bluuebunny/crossref_metadata_2025 huggingface dataset:
Carotid Plaque and Intima-Media Thickness Assessed by B-Mode Ultrasonography in Subjects Ranging From Young Adults to Centenarians
Authors: Homma Satoki , Hirose Nobuyoshi , Ishida Hiroyuki , Ishii Toshiharu , Araki Goro
Published: June 2011

Background and Purpose
—To investigate relationships among plaque formation, increasing intima-media thickness, and age, we examined ultrasonographically carotid arteries of subjects who had no major atherosclerotic risk factors and who ranged in age from young adults to centenarians.

Methods
—We studied 319 healthy subjects (154 men, 165 women; age range, 21 to 105 years) with no history of hypertension, diabetes mellitus, or atherosclerotic disease. Mean intima-media wall thickness (IMT) of common carotid arteries at plaque-free sites and prevalence of plaques were evaluated by B-mode ultrasound.

Results
—Mean common carotid IMT increased in a linear manner with age for all decades of life, including centenarians [IMT=(0.009×Age)+0.116] (
r
=0.83). In centenarians (n=30), intima-media complexes were diffusely thickened (mean IMT, 1.01 mm). Plaque prevalence increased up to the tenth decade of life (83.3%, n=30) but decreased in centenarians (60.0%). IMT and plaque prevalence were closely associated in the seventh and eighth decades of life but not at older ages.

Conclusions
—The present study indicates that increased IMT is a physiological effect of aging that corresponds to diffuse intimal thickening, especially in very elderly persons, and that IMT is distinct from pathological plaque formation.
Utilization of Intravenous Tissue-Type Plasminogen Activator for Ischemic Stroke at Academic Medical Centers
Authors: Johnston S. Claiborne , Fung Lawrence H. , Gillum Leslie A. , Smith Wade S. , Brass Lawrence M. , Lichtman Judith H. , Brown Andrew N.
Published: June 2011

Background and Purpose
—We sought to measure the overall rate of usage of tissue-type plasminogen activator (tPA) for ischemic stroke at academic medical centers, and to determine whether ethnicity was associated with usage.

Methods
—Between June and December 1999, 42 academic medical centers in the United States each identified 30 consecutive ischemic stroke cases. Medical records were reviewed and information on demographics, medical history, and treatment were abstracted. Rates of tPA use were compared for African Americans and whites in univariate analysis and after adjustment for age, gender, stroke severity, and type of medical insurance with multivariable logistic regression.

Results
—Complete information was available for 1195 ischemic stroke patients; 788 were whites and 285 were African Americans. Overall, 49 patients (4.1%) received tPA. In the subgroup of 189 patients without a documented contraindication to therapy, 39 (20.6%) received tPA. Ten (20%) of those receiving tPA had documented contraindication.African Americans were one fifth as likely to receive tPA as whites (1.1% African Americans versus 5.3%;
P
=0.001), and the difference persisted after adjustment (OR 0.21, 95% CI 0.06 to 0.68;
P
=0.01). When comparison was restricted to those without a documented contraindication to tPA, the difference remained significant (OR 0.24, 95% CI 0.06 to 0.93;
P
=0.04).Medical insurance type was independently associated with tPA treatment. After adjustment for ethnicity and other demographic characteristics, those with Medicaid or no insurance were one ninth as likely to receive tPA as those with private medical insurance (OR 0.11, 95% CI 0.02 to 0.17;
P
=0.003).

Conclusions
—tPA is used infrequently for ischemic stroke at US academic medical centers, even among qualifying candidates. African Americans are significantly less likely to receive tPA for ischemic stroke. Contraindications to treatment do not appear to account for the difference.
Insulin Resistance and Elevated Levels of Tissue Plasminogen Activator in First-Degree Relatives of South Asian Patients With Ischemic Cerebrovascular Disease
Authors: Kain Kirti , Catto Andrew J. , Young John , Bamford John , Bavington John , Grant Peter J.
Published: June 2011

Background and Purpose
—South Asians in the United Kingdom suffer from an increased mortality from cerebrovascular disease compared with whites. Evidence suggests that the relatives of white stroke patients are at increased risk of vascular disease. The aim of this study was to investigate atherothrombotic risk factors in the first-degree relatives of South Asian patients suffering from ischemic cerebrovascular disease and to compare them with South Asian subjects free from clinically detectable cerebrovascular disease.

Methods
—We compared 143 relatives of South Asians with ischemic stroke (South Asian relatives group) with 146 South Asian control subjects from West Yorkshire, UK.

Results
—The ages and ethnic and sex distributions of South Asian relatives and South Asian controls were similar. There were no significant differences in body mass index, waist-hip ratio, number of current smokers, and past medical history of hypertension, diabetes mellitus, or myocardial infarction between the 2 groups. Fasting blood glucose, glycosylated hemoglobin (HbA
1c
), total cholesterol, triglycerides, and HDL cholesterol were similar in the 2 groups. Fasting insulin (South Asian relatives, 12.0; South Asian controls, 8.5 mU/L;
P
<0.0001) (independent of tissue plasminogen activator) and insulin resistance (derived by Homeostasis Model Assessment) (South Asian relatives, 2.7; South Asian controls, 1.9;
P
=0.001) were significantly raised in stroke relatives. Stroke relatives showed elevated levels of tissue plasminogen activator (South Asian relatives, 11.6; South Asian controls, 8.4 ng/mL;
P
<0.0001), which was independent of plasma insulin. There were no differences in plasminogen activator inhibitor antigen or activity between the groups.

Conclusions
—South Asians stroke relatives exhibit hyperinsulinemia, increased insulin resistance, and increased tissue plasminogen activator levels. These observations might account for increased susceptibility to atherothrombotic disease in this ethnic group.
Changes in Cardiovascular Risk Factors During the Perimenopause and Postmenopause and Carotid Artery Atherosclerosis in Healthy Women
Authors: Matthews Karen A. , Kuller Lewis H. , Sutton-Tyrrell Kim , Chang Yue-Fang
Published: June 2011

Background and Purpose
—The objectives of this study were to describe the changes in cardiovascular risk factors during the perimenopausal and early postmenopausal years and correlate those changes in risk factors with carotid intimal-medial thickness (IMT) and plaque index measured 5 to 8 years after menopause.

Methods
—Participants were women (n=372) from Allegheny County, Pennsylvania, enrolled in the Healthy Women Study who had been postmenopausal for at least 5 years. Risk factor changes were measured during the perimenopause, ie, between the premenopausal and first year postmenopausal examinations, and during the early postmenopause, ie, between the first and fifth year postmenopausal examinations. Carotid ultrasound scans measured IMT and plaque at examinations 5 to 8 years after menopause among 314 of the women.

Results
—Increases in LDL cholesterol and triglycerides and declines in HDL cholesterol were greater during perimenopause than postmenopause, whereas increases in blood pressure and fasting glucose levels were greater during postmenopause. Premenopausal systolic and pulse pressure, LDL and HDL cholesterol, triglycerides, and body mass index predicted IMT and plaque. Only the change in pulse pressure between premenopausal and first year postmenopausal examinations was related to both IMT and plaque.

Conclusions
—Absolute risk for cardiovascular disease increases substantially in midlife, with a particularly adverse effect on lipid metabolism at the menopause. Premenopausal levels of risk factors are adequate to identify which women should be targeted for intervention.
Does Pretreatment With Statins Improve Clinical Outcome After Stroke?
Authors: Jonsson Niklas , Asplund Kjell
Published: June 2011

Background and Purpose
—In primary and secondary prevention trials, statins have been shown to reduce the risk of stroke. In addition to lipid lowering, statins have a number of antiatherothrombotic and neuroprotective properties. In a preliminary observational study, we explored whether clinical outcome is improved in patients who are on treatment with statins when stroke occurs.

Methods
—We conducted a population-based case-referent study of 25- to 74-year-old stroke patients with, for each case of a patient who was on statin treatment at the onset of stroke (n=125), 2 referent patients who were not treated with statins but were matched for age, gender, year of onset, and stroke subtype (n=250).

Results
—The unadjusted odds ratio for early discharge to home (versus late discharge or death) was 1.41 (95% CI 0.91 to 2.17) when patients on statin treatment were compared with referent stroke patients not on statins. Prognostic factors were, in general, more unfavorable among patients on statins. When this was adjusted for in a logistic regression model, the use of statins was a moderately strong but statistically nonsignificant predictor of discharge to home (multiple-adjusted odds ratio 1.42, 95% CI 0.90 to 2.22).

Conclusions
—The statistical power of this case-referent study was such that only large beneficial effects of statins in acute stroke could be confirmed. However, the observed trend, together with experimental observations, is interesting enough to warrant a more detailed analysis of the relationship between statins and stroke outcome.
Hypertensive Caudate Hemorrhage Prognostic Predictor, Outcome, and Role of External Ventricular Drainage
Authors: Liliang Po-Chou , Liang Cheng-Loong , Lu Cheng-Hsien , Chang Hsueh-Wen , Cheng Ching-Hsiao , Lee Tao-Chen , Chen Han-Jung
Published: June 2011

Background and Purpose
—The purpose of the present study was to analyze the outcome and outcome predictors of caudate hemorrhage and role of external ventricular drainage in acute hydrocephalus.

Methods
—Clinical data from 36 consecutive patients with hypertensive caudate hemorrhage was used in the present study. Age, gender, volume of parenchymal hematoma, hematoma in the internal capsule, initial Glasgow Coma Scale (GCS), hydrocephalus, severity of intraventricular hemorrhage, and hemorrhagic dilatation of the fourth ventricle were analyzed for effect on outcome. Effect of external ventricle drainage for hydrocephalus was evaluated by comparing preoperative and postoperative GCS scores.

Results
—By univariate analyses, poor outcome was associated with a poor initial GCS score (
P
=0.016), hydrocephalus (
P
<0.001), intraventricular hemorrhage severity (
P
<0.01), and hemorrhagic dilatation of the fourth ventricle (
P
=0.02). By multivariate analysis, stepwise logistic regression revealed that hydrocephalus was the only independent prognostic factor for poor outcome (
P
<0.001). Postoperative 48-hour GCS score was better than the preoperative score by use of paired-sample
t
test (
P
<0.001).

Conclusions
—Hydrocephalus is the most important predictor of poor outcome. External ventricular drainage response for hydrocephalus was good in the present study, whereas an early decision should be made regarding preoperative neurological condition.
Stress-Induced Blood Pressure Reactivity and Incident Stroke in Middle-Aged Men
Authors: Everson Susan A. , Lynch John W. , Kaplan George A. , Lakka Timo A. , Sivenius Juhani , Salonen Jukka T.
Published: June 2011

Background and Purpose
—Exaggerated blood pressure reactivity to stress is associated with atherosclerosis and hypertension, which are known stroke risk factors, but its relation to stroke is unknown. Previous work also indicates that the association between reactivity and cardiovascular diseases may be influenced by socioeconomic status.

Methods
—The impact of blood pressure reactivity and socioeconomic status on incident stroke was examined in 2303 men (mean age, 52.8±5.1 years) from a population-based, longitudinal study of risk factors for ischemic heart disease in eastern Finland. Reactivity was calculated as the difference between blood pressure measured during the anticipatory phase of an exercise tolerance test (before exercise) and resting blood pressure, measured 1 week earlier. Mean systolic reactivity was 20 mm Hg (±15.9), and mean diastolic reactivity was 8.6 mm Hg (±8.5). Socioeconomic status was assessed as years of education. One hundred thirteen incident strokes (90 ischemic) occurred in 11.2 (±1.6) years of follow-up.

Results
—Men with exaggerated systolic reactivity (≥20 mm Hg) had 72% greater risk of any stroke (relative hazard ratio [RH], 1.72; 95% CI, 1.17 to 2.54) and 87% greater risk of ischemic stroke (RH, 1.87; 95% CI, 1.20 to 2.89) relative to less reactive men. Moreover, men who were high reactors and poorly educated were nearly 3 times more likely to suffer a stroke than better educated, less reactive men (RH, 2.90; 95% CI, 1.66 to 5.08). Adjustment for stroke risk factors had little impact on these associations. Diastolic reactivity was unrelated to stroke risk.

Conclusions
—Excessive sympathetic reactivity to stress may be etiologically important in stroke, especially ischemic strokes, and low socioeconomic status confers added risk.
A Modified National Institutes of Health Stroke Scale for Use in Stroke Clinical Trials
Authors: Lyden Patrick D. , Lu Mei , Levine Steven R. , Brott Thomas G. , Broderick Joseph
Published: June 2011

Background and Purpose
—The National Institutes of Health Stroke Scale (NIHSS) is accepted widely for measuring acute stroke deficits in clinical trials, but it contains items that exhibit poor reliability or do not contribute meaningful information. To improve the scale for use in clinical research, we used formal clinimetric analyses to derive a modified version, the mNIHSS. We then sought to demonstrate the validity and reliability of the new mNIHSS.

Methods
—The mNIHSS was derived from our prior clinimetric studies of the NIHSS by deleting poorly reproducible or redundant items (level of consciousness, face weakness, ataxia, dysarthria) and collapsing the sensory item into 2 responses. Reliability of the mNIHSS was assessed with the certification data originally collected to assess the reliability of investigators in the National Institute of Neurological Disorders and Stroke (NINDS) rtPA (recombinant tissue plasminogen activator) Stroke Trial. Validity of the mNIHSS was assessed with the outcome results of the NINDS rtPA Stroke Trial.

Results
—Reliability was improved with the mNIHSS: the number of scale items with poor κ coefficients on either of the certification tapes decreased from 8 (20%) to 3 (14%) with the mNIHSS. With the use of factor analysis, the structure underlying the mNIHSS was found identical to the original scale. On serial use of the scale, goodness of fit coefficients were higher with the mNIHSS. With data from part I of the trial data, the proportion of patients who improved ≥4 points within 24 hours after treatment was statistically significantly increased by tPA (odds ratio, 1.3; 95% confidence limits, 1.0, 1.8;
P
=0.05). Likewise, the odds ratio for complete/nearly complete resolution of stroke symptoms 3 months after treatment was 1.7 (95% confidence limits, 1.2, 2.6) with the mNIHSS. Other outcomes showed the same agreement when the mNIHSS was compared with the original scale. The mNIHSS showed good responsiveness, ie, was useful in differentiating patients likely to hemorrhage or have a good outcome after stroke.

Conclusions
—The mNIHSS appears to be identical clinimetrically to the original NIHSS when the same data are used for validation and reliability. Power appears to be greater with the mNIHSS with the use of 24-hour end points, suggesting the need for fewer patients in trials designed to detect treatment effects comparable to rtPA. The mNIHSS contains fewer items and might be simpler to use in clinical research trials. Prospective analysis of reliability and validity, with the use of an independently collected cohort, must be obtained before the mNIHSS is used in a research setting.
Hemorrhagic Transformation of Ischemic Brain Tissue
Authors: Berger Christian , Fiorelli Marco , Steiner Thorsten , Schäbitz Wolf-Rüdiger , Bozzao Luigi , Bluhmki Erich , Hacke Werner , von Kummer Rüdiger
Published: June 2011

Background and Purpose
—The term
symptomatic hemorrhage
secondary to ischemic stroke implies a clear causal relationship between clinical deterioration and hemorrhagic transformation (HT) regardless of the type of HT. The aim of this study was to assess which type of HT independently affects clinical outcome.

Methods
—We used the data set of the European Cooperative Acute Stroke Study (ECASS) II for a post hoc analysis. All patients had a control CT scan after 24 to 96 hours or earlier in case of rapid and severe clinical deterioration. HT was categorized according to radiological criteria: hemorrhagic infarction type 1 and type 2 and parenchymal hematoma type 1 and type 2. The clinical course was prospectively documented with the National Institutes of Health Stroke Scale and the modified Rankin Scale. The independent risk of each type of HT was calculated for clinical deterioration at 24 hours and disability and death at 3 months after stroke onset and adjusted for possible confounding factors such as age, severity of stroke syndrome at baseline, and extent of the ischemic lesion on the initial CT.

Results
—Compared with absence of HT, only parenchymal hematoma type 2 was associated with an increased risk for deterioration at 24 hours after stroke onset (adjusted odds ratio, 18; 95% CI, 6 to 56) and for death at 3 months (adjusted odds ratio, 11; 95% CI, 3.7 to 36). All other types of HT did not independently increase the risk of late deterioration.

Conclusions
—Only parenchymal hematoma type 2 independently causes clinical deterioration and impairs prognosis. It has a distinct radiological feature: it is a dense homogeneous hematoma >30% of the ischemic lesion volume with significant space-occupying effect.
Variations Between Countries in Outcome After Stroke in the International Stroke Trial (IST)
Authors: Weir N. U. , Sandercock P. A. G. , Lewis S. C. , Signorini D. F. , Warlow C. P.
Published: June 2011

Background and Purpose
—This study describes the large variations in outcome after stroke between countries that participated in the International Stroke Trial and seeks to define whether they could be explained by variations in case mix or by other factors.

Methods
—We analyzed data from the 15 116 patients recruited in Argentina, Australia, Italy, the Netherlands, Norway, Poland, Sweden, Switzerland, and the United Kingdom. We compared crude case fatality and the proportion of patients dead or dependent at 6 months; we used logistic regression to adjust for age, sex, atrial fibrillation, systolic blood pressure, level of consciousness, and number of neurological deficits. We used the frequency of prerandomization head CT scan and prescription of aspirin at discharge to indicate quality of care.

Results
—The differences in outcome (all treatment groups combined) between the “best” and “worst” countries were very large for death (171 cases per 1000 patients) and for death or dependency (375 cases per 1000 patients). The differences were somewhat smaller after adjustment for case mix (160 and 311 cases per 1000 patients, respectively). Process of care may have accounted for some but not all of the residual variation in outcome.

Conclusions
—Adjustment for case mix explained only some of the variation in outcome between countries. The residual differences in outcome were too large to be explained by variations in care and most likely reflect differences in unmeasured baseline factors. These findings demonstrate the need to achieve balance of treatment and control within each country in multinational randomized controlled stroke trials and the need for caution in the interpretation of nonrandomized comparisons of outcome after stroke between countries.
Neuroprotection in Transient Focal Brain Ischemia After Delayed Intravenous Administration of Brain-Derived Neurotrophic Factor Conjugated to a Blood-Brain Barrier Drug Targeting System
Authors: Zhang Yun , Pardridge William M.
Published: June 2011

Background and Purpose
—Neuroprotection with brain-derived neurotrophic factor (BDNF) requires direct injection into the brain owing to poor transport of the neurotrophin through the blood-brain barrier (BBB) in vivo. The present studies investigate whether BDNF alone or conjugated to a BBB drug targeting system is neuroprotective in focal, reversible brain ischemia after delayed intravenous administration at 60 or 120 minutes after middle cerebral arterial occlusion.

Methods
—BDNF was conjugated to the OX26 murine monoclonal antibody to the rat transferrin receptor, which undergoes transport into brain from blood via the BBB transferrin receptor transcytosis system. After a 1-hour occlusion of the middle cerebral artery in nitrous oxide– ventilated animals with normal blood sugar, the brain was reperfused, and either BDNF or the BDNF/OX26 conjugate was administered as a single intravenous injection at a dose of 50 μg per rat.

Results
—After the intravenous administration of unconjugated BDNF, there was no neuroprotection on the basis of analysis of brain at either 24 hours or 7 days after a 1-hour middle cerebral arterial occlusion. In contrast, there was a 68% and 70% reduction in cortical stroke volume at 24 hours and 7 days, respectively, after intravenous administration of 50 μg per rat of the BDNF conjugate (
P
<0.01). No effects on subcortical stroke volume were observed.

Conclusions
—These studies demonstrate marked neuroprotection in focal, transient brain ischemia with a single, delayed intravenous injection of BDNF if the neurotrophin is conjugated to a BBB drug targeting system. The neuroprotection is long lasting and persists for at least 7 days after a 1-hour middle cerebral artery occlusion.
Towards a National System for Monitoring the Quality of Hospital-Based Stroke Services
Authors: Weir Nicolas , Dennis Martin S.
Published: June 2011

Background and Purpose
—We sought to evaluate a system for monitoring the quality of hospital-based stroke services that uses routinely collected case fatality data, adjusted for case mix, as well as simple measures of the process of stroke care.

Methods
—We compared the process of care and case fatality after stroke between 5 Scottish hospitals (A through E) during 1995–1997. We retrospectively identified 2724 patients with acute stroke using routine discharge data and obtained case mix and process of care data from the medical record. We ascertained case fatality by record linkage and adjusted for case mix using a simple, externally validated regression model.

Results
—Crude case fatality varied by 21 deaths per 100 admissions between the 5 hospitals. After adjustment, case fatality still differed significantly (
P
=0.047), with 5 to 7 more deaths per 100 admissions at Hospital A than at Hospitals B through E. There were major shortcomings in the specialization and organization of care, the use of CT scanning, and the completeness of documentation at Hospital A compared with the other hospitals. There were smaller, but clinically important, differences in care between Hospitals B through E but no significant differences in adjusted case fatality.

Conclusions
—Once adjusted for important prognostic variables, routinely collected case fatality data might identify hospitals with major shortcomings in the processes of stroke care. More moderate, but still clinically important, variations in stroke care can only be identified by monitoring the process of care directly.
The Utility of Health States After Stroke
Authors: Post Piet N. , Stiggelbout Anne M. , Wakker Peter P.
Published: June 2011

Background
—To perform decision analyses that include stroke as one of the possible health states, the utilities of stroke states must be determined. We reviewed the literature to obtain estimates of the utility of stroke and explored the impact of the study population and the elicitation method.

Summary of Review
—We searched various databases for articles reporting empirical assessment of utilities. Mean utilities of major stroke (Rankin Scale 4 to 5) and minor stroke (Rankin Scale 2 to 3) were calculated, stratified by study population and elicitation method. Additionally, the modified Rankin Scale was mapped onto the EuroQol classification system. Utilities were obtained from 23 articles. Patients at risk for stroke assigned utilities of 0.26 and 0.55 to major and minor stroke, respectively. Stroke survivors assigned higher utilities to both major (0.41) and minor stroke (0.72). The EuroQol completed by stroke survivors revealed a utility of 0.32 and 0.71 for major and minor stroke, respectively. Utilities elicited by the Standard Gamble were generally higher, while those obtained by the Visual Analogue Scale were lower than the Time Trade Off values. Remaining variation between utilities may be caused by differences in definitions of the health states. The mapped EuroQol indicated a utility of 0.64 for minor stroke and a value just below zero for major stroke.

Conclusions
—For minor stroke, a utility between 0.50 and 0.70 seems to be reasonable for both decision analyses and cost-effectiveness studies. The utility of major stroke may range between 0 and 0.30 and may possibly be negative.
Middle Cerebral Artery Occlusion and Reperfusion in Primates Monitored by Microdialysis and Sequential Positron Emission Tomography
Authors: Enblad Per , Frykholm Peter , Valtysson Johann , Silander Hans C:son , Andersson Jesper , Fasth Karl-Johan , Watanabe Yasuyoshi , Långström Bengt , Hillered Lars , Persson Lennart
Published: June 2011

Background and Purpose
—In a previous investigation concerning the hemodynamic and metabolic changes over time displayed by sequential positron emission tomography (PET) in a middle cerebral artery (MCA) occlusion/reperfusion primate model, a metabolic threshold for irreversible ischemia could be identified (reduction of metabolic rate of oxygen [CMRO
2
] to ≈60% of the contralateral hemisphere). To evaluate the potential of microdialysis (MD) as an instrument for chemical brain monitoring, the aim of this subsequent study was to relate the chemical changes in MD levels directly to the regional metabolic status (CMRO
2
above or below the metabolic threshold) and the occurrence of reperfusion, as assessed by PET.

Methods
—Continuous MD (2 probes in each brain) and sequential PET measurements were performed during MCA occlusion (2 hours) and 18 hours (mean) of reperfusion in 8 monkeys (
Macaca mulatta
). Energy-related metabolites (lactate, pyruvate, and hypoxanthine) and glutamate were analyzed. The MD probe regions were divided into 3 categories on the basis of whether CMRO
2
was below or above 60% of the contralateral region (metabolic threshold level) during MCA occlusion and whether reperfusion was obtained: severe ischemia with reperfusion (n=4), severe ischemia without reperfusion (n=4), and penumbra with reperfusion (n=5).

Results
—The lactate/pyruvate ratio, hypoxanthine, and glutamate showed similar patterns. MD probe regions with severe ischemia and reperfusion and probe regions with severe ischemia and no reperfusion displayed high and broad peaks, respectively, during MCA occlusion, and the levels almost never decreased to baseline. Penumbra MD probe regions displayed only slight transient increases during MCA occlusion and returned to baseline.

Conclusions
—This experimental study of focal ischemia showed that the extracellular changes of energy-related metabolites and glutamate differed depending on the ischemic state of the brain during MCA occlusion and depending on whether reperfusion occurred. If MD proves to be beneficial in clinical practice, it appears important to observe relative changes over time.
Constraint-Induced Therapy of Chronic Aphasia After Stroke
Authors: Pulvermüller Friedemann , Neininger Bettina , Elbert Thomas , Mohr Bettina , Rockstroh Brigitte , Koebbel Peter , Taub Edward
Published: June 2011

Abstract
—Patients with chronic aphasia were assigned randomly to a group to receive either conventional aphasia therapy or constraint-induced (CI) aphasia therapy, a new therapeutic technique requiring intense practice over a relatively short period of consecutive days. CI aphasia therapy is realized in a communicative therapeutic environment constraining patients to practice systematically speech acts with which they have difficulty. Patients in both groups received the same amount of treatment (30 to 35 hours) as 10 days of massed-practice language exercises for the CI aphasia therapy group (3 hours per day minimum; 10 patients) or over a longer period of ≈4 weeks for the conventional therapy group (7 patients). CI aphasia therapy led to significant and pronounced improvements on several standard clinical tests, on self-ratings, and on blinded-observer ratings of the patients’ communicative effectiveness in everyday life. Patients who received the control intervention failed to achieve comparable improvements. Data suggest that the language skills of patients with chronic aphasia can be improved in a short period by use of an appropriate massed-practice technique that focuses on the patients’ communicative needs.
The ABILHAND Questionnaire as a Measure of Manual Ability in Chronic Stroke Patients
Authors: Penta Massimo , Tesio Luigi , Arnould Carlyne , Zancan Arturo , Thonnard Jean-Louis
Published: June 2011

Background and Purpose
—Chronic hemiparetic patients often retain the ability to manage activities requiring both hands, either through the use of the affected arm or compensation with the unaffected limb. A measure of this overall ability was developed by adapting and validating the ABILHAND questionnaire through the Rasch measurement model. ABILHAND measures the patient’s perceived difficulty in performing everyday manual activities.

Methods
—One hundred three chronic (>6 months) stroke outpatients (62% men; mean age, 63 years) were assessed (74 in Belgium, 29 in Italy). They lived at home and walked independently and were screened for the absence of major cognitive deficits (dementia, aphasia, hemineglect). The patients were administered the ABILHAND questionnaire, the Brunnström upper limb motricity test, the box-and-block manual dexterity test, the Semmes-Weinstein tactile sensation test, and the Geriatric Depression Scale. The brain lesion type and site were recorded. ABILHAND results were analyzed with the use of Winsteps Rasch software.

Results
—The Rasch refinement of ABILHAND led to a change from the original unimanual and bimanual 56-item, 4-level scale to a bimanual 23-item, 3-level scale. The resulting ability scale had sufficient sensitivity to be clinically useful. Rasch reliability was 0.90, and the item-difficulty hierarchy was stable across demographic and clinical subgroups. Grip strength, motricity, dexterity, and depression were significantly correlated with the ABILHAND measures.

Conclusions
—The ABILHAND questionnaire results in a valid person-centered measure of manual ability in everyday activities. The stability of the item-difficulty hierarchy across different patient classes further supports the clinical application of the scale.
Spouses of First-Ever Stroke Patients
Authors: Forsberg-Wärleby Gunilla , Möller Anders , Blomstrand Christian
Published: June 2011

Background and Purpose
—A stroke affects not only the patient but also the spouse. To better support the spouse during the acute phase of stroke, knowledge is needed about his or her experience with the situation. The aim of the present study was to study the well-being of the spouses of stroke patients during the acute state of stroke and to identify factors that may influence their well-being.

Methods
—Eighty-three consecutively enrolled spouses of first-ever stroke patients <75 years old participated. Their psychological well-being, measured by the Psychological General Well-Being Index 10 days after the stroke, was compared with norm values. Multiple analyses of correlation were performed to investigate the effects on psychological well-being of (1) age and sex, (2) level of impairment of the stroke patient, and (3) intrapersonal variables such as previous life satisfaction and view of the future.

Results
—The study group showed significantly lower psychological well-being compared with norm values except for the dimension of general health. The variables that correlated significantly with the Psychological General Well-Being total score were the sensorimotor impairment of the stroke patient and the “view of the future.” This view of the future also correlated significantly with the level of functional ability of the stroke patients.

Conclusions
—During the acute phase of stroke, the severity of the stroke has an impact on the spouse’s image of his or her future life, whereas the individual appraisal of personal consequences and of his or her own coping capacity seems to have a greater impact on the psychological well-being of the spouses than does the objective state of disability.
A Comparison of the Costs and Survival of Hospital-Admitted Stroke Patients Across Europe
Authors: Grieve R. , Hutton J. , Bhalla A. , Rastenytë D. , Ryglewicz D. , Sarti C. , Lamassa M. , Giroud M. , Dundas R. , Wolfe C.D.A.
Published: June 2011

Background and Purpose
—Policy makers require evidence on the costs and outcomes of different ways of organizing stroke care. This study compared the costs and survival of different ways of providing stroke care.

Methods
—Hospitalized stroke patients from 13 European centers were included, with demographic, case-mix, and resource use variables measured for each patient. Unit costs were collected and converted into US dollars using the purchasing power parity (PPP) index. Cox and linear regression analyses were used to compare survival and costs between the centers adjusting for case mix.

Results
—A total of 1847 patients were included in the study. After case-mix adjustment, the mean predicted costs ranged from $466 [95% CI 181 to 751] in Riga (Latvia) to $8512 [7696 to 9328] in Copenhagen (Denmark), which reflected differences in unit costs, and resource use. The mean length of hospitalization ranged from 8.3 days in Menorca (Spain) to 36.8 days in Turku B (Finland). In the 3 Finnish centers at least 80% of patients were admitted to wards providing organized stroke care, which was not provided at the centers in Almada (Portugal), Menorca, or Riga. Patients in Turku A and Turku B were less likely to die than those in Riga, Warsaw (Poland), or Menorca. The adjusted hazard ratios were 0.18 [0.10 to 0.32] for Turku A, 0.18 [0.10 to 0.32] for Turku B, 0.68 [0.48 to 0.96] for Warsaw, and 0.56 [0.33 to 0.96] for Menorca, all compared with Riga.

Conclusions
—The cost of stroke care varies across Europe because of differences in unit costs, and resource use. Further research is needed to assess which ways of organizing stroke care are the most cost-effective.
β
2
-Glycoprotein 1–Dependent Anticardiolipin Antibodies and Risk of Ischemic Stroke and Myocardial Infarction
Authors: Brey Robin L. , Abbott Robert D. , Curb J. David , Sharp Dan S. , Ross G. Webster , Stallworth Christian L. , Kittner Steven J.
Published: June 2011

Background

—

It has been hypothesized that immunoreactivity to β
2
-glycoprotein 1 (β2GP1)-dependent anticardiolipin antibody (aCL), but not β2GP1-independent aCL, is associated with increased risk of ischemic stroke and myocardial infarction (MI).

Methods

—

We performed a nested case-control study examining aCL as a risk factor for ischemic stroke and MI by using stored frozen sera obtained from subjects enrolled in the Honolulu Heart Program and followed for up for 20 years. We measured β2GP1-dependent and β2GP1-independent aCL and anti-β2GP1 immunoreactivity in 259 men who developed an ischemic stroke, in 374 men who developed an MI, and in a control group of 1360 men who remained free of both conditions.

Results

—

Only β2GP1-dependent aCL of the IgG class was significantly associated with both incident ischemic stroke and MI. This association was attenuated in the last 5 years of the 20-year follow-up. For stroke, the risk factor–adjusted relative odds for men with a positive versus a negative β2GP1-dependent aCL of the IgG class were 2.2 (95% CI 1.5 to 3.4) at 15 years and 1.5 (95% CI 1.0 to 2.3) at 20 years. For MI, the adjusted relative odds were 1.8 (95% CI 1.2 to 2.6) at 15 years and 1.5 (95% CI 1.1 to 2.1) at 20 years.

Conclusions

—

These data suggest that aCL IgG, particularly the β2GP1-dependent variety, is an important predictor of future stroke and MI in men.
Seasonal Distribution of Antiphospholipid Antibodies
Authors: Luong Thanh-Ha , Rand Jacob H. , Wu Xiao-Xuan , Godbold James H. , Gascon-Lema Mayra , Tuhrim Stanley
Published: June 2011

Background and Purpose

—

The purpose of this study was to determine if there was a seasonal variation in antiphospholipid antibody (aPL) titers and whether this variation differed between stroke cases and control subjects.

Methods

—

IgG and IgM anticardiolipin and antiphosphatidyl serine antibody titers were obtained on serum samples from 884 stroke patients and 1024 control subjects over a 7-year period. Temporal distributions by month of blood draw were evaluated.

Results

—

Marked seasonal differences in the proportion of positive titers were found for control subjects, but no seasonal variability among patients was noted. In control subjects, positive titers occurred less frequently in the summer months, mirroring the seasonal trends seen in respiratory track infections and rheumatic fever.

Conclusions

—

Our data suggest some aPL antibodies arise from different origins in patients and control subjects. The seasonality observed in the apparently normal population may be related to antibodies of infectious origin and is consistent with the reported lack of association with thrombosis of infection-related antibodies.
Ankle-Brachial Index and 7-Year Ischemic Stroke Incidence
Authors: Tsai Albert W. , Folsom Aaron R. , Rosamond Wayne D. , Jones Daniel W.
Published: June 2011

Background and Purpose

—

Low ankle-brachial index (ABI), which is the ratio of tibial artery systolic blood pressure to brachial systolic artery pressure, is known to be a measure of lower limb peripheral artery disease as well as a marker for other cardiovascular disease events. The ability of ABI to predict incident ischemic stroke, however, is not established in population-based studies.

Methods

—

ABI was measured in a cohort of 14 839 black and white men and women aged 45 to 64 years. Stroke incidence was calculated during approximately 7 years of follow-up.

Results

—

A total of 206 incident strokes occurred. Adjusted stroke incidence rates were markedly higher for those in the lowest versus the highest categories of ABI for men, women, blacks, and whites. The proportional hazards regression model, adjusted for age, race, gender, and field center, showed an inverse linear trend between ABI and ischemic stroke incidence (
P
<0.0001). The lowest group (ABI <0.80) had a hazard ratio of 5.68 (95% CI 2.77 to 11.66). After adjustment for major risk factors in a multivariate model, the hazard ratio in the lowest group was elevated (1.93) but no longer statistically significant (95% CI 0.78 to 4.78). There was, however, still an indication of an overall inverse linear trend between ABI and incident stroke (
P
=0.03).

Conclusions

—

Low ABI was strongly associated with increased incidence of ischemic stroke, but the relationship was substantially reduced after adjustment for major cardiovascular risk factors.
Life Expectancies Among Survivors of Acute Cerebrovascular Disease
Authors: Hannerz Harald , Nielsen Martin Lindhardt
Published: June 2011

Background and Purpose

—

Stroke survivors represent a large group of persons for whom age-differentiated life expectancy tables do not exist. Such tables are vital for many purposes. The aim of the present study was to estimate age- and sex-specific life expectancies among individuals who have survived the acute phase (1 month) of a cerebrovascular disease (CVD).

Methods

—

All patients who were registered with the Swedish National Hospital Discharge Registry with an admission for CVD (ICD codes 430 to 438) between January 1, 1989, and November 30, 1993, and were alive at the end of 1993 (N=103 591) were followed for mortality rates in 1994. The same was done for 1983. Actuarial analyses were used to convert death rates into life expectancies.

Results

—

Life expectancy among CVD survivors increased with time (1983 versus 1994): 22.9% for men (95% CI 18.3% to 27.6%) and 12.9% for women (95% CI 9.1% to 16.6%). The life expectancy ratio in 1983 between CVD survivors and the general population was 0.571 (95% CI 0.533 to 0.590) for men and 0.578 (95% CI 0.562 to 0.592) for women. In 1994, the corresponding ratios were 0.641 (95% CI 0.629 to 0.654) and 0.611 (95% CI 0.601 to 0.622). The life expectancy ratios between female and male survivors were 1.28 (95% CI 1.23 to 1.34) in 1983 and 1.18 (95% CI 1.15 to 1.21) in 1994. The prognosis for survivors who experienced occlusion and stenosis of the precerebral arteries was better than that for survivors of an intracerebral hemorrhage (
P
=4.4E-4) or occlusion of cerebral arteries (
P
=3.8E-8).

Conclusions

—

Although the prognosis has improved for all ages, stroke survivors still constitute a large group of persons with a low life expectancy compared with the general population.
Significance of Earlier Carotid Atherosclerosis for Stroke Subtypes
Authors: Nagai Yoji , Kitagawa Kazuo , Sakaguchi Manabu , Shimizu Yoshiomi , Hashimoto Hiroyuki , Yamagami Hiroshi , Narita Masako , Ohtsuki Toshiho , Hori Masatsugu , Matsumoto Masayasu
Published: June 2011

Background and Purpose

—

In addition to advanced stenosis, earlier stages of carotid atherosclerosis are associated with the risk for stroke. However, the significance has not been established for specific stroke subtypes. This study examines the association of earlier carotid atherosclerosis with stroke subtypes.

Methods

—

The subjects comprised 1059 patients (mean±SD age, 62±11 years) with <60% carotid stenosis. With the use of ultrasound, carotid atherosclerosis was evaluated by the plaque score, as defined by the sum of all plaque heights in bilateral carotid arteries. On the basis of neurological signs and symptoms, medical history, and brain MRI, we diagnosed stroke and its subtypes as follows: no stroke (n=738), atherothrombotic infarction (AI) (n=56), lacunar infarction (LI) (n=117), cardioembolic infarction (n=65), cerebral hemorrhage (n=26), and other or unclassified stroke (n=57).

Results

—

The plaque score was higher in AI (10.5±5.9) and LI (6.0±5.1) groups than in the no-stroke group (4.3±4.9) (both
P
<0.05), although it was similar between other stroke groups and the no-stroke group. Each 1 SD greater plaque score was associated with 2.5-fold (95% CI, 2.0 to 3.2) higher risk for AI and 1.4-fold (95% CI, 1.2 to 1.7) higher risk for LI compared with the no-stroke group. When we adjusted for cardiovascular risk factors, plaque score remained significantly associated with AI but not with LI. By receiver operating characteristic curve analyses, the receiver operating characteristic area for AI (0.81 to 0.86) was greater than that for LI (0.62 to 0.67) when we used plaque score either alone or in combination with cardiovascular risk factors.

Conclusions

—

Although evaluation of carotid atherosclerosis may aid in the risk assessment for AI and LI, the benefit appears to be greater for AI.
Prothrombotic Disorders in Children With Moyamoya Syndrome
Authors: Bonduel Mariana , Hepner Mirta , Sciuccati Gabriela , Torres Aurora Feliú , Tenembaum Silvia
Published: June 2011

Background and Purpose

—

Moyamoya syndrome is an uncommon chronic occlusive cerebrovascular disease in children. The origin of moyamoya syndrome remains undetermined. The role of the prothrombotic disorders contributing to its pathogenesis has not been completely elucidated. The purpose of this study was to determine the frequency of prothrombotic disorders in a pediatric population with moyamoya syndrome.

Methods

—

From May 1992 to April 2000, a prospective study of 10 consecutive children with moyamoya syndrome was carried out at a single center. Evaluation included the following assays: protein C, protein S, antithrombin, plasminogen, activated protein C resistance, factor V Leiden, and prothrombin gene mutations. Lupus anticoagulant, anticardiolipin antibodies, and anti–β
2
-glycoprotein I antibodies assays were also performed. The clinical characteristics, underlying diseases, family history of thrombosis, radiological findings, treatment, and outcome were also recorded.

Results

—

In our series, prothrombotic disorders were detected in 4 patients (40%). Inherited protein S deficiency was found in 1 patient; lupus anticoagulant and anticardiolipin antibodies were detected in the remaining 3 patients. One presented persistent lupus anticoagulant for 2.7 years until his death. In the case of the other 2 patients, 1 has maintained lupus anticoagulant for 9 months, whereas the other has kept anticardiolipin/anti–β
2
-glycoprotein I antibodies for 10 months.

Conclusions

—

We report the hemostatic data of the largest prospective pediatric study carried out at a single center in the western hemisphere. In 4 patients (40%), a prothrombotic disorder was detected. It is tempting to speculate that these hemostatic abnormalities may contribute to the pathogenesis of moyamoya syndrome in some of our patients.
Ebselen Reduces Cytochrome
c
Release From Mitochondria and Subsequent DNA Fragmentation After Transient Focal Cerebral Ischemia in Mice
Authors: Namura Shobu , Nagata Izumi , Takami Shinya , Masayasu Hiroyuki , Kikuchi Haruhiko
Published: June 2011

Background and Purpose—

The seleno-organic compound ebselen has both antioxidant and anti-inflammatory properties. Although ebselen has been shown to protect the brain against stroke, it is unclear how ebselen provides neuroprotection. In the present study the authors examined whether ebselen inhibits neuronal apoptosis resulting from transient focal cerebral ischemia in mice. The cytochrome
c
release and DNA fragmentation, both of which are biochemical markers of apoptosis, were compared between vehicle- and ebselen-treated mice.

Methods—

Cerebral ischemia was induced by transient middle cerebral artery occlusion for 30 minutes in ICR mice under halothane anesthesia. Ebselen (10 mg/kg) was given orally twice, 30 minutes before ischemia and 12 hours after reperfusion. By Western blot analysis, we examined release of mitochondrial cytochrome
c
. To evaluate brain damage, the brain sections were treated for terminal deoxynucleotidyl transferase–mediated DNA nick-end labeling (TUNEL) and Nissl staining. Prolonged neuroprotective efficacy of ebselen was determined by counting neuronal nuclei (NeuN) immunopositive cells at 21 days after ischemia.

Results—

Cytochrome
c
release was detected in the ischemic hemisphere at 3 to 24 hours after ischemia. Ebselen treatment diminished the cytochrome
c
release at 12 and 24 hours. In addition, ebselen decreased both DNA fragmentation determined by TUNEL and brain damage volume at 3 days after ischemia. Furthermore, ebselen increased the number of NeuN immunopositive cells at 21 days after ischemia.

Conclusions—

These results indicate that ebselen attenuates ischemic neuronal apoptosis by inhibiting cytochrome
c
release. Ebselen may be a potential compound in stroke therapy.