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1.
Sensors (Basel) ; 22(4)2022 Feb 13.
Artículo en Inglés | MEDLINE | ID: mdl-35214337

RESUMEN

The generative adversarial network (GAN) has demonstrated superb performance in generating synthetic images in recent studies. However, in the conventional framework of GAN, the maximum resolution of generated images is limited to the resolution of real images that are used as the training set. In this paper, in order to address this limitation, we propose a novel GAN framework using a pre-trained network called evaluator. The proposed model, higher resolution GAN (HRGAN), employs additional up-sampling convolutional layers to generate higher resolution. Then, using the evaluator, an additional target for the training of the generator is introduced to calibrate the generated images to have realistic features. In experiments with the CIFAR-10 and CIFAR-100 datasets, HRGAN successfully generates images of 64 × 64 and 128 × 128 resolutions, while the training sets consist of images of 32 × 32 resolution. In addition, HRGAN outperforms other existing models in terms of the Inception score, one of the conventional methods to evaluate GANs. For instance, in the experiment with CIFAR-10, a HRGAN generating 128 × 128 resolution demonstrates an Inception score of 12.32, outperforming an existing model by 28.6%. Thus, the proposed HRGAN demonstrates the possibility of generating higher resolution than training images.


Asunto(s)
Procesamiento de Imagen Asistido por Computador , Procesamiento de Imagen Asistido por Computador/métodos
2.
Stroke ; 52(5): 1662-1672, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33794654

RESUMEN

Background and Purpose: Data on the effect on vascular outcomes of concomitant atherosclerotic vascular disease (ASVD) with atrial fibrillation (AF) after stroke are limited. This study evaluated the effect of ASVD with AF versus AF only on the risk of vascular events. Methods: We retrospectively analyzed a prospectively registered multicenter database involving 3213 stroke patients with AF. ASVD included extracranial atherosclerosis measured in the proximal portion of the internal carotid artery, intracranial atherosclerosis (all ≥50% stenosis), coronary artery disease, and peripheral artery disease and was categorized into 4 strata depending on the number of ASVDs (0, 1, 2, and 3­4). The independent associations of ASVD with major adverse cardiovascular events, stroke, and all-cause death were assessed. Results: A total of 2670 patients were included (mean age, 73.5±9.8 years; median CHA2DS2-VASc score, 5; interquartile range, 4−6). During the follow-up (mean, 1.7 years), a total of 672 (25.2%) major adverse cardiovascular events, 170 (6.4%) stroke events, and 501 (18.8%) all-cause deaths were noted. The adjusted hazard ratio for major adverse cardiovascular events versus no ASVD was 1.25 (95% CI, 1.00­1.56) for ASVD 1, 1.34 (95% CI, 1.02­1.76) for ASVD 2, and 1.93 (95% CI, 1.24­2.99) for ASVD 3­4. The adjusted hazard ratio for all-cause death versus no ASVD was 1.32 (1.01­1.74), 1.47 (1.06­2.03), and 2.39 (1.47­3.89), respectively. Among ASVD components, the presence of symptomatic or asymptomatic extracranial atherosclerosis was a more potent predictor of major adverse cardiovascular events (1.27 [1.05­1.54]) and all-cause death (1.45 [1.17­1.81]). Conclusions: ASVD burden with AF can be a cumulative marker of a high risk for untoward vascular outcomes. Among ASVD components, extracranial atherosclerosis seems to have a predominant effect.


Asunto(s)
Enfermedad de la Arteria Coronaria , Bases de Datos Factuales , Enfermedad Arterial Periférica , Accidente Cerebrovascular , Anciano , Anciano de 80 o más Años , Fibrilación Atrial/complicaciones , Fibrilación Atrial/mortalidad , Fibrilación Atrial/fisiopatología , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/mortalidad , Enfermedad de la Arteria Coronaria/fisiopatología , Femenino , Humanos , Arteriosclerosis Intracraneal , Masculino , Persona de Mediana Edad , Enfermedad Arterial Periférica/complicaciones , Enfermedad Arterial Periférica/mortalidad , Enfermedad Arterial Periférica/fisiopatología , Estudios Retrospectivos , Factores de Riesgo , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/fisiopatología
3.
Cerebrovasc Dis ; 50(3): 288-295, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33588410

RESUMEN

BACKGROUND: Stroke risk scores (CHADS2 and CHA2DS2-VASc) not only predict the risk of stroke in atrial fibrillation (AF) patients, but have also been associated with prognosis after stroke. OBJECTIVE: The aim of this study was to evaluate the relationship between stroke risk scores and early neurological deterioration (END) in ischemic stroke patients with AF. METHODS: We included consecutive ischemic stroke patients with AF admitted between January 2013 and December 2015. CHADS2 and CHA2DS2-VASc scores were calculated using the established scoring system. END was defined as an increase ≥2 on the total National Institutes of Health Stroke Scale (NIHSS) score or ≥1 on the motor NIHSS score within the first 72 h of admission. RESULTS: A total of 2,099 ischemic stroke patients with AF were included. In multivariable analysis, CHA2DS2-VASc score (adjusted odds ratio [aOR] = 1.17, 95% confidence interval [CI] = 1.04-1.31) was significantly associated with END after adjusting for confounders. Initial NIHSS score, use of anticoagulants, and intracranial atherosclerosis (ICAS) were also found to be closely associated with END, independent of the CHA2DS2-VASc score. Multivariable analysis stratified by the presence of ICAS demonstrated that both CHA2DS2-VASc (aOR = 1.20, 95% CI = 1.04-1.38) and CHADS2 scores (aOR = 1.24, 95% CI = 1.01-1.52) were closely related to END in only patients with ICAS. In patients without ICAS, neither of the risk scores were associated with END. CONCLUSIONS: High CHA2DS2-VASc score was associated with END in ischemic stroke patients with AF. This close relationship is more pronounced in patients with ICAS.


Asunto(s)
Técnicas de Apoyo para la Decisión , Evaluación de la Discapacidad , Servicios Médicos de Urgencia , Accidente Cerebrovascular Isquémico/diagnóstico , Anciano , Anciano de 80 o más Años , Fibrilación Atrial/complicaciones , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/fisiopatología , Progresión de la Enfermedad , Femenino , Humanos , Arteriosclerosis Intracraneal/complicaciones , Arteriosclerosis Intracraneal/diagnóstico , Arteriosclerosis Intracraneal/fisiopatología , Accidente Cerebrovascular Isquémico/etiología , Accidente Cerebrovascular Isquémico/fisiopatología , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Sistema de Registros , República de Corea , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo
4.
BMC Neurol ; 21(1): 148, 2021 Apr 06.
Artículo en Inglés | MEDLINE | ID: mdl-33823819

RESUMEN

BACKGROUND: Neurodegenerative disorders are characterized by insidious progression with poorly-delineated long latent period. Antecedent clinical insult could rarely unmask latent neurodegenerative disorders. Here, we report an autopsy-proven case of corticobasal degeneration which was preceded by a lacunar infarction. CASE PRESENTATION: A 58-year-old man presented with acute ataxia associated with a lacunar infarction in the right paramedian pons. His ataxia persisted with additional progressive gait difficulty and left arm clumsiness. Six months later, a follow-up neurological examination showed asymmetrical bradykinesia, apraxia, dystonic posturing, postural instability, and mild ataxia of the left limbs. Cognitive examination revealed frontal executive dysfunction and visuospatial difficulties. Dopamine transporter imaging scan demonstrated bilateral reduced uptakes in mid-to-posterior putamen, more prominent on the right side. Levodopa-unresponsive parkinsonism, asymmetric limb dystonia, and ideomotor apraxia became more conspicuous, while limb ataxia gradually vanished. The patient became unable to walk without assistance after 1 year, and died 4 years after the symptom onset. Autopsy findings showed frontoparietal cortical atrophy, ballooned neurons, and phosphorylated tau-positive astrocytic plaques and neuropil threads with gliosis and neuronal loss, confirming the corticobasal degeneration. CONCLUSIONS: The case illustrates that precedent clinical events such as stroke might tip a patient with subclinical CBS into overt clinical manifestations.


Asunto(s)
Enfermedades de los Ganglios Basales/diagnóstico , Infartos del Tronco Encefálico/diagnóstico , Apraxias/diagnóstico , Atrofia/diagnóstico , Autopsia , Humanos , Masculino , Persona de Mediana Edad , Trastornos del Movimiento/diagnóstico
5.
Sensors (Basel) ; 21(8)2021 Apr 17.
Artículo en Inglés | MEDLINE | ID: mdl-33920696

RESUMEN

The development of deep learning has achieved great success in object detection, but small object detection is still a difficult and challenging task in computer vision. To address the problem, we propose an improved single-shot multibox detector (SSD) using enhanced feature map blocks (SSD-EMB). The enhanced feature map block (EMB) consists of attention stream and feature map concatenation stream. The attention stream allows the proposed model to focus on the object regions rather than background owing to channel averaging and the effectiveness of the normalization. The feature map concatenation stream provides additional semantic information to the model without degrading the detection speed. By combining the output of these two streams, the enhanced feature map, which improves the detection of a small object, is generated. Experimental results show that the proposed model has high accuracy in small object detection. The proposed model not only achieves good detection accuracy, but also has a good detection speed. The SSD-EMB achieved a mean average precision (mAP) of 80.4% on the PASCAL VOC 2007 dataset at 30 frames per second on an RTX 2080Ti graphics processing unit, an mAP of 79.9% on the VOC 2012 dataset, and an mAP of 26.6% on the MS COCO dataset.

6.
J Stroke Cerebrovasc Dis ; 30(5): 105721, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33735669

RESUMEN

OBJECTIVES: Type D personality is vulnerable to stress and is associated with high symptom severity, unhealthy behaviors, and low quality of life (QoL) in patients with chronic diseases. This study aimed to identify the influence of type D personality on health promoting behaviors and QoL in patients with ischemic stroke in South Korea. MATERIALS AND METHODS: A descriptive, cross-sectional design was used. This study collected data from a convenience sample of 170 patients with ischemic stroke. Demographic and clinical characteristics, health promoting behaviors, and QoL were compared between the type D personality group and the non-type D group. Stepwise multiple regression analysis was performed to identify factors influencing patients' QoL. RESULTS: Of the 170 subjects, 39 (22.9%) were classified as having type D personality. Type D personality was associated with higher National Institutes of Health Stroke Scale scores at admission and discharge, higher modified Rankin Scale (mRS) scores at 3 months after stroke, lower scores for health promoting behaviors, and lower QoL. Regression analysis showed that mRS score 3 months after stroke was the most significant factor influencing QoL, followed by health promoting behaviors, type D personality, speech deficits, and family income. CONCLUSIONS: Type D personality should be considered together with health promoting behaviors and QoL in patients with ischemic stroke. Interventions considering type D personality may be helpful in improving health promoting behavior and QoL for the stroke patients.


Asunto(s)
Conductas Relacionadas con la Salud , Conocimientos, Actitudes y Práctica en Salud , Accidente Cerebrovascular Isquémico/psicología , Calidad de Vida , Personalidad Tipo D , Anciano , Estudios Transversales , Femenino , Estado de Salud , Estilo de Vida Saludable , Humanos , Accidente Cerebrovascular Isquémico/diagnóstico , Accidente Cerebrovascular Isquémico/fisiopatología , Accidente Cerebrovascular Isquémico/terapia , Masculino , Salud Mental , Persona de Mediana Edad , Pronóstico , República de Corea , Factores de Riesgo , Conducta de Reducción del Riesgo , Factores de Tiempo
7.
Stroke ; 51(3): 931-937, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31856691

RESUMEN

Background and Purpose- Although cilostazol has shown less hemorrhagic events than aspirin, only marginal difference was observed in hemorrhagic stroke events among patients at high risk for cerebral hemorrhage. To identify patients who would most benefit from cilostazol, this study analyzed interactions between treatment and subgroups of the PICASSO trial (Prevention of Cardiovascular Events in Asian Ischemic Stroke Patients With High Risk of Cerebral Hemorrhage). Methods- Ischemic stroke patients with a previous intracerebral hemorrhage or multiple microbleeds were randomized to treatment with cilostazol or aspirin and followed up for a mean 1.8 years. Efficacy, defined as the composite of any stroke, myocardial infarction, and vascular death, and safety, defined as the incidence of hemorrhagic stroke, were analyzed in the 2 groups. Interactions between treatment and age, sex, presence of hypertension and diabetes mellitus, index of high-risk cerebral hemorrhage, and white matter lesion burden were analyzed for primary and key secondary outcomes. Changes in vital signs and laboratory results were compared in the 2 groups. Results- Among all 1534 patients enrolled, a significant interaction between treatment group and index of high risk for cerebral hemorrhage on hemorrhagic stroke (P for interaction, 0.03) was observed. Hemorrhagic stroke was less frequent in the cilostazol than in the aspirin group in patients with multiple microbleeds (1 versus 13 events; hazard ratio, 0.08 [95% CI, 0.01-0.61]; P=0.01). A marginal interaction between treatment group and white matter change on any stroke (P for interaction, 0.08) was observed. Cilostazol reduced any stroke significantly in patients with mild (5 versus 16 events; hazard ratio, 0.36 [95% CI, 0.13-0.97]; P=0.04)-to-moderate (16 versus 32 events; hazard ratio, 0.50 [95% CI, 0.29-0.92]; P=0.03) white matter changes. Heart rate and HDL (high-density lipoprotein) cholesterol level were significantly higher in the cilostazol group than in the aspirin group at follow-up. Conclusions- Cilostazol may be more beneficial for ischemic stroke patients with multiple cerebral microbleeds and before white matter changes are extensive. Registration- URL: https://www.clinicaltrials.gov. Unique identifier: NCT01013532.


Asunto(s)
Aspirina/administración & dosificación , Isquemia Encefálica/tratamiento farmacológico , Hemorragia Cerebral/tratamiento farmacológico , Cilostazol/administración & dosificación , Accidente Cerebrovascular/tratamiento farmacológico , Anciano , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo
8.
Sensors (Basel) ; 20(18)2020 Sep 14.
Artículo en Inglés | MEDLINE | ID: mdl-32937799

RESUMEN

This article presents a dual-polarized, high gain multi-beam and high T/Rx channel-to-channel isolation antenna module for 24 GHz sensor applications. The proposed antenna is configured to support 2-Tx and 2-Rx channels with a pair of vertically polarized (VP) radiation pattern and a pair of horizontally polarized (HP) radiation pattern. Further, each linearly polarized T/Rx antenna is configured by 2 × 4 array with a multi-layer integrated feed network, resulting in four sets of 2 × 4 array antennas fabricated within a single printed circuit board (PCB). Since multiple RF channels must be ensured with minimal interference, high antenna-to-antenna, including Tx-to-Tx, Rx-to-Rx, and Tx-to-Rx port isolations in the proposed antenna are achieved by multi-layered feed network and four sets of T-shaped magnetic walls. To verify the performance of the proposed structure, a 2-Tx and 2-Rx antenna module was fabricated at 24 GHz. The fabricated antenna showed a measured maximum 10-dB impedance bandwidth of 3.9% with a maximum measured gain of 11.7 dBi, considering both Tx and Rx. Further, the measured channel-to-channel isolations were always better than 35.6 dB at 24 GHz.

9.
Entropy (Basel) ; 21(5)2019 May 22.
Artículo en Inglés | MEDLINE | ID: mdl-33267229

RESUMEN

In this paper, we consider a 2 × 2 space-time line coded (STLC) system having two-transmit and two-receive antennas. To improve the secrecy rate of the STLC system, in which an illegitimate receiver eavesdrops the information delivered from the STLC transmitter to the STLC receiver, we propose an artificial noise (AN) injection method. By exploiting the STLC structure, a novel AN for the STLC is designed and its optimal power loading factor is derived. Numerical results verify that the proposed secure STLC systems with the designed AN injection and the power control method can significantly improve the secrecy rate compared to the conventional STLC systems. It is observed that the proposed method is more effective if there is a significant gap between the main-channel and the eavesdropper-channel gains.

13.
Stroke ; 48(4): 840-845, 2017 04.
Artículo en Inglés | MEDLINE | ID: mdl-28258257

RESUMEN

BACKGROUND AND PURPOSE: Prediabetes is a known risk factor for vascular diseases; however, its differential contribution to mortality risk from various vascular disease subtypes is not known. METHODS: The subjects of the National Health Insurance Service in Korea (2002-2013) nationwide cohort were stratified into normal glucose tolerance (fasting glucose <100 mg/dL), impaired fasting glucose (IFG) stage 1 (100-109 mg/dL), IFG stage 2 (110-125 mg/dL), and diabetes mellitus groups based on the fasting glucose level. A Cox regression analysis with counting process formulation was used to assess the mortality risk for vascular disease and its subtypes-ischemic heart disease, ischemic stroke, and hemorrhagic stroke. RESULTS: When adjusted for age, sex, and body mass index, IFG stage 2, but not stage 1, was associated with significantly higher all-cause mortality (hazard ratio [HR], 1.26; 95% confidence interval [CI], 1.18-1.34) and vascular disease mortality (HR, 1.27; 95% CI, 1.08-1.49) compared with normal glucose tolerance. Among the vascular disease subtypes, mortality from ischemic stroke was significantly higher (HR, 1.60; 95% CI, 1.18-2.18) in subjects with IFG stage 2 but not from ischemic heart disease and hemorrhagic stroke. The ischemic stroke mortality associated with IFG stage 2 remained significantly high when adjusted other modifiable vascular disease risk factors (HR, 1.51; 95% CI: 1.10-2.09) and medical treatments (HR, 1.75; 95% CI, 1.19-2.57). CONCLUSIONS: Higher IFG degree (fasting glucose, 110-125 mg/dL) was associated with increased all-cause and vascular disease mortality. The increased vascular disease mortality in IFG stage 2 was attributable to ischemic stroke, but not ischemic heart disease or hemorrhagic stroke in Korean adults.


Asunto(s)
Glucemia , Isquemia Encefálica/mortalidad , Estado Prediabético/mortalidad , Accidente Cerebrovascular/mortalidad , Adulto , Anciano , Isquemia Encefálica/sangre , Isquemia Encefálica/epidemiología , Estudios de Cohortes , Comorbilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Programas Nacionales de Salud/estadística & datos numéricos , Estado Prediabético/sangre , Estado Prediabético/epidemiología , República de Corea/epidemiología , Accidente Cerebrovascular/sangre , Accidente Cerebrovascular/epidemiología
14.
Stroke ; 47(11): 2729-2736, 2016 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-27729583

RESUMEN

BACKGROUND AND PURPOSE: We investigated clinical and radiological characteristics of ischemic stroke patients with Takotsubo-like myocardial dysfunction. METHODS: From multicenter stroke registry database, ischemic stroke patients who underwent transthoracic echocardiography were found. Among these, patients were classified if they had specific ventricular regional wall motion abnormalities discording with coronary artery distribution, such as apical (typical pattern) or nonapical ballooning (atypical pattern), considered as echocardiographic findings of Takotsubo cardiomyopathy. Patients with ischemic heart disease history, myocarditis, or pheochromocytoma were excluded. We compared patients with Takotsubo-like myocardial dysfunction with those without and further performed systematic literature review on those with Takotsubo cardiomyopathy. RESULTS: This study included 23 patients (0.42%). The mean age was 70.7±13.9 years, with predominance of women (73.9%) and typical pattern of Takotsubo-like myocardial dysfunction (91.3%). They were associated with short-term poor functional outcomes, including high mortality, neurological deterioration, and functional status at discharge, compared with those without (39.1% versus 2.4%, 47.8% versus 7.4%; and median [interquartile range], 5 [5-6] versus 3 [2-4]; all P<0.001). They had a higher inflammatory marker level and lower triglyceride level. Ischemic lesions were more commonly found in the right anterior circulation with specific dominant regions being the insula and peri-insular areas. In addition, a trend toward a remarkable mortality rate and higher prevalence of insular involvement was observed in the propensity-score matching, subgroup fulfilling the strict Takotsubo cardiomyopath criteria, and was as reported in literature review. CONCLUSION: Stroke patients with Takotsubo-like myocardial dysfunction may differ from those without in clinical outcomes, laboratory findings, and radiological features.


Asunto(s)
Isquemia Encefálica/diagnóstico por imagen , Sistema de Registros , Accidente Cerebrovascular/diagnóstico por imagen , Cardiomiopatía de Takotsubo/diagnóstico por imagen , Anciano , Anciano de 80 o más Años , Isquemia Encefálica/epidemiología , Comorbilidad , Femenino , Hospitales/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Accidente Cerebrovascular/sangre , Accidente Cerebrovascular/epidemiología , Cardiomiopatía de Takotsubo/epidemiología
16.
Eur Neurol ; 75(1-2): 89-95, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-26863137

RESUMEN

BACKGROUND: It is not well known whether prestroke antiplatelet agents (PAs) are associated with the subtypes of ischemic stroke. METHODS: We screened patients in a hospital-based stroke registry. Patients who were admitted with a diagnosis of first-time ischemic stroke within 5 days of symptom onset were included. Ischemic stroke subtypes were classified in accordance with the Trial of ORG 10172 in Acute Stroke Treatment classification based on stroke mechanism: large-artery atherosclerosis (LA), cardioembolism (CE), small vessel occlusion (SVO), other determined (OC) or undetermined causes (UC). Multinomial logistic regression analyses were performed to evaluate the effect of PA on stroke subtypes before and after propensity score matching. RESULTS: Among 3,025 patients, 748 (24.7%) were taking antiplatelet agents prior to stroke. After propensity score matching, 1,190 patients were ultimately included. The PA group was associated with strokes caused by SVO rather than LA in multinomial logistic regression of an unmatched dataset. However, multivariable analysis after propensity score matching demonstrated that PA use was associated with a higher probability of SVO and CE (OR 2.05, p < 0.001 and OR 1.62, p = 0.05, respectively) compared with LA. CONCLUSIONS: PAs were associated with specific index stroke subtypes.


Asunto(s)
Inhibidores de Agregación Plaquetaria/uso terapéutico , Accidente Cerebrovascular/patología , Adulto , Anciano , Femenino , Hospitalización , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Sistema de Registros
17.
Stroke ; 46(4): 1009-13, 2015 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-25712944

RESUMEN

BACKGROUND AND PURPOSE: Controversy exists over the prognostic significance of perihematomal edema (PHE) in intracerebral hemorrhage. We aimed to determine the association of early PHE and clinical outcome among participants of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT) studies. METHODS: Pooled analyses of computed tomographic substudies in the pilot phase (INTERACT1) and main phase (INTERACT2), both international, prospective, open, blinded end point, randomized controlled trials, of patients with spontaneous intracerebral hemorrhage (<6 hours) and elevated systolic blood pressure, randomly assigned to intensive (target systolic blood pressure, <140 mm Hg) or guideline-based (systolic blood pressure, <180 mm Hg) blood-pressure management. Substudy participants (n=1310; 346 INTERACT1, 964 INTERACT2) had blinded central analyses of digital images from standardized baseline and 24-hour computed tomography. Predictors of death or dependency (modified Rankin scale scores, ≥3) at 90 days were assessed in logistic regression models and reported with odds ratios and 95% confidence intervals. INTERACT studies are registered at ClinicalTrials.gov (NCT00226096 and NCT00716079). RESULTS: Of 1138 (87%) patients with 2 CTs available for edema analysis and outcome information, time from intracerebral hemorrhage onset to baseline computed tomography, baseline hematoma volume, 24-hour hematoma growth, and intraventricular extension were independent predictors of 24-hour PHE growth. Absolute growth in PHE volume was significantly associated with death or dependency (adjusted odds ratio, 1.17; 95% confidence interval, 1.02-1.33 per 5 mL increase from baseline; P=0.025) at 90 days after adjustment for demographic, clinical, and hematoma parameter prognostic factors. Associations were consistent across various sensitivity analyses. CONCLUSION: PHE growth is an independent prognostic factor in intracerebral hemorrhage. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00226096 and NCT00716079.


Asunto(s)
Edema Encefálico/diagnóstico por imagen , Hemorragia Cerebral/diagnóstico por imagen , Progresión de la Enfermedad , Anciano , Anciano de 80 o más Años , Antihipertensivos/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Edema Encefálico/mortalidad , Hemorragia Cerebral/mortalidad , Femenino , Hematoma Intracraneal Subdural/diagnóstico por imagen , Hematoma Intracraneal Subdural/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Radiografía , Índice de Severidad de la Enfermedad , Método Simple Ciego , Factores de Tiempo
18.
Stroke ; 45(6): 1849-52, 2014 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-24803594

RESUMEN

BACKGROUND AND PURPOSE: The objective of this study was to investigate the potential benefits of statin therapy on mortality and stroke recurrence after cardioembolic stroke. METHODS: In this retrospective observational study, we analyzed data from 535 patients with first-ever cardioembolic stroke. Patients were classified into nonstatin, low-potency statin, and high-potency statin groups. The primary outcomes were time to mortality and time to recurrent stroke. RESULTS: The mean duration of follow-up was 22.2 months. The cumulative mortality rate was 7% at the end of the first year and 10% at the end of the third year. Statin therapy was independently associated with reduced mortality (hazard ratio, 0.237; 95% confidence interval, 0.080-0.703 for nonstatin versus low-potency statin; hazard ratio, 0.158; 95% confidence interval, 0.037-0.686 for nonstatin versus high-potency statin). Statin treatment did not affect the incidence of recurrent stroke in patients with cardioembolic stroke. CONCLUSIONS: Statin therapy could be associated with reduced mortality in patients with cardioembolic stroke.


Asunto(s)
Inhibidores de Hidroximetilglutaril-CoA Reductasas/administración & dosificación , Embolia Intracraneal/tratamiento farmacológico , Embolia Intracraneal/mortalidad , Accidente Cerebrovascular/tratamiento farmacológico , Accidente Cerebrovascular/mortalidad , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Estudios Retrospectivos , Tasa de Supervivencia
19.
Eur Stroke J ; : 23969873241253670, 2024 May 17.
Artículo en Inglés | MEDLINE | ID: mdl-38760933

RESUMEN

BACKGROUND: Late hospital arrival keeps patients with stroke from receiving recanalization therapy and is associated with poor outcomes. This study used a nationwide acute stroke registry to investigate the trends and regional disparities in prehospital delay and analyze the significant factors associated with late arrivals. METHODS: Patients with acute ischemic stroke or transient ischemic attack between January 2012 and December 2021 were included. The prehospital delay was identified, and its regional disparity was evaluated using the Gini coefficient for nine administrative regions. Multivariate models were used to identify factors significantly associated with prehospital delays of >4.5 h. RESULTS: A total of 144,014 patients from 61 hospitals were included. The median prehospital delay was 460 min (interquartile range, 116-1912), and only 36.8% of patients arrived at hospitals within 4.5 h. Long prehospital delays and high regional inequality (Gini coefficient > 0.3) persisted throughout the observation period. After adjusting for confounders, age > 65 years old (adjusted odds ratio [aOR] = 1.23; 95% confidence interval [CI], 1.19-1.27), female sex (aOR = 1.09; 95% CI, 1.05-1.13), hypertension (aOR = 1.12; 95% CI, 1.08-1.16), diabetes mellitus (aOR = 1.38; 95% CI, 1.33-1.43), smoking (aOR = 1.15, 95% CI, 1.11-1.20), premorbid disability (aOR = 1.44; 95% CI, 1.37-1.52), and mild stroke severity (aOR = 1.55; 95% CI, 1.50-1.61) were found to independently predict prehospital delays of >4.5 h. CONCLUSION: Prehospital delays were lengthy and had not improved in Korea, and there was a high regional disparity. To overcome these inequalities, a deeper understanding of regional characteristics and further research is warranted to address the vulnerabilities identified.

20.
Neurology ; 100(23): e2374-e2385, 2023 06 06.
Artículo en Inglés | MEDLINE | ID: mdl-37076307

RESUMEN

BACKGROUND AND OBJECTIVES: The interpretation of video head-impulse tests (video-HITs) can often be complicated, limiting their clinical utility in acute vestibular syndrome. We aimed to determine video-HIT findings in patients with posterior circulation strokes (PCSs) and vestibular neuritis (VN). METHODS: We retrospectively analyzed the results of video-HITs in 59 patients with PCS. Irrespective of the actual lesion revealed later on MRIs, ipsilateral and contralateral sides were assigned according to the direction of slow phase of spontaneous nystagmus (SN). Then, the patterns of video-HIT findings were classified according to the vestibulo-ocular reflex (VOR) gain for the horizontal canals; (1) ipsilaterally positive, (2) contralaterally positive, (3) bilaterally normal, and (4) bilaterally positive. The abnormal responses were further defined into (5) wrong-way saccades, (6) perverted, and (7) early acceleration followed by premature deceleration. We also analyzed the asymmetry of the corrective saccadic amplitude between the sides, calculated from the sum of cumulative saccadic amplitudes on both sides. The results were compared with video-HIT results from 71 patients with VN. RESULTS: Video-HITs were normal in 32 (54%), ipsilaterally positive in 11 (19%), bilaterally positive in 10 (17%), and contralaterally positive in 6 (10%) patients with PCS. Wrong-way saccades were more frequently observed in VN than in PCS (31/71 [44%] vs 5/59 [8%], p < 0.001). Saccadic amplitude asymmetry was greater in VN than in PCS (median 100% [interquartile range 82-144, 95% CI 109-160] vs 0% [-29 to 34, -10 to 22, p < 0.001]). When differentiating VN from PCS, the sensitivity was 81.7%, and specificity was 91.5% at the cutoff value of 71% for saccadic amplitude asymmetry with an area under the curve (AUC) of 0.91 (95% CI 0.86-0.97). The AUC for saccadic amplitude asymmetry was larger than that for the ipsilateral VOR gain (p = 0.041) and other parameters. DISCUSSION: Patients with PCS may show various head-impulse responses that deviate from the findings expected in VN, which include normal, contralaterally positive, and negative saccadic amplitude asymmetry (i.e., greater cumulative saccadic amplitude contralaterally). A thorough analysis of corrective saccades in video-HITs can improve the differentiation of PCS from VN even before MRIs.


Asunto(s)
Accidente Cerebrovascular , Neuronitis Vestibular , Humanos , Neuronitis Vestibular/diagnóstico , Estudios Retrospectivos , Vértigo , Prueba de Impulso Cefálico , Reflejo Vestibuloocular/fisiología , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/diagnóstico por imagen
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