ABSTRACT
Background and Purpose- The increasing demand and shortage of experts to evaluate and treat acute stroke patients has led to the development of remote communication tools to aid stroke management. We aimed to evaluate the JOIN App smartphone system-a low-cost tool for rapid clinical and neuroimaging data sharing to expedite decision-making in stroke. Methods- Consecutive acute ischemic stroke patients treated at a University Hospital in Brazil from December 2014 to December 2015 were evaluated. The analysis included all patients presenting with acute ischemic stroke who underwent initial evaluation by neurology residents followed by JOIN teleconsultation with a stroke neurologist on call for management decisions. An expert panel of stroke neurologists and neuroradiologists revised all cases using a standard Picture Archiving and Communication System imaging workstation within 24 hours and analyzed the decision made with remote assistance during the emergency setting. Results- A total of 720 stroke codes were evaluated with 442 acute ischemic stroke qualifying. Seventy-eight (18%) patients were treated with intravenous thrombolysis. The main reasons for tPA (tissue-type plasminogen activator) exclusion were symptom onset >4.5 hours (n=295; 67%) and hypodense middle cerebral artery territory area >1/3 (n=31; 7%). The agreement rates between Picture Archiving and Communication System versus JOIN-based thrombolysis decisions were 100% for the stroke (unblinded) and 99.3% for the neuroradiologist (blinded) experts. The use of the application resulted in a significant reduction in the door-to-needle times across the pre- versus postimplementation periods (median, 90 [interquartile range, 75-106] versus 63 [interquartile range, 61-117] minutes; P=0.03). The rates of 90-day excellent outcomes (modified Rankin Scale, 0-1) were 51.3%; 90-day mortality, 2.6%; and symptomatic intracranial hemorrhage, 3.8%. Conclusions- The JOIN smartphone system allows rapid sharing of clinical and imaging data to facilitate decisions for stroke treatment. The remote application-based decisions seem to be as accurate as the physical presence of stroke experts and might lead to faster times to treatment. This system represents an easily implementable low-cost telemedicine solution for centers that cannot afford the full-time presence of stroke specialists.
Subject(s)
Mobile Applications , Neuroimaging , Smartphone , Stroke , Telemedicine , Thrombolytic Therapy , Tissue Plasminogen Activator/therapeutic use , Acute Disease , Administration, Intravenous , Aged , Female , Hospitals, Special , Humans , Male , Middle Aged , Stroke/diagnostic imaging , Stroke/drug therapySubject(s)
Diabetes Mellitus, Experimental/physiopathology , Disease Models, Animal , Fibroblast Growth Factor 2/physiology , Interleukin-1beta/physiology , Mouth Diseases/physiopathology , Tumor Necrosis Factor-alpha/physiology , Wound Healing , Animals , Diabetes Mellitus, Experimental/metabolism , Diabetes Mellitus, Experimental/pathology , Male , Mouth Diseases/metabolism , Mouth Diseases/pathology , Rats , Rats, WistarABSTRACT
O objetivo do presente trabalho foi comparar os cromégenos Diaminobenzidina e fucsina básica em estudos imunoistoquímicos de lesões pigmentadas. O carcinoma basocelular pigmentado foi escolhido como modelo tumoral para o estudo utilizando-se o anticorpo: bcl-2. Quatro carcinomas basocelulares pigmentados e quatro não-pigmentados foram selecionados, seccionados em cortes para coloração em hematoxilina e eosina e para técnica de imunoistoquímica utilizando-se dois cromógenos diferentes: diaminobenzidina e fucsina básica. A maioria das células positivas para a proteína bcl-2 e coradas com diaminobenzidina exibiu uma marcação citoplasmática acastanhada homogênea similar com o padrão de coloração promovido pela prersença de melanina nas células pigmentadas. Baseado nos resultados sugere-se a utilização da fucsina básica em tecidos pigmentados evitando o cromógeno diaminobenzidina, o qual dificulta a avaliação dos resultados comumente apresentando falso positivo.
