Stroke incidence and case fatality rate in an urban population.

BACKGROUND: The epidemiology of stroke in sub-Saharan African populations and variation of subtypes between communities are not well understood. Our aim was to ascertain prospectively the incidence of first-ever stroke and ischemic stroke subtypes in an urban city population of Southwestern Nigeria. METHODS: A community-based stroke registry was set up to enroll hospitalized and nonhospitalized first-ever stroke cases at all health care facilities located in the assigned community. The study was conducted between November 1, 2010, and October 31, 2011, in Akure North and South Local Government Areas of Ondo State, Southwestern Nigeria. RESULTS: We identified 298 incidents of strokes in patients presenting for the first time ever. Pathologic diagnosis was confirmed in 75% of the cases. Adjusted age-standardized incidence rate was 60.67 per 100,000 per year after adjustment to the World Health Organization World Population. Incidence of cerebral infarction and intracerebral hemorrhage increased with age in both men and women. CONCLUSIONS: The incidence of stroke in our population-based study ranks low compared with high-income countries. However, when incidence rates were compared by pathologic type, our rates for intracerebral hemorrhage and that of subarachnoid hemorrhage are comparable with those of high-income countries.

Characteristics of lung cancer screening eligible population in the US and prediction of the eligibility with simplified criteria.

Background: In 2021, updates to the lung cancer screening (LCS) guidelines extended the eligibility to include younger individuals and those with lower lifetime smoking intensity. A significant challenge in the LCS implementation is identifying eligible individuals because lifetime smoking intensity, a key criterion of current guidelines, is typically unavailable in electronic health records and difficult to assess accurately. This study aimed to (I) examine the characteristics of the eligible population in the US based on current guidelines and (II) evaluate the performance of five simplified criteria as alternative tools for predicting LCS eligibility. Methods: National Health and Nutrition Examination Survey (NHANES) 2013-2018 data were used. Five simplified criteria were: (I) ever smoker, defined as an individual with any positive smoking history; (II) current or former smoker, an individual with any positive smoking history or who quit smoking within 15 years; (III) current smoker, an individual currently smoking; (IV) current smoker, an individual currently smoking >0.5 packs per day (ppd); (V) current smoker, a person currently smoking >1 ppd. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated. The complex survey design was considered. Results: About 16.70 million individuals (representing 16.01% of population aged 50-80 years) were eligible for LCS in the US. The percentage of LCS eligibility was higher among people who were younger, male, non-Hispanic White, less educated, single, not insured, with poorer health status and lower socioeconomic status. Except for the criterion of current smoker with >1 ppd having low sensitivity (0.08), other criteria had sensitivity ranging between 0.45 and 1.00. The accuracy of the five criteria used ranged between 0.70 and 0.91. Conclusions: Individuals with less favorable social and clinical characteristics have higher chances of being eligible for LCS, potentially amplifying disparities in LCS utilization. Simplified criteria can be used as prescreening tools to identify target populations, which could facilitate LCS implementation at the population level.

Panniculus Retractor Use for Visualization of Fetal Anatomy: A Randomized Controlled Trial.

OBJECTIVE: To evaluate whether use of a panniculus retractor device for pregnant patients with body mass index (BMI) 40 or higher and a panniculus improves the completion rate of the fetal anatomic examination. METHODS: This was a randomized trial in which eligible patients with BMI 40 or higher and a panniculus were randomized to undergo their detailed fetal anatomic examination with a panniculus retractor device in place compared with usual care. The primary outcome was the completion rate of 16 prespecified views from the anatomic examination. Secondary outcomes included completion rate of all 64 views from our institution's detailed anatomic examination, duration of examination, major fetal anomaly detection rate, depth from the skin to amniotic cavity before and after retractor placement, patient and ultrasonographer satisfaction, and prespecified adverse events. We assumed a baseline completion rate of 23% for the primary outcome and targeted a twofold improvement with 80% power and two-sided α of 0.05, which resulted in a sample size of 132 participants. The goal enrollment was increased to 150 participants to account for potential dropout. Statistical tests included the Student's t test, χ2, and relative risks (RRs) as appropriate. RESULTS: From March to July of 2023, 150 participants completed the study: 74 in the retractor group and 76 in the usual care group. Baseline characteristics were similar between groups except for panniculus grade. The completion rate of 16 prespecified views was 25.7% (19/74) in the retractor group and 31.6% (24/76) in the control group (RR 0.81, 95% CI, 0.49-1.35). There were no significant differences between groups for any of the secondary outcomes. Patient satisfaction and ultrasonographer satisfaction were similar between groups. CONCLUSION: Use of a panniculus retractor device during the fetal anatomic examination for patients with BMI 40 or higher and a panniculus was well tolerated by patients and ultrasonographers but did not improve the completion rate of 16 prespecified fetal anatomic views. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT05764408.

The association of urbanicity and travel time with lung cancer screening utilization.

BACKGROUND: To examine 1) the rate of lung cancer screening (LCS) utilization in a large healthcare system in South Carolina; 2) associations of urbanicity and travel time with LCS utilization. METHODS: LCS-eligible patients from 2019 were identified. The outcome was LCS utilization. The exposures were zip-code level urbanicity and travel time from the centroid of zip-code area to the nearest screening site (<10,10-<20, ≥20 min). Covariates included age, sex, race, marital status, insurance, body mass index, chronic obstructive pulmonary disease, Charlson Comorbidity Index (0, 1, 2, ≥3), and zip-code level median income. Chi-square tests and logistic regressions were employed. RESULTS: The analysis included 6930 patients, among whom 1432 (20.66%) received LCS. After adjusting for covariates, living in a non-metropolitan area (adjusted odds ratio: 0.32; 95% confidence interval: 0.26-0.40) and having longer travel time (0.80 [0.65-0.98] and 0.68 [0.54-0.86] for 10-<20 and ≥20 min travel time, respectively, compared to <10 min travel time) were significantly associated with lower odds of LCS utilization. CONCLUSIONS: The LCS utilization rate of a healthcare system was about 20% in 2019. Living in non-metropolitan areas or having longer travel time to LCS site were associated with lower LCS utilization.

Risk factors and ambulatory outcome in ischemic stroke patients with pre-stroke depression.

OBJECTIVE: It is well known that post-stroke depression might be a negative factor for stroke recovery, however there is limited evidence to establish the link between pre-stroke depression and stroke outcome such motor recovery. The objective is to determine clinical risk factors in ischemic stroke patients with pre-stroke depression that are associated functional ambulatory outcome. METHODS: Data from acute ischemic patients from a regional stroke registry were collected for consecutive recombinant tissue plasminogen activator(rtPA)-treated acute ischemic stroke patients between January 2010 and June 2016. Logistic regression model was used to predict risk factors that served as predictive variables, while the increase or reduce odds of improvement in ambulatory outcome was considered as the primary outcome. Multicollinearity and possible interactions among the independent variables were analyzed using the variance inflation factor. RESULTS: A total of 1446 patients were eligible for recombinant tissue plasminogen activator (rtPA) and 596 of these patients received rtPA. Of the 596 ischemic stroke patients, 286 patients presented with recent pre-stroke depression, 310 had no pre-stroke depression. Carotid artery stenosis (OR = 11.577, 95% CI, 1.281-104.636, P = 0.029) and peripheral vascular disease (OR = 18.040, 95% CI, 2.956-110.086, P = 0.002) were more likely to be associated with increase odds of improvement in ambulation in patients with no pre-stroke depression treated with rtPA, while antihypertensive medications (OR = 0.192, 95% CI, 0.035-1.067, P = 0.050),previous TIA (OR = 0.177, 95% CI, 0.038-0.818, P = 0.027), and congestive heart failure (OR = 0. 0.160, 95% CI, 0.030-0.846, P = 0.031) were associated with reduced odds of improvement in ambulation. In addition, carotid artery stenosis (OR = 0.078, 95% CI, 0.10-0.614, P = 0.015, congestive heart failure (OR = 0.217, 95% CI, 0.318-0.402, P = 0.030), previous TIA (OR = 0.444, 95% CI, 0.517-0.971, P = 0.012), higher NIHSS scores ((OR = 0.887, 95% CI, 0.830-0.948, P < 0.001), and antihypertensive medications (OR = 0.810, 95% CI, 0.401-0.529, P = 0.019) were associated with the reduced odd of improvement in ambulation in an ischemic stroke population with pre-stroke depression treated with rtPA. CONCLUSION: Our findings indicate that more risk factors were associated with the decreased odds of an improvement in ambulation following thrombolytic therapy in an ischemic stroke population with pre-stroke depression when compared with those without pre-stroke depression. This finding maybe helpful in the development of management strategies to increase the use of thrombolytic therapy for pre-stroke depressed ischemic stroke to increased their eligibility for rtPA.

Clinical Risk Factors Associated with Ambulatory Outcome in Acute Ischemic Stroke Patient Smokers Treated with Thrombolytic Therapy.

BACKGROUND: Patients who have suffered an acute ischemic stroke (AIS) and are smokers may have a better outcome following thrombolytic therapy when compared with non-smokers. While this finding is controversial, data on baseline clinical risk factors to predict treatment efficacy of thrombolytic therapy using ambulatory status in patients who suffered AIS and are smokers is not common. METHODS: Between 2010 and 2016, retrospective data on patients who have suffered an AIS and received recombinant tissue plasminogen activator (rtPA) were obtained from Greenville health system registry. Assessment of clinical risk factors and the likelihood of an improvement in post-stroke ambulation among smokers and non-smokers was carried out using multivariate logistic regression. RESULTS: Of 1001 patients, 70.8% were smokers and 29.2% non-smokers. Among the smokers and non-smokers, 74.6% and 84.6% improvement in ambulation respectively at discharge. The odds of improved ambulation decrease among smokers as age group increases compared to those below 50 [(60-69 years, aOR, 0.30, 95% C.I, 0.108-0.850, p < 0.05), (70-79 years aOR, 0.27, 95% C.I, 0.096-0.734, p < 0.05), (80+ years aOR, 0.16, 95% C.I, 0.057-0.430, P < 0.01). Patients with National Institute of Health Stroke Scale Score (NIHSS) score > 7 (reference <7) were 91% less likely to have improved ambulation among smokers and non-smokers (aOR, 0.09, 95% C.I, 0.055-0.155, P = 0.01), and (aOR, 0.08, 95% C.I, 0.027-0.214, P = 0.01) respectively. Atrial fibrillation was an independent predictor of decreased improvement in ambulation only among smokers (aOR, 0.58, 95% C.I, 0.356-0.928 P < 0.05). CONCLUSION: Our findings suggest that elderly smokers with atrial fibrillation would benefit more from aggressive management of atrial fibrillation than non-smokers.

Exploratory behavior and withdrawal signs in crayfish: chronic central morphine injections and termination effects.

Functional and evolutionary conservation of neural circuits of reward seeking >is a symbol of survival. It is found in most animals from insects to humans. Exploration is a component of a wide range of drug-elicited behaviors that reflects an appetitive motivational state when animals seek natural rewards such as food, water, and shelter for survival. Not only does the characterization of exploratory behaviors indicate the specific components of appetitive motor patterns, it also reveals how exploratory behavioral patterns are implemented via increased incentive salience of environmental stimuli. The current work demonstrates that novel stimuli appear to directly augment exploration in crayfish, while injections of morphine directly into the brain of crayfish enhanced robust arousal resulting in increased locomotion and exploration of the environment. Elimination of morphine suppressed exploratory motor patterns. Crayfish displayed atypical behavioral changes evident of withdrawal-like states when saline is injected into the brain. With proven evidence of rewarding to the exposure to mammalian drugs of abuse, modularly organized and experimentally accessible nervous system makes crayfish exceptionally suitable for characterizing the central workings of addiction at its key behavioral and neuroanatomic locations.

Metabolic regulatory clues from the naked mole rat: toward brain regulatory functions during stroke.

Resistance to tissue hypoxia is a robust fundamental adaptation to low oxygen supply, and represents a novel neuroscience problem with significance to mammalian physiology as well as human health. With the underlying mechanisms strongly conserved in evolution, the ability to resist tissue hypoxia in natural systems has recently emerged as an interesting model in mammalian physiology research to understand mechanisms that can be manipulated for the clinical management of stroke. The extraordinary ability to resist tissue hypoxia by the naked mole rat (NMR) indicates the presence of a unique mechanism that underlies the remarkable healthy life span and exceptional hypoxia resistance. This opens an interesting line of research into understanding the mechanisms employed by the naked mole rat (Heterocephalus glaber) to protect the brain during hypoxia. In a series of studies, we first examined the presence of neuroprotection in the brain cells of naked mole rats (NMRs) subjected to hypoxic insults, and then characterized the expression of such neuroprotection in a wide range of time intervals. We used oxygen nutrient deprivation (OND), an in vitro model of resistance to tissue hypoxia to determine whether there is evidence of neuronal survival in the hippocampal (CA1) slices of NMRs that are subjected to chronic hypoxia. Hippocampus neurons of NMRs that were kept in hypoxic condition consistently tolerated OND right from the onset time of 5h. This tolerance was maintained for 24h. This finding indicates that there is evidence of resistance to tissue hypoxia by CA1 neurons of NMRs. We further examined the effect of hypoxia on metabolic rate in the NMR. Repeated measurement of metabolic rates during exposure of naked mole rats to hypoxia over a constant ambient temperature indicates that hypoxia significantly decreased metabolic rates in the NMR, suggesting that the observed decline in metabolic rate during hypoxia may contribute to the adaptive mechanism used by the NMR to resist tissue hypoxia. This work is aimed to contribute to the understanding of mechanisms of resistance to tissue hypoxia in the NMR as an important life-sustaining process, which can be translated into therapeutic interventions during stroke.