Abstract T P219: A Novel Method for Measuring Oxidative Stress in Patients with Stroke Symptoms

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Jeffrey C Wagner ◽  
Kristin Salottolo ◽  
Christopher V Fanale ◽  
Michelle Whaley ◽  
Kathryn L McCarthy ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Thrombolytic Therapy ◽  
Linear Models ◽  
Pearson Correlation ◽  
Chi Square ◽  
Novel Device ◽  
Stroke Population ◽  
Primary Stroke Center ◽  
Student’S T ◽  
Stroke Center

Introduction: A novel device was developed to measure oxidation reduction potential (ORP), which is the balance of oxidants and reductants, providing a direct measure of oxidative stress. Our purpose was to measure ORP in patients admitted with stroke symptoms. Methods: This prospective observational study included patients admitted to our Primary Stroke Center from 1/2010-12/2012; children ≤18 and transfers were excluded. We examined ORP’s association with stroke type, demographics (age, gender, race), NIHSS, thrombolytic therapy, and outcomes (in-hospital mortality, mRS, LOS, readmission) using Pearson correlation, generalized linear models, chi-square and student’s t-tests. Blinded operators tested plasma samples in duplicate for static ORP (resting ORP, mV), where greater values indicate more oxidative stress, as well as Capacity (antioxidant reserve, uC). Capacity was inverse-transformed (icORP), where greater values indicate less reserves. Results: There were 101 patients including 52 ischemic strokes, 10 hemorrhagic strokes, 19 TIAs, and 20 mimics. Six patients died (6%); arrival ORP was significantly lower in patients who died than who survived (sORP: 137.2 vs 163.9, p = 0.004; icORP: 2.7 vs. 4.5, p = 0.02); the change in ORP between day 2 and arrival (ΔORP) was significantly greater in patients who died (sORP: 26.3 vs 5.4, p = 0.002; icORP: 1.5 vs. 0.0, p = 0.004). Arrival ORP was lowest in patients with severe stroke, while ΔORP was greatest in these patients (table 1), independent of thrombolytic therapy (interaction p =0.36). Arrival ORP was positively correlated with LOS (p = 0.003). Conclusions: These results demonstrate the ability of ORP to identify oxidative stress and amount of antioxidant reserves in a stroke population. We propose ORP monitoring as a potentially useful tool in evaluation of acute stroke patients.

In-Hospital Stroke Care: A Six-Year Community-Based Primary Stroke Center Experience

2021 ◽  
pp. 194187442110070
Author(s):  
Felix Ejike Chukwudelunzu ◽  
Bart M Demaerschalk ◽  
Leonardo Fugoso ◽  
Emeka Amadi ◽  
Donn Dexter ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Statistical Significance ◽  
Intravenous Thrombolysis ◽  
Stroke Care ◽  
Community Based ◽  
Chi Square ◽  
Stroke Team ◽  
Primary Stroke Center ◽  
Stroke Center

Background and purpose: In-hospital stroke-onset assessment and management present numerous challenges, especially in community hospitals. Comprehensive analysis of key stroke care metrics in community-based primary stroke centers is under-studied. Methods: Medical records were reviewed for patients admitted to a community hospital for non-cerebrovascular indications and for whom a stroke alert was activated between 2013 and 2019. Demographic, clinical, radiologic and laboratory information were collected for each incident stroke. Descriptive statistical analysis was employed. When applicable, Kruskal-Wallis and Chi-Square tests were used to compare median values and categorical data between pre-specified groups. Statistical significance was set at alpha = 0.05. Results: There were 192 patients with in-hospital stroke-alert activation; mean age (SD) was 71.0 years (15.0), 49.5% female. 51.6% (99/192) had in-hospital ischemic and hemorrhagic stroke. The most frequent mechanism of stroke was cardioembolism. Upon stroke activation, 45.8% had ischemic stroke while 40.1% had stroke mimics. Stroke team response time from activation was 26 minutes for all in-hospital activations. Intravenous thrombolysis was utilized in 8% of those with ischemic stroke; 3.4% were transferred for consideration of endovascular thrombectomy. In-hospital mortality was 17.7%, and the proportion of patients discharged to home was 34.4% for all activations. Conclusion: The in-hospital stroke mortality was high, and the proportions of patients who either received or were considered for acute intervention were low. Quality improvement targeting increased use of acute stroke intervention in eligible patients and reducing hospital mortality in this patient cohort is needed.

92 INSULIN-LIKE GROWTH FACTOR-1 PROTECTS BOVINE PRE-IMPLANTATION EMBRYOS PRODUCED IN VITRO FROM ANTI-DEVELOPMENTAL ACTIONS OF MENADIONE

2016 ◽  
Vol 28 (2) ◽  
pp. 176
Author(s):  
N. A. S. Rocha-Frigoni ◽  
B. C. S. Leão ◽  
P. C. Dall'Acqua ◽  
M. Ambrogi ◽  
G. Z. Mingoti
Keyword(s):  
Oxidative Stress ◽  
Growth Factor ◽  
Molecular Probes ◽  
Insulin Like Growth Factor ◽  
Blastocyst Development ◽  
Chi Square ◽  
Fluorescent Intensity ◽  
Chi Square Test ◽  
Student’S T

The objective of this study was to evaluate the protective effect of insulin-like growth factor (IGF-1) on blastocyst development and cryotolerance of bovine embryos in in vitro culture (IVC) under oxidative stress induced by menadione (MD). Cumulus-oocyte complexes (n = 1421) were matured in TCM-199 with bicarbonate, hormones, and 10% FCS for 22 h. After fertilization, the presumptive zygotes were cultured up to 7 days in SOF medium with 2.5% FCS and 0.5% BSA (control), and also supplemented with 100 μM IGF-1 (IGF). At Day 6, MD was included in the culture medium (0 μM, control; or 5.0 μM, MD) during 24 h. Cultures were conducted at 38.5°C in 5% CO2 in air. The cleavage and blastocysts rates were evaluated, respectively, at Days 3 and 7 (IVF = Day 0). At Day 7, a sample of the blastocysts was stained with 5 μM H2DCFDA (Molecular Probes, Canada) to evaluate the intracellular ROS levels or was stained for TUNEL (In Situ Cell Death Detection Kit, Roche, Indianapolis, IN, USA). Stained embryos were immediately evaluated under an epifluorescence microscope (excitation 495/550 nm and emission 404/590 nm, respectively, for ROS and TUNEL), and the images of embryos stained with H2DCFDA were analysed by Q-Capture Pro image software for determining the fluorescent intensity. Other blastocysts were vitrified (Ingámed®, Maringá-PR, Brazil), and after warming, they were cultured for 24 h to evaluate the re-expansion rates. The results were compared by ANOVA followed by Student’s t-test (mean ± s.e.M) and re-expansion rates by chi-square test (P < 0.05). The cleavage rates did not differ (P > 0.05) among groups (77.1 ± 1.9% to 82.75 ± 2.2%). The blastocyst rates were similar between control (35.4 ± 2.0%) and IGF (34.5 ± 3.7%), and both were higher (P < 0.05) than MD (21.3 ± 2.7%); the IGF+MD group (28.3 ± 1.6%) was similar (P > 0.05) to all groups. The intracellular levels of ROS were higher (P < 0.05) for the MD group (21.7 ± 0.7) than for control (17.0 ± 1.6), and both were similar (P > 0.05) to the IGF (19.2 ± 0.6) and IGF+MD (18.0 ± 1.0) groups. The highest rates of apoptosis were found in the MD group (22.3% ± 2.3) and the smallest in IGF (9.1% ± 0.7), and both differed (P < 0.05) from control (12.8% ± 1.0), and IGF+MD (15.6% ± 1.6). The re-expansion rates were similar between control (77.4%) and IGF (69.2%), and both were higher (P < 0.05) than MD (49.1%); however, the IGF+MD group (57.6%) was similar (P > 0.05) to IGF and MD groups. In conclusion, the supplementation with IGF-1 during IVC reversed the detrimental effects of MD on embryonic levels of ROS and apoptosis, as well as improved the embryo development and cryotolerance of blastocysts under oxidative stress. Financial support was provided by FAPESP (#2012/10083–8 and #2013/07382–6).

scholarly journals Impact of Establishing a Primary Stroke Center at a Community Hospital on the Use of Thrombolytic Therapy

Stroke ◽  
2003 ◽  
Vol 34 (6) ◽  
Author(s):  
Susan Unipan Lattimore ◽  
Julio Chalela ◽  
Lisa Davis ◽  
Thomas DeGraba ◽  
Mustapha Ezzeddine ◽  
...  
Keyword(s):  
Thrombolytic Therapy ◽  
Community Hospital ◽  
Primary Stroke Center ◽  
Stroke Center

scholarly journals Pathological Investigations And Correlation Research of Microfibrillar-Associated Protein 4 And Tropoelastin In Oral Submucous Fibrosis

2021 ◽  
Author(s):  
Binjie Liu ◽  
Wenqun Gou ◽  
Hui Feng
Keyword(s):  
Pearson Correlation ◽  
Oral Submucous Fibrosis ◽  
Treatment Strategies ◽  
Clinicopathological Characteristics ◽  
Expression Level ◽  
Categorical Variables ◽  
Chi Square ◽  
Chi Square Test ◽  
Submucous Fibrosis ◽  
Student’S T

Abstract Background: Oral submucous fibrosis (OSF), distinguished by abnormal collagen deposition, is a precancerous disorder with 7%-30% of malignant transformation and rising global prevalence. However, the precise pathogenesis and effective treatment still remains elusive and controversial despite superfluity of literature. Therefore, it is extremely necessary and significant to explore the clinicopathological characteristics and potential markers for diagnosis and prognosis of OSF. Here, the objective of this research is to evaluate the influence and correlation of Microfibrillar-associated protein 4 [MFAP4] and tropoelastin [TE] on the development of OSF patients. Material and Methods: Classic clinicopathological factors, HE and Masson trichome staining, immunohistochemical characteristics and the correlation (MFAP4 and TE) were recorded and compared among different stages of OSF cases (n = 60) and among those normal individuals (n = 10). Then, the comparison using Student's t test, ANOVA analysis, the chi-square test for categorical variables was conducted in clinicopathological characteristics and the expression level of MFAP4 and TE between the patients' and normal tissue. The correlation analysis of MFAP4 and TE were assessed via means of Pearson's correlation test and linear regression. Results: MFAP4 and TE proteins are upregulated and even increasing gradually in varying grades of OSF patients relative to the normal cases. Furthermore, statistical analyses yielded that the expression level of MFAP4 was positively associated with TE, and the Pearson correlation coefficient was 0.3781 (p = 0.0048). Clinically, we found that OSF affected more male than female with a ratio of 29: 1. The age range was 16-60 years, and the mean age was 36.25 ± 10.25 years old. Moreover, the positive expression rate of MFAP4 and TE in patients less than 40 years old is higher than that of those over 40 years old. Meanwhile, all OSF cases had chewed areca nut, with 51.67% smoking tobacco. Conclusions: Our study elucidates that the accumulation of MFAP4 and TE proteins may play a vitally important effect in the occurrence and development of OSF and has a hope to become a promising candidate molecular for prevention, diagnosis, and treatment strategies of OSF in the future.

Abstract TMP41: Early Mobility Initiated at 12 Hours Post Thrombolytic Therapy for Stroke Increases Likelihood for Discharge to Home

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
John Gwilliam ◽  
Mechelle McNicholas
Keyword(s):  
Thrombolytic Therapy ◽  
Positive Impact ◽  
Chi Square ◽  
Comfort Care ◽  
Early Mobility ◽  
Discharge Disposition ◽  
Increased Risk ◽  
Significant Difference ◽  
Discharge Outcomes ◽  
Stroke Center

Purpose: To assess patient safety and discharge outcomes of initiating early mobility after 12 hours of receiving thrombolytic therapy (tPA) for stroke at a Primary Stroke Center. Background: Patients receiving tPA are traditionally maintained on bedrest for 24 hours due to an alleged risk of increased complications or falls, however this standard is not supported by data. Prior data among patients receiving tPA supports the concept of providing early mobility before 24 hours without an increased risk of falls or other adverse response. There is also evidence that early mobility in other critical care populations has positive impact on discharge disposition and decreasing the length of stay (LOS). Methods: A validated Early Mobility Protocol was implemented within 24 hours for all patients receiving tPA for stroke with a focus to progress each patient through the stages of the mobility protocol based on clinical presentation. Data from pre-implementation (January – May 2018) and post implementation (June 2018-December 2018) were compared for outcomes, including discharge disposition, adverse responses and LOS. T-test and Chi-square were used to determine significant difference in outcomes between groups. Results: Between January to December 2018 44 patients received tPA (18 pre-implementation and 26 post implementation). For the post implementation group 18/26 early mobility was initiated with 24 hours, 4/26 were placed on comfort care and 4/26 were transferred to a comprehensive stroke center. Among the early mobility group, there were no falls or adverse physiological events. Patients that participated with early mobility were more likely to discharge home, 46.15% vs 33.33%, less likely to require post-acute services, 15.38% vs 27.78%, and less likely to require transfer to a higher level of care, 15.38% vs 33.78%. There was not a significant difference in LOS. Conclusion: Providing early mobility to patients post thrombolytic therapy between 12-24 hours does not cause an increase in adverse physiological events. Additionally, providing early mobility has a positive impact on patient discharges to home. Further study may include initiating mobility at an early timeframe to examine the correlation to LOS and discharge outcomes.

Abstract P854: Lean A3 Project in a Primary Stroke Center Results in Improved Dysphagia Screening Compliance for Stroke

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Melanie Henderson ◽  
Susan Boesch ◽  
Kristine Peyton ◽  
Chris Hackett ◽  
Patty Noah ◽  
...  
Keyword(s):  
Oral Intake ◽  
Stroke Patients ◽  
Chi Square ◽  
Improvement Project ◽  
Charge Nurses ◽  
Before And After ◽  
Primary Stroke Center ◽  
Stroke Center ◽  
Risk Of Aspiration ◽  
Get With The Guidelines

Introduction: Dysphagia is a common comorbidity after stroke linked to increased morbidity and mortality. Evidence-based guidelines recommend a bedside dysphagia screen before oral intake to reduce the risk of aspiration pneumonia in stroke patients. Prior studies have reviewed barriers to dysphagia screens being completed or documented timely on stroke patients before giving oral intake. Through Lean A3 process, we aimed to improve overall nursing documentation, including dysphagia screen, for stroke patients in the Emergency Department (ED) at an established Primary Stroke Center. Methods: The ED Charge Nurses and the Stroke Coordinator began an A3 project in May 2019 which focused on ED nurse documentation for stroke patients. Data included was 7 months prior to A3 implementation and 8 months post-implementation using Get With The Guidelines quality “Dysphagia Screen” measure. Lean A3 process involved changes to the computer system and re-education of nursing staff in July 2019 by the charge nurses and Stroke Coordinator. The post-A3 measurement period was between August 2019 and March 2020. Chi square tests were used to assess proportion differences in completed dysphagia screen and proportion of meeting or exceeding goal before and after the A3. Results: Overall compliance of patients screened for dysphagia was 87.3% (n = 379/434). After the A3 project, compliance for dysphagia screening was significantly higher than prior to the A3 implementation ((91.9% (n = 228/248) vs. 81.2% (n = 151/186), OR = 2.64 [95%CI 1.47-4.75], p < 0.001). In addition, the 90% goal for dysphagia screen compliance was achieved only 1 month of 7 (14.3%) prior to A3, but was achieved in 6 months of 8 post-A3 (75%), p = 0.04. Conclusion: In conclusion, we found that dysphagia screening documentation by ED nurses improved due to the Lean A3 process improvement project conducted in the ED.

Abstract NS6: Early Mobility Initiated at 12 Hours Post Thrombolytic Therapy for Stroke Increases Likelihood for Discharge to Home

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
John Gwilliam ◽  
Mechelle McNicholas
Keyword(s):  
Thrombolytic Therapy ◽  
Positive Impact ◽  
Chi Square ◽  
Comfort Care ◽  
Early Mobility ◽  
Discharge Disposition ◽  
Increased Risk ◽  
Significant Difference ◽  
Discharge Outcomes ◽  
Stroke Center

Purpose: To assess patient safety and discharge outcomes of initiating early mobility after 12 hours of receiving thrombolytic therapy (tPA) for stroke at a Primary Stroke Center. Background: Patients receiving tPA are traditionally maintained on bedrest for 24 hours due to an alleged risk of increased complications or falls, however this standard is not supported by data. Prior data among patients receiving tPA supports the concept of providing early mobility before 24 hours without an increased risk of falls or other adverse response. There is also evidence that early mobility in other critical care populations has positive impact on discharge disposition and decreasing the length of stay (LOS). Methods: A validated Early Mobility Protocol was implemented within 24 hours for all patients receiving tPA for stroke with a focus to progress each patient through the stages of the mobility protocol based on clinical presentation. Data from pre-implementation (January – May 2018) and post implementation (June 2018-December 2018) were compared for outcomes, including discharge disposition, adverse responses and LOS. T-test and Chi-square were used to determine significant difference in outcomes between groups. Results: Between January to December 2018 44 patients received tPA (18 pre-implementation and 26 post implementation). For the post implementation group 18/26 early mobility was initiated with 24 hours, 4/26 were placed on comfort care and 4/26 were transferred to a comprehensive stroke center. Among the early mobility group, there were no falls or adverse physiological events. Patients that participated with early mobility were more likely to discharge home, 46.15% vs 33.33%, less likely to require post-acute services, 15.38% vs 27.78%, and less likely to require transfer to a higher level of care, 15.38% vs 33.78%. There was not a significant difference in LOS. Conclusion: Providing early mobility to patients post thrombolytic therapy between 12-24 hours does not cause an increase in adverse physiological events. Additionally, providing early mobility has a positive impact on patient discharges to home. Further study may include initiating mobility at an early timeframe to examine the correlation to LOS and discharge outcomes.

scholarly journals Morphometric analysis of duodenum in human fetus

2021 ◽  
Vol 29 (3) ◽  
pp. 245-249
Author(s):  
Sevil Karabağ ◽  
Kıvılcım Eren Erdoğan ◽  
Perihan Alsancak ◽  
Nazlı Soygun ◽  
Figen Doran
Keyword(s):  
Human Fetus ◽  
Pearson Correlation ◽  
First Trimester ◽  
Width Ratio ◽  
Villus Height ◽  
Chi Square ◽  
Kolmogorov Smirnov ◽  
The Mean ◽  
Student’S T ◽  
Age Range

Objective The mucosa of the duodenum is lined by finger-like villi. In adults, the villus height to width ratio is about 4–5:1. The aim of this study is to evaluate the villus height to width ratio in the human fetus. Methods Eighty-one human fetal autopsies were included in the study. Three random villi were measured with the X and Y-axes. The statistical analysis was performed by Pearson correlation, Kolmogorov-Smirnov, chi-square, linear regression tests, and Student’s t-test. Results There were 29 female and 52 male fetuses. The age range was between 12 and 40 weeks of gestation. Of 81 fetuses, 2 were in the first trimester, 73 in the second trimester, and 6 in the third trimester. The mean villus height to width ratios in the first, second, and third trimesters were 2.75±0.37, 3.21±0.17, and 3.76±0.6, respectively. There was no correlation between the week of gestation and duodenum villus height to width ratio (p=0.080). The mean villus height to width ratios among females and males were 3.62±1.28 and 3.02±0.84, respectively (p=0.014). Conclusion In our study, villi were blunter and shorter in fetuses than in adults but not in children regardless of weeks of gestation compared to the literature. The gradual elongation of villi after birth may be attributed to environmental factors.

scholarly journals Comparative analysis of the prevalence of congenital malformations of the brain in children of the radioactively contaminated territories of the Bryansk region after the Chernobyl disaster (1999-2014)

2020 ◽  
Vol 99 (4) ◽  
pp. 356-362
Author(s):  
Антон Вячеславович Корсаков ◽  
Э. В. Гегерь ◽  
Д. Г. Лагерев ◽  
Л. И. Пугач ◽  
Ю. П. Пивоваров ◽  
...  
Keyword(s):  
Comparative Analysis ◽  
Congenital Malformations ◽  
Pearson Correlation ◽  
Chi Square ◽  
Chernobyl Disaster ◽  
Strontium 90 ◽  
Cesium 137 ◽  
Chi Square Test ◽  
Student’S T ◽  
The Brain

Purpose of the study. Based on the official statistics for 1999-2014, we carried out a comparative analysis of the incidence of congenital brain malformations in children resided in the radiation-contaminated areas of the Bryansk region after the Chernobyl disaster with different densities of Cesium-137 and Strontium-90. Material and Methods. Student’s t-test, Pearson chi-square test, Pearson correlation test, linear regression. Results. As a result of the study, no statistically significant excess in the frequency of anencephaly, hydrocephalus and encephalocele in children in more radiation-contaminated south-western territories (SWT) was found compared to the average regional data. However, in the SWT, the prevalence of microcephaly is statistically significant (p<0,05) above the average regional values (5.8 times). While the maximum values are recorded in the most radioactively polluted areas of the region when high statistically significant correlations are detected with the density of radioactive contamination with Cesium-137 (r=0.69; p=0.040) and Strontium 90 (r=0.70; p=0.037), while there are no significant dependencies for other brain defects of the brain. A statistically significant decrease in the long-term trend in the prevalence of microcephaly throughout the region without SWT in the period 1999-2014, and an increase in the radiation-contaminated SWT, was found. Conclusions. The results obtained presumably indicate to the influence of the radiation factor on the increased incidence of microcephaly in SWT relative to the average regional values without SWT for a sixteen-year period (1999-2014). The further studies are needed to analyze the incidence of various types of congenital malformations in order to determine a strategy for preventing birth of children with congenital anomalies.

Abstract WMP119: Evaluating Discharge Patterns in the Stroke Population

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Theresa Hamm
Keyword(s):  
Outpatient Services ◽  
Stroke Subtype ◽  
Missed Opportunities ◽  
Stroke Population ◽  
Primary Stroke Center ◽  
Barriers And Opportunities ◽  
Stroke Center ◽  
Discharge Patterns ◽  
Acute Rehabilitation ◽  
Treatment Window

Hypothesis: Determining discharge patterns in the stroke population will assist in directing appropriate resources and patient outcomes. Methods: A retrospective review of 917 records was completed at a Joint Commission Certified Primary Stroke Center. Only patients with a confirmed diagnosis of stroke were included. Discharge destination was evaluated as well as NIHSS scores (which were then averaged) and stroke subtype. An assessment of rationale for patients not receiving Activase was also completed. Results: The following table illustrates the results of this review. This subset was further evaluated for non-treatment rationale; 80% arrived outside a treatment window; 13% were mild or rapidly improving; 5% had documented contraindications; the remaining 2% were a combination of patient refusal and missed opportunities. Interestingly, all missed opportunities resulted in discharge to SNF or AR. It appears, based on these data, clinical decisions made to withhold Activase in the setting of rapidly resolving symptoms did not result in further in-patient care in the majority of patients. Conclusions: Based on these data, nearly half of all strokes are discharged back into the community; an evaluation of available community and outpatient services may be beneficial. Further evaluation of potential barriers and opportunities to expand access to acute rehabilitation may be warranted. An evaluation of patients discharged to SNF may also be valuable to ensure discharge to most appropriate level of care to ensure best outcomes

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