Thrombolysis for acute ischemic stroke: do patients treated out of hours have a worse outcome?

Introduction: Previous studies on the impact of nonworking hours (NWH) have produced conflicting results. We aimed to compare the time to treatment with thrombolysis between NWH and working hours (WH) at an Australian comprehensive stroke center.

Materials And Methods: All acute ischemic stroke patients treated with intravenous alteplase (IV-alteplase) from January 2003 to December 2011 at the Royal Melbourne Hospital were included.

Stroke rehabilitation in China: a systematic review and meta-analysis.

Background: Stroke rehabilitation is regarded as an essential component of organized care, therefore withholding treatment is considered unethical in Western trials. Poststroke rehabilitation is not standard in China, and trials with no treatment controls have been possible. We believed aggregation of these data represented a unique opportunity to examine the 'effect size' of this intervention.

Changes in physical activity and related functional and disability levels in the first six months after stroke: a longitudinal follow-up study.

Objective: To investigate how physical activity changes over the first 6 months after stroke, and how activity is related to function.

Design: A longitudinal study with an initial assessment within 14 days after stroke (in hospital) and follow-up assessments 1, 3 and 6 months later (in-patient rehabilitation or at home).

Subjects: Patients with acute stroke.

Worse stroke outcome in atrial fibrillation is explained by more severe hypoperfusion, infarct growth, and hemorrhagic transformation.

Background: Atrial fibrillation is associated with greater baseline neurological impairment and worse outcomes following ischemic stroke. Previous studies suggest that greater volumes of more severe baseline hypoperfusion in patients with history of atrial fibrillation may explain this association. We further investigated this association by comparing patients with and without atrial fibrillation on initial examination following stroke using pooled multimodal magnetic resonance imaging and clinical data from the Echoplanar Imaging Thrombolytic Evaluation Trial and the Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution studies.

Advanced imaging improves prediction of hemorrhage after stroke thrombolysis.

Objective: Very low cerebral blood volume (VLCBV), diffusion, and hypoperfusion lesion volumes have been proposed as predictors of hemorrhagic transformation following stroke thrombolysis. We aimed to compare these parameters, validate VLCBV in an independent cohort using DEFUSE study data, and investigate the interaction of VLCBV with regional reperfusion.

Methods: The EPITHET and DEFUSE studies obtained diffusion and perfusion magnetic resonance imaging (MRI) in patients 3 to 6 hours from onset of ischemic stroke.

Montreal Cognitive Assessment and Mini-Mental State Examination are both valid cognitive tools in stroke.

Objective: To determine the validity of the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE) as screening tools for cognitive impairment after stroke.

Materials And Methods: Cognitive assessments were administered over 2 sessions (1 week apart) at 3 months post-stroke. Scores on the MoCA and MMSE were evaluated against a diagnosis of cognitive impairment derived from a comprehensive neuropsychological battery (the criterion standard).

Clopidogrel hyper-response and bleeding risk in neurointerventional procedures.

Background And Purpose: Antiplatelet therapy is associated with decreased ischemic events after neurointerventional procedures. Antiplatelet resistance negates the protective effects of antiplatelet medication, leading to a higher incidence of ischemic events. A possible link between antiplatelet hyper-response and increased hemorrhagic complications has been inadequately investigated.

The effects of alteplase 3 to 6 hours after stroke in the EPITHET-DEFUSE combined dataset: post hoc case-control study.

Background And Purpose: Two phase 2 studies of alteplase in acute ischemic stroke 3 to 6 hours after onset, Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET; a randomized, controlled, double-blinded trial), and Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution Study (DEFUSE; open-label, treatment only) using MR imaging-based outcomes have been conducted. We have pooled individual patient data from these to assess the response to alteplase. The primary hypothesis was that alteplase would significantly attenuate infarct growth compared with placebo in mismatch-selected patients using coregistration techniques.

Gender and being born overseas influences the amount of acute stroke therapy.

Objective: To identify patient factors that influence the amount, frequency and intensity of physical and occupational therapy received by patients each weekday within 14 days of stroke.

Design: Exploration of data from studies conducted to monitor activity and therapy.

Participants: Stroke patients receiving active treatment (not for palliative care).

Association of aspirin resistance with increased stroke severity and infarct size.

Objective: To investigate the relationship between aspirin resistance and clinical and neuroimaging measures of stroke severity in acute stroke patients.

Design: Prospective single-center survey of acute ischemic stroke patients receiving aspirin therapy.

Setting: The Royal Melbourne Hospital, Parkville, Victoria, Australia.

Selection for inpatient rehabilitation after severe stroke: what factors influence rehabilitation assessor decision-making?

Objectives: This study aimed to identify factors that assessors considered important in decision-making regarding suitability for inpatient rehabilitation after acute severe stroke.

Design: Multi-site prospective observational cohort study.

Subjects: Consecutive acute, severe stroke patients and their assessors for inpatient rehabilitation.

Immunophysiology versus immunopathology: Natural autoimmunity in human health and disease.

Based on the analysis of literature and our own data, some key concepts of natural autoimmunity are reviewed from the point of the Pathophysiology: immunological regulation of homeodynamics, physiological autoimmunity versus autoallergy and predictive roles of natural autoantibodies are discussed. Hypothesis of Immunculus and principle of Immunacea are correlated to some of clinical examples with immunopathological data and the perspectives of autoimmunomics are described.

Multiattribute selection of acute stroke imaging software platform for Extending the Time for Thrombolysis in Emergency Neurological Deficits (EXTEND) clinical trial.

Background: The appropriateness of a software platform for rapid MRI assessment of the amount of salvageable brain tissue after stroke is critical for both the validity of the Extending the Time for Thrombolysis in Emergency Neurological Deficits (EXTEND) Clinical Trial of stroke thrombolysis beyond 4.5 hours and for stroke patient care outcomes.

Aims: The objective of this research is to develop and implement a methodology for selecting the acute stroke imaging software platform most appropriate for the setting of a multi-centre clinical trial.

The benefit of hypothermia in experimental ischemic stroke is not affected by pethidine.

Background: Hypothermia is a promising experimental treatment for acute ischemic stroke. Human trials are still at an early stage, with the focus now on using hypothermia in awake patients. Pethidine (meperidine) is the principle agent used to control shivering in humans; however, whether it has any modulating effects on the neuroprotective efficacy of hypothermia is unknown.

Accessing inpatient rehabilitation after acute severe stroke: age, mobility, prestroke function and hospital unit are associated with discharge to inpatient rehabilitation.

The objective of this study was to identify the variables associated with discharge to inpatient rehabilitation following acute severe stroke and to determine whether hospital unit contributed to access. Five acute hospitals in Victoria, Australia participated in this study. Patients were eligible for inclusion if they had suffered an acute severe stroke (Mobility Scale for Acute Stroke ≤ 15).

Enhancing physical activity in older adults receiving hospital based rehabilitation: a phase II feasibility study.

Background: Older adults receiving inpatient rehabilitation have low activity levels and poor mobility outcomes. Increased physical activity may improve mobility. The objective of this Phase II study was to evaluate the feasibility of a randomized controlled trial (RCT) of enhanced physical activity in older adults receiving rehabilitation.

Moving beyond a single perfusion threshold to define penumbra: a novel probabilistic mismatch definition.

Background And Purpose: The mismatch lesion volumes defined by perfusion-weighted imaging exceeding diffusion-weighted imaging have been used as a marker of ischemic penumbral tissue. Defining the perfusion lesion by thresholding has shown promise as a practical tool; several positron emission tomography studies have indicated a more probabilistic relationship between perfusion and infarction. Here, we used a randomized controlled trial dataset of tissue-type plasminogen activator 3 to 6 hours after stroke to: (1) quantify the relationship between severity of hypoperfusion (measured by Tmax) and risk of infarction; (2) exploit this relationship to present a novel definition of mismatch based on infarct probabilities rather than dichotomies; and (3) examine the treatment response in the subgroup of patients with mismatch by the new definition.

Subacute ischemic stroke is associated with focal 11C PiB positron emission tomography retention but not with global neocortical Aβ deposition.

Background And Purpose: Conflicting evidence exists as to whether focal cerebral ischemia contributes to cerebral amyloid deposition. We aimed to look at Aβ deposits, detected by N-methyl-2-(4'-methylaminophenyl)-6-hydroxybenzothiazole (PiB) positron emission tomography, in patients with recent ischemic stroke. Specifically, we hypothesized that patients with recent ischemic stroke have higher local and neocortical PiB positron emission tomography retention and that this may be associated with major vascular risk factors.

[The clinical pathophysiology of the early metabolic syndrome: pathogenetic roles of juvenile dyspituitarism, connective tissue dysplasiae and autoimmune thyroiditis].

A review of world literature, including authors' original papers, establishes the clinical pathophysiological hypothesis, initially coined in by authors in 2002, about regular transition of adolescent hypothalamic syndrome (obesity with rose striae) with age into early metabolic syndrome, complicated by autoimmune thyroiditis. Some evidences are obtained, that witness for marfanoid phenotype and chronic disequilibrium between local, autacoid-mediated and systemic, hormone-mediated regulation, typical for inherited connective tissue disorders, may promote this transition (6 fig., 3 tables, bibl.

A multicentre, randomized, double-blinded, placebo-controlled Phase III study to investigate EXtending the time for Thrombolysis in Emergency Neurological Deficits (EXTEND).

Background And Hypothesis: Thrombolytic therapy with tissue plasminogen activator is effective for acute ischaemic stroke within 4·5 h of onset. Patients who wake up with stroke are generally ineligible for stroke thrombolysis. We hypothesized that ischaemic stroke patients with significant penumbral mismatch on either magnetic resonance imaging or computer tomography at three- (or 4·5 depending on local guidelines) to nine-hours from stroke onset, or patients with wake-up stroke within nine-hours from midpoint of sleep duration, would have improved clinical outcomes when given tissue plasminogen activator compared to placebo.

Bed rest or mobilization after rt-PA? A case-crossover study of factors influencing clinical decision making in stroke services.

Background: Acute stroke management is a dynamic field. Treatment with recombinant tissue plasminogen activator is standard care in Australia, but there are no evidence-based practice guidelines about first out of bed activity (mobilization) after recombinant tissue plasminogen activator.

Aims: To identify factors influencing clinicians' decisions to delay or allow mobilization.

Greater effect of stroke thrombolysis in the presence of arterial obstruction.

Objective: Recanalization of arterial obstruction is associated with improved clinical outcomes. There are no controlled data demonstrating whether arterial obstruction status predicts the treatment effect of intravenous (IV) tissue plasminogen activator (tPA). We aimed to determine if the presence of arterial obstruction improves the treatment effect of IV tPA over placebo in attenuating infarct growth.

Frequent early cardiac complications contribute to worse stroke outcome in atrial fibrillation.

Background: Atrial fibrillation (AF) is associated with worse outcomes following ischemic stroke and more frequent cardiac complications in the general population. We aimed to establish whether early cardiac complications contribute to the poorer ischemic stroke outcomes in patients with AF, independent of baseline differences in age, stroke severity and cardiovascular risk factors. This might have important implications for acute stroke management in patients with AF.

The effect of physical activity on cognitive function after stroke: a systematic review.

Background: Research in both humans and animals indicates that physical activity can enhance cognitive activity, but whether this is true in patients with stroke is largely unknown.We aimed to evaluate the relationship between increased physical activity after stroke and cognitive performance.

Methods: A systematic review was conducted of MEDLINE, EMBASE, PsycINFO and other electronic databases.