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  • 1
    Online Resource
    Online Resource
    Successful management of super‐refractory status epilepticus with thalamic deep brain stimulation
    Wiley ; 2017
    In:  Annals of Neurology Vol. 81, No. 1 ( 2017-01), p. 142-146
    Details
    In: Annals of Neurology, Wiley, Vol. 81, No. 1 ( 2017-01), p. 142-146
    Abstract: Super‐refractory status epilepticus is a condition characterized by recurrence of status epilepticus despite use of deep general anesthesia, and it has high morbidity and mortality rates. We report a case of a 17‐year‐old boy with a prolonged super‐refractory status epilepticus that eventually resolved after commencing deep brain stimulation of the centromedian nucleus of the thalamus. Later attempt to reduce stimulation parameters resulted in immediate relapse of status epilepticus, suggesting a pivotal role of deep brain stimulation in the treatment response. Deep brain stimulation may be a treatment option in super‐refractory status epilepticus when other treatment options have failed. ANN NEUROL 2017;81:142–146
    Type of Medium: Online Resource
    ISSN: 0364-5134 , 1531-8249
    URL: Issue
    URL: Article
    DOI: 10.1002/ana.v81.1
    DOI: 10.1002/ana.24821
    Language: English
    Publisher: Wiley
    Publication Date: 2017
    detail.hit.zdb_id: 2037912-2
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  • 2
    Online Resource
    Online Resource
    Stroke Etiology and Outcomes after Endovascular Thrombectomy: Results from the SITS Registry and a Meta-Analysis
    Korean Stroke Society ; 2021
    In:  Journal of Stroke Vol. 23, No. 3 ( 2021-09-30), p. 388-400
    Details
    In: Journal of Stroke, Korean Stroke Society, Vol. 23, No. 3 ( 2021-09-30), p. 388-400
    Abstract: Background and Purpose The influence of stroke etiology on outcomes after endovascular thrombectomy (EVT) is not well understood. We aimed to investigate whether stroke etiology subgrouped as large artery atherosclerosis (LAA) and cardiac embolism (CE) influences outcomes in large artery occlusion (LAO) treated by EVT.Methods We included EVT treated LAO stroke patients registered in the Safe Implementation of Treatment in Stroke (SITS) thrombectomy register between January 1, 2014 and September 3, 2019. Primary outcome was successful reperfusion (modified Treatment in Cerebral Infarction 2b-3). Secondary outcomes were symptomatic intracranial hemorrhage (SICH), 3-month functional independence (modified Ranking Scale 0–2) and death. Multivariable logistic regression models were used for comparisons. In addition, a meta-analysis of aggregate data from the current literature was conducted (PROSPERO, ID 167447).Results Of 7,543 patients, 1,903 (25.2%) had LAA, 3,214 (42.6%) CE, and 2,426 (32.2%) unknown, other, or multiple etiologies. LAA patients were younger (66 vs. 74, P 〈 0.001) and had lower National Institutes of Health Stroke Scale score at baseline (15 vs. 16, P 〈 0.001) than CE patients. Multivariable analyses showed that LAA patients had lower odds of successful reperfusion (odds ratio [OR], 0.70; 95% confidence interval [CI] , 0.57 to 0.86) and functional independence (OR, 0.74; 95% CI, 0.63 to 0.85), higher risk of death (OR, 1.44; 95% CI, 1.21 to 1.71), but no difference in SICH (OR, 1.09; 95% CI, 0.71 to 1.66) compared to CE patients. The systematic review found 25 studies matching the criteria. The meta-analysis did not find any difference between etiologies. Conclusions From the SITS thrombectomy register, we observed a lower chance of reperfusion and worse outcomes after thrombectomy in patients with LAA compared to CE etiology, despite more favorable baseline characteristics. In contrast, the meta-analysis did not find any difference between etiologies with aggregate data.
    Type of Medium: Online Resource
    ISSN: 2287-6391 , 2287-6405
    URL: Article
    DOI: 10.5853/jos.2021.00850
    Language: English
    Publisher: Korean Stroke Society
    Publication Date: 2021
    detail.hit.zdb_id: 2814366-8
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  • 3
    Online Resource
    Online Resource
    Origins and Recovery from Superinfections and Soft Tissue Necrosis
    Scientific Research Publishing, Inc. ; 2022
    In:  Open Journal of Stomatology Vol. 12, No. 08 ( 2022), p. 209-228
    Details
    In: Open Journal of Stomatology, Scientific Research Publishing, Inc., Vol. 12, No. 08 ( 2022), p. 209-228
    Type of Medium: Online Resource
    ISSN: 2160-8709 , 2160-8717
    URL: Article
    DOI: 10.4236/ojst.2022.128020
    Language: Unknown
    Publisher: Scientific Research Publishing, Inc.
    Publication Date: 2022
    detail.hit.zdb_id: 2619430-2
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  • 4
    Online Resource
    Online Resource
    In-Hospital Intravenous Thrombolysis Offers No Benefit in Mechanical Thrombectomy in Optimized Tertiary Stroke Center Setting
    Springer Science and Business Media LLC ; 2021
    In:  CardioVascular and Interventional Radiology Vol. 44, No. 4 ( 2021-04), p. 580-586
    Details
    In: CardioVascular and Interventional Radiology, Springer Science and Business Media LLC, Vol. 44, No. 4 ( 2021-04), p. 580-586
    Abstract: Mechanical thrombectomy (MT) is the first-line treatment in acute stroke patients presenting with large vessel occlusion (LVO). The efficacy of intravenous thrombolysis (IVT) prior to MT is being contested. The objective of this study was to evaluate the efficacy of MT without IVT in patients with no contraindications to IVT presenting directly to a tertiary stroke center with acute anterior circulation LVO. Materials and Methods We collected the data of 106 acute stroke patients who underwent MT in a single high-volume stroke center. Patients with anterior circulation LVO eligible for IVT and directly admitted to our institution who subsequently underwent MT were included. We recorded baseline clinical, laboratory, procedural, and imaging variables and technical, imaging, and clinical outcomes. The effect of intravenous thrombolysis on 3-month clinical outcome (mRS) was analyzed with univariate tests and binary and ordinal logistic regression analysis. Results Fifty-eight out of the 106 patients received IVT + MT. These patients had 2.6-fold higher odds of poorer clinical outcome in mRS shift analysis ( p  = 0.01) compared to MT-only patients who had excellent 3-month clinical outcome (mRS 0–1) three times more often ( p  = 0.009). There were no significant differences between the groups in process times, mTICI, or number of hemorrhagic complications. A trend of less distal embolization and higher number of device passes was observed among the MT-only patients. Conclusions MT without prior IVT was associated with an improved overall three-month clinical outcome in acute anterior circulation LVO patients.
    Type of Medium: Online Resource
    ISSN: 0174-1551 , 1432-086X
    URL: Article
    DOI: 10.1007/s00270-020-02727-8
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 1458490-6
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  • 5
    Online Resource
    Online Resource
    Support for hospital patients and associated factors : Support for hospital patients
    Wiley ; 2010
    In:  Scandinavian Journal of Caring Sciences Vol. 24, No. 4 ( 2010-12), p. 734-745
    Details
    In: Scandinavian Journal of Caring Sciences, Wiley, Vol. 24, No. 4 ( 2010-12), p. 734-745
    Type of Medium: Online Resource
    ISSN: 0283-9318
    URL: Issue
    URL: Article
    DOI: 10.1111/scs.2010.24.issue-4
    DOI: 10.1111/j.1471-6712.2010.00771.x
    Language: English
    Publisher: Wiley
    Publication Date: 2010
    detail.hit.zdb_id: 2031090-0
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  • 6
    Online Resource
    Online Resource
    Oral Dipyridamole-Associated Circulatory Collapse
    Elsevier BV ; 2018
    In:  Journal of Stroke and Cerebrovascular Diseases Vol. 27, No. 12 ( 2018-12), p. 3460-3462
    Details
    In: Journal of Stroke and Cerebrovascular Diseases, Elsevier BV, Vol. 27, No. 12 ( 2018-12), p. 3460-3462
    Type of Medium: Online Resource
    ISSN: 1052-3057
    URL: Article
    DOI: 10.1016/j.jstrokecerebrovasdis.2018.08.009
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2018
    detail.hit.zdb_id: 2052957-0
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  • 7
    Online Resource
    Online Resource
    Within-Day and Weekly Variations of Thrombolysis in Acute Ischemic Stroke : Results From Safe Implementation of Treatments in Stroke-International Stroke Thrombolysis Register
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Stroke Vol. 45, No. 1 ( 2014-01), p. 176-184
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 45, No. 1 ( 2014-01), p. 176-184
    Abstract: Temporal variations of thrombolysis delivery and their influence on outcome have been reported with controversial results. In this large cohort study, we evaluated whether thrombolytic treatment has a within-day and weekly variability corresponding to circadian and weekly patterns of ischemic stroke onset, and whether these have impact on clinical outcome. Methods— We retrospectively analyzed patients with acute ischemic stroke receiving intravenous alteplase, prospectively included in the Safe Implementation of Treatments in Stroke-International Stroke Thrombolysis Register. Patients were grouped by treatment on day hours (08:00–19:59) or night hours (20:00–07:59) and treatment on weekdays and weekends. For each subgroup, we analyzed frequency of thrombolytic treatments, time intervals, and outcomes (3-month modified Rankin Scale score 0–2 as good functional outcome, mortality, symptomatic intracerebral hemorrhage). Results— We included 21 513 patients. Considering the mean expected number of patients treated per hour (0.4) and per day of the week (9.8), if no temporal variations were present, patients were significantly treated more during day hours and weekdays ( P 〈 0.0001). Median door-to-needle and onset-to-treatment times were longer for patients treated during night hours and on weekends ( P 〈 0.01). After adjustment for confounding variables, treatment during day hours was an independent predictor of good functional outcome (odds ratio, 1.12; 95% confidence interval, 1.04–1.21; P =0.004), and patients treated during weekdays were at risk of higher mortality (odds ratio, 1.15; 95% confidence interval, 1.04–1.28; P =0.008). Conclusions— Frequency of thrombolytic treatment seems to follow the same circadian pattern of stroke incidence, whereas its correspondence to a weekly pattern is less clear. Time of treatment is an independent predictor of outcome.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.113.002133
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
    detail.hit.zdb_id: 1467823-8
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  • 8
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    Validation of the DRAGON Score in 12 Stroke Centers in Anterior and Posterior Circulation
    Ovid Technologies (Wolters Kluwer Health) ; 2013
    In:  Stroke Vol. 44, No. 10 ( 2013-10), p. 2718-2721
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 44, No. 10 ( 2013-10), p. 2718-2721
    Abstract: The DRAGON score predicts functional outcome in the hyperacute phase of intravenous thrombolysis treatment of ischemic stroke patients. We aimed to validate the score in a large multicenter cohort in anterior and posterior circulation. Methods— Prospectively collected data of consecutive ischemic stroke patients who received intravenous thrombolysis in 12 stroke centers were merged (n=5471). We excluded patients lacking data necessary to calculate the score and patients with missing 3-month modified Rankin scale scores. The final cohort comprised 4519 eligible patients. We assessed the performance of the DRAGON score with area under the receiver operating characteristic curve in the whole cohort for both good (modified Rankin scale score, 0–2) and miserable (modified Rankin scale score, 5–6) outcomes. Results— Area under the receiver operating characteristic curve was 0.84 (0.82–0.85) for miserable outcome and 0.82 (0.80–0.83) for good outcome. Proportions of patients with good outcome were 96%, 93%, 78%, and 0% for 0 to 1, 2, 3, and 8 to 10 score points, respectively. Proportions of patients with miserable outcome were 0%, 2%, 4%, 89%, and 97% for 0 to 1, 2, 3, 8, and 9 to 10 points, respectively. When tested separately for anterior and posterior circulation, there was no difference in performance ( P =0.55); areas under the receiver operating characteristic curve were 0.84 (0.83–0.86) and 0.82 (0.78–0.87), respectively. No sex-related difference in performance was observed ( P =0.25). Conclusions— The DRAGON score showed very good performance in the large merged cohort in both anterior and posterior circulation strokes. The DRAGON score provides rapid estimation of patient prognosis and supports clinical decision-making in the hyperacute phase of stroke care (eg, when invasive add-on strategies are considered).
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.113.002033
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
    detail.hit.zdb_id: 1467823-8
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  • 9
    Online Resource
    Online Resource
    Safety and Outcomes of Thrombectomy in Ischemic Stroke With vs Without IV Thrombolysis
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Neurology Vol. 97, No. 8 ( 2021-08-24), p. e765-e776
    Details
    In: Neurology, Ovid Technologies (Wolters Kluwer Health), Vol. 97, No. 8 ( 2021-08-24), p. e765-e776
    Abstract: To test the hypothesis that IV thrombolysis (IVT) treatment before endovascular thrombectomy (EVT) is associated with better outcomes in patients with anterior circulation large artery occlusion (LAO) stroke, we examined a large real-world database, the Safe Implementation of Treatment in Stroke–International Stroke Thrombectomy Register (SITS-ISTR). Methods We identified centers recording ≥10 consecutive patients in the SITS-ISTR, with at least 70% available modified Rankin Scale (mRS) scores at 3 months during 2014 to 2019. We defined LAO as intracranial internal carotid artery, first and second segment of middle cerebral artery, and first segment of anterior cerebral artery. Main outcomes were functional independence (mRS score 0–2) and death at 3 months and symptomatic intracranial hemorrhage (SICH) per modified SITS–Monitoring Study. We performed propensity score–matched (PSM) and multivariable logistic regression analyses. Results Of 6,350 patients from 42 centers, 3,944 (62.1%) received IVT. IVT + EVT–treated patients had less frequent atrial fibrillation, ongoing anticoagulation, previous stroke, heart failure, and prestroke disability. PSM analysis showed that IVT + EVT–treated patients had a higher rate of functional independence than patients treated with EVT alone (46.4% vs 40.3%, p 〈 0.001) and a lower rate of death at 3 months (20.3% vs 23.3%, p = 0.035). SICH rates (3.5% vs 3.0%, p = 0.42) were similar in both groups. Multivariate adjustment yielded results consistent with PSM. Conclusion Pretreatment with IVT was associated with favorable outcomes in EVT-treated LAO stroke in the SITS-ISTR. These findings, while indicative of international routine clinical practice, are limited by observational design, unmeasured confounding, and possible residual confounding by indication. Classification of Evidence This study provides Class II evidence that IVT before EVT increases the probability of functional independence at 3 months compared to EVT alone.
    Type of Medium: Online Resource
    ISSN: 0028-3878 , 1526-632X
    URL: Article
    DOI: 10.1212/WNL.0000000000012327
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
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  • 10
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    Online Resource
    Self-reported health problems and obesity predict sickness absence during a 12-month follow-up: a prospective cohort study in 21 608 employees from different industries
    BMJ ; 2019
    In:  BMJ Open Vol. 9, No. 10 ( 2019-10), p. e025967-
    Details
    In: BMJ Open, BMJ, Vol. 9, No. 10 ( 2019-10), p. e025967-
    Abstract: To study whether self-reported health problems predict sickness absence (SA) from work in employees from different industries. Methods The results of a health risk appraisal (HRA) were combined with archival data of SA of 21 608 employees (59% female, 56% clerical). Exposure variables were self-reported health problems, labelled as ‘work disability (WD) risk factors’ in the HRA, presence of problems with occupational well-being and obesity. Age, socioeconomic grading and the number of SA days 12 months before the survey were treated as confounders. The outcome measure was accumulated SA days during 12-month follow-up. Data were analysed separately for males and females. A Hurdle model with negative binomial response was used to analyse zero-inflated count data of SA. Results The HRA results predicted the number of accumulated SA days during the 12-month follow-up, regardless of occupational group and gender. The ratio of means of SA days varied between 2.7 and 4.0 among those with ‘WD risk factors’ and the reference category with no findings, depending on gender and occupational group. The lower limit of the 95% CI was at the lowest 2.0. In the Hurdle model, ‘WD risk factors’, SA days prior to the HRA and obesity were additive predictors for SA and/or the accumulated SA days in all occupational groups. Conclusion Self-reported health problems and obesity predict a higher total count of SA days in an additive fashion. These findings have implications for both management and the healthcare system in the prevention of WD.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    DOI: 10.1136/bmjopen-2018-025967
    Language: English
    Publisher: BMJ
    Publication Date: 2019
    detail.hit.zdb_id: 2599832-8
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