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How to Design Economic Predictive Laboratory Panel Evaluating Acute Ischemic Stroke Outcome  [PDF]
Hasnaa A. Abo-Elwafa, Hazem K. Ibrahim, Hassan M. El-Nady, Asmaa H. Abbas
Neuroscience & Medicine (NM) , 2019, DOI: 10.4236/nm.2019.101001
Abstract: Background: acute ischemic stroke (AIS) remains the third cause of death and disability, and acute phase responses, both increasing international normalized ratio (INR) and activated partial thromboplastin time (APTT) are associated with worse outcome. Erythrocyte sedimentation rate (ESR) serves as severity marker, and non-fasting triglycerides (TG) indicates remnants of chylomicrons and very low density lipoproteins potentially pro-inflammatory. Aims: to design predictive economic panel evaluating AIS. Patients and methods: 100(AIS) patients were included, clinically evaluated by Scandinavian Stroke Scale (SSS) and Modified Rankin Score (MRS), subjected to complete blood count (CBC) on Cell-Dyne3700, manual ESR, INR and APTT on SYSMEX-CA1500, serum uric acid (SUA), serum albumin and non-fasting (TG) on Beckman Coulter AU480. Statistical analysis: STATA intercooled version 9.2. Results: odd ratio (OR), confidence interval (CI) of (MRS) in correlation to WBCs count in quartile (Q)3, 4 (OR 8.14, CI 2.29 - 8.90, significant P = 0.01; and OD13.5, CI 3.39 - 53.68, high significant P = 0.001 respectively), to APTT in Q3 (OD 4.15, CI 1.09 - 15.82, P = 0.04), SUA in Q3 (OD 0.19, CI 0.05 - 0.68, P = 0.01), TG in Q3,4 (OD 0.24 CI 0.06 - 0.88, P = 0.03; and OD 0.09, CI 0.02 - 0.34 P = 0.001 respectively) and serum albumin in Q3(OD 0.13, CI 0.04 - 0.51, P = 0.003), insignificant correlations to ESR, INR and platelets. Conclusion: according to (MRS), the economic predictive panel should be included WBCs, APTT, SUA, and non-fasting TG with serum albumin as prognostic tool evaluating functional disability in AIS.
A biochemical marker panel in MRI-proven hyperacute ischemic stroke-a prospective study
Carolin Knauer, Katharina Knauer, Susanne Müller, Albert C Ludolph, Dietmar Bengel, Hans P Müller, Roman Huber
BMC Neurology , 2012, DOI: 10.1186/1471-2377-12-14
Abstract: We investigated all consecutive patients admitted to our stroke unit during a time period of 5 months. Only patients with clinical investigation, blood sample collection and MRI within six hours from symptom onset were included. Values of biochemical markers were analyzed according to the results of diffusion weighted MR-imaging. In addition MMX-values in ischemic strokes were correlated with the TOAST-criteria. For statistical analysis the SAS Analyst software was used. Correlation coefficients were analyzed and comparison tests for two or more groups were performed. Statistical significance was assumed in case of p < 0.05. Finally a ROC-analysis was performed for the MMX-Index.In total 174 patients were included into this study (n = 100 strokes, n = 49 mimics, n = 25 transitoric ischemic attacks). In patients with ischemic strokes the mean NIHSS was 7.6 ± 6.2, while the mean DWI-lesion volume was 20.6 ml (range 186.9 to 4.2 ml). According to the MMX or the individual markers there was no statistically significant difference between the group of ischemic strokes and the group of mimics. Moreover the correlation of the index and the DWI-lesion-volume was poor (p = 0.2).In our setting of acute MRI-proven ischemic stroke the used multimarker-assay (Triage? Stroke Panel) was not of diagnostic validity. We do not recommend to perform this assay as this might lead to a unjustified time delay.Stroke represents the 2nd leading cause of death and the most common cause of morbidity in industrialized countries. Although systemic fibrinolysis has been proven to be an effective therapy even in industrialized countries only the minority of all ischemic stroke patients receives rtPA therapy [1,2]. Therefore, acute stroke therapy remains one of the essential challenges of Neurology. In case of acute stroke it's important to apply immediately reliable diagnostic tools to start treatment as soon as possible as the time to recanalization is a very substantial predictor of the clinica
Dora Peychinska, Maya Danovska, Dimitar Chakarov, Virginia Simeonova, Christo Lilovski
Journal of IMAB : Annual Proceeding (Scientific Papers) , 2004, DOI: http://dx.doi.org/10.5272/jimab.2004101.19
Abstract: The dynamic follow up of aphasic disorders in patients with acute ischemic stroke is of great importance because of its prognostic value for their future recovery. The purpose of that clinical study is to compare the type of aphasia with the CT data about the infarction localization and to evaluate the prospective aphasia recovery. In the clinical study were included 37 patients with ischemic stroke and aphasia, theated in II-nd Neurology Clinic, Medical University Pleven. The diagnosis ischemic stroke was confirmed by clinical and CT investigations. Partial and full recovery of sensory aphasia was registered in all the patients with total aphasia, while motor aphasia showed little tendency of reduction in acute ischemic stroke. Aphasic disorders were more severe in cases with ischemic infarctions localized in the specific anatomical regions responsible for the speech function. The dynamic follow up of aphasic disorders has prognostic value for the speech recovery. Better prognosis show sensory and amnestic aphasia. Lesion localization also influences the prognosis.
Mean Platelet Volume and Peripheral Blood Count Response in Acute Ischemic Stroke
Baburhan Guldiken,Hulya Ozkan,Levent Kabayel
Trakya Universitesi Tip Fakultesi Dergisi , 2008,
Abstract: Objectives: Mean platelet volume (MPV) is a marker of the platelet activity and is reported to increase in vascular diseases. The aim of the study is to investigate the relationship between MPV and the subtypes of acute ischemic stroke.Patients and Methods: The patient group consisted of 102 acute ischemic stroke patients who were divided into the large vessel (n=43) and the small vessel (n=59) disease subgroups. Their MPV values were compared with those of 48 age/sex-matched healthy individuals. The relationship of MPV with the subtypes and severity of stroke, and other hematological parameters (platelet count, platecrit, hemoglobin, hematocrit, erythrocyte count, mean corpuscular volume, leukocyte, neutrophil, lymphocyte, monocyte) was further investigated.Results: No difference was found in terms of MPV values between the patient subgroups and control group, and no relation was found between MPV and stroke severity and other hematological parameters (p>0.05). A significant increase in the leukocyte and neutrophil count was seen in patients of the large vessel disease group when compared with the small vessel disease and control group (p<0.005). Neutrophil count is found to be a risk factor for the stroke severity (β=0.362, p=0.01, OR=1.437, CI %95 0.02-0.08).Conclusion: No significant change in MPV was seen in acute ischemic stroke. High leukocyte and neutrophil levels are markers for the large vessel disease subtype and severity of ischemic stroke.
New multi-sample nonparametric tests for panel count data  [PDF]
N. Balakrishnan,Xingqiu Zhao
Mathematics , 2009, DOI: 10.1214/08-AOS599
Abstract: This paper considers the problem of multi-sample nonparametric comparison of counting processes with panel count data, which arise naturally when recurrent events are considered. Such data frequently occur in medical follow-up studies and reliability experiments, for example. For the problem considered, we construct two new classes of nonparametric test statistics based on the accumulated weighted differences between the rates of increase of the estimated mean functions of the counting processes over observation times, wherein the nonparametric maximum likelihood approach is used to estimate the mean function instead of the nonparametric maximum pseudo-likelihood. The asymptotic distributions of the proposed statistics are derived and their finite-sample properties are examined through Monte Carlo simulations. The simulation results show that the proposed methods work quite well and are more powerful than the existing test procedures. Two real data sets are analyzed and presented as illustrative examples.
The follow-up of patients of sixty-five years of age and younger with acute ischemic stroke and transient ischemic attacks, and elevated D-dimer levels in plasma  [cached]
Magnus Vrethem,Tomas Lindahl
Neurology International , 2009, DOI: 10.4081/ni.2009.e11
Abstract: D-dimer levels in plasma, a degradation product of fibrin, have been shown to correlate with the severity of ischemic stroke. In order to investigate the outcome of patients with elevated D-dimer we have carried out a follow-up study of patients of 65 years of age and younger with acute ischemic stroke or transient ischemic attacks (TIA) admitted to our stroke unit from 1991 to 1992. Twenty-two of the 57 patients had elevated D-dimer levels in the plasma. High levels were associated with cardioembolic stroke. On follow-up after a mean of 12 years, 15 patients had died and six patients had suffered another stroke or TIA (three of whom were dead). Ten patients had suffered other cardiovascular events and seven of them were dead. We concluded that high levels of D-dimer in acute ischemic stroke patients on admission were associated with cardioembolic stroke and might have prognostic value for the development of further cardio- or cerebrovascular events. Advanced age was found to be an independent risk factor.
The Ischemic Stroke Genetics Study (ISGS) Protocol
James F Meschia, Thomas G Brott, Robert D Brown, Richard JP Crook, Michael Frankel, John Hardy, José G Merino, Stephen S Rich, Scott Silliman, Bradford Burke Worrall
BMC Neurology , 2003, DOI: 10.1186/1471-2377-3-4
Abstract: The Ischemic Stroke Genetic Study is a prospective, multicenter genetic association study in adults with recent first-ever ischemic stroke confirmed with computed tomography or magnetic resonance imaging. Patients are evaluated at academic medical centers in the United States and compared with sex- and age-matched controls. Stroke subtypes are determined by central blinded adjudication using standardized, validated mechanistic and syndromic classification systems. The panel of genes to be tested for polymorphisms includes β-fibrinogen and platelet glycoprotein Ia, Iba, and IIb/IIIa. Immortalized cell lines are created to allow for time- and cost-efficient testing of additional candidate genes in the future.The study is designed to minimize survival bias and to allow for exploring associations between specific polymorphisms and individual subtypes of ischemic stroke. The data set will also permit the study of genetic determinants of stroke outcome. Having cell lines will permit testing of future candidate risk factor genes.Cross-sectional, longitudinal, and twin studies strongly support an inherited component to stroke risk, but except for rare mendelian and mitochondrial stroke syndromes, the molecular basis for inherited ischemic stroke risk remains ill defined. The ability to identify high-risk patients through genetic testing could make screening for treatable intermediate phenotypes more cost-effective. For example, identification of patients with a high genetic risk of cervical carotid atherosclerosis might enable the efficient use of endarterectomy for primary stroke prevention [1]. In addition, a clear and comprehensive understanding of genetic risk may promote advances in gene therapy and in the development of novel pharmaceutical agents.Herein we describe the protocol of an ongoing prospective, multicenter study, the Ischemic Stroke Genetics Study (ISGS). This study uses a candidate gene approach in which rates of variant polymorphisms of the candidate gene
Selected acute phase CSF factors in ischemic stroke: findings and prognostic value
Maia Beridze, Tamar Sanikidze, Roman Shakarishvili1, Nino Intskirveli, Natan M Bornstein
BMC Neurology , 2011, DOI: 10.1186/1471-2377-11-41
Abstract: Ninety five acute ischemic stroke patients were investigated. Ischemic region visualized at the twenty fourth hour by conventional Magnetic Resonance Imaging. Stroke severity evaluated by National Institute Health Stroke Scale. One month outcome of disease was assessed by Barthel Index. Cerebrospinal fluid was taken at the sixth hour of stroke onset. CSF pro- and anti-inflammatory cytokines were studied by Enzyme Linked Immunosorbent Assay. Nitric Oxide and Lipoperoxide radical were measured by Electron Paramagnetic Resonance. CSF Nitrate levels were detected using the Griess reagent. Statistics performed by SPSS-11.0.At the sixth hour of stroke onset, cerebrospinal fluid cytokine levels were elevated in patients against controls. Severe stroke patients had increased interleukin-6 content compared to less severe strokes (P < 0.05). Cerebrospinal fluid Electron Paramagnetic Resonance signal of nitric oxide was increased in patients against controls. Severe stroke group had an elevated Electron Paramagnetic Resonance signal of lipoperoxiradical compared to less severe stroke. Cerebrospinal fluid nitrate levels in less severe stroke patients were higher than those for severe stroke and control. Positive correlation was established between the initial interleukin-6 content and ischemic lesion size as well as with National Institute Health Stroke Scale score on the seventh day. Initial interleukin-6 and nitrate levels in cerebrospinal fluid found to be significant for functional outcome of stroke at one month.According to present study the cerebrospinal fluid contents of interleukin-6 and nitrates seem to be the most reliable prognostic factors in acute phase of ischemic stroke.Modern concepts of acute cerebral ischemia highlight the role of neurovascular units and emphasize the importance of integrative tissue responses that result from dynamic interactions of endothelial cells, vascular sooth muscles, matrix elements, astroglia, microglia and neurons. By means of infla
Microemboli-monitoring during the acute phase of ischemic stroke: Is it worth the time?
Titto T Idicula, Halvor Naess, Lars Thomassen
BMC Neurology , 2010, DOI: 10.1186/1471-2377-10-79
Abstract: We included unselected ischemic stroke patients who underwent microemboli-monitoring within six hours after stroke onset. Microemboli-monitoring of both middle cerebral arteries (MCA) was done for a period of 1 hour using 2-MHz probes applied over the trans-temporal window. Prevalence of MES, predictors for the presence of MES and the association between MES and various outcome factors were analyzed.Forty patients were included. The mean age of the patients was 70 years. The prevalence of either ipsilateral or contralateral MES were 25% (n = 10). The predictors for the presence of MES were older age (OR 9; p = 0.03), higher NIHSS (OR 28; p = 0.02), intracranial stenosis (OR 10; p = 0.04) and embolic stroke (large-artery atherosclerosis and cardioembolism on TOAST classification) (OR 7; p = 0.06). MES were not independently associated with short-term functional outcome, long-term mortality or future vascular events.MES are moderately frequent following acute ischemic stroke. Microemboli-monitoring helps to better classify the stroke etiology. However, the presence MES did not have any prognostic significance in this study.Previous studies have shown that microemboli to brain occurs following an ischemic stroke [1-12]. These clinically silent microemboli can be detected as microembolic signals (MES) using transcranial Doppler (TCD). There is a wide variation in the prevalence of MES after stroke. A pooled analysis of ischemic stroke patients with a known source of embolism have shown that the prevalence of MES in symptomatic ICA stenosis, asymptomatic ICA stenosis and aortic atheroma as 42%, 8% and 32% respectively [13]. However, the prevalence of MES also depends on timing of monitoring, showing higher prevalence when microemboli-monitoring is done closer to stroke onset [2,3,10]. But studies to assess the true prevalence of MES immediately following ischemic events are lacking. Also, the implications of MES in the first six hours after stroke onset is not studied be
Intravenous Thrombolysis in Acute Ischemic Stroke: Experiences in Dokuz Eylül University Hospital, Medical Faculty, Department of Neurology  [PDF]
Journal of Neurological Sciences , 2008,
Abstract: Acute stroke is the second leading cause of death after heart diseases in the world. Acute ischemic stroke (AIS) accounts for 80% of all strokes. The idea that AIS is an incurable disease has been abolished during the recent years because of thrombolytic treatment. To date, the only proven therapy in acute ischemic stroke to prevent infarction and minimize the degree of permanent brain injury is thrombolytic treatment. But it has some limitations; it has narrow theuropatic index and high risk of serious complications and also well-established stroke centers are needed for this therapy. We present 21 patients with acute ischemic stroke (13 male, 8 female) who were treated with intravenous recombinant tissue plasminogen activator (IV rt-PA) in our department between 19.09.2006 – 30.01.2008. The neurological statuses of the patients were assessed by “The National Institutes of Health Stroke Scale” (NIHSS) before thrombolysis application, at 24 hour, at 1 week and at 3 months. At the first day of the therapy, 75% of patients had excellent global outcomes (minimal or no deficit). The neurological examinations of IV rt-PA patients at 1 month and at 3 months were also excellent. Symptomatic intracranial bleeding was occured in one patient as a result of IV rt-PA threapy. Four patients were died, one patient died because of brain edema without hemorrhage, one patient died because of brain hemorrhage, the others died because of systemic reasons. Despite low number of patients, our experience contributed important information that IV rt-PA treatment is effective and reliable in well-selected patients.
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