Clinical predictors of early neurological deterioration in patients with acute minor ischemic stroke

@#Background: Early neurological deterioration is a critical determinant of functional outcome in patients with acute minor ischemic stroke. This study aimed to identify clinical predictors of early neurological deterioration in patients with acute minor ischemic stroke. Methods: A total of 739 patients who experienced acute minor ischemic stroke symptoms between January 2014 and December 2018 were enrolled in this study. All patients were presented within a 4.5-hour time window of stroke symptom onset. Early neurological deterioration was defined as an increment of at least one point in motor power or total National Institute of Health Stroke Scale (NIHSS) score deterioration ≥ 2 points within 3 days after admission. Unfavorable functional outcome was defined as a modified Rankin Scale score of ≥ 2 at 90 days after stroke onset. Demographic characteristics, risk factors for vascular diseases, stroke severity, stroke subtypes, and neuroimaging parameters were analyzed. Regression analysis was used to determine clinical predictors of early neurological deterioration. Results: Of the 739 patients, 78 (10.5%) patients had early neurological deterioration. Among the 78 patients with early neurological deterioration, 61 (78.2%) had unfavorable functional outcome at 90 days after stroke onset. In contrast, 131 of the remaining 661 (19.8%) patients without early neurological deterioration had unfavorable functional outcome. Multivariate analysis identified hemorrhagic transformation (odds ratio, 3.8; 95% confidence interval, 1.4-10.5; P = 0.010), higher NIHSS score at admission (odds ratio, 1.4; 95% confidence interval, 1.1-1.7; P = 0.003), arterial stenosis (odds ratio, 2.0; 95% confidence interval, 1.2-3.5; P = 0.014) and occlusion (odds ratio, 2.6; 95% confidence interval, 1.4-4.8; P = 0.004) in the territory of stroke as significant predictors of early neurological deterioration. Conclusions: The results of this study suggest that hemorrhagic transformation, higher NIHSS score at admission, and arterial steno-occlusive lesions in the territory of stroke are independent predictors of early neurological deterioration in patients with acute minor ischemic stroke.

Taping Therapy Simultaneously applied to the Ankle and Hip Joint: Effect on Balance and Gait in Patients with Chronic Stroke

PURPOSE: This study examined the effects of taping therapy on the balance and gait of stroke patients. METHODS: The subjects of this study were 30 stroke patients. The treatment groups were prescribed a combination of taping, therapy applied simultaneously to the ankle and the hip joint, and general physical therapy twice a day for 30 minutes each, five days per week for 4 weeks for a total of 40 times. The control group was treated with general physical therapy for 30 minutes, 5 times per week for 4 weeks, and total 40 times. All subjects were followed up on a Berg balance scale, timed up and go test, activity-specific balance confidence scale, and GaitRite. RESULTS: The group that simultaneously received taping therapy to the ankle and hip joint showed more significant effects than the group treated with ankle joint taping only (p<0.05). Effects were noted in the Berg balance scale, timed up and go test, activity-specific balance confidence scale and gait ability test. Compared to the control group, the group treated at the ankle and hip joint showed significant effects after the experiment in the Berg balance scale, timed up and go test, activity-specific balance confidence scale, and gait ability test (p<0.05). CONCLUSION: Taping therapy applied to both the ankle and hip joints, and combined with general physical therapy appears to be effective in patients with chronic stroke who have an impaired balance and gait ability.

Factors affecting the satisfaction of emergency medical services in capital and non-capital areas

OBJECTIVE: This study examined the factors affecting the satisfaction of emergency medical services in capital and non-capital areas. METHODS: Descriptive and logistic regression analysis was performed using the data from the 2014 Korea Health Panel Survey. RESULTS: Patients who resided in capital areas were likely to be more satisfied than those who resided in non-capital areas. In capital and non-capital areas, post-of-service action was an influential factor. Capital area patients, who were transferred to other hospitals instead of being admitted or returned to their homes, reported less satisfaction. In non-capital areas, delayed emergency room arrival that was self-perceived was also an influential factor. Moreover, patients who were transferred to other hospitals instead of being returned to their homes reported less satisfaction. CONCLUSION: In both capital and non-capital areas, the satisfaction of emergency medical services can be increased by avoiding transferring patients to other hospitals. For Koreans to be satisfied with emergency medical services, efficient and rapid emergency medical services will e needed to avoid delays in emergency room arrivals, particularly in non-capital areas.

An Analysis of the Reliability and Validity of a Korean Version of the Mobility and Gait Assessment Tools for Patients with Stroke

PURPOSE: This study aimed to systematically analyze the reliability and validity of Korean versions of mobility and gait assessment tools for patients with stroke. METHODS: Two reviewers conducted an independent literature search and systematically reviewed the literature. Literature published until June of 2017 was searched using search engines for electronic databases. The 2 reviewers reviewed the title and abstract of each article. Among the articles examined, we read the full text of those judged to be suitable for our study. We classified the selected data into research methods and results. The determination was made through mutual agreement. RESULTS: The reviewers selected 5 articles related to the purpose of this study. The DGI was found to be moderately associated with BBS, 10MWT, and TUG in intra-rater reliability (ICC=0.92), inter-rater reliability (ICC=0.88), and concurrent validity tests. The FGA demonstrated a high level of reliability with intra-rater (ICC=0.92–0.95) and inter-rater reliability (ICC=0.91, 0.95). The intra-rater reliability of the RMI was high at ICC=0.98. Its concurrent validity showed a high association with STREAM and BI. The intra-rater reliability of the MAS was ICC=0.75–0.99. Its inter-rater reliability was very high, exceeding 0.99. The inter-rater reliability of the Tinetti-gait Scale was ICC=0.91, and its concurrent validity was moderately associated with the DGI, 10WMT, OLST, FM-L/E, and STS. CONCLUSION: The results of this study revealed that the reliability and validity of the Korean versions of the mobility and gait assessment tools were high.

Prognostic Significance of KAI-1 and Survivin Expressions in Ovarian Epithelial Carcinomas / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The purpose of this study was to evaluate the expressions of KAI-1 and survivin, and to investigate their correlation with the clinical stage and survival rate of patients with ovarian carcinomas. MATERIALS AND METHODS: The expressions of survivin and KAI-1 were immunohistochemically determined in 54 serous and mucinous ovarian adenocarcinomas and borderline malignancy tumors. 10 of the 54 cases were also analyzed for the expressions of survivin and KAI-1 using western blot. RESULTS: The down-regulation of the expression of KAI-1 was observed by immunohistochemical staining (IHC) in 53.7% of the ovarian cancers, and a negative reaction in 50% by the western blot analysis. From the IHC, the survivin expression was positive and strongly positive in 51.9 and 18% of the ovarian cancers, respectively. From the western blot analysis, 10% of the ovarian cancer showed positive reactions. The down- regulation of the KAI-1 expression was significantly correlated with the clinical stage (p=0.001) and disease free survival rate (p<0.001), but not with the histological type. The expression of survivin was not correlated with the clinical stage or histological type. However, the patients with a negative survivin expression had a significantly longer disease survival rate than those with a strong positive expression. CONCLUSION: The down- and up-regulation of the KAI-1 and survivin, respectively, might be independent prognostic factors in human ovarian carcinomas.