Introduction: Increased blood pressure variability (BPV) is detrimental after acute ischaemic stroke, but the interaction between BPV and neuroimaging factors that directly influence stroke outcome has not been explor...Introduction: Increased blood pressure variability (BPV) is detrimental after acute ischaemic stroke, but the interaction between BPV and neuroimaging factors that directly influence stroke outcome has not been explored. Methods: We retrospectively reviewed inpatients from 2007 to 2014 with acute anterior circulation ischaemic stroke, CT perfusion and angiography at hospital admission, and a modified Rankin Scale (MRS) 30- 365 days after stroke onset. BPV indices included SD, coefficient of variation and successive variation of the systolic blood pressure between 0 and 120 hours after admission. Ordinal logistic regression models were fitted to MRS with predictor variables of BPV indices. Models were further stratified by CT perfusion volumetric measurements, proximal vessel occlusion and collateral score. Results: 110 patients met the inclusion criteria. The likelihood of a 1-point rise in the MRS increased with every 10 mm Hg increase in BPV (OR for the 3 BPV indices ranged from 2.27 to 5.54), which was more pronounced in patients with larger ischaemic core volumes (OR 8.37 to 18.0) and larger hypoperfused volumes (OR 6.02 to 15.4). This association also held true for patients with larger mismatch volume, proximal vessel occlusion and good collateral vessels. Conclusions: These results indicate that increased BPV is associated with worse neurological outcome after stroke, particularly in patients with a large lesion core volume, concurrent viable ischaemic penumbra, proximal vessel occlusion and good collaterals. This subset of patients, who are often not candidates for or fail acute stroke therapies such as intravenous tissue plasminogen activator or endovascular thrombectomy, may benefit from interventions aimed at reducing BPV.展开更多
3月底,太平洋海事协会(Pacific M aritime Association)主席James McKenna表示,在与美国西海岸码头工人合同谈判的过程中发生波折的概率可能是50%,其传达了资方对谈判结果的一种深层次的不确定性的担忧。目前正在执行中的合同将于今年7...3月底,太平洋海事协会(Pacific M aritime Association)主席James McKenna表示,在与美国西海岸码头工人合同谈判的过程中发生波折的概率可能是50%,其传达了资方对谈判结果的一种深层次的不确定性的担忧。目前正在执行中的合同将于今年7月1日到期,新合同的谈判将于5月12日开始。有消息人士表示,任何情形都有可能发生。展开更多
Introduction Patients with stroke-like symptoms may be underutilising emergency medical services and avoiding hospitalisation during the COVID-19 pandemic.We investigated a decline in admissions for stroke and transie...Introduction Patients with stroke-like symptoms may be underutilising emergency medical services and avoiding hospitalisation during the COVID-19 pandemic.We investigated a decline in admissions for stroke and transient ischaemic attack(TIA)and emergency department(ED)stroke alert activations.Methods We retrospectively compiled total weekly hospital admissions for stroke and TIA between 31 December 2018 and 21 April 2019 versus 30 December 2019 and 19 April 2020 at five US tertiary academic comprehensive stroke centres in cities with early COVID-19 outbreaks in Boston,New York City,Providence and Seattle.We collected available data on ED stroke alerts,stroke severity using the National Institutes of Health Stroke Scale(NIHSS)and time from symptom onset to hospital arrival.Results Compared with 31 December 2018 to 21 April 2019,a decline in stroke/TIA admissions and ED stroke alerts occurred during 30 December 2019 to 19 April 2020(p trend<0.001 for each).The declines coincided with state stay-at home recommendations in late March.The greatest decline in hospital admissions was observed between 23 March and 19 April 2020,with a 31%decline compared with the corresponding weeks in 2019.Three of the five centres with 2019 and 2020 stroke alert data had a 46%decline in ED stroke alerts in late March and April 2020,compared with 2019.Median baseline NIHSS during these 4 weeks was 10 in 2020 and 7 in 2019.There was no difference in time from symptom onset to hospital arrival.Conclusion At these five large academic US hospitals,admissions for stroke and TIA declined during the COVID-19 pandemic.There was a trend for fewer ED stroke alerts at three of the five centres with available 2019 and 2020 data.Acute stroke therapies are time-sensitive,so decreased healthcare access or utilisation may lead to more disabling or fatal strokes,or more severe non-neurological complications related to stroke.Our findings underscore the indirect effects of this pandemic.Public health officials,hospital systems and healthcare providers mu展开更多
Objective: To perform a health maintenance organization-based case-contro l study to evaluate the association of total and high density lipoprotein (HDL) cholesterol with the risk of stroke subtypes and in patient sub...Objective: To perform a health maintenance organization-based case-contro l study to evaluate the association of total and high density lipoprotein (HDL) cholesterol with the risk of stroke subtypes and in patient subgroups. Methods: Cases had a confirmed incident ischemic stroke (n = 1,242) or hemorrhagic stroke (n = 313). Controls (n = 6,455) were identified in a companion myocardial infar ction study. Risk of stroke was modeled using logistic regression. Results: The highest total cholesterol quintile was associated with an increased risk of isch emic stroke compared to the lowest quintile (OR = 1.6, 95% CI 1.3 to 2.0) with the strongest subtype associations for atherosclerotic stroke (OR = 3.2) and la cunar stroke (OR = 2.4). The highest HDL cholesterol quintile was associated wit h a decreased risk of ischemic stroke compared to the lowest quintile (OR = 0.8, CI 0.6 to 1.0). Subgroup analyses suggested that the total cholesterol associat ion was more important for patients < 66 years of age and those with HDL < 50 mg /dL; the HDL association was more important for patients without diabetes or atr ial fibrillation. The second through fourth total cholesterol quintiles were ass ociated with a decreased isk of hemorrhagic stroke compared to the lowest quinti le (OR = 0.7, CI 0.5 to 1.0). Conclusions: Higher total and lower HDL cholestero l levels were associated with increased risk of ischemic stroke, especially cert ain stroke subtypes and patient subgroups. The lowest levels of total cholestero l were associated with an increased risk of all hemorrhagic strokes.展开更多
基金the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number KL2TR001065.
文摘Introduction: Increased blood pressure variability (BPV) is detrimental after acute ischaemic stroke, but the interaction between BPV and neuroimaging factors that directly influence stroke outcome has not been explored. Methods: We retrospectively reviewed inpatients from 2007 to 2014 with acute anterior circulation ischaemic stroke, CT perfusion and angiography at hospital admission, and a modified Rankin Scale (MRS) 30- 365 days after stroke onset. BPV indices included SD, coefficient of variation and successive variation of the systolic blood pressure between 0 and 120 hours after admission. Ordinal logistic regression models were fitted to MRS with predictor variables of BPV indices. Models were further stratified by CT perfusion volumetric measurements, proximal vessel occlusion and collateral score. Results: 110 patients met the inclusion criteria. The likelihood of a 1-point rise in the MRS increased with every 10 mm Hg increase in BPV (OR for the 3 BPV indices ranged from 2.27 to 5.54), which was more pronounced in patients with larger ischaemic core volumes (OR 8.37 to 18.0) and larger hypoperfused volumes (OR 6.02 to 15.4). This association also held true for patients with larger mismatch volume, proximal vessel occlusion and good collateral vessels. Conclusions: These results indicate that increased BPV is associated with worse neurological outcome after stroke, particularly in patients with a large lesion core volume, concurrent viable ischaemic penumbra, proximal vessel occlusion and good collaterals. This subset of patients, who are often not candidates for or fail acute stroke therapies such as intravenous tissue plasminogen activator or endovascular thrombectomy, may benefit from interventions aimed at reducing BPV.
文摘3月底,太平洋海事协会(Pacific M aritime Association)主席James McKenna表示,在与美国西海岸码头工人合同谈判的过程中发生波折的概率可能是50%,其传达了资方对谈判结果的一种深层次的不确定性的担忧。目前正在执行中的合同将于今年7月1日到期,新合同的谈判将于5月12日开始。有消息人士表示,任何情形都有可能发生。
基金This research is supported by the National Institutes of Health(NIH 1UL1TR001430).
文摘Introduction Patients with stroke-like symptoms may be underutilising emergency medical services and avoiding hospitalisation during the COVID-19 pandemic.We investigated a decline in admissions for stroke and transient ischaemic attack(TIA)and emergency department(ED)stroke alert activations.Methods We retrospectively compiled total weekly hospital admissions for stroke and TIA between 31 December 2018 and 21 April 2019 versus 30 December 2019 and 19 April 2020 at five US tertiary academic comprehensive stroke centres in cities with early COVID-19 outbreaks in Boston,New York City,Providence and Seattle.We collected available data on ED stroke alerts,stroke severity using the National Institutes of Health Stroke Scale(NIHSS)and time from symptom onset to hospital arrival.Results Compared with 31 December 2018 to 21 April 2019,a decline in stroke/TIA admissions and ED stroke alerts occurred during 30 December 2019 to 19 April 2020(p trend<0.001 for each).The declines coincided with state stay-at home recommendations in late March.The greatest decline in hospital admissions was observed between 23 March and 19 April 2020,with a 31%decline compared with the corresponding weeks in 2019.Three of the five centres with 2019 and 2020 stroke alert data had a 46%decline in ED stroke alerts in late March and April 2020,compared with 2019.Median baseline NIHSS during these 4 weeks was 10 in 2020 and 7 in 2019.There was no difference in time from symptom onset to hospital arrival.Conclusion At these five large academic US hospitals,admissions for stroke and TIA declined during the COVID-19 pandemic.There was a trend for fewer ED stroke alerts at three of the five centres with available 2019 and 2020 data.Acute stroke therapies are time-sensitive,so decreased healthcare access or utilisation may lead to more disabling or fatal strokes,or more severe non-neurological complications related to stroke.Our findings underscore the indirect effects of this pandemic.Public health officials,hospital systems and healthcare providers mu
文摘Objective: To perform a health maintenance organization-based case-contro l study to evaluate the association of total and high density lipoprotein (HDL) cholesterol with the risk of stroke subtypes and in patient subgroups. Methods: Cases had a confirmed incident ischemic stroke (n = 1,242) or hemorrhagic stroke (n = 313). Controls (n = 6,455) were identified in a companion myocardial infar ction study. Risk of stroke was modeled using logistic regression. Results: The highest total cholesterol quintile was associated with an increased risk of isch emic stroke compared to the lowest quintile (OR = 1.6, 95% CI 1.3 to 2.0) with the strongest subtype associations for atherosclerotic stroke (OR = 3.2) and la cunar stroke (OR = 2.4). The highest HDL cholesterol quintile was associated wit h a decreased risk of ischemic stroke compared to the lowest quintile (OR = 0.8, CI 0.6 to 1.0). Subgroup analyses suggested that the total cholesterol associat ion was more important for patients < 66 years of age and those with HDL < 50 mg /dL; the HDL association was more important for patients without diabetes or atr ial fibrillation. The second through fourth total cholesterol quintiles were ass ociated with a decreased isk of hemorrhagic stroke compared to the lowest quinti le (OR = 0.7, CI 0.5 to 1.0). Conclusions: Higher total and lower HDL cholestero l levels were associated with increased risk of ischemic stroke, especially cert ain stroke subtypes and patient subgroups. The lowest levels of total cholestero l were associated with an increased risk of all hemorrhagic strokes.
