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Hyperdense artery sign, symptomatic infarct swelling and effect of alteplase in acute ischaemic stroke

Stroke & Vascular Neurology 2021年第2期6卷 238-243页

作者： Simiao Wu Grant Mair Geoff Cohen zoe morris Anders von Heijne Nick Bradey Lesley Cala Andre Peeters Andrew J Farrall Alessandro Adami Gillian Potter Ming Liu Richard I Lindley Peter A G Sandercock Joanna M Wardlaw the IST-3 Collaborative Group Department of Neurology West China HospitalSichuan UniversityChengduSichuanChina Centre for Clinical Brain Sciences The University of EdinburghEdinburghUK Department of Clinical Sciences Danderyd HospitalStockholmSweden Neuroradiology James Cook University HospitalSouth Tees Hospital NHS TrustMiddlesbroughUK Division of Pathology and Laboratory Medicine School of MedicineThe University of Western AustraliaPerthWestern AustraliaAustralia Department of Neurology Cliniques universitaires Saint-LucBruxellesBelgium Stroke Center IRCCS Sacro Cuore Don CalabriaVeronaItaly Department of Neuroradiology Manchester Centre for Clinical NeurosciencesSalford Royal NHS Foundation TrustSalfordUK Westmead Applied Research Centre Westmead Clinical SchoolThe University of SydneySydneyNew South WalesAustralia The George Institute for Global Health NewtownNew South WalesAustralia UK Dementia Research Institute Centre at the University of Edinburgh EdinburghUnited Kingdom 不详

Background Alteplase improves functional outcomes of patients with acute ischaemic stroke,but its effects on symptomatic infarct swelling,an adverse complication of stroke and the influence of CT hyperdense artery sign(HAS)are *** substudy of the Third International Stroke Trial aimed to investigate the association between HAS and symptomatic infarct swelling and effect of intravenous alteplase on this *** We included stroke patients whose prerandomisation scan was non-contrast ***,masked to clinical information,assessed baseline(prerandomisation)and follow-up(24-48 hours postrandomisation)CT scans for HAS,defined as an intracranial artery appearing denser than contralateral *** infarct swelling was defined as clinically significant neurological deterioration≤7 days after stroke with radiological evidence of midline shift,effacement of basal cisterns or uncal *** Among 2961 patients,HAS presence at baseline was associated with higher risk of symptomatic infarct swelling(OR 2.21;95% CI 1.42 to 3.44).Alteplase increased the risk of swelling(OR 1.69;95% CI 1.11 to 2.57),with no difference between patients with and those without baseline HAS(p=0.49).In patients with baseline HAS,alteplase reduced the proportion with HAS at follow-up(OR 0.67;95% CI 0.50 to 0.91),where HAS disappearance was associated with reduced risk of swelling(OR 0.25,95% CI 0.14 to 0.47).Conclusion Although alteplase was associated with increased risk of symptomatic infarct swelling in patients with or without baseline HAS,it was also associated with accelerated clearance of HAS,which in return reduced swelling,providing further mechanistic insights to underpin the benefits of alteplase.

关键词： infarct swelling effect

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Seasonal variation and living alone are related to pulmonary rehabilitation non-completion

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World Journal of Respirology 2013年第2期3卷 29-37页

作者： James R Walsh zoe J Mc Keough Norman R morris Stephanie T Yerkovich Michelle E Wood Jenny D Paratz Queensland Lung Transplant Service Prince Charles Hospital Queensland 4032 Australia School of Medicine University of Queensland Queensland 4072 Australia Discipline of Physiotherapy University of Sydney Sydney NSW 2141 Australia School of Rehabilitation Sciences and Griffith Health Institute Griffith University Gold Coast 4215 Australia Adult Cystic Fibrosis Centre Prince Charles Hospital Queensland 4032 Australia

AIM: To identify baseline characteristics that independently predict pulmonary rehabilitation non-completion and compare these findings against the participant's reasons for non-completion. METHODS: Participants with chronic obstructive pulmonary disease(COPD) who attended a standardised twice weekly, eight week pulmonary rehabilitation program(located in the sub-tropics, latitude 27°29' South) between 2010 and 2012 were recruited. Thebaseline characteristics of program completers and non-completers were compared in a case-controlled design. Participants who attended 4 session of the program) were asked by one independent investigator to participate in a survey about their pulmonary rehabilitation experience. Baseline characteristics were assessed for differences between program completers and non-completers. The baseline characteristics included disease severity, exercise capacity, smoking history, participant's social support and the season when each participant commenced rehabilitation. Non-completers that agreed to participate in the survey were asked to indicate what personal factors or external factors contributed to their program non-completion. Comparisons of completers and non-completers baseline characteristics were performed using cross-tabulations and t-tests, with significant measures analysed in a multivariate binary logistic regression model. Non-completers survey responses were compared to the identified independent predictors using ***: Twenty-six participants(23.4%) of the 111 participants with COPD [(mean ± SD) age was 67.4 ± 9.2 years and FEV1 54.6% ± 22.3%)], were classified as non-completers. Forty-five participants(40.5%) commenced pulmonary rehabilitation during winter. Thirty-six participants(32.4%) were living alone at program commencement. In the multivariate analysis(n = 111), only programs that commenced in winter(Exp B: 0.255, 95

关键词： Chronic obstructive pulmonary disease Pulmonary rehabilitation Predictive factors Program completion Program non-completion

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