Quantifying Nonuse in Chronic Stroke Patients: A Study Into Paretic, Nonparetic, and Bimanual Upper-Limb Use in Daily Life

And just what the hell good does quantifying non-use do for getting survivors recovered? SOLVE THE FUCKING 100% RECOVERY PROBLEM instead of this useless crapola!  I'd have you all fired.

Oops, I'm not playing by the polite rules of Dale Carnegie,  'How to Win Friends and Influence People'. 

Telling supposedly smart stroke medical persons they know nothing about stroke is a no-no even if it is true. 

Politeness will never solve anything in stroke. Yes, I'm a bomb thrower and proud of it. Someday a stroke 'leader' will try to ream me out for making them look bad by being truthful, I look forward to that day.

The latest crapola here:

 

Quantifying Nonuse in Chronic Stroke Patients: A Study Into Paretic, Nonparetic, and Bimanual Upper-Limb Use in Daily Life

 
ORIGINAL ARTICLE
Quantifying Nonuse in Chronic Stroke Patients: A StudyInto Paretic, Nonparetic, and Bimanual Upper-LimbUse in Daily Life
 Marian E. Michielsen, MSc
†
 , Ruud W. Selles, PhD, Henk J. Stam, MD, PhD Gerard M. Ribbers, MD, PhD, Johannes B. Bussmann, PhD
ABSTRACT. Michielsen ME, Selles RW, Stam HJ, RibbersGM, Bussmann JB. Quantifying nonuse in chronic stroke pa-tients: a study into paretic, nonparetic, and bimanual upper-limb use in daily life. Arch Phys Med Rehabil 2012;xx:xxx.
Objective:
 To quantify uni- and bimanual upper-limb use inpatients with chronic stroke in daily life compared with healthy controls.
Design:
 Cross-sectional observational study.
Setting:
 Outpatient rehabilitation center.
Participants:
 Patients with chronic stroke (n=38) and healthy controls (n=18).
Intervention:
 Not applicable.
Main Outcome Measures:
 Upper-limb use in daily life was measured with an accelerometry based upper-limb activity monitor, an accelerometer based measurement device. Uni-manual use of the paretic and the nonparetic side and bimanual upper limb use were measured for a period of 24 hours. Out-comes were expressed in terms of both duration and intensity.
Results:
 Patients used their unaffected limb much more than their affected limb (5.3h vs 2.4h), while controls used both limbs a more equal amount of time (5.4h vs 5.1h). Patients used their paretic side less than controls used their nondominant side and their nonparetic side more than controls their dominant side. The intensity with which patients used their paretic sidewas lower than that with which controls used their nondomi-nant side, while that of the nonparetic side was higher than that of the dominant side of controls. Finally, patients used theirparetic side almost exclusively in bimanual activities. During bimanual activities, the intensity with which they used their affected side was much lower than that of the nonaffected side.
Conclusion:
 Our data show considerable nonuse of the paretic side, both in duration and in intensity, and both during unimanual and bimanual activities in patients with chronic stroke. Patients do compensate for this with increased use of the nonparetic side.

Quantifying Nonuse in Chronic Stroke Patients: A Study Into Paretic, Nonparetic, and Bimanual Upper-Limb Use in Daily Life

 And just what the hell good does quantifying non-use do for getting survivors recovered? SOLVE THE FUCKING 100% RECOVERY PROBLEM instead of this useless crapola!  I'd have you all fired.

Oops, I'm not playing by the polite rules of Dale Carnegie,  'How to Win Friends and Influence People'. 

Telling supposedly smart stroke medical persons they know nothing about stroke is a no-no even if it is true. 

Politeness will never solve anything in stroke. Yes, I'm a bomb thrower and proud of it. Someday a stroke 'leader' will try to ream me out for making them look bad by being truthful, I look forward to that day.

The latest here:

Quantifying Nonuse in Chronic Stroke Patients: A Study Into Paretic, Nonparetic, and Bimanual Upper-Limb Use in Daily Life

• Marian E. Michielsen, MSc ^†
• Ruud W. Selles, PhD
• Henk J. Stam, MD, PhD
• Gerard M. Ribbers, MD, PhD
• Johannes B. Bussmann, PhD
• Show footnotes

Published:March 29, 2012DOI:https://doi.org/10.1016/j.apmr.2012.03.016

PlumX Metrics

Abstract

Michielsen ME, Selles RW, Stam HJ, Ribbers GM, Bussmann JB. Quantifying nonuse in chronic stroke patients: a study into paretic, nonparetic, and bimanual upper-limb use in daily life.

Objective

To quantify uni- and bimanual upper-limb use in patients with chronic stroke in daily life compared with healthy controls.

Design

Cross-sectional observational study.

Setting

Outpatient rehabilitation center.

Participants

Patients with chronic stroke (n=38) and healthy controls (n=18).

Intervention

Not applicable.

Main Outcome Measures

Upper-limb use in daily life was measured with an accelerometry-based upper-limb activity monitor, an accelerometer based measurement device. Unimanual use of the paretic and the nonparetic side and bimanual upper-limb use were measured for a period of 24 hours. Outcomes were expressed in terms of both duration and intensity.

Results

Patients used their unaffected limb much more than their affected limb (5.3h vs 2.4h), while controls used both limbs a more equal amount of time (5.4h vs 5.1h). Patients used their paretic side less than controls used their nondominant side and their nonparetic side more than controls their dominant side. The intensity with which patients used their paretic side was lower than that with which controls used their nondominant side, while that of the nonparetic side was higher than that of the dominant side of controls. Finally, patients used their paretic side almost exclusively in bimanual activities. During bimanual activities, the intensity with which they used their affected side was much lower than that of the nonaffected side.

Conclusion

Our data show considerable nonuse of the paretic side, both in duration and in intensity, and both during unimanual and bimanual activities in patients with chronic stroke. Patients do compensate for this with increased use of the nonparetic side.

Thrombectomy With and Without Computed Tomography Perfusion Imaging in the Early Time Window: A Pooled Analysis of Patient-Level Data

Please explain what the hell we should do with this data. You created it, analyze it and provide recommendations for its use.   Throwing this out into the ether with nothing is useless.

Thrombectomy With and Without Computed Tomography Perfusion Imaging in the Early Time Window: A Pooled Analysis of Patient-Level Data

Ashutosh P. Jadhav

,

Mayank Goyal

,

Johanna Ospel

,

Bruce C. Campbell

,

Charles B.L.M. Majoie

,

Diederik W. Dippel

,

Phil White

,

Serge Bracard

,

Francis Guillemin

,

Antoni Davalos

,

Michael D. Hill

, … See all authors

Originally published30 Nov 2021https://doi.org/10.1161/STROKEAHA.121.034331Stroke. 2022;53:1348–1353

Abstract

Background:

The optimal imaging paradigm for endovascular thrombectomy (EVT) patient selection in early time window (0–6 hours) treated acute ischemic stroke patients remains uncertain.(Did you make it certain? Created a protocol on it?) We aimed to compare post-EVT outcomes between patients who underwent prerandomization basic (noncontrast computed tomography [CT], CT angiography only) versus additional advanced imaging (computed tomography perfusion [CTP] imaging) and to determine the association of performance of prerandomization CTP imaging with clinical outcomes.

Methods:

The HERMES collaboration (Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials) pooled patient-level data from randomized controlled trials comparing EVT with usual care for acute ischemic stroke due to anterior circulation large vessel occlusion. Good functional outcome, defined as modified Rankin Scale score 0 to 2 at 90 days, was compared between randomized patients with and without CTP baseline imaging. Univariable and multivariable binary logistic regression analysis was performed to determine the association of baseline CTP imaging and good functional outcome.

Results:

We analyzed 1348 patients 610 (45.3%) of whom underwent CTP prerandomization. The benefit of EVT compared with best medical management was maintained irrespective of the baseline imaging paradigm (90-day modified Rankin Scale score 0–2 in EVT versus control patients: with CTP: 46.0% (137/298) versus 28.9% (88/305), without CTP: 44.1% (162/367) versus 27.3% (100/366). Performance of CTP baseline imaging compared with baseline noncontrast CT and CT angiography only yielded similar rates of good outcome (odds ratio, 1.05 [95% CI, 0.82–1.33], adjusted odds ratio, 1.04, [95% CI, 0.80–1.35]).

Conclusions:

Rates of good functional outcome were similar among patients in whom CTP was or was not performed, and EVT treatment effect in the 0- to 6-hour time window was similar in patients with and without baseline CTP imaging.

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Validity study of a triaxial accelerometer for measuring energy expenditure in stroke inpatients of a physical medicine and rehabilitation center

Just what the hell good does measuring energy expenditure do for stroke patients?  Unless you do followup research that provides protocols that gets them back to normal walking? My walking 16 years later still is awful and consumes way more energy than it should.

Validity study of a triaxial accelerometer for measuring energy expenditure in stroke inpatients of a physical medicine and rehabilitation center

Christiane Riedi Daniel

,

Paulo Yazbek

,

Artur Cesar Aquino Santos

&

Linamara Rizzo Battistella

Received 03 Nov 2021, Accepted 20 Mar 2022, Published online: 06 Apr 2022

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• https://doi.org/10.1080/10749357.2022.2058292
• CrossMark

 

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ABSTRACT

Purpose

Establish the validity of a triaxial accelerometer (Dynaport®) for evaluating the energy expenditure of patients with stroke sequelae at a rehabilitation hospital

Methods

This is a cross-sectional study with 24 stroke inpatients of a rehabilitation hospital. The participants were assessed on energy expenditure by an ergospirometer system and the triaxial accelerometer simultaneously during a walk test. The data collected by both devices were compared by intraclass correlation coefficient (ICC) and Bland-Altman limits of agreement

Results

An almost perfect agreement (ICC = 0,94) in the energy expenditure measured by the accelerometer compared to the results of the ergospirometer system was found during the exercise test. The Bland-Altman analysis has shown suitable limits of agreement. Post hoc analyses with the maximum volume of oxygen and the total energy expenditure measured by the ergospirometer system evidenced significant correlation with the energy expenditure measurements by the accelerometer

Conclusion

Our results evidence that the triaxial accelerometer Dynaport® and its built-in software are valid for estimating the energy expenditure of stroke sequelae during a walk exercise.(So what?)

 

New imaging score for outcome prediction in basilar artery occlusion stroke

 What the hell good does predicting failure to recover do for survivors? Will you actually just solve stroke? 100% rehab recovery protocols. That's what survivors want, not this lazy crapola of prediction shit.

New imaging score for outcome prediction in basilar artery occlusion stroke

 

• Gabriel Broocks,
• Lukas Meyer,
• Tobias D. Faizy,
• Sarah Elsayed,
• Helge Kniep,
• Andre Kemmling,
• Wolfgang Haupt,
• Rosalie McDonough,
• Matthias Bechstein,
• Peter Sporns,
• Thilo Rusche,
• Gerhard Schön,
• Jawed Nawabi,
• Jens Fiehler &
• Uta Hanning 

European Radiology (2022)Cite this article

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• Metrics details

Abstract

Objective

In ischemic posterior circulation stroke, the utilization of standardized image scores is not established in daily clinical practice. We aimed to test a novel imaging score that combines the collateral status with the rating of the posterior circulation Acute Stroke Prognosis Early CT score (pcASPECTS). We hypothesized that this score (pcASCO) predicts functional outcome and malignant cerebellar edema (MCE).

Methods

Ischemic stroke patients with acute BAO who received multimodal-CT and underwent thrombectomy on admission at two comprehensive stroke centers were analyzed. The posterior circulation collateral score by van der Hoeven et al was added to the pcASPECTS to define pcASCO as a 20-point score. Multivariable logistic regression analyses were performed to predict functional independence at day 90, assessed using modified Rankin Scale scores, and occurrence of MCE in follow-up CT using the established Jauss scale score as endpoints.

Results

A total of 118 patients were included, of which 84 (71%) underwent successful thrombectomy. Based on receiver operating characteristic curve analysis, pcASCO ≥ 14 classified functional independence with higher discriminative power (AUC: 0.83, 95%CI: 0.71–0.91) than pcASPECTS (AUC: 0.74). In multivariable logistic regression analysis, pcASCO was significantly and independently associated with functional independence (aOR: 1.91, 95%CI: 1.25–2.92, p = 0.003), and MCE (aOR: 0.71, 95%CI: 0.53–0.95, p = 0.02).

Conclusion

The pcASCO could serve as a simple and feasible imaging tool to assess BAO stroke patients on admission and might be tested as a complementary tool to select patients for thrombectomy in uncertain situations, or to predict clinical outcome.

Key Points

• The neurological assessment of basilar artery occlusion stroke patients can be challenging and there are yet no validated imaging scores established in daily clinical practice.

• The pcASCO combines the rating of early ischemic changes with the status of the intracranial posterior circulation collaterals.

• The pcASCO showed high diagnostic accuracy to predict functional outcome and malignant cerebellar edema and could serve as a simple and feasible imaging tool to support treatment selection in uncertain situations, or to predict clinical outcome.

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Association between Pneumonia, Fracture, Stroke, Heart Attack and Other Hospitalizations with Changes in Mobility Disability and Gait Speed in Older Adults

 And just what the hell use is this research?

Association between Pneumonia, Fracture, Stroke, Heart Attack and Other Hospitalizations with Changes in Mobility Disability and Gait Speed in Older Adults

Joshua D Brown  ¹ , Reiko Sato  ² , John E Morley  ³

Affiliations

• PMID: 34501250
• PMCID: PMC8432233
• DOI: 10.3390/jcm10173802

Free PMC article

Abstract

Pathophysiological changes after acute hospitalizations may influence physical functioning in older adults, which can lead to disability and loss of independence. This study evaluated the association between pneumonia, fracture, heart attack, stroke, and other hospitalizations with major mobility disability (MMD) and gait speed. This was a secondary analysis of the Lifestyle Interventions and Independence for Elders (LIFE) Study, which was conducted across eight sites during 2010-2013 with longitudinal follow-up for 1635 individuals over an average of 2.6 years. Participants included adults ≥70 years old with pre-existing mobility limitations randomized to a physical activity intervention or a health education control arm. Hospitalizations were recorded via self-report and adjudicated by medical reviewers. MMD was measured by the inability to complete a 400 m walk test, or other proxies, as a binary outcome. Gait speed was recorded during the walk test in meters per second (m/s) and measured on a linear scale. Mixed-effects repeated measures regression adjusted for baseline demographics, comorbid conditions, and frailty. Among the 1635 participants, there were 1458 hospitalizations, which included 80 (5.5% of all hospitalizations) cases of pneumonia, 92 (6.3%) hospitalized fractures, 87 (6.0%) heart attacks, and 61 (4.2%) strokes. In the short-term measurement period immediately following hospitalization (1 day to 6 months), stroke (OR = 3.98 (3.41-4.54)) had the strongest association with MMD followed by fracture (OR = 3.03 (2.54-3.52)), pneumonia (OR = 2.76 (2.23-3.30)), and heart attack (OR = 2.03 (1.52-2.53)). Associations with long-term (6-12 months after) MMD were decreased or not significant for all causes. Pneumonia, fracture, stroke, and other hospitalizations were associated with short-term relative gait speed changes between -4.8% up to -19.5%, and only fracture was associated with long-term changes. Hospitalizations for pneumonia, heart attack, stroke, and fractures were associated with short-term decreases in mobility in older adults. Older adults may be at risk for decreased mobility and disability following acute hospitalizations, with the magnitude determined by the cause of the precipitating event.

 

Clinical outcomes of rescue stenting for failed endovascular thrombectomy: a multicenter prospective registry

But you don't tell us the primary outcome; 100% recovery. As such you're not even trying to get stroke survivors recovered. WHAT THE HELL ARE YOU IN STROKE FOR?

Clinical outcomes of rescue stenting for failed endovascular thrombectomy: a multicenter prospective registry

1. Jang-Hyun Baek1,2,
2. http://orcid.org/0000-0001-8593-6841Byung Moon Kim3,
3. Eun Hyun Ihm4,
4. Chang-Hyun Kim5,
5. http://orcid.org/0000-0002-7035-087XDong Joon Kim3,
6. Ji Hoe Heo2,
7. Hyo Suk Nam2,
8. Young Dae Kim2,
9. Sangil Suh6,
10. Byungjun Kim7,
11. Yoodong Won8,
12. Byung Hyun Baek9,
13. http://orcid.org/0000-0002-8804-1848Woong Yoon9,
14. http://orcid.org/0000-0002-3988-1680Hyon-Jo Kwon10,
15. Yoonkyung Chang11,
16. http://orcid.org/0000-0002-8862-7347Cheolkyu Jung12,
17. Hae Woong Jeong13

1. Correspondence to Dr Byung Moon Kim, Radiology, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea (the Republic of); bmoon21@hanmail.net

Abstract

Background Mechanical thrombectomy (MT) is a primary endovascular modality for acute intracranial large vessel occlusion. However, further treatment, such as rescue stenting, is occasionally necessary for refractory cases. We aimed to investigate the efficacy and safety of rescue stenting in first-line MT failure and to identify the clinical factors affecting its clinical outcome.

Methods A multicenter prospective registry was designed for this study. We enrolled consecutive patients who underwent rescue stenting for first-line MT failure. Endovascular details and outcomes, follow-up patency of the stented artery, and clinical outcomes were summarized and compared between the favorable and unfavorable outcome groups.

Results A total of 78 patients were included. Intracranial atherosclerotic stenosis was the most common etiology for rescue stenting (97.4%). Seventy-seven patients (98.7%) were successfully recanalized by rescue stenting. A favorable outcome was observed in 66.7% of patients. Symptomatic intracranial hemorrhage and mortality were observed in 5.1% and 4.0% of patients, respectively. The stented artery was patent in 82.1% of patients on follow-up angiography. In a multivariable analysis, a patent stent on follow-up angiography was an independent factor for a favorable outcome (OR 87.6; 95% CI 4.77 to 1608.9; p=0.003). Postprocedural intravenous maintenance of glycoprotein IIb/IIIa inhibitor was significantly associated with the follow-up patency of the stented artery (OR 5.72; 95% CI 1.45 to 22.6; p=0.013).

Conclusions In this multicenter prospective registry, rescue stenting for first-line MT failure was effective(What is your definition of effective? Mine is 100% recovery!) and safe. For a favorable outcome, follow-up patency of the stented artery was important, which was significantly associated with postprocedural maintenance of glycoprotein IIb/IIIa inhibitors.

Data availability statement

Data are available upon reasonable request. The relevant anonymized data are available on reasonable request.

http://dx.doi.org/10.1136/neurintsurg-2021-018308

Atypical cortical drive during activation of the paretic and nonparetic tibialis anterior is related to gait deficits in chronic stroke

What the hell do we do with this to get survivors recovered? That is the whole point of stroke research, isn't it?

Atypical cortical drive during activation of the paretic and nonparetic tibialis anterior is related to gait deficits in chronic stroke

 Jacqueline A. Palmer a,b,
Alan R. Needle c 

Ryan T. Pohlig d
Stuart A. Binder-Macleod a,b
a Department of Physical Therapy, University of Delaware, Newark, DE 19713, USA
b Graduate Program in Biomechanics and Movement Science, University of Delaware, Newark, DE 19713, USA
c Department of Health and Exercise Science, Appalachian State University, Boone, NC 28608, USA
d Biostatistics Core Facility, University of Delaware, Newark, DE 19713, USA

Article history:
Accepted 12 June 2015

 a b s t r a c t

Objective:
 The role of cortical drive in stroke recovery for the lower extremity remains ambiguous. The purpose of this study was to investigate the relationship between cortical drive and gait speed in a group of stroke survivors.
Methods:
 Eighteen individuals with stroke were dichotomized into fast or slow walking groups.Transcranial magnetic stimulation (TMS) was used to collect motor evoked potentials (MEPs) from the tibialis anterior of each lower extremity during rest, paretic muscle contractions, and nonparetic muscle contractions. An asymmetry-index (AI) was calculated using motor thresholds and compared between groups. The average MEP of the paretic leg during TMS at maximal intensity (MEP₁₀₀) for each condition was compared within and between groups.
Results:
 A significant positive correlation was found between AI and walking speed. Slow-walkers had greater MEP₁₀₀s during the nonparetic contraction than during the paretic contraction or rest conditions.In contrast, fast-walkers had greatest MEP₁₀₀s during the paretic contraction.
Conclusions:
 Alterations in the balance of corticomotor excitability occur in the lower extremity of individuals with poor motor recovery post-stroke. This atypical cortical drive is dependent on activation of the unaffected hemisphere and contraction of the nonparetic leg.
Significance:
 Understanding mechanisms underlying motor function can help to identify specific patient deficits that impair function.

 2015 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rightsreserved.

Corticospinal Tract Lesion Load Originating From Both Ventral Premotor and Primary Motor Cortices Are Associated With Post-stroke Motor Severity

What the hell do we do with this information to get 100% recovered?  Nothing here can help me explain to my therapists what needs to be done. Useless.  And the mentors and senior researchers approved this crapola.

Corticospinal Tract Lesion Load Originating From Both Ventral Premotor and Primary Motor Cortices Are Associated With Post-stroke Motor Severity

Show all authors

Kaori L. Ito, PhD, OTR/L, Bokkyu Kim, PhD, PT, Jingchun Liu, MD, ...

First Published December 24, 2021 Research Article 

https://doi.org/10.1177/15459683211068441

Article information

Abstract

Lesion load of the corticospinal tract (CST-LL), a measure of overlap between a stroke lesion and the CST, is one of the strongest predictors of motor outcomes following stroke. CST-LL is typically calculated by using a probabilistic map of the CST originating from the primary motor cortex (M1). However, higher order motor areas also have projections that contribute to the CST and motor control. In this retrospective study, we examined whether evaluating CST-LL from additional motor origins is more strongly associated with post-stroke motor severity than using CST-LL originating from M1 only. We found that lesion load to both the ventral premotor (PMv) cortex and M1 were more strongly related to stroke motor severity indexed by Fugl-Meyer Assessment cut-off scores than CST-LL of M1 alone, suggesting that higher order motor regions add clinical relevance to motor impairment.

Keywords

corticospinal tract, stroke, Fugl-Meyer, motor, ventral premotor cortex, M1

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Long-Term Impact of Urgent Secondary Prevention After Transient Ischemic Attack and Minor Stroke: Ten-Year Follow-Up of the EXPRESS Study

But you didn't measure 100% recovery, so you're really NOT EVEN TRYING TO SOLVE STROKE. What the hell are you working in stroke for then?  And measuring cost!

With no measurements of 100% recovery they obviously have no intention of solving stroke at all.

Business 101: If you don't measure it, it is not important, so obviously 100% recovery is not important. 

“What's measured, improves.” So said management legend and author Peter F. Drucker 

The latest here:

Long-Term Impact of Urgent Secondary Prevention After Transient Ischemic Attack and Minor Stroke: Ten-Year Follow-Up of the EXPRESS Study

 

Ramon Luengo-Fernandez

,

Linxin Li

,

Louise Silver

,

Sergei Gutnikov

,

Nicola C. Beddows

,

Peter M. Rothwell

Originally published28 Oct 2021https://doi.org/10.1161/STROKEAHA.121.034279Stroke. 2021;0:STROKEAHA.121.034279

Abstract

Background and Purpose:

Urgent assessment aimed at reducing stroke risk after transient ischemic attack or minor stroke is cost-effective over the short-term. However, it is unclear if the short-term impact is lost on long-term follow-up, with recurrent events being delayed rather than prevented. By 10-year follow-up of the EXPRESS study (Early Use of Existing Preventive Strategies for Stroke), previously showing urgent assessment reduced 90-day stroke risk by 80%, we determined whether that early benefit was still evident long-term for stroke risk, disability, and costs.

Methods:

EXPRESS was a prospective population-based before (phase 1: April 2002–September 2004; n=310) versus after (phase 2: October 2004–March 2007; n=281) study of the effect of early assessment and treatment of transient ischemic attack/minor stroke on early recurrent stroke risk, with an external control. This report assesses the effect on 10-year recurrent stroke risk, functional outcomes, quality-of-life, and costs.

Results:

A reduction in stroke risk in phase 2 was still evident at 10 years (55/23.3% versus 82/31.6%; hazard ratio=0.68 [95% CI, 0.48–0.95]; P=0.024), as was the impact on risk of disabling or fatal stroke (17/7.7% versus 32/13.1%; hazard ratio=0.54 [0.30–0.97]; P=0.036). These effects were due to maintenance of the early reduction in stroke risk, with neither additional benefit nor rebound catch-up after 90 days (post-90 days hazard ratio=0.88 [0.65–1.44], P=0.88; and hazard ratio=0.83 [0.42–1.65], P=0.59, respectively). Disability-free life expectancy was 0.59 (0.03–1.15; P=0.043) years higher in patients in phase 2, as was quality-adjusted life expectancy (0.49 [0.03–0.95]; P=0.036). Overall, 10-year costs were nonsignificantly higher in patients attending the phase 2 clinic ($1022 [-3865–5907]; P=0.66). The additional cost per quality-adjusted life year gained in phase 2 versus phase 1 was $2103, well below current cost-effectiveness thresholds.

Conclusions:

Urgent assessment and treatment of patients with transient ischemic attack or minor stroke resulted in a long-term reduction in recurrent strokes and improved outcomes, with little atrophy of the early benefit over time, representing good value for money even with a 10-year time horizon. Our results suggest that other effective acute treatments in transient ischemic attack/minor stroke in the short-term will also have the potential to have long-term benefit.

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Drinking 3 cups of coffee daily slashes heart attack, stroke risk by a third — but don’t switch to decaf

 Well shit, I switched to decaf because of this earlier research.

Benefits Aren't Just From Caffeine December 2018

I did just switch to decaf for this reason.

This Many Coffees Is Bad For Your Heart Health

 

 

WHAT THE HELL SHOULD I DO?

Drinking 3 cups of coffee daily slashes heart attack, stroke risk by a third — but don’t switch to decaf

DALLAS, Texas — There’s good news for people who love to start their day with a hot cup of coffee. New research from the American Heart Association finds drinking more coffee every day can dramatically cut a person’s risk for heart failure. In fact, three cups of coffee a day can slash the risks for heart attack or stroke by a third.

Coffee is rich in antioxidants and beneficial plant chemicals that dampen inflammation, researchers say. Their findings revealed caffeinated coffee reduces the risk of heart failure by up to 12 percent per cup. The review looked at three major heart disease studies, comparing participants who drank one, two, or more than three cups a day with peers who never touched the stuff.

The link between coffee and health has been debated for years. Past studies have even claimed the “pick-me-up” drink damages the heart by raising blood pressure and cholesterol.

“The association between caffeine and heart failure risk reduction was surprising,” says senior author Dr. David Kao from the University of Colorado in a media release.

“Coffee and caffeine are often considered by the general population to be ‘bad’ for the heart because people associate them with palpitations, high blood pressure, etc. The consistent relationship between increasing caffeine consumption and decreasing heart failure risk turns that assumption on its head.”

More coffee is better for the heart

The findings, published in the journal Circulation: Heart Failure, are based on more than 21,000 U.S. adults who researchers followed for at least ten years. Kao’s team relied on machine learning systems to analyze participants in the Framingham Heart Study. Residents of this Massachusetts town have had their health tracked for decades.

Study authors then compared those calculations to data from the Atherosclerosis Risk in Communities Study and the Cardiovascular Health Study. In all three, heart failure rates fell among people who reported drinking one or more cups of caffeinated coffee daily.

In the Framingham and Cardiovascular reports, heart failure risk over the course of decades fell by five to 12 percent per cup per day. The Atherosclerosis study reveals drinking more than two cups a day lowers heart failure risk by about 30 percent. That study did not identify any added protection from drinking only one cup however.

Switching to decaf could be a fatal decision

On the other hand, researchers find decaffeinated coffee seems to have the opposite effect on heart health.

It significantly increases the risk of heart failure – or offered no protection – according to the Framingham and Cardiovascular studies. Further investigations reveal caffeine consumption from any source appears to hold the key. The stimulant is at least part of the reason for the apparent boost to the heart from drinking more coffee.

“However, there is not yet enough clear evidence to recommend increasing coffee consumption to decrease risk of heart disease with the same strength and certainty as stopping smoking, losing weight or exercising,” Dr. Kao explains.

Coronary artery disease, heart failure, and stroke are among the top causes of death in the United States.

“While smoking, age and high blood pressure are among the most well-known heart disease risk factors, unidentified risk factors for heart disease remain,” the researcher adds.

So how much coffee is the right amount?

Across the three studies, participants self-reported their coffee consumption and with no standard unit of measure. Government guidelines, however, suggest three to five eight-ounce cups of plain black coffee can be part of a healthy diet.

Coffee also has a connection to fighting cancer, type 2 diabetes, depression, and neurodegenerative diseases like dementia. While that may sound great, the AHA warns that not all coffees are created equal. Popular coffee-based drinks such as lattes and macchiatos are often high in calories, added sugar, and fat — making black coffee the safest choice for the heart.

Excessive caffeine consumption can be dangerous too. The American Academy of Pediatrics recommends kids generally avoid beverages containing it.

“It is intriguing that these three studies suggest that drinking coffee is associated with a decreased risk of heart failure and that coffee can be part of a healthy dietary pattern if consumed plain, without added sugar and high fat dairy products such as cream,” says Professor Penny Kris-Etherton from Penn State University.

“The bottom line: enjoy coffee in moderation as part of an overall heart-healthy dietary pattern that meets recommendations for fruits and vegetables, whole grains, low-fat/non-fat dairy products, and that also is low in sodium, saturated fat and added sugars. Also, it is important to be mindful that caffeine is a stimulant and consuming too much may be problematic – causing jitteriness and sleep problems.”

“The risks and benefits of drinking coffee have been topics of ongoing scientific interest due to the popularity and frequency of consumption worldwide,” adds Prof. Linda Van Horn of Northwestern University. “Studies reporting associations with outcomes remain relatively limited due to inconsistencies in diet assessment and analytical methodologies, as well as inherent problems with self-reported dietary intake.”

 

Prognostic Utility of Serum Biomarkers in Intracerebral Hemorrhage: A Systematic Review

Useless, you describe a biomarker prediction; THEN GIVE US NOTHING TO PREVENT THAT MORBIDITY AND MORTALITY. What the hell do you think research is for?

 

Prognostic Utility of Serum Biomarkers in Intracerebral Hemorrhage: A Systematic Review

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Zachary Troiani, BA, Luis Ascanio, MD, Christina P. Rossitto, BS, ...

First Published September 18, 2021 Review Article 

https://doi.org/10.1177/15459683211041314

Article information

Abstract

Background. 

Intracerebral hemorrhage (ICH) accounts for 10–20% of all strokes and is associated with high morbidity and mortality. Recent studies have identified serum biomarkers as a means to improve outcome prognostication in poor grade ICH patients. Poor prognosis of ICH patients and complex pathophysiology of the disease necessitate prognostic serum biomarkers to help guide treatment recommendations.  

Objective. 

The objective is to systematically review all biomarkers used to predict long-term functional outcome in patients with spontaneous intracerebral hemorrhage.  

Results. 

We identified 36 studies investigating the predictive utility of 50 discrete biomarkers. Data from 4865 ICH patients were reviewed. Inflammatory biomarkers (11/50) were most often studied, followed by oxidative (8/50), then neuron and astrocyte-specific (7/50). S100 calcium binding protein B, white blood cell count, and copeptin were the most often studied individual biomarkers. The prognostic utility of 23 biomarkers was analyzed using receiver operating characteristic curves. Area under the curve (AUC) values for all available biomarkers except neutrophil/lymphocyte ratio were acceptable. Twenty of the 23 biomarkers were characterized by at least one excellent AUC value. Vascular endothelial growth factor, glial fibrillary astrocyte protein, and S100 calcium binding protein B were characterized by outstanding AUC.  

Conclusions. 

We identified the inflammatory and neuron and astrocyte-specific biomarker categories as having the greatest number of significant individual biomarker predictors of long-term outcome. Further investigation utilizing cross-validation of prediction models in a second independent group and blinded assessment of outcomes for the predictive utility of biomarkers in patients with ICH is warranted.

Keywords

intracerebral hemorrhage, biomarkers, prognosis, systematic review

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Phenotypes of Chronic Covert Brain Infarction in Patients With First-Ever Ischemic Stroke: A Cohort Study

 What the hell are survivors supposed to do with this information? Describing a problem with no solution is useless. As a programmer I'd be fired in no time for doing that.

Phenotypes of Chronic Covert Brain Infarction in Patients With First-Ever Ischemic Stroke: A Cohort Study

Jan Vynckier

,

Johannes Kaesmacher

,

Joanna Marguerite Wardlaw

,

Laurent Roten

,

Morin Beyeler

,

Nebiyat Filate Belachew

,

Lorenz Grunder

,

David Julian Seiffge

,

Simon Jung

,

Jan Gralla

, … See all authors

Originally published16 Sep 2021https://doi.org/10.1161/STROKEAHA.121.034347Stroke. ;0:STROKEAHA.121.034347

Abstract

Background and Purpose:

The aim of this study was to assess the rate of chronic covert brain infarctions (CBIs) in patients with acute ischemic stroke (AIS) and to describe their phenotypes and diagnostic value.

Methods:

This is a single-center cohort study including 1546 consecutive patients with first-ever AIS on magnetic resonance imaging imaging from January 2015 to December 2017. The main study outcomes were CBI phenotypes, their relative frequencies, location, and association with vascular risk factors.

Results:

Any CBI was present in 574/1546 (37% [95% CI, 35%–40%]) of patients with a total of 950 CBI lesions. The most frequent locations of CBI were cerebellar in 295/950 (31%), subcortical supratentorial in 292/950 (31%), and cortical in 213/950 (24%). CBI phenotypes included lacunes (49%), combined gray and white matter lesions (30%), gray matter lesions (13%), and large subcortical infarcts (7%). Vascular risk profile and white matter hyperintensities severity (19% if no white matter hyperintensity, 63% in severe white matter hyperintensity, P<0.001) were associated with presence of any CBI. Atrial fibrillation was associated with cortical lesions (adjusted odds ratio, 2.032 [95% CI, 1.041–3.967]). Median National Institutes of Health Stroke Scale scores on admission were higher in patients with an embolic CBI phenotype (median National Institutes of Health Stroke Scale, 5 [2–10], P=0.025).

Conclusions:

CBIs were present in more than a third of patients with first AIS. Their location and phenotypes as determined by MRI were different from previous studies using computed tomography imaging. Among patients suffering from AIS, those with additional CBI represent a vascular high-risk subgroup and the association of different phenotypes of CBIs with differing risk factor profiles potentially points toward discriminative AIS etiologies.

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