khasanova, Leila Akhmadeeva, Aida Iakupova, Ekaterina A. Drozdova, Marine Tanashyan, Evgenij Pudov, Lybov A. Shpagina, Svetlana Berns, Liudmila G. Lenskaya, Konstantin Golikov, Andrey V. Kovalenko, Elena Vasilieva, Elena Reznik, Mikhail Zykov, Evgeniy Kovalchuk, Dmitry Popov, Andrey Belkin, Olga Androfagina, Tatyana Lokshtanova, Elena V. Melnikova, Fahmi Al-Senani, Nouf Almansour, Fawaz Alhussein, Ali Alkhathaami, Saeed Alghamdi, Miroslav Brozman, Marta Mikloskova, Georgi Krastev, Vlastimil Serdahely, Michal Kovacik, Ladislav Gurcik, Miloslav Dvorak, Egon Kurca, Andrea Cimprichova, Marian Kycina, Erika Zacharova, Richard Risnovsky, Hee-Joon Bae, Kyung Bok Lee, Yong-Jin Cho, Jong-Moo Park, Joon-Tae Kim, Jun Lee, Jae-Kwan Cha, Sung-Il Sohn, Dong-Ick Shin, Soo Joo Lee, Byung-Chul Lee, Jay Chol Choi, Moo Seok Park, Dae-Il Chang, Joung-Ho Rha, Sang Min Sung, Yangha Hwang, Jaume Roquer González, Jaime Masjuan Vallejo, Meritxell Gomis Cortina, Francisco Moniche Álvarez, Miguel Ángel Gamero García, Soledad Pérez Sánchez, Francisco Purroy García, Santiago Trillo Senín, Tomás Segura Martín, Joaquín Serena Leal, Juan Arenillas Lara, Joan Martí-Fàbregas, Aida Lago Martín, Carlos Tejero Juste, Javier Marta Moreno, Nicolás López Hernández, Lars Sjöblom, Ann Charlotte Laska, Margarita Callander, Thomas Mooe, Jan-Erik Karlsson, Mihaela Oana Romanitan, Arne Lindgren, Niaz Ahmed, Björn Cederin, Christine Kremer, Tsong-Hai Lee, Jiann-Shing Jeng, Chih-Hung Chen, Helen L. Po, Chia-Wei Liou, Huey-Juan Lin, Ruey-Tay Lin, Hsiu-Fen Lin, Li-Ming Lien, Lung Chan, Wei-Shih Huang, Wen-Yi Huang, Ta-Cheng Chen, Chin-I Chen, Po-Lin Chen, Chun-Pai Yang, Yu Sun, Aurauma Chutinet, Tasanee Tantirittisak, Sombat Muengtaweepongsa, Yongchai Nilanont, Somsak Tiamkao, Chesda Udommongkol, Witoon Jantararotai, Tabtim Chongsuvivatwong, Suwat Srisuwananukorn, Wasutha Khaykhaew, Supachai Paiboonpol, Makorn Limudomporn, Saengduan Mayotarn, Kanoksri Samintharapanya, Arkhom Arayawichanon, Thanoot Thamangraksat, Duangpol Srimanee, Galyna Chmyr, Nataliya Tomakh, Alla Cherkez, Sergii Moskovko, Vadym Nikonov, Svitlana Shkrobot, Lyudmyla Shulga, Hanna Hrebeniuk, Valentyna Yavorska, Nataliia Lytvynenko, Marta Khavunka, Iryna Kobets, Nataliia Chemer, Ivanna Tashchuk, Olha Myronova, Thang H. Nguyen, Tan V. Vo, Thanh T. Tran, Nga T.P. Nguyen, Anh D. Nguyen, Binh T. Nguyen, Thang B. Nguyen, Ngoc H. Nguyen, Quang D. Nguyen, Nhan D. Le, Dai D. Pham., UCL - SSS/IONS - Institute of NeuroScience, UCL - (MGD) Service de neurologie, Yperzeele, Laetitia, and THALES Steering Committee and Investigators

Subjects
Male, Atherosclerotic stenosis, Ticagrelor, Neurology, Neurologi, Original Contributions, population, Constriction, Pathologic, Severity of Illness Index, Recurrence, Secondary Prevention, Medicine, Cardiac and Cardiovascular Systems, Stroke, education.field_of_study, Aspirin, Kardiologi, Dual Anti-Platelet Therapy, Ischemic strokes, Middle Aged, stroke, Ischemic Attack, Transient, ComputingMethodologies_DOCUMENTANDTEXTPROCESSING, Cardiology, ÍNDICE DE GRAVIDADE DA DOENÇA, Female, Cardiology and Cardiovascular Medicine, medicine.drug, medicine.medical_specialty, aspirin, Population, atherosclerosis, death, ticagrelor, transient ischemic attack, Clinical and Population Sciences, Internal medicine, Humans, education, Aged, Ischemic Stroke, Proportional Hazards Models, Advanced and Specialized Nursing, business.industry, Atherosclerosis, medicine.disease, Cerebrovascular Disorders, Ischemic stroke, Human medicine, Neurology (clinical), business, Platelet Aggregation Inhibitors
Abstract

Supplemental Digital Content is available in the text., Background and Purpose: Among patients with a transient ischemic attack or minor ischemic strokes, those with ipsilateral atherosclerotic stenosis of cervicocranial vasculature have the highest risk of recurrent vascular events. Methods: In the double-blind THALES (The Acute Stroke or Transient Ischemic Attack Treated With Ticagrelor and ASA for Prevention of Stroke and Death) trial, we randomized patients with a noncardioembolic, nonsevere ischemic stroke, or high-risk transient ischemic attack to ticagrelor (180 mg loading dose on day 1 followed by 90 mg twice daily for days 2–30) or placebo added to aspirin (300–325 mg on day 1 followed by 75–100 mg daily for days 2–30) within 24 hours of symptom onset. The present paper reports a prespecified analysis in patients with and without ipsilateral, potentially causal atherosclerotic stenosis ≥30% of cervicocranial vasculature. The primary end point was time to the occurrence of stroke or death within 30 days. Results: Of 11 016 randomized patients, 2351 (21.3%) patients had an ipsilateral atherosclerotic stenosis. After 30 days, a primary end point occurred in 92/1136 (8.1%) patients with ipsilateral stenosis randomized to ticagrelor and in 132/1215 (10.9%) randomized to placebo (hazard ratio 0.73 [95% CI, 0.56–0.96], P=0.023) resulting in a number needed to treat of 34 (95% CI, 19–171). In patients without ipsilateral stenosis, the corresponding event rate was 211/4387 (4.8%) and 230/4278 (5.4%), respectively (hazard ratio, 0.89 [95% CI, 0.74–1.08]; P=0.23, Pinteraction=0.245). Severe bleeding occurred in 4 (0.4%) and 3 (0.2%) patients with ipsilateral atherosclerotic stenosis on ticagrelor and on placebo, respectively (P=NS), and in 24 (0.5%) and 4 (0.1%), respectively, in 8665 patients without ipsilateral stenosis (hazard ratio=5.87 [95% CI, 2.04–16.9], P=0.001). Conclusions: In this exploratory analysis comparing ticagrelor added to aspirin to aspirin alone, we found no treatment by ipsilateral atherosclerosis stenosis subgroup interaction but did identify a higher absolute risk and a greater absolute risk reduction of stroke or death at 30 days in patients with ipsilateral atherosclerosis stenosis than in those without. In this easily identified population, ticagrelor added to aspirin provided a clinically meaningful benefit with a number needed to treat of 34 (95% CI, 19–171). Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03354429.

Published
2020

29. Renal function is associated with 1-month and 1-year mortality in patients with ischemic stroke

Author

I-Kuan Wang, Chung-Hsiang Liu, Tzung-Hai Yen, Jiann-Shing Jeng, Sheng-Feng Sung, Pai-Hao Huang, Jie-Yuan Li, Yu Sun, Cheng-Yu Wei, Li-Ming Lien, I-Ju Tsai, Fung-Chang Sung, Chung Y. Hsu, Chon-Haw Tsai, Wei-Shih Huang, Chung-Ta Lu, Tzung-Chang Tsai, Chun-Hung Tseng, Kang-Hsu Lin, Woei-Cherng Shyu, Yu-Wan Yang, Yen-Liang Liu, Der-Yang Cho, Chun-Chung Chen, Sung-Chun Tang, Li-Kai Tsai, Shin-Joe Yeh, Chih-Hao Chen, Hsin-Hsi Tsai, Han-Jung Chen, Kan Lu, Shih-Pin Hsu, Hung-Chang Kuo, Jung-Chi Tsou, Yan-Tang Wang, Yi-Cheng Tai, Meng-Tsang Hsieh, Po-Chao Liliang, Cheng-Loong Liang, Hao-Kuang Wang, Yu-Tun Tsai, Kuo-Wei Wang, Jui-Sheng Chen, Po-Yuan Chen, Yi-Ching Wang, Chih-Hung Chen, Pi-Shan Sung, Han-Chieh Hsieh, Hui-Chen Su, Hou-Chang Chiu, Wei-Hung Chen, Chyi-Huey Bai, Tzu-Hsuan Huang, Chi-Ieong Lau, Ya-Ying Wu, Hsu-Ling Yeh, Anna Chang, Ching-Huang Lin, Cheng-Chang Yen, Ruey-Tay Lin, Chun-Hung Chen, Gim-Thean Khor, A-Ching Chao, Hsiu-Fen Lin, Poyin Huang, Huey-Juan Lin, Der-Shin Ke, Chia-Yu Chang, Poh-Shiow Yeh, Kao-Chang Lin, Tain-Junn Cheng, Chih-Ho Chou, Chun-Ming Yang, Hsiu-Chu Shen, An-Chih Chen, Shih-Jei Tsai, Tsong-Ming Lu, Sheng-Ling Kung, Mei-Ju Lee, Hsi-Hsien Chou, Wei-Lun Chang, Pai-Yi Chiu, Min-Hsien Hsu, Po-Chi Chan, Chau-Hsiung Pan, Hai-Ming Shoung, Yi-Chen Lo, Fu-Hwa Wang, Wei-Chieh Chang, Ta-Chang Lai, Jiu-Haw Yin, Chung-Jen Wang, Kai-Chen Wang, Li-Mei Chen, Jong-Chyou Denq, Chien-Jung Lu, Cheng-Huai Lin, Chieh-Cheng Huang, Chang-Hsiu Liu, Hoi-Fong Chan, Siu-Pak Lee, Ming-Hui Sun, Li-Ying Ke, Po-Lin Chen, Yu-Shan Lee, Cheung-Ter Ong, Chi-Shun Wu, Yung-Chu Hsu, Yu-Hsiang Su, Ling-Chien Hung, Jiunn-Tay Lee, Jiann-Chyun Lin, Yaw-Don Hsu, Giia-Sheun Peng, Chang-Hung Hsu, Chun-Chieh Lin, Che-Hung Yen, Chun-An Cheng, Yueh-Feng Sung, Yuan-Liang Chen, Ming-Tung Lien, Chung-Hsing Chou, Chia-Chen Liu, Fu-Chi Yang, Yi-Chung Wu, An-Chen Tso, Yu- Hua Lai, Chun-I. Chiang, Chia-Kuang Tsai, Meng-Ta Liu, Ying-Che Lin, Yu-Chuan Hsu, Tsuey-Ru Chiang, Pin-Wen Liao, Mei-Ching Lee, Jen-Tse Chen, Sian-King Lie, Mu-Chien Sun, Pi-Ju Hsiao, Wei-Liang Chen, Ta-Cheng Chen, Chen-Shu Chang, Chien-Hsu Lai, Chieh-Sen Chuang, Yen-Yu Chen, Shinn-Kuang Lin, Yu-Chin Su, Jen-Lun Shiao, Fu-Yi Yang, Chih-Yang Liu, Han-Lin Chiang, Guei-Chiuan Chen, Po-Jen Hsu, Chun-Yuan Chang, I.-sheng Lin, Chung-Hsien Chien, Yang-Chuang Chang, Ping-Kun Chen, Yu-Jen Hsiao, Chen-Wen Fang, Yu-Wei Chen, Kuo-Ying Lee, Yun-Yu Lin, Chen-Hua Li, Hui-Fen Tsai, Chuan-Fa Hsieh, Chih-Dong Yang, Shiumn-Jen Liaw, How-Chin Liao, Shoou-Jeng Yeh, Ling-Li Wu, Liang-Po Hsieh, Yong-Hui Lee, Chung-Wen Chen, Chih-Shan Hsu, Ye-Jian Jhih, Hao-Yu Zhuang, Yan-Hong Pan, Shin-An Shih, Chin-I. Chen, Jia-Ying Sung, Hsing-Yu Weng, Hao-Wen Teng, Jing-Er Lee, Chih-Shan Huang, Shu-Ping Chao, Rey-Yue Yuan, Jau-Jiuan Sheu, Jia-Ming Yu, Chun-Sum Ho, Ting-Chun Lin, Shih-Chieh Yu, Jiunn-Rong Chen, Song-Yen Tsai, Chao-Hsien Hung, Chia Fang Lee, Sheng-Kung Yang, Chih-Lin Chen, Wei Lin, Hung-Pin Tseng, Chin-Hsiung Liu, Chun-Liang Lin, Hung-Chih Lin, Pi-Tzu Chen, Chaur-Jong Hu, Lung Chan, Nai-Fang Chi, Chang-Ming Chern, Chun-Jen Lin, Shuu-Jiun Wang, Li-Chi Hsu, Wen-Jang Wong, I-Hui Lee, Der-Jen Yen, Ching-Piao Tsai, Shang-Yeong Kwan, Bing-Wen Soong, Shih-Pin Chen, Kwong-Kum Liao, Kung-Ping Lin, Chien Chen, Din-E. Shan, Jong-Ling Fuh, Pei-Ning Wang, Yi-Chung Lee, Yu-Hsiang Yu, Hui-Chi Huang, Jui-Yao Tsai, Ming-Hsiu Wu, Szu-Yi Chiang, Chiung-Yao Wang, Ming-Chin Hsu, Chien-Chung Chen, Po-Yen Yeh, Yu-Tai Tsai, Ko-Yi Wang, Tsang-Shan Chen, Cheng-Yang Hsieh, Wei-Fen Chen, Ping-Keung Yip, Vinchi Wang, Kaw-Chen Wang, Chung-Fen Tsai, Chao-Ching Chen, Yi-Chien Liu, Shao-Yuan Chen, Zi-Hao Zhao, Zhi-Peng Wei, Shey-Lin Wu, Ching-Kuan Liu, Ryh-Huei Lin, Ching-Hua Chu, Sui-Hing Yan, Yi-Chun Lin, Pei-Yun Chen, Sheng-Huang Hsiao, Bak-Sau Yip, Pei-Chun Tsai, Ping-Chen Chou, Tsam-Ming Kuo, Yi-Chen Lee, Yi-Pin Chiu, Kun-Chang Tsai, Yi-Sheng Liao, Ming-Jun Tsai, and Hsin-Yi Kao

Subjects
Adult, Male, Stroke registry, medicine.medical_specialty, Time Factors, Adolescent, Taiwan, Renal function, 030204 cardiovascular system & hematology, Kidney, Risk Assessment, Brain Ischemia, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, Humans, Medicine, In patient, Registries, Risk factor, Stroke, Aged, Retrospective Studies, Aged, 80 and over, business.industry, Mortality rate, Middle Aged, Prognosis, medicine.disease, Ischemic stroke, Cardiology, Female, Kidney Diseases, Cardiology and Cardiovascular Medicine, business, 1 year mortality, 030217 neurology & neurosurgery, Glomerular Filtration Rate
Abstract

Background and aims Renal dysfunction is a potent risk factor for cardiovascular diseases, including stroke. This study aimed to evaluate the impact of admission estimated glomerular filtration rate (eGFR) levels on short-term (1-month) and long-term (1-year) mortality in patients with acute ischemic stroke. Methods From the Taiwan Stroke Registry data, we classified ischemic stroke patients, identified from April 2006 to December 2015, into 5 groups by eGFR at admission: ≥ 90, 60–89, 30–59, 15–29, and Results Among 52,732 ischemic stroke patients, 1480 died within one month. The 1-month mortality rate was over 5-fold greater in patients with eGFR Conclusions After acute ischemic stroke, patients with reduced eGFR are at elevated risks of short-term and long-term deaths in a graded relationship.

Published
2018

30. Intake of potassium- and magnesium-enriched salt improves functional outcome after stroke: a randomized, multicenter, double-blind controlled trial

Author

Anna Chang, Wei Hung Chen, Chang-Ming Chern, Wen-Harn Pan, Jiunn Rong Chen, Tsong Hai Lee, Wen Ting Yeh, Jiann-Shing Jeng, Chin-Fu Hsiao, Chung-Hsiang Liu, Li Ming Lien, Ku Chou Chang, Ying Ho Lai, Ruey Tay Lin, Huey Juan Lin, and Chyi Huey Bai

Subjects
Male, medicine.medical_specialty, Potassium, Taiwan, Medicine (miscellaneous), chemistry.chemical_element, Salt (chemistry), Recommended Dietary Allowances, Gastroenterology, law.invention, 03 medical and health sciences, 0302 clinical medicine, Asian People, Double-Blind Method, Randomized controlled trial, Risk Factors, Modified Rankin Scale, law, Diabetes mellitus, Internal medicine, Humans, Medicine, Magnesium, 030212 general & internal medicine, Stroke, Aged, chemistry.chemical_classification, Nutrition and Dietetics, business.industry, Potassium, Dietary, Recovery of Function, Middle Aged, medicine.disease, Logistic Models, Treatment Outcome, chemistry, Dietary Reference Intake, Female, Salts, business, 030217 neurology & neurosurgery
Abstract

Background: Stroke is one of the leading causes of mortality and neurologic deficits. Management measures to improve neurologic outcomes are in great need. Our previous intervention trial in elderly subjects successfully used salt as a carrier for potassium, demonstrating a 41% reduction in cardiovascular mortality by switching to potassium-enriched salt. Dietary magnesium has been associated with lowered diabetes and/or stroke risk in humans and with neuroprotection in animals.Objective: Because a large proportion of Taiwanese individuals are in marginal deficiency states for potassium and for magnesium and salt is a good carrier for minerals, it is justifiable to study whether further enriching salt with magnesium at an amount near the Dietary Reference Intake (DRI) amount may provide additional benefit for stroke recovery.Design: This was a double-blind, randomized controlled trial comprising 291 discharged stroke patients with modified Rankin scale (mRS) ≤4. There were 3 arms: 1) regular salt (Na salt) (n = 99), 2) potassium-enriched salt (K salt) (n = 97), and 3) potassium- and magnesium-enriched salt (K/Mg salt) (n = 95). The NIH Stroke Scale (NIHSS), Barthel Index (BI), and mRS were evaluated at discharge, at 3 mo, and at 6 mo. A good neurologic performance was defined by NIHSS = 0, BI = 100, and mRS ≤1.Results: After the 6-mo intervention, the proportion of patients with good neurologic performance increased in a greater magnitude in the K/Mg salt group than in the K salt group and the Na salt group, in that order. The K/Mg salt group had a significantly increased OR (2.25; 95% CI: 1.09, 4.67) of achieving good neurologic performance compared with the Na salt group. But the effect of K salt alone (OR: 1.58; 95% CI: 0.77, 3.22) was not significant.Conclusions: This study suggests that providing the DRI amount of magnesium and potassium together long term is beneficial for stroke patient recovery from neurologic deficits. This trial was registered at clinicaltrials.gov as NCT02910427.

Published
2017

31. Cholesterol Levels Are Associated with 30-day Mortality from Ischemic Stroke in Dialysis Patients

Author

I.-Kuan Wang, Chung-Hsiang Liu, Tzung-Hai Yen, Jiann-Shing Jeng, Shih-Pin Hsu, Chih-Hung Chen, Li-Ming Lien, Ruey-Tay Lin, An-Chih Chen, Huey-Juan Lin, Hsin-Yi Chi, Ta-Chang Lai, Yu Sun, Siu-Pak Lee, Sheng-Feng Sung, Po-Lin Chen, Jiunn-Tay Lee, Tsuey-Ru Chiang, Shinn-Kuang Lin, Chih-Hsin Muo, Henry Ma, Chi-Pang Wen, Fung-Chang Sung, Chung Y. Hsu, Chon-Haw Tsai, Wei-Shih Huang, Chung-Ta Lu, Tzung-Chang Tsai, Chun-Hung Tseng, Kang-Hsu Lin, Woei-Cherng Shyn, Yu-Wan Yang, Yen-Liang Liu, Der-Yang Cho, Chun-Chung Chen, Sung-Chun Tang, Li-Kai Tsai, Shin-Joe Yeh, Han-Jung Chen, Cheng-Sen Chang, Hung-Chang Kuo, Lian-Hui Lee, Huan-Wen Tsui, Jung-Chi Tsou, Yan-Tang Wang, Yi-Cheng Tai, Kun-Chang Tsai, Yen-Wen Chen, Kan Lu, Po-Chao Liliang, Yu-Tun Tsai, Cheng-Loong Liang, Kuo-Wei Wang, Hao-Kuang Wang, Jui-Sheng Chen, Po-Yuan Chen, Cien-Leong Chye, Wei-Jie Tzeng, Pei-Hua Wu, Pi-Shan Sung, Han-Chieh Hsieh, Hui-Chen Su, Hou-Chang Chiu, Wei-Hung Chen, Chyi-Huey Bai, Tzu-Hsuan Huang, Chi-Ieong Lau, Ya-Ying Wu, Hsu-Ling Yeh, Anna Chang, Ching-Huang Lin, Cheng-Chang Yen, Chun-Hung Chen, Gim-Thean Khor, A-Ching Chao, Hsiu-Fen Lin, Poyin Huang, Der-Shin Ke, Chia-Yu Chang, Poh-Shiow Yeh, Kao-Chang Lin, Tain-Junn Cheng, Chih-Ho Chou, Chun-Ming Yang, Hsiu-Chu Shen, Shih-Jei Tsai, Tsong-Ming Lu, Sheng-Ling Kung, Mei-Ju Lee, Hsi-Hsien Chou, Chou-Hsiung Pan, Po-Chi Chan, Min-Hsien Hsu, Wei-Lun Chang, Zhi-Zang Huang, Hai-Ming Shoung, Yi-Chen Lo, Fu-Hwa Wang, Jiu-Haw Yin, Chung-Jen Wang, Kai-Chen Wang, Li-Mei Chen, Jong-Chyou Denq, Chien-Jung Lu, Cheng-Huai Lin, Chieh-Cheng Huang, Chang-Hsiu Liu, Hoi-Fong Chan, Ming-Hui Sun, Li-Ying Ke, Yu-Shan Lee, Cheung-Ter Ong, Chi-Shun Wu, Yung-Chu Hsu, Yu-Hsiang Su, Ling-Chien Hung, Jiann-Chyun Lin, Yaw-Don Hsu, Giia-Sheun Peng, Chang-Hung Hsu, Chun-Chieh Lin, Che-Hung Yen, Chun-An Cheng, Yueh-Feng Sung, Yuan-Liang Chen, Ming-Tung Lien, Chung-Hsing Chou, Chia-Chen Liu, Fu-Chi Yang, Yi-Chung Wu, An-Chen Tso, Yu-Hua Lai, Chun-I Chiang, Chia-Kuang Tsai, Meng-Ta Liu, Ying-Che Lin, Yu-Chuan Hsu, Mei-Ching Lee, Pai-Hao Huang, Sian-King Lie, Pin-Wen Liao, Jen-Tse Chen, Mu-Chien Sun, Tien-Pao Lai, Wei-Liang Chen, Yen-Chun Chen, Ta-Cheng Chen, Wen-Fu Wang, Kwo-Whei Lee, Chen-Shu Chang, Chien-Hsu Lai, Siao-Ya Shih, Chieh-Sen Chuang, Yen-Yu Chen, Chien-Min Chen, Yu-Chin Su, Cheng-Lun Hsiao, Fu-Yi Yang, Chih-Yang Liu, Han-Lin Chiang, Chun-Yuan Chang, I-sheng Lin, Chung-Hsien Chien, Yang-Chuang Chang, Ping-Kun Chen, Pai-Yi Chiu, Yu-Jen Hsiao, Chen-Wen Fang, Yu-Wei Chen, Kuo-Ying Lee, Yun-Yu Lin, Chen-Hua Li, Hui-Fen Tsai, Chuan-Fa Hsieh, Chih-Dong Yang, Shiumn-Jen Liaw, How-Chin Liao, Shoou-Jeng Yeh, Ling-Li Wu, Liang-Po Hsieh, Yong-Hui Lee, Chung-Wen Chen, Chih-Shan Hsu, Ye-Jian Jhih, Hao-Yu Zhuang, Yan-Hong Pan, Shin-An Shih, Chin-I Chen, Jia-Ying Sung, Hsing-Yu Weng, Hao-Wen Teng, Jing-Er Lee, Chih-Shan Huang, Shu-Ping Chao, Rey-Yue Yuan, Jau- Jiuan Sheu, Jia-Ming Yu, Chun-Sum Ho, Ting-Chun Lin, Shih-Chieh Yu, Jiunn-Rong Chen, Song-Yen Tsai, Cheng-Yu Wei, Chao-Nan Yang, Chao-Hsien Hung, Ian Shih, Hung-Pin Tseng, Chin-Hsiung Liu, Chun-Liang Lin, Hung-Chih Lin, Pi-Tzu Chen, Chaur-Jong Hu, Nai-Fang Chi, Lung Chan, Chang-Ming Chern, Chun-Jen Lin, Shuu-Jiun Wang, Li-Chi Hsu, Wen-Jang Wong, I-Hui Lee, Der-Jen Yen, Ching-Piao Tsai, Shang-Yeong Kwan, Bing-Wen Soong, Shih-Pin Chen, Kwong-Kum Liao, Kung-Ping Lin, Chien Chen, Din-E Shan, Jong-Ling Fuh, Pei-Ning Wang, Yi-Chung Lee, Yu-Hsiang Yu, Hui-Chi Huang, Jui-Yao Tsai, Ming-Hsiu Wu, Shi-Cheng Chen, Szu-Yi Chiang, Chiung-Yao Wang, Ming-Chin Hsu, Chien-Chung Chen, Po-Yen Yeh, Yu-Tai Tsai, Ko-Yi Wang, Tsang-Shan Chen, Ping-Keung Yip, Vinchi Wang, Kaw-Chen Wang, Chung-Fen Tsai, Chao-Ching Chen, Chih-Hao Chen, Yi-Chien Liu, Shao-Yuan Chen, Zi-Hao Zhao, Zhi-Peng Wei, Shey-Lin Wu, Ching-Kuan Liu, Ryh-Huei Lin, Ching-Hua Chu, Sui-Hing Yan, Yi-Chun Lin, Pei-Yun Chen, Sheng-Huang Hsiao, Bak-Sau Yip, Pei-Chun Tsai, Ping-Chen Chou, Tsam-Ming Kuo, Yi-Chen Lee, Yi-Pin Chiu, Yi-Sheng Liao, Ming-Jun Tsai, and Hsin-Yi Kao

Subjects
Male, Stroke registry, medicine.medical_specialty, Time Factors, medicine.medical_treatment, Taiwan, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, Dialysis patients, Brain Ischemia, 03 medical and health sciences, chemistry.chemical_compound, Patient Admission, 0302 clinical medicine, Renal Dialysis, Risk Factors, Internal medicine, medicine, Humans, Registries, Serum cholesterol, Dialysis, Aged, Proportional Hazards Models, Aged, 80 and over, Cholesterol, business.industry, Mortality rate, Rehabilitation, Middle Aged, Prognosis, Stroke, chemistry, 30 day mortality, Ischemic stroke, Cardiology, Kidney Failure, Chronic, Female, Surgery, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, Biomarkers, 030217 neurology & neurosurgery
Abstract

We investigated the impact of serum cholesterol levels on 30-day mortality after ischemic stroke in dialysis patients.From the Taiwan Stroke Registry data, we identified 46,770 ischemic stroke cases, including 1101 dialysis patients and 45,669 nondialysis patients from 2006 to 2013.Overall, the 30-day mortality was 1.46-fold greater in the dialysis group than in the nondialysis group (1.75 versus 1.20 per 1000 person-days). The mortality rates were 1.64, .62, 2.82, and 2.23 per 1000 person-days in dialysis patients with serum total cholesterol levels of 120 mg/dL, 120-159 mg/dL, 160-199 mg/dL, and ≥200 mg/dL, respectively. Compared to dialysis patients with serum total cholesterol levels of 120-159 mg/dL, the corresponding adjusted hazard ratios of mortality were 4.20 (95% confidence interval [CI] = 1.01-17.4), 8.06 (95% CI = 2.02-32.2), and 6.89 (95% CI = 1.59-29.8) for those with cholesterol levels of 120 mg/dL, 160-199 mg/dL, and ≥200 mg/dL, respectively.Dialysis patients with serum total cholesterol levels of ≥160 mg/dL or 120 mg/dL on admission are at an elevated hazard of 30-day mortality after ischemic stroke.

Published
2017

32. Regional variation in acute stroke care organisation

Author

Paula Muñoz Venturelli, Octavio M. Pontes-Neto, Jeyaraj D Pandian, Hisatomi Arima, H Asita de Silva, Lily Song, Gillian Mead, Craig S. Anderson, Bin Peng, Maree L. Hackett, Caroline L Watkins, Joyce Y Lim, Tsong-Hai Lee, Pablo M. Lavados, Ruey-Tay Lin, Sandy Middleton, Liying Cui, Verónica V. Olavarría, Laurent Billot, and Thompson G. Robinson

Subjects
acute ischemic stroke, thrombolysis, medicine.medical_specialty, Quality Assurance, Health Care, medicine.medical_treatment, stroke care, Patient Positioning, Brain Ischemia, 03 medical and health sciences, 0302 clinical medicine, Clinical Protocols, Multidisciplinary approach, Surveys and Questionnaires, Health care, medicine, Humans, Thrombolytic Therapy, Health Workforce, 030212 general & internal medicine, Stroke, Acute stroke, Intracerebral hemorrhage, Cross-Over Studies, Rehabilitation, business.industry, Thrombolysis, medicine.disease, stroke, intracerebral hemorrhage, Hospitals, Patient Discharge, B702, Gross national income, Socioeconomic Factors, Neurology, Hospital Bed Capacity, Family medicine, in- and out-hospital stroke care organisation, Physical therapy, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract

Background\ud \ud Few studies have assessed regional variation in the organisation of stroke services, particularly health care resourcing, presence of protocols and discharge planning. Our aim was to compare stroke care organisation within middle- (MIC) and high-income country (HIC) hospitals participating in the Head Position in Stroke Trial (HeadPoST).\ud \ud Methods\ud \ud HeadPoST is an on-going international multicenter crossover cluster-randomized trial of ‘sitting-up’ versus ‘lying-flat’ head positioning in acute stroke. As part of the start-up phase, one stroke care organisation questionnaire was completed at each hospital. The World Bank gross national income per capita criteria were used for classification.\ud \ud Results\ud \ud 94 hospitals from 9 countries completed the questionnaire, 51 corresponding to MIC and 43 to HIC. Most participating hospitals had a dedicated stroke care unit/ward, with access to diagnostic services and expert stroke physicians, and offering intravenous thrombolysis. There was no difference for the presence of a dedicated multidisciplinary stroke team, although greater access to a broad spectrum of rehabilitation therapists in HIC compared to MIC hospitals was observed. Significantly more patients arrived within a 4-h window of symptoms onset in HIC hospitals (41 vs. 13%; P < 0.001), and a significantly higher proportion of acute ischemic stroke patients received intravenous thrombolysis (10 vs. 5%; P = 0.002) compared to MIC hospitals.\ud \ud Conclusions\ud \ud Although all hospitals provided advanced care for people with stroke, differences were found in stroke care organisation and treatment. Future multilevel analyses aims to determine the influence of specific organisational factors on patient outcomes.

Published
2016

33. Impact of evidence-based stroke care on patient outcomes : A multilevel analysis of an international study

Author

Paula Muñoz Venturelli, Xian Li, Sandy Middleton, Caroline Watkins, Pablo M. Lavados, Verónica V. Olavarría, Alejandro Brunser, Octavio Pontes‐Neto, Taiza E. G. Santos, Hisatomi Arima, Laurent Billot, Maree L. Hackett, Lily Song, Thompson Robinson, Craig S. Anderson, Gillian Mead, H. Asita De Silva, Jeyaraj D. Pandian, Ruey‐Tay Lin, Tsong‐Hai Lee, Liying Cui, Bin Peng, Stephane Heritier, Richard Lindley, Stephen Jan, Elizabeth Boaden, Christopher P. L. H. Chen, Anne Forster, Mark Woodward, Kris Rogers, Anish Scaria, Joyce Y. Lim, Natalie Espinosa, Lucy McEvoy, Lee Blackburn, Sarah S. Richtering, Shoujiang You, Simon Ladwig, Gabrielle P. Merritt, Bryce Thomsen, Kerry Jenson, Penelope Gordon, Dennis Ryan Nguyen, Wei Wei Quan, Tessa Pei‐Yi Lo, Jonathan Lim, Selena Goh, Leibo Liu, Mirza Ahmad Baig, Ravider Singh, Paul Donnelly, Manuela Armenis, Marna Van Zyl, Helen Monaghan, Phillipa Smith, Parisa Glass, Fanli Zhou, Yun Shen, Li Lei, Di Li, Ting Zhang, Xiaoyan Zhang, Yun Peng, Lingling Feng, Zhiping Ye, Philip Gregory, Jeyaraj D. Pandain, Deepti Arora, Francisca Gonzalez, Bernardita Portales, Taiza Santos‐Pontelli, Brunna Rimoli, Monica Braga, Carolina Vidal, Dafna Benadof, Rodrigo J. Rivas, Laura Carvallo, Pamela Carvallo, Rubia Miranda, Brunna Pileggi, H. Asita de Silva, Shalomi Weerawardena, Thanushanthan Jeevarajah, Devaki Dharmawardena, Dumindi Ranasinghe, Matheesha Dharshana, Nilesh Nandadeva, Savithri Nawarathna, Jiu‐Haw Yin, Shoou‐Jeng Yeh, Ruei‐Jen Ma, Caroline L. Watkins, Gemma Whiteley, Denise Forshaw, Catherine Elizabeth Lightbody, Joanna Cox, Jane Fitzgerald, John F. Heney, Helen Byfield, Simone Finley, Hayley E. Tyrer, Carole Bruce, Alison Gibbon, Brett Jones, Emma Siracusa, Koushik Gowda, Shahla Cowans, Briana Forman, Sherin Jacob, Kristine Caprecho, Roshan Khatri, Po Yi Wan, Maria Lopez, Sifiso Vanika, Wilhelmina Bleeker, Marinka Ireland, Sheila Jala, Susan Day, Eric Ha, Martin Krause, Melissa Passer, Sarah Giaccari, Nadia Burkolter, Michael Braithwaite, Kylie Tastula, Darshan Ghia, Tapuwa Musuka, Anthony Alvaro, Gillian Edmonds, Nicole O'Loughin, Rebecca Phair, Joanne Kaoutal, David J. Blacker, Belinda L Saint, Kim Parrey, Michelle Coad, Matthew Kinchington, Nishantha Senanayake, Johanna Alaban, Irma Kuehne, Millene Camilo, Milena Libardi, Sheila Martins, Batista Carlos, Magda Martins, Leonardo Carbonera, Andrea Almeida, Martin Kelin, Carla Pauli, Mariana Lunardi, Luciane Silveira, Olga Chagas, Daily Souza, Gabriel Braga, Priscila Ribeiro, Gustavo Luvizutto, Marcia Polin, Fernanda Winckler, Jinfeng Liu, Zhenjiang Wang, Huibing Wang, Suying Lin, Jing Dong, Junshan Zhou, Suping Qin, Hui Zhan, Yongquan Xue, Dong Tian, Dan Yang, Yan Yin, He Li, Changming Geng, Jieyi Liu, Xiaolin Jiang, Yujun Wu, Wei Sun, Bingqi Yu, Yanmei Guan, Qin Wang, Bo Wei, Huirong Wang, Yan Wang, Liwen Tai, Wenchao Zhang, Weili Zhao, Xueying Wang, Guoli Li, Zhiming Ni, Fudong Guo, Lan Cen, Jun Lu, Zheng Chen, Guoming Yin, Yingchun Wang, Jiping Zheng, Zhimin Zhou, Hongquan Wang, Renlin Zou, Bin Xue, Airu Li, Jing Guo, Ying Guo, Xingguo Jiang, Xiuge Tan, Chunpeng Zhang, Bei Shao, Xiaoting Niu, Chunfeng Liu, Dongqin Chen, Ping Liang, Xia Zhang, Chunqing Zhang, Wenjie Gong, Zhichao Huang, Huihui Liu, Junying Huang, Rongfang Shi, Cuilan Wang, Ying Liu, Jinchao Wang, Guojun Wu, Zhihong Gao, Qunli Lin, Cong Xu, Huile Zheng, Xinghai Ye, Xiaoqiong Jin, Junyan Liu, Xiaoyun Cao, Yan Zhang, Jinyang Wang, Yuzhu Xu, Yan Li, Xin Ma, Qi Kong, Yanlei Hao, Baojun Qiao, Hui Yan, Zhiyong Huang, Baoqiang Chang, Jinjin Yan, Pinjun Liao, Wei Zhang, Ling Liu, Tingting Zhu, Xuehui Liu, Yongping Li, Ruifang Dong, Miao Chen, Xiaoli Ge, Hairong Wang, Lihua Dai, Jiafu Liu, Shixia Wang, Jihui Du, Aixiu Song, Yunhai Li, Jie Feng, Cheng Yu, Honglin Feng, Xiaojia Sun, Ruihong Sun, Weisong Liu, Jianfeng Liu, Xuesheng Lu, Enzhuo Chen, Wei Gao, Hui Liu, Heping Wang, Yanxia Wang, Juan Song, Dongqi Liu, Wenhui Du, Guixia Li, Cuiling Li, Yanling Liang, Xuekun Cai, Jinli Zhang, Xiaowei Tao, Pingshun An, Ranran Tang, Xu Qin, Yingling Wang, Wenjun Zhang, Rong Ma, Xiaoqiong Huang, Yonglin Liu, Yazhi Wang, Ping Fan, Hailan Yang, Lianyuan Feng, Jianxia Zhi, Jiewen Zhang, Yao Zhou, Danhong Wu, Haiyan He, Xiaohong Chen, Yongge Hou, Xiaohui Su, Siyuan Fan, Luis Suárez, Juan de Dios Polanco, Patricio Sotomayor, Ricardo Urzúa, Daniela Urrutia, Nathalie Conejan, Arturo Escobar, Monica Gonzalez, Danisa Vargas, Angel Constante, Erika Vásquez, Elizabeth Godoy, Christian Figueroa, Vanesa San Martin, Nataly Vidal, Madeleyn Muñoz, María Spencer, Juan Almeida, Ignacio Acosta, Rodrigo Guerrero, Prudencio Lozano, Camila Aguayo, Jimena Pizarro, Alvaro Soto, Flor Bonilla, Pía García, Carolina Del Castillo, Marcela Grandjean, Alexis Von Johnn, Ignacio Gutierrez, Francisca Rivero, Ignacio López, Federico Silva, Marlen Pachón, José Mendoza, Alexander Pabón, Mahesh Kate, Naushad Akhtar, Gibbsdeep S. Narang, Ashish Deepak, Vikram Huded, Romnesh De Sowza, Alben Sigamani, Karthikeyan Rajendran, Anisha Vishwanath, Anusha K, Somasundaram Kumaravelu, Syed Rahamath, Sandeep Kannneganti, Dheeraj Khurana, Cheena Katoch, Taranpreet Kaur, Ummer Karadan, Anu Kuriakose, Jaison John, Mumthaz Basheer, Harsha Hemal Gunasekara, Gamlath Chandima Udeni De Silva, Peetagam Harshi Lakmali Ubeywickrama, Kavisha Chathumali Silva, Eshani Anuradha De Silva, Udaya Ranawaka, Chamila Mettananda, Yamuna Nanayakkara, Tharini Mendis, Gayathri Fernando, Ahamed Imthikab, Kandula Pieris, Saman B. Gunatilake, Pamuditha M. W. Madanayake, Shiran A. Paranavitane, Bimsara Senanayake, Vaidhehi Vishwanathan, Maathury Sivapalan, Ruwangi U. Murage, Uthpala Chandradeva, Yao‐Hua Liu, Chih‐Lung Lin, Hsiu‐Fen Lin, Kuan‐Ting Liu, Chien‐Fu Chen, Meng‐Ni Wu, Su‐Hua Tsai, Chi‐Ching Chen, Lan‐Yi Chen, Chien‐Hung Chang, Yeu‐Jhy Chang, Kuo‐Lun Huang, Ting‐Yu Chang, Chi‐Hung Liu, Chen‐June Seak, Yu‐Li Lin, Jia‐Yi Luo, Hsiao‐Ying Yang, Ching‐Yi Wang, Lung Chan, Chaur‐Jong Hu, Nai‐Fang Chi, Dean Wu, Yao‐Hsien Huang, Yi‐Chun Kuan, Chien‐Tai Hong, Yi‐Chun Chen, Yu Sun, Cheng‐Huai Lin, Chien‐Jung Lu, Hai‐Jui Chu, Yi‐Chia Lo, Wen‐Hui Chang, Wan‐Jung Lin, Hui‐Chen Su, Tien‐Yu Lin, Chi‐Hsuan Cho, Shu‐Lan Lu, Ya‐Fang Hsueh, Ching‐Yi Lai, David Jarrett, Claire James, Stacey Valentine, Clare Whistler, Rebecca Butler, Simone Browning, Caroline Watchurst, Renuka Erande, Emma Elliott, Krishna Patel, Maria Brezitski, Caroline Hogan, Asra Banaras, Lucinda Crook, Rashidat Ahmed, Lindsay Potter, Rosie Laird, Natasha Clarke, Alison Loosemore, J. Godber, Sara Gawned, K. A. Hamilton, Rachael Jones, Paul Guyler, Sharon Tysoe, Raji Prabakaran, Sweni Shah, Joanne Calver, Laszlo K. Sztriha, Maria Fitzpatrick, Stephanie Drysdale, John Aeron‐Thomas, Emma McKenzie, Belinda Chitando, Paul Willcoxson, Elizabeth Iveson, Peter Wanklyn, Natasha Dyer, Michael Keeling, Romina Rodriguez, Kerry Elliott, Mia Porteous, Mark O'Neill, Sheridan Orme, Carla Richardson, Janet Tomlinson, Suzanne Hawkins, Delia Bester, Carol Jeffs, Joanne Howard, Pauline Brown, Deborah Ward, Jennifer Turfrey, Leanne Raybould, Allison Bates, Sue O'Connell, Margaret O'Connor, Samantha Williams, Hedley C. A. Emsley, Alison McLoughlin, Sonia Raj, Bindu Gregary, Donna Doyle, G. M. Courtauld, C. Schofield, L. Lucas, A. Lydon, A. James, Kari Saastamoinen, Laura Howaniec, Premchand Daboo, Ali N. Ali, Emma Richards, Joanne Howe, Christine Kamara, Kathy Stocks, Ralf Lindert, Diana J. Day, Sarah Finlay, Joanne McGee, Jennifer Mitchell, Elaine Amis, Rosemary Macey, Suzanne Tauro, Lauren Henry, Sarah Cuddy, Andrew Steele, Kerry Mullen, Sarah Kirker, Murudappa Bhattad, Michael Carpenter, Prabal Datta, Ann Needle, Linda Jackson, Julie Ball, Rosie Beckitt, Nicola Chivers, Angela Bowring, Sara Eddy, Kevin Thorpe, Samantha Keenan, Alison Griffin, Stuart Maguire, Chris Patterson, Hawraman Ramadan, Ruth Bellfield, Michaela Hooley, Kelvin Stewart, Lucy Williams, Cara Gurney, Deborah Oliver, Maria Gardiner, Sarah Grayland, Mohit Bhandari, David M. Collas, Tolu Adesina, Saul Sundayi, Ruth Harvey, Emma Pope, Audrey Lam, Elaine Walker, Colin Merrill, Soma Banerjee, Kirsten Hannah Harvey, Sheila Mashate, Peter Wilding, Linda Johnson, Robert Namushi, Patricia Jacob, Sreeman Andole, Karen Dunne, Naveen Gadapa, Sam King, Sonata Siliuzaite, Sharon Dealing, Karen Attwood, Annette Woods, Banher Sandhu, Maam Mamun, Afzal Mahmood, June Jones, Abimbola Ojo, Denise Carter‐Evans, Royal Liverpool, Aravind Manoj, Glyn Fletcher, Paula Lopez, Jill Greig, Matthew Robinson, Sarah Jones, Lorinda Jones, Claire West, Helen Tench, Rachel Gascoyne, Amanda Whileman, Emily Hall, Stephanie Wright, Julie Toms, Duke Phiri, Sakthivel Sethuraman, Niaz Mohammed, Frances Justin, Margaret Louise Tate, Meena Chauhan, Syed I. Haider, Arumugam Nallasivan, Tim Webster, Sandra Leason, Samantha Seagrave, Peterborough City Hospital, Peter Owksu‐Agyei, Natalie Temple, Nicola Butterworth‐Cowin, Frederick Magezi, Leicester Royal Infirmary, Shagufta Khan, Claire Stephens, Amit Mistri, Aidan Murphy, Manda Lam, Paul Underwood, Catherine Thompson, Clare Buckley, Diane Wood, Sarah Board, Linda Howard, Ashraf Ahmed, Bethany Oates, Sara Leonard, Royal Bournemouth Hospital, Royal Bournemouth, Kamy Thavanesan, Michelle Dharmasiri, Sathyabama Logianathan, Catherine Ovington, Gail Hann, Chantel Cox, Craigavon Area Hospital, Southern Health, Social Care Trust, Catherine Douglas, Michael Goggin, Patricia Fearon, Sara Gilpin, Margaret O'Hagan, Pilgrim Hospital, Anne Hardwick, Kimberley Netherton, Judith Quinn, Tulu Bozkaplan, Josin Jose, Univ New South Wales, Ctr Estudios Clin, Clin Alemana Univ Desarrollo, Peking Univ, Australian Catholic Univ, Univ Cent Lancashire, Univ Chile, Universidade de São Paulo (USP), Fukuoka Univ, Univ Leicester, Univ Edinburgh, George Inst Global Hlth, Univ Desarrollo, St Vincents Hlth Australia Sydney, Univ Kelaniya, Christian Med Coll & Hosp, Kaohsiung Med Univ & Hosp, Linkou Chang Gung Mem Hosp, Peking Union Med Coll Hosp, Monash Univ, Natl Univ Singapore, Bradford Royal Infirm, Christian Med College, RemediumOne Pvt Ltd, Kaohsiung Med Univ, Calvary Publ Hosp Bruce, Royal North Shore Hosp, Royal Prince Alfred Hosp, Concord Repatriat Gen Hosp, Fiona Stanley Hosp, Macquarie Base Hosp, Hosp Governador Celso Ramos, Universidade Estadual Paulista (Unesp), Yangquan Coalmine Grp Gen Hosp, Nanjing Med Univ, 85 Hosp Peoples Liberat Army, Chifeng Univ, Beijing Pinggu Hosp, Wenzhou Med Univ, Soochow Univ, Hebei Med Univ, Capital Med Univ, Jining Med Univ, Third Peoples Hosp Huizhou, Second Cangzhou Cent Hosp, Shanghai Jiao Tong Univ, Baogang Hosp, Harbin Med Univ, Shanghai Jiao Tong Univ Sch, Guangzhou Med Univ, Second Hosp Nanchang, Bethune Int Peace Hosp, Hua Henan Prov Peoples Hosp, Shijiazhuang Cent Hosp, Hosp Base San Jos de Osorno, Unit Narayana Hrudayalaya Ltd, Dr Ramesh Cardiac & Multispecial Hosp Pvt Ltd, Post Grad Inst Med Educ & Res, Baby Mem Hosp Ltd, Sree Chitra Tirunal Inst Med Sci & Technol, Sri Jayawardenepura Gen Hosp, Colombo North Teaching Hosp, Colombo South Coching Hosp, Taipei Med Univ, En Chu Kong Hosp, Natl Cheng Kung Univ Hosp, Queen Alexandra Hosp, Portsmouth Hosp NHS Natl Hlth Serv iTrust, Univ Coll London Hosp NHS Fdn Trust, Univ Hosp Birmingham NHS Fdn Trust, Southend Univ Hosp NHS Fdn Trust, Kings Coll Hosp London, York Teaching Hosp NHS Fdn Trust, Nottingham Univ Hosp NHS Trust, Blackpool Teaching Hosp NHS Fdn Trust, Gloucestershire Hosp NHS Fdn Trust, Teaching Hospi NHS Fdn Trust, Royal Cornwall Hosp NHS Trust, Royal London Hosp, Sheffield Teaching Hosp NHS Fdn Trust, Cambridge Univ Hosp NHS Fdn Trust, Royal Victoria Hosp, Pinderfields Gen Hosp, Royal Devon & Exeter NHS Fdn Trust, Bradford Teaching Hosp NHS Fdn Trust, Great Western Hosp NHS Fdn Trust, Watford Dist Gen Hosp, Imperial Coll Healthcare NHS Trust, Medway NHS Fdn Trust, Royal Liverpool & Broadgreen Univ NHS Trust, Calderdale & Huddersfield NHS Fdn Trust, Hywel Dda Univ Hlth Board, Chesterfield Royal Hosp NHS Fdn Trust, Luton & Dunstable Univ Hosp NHS Fdn Trust, Countess Chester Hosp NHS Fdn Trust, Peterborough City Hosp, Univ Hosp Leicester NHS Trust, Dist Hosp NHS Fdn Trust, Barnsley Hosp NHS Fdn Trust, Dorset Cty Hosp NHS Fdn Trust, Royal Bournemouth & Christchurch Hosp NHS Fdn Tru, Southern Hlth & Social Care Trust, United Lincolnshire Hosp NHS Trust, and Bedford Hosp NHS Trust

Subjects
Male, Stroke care, Brain Ischemia, 0302 clinical medicine, Atrial Fibrillation, Clinical Studies, Thrombolytic Therapy, 030212 general & internal medicine, Acute ischemic stroke, Stroke, Thrombectomy, Original Research, Aged, 80 and over, Evidence-Based Medicine, Quality and Outcomes, Multilevel model, Middle Aged, 16. Peace & justice, 3. Good health, Outcome and Process Assessment, Health Care, quality, outcome, Female, multilevel analysis, Cardiology and Cardiovascular Medicine, China, medicine.medical_specialty, Evidence-based practice, Taiwan, India, Patient Positioning, 03 medical and health sciences, medicine, Humans, Intensive care medicine, Antihypertensive Agents, Physical Therapy Modalities, Aged, Sri Lanka, Ischemic Stroke, business.industry, Australia, Anticoagulants, South America, A300, Process of care, medicine.disease, United Kingdom, Logistic Models, acute stroke care, Cerebrovascular Disease/Stroke, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Deglutition Disorders, business, Platelet Aggregation Inhibitors, 030217 neurology & neurosurgery
Abstract

Made available in DSpace on 2019-10-04T12:41:37Z (GMT). No. of bitstreams: 0 Previous issue date: 2019-07-02 National Health and Medical Research Council of Australia Background-The uptake of proven stroke treatments varies widely. We aimed to determine the association of evidence-based processes of care for acute ischemic stroke (AIS) and clinical outcome of patients who participated in the HEADPOST (Head Positioning in Acute Stroke Trial), a multicenter cluster crossover trial of lying flat versus sitting up, head positioning in acute stroke. Methods and Results-Use of 8 AIS processes of care were considered: reperfusion therapy in eligible patients; acute stroke unit care; antihypertensive, antiplatelet, statin, and anticoagulation for atrial fibrillation; dysphagia assessment; and physiotherapist review. Hierarchical, mixed, logistic regression models were performed to determine associations with good outcome (modified Rankin Scale scores 0-2) at 90 days, adjusted for patient and hospital variables. Among 9485 patients with AIS, implementation of all processes of care in eligible patients, or defect-free care, was associated with improved outcome (odds ratio, 1.40; 95% CI, 1.18-1.65) and better survival (odds ratio, 2.23; 95% CI, 1.62-3.09). Defect-free stroke care was also significantly associated with excellent outcome (modified Rankin Scale score 0-1) (odds ratio, 1.22; 95% CI, 1.04-1.43). No hospital characteristic was independently predictive of outcome. Only 1445 (15%) of eligible patients with AIS received all processes of care, with significant regional variations in overall and individual rates. Conclusions-Use of evidence-based care is associated with improved clinical outcome in AIS. Strategies are required to address regional variation in the use of proven AIS treatments. Univ New South Wales, Fac Med, George Inst Global Hlth, Sydney, NSW, Australia Ctr Estudios Clin, Inst Ciencias & Innovac Med, Santiago, Chile Clin Alemana Univ Desarrollo, Fac Med, Serv Neurol, Dept Neurol & Psiquiatria, Santiago, Chile Peking Univ, Hlth Sci Ctr, George Inst Global Hlth, Beijing, Peoples R China Australian Catholic Univ, Nursing Res Inst, St Vincents Hlth Australia Sydney, Sydney, NSW, Australia Univ Cent Lancashire, Fac Hlth & Wellbeing, Preston, Lancs, England Univ Chile, Fac Med, Dept Ciencias Neurol, Santiago, Chile Univ Sao Paulo, Ribeirao Preto Med Sch, Stroke Serv Neurol Div, Ribeirao Preto, Brazil Fukuoka Univ, Fac Med, Dept Prevent Med & Publ Hlth, Fukuoka, Fukuoka, Japan Univ Leicester, Dept Cardiovasc Sci, Leicester Biomed Res Ctr, Leicester, Leics, England Univ Leicester, Natl Inst Hlth Res, Leicester Biomed Res Ctr, Leicester, Leics, England Univ Edinburgh, Ctr Clin Brain Sci, Edinburgh, Midlothian, Scotland George Inst Global Hlth, Sydney, NSW, Australia Univ Desarrollo, Serv Neurol, Dept Neurol & Psiquiatria Clin Alemana Santiago, Santiago, Chile St Vincents Hlth Australia Sydney, Sydney, NSW, Australia Australian Catholic Univ, Sydney, NSW, Australia Univ Cent Lancashire, Stroke Practice Res Unit, Sch Hlth, Lancashire Clin Trials Unit, Preston, Lancs, England Univ Leicester, Dept Cardiovasc Sci, Cardiovasc Res Ctr, British Heart Fdn, Leicester, Leics, England Univ Kelaniya, Dept Pharmacol, Fac Med, Colombo, Sri Lanka Christian Med Coll & Hosp, Dept Neurol, Ludhiana, India Kaohsiung Med Univ & Hosp, Dept Neurol, Kaohsiung, Taiwan Linkou Chang Gung Mem Hosp, Dept Neurol, Taipei, Taiwan Peking Union Med Coll Hosp, Beijing, Peoples R China Univ Sao Paulo, Ribeirao Preto Sch Med, Ribeirao Preto, Brazil Monash Univ, Dept Epidemiol & Prevent Med, Melbourne, Vic, Australia Univ Cent Lancashire, Sch Hlth Sci, Coll Hlth & Wellbeing, Preston, Lancs, England Univ Desarrollo, Santiago, Chile Univ New South Wales, Neurosci Res Australia, Sydney, NSW, Australia Natl Univ Singapore, Dept Pharmacol, Singapore, Singapore Bradford Royal Infirm, Bradford Inst Hlth Res, Leeds, W Yorkshire, England Christian Med College, Ludhiana, Punjab, India RemediumOne Pvt Ltd, Kandy, Sri Lanka Kaohsiung Med Univ, Chung Ho Mem Hosp, Kaohsiung, Taiwan Calvary Publ Hosp Bruce, Bruce, Australia Royal North Shore Hosp, St Leonards, NSW, Australia Royal Prince Alfred Hosp, Camperdown, NSW, Australia Concord Repatriat Gen Hosp, Camperdown, NSW, Australia Fiona Stanley Hosp, Camperdown, NSW, Australia Macquarie Base Hosp, Melbourne, Vic, Australia Univ Sao Paulo, Fac Med Ribeirao Preto, Hosp Clin, Sao Paulo, Brazil Hosp Governador Celso Ramos, Florianopolis, SC, Brazil Sao Paulo State Univ, Hosp Fac Med Botucatu, UNESP, Sao Paulo, Brazil Yangquan Coalmine Grp Gen Hosp, Yangquan, Peoples R China Nanjing Med Univ, Nanjing Hosp 1, Nanjing, Jiangsu, Peoples R China 85 Hosp Peoples Liberat Army, Beijing, Peoples R China Chifeng Univ, Affiliated Hosp, Chifeng, Peoples R China Beijing Pinggu Hosp, Beijing, Peoples R China Wenzhou Med Univ, Affiliated Hosp 1, Wenzhou, Peoples R China Soochow Univ, Affiliated Hosp 2, Suzhou, Peoples R China Hebei Med Univ, Hosp 3, Shijiazhuang, Hebei, Peoples R China Capital Med Univ, Xuanwu Hosp, Beijing, Peoples R China Jining Med Univ, Affiliated Hosp, Jining, Peoples R China Third Peoples Hosp Huizhou, Huizhou, Peoples R China Second Cangzhou Cent Hosp, Cangzhou, Peoples R China Shanghai Jiao Tong Univ, Hosp Affiliated, Sch Med, Shanghai, Peoples R China Baogang Hosp, Baotou, Peoples R China Harbin Med Univ, Affiliated Hosp 1, Harbin, Heilongjiang, Peoples R China Shanghai Jiao Tong Univ Sch, Tong Ren Hosp, Peoples Hosp Hejian City, Shanghai, Peoples R China Peking Univ, Shougang Hosp, Beijing, Peoples R China Guangzhou Med Univ, Affiliated Hosp 3, Guangzhou, Guangdong, Peoples R China Second Hosp Nanchang, Nanchang, Jiangxi, Peoples R China Bethune Int Peace Hosp, Beijing, Peoples R China Hua Henan Prov Peoples Hosp, Beijing, Peoples R China Hua Henan Prov Peoples Hosp, Zhengzhou, Henan, Peoples R China Shanghai Jiao Tong Univ, Sch Med, Shanghai Ninth Peoples Hosp, Shanghai, Peoples R China Shijiazhuang Cent Hosp, Shijiazhuang, Hebei, Peoples R China Hosp Base San Jos de Osorno, Osorno, Chile Christian Med Coll & Hosp, Ludhiana, Punjab, India Unit Narayana Hrudayalaya Ltd, Mazumdar Shaw Med Ctr, Bangalore, Karnataka, India Dr Ramesh Cardiac & Multispecial Hosp Pvt Ltd, Guntur, India Post Grad Inst Med Educ & Res, Chandigarh, India Baby Mem Hosp Ltd, Calicut, Kerala, India Sree Chitra Tirunal Inst Med Sci & Technol, Thiruvananthapuram, Kerala, India Sri Jayawardenepura Gen Hosp, Sri Jayawardenepura Kott, Sri Lanka Colombo North Teaching Hosp, Colombo, Sri Lanka Colombo South Coching Hosp, Colombo, Sri Lanka Linkou Chang Gung Mem Hosp, Taoyuan, Taiwan Taipei Med Univ, Shuang Ho Hosp, Taipei, Taiwan En Chu Kong Hosp, New Taipei, Taiwan Natl Cheng Kung Univ Hosp, Tainan, Taiwan Queen Alexandra Hosp, Portsmouth, Hants, England Portsmouth Hosp NHS Natl Hlth Serv iTrust, Portsmouth, Hants, England Univ Coll London Hosp NHS Fdn Trust, London, England Univ Hosp Birmingham NHS Fdn Trust, Queen Elizabeth Hosp Birmingham, Birmingham, W Midlands, England Southend Univ Hosp NHS Fdn Trust, Southend On Sea, England Kings Coll Hosp London, London, England York Teaching Hosp NHS Fdn Trust, York, N Yorkshire, England Nottingham Univ Hosp NHS Trust, Nottingham, England Blackpool Teaching Hosp NHS Fdn Trust, Blackpool, England Gloucestershire Hosp NHS Fdn Trust, Gloucestershire Royal Hosp, Gloucester, England Teaching Hospi NHS Fdn Trust, London, England Royal Cornwall Hosp NHS Trust, Truro, England Royal London Hosp, Barts Hlth NHS Trust, London, England Sheffield Teaching Hosp NHS Fdn Trust, Sheffield, S Yorkshire, England Cambridge Univ Hosp NHS Fdn Trust, Addenbrookes Hosp, Cambridge, England Royal Victoria Hosp, Belfast Hlth & Social Care Trust, London, England Pinderfields Gen Hosp, Mid Yorkshire Hosp NHS Trust, Wakefield, England Royal Devon & Exeter NHS Fdn Trust, London, England Bradford Teaching Hosp NHS Fdn Trust, Bradford, W Yorkshire, England Great Western Hosp NHS Fdn Trust, Swindon, Wilts, England Watford Dist Gen Hosp, Watford, England Imperial Coll Healthcare NHS Trust, London, England Medway NHS Fdn Trust, Gillingham, England Royal Liverpool & Broadgreen Univ NHS Trust, Liverpool, Merseyside, England Calderdale & Huddersfield NHS Fdn Trust, Huddersfield, W Yorkshire, England Hywel Dda Univ Hlth Board, Haverfordwest, Wales Chesterfield Royal Hosp NHS Fdn Trust, Calow, England Luton & Dunstable Univ Hosp NHS Fdn Trust, Luton, Beds, England Countess Chester Hosp NHS Fdn Trust, Chester, Cheshire, England Peterborough City Hosp, Peterborough, Cambs, England Univ Hosp Leicester NHS Trust, Leicester Royal Infirm, Leicester, Leics, England Dist Hosp NHS Fdn Trust, London, England Barnsley Hosp NHS Fdn Trust, Barnsley, England Dorset Cty Hosp NHS Fdn Trust, Dorchester, England Royal Bournemouth & Christchurch Hosp NHS Fdn Tru, Royal Bournemouth Hosp, Bournemouth, Dorset, England Southern Hlth & Social Care Trust, Craigavon Area Hosp, Portadown, England United Lincolnshire Hosp NHS Trust, Pilgrim Hosp, Lincoln, England Bedford Hosp NHS Trust, Bedford, England Sao Paulo State Univ, Hosp Fac Med Botucatu, UNESP, Sao Paulo, Brazil National Health and Medical Research Council of Australia: 1066966

Published
2019

34. MicroRNA let-7g possesses a therapeutic potential for peripheral artery disease

Author

Tzu-Ming Wang, Po-Yuan Hsu, Ruey-Tay Lin, Suh-Hang Hank Juo, Edward Hsi, and Yi-Chu Liao

Subjects
Male, Vascular Endothelial Growth Factor A, 0301 basic medicine, medicine.medical_specialty, Angiogenesis, Ischemia, Neovascularization, Physiologic, Apoptosis, Biology, peripheral artery disease, Cell Line, vascular endothelial growth factor‐A, Neovascularization, angiogenesis, Mice, Peripheral Arterial Disease, 03 medical and health sciences, medicine, Animals, microRNA let‐7g, Progenitor cell, Endothelial Progenitor Cells, Kinase insert domain receptor, Original Articles, Cell Biology, Atherosclerosis, medicine.disease, Vascular Endothelial Growth Factor Receptor-2, Hindlimb, Surgery, Mice, Inbred C57BL, Vascular endothelial growth factor B, Disease Models, Animal, MicroRNAs, Vascular endothelial growth factor A, 030104 developmental biology, Cancer research, Molecular Medicine, Original Article, Angiogenesis Inducing Agents, medicine.symptom, Signal Transduction
Abstract

Peripheral artery disease (PAD) is a manifestation of systemic atherosclerosis and conveys a significant health burden globally. Critical limb ischaemia encompasses the most severe consequence of PAD. Our previous studies indicate that microRNA let‐7g prevents atherosclerosis and improves endothelial functions. This study aimed to investigate whether and how let‐7g therapy may improve blood flow to ischaemic limbs. The present study shows that let‐7g has multiple pro‐angiogenic effects on mouse ischaemic limb model and could be a potential therapeutic agent for PAD. Mice receiving intramuscular injection of let‐7g had more neovascularization, better local perfusion and increased recruitment of endothelial progenitor cells after hindlimb ischaemia. The therapeutic effects of let‐7g's on angiogenesis are mediated by multiple regulatory machinery. First, let‐7g increased expression of vascular endothelial growth factor‐A (VEGF‐A) and VEGF receptor‐2 (VEGFR‐2) through targeting their upstream regulators HIF‐3α and TP53. In addition, let‐7g affected the splicing factor SC35 which subsequently enhanced the alternative splicing of VEGF‐A from the anti‐angiogenic isoform VEGF‐A165b towards the pro‐angiogenic isoform VEGF‐A164a. The pleiotropic effects of let‐7g on angiogenesis imply that let‐7g may possess a therapeutic potential in ischaemic diseases.

Published
2016

35. Clinical implication of hemorrhagic transformation in ischemic stroke patients treated with recombinant tissue plasminogen activator

Author

Ching-Kuan Liu, A-Ching Chao, Chien-Fu Chen, Ruey-Tay Lin, and Bo-Lin Ho

Subjects
medicine.medical_specialty, medicine.medical_treatment, Dermatology, Asymptomatic, Gastroenterology, Tissue plasminogen activator, Brain Ischemia, Brain ischemia, 03 medical and health sciences, 0302 clinical medicine, Fibrinolytic Agents, Modified Rankin Scale, Internal medicine, Outcome Assessment, Health Care, medicine, Humans, Prospective Studies, 030212 general & internal medicine, Prospective cohort study, Stroke, Aged, business.industry, General Medicine, Thrombolysis, medicine.disease, Surgery, Psychiatry and Mental health, Tissue Plasminogen Activator, Neurology (clinical), medicine.symptom, business, Intracranial Hemorrhages, 030217 neurology & neurosurgery, Fibrinolytic agent, medicine.drug
Abstract

To determine the clinical implications of hemorrhagic transformation (HT) after thrombolysis, 241 eligible patients receiving alteplase for acute ischemic stroke were studied. HT was classified, according to the European Cooperative Acute Stroke Study criteria, as hemorrhagic infarction (HI) or parenchymal hemorrhage (PH). Symptomatic intracranial hemorrhage (SICH) was defined according to the National Institute of Neurological Disorders and Stroke study. A novel classification, clinically significant intracranial hemorrhage (CSICH) was defined as HTs associated with an unfavorable clinical outcome (modified Rankin Scale 5-6) at 3 months. For all subtypes of HT, we found that patients receiving alteplase were more often in the standard-dose group (0.90 ± 0.02 mg/kg) than in the lower dose group (0.72 ± 0.07 mg/kg). PH and SICH were related to an unfavorable clinical outcome, while HI was not. There was a positive trend between age and CSICH in patients receiving the standard dose (P = 0.0101), and between alteplase dose and CSICH in patients ≥70 years old (P = 0.0228). All PHs (including asymptomatic PHs) and symptomatic HIs have been found to be associated with unfavorable outcome, and for this reason defined as CSICH. Independent predictors of CSICH were age ≥70 years and the standard dose of alteplase. Further studies of thrombolysis for ischemic stroke with different doses of alteplase are warranted.

Published
2016

36. Cost-effectiveness of amlodipine compared with valsartan in preventing stroke and myocardial infarction among hypertensive patients in Taiwan

Author

Ruey Tay Lin, Jim Z. Li, Yi-Heng Li, Lung Chan, Kou Gi Shyu, Juey-Jen Hwang, San Jou Yeh, Wen Yi Shau, Larry Z. Liu, Te Chang Weng, and Chen Huan Chen

Subjects
medicine.medical_specialty, Cost effectiveness, International Journal of General Medicine, 030204 cardiovascular system & hematology, Lower risk, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Medicine, 030212 general & internal medicine, Amlodipine, Myocardial infarction, Risk factor, Stroke, cost-effectiveness, CCB, health care economics and organizations, Original Research, business.industry, General Medicine, medicine.disease, ARB, Markov model, pharmacoeconomic, Valsartan, Cohort, Medical emergency, business, medicine.drug
Abstract

Lung Chan,1 Chen-Huan Chen,2 Juey-Jen Hwang,3 San-Jou Yeh,4 Kou-Gi Shyu,5 Ruey-Tay Lin,6 Yi-Heng Li,7 Larry Z Liu,8 Jim Z Li,9 Wen-Yi Shau,10 Te-Chang Weng,10 1Department of Neurology, Shuang-Ho Hospital, School of Medicine, College of Medicine, Taipei Medical University, New Taipei, 2Department of Internal Medicine, Faculty of Medicine, National Yang-Ming University, 3Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, 4Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, 5Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, 6Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, 7Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; 8Pfizer Inc, New York, NY, USA; 9Pfizer Inc, San Diego, CA ,USA; 10Pfizer Ltd., New Taipei City, Taiwan Abstract: Hypertension is a major risk factor for strokes and myocardial infarction (MI). Given its effectiveness and safety profile, the calcium channel blocker amlodipine is among the most frequently prescribed antihypertensive drugs. This analysis was conducted to determine the costs and quality-adjusted life years (QALYs) associated with the use of amlodipine and valsartan, an angiotensin II receptor blocker, in preventing stroke and MI in Taiwanese hypertensive patients. A state transition (Markov) model was developed to compare the 5-year costs and QALYs for amlodipine and valsartan. Effectiveness data were based on the NAGOYA HEART Study, local studies, and a published meta-analysis. Utility data and costs of MI and stroke were retrieved from the published literature. Medical costs were based on the literature and inflated to 2011 prices; drug costs were based on National Health Insurance prices in 2014. A 3% discount rate was used for costs and QALYs and a third-party payer perspective adopted. One-way sensitivity and scenario analyses were conducted. Compared with valsartan, amlodipine was associated with cost savings of New Taiwan Dollars (NTD) 2,251 per patient per year: costs were NTD 4,296 and NTD 6,547 per patient per year for amlodipine and valsartan users, respectively. Fewer cardiovascular events were reported in patients receiving amlodipine versus valsartan (342 vs 413 per 10,000 patients over 5 years, respectively). Amlodipine had a net gain of 58 QALYs versus valsartan per 10,000 patients over 5 years. Sensitivity analyses showed that the discount rate and cohort age had a larger effect on total cost and cost difference than on QALYs. However, amlodipine results were more favorable than valsartan irrespective of discount rate or cohort age. When administered to Taiwanese patients for hypertension control, amlodipine was associated with lower cost and more QALYs compared with valsartan due to a lower risk of stroke and MI events. Keywords: cost-effectiveness, pharmacoeconomic, Markov model, CCB, ARB

Published
2016

37. Immediate effects of noxious and innocuous thermal stimulation on brain activation in patients with stroke

Author

Ruey-Tay Lin, Jau-Hong Lin, Sharon C.-A. Chen, Miao-Ju Hsu, Sing Kai Lo, and Yu-Ting Kuo

Subjects
Adult, Male, Hot Temperature, Observational Study, Somatosensory system, stimulation, rehabilitation, Lesion, 03 medical and health sciences, 0302 clinical medicine, Physical Stimulation, brain activity, Neuroplasticity, medicine, Humans, 030212 general & internal medicine, Anterior cingulate cortex, Aged, Analysis of Variance, Supplementary motor area, Secondary somatosensory cortex, business.industry, Stroke Rehabilitation, General Medicine, Middle Aged, Magnetic Resonance Imaging, functional magnetic resonance imaging, stroke, medicine.anatomical_structure, Case-Control Studies, 030220 oncology & carcinogenesis, Anesthesia, Finger tapping, Female, Primary motor cortex, medicine.symptom, business, Research Article
Abstract

Case-control studies have shown that noxious thermal stimulation (TS) can improve arm function in patients with stroke. However, the neural mechanisms underlying this improvement are largely unknown. We explored functional neural activation due to noxious and innocuous TS intervention applied to the paretic arm of patients with stroke. Sixteen participants with unilateral cortical infarctions were allocated to one of two groups: noxious TS (8 patients; temperature combination: hot pain 46°C to 47°C, cold pain 7°C–8°C) or innocuous TS (n = 8; temperature combination: hot 40°C–41°C, cold 20°C–21°C). All subjects underwent fMRI scanning before and after 30 min TS intervention and performed a finger tapping task with the affected hand. Immediate brain activation effects were assessed according to thermal type (noxious vs. innocuous TS) and time (pre-TS vs post-TS). Regions activated by noxious TS relative to innocuous TS (P

Published
2020

38. Low-dose versus standard-dose intravenous alteplase for octogenerian acute ischemic stroke patients: A multicenter prospective cohort study

Author

Sheng-Feng Lin, Chyi Huey Bai, Cheng-Yu Wei, Yu Sun, Ruey-Tay Lin, Chih Hung Chen, Lung Chan, Han-Hwa Hu, Po Lin Chen, Yu-Te Lin, Jiunn-Tay Lee, Huey-Juan Lin, Ke Han, A-Ching Chao, Yung-Yang Lin, and Shinn-Kuang Lin

Subjects
Male, medicine.medical_specialty, Stroke patient, Mild stroke, Tissue plasminogen activator, Severity of Illness Index, Brain Ischemia, Stroke onset, 03 medical and health sciences, 0302 clinical medicine, Fibrinolytic Agents, Internal medicine, medicine, Humans, 030212 general & internal medicine, Prospective Studies, High severity, Prospective cohort study, Acute ischemic stroke, Aged, 80 and over, Dose-Response Relationship, Drug, business.industry, Low dose, Age Factors, Stroke, Treatment Outcome, Neurology, Tissue Plasminogen Activator, Cardiology, Administration, Intravenous, Female, Neurology (clinical), business, 030217 neurology & neurosurgery, medicine.drug
Abstract

Background and purpose The optimal dose of alteplase for acute ischemic stroke among geriatric patients is unclear. We aimed to assess the efficacy and safety of a low-dose (0.6 mg/kg) and standard-dose (0.9 mg/kg) alteplase for varying severity of Asian geriatric stroke patients. Methods The favorable functional outcome on day 90 after stroke onset, and the symptomatic intracranial hemorrhage (SICH) rate following 24–36 h of intravenous alteplase were measured. The baseline NIHSS of 4–8, 9–13, ≥14 were defined as mild, moderate, and high severity, respectively. Results Totally, 249 geriatric patients treated with low-dose (n = 108) and standard-dose (n = 141) alteplase. Compared to standard-dose alteplase, low-dose alteplase had decrease in favorable functional outcome (22.2% versus 34.8%), and no difference in SICH rates was observed. For mild severity patients, the mortality was significantly increased with standard-dose alteplase (the NNT/NNH = 22.9/8.0 for mild severity, the NNT/ NNH = 15.0/14.7 for moderate severity, and the NNT/NNH = 13.5/19.6 for high severity). Conclusions Standard-dose and low-dose alteplase were comparable in reducing major disability, but low-dose alteplase for mild stroke showed much reduced mortality on day 90 for octogenarians.

Published
2018

39. MicroRNA let-7g inhibits angiotensin II-induced endothelial senescence via the LOX-1-independent mechanism

Author

Po‑Yuan Hsu, Suh‑Hang H. Juo, Ruey‑Tay Lin, and Wen-Yi Lin

Subjects
0301 basic medicine, Senescence, Small interfering RNA, medicine.medical_treatment, Down-Regulation, 030204 cardiovascular system & hematology, insulin-like growth factor, 03 medical and health sciences, 0302 clinical medicine, Downregulation and upregulation, Genetics, medicine, Humans, RNA, Small Interfering, Scavenger receptor, Cellular Senescence, Insulin-like growth factor 1 receptor, human umbilical vein endothelial cells, biology, Sirtuin 1, Chemistry, Angiotensin II, Growth factor, Endothelial Cells, Articles, General Medicine, Scavenger Receptors, Class E, Up-Regulation, Cell biology, microRNA let-7g, lectin-like oxidized low-density lipoprotein receptor-1, MicroRNAs, 030104 developmental biology, cell senescence, biology.protein, RNA Interference, lipids (amino acids, peptides, and proteins)
Abstract

Endothelial senescence leads to cell dysfunction, which in turn eventually results in cardiovascular disease. Identifying factors that regulate endothelial senescence may provide insight into the pathogenesis of aging. Insulin-like growth factor (IGF) signaling has a significant role in the physiology of endothelial cells (ECs). Overactivation of IGF signaling has been implicated in promoting the aging process. Lectin‑like oxidized low‑density lipoprotein (oxLDL) receptor‑1 (LOX‑1) is a scavenger receptor that mediates the internalization of oxLDL into cells. Previous studies by our group have indicated that microRNA let‑7g exerts an anti‑aging effect on ECs and also suppresses LOX-1 expression. Since LOX‑1 also induces the aging process, the present study we explored whether let‑7g still exerts an anti‑aging effect on ECs when LOX‑1 is suppressed. Angiotensin II (Ang II) was used to induce senescence in ECs. It was revealed that Ang II significantly increased the expression of aging markers, including β‑galactosidase, LOX‑1, IGF1 and its receptor IGF1R. On the contrary, Ang II decreased the expression of the anti‑aging gene sirtuin 1 (SIRT1). When LOX‑1 was knocked down by small interfering RNA, let‑7g still dose‑dependently decreased the expression of β‑galactosidase (β‑gal), LOX‑1, IGF1 and IGF1R, and SIRT1 was still upregulated. Using senescence‑associated β‑gal staining, it was confirmed that let‑7g exerts a LOX‑1‑independent anti‑aging effect on ECs. In conclusion, the present study demonstrated that let‑7g has an anti‑aging effect regardless of the presence or absence of LOX-1.

Published
2018

40. Hyperglycemia predicts unfavorable outcomes in acute ischemic stroke patients treated with intravenous thrombolysis among a Chinese population: A prospective cohort study

Author

Lung Chan, Jiunn-Tay Lee, Yu Sun, Ruey-Tay Lin, Sheng-Feng Lin, Yung-Yang Lin, Huey-Juan Lin, Yu-Te Lin, Han-Hwa Hu, Chih Hung Chen, Shinn-Kuang Lin, Cheng-Yu Wei, Ming-Hui Sun, A-Ching Chao, Chi-Huey Bai, and Po Lin Chen

Subjects
Blood Glucose, Male, medicine.medical_specialty, medicine.medical_treatment, Tissue plasminogen activator, Brain Ischemia, 03 medical and health sciences, 0302 clinical medicine, Fibrinolytic Agents, Internal medicine, medicine, Humans, Thrombolytic Therapy, 030212 general & internal medicine, Serum glucose level, Longitudinal Studies, Prospective Studies, Prospective cohort study, Acute ischemic stroke, Aged, Chinese population, business.industry, Thrombolysis, Middle Aged, Prognosis, Stroke, Treatment Outcome, Neurology, Hyperglycemia, Tissue Plasminogen Activator, Cohort, Administration, Intravenous, Female, Neurology (clinical), business, Intracranial Hemorrhages, 030217 neurology & neurosurgery, Biomarkers, medicine.drug, Cohort study
Abstract

Poorly controlled blood glucose was reported to cause deterioration of acute ischemic stroke. In this study, we investigated whether an elevated admission serum glucose level in the 3-h time window of intravenous thrombolysis for acute ischemic stroke determined poor functional outcomes among Chinese population.This was a prospective cohort study. From December 1, 2004 to December 31, 2016, a total of 2370 patients were enrolled and categorized into two cohorts by blood glucose levels of ≥200 and200 mg/dl in the 3 h after stroke onset. The primary objective was to determine whether admission hyperglycemia increased major disability and death at 30 and 90 days, which was defined by a modified Rankin Scale of 3-6. The secondary objective was to determine whether admission hyperglycemia increased the symptomatic intracranial hemorrhage (SICH) at 90 days. The number needed to harm (NNH) and patient expected event rate (PEER) were evaluated for both the primary and secondary objectives.The primary outcome occurred in 216 of 305 patients (70.8%) in the blood glucose ≥200 mg/dl cohort and in 951 of 1587 patients (59.9%) in the blood glucose200 mg/dl cohort at 30 days, and in 191 of 287 patients (66.6%) in the blood glucose ≥200 mg/dl cohort and in 827 of 1517 patients (54.5%) in the blood glucose200 mg/dl cohort at 90 days. Patients with admission hyperglycemia had significantly increased major disability and death at 30 (adjusted relative risk (RR): 1.194 [1.073-1.329], p = 0.0012) and 90 days (adjusted RR: 1.203 [1.079-1.340], p = 0.0008). Admission hyperglycemia increased the risk of the occurrence of SICH by nearly 2-fold (adjusted RR: 1.891 [0.977-3.657], p = 0.0585 with the SITS-MOST criteria and adjusted RR: 1.884 [1.138-3.121], p = 0.0139 with the NINDS criteria). NNH values of admission hyperglycemia in major disability and death at 30 and 90 days were 9 and 10, and NNH values of SICH by the SITS-MOST NINDS criteria were 44 and 34, respectively.The study evidenced the association and temporal relationship of admission hyperglycemia causing deterioration of functional outcomes and increased SICH among Chinese population with acute ischemic stroke treated with intravenous thrombolysis.

Published
2018

41. Determinants of cerebral white matter changes in patients with stroke

Author

Meng-Ni Wu, Ping-Song Chou, Y.-H. Lin, Chiao-Yun Chen, Ya-Hui Yang, Ruey-Tay Lin, and Chiou-Lian Lai

Subjects
medicine.medical_specialty, education.field_of_study, medicine.diagnostic_test, Cerebral white matter, business.industry, Population, Leukoaraiosis, Magnetic resonance imaging, Odds ratio, Logistic regression, medicine.disease, Confidence interval, Internal medicine, Internal Medicine, medicine, Physical therapy, education, business, Stroke
Abstract

Background/Aim Cerebral white matter changes (WMC) are commonly observed in magnetic resonance imaging (MRI) scans of elderly people. Information about the prevalence of WMC is limited, and little is known about site-specific risk factors for the subcortical and periventricular regions in patients with ischaemic stroke. The study aims to analyse the prevalence and severity of WMC and investigate the risk factors of periventricular WMC (PVWMC) and deep WMC (DWMC) separately in patients with ischaemic stroke. Methods The data were collected between January and December 2013 from a medical centre in southern Taiwan. Every patient underwent a cerebral MRI scan, and WMC was separately rated as PVWMC and DWMC by using the modified Fazekas scale. Results In total, 527 patients who had experienced ischaemic stroke were included. The mean age of the patients was 67.0 ± 12.5 years (range: 31–94) and 62% of them were men. The mean age was significantly different among the four grades of severity in both the PVWMC (P < 0.001) and DWMC (P < 0.001) groups after adjustments for sex and vascular risk factors. Hypertension was independently correlated with severity of DWMC (P = 0.032) but not with PVWMC (P = 0.222). In multiple logistic regressions model, hypertension was a significant independent indicator of DWMC (odds ratio = 4.30; 95% confidence interval = 1.70–10.89). Conclusion Our results suggest a region-specific pathogenesis of cerebral white matter in Asian patients with ischaemic stroke that may differ from those in the general population.

Published
2015

42. The Efficacy and Safety of Cilostazol in Ischemic Stroke Patients with Peripheral Arterial Disease (SPAD): Protocol of a Randomized, Double-Blind, Placebo-Controlled Multicenter Trial

Author

Jiann-Shing, Jeng, Yu, Sun, Jiunn-Tay, Lee, Ruey-Tay, Lin, Chih-Hung, Chen, Helen L, Po, Huey-Juan, Lin, Chung-Hsiang, Liu, Ming-Hui, Sun, Mu-Chien, Sun, Chang-Ming, Chern, Li-Ming, Lien, Hou-Chang, Chiu, Han-Hwa, Hu, Hung-Yi, Chiou, Sien-Tsong, Chen, Henry, Ma, Chung Y, Hsu, and Ko-Chung, Tsui

Subjects
Male, medicine.medical_specialty, Arterial disease, Tetrazoles, Placebo, Peripheral Arterial Disease, Double-Blind Method, Fibrinolytic Agents, Internal medicine, Multicenter trial, medicine, Humans, cardiovascular diseases, Aspirin, business.industry, Middle Aged, Cilostazol, Surgery, Peripheral, Stroke, Neurology, Intima-media thickness, Research Design, Ischemic stroke, Cardiology, Drug Therapy, Combination, Female, business, medicine.drug
Abstract

Rationale It is not uncommon for patients with ischemic stroke to have peripheral arterial disease (PAD). Patients with polyvascular diseases carry greater burden of atherosclerosis and higher risks of developing vascular events and death. More effective regimens, such as dual antiplatelet agents, may be more effective for controlling progression of atherosclerosis in secondary prevention. Aim This study aims to evaluate whether cilostazol plus aspirin is more efficacious than aspirin alone for preventing progression of atherosclerosis in patients with ischemic stroke or transient ischemic attack (TIA) who also have peripheral arterial disease. Design The Safety and Efficacy of Cilostazol in Ischemic Stroke Patients with Peripheral Arterial Disease (SPAD) study is a randomized double-blinded placebo-controlled trial. Patients with previous ischemic stroke or TIA who had been taking aspirin (100 mg per day), aged 50 years or older, with PAD in the lower limbs based on ankle-brachial index (ABI) Study outcomes Patients will be evaluated at 1, 3, 6, 9 and 12 months after randomization. The primary endpoint is difference in change in ABI between groups. The secondary and tertiary endpoints are the difference between groups in change in carotid intima-media thickness (IMT) and incidence rate of major cardiovascular events, including recurrent stroke, myocardial infarction, unstable angina, other vascular events, and death; and the safety measures, including major bleeding events, hemorrhagic stroke and death of any cause. Conclusion The SPAD trial is the first study to evaluate the safety and efficacy of dual antiplatelet agents, aspirin plus cilostazol, in comparison with aspirin alone in patients with both ischemic stroke or TIA and PAD. Results from this trial will provide important information on the merit of adding cilostazol to aspirin for slowing down progression of atherosclerosis in patients with ischemic stroke and PAD.

Published
2014

43. Risk for Major Bleeding in Patients Receiving Ticagrelor Compared With Aspirin After Transient Ischemic Attack or Acute Ischemic Stroke in the SOCRATES Study (Acute Stroke or Transient Ischemic Attack Treated With Aspirin or Ticagrelor and Patient Outcomes)

Author

J. Donald Easton, Maria Aunes, Gregory W. Albers, Pierre Amarenco, Sara Bokelund-Singh, Hans Denison, Scott R. Evans, Peter Held, Marianne Jahreskog, Jenny Jonasson, Kazuo Minematsu, Carlos A. Molina, Yongjun Wang, K.S. Lawrence Wong, S. Claiborne Johnston, Sebastiá F. Ameriso, Geoffrey Donnan, Robin Lemmens, Ayrton Massaro, Ekaterina Titianova, Michael D. Hill, Pablo Lavados, David Skoloudik, Joachim Röther, Szegedi Norbert, Giancarlo Agnelli, Natan Bornstein, Norio Tanahashi, Angel Arauz Góngora, Edwin Pretell, Maria Cristina Z. San Jose, Anna Czlonkowska, Ovidiu Bajenaru, Ludmila Stakhovskaya, Miroslav Brozman, Jong-Sung Kim, Nils Wahlgren, Patrik Michel, Tsong Hai Lee, Nijasri Charnnarong Suwanwela, Kursad Kutluk, Sergii Moskovko, Scott Kasner, Daniel Laskowitz, Wayne Clark, Huy Thang Nguyen, Sebastian Ameriso, Sandra Lepera, Marina Romano, David Paulon, Pablo Ioli, Cristina Zurru, Guadalupe Bruera, Lorena Jure, Francisco Klein, Guillermo Povedano, Christopher Levi, Thanh Phan, Romesh Markus, Craig Anderson, Arman Sabet, Stephen Davis, Andrew Lee, Timothy Kleinig, Andrew Wong, Martin Krause, Jim Jannes, Tissa Wijeratne, Dimitri Hemelsoet, André Peeters, Philippe Tack, Peter Vanacker, Patrice Laloux, William Van Landegem, Geert Vanhooren, Philippe Desfontaines, Marc Van Orshoven, Fabio Oliveira, Mauricio Friedrich, Rosane Brondani, Rubens Gagliardi, Soraia Fabio, Marianna Dracoulakis, Rodrigo Bazan, Luiz Marrone, Octavio Pontes Neto, Gisele Silva, Pedro Kowacs, Paraskeva Stamenova, Marin Daskalov, Ivan Staikov, Dimo Baldaranov, Dimitar Maslarov, Hristo Lilovski, Plamen Petkov, Neli Petrova, Radoslav Mavrov, Veska Markova, Valeria Petrova, Tanya Beleva, Borislav Kralev, Nikolay Sotirov, Veska Lekova, Dimcho Hristov, Vera Ermenkova, Lyudmil Mateev, Rumeliya Mitkova, Liybomir Haralanov, Rosen Ikonomov, Margarita Mihailova, Ivan Georgiev, Ashfaq Shuaib, Vladimir Hachinski, Jean-Martin Boulanger, Sharan Mann, Ayman Hassan, Ariane Mackey, Bijoy Menon, Jeffrey Minuk, Muzaffar Siddiqui, Marsha Eustace, Lucia Vieira, Daniel Selchen, Michel Beaudry, Grant Stotts, Angel Castro, Kristo Gasic, Rodrigo Rivas, Pablo Sanchez, Andres Roldan, Ingrid Grossmann, Christian Figueroa, Jimei Li, Xiaolin Xu, Huisheng Chen, Xiaohong Li, Yi Yang, Chunsheng Zhang, Baojun Wang, Guanglai Li, Dong Wang, Hong Lin, Yamei Tang, Anding Xu, Yanjiang Wang, Wenke Hong, Zhi Song, Xu Zhang, Xiaoping Jin, Yun Xu, Fuling Yan, Weihong Zheng, Xiaoping Wang, Qiang Dong, Zhongxin Zhao, Baorong Zhang, Wangtao Zhong, Guoqiang Wen, Jun Xu, Guozhong Li, Xueshuang Dong, Xiangyang Tian, Zhaohui Zhang, En Xu, Kaixiang Liu, Jun Chen, Ondrej Skoda, Edvard Ehler, Daniel Vaclavik, Daniel Sanak, Sylva Klimosova, Eva Vitkova, Jan Fiksa, Robert Mikulik, Jiri Neumann, Richard Plny, Didier Leys, Igor Sibon, Jean-Louis Mas, Sonia Alamowitch, Fernando Pico, Hassan Hosseini, Marie-Hélène Mahagne, Emmanuel Touze, Wilfried Vadot, Stéphane Vannier, Norbert Nighoghossian, Yves Samson, Pierre Garnier, Emmanuel Ellie, Benoît Guillon, Serge Timsit, Maurice Giroud, Frédéric Philippeau, Aude Bagan-Triquenot, Valérie Wolff, Nicolas Raposo, Michel Obadia, Severine Debiais, Jérôme Grimaud, Stéphane Illouz, Didier Smadja, Cédric Urbanczyk, Jörg Berrouschot, Christian Weimar, Georg Gahn, Hassan Soda, Sven Klimpe, Darius Nabavi, Jörg Glahn, Martin Köhrmann, Lars Krause, Christoph Terborg, Peter Urban, Thorsten Steiner, Andreas Ferbert, Rainer Dziewas, Günter Seidel, Götz Thomalla, Richard Li, Wing Chi Fong, Raymond Cheung, Norbert Szegedi, Krisztián Pozsegovits, Attila Valikovics, Gyula Pánczél, Csilla Rózsa, László Németh, Péter Diószeghy, Csaba Óváry, Attila Csányi, Levente Kerényi, Valéria Nagy, Sámuel Komoly, Dániel Bereczki, Sándor Molnár, István Kondákor, David Tanne, Guy Raphaeli, Gregory Telman, Ronen Leker, Yair Lampl, Francesco Corea, Stefano Ricci, Donata Guidetti, Giovanni Malferrari, Simona Marcheselli, Giuseppe Micieli, Andrea Zini, Vincenzo Di Lazzaro, Carlo Gandolfo, Andrea Salmaggi, Rossana Tassi, Maurizia Rasura, Giovanni Orlandi, Giancarlo Comi, Michelangelo Mancuso, Marialuisa Delodovici, Paolo Bovi, Domenico Consoli, Kimiaki Utsugisawa, Tsuneo Fujita, Hideyuki Kurihara, Chikashi Maruki, Takeshi Hayashi, Tsuneaki Ogiichi, Morio Kumagai, Katsunobu Takenaka, Kazunori Toyoda, Kazuhiro Takamatsu, Ryo Ogami, Shigenari Kin, Takeshi Aoki, Katsumi Takizawa, Shigehiro Omori, Takehiko Umezawa, Yasuyuki Toba, Yutaka Nonoyama, Hidemitsu Nakagawa, Takashi Naka, Masanori Morimoto, Shuichi Matsumoto, Tsutomu Hitotsumatsu, Tatsuya Shingaki, Satoshi Okuda, Mamoru Ota, Nobuyuki Sakai, Takeshi Yamada, Jun Niwa, Hitoshi Fujita, Akihito Moriki, Kimihiro Yoshino, Yoshihisa Fukushima, Takahisa Mori, Atsushi Sato, Yoshikazu Kusano, Michiya Kubo, Masashi Yamazaki, Takao Ooasa, Takafumi Nishizaki, Naoki Kitagawa, Masahiro Yasaka, Yasuhiro Manabe, Akira Yoshioka, Masayuki Ishihara, Takato Kagawa, Toshikazu Ichihashi, Hideki Matsuoka, Yasuhiro Ito, Masahiro Yamasaki, Hitonori Takaba, Hisatoshi Saito, Masahiro Sato, Kazumasa Fukuda, Sumio Endo, Minoru Kidooka, Toshitaka Umemura, Yuriko Kikkawa, Shuta Toru, Kentaro Yamada, Hideki Sakai, Jun Asari, Masayuki Ezura, Hisashi Nitta, Keiko Nagano, Jun Ochiai, Keiichi Sakai, Yasutaka Kobayashi, Yasuhiro Yoshii, Hirotomo Miake, Tomohiro Takita, Hidekazu Taniguchi, Kazuhiko Kuroki, Takamitsu Mizota, Kenichi Yamamoto, Hiroshi Nakane, Takeshi Iwanaga, Kei Chiba, Tetsuyuki Yoshimoto, Tsuyoshi Torii, Takeo Kitagawa, Hiroshi Takashima, Naoki Shirasaki, Makoto Dehara, Naomichi Wada, Kensuke Hamada, Noriyuki Kato, Yoshinori Go, Ichiro Izumi, Hirotomo Ninomiya, Junichiro Kumai, Yoshikazu Nakajima, Yasuhiko Kaku, Yukihiro Isayama, Masahiro Kawanishi, Shinya Noda, Kazuhide Yamamoto, Takanori Hazama, Hiroshi Takahashi, Yohei Tanaka, Takashi Hata, Kiyoshi Kazekawa, Eisuke Furui, Hideki Hondo, Nobuyuki Sato, Katsusuke Kusunoki, Kazunori Nanri, Satoshi Abe, Noboru Sasaoka, Takayuki Kuroyanagi, Hisahiko Suzuki, Kouzou Fukuyama, Kimihiro Nakahara, Fernando Gongora, Carlos Cantú Brito, Jorge Villarreal Careaga, Rosalia Vazquez Alfaro, Geronimo Aguayo Leytte, Percy Berrospi, Carlos Chavez, Liliana Rodriguez, Nilton Custodio, Cesar Castañeda, Julio Perez, Maria Cristina San Jose, Alejandro Baroque, Epifania Collantes, Abdias Aquino, Alejandro Díaz, Artemio Roxas, Johnny Lokin, Joel Advincula, Emerito Calderon, Jose Navarro, John Hiyadan, Arturo Surdilla, Danuta Ryglewicz, Grzegorz Krychowiak, Waldemar Fryze, Piotr Sobolewski, Ryszard Nowak, Urszula Fiszer, Beata Papierowska, Justyna Zielińska-Turek, Anetta Lasek-Bal, Ewa Kołodziejska, Anna Kamińska, Bożena Adamkiewicz, Andrzej Tutaj, Dorota Szkopek, Krzysztof Musiatowicz, Zbigniew Bąk, Sławomir Brzozowski, Waldemar Brola, Antoni Ferens, Marek Zalisz, Konrad Rejdak, Monika Rudzińska, Cristina Panea, Mihaela Simu, Rodica Balasa, Iulian Cuciureanu, Bogdan Popescu, Monica Sabau, Corina Roman-Filip, Leonid Pimenov, Alla Gekht, Anna Milto, Ivan Shchukin, Vladimir Parfenov, Liudmila Stakhovskaya, Mikhail Arkhipov, Nadezhda Sokolova, Enver Bogdanov, Radiy Esin, Dina Khasanova, Konstantin Golikov, Elena Melnikova, Leonid Zaslavskiy, Igor Voznyuk, Alexander Nazarov, Leila Akhmadeeva, Aida Iakupova, Nikolay Shamalov, Galina Belskaya, Svetlana Chuprina, Olga Denisova, Ekaterina Drozdova, Yuliya Karakulova, Ilya Sholomov, Nikolay Spirin, Elena Vostrikova, Elena Mordvintseva, Vera Grigoryeva, Dmitry Zateyshchikov, Vladimir Gorbachev, Zhanna Chefranova, Mikhail Dudarev, Rostislav Nilk, Alexey Rozhdestvenskiy, Ladislav Gurcik, Miloslav Dvorak, Georgi Krastev, Egon Kurca, Juraj Vyletelka, Jong Sung Kim, Hee-Joon Bae, Yong-Won Kim, Joon-Tae Kim, Jae-Kwan Cha, Hyo Suk Nam, Dae-Il Chang, Yong-Seok Lee, Kyungmi Oh, Sung-Wook Yu, Sung-Il Sohn, Jun Lee, Han Jin Cho, Eung-Gyu Kim, Joung-Ho Rha, Seo Hyun Kim, Carlos Molina Cateriano, Joaquín Serena Leal, José Vivancos Mora, Manuel Rodríguez Yañez, Jaume Roquer González, Francisco Purroy García, Meritxell Gomis Cortina, Jaime Masjuan Vallejo, Juan Arenillas Lara, Tomás Segura Martín, José Antonio Egido Herrero, Jose Ignacio Tembl Ferrairó, Jaime Gállego Culleré, Francisco Moniche Álvarez, Anna Steinberg, Margarita Callander, Ann Charlotte Laska, Lena Bokemark, Thomas Mooe, Tor-Björn Käll, Lennart Welin, Lars Sjöblom, Joakim Hambraeus, Jörg Teichert, Hans Wannberg, Johan Sanner, Bo Ramströmer, Bo Ziedén, Stefan Olsson Hau, Claes Gustafsson, Timo Kahles, Philippe Lyrer, Marcel Arnold, Martin Liesch, Friedrich Medlin, Carlo Cereda, Georg Kägi, Andreas Luft, Emmanuel Carrera, Tsong-Hai Lee, Helen L. Po, Chang-Ming Chern, Li-Ming Lien, Lung Chan, Chung-Hsiang Liu, Shey-Lin Wu, Jiann-Der Lee, Chih-Hung Chen, Huey-Juan Lin, Ruey-Tay Lin, Wei-Hsi Chen, Yu Sun, Tasanee Tantirittisak, Sombat Muengtaweepongsa, Yongchai Nilanont, Somsak Tiamkao, Chesda Udommongkol, Kanokwan Watcharasaksilp, Witoon Jantararotai, Hadiye Sirin, Birsen Ince, Talip Asil, Murat Arsava, Tulay Kurt Incesu, Hulya Tireli, Hayriye Kucukoglu, Fikri Ak, Ali Unal, Serefnur Ozturk, Nevzat Uzuner, Galyna Chmyr, Volodymyr Lebedynets, Vadym Nikonov, Lyudmyla Shulga, Volodymyr Smolanka, Marta Khavunka, Valentyna Yavorska, Nataliya Tomakh, Olexandr Kozyolkin, Galyna Litovaltseva, Maarten Lansberg, Richard Bernstein, David Brown, Jonathan Dissin, Carmelo Graffagnino, Jonathan Harris, William Hicks, Irene Katzan, Jeffrey Kramer, Joshua Willey, Scott Silliman, Sidney Starkman, David Thaler, Margaret Tremwel, Mauricio Concha, Kumar Rajamani, Bhuvaneswari Dandapani, Brian Silver, Nathan Deal, Ira Chang, Ameer Hassan, Steven Rudolph, Kenneth Fischer, Howard Kirshner, William Logan, Sidney Mallenbaum, Hebah Hefzy, Julius Latorre, Steven Levine, Anthony Ciabarra, Rima Dafer, Benjamin Anyanwu, Laurel Cherian, Spozhmy Panezai, Anna Khanna, Jodi Dodds, Michel Torbey, James Gebel, Henry Woo, David Chiu, Xiao Androulakis, William Burgin, Maria Pineda, Engin Yilmaz, Irfan Altafullah, Christine Boutwell, Salvador Cruz-Flores, Biggya Sapkota, Pierre Fayad, Michael Jacoby, Shahid Rafiq, Efrain Salgado, Eugene Lafranchise, Warren Felton, Ramesh Madhavan, Osama Zaidat, Connie Pieper, Ralph Riviello, Aaron Burnett, Michelle Fischer, Nina Gentile, Christopher Calder, Dennis Dietrich, Jonathan Cross, Larry Blankenship, Liliana Montoya, Wendell Grogan, Mark Young, Farrukh Khan, Duane Campbell, Nizar Daboul, Andrey Espinoza, Paul Cullis, Gilberto Concepcion, John Wulff, Haider Afzal, Naseem Jaffrani, William Reiter, Tamjeed Arshad, Timothy Lukovits, James Welker, Fen Lei Chang, Aamir Badruddin, Viken Babikian, Ravi Menon, James Sander, Mellanie Springer, Ashish Nanda, Luis Mas, Raj Rajan, Bruce Silverman, David Huang, David Carpenter, Joni Clark, Marilou Ching, Sunitha Santhakumar, Jeffrey Gould, Vibhav Bansal, Gabriel Vidal, Timothy Mikesell, John Brick, William French, Qaisar Shah, Christine Holmstedt, Nadir Ishag-Osman, John Kostis, Abbas Shehadeh, Pramodkumak Sethi, Asher Imam, Carl Mccomas, Duc Tran, Mehari Gebreyohanns, Brian Wiseman, Maheen Malik, Aron Schwarcz, Dorothea Altschul, John Castaldo, Amer Alshekhlee, Stephen Gancher, Nagesh Krish, Mai Nguyen-Huynh, Margaret Tremwell, Jitendra Sharma, Lance Lee, William Neil, Fazeel Siddiqui, Ali Malek, Charles Romero, Thang Nguyen Huy, Hoa Hoang, Thang Nguyen, Anh Nguyen, Hung Nguyen, Laboratoire de Recherche Vasculaire Translationnelle ( LVTS ), Université Paris 13 ( UP13 ) -Université Paris Diderot - Paris 7 ( UPD7 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), AstraZeneca, National Cerebral and Cardiovascular Center ( NCCC - OSAKA ), Osaka University [Osaka], Department of Neurology ( Dep Neuro - BEIJING ), Tiantan Hospital, University of Melbourne, Faculty of Mathematics and Statistics, Ton Duc Thang University, Ho Chi Minh City, Heidelberg University, Centre hospitalier de Namur, IBM Thomas J. Watson Research Center, IBM, Bulgarian Academy of Sciences, Department of Clinical Neurological Sciences [London, Canada], University of Western Ontario ( UWO ), Servicio de Neurologia ( SANTIAGO - Neurologie ), Universidad de Santiago de Chile [Santiago] ( USACH ) -Universidad del Desarrollo, Institut de Chimie de Clermont-Ferrand - Clermont Auvergne ( ICCF ), Sigma CLERMONT ( Sigma CLERMONT ) -Université Clermont Auvergne ( UCA ) -Centre National de la Recherche Scientifique ( CNRS ), Universidad de Talca, Shanghai Second Polytechnic University, Northwest Normal University [Lanzhou], Zhongda Hospital, Southeast University [Jiangsu], Cryogenics Laboratory ( CRYOGENICS LABORATORY ), Huazhong University of Science and Technology [Wuhan] ( HUST ) -Wuhan University [China], Centre for Synthetic and Systems Biology, University of Edinburgh-School of Biological Sciences, Duke university [Durham], Fiber Glass, Glass Business and Discovery Center, PPG Industries, National University of Defense Technology [Changsha], School of Oceanography [Seattle], University of Washington [Seattle], Key Laboratory of New Processing Technology for Nonferrous Metals and Materials, Guilin University of Technologie, Laboratoire de Génie Electrique et Ferroélectricité ( LGEF ), Institut National des Sciences Appliquées de Lyon ( INSA Lyon ), Université de Lyon-Institut National des Sciences Appliquées ( INSA ) -Université de Lyon-Institut National des Sciences Appliquées ( INSA ), Centre Hospitalier Régional Universitaire [Lille] ( CHRU Lille ), Université de Bordeaux ( UB ), Service de Pédiatrie, Centre Hospitalier Universitaire de Nice ( CHU Nice ) -Hôpital l'Archet, Université Pierre et Marie Curie - Paris 6 ( UPMC ), Centre Hospitalier de Versailles ( CHV ), Service de neurologie, Hôpital Sainte-Anne, Functional Exploration of Nervous, CHU Grenoble, Service de Neurologie [Rennes], Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Equipe NEMESIS - Centre de Recherches de l'Institut du Cerveau et de la Moelle épinière ( NEMESIS-CRICM ), Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière ( CRICM ), Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ) -Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ), Institut Français de Mécanique Avancée ( IFMA ), Neurologie - Côte Basque ( NEUROLOGIE ), Hopital, Laboratoire d'Intégration des Systèmes et des Technologies ( LIST ), Université Paris-Saclay-Direction de Recherche Technologique (CEA) ( DRT (CEA) ), Commissariat à l'énergie atomique et aux énergies alternatives ( CEA ) -Commissariat à l'énergie atomique et aux énergies alternatives ( CEA ), Génétique, génomique fonctionnelle et biotechnologies (UMR 1078) ( GGB ), Institut Brestois Santé Agro Matière ( IBSAM ), Université de Brest ( UBO ) -Université de Brest ( UBO ) -EFS-Institut National de la Santé et de la Recherche Médicale ( INSERM ), CIC Brest, Université de Brest ( UBO ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Hôpital de la Cavale Blanche, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand ( CHU Dijon ), CHU Strasbourg, Imagerie cérébrale et handicaps neurologiques, Institut des sciences du cerveau de Toulouse. ( ISCT ), Centre National de la Recherche Scientifique ( CNRS ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -CHU Toulouse [Toulouse]-Université Toulouse III - Paul Sabatier ( UPS ), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Université Toulouse - Jean Jaurès ( UT2J ) -Centre National de la Recherche Scientifique ( CNRS ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -CHU Toulouse [Toulouse]-Université Toulouse III - Paul Sabatier ( UPS ), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Université Toulouse - Jean Jaurès ( UT2J ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Department of Neurology, Asklepios Klinik Altona, Department of Neurology and Stroke Center, Universität Duisburg-Essen [Essen], Department of Neurology, University of Mainz, Vivantes Klinikum Neukölln, University of Erlangen, University Hospital Münster, Universitaetsklinikum Hamburg-Eppendorf = University Medical Center Hamburg-Eppendorf [Hamburg] ( UKE ), PROTOMED, Neurology Department, Ichilov Medical Center, Internal and Cardiovascular Medicine - Stroke Unit ( PERUGIA - ICM-SU ), Università degli Studi di Perugia ( UNIPG ), University Hospital San Raffaele Milan, Scientific Institute and University Ospedale San Raffaele, Dipartimento di Scienze Fisiche, della Terra e dell'Ambiente., Università degli Studi di Siena ( UNISI ), Department of Education, Yamagata University, Nippon Medical School, Catalan Institute of Ornithology (ICO), Museu de Ciències Naturals (Zoologia), Wroclaw University of Science and Technology, Department of neurology, Jagiellonian University [Krakow] ( UJ ), LInguistique et DIdactique des Langues Étrangères et Maternelles ( LIDILEM ), Université Stendhal - Grenoble 3-Université Grenoble Alpes ( UGA ), Metacohorts Consortium, GenXpro GmBH, Lausanne University Hospital, Lausanne university hospital, Northeastern University [Boston], Laboratoire de Recherche Vasculaire Translationnelle (LVTS (UMR_S_1148 / U1148)), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), National Cerebral and Cardiovascular Center (NCCC - OSAKA), Department of Neurology (Dep Neuro - BEIJING), Bulgarian Academy of Sciences (BAS), University of Western Ontario (UWO), Servicio de Neurologia (SANTIAGO - Neurologie), Universidad del Desarrollo, Institut de Chimie de Clermont-Ferrand (ICCF), SIGMA Clermont (SIGMA Clermont)-Institut de Chimie du CNRS (INC)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Centre National de la Recherche Scientifique (CNRS), Shanghai Polytechnic University (SSPU), Cryogenics Laboratory (CRYOGENICS LABORATORY), Huazhong University of Science and Technology [Wuhan] (HUST)-Wuhan University [China], Centre for Synthetic and Systems Biology (Ssynthsys), University of Edinburgh, Duke University [Durham], National University of Defense Technology [China], Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Université de Bordeaux (UB), Centre Hospitalier Universitaire de Nice (CHU Nice)-Hôpital l'Archet, Université Pierre et Marie Curie - Paris 6 (UPMC), Centre Hospitalier de Versailles André Mignot (CHV), Service de Neurologie [Rennes] = Neurology [Rennes], CHU Pontchaillou [Rennes], Equipe NEMESIS - Centre de Recherches de l'Institut du Cerveau et de la Moelle épinière (NEMESIS-CRICM), Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière (CRICM), Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Pierre et Marie Curie - Paris 6 (UPMC), Institut Français de Mécanique Avancée (IFMA), Neurologie - Côte Basque (NEUROLOGIE), Centre hospitalier universitaire de Nantes (CHU Nantes), Génétique, génomique fonctionnelle et biotechnologies (UMR 1078) (GGB), Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO)-EFS-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital de la Cavale Blanche, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), University Hospital Münster - Universitaetsklinikum Muenster [Germany] (UKM), Universitaetsklinikum Hamburg-Eppendorf = University Medical Center Hamburg-Eppendorf [Hamburg] (UKE), Internal and Cardiovascular Medicine - Stroke Unit (PERUGIA - ICM-SU), Università degli Studi di Perugia (UNIPG), Università degli Studi di Siena = University of Siena (UNISI), Uniwersytet Jagielloński w Krakowie = Jagiellonian University (UJ), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Neurologie - Côte Basque, Centre Hospitalier de la Côte Basque (CHCB), EFS-Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO), Universität Duisburg-Essen = University of Duisburg-Essen [Essen], Università degli Studi di Perugia = University of Perugia (UNIPG), Centre National de la Recherche Scientifique (CNRS)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-SIGMA Clermont (SIGMA Clermont), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Jagiellonian University [Krakow] (UJ), Université Paris Diderot - Paris 7 (UPD7)-Université Paris 13 (UP13)-Institut National de la Santé et de la Recherche Médicale (INSERM), Weimar, Christian (Beitragende*r), and Calvez, Ghislaine

Subjects
Male, Risk, Ticagrelor, Adenosine, [SDV]Life Sciences [q-bio], Population, Medizin, Hemorrhage, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Platelet aggregation inhibitors, Physiology (medical), [ SDV.MHEP ] Life Sciences [q-bio]/Human health and pathology, medicine, Humans, Myocardial infarction, education, Stroke, ComputingMilieux_MISCELLANEOUS, Aged, Aspirin, Ischemic attack, Transient, Female, Ischemic Attack, Transient, Purinergic P2Y Receptor Antagonists, Treatment Outcome, Cardiology and Cardiovascular Medicine, education.field_of_study, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, [ SDV ] Life Sciences [q-bio], Ischemic Attack, business.industry, medicine.disease, Clopidogrel, [SDV] Life Sciences [q-bio], Anesthesia, Platelet aggregation inhibitor, business, 030217 neurology & neurosurgery, TIMI, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, medicine.drug
Abstract

Background: Patients with minor acute ischemic stroke or transient ischemic attack are at high risk for subsequent stroke, and more potent antiplatelet therapy in the acute setting is needed. However, the potential benefit of more intense antiplatelet therapy must be assessed in relation to the risk for major bleeding. The SOCRATES trial (Acute Stroke or Transient Ischemic Attack Treated With Aspirin or Ticagrelor and Patient Outcomes) was the first trial with ticagrelor in patients with acute ischemic stroke or transient ischemic attack in which the efficacy and safety of ticagrelor were compared with those of aspirin. The main safety objective was assessment of PLATO (Platelet Inhibition and Patient Outcomes)–defined major bleeds on treatment, with special focus on intracranial hemorrhage (ICrH). Methods: An independent adjudication committee blinded to study treatment classified bleeds according to the PLATO, TIMI (Thrombolysis in Myocardial Infarction), and GUSTO (Global Use of Strategies to Open Occluded Coronary Arteries) definitions. The definitions of ICrH and major bleeding excluded cerebral microbleeds and asymptomatic hemorrhagic transformations of cerebral infarctions so that the definitions better discriminated important events in the acute stroke population. Results: A total of 13 130 of 13 199 randomized patients received at least 1 dose of study drug and were included in the safety analysis set. PLATO major bleeds occurred in 31 patients (0.5%) on ticagrelor and 38 patients (0.6%) on aspirin (hazard ratio, 0.83; 95% confidence interval, 0.52–1.34). The most common locations of major bleeds were intracranial and gastrointestinal. ICrH was reported in 12 patients (0.2%) on ticagrelor and 18 patients (0.3%) on aspirin. Thirteen of all 30 ICrHs (4 on ticagrelor and 9 on aspirin) were hemorrhagic strokes, and 4 (2 in each group) were symptomatic hemorrhagic transformations of brain infarctions. The ICrHs were spontaneous in 6 and 13, traumatic in 3 and 3, and procedural in 3 and 2 patients on ticagrelor and aspirin, respectively. In total, 9 fatal bleeds occurred on ticagrelor and 4 on aspirin. The composite of ICrH or fatal bleeding included 15 patients on ticagrelor and 18 on aspirin. Independently of bleeding classification, PLATO, TIMI, or GUSTO, the relative difference between treatments for major/severe bleeds was similar. Nonmajor bleeds were more common on ticagrelor. Conclusions: Antiplatelet therapy with ticagrelor in patients with acute ischemic stroke or transient ischemic attack showed a bleeding profile similar to that of aspirin for major bleeds. There were few ICrHs. Clinical Trial Registration: URL: http://www.clinicaltrials.gov . Unique identifier: NCT01994720.

Published
2017

44. Organizational Update: Asia Pacific Stroke Organization

Author

Narayanaswamy Venketasubramanian, Craig Anderson, Manmohan Mehndiratta, Ruey-Tay Lin, Kay-Sin Tan, and Chen-Ya Huang

Subjects
Advanced and Specialized Nursing, Stroke, Asia, Health Policy, Financing, Organized, Humans, Education, Medical, Continuing, Neurology (clinical), Cooperative Behavior, Cardiology and Cardiovascular Medicine, Societies, Medical, Quality of Health Care
Published
2017

45. A multiparameter model predicting in-hospital mortality in malignant cerebral infarction

Author

Chien-Fu Chen, A-Ching Chao, Hsiu-Fen Lin, and Ruey-Tay Lin

Subjects
Adult, Male, medicine.medical_specialty, malignant cerebral infarction, Infarction, Observational Study, Brain Edema, 030204 cardiovascular system & hematology, Models, Biological, Severity of Illness Index, CHADS2 score, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, medicine.artery, Diabetes mellitus, Severity of illness, medicine, Humans, cardiovascular diseases, Hospital Mortality, Prospective Studies, Prospective cohort study, Stroke, Aged, Aged, 80 and over, middle cerebral artery, business.industry, Cerebral infarction, Infarction, Middle Cerebral Artery, General Medicine, Middle Aged, medicine.disease, Prognosis, Intensive Care Units, ROC Curve, Heart failure, Area Under Curve, Middle cerebral artery, Cardiology, Female, business, large hemisphere infarction, 030217 neurology & neurosurgery, Research Article
Abstract

The early identification of patients with large hemisphere infarctions (LHIs) at risk of fatal brain edema may result in better outcomes. A quantitative model using parameters obtained at admission may be a predictor of in-hospital mortality from LHI. This prospective study enrolled all patients with LHI involving >50% of the middle cerebral artery (MCA) admitted to our neurological intensive care unit within 48 hours of symptom onset. Early clinical and radiographic parameters and the baseline CHADS2 score (congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, stroke [double weight]) were analyzed regarding their ability to predict patient outcomes. Seventy-seven patients with LHIs were identified, 33 (42.9%) with complete MCA infarction (CMCA), and 44 (57.1%) with incomplete MCA infarction (IMCA). The predictors of CMCA score included: >1/3 early hypodensity in computed tomography findings, hyperdense MCA sign, brain edema, initial National Institutes of Health Stroke Scale (NIHSS) score ≥17, and stroke in progression during the 1st 5 days of admission. The cutoff CMCA score was 2, with a sensitivity of 81.8% and specificity of 70.5%. Mortality score 1, used for predicting in-hospital mortality from LHI, included CMCA and CHADS2 scores ≥4 (sensitivity 100.0%, specificity 57.4%), and mortality score 2 included CMCA and CHADS2 scores ≥4, and NIHSS score ≥26, during the 1st 5 days (sensitivity 100.0%, specificity 91.7%). Patients qualifying for a mortality score of 2 were at high-risk of in-hospital mortality from LHI. These findings may aid in identifying patients who may benefit from invasive therapeutic strategies, and in better describing the characteristics of those at risk of mortality.

Published
2017

46. TRPV4 Activation Contributes Functional Recovery from Ischemic Stroke via Angiogenesis and Neurogenesis

Author

Tzu-Ming Wang, Po-Yuan Hsu, Chun-Kai Chen, Ruey-Tay Lin, Suh-Hang H. Juo, and Zhi-Feng Miao

Subjects
Vascular Endothelial Growth Factor A, 0301 basic medicine, TRPV4, medicine.medical_specialty, Nitric Oxide Synthase Type III, Angiogenesis, Neurogenesis, Neuroscience (miscellaneous), Neovascularization, Physiologic, TRPV Cation Channels, Brain Ischemia, Rats, Sprague-Dawley, Brain ischemia, 03 medical and health sciences, Cellular and Molecular Neuroscience, 0302 clinical medicine, Neural Stem Cells, Cell Movement, Enos, Internal medicine, Phorbol Esters, medicine, Animals, RNA, Messenger, Progenitor cell, Cell Proliferation, biology, Recovery of Function, biology.organism_classification, medicine.disease, Vascular Endothelial Growth Factor Receptor-2, Stroke, Nitric oxide synthase, Vascular endothelial growth factor A, 030104 developmental biology, Endocrinology, Neurology, Microvessels, biology.protein, Ion Channel Gating, 030217 neurology & neurosurgery
Abstract

The endothelial transient receptor potential cation channel subfamily V member 4 (TRPV4) plays a crucial role in vascular remodeling; however, TRPV4-mediated angiogenesis after ischemic neuronal death as a neurorestorative strategy has not yet been thoroughly examined. In this study, we first tested whether TRPV4 activation can improve functional recovery in rats subjected to transient brain ischemia. The possible mechanisms for TRPV4 activation-promoted functional recovery were explored. A TRPV4 agonist, 4α-phorbol 12,13-didecanoate (4α-PDD), was intravenously injected via the tail vein at 6 h and 1, 2, 3, 4 days after ischemic stroke. The treatment reduced infarct volume by almost 50% (14.7 ± 3.7 vs. 29.2 ± 6.2%; p

Published
2017

47. Abstract TP371: Monitoring a Large-scale International Cluster Stroke Trial: Lessons From Head Position in Stroke Trial

Author

Verónica V. Olavarría, Gillian Mead, Sandy Middleton, Alejandro M. Brunser, H.A. de Silva, Ruey-Tay Lin, Bin Peng, Octavio M. Pontes-Neto, Maree L. Hackett, Joyce Y Lim, Jeyaraj D Pandian, Pablo M. Lavados, Hisatomi Arima, Caroline L Watkins, Thompson G. Robinson, Liying Cui, Craig S. Anderson, Tsong-Hai Lee, and Paula Muñoz-Venturelli

Subjects
Advanced and Specialized Nursing, Intracerebral hemorrhage, medicine.medical_specialty, business.industry, medicine.disease, Disease cluster, Clinical trial, Physical medicine and rehabilitation, Head position, Medicine, Neurology (clinical), Limited evidence, Cardiology and Cardiovascular Medicine, business, Stroke, Acute ischemic stroke
Abstract

Background and Purpose: There is limited evidence on head positioning in acute ischemic stroke (AIS) or intracerebral hemorrhage (ICH). Potential benefits for lying flat (0°) include improved collateral blood flow in AIS and for head up (30°) reduced cerebral oedema in ICH. The Head Positioning in Stroke Trial (HeadPoST) aims to provide reliable evidence on the optimum head position in acute stroke. Methods: HeadPoST is a prospective, cluster randomised, crossover, blinded outcome assessed, clinical trial with consecutive patient recruitment who were positioned within 24 hours of admission. Hospitals were randomised to service organisation to compare lying flat vs. sitting up (≥30°) head positioning of stroke patients. An innovative centralized remote monitoring system was used to assess data quality across participating countries. Results: Over a 30 month study period, 10,000+ patients were recruited across 114 hospitals in 9 countries. A web-based monitoring system provided alerts for cross-over time points and achievement of cluster balance. Centralised reports included serious adverse events, protocol deviations, forms completion, data queries, entry delays and data validation, which were distributed to regional co-ordinating centres for action. Details of these procedures are outlined. Conclusions: Reliable, complete, and high quality data were required for this pragmatic international nursing care clinical trial, which used a novel cluster cross-over design.

Published
2017

48. Recent advances of stroke thrombolysis in Taiwan: A successful interaction between physicians, regulators, and National Health Insurance Administration

Author

Ruey-Tay Lin, Cheng-Yang Hsieh, and Han-Hua Hu

Subjects
medicine.medical_specialty, National Health Programs, Alternative medicine, Taiwan, Tissue plasminogen activator, 03 medical and health sciences, 0302 clinical medicine, Fibrinolytic Agents, Physicians, medicine, Humans, Intensive care medicine, Stroke, Medicine(all), lcsh:R5-920, business.industry, 030208 emergency & critical care medicine, General Medicine, medicine.disease, National health insurance, Tissue Plasminogen Activator, Stroke thrombolysis, lcsh:Medicine (General), business, Administration (government), 030217 neurology & neurosurgery, Fibrinolytic agent, medicine.drug
Published
2017
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49. Impact of MCA stenosis on the early outcome in acute ischemic stroke patients

Author

Shih Pin Hsu, Li Ming Lien, Chin I. Chen, Ruey Tay Lin, Ta Chang Lai, Chih Hung Chen, Bak Sau Yip, Wei Hung Chen, Mu Chien Sun, Po-Lin Chen, Jiann-Shing Jeng, Huey Juan Lin, Lung Chan, Yuk Keung Lo, Chung-Hsiang Liu, Hsu Ling Yeh, Chung Hsin Yeh, Hou Chang Chiu, Chung Y. Hsu, Sien Tsong Chen, Sung-Chun Tang, Hung Yi Chiou, Jiunn Tay Lee, Fang I. Hsieh, Ming Hui Sun, Tsuey Ru Chiang, Shinn Kuang Lin, Chi Huey Bai, Yu Sun, and Yu-Wei Chen

Subjects
Male, Middle Cerebral Artery, Etiology, lcsh:Medicine, Blood Pressure, Constriction, Pathologic, 030204 cardiovascular system & hematology, Pathology and Laboratory Medicine, Vascular Medicine, Geographical Locations, Endocrinology, 0302 clinical medicine, Medicine and Health Sciences, lcsh:Science, Stroke, Stenosis, Multidisciplinary, Hazard ratio, Middle Aged, Hyperlipidemia, Neurology, Hypertension, Middle cerebral artery, Cardiology, cardiovascular system, Female, Internal carotid artery, Research Article, medicine.medical_specialty, Asia, Endocrine Disorders, Cerebrovascular Diseases, Hypercholesterolemia, Taiwan, 03 medical and health sciences, Signs and Symptoms, Diagnostic Medicine, medicine.artery, Internal medicine, Diabetes mellitus, Diabetes Mellitus, medicine, Humans, cardiovascular diseases, Aged, Ischemic Stroke, business.industry, Proportional hazards model, Arterial stenosis, lcsh:R, medicine.disease, nervous system diseases, Metabolic Disorders, People and Places, lcsh:Q, business, 030217 neurology & neurosurgery
Abstract

Background Asians have higher frequency of intracranial arterial stenosis. The present study aimed to compare the clinical features and outcomes of ischemic stroke patients with and without middle cerebral artery (MCA) stenosis, assessed by transcranial sonography (TCS), based on the Taiwan Stroke Registry (TSR). Methods Patients with acute ischemic stroke or transient ischemic attack registered in the TSR, and received both carotid duplex and TCS assessment were categorized into those with stenosis (≥50%) and without (

Published
2017

50. Cluster-randomized, crossover trial of head positioning in acute stroke

Author

Jeyaraj D Pandian, Gillian Mead, Pablo M. Lavados, C. Elizabeth Lightbody, Maree L. Hackett, Bin Peng, Mark Woodward, Craig S. Anderson, Octavio M. Pontes-Neto, Hisatomi Arima, Liying Cui, Kris Rogers, Paula Muñoz Venturelli, Denise Forshaw, Tsong-Hai Lee, Thompson G. Robinson, Caroline L Watkins, Laurent Billot, Lily Song, H Asita de Silva, Alejandro M. Brunser, Verónica V. Olavarría, Sandy Middleton, Ruey-Tay Lin, and Joyce Y Lim

Subjects
medicine.medical_specialty, TELEPHONE, Randomization, Supine position, CEREBRAL OXYGENATION, Aspiration pneumonia, GUIDELINES, BLOOD-FLOW-VELOCITY, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Medicine, 030212 general & internal medicine, ACUTE ISCHEMIC-STROKE, Cerebral perfusion pressure, Stroke, SCALE, business.industry, FLUXO SANGUÍNEO, General Medicine, A300, CARE, medicine.disease, Crossover study, 3. Good health, Cerebral blood flow, Physical therapy, business, 030217 neurology & neurosurgery
Abstract

BACKGROUND\ud The role of supine positioning after acute stroke in improving cerebral blood flow and the countervailing risk of aspiration pneumonia have led to variation in head positioning in clinical practice. We wanted to determine whether outcomes in patients with acute ischemic stroke could be improved by positioning the patient to be lying flat (i.e., fully supine with the back horizontal and the face upwards) during treatment to increase cerebral perfusion.\ud METHODS\ud In a pragmatic, cluster-randomized, crossover trial conducted in nine countries, we assigned 11,093 patients with acute stroke (85% of the strokes were ischemic) to receive care in either a lying-flat position or a sitting-up position with the head elevated to at least 30 degrees, according to the randomization assignment of the hospital to which they were admitted; the designated position was initiated soon after hospital admission and was maintained for 24 hours. The primary outcome was degree of disability at 90 days, as assessed with the use of the modified Rankin scale (scores range from 0 to 6, with higher scores indicating greater disability and a score of 6 indicating death).\ud RESULTS\ud The median interval between the onset of stroke symptoms and the initiation of the assigned position was 14 hours (interquartile range, 5 to 35). Patients in the lying-flat group were less likely than patients in the sitting-up group to maintain the position for 24 hours (87% vs. 95%, P

Published
2017

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