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1.
Enferm. foco (Brasília) ; 11(2): 112-119, jul. 2020. tab
Article in Portuguese | LILACS (Americas), BDENF | ID: biblio-1104386

ABSTRACT

Objetivo: Elaborar enunciados de diagnósticos de enfermagem da Classificação Internacional para a Prática de Enfermagem para o cuidado intensivo às vítimas de acidente vascular encefálico isquêmico, à luz da Teoria da Adaptação de Roy. Método: Pesquisa metodológica, realizada em três etapas: construção dos enunciados diagnósticos de enfermagem da Classificação naVersão 2017; elaboração das definições operacionais dos enunciados; e validação de conteúdo por especialistas. Resultados: Foram construídos 60 diagnósticos de enfermagem com respectivas definições operacionais. Destes, 48 enunciados foram validados, com predomínio os diagnósticos referentes ao modo adaptativo fisiológico. Conclusão: Os diagnósticos de enfermagem validados para cuidado com vítimas de acidente vascular encefálico isquêmico apresentam potencialidade para proporcionar adaptação do indivíduo e fortalecer o registro das necessidades identificadas pelos enfermeiros. (AU)


Objective: To elaborate nursing diagnosis statements of the International Classification for Nursing Practice for the intensive care of victims of ischemic stroke, in light of Roy's Theory of Adaptation. Method: Methodological research, carried out in three stages: construction of the diagnostic nursing statements of the Classification in the 2017 Version; elaboration of operational definitions of statements; and validation of content by experts. Results: Sixty nursing diagnoses were constructed with respective operational definitions. Of these, 48 statements were validated, predominating the diagnoses referring to the physiological adaptive mode. Conclusion: The validated nursing diagnoses for care of victims of ischemic cerebrovascular accident have the potential to adapt the individual and strengthen the registry of the needs identified by the nurses. (AU)


Objetivo: Elaborar enunciados de diagnósticos de enfermería de la Clasificación Internacional para la Práctica de Enfermería para el cuidado intensivo a las víctimas de accidente vascular encefálico isquémico, a la luz de la Teoría de la Adaptación de Roy. Método: Investigación metodológica, llevada a cabo en tres etapas: construcción de los enunciados diagnósticos de enfermería de la Clasificación, en la versión 2017; elaboración de las definiciones operativas de los enunciados; y validación de contenido por expertos. Resultados: Se construyeron 60 diagnósticos de enfermería con definiciones operativas. De estos, 48 enunciados fueron validados, predominaron los diagnósticos referentes al modo adaptativo fisiológico. Conclusión: Los diagnósticos de enfermería válidos para la atención a las víctimas de accidente vascular encefálico isquémico presentan potencialidad para proporcionar adaptación del individuo y fortalecer el registro de las necesidades identificadas por enfermeros. (AU)


Subject(s)
Standardized Nursing Terminology , Nursing Diagnosis , Brain Ischemia , Stroke , Adaptation
3.
Dement. neuropsychol ; 14(1): 41-46, Jan.-Mar. 2020. tab
Article in English | LILACS (Americas) | ID: biblio-1089810

ABSTRACT

ABSTRACT A few studies have shown that serum brain-derived neurotrophic factor (BDNF) level in post-stroke depression is highly correlated with memory and neuropsychiatric disturbances. Objective: This study aimed to elucidate the relationship of serum BDNF, malondialdehyde (MDA), and 8-Hydroxy 2-Deoxyguanosine (8-OhdG) levels in acute stroke cases with one-month post-stroke depression. Methods: An observational study was conducted of 72 post-ischemic stroke patients in the Neurology ward of the Dr. M. Djamil Hospital, Padang, West Sumatra, Indonesia. Acute stroke (< 48 hours) serum BDNF, MDA, and 8-OhdG levels were measured using ELISA. Based on observations using the Hamilton Depression Rating Scale conducted one month after stroke, respondents were divided into two groups: with and without depression. The mean serum level was analyzed using the t-test and Mann-Whitney test, while differences in basic characteristics were analyzed using the Chi-square test. Multivariate analysis was conducted to determine the most significant factor associated with post-stroke depression. The error rate was set at 5%. Results: BDNF levels in acute stroke were significantly lower in the depression group than in the non-depression group (p < 0.05). MDA and 8-OhdG levels in acute stroke were higher in the depression group (p < 0.05). BDNF level during acute stroke was negatively correlated with post-stroke depression, while, conversely, acute stroke MDA and 8-OhdG levels were positively correlated with depression. Conclusion: BDNF had a negative correlation, while MDA and 8-OhdG had a positive correlation, with depression one-month post-stroke. 8-OhdG was the most influential factor in post-stroke depression.


RESUMO Alguns estudos mostraram que o nível sérico de fator neurotrófico derivado do cérebro (BDNF) na depressão pós-AVC está altamente correlacionado com a memória e com os distúrbios neuropsiquiátricos. Objetivo: Este estudo teve como objetivo elucidar a relação entre os níveis séricos de BDNF, malondialdeído (MDA) e 8-hidroxi 2-desoxiganosanos (8 OhdG) em casos de AVC agudo com depressão pós-AVC de um mês. Métodos: Um estudo observacional foi realizado em 72 pacientes com AVC pós-isquêmico na enfermaria de Neurologia do Hospital Dr. M. Djamil, Padang, Sumatra Ocidental, Indonésia. Os níveis séricos de BDNF, MDA e 8-OhdG no AVC agudo (< 48 horas) foram medidos usando ELISA. Com base nas observações da Hamilton Depression Rating Scale realizada um mês após o AVC, os entrevistados foram divididos em dois grupos: com e sem depressão. O nível sérico médio foi analisado pelo teste T e Mann-Whitney, enquanto as diferenças nas características básicas foram analisadas pelo teste do qui-quadrado. A análise multivariada foi realizada para determinar o fator mais significativo associado à depressão pós-AVC. A taxa de erro foi fixada em 5%. Resultados: O nível de BDNF no AVC agudo foi significativamente menor na depressão do que no grupo sem depressão (p < 0,05). Os níveis de MDA e 8-OhdG no AVC agudo foram maiores no grupo de depressão (p < 0,05). O nível de BDNF durante o AVC agudo foi negativamente correlacionado com os casos de depressão pós-AVC, enquanto, inversamente, os níveis de MDA e 8-OhdG do AVC agudo foram positivamente correlacionados com os casos de depressão. Conclusão: O BDNF tem uma correlação negativa, enquanto o MDA e o 8-OhdG tiveram uma correlação positiva com a depressão um mês após o AVC. 8-OhdG foi o fator mais influente na depressão pós-AVC.


Subject(s)
Humans , Brain-Derived Neurotrophic Factor , Stroke , Depression , Ischemia , Malondialdehyde
4.
Blood Research ; : 67-68, 2020.
Article in English | WPRIM (Western Pacific) | ID: wprim-820799

ABSTRACT

No abstract available.


Subject(s)
Humans , Mass Screening , Stroke
5.
Article in Korean | WPRIM (Western Pacific) | ID: wprim-811449

ABSTRACT

PURPOSE: The purpose of this study was to investigate the muscle activities of the brachioradialis and extensor carpi radialis longus according to the type of backhand stroke in badminton.METHODS: To measure the muscle activities, we used electromyography (EMG) equipment to measure EMG values by performing maximal voluntary contraction (MVC) of the forearm muscles, which depends on the type of backhand stroke. With these values, the %maximum voluntary isometric contraction values were obtained. The data were calculated using SPSS ver. 21.0 and one-way repeated measures analysis of variance with a post-hoc least significant difference test.RESULTS: In this study, the backhand clear achieved higher maximum muscle activity values than those by the backhand push, under clear, and drive in the brachioradialis. The backhand smash achieved higher maximum muscle activity values than those by the backhand push in the extensor carpi radialis longus.CONCLUSION: The backhand clear is associated with a higher injury rate than those associated with the backhand push, under clear, and drive. The backhand smash is associated with a higher rate of the occurrence of tennis elbow than that associated with the backhand push. To prevent injuries, it is considered that the forearm's strength, stretching before and after exercise, and sufficient time to rest are important.


Subject(s)
Electromyography , Forearm , Isometric Contraction , Muscles , Racquet Sports , Stroke , Tennis Elbow
6.
Korean Circulation Journal ; : 330-342, 2020.
Article in English | WPRIM (Western Pacific) | ID: wprim-811367

ABSTRACT

BACKGROUND AND OBJECTIVES: There is insufficient evidence regarding the optimal treatment for asymptomatic carotid stenosis.METHODS: Bayesian cross-design and network meta-analyses were performed to compare the safety and efficacy among carotid artery stenting (CAS), carotid endarterectomy (CEA), and medical treatment (MT). We identified 18 studies (4 randomized controlled trials [RCTs] and 14 nonrandomized, comparative studies [NRCSs]) comparing CAS with CEA, and 4 RCTs comparing CEA with MT from MEDLINE, Cochrane Library, and Embase databases.RESULTS: The risk for periprocedural stroke tended to increase in CAS, compared to CEA (odds ratio [OR], 1.86; 95% credible interval [CrI], 0.62–4.54). However, estimates for periprocedural myocardial infarction (MI) were quite heterogeneous in RCTs and NRCSs. Despite a trend of decreased risk with CAS in RCTs (OR, 0.70; 95% CrI, 0.27–1.24), the risk was similar in NRCSs (OR, 1.02; 95% CrI, 0.87–1.18). In indirect comparisons of MT and CAS, MT showed a tendency to have a higher risk for the composite of periprocedural death, stroke, MI, or nonperiprocedural ipsilateral stroke (OR, 1.30; 95% CrI, 0.74–2.73). Analyses of study characteristics showed that CEA-versus-MT studies took place about 10-year earlier than CEA-versus-CAS studies.CONCLUSIONS: A similar risk for periprocedural MI between CEA and CAS in NRCSs suggested that concerns about periprocedural MI accompanied by CEA might not matter in real-world practice when preoperative evaluation and management are working. Maybe the benefits of CAS over MT have been overestimated considering advances in medical therapy within10-year gap between CEA-versus-MT and CEA-versus-CAS studies.


Subject(s)
Carotid Arteries , Carotid Stenosis , Endarterectomy, Carotid , Myocardial Infarction , Stents , Stroke
7.
Korean Circulation Journal ; : 267-277, 2020.
Article in English | WPRIM (Western Pacific) | ID: wprim-811351

ABSTRACT

BACKGROUND AND OBJECTIVES: Nationwide social inequalities of oral anticoagulation (OAC) usage after the introduction of non-vitamin K antagonist oral anticoagulants (NOACs) have not been well identified in patients with atrial fibrillation (AF). This study assessed overall rate and social inequalities of OAC usage after the introduction of NOAC in Korea.METHODS: Between January 2002 and December 2016, we identified 888,540 patients with AF in the Korea National Health Insurance system database. The change of OAC rate in different medical systems after the introduction of NOAC were evaluated.RESULTS: In all population, overall OAC use increased from 13.2% to 23.4% (p for trend <0.001), and NOAC use increased from 0% to 14.6% (p for trend <0.001). Compared with pre-reimbursement (0.48%), the annual increase of OAC use was significantly higher after partial (1.16%, p<0.001), and full reimbursement of OAC (3.72%, p<0.001). Full reimbursement of NOAC (adjusted odds ratio, 2.10; 95% confidence interval, 2.04–2.15) was independently associated with higher OAC use. However, the difference of overall OAC usage between tertiary referral hospitals and nursing or public health centers increased from 17.9% in 2010 to 36.8% in 2016. Moreover, usage rate of NOAC was significantly different among different medical systems from 37.2% at the tertiary referral hospital and 5.5% at nursing or public health centers.CONCLUSIONS: Introduction of NOACs in routine practice for stroke prevention in AF was associated with improved rates of overall OAC use. However, significant practice-level variations in OAC and NOAC use remain producing social inequalities of OAC despite full reimbursement.


Subject(s)
Anticoagulants , Atrial Fibrillation , Humans , Insurance , Korea , National Health Programs , Nursing , Odds Ratio , Public Health , Socioeconomic Factors , Stroke , Tertiary Care Centers
8.
Article in Korean | WPRIM (Western Pacific) | ID: wprim-811254

ABSTRACT

PURPOSE: This study assessed the food intake and nutritional status of the elderly in long-term care facilities in order to provide adequate food services and improve the nutritional status.METHODS: The survey was carried out from August 2019 to October 2019 for the elderly in long-term care facilities located in Gwangju Metropolitan City. The survey was conducted to collect data from 199 elderly persons (34 males and 165 females) aged over 65 years old. The food intake was assessed using a 1-day 24-hour recall method.RESULTS: More than 90% of the subjects were over 75 years old. Forty five percent of the subjects were active, 44.2% of the subjects perceived themselves as not being healthy. Dementia and Parkinson's disease were the most common diseases, followed by hypertension, musculo-skeletal disease, diabetes, and stroke. Only 25.6% of the subjects had most of their teeth intact, and 44.7% of the subjects had difficulty in chewing and swallowing. The total food intake was 1,127 g in males and 1,078 g in females. The most frequently consumed foods were kimchi, cooked rice with multi-grains, soybean soup, cooked rice with white rice, yogurt, pumpkin porridge, soy milk, and duck soup. The average energy intake of the subjects was 1,564.9 kcal in males and 1,535.5 kcal in females. The overall nutritional status of the elderly in the long-term care facilities was poor. In particular, the intake of vitamin D and calcium, vitamin C, riboflavin, and potassium were very low. The intake of vitamin D was 5 µg, and 86.4% of the elderly were below the estimated average requirement, while the intake of sodium was high.CONCLUSION: The results of this study can be used to understand the health and nutritional status and to improve the food services and nutrition management for the elderly in long-term care facilities.


Subject(s)
Aged , Ascorbic Acid , Calcium , Cucurbita , Deglutition , Dementia , Ducks , Eating , Energy Intake , Female , Food Services , Humans , Hypertension , Long-Term Care , Male , Mastication , Methods , Nutritional Status , Parkinson Disease , Potassium , Riboflavin , Sodium , Soy Milk , Soybeans , Stroke , Tooth , Vitamin D , Yogurt
9.
Yonsei Medical Journal ; : 120-128, 2020.
Article in English | WPRIM (Western Pacific) | ID: wprim-782200

ABSTRACT

PURPOSE: Stroke prevention in patients with atrial fibrillation (AF) is influenced by many factors. Using a contemporary registry, we evaluated variables associated with the use of warfarin or direct oral anticoagulants (OACs).MATERIALS AND METHODS: In the prospective multicenter CODE-AF registry, 10529 patients with AF were evaluated. Multivariate analyses were performed to identify variables associated with the use of anticoagulants.RESULTS: The mean age of the patients was 66.9±14.4 years, and 64.9% were men. The mean CHA2DS2-VASc and HAS-BLED scores were 2.6±1.7 and 1.8±1.1, respectively. In patients with high stroke risk (CHA2DS2-VASc ≥2), OACs were used in 83.2%, including direct OAC in 68.8%. The most important factors for non-OAC treatment were end-stage renal disease [odds ratio (OR) 0.27; 95% confidence interval (CI): 0.19–0.40], myocardial infarct (OR 0.53; 95% CI: 0.40–0.72), and major bleeding (OR 0.57; 95% CI: 0.39–0.84). Female sex (OR 1.40; 95% CI: 1.21–1.61), cancer (OR 1.78; 95% CI: 1.38–2.29), and smoking (OR 1.60; 95% CI: 1.15–2.24) were factors favoring direct OAC use over warfarin. Among patients receiving OACs, the rate of combined antiplatelet agents was 7.8%. However, 73.6% of patients did not have any indication for a combination of antiplatelet agents.CONCLUSION: Renal disease and history of valvular heart disease were associated with warfarin use, while cancer and smoking status were associated with direct OAC use in high stroke risk patients. The combination of antiplatelet agents with OAC was prescribed in 73.6% of patients without definite indications recommended by guidelines.


Subject(s)
Anticoagulants , Atrial Fibrillation , Female , Heart Valve Diseases , Hemorrhage , Humans , Kidney Failure, Chronic , Male , Multivariate Analysis , Myocardial Infarction , Platelet Aggregation Inhibitors , Prospective Studies , Smoke , Smoking , Stroke , Warfarin
10.
Article in English | WPRIM (Western Pacific) | ID: wprim-782170

ABSTRACT

Appropriate use and analysis of neuroimaging techniques is an inevitable aspect of clinical trials for patients with acute ischemic stroke. Neuroimaging examinations were recently used to define the core eligibility criteria and outcomes in acute ischemic stroke research. Recent clinical trials for endovascular treatment in acute ischemic stroke have also demonstrated the efficacy or safety of endovascular treatment using various imaging modalities as well as clinical indices. Furthermore, independent imaging reviews and imaging core laboratory assessments are essential to manage and analyze imaging data in order to enhance the reliability of the outcomes. Therefore, we systematically reviewed the use of neuroimaging in recent randomized clinical trials for endovascular treatment of acute ischemic stroke in order to provide a thorough summary, which would serve as a resource guiding the use of appropriate imaging protocols and analyses in future clinical trials for acute ischemic stroke. This review will help researchers select appropriate imaging biomarkers among the various imaging protocols available and apply the selected type of imaging examination for each study in accordance with the academic purpose.


Subject(s)
Biomarkers , Humans , Neuroimaging , Stroke
11.
Article in English | WPRIM (Western Pacific) | ID: wprim-782165

ABSTRACT

OBJECTIVE: Avoiding a catastrophic outcome may be a more realistic goal than achieving functional independence in the treatment of acute stroke in octogenarians. This study aimed to investigate predictors of catastrophic outcome in elderly patients after an endovascular thrombectomy with an acute anterior circulation large vessel occlusion (LVO).MATERIALS AND METHODS: Data from 82 patients aged ≥ 80 years, who were treated with thrombectomy for acute anterior circulation LVO, were analyzed. The association between clinical/imaging variables and catastrophic outcomes was assessed. A catastrophic outcome was defined as a modified Rankin Scale score of 4–6 at 90 days.RESULTS: Successful reperfusion was achieved in 61 patients (74.4%), while 47 patients (57.3%) had a catastrophic outcome. The 90-day mortality rate of the treated patients was 15.9% (13/82). The catastrophic outcome group had a significantly lower baseline diffusion-weighted imaging-Alberta stroke program early CT score (DWI-ASPECTS) (7 vs. 8, p = 0.014) and a longer procedure time (42 minutes vs. 29 minutes, p = 0.031) compared to the non-catastrophic outcome group. Successful reperfusion was significantly less frequent in the catastrophic outcome group (63.8% vs. 88.6%, p = 0.011) compared to the non-catastrophic outcome group. In a binary logistic regression analysis, DWI-ASPECTS (odds ratio [OR], 0.709; 95% confidence interval [CI], 0.524–0.960; p = 0.026) and successful reperfusion (OR, 0.242; 95% CI, 0.071–0.822; p = 0.023) were independent predictors of a catastrophic outcome.CONCLUSION: Baseline infarct size and reperfusion status were independently associated with a catastrophic outcome after endovascular thrombectomy in elderly patients aged ≥ 80 years with acute anterior circulation LVO.


Subject(s)
Aged , Aged, 80 and over , Humans , Logistic Models , Mortality , Reperfusion , Stroke , Thrombectomy
12.
Article in English | WPRIM (Western Pacific) | ID: wprim-782080

ABSTRACT

BACKGROUND AND PURPOSE: Fibroblast growth factor 23 (FGF23) is associated with atherosclerosis via nitric-oxide-associated endothelial dysfunction and calcium-phosphate-related bone mineralization. This study aimed to determine the association of the plasma FGF23 concentration with intracranial cerebral atherosclerosis (ICAS) and extracranial cerebral atherosclerosis (ECAS).METHODS: We prospectively enrolled 262 first-ever ischemic stroke patients in whom brain magnetic resonance was performed and a blood sample acquired within 24 h after admission. Plasma FGF23 concentrations were measured using an enzyme-linked immunosorbent assay. The presence of ICAS or ECAS was defined as a ≥50% decrease in arterial diameter in magnetic resonance angiography. The burden of cerebral atherosclerosis was calculated by adding the total number of vessels defined as ICAS or ECAS.RESULTS: Our study population included 152 (58.0%) males. The mean age was 64.7 years, and the plasma FGF23 concentration was 347.5±549.6 pg/mL (mean±SD). ICAS only, ECAS only, and both ICAS and ECAS were present in 31.2% (n=82), 4.9% (n=13), and 6.8% (n=18) of the subjects, respectively. In multivariate binary and ordinal logistic analyses, after adjusting for sex, age, and variables for which p < 0.1 in the univariate analysis, the plasma FGF23 concentration (per 100 pg/mL) was positively correlated with the presence of ICAS [odds ratio (OR)=1.07, 95% CI=1.00–1.15, p=0.039], burden of ICAS (OR=1.09, 95% CI=1.04–1.15, p=0.001), and burden of ECAS (OR=1.06, 95% CI=1.00–1.12, p=0.038), but it was not significantly related to the presence of ECAS (OR=1.05, 95% CI=0.99–1.12, p=0.073).CONCLUSIONS: The plasma FGF23 may be a potential biomarker for cerebral atherosclerosis, particularly the presence and burden of ICAS in stroke patients.


Subject(s)
Atherosclerosis , Brain , Calcification, Physiologic , Enzyme-Linked Immunosorbent Assay , Fibroblast Growth Factors , Fibroblasts , Humans , Intracranial Arteriosclerosis , Magnetic Resonance Angiography , Male , Plasma , Prospective Studies , Stroke
13.
Article in English | WPRIM (Western Pacific) | ID: wprim-782076

ABSTRACT

BACKGROUND AND PURPOSE: Gamma-glutamyl transferase (GGT) is reported to be associated with stroke independently of the conventional risk factors. However, the underlying mechanism remains to be identified. This study focused on atrial fibrillation (AF), which also reportedly has a close association with GGT.METHODS: Acute ischemic stroke patients who were admitted to the Seoul National University Hospital within 7 days of stroke onset were analyzed. Multinomial logistic regression was performed to assess the relationship between GGT and cardioembolic stroke. Mediation analysis based on binary logistic regression was used to determine whether AF mediates the relationship between GGT and cardioembolic stroke.RESULTS: AF was found in 132 (15.0%) of 880 eligible patients with acute ischemic stroke, and 270 (30.7%) patients were categorized as cardioembolic stroke. High GGT levels in acute ischemic stroke patients was associated with cardioembolic stroke [odds ratio (OR)=3.42, 95% CI=1.59–7.37], but not with large-artery atherosclerosis stroke (OR=1.10, 95% CI=0.54–2.23). Approximately half (53.9%) of the total effect of GGT levels on cardioembolic stroke was mediated by AF.CONCLUSIONS: The GGT level was significantly associated with cardioembolic stroke via AF. The results obtained in the present study may explain why GGT is associated with stroke.


Subject(s)
Atherosclerosis , Atrial Fibrillation , Biomarkers , Humans , Logistic Models , Negotiating , Risk Factors , Seoul , Stroke , Transferases
14.
Article in English | WPRIM (Western Pacific) | ID: wprim-782068

ABSTRACT

BACKGROUND AND PURPOSE: Similar-sized stroke lesions at similar locations can have different prognoses in clinical practice. Lesion-network mapping elucidates network-level effects of lesions that cause specific neurologic symptoms and signs, and also provides a group-level understanding. This study visualized the effects of stroke lesions on the functional brain networks of individual patients.METHODS: We enrolled patients with ischemic stroke who were hospitalized within 1 week of the stroke occurrence. Resting-state functional magnetic resonance imaging was performed 3 months after the index stroke. For image preprocessing, acute stroke lesions were visually delineated based on diffusion-weighted images obtained at admission, and the lesion mask was drawn using MRIcron software. Correlation matrices were calculated from 280 brain regions using the Brainnetome Atlas, and connectograms were visualized using in-house MATLAB code.RESULTS: We found characteristic differences in connectograms between pairs of patients who had comparable splenial, frontal cortical, cerebellar, and thalamocapsular lesions. Two representative patients with bilateral thalamic infarctions showed significant differences in their reconstructed connectograms. The cognitive function had recovered well at 3 months after stroke occurrence in patients with well-maintained interhemispheric and intrahemispheric connectivities.CONCLUSIONS: This pilot study has visualized the effects of stroke lesions on the functional brain networks of individual patients. Consideration of the neurobiologic mechanisms underlying the differences between their connectograms has yielded new hypotheses about differences in the effects of stroke lesions.


Subject(s)
Brain , Cerebral Infarction , Cognition , Connectome , Functional Neuroimaging , Humans , Infarction , Magnetic Resonance Imaging , Masks , Neurologic Manifestations , Pilot Projects , Prognosis , Stroke
15.
Article in Chinese | WPRIM (Western Pacific) | ID: wprim-781775

ABSTRACT

OBJECTIVE@#To compare the differences in the clinical effect on post-stroke hand spasm among the combined treatment of penetrating acupuncture and kinesiotherapy, the simple application of penetrating acupuncture and the simple application of kinesiotherapy.@*METHODS@#A total of 105 patients with post-stroke hand spasm were randomized into a penetrating acupuncture group, a kinesiotherapy group and a combined treatment group, 35 cases in each one, of which, 2 cases were dropped out in either the combined treatment group and the penetrating acupuncture group, and 1 case dropped out in the kinesiotherapy group. The routine rehabilitation training, e.g. occupational therapy and Bobath exercise and medication were adopted in all of the three groups. In the penetrating acupuncture group, the penetrating needling technique was exerted from Hegu (LI 4) to Houxi (SI 3) and from Waiguan (TE 5) to Sidu (TE 9) on the affected side. In the kinesiotherapy group, the persistent movement or passive movement was exerted on the wrist joint, the metacarpophalangeal joints and the interphalangeal joints. In the combined treatment group, the penetrating acupuncture (the same as the penetrating acupuncture group) was exerted combined with kinesiotherapy (the same as the kinesiotherapy group). In each group, the treatment was given once a day, 30 min in each time, 6 treatments a week in total, with the interval of 1 day between the courses. The treatment for 2 weeks was as one course and 2 courses were required totally. Before and after treatment, the scores of hand spasm index, hand-wrist motor function and the activity of daily living (ADL) were compared in each group.@*RESULTS@#After treatment, the scores of hand spasm index were reduced as compared with those before treatment in each group (0.05).@*CONCLUSION@#Compared with the simple application of either penetrating acupuncture or kinesiotherapy, the combined treatment of them achieves the significant improvements in hand spasm degree, hand wrist motor function and ADL in patients with stroke.


Subject(s)
Acupuncture Points , Acupuncture Therapy , Humans , Kinesis , Spasm , Therapeutics , Stroke , Stroke Rehabilitation , Treatment Outcome
16.
Article in Chinese | WPRIM (Western Pacific) | ID: wprim-781774

ABSTRACT

OBJECTIVE@#To compare the therapeutic effect of plum-blossom needle tapping at three meridians of wrist combined with rehabilitation training and simple rehabilitation training on wrist joint contracture after stroke.@*METHODS@#A total of 72 patients with wrist joint contracture after stroke were randomized into an observation group and a control group, 36 cases in each one. In the control group, simple rehabilitation training was applied, 5 times a week, 3 weeks as one course and totally 3 courses were required. On the basis of the treatment in the control group, plum-blossom needle tapping at three meridians of wrist was adopted in the observation group. The tapping regions were wrist traveling parts of three meridians of hand, ranging from up 3 to below 1 of wrist crease, 3 times a week, 3 weeks as one course and totally 3 courses were required. The active range of motion (AROM) of active wrist extension, Fugl-Meyer score (FMA) and Barthel index (BI) score were observed before and after treatment in the two groups.@*RESULTS@#The AROM, FMA scores and BI scores after treatment in the two groups were superior to before treatment (<0.05), and the improvements of 3 indexes in the observation group were superior to the control group (<0.05).@*CONCLUSION@#The therapeutic effect of plum-blossom needle tapping at three meridians of wrist combined with rehabilitation training is superior to simple rehabilitation training on wrist joint contracture after stroke.


Subject(s)
Acupuncture Therapy , Contracture , Therapeutics , Humans , Meridians , Stroke , Stroke Rehabilitation , Treatment Outcome , Wrist , Wrist Joint
17.
Chonnam Medical Journal ; : 36-43, 2020.
Article in English | WPRIM (Western Pacific) | ID: wprim-787276

ABSTRACT

We evaluated whether thrombus aspiration (TA) during primary percutaneous coronary intervention (PCI) reduces adverse clinical outcomes within 30-days and 1-year periods. There is no well-designed, Korean data about the clinical impact of intracoronary TA during primary PCI in patients with ST-segment elevation myocardial infarction (STEMI). From the Korea Acute Myocardial Infarction Registry-National Institute of Health, 3749 patients with STEMI undergoing primary PCI within 12 hours (60.8±12.9 years, 18.7% women) with pre-procedural Thrombolysis in Myocardial Infarction (TIMI) flow 0, 1 in coronary angiography were enrolled between November 2011 and December 2015. The patients were divided into two groups: PCI with TA (n=1630) and PCI alone (n=2119). The primary end-point was major adverse cardiac event (MACE), defined as the composite of cardiovascular death (CVD), recurrent MI and stroke for 30-days and 1-year. TA did not diminish the risk of MACE, all-cause mortality and CVD in all patients during 30-days or 1-year. After performing the propensity score matching, TA also did not reduce the risk of MACE (Hazard ratio (HR) with 95% Confidence Interval (CI):1.187 [0.863-1.633], p value=0.291), all-cause mortality (HR with 95% CI: 1.130 [0.776-1.647], p value=0.523) and CVD (HR with 95% CI: 1.222 [0.778-1.920], p value=0.384) during the 1-year period. In subgroup analysis, there was no benefit of clinical outcomes favoring PCI with TA. In conclusion, primary PCI with TA did not reduce MACE, all-cause mortality or CVD among the Korean patients with STEMI and pre-procedural TIMI flow 0, 1 during the 30-day and 1-year follow ups.


Subject(s)
Coronary Angiography , Follow-Up Studies , Humans , Korea , Mortality , Myocardial Infarction , Percutaneous Coronary Intervention , Propensity Score , Stroke , Thrombectomy , Thrombosis
18.
Chonnam Medical Journal ; : 55-61, 2020.
Article in English | WPRIM (Western Pacific) | ID: wprim-787273

ABSTRACT

The optimal dose of beta blockers after acute myocardial infarction (MI) remains uncertain. We evaluated the effectiveness of low-dose nebivolol, a beta1 blocker and a vasodilator, in patients with acute MI. A total of 625 patients with acute MI from 14 teaching hospitals in Korea were divided into 2 groups according to the dose of nebivolol (nebistol®, Elyson Pharmaceutical Co., Ltd., Seoul, Korea): low-dose group (1.25 mg daily, n=219) and usual- to high-dose group (≥2.5 mg daily, n=406). The primary endpoints were major adverse cardiac and cerebrovascular events (MACCE, composite of death from any cause, non-fatal MI, stroke, repeat revascularization, rehospitalization for unstable angina or heart failure) at 12 months. After adjustment using inverse probability of treatment weighting, the rates of MACCE were not different between the low-dose and the usual- to high-dose groups (2.8% and 3.1%, respectively; hazard ratio: 0.92, 95% confidence interval: 0.38 to 2.24, p=0.860). The low-dose nebivolol group showed higher rates of MI than the usual- to high-dose group (1.2% and 0%, p=0.008). The 2 groups had similar rates of death from any cause (1.1% and 0.3%, p=0.273), stroke (0.4% and 1.1%, p=0.384), repeat PCI (1.2% and 0.8%, p=0.428), rehospitalization for unstable angina (1.2% and 1.0%, p=0.743) and for heart failure (0.6% and 0.7%, p=0.832). In patients with acute MI, the rates of MACCE for low-dose and usual- to high-dose nebivolol were not significantly different at 12-month follow-up.


Subject(s)
Angina, Unstable , Follow-Up Studies , Heart , Heart Failure , Hospitals, Teaching , Humans , Hypertension , Korea , Myocardial Infarction , Nebivolol , Observational Study , Receptors, Adrenergic, beta , Seoul , Stroke
19.
Article in English | WPRIM (Western Pacific) | ID: wprim-811143

ABSTRACT

BACKGROUND: Diabetes mellitus is associated with an increased risk of dementia. We aimed to comprehensively analyze the incidence and risk factors for dementia and young-onset dementia (YOD) in diabetic patients in Korea using the National Health Insurance Service data.METHODS: Between January 1, 2009 and December 31, 2012, a total of 1,917,702 participants with diabetes were included and followed until the date of dementia diagnosis or until December 31, 2015. We evaluated the incidence and risk factors for all dementia, Alzheimer's disease (AD), and vascular dementia (VaD) by Cox proportional hazards analyses. We also compared the impact of risk factors on the occurrence of YOD and late-onset dementia (LOD).RESULTS: During an average of 5.1 years of follow-up, the incidence of all types of dementia, AD, or VaD was 9.5, 6.8, and 1.3/1,000 person-years, respectively, in participants with diabetes. YOD comprised 4.8% of all dementia occurrence, and the ratio of AD/VaD was 2.1 for YOD compared with 5.5 for LOD. Current smokers and subjects with lower income, plasma glucose levels, body mass index (BMI), and subjects with hypertension, dyslipidemia, vascular complications, depression, and insulin treatment developed dementia more frequently. Vascular risk factors such as smoking, hypertension, and previous cardiovascular diseases were more strongly associated with the development of VaD than AD. Low BMI and a history of stroke or depression had a stronger influence on the development of YOD than LOD.CONCLUSION: The optimal management of modifiable risk factors may be important for preventing dementia in subjects with diabetes mellitus.


Subject(s)
Alzheimer Disease , Blood Glucose , Body Mass Index , Cardiovascular Diseases , Dementia , Dementia, Vascular , Depression , Diabetes Mellitus , Diabetes Mellitus, Type 2 , Diagnosis , Dyslipidemias , Follow-Up Studies , Humans , Hypertension , Incidence , Insulin , Korea , National Health Programs , Risk Factors , Smoke , Smoking , Stroke
20.
Article in English | WPRIM (Western Pacific) | ID: wprim-811125

ABSTRACT

BACKGROUND: The number of patients with systemic lupus erythematosus (herein, lupus) undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA) is increasing. There is disagreement about the effect of lupus on perioperative complication rates. We hypothesized that lupus would be associated with higher complication rates in patients who undergo elective primary THA or TKA.METHODS: Records of more than 6.2 million patients from the National Inpatient Sample who underwent elective primary THA or TKA from 2000 to 2009 were reviewed. Patients with lupus (n = 38,644) were compared with those without lupus (n = 6,173,826). Major complications were death, pulmonary embolism, myocardial infarction, stroke, pneumonia, and acute renal failure. Minor complications were wound infection, seroma, deep vein thrombosis, hip dislocation, wound dehiscence, and hematoma. Patient age, sex, duration of hospital stay, and number of Elixhauser comorbidities were assessed for both groups. Multivariate logistic regression models using comorbidities, age, and sex as covariates were used to assess the association of lupus with major and minor perioperative complications. The alpha level was set to 0.001.RESULTS: Among patients who underwent THA, those with lupus were younger (mean age, 56 vs. 65 years), were more likely to be women (87% vs. 56%), had longer hospital stays (mean, 4.0 vs. 3.8 days), and had more comorbidities (mean, 2.5 vs. 1.4) than those without lupus (all p < 0.001). In patients with THA, lupus was independently associated with major complications (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.1 to 1.7) and minor complications (OR, 1.2; 95% CI, 1.0 to 1.5). Similarly, among patients who underwent TKA, those with lupus were younger (mean, 62 vs. 67 years), were more likely to be women (93% vs. 64%), had longer hospital stays (mean, 3.8 vs. 3.7 days), and had more comorbidities (mean, 2.8 vs. 1.7) than those without lupus (all p < 0.001). However, in TKA patients, lupus was not associated with greater odds of major complications (OR, 1.2; 95% CI, 0.9 to 1.4) or minor complications (OR, 1.1; 95% CI, 0.9 to 1.3).CONCLUSIONS: Lupus is an independent risk factor for major and minor perioperative complications in elective primary THA but not TKA.


Subject(s)
Acute Kidney Injury , Arthroplasty, Replacement, Hip , Arthroplasty, Replacement, Knee , Comorbidity , Female , Hematoma , Hip Dislocation , Hip , Humans , Inpatients , Knee , Length of Stay , Logistic Models , Lupus Erythematosus, Systemic , Myocardial Infarction , Pneumonia , Pulmonary Embolism , Risk Factors , Seroma , Stroke , Venous Thrombosis , Wound Infection , Wounds and Injuries
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