Classical and intermediate monocytes and their ratios in the natural immune course of ischemic stroke

 WOW! Nothing on how well these patients recovered! Not measuring recovery IS THE HEIGHT OF INCOMPETENCE! You're all fired!

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

If you don't measure it, you can't improve it and make it repeatable! 

The latest crapola here:

Classical and intermediate monocytes and their ratios in the natural immune course of ischemic stroke

• 

  Marta Oses ^1,2,3‡

• M

  María Araceli García-Torres ^2,3‡

• 

  Cristina Serrano del Castillo ^3,4‡

• 

  Ana Moraga ^5‡

• I

  Inmaculada Navas ^2,3‡

• M

  Marta Guillán ^2,3‡

• I

  Ivana Zamarbide ²

• 

  Víctor Mora ^6‡

• 

• 

• P

• 

• 

• 

  Ignacio Lizasoain ^{6,10† ‡ *}

• 1. PhD Program in Neuroscience, Universidad Autónoma de Madrid-Cajal Institute, Madrid, Spain 28029

• 2. Stroke Unit, Department of Neurology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain

Abstract

Introduction: 

Monocytes contribute to the immune response to ischemic stroke (IS), participating in both acute inflammation and post-ischemic repair. However, classical (cMo), intermediate (intMo), and non-classical (ncMo) monocytes differ in function, and composite indices such as the lymphocyte-to-monocyte ratio (LMR) do not distinguish between them. We characterized the dynamics of monocyte subpopulations and of two subset-derived ratios, the lymphocyte-to-classical monocyte ratio (LMRclas) and the lymphocyte-to-intermediate monocyte ratio (LMRint), in patients with acute IS who did not undergo reperfusion therapy, allowing assessment of the natural immune response.

Methods: 

We prospectively studied 31 patients and 16 controls, obtaining complete blood counts and/or flow cytometry in patients at admission, 24 h, and 48 h, and relating these findings to the National Institutes of Health Stroke Scale (NIHSS), the modified Rankin Scale (mRS) through 90 days, and the development of stroke-associated infection (SAI). Correlations were assessed using Spearman’s rank correlation coefficient, with Benjamini-Hochberg correction applied within four prespecified families.

Results: 

Compared with controls, patients showed reduced lymphocyte counts at admission, 24 h, and 48 h, whereas total monocyte counts did not differ at any time point. Within the monocyte compartment, intMo counts increased at 24 h and 48 h, and LMRint decreased at 48 h, while cMo and ncMo counts remained unchanged. A lower LMR at 48 h was associated with greater stroke severity and with poorer functional outcome; higher cMo counts at 48 h and a lower LMRclas at 24 h were associated with poorer outcome at 90 days; and a lower LMRclas at admission was associated with the development of SAI. None of these associations retained significance after correction for multiple comparisons, and neither ratio remained independently associated with 90-day outcome after adjustment for age, sex, and baseline NIHSS.

Discussion: 

Taken together, these exploratory findings suggest a reorganization of the monocyte compartment after ischemic stroke despite an unchanged total monocyte count, a shift that composite indices cannot capture but that LMRclas and LMRint might reflect. The estimates reported here may serve as a basis for evaluating these ratios in larger, adequately powered cohorts.

Graphical Abstract

Measuring arm function early after stroke: is the DASH good enough?

 Unless there are EXACT PROTOCOLS that recover function based on these measurements, THE DASH IS COMPLETELY FUCKING USELESS! And somehow you don't understand that?

Look at it yourself, you can see it has no objectivity at all and nothing that could generate an EXACT RECOVERY PROTOCOL! In my opinion; TOTALLY WORTHLESS! 

Any doctor using it has to be incompetent! Ask them SPECIFICALLY  how that will get them recovered! 100% recovery is the only goal in stroke!

Free online DASH score calculator

Measuring arm function early after stroke: is the DASH good enough?

Abstract

 Despite a growing call to use patient-reported outcomes in clinical research, few are available for measuring upper limb function post-stroke. We examined the Disabilities of the Arm, Shoulder and Hand (DASH) to evaluate its measurement performance in acute stroke. In doing so, we compared results from traditional and modern psychometric methods. 172 people with acute stroke completed the DASH. Those with upper limb impairments completed the DASH again at 6 weeks (n=99). Data (n=271) were analysed using two psychometric paradigms: traditional psychometric (Classical Test Theory, CTT) analyses examined data completeness, scaling assumptions, targeting, reliability and responsiveness; Rasch Measurement Theory (RMT) analyses examined scale-to-sample targeting, scale performance and person measurement. CTT analyses implied the DASH was psychometrically robust in this sample. Data completeness was high, criteria for scaling assumptions were satisfied (item-total correlations 0.55-0.95), ...

More failed hospitals promoting their 'care' rather than their recovery statistics! Don't go there!

 If everyone in your hospital can't immediately tell you these three statistics THEY ARE A COMPLETE FUCKING FAILURE! It means they aren't measuring anything at all! You can't measure 'care'. They should be in neon lights over the front entry desk!

There is no quality here if you don't measure the right things. Is your incompetent? hospital even measuring these?

1. tPA full recovery? Better than 12%?
2. 30 day deaths? Better than competitors?
3. rehab full recovery? Better than 10%?

Here is your business101 requirements. Not measuring 100% recovery is the height of incompetence!

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

The latest here:

 UHS earns national recognition for excellence in stroke care for third consecutive year 

Stony Brook Eastern Long Island Hospital earns national stroke care award 

HCA Florida Lehigh Hospital Awarded Primary Stroke Certification from Joint Commission 

Hendrick Health wins national awards for cardiac care - Abilene Reporter-News 

PBRMC earns national recognition for excellence in stroke care - Daily American Republic 

Piedmont Cartersville Nationally Recognized for High-Quality Stroke and Diabetes Care 

St. Bernards Receives National Recognition for Regional Heart, Stroke Care -NEA Report 

Munson Medical Center honored for excellence in stroke care 

American Heart Assoc. recognizes DMH, Springfield Memorial Hospital for stroke care 

Aspirus hospitals recognized with American Heart Association awards - Wausau Pilot & Review

Outcomes and Safety of Revascularization Approaches for Stroke Related to Isolated Vertebral Artery Occlusions (BRAVO)

 'Better' and 'may' signify COMPLETE FUCKING FAILURE OF 100% RECOVERY! Don't you even know that is the only goal in stroke and you aren't even measuring that. With NO measurements, you'll never get there! 

Here is your business101 requirements. Not measuring 100% recovery is the height of incompetence!

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

The latest here:

Outcomes and Safety of Revascularization Approaches for Stroke Related to Isolated Vertebral Artery Occlusions (BRAVO)

Alexander Salerno, MD, PhD https://orcid.org/0000-0001-8494-5527 alexander.salerno@chuv.ch, 

Vincent Dunet, MD https://orcid.org/0000-0002-9897-4561, 

Marek Sykora, MD, PhD https://orcid.org/0000-0003-3508-2176, 

Philipp Baumgartner, MD https://orcid.org/0000-0003-1525-2019, 

Visnja Padjen, MD, PhD https://orcid.org/0000-0002-6126-8305, 

Guido Bigliardi, MD https://orcid.org/0000-0001-5312-7206, 

Dylan Ryan, MD https://orcid.org/0000-0001-7254-0020, … Show All … on behalf of the EVA-TRISP and BRAVO Investigators

Abstract

BACKGROUND:

The best revascularization strategy for acute ischemic stroke from isolated vertebral artery occlusion remains unclear.

METHODS:

This retrospective, international, multicenter cohort study included patients from 30 comprehensive stroke centers across Europe (n=23), North America (n=5), and Asia (n=2) between 2016 and 2022. Eligible patients presented with acute ischemic stroke within 24 hours of last seen well and had imaging-confirmed isolated vertebral artery occlusion. Two treatment comparisons were analyzed: intravenous thrombolysis (IVT)-only versus conservative treatment (Cx), and endovascular treatment (EVT)±IVT versus medical management (Cx and IVT). The primary outcome was the shift in 3-month modified Rankin Scale (mRS) score; secondary outcomes included early neurological improvement (24-hour-delta National Institutes of Health Stroke Scale score), recanalization, early neurological deterioration of ischemic origin, symptomatic intracerebral hemorrhage, and 3-month mortality. Analyses were adjusted using inverse probability of treatment weighting (IPTW).

RESULTS:

Among 494 patients, 143 (29%) received Cx, 218 (44%) IVT-only, and 133 (27%) EVT±IVT. Compared with Cx, IVT-only showed similar 3-month mRS score (IPTW-adjusted odds ratio [aOR] mRS shift score, 1.32 [95% CI, 0.80–2.18]), greater early neurological improvement (IPTW-adjusted-β coefficient, −1 [95% CI, −2.05 to 0.05]), and higher recanalization rates (IPTW-aOR, 4.33 [95% CI, 1.36–13.78]). Compared with MM (=IVT+Cx), EVT±IVT was associated with an unfavorable mRS shift score (IPTW-aOR mRS shift score, 0.51 [95% CI, 0.35–0.74]), higher early neurological deterioration of ischemic origin (IPTW-aOR, 9.06 [95% CI, 2.86–28.67]), and symptomatic intracerebral hemorrhage (IPTW-aOR, 6.05 [95% CI, 1.14–32.1]) though recanalization was over 4-fold higher (OR, 4.64 [95% CI, 1.90–11.33]). Patients with National Institutes of Health Stroke Scale score ≥10 showed point estimates favoring EVT+IVT (Pinteraction=0.025).

CONCLUSIONS:

IVT-only appeared safe and was associated with better early recovery and recanalization. EVT±IVT showed overall worse outcomes, potentially due to increased early neurological deterioration of ischemic origin and symptomatic intracerebral hemorrhage rates, but may confer benefit in moderate-to-severe strokes, warranting prospective trials in symptomatic isolated vertebral artery occlusion.

Graphical Abstract

Despite robust evidence demonstrating the benefits of revascularization treatments for large vessel occlusions in anterior circulation strokes, the optimal acute management of occlusive posterior circulation (PC) acute ischemic strokes (AISs) other than basilar artery occlusion (BAO) remains less clear.

“How involved do you feel?” The PILS-Stroke questionnaire: a Rasch-built measure of social participation after stroke

 You wouldn't have to worry about social participation if you solved the primary problem of 100% recovery. CAN'T YOU SEE THAT?

'Measurements' DO NOTHING  towards recovery! What a waste of time!

“How involved do you feel?” The PILS-Stroke questionnaire: a Rasch-built measure of social participation after stroke

• 

  Edouard Ducoffre 1,2*

• 

  Yannick Bleyenheuft 1

• 

  Massimo Penta 3,4

• M

  Merlin Somville 1

• Z

  Zélie Rosselli 1

• G

  Geoffroy Saussez 1,2

• 

  Yves Vandermeeren 5,6

• 

  Carlyne Arnould 2*

• 1. Motor Skill Learning and Intensive Neurorehabilitation Lab, Institute of Neuroscience, UCLouvain, Louvain-la-Neuve, Belgium

• 2. Forme & fonctionnement Humain (FfH) Unit, CeREF-Santé, Haute Ecole Louvain en Hainaut, Montignies-sur-Sambre, Belgium

Abstract

Introduction:

Advances in acute stroke management have increased the number of individuals living with long-term disabilities, presenting challenges in maintaining prior levels of participation in life situations. Return to active participation can be seen as the goal of rehabilitation, given its clear impact on patients‘ quality of life. In this study, we aimed to develop the Participation in Life Situations-Stroke (PILS-Stroke) questionnaire, a self-reported Rasch-built tool for measuring patients' social involvement in meaningful life situations.

Methods:

We assembled a 72-item experimental version of PILS-Stroke, which was grounded on patients' and experts' perspectives via an initial item content review followed by item relevance/comprehensibility assessment. We then administered the questionnaire to 105 post-stroke individuals (58% males; mean ± SD: 62 ± 14 years) discharged for at least one month from hospital. Participants rated their involvement in life situations using a 3-point scale (0: “I would like to, but I don't get involved”; 1: “I get involved a little”; 2: “I get involved a lot”; ?: “I don't know/I don't want to get involved”). The responses were analyzed using the Rasch measurement model (RUMM2030+ software) to select the items presenting the best psychometric properties, resulting in an objective and unidimensional measurement tool. Construct validity was assessed using ten clinical measures covering International Classification of Functioning, Disability, and Health (ICF) domains (body functions, activities, participation).

Results:

The final 38-item PILS-Stroke demonstrated good reliability [Person Separation Index (PSI) = 0.89] and defined a unidimensional and linear scale for measuring stroke patients' social participation. There was a high correlation between social participation with satisfaction regarding activities/participation (SATIS-Stroke, r_s = 0.7, P < 0.001) and weak-to-moderate correlation with performance of motor activities (ACTIVLIM-CS, ABILHAND-CS, ABILOCO-CS; 0.20 ≤ r_s ≤ 0.39, P < 0.049) and certain psychological indicators (depression [HADS], r_s = −0.45, P < 0.001; confidence [CaSM], r_s = 0.47, P < 0.001).

Conclusions:

PILS-Stroke is a valid and reliable unidimensional tool specifically developed to measure stroke patients' social involvement in life situations. Its psychometric properties show promising potential for monitoring patients' social participation and quantifying the effectiveness of rehabilitation programs promoting their social inclusion.