scholarly journals Revealing an extended critical window of recovery post-stroke

2018 ◽  
Author(s):  
Belen Rubio Ballester ◽  
Armin Duff ◽  
Martina Maier ◽  
Monica Cameirao ◽  
Sergi Bermudez ◽  
...  
Keyword(s):  
Spontaneous Recovery ◽  
Meta Analysis ◽  
Analysis Method ◽  
Homogeneous Sample ◽  
Bootstrap Analysis ◽  
Critical Window ◽  
Functional Deficits ◽  
Post Stroke ◽  
One Year ◽  
The Impact

ABSTRACTThe impact of rehabilitation on post-stroke motor recovery and its dependency on the patient’s chronicity remain unclear. The existence and regularity of a, so called, proportional recovery rule across a range of functional deficits and therapies supports the notion that functional interventions have little or no impact beyond spontaneous recovery rates in a ‘critical window of recovery’ which lasts from 3 to 6 months post-stroke. In this meta-analysis, we apply a bootstrap analysis method to assess the overall impact of a specific VR-based rehabilitation protocol for the upper extremities on a homogeneous sample of 219 individuals with hemiparesis at various stages post stroke. Our analysis uncovers a precise gradient of sensitivity to treatment that expands more than one year beyond the limits of the so-called ‘critical window of recovery’. These findings redefine the limits of the so-called ‘critical window of recovery’ and suggest that stroke-derived plasticity mechanisms do facilitate functional recovery even at the chronic and late chronic stage.

scholarly journals A critical time window for recovery extends beyond one-year post-stroke

2019 ◽  
Vol 122 (1) ◽  
pp. 350-357 ◽  
Author(s):  
Belén Rubio Ballester ◽  
Martina Maier ◽  
Armin Duff ◽  
Mónica Cameirão ◽  
Sergi Bermúdez ◽  
...  
Keyword(s):  
Time Window ◽  
Temporal Structure ◽  
Critical Time ◽  
Motor Recovery ◽  
Homogeneous Sample ◽  
Critical Window ◽  
Post Stroke ◽  
Enhanced Sensitivity ◽  
One Year ◽  
The Impact

The impact of rehabilitation on post-stroke motor recovery and its dependency on the patient’s chronicity remain unclear. The field has widely accepted the notion of a proportional recovery rule with a “critical window for recovery” within the first 3–6 mo poststroke. This hypothesis justifies the general cessation of physical therapy at chronic stages. However, the limits of this critical window have, so far, been poorly defined. In this analysis, we address this question, and we further explore the temporal structure of motor recovery using individual patient data from a homogeneous sample of 219 individuals with mild to moderate upper-limb hemiparesis. We observed that improvement in body function and structure was possible even at late chronic stages. A bootstrapping analysis revealed a gradient of enhanced sensitivity to treatment that extended beyond 12 mo poststroke. Clinical guidelines for rehabilitation should be revised in the context of this temporal structure. NEW & NOTEWORTHY Previous studies in humans suggest that there is a 3- to 6-mo “critical window” of heightened neuroplasticity poststroke. We analyze the temporal structure of recovery in patients with hemiparesis and uncover a precise gradient of enhanced sensitivity to treatment that expands far beyond the limits of the so-called critical window. These findings highlight the need for providing therapy to patients at the chronic and late chronic stages.

scholarly journals Evaluation of Antiviral Therapy Performed after Curative Therapy in Patients with HBV-Related Hepatocellular Carcinoma: An Updated Meta-Analysis

2016 ◽  
Vol 2016 ◽  
pp. 1-11 ◽  
Author(s):  
Peng Yuan ◽  
Peng Chen ◽  
Yeben Qian
Keyword(s):  
Hepatocellular Carcinoma ◽  
Meta Analysis ◽  
Disease Free Survival ◽  
Curative Therapy ◽  
B Virus ◽  
Effect Of Treatment ◽  
Long Term Prognosis ◽  
One Year ◽  
The One ◽  
The Impact

Background.The long-term prognosis after curative therapy for hepatitis B virus- (HBV-) related hepatocellular carcinoma (HCC) remains unsatisfactory due to the high incidence of recurrence. The effect of treatment with nucleotide analogues (NAs) in patients with HBV-related HCC after curative therapy remains unclear.Objective.To assess the impact of using NAs after curative therapy.Method.A computerized literature search was performed; eligible studies were identified from databases. The pooled risk ratios (RRs) and 95% CIs were calculated using Review Manager 5.3.Result.The meta-analysis included a total of 15 studies with 8060 patients. The one-year and three-year recurrence (one-year recurrence: RR 0.41 [95% CI 0.28 to 0.61];P<0.00001; three-year recurrence: RR 0.63 [95% CI 0.43 to 0.94];P=0.001) and the one-, three-, and five-year overall survival (OS) and disease-free survival (DFS) were significantly better in the treatment group.Conclusion.NAs can reduce the recurrence and improve the prognosis of HBV-related HCC after curative therapy.

Abstract 223: Impact of Differences in Once- vs Twice-Daily Medications Adherence on the Risk of Bleed and Stroke in Non-Valvular Atrial Fibrillation: Analysis of Randomized Trials and Claims Data Sources

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Colleen A McHorney ◽  
Eric D Peterson ◽  
Mike Durkin ◽  
Veronica Ashton ◽  
François Laliberté ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Stroke Risk ◽  
Claims Data ◽  
Meta Analysis ◽  
Oral Anticoagulants ◽  
Once Daily ◽  
Cardiovascular Medications ◽  
One Year ◽  
The Impact ◽  
Similar Risk

Background: In non-valvular atrial fibrillation (NVAF) patients, those receiving once-daily (QD) versus twice-daily (BID) non vitamin-K antagonist oral anticoagulants (NOACs) may have better medication adherence. The impact on stroke and bleed risk is not known. Objective: To estimate the impact of adherence differences between QD vs BID therapies on bleed and stroke risks in NVAF patients. Methods: The relation between adherence (proportion of days covered [PDC]) for QD vs BID NOACs and one year bleed risk was modeled using claims data from Truven Health Analytics MarketScan databases (7/2012-10/2015). Next, the relation between adherence and bleeding was calibrated to match that seen in the placebo and NOAC arms of previous randomized controlled trials (RCTs). Finally, we used adherence rates for QD (PDC=0.849) and BID (PDC=0.738) cardiovascular medications from a meta-analysis (Coleman et al.). These rates were used in the calibrated model to estimate bleeds. An analogous method was applied to evaluate the impact of QD vs BID adherence on stroke risk. Results: The relation between PDC and risks of bleed and stroke was modeled using claims data (N=65,022) and calibrated using RCTs. In the calibrated model, compared with BID dosing, QD dosing was associated with 81 fewer strokes (34% reduction) and 14 more bleeds (6% more) per 10,000 patients/year (Figure). Conclusion: Among NVAF patients, better adherence to QD dosing was associated with a significantly lower stroke risk of QD but similar risk of bleed.

scholarly journals Systematic Review and Meta-Analysis on the Impact of Thrombolytic Therapy in Liver Transplantation Following Donation after Circulatory Death

2018 ◽  
Vol 7 (11) ◽  
pp. 425 ◽  
Author(s):  
Kumar Jayant ◽  
Isabella Reccia ◽  
Francesco Virdis ◽  
A. Shapiro
Keyword(s):  
Liver Transplantation ◽  
Blood Transfusion ◽  
Graft Survival ◽  
Meta Analysis ◽  
Donation After Cardiac Death ◽  
Clinical Trial Registry ◽  
Increased Risk ◽  
Increasing Demand ◽  
One Year ◽  
The Impact

Aim: The livers from DCD (donation after cardiac death) donations are often envisaged as a possible option to bridge the gap between the availability and increasing demand of organs for liver transplantation. However, DCD livers possess a heightened risk for complications and represent a formidable management challenge. The aim of this study was to evaluate the effects of thrombolytic flush in DCD liver transplantation. Methods: An extensive search of the literature database was made on MEDLINE, EMBASE, Cochrane, Crossref, Scopus databases, and clinical trial registry on 20 September 2018 to assess the role of thrombolytic tissue plasminogen activator (tPA) flush in DCD liver transplantation. Results: A total of four studies with 249 patients in the tPA group and 178 patients in the non-tPA group were included. The pooled data revealed a significant decrease in ischemic-type biliary lesions (ITBLs) (P = 0.04), re-transplantation rate (P = 0.0001), and no increased requirement of blood transfusion (P = 0.16) with a better one year graft survival (P = 0.02). Conclusions: To recapitulate, tPA in DCD liver transplantation decreased the incidence of ITBLs, re-transplantation and markedly improved 1-year graft survival, without any increased risk for blood transfusion, hence it has potential to expand the boundaries of DCD liver transplantation.

scholarly journals Acupuncture Treatments for Post-stroke Depression: A Systematic Review and Network Meta-analysis

2021 ◽  
Author(s):  
Lam Wai Ching ◽  
Hui Juan Li ◽  
Jianwen Guo ◽  
Liang Yao ◽  
Janita Chau ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Randomized Clinical Trials ◽  
Rating Scale ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Depression Symptoms ◽  
Post Stroke ◽  
Significant Difference ◽  
Post Stroke Depression ◽  
The Impact

Abstract Background: Depression is one of the most common complications after stroke, with a prevalence of 30-33%. Patients with post-stroke depression (PSD) usually experience anxiety, hopelessness, and insomnia, which have a negative impact on their daily activities and post-stroke rehabilitation. In this review, we aimed to explore the impact of acupuncture in alleviating symptoms of PSD and to evaluate the difference in effectiveness between acupuncture combined with pharmacotherapies and various non-pharmacotherapies in order to provide guides and advice for clinical personnel. Methods: Six databases (Cochrane Library, PubMed, EMBASE, China National Knowledge Infrastructure, Wanfang Database, Chongqing VIP Database) and two clinical trials registration platforms were searched from inception to May 2021. Randomized clinical trials (RCTs) comparing needle-based acupuncture with pharmacotherapy, and other non-pharmacotherapy or invalid group were included. Two independent reviewers identified eligible studies. Two reviewers independently abstracted and recorded data into a pre-made form. A Bayesian network meta-analysis (NMA) was conducted to assess and compare different techniques using RStudio 3.6.0. The primary outcome was the change in scores of scales measuring depressive symptoms. The secondary outcomes were changes in serotonin levels and in quality of life. Results: Fifty-nine RCTs were included. The results of this NMA showed that compared with western medicine (WM), acupuncture alone or with repetitive transcranial magnetic stimulation (RTMS), Traditional Chinese medicine (TCM) alone or with WM, were superior for alleviating depression symptoms. Compared to Usual Care, acupuncture alone or plus other therapies could significantly decrease scores of the Hamilton Depression Rating scale. However, there was no significant difference found among acupuncture, WM, TCM with AC plus any of other treatment.Conclusions: The results of this study indicate that acupuncture alone or combined with other therapies appear to be effective in improving depression symptoms of stroke survivors. Moreover, in comparison with WM, acupuncture alone or plus RTMS, TCM, TCM with WM, or WM, were more effective in improving depression symptoms. Also, acupuncture with RTMS seems to be the most effective with the highest probability.

The Impact of Immersive and Non-Immersive Virtual Reality Trends in Sensorimotor Recovery of Post-Stroke Patients-A Meta-Analysis

2021 ◽  
Vol 9 (5) ◽  
pp. 555-564
Author(s):  
Jaza Rizvi ◽  
◽  
Abid Khan ◽  
Sumaira Imran Farooqui ◽  
Bashir Ahmed Soomro ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Stroke Patients ◽  
Post Stroke ◽  
Randomized Controlled ◽  
Sensorimotor Recovery ◽  
The Impact

Virtual Reality (VR) is an approach in stroke rehabilitation with ever-improving technological advancement for targeted motor rehabilitation by providing a user interface in a simulated environment with proprioceptive and visual feedback. This meta-analysis intended to evaluate the impact of immersive and non-immersive VR-based interventions compared to conventional rehabilitation in sensorimotor recovery following stroke. Randomized Controlled Trials based on the impact of VR, either immersive or non-immersive type in comparison to conventional rehabilitation on post-stroke patients (>18 years) sensorimotor recovery were searched on six databases including Google Scholar, PEDro, MEDLINE, Cochrane Library, EMBASE, and Web of Science from August to November 2020. A total of 17 randomized controlled trials on VR based intervention showed significant improvement in sensorimotor recovery following a stroke in overall FMA outcomes in comparison to the control group with pool effects in terms of SMD in a random effect model showed an impact of 0.498 at 95% CI (p<0.001) depicts a moderate effect size. An immersive and non-immersive emerging VR trend appears to be a promising therapeutic tool in sensorimotor recovery following stroke.

scholarly journals Effect of Web 2.0 Technologies on Academic Performance: A Meta-analysis Study

2020 ◽  
Vol 5 (1) ◽  
pp. 108-127
Author(s):  
Esra Ergül Sönmez ◽  
Hasan Çakır
Keyword(s):  
Academic Performance ◽  
Web 2.0 ◽  
Experimental Approach ◽  
Meta Analysis ◽  
Control Group ◽  
Analysis Method ◽  
Web 2.0 Technologies ◽  
Quasi Experimental ◽  
G Value ◽  
The Impact

With the development of Web 2.0 technologies, the studies conducted in this field are diversifying and quite different results are obtained. In the current study, the contributions of wikis and blogs, which are considered as web 2.0 technologies, to academic performance were examined with meta-analysis method. The studies following quasi-experimental approach and have a control group with pretest-posttest measures published both in Turkish and English are included in the study. In consideration of the criteria determined, 19 studies were selected to be considered for the current study. The studies having participants from nine different countries were coded, and then they were analyzed in a meta-analysis software called CMA. As the distribution of data was heterogeneous, a random effects model was selected and the analysis was performed. Effect size (E++) according to the analysis performed by the Hedge’s g value and 95% confidence interval was found as 0.740. Results show that the impact of web 2.0 technologies on academic performance is positive and moderate.

Outcomes of North American, Japanese, and European extensive-disease small cell lung cancer (ED-SCLC) patients under irinotecan-platinum or etoposide-platinum therapy: Systematic review and meta-analysis.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e18534-e18534
Author(s):  
Joao Paulo Da S.N. Lima ◽  
Andre Deeke Sasse ◽  
Emma C. Sasse ◽  
Lucas Vieira dos Santos
Keyword(s):  
Systematic Review ◽  
North American ◽  
Meta Analysis ◽  
Geographic Origin ◽  
First Line ◽  
First Line Therapy ◽  
Geographic Origins ◽  
One Year ◽  
Meta Analyses ◽  
The Impact

e18534 Background: Superiority of irinotecan-platinum (IP) regimens over etoposide-platinum (EP) in ED-SCLC has been extensively debated, with ethnic and pharmacogenomics issues hypothesized as causes of the divergent findings. We undertook a systematic review to scrutinize the data according to geographic origin. Methods: Randomized controlled trials comparing first-line EP doublets versus IP in ED-SCLC patients were searched in major meeting proceedings and databases. The outcomes were overall survival (OS), one-year survival, two-year survival, and safety. Meta-analyses were performed using random-effects model. Subgroup analyses and meta-regression were undertaken to compare and measure the impact of geographical origin of study over the estimated effect size. Results: Seven studies (2,029 patients) were included. IP improved OS worldwide (HR = 0.83; 95% CI 0.76-0.92; P>0.001; I²=0%). However, the impact of IP on OS was different according to geographic origin, with relevant benefit for Japanese, little benefit for North American/Australian and intermediate for European patients (P for interaction = 0.029, table 1). One year survival was homogenously improved from 34% with EP to 40% with IP (P=0.006). IP improved two year survival just for Japanese and European patients but not to North American ones (Table). Toxicity was not impacted by trial origin. Conclusions: IP improved survival for both Western and Eastern patients, but seems to exist a gradient of benefit according to geographic origins, with maximal benefit for Japanese, some relevant for European ones and little, if any, for North American/Australian patients. These findings should be taken in account when considering IP or EP as first-line therapy for ED-SCLC patients worldwide. [Table: see text]

scholarly journals Is deterrence approach effective in combating tax evasion? A meta-analysis

2019 ◽  
Vol 17 (2) ◽  
pp. 93-113 ◽  
Author(s):  
Muh Dularif ◽  
Sutrisno T. ◽  
Nurkholis ◽  
Erwin Saraswati
Keyword(s):  
Cultural Values ◽  
Effect Size ◽  
Tax Evasion ◽  
Meta Analysis ◽  
Empirical Studies ◽  
Income Level ◽  
Analysis Method ◽  
Tax Rate ◽  
The Impact ◽  
The Relationship

The purpose of this paper is to present the results of a meta-analysis of the relationship between determinant factors and tax evasion based on deterrence approach. Using the meta-analysis method, each statistical result of empirical studies is converted into r-pearson as standardized effect size, and then synthesized into a mean effect size in order to increase power and to resolve uncertainty. Theoretically, increasing audit, tax rate and tax penalty will decrease tax evasion. However, the results show that only tax rate has a significant impact on tax evasion. Synthesizing totally 478 outcomes from articles published between 1978 and 2018, there is a robust conclusion that decreasing tax rate is an effective tool in combating tax evasion. On the other hand, audit and penalty are not significant in influencing tax evasion. In addition, the results of heterogeneity analysis suggest that national culture and income level of the country are useful in explaining the impact of audit, tax rate and tax penalty on tax evasion. These findings should be of interest to policymakers. First, instead of sacrificing more resources in conducting audit or imposing more penalty, tax authorities should consider setting the tax rate as low as possible to diminish tax evasion. Second, considering that culture and income level influence the impact of audit and penalty on tax evasion, policymakers should consider national cultural values and income level condition when designing audit techniques and setting penalty structures.

Impact of intraprocedural stent thrombosis on outcomes of percutaneous coronary intervention: a meta-analysis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Aggarwal ◽  
A Jain ◽  
V Kohli
Keyword(s):  
Stent Thrombosis ◽  
Literature Search ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Target Vessel Revascularization ◽  
Percutaneous Coronary ◽  
One Year ◽  
Post Hoc ◽  
The Impact ◽  
Definite Stent Thrombosis

Abstract Background Intraprocedural stent thrombosis (IPST), defined as the development of occlusive or nonocclusive new thrombus in or adjacent to a recently implanted stent before completion of PCI. IPST even though a rare entity, yet is associated with worse prognosis amongst all intraprocedural thrombotic events. Purpose Data regarding the impact of IPST is scarce and needs further investigation. Methods We performed literature search of all published full-length articles that studied and compared data on patients with IPST and with no IPST during PCI. We calculated odds ratios via the random effects model for 30 day and 1 year outcomes. Results Our literature search yielded 3 studies (1 retrospective, 2 observational post-hoc analysis) relevant to the meta-analysis. Total 19272 patients were included. IPST occurred in 159 patients (0.8%). At 30 days, IPST was associated with statistically significant higher all-cause mortality (OR 10.79, 95% CI [6.31, 18.45] p&lt;0.00001), MI (OR 4.82, 95% CI [2.39, 9.73] p&lt;0.0001), target vessel revascularization (TVR) (OR 6.70, 95% CI [3.38, 13.29] p&lt;0.00001), definite stent thrombosis (OR 10.44, 95% CI [5.87, 18.58] p&lt;0.00001), definite or probable stent thrombosis (OR 9.28), 95% CI [5.54, 15.56] p&lt;0.00001) and death or MI or TVR (OR 7.20], 95% CI [4.10, 12.64] p&lt;0.00001), than those without IPST. At one year, results remained statistically significant for higher mortality (OR 4.27, 95% CI [1.92, 9.49] p=0.0004) and death or MI or TVR (OR 2.91, 95% CI [1.58, 5.36] p=0.0006) in patients with IPST. Conclusions IPST even though is a rare occurrence, is associated with more adverse ischemic events, including higher mortality at 30 days and 1 year. Funding Acknowledgement Type of funding source: None

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