Long-Term Changes in Post-Stroke Depression, Emotional Incontinence, and Anger / 대한뇌졸중학회지

Background@#and Purpose Long-term changes in post-stroke depression (PSD), post-stroke emotional incontinence (PSEI), and post-stroke anger (PSA) have rarely been studied. @*Methods@#This is a sub-study of EMOTION, a randomized, placebo-controlled trial, that examined the efficacy of escitalopram on PSD, PSEI, and PSA in patients with stroke. We interviewed patients at the long-term period (LTP) using predefined questionnaires: Montgomery-Åsberg depression rating scale (MADRS) for PSD, modified Kim’s criteria for PSEI, and Spielberger trait anger scale for PSA. Additionally, the ENRICHD Social Support Instrument (ESSI) for the social support state and the modified Rankin Scale (mRS) were measured. We investigated the changes in and factors behind PSD, PSEI, and PSA at LTP. @*Results@#A total of 222 patients were included, and the median follow-up duration was 59.5 months (interquartile range, 50 to 70). Compared to the data at 6 months post-stroke, the prevalence of PSEI (11.7% at 6 months, 6.3% at LTP; P=0.05) and mean anger score (21.62, 16.24; P<0.01) decreased, while the prevalence of PSD (35.6%, 44.6%; P=0.03) and mean MADRS (6.16, 8.67; P<0.01) increased at LTP. ESSI was associated with PSD and PSA, but not with PSEI. The effect of the baseline National Institutes of Health Stroke Scale score on PSD decreased over time. The effect of low social support on PSD was greater than that of mRS at LTP. @*Conclusions@#The prevalence and degree of PSD significantly increased, while those of PSEI and PSA decreased at LTP. PSD in this stage appeared to be more closely associated with a lack of social support than patients' physical disabilities.

Long-Term Changes in Post-Stroke Depression, Emotional Incontinence, and Anger / 대한뇌졸중학회지

Background@#and Purpose Long-term changes in post-stroke depression (PSD), post-stroke emotional incontinence (PSEI), and post-stroke anger (PSA) have rarely been studied. @*Methods@#This is a sub-study of EMOTION, a randomized, placebo-controlled trial, that examined the efficacy of escitalopram on PSD, PSEI, and PSA in patients with stroke. We interviewed patients at the long-term period (LTP) using predefined questionnaires: Montgomery-Åsberg depression rating scale (MADRS) for PSD, modified Kim’s criteria for PSEI, and Spielberger trait anger scale for PSA. Additionally, the ENRICHD Social Support Instrument (ESSI) for the social support state and the modified Rankin Scale (mRS) were measured. We investigated the changes in and factors behind PSD, PSEI, and PSA at LTP. @*Results@#A total of 222 patients were included, and the median follow-up duration was 59.5 months (interquartile range, 50 to 70). Compared to the data at 6 months post-stroke, the prevalence of PSEI (11.7% at 6 months, 6.3% at LTP; P=0.05) and mean anger score (21.62, 16.24; P<0.01) decreased, while the prevalence of PSD (35.6%, 44.6%; P=0.03) and mean MADRS (6.16, 8.67; P<0.01) increased at LTP. ESSI was associated with PSD and PSA, but not with PSEI. The effect of the baseline National Institutes of Health Stroke Scale score on PSD decreased over time. The effect of low social support on PSD was greater than that of mRS at LTP. @*Conclusions@#The prevalence and degree of PSD significantly increased, while those of PSEI and PSA decreased at LTP. PSD in this stage appeared to be more closely associated with a lack of social support than patients' physical disabilities.

Pharmacologically Induced Hypertension Therapy for Acute Stroke Patients / 대한뇌졸중학회지

No abstract available.

Multidisciplinary Approach to Decrease In-Hospital Delay for Stroke Thrombolysis / 대한뇌졸중학회지

BACKGROUND AND PURPOSE: Decreasing the time delay for thrombolysis, including intravenous thrombolysis (IVT) with tissue plasminogen activator and intra-arterial thrombectomy (IAT), is critical for decreasing the morbidity and mortality of patients experiencing acute stroke. We aimed to decrease the in-hospital delay for both IVT and IAT through a multidisciplinary approach that is feasible 24 h/day. METHODS: We implemented the Stroke Alert Team (SAT) on May 2, 2016, which introduced hospital-initiated ambulance prenotification and reorganized in-hospital processes. We compared the patient characteristics, time for each step of the evaluation and thrombolysis, thrombolysis rate, and post-thrombolysis intracranial hemorrhage from January 2014 to August 2016. RESULTS: A total of 245 patients received thrombolysis (198 before SAT; 47 after SAT). The median door-to-CT, door-to-MRI, and door-to-laboratory times decreased to 13 min, 37.5 min, and 8 min, respectively, after SAT implementation (P<0.001). The median door-to-IVT time decreased from 46 min (interquartile range [IQR] 36–57 min) to 20.5 min (IQR 15.8–32.5 min; P<0.001). The median door-to-IAT time decreased from 156 min (IQR 124.5–212.5 min) to 86.5 min (IQR 67.5–102.3 min; P<0.001). The thrombolysis rate increased from 9.8% (198/2,012) to 15.8% (47/297; P=0.002), and the post-thrombolysis radiological intracranial hemorrhage rate decreased from 12.6% (25/198) to 2.1% (1/47; P=0.035). CONCLUSIONS: SAT significantly decreased the in-hospital delay for thrombolysis, increased thrombolysis rate, and decreased post-thrombolysis intracranial hemorrhage. Time benefits of SAT were observed for both IVT and IAT and during office hours and after-hours.

Japanese Encephalitis Associated with Flaccid Quadriplegia

Japanese encephalitis is the one of the leading causes of viral encephalitis in Asia. We report on a 56-year-old man with Japanese encephalitis with an unusual manifestation of flaccid quadriplegia. Brain MRI revealed bilateral lesions in the thalamus, midbrain, and medial temporal lobe. Cervical MRI revealed lesion in the bilateral anterior spinal cord. Electromyography revealed active denervation in all four limbs and paraspinal muscles, suggesting a diffuse anterior-horn cell lesion. We report a patient with Japanese encephalitis accompanied by flaccid quadriplegia.

Effects of Benincasa hispida Fractions on Hepatic Lipid Levels and Lipid Peroxidation in Streptozotocin Induced Diabetic Rats

The effects of fractions of ethanol extract of Benincasa hispida (wax gourd) on lipid levels and lipid peroxidation in streptozotocin (STZ) induced diabetic rats were examined. Sprague-Dawley rats were induced diabetes mellitus by STZ injection (45 mg/kg) into the tail vein and were divided into 5 groups: normal, STZ-control, three experimental diabetic groups [chloroform (CHCl3) fraction group, butanol (BuOH) fraction group, and water fraction group]. Fractions of ethanol extract of Benincasa hispida were administered orally into the diabetic rats for 14 days. The liver glycogen levels of CHCl3 fraction group and the muscle glycogen levels of BuOH and water fraction groups were significantly higher than that of STZ-control group. Pancreas protein levels of BuOH and water fraction groups were significantly higher than that of STZ-control group. The liver cholesterol level of BuOH and water fraction groups were significantly lower when compared with the STZ-control group. The level of liver triglyceride in BuOH and water fraction groups were significantly higher than that of STZ-control group. Malondialdehyde (MDA) levels in liver of normal and diabetic groups were not significantly different. In the pancreas, the MDA levels of BuOH and water fraction group were significantly lower than that of STZ-control group. The results suggested that the supplementation of the BuOH and water fractions of Benincasa hispida extract could be beneficial for the diabetic complications and damages from the lipid peroxidation.

Effects of Fractions of Benincasa hispida on Plasma Levels of Glucose and Lipid in Streptozotocin Induced Diabetic Rats

This study was designed to examine the effects of fractions of ethanol extract of Benincasa hispida (wax gourd) on plasma glucose and lipid levels in streptozotocin (STZ) induced diabolic rats. sprague-Dawley rats were induced diabetes mellitus by STZ injection (45 mg/kg) into the tail vein and were divided into 5 groups: normal, STZ-control, three experimental diabetic groups. fractions of ethanol extract of Benincasa hispida were administered orally into the diabetic rats for 14 days. The food intake and body weight were monitored and plasma levels of glucose, cholesterol, HDL-cholesterol, triglyceride (TG) , free fatty acid (FFA) , and aminotransferase activity were analyzed. A significant lowering effects of plasma glucose levels were observed in the chloroform fraction and H2O fraction group compared to STZ-control group at 14 days. Administrations of each of the three fractions decreased plasma TG and FFA levels in diabetic rats. Activity of alanine aminotransferase (ALT) in CHCl3 fraction and H2O fraction groups and aspartate aminotransferase (AST) in $H_2O$ fraction group significantly lower than STZ-control group. The results show that CHCl3 fraction of Benincasa hispida could be effective to control the STZ-induced diabetic rats.