Stroke 20 p2003 by 8Fb959a

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Adams, J.G. and Chisholm, C.D. (2003), The society for academic emergency medicine
   position on optimizing care of the stroke patient. Academic Emergency Medicine, 10
   (7), 805
Keywords:        emergency/emergency        medicine/MI/PA/patient/position/stroke/stroke
Summers, R.L., Shoemaker, W.C., Peacock, W.F., Ander, D.S. and Coleman, T.G.
   (2003), Bench to bedside: Electrophysiologic and clinical principles of noninvasive
   hemodynamic monitoring using impedance cardiography. Academic Emergency
   Medicine, 10 (6), 669-680.
Abstract: The evaluation of the hemodynamic state of the severely ill patient is a
   common problem in emergency medicine. While conventional vital signs offer some
   insight into delineating the circulatory pathophysiology, it is often impossible to
   determine the true clinical state from an analysis of blood pressure and heart rate
   alone. Cardiac output measurements by thermodilution have been the criterion
   standard for the evaluation of hemodynamics. However, this technology is invasive,
   expensive, time-consuming, and impractical for most emergency department
   environments. Impedance cardiography (ICG) is a noninvasive method of obtaining
   continuous measurements of hemodynamic data such as cardiac output that requires
   little technical expertise. ICG technology was first developed by NASA in the 1960s
   and is based on the idea that the human thorax is electrically a nonhomogeneous,
   bulk conductor. Variation in the impedance to flow of a high-frequency,
   low-magnitude alternating current across the thorax results in the generation of a
   measured waveform. from which stroke volume can be calculated by a modification
   of the pulse contour method. To adequately judge the possible role of this technology
   in the practice of emergency medicine, it is important to have a sufficient
   understanding of the basic scientific principles involved as well as the clinical
   validity and limitations of the technique
Keywords:                     analysis/blood/blood               pressure/cardiac/cardiac
   LY ILL/EJECTION FRACTION/emergency/emergency department/emergency
   medicine/EMERGENCY                     PATIENTS/evaluation/expertise/flow/heart/heart
   VOLUME/technique/technology/thermodilution/THORACIC                    ELECTRICAL
   BIOIMPEDANCE/TIME INTERVALS/understanding/USA/validity/volume
Clayton, D.B. and Lenkinski, R.E. (2003), MR imaging of sodium in the human brain
   with a fast three- dimensional gradient-recalled-echo sequence at 4 T. Academic
   Radiology, 10 (4), 358-365.
Abstract: Rationale and Objectives. Sodium ions play a vital role in cellular homeostasis
   and electrochemical activity throughout the human body. However, the in vivo
   detection of sodium (Na- 23) with magnetic resonance (MR) techniques is hindered
   by the fast transverse relaxation, low tissue equivalent concentration, and small
   gyromagnetic ratio of sodium ions compared with protons (H-1). The goals of this
   study were to acquire MR images of sodium in the whole human brain by using a
   fast three-dimensional gradient-recalled-echo sequence and to investigate the effect
   that restrictions on specific absorption ratio have on MR imaging of sodium at 4 T.
  Materials and Methods. A three-dimensional gradient-recalled-echo sequence with
  short echo time was developed for MR imaging of sodium. Slab encoding was
  removed and a hard excitation pulse was used. Five healthy human volunteers were
  examined in a whole-body MR imager with the use of a custom transmit-and-receive
  birdcage coil. Fields of view were selected to cover the entire brain: 38 X 38 cm in
  the axial plane, with 24 sections of 5.8 mm each or 12 sections of 1.1 cm each. The
  in-plane acquisition matrix was 64 X 128, and voxel size was 0.2 cm(3). Results.
  Sodium in white matter was depicted with an acceptable signal-to-noise ratio of
  20-25. The echo time, and hence the signal-to-noise ratio, was limited by the MR
  imager's maximum allowable gradient strength. To keep the specific absorption ratio
  below 3 W/kg (the limit established by the Food and Drug Administration), it was
  necessary to prolong the repetition time to 30 msec. Conclusion. The MR imaging
  protocol used in this study provided acceptable visualization of sodium in the whole
  brain in a tolerable total acquisition time of 15 minutes
Keywords: 1.5 T/activity/brain/cellular/detection/effect/electrochemical/H-1/healthy
  human/homeostasis/human/human                                           brain/imaging/in
  resonance/MAGNETIC-RESONANCE/MR/MR                                imaging/NA-23/NMR
  SODIUM/USA/use/white matter
Swan, J.S., Sainfort, F., Lawrence, W.F., Kuruchittham, V., Kongnakorn, T. and Heisey,
  D.M. (2003), Process utility for imaging in cerebrovascular disease. Academic
  Radiology, 10 (3), 266-274.
Abstract: Rationale and Objectives. The morbidity associated with a diagnostic test can
  influence its cost-effectiveness, but the quantification of that morbidity is
  controversial. Accounting for pain and invasiveness requires the measurement of
  "process utility" in addition to the expected value of testing. An original time
  trade-off variant was applied to the imaging evaluation of cerebrovascular disease,
  for which differences in morbidity are important to patients. Materials and Methods.
  A "waiting trade-off' (WTO) was used to evaluate the preferences of 89 patients for
  magnetic resonance (MR) angiography and conventional x-ray angiography. Patients
  were experienced with both tests. A weighted difference was calculated between the
  period a patient was willing to wait for a test result and treatment after a hypothetical
  "ideal" test and the choice to undergo conventional angiography or MR angiography
  with immediate treatment. A rating scale was used to check the convergent validity
  of the WTO. Results. Paired data showed a highly significant difference (P =.0001)
  between the mean preference for conventional and MR angiography, favoring the
  latter and translating into a difference of 5 quality-adjusted life days. The more
  negatively patients judged their conventional angiographic experience, the longer
  they were willing to wait for the ideal test result. Conclusion. The WTO provides a
  reasonable estimate of the relative morbidity of more invasive conventional
  angiographic procedures and provides a quality-adjustment term for economic
  analysis. Such an approach may enable more complete evaluation of the effects of
  other processes on medical care
Keywords:       addition/analysis/angiography/approach/cerebrovascular/cerebrovascular
   c resonance/magnetic resonance (MR)/measurement/medical/morbidity/MR/MR
   tion/RADIOLOGY/radiology                         and                   radiologists/rating
   scale/STROKE/testing/tests/treatment/USA/utility/validity/vascular studies
Nozaki, J., Kitahata, H., Tanaka, K., Kawahito, S. and Oshita, S. (2003), Effects of
   acute normovolemic hemodilution on ventriculoarterial coupling in dogs. Acta
   Anaesthesiologica Scandinavica, 47 (1), 46-52.
Abstract: Background: Acute normovolemic hemodilution (ANH) causes a decrease in
   systemic vascular resistance. Similar to vasodilating drugs, ANH might modify
   ventriculoarterial coupling. Left ventricular elastance (Ees), effective arterial
   elastance (Ea), stroke work (SW), and pressure volume area (PVA) were used as
   indicators to examine the effects of ANH on this coupling. Methods: After
   institutional approval eight dogs were anesthetized with isoflurane and subjected to
   measurements including aortic pressure, left ventricular (LV) pressure, and LV
   volume. Left ventricular volume was measured with a conductance catheter. Ees was
   determined as the slope of the end-systolic pressure-volume relationship. Ea was
   determined as the ratio of LV end-systolic pressure to stroke volume.
   Ventriculoarterial coupling was evaluated as the ratio of Ees to Ea. Mechanical
   efficiency, another criterion for ventriculoarterial coupling, was calculated as the
   ratio of SW to PVA. Data are expressed as mean+/-SD, and P <0.05 was considered
   significant. Results: Normovolemic exchange of 50 ml kg(-1) of blood for 6%
   hydroxyethyl starch (ANH50) reduced hemoglobin concentration from 12.8+/-3.0 g
   dl(-1) to 6.4+/-1.3 g dl(-1) . Acute normovolemic hemodilution 50 did not change
   Ees significantly although it significantly decreased Ea. Left ventricular elastance/Ea
   did not change after ANH (1.0+/-0.4 at baseline and 1.2+/-0.5 at ANH50). Acute
   normovolemic hemodilution 50 significantly increased SW and PVA, preventing
   SW/PVA from changing significantly after ANH (0.57+/-0.10 at baseline and
   0.62+/-0.14 at ANH50). Conclusion: Before ANH, ventriculoarterial coupling was so
   matched as to maximize SW at the expense of the work efficiency. This relation was
   preserved at ANH50
Keywords:          acute/AFTERLOAD/anemia/aortic/aortic            pressure/arterial/arterial
   elastance/blood/CANINE                                      LEFT-VENTRICLE/cardiac
   performance/catheter/causes/conductance/conductance catheter/CONDUCTANCE
   CATHETER/COPENHAGEN/coupling/DENMARK/dogs/drugs/effective                         arterial
   elastance/effects/EFFICIENCY/elastance/end-systolic                      pressure-volume
   yethyl         starch/indicators/isoflurane/Japan/left/left       ventricular/OXYGEN-
   CONSUMPTION/pressure/resistance/slope/stroke/stroke                        volume/stroke
   work/systemic/systemic                 vascular             resistance/vascular/vascular
   resistance/ventricular/ventricular volume/ventriculoarterial coupling/VOLUME/work
Sellgren, J., Soderstrom, S., Johansson, G., Biber, B., Haggmark, S. and Ponten, J.
   (2003), Preload changes by positive pressure ventilation can be used for assessment
   of left ventricular systolic function. Acta Anaesthesiologica Scandinavica, 47 (5),
Abstract: Background: Assessment of preload independent left ventricular function with
   conductance volumetry is traditionally accomplished by inflating a balloon in the
   inferior caval vein. Our aim was to investigate if a similar change in preload could be
   achieved by positive pressure ventilation with large tidal volume. Methods:
  Conductance volumetry generating left ventricular pressure-volume loops was used
  in seven pentobarbital-anesthetized pigs. Changes in preload recruitable stroke work
  were studied, comparing the effects of inferior vena cava occlusion (IVCO) or large
  tidal volume (LTV). Cardiodepression was induced by halothane anesthesia and
  halothane + phenylephrine, and stimulation by epinephrine infusion. Results:
  Although the decreasis in left ventricular end diastolic volume was slightly less with
  LTV (16.5 +/- 1.7 ml, mean +/- SEM) than with IVCO (22.4 +/- 1.7 ml) (P < 0.0001)
  the PRSW-slopes showed a high degree of correlation (r= 0.80, P < 0.0001).
  Although peak tracheal pressures increased significantly to 27.8 +/- 0.9 mmHg
  during LTV, esophageal pressures (used as an indicator of pericardial pressure) were
  unchanged. Conclusions: Positive pressure ventilation with LTV is similar to IVCO
  in creating transient changes in preload, necessary for assessment of left ventricular
  systolic function. This observation was valid also during drug-induced cardiac
  depression and stimulation. The preload recruitable stroke work used for this
  validation was shown to be a reliable and stable method
  ventricular/left        ventricular         function/left     ventricular         systolic
  pressure/phenylephrine/pigs/positive-pressure respiration/preload/preload recruitable
  stroke                work/pressure/pressures/RECRUITABLE                       STROKE
  WORK/stimulation/stroke/stroke work/Sweden/swine/systolic/systolic function/tidal
Tuz, M., Erodlu, F., Dodru, H., Uygur, K. and Yavuz, L. (2003), Transient locked-in
  syndrome resulting from stellate ganglion block in the treatment of patients with
  sudden hearing loss. Acta Anaesthesiologica Scandinavica, 47 (4), 485-487.
Abstract: Stellate ganglion blockage (SGB) is a local anesthetic procedure intended to
  block the lower cervical and upper thoracic sympathetic chain and is one of the
  treatment modalities for a wide range of disorders such as sudden hearing loss,
  Menier's disease, stroke, sudden blindness, shoulder/hand syndrome and vascular
  headache. The complications of SGB are recurrent laryngeal or phrenic nerve block,
  pneumothorax, unconsciousness, respiratory paralysis, convulsions and sometimes
  severe arterial hypotension. We present a case with transient locked-in syndrome
  following SGB for the management of sudden hearing loss. The risk of an
  intra-arterial injection can be eliminated by rotating the needle, as is described in this
Keywords:                                                                   arterial/arterial
  nerve/procedure/range/recurrent/risk/severe/stellate       ganglion/stellate     ganglion
  block/stroke/sudden/sudden                                                        hearing
  loss/sympathetic/syndrome/thoracic/transient/transient                          locked-in
Huber, J., Stollberger, C., Finsterer, J., Schneider, B. and Langer, T. (2003), Quality of
  blood pressure control and risk of cerebral bleeding in patients with oral
  anticoagulation. Acta Medica Austriaca , 30 (1), 6-9.
Abstract: Background: We assessed how many patients on long-term oral
  anticoagulation (OAC) (i) suffer from arterial hypertension (AH), (ii) are aware of
  AH, (iii) need improvement of their therapy and (iv) suffer from cerebral bleeding.
  Methods: Outpatients on long-term OAC were asked to measure blood pressure at
  least 4 times. Blood pressure was classified as normotensive if at least 75 % of all
  measurements were < 139/89 mm Hg; as mild/moderate AH if > 25 % of all
  measurements were 140 - 179 mm Hg systolic or 90 - 109 mm Hg diastolic; and as
  severe AH if > 25 % of all measurements were > 180 mm Hg systolic or > 110 mm
  Hg diastolic. Bleeding complications were registered. Results: Of the 235 patients
  (108 female, 67 +/- 12 years), 80 % suffered from AH. Severe AH was present in 5
  %. Only 56 % were aware of suffering from AH. An improvement of
  antihypertensive therapy was needed in 64 %. Over 225 days, only one cerebral
  bleeding occurred. Blood pressure was normotensive in 30 % with known AH.
  Conclusions: Blood pressure control seems better in OAC patients than in normals, if
  the patient is aware of AH. Patients with AH on OAC are not aware of AH in > 50 %.
  Repeated blood pressure measurements in OAC are recommended, even if patients
  are not aware of AH
Keywords:                              anticoagulation/antihypertensive/antihypertensive
  therapy/ANTITHROMBOTIC                                      THERAPY/arterial/arterial
  hypertension/Austria/AWARENESS/bleeding/blood/blood pressure/blood pressure
  control/cerebral/cerebral                                          bleeding/CHRONIC
Pniewski, J., Chodakowska-Zebrowska, M., Wozniak, R., Stepien, K. and Stafiej, A.
  (2003), Plasma homocysteine level and the course of ischemic stroke. Acta
  Neurobiologiae Experimentalis, 63 (2), 127-130.
Abstract: Increased level of homocysteine (Hcy) in blood seems to influence negatively
  the course of ischemic stroke (IS), the possible mechanism of this action could be
  acceleration of oxidative stress. The aim of this study is to assess the influence of
  Hcy level in patients with IS on the prognosis 3 months after the stroke onset. 75
  patients aged 68.27 +/- 12.62 years, with the diagnosis of first ever IS were examined.
  Patients with the symptoms corresponding with TACS at the beginning of stroke and
  with diminished level of consciousness were not included. The level of Hcy over 15
  mumol/l was assessed as mild hiperhomocysteinemia (MHcy). 74 (98.7%) patients
  were assessed 3 months after IS onset in the Rankin scale. Recovery was assessed,
  according to Rankin Scale: good recovery (GR) 0-2, bad recovery (BR) 3-5 and
  death. MHcy was seen in 9 (14.5%) with GR and in 8 (66.7%) with BR (P=0.0005).
  MHcy increases the risk of BR 11.78 times (95%CI 2.93-47.42)
Keywords: acceleration/action/ACUTE CORONARY SYNDROMES/aged/ARTERY
  stress/patients/Poland/prognosis/Rankin       scale/recovery/RISK/stress/stroke/stroke
Vuorinen, V., Hinkka, S., Farkkila, M. and Jaaskelainen, J. (2003), Debulking or biopsy
  of malignant glioma in elderly people - a randomised study. Acta Neurochirurgica,
  145 (1), 5-10.
Abstract: Background. Patients with radiologically (MRI and/or CT images) suspected
  malignant glioma is referred to radiotherapy after craniotomy and resection of the
  tumour or after diagnostic biopsy. Patients with poor preoperative status and elderly
  patients are diagnosed more often by biopsy and treated by radiotherapy rather than
  by craniotomy and tumour resection. However, based on previous retrospective
  studies it is not possible to conclude which procedure is better for elderly patients.
  Thus a prospective study comparing these two procedures with elderly patients was
  planned. Methods. 30 patients older than 65 years with radiologically (CT and/or
  MRI) obvious malignant glioma were randomised into two groups: I) stereotactic
  biopsy and II) open craniotomy and resection of the tumour. Nineteen patients were
  diagnosed to have grade IV glioma and four patients grade III glioma. Seven out of
  30 (23%) were followed in the "intention-to-treat" group with diagnosis of stroke (n
  = 3), metastasis (n = 2), malignant lymphoma (n = 1) and one with out histological
  diagnosis. Patients with histologically verified malignant glioma (grade III-IV) were
  diagnosed by stereotactic biopsy (n = 13) or by open craniotomy and resection (n =
  10) and all the patients were referred to radiotherapy. Survival and time of
  deterioration were followed. Findings. The overall median survival time was 146
  (95%, CI 89-175) days after the procedure. The estimated median survival time was
  171 (95%, CI 146-278) days after the craniotomy versus 85 (95% CI 55-157) days
  after the biopsy (p = 0.035). The estimated survival time was 2.757 times longer
  (95% CI 1.004-7.568, p = 0.049) after craniotomy. However, there was no significant
  difference in the time of deterioration between these two treatments (p = 0.057).
  Amount of radiotherapy given had a significant effect on survival (p = 0.001).
  Interpretation. Longer survival time is achieved after open craniotomy and resection
  of tumour. However, overall benefit of open surgery to patient seems to be modest.
  while time of deterioration did not differ between two treatment groups. Our results
  support previous studies on the benefit of radiotherapy in the treatment of malignant
  osis/diagnostic/effect/elderly/elderly       patients/elderly   people/Finland/GLIAL
  ive                     study/radiotherapy/resection/RESECTION/results/retrospective
Westermaier, T., Hungerhuber, E., Zausinger, S., Baethmann, A. and Schmid-Elsaesser,
  R. (2003), Neuroprotective efficacy of intra-arterial and intravenous magnesium
  sulfate in a rat model of transient focal cerebral ischemia. Acta Neurochirurgica, 145
  (5), 393-399.
Abstract: Background. Many neurovascular procedures necessitate temporary occlusion
  of cerebral arteries. In this situation neuroprotective drugs may increase the safety of
  the procedures. Magnesium may inhibit ischemic damage by anti- excitotoxic,
  calcium channel blocking and vasodilatory action. Some evidence suggests that
  intra-arterial administration might provide a much higher degree of protection than
  intravenous treatment. In this study the neuroprotective efficacy of intra- arterial and
  intravenous magnesium administration was examined in a rat model of transient
  focal ischemia. Methods. 34 male Sprague-Dawley rats were subjected to 90 minutes
   of middle cerebral artery occlusion (MCAO) by an intraluminal thread. Before
   ischemia, animals received an infusion of either (1) vehicle (0.9% NaCl) (2) MgSO4
   intra-arterially or (3) MgSO4 intravenously. Local cortical blood flow (LCBF) was
   continuously measured by laser-Doppler flowmetry. Functional deficits were
   quantified daily, infarct volumes were assessed histologically after 7 days. Findings.
   There was no difference between the treatment groups concerning LCBF.
   Magnesium serum levels increased from similar to1 mmol/l to similar to1.8 mmol/l
   by either route of administration. Both intra-arterial and intravenous treatment
   improved neurological recovery and equally reduced total infarct volume by similar
   to25%. Interpretation. The results indicate that there is no advantage of intra-arterial
   over intravenous magnesium administration. A comparison with previous studies
   suggests that even within the normal range of serum magnesium concentrations,
   low-normal levels may be hazardous and high-normal levels may be protective in
   transient focal ischemia
Keywords: action/animals/arterial/arteries/artery/ARTERY OCCLUSION/blood/blood
   flow/BRAIN/CALCIUM/cerebral/cerebral arteries/cerebral artery/cerebral artery
   citotoxic/flow/focal/focal                   cerebral                   ischemia/focal
   ischemia/Germany/HIPPOCAMPAL                                SLICES/infarct/INFARCT
   thread/intravenous/ischemia/ischemic/laser                                     Doppler
   flowmetry/laser-Doppler/laser-Doppler               flowmetry/magnesium/magnesium
   sulfate/male/MCAO/MECHANISMS/middle cerebral/middle cerebral artery/middle
   cerebral                                                                         artery
   fety/serum/SPREADING DEPRESSION/STROKE/sulfate/transient/transient focal
   cerebral ischemia/transient focal ischemia/treatment/vasodilatory/vehicle/volume
Laloux, P. (2003), Statins and stroke prevention. Acta Neurologica Belgica, 103 (1),
Keywords:          ATHEROSCLEROSIS/cerebrovascular              disease/CHOLESTEROL
   LEVELS/CORONARY-HEART-DISEASE/hydroxymethylglutaryl-CoA reductase
Appelros, P., Hogeras, N. and Terent, A. (2003), Case ascertainment in stroke studies:
   the risk of selection bias. Acta Neurologica Scandinavica, 107 (2), 145-149.
Abstract: Objectives - The purpose was to compare the completeness of case
   ascertainment in two stroke registers, one local population-based, the other a national
   quality register (Riks- Stroke), and to examine if patient characteristics could be
   affected by selection bias. Material and methods - By the way of linking and
   matching computer files, the completeness of case ascertainment was evaluated.
   Results - In the local stroke incidence study 377 patients were included. Of them,
   63% were reported to the hospital-based national quality register. The case-fatality
   was lower in the national register. A larger proportion of the patients in the national
   register appeared to have been treated in a stroke unit and undergone rehabilitation,
   and computerized tomography seemed to have been performed in a larger proportion.
   Conclusions - Because of selection bias, outcome data get skewed when case
   ascertainment does not embrace all stroke cases. A community-based stroke register
  is the golden standard when measuring stroke incidence
Keywords:                  bias/case                 fatality/case-fatality/cerebrovascular
  ality               control/register/REGISTRY/rehabilitation/risk/selection/selection
  bias/standard/stroke/stroke                incidence/stroke                 studies/stroke
  unit/Sweden/tomography/two stroke/two-stroke/when
Ardehali, M.R. and Rondouin, G. (2003), Microsurgical intraluminal middle cerebral
  artery occlusion model in rodents. Acta Neurologica Scandinavica, 107 (4), 267-275.
Abstract: Objectives - Focal brain ischemia induced in rodents by occlusion of the
  middle cerebral artery (MCA) is a widely used paradigm of human brain infarct. The
  objective of this study is to compare the effectiveness and reproducibility of MCA
  filament occlusion model in rats and mice. Materials and methods - A total of 140
  rodents (69 rats and 71 mice) were operated. Ninety-five animals were subjected to
  MCA occlusion; the surgical procedure consisted of introducing an uncoated surgical
  nylon monofilament into the cervical common carotid artery (CCA) and advancing it
  intracranially to permanently block blood flow into the right MCA. Forty-five
  sham-occluded rodents underwent CCA ligation. Surgical success, autopsy
  confirmed success and mortality rate were evaluated. Effective MCA occlusion was
  confirmed by the evidence of motor neurological deficit, by histopathology,
  immunohistochemistry (IHC) and reverse transcriptase-polymerase chain reaction
  (RT- PCR). IHC was performed in a randomly selected number of animals to detect
  the protein product of monocyte chemoattractant protein-1. The brain tissue in mice
  was examined by RT-PCR for the expression of macrophage inflammatory protein-1
  alpha mRNA. Results - Surgical success rate was 89% in the rats, significantly lower
  than that in the mice (100%, P < 0.05). Autopsy confirmed success rate in the rats,
  60%, was also significantly different from that in the mice (92.5%, P < 0.001). The
  operative mortality rate was 4.3% in the rats and 15% in the mice. Conclusion - The
  present study demonstrates that the microsurgical filament occlusion of the MCA can
  be more successfully performed in mice. The lower rate of success in rats seems to
  be as a result of the architecture of the carotid canal in this animal. No previous
  reports, using a considerable number of animals, have compared the feasibility of
  intraluminal model in the rat with that in the mouse
Keywords:        animal/animals/artery/autopsy/blood/blood          flow/BP/BRAIN/brain
  infarct/brain ischemia/carotid/carotid artery/cerebral/cerebral artery/cerebral artery
  occlusion/cerebral                  ischemia/common/common                         carotid
  n/human                        brain/immunohistochemistry/induced/infarct/INFARCT
  EXPRESSION/methods/MICE/mice/middle cerebral/middle cerebral artery/middle
  cerebral artery occlusion/middle cerebral artery occlusion model/MIP1
  alpha/model/monocyte/MONOCYTE                                  CHEMOATTRACTANT
Gariballa, S.E. (2003), Potentially treatable causes of poor outcome in acute stroke
  patients with urinary incontinence. Acta Neurologica Scandinavica, 107 (5),
Abstract: Objective - To identify potentially treatable clinical risk factors responsible
   for poor outcome in acute stroke patients with urinary incontinence. Material and
   methods - All acute stroke patients admitted to our hospital within a 12-month period
   were considered for inclusion in this observational prospective study. Their clinical
   details were recorded prospectively during the hospital stay and at 3 months. Results
   - Two hundred and fifteen patients with complete records were enrolled in the study.
   After adjusting for age, disability, and comorbidity, urinary incontinence at
   admission was a significant predictor of stroke death at 3 months [hazard ratio 2.8
   (95% CI 1.3-5.8), P = 0.006]. Stroke patients incontinent of urine were malnourished
   and had an increased risk of infective complications during the hospital stay
   compared with those without incontinence. Conclusion - Part of the poor outcome
   associated with incontinence of urine after acute stroke may be due to treatable
   conditions such malnutrition and infections
Keywords:                                                                        acute/acute
   pective/prospective       study/records/risk/risk      factors/risk-factors/stroke/stroke
   patients/TRIAL/urinary/urinary incontinence/urine
Jaracz, K. and Kozubski, W. (2003), Quality of life in stroke patients. Acta Neurologica
   Scandinavica, 107 (5), 324-329.
Abstract: Objectives - To describe global and domain-specific quality of life (QOL)
   after stroke and to identify the factors that are important for post-stroke QOL.
   Material and methods - A hospital-based sample of 72 stroke patients was followed
   up for 6 months after stroke onset. QOL was assessed using the Polish version of the
   Quality of Life Index. Regression analysis was performed to identify the variables
   that best predicted QOL. Results - The overall QOL of stroke patients was relatively
   good, although worse than that of subjects in a comparison group. The highest QOL
   was found in the 'Family' domain, and the lowest in the 'Health and functioning'
   domain. Emotional support, depression and functional disability were three separate
   variables explaining 38% of the variance in QOL. Conclusions - Strengthening of
   family support, treatment of depression and reduction of physical dependence may
   be the decisive factors in improving post-stroke QOL
   nd/poststroke/quality/quality     of     life/SCALES/social        support/stroke/stroke
   onset/stroke patients/support/treatment
Konrad, C., Nabavi, D.G., Junker, R., Dziewas, R., Henningsen, H. and Stogbauer, F.
   (2003), Spontaneous internal carotid artery dissection and alpha-1- antitrypsin
   deficiency. Acta Neurologica Scandinavica, 107 (3), 233-236.
Abstract: Spontaneous cervical arterial dissection is an important cause of juvenile
   stroke. However, etiopathology and genetic background remain poorly understood.
   We report on a 45-year- old-male patient with homozygous alpha-1-antitrypsin
   (alpha-1- AT) deficiency in whom internal carotid artery dissection occurred in the
   absence of any other known risk factors. The relevance of alpha-1-AT deficiency for
   spontaneous cervical arterial dissections is discussed
Keywords: acute cerebral infarction/acute stroke syndromes/alpha-1-antitrypsin
  deficiency/arterial/arterial dissection/artery/artery dissection/carotid/carotid and
  vertebral         artery         dissections/carotid       artery/carotid        artery
  ions/genetic/Germany/internal/internal carotid/internal carotid artery/internal carotid
  artery dissection/juvenile stroke/patient/risk/risk factors/risk factors for
Masana, Y. and Motozaki, T. (2003), Emergence and progress of white matter lesion in
  brain check-up. Acta Neurologica Scandinavica, 107 (3), 187-194.
Abstract: White matter lesion (WML) is thought to emerge and progress with increasing
  age but has not yet been well investigated. In this study of WML, risk factors and
  prevalence added to emergence rate (%/person year) and progress speed [increase of
  leukoencephalopathy score (LES)/person year] were investigated in 1674 brain
  check-up subjects from August 1993 to August 2001. Significant (P < 0.01) risk
  factors were aging and hypertension. Prevalence rate (%) was 0 in 20-29 years, 1.4 in
  30-39 years, 4.2 in 40-49 years, 20.9 in 50-59 years, 42.6 in 60-69 years, and 73.9 in
  70-years. Emergence rate was 0 in 20- 29 years, 0.7 in 30-39 years, 1.5 in 40-49
  years, 3.4 in 50-59 years, 6.0 in 60-69 years, and 20 in 70-years. And progress speed
  was 0.12 in 40-49 years, 0.15 in 50-59 years, 0.21 in 60- 69 years, and 0.21 in
  70-years. WML begins to emerge early in middle age and both prevalence and
  severity increase with age
Keywords:                                     age/aging/BLOOD-PRESSURE/brain/brain
  koencephalopathy/MRI/prevalence/progress/risk/risk                          factor/risk
  HYPERINTENSITIES/speed/STROKE                                PATIENTS/VASCULAR
  RISK-FACTORS/VOLUNTEERS/White/white matter/white matter lesion
McCarron, M.O., Weir, C.J., Muir, K.W., Hoffmann, K.L., Graffagnino, C., Nicoll,
  J.A.R., Lees, K.R. and Alberts, M.J. (2003), Effect of apolipoprotein E genotype on
  in-hospital mortality following intracerebral haemorrhage. Acta Neurologica
  Scandinavica, 107 (2), 106-109.
Abstract: Objective - To determine the relationship between the apolipoprotein E
  (APOE ) epsilon4 allele and in-hospital mortality from intracerebral haemorrhage
  (ICH). Material and methods - Patients admitted to two acute stroke units with ICH
  were prospectively evaluated and APOE genotyped. In-hospital survival was
  recorded in 176 patients. Results - There were 85 men and 91 women, mean age 68
  years. Fifty-two (30%) of the 176 patients died in hospital. After adjusting for sex,
  age, hospital, and race, increased age (P = 0.009) and the presence of the APOE
  epsilon4 allele (P = 0.026) significantly reduced in-hospital survival. Conclusion -
  The APOE epsilon4 allele in this population may be associated with poor survival
  following ICH
Keywords:      acute/acute     stroke/age/ALLELE/APOE/apolipoprotein/apolipoprotein
  E/apolipoprotein                                                                      E
  TROKE/stroke units/survival/SURVIVAL/women
Nolfe, G., D'Aniello, A.M., Muschera, R. and Giaquinto, S. (2003), The aftermath of
  rehabilitation for patients with severe stroke. Acta Neurologica Scandinavica, 107
  (4), 281-284.
Abstract: Objective - The study evaluates the aftermath of stroke in patients with very
  severe disability after their first ever stroke and dismissed after rehabilitation.
  Materials and methods - Sixty-nine inpatients were studied, who were highly
  disabled at discharge with a Functional Independence Measure (FIM) score in the
  range of 18-39. Their rehabilitation program had lasted 60 days. The degree of
  functional independence was measured by means of the FIM at the beginning of
  treatment, at discharge and at follow-up. The data collected were examined by using
  parametric and distribution-free statistical methods. The role of age in the process of
  recovery was also evaluated. Results - All patients were discharged home after 2
  months. At 6 month follow-up, 15 patients (21.7%) were lost, 27 (39.1%) had died
  and 27 (39.1%) lived at home. Among stroke survivors a clear trend toward an
  improvement was detected during the 6 months observation period. Indeed, the third
  quartile changed from 33 to 63 and a patient approached to independence (FIM 87).
  None underwent a rehabilitation program at home beside the relatives' assistance.
  Conclusions - Highly disabled stroke patients are probably to undergo unfavourable
  outcome but unexpected recovery cannot be ruled-out on the basis of cut-off
  parameters measured after the acute phase of stroke. Multivariate statistical methods
  can identify factors which can interfere with functional recovery but are error-prone
  in setting individual prognosis. Moreover the recovery process may develop in a long
  period of time. Taking into consideration the spontaneous recovery observed during
  the follow-up period after the dismissal from rehabilitation ward, a suitable
  rehabilitation at home might be fruitful in these patients, who should not be
  considered as "lost"
Keywords:             acute/age/COPENHAGEN/DENMARK/disability/ER/FIM/follow
  up/follow-up/functional/Functional           Independence           Measure/functional
  program/score/severe/severe                            stroke/spontaneous/spontaneous
  recovery/statistical/stroke/stroke patients/stroke survivors/treatment/unexpected
  functional recovery
Rasmussen, A., Christensen, J., Clemmensen, P.M., Dalsgaard, N.J., Dam, H., Hindberg,
  I., Lunde, M., Plenge, P. and Mellerup, E. (2003), Platelet serotonin transporter in
  stroke patients. Acta Neurologica Scandinavica, 107 (2), 150-153.
Abstract: Objectives - Post-stroke depression can be treated with serotonin transport
  inhibitors suggesting a role for the serotonin system in these patients. The number of
  platelet serotonin transporters in stroke patients and in control subjects have been
  measured in this study. Materials and methods - Newly admitted stroke patients who
  did develop or who did not develop a post-stroke depression, non-acute patients who
  previously had had a stroke and control subjects were compared. The number of
  platelet serotonin transporters was analysed by ligand binding methodology. Results
  - The number of platelet serotonin transporters was low shortly after a stroke
  compared with normal subjects; no difference was found between the stroke patients
  who developed a post-stroke depression and those who did not. Conclusion - A low
  number of platelet serotonin transporters may be a non-specific state marker for a
  condition as acute stroke
Keywords:                      acute/acute                   stroke/ANTIDEPRESSANT
  ON/H-3-                                                                  IMIPRAMINE
   subjects/patients/platelet/platelet          serotonin         transporter/post      stroke
   depression/post-stroke                                     depression/poststroke/poststroke
   depression/serotonin/stroke/stroke patients/transport/TRITIATED IMIPRAMINE
Roby-Brami, A., Feydy, A., Combeaud, M., Biryukova, E.V., Bussel, B. and Levin,
   M.F. (2003), Motor compensation and recovery for reaching in stroke patients. Acta
   Neurologica Scandinavica, 107 (5), 369-381.
Abstract: Objectives - To examine the mechanisms of alternative strategies developed
   by stroke patients to compensate their motor impairment and their role in recovery.
   Material and methods - The three-dimensional kinematics of the upper limb were
   quantified during unconstrained reaching movements in seven healthy individuals
   and in 15 stroke patients. Nine patients were followed-up. Individual observations
   were correlated with anatomical and functional brain imaging described elsewhere
   (Feydy et al. Stroke 2002;33 :1610). Results - Healthy subjects used mainly elbow
   extension and shoulder flexion, scaled to movement distance. Patients with
   hemiparesis because of stroke used different patterns of joint recruitment with
   different scaling rules. Patients with the greatest impairment compensated by
   recruiting extra degrees of freedom, particularly trunk bending. Improvement was
   because of a restoration towards a normal movement pattern (recovery) and/or to a
   reinforcement of compensation, which led to a poorer outcome. Conclusion -
   Individual behavioural data are necessary to discuss the mechanisms of functional
   improvement following stroke with respect to recovery and/or compensation
Keywords:                           ADULT                            NORMS/ARM/brain/brain
   /DEXTERITY/disability/elbow/France/functional/functional                              brain
   ON/scaling/shoulder/stroke/stroke             patients/three-dimensional/three-dimensional
   movement recording/trunk/upper limb
Studer, A., Georgiadis, D. and Baumgartner, R.W. (2003), Ischemic infarct involving
   all arterial territories of the thalamus. Acta Neurologica Scandinavica, 107 (6),
Abstract: Ischemic infarcts of the thalamus involve one or two of its four arterial
   territories that are usually supplied by the posterior cerebral (PCA) and the posterior
   communicating (PCoA) arteries. We report a patient who suffered ischemic infarcts
   in all arterial territories of the right thalamus. Magnetic resonance (MR) angiography
   showed an occlusion of the right PCA and failed to visualize a PCoA. We assume
   that the absence of a relevant thalamic blood supply deriving from the PCoA enabled
   PCA occlusion to cause infarcts in all thalamic territories
Sumer, M.M., Ozdemir, I. and Tascilar, N. (2003), Predictors of outcome after acute
   ischemic stroke. Acta Neurologica Scandinavica, 107 (4), 276-280.
Abstract: The aim of this study was to determine which variables should be the
  predictors for clinical outcome at discharge and sixth month after acute ischemic
  stroke. Methods - Two hundred and sixty-six consecutive patients, each with an
  acute ischemic cerebrovascular disease, were evaluated within 24 h of symptom
  onset. We divided our patients into two groups; 1 - Independent (Rankin scale RS
  less than or equal to 2) and, 2 - Dependent (RS>3) and death. Baseline characteristics,
  clinical variables, risk factors, infarct subtypes and radiologic parameters were
  analyzed. Results - Canadian Neurological Scale (CNS) on admission <6.5 [odds
  ratio (OR) 22] and posterior circulation infarction (OR 4.2) were associated with a
  poor outcome at discharge from hospital whereas only a CNS score <6.5 (OR 14)
  was associated with a poor outcome at 6 months. Conclusions - Severity of
  neurologic deficit is the most important indicator for clinical outcome in acute
  ischemic stroke both at short- term and at sixth month, whereas posterior circulation
  infarction also predicts a poor outcome at discharge
Keywords: acute/acute ischemic/acute ischemic stroke/Canadian Neurological
  Scale/CEREBRAL-ARTERY                            SIGN/cerebrovascular/cerebrovascular
  outcome/hospital/infarct/INFARCT               VOLUME/infarction/ischemic/ischemic
  cerebrovascular      disease/ischemic      stroke/MORTALITY/neurologic/neurologic
  deficit/outcome/patients/posterior              circulation/predictors/prognosis/Rankin
Szczudlik, A., Turaj, W., Slowik, A. and Strojny, J. (2003), Microalbuminuria and
  hyperthermia independently predict long- term mortality in acute ischemic stroke
  patients. Acta Neurologica Scandinavica, 107 (2), 96-101.
Abstract: Objectives - To investigate the association between microalbuminuria (MA)
  and hyperthermia in acute ischemic stroke and to evaluate their significance as the
  predictors of long- term mortality after stroke. Material and methods - We assessed
  neurologic deficit, urinary albumin excretion and body temperature in 60 patients
  admitted within 24 h after the onset of their first ischemic stroke. Outcome was
  assessed by 90-day and 1-year mortality. Results - MA was found in 46.7% of
  patients. Hyperthermia was found in 18.3% patients on Day 1 and in 25% patients on
  Day 2. The correlation between albuminuria on Day 2 and the body temperature on
  Days 1 and 2 was found (r = 0.45, and r = 0.30, respectively; both P < 0.05).The
  mortality was significantly higher in the group of patients with both MA and
  hyperthermia on Day 2 (73% vs 10% after 90 days; P < 0.0001 and 73% vs 18%
  after 1 year, P < 0.005). In the logistic regression analysis, albuminuria (P = 0.017),
  hyperthermia on Day 1 (P = 0.028) and neurologic deficit on admission (P = 0.044)
  independently predicted 1-year mortality after ischemic stroke. Conclusion - Daily
  urinary albumin excretion correlates with the body temperature in acute stroke
  patients, but the predictive power of both these variables is independent of that
Keywords:         acute/acute        ischemic/acute         ischemic       stroke/ACUTE
  temperature/BODY-TEMPERATURE/BRAIN                                    TEMPERATURE
  stroke/logistic regression/methods/microalbuminuria/mortality/neurologic/neurologic
  analysis/SEVERITY/stroke/stroke patients/temperature/urinary/urinary albumin
Weise, J., Bahr, M., Strayle-Batra, M. and Kuker, W. (2003), Detection of acute
  thalamo-mesencephalic infarction: diffusion abnormality precedes T2 hyperintensity.
  Acta Neurologica Scandinavica, 108 (1), 52-54.
Abstract: Objective - To examine the time course of signal changes in
  diffusion-weighted magnetic resonance imaging (DW-MRI) and T2- weighted MRI
  in a case of cerebral infarction in the posterior circulation territory. Materials and
  methods - Diffusion- and T2-weighted MRI and comparison of signal changes in
  these sequences at 4 h, 1 day and 4 days after the onset of clinical symptoms caused
  by acute thalamomesencephalic infarction. Results - Four hours after the onset of
  symptoms, signal changes in DW-MRI revealed an infarction in the territory of the
  posterior perforating thalamic artery, whereas no signal changes were detected in
  T2-weighted MRI. In follow-up MRI 1 an 4 days after infarction, however, a marked
  hyperintensity matching the location of the diffusion deficit could be identified in T2
  images. Conclusion - Signal changes in DW-MRI precede T2 hyperintensity after
  infarction in the posterior circulation territory after hemispheric infarction
Keywords:                 acute/artery/cerebral/cerebral                  infarction/cerebral
  weighted/diffusion- weighted MRI/diffusion-weighted/diffusion-weighted magnetic
  resonance/diffusion-weighted magnetic resonance imaging/DW-MRI/follow
  magnetic       resonance/magnetic        resonance        imaging/methods/MRI/posterior
  circulation/posterior                    circulation                   territory/resonance
  imaging/STROKE/symptoms/T2-WEIGHTED MRI/time course
Alexander, M., Forster, C., Sugimoto, K., Clark, H.B., Vogel, S., Ross, M.E. and
  Iadecola, C. (2003), Interferon regulatory factor-1 immunoreactivity in neurons and
  inflammatory cells following ischemic stroke in rodents and humans. Acta
  Neuropathologica, 105 (5), 420-424.
Abstract: Interferon regulatory factor-1 (IRF-1), a transcription factor that controls the
  expression of genes related to inflammation and injury, may be involved in the
  mechanisms of cerebral ischemia. In this study, we used immunohistochemistry to
  determine whether IRF-1 protein is up-regulated after cerebral ischemia, and to
  define the identity of the cells that express IRF-1 in the postischemic brain. In mice,
  IRF-1 immunoreactivity was present in intravascular neutrophils 24 h after middle
  cerebral artery occlusion. At 96 h, immunoreactivity was observed in neutrophils
  infiltrating the ischemic tissue and in neurons at the outer border of the ischemic
  territory. IRF-1 immunoreactivity was also found in neurons and inflammatory cells
  in the brain of patients who died 1-2 days after ischemic stroke. The neuronal
  expression of IRF-1, in conjunction with the finding that IRF-1 deletion is beneficial
  to the post-ischemic brain, suggests that expression of IRF-1-dependent genes in
  neurons plays a role in ischemic neuronal death
Keywords: artery/BRAIN/cerebral/cerebral artery/cerebral artery occlusion/cerebral
  stroke/MACROPHAGES/mechanisms/mice/middle                    cerebral/middle       cerebral
   artery/middle                                cerebral                            artery
Jellinger, K.A. and Attems, J. (2003), Incidence of cerebrovascular lesions in
   Alzheimer's disease: a postmortem study. Acta Neuropathologica, 105 (1), 14-17.
Abstract: Recent epidemiological and clinico-pathological data suggest overlaps
   between Alzheimer's disease (AD) and cerebrovascular lesions (CVL) that may show
   some synergistic effects, but the results of studies of the relationship between AD
   and stroke have been controversial. The objective of this study was to compare the
   frequency of cerebral infarcts, hemorrhages and minor cerebrovascular lesions in
   autopsy-confirmed AD and age- matched control brains. Using current routine and
   immunohistochemical methods 173 consecutive cases of autopsy- confirmed AD and
   130 age-matched controls were compared. The total incidence of vascular pathology
   (56.5%) in AD was significantly less than in a previously reported smaller AD
   autopsy cohort (82.3%) (P<0.01), and was higher than in controls (42.4%). The
   incidence of severe CVL (old and recent infarcts, hemorrhages) in our cohort was
   slightly higher (12.7%) than in controls (8.5%), that of minor to moderate CVL
   (lacunes, cerebral amyloid angiopathy with or without minor vascular lesions) was
   more frequent in AD (43.8%) than in controls (33.9%), but the results were not
   statistically significant (P<0.03). The brain weight and severity of cognitive decline
   did not correspond to the degree of vascular pathology, but higher neuritic Braak
   scores and reduced brain weight contributed to the production of cognitive
   impairment. Like previous findings in Parkinson's disease, our data do not indicate a
   protective effect from stroke or a significantly greater susceptibility to death from
   stroke in AD in the population studied, but further prospective clinico- pathological
   studies are necessary
Keywords:                     AD/age/Alzheimer's                  disease/amyloid/amyloid
   angiopathy/angiopathy/Austria/autopsy/brain/brain weight/CERAD/cerebral/cerebral
   amyloid           angiopathy/cerebral          infarcts/cerebrovascular/cerebrovascular
   lesions/cognitive/COGNITIVE                                        DECLINE/cognitive
   disease/pathology/population/postmortem         study/production/prospective/protective
   effect/results/severe/stroke/susceptibility/USA/vascular/vascular lesions/weight
Jellinger, K.A. (2003), Prevalence of cerebrovascular lesions in Parkinson's disease. A
   postmortem study. Acta Neuropathologica, 105 (5), 415-419.
Abstract: Data on the relationship between Parkinson's disease (PD) and stroke have
   been conflicting, some studies showing a reduced risk of stroke during life, and
   others indicating an increased risk of stroke-related death. Consecutive cases (n=617)
   of autopsy-proven idiopathic PD (Lewy body disease of the brain stem type) and
   age-matched controls (n=535) were compared using current routine and
   immunohistochemical methods. The total frequency of cerebrovascular lesions
   (lacunes, amyloid angiopathy, white matter lesions, old and recent ischemic infarcts
   and hemorrhages) in PD (44.0%) was higher than in controls (32.8%), while acute,
   often fatal ischemic or hemorrhagic strokes were less frequent in parkinsonian
   patients (1.8% vs 2.6%). Like previous postmortem findings in a smaller cohort,
   these findings neither indicate a protective effect against stroke nor a greater
  susceptibility to death from stroke in the populations studied. Cognitive impairment
  in PD appears to be largely independent from coexistent vascular pathology except in
  cases with severe cerebrovascular lesions
Keywords:                               acute/ALZHEIMER-DISEASE/amyloid/amyloid
  angiopathy/angiopathy/Austria/brain/brain         stem/cerebrovascular/cerebrovascular
  WORKSHOP/ischemic/lacunes/Lewy                       body            disease/MENTAL
  disease/PATHOLOGY/patients/PD/postmortem study/protective effect/risk/risk of
  matter/white matter lesions
Tanji, K., Gamez, J., Cervera, C., Mearin, F., Ortega, A., de la Torre, J., Montoya, J.,
  Andreu, A.L., DiMauro, S. and Bonilla, E. (2003), The A8344G mutation in
  mitochondrial DNA associated with stroke-like episodes and gastrointestinal
  dysfunction. Acta Neuropathologica, 105 (1), 69-75.
Abstract: We report an unusual case of encephalo-entero-myopathy associated with the
  A8344G mutation in the tRNA(Lys), gene of mitochondrial DNA (mtDNA). This
  patient had mitochondrial myopathy, multiple lipomatosis, mild hearing loss,
  stroke-like episodes, and paralytic ileus, but she lacked the canonical clinical features
  of MERRF, myoclonus, epilepsy, or ataxia. We conducted genetic, biochemical,
  histochemical, and immunohistochemical studies in skeletal muscle, brain, intestine,
  and lipoma tissue. The mutation was abundant in all tissues, and cytochrome c
  oxidase (COX) activity was selectively decreased in brain and small intestine. COX
  deficiency was also documented histochemically and immunohistochemically in the
  small intestine, suggesting that mitochondrial dysfunction played a role in the
  pathogenesis of paralytic ileus. This case illustrates an unusual and dramatic clinical
  phenotype of the A8344G mutation, characterized by stroke-like episodes and acute
Keywords: activity/acute/ataxia/brain/clinical/clinical features/cytochrome/cytochrome
  e/genetic/hearing/hearing                                                 loss/intestinal
  ondrial                 DNA/mitochondrial                    dysfunction/mitochondrial
  SYNDROME/pathogenesis/patient/phenotype/POINT MUTATION/RAGGED-RED
  FIBERS/RNALYS                GENE/skeletal/skeletal            muscle/small/stroke-like
  episodes/tRNA(Lys)/TRNA(SER(UCN)) GENE/USA
Yasumura, S., Aso, S., Fujisaka, M. and Watanabe, Y. (2003), Cochlear implantation in
  a patient with mitochondrial encephalopathy, lactic acidosis and stroke-like episodes
  syndrome. Acta Oto-Laryngologica , 123 (1), 55-58.
Abstract: Objective-The aim of this study was to investigate the usefulness of a
  Nucleus(R) C124M cochlear implant in a patient with mitochondrial encephalopathy,
  lactic acidosis and stroke- like episodes (MELAS) syndrome. Material and
  methods-A 29-year- old woman with MELAS syndrome presented with
  sensorineural hearing loss and diabetes mellitus and underwent multichannel
  cochlear implantation. The follow-up period was 10 months. The case history,
  assessment of mitochondrial disease, indications for the cochlear implant and the
  benefits of cochlear implantation were evaluated. Results-Nine months after the
  surgery the patient could use the telephone and was quite satisfied with the
  improvement in communication due to the cochlear implant. Conclusion-Cochlear
  implantation can be recommended for patients with MELAS syndrome if they have
  residual retrocochlear function. Single photon emission computerized tomography
  was found to be Very useful for evaluating retrocochlear function
Keywords:          and         stroke-like        episodes/assessment/AUDIOLOGICAL
  FINDINGS/benefits/case history/central nervous system/cochlear implant/cochlear
  loss/history/implant/implantation/indications/Japan/lactic acidosis/lactic acidosis and
  stroke-                        like                     episodes/loss/MELAS/MELAS
  SYNDROME/mitochondrial/mitochondrial                               disease/mitochondrial
  eriod/residual/retrocochlear function/single photon emission computerized
  tomography/stroke/stroke-like                 episodes/stroke-like              episodes
Peng, H., Li, Y.F. and Sun, S.G. (2003), Effects of Ginkgo biloba extract on acute
  cerebral ischemia in rats analyzed by magnetic resonance spectroscopy. Acta
  Pharmacologica Sinica, 24 (5), 467-471.
Abstract: Aim: To study the effect of Ginkgo biloba extract (GbE) on acute cerebral
  ischemia in rats. Methods: The rats were randomly divided into four groups:
  sham-operated group (group I as control), ischemic group (group II), the prophylactic
  (GbE premedication) group (group III) and GbE-treatment group (group IV).
  Magnetic resonance spectroscopy (MRS) was carried out to dynamically monitor the
  changes in biochemical metabolic variations 48 h after cerebral ischemia and effects
  of GbE (100 mg/kg, ip, qd). Results: (1) Lactate (Lac) peak could be detectable at the
  infarction area 90 min after acute cerebral ischemia and increased with time. Lac
  peak in the prophylactic group was elevated slightly (P<0.01, n=6), whereas in the
  treatment group the elevation of Lac was more remarkable than that in the
  prophylactic group (P<0.05, n=6). (2) In the ischemic group, the level of N-acetyl
  aspartate (NAA) was decreased within 4 h after ischemia (P<0.05, n=6), and the
  decline persisted (P<0.01, n=6). In the treatment group and prophylactic group, NAA
  was decreased slightly after 24 h (P<0.05, n=6). (3) Twenty-four hours after
  ischemia, in both ischemic group and treatment group, choline (Cho) was elevated
  slightly (P<0.05, n=6) and creatine (Cr) was decreased slightly (P<0.05, n=6), but in
  the prophylactic group these changes occurred only after 48 h. Conclusion: GbE
  could prevent and treat acute cerebral ischemia. The effectiveness was more
  satisfactory when GbE was used preventively
Keywords:                acute/acute             cerebral              ischemia/ARTERY
  Ginkgo                                 biloba/Ginkgo                              biloba
  extract/II/infarction/ischemia/ischemic/magnetic/magnetic            resonance/magnetic
  resonance                   spectroscopy/METABOLITES/monitor/MR/MRS/N-acetyl
Sheng, R. and Liu, G.Q. (2003), EDT, a tetrahydroacridine derivative inhibits cerebral
  ischemia and protects rat cortical neurons against glutamate-induced cytotoxicity.
  Acta Pharmacologica Sinica, 24 (5), 390-393.
Abstract: Aim: To study the effects of 9-(4-ethoxycarbonylyphenoxy)-6,7-
  dimethoxy-1,2,3,4-tetrahydroacridine (EDT) on cerebral ischemia and glutamic acid
  (Glu) and sodium nitroprusside (SNP)-induced neurocytotoxicity in primary cortical
  culture. Methods: Focal cerebral ischemia was produced by permanent occlusion of
  left middle cerebral artery (MCA) in mice. The infarct tissue was measured by
  2,3,5-triphenyltetrazolium chloride (TTC) staining technique. The extent of
  neurological deficits was evaluated. In primary cortical culture, colorimetric MTT
  assay was used to determine cell survival rate, and leakage of LDH and NO release
  assay were measured. Results: In focal cerebral ischemia, pretreatment with EDT 2.5,
  5, and 10 mg/kg and nimodipine 2 mg/kg for 5 d effectively improved the abnormal
  neurological symptoms and reduced the infarct rate. In primary cortical culture, EDT
  0.01-3 mumol/L concentration-dependently attenuated NO release induced by Glu
  500 mumol/L and increased the cell survival. It also remarkably reduced the LDH
  excessive efflux. Conclusion: EDT possessed protective effects against cerebral
  ischemia, which may be related to blocking Glu receptor and inhibiting NO
Keywords: 9-(4-ethoxycarbonylyphenoxy)-6/7-dimethoxy-1/2/3/4- tetrahydroacridine
  (EDT)/artery/brain        ischemia/cell     culture/cell       survival/cerebral/cerebral
  artery/cerebral                               ischemia/China/chloride/cortical/cortical
  neurons/deficits/effects/focal/focal             cerebral             ischemia/glutamic
  acid/induced/infarct/ischemia/left/MCA/mice/middle          cerebral/middle      cerebral
  artery/neurological/neurological                                    deficits/neurological
  oxide/nitroprusside/NO/occlusion/PEOPLE/primary            cortical    culture/protective
Eckberg, D.L. (2003), Bursting into space: alterations of sympathetic control by space
  travel. Acta Physiologica Scandinavica, 177 (3), 299-311.
Abstract: Aim: Astronauts return to Earth with reduced red cell masses and
  hypovolaemia. Not surprisingly, when they stand, their heart rates may speed
  inordinately, their blood pressures may fall, and some may experience frank syncope.
  We studied autonomic function in six male astronauts (average +/- SEM age: 40 +/-
  2 years) before, during, and after the 16-day Neurolab space shuttle mission. Method:
  We recorded electrocardiograms, finger photoplethysmographic arterial pressures,
  respiration, peroneal nerve muscle sympathetic activity, plasma noradrenaline and
  noradrenaline kinetics, and cardiac output, and we calculated stroke volume and total
  peripheral resistance. We perturbed autonomic function before and during
  spaceflight with graded Valsalva manoeuvres and lower body suction, and before
  and after the mission with passive upright tilt. Results: In-flight baseline sympathetic
  nerve activity was increased above pre-flight levels (by 10-33%) in three subjects, in
  whom noradrenaline spillover and clearance also were increased. Valsalva straining
  provoked greater reductions of arterial pressure, and proportionally greater
  sympathetic responses in space than on Earth. Lower body suction elicited greater
  increases of sympathetic nerve activity, plasma noradrenaline, and noradrenaline
  spillover in space than on Earth. After the Neurolab mission, left ventricular stroke
  volume was lower and heart rate was higher during tilt, than before spaceflight. No
  astronaut experienced orthostatic hypotension or pre-syncope during 10 min of
  post-flight tilting. Conclusion: We conclude that baseline sympathetic outflow,
  however measured, is higher in space than on earth, and that augmented sympathetic
  nerve responses to Valsalva straining, lower body suction, and post-flight upright tilt
  represent normal adjustments to greater haemodynamic stresses associated with
Keywords:            activity/age/arterial/arterial         pressure/autonomic/autonomic
  function/baroreceptor reflex/blood/cardiac/cardiac output/CARDIAC REFLEX
  rate/HUMANS/hypotension/hypovolaemia/kinetics/left/left                    ventricular/left
  ventricular                                                                         stroke
  kinetics/normal/orthostatic/orthostatic               hypotension/peripheral/peripheral
  piration/space/SPACEFLIGHT/speed/stroke/stroke volume/sympathetic/sympathetic
  activity/sympathetic nerve/sympathetic nerve activity/sympathetic nervous
  system/syncope/TILT/total                                                       peripheral
  resistance/USA/VA/VAGAL/Valsalva/ventricular/ventricular                            stroke
Sundstedt, M., Jonason, T., Ahren, T., Damm, S., Wesslen, L. and Henriksen, E. (2003),
  Left ventricular volume changes during supine exercise in young endurance athletes.
  Acta Physiologica Scandinavica, 177 (4), 467-472.
Abstract: Aim: The primary objective of the study was to measure the relative left
  ventricular volumes and the changes in left ventricular ejection fraction during
  supine position from rest to exercise in young endurance athletes. The secondary
  objective was to examine if there were gender differences regarding the volume reply
  and ejection fraction with exercise. Method: Sixty-five (35 female and 30 males)
  young healthy Swedish orienteers participated in the study. Left ventricular volume
  and ejection fraction changes between rest and submaximal supine bicycle exercise
  were measured with radionuclide ventriculography. Results: The mean left
  ventricular end-diastolic volume increased by 13% (P < 0.001) but there was no
  change in end-systolic volume. Stroke volume was found to increase by 21% (P <
  0.001). Left ventricular ejection fraction increased significantly (>0.04 units) in 54%
  of the athletes from rest to exercise; 5% of the athletes showed a decrease in ejection
  fraction. A negative correlation was found between ejection fraction at rest and the
  difference in ejection fraction from rest to exercise (r = -0.38, P = 0.002). There were
  no gender differences in the left ventricular volume changes or ejection fraction.
  Conclusion: During submaximal supine exercise, the adjustments in cardiac volumes
  in endurance athletes were small. There were no gender disparities concerning the
  left ventricular volume reply during exercise
Keywords:                      athletes/bicycle                    exercise/cardiac/cardiac
  fraction/EJECTION-FRACTION/end-diastolic                             volume/end-systolic
  volume/endurance/ENGLAND/exercise/female/gender/gender                differences/left/left
  ventricular/left ventricular dynamics/left ventricular ejection fraction/left ventricular
  end-diastolic                            volume/left                           ventricular
   position/Sweden/ventricular/ventricular           ejection/ventricular          ejection
   fraction/ventricular volume/volume/young
Nilsson, F.M., Kessing, L.V., Sorensen, T.M., Andersen, P.K. and Bolwig, T.G. (2003),
   Affective disorders in neurological diseases: a case register- based study. Acta
   Psychiatrica Scandinavica, 108 (1), 41-50.
Abstract: Objective: To investigate the temporal relationships between a range of
   neurological diseases and affective disorders. Method: Data derived from linkage of
   the Danish Psychiatric Central Register and the Danish National Hospital Register.
   Seven cohorts with neurological index diagnoses and two control group diagnoses
   were followed for up to 21 years. The incidences of affective disorders in the
   different groups were compared with the control groups, using competing risks to
   consider the risk of affective disorder and the risk of death in the same analysis.
   Results: We found an increased incidence of affective disorders in dementia,
   Parkinson's disease, epilepsy, stroke and intracerebral haemorrhage compared with
   control groups. The association was found to be the strongest for dementia and
   Parkinson's disease. In hospitalized patients, with incident multiple sclerosis, the
   incidence of affective disorder was lower than the incidence in the control groups.
   Conclusion: In neurological diseases there seems to be an increased incidence of
   affective disorders. The elevated incidence was found to be particularly high for
   dementia and Parkinson's disease (neurodegenerative diseases)
Keywords:                              affective                         disorder/affective
   /index/intracerebral/intracerebral                haemorrhage/linkage/lower/MAJOR
   DEPRESSIVE           DISORDER/mania/MOOD               DISORDERS/multiple/multiple
   sclerosis/MULTIPLE-         SCLEROSIS/neurodegenerative/neurological/neurological
Hald, J.K., Brunberg, J.A., Dublin, A.B. and Wootton-Gorges, S.L. (2003), Delayed
   diffusion-weighted MR abnormality in a patient with an extensive acute cerebral
   hypoxic injury - A case report. Acta Radiologica, 44 (3), 343-346.
Abstract: Diffusion-weighted (DW) MR imaging usually identifies acute cerebral
   infarction injury in symptomatic patients. We report a patient with severe hypoxic
   brain injury following suicide attempt by hanging, but with normal DW MR imaging
   5-6 h after the event. Follow-up DW MR imaging 3 days after the event, and
   subsequent autopsy, revealed extensive cerebral anoxic injury
Keywords:          acute/acute        cerebral      infarction/ACUTE           ISCHEMIC
   STROKE/autopsy/brain/BRAIN/brain              injury/case      report/cerebral/cerebral
   weighted/diffusion-weighted/diffusion-weighted                    MR/HYPERACUTE
Batty, G.M., Grant, R.L., Aggarwal, R., Lowe, D., Potter, J.M., Pearson, M.G. and
   Jackson, S.H.D. (2003), Using prescribing indicators to measure the quality of
   prescribing to elderly medical in-patients. Age and Ageing, 32 (3), 292-298.
Abstract: Objectives: to evaluate the performance of hospitals using eight indicators
   designed to assess prescribing practice in medical in-patients aged greater than or
   equal to65 years. Design: local coalition teams were invited to collect cross-
   sectional prescribing and clinical data on 100 consecutive medical in-patients aged
   greater than or equal to65 years during a specific week in April 1999. Setting: 102
   hospitals across England. Participants: all NHS Trust hospitals in Wales and England
   were invited to participate in the study. Main outcome measures: the performance
   and inter-hospital variation of hospitals in eight indicators of prescribing. Also, the
   age- related appropriate use of anti-thrombotic stroke prophylaxis in atrial fibrillation,
   of aspirin in angina and of benzodiazepines. Results: data were collected on 9,979
   patients prescribed 70,458 medications. The number of hospitals achieving the
   prescribing goal for the indicators varied between 0 and 70. Frequency of
   administration instructions with 'as required' prescriptions were documented on 60%
   (10,403/17,258) of occasions. Generic (or acceptable proprietary) names were used
   for 84% (58,953/70,458) medications, 50% (4,870/9,778) of patients had
   documentation of allergy status on the drug chart and 23% (1,380/6,060) of patients
   had the potential risk of exceeding the maximum recommended dosage (4 g/24 h) of
   paracetamol. Long-acting hypoglycaemic drugs were prescribed to 50 patients. Anti-
   thrombotic stroke prophylaxis in atrial fibrillation were used appropriately for 53%
   (805/1,518) of patients, aspirin was used appropriately in angina for 90% (952/1,052)
   of patients and benzodiazepines were used appropriately for 49% (824/1,689) of
   patients. For the latter three indicators, the appropriate use of medications declined
   from 60% to 44%, 95% to 85% and 53% to 44% in patients aged greater than or
   equal to85 years compared with those aged 65-74 years. Conclusions: prescribing
   indicators were effective in evaluating the performance of 102 hospitals on
   prescribing practice to medical in-patients aged greater than or equal to65 years.
   Prescribing to elderly medical in-patients is sub-optimal but targets were achieved by
   some hospitals. This should inspire those hospitals not achieving high standards to
   improve their performance. The higher level of inappropriate prescribing with
   increasing age is unacceptable
   ylaxis/quality/risk/status/stroke/thrombotic stroke/use/Wales
Claesson, L., Gosman-Hedstrom, G., Fagerberg, B. and Blomstrand, C. (2003), Hospital
   re-admissions in relation to acute stroke unit care versus conventional care in elderly
   patients the first year after stroke: the Goteborg 70+ Stroke study. Age and Ageing,
   32 (1), 109-113.
Abstract: Background: re-hospitalisation after discharge following index stroke varies
   over time and with age and comorbidity. There is little knowledge about whether
   stroke unit care reduces the need of re-admissions. Objectives: to examine whether
   stroke unit care as compared with care in general medical wards was associated with
   fewer re-hospitalisations for conditions judged to be secondary to acute stroke and to
   identify the influence of stroke severity on re-admission rates. Design: we conducted
   a one-year randomised study to compare the outcome of treatment at an acute stroke
   unit in a care continuum with the outcome of treatment at general medical wards.
   Settings: acute and geriatric hospitals in Goteborg, Sweden. Subjects: 216 elderly
   patients aged greater than or equal to70 years discharged to their own homes or to
   institutionalised living after index stroke. Methods: comparison of comorbidity
   classified according to Charlson's morbidity index, re-admission rates, length of
  hospital stay, number of re-admissions and diagnoses between a group treated at a
  stroke unit and a group treated at general wards. Results: the re-admission rates,
  length of hospital stay and causes of re-admissions did not differ between the two
  groups. Complications related to the damage to the brain and concomitant heart
  disease were the most common causes of re- admissions in both groups. Index stroke
  severity did not influence the re-admission rates. Conclusions: re-admissions for
  conditions judged to be secondary to acute stroke were equal in the two groups in
  this prospective study
Keywords:                                                             1-YEAR/acute/acute
  patients/ENGLAND/FOLLOW-UP/general/general                                      medical
  wards/geriatric/heart/heart                disease/hospital/hospitals/index/ISCHEMIC
  STROKE/knowledge/length of hospital stay/medical/morbidity/NEUROLOGICAL
  study/RANDOMIZED                                                        CONTROLLED
  TRIAL/REHABILITATION/secondary/SEVERITY/stroke/stroke                     outcome/stroke
  severity/stroke unit/stroke units/SWEDEN/treatment/TRENDS
Henry, O.F., Blacher, J., Verdavaine, J., Duviquet, M. and Safar, M.E. (2003), Alpha
  1-acid glycoprotein is an independent predictor of in- hospital death in the elderly.
  Age and Ageing, 32 (1), 37-42.
Abstract: Objectives: to determine the contribution of the two acute phase proteins
  alpha 1-acid glycoprotein, and C-reactive protein to the prediction of overall
  mortality in hospitalised elderly patients. Design: prospective cohort study. Setting: a
  department of geriatric medicine of Charles Richet Hospital, in the Paris-Ile de
  France area. Subjects: 433 consecutive patients (mean age 84+/-7 years) admitted for
  rehabilitation in a department of geriatric medicine. Methods: clinical and laboratory
  examinations were performed at baseline. Follow-up ended at hospital discharge or
  death. Prognostic factors of survival were identified using Cox proportional hazards
  regression model. Results: compared with the survivor group, the mean serum levels
  of both C-reactive protein and alpha 1- acid glycoprotein at baseline were higher in
  the deceased group (44+/-51 mg/l versus 22+/-34 mg/l and 1691+/-69 mg/l versus
  1340+/-456 mg/l respectively; P<0.001 for each). Baseline levels of albumin and
  prealbumin were significantly lower in patients who died than in patients who
  survived. In multivariate analysis, alpha 1-acid glycoprotein (but not C- reactive
  protein), previous stroke, previous heart failure, and age emerged as the only
  parameters significantly and independently related to overall mortality. Conclusion:
  this study shows that the increase in plasma levels at admission of two acute-phase
  proteins, alpha 1-acid glycoprotein and C- reactive protein, were associated with
  in-hospital mortality in a population of hospitalised elderly patients. Furthermore,
  associations of overall mortality with inflammation differed among the markers and
  only alpha 1-acid glycoprotein entered the multivariate prediction model. Our
  findings support the hypothesis that alpha 1-acid glycoprotein may be superior to C-
  reactive protein in mortality risk assessment strategies for elderly patients
Keywords: acute/AGE/albumin/alpha 1-acid glycoprotein/analysis/assessment/C-
  reactive              protein/C-reactive/C-reactive               protein/C-REACTIVE
  study/death/elderly/elderly       patients/ENGLAND/failure/France/geriatric/geriatric
  medicine/heart/heart              failure/hospital/IL-6             LEVELS/in-hospital
  ALITY/mortality/mortality                risk/multivariate             analysis/OLDER
  model/predictor/prospective/prospective               cohort/prospective           cohort
  study/protein/proteins/regression/regression                model/rehabilitation/risk/risk
  rvivor/the elderly
Morimoto, T., Schreiner, A.S. and Asano, H. (2003), Caregiver burden and
  health-related quality of life among Japanese stroke caregivers. Age and Ageing, 32
  (2), 218-223.
Abstract: Objective: the present study had two main purposes: 1. To examine the
  relationship between caregiver burden and health- related quality of life in family
  caregivers of older stroke patients in Japan; and 2. To examine which characteristics
  of the caregiving situation significantly relate to increased burden. Methods: subjects
  (n = 100) were recruited from seven randomly selected neurological hospitals with
  out-patient rehabilitation clinics in western Japan and interviewed using the Zarit
  Burden Interview, the Modified Barthel Index, the Geriatric Depression Scale and
  the SF-12 Health Survey for health-related quality of life. Results: increased
  caregiver burden was significantly related to worsening health-related quality of life,
  particularly worsening mental health (Geriatric Depression Scale and SF-12 items),
  even after controlling for caregiver age, sex, chronic illness, average caregiving
  hours/day, and functional dependence of the care- recipient. Discussion: findings
  indicate that increased burden significantly relates to decreased health-related quality
  of life among stroke caregivers. In addition, the prevalence of depressive symptoms
  among caregivers was twice that of community dwelling older people. Roughly 52%
  of caregivers had Geriatric Depression Scale scores that warranted further evaluation.
  Despite the prevalence of depressive symptoms only one caregiver had received any
  psychiatric care during their caregiving tenure
Keywords:          addition/AGE/Barthel/Barthel           Index/burden/caregiver/caregiver
  symptoms/ENGLAND/evaluation/family/functional/Geriatric                       Depression
  Scale/health/health-related                            quality                          of
  people/patients/prevalence/psychiatric/quality/quality                                  of
  life/rehabilitation/sex/SF-12/stroke/stroke                             caregivers/stroke
  patients/symptoms/VALIDATION/Zarit Burden Interview
Rodgers, H., Dennis, M., Cohen, D. and Rudd, A. (2003), British Association of Stroke
  Physicians: benchmarking survey of stroke services. Age and Ageing, 32 (2),
Abstract: Background: the National Service Framework for Older People requires every
  general hospital which cares for stroke patients to introduce a specialist stroke
  service by 2004. Objective: to describe the organisation and staffing of specialist
  hospital- based stroke services in the UK. Design: a national postal survey of
  consultant members of the British Association of Stroke Physicians (BASP) seeking
  details of the provision of neurovascular clinics, acute stroke units (ASUs), stroke
  rehabilitation units (SRUs), and the organisation and staffing of these services.
  Results: the response rate was 91/126 (72%). Fifty-four neurovascular clinics, 40
  ASUs and 68 SRUs were identified. Neurovascular clinics used a number of
  strategies to maintain rapid access and 30 (56%) were run by a single consultant.
  Only 50% ASUs usually admitted patients within 24 h of stroke. As the number of
  beds available on ASUs and SRUs did not reflect the total number of stroke
  in-patients, 21 (53%) ASUs and 45 (79%) SRUs had admission criteria. Training
  opportunities were limited: 37% ASUs and 82% SRUs had no specialist registrar.
  The therapy sessions (1 session = half a day) available per bed per week on a SRU
  were: physiotherapy 0.8; occupational therapy 0.6; speech and language therapy 0.25.
  Conclusions: significant development is needed to achieve the NSF target for
  hospital-based stroke services as few Trusts currently have all components in place
  and even when available not all stroke patients have access to specialist care. Stroke
  specialists will be required to run these services but training opportunities are
  currently limited. Stroke unit therapy staffing levels were lower than was available in
  randomised controlled trials
Keywords: acute/acute stroke/AGE/benchmarking/British Association of Stroke
  wer/NSF              for              Older           People/occupational/occupational
  therapy/organisation/organisation                             o                         f
  patients/stroke        rehabilitation/stroke        service/stroke        services/stroke
  units/survey/therapy/training/TRANSIENT                                      ISCHEMIC
Andre-Petersson, L., Elmstahkl, S., Hagberg, B., Janzon, L., Reinprecht, F. and Steen,
  G. (2003), Is blood pressure at 68 an independent predictor of cognitive decline at 81?
  Results from follow-up study 'Men born in 1914', Malmo Sweden. Aging & Mental
  Health, 7 (1), 61-72.
Abstract: One hundred and sixty-eight men who were participants in the study Men
  born in 1914' had their blood pressure and cognitive function examined when they
  were 68 years old. They were then re-examined at the age of 81. Decline on five
  standardized cognitive tests at the age of 81 years was studied in relation to four
  levels of baseline blood pressure at the age of 68. Results from multivariate analyses
  suggested that blood pressure, when studied in conjunction with other factors related
  to cognitive function, contribute to a rather modest extent and not unambiguously to
  the variability in cognitive decline. When decline on each separate test had been
  combined into a composite measure, where equal weight had been given to memory,
  crystallized and fluid abilities, it was shown that hypertension stage 2 (SBP 160-179
  mmHg or DBP 100-109 mmHg) was associated with greater levels of overall decline.
  Hypertension stage 3 (SBP greater than or equal to180 mmHg or DBP greater than or
  equal to110 mmHg), on the other hand, was associated with lower levels of overall
  decline. Depressive symptoms at follow-up had a negative effect on cognitive levels
  and were discussed as potential confounders of hypertension-related cerebral lesions
Keywords:        68-YEAR-OLD             MEN/age/blood/blood          pressure/CAROTID
  STENOSIS/cerebral/cognitive/cognitive                                   decline/cognitive
  LAND/fluid/follow                                                up/follow-up/follow-up
Kardas, P. and Ratajczyk-Pakalska, E. (2003), Reasons for elderly patient
  hospitalization in departments of internal medicine in Lodz. Aging Clinical and
  Experimental Research, 15 (1), 25-31.
Abstract: Background and aims: The number of hospitalizations of elderly patients in
  Poland has been increasing rapidly in recent years. For Lodz, with the oldest
  population among big cities in Poland, this is an especially important problem. In
  order to reduce the number of elderly patient hospitalizations, it is first necessary to
  know the main reasons for these hospitalizations. This study aimed to determine the
  reasons for elderly patient hospitalizations in Lodz. Methods: Data related to elderly
  patients (65 and over) admitted to departments of internal medicine in three district
  hospitals in Lodz were collected. The reasons for hospital admission, coded
  according to the International Classification of Diseases-10th Revision, were used for
  the calculations. Results: Elderly persons accounted for 53.6% of patients
  hospitalized at the departments studied. The most frequent reasons for hospital
  admission of the elderly were cardiovascular diseases (CVD) (54.7%) and respiratory
  tract diseases (19.9%). The most frequent specific diagnoses for hospitalization were
  coronary heart disease (CHD) (15.7%), pneumonia (11.5%), stroke (8.5%),
  hypertension (7.2%), heart failure (5.4%). non-insulin-dependent diabetes (5.3%) and
  insufficiency of cerebral arteries (5.3%). Hypertension was nearly twice as frequent a
  reason for hospital admission in women as in men. Conclusions: Elderly persons
  account for more than half of patients in departments of internal medicine in Lodz.
  The most frequent reason for hospital admission of the elderly is CVD, particularly
Keywords: admission diagnosis/ADMISSIONS/arteries/cardiovascular/cardiovascular
  disease/cardiovascular diseases/cerebral/cerebral arteries/CHD/coronary/coronary
  heart/coronary                         heart                     disease/CORONARY
  patients/FAILURE/geriatrics/heart/heart                                    disease/heart
  GLUCOSE-TOLERANCE/internal/internal                    medicine/men/non           insulin
  /reasons for hospitalization/stroke/the elderly/tract/UNITED-STATES/WOMEN
Lundin-Olsson, L., Jensen, J., Nyberg, L. and Gustafson, Y. (2003), Predicting falls in
  residential care by a risk assessment tool, staff judgement, and history of falls. Aging
  Clinical and Experimental Research, 15 (1), 51-59.
Abstract: Background and aims: It is of great importance to consider whether a tool's
  predictive value is generalizable to similar samples in other locations. Numerous fall
  prediction systems have been developed, but very few are evaluated over a different
  time period in a different location. The purpose of this study was to validate the
  predictive accuracy of the Mobility Interaction Fall (MIF) chart, and to compare it to
  staff judgement of fall risk and history of falls. Methods: The MIF chart, staff
  judgement, and fall history were used to classify the risk of falling in 208 residents
  (mean age 83.2+/- 6.8 years) living in four residential care facilities in northern
  Sweden. The MIF chart includes an observation of the ability to walk and
  simultaneously interact with a person or an object, a vision test. and a concentration
  rating. Staff rated each resident's risk as high or low and reported the resident's
  history of falls during the post 6 months. Falls were followed up for 6 months.
  Results: During the follow-up period, 104 residents (50%) fell at least once indoors.
  Many of the factors commonly associated with falls did not differ significantly
  between residents who fell at least once and residents who did not fall. In this
  validating sample the predictive accuracy of the MIF chart was notably lower than in
  the developmental sample. A combination of any two of the MIF chart, staff
  judgement, and history of falls was more accurate than any approach alone: more
  than half of the residents classified as 'high risk' by two approaches sustained a fall
  within 3 months. Conclusions: Residents classified as 'high risk' by any two of the
  MIF chart, staff judgement, and history of falls should be regarded as 9 particularly
  prone to falling and in urgent need of preventive measures
  RLY             PEOPLE/fall/fall            risk          prediction/falling/falls/follow
  BILITY/Mobility              Interaction          Fall        chart/NURSING-HOME
  value/PRONE         PATIENT/RECURRENT               FALLS/residential      care/risk/risk
  assessment/STROKE REHABILITATION/Sweden/vision
Hassing, L.B., Johansson, B., Pedersen, N.L., Nilsson, S.E., Berg, S. and McClearn, G.
  (2003), Type 2 diabetes mellitus and cognitive performance in a population-based
  sample of the oldest old: Impact of comorbid dementia. Aging Neuropsychology and
  Cognition, 10 (2), 99-107.
Abstract: We examined the relationship between type 2 diabetes mellitus and cognitive
  function in a population-based sample of very old people. The sample comprised 338
  persons, aged 80-93 years (mean age 83.5 years), of whom 70 persons had type 2
  diabetes mellitus. Measures of cognitive functioning included tests of perceptual
  speed, visuo-spatial ability, inductive reasoning, short-term memory, semantic
  memory, episodic memory, and the Mini-Mental State Examination. Regression
  analyses showed that type 2 diabetes mellitus duration was related to test
  performance across all cognitive domains, with the exception of short-term memory,
  such that longer duration was associated with lower test performance. When cases
  with dementia were excluded from the sample, further analyses showed that diabetes
  duration was not associated with cognitive test performance. This indicates that
  diabetes is not related to lower cognitive function in the general population of
  non-demented old people. Diabetes, however, increases the risk for cerebrovascular
  incidents, like stroke, that may contribute to vascular dementia
  function/cognitive                                                functioning/cognitive
  population/IMPAIRMENT/lower/memory/Mini-Mental                                       State
  FACTORS/semantic memory/short-term memory/speed/stroke/Sweden/tests/type
  2/Type 2 diabetes/Type 2 diabetes mellitus/vascular/VASCULAR DEMENTIA/very
  old/visuospatial/visuospatial ability
Bazner, H. and Hennerici, M. (2003), Should asymptomatic carotid stenosis be operated
  on? Aktuelle Neurologie, 30 (2), 76-86.
Abstract: In contrast to the proven benefit of carotid endarterectomy (CEA) in patients
  with middle- and high-grade symptomatic stenoses of the internal carotid artery,
  there exist controversies about the use of this procedure in asymptomatic patients
  which is not supported by study data. Recent metaanalyses compared all completed
  randomized studies which analysed the effect of CEA in comparison to conservative
  management, and concluded that there is a certain evidence in favour of the surgical
  procedure in the treatment of asymptomatic internal carotid stenosis, which, however,
  is not significant with regard to absolute risk reduction. In this review, we report on
  the original data and the results of metaanalyses and discuss the controversial
  recommendations. Accordingly, an individual decision for an experimental surgical
  therapy after a thorough risk-modelling analysis may be justified, which, apart from
  measurable parameters (e.g. in an algorithm as it is used in symptomatic carotid
  stenosis patients), has to consider individual patient's attitudes towards medical vs.
  surgical management. In conclusion, on the basis of outdated original data a
  reasonable argument in favour or against the procedure is no longer possible. This
  points to a need of new large studies with intelligent designs and low individual risks
Keywords:                 absolute                risk/algorithm/analysis/artery/ARTERY
  STENOSIS/asymptomatic/asymptomatic carotid stenosis/attitudes/carotid/carotid
  artery/carotid endarterectomy/carotid stenosis/CEA/CEREBRAL VASOMOTOR
  carotid/internal           carotid          artery/ISCHEMIC              STROKE/large
  al    therapy/symptomatic       carotid    stenosis/therapy/treatment/use/VASCULAR
Forsting, M. and Wanke, I. (2003), What is new in neuroradiology 2001/2002? Aktuelle
  Neurologie, 30 (4), 159-164.
Abstract: This review covers recent publications on the field of diagnostic imaging of
  the brain and spine and gives an overview about the newest results in interventional
  neuroradiology, mainly in endo-vascular therapy of intracranial aneurysms
Keywords:                                           aneurysms/brain/diagnostic/diagnostic
  erventional neuroradiology/intracranial/intracranial aneurysms/INTRACRANIAL
Kodal, H., Liu, W., Bektas, N., Neveling, M. and Petereit, H.F. (2003), Consecutive
  meningitis, abscess and stroke as a consequence of infection with aspergillus
  fumigatus in a patient with diabetes mellitus. Aktuelle Neurologie, 30 (4), 195-198.
Abstract: Cerebral aspergillosis is a widespread sequelae of systemic aspergillosis in
  immunocompromised hosts. However, a local invasive form in immunocompetent
  individuals originating from chronic fungal sinusitis has been described as well. Here
  we present a case of sinusitis with consecutive visual loss, meningitis and
  disseminated brain ischemia in a 69-year old diabetic man. Despite improved
  diagnostic tools, and new antifungal treatment, the most important factor for the
  patients outcome is the early diagnosis. Therefore, we recommend the search for
  aspergillosis sinusitis in all patients with neurological signs that point to the skull
  base and in those with atypical meningitis
Keywords:              abscess/brain/brain              ischemia/chronic/diabetes/diabetes
  mellitus/DIAGNOSING INVASIVE ASPERGILLOSIS/diagnosis/diagnostic/early
Kremer, R. (2003), The influence of sociodemographical characteristics on functional
  independence coping - A cross-sectional study in stroke patients. Aktuelle Neurologie,
   30 (4), 174-179.
Abstract: Objective: The object of this study was to assess the influence of different
   coping activities on the functional independence of stroke patients. It was special
   interest to investigate if and how variables like age, gender and education influence
   the relationship between coping activities and functional independence. Subjects and
   methods: 105 stroke patients (50 women, 55 men; mean age 71 years) were tested.
   The coping activities of the stroke patients were investigated by the,Freiburg
   Questionnaire of Coping with Illness" (FQCI). The functional independence of the
   stroke patients was investigated with the,Functional Independence Measure" (FIM).
   Results:      The      coping     strategies,,distractive   and       self-reconstructing
   coping",,trivialization and wishful thinking" as well as,active and problem-focussed
   coping" have no influence on functional independence. Depressive coping and
   the ,,religiosity and quest for meaning" strategies, on the contrary, show an
   ambivalent (both negative and positive) age-, gender- and school education-specific
   mode of influence
Keywords:                                      age/coping/coping-activities/cross-sectional
   en/methods/patients/school/stroke/stroke patients/women
Kuker, W., Schulz, J.B., Kastrup, A., Nagele, T. and Krapf, H. (2003), Intravenous
   therapy at basilar artery occlusion: MRI findings at 1.5 and 3 T. Aktuelle Neurologie,
   30 (4), 199-203.
Abstract: Purpose: Acute basilar artery occlusion is a life threatening condition which
   requires rapid diagnosis and treatment. The purpose of this paper is to compare MR
   findings of basilar artery occlusion before and after systemic treatment at 1.5 and 3 T.
   Material and Methods: MRI was performed according to a stroke protocol in a
   patient with acute basilar artery occlusion before and after systemic treatment. The
   examinations at 1.5 and 3 T included T-2- and diffusion-weighted sequences as well
   as MRA using a time-of-flight technique. Results: The initial MRI demonstrated
   basilar artery occlusion as well as early signs of brain-stem ischemia. Complete
   recanalization was achieved by systemic therapy with rt-PA and Abciximab. MRI at
   3 T supplied superior flow information by MRA and demonstrated high sensitivity
   for intracerebral haemorrhage. Diffusion- weighted images at 3 T were of good
   quality and not degraded by susceptibility artefacts in the posterior fossa.
   Conclusions: Stroke-MRI for basilar artery occlusion can be performed at 1.5 and 3
   T. The advantages of high-field MRI seem to be superior quality of MRA and high
   sensitivity for intracerebral haemorrhage. Basilar artery recanalization can be
   achieved using a systemic protocol combining rt-PA with Abciximab
Keywords:         ABCIXIMAB/acute/artery/basilar/basilar          artery/basilar      artery
   occlusion/brain                           stem/brainstem/condition/diagnosis/diffusion
   ATOR/posterior                 fossa/quality/recanalization/sensitivity/STROKE/stroke
Liepert, J. (2003), New therapies in neurorehabilitation. Aktuelle Neurologie, 30 (5),
Abstract: Even years after a stroke a large number of patients still suffer from motor
   impairment. In recent years some new motor rehabilitation techniques have emerged.
   This review focusses on forced use treatments, bilateral arm training, robot-assisted
   sensorimotor therapies, modulations of afferent input and drugs that might promote
   motor rehabilitation
Keywords:              arm/bilateral/BOTULINUM-TOXIN/CHRONIC                      STROKE
   PATIENTS/CORTICAL                                    REORGANIZATION/drugs/forced
   use/FORCED-USE/German/GERMANY/impairment/INDUCED                          MOVEMENT
   THERAPY/MAGNETIC                      STIMULATION/motor/MOTOR                  CORTEX
   PLASTICITY/motor                     impairment/neurorehabilitation/patients/PHYSICAL
Ziegler, V., Soda, H., Achner, S., Kiessecker, U. and Griewing, B. (2003), Development
   of German DRG and cost weights presentation of stroke care in an integrative care
   system under G-DRG- conditions. Aktuelle Neurologie, 30 (3), 140-144.
Abstract: Background: The introduction of a casemix-system (diagnosis related groups)
   in Germany will change the conditions of funding. Payment per diem will be
   removed by payment of flat rates for groups of patients with similar resource use.
   The patients treated in hospitals in Germany which provide an integrative structure
   of treatment for stroke patients, including stroke unit care, acute care and
   rehabilitation, are not sufficiently represented in the G-DRG-system. Method: All
   patients admitted to the stroke unit of our hospital from 2002- 01-01 to 2002-07-31
   were included. Compared was the cost data of our sample with the data provided by
   the stroke data bank of the german foundation of stroke aid (DSD). Costs of
   treatment were calculated on the basis of hospital per diem charge and
   DRG-payment according to the present specifications. Results: Looking at the
   hospital per diem charge, there was a trend to accordance between data of DSD and
   data of Bad Neustadt (NES). The comparison of payment per case according to the
   G-DRG- System and hospital per diem charge showed a difference of -
   221000.-EURO That means a deficit of 700.-EURO per patient coming out of
   DRG-payment. With an average length of stay up to 15 days the DRG-payment
   could cover the costs of treatment. With an average length of stay over 20 days the
   deficit was increasing constantly. Conclusion: The costs of integrative treatment of
   stroke-patients are not sufficiently represented in the G-DRG-system according to
   the tasks of treatment and targets of outcome. Especially for the phase B (early
   mobilisation and rehabilitation starting immediately with acute care) there is no
   cost-covering payment coming out of the G- DRG-System. Considered separately,
   the payment for acute care of stroke-patients including German stroke unit system
   could cover the costs
Keywords: acute/acute care/comparison/cost/costs/DATA-BANK/diagnosis/diagnosis
   related groups/FOUNDATION/German/GERMANY/hospital/hospitals/length of
   stay/outcome/patient/patients/presentation/rehabilitation/stroke/stroke       care/stroke
   data bank/stroke patients/stroke unit/structure/treatment/use/weights
Reuthebuch, O., Schmidt, D., Lang, A., Groscurth, P. and Turina, M. (2003), Totally
   artificial training model for coronary heart surgery: the end of animal experiments?
   Altex-Alternativen zu Tierexperimenten, 20 (1), 17-20.
Abstract: Totally artificial training model for coronary heart surgery: the end of animal
   experiments? Aim: Animal protection laws will lead to stricter and more selective
   criteria thus resulting in a decline of available animals. Yet to train cardiac surgical
   skills a totally artificial training model was developed. Description of training model:
   The model is based on differently hardened polyurethane. Cover is a 1:1 replica of
   the human thoracic wall. Disposable coronaries are integrated in the heart-model.
   Vessels and part of the ascending aorta can be rinsed. By means of a newly designed
   air-pump stroke volume, heart-rate and rhythm can be adjusted. Experiences: Set-up
   of the model is easy and quick. Accustomed instruments can be used. Handling of
   artificial tissue is nature-like. Degree of difficulty is dependent on stroke volume,
   heart rate, arrhythmia, vessel-size and vessel-quality. Conclusion: The phantom helps
   to achieve confidence in coronary revascularisation. It facilitates an accompanying
   training for the less-trained as well as the skilled surgeon. The nature- like
   characteristics will help to reduce animal experiments in future
Keywords:           ANASTOMOSIS/animal/animals/aorta/arrhythmia/artificial/ascending
   aorta/cardiac/coronary/coronary                                         disease/coronary
   heart/criteria/decline/German/GERMANY/heart/heart                              rate/heart
   oke/stroke               volume/surgery/surgical/Switzerland/thoracic/training/training
Klatte, E.T., Scharre, D.W., Nagaraja, H.N., Davis, R.A. and Beversdorf, D.Q. (2003),
   Combination therapy of donepezil and vitamin E in Alzheimer disease. Alzheimer
   Disease & Associated Disorders, 17 (2), 113-116.
Abstract: A retrospective chart review was performed on 130 patients from the Ohio
   State University Memory Disorders Clinic to examine the long-term effects of
   combination therapy with donepezil and vitamin E on patients with Alzheimer
   disease. Subjects were included if they met National Institute of Neurological and
   Communicative Disorders and Stroke and Alzheimer's Disease and Related
   Disorders Association criteria for probable Alzheimer disease, had taken at least 5
   mg donepezil and at least 1000 U vitamin E daily, had at least a 1-year follow-up
   while continuing these medications, and had a Mini-Mental State Examination score
   of 10-24. The Mini-Mental State Examination was then recorded annually thereafter.
   These data were compared with the Consortium to Establish a Registry for
   Alzheimer's Disease database for patients collected prior to the availability of these
   treatment options. Patients declined at a significantly lower rate as compared with the
   Consortium to Establish a Registry for Alzheimer's Disease data. The long- term
   combination therapy of donepezil and vitamin E appears beneficial for patients with
   Alzheimer disease. Future prospective studies would be needed to compare
   combination treatment to vitamin E and donepezil alone
Keywords:               Alzheimer/Alzheimer              disease/combination/combination
   therapy/combination                                          treatment/CONTROLLED
   low                         up/follow-up/lower/Mini-Mental                          State
   studies/review/SAFETY/score/therapy/treatment/USA/vitamin/vitamin E
Brewer, D. (2003), Does long-term anticoagulation improve function after stroke?
   American Family Physician, 67 (11), 2317-2318
Briguori, C., Sarais, C., Pagnotta, P., Airoldi, F., Liistro, F., Sgura, F., Spanos, V.,
   Carlino, M., Montorfano, M., Di Mario, C. and Colombo, A. (2003), Elective versus
   provisional intra-aortic balloon pumping in high-risk percutaneous transluminal
   coronary angioplasty. American Heart Journal, 145 (4), 700-707.
Abstract: Background Elective intra-aortic balloon. pump (IABP) support may reduce
   acute complications occurring during percutaneous coronary interventions (PCI) in
  patients with severe depression of the left ventricular ejection fraction (EF less than
  or equal to 30%). Methods Since February 1998, 133 consecutive patients with EF
  less than or equal to 30% underwent elective PCI in our institution; 61 had elective
  preprocedural IABP support (group A) and 72 patients had conventional PCI (group
  B). Jeopardy score was calculated in each patient from the coronary angiograms to
  quantify the myocardium at risk. Results EF was similar in-the 2 groups, Jeopardy
  score was higher in group A (8.0 +/- 2.8 vs 6.7 +/- 2.4, P = .008). The other principal
  clinical and angiographic characteristics were similar in the 2 groups. Severe
  hypotension and/or shock occurred in I I patients, all in group B (P = .001). All
  required urgent IABP support, and 3 eventually died. Intraprocedural major adverse
  cardiac and cerebral events (eg, myocardial infarction, severe hypotension and/or
  shock, urgent bypass surgery, stroke, and death) were higher in group B (17% vs 0%,
  P = .001). By stepwise logistic regression analysis, elective IABP support (odds
  ration [OR] 0.11 [95% CI 0.21- 0.60], P = .011), jeopardy score (OR 5.37 [95% CI
  1.10-8.70], P = .040), and female sex (OR 2.72 [95% CI 1.85-3.10], P = .015), were
  the correlates of intraprocedural events. Conclusions This study supports the
  potential usefulness of elective versus' provisional IABP to prevent intraprocedural
  major adverse cardiac and cerebral events, in high-risk PCI
Keywords:                                                                   acute/ACUTE
  ventricular/left            ventricular             ejection            fraction/logistic
  infarction/myocardium/patient/patients/percutaneous             coronary/percutaneous
  transluminal coronary angioplasty/PROGNOSTIC VALUE/regression/regression
  cular/ventricular ejection/ventricular ejection fraction
Connolly, S.J. (2003), Preventing stroke in patients with atrial fibrillation: Current
  treatments and new concepts. American Heart Journal, 145 (3), 418-423.
Abstract: Atrial fibrillation (AF), is common, and it increases the risk of stroke.
  Placebo-controlled trials consistently showed that warfarin reduces the risk of stroke
  by two thirds, and a meta- analysis of trials of aspirin show a one-fifth reduction.
  Meta- analysis of trials directly comparing warfarin and aspirin shows that warfarin
  reduces the risk of stroke compared with aspirin by about one third. Major advisory
  bodies recommend risk stratification of patients with AF and prophylactic therapy
  with warfarin for patients at higher risk. There are several problems with warfarin
  therapy, which have resulted in a widely documented underuse. These problems
  include a narrow therapeutic window, marked variability in pharmacokinetics, and
  contraindications. There are new promising approaches to stroke prevention in AF.
  One of these is combination antiplatelet therapy. In a large randomized trial, the
  combination of dipyridamole and aspirin has been shown to have additive benefits
  against stroke. The combination of clopidogrel and aspirin results in additive benefits
  against vascular events, with only a modest increase in bleeding. A trial of combined
  antiplatelet therapy in AF is warranted. Occlusion of the left atrial appendage, either
  with a transvenous device or with surgery, is another strategy that is being explored.
  A direct thrombin inhibitor, ximelagatran, has been shown to have an excellent
  pharmacokinetic profile and is being developed as an oral agent for stroke prevention
  in AF, and it will not need regular monitoring
Keywords:                                      AF/analysis/antiplatelet/ANTIPLATELET
  THERAPY/ANTITHROMBOTIC                                 THERAPY/ASPIRIN/atrial/atrial
  PATIENTS/inhibitor/left/left                    atrial                 appendage/meta-
  zed/randomized trial/results/risk/risk of stroke/risk stratification/SECONDARY
  PREVENTION/strategy/stroke/stroke                            prevention/surgery/TERM
  ANTICOAGULATION/therapeutic/therapeutic window/therapy/thrombin/thrombin
  events/warfarin/WARFARIN USE
Cotter, G., Cannon, C.P., Mccabe, C.H., Michowitz, Y., Kaluski, E., Charlesworth, A.,
  Milo, O., Bentley, J., Blatt, A., Krakover, R., Zimlichman, R., Reisin, L., Marmor, A.,
  Lewis, B., Vered, Z., Caspi, A. and Braunwald, E. (2003), Prior peripheral arterial
  disease and cerebrovascular disease are independent predictors of adverse outcome
  in patients with acute coronary syndromes: Are we doing enough? Results from the
  Orbofiban in Patients with Unstable Coronary Syndromes- Thrombolysis In
  Myocardial Infarction (OPUS-TIMI) 16 study. American Heart Journal, 145 (4),
Abstract: Background Cerebrovascular accidents (CVAs), transient ischemic attacks
  (TIAs), and peripheral arterial disease (PAD) frequently coexist with coronary artery
  disease (CAD) and were previously reported to adversely affect the prognosis of
  patients with chronic CAD. Methods We examined the effect of prior CVA/TIA or
  PAD (extra-cardiac vascular disease [EVD]) on the outcome of 10,281 patients with
  acute coronary syndromes enrolled in. the Orbofiban in Patients with Unstable
  Coronary Syndromes-Thrombolysis in Myocardial Infarction (OPUS-TIMI) 16 trial
  of the oral glycoprotein Ilb/IIIa antagonist orbofiban plus aspirin versus aspirin alone.
  We evaluated mortality, recurrent cardiac events, and stroke and used multivariate
  analysis to control for differences in baseline characteristics. Results Patients with
  EVD were older, had more coronary risk factors, had a history of CAD, and received
  more intensive medical treatment at baseline. The acute event in these patients was
  more often unstable angina pectoris and less commonly Q-wave myocardial
  infarction. With coronary angiography, patients with prior EVD more often had
  multivessel disease. During the 10 months of follow-up, the presence of EVD was
  predictive of an increased hazard of death, reinfarction, recurrent ischemia, stroke,
  and a composite of these events. Despite the increased severity of the CAD and
  increased risk of events, patients with EVD were treated less frequently with
  beta-blockers and more frequently with calcium blockers. Despite patients with EVD
  having a 45% higher incidence of hypercholesterolemia, lipid-lowering agents were
  prescribed in a similar percentage of patients as patients without EVD. Conclusion In
  patients with acute coronary syndromes, the presence of prior CVA, TIA, or PAD is
  associated with more extensive CAD and worse outcome. These patients appear to
  receive less aggressive treatment, which may explain, at least in part, their worse
Keywords:            accidents/acute/acute          coronary           syndromes/adverse
  disease/artery/aspirin/ATHEROSCLEROSIS/baseline                      characteristics/beta
  disease/chronic/control/coronary/coronary angiography/coronary artery/coronary
  artery         disease/coronary        risk/CVA/death/disease/effect/EVENTS/follow
  chemic/ischemic                            attacks/lipid                       lowering
  agents/lipid-lowering/medical/mortality/multivariate analysis/myocardial/myocardial
  infarction/older/oral/outcome/patients/peripheral/peripheral                      arterial
  factors/risk-factors/stroke/syndromes/TIA/transient/transient                  ischemic
  attacks/treatment/trial/unstable                  angina/unstable                 angina
  pectoris/USA/vascular/vascular disease
Crystal, E., Lamy, A., Connolly, S.J., Kleine, P., Hohnloser, S.H., Semelhago, L.,
  Abouzhar, L., Cybulsky, I., Shragge, B., Teoh, K., Lonn, E., Sawchuk, C. and
  Oezaslan, F. (2003), Left Atrial Appendage Occlusion Study (LAAOS): A
  randomixed clinical trial of left atrial appendage occlusion during routine coronary
  artery bypass graft surgery for long-term stroke prevention. American Heart
  Journal, 145 (1), 174-178.
Abstract: Background Many patients undergoing coronary artery bypass graft (CABG)
  surgery have risk factors for both atrial fibrillation (AF) and stroke. The left atrial
  appendage (LAA) is a main source of thrombus coming from the left atrium. LAA
  occlusion should be tested as a means to reduce future cerebral ischemic events in
  these patients. Methods The Left Atrial Appendage Occlusion Study (LAAOS) is a
  randomized clinical trial designed to evaluate the feasibility, safety, and efficacy of
  LAA occlusion for prevention of ischemic stroke in patients undergoing CABG. The
  target population consists of patients at risk of AF and stroke who are having routine
  CABG surgery. The main study will be a prospective, controlled, unblinded trial.
  Patients at risk of future development of AF, or having AF, will be randomly
  assigned to undergo or not undergo LAA occlusion. A total of 2500 patients will be
  randomly assigned and followed for 5 years for the primary outcome of stroke. This
  study of 2500 patients will have 90% power to detect a relative reduction of 20% in
  stroke, from a 5-year incidence of 20% in the control group to 16% in the
  intervention group. Currently, a pilot trial is underway that will enroll 100 patients to
  assess feasibility, safety, and rates of successful LAA occlusion as assessed by
  postoperative transesophageal echocardiography. The most suitable surgical
  technique will also be assessed during the pilot trial. In the pilot study, the main
  outcomes are safety and rate of successful obliteration of the LAA after surgical
  occlusion. Conclusions The clinical trial designed to evaluate LAA occlusion at the
  time of routine CABG surgery is currently in the pilot phase
Keywords:            AF/APPENDECTOMY/artery/atrial/atrial                 appendage/atrial
  trial/control/coronary/coronary artery/coronary artery bypass/coronary artery bypass
  graft/coronary                   artery                   bypass                     graft
  RT/incidence/intervention/ischemic/ischemic stroke/left/left atrial appendage/left
  r/prevention/prospective/randomized/randomized clinical trial/RELEASE/risk/risk
Fox, E.R., Picard, M.H., Chow, C.M., Levine, R.A., Schwamm, L. and Kerr, A.J.
  (2003), Interatrial septal mobility predicts larger shunts across patent foramen ovales:
  An analysis with transmitral Doppler scanning. American Heart Journal, 145 (4),
Abstract: Background The association of patent foramen ovale (PFO) with cryptogenic
  stroke is strongest in patients with larger shunts and patients with atrial septal
  aneurysms (ASAs). We postulated that the potency of ASA as a risk factor for stroke
  relates to the size of shunt across PFOs associated with mobile atrial septae. The
  purpose of this study was to investigate the relationship between atrial septal
  mobility and the degree of right-to-left shunting with a transthoracic transmitral
  Doppler scanning (TMD) contrast technique. Methods In 165 consecutive patients,
  transthoracic TMD recordings were made during a saline contrast study with the
  patient at rest and after a maneuver to increase right atrial pressure. Bubble transit
  corresponded to high intensity signals in the velocity envelope of the mitral inflow
  profile and was quantified by a bubble score. Results A PFO was diagnosed in 59
  patients (36%). In 50 patients with PFO and adequate echocardiography images, the
  incidence of ASA was 52%. In this group, both total septal mobility and leftward
  deviation predicted the TMD bubble score at rest (Spearman rho 0.6,4, 0.64,
  respectively, P < .001) and after the maneuver (Spearman rho 0.74, 0.73, P < .001).
  In 28 patients with cerebral ischemic events, the maneuver bubble score was
  predictive for cryptogenic stroke (P = .02, odds ratio 7.58). There was a trend toward
  significance between total septal motion and cryptogenic stroke (P = .06).
  Conclusion Atrial septal mobility predicts the degree of right- to-left shunts across
  PFOs. The role of excessive septal mobility in the etiology of stroke may therefore
  be caused by the greater opportunity,for paradoxical embolism because of the size of
  the associated trans-PFO shunt
Keywords:                                                                         ADULT
  STROKE/mobility/motion/MULTICENTER/odds                    ratio/paradoxical/paradoxical
  embolism/patent/patent                                                          foramen
  CEREBROVASCULAR                EVENTS/right/right          atrial    pressure/RISK/risk
  EAL                                 ECHOCARDIOGRAPHY/TWO-DIMENSIONAL
Gerschutz, G.P. and Bhatt, D.L. (2003), The Clopidogrel in Unstable Angina to Prevent
  Recurrent Events (CURE) study: To what extent should the results be generalizable?
  American Heart Journal, 145 (4), 595-601.
Abstract: The Clopidogrel in Unstable Angina to Prevent Recurrent Events (CURE)
  study investigated the use of clopidogrel in the treatment of acute coronary
  syndromes. Clopidogrel treatment led to an impressive 20% relative risk reduction in
  the composite outcome measure of vascular death, myocardial infarction, and stroke.
  Increased bleeding and greater requirements for blood transfusions were seen with
  clopidogrel. The addition-of clopidogrel to aspirin represents a major advance in the
  treatment of acute coronary syndromes
Keywords: acute/acute coronary syndromes/ANTIPLATELET THERAPY/ARTERY
  infarction/outcome/outcome            measure/PERCUTANEOUS                 CORONARY
  INTERVENTION/PLACEMENT/relative                                 risk/results/risk/STENT
Grines, C., Patel, A., Zijlstra, F., Weaver, W.D., Granger, C., Simes, R.J., Ellis, S.,
  Betriu, A., Grines, C., Garcia, E., Grinfeld, L., Gibbons, R., Ribeiro, E., Ribichini, F.,
  Akhras, F., Jones, M., Topol, E., Califf, R., Van der Werf, F., Ardissino, D.,
  Armstrong, P.W., Aylward, P., Bates, E., Beatt, K., Cheseboro, J., Col, J.,
  Emanuelsson, H., Fuster, V., Gibler, W.B., Gore, J., Guerci, A., Hochman, J.,
  Holmes, D., Kleiman, N., Morris, D., Neuhaus, K., Ohman, M., Pfisterer, M.,
  Phillips, H., Rutsch, W., Simoons, M., Vahanian, A., White, H., Stone, G., Browne,
  K., Marco, J., Rothbaum, D., O'Keefe, D.R.J., Overlie, P., Donohue, B., O'Neill, W.,
  de Boer, M.J., 'T Hof, A.W.J., Hoorntje, J.C.A., Ottervanger, J.P., Suryapranata, H.,
  Moreno, R., Abeytua, M., De Sa, E.L., Lopez-Sendon, J.L., Delcan, J.L., Berrocal,
  D., Bellardi, J., Steffenino, G., Dellavalle, A., Holmes, D.R., Gersh, B.J.,
  Hopfenspirger, M.R., Silva, L.A., Carneiro, R., Akhras, F. and Abu Ousa, A. (2003),
  Primary coronary angioplasty compared with intravenous thrombolytic therapy for
  acute myocardial infarction: Six-month follow up and analysis of individual patient
  data from randomized trials. American Heart Journal, 145 (1), 47-57.
Abstract: Background Overviews of trials suggest that percutaneous transluminal
  coronary angioplasty (PTCA) may be more effective than thrombolysis. However,
  whether these effects are sustained beyond hospital discharge, and the extent to
  which the results are applicable to a broad cross section of patients and the wider
  community are unknown. We compared the effectiveness of primary PTCA and
  thrombolysis in acute myocardial infarction during a 6-month follow-up period.
  Methods Detailed individual patient data were collected from randomized trials
  commenced from 1989 to 1996 that compared primary PTCA with thrombolysis.
  Data were combined to produce estimates of relative reduction in events at 30 days
  and 6 months for the group and for predefined clinical subgroups. Treatment effects
  were also assessed in relation to several study-related factors. Results Eleven trials
  were identified. The mortality rate at 30 days was 4.3% for 1348 patients randomized
  to undergo PTCA, and 6.9% for 1377 patients assigned to thrombolytic therapy
  (relative risk [RR] 0.62, 95% Cl 0.44-0.86, P = .004). At 6 months, the mortality rate
  was 6.2% for PTCA and 8.2% for thrombolysis (RR 0.73, 95% Cl 0.55-0.98, P
  = .04). Combined death and reinfarction rates at 30 days were 7.0% for PTCA and
  12.9% for thrombolysis, with a sustained effect at 6 months (RR 0.60, 95% Cl
  0.48-0.75, P < .0001). The risk of hemorrhagic stroke at 30 days was lower in the
  PTCA group (RR 0.06, 95% Cl 0.0-0.50, P = .009). The relative treatment effect did
  not vary across clinically important subgroups, but the absolute benefit varied
  according to baseline risk. The relative treatment effect varied across the trials and
  according to the thrombolytic comparator used, the delay in performing PTCA, and
  the recruitment rate. Conclusion In the context of these trials, primary PTCA was
  more effective than thrombolytic therapy in reducing death, reinfarction, and stroke,
  with the greatest absolute benefit in patients who were at the highest risk. These
  benefits appear to be sustained for 6 months. The effect of treatment varied
  significantly across the trials, and this raises issues about how widely the results can
  be applied
Keywords:               acute/acute             myocardial/acute               myocardial
  ext/coronary/coronary angioplasty/DEATH/delay/effect/effectiveness/effects/follow
  up/follow-up/HEART/hemorrhagic/hemorrhagic                stroke/hospital/IMMEDIATE
  ortality                                                     rate/myocardial/myocardial
  infarction/OLDER/OUTCOMES/patient/patients/percutaneous                    transluminal
  coronary                             angioplasty/period/PTCA/randomized/randomized
  is/thrombolytic/thrombolytic therapy/TIME/transluminal/treatment/trials/USA
Guo, Y.F. and Stein, P.K. (2003), Circadian rhythm in the cardiovascular system:
  Chronocardiology. American Heart Journal, 145 (5), 779-786.
Abstract: Background We reviewed recent progress in the study of the chronobiological
  aspects of the cardiovascular system. Methods Medline was used as the main search
  tool, and the full texts of selected papers were obtained. Results More than 300
  references were found, and 52 of them, representing the major findings in this field,
  were included in the reference list. Results of these studies confirm that most
  cardiovascular physiological parameters (such as heart rate, blood pressure,
  electrocardiogram indices) and pathophysiological events (myocardial
  ischemia/infarction, sudden cardiac death) show circadian rhythms. Results also
  suggest that consideration of these rhythms is important for the diagnosis and
  treatment of cardiovascular disorders and that restoration of normal circadian
  rhythms may be associated with clinical improvement. Conclusion The study of
  circadian rhythms in the cardiovascular system is emerging as an important area of
  investigation because of its potential implications for patient management
Keywords:                                        ATRIAL-FIBRILLATION/blood/blood
  pressure/BLOOD-PRESSURE/cardiac/cardiac death/cardiovascular/cardiovascular
  disorders/cardiovascular                              system/China/circadian/circadian
  GIOTENSIN/rhythms/search/sudden/SUDDEN                                       CARDIAC
Hague, W., Forder, P., Simes, J., Hunt, D. and Tonkin, A. (2003), Prevention and
  rehabilitation - Effect of pravastatin on cardiovascular events and mortality in 1516
  women with coronary heart disease: Results from the Long-Term Intervention with
  Pravastatin in Ischemic Disease (LIPID) study. American Heart Journal, 145 (4),
Abstract: Background The Long-Term Intervention with Pravastatin in Ischaemic
  Disease (LIPID) study showed that cholesterol- lowering therapy prevented further
  events in patients with coronary heart disease and average cholesterol levels. The aim
  of this subgroup analysis Was to assess the effects of pravastatin in women. Methods
  A total of 1516 women (756 assigned to take pravastatin) in a cohort of 9014 patients
  with previous myocardial infarction or. unstable angina and a baseline plasma
  cholesterol level of 4.0 to 7.0 mmol/L (155-271 mg/dL) were assigned to receive
  pravastatin (40 mg/d) or placebo. Major cardiovascular disease events in 6 years
  were measured. Results Women were at a lesser risk than men for death from any
  cause (10.3% vs 14.8%, P < .01), death from coronary heart disease (6.6% vs 8.6%,
  P = .04), and coronary revascularization (13.6% vs 16.2%, P = .05) and at a similar
  risk of myocardial infarction (9.2% vs 10.5%, P = .26), stroke (3.6% vs 4.7%, P
  = .11), and hospitalization for unstable angina (25.1% vs 24.5%, P = 0.90).
  Pravastatin significantly reduced the risk of all prespecified cardiovascular events in
  all LIPID patients. Relative treatment effects in women did not differ significantly
  from those in men (P > .05) for any events except hospitalization for unstable angina.
  There were too few events to demonstrate separately significant effects in women;
  the estimated relative risk reduction with pravastatin was 11% (95% Cl -18%-33%)
  for coronary heart disease death or nonfatal myocardial infarction, 18% (95% Cl
  -25%-46%) for coronary heart disease death, 16% (95% Cl -19%-41%) for
  myocardial infarction, and 17% (95% Cl -2%-33%) for coronary heart disease death,
  myocardial infarction, or coronary revascularization. Conclusions The study had the
  largest secondary-prevention female cohort studied thus far, but was not adequately
  powered to show separate effects in women. Nevertheless, the results were consistent
  with the main results of this and other trials in showing reduced risks with
  cholesterol-lowering treatment
Keywords:                         analysis/angina/Australia/cardiovascular/cardiovascular
  heart/coronary                            heart                       disease/coronary
  prevention/stroke/therapy/treatment/treatment             effects/TRIAL/trials/unstable
Malinin, A.I., O'Connor, C.M., Dzhanashvili, A.I., Sane, D.C. and Serebruany, V.L.
  (2003), Platelet activation in patients with congestive heart failure: Do we have
  enough evidence to consider clopidogrel? American Heart Journal, 145 (3), 397-403.
Abstract: Our understanding of the pathogenesis of congestive heart failure (CHF) has
  improved remarkably in recent years. However, despite better knowledge and novel
  pharmaceutical strategies, this disease is still one of the most brutal killers in the
  Western world. The pathophysiology of CHF is complex, and much of our
  comprehension revolves strictly around the neurohormonal and mechanical.
  mechanisms involved. It has been suggested that CHF is associated with altered
  hemostasis, but whether a prothrombotic state contributes to the pathogenesis and
  progression of the disease is still not well known. The purpose of this review article
  is to discuss our current knowledge of platelet activation in patients with CHF and
  the potential role of antiplatelet agents in preventing these hemostatic abnormalities.
  Clopidogrel is an established medication that reduces the incidence of,stroke,
  myocardial ischemia, or vascular death. It is currently the drug of choice in the
  prophylaxis of subacute stent thrombosis and postischemic stroke treatment.
  Promising results of the most resent trials (Clopidogrel versus Aspirin in Patients at
  Risk of Ischemic Events [CAPRIE] and Clopidogrel in Unstable angina to prevent
  Recurrent Events [CURE]) may expand future indications of this ADP receptor
  antagonist for prevention of thrombotic complications in the CHF population.
  Currently conducted clinical trials (Warfarin and Antiplatelet Therapy in Chronic
  Heart Failure [WATCH] and Plavix Use for Treatment of Congestive Heart Failure
  [PLUTO-CHF] should clarify the, role of clopidogrel in these patients
Keywords:                                                abnormalities/activation/ACUTE
  receptor/ADP                   RECEPTORS/angina/antagonist/antiplatelet/antiplatelet
  trials/clopidogrel/complications/comprehension/congestive/congestive                heart
  W                                                            CONDITIONS/heart/heart
  nt/stroke/stroke                                       treatment/thrombosis/thrombotic
Metra, M., Nodari, S., Parrinello, G., Giubbini, R., Manca, C. and Dei Cas, L. (2003),
  Marked improvement in left ventricular ejection fraction during long-term
  beta-blockade in patients with chronic heart failure: Clinical correlates and
  prognostic significance. American Heart Journal, 145 (2), 292-299.
Abstract: Background Some patients with heart failure (HF) may have a marked
  improvement in left ventricular ejection fraction (LVEF) after long-term p-blockade.
  We compared the clinical characteristics and the prognosis of these patients with
  those of other patients. Methods One hundred seventy-one patients with chronic HF
  were assessed before and after 9 to 12 months of maintenance therapy with
  metoprolol or carvedilol. Results Thirty-eight patients (22%) showed an increase in
  their LVEF ! 15 units (from 20% +/- 8% to 43% +/- 10%). Compared with the other
  patients (LVEF change from 21% +/- 7% to 26% +/- 9%, P < .0001 for differences
  between groups), these patients also had a greater decline in the left ventricular
  end-diastolic volume (from 175 +/- 74 mL/m(2) to 113 36 mL/m(2)) and in the right
  atrial, mean pulmonary artery, and pulmonary wedge pressures, with a greater
  increase in the cardiac index, stroke volume index, stroke work index, and maximal
  functional capacity. Their long-term prognosis was excellent, with a 2-year
  cumulative survival rate of 95%, versus 81% for the other patients, and a
  hospitalization-free survival rate of 73%, versus 50% for the other patients (all P
  < .05). By means of multivariate analysis, only the nonischemic cause of HF and the
  mean arterial pressure at baseline were independently associated with an increase of
  greater than or equal to0.15 in LVEF. Conclusions Patients who show a marked
  improvement in their LVEF after long-term p-blockade have an excellent prognosis
  and have a high prevalence of nonischemic HF and a higher blood pressure at
Keywords:                 analysis/arterial/arterial            pressure/artery/atrial/beta
  pressure/cardiac/cardiac        index/CARVEDILOL/cause/chronic/chronic              heart
  failure/clinical/clinical characteristics/decline/DOUBLE- BLIND/ejection/ejection
  fraction/end-diastolic             volume/failure/functional/GUIDELINES/heart/heart
  failure/IDIOPATHIC          DILATED           CARDIOMYOPATHY/index/Italy/left/left
  ventricular/left ventricular ejection fraction/left ventricular end-diastolic
  volume/long-term            prognosis/mean          arterial       pressure/MEDICAL
   /pulmonary      artery/right/stroke/stroke    volume/stroke      work/survival/survival
   rate/therapy/USA/ventricular/ventricular           ejection/ventricular        ejection
Palmieri, V., Bella, J.N., Arnett, D.K., Oberman, A., Kitzman, D.W., Hopkins, P.N.,
   Rao, D.C., Roman, M.J. and Devereux, R.B. (2003), Associations of aortic and
   mitral regurgitation with body composition and myocardial energy expenditure in
   adults with hypertension: The Hypertension Genetic Epidemiology Network study.
   American Heart Journal, 145 (6), 1071-1077.
Abstract: Background it has been reported that aortic regurgitation, mitral valve
   regurgitation, or both are associated with lower body mass index, an index of body
   adiposity. However, the relations of valvular regurgitation to body composition and
   myocardial bioenergetic expenditure have not been previously investigated in a
   population-based sample. Methods We selected 1496 patients with hypertension who
   did not have diabetes mellitus to participate in the Hypertension Genetic
   Epidemiology Network (HyperGEN) study. We excluded participants with severe
   aortic or mitral stenosis or with known coronary heart disease. Bioimpedance was
   used to assess body composition. Echocardiography was used to assess left
   ventricular (LV) structure and function and to calculate myocardial workload
   (expressed as energy expenditure) from end- systolic stress, ejection time, and stroke
   volume. The study sample was divided into groups without mitral or aortic
   regurgitation (control subjects, n = 1175), with mild valvular regurgitation (1 +, n =
   246), and with at least moderate (greater than or equal to2+) mitral or aortic
   regurgitation (n = 75). Results The mean patient age was higher with more severe
   valvular insufficiency. Sex distribution and blood pressure were similar among the 3
   groups. Body mass index and fat mass were significantly lower with more severe
   valvular regurgitation, whereas fat-free mass was only slightly lower in the group
   with greater than or equal to2+ regurgitation compared with control subjects.
   Skinfold thicknesses (brachial and subscapular) were lower with more severe
   valvular regurgitation, whereas self-reported physical activity per week was similar
   among the 3 groups. LV mass and circumferential end-systolic stress were higher
   with more severe valvular regurgitation. Noninvasively estimated myocardial energy
   expenditure was slightly higher in participants with 1 + valvular regurgitation
   and-was significantly higher with greater than or equal to2+ regurgitation. Ejection
   fraction was mildly lower with greater than or equal to2+ aortic insufficiency, mitral
   insufficiency, or both. Midwall shortening and stress-corrected midwall shortening
   did not differ among groups. Conclusions In a population-based sample of adults
   with hypertension and without diabetes mellitus, known coronary heart disease, or
   significant valvular stenosis, mitral and aortic regurgitation were associated with
   higher LV mass and total myocardial biomechanical workload but with lower body
   fat mass and slightly lower body fat-free mass, which suggests that global
   myocardial bioenergetic expenditure is elevated by concomitant valvular
   regurgitation beyond the effect of pressure overload caused by hypertension
Keywords:              activity/adiposity/adults/age/AMERICAN-INDIANS/aortic/aortic
   regurgitation/blood/blood pressure/body composition/body fat/body mass
   heart/coronary                       heart                    disease/diabetes/diabetes
  disease/HEMODYNAMIC DETERMINANTS/hypertension/II/index/Italy/left/left
  ventricular/LEFT-VENTRICULAR MASS/lower/mild/mitral regurgitation/mitral
  stenosis/mitral                            valve/mitral                           valve
  volume/structure/SYSTEMIC                    HYPERTENSION/systolic/USA/valvular
  regurgitation/valvular stenosis/ventricular/volume/week/workload
Polonski, L., Gasior, M., Wasilewski, J., Wilczek, K., Wnek, A., Adamowicz-Czoch, E.,
  Sikora, J., Lekston, A., Zebik, T., Gierlotka, M., Wojnar, R., Szkodzinski, J., Kondys,
  M., Szygula-Jurkiewicz, B., Wolk, R. and Zembala, M. (2003), Outcomes of primary
  coronary angioplasty and angioplasty after initial thrombolysis in the treatment of
  374 consecutive patients with acute myocardial infarction. American Heart Journal,
  145 (5), 855-861.
Abstract: Background In patients with acute myocardial infarction (MI), the efficacy of
  thrombolysis is low. Angioplasty after failed thrombolysis (rescue percutaneous
  coronary angioplasty [PTCA]) has been associated with an increase in the incidence
  of inhospital complications. It has been proposed that these complications result from
  the procedure itself. Thus, the aim of this study was to compare the efficacy,
  inhospital complications, and mortality rate of patients with MI who are treated with
  primary PTCA and PTCA after initial thrombolysis (rescue or immediate rescue) in
  an experienced clinical center specializing in percutaneous coronary interventions.
  Methods and Results The study group consisted of consecutive patients with MI
  treated with primary PTCA (n = 195) or PTCA after initial thrombolysis (n = 179).
  The study was performed in a referral center with a 24-hour catheter-laboratory
  service. The success rate of the procedure was 90.5% and 88.2% in the PTCA after
  initial thrombolysis group and primary PTCA group, respectively. The groups did
  not differ in the frequency of reocclusion, emergency surgical revascularization
  (coronary artery bypass grafting), or stroke. In patients without cardiogenic shock,
  the inhospital mortality rates were 3.2% and 0.6% in the rescue and immediate
  rescue group and primary PTCA group, respectively (not significant). In a subgroup
  of patients with cardiogenic shock, the mortality rate was 36.0% in the initial
  thrombolysis PTCA group and 30.8% in the primary PTCA group. However, after
  successful PTCA in this subgroup, the mortality rate dropped to 18% and 10%,
  respectively. Conclusions After initial thrombolysis, PTCA is safe, effective, and
  likely to restore grade 3 Thrombolysis In Myocardial Infarction flow in about 90% of
  patients. When available, immediate rescue PTCA should be performed in all
  patients, including patients with cardiogenic shock
Keywords:               acute/acute             myocardial/acute              myocardial
  infarction/angioplasty/artery/bypass/cardiogenic              shock/CARDIOGENIC-
  SHOCK/clinical/complications/coronary/coronary                   angioplasty/coronary
  artery/coronary artery bypass/coronary artery bypass grafting/coronary
  cidence/infarction/MI/MORTALITY/mortality                  rate/myocardial/myocardial
  infarction/patients/percutaneous           coronary/Poland/primary            coronary
Stoddard, M.F., Singh, P., Dawn, B. and Longaker, R.A. (2003), Left atrial thrombus
   predicts transient ischemic attack in patient's with atrial fibrillation. American Heart
   Journal, 145 (4), 676-682.
Abstract: Background Atrial fibrillation (AF) is widely accepted as a direct cause of
   cardioembolic stroke from left atrial (LA) thrombus formation. However, the
   relationship between LA thrombus and transient ischemic attack (TIA) in, patients
   with AF is less well established. Methods Two hundred sixty-one adult patients
   (mean age 66 +/- I I years, 220 men and 41 women) with AF undergoing
   transesophageal echocardiography (TEE) were prospectively followed up for TIA
   (mean duration 30.3 +/- 20.6 months). Results LA thrombus was present in 18% (n =
   46) and LA spontaneous echocardiographic contrast in 50% (n = 131) of the group.
   Nineteen of 261 patients had TIA during follow-up. Multivariate logistic regression
   showed congestive heart failure (CHF) as the only predictor of TIA when a model of
   clinical variables was constructed (odds ratio [OR] 2.7, P = .04). Age, sex,
   hypertension, and use of warfarin or aspirin were not predictors. When TEE
   variables were added to the model, LA thrombus became the only predictor of TIA
   (OR 7.7, P = .0001). Survival free of TIA (Kaplan-Meier) was Significantly less (P
   = .0001) in patients with LA thrombus compared with those without, and the annual
   TIA event rate was 9.2% per year versus 1.9% per year (P < .0001), respectively.
   Conclusions To our knowledge, this is the first prospective study documenting an
   association between LA thrombus and TIA in patients with AF. Other TEE variables,
   including aortic atheromata, and clinical parameters were not independently
   predictive. These data support a likely thromboembolic mechanism for TIA from LA
   thrombus in patients with AF
Keywords:                  adult/adult               patients/AF/age/aortic/APPENDAGE
   FUNCTION/aspirin/association/atrial/atrial fibrillation/cardioembolic/cardioembolic
   stroke/cause/clinical/congestive/congestive                                            heart
   CARDIOVERSION/EMBOLIC                  RISK/event          rate/failure/fibrillation/follow
   up/follow-up/HEART/heart                        failure/hypertension/ischemic/ischemic
   attack/knowledge/left/logistic regression/mechanism/men/model/odds ratio/PATENT
   pective/prospective study/regression/sex/spontaneous/SPONTANEOUS ECHO
   ECHOCARDIOGRAPHY/transient/transient                                               ischemic
Abdel-Sayed, S., Nussberger, L., Aubert, J.F., Gohlke, P., Brunner, H.R. and Brakch, N.
   (2003), Measurement of plasma endothelin-1 in experimental hypertension and in
   healthy subjects. American Journal of Hypertension, 16 (7), 515-521.
Abstract: Background: Endothelin-1 is an endothelium-derived potent vasoconstrictor
   peptide of 21 amino acids. To establish reference values in different models of
   hypertension and in human subjects an assay for plasma immunoreactive
   endothelin-1 (ET-1) was optimized. Methods: ET-I is extracted by acetone from I
   mL of plasma and subjected to a sensitive enzyme-linked immunosorbent assay.
   Results: The detection limit for plasma ETA is 0.05 fmol/mL. Mean recoveries of the
   1, 2, 5, and 10 fmol of ET-1 added to 1 mL of plasma were 66%, 75%, 85%, and
   92%, respectively. Within- and between-assay coefficients of variation were less
  than or equal to12% and less than or equal to10%, respectively. Assay accuracy was
  demonstrated by consistent recoveries of added ET-1 over the entire physiologic
  range of plasma concentrations and by the linearity of ET-1 concentrations measured
  in serially diluted plasma extracts (r = 0.99). No ET-1 was detected when albumin
  buffer was extracted instead of plasma. Using this method, we found increased ET-1
  levels in plasma of three experimental rat models of hypertension: stroke prone
  spontaneously hypertensive rats (SP- SHR), deoxycorticosterone acetate-salt
  hypertensive rats, and one kidney-one clip hypertensive rats. In contrast, plasma
  ET-1 levels of SHR were half those of normotensive Wistar rats. In two kidney-one
  clip hypertensive rats, plasma ET-1 concentrations were not different from those
  found in sham- operated control rats. Plasma ET-1 concentrations of 37 healthy men
  were 0.85 +/- 0.26 fmol/ml (mean +/-SD). Conclusions: The present assay reliably
  measures ET-1 levels in rat and human plasma. It allows to discriminate between
  different forms of hypertension with high or low circulating levels of ET-1. Am J
  Hypertens 2003;16: 515-521 (C) 2003 American Journal of Hypertension, Ltd
Keywords:                                                        accuracy/albumin/amino
  in         1/endothelin-1/enzyme-linked           immunoassay/experimental/FAMILY
  ma             concentrations/range/rat/RATS/reference              values/renovascular
  hypertension/SALT/SHR/spontaneously hypertensive/spontaneously hypertensive
  rats/stroke/stroke      prone/stroke       prone       spontaneously        hypertensive
  rats/Switzerland/USA/VASCULAR HYPERTROPHY/when/Wistar/Wistar rats
Addington, W.R., Stephens, R.E., Widdicombe, J.G., Ockey, R.R., Anderson, J.W. and
  Miller, S.P. (2003), Electrophysiologic latency to the external obliques of the
  laryngeal cough expiration reflex in humans. American Journal of Physical Medicine
  & Rehabilitation, 82 (5), 370-373.
Abstract: Objective: The purpose of this study was to trigger the laryngeal cough
  expiration reflex using inhaled tartaric acid aerosol and to record the latency between
  the time of initiation of the laryngeal cough expiration reflex component of the
  laryngeal cough reflex and the onset of electromyographically recorded responses in
  the external abdominal oblique in humans. Design: Five male subjects were tested in
  the seated position, and four latencies were recorded for each subject. The latencies
  were recorded from laryngeal stimulation to an electromyogram in the muscle belly
  of the left external abdominal oblique. The time line was activated by a microswitch
  attached to a breath-activated nebulizer. Data were analyzed using SPSS for mean
  latency and standard deviation. Results: The mean (standard deviation) latency to the
  external abdominal oblique muscle was 17.6 +/- 10.6 msec. No adverse events to
  inhalation were reported. Conclusions: In humans, nebulized tartaric acid stimulates
  primarily rapid adapting receptors in the supraglottic larynx rather than C- fiber
  receptors. This receptor location in humans evolved neurologically to protect the
  airway during speech and swallowing, making the laryngeal cough expiration reflex
  an inseparable component of the laryngeal cough reflex, thus making it clinically
  significant when assessing airway protection
  events/aerosol/airway/cough/cough                                reflex/DEVELOPING
  receptor/RECEPTOR                         SENSITIVITY/receptors/reflex/RISK/seated
Addington, W.R., Stephens, R.E., Widdicombe, J.G., Anderson, J.W. and Rekab, K.
  (2003), Effect of tartaric acid-induced cough on pulmonary function in normal and
  asthmatic humans. American Journal of Physical Medicine & Rehabilitation, 82 (5),
Abstract: Objective: The laryngeal cough reflex and the laryngeal cough expiratory
  reflex are brainstem reflexes that protect the upper airway from significant aspiration.
  The purpose of this investigation was to examine the effects of tartaric acid- induced
  cough on pulmonary function in normal healthy and asthmatic individuals. Design:
  Twenty healthy and 20 asymptomatic, medicated, asthmatic volunteers engaged in a
  two- part evaluation of pulmonary function testing. All 40 subjects were nonsmokers.
  The reflex cough test, a 20% solution of prescription-grade L-tartaric acid dissolved
  in 0.15 M NaCl solution, initiated the laryngeal cough expiratory reflex/laryngeal
  cough reflex. The solution was placed in a Bennett Twin nebulizer and inhaled as a
  microaerosol. Pulmonary function testing was with a Spiromate AS-600. Baseline
  pulmonary function testing was initially performed, followed by two separate
  inhalations of the reflex cough test. The pulmonary function testing was repeated 5
  min after the second reflex cough test. Results: Statistically significant changes seen
  after the reflex cough test included increases in the peak inspiratory flow in normal
  subjects (P = 0.004) and in the peak expiratory flow in asthmatic subjects (P = 0.014).
  No respiratory adverse events occurred after the reflex cough test. Conclusions:
  Explanations for these findings include the possibility that tartaric acid-induced
  cough produces central nervous system-mediated bronchodilatation, through the
  bough itself or by secondary mechanisms
Keywords:                                                                         adverse
  reflexes/BRONCHIAL                          RESPONSIVENESS/changes/cough/cough
  eal/mechanisms/normal/normal                        subjects/PA/pulmonary/pulmonary
Alvarez-Linera, J., Benito-Leon, J., Escribano, J., Campollo, J. and Gesto, R. (2003),
  Prospective evaluation of carotid artery stenosis: Elliptic centric contrast-enhanced
  MR angiography and spiral CT angiography compared with digital subtraction
  angiography. American Journal of Neuroradiology, 24 (5), 1012-1019.
Abstract: BACKGROUND AND PURPOSE: Although digital subtraction angiography
  (DSA) is the reference standard for assessing carotid arteries, it is uncomfortable for
  patients and has a small risk of disabling stroke and death. These problems have
  fueled the use of spiral CT angiography and MR angiography. We prospectively
  compared elliptic centric contrast-enhanced MR angiography and spiral CT
  angiography with conventional DSA for detecting carotid artery stenosis.
  METHODS: Eighty carotid arteries (in 40 symptomatic patients) were assessed.
  Elliptic centric MR and spiral CT angiographic data were reconstructed with
  maximum intensity projection and multiplanar reconstruction techniques. All patients
  had been referred for DSA evaluation on the basis of findings at Doppler sonography,
  which served as a screening method (degree of stenosis greater than or equal to 70%
  or inconclusive results). Degree of carotid stenosis estimated by using the three
  modalities was compared. RESULTS: Significant correlation with DSA was found
  for stenosis degree for both elliptic centric MR and spiral CT angiography; however,
  the correlation coefficient was higher for MR than for CT angiography (r = 0.98 vs r
  = 0.86). Underestimation of stenoses of 70-99% occurred in one case with elliptic
  centric MR angiography (a 70% stenosis was underestimated as 65%) and in nine
  cases with spiral CT angiography, in comparison to DSA findings. Overestimation
  occurred in two cases with MR angiography (stenoses of 65-67% were overestimated
  as 70-75%). With CT, overestimation occurred in seven cases; a stenosis of 60% in
  one case was overestimated as 70%. Both techniques confirmed the three cases of
  carotid occlusion. With elliptic centric MR angiography, carotid stenoses of 70% or
  greater were detected with high sensitivity, 97.1%; specificity, 95.2%; likelihood
  ratio (LR) for a positive test result, 20.4; and ratio of LR+ to LR-, -0.3. With spiral
  CT angiography, sensitivity, specificity, LR+, and LR+:LR- were 74.3%, 97.6%,
  31.2, and 0.3, respectively. CONCLUSION. Elliptic centric contrast-enhanced MR
  angiograpby is more accurate than spiral CT angiography to adequately evaluate
  carotid stenosis. Furthermore, elliptic centric contrast-enhanced MR angiography
  appears to be adequate to replace conventional DSA in most patients examined
Keywords:                             angiography/arteries/artery/ATHEROSCLEROTIC
  PLAQUE/carotid/carotid arteries/carotid artery/carotid artery stenosis/carotid
  occlusion/carotid                                                      stenoses/carotid
  ANGIOGRAPHY/CONVENTIONAL                          ANGIOGRAPHY/correlation/CT/CT
  angiography/death/degree of stenosis/digital subtraction/digital subtraction
  angiography/Doppler/Doppler sonography/DSA/evaluation/HELICAL CT/IMAGE
  QUALITY/intensity/MAGNETIC-RESONANCE                       ANGIOGRAPHY/maximum
  intensity     projection/MR/MR         angiography/occlusion/patients/PRELIMINARY
  ain/specificity/spiral                                   CT/standard/STEADY-STATE
  VESSELS/techniques/UNENHANCED 2D/USA/use
Au-Yeung, S.S.Y., Ng, J.T.W. and Lo, S.K. (2003), Does balance or motor impairment
  of limbs discriminate the ambulatory status of stroke survivors? American Journal of
  Physical Medicine & Rehabilitation, 82 (4), 279-283.
Abstract: Objective: This study was performed to determine if ambulatory function is
  governed by motor impairment of limbs or balance ability in subjects with
  hemiplegia caused by stroke. Design: Seven patients who walked with physical
  assistance (FIM(TM) 4) after stroke and 13 who walked independently with assistive
  devices (FIM 6) were compared with 13 healthy subjects. Motor impairment of limbs
  was evaluated with the Fugl-Meyer Assessment. The Berg Balance Scale and limit of
  stability test of the Smart Balance Master were used to evaluate balance ability.
  Results: The FIM 6 group and the controls were best differentiated by motor
  impairment of the paretic limbs and limit of stability in the backward direction.
  Motor impairment of the upper limb and limit of stability in direction toward the
  paretic side separated the FIM 4 from the FIM 6 group. Upper limb motor
  impairment and the Berg Balance Scale consistently separated the three subject
  groups. Conclusions: Motor impairment in the paretic upper limb and balance
  dysfunction should be addressed in treatments working toward independent
Keywords:                  ambulation/ambulatory/balance/Berg                    Balance
  ASSESSMENT/function/hemiplegia/HEMIPLEGIC                             PATIENT/Hong
  /SCALE/stability/STABILITY             LIMITS/status/stroke/stroke      survivors/upper
Babiarz, L.S., Yousem, D.M., Wasserman, B.A., Wu, C., Bilker, W. and Beauchamp,
  N.J. (2003), Cavernous carotid artery calcirication and white matter ischemia.
  American Journal of Neuroradiology, 24 (5), 872-877.
Abstract: BACKGROUND AND PURPOSE: The relevance of cavernous carotid artery
  calcification on unenhanced CT scans of the brain has recently been investigated
  against the backdrop of the widespread implementation of coronary artery
  calcification scoring. We sought to determine whether the degree of cavernous
  carotid artery calcification correlated with scores of white matter hyperintensity seen
  on MR images. In so doing, we sought to establish a relative risk for future stroke on
  the grade of carotid calcification. METHODS: Neuroradiologic findings in 187
  patients who underwent CT and MR imaging examinations within 1 month of each
  other were retrospectively reviewed. The degree of circumferential calcification and
  thickness of calcification were graded for the cavernous carotid arteries on the basis
  of CT findings. Using the scale developed by the Cardiovascular Health Study, the
  white matter was graded for degree of disease on the basis of MR findings.
  Correlation tests and regression analyses were performed to determine the impact of
  age, race, and sex on results. RESULTS: Although the cavernous carotid
  calcification scores and the MR imaging white matter scores showed good
  correlation (P < .001), the effect was mediated by age. With age factored in as a
  covariant, no correlation was shown between CT calcification scores and MR
  imaging white matter scores. Sex had no effect, but African American study
  participants had worse MR imaging white matter scores than did white participants.
  CONCLUSION. After adjusting for age, cavernous carotid calcification grades and
  MR imaging white matter scores do not show a significant correlation. The relative
  risk for future stroke cannot be predicted from cavernous carotid calcifications
Keywords:          African/African         American/African-American/age/ANATOMIC
  HEALTH/carotid/carotid                arteries/carotid         artery/coronary/coronary
  artery/correlation/CT/CT                                                    findings/CT
Bae, H.S., Kim, Y.S., Cho, K.H., Lee, K.S., Kim, J.J., Lee, H.U. and Kim, D.H. (2003),
  Hepatoprotective activity of Reduohanxiao-tang (Yuldahanso- tang) is related to the
  inhibition of beta-glucuronidase. American Journal of Chinese Medicine, 31 (1),
Abstract:    beta-Glucuronidase-inhibitory        and    hepatoprotective    effects    of
  Reduohanxiao-tang (Yuldahanso-tang), which has been used for liver diseases and
  stroke, on carbon tetrachloride (CCl4)- induced hepatotoxicity of rats were
  investigated. Reduohanxiao- tang potently inhibited beta-glucuronidases. Serum
  aspartate aminotransferase (AST), alanine aminotransferase (ALT) and lactic acid
  dehydrogenase (LDH) levels of the CCl4 group orally treated with
  Reduohanxiaotang (100 mg/kg) were lowered to 54%, 71.5% and 66.1% of the
  CCl4-treated control group, respectively. Among the ingredients of the
  Reduohanxiao-tang, the rhizomes of Pueraria thunbergiana and Scutellaria
  baicalensis potently inhibited beta-glucuronidases and protected against
  CCl4-induced liver injury. Orally administered puerarin, which is a main component
  of Pueraria thunbergiana, showed potent hepatoprotective activity, but did not inhibit
  beta-glucuronidase. However, daidzein, which is produced from puerarin by human
  intestinal bacteria, potently inhibited beta-glucuronidase. These results suggest that
  beta- glucuronidase inhibition by herbal medicines may protect against CCl4-induced
  liver injury
Keywords:                                activity/aspartate/beta/beta-glucuronidase/carbon
Ball, S.G. and White, W.B. (2003), Debate: Angiotensin-converting enzyme inhibitors
  versus angiotensin II receptor blockers - A gap in evidence-based medicine.
  American Journal of Cardiology, 91 (10), 15G-21G.
Abstract: In this article, 2 leading physicians debate the strength of outcome data on the
  efficacy of angiotensin-converting enzyme (ACE) inhibitors versus angiotensin II
  receptor blockers (ARBs) for reducing the incidence of cardiovascular,
  cerebrovascular, and renovascular events. Dr. Stephen G. Ball notes that the efficacy
  of ACE inhibitors for reducing the risk for myocardial infarction independent of their
  effects on blood pressure is controversial. In the Heart Outcomes Prevention
  Evaluation (HOPE) study, ramipril treatment in high-risk patients was associated
  with a 20% reduction in the risk for myocardial infarction; mean reduction in blood
  pressure was 3 mm Hg for systolic blood pressure and 1 mm Hg for diastolic blood
  pressure. The HOPE investigators propose that the 20% reduction was much greater
  than would be expected based on the observed blood pressure reduction. However, a
  meta-regression analysis of blood pressure reduction in >20 antihypertensive therapy
  outcome trials found that the reduction in myocardial infarction risk with ramipril
  observed in HOPE was consistent with the modest blood pressure reduction seen
  with that agent. Nevertheless, there are convincing data for prevention of myocardial
  infarction with ACE inhibitors in patients with heart failure, including those with
  heart failure after myocardial infarction, as well as supportive evidence from studies
  in patients with diabetes mellitus and cancomitant hypertension. On the other hand,
  Dr. William B. White takes the position that ARBs are well-tolerated
  antihypertensive agents that specifically antagonize the angiotensin II type 1 (AT(1))
  receptor and provide a more complete block of the pathologic effects of angiotensin
  II-which are mediated via the AT(1) receptor-than ACE inhibitors. The Evaluation of
  Losartan in the Elderly (ELITE) 11 study and the Valsartan Heart Failure Trial
  (ValHeFT) suggest that ARBs reduce the risk for mortality in patients with
  congestive heart failure. The Losartan Intervention for Endpoint (LIFE) Reduction in
  Hypertension trial also demonstrated beneficial effects of ARBs in the prevention of
  stroke events. The Irbesartan in Patients with Diabetes and Microalbuminuria (IRMA)
  study, the Irbesartan Diabetic Nephropathy Trial (IDNT), and the Reduction of
  Endpoints in NIDDM with the Angiotensin II Antagonist Losartan (RENAAL) study
  demonstrated significant reductions in the rate of progression of renal disease in
  patients receiving ARBs, independent of effects on blood pressure. These data
  support the use of ARBs, in addition to the standard of care, in hypertensive patients
  with heart failure who are intolerant of ACE inhibitors, and also provide compelling
  evidence for their use in patients with hypertension and type 2 diabetes. (C) 2003 by
  Excerpta Medica, Inc
Keywords: ACE/ACE inhibitors/addition/analysis/angiotensin/angiotensin converting
  enzyme/angiotensin           II/angiotensin      II     receptor/angiotensin-converting
  enzyme/ANTAGONISTS/antihypertensive/antihypertensive agents/antihypertensive
  therapy/beneficial            effects/blood/blood         pressure/BLOOD-PRESSURE
  MORBIDITY/cerebrovascular/congestive/congestive                                      heart
  failure/CT/diabetes/diabetes                                          mellitus/DIABETIC
  NEPHROPATHY/diastolic/diastolic blood pressure/disease/effects/efficacy/evidence
  based                                           medicine/evidence-based/evidence-based
  ention/progression/ramipril/RANDOMIZED                       TRIAL/rate                 of
  disease/risk/standard/strength/stroke/support/systolic/systolic blood/systolic blood
  pressure/therapy/treatment/trial/trials/type 2/type 2 diabetes/USA/use
Bayramoglu, M., Karatas, M., Leblebici, B., Cetin, N., Sozay, S. and Turhan, N. (2003),
  Hemorrhagic transformation in stroke patients. American Journal of Physical
  Medicine & Rehabilitation, 82 (1), 48-52.
Abstract: Objective: To identify the predictors of hemorrhagic transformation in stroke
  patients and to evaluate the impact of hemorrhagic transformation on rehabilitation
  outcome. Design: The records of 203 hemiplegic patients hospitalized for
  rehabilitation after the acute phase of stroke were retrospectively analyzed. In 121
  cases, the first computed tomographic scan and a repeat scan were compared to
  determine whether hemorrhagic transformation occurred. Correlations between the
  occurrence of hemorrhagic transformation and use of anticoagulants, antiaggregants,
  and antiedema drugs were evaluated. Admission and discharge FIM(TM) and
  Adapted Patient Evaluation Conference System scores were noted, and functional
  gain was calculated from these. These data were also analyzed for associations with
  hemorrhagic transformation. Results: Hemorrhagic transformation was detected in 39
  of the 121 cases. There was no significant difference in functional outcome between
  patients who did and did not show hemorrhagic transformation. Although not
  statistically significant, the use of antiedema drugs was found to increase the risk of
  hemorrhagic transformation, whereas the use of anticoagulants and antiaggregants
  had no influence. Conclusions: Hemorrhagic transformation of an ischemic lesion
  does not affect rehabilitation outcome in stroke survivors. The study results favor the
  use of anticoagulants and antiaggregants in the acute phase unless these drugs are
  contraindicated by the patient's condition. Still, prospective trials are needed to make
  definite conclusions
Keywords: acute/ACUTE ISCHEMIC STROKE/affect/anticoagulants/CEREBRAL
  INFARCTION/computed                      tomographic/computed                 tomographic
  scan/condition/COOPERATIVE                                                        ACUTE
  STROKE/CT/DETERIORATION/drugs/ECASS                                I/functional/functional
  gain/functional outcome/hemiplegic/hemiplegic patients/hemorrhagic/hemorrhagic
  outcome/results/RISK/stroke/stroke patients/stroke survivors/trials/USA/use
Bean, J.F., Kiely, D.K., Cairns, K.D. and Morris, J.N. (2003), Influence of poststroke
   urinary incontinence on disability - The nursing home setting. American Journal of
   Physical Medicine & Rehabilitation , 82 (3), 175-181.
Abstract: Objective: To characterize the association of poststroke urinary incontinence
   with disability progression in nursing home residents. Design: In this prospective
   cohort study, the Minimum Data Set from the State of New York between 1994 and
   1997 was utilized. From a pool of over 240,000 potential subjects, 500 met
   inclusion/exclusion criteria. Previously continent, first-time stroke survivors were
   classified as being continent or incontinent immediately after their stroke and were
   followed for changes in activities of daily living status (disability) at quarterly
   intervals for a 1 yr. In addition, a post hoc analysis was performed examining
   changes in activities of daily living status from the prestroke condition and exploring
   the relationship between poststroke impairments in continence and limitations in
   mobility. Results: An almost 2- fold difference in level of disability was noted
   poststroke among those who were incontinent vs. those who were continent (P <
   0.001). This difference in disability level remained unchanged for 1 yr. Through the
   post hoc analysis, it was determined that, although the onset of stroke produced
   significant elevations in disability for both continent and incontinent stroke survivors
   (P < 0.001), the presence of an impairment in urinary continence was associated with
   a significantly greater increase (94% vs. 13%) in disability (P < 0.001). In addition,
   incontinence occurred more frequently among those who had a loss in mobility
   function. Conclusion: Incontinence is a clinical factor after stroke that is associated
   with greater disability among nursing home residents. These findings have clinical
   implications for physiatrists and nursing home clinicians and provide a context in
   which future disability research can be conducted
Keywords:               activities            of            daily           living/ACUTE
   ss/MDS/Minimum Data Set/mobility/nursing/nursing home/nursing home
   residents/PA/poststroke/progression/prospective/prospective          cohort/prospective
   INSTRUMENT/status/stroke/stroke survivors/urinary/urinary incontinence/USA
Blake, G.J., Ridker, P.M. and Kuntz, K.M. (2003), Potential cost-effectiveness of
   C-reactive protein screening followed by targeted statin therapy for the primary
   prevention of cardiovascular disease among patients without overt hyperlipidemia.
   American Journal of Medicine, 114 (6), 485-494.
Abstract: BACKGROUND: Evidence suggests that statin therapy reduces the rate of
   cardiovascular events among patients with low lipid levels but elevated C-reactive
   protein levels. However, no cost-effectiveness analyses have been performed to
   assist in determining whether large-scale randomized trials are merited to test this
   hypothesis. METHODS: We used a Markov model to estimate the benefits, costs,
   and incremental cost- effectiveness of C-reactive protein screening followed by
   targeted statin therapy for elevated C-reactive protein levels, compared with dietary
   counseling alone, for the primary prevention of cardiovascular events among patients
   with low- density lipoprotein cholesterol levels < 149 mg/ dL. All costs were in 2000
   U.S. dollars. RESULTS: The potential incremental cost-effectiveness ratio for
   screening followed by statin therapy compared with no screening and no statin
   therapy was $48,100 per quality-adjusted life-year (QALY) for 58-year-old men and
   $94,400 per QALY for 58-year-old women. Screening was most cost-effective for
   65-year-old men ($42,600 per QALY) and least cost-effective for 35-year-old
  women ($207,300 per QALY). Our results were most sensitive to the baseline risk of
  coronary heart disease, the cost of statin therapy, and the efficacy of statin therapy
  for preventing myocardial infarction in patients with high C-reactive protein levels.
  If a 58-year- old man who smokes and is hypertensive was considered, screening for
  C-reactive protein followed by statin therapy would be cost saving if the cost of
  statin therapy was reduced to $500 per year. If the cost of statin therapy was reduced
  to $1 per day, the cost-effectiveness of screening would be $4900 per QALY for
  58-year-old men and $19,600 per QALY for women of the same age. If the costs
  associated with elective revascularization (percutaneous coronary intervention or
  coronary artery bypass surgery) were included in the base case analyses, the
  incremental cost-effectiveness ratios for screening would be $40,100 per QALY for
  58-year-old men and $87,300 per QALY for women. CONCLUSION: A strategy
  involving C- reactive protein screening to target statin therapy for the primary
  prevention of cardiovascular disease among middle-aged patients without overt
  hyperlipidemia could be relatively cost- effective and, in some cases, cost saving.
  Am J Med. 2003,114:485-494. (C) 2003 by Excerpta Medica Inc
Keywords:        ACUTE          MYOCARDIAL-INFARCTION/age/artery/AVERAGE
  CHOLESTEROL             LEVELS/benefits/bypass/bypass           surgery/C-        reactive
  protein/C-reactive/C-reactive                    protein/cardiovascular/cardiovascular
  disease/cardiovascular                             events/cholesterol/CONTROLLED
  TRIALS/coronary/coronary artery/coronary artery bypass/coronary artery bypass
  surgery/coronary           heart/coronary          heart          disease/CORONARY
  HEART-DISEASE/cost/cost                                                     effective/cost
  cost/infarction/INFLAMMATION/intervention/lipid/lipoprotein/low                    density
  infarction/NEW-YORK/old/patients/percutaneous coronary/percutaneous coronary
  prevention/protein/QALY/randomized/randomized                       trials/REDUCTASE
Bonduel, M., Sciuccati, G., Hepner, M., Pieroni, G., Torres, A.F., Mardaraz, C. and
  Frontroth, J.P. (2003), Factor V Leiden and prothrombin gene G20210A mutation in
  children with cerebral thromboembolism. American Journal of Hematology, 73 (2),
Abstract: We investigated whether there is an association between factor V Leiden
  (FVL) and/or prothrombin gene G20210A mutation (PT20210A) and cerebral
  thromboembolism in a pediatric Argentinean population. From May 1992 to January
  2002, 44 consecutive children with arterial ischemic stroke (AIS) and 23 children
  with cerebral sinovenous thrombosis (SVT) were prospectively studied at a single
  center. The prevalence of both mutations was compared with a 102 age-matched
  controls. In children with AIS, the frequencies (patients vs. controls), odds ratio (OR),
  and 95% confidence interval (95% CI) for the presence of FVL were as follows:
  2.3% vs. 2%, OR/95% Cl, 1.16/0.2 to 13.2; P value = 0.99. No cases of PT20210A
  were found in this group. In children with SVT, the frequencies (patients vs.
  controls), OR, and 95% Cl were as follows: FVL (4.3% vs. 2%, OR/95% Cl,
  2.27/0.22 to 6.2; P value = 0.99) and PT20210A (4.3% vs. 1%; OR/95% Cl, 4.6/0.3
  to 76.3; P value = 0.3354). One child with PT20210A also had an inherited protein C
  deficiency. In 12 (18%) out of the 67 children with cerebral thromboembolism,
  without the aforementioned mutations, other prothrombotic disorders were detected.
  Although a multi-center prospective study with a large number of Argentinean
  pediatric patients is needed to obtain considerable evidence, no association between
  factor V Leiden and/or prothrombin gene G20210A mutation and cerebral
  thromboembolism was found in this pediatric series. (C) 2003 Wiley-Liss, Inc
Keywords:                   3'-UNTRANSLATED                        REGION/ACQUIRED
  STROKE/children/controls/deficiency/DISEASE/DISORDERS/factor V/factor V
  Leiden/gene/INHERITED                       THROMBOPHILIA/ischemic/ISCHEMIC
  STROKE/mutation/NEW-YORK/odds                          ratio/patients/pediatric/pediatric
  patients/population/prevalence/prospective/prospective             study/protein/protein
  C/protein C deficiency/prothrombin/prothrombin gene/prothrombin gene G20210A
Bosma, G.P.T., Huizinga, T.W.J., Mooijaart, S.P. and van Buchem, M.A. (2003),
  Abnormal brain diffusivity in patients with neuropsychiatric systemic lupus
  erythematosus. American Journal of Neuroradiology, 24 (5), 850-854.
Abstract: BACKGROUND AND PURPOSE: Neuroimaging techniques have increased
  our knowledge of the pathogenesis of neuropsychiatric systemic lupus erythematosus
  (NPSLE) and have been useful in supporting the diagnosis. Nevertheless, new
  imaging techniques are needed to unravel the exact pathogenesis and to provide
  diagnostic criteria for NPSLE. In this preliminary study, we investigated whether
  diffusion-weighted imaging (DWI) can depict cerebral abnormalities in patients with
  a history of NPSLE, and we assessed whether apparent diffusion coefficient (ADC)
  histograms in these patients differ from those of healthy control subjects.
  METHODS: Eleven female patients with a history of NPSLE (mean age [+/- SD], 35
  years +/- 9) and 10 healthy control subjects (eight female, two male; mean age, 37
  years +/- 16) underwent DWI. DWI and ADC images were assessed by means of
  visual inspection, and histograms were composed from the ADC images. From these,
  we derived a variety of parameters that quantitatively reflect the diffusivity of brain
  parenchyma. RESULTS: Visual inspection of ADC images and DWIs did not reveal
  any abnormalities in either patients with NPSLE or control subjects. In contrast,
  ADC histograms of the NPSLE group were, on average, significantly lower and
  broader, with a higher mean ADC value. CONCLUSION. The data suggest an
  increased general diffusivity in brain parenchyma of patients with NPSLE, probably
  based on loss of tissue integrity. In addition to increasing our battery of highly
  wanted diagnostic tools and our understanding of the pathogenesis of NPSLE, the
  present method seems to be useful in quantifying the disease burden, enabling
  monitoring in treatment trials and the study of disease progression
Keywords:                abnormalities/ADC/addition/age/apparent                  diffusion
  criteria/diffusion/diffusion coefficient/diffusion weighted/diffusion weighted
  imaging/diffusion-weighted/diffusion-weighted                  imaging/disease/disease
  IONS/loss/lower/lupus/lupus                erythematosus/MAGNETIC-RESONANCE
  esis/patients/POSITRON                                                    EMISSION
  TOMOGRAPHY/progression/STROKE/systemic/systemic                                lupus
Bronzwaer, J.G.F., Heymes, C., Visser, C.A. and Paulus, W.J. (2003), Myocardial
  fibrosis blunts nitric oxide synthase-related preload reserve in human dilated
  cardiomyopathy. American Journal of Physiology-Heart and Circulatory Physiology,
  284 (1), H10-H16.
Abstract: The purpose of the study was to investigate interactions between myocardial
  nitric oxide synthase (NOS) and myocardial fibrosis, both of which determine left
  ventricular (LV) preload reserve in patients with nonischemic dilated
  cardiomyopathy (DCM). In previous animal experiments, chronic inhibition of NOS
  induced myocardial fibrosis and limited LV preload reserve. Twenty-eight DCM
  patients underwent LV catheterization, balloon caval occlusions (BCO; n = 8),
  intracoronary substance P infusion (n = 8), and procurement of LV endomyocardial
  biopsies for determinations of collagen volume fraction (CVF), of gene expression of
  NOS2, NOS3, heme oxygenase (HO)-1, and TNF-alpha, and of NOS2 protein. CVF
  was unrelated to the intensity of NOS2, NOS3, HO-1, or TNF-alpha gene expression
  or of NOS2 protein expression. Preload recruitable LV stroke work (PR- LVSW)
  correlated directly with NOS2 gene expression (P = 0.001) and inversely with CVF
  (P = 0.04). High CVF (>10%) reduced baseline LVSW and PR- LVSW at each level
  of NOS2 gene expression. In DCM, myocardial fibrosis is unrelated to the intensity
  of myocardial gene expression of NOS, antioxidative enzymes (HO-1), or cytokines
  (TNF-alpha) and blunts NOS2- related recruitment of LV preload reserve
  cardiomyopathy/DYSFUNCTION/enzymes/EXPRESSION/FAILING                       HUMAN
  HEART/FAILURE/fibrosis/gene/gene                               expression/heme/heme
  ventricular/LEFT-        VENTRICULAR         RELAXATION/myocardial/myocardial
  contraction/myocardial fibrosis/NECROSIS-FACTOR-ALPHA/Netherlands/nitric
  oxide/nitric                                                                   oxide
  MECHANISM/stroke/stroke                                                    work/TNF
Calbet, J.A.L., Boushel, R., Radegran, G., Sondergaard, H., Wagner, P.D. and Saltin, B.
  (2003), Determinants of maximal oxygen uptake in severe acute hypoxia. American
  Journal of Physiology-Regulatory Integrative and Comparative Physiology, 284 (2),
Abstract: To unravel the mechanisms by which maximal oxygen uptake ((V) over
  dotO(2max)) is reduced with severe acute hypoxia in humans, nine Danish
  lowlanders performed incremental cycle ergometer exercise to exhaustion, while
  breathing room air (normoxia) or 10.5% O-2 in N-2 (hypoxia, similar to5,300 m
  above sea level). With hypoxia, exercise Pa-O2 dropped to 31-34 mmHg and arterial
  O-2 content (Ca-O2) was reduced by 35% (P < 0.001). Forty-one percent of the
  reduction in Ca-O2 was explained by the lower inspired O-2 pressure (PIO2) in
  hypoxia, whereas the rest was due to the impairment of the pulmonary gas exchange,
  as reflected by the higher alveolar-arterial O-2 difference in hypoxia (P < 0.05).
  Hypoxia caused a 47% decrease in (V) over dot O-2max (a greater fall than
  accountable by reduced Ca-O2). Peak cardiac output decreased by 17% (P < 0.01),
  due to equal reductions in both peak heart rate and stroke volume (P < 0.05). Peak
  leg blood flow was also lower (by 22%, P < 0.01). Consequently, systemic and leg
  O-2 delivery were reduced by 43 and 47%, respectively, with hypoxia (P < 0.001)
  correlating closely with (V) over dotO(2max) (r = 0.98, P < 0.001). Therefore, three
  main mechanisms account for the reduction of (V) over dotO(2max) in severe acute
  hypoxia: 1) reduction of PIO2, 2) impairment of pulmonary gas exchange, and 3)
  reduction of maximal cardiac output and peak leg blood flow, each explaining about
  one-third of the loss in (V) over dot O- 2max
Keywords:      acute/air/arterial/blood/blood    flow/BLOOD-FLOW/breathing/Canary
  Islands/cardiac/cardiac                    output/CARDIAC-OUTPUT/cardiovascular
  physiology/CENTRAL              NEURAL          MECHANISMS/delivery/DIFFUSION
  LIMITATION/DYNAMIC                     EXERCISE/ergometer/exercise/fatigue/flow/gas
  rate/HEART-RATE/humans/hypoxia/impairment/LEG/loss/lower/maximal oxygen
  uptake/mechanisms/N2/O-2/OPERATION                      EVEREST-II/oxygen/oxygen
  y           gas            exchange/severe/SKELETAL-MUSCLE/Spain/stroke/stroke
Casanelles, M.D.C., Gil-Fernandez, J.J., Casero, L.F.M., Bengoechea, M.G., Serrano,
  R., Ranada, J.M.F. and Jurado, L.A.P. (2003), Portal hypertension in Williams
  syndrome: Report of two patients. American Journal of Medical Genetics Part A,
  118A (4), 372-376.
Abstract: Williams or Williams-Beuren syndrome (WBS) is a developmental disorder
  with multisystemic manifestations characterized by distinctive facial features, mental
  disability with unique cognitive and personality profiles, vascular stenoses, growth
  retardation, and occasional infantile hypercalcemia, caused by haploinsufficiency for
  genes deleted in chromosome band 7q11.23. However, with the exception of arterial
  stenoses caused by haploinsufficiency for the elastin gene (ELN), no specific
  implication of any other gene in the phenotype has been established. We present two
  patients with portal hypertension leading to splenomegaly and pancytopenia carrying
  the common 1.5 Mb WBS deletion. We propose this is an additional severe vascular
  complication of ELN deficiency and discuss the specific characteristics of the portal
  venous tract that could explain the impact of ELN deficiency in that venous territory.
  This complication is potentially lethal and should thus be considered in any patient
  with WBS and splenomegaly. (C) 2003 Wiley-Liss, Inc
  t/USA/vascular/Williams syndrome
Chae, J., Labatia, I. and Yang, G. (2003), Upper limb motor function in hemiparesis -
  Concurrent validity of the arm motor ability test. American Journal of Physical
  Medicine & Rehabilitation, 82 (1), 1-8.
Abstract: Objective: To evaluate the concurrent validity of the Arm Motor Ability Test
  (AMAT) using the Fugl-Meyer Assessment (FMA) as the criterion measure of
  poststroke upper limb motor impairment. Design: Upper limb motor impairment and
  arm ability of 30 chronic stroke survivors were assessed with the FMA and AMAT,
  respectively. Spearman's correlation coefficients were generated relating the
  components of FMA and AMAT. Scatterplots were generated to provide qualitative
  assessments of the relationship between FMA and AMAT. Bar graphs of FMA and
  AMAT normalized to their maximum scores were generated to compare the levels of
  motor status measured by each instrument. Results: All components of AMAT
  correlated highly with FMA total (r=0.92-0.94; P<0.001). AMAT functional ability
  and AMAT quality of movement were linearly related with FMA total. However,
  AMAT time of performance exhibited significant ceiling and floor effects with
  respect to FMA. Normalized AMAT scores were generally lower than normalized
  FMA scores (P<0.001), with the greatest difference in scores observed in subjects
  with more severe motor impairments. Conclusion: This study demonstrates a high
  degree of concurrent criterion validity of the AMAT. However, AMAT tends to
  underestimate the arm motor status of those with more severe motor impairments
Keywords:               ability/activity/arm/chronic/chronic              stroke/concurrent
  MOVEMENT THERAPY/instrument/lower/measure/motor/motor function/motor
  REHABILITATION/RELIABILITY/severe/status/STROKE/stroke survivors/upper
  limb/upper limb hemiparesis/USA/validity
Chalmers, J. (2003), Trials on blood pressure-lowering and secondary stroke prevention.
  American Journal of Cardiology, 91 (10), 3G-8G.
Abstract: The risk of stroke is strongly and persistently related to the usual level of both
  systolic blood pressure (SBP) and diastolic blood pressure (DBP). This relation holds
  for primary and secondary stroke, both ischemic and hemorrhagic. The Perindopril
  Protection Against Recurrent Stroke Study (PROGRESS) has now provided
  definitive evidence that lowering the blood pressure of patients with preexisting
  cerebrovascular disease (prior stroke or transient ischemic attack [TIA]) also reduces
  the incidence of secondary stroke. PROGRESS showed that a flexible blood
  pressure-lowering regimen involving an angiotensin-converting enzyme inhibitor
  (perindopril) and a diuretic (indapamide) reduces the incidence of stroke, major
  coronary events, and major vascular events by 28%, 26%, and 26%, respectively.
  These benefits were associated with an average reduction of 9.0 mm Hg (SBP) and
  4.0 mm Hg (DBP). The 28% reduction in stroke incidence translated into a 24%
  reduction in ischemic stroke and a 50% reduction in hemorrhagic stroke.
  Combination therapy with perindopril and indapamide decreased blood pressure,
  more effectively than did perindopril monotherapy (mean reduction of 12.3 mm Hg
  [SBP] and 5.0 mm H9 [DBP] vs 4.9 mm Hg [SBP] and 2.8 mm Hg [DBP],
  respectively) and was equally effective in reducing stroke risk in patients with and
  without hypertension. In conclusion, blood pressure- lowering therapy is now
  established as the most important measure for primary and secondary stroke
  prevention. Results of PROGRESS suggest that antihypertensive treatment with a
  combination of perindopril plus indapamide should now be routinely considered for
  all patients with previous stroke or TIA. (C) 2003 by Excerpta Medica, Inc
Keywords: angiotensin converting enzyme/angiotensin converting enzyme
  inhibitor/angiotensin-converting          enzyme/angiotensin-converting           enzyme
  inhibitor/antihypertensive/antihypertensive treatment/Australia/benefits/blood/blood
  pressure/blood             pressure           lowering/cerebrovascular/cerebrovascular
  disease/combination/coronary/diastolic/diastolic                                  blood
  attack/ischemic                           stroke/major                         coronary
  RISK/risk       of    stroke/secondary/secondary     stroke    prevention/stroke/stroke
  incidence/stroke prevention/stroke risk/systolic/systolic blood/systolic blood
  pressure/therapy/TIA/transient/transient                                       ischemic
  attack/treatment/USA/vascular/vascular events
Chen, H.J., Liang, C.L., Lu, K. and Lui, C.C. (2003), Rapidly growing internal carotid
  artery aneurysm after amphetamine abuse - Case report. American Journal of
  Forensic Medicine and Pathology, 24 (1), 32-34.
Abstract: Amphetamine is one of the most common illicitly abused drugs in certain
  countries. It is a potent sympathomimetic that may lead to vascular events, including
  stroke and myocardial infarction. Most reports of stroke after amphetamine abuse are
  of intracerebral hemorrhage. In this report, the authors describe a ruptured aneurysm
  of the right internal carotid artery in a young man with amphetamine abuse. It grew
  rapidly within 2 weeks. Surgery revealed fibrosis and fibrinoid necrosis around the
  aneurysm. The aneurysm was successfully embolized with Guglielmi detachable coil.
  A rapidly growing aneurysm in the major intracranial vessels resulting from
  amphetamine abuse is very rare
Keywords:                             abuse/amphetamine/aneurysm/artery/carotid/carotid
  artery/common/drugs/fibrosis/Guglielmi                                       detachable
  coil/hemorrhage/infarction/internal/internal           carotid/internal          carotid
  artery/intracerebral/INTRACEREBRAL HEMORRHAGE/intracranial/intracranial
Cherkassky, T., Oksenberg, A., Froom, P. and Ring, H. (2003), Sleep-related breathing
  disorders and rehabilitation outcome of stroke patients - A prospective study.
  American Journal of Physical Medicine & Rehabilitation, 82 (6), 452-455.
Abstract: Objective: Sleep-related breathing disorder (SRBD) is more prevalent in
  stroke patients than in age- and sex-matched controls, but the relationship between
  SRBD, functional levels at admission, and subsequent recovery is unclear. We
  evaluated patients after a first stroke to determine the prevalence of SRBD and the
  influence of SRBD on the recovery of discharge functional status after a
  rehabilitation program. Design: In a prospective study, 30 stroke patients were
  studied by continuous overnight pulse oximetry during sleep for the presence of
  desaturation events (fall of arterial saturation of >4% from the baseline). The
  Respiratory Disturbance Index was defined as number of desaturations per hour of
  sleep. Functional assessment was done at admission using the FIM(TM) instrument.
  The patients were asked about total hours of sleep and the presence or absence of
  habitual snoring before and after the stroke. The outcome measure at discharge was
  the FIM score. Results: On linear regression, after including the FIM score at
  admission, in the model, the Respiratory Disturbance Index score was negatively
  correlated with the FIM gain (coefficient, -0.635 +/- 0.27; P = 0.025), and together,
  the variables explained 20.9% of the total variance (adjusted r(2)). All patients with
  an admission FIM score of greater than or equal to70 (only mild functional
  impairment) had a good outcome (FIM score of >100 at discharge). However, only
  two of six of those with FIM scores of <70 with SRBD (defined as a Respiratory
  Disturbance Index score of >10) had significant improvement (greater than or equal
  to30 points), whereas this occurred in seven of nine of those without SRBD
  (prevalence ratio, 0.43; 95% confidence interval, 0.13-1.40; P = 0.085) Conclusions:
  Even after adjusting for the admission functional status, the presence of hypoxic
  events during sleep predicts a poorer recovery, especially in stroke patients with poor
  function at admission
  M/FIM (TM)/function/functional/functional status/impairment/instrument/linear
  regression/measure/mild/model/obstructive           sleep       apnea/outcome/outcome
  study/pulse/PULSE        OXIMETRY/recovery/regression/rehabilitation/rehabilitation
  outcome/rehabilitation             program/SCORE/sleep/snoring/status/stroke/stroke
Chou, S.W., Wong, A.M.K., Leong, C.P., Hong, W.S., Tang, F.T. and Lin, T.H. (2003),
  Postural control during sit-to stand and gait in stroke patients. American Journal of
  Physical Medicine & Rehabilitation , 82 (1), 42-47.
Abstract: Objective: To investigate the relationship of sit-to-stand and gait performance
  in hemiplegic stroke patients. Design: A total of 40 chronic stroke patients with
  hemiplegia and 22 age- matched healthy subjects were included in this study. Data of
  a motion analysis system and three force platforms were collected in a rehabilitation
  unit of a medical center. Results: Laboratory sit-to-stand measurement and gait
  analysis were evaluated in both via three AMTI (Advanced Mechanical Technology
  Inc.) force platforms and a Vicon 370 system (six high-resolution cameras and one
  AMTI force plate), respectively. The sit-to-stand and gait parameters of hemiplegic
  patients were correlated significantly, especially in rising speed and the maximal
  vertical force of both legs during rising. Conclusions: Hemiplegic stroke patients,
  who could stand up within 4.5 sec or who had a maximal vertical force difference of
  less than 30% of body weight between both legs, had better gait performance than
  the others did
Keywords:          age/analysis/BALANCE/body               weight/CHAIR/chronic/chronic
  stroke/control/FORCE/force                    plate/gait/gait               analysis/gait
  performance/hemiplegia/hemiplegic/hemiplegic patients/hemiplegic stroke/high
  oke/stroke patients/TASK/USA/vertical force/weight
Chuang, Y.M., Chao, A.C., Teng, M.M.H., Wu, H.M., Lirng, J.F., Wu, Z.A., Chiang,
  J.H. and Hu, H.H. (2003), Use of CT angiography in patient selection for
  thrombolytic therapy. American Journal of Emergency Medicine, 21 (3), 167-172.
Abstract: It has been shown that thrombolytic therapy can improve clinical outcome in
  some patients with acute cerebral ischemia. These patients have been reported to be
  characterized by certain clinical and imaging findings, mainly with non-contrast
  enhanced computed tomography (CT). Our purpose in this study was to find out
  whether CT angiography (CTA) information about the status of the cerebral vessels
  is helpful in the selection of patients who may benefit the most from thrombolytic
  therapy for acvte cerebral ischemia. CTA was prospectively performed in 15
  consecutive patients (6 women and 9 men; age range 44-83 years) with moderate or
  severe symptoms of hyperacute cerebral ischemia. The clinical manifestations of the
  patient's condition and the findings on CTA were analyzed. Three- dimensionally
  reconstructed CTA images of diagnostic quality could be obtained for all 15 patients.
  Of the 15 patients 14 had a vessel occlusion identified on CTA, which was consistent
  with and/or helpful for making the clinical diagnosis in all 14 cases; one patient had
  an aneurysm of the anterior communicating artery without detectable hemorrhage on
  CTA. Although a thrombolytic agent was not given because of CTA evidence of
  intracranial aneurysm, the patient nevertheless developed a massive subarachnoid
  hemorrhage during hospitalization. Ischemic symptoms reversed after CTA and
  before the initiation of thrombolytic therapy in 2 patients whose CTAs showed
  occlusion of secondary branch of the middle cerebral artery (MCA). CTA can
  provide important information before the initiation of thrombolytic therapy.
  Identification both of the occluded vessel and of an intracranial aneurysm is feasible
  with the use of CTA, which is particularly important if the intracranial aneurysm is a
  potential contraindication to thrombolytic therapy. Occlusion of a secondary branch
  of the MCA and internal carotid artery occlusion are valuable prognostic predictors.
  (C) 2003 Elsevier Inc. All rights reserved
Keywords: acute/acute cerebral ischemia/ACUTE HEMISPHERIC STROKE/ACUTE
  artery/carotid artery occlusion/cerebral/cerebral artery/cerebral ischemia/cerebral
  vessels/clinical/clinical          diagnosis/clinical           outcome/CO/computed
  DEPENDENCE/information/internal/internal carotid/internal carotid artery/internal
  carotid                     artery                    occlusion/intracranial/intracranial
  aneurysm/ischemia/MCA/men/middle cerebral/middle cerebral artery/MIDDLE
Chung, S.P., Ha, Y.R., Kim, S.W. and Yoo, I.S. (2003), Diffusion-weighted MRI of
  intracerebral hemorrhage clinically undifferentiated from ischemic stroke. American
  Journal of Emergency Medicine, 21 (3), 236-240.
Abstract: This report describes diffusion-weighted MRI findings of some intracerebral
  hemorrhages clinically undifferentiated from ischemic stroke. We treated patients
  with characteristic features of intracerebral hemorrhages that could distinguish
  themselves from ischemic lesion on diffusion-weighted imaging. Therefore, we think
  diffusion-weighted imaging could be an emergency screening tool for ischemic
  stroke as an alternative to computed tomography, and the EP should be familiar with
  the diffusion-weighted imaging findings of intracerebral hemorrhage as well as
  cerebral infarction. (C) 2003 Elsevier Inc. All rights reserved
Keywords:       cerebral/cerebral     infarction/CO/computed        tomography/diffusion
  weighted/diffusion             weighted            imaging/diffusion            weighted
  MRI/diffusion-weighted/diffusion-weighted                   imaging/diffusion-weighted
  acerebral           hemorrhage/intracerebral            hemorrhages/INTRACRANIAL
  HEMORRHAGE/ischemic/ischemic                stroke/Korea/lesion/magnetic       resonance
Clow, K.A., Giraud, G.D., Ogden, B.E. and Brooks, V.L. (2003), Pregnancy alters
  hemodynamic responses to hemorrhage in conscious rabbits. American Journal of
  Physiology-Heart and Circulatory Physiology, 284 (4), H1110-H1118.
Abstract: Pregnant animals are less able to maintain mean arterial pressure (MAP)
  during hemorrhage compared with nonpregnant animals, but the hemodynamic basis
  of this difference is unknown. The hypothesis that pregnancy attenuates responses of
  cardiac output, as well as total peripheral resistance (TPR) and femoral conductance,
  to hemorrhage was tested in conscious rabbits in both the pregnant and nonpregnant
  state (n = 10). During continuous slow blood loss (2% of the initial blood volume per
  minute), MAP was maintained initially in both groups. However, MAP then abruptly
  decreased to <45 mmHg in all animals after a smaller percentage of the initial blood
  volume was removed in pregnant compared with nonpregnant rabbits (43.6 +/- 1.7%,
  nonpregnant; 29.6 +/- 2.2%, pregnant; P < 0.005). The more rapid transition to
  hypotension exhibited by pregnant rabbits was associated with greater initial falls in
  cardiac output (-56 +/- 10 ml/min, nonpregnant; -216 +/- 33 ml/min, pregnant; P <
  0.005) and stroke volume (0.8 +/- 0.1 ml/beat, nonpregnant; -1.3 +/- 0.1 ml/beat,
  pregnant; P < 0.05). In addition, the increase in TPR as a function of the decrease in
  cardiac output was markedly attenuated (P < 0.0001) during pregnancy. Whereas
  femoral conductance decreased in nonpregnant rabbits, it did not change significantly
  in pregnant animals. In conclusion, the lesser ability of conscious pregnant rabbits to
  maintain MAP during hemorrhage is due largely to a greater decrease in cardiac
  output but also to inadequate reflex increases in TPR, possibly in part in the femoral
  vascular bed
Keywords: ability/addition/animals/arterial/arterial pressure/blood/blood loss/blood
  volume/cardiac/cardiac output/conductance/conscious/conscious rabbits/falls/femoral
  arterial                                                 pressure/peripheral/peripheral
  resistance/pregnancy/PRESSURE/rabbits/reflex/resistance/stroke/stroke volume/total
  peripheral resistance/USA/vascular/volume
Crook, E.D., Clark, B.L., Bradford, S.T.J., Golden, K., Calvin, R., Taylor, H.A. and
  Flack, J.M. (2003), From 1960s Evans County Georgia to present-day Jackson,
  Mississippi: An exploration of the evolution of cardiovascular disease in African
  Americans. American Journal of the Medical Sciences, 325 (6), 307-314.
Abstract: Cardiovascular disease (CVD) is the No. 1 cause of mortality in the United
  States and it disproportionately affects African Americans. However, there are earlier
  reports that African Americans had significantly less CVD than whites. This racial
  discrepancy in CVD rates was noticed primarily for coronary heart disease (CHD).
  This issue was examined in the Evans County (Georgia) Cardiovascular Disease
  Study conducted in the 1960s. It showed that African American men had
  significantly lower rates of CHID than white men. Over the last couple of decades,
  the rates of CVD have been declining. However, the rate of decline of CVD in
  African Americans has not been equal to that seen in whites, such that African
  Americans now have a disproportionate share of CVD in the United States. In the
  1990s, the Jackson Heart Study was designed to explore the reasons for the current
  racial discrepancy. This articles reviews the findings of the Evans County Study and
  explores various hypotheses for why CVD in African Americans has evolved from a
  disease from which African Americans may have been "protected" to one in which
  they shoulder a disproportionate burden
Keywords:                        African/African                       American/African
  lar disease/cause/CHD/coronary/coronary heart/coronary heart disease/CORONARY
  HEART-DISEASE/CVD/decline/disease/Evans County study of cardiovascular
  disease/HYPERTENSION/Jackson                                                       Heart
  eviews/RISK/SCI/shoulder/SOCIAL-CLASS/STROKE                     MORTALITY/United
Dankner, R., Goldbourt, U., Boyko, V. and Reicher-Reiss, H. (2003), Predictors of
  cardiac and noncardiac mortality among 14,697 patients with coronary heart disease.
  American Journal of Cardiology, 91 (2), 121-127.
Abstract: The decrease in mortality from ischemic heart disease during the last 25 years
  may partly reflect improvement in diagnosis and treatment of patients with coronary
  heart disease. These patients, therefore, are experiencing morbidity and mortality due
  to other causes. The aim of our study was to describe the incidence and causes of
  cardiac mortality (CM) and noncardiac Mortality (NCM) and to identify predictive
  factors. A cohort of 14,697 patients with coronary heart disease was merged with the
  Central Population Registry to identify mortality records from 1990 to 1996. Among
  the 1,839 deaths, 1,055 (57.4%) were cardiac, 626 (34.0%) were noncardiac, and 158
  deaths (8.6%) were due to unknown causes as classified in the International
  Classification of Diseases-Ninth Edition (ICD). The 3 most significant predictors
  were age for a 10-year increment (odds ratios 1.75 and 2.25 for CM and NCM,
  respectively), chronic obstructive pulmonary disease (odds ratios 1.67 and 1.71), and
  current smoking (odds ratios 1.29 and 1.66). A history of cancer was a predictor of
  NCM, but not of CM, whereas peripheral vascular disease predicted CM but not
  NCM. As the number of predictive factors increased from none to greater than or
  equal to5, the risk of NCM gradually increased from 1.9% to 15.5%. Similar
  predictors expose subjects with coronary disease to CM and NCM, but smoking
  plays a more pronounced role in the prediction of NCM, whereas past myocardial
  infarction, lower levels of high-density lipoprotein cholesterol, and peripheral
  vascular disease are mainly associated with CM. Because of the similarity of
  antecedent predictors, treatment of risk factors among patients with coronary heart
  disease should prove valuable for the prevention of all-cause mortality. (C) 2003 by
  Excerpta Medica, Inc
Keywords:                                                          age/all-cause/all-cause
  mortality/cancer/cardiac/causes/cholesterol/chronic/chronic obstructive pulmonary
  disease/cohort/coronary/coronary        disease/coronary       heart/coronary      heart
  disease/diagnosis/disease/FACTOR            INTERVENTION             TRIAL/heart/heart
  disease/high-density                                                         lipoprotein
  cholesterol/history/incidence/infarction/ischemic/ischemic                         heart
  disease/lipoprotein/LOW       SERUM-         CHOLESTEROL/lower/LUNG-CANCER
  MORTALITY/morbidity/morbidity                                                        and
  eral/peripheral            vascular             disease/prediction/predictive/predictive
  CESSATION/STROKE/treatment/USA/vascular/vascular disease/WOMEN
Di Monaco, M., Vallero, F., Di Monaco, R., Mautino, F. and Cavanna, A. (2003),
  Functional recovery and length of stay after hip fracture in patients with neurologic
  impairment. American Journal of Physical Medicine & Rehabilitation, 82 (2),
Abstract: Objective: To evaluate the functional recovery and the length of stay after hip
  fracture in patients with neurologic impairment. Design: A total of 577 inpatients
  with hip fracture consecutively admitted to our rehabilitation hospital were included
  in this retrospective study. A total of 71 of 577 were affected by neurologic
  impairment caused by stroke with hemiplegia (n = 37), Parkinson's disease (n 25), or
  other diseases (n = 9). Results: Mean Barthel index was significantly lower in the
  patients with neurologic impairment than in the controls: 10.8 (95% confidence
  interval, 5.9-15.6; P < 0.001) at admission and 13.1 (95% confidence interval,
  5.55-20.65; P < 0.001) at discharge. Multiple regression including eight confounding
  variables showed that neurologic impairment was negatively associated with the
  Barthel index. However, the mean increase in Barthel index through the course of
  rehabilitation was not affected by neurologic impairment. The length of stay was
  significantly higher in the patients with neurologic impairment, 3.84 days (95%
  confidence interval, 0.51-7.17; P < 0.05), and multiple regression showed that
  neurologic impairment was positively associated with the length of stay. Conclusions:
  After hip fracture, the presence of neurologic impairment was associated with lower
  Barthel index and longer length of stay, but it did not affect the increase in Barthel
  index due to a course of rehabilitation
Keywords:                                                           affect/Barthel/Barthel
  fracture/hospital/impairment/index/inpatients/Italy/length                             of
  BILITATION/retrospective                       study/RISK-FACTORS/stroke/STROKE
Djousse, L., Folsom, A.R., Province, M.A., Hunt, S.C. and Ellison, R.C. (2003), Dietary
  linolenic acid and carotid atherosclerosis: the National Heart, Lung, and Blood
  Institute Family Heart Study. American Journal of Clinical Nutrition, 77 (4),
Abstract: Background: Dietary intake of linolenic acid is associated with a lower risk of
  cardiovascular disease mortality. However, it is unknown whether linolenic acid is
  associated with a lower risk of carotid atherosclerosis. Objective: The objective was
  to examine the association between dietary linolenic acid and the presence of
  atherosclerotic plaques and the intima-media thickness of the carotid arteries. Design:
  In a cross-sectional design, we studied 1575 white participants of the National Heart,
  Lung, and Blood Institute Family Heart Study who were free of coronary artery
  disease, stroke, hypertension, and diabetes mellitus. High-resolution ultrasound was
  used to assess intima-media thickness and the presence of carotid plaques beginning
  1 cm below to 1 cm above the carotid bulb. We used logistic regression and a
  generalized linear model for the analyses. Results: From the lowest to the highest
  quartile of linolenic acid intake, the prevalence odds ratio (95% CI) of a carotid
  plaque was 1.0 (reference), 0.47 (0.30, 0.73), 0.38 (0.22, 0.66), and 0.49 (0.26, 0.94),
  respectively, in a model that adjusted for age, sex, energy intake, waist-to-hip ratio,
  education, field center, smoking, and the consumption of linoleic acid, saturated fat,
  fish, and vegetables. Linoleic acid, fish long-chain fatty acids, and fish consumption
  were not significantly related to carotid artery disease. Linolenic acid was inversely
  related to thickness of the internal and bifurcation segments of the carotid arteries but
  not to the common carotid artery. Conclusion: Higher consumption of total linolenic
  acid is associated with a lower prevalence odds of carotid plaques and with lesser
  thickness of segment-specific carotid intima-media thickness
Keywords:           age/and          Blood           Institute         Family         Heart
  plaques/cardiovascular/cardiovascular             disease/cardiovascular          disease
  mortality/carotid/carotid arteries/carotid artery/carotid artery disease/carotid
  atherosclerosis/carotid intima media thickness/carotid intima-media thickness/carotid
  plaque/carotid                      plaques/common/common                         carotid
  artery/consumption/coronary/coronary                   artery/coronary              artery
  disease/CORONARY-ARTERY                           DISEASE/DENSITY-LIPOPROTEIN
  mellitus/diet/dietary/disease/education/energy/energy           intake/Family       Heart
  Study/fat/fatty        acids/fish/fish        consumption/FOOD             FREQUENCY
  QUESTIONNAIRE/hypertension/internal/intima                                         media
  thickness/intima-media/intima-media            thickness/intima-media-thickness/linoleic
  acid/linolenic acid/logistic regression/lower/Lung/MEN/model/mortality/n-3 fatty
  acids/n-6            fatty            acids/National             Heart/NUTRITION/odds
Eastwood, J.D., Engelter, S.T., MacFall, J.F., Delong, D.M. and Provenzale, J.M.
  (2003), Quantitative assessment of the time course of infarct signal intensity on
  diffusion-weighted images. American Journal of Neuroradiology, 24 (4), 680-687.
Abstract: Background and purpose: Diffusion-weighted (Dw) Mr imaging is important
  in evaluating acute stroke, and knowledge of the signal intensity changes associated
  with acute stroke is valuable. Our purpose was to model the time course of the signal
  intensity of infarcts and to characterize the apparent diffusion coefficient (Adc) And
  t2 effects on total signal intensity. Methods: Ninety-two patients were included in
  this prospective cross-sectional study. Signal intensity in infarcts (4 Hours to 417
  days) And control regions were recorded on dw images (B = 0 and 1000 s/mm(2)),
  Adc maps, and ratio images (Image with b = 1000 s/mm(2) Divided by image with b
  = 0 s/mm2). Cubic spline functions were used for polynomial fitting. The time
  courses of log signal intensity with log time were modeled. The independent
  contributions of t2 and adc to the total signal intensity were retrospectively compared
  at 0- 63 hours, 3-10 days, 11-57 days, and 57 days onward. Results: Mean signal
  intensity on dw images was maximal at 40 hours after infarction and normalized at
  57 days. At 0-63 hours, the positive effect of adc on signal intensity was greater than
  that of t2 (Log value,13 +/- 0.04 Vs 0.11 +/- 0.05; P =.04). At days 3-10, the positive
  t2 effect predominated (0.13 +/- 0.08 Vs 0.08 +/- 0.04; P =.12). At 10-57 days, the
  positive t2 effect was greater than the negative adc effect. After day 57, the negative
  adc effect predominated. Conclusion. The signal intensity of infarcts on dw images
  normalizes at 57 days, which is substantially later than previously suggested. T2
  (Shine- through) Effect contributes largely to the total infarct signal intensity
Keywords: acute/ACUTE HUMAN STROKE/acute stroke/AGE/apparent diffusion
  study/diffusion/diffusion      coefficient/diffusion      weighted/diffusion     weighted
  IMAGES/patients/polynomial/prospective/SERIAL/stroke/time course/USA
Ebrahim, S., Smith, G.D., May, M. and Yarnell, J. (2003), Shaving, coronary heart
   disease, and stroke - The Caerphilly Study. American Journal of Epidemiology, 157
   (3), 234-238.
Abstract: The relation between frequency of shaving and all-cause and cardiovascular
   disease mortality, coronary heart disease, and stroke events was investigated in a
   cohort of 2,438 men aged 45-59 years. The one fifth (n = 521, 21.4%) of men who
   shaved less frequently than daily were shorter, were less likely to be married, had a
   lower frequency of orgasm, and were more likely to smoke, to have angina, and to
   work in manual occupations than other men. Over the 20-year follow-up period from
   1979- 1983 to December 31, 2000, 835 men (34.3%) died. Of those who shaved less
   frequently than daily, 45.1% died, as compared with 31.3% among those who shaved
   at least daily. Men who shaved less frequently had fully adjusted hazard ratios
   (adjusted for testosterone, markers of insulin resistance, social factors, lifestyle, and
   baseline coronary heart disease) of 1.24 (95% confidence interval (CI): 1.03, 1.50)
   for all-cause mortality, 1.30 (95% CI: 0.99, 1.71) for cardiovascular disease mortality,
   1.08 (95% CI: 0.61, 1.92) for lung cancer mortality, 1.16 (95% CI: 0.90, 1.48) for
   coronary heart disease events, and 1.68 (95% CI: 1.16, 2.44) for stroke events. The
   association between infrequent shaving and all-cause and cardiovascular disease
   mortality is probably due to confounding by smoking and social factors, but a small
   hormonal effect may exist. The relation with stroke events remains unexplained by
   smoking or social factors
Keywords:                 aged/all-cause/all-cause              mortality/angina/ARTERY
   DISEASE/association/cancer/cancer               mortality/cardiovascular/cardiovascular
   disease/cardiovascular                 disease                mortality/cerebrovascular
   accident/COHORT/coronary/coronary disease/coronary heart/coronary heart
   resistance/lifestyle/lower/lung/lung             cancer/MALE                  PATTERN
Fillenbaum, G.G., Burchett, B.M., Lee, J.H. and Blazer, D.G. (2003), Mortality and
   apolipoprotein E in African-American, and White elders: An attempted replication.
   American Journal of Medical Genetics Part A, 119A (2), 141-146.
Abstract: We have tried, with only partial success, to confirm findings in a recently
   reported study in this journal on the relationship of APOE genotype to mortality in
   community representative Hispanics (n = 659), Whites (n = 272), and
   African-Americans (n = 450), aged 65 and over, living in Northern Manhattan, New
   York. That study found that using proportional hazards models adjusted for sex and
   lipid levels, Hispanics and Whites with the E2/E3 genotype, but not African-
   Americans, had the lowest mortality risk. Those under age 75 had risks comparable
   to those over age 75, suggesting minimal survivor bias. Nearly 50% of the mortality
   risk associated with the APOE genotype appeared to act through heart disease,
   diabetes, and stroke. The current study of African-Americans (n = 1,083) and Whites
   (n = 915) aged 71 and over living in the more rural Southeastern US, found no
   protective effect of the E2/E3 genotype for either African-Americans or Whites.
   Among younger Whites (age 71-75), point estimates suggested that the E2/E3
   genotype might be protective, but at a nonsignificant level; self-reported
   African-American race, but not genotype, was a risk factor for mortality in this age
  group. Neither lipid level nor health condition attenuated the effect of APOE
  genotype. Differences in findings may reflect issues of sampling, age, the relative
  distribution of the APOE alleles, or some other factor. Until such time as studies use
  truly representative samples and include younger ages, findings in this area must be
  treated with caution. (C) 2003 Wiley-Liss, Inc
Keywords:          African/African          American/African            Americans/African-
  ibution/E                               GENOTYPE/effect/genotype/health/heart/heart
  risk/NEW-YORK/PART/proportional hazards models/protective effect/race/risk/risk
Fujiwara, T., Liu, M.G. and Chino, N. (2003), Effect of pedaling exercise on the
  hemiplegic lower limb. American Journal of Physical Medicine & Rehabilitation, 82
  (5), 357-363.
Abstract: Objective: To assess the effects of pedaling exercise on the muscle activities
  in hemiparetic lower limbs in patients with stroke. Design: In this before-and-after
  trial, 17 nonambulatory patients with chronic hemiparetic stroke were recruited.
  Using a servo-dynamically controlled ergometer with a trunk support, the patients
  pedaled at a resistance of 5 N-m at their comfortable speeds. Muscle activities were
  recorded with surface electrodes from bilateral quadriceps femoris,
  media[ hamstrings, tibialis anterior, and medial gastrocnemius, and integrated
  electromyograms were used for analysis of muscle activity patterns during the
  pedaling cycle. Muscle activities during pedaling were compared with those during
  voluntary knee extension of the affected limb before, immediately after, and 30 min
  after the pedaling. Results: We found phasic muscle activities in the affected limb
  during pedaling that were antiphasic to the contralateral side. The muscle activities of
  quadriceps femoris and tibialis anterior increased significantly during pedaling
  compared with those during voluntary knee extension effort, whereas the muscle
  activity of medial hamstrings did not change. The postpedaling facilitation of
  quadriceps and tibialis anterior and the inhibition of gastrocnemius during voluntary
  knee extension effort lasted at least for 30 min. Conclusion: Pedaling could facilitate
  phasic and coordinated muscle activities even in patients with severe hemiparesis,
  and it is potentially an effective mode of muscle reeducation
Keywords: activity/analysis/bilateral/BODY-WEIGHT SUPPORT/central pattern
  ion/lower/MOVEMENT/muscle/PA/patients/patients                                      with
  stroke/patterns/POSTSTROKE                        HEMIPLEGIA/quadriceps/reciprocal
  inhibition/resistance/severe/stroke/support/tibialis anterior/trial/trunk/USA
Funk, J.L., Migliati, E., Chen, G.J., Wei, H.B., Wilson, J., Downey, K.J., Mullarky, P.J.,
  Coull, B.M., McDonagh, P.F. and Ritter, L.S. (2003), Parathyroid hormone-related
  protein induction in focal stroke: a neuroprotective vascular peptide. American
  Journal of Physiology-Regulatory Integrative and Comparative Physiology, 284 (4),
Abstract: Parathyroid hormone-related protein (PTHrP) is a multifunctional peptide that
  enhances blood flow in non-central nervous system (CNS) vascular beds by causing
  vasodilation. PTHrP expression is induced in non-CNS organs in response to
  ischemia. Experiments were therefore undertaken to determine whether PTHrP can
  be induced in brain in response to ischemic injury and whether PTHrP can act locally
  as a vasodilator in the cerebral vasculature, an effect that could be neuroprotective in
  the setting of stroke. PTHrP expression was examined by Northern analysis and
  immunohistochemical staining in male Sprague-Dawley rats subjected to permanent
  middle cerebral artery occlusion (MCAO). Vasodilatory effects of superfused
  PTHrP(1-34) on pial arterioles were determined by intravital fluorescence
  microscopy. Effects of PTHrP(1-34) peptide administration on MCAO infarction
  size reduction were assessed. PTHrP expression was induced in the ischemic
  hemisphere as early as 4 h after MCAO and remained elevated for up to 24 h.
  Increased immunoreactive PTHrP at sites of ischemic tissue injury was located in the
  cerebral microvessels. Superfusion with PTHrP(1-34) peptide for up to 25 min
  increased pial arteriolar diameter by 30% in normal animals. In animals with
  permanent MCAO, PTHrP(1-34) peptide treatment significantly decreased cortical
  infarct size (-47%). In summary, PTHrP expression increases at sites of ischemic
  brain injury in the cerebrovasculature. This local increase in PTHrP could be an
  adaptive response that enhances blood flow to the ischemic brain, thus limiting cell
Keywords:      ADENYLATE-CYCLASE/analysis/animals/arterioles/artery/blood/blood
  injury/CENTRAL-NERVOUS-SYSTEM/cerebral/cerebral artery/cerebral artery
  occlusion/cerebral               microvessels/cerebrovasculature/CNS/cortical/cortical
  /fluorescence      microscopy/focal/focal     stroke/hemisphere/induced/infarct/infarct
  INJECTION/ischemia/ischemic/ischemic            injury/male/MCAO/microscopy/middle
  cerebral/middle cerebral artery/middle cerebral artery occlusion/MIDDLE
  CEREBRAL-                                                    ARTERY/nervous/nervous
  system/neuroprotective/normal/occlusion/permanent MCAO/permanent middle
  cerebral          artery         occlusion/protein/RAT/rats/size/SMOOTH-MUSCLE
Gable, D.R., Bergamini, T., Garrett, W.V., Hise, J., Smith, B.L., Shutze, W.P., Pearl, G.
  and Grimsley, B.R. (2003), Intermediate follow-up of carotid artery stent placement.
  American Journal of Surgery, 185 (3), 183-187.
Abstract: Background: Carotid artery stent placement (CAS) is becoming more popular
  among various specialties for the treatment of primary and recurrent carotid artery
  disease. The morbidity associated with this procedure is improving but the
  intermediate- and long-term follow-up remains unknown. We report our restenosis
  rates and follow-up associated with CAS. Methods: Thirty-one interventions on 29
  patients from May 1998 to January 2002 were reviewed. All patients have undergone
  serial follow-up using Doppler ultrasound at 3 and 6 months and every 6 months
  thereafter. Ten interventions (32%) were performed on patients with recurrent carotid
  artery disease and 21 (68%) on patients with primary disease. Results: Five
  periprocedural complications occurred (transient ischemic attack, n = 3; major stroke,
  n = 1; immediate intrastent restenosis requiring lysis, n 1) for a total immediate
  complication rate of 16%. No deaths occurred. Follow-up was achieved in all 29
  patients (mean 28 months; range 20 to 46). Twenty-seven patients (29 vessels; 94%)
  remain asymptomatic with less than 50% stenosis. Two vessels (6%) have been
  found to have a critical restenosis of greater than 90%. Both patients were
  symptomatic from their recurrence (transient ischemic attack, n = 1; acute stroke, n =
   1). Cumulative major stroke and death rate including all follow-up was 6%.
   Conclusions: CAS can be performed with an acceptable stroke/death rate (3%) in a
   properly selected patient population. In our small series of patients, the restenosis
   rate at a mean of 28 months after CAS is 6%. (C) 2003 Excerpta Medica Inc. All
   rights reserved
Keywords:         acute/acute      stroke/angioplasty/artery/asymptomatic/carotid/carotid
   artery/carotid                          artery                           disease/carotid
   up/follow-up/intermediate/ischemic/ischemic                            attack/long-term
   DETECTION/patient/patients/PERCUTANEOUS                             TRANSLUMINAL
   /STENOSIS/stent/stent             placement/stroke/transient/transient         ischemic
Gadegbeku, C.A., Dhandayuthapani, A., Shrayyef, M.Z. and Egan, B.M. (2003),
   Hemodynamic effects of nicotinic acid infusion in normotensive and hypertensive
   subjects. American Journal of Hypertension, 16 (1), 67-71.
Abstract: Nicotonic acid (NA) infusions are associated with peripheral vasodilation
   from the generation of vascular prostaglandins with minimal effects on blood
   pressure (BP) in normotensive subjects. We studied the effects of a NA infusion in
   10 hypertensive and 11 normotensive individuals to further characterize systemic
   hemodynamic responses to NA using pulse waveform analysis. Blood pressure,
   stroke volume, cardiac output, total peripheral resistance, large and small artery
   elasticity were determined before and after a 1-h NA infusion. In the normotensives,
   systolic, diastolic, mean BP, and pulse pressure were not affected by NA. In contrast,
   the hypertensive subjects experienced a decrease in mean BP from 105 +/- 2 mm Hg
   to 100 +/- 3 mm Hg (P < .01) accompanied by significant decreases in systolic,
   diastolic, and pulse pressures. The differential BP response occurred despite
   comparable increases in heart rate (11% to 13%, P &LE; .05) and similar decreases
   in total peripheral resistance (6%, P &LE; .05) in both groups. However, the
   normotensive group demonstrated a decrease in overall vascular compliance,
   measured as stroke volume to pulse pressure ratio, from 2.12 &PLUSMN; 0.09 to
   1.93 &PLUSMN; 0.09 mL/mm Hg (P < .05). This finding was supported by a
   decrease in Cl (large artery compliance), assessed by pulse waveform analysis, from
   15.8 +/- 1 to 14.2 +/- 1 mL/mm Hg (P < .05). In contrast, overall compliance and Cl
   were unchanged after the NA infusion in the hypertensive group. These results
   suggest that there is a differential hemodynamic response to NA infusion in
   normotensive and hypertensive individuals. The adjustment in vascular compliance
   may be an important factor in determining overall BP response to NA
Keywords:                adjustment/analysis/arterial             compliance/ARTERIAL
   COMPLIANCE/artery/blood/blood                               pressure/BP/cardiac/cardiac
   output/compliance/contrast/diastolic/effects/elasticity/fatty          acids/heart/heart
   pressure/resistance/results/small/stroke/stroke          volume/systemic/systolic/total
   peripheral resistance/USA/vascular/vasodilation/volume
Gillot, A.J., Holder-Walls, A., Kurtz, J.R. and Varley, N.C. (2003), Perceptions and
  experiences of two survivors of stroke who participated in constraint-induced
  movement therapy home programs. American Journal of Occupational Therapy, 57
  (2), 168-176.
Abstract: The purpose of this study was to explore and describe the perceptions and
  experiences of two survivors of stroke who participated in constraint-induced
  movement therapy (CIMT) home programs. Data sources were analyzed with a
  phenomenological approach, and common themes were identified. Themes were
  translated using the Occupational Adaptation frame of reference as a template. Three
  themes were generated from the data: (a) motivational factors and expectations
  represented personal desires to increase functional ability and environmental
  demands that created a press to participate in CIMT-1 (b) neurorehabilitation as an
  ongoing process suggested that rehabilitation should continue as long as functional
  deficits exist, and (c) perceived changes in function represented perceived changes in
  efficiency, effectiveness, and satisfaction after CIMT. CIMT was found to help the
  participants in this study become more satisfied with performance and to increase
  efficiency and effectiveness of function in daily activities
Keywords:              ability/approach/BRAIN              PLASTICITY/cerebrovascular
  USE/function/functional/functional ability/FUNCTIONAL MRI/home/LEARNED
  NONUSE/MOTOR                                     RECOVERY/movement/multimethod
  study/neurorehabilitation/occupational                                         therapy
Gregory, P.C. and Kuhlemeier, K.V. (2003), Prevalence of venous thromboembolism in
  acute hemorrhagic and thromboembolic stroke. American Journal of Physical
  Medicine & Rehabilitation, 82 (5), 364-369.
Abstract: Objective: Deep venous thromboembolism (DVT) is an important health issue
  in the hospitalized geriatric population that leads to increased length of stay,
  morbidity, and mortality. Patients with hemorrhagic strokes are usually not placed on
  prophylactic therapy because of the risk of hemorrhagic extension of the stroke. The
  purpose of this study was to evaluate the prevalence of DVTs in hospitalized patients
  with hemorrhagic vs. thromboembolic strokes. Design: Retrospective chart review of
  data obtained from the Maryland Health Services Cost Review Commission data
  base for 1999 to determine the prevalence of DVTs in both hemorrhagic and
  thromboembolic stroke patients hospitalized acutely. Multiple logistic regression was
  performed to evaluate possible risk factors. Results: There were 1,926 patients
  hospitalized with a primary diagnosis of hemorrhagic stroke and 15,599 with
  thromboembolic stroke. Women in general had more strokes than men did. Older
  patients were more likely to have strokes as evidenced by the mean ages of 66 and 71
  yr for hemorrhagic and thromboembolic strokes, respectively. A total of 37 patients
  (1.9%) with hemorrhagic strokes had DVTs, whereas 74 patients (0.5%) with
  thromboembolic strokes had DVTs. Hemorrhagic stroke was an independent risk
  factor for DVT (odds ratio, 2.60; 95% confidence interval, 1.49-4.55; P = 0.0008).
  Conclusions: DVT prevalence and risk was higher among patients with hemorrhagic
  strokes in comparison with patients with thromboembolic strokes
Keywords:        acute/comparison/deep       venous      thromboembolism/DEEP-VEIN
  stroke/INJURY/intracranial            hemorrhage/length         of        stay/logistic
  ATION/review/risk/risk              factor/risk           factors/risk-factors/stroke/stroke
  stroke/thromboembolism/USA/venous thromboembolism
Grey, E., Bratteli, C., Glasser, S.P., Alinder, C., Finkelstein, S.M., Lindgren, B.R. and
  Cohn, J.N. (2003), Reduced small artery but not large artery elasticity is an
  independent risk marker for cardiovascular events. American Journal of
  Hypertension, 16 (4), 265-269.
Abstract: Background: Atherosclerosis begins in the arterial wall, with endothelial
  dysfunction accompanied by functional and structural changes that influence arterial
  stiffness. Pulse contour analysis provides an assessment of compliance or elasticity
  of the large conduit arteries (C-1) and small microcirculatory arteries (C-2). In this
  study, the predictive value of reduced elasticity of these arteries was evaluated by
  follow-up of subjects who underwent pulse contour analysis at the University of
  Minnesota. Methods: Questionnaires were sent to 870 subjects who had radial artery
  pulse wave analysis performed between 1993 and 1999 using a noninvasive sensor,
  parameter estimating algorithm and modified Windkessel model of the circulation.
  Responses from 419 subjects >19 years of age reported on any cardiovascular events
  including death, myocardial infarction, stroke, transient ischemic attacks, angina, or
  coronary or peripheral vascular interventional procedures. Results: Of the subjects,
  168 (41%) reported one or more cardiovascular events. Events were more common
  in those with elevated blood pressure, elevated cholesterol, diabetes, and family
  history of events. Age, reduced C-1, and reduced C-2 were univariate predictors of
  events. After adjusting for age, a 2-unit decrease in C-2 remained a significant
  predictor (odds ratio 1.50, P <.001), whereas C-1 was no longer predictive.
  Conclusion: Reduced small artery elasticity, which is a measure of endothelial
  dysfunction, is significantly associated with cardiovascular events independent of
  age. Am J Hypertens 2003;16:265-269 (C) 2003 American Journal of Hypertension,
Keywords:                    ADHESION/AGE/algorithm/analysis/angina/arterial/arterial
  elasticity/arterial    stiffness/arterial     wall/arteries/artery/assessment/blood/blood
  DISEASE/dysfunction/elasticity/endothelial/endothelial dysfunction/ESSENTIAL-
  HYPERTENSION/family/family                                                   history/follow
  procedures/ischemic/ischemic attacks/marker/measure/model/myocardial/myocardial
  infarction/NEW-YORK/noninvasive/odds                 ratio/peripheral/predictive/predictive
  value/predictor/predictors/pressure/pulse/pulse             contour           analysis/pulse
  artery/risk/sensor/small/stiffness/stroke/structural/transient/transient           ischemic
  attacks/USA/vascular/VASCULAR                        ABNORMALITIES/WAVE-FORM
Hammoud, D., Gailloud, P., Olivi, A. and Murphy, K.J. (2003), Acute vasogenic edema
  induced by thrombosis of a giant intracranial aneurysm: A cause of pseudostroke
  after therapeutic occlusion of the parent vessel. American Journal of Neuroradiology,
  24 (6), 1237-1239.
Abstract: A 16-year-old male adolescent presenting with acute retro- orbital pain
  underwent emergent internal carotid occlusion for a giant cavernous aneurysm. Three
  weeks later, the patient complained of headache and right hemiparesis, which
  suggested an acute stroke. CT and MR imaging revealed vasogenic brain edema
  without infarct. The symptoms rapidly resolved with steroid therapy. Follow-up CT
  showed resolution of the edema. The imaging characteristics, clinical implications,
  and etiology of vasogenic edema occurring after thrombosis of a giant intracranial
  aneurysm are discussed
Keywords: acute/acute stroke/adolescent/aneurysm/ARTERY ANEURYSM/brain/brain
  carotid/intracranial/intracranial                               aneurysm/male/MR/MR
  tic/therapy/thrombosis/USA/vasogenic edema
Han, B.S., Jang, S.H., Chang, Y.M., Byun, W.M., Lim, S.K. and Kang, D.S. (2003),
  Functional magnetic resonance image finding of cortical activation by neuromuscular
  electrical stimulation on wrist extensor muscles. American Journal of Physical
  Medicine & Rehabilitation, 82 (1), 17-20.
Abstract: Objective: To investigate the effects that neuromuscular electrical stimulation
  on the wrist extensor muscles have on the cerebral cortex. Design: A functional
  magnetic resonance imaging study was performed on eight normal volunteers. The
  activation task was the maximum wrist extension by neuromuscular electrical
  stimulation, applied through a two- channel electrical stimulator. Monophasic
  square-wave pulses were used. The activation maps were generated by the threshold t
  test maps. The level of primary motor cortex and primary sensory cortex activations
  was estimated. Results: Among the eight subjects, seven showed significant
  activation on contralateral primary sensorimotor cortex by neuromuscular electrical
  stimulation on the wrist extensor muscles. In these seven subjects, additional bilateral
  or contralateral supplementary motor area activations were also observed. The
  number of activated pixels on the primary sensory cortex was slightly greater than
  that on the primary motor cortex. Conclusion: Neuromuscular electrical stimulation,
  when applied to the peripheral muscles, seems to have a direct effect on the cerebral
Keywords:        activation/bilateral/cerebral/cerebral      cortex/cortex/cortical/cortical
  activation/effect/effects/electric                                 stimulation/electrical
  stimulation/functional/functional magnetic resonance/functional magnetic resonance
  STROKE/imaging/Korea/magnetic/magnetic                resonance/magnetic       resonance
  image/magnetic                         resonance                      imaging/MEDIAN
  CORTEX/muscles/neuromuscular/neuromuscular                                      electrical
  N/resonance                                          imaging/sensorimotor/sensorimotor
Han, T.R., Chung, S.G. and Shin, H.I. (2003), Gait patterns of transtibial amputee
  patients walking indoors barefoot. American Journal of Physical Medicine &
  Rehabilitation, 82 (2), 96-100.
Abstract: Han TR, Chung SG, Shin HI: Gait patterns of transtibial amputee patients
  walking indoors barefoot. Am J Phys Med Rehabil 2003;82:96-100. Objective: To
  evaluate the gait patterns of lower limb amputee patients walking with and without
  shoes and to identify differences in barefoot gait patterns when using different
  prosthetic feet. Design: Optoelectronic three- dimensional motion analysis of gait
  was performed on six transtibial amputees using a solid ankle cushion heel foot and a
  single-axis foot, both with and without shoes. Results: Gait abnormalities were
  observed during barefoot walking when the solid ankle cushion heel foot was used.
  These included knee joint hyperextension of 9.9 +/- 2.0 degrees and the loss of ankle
  plantar flexion in the early stance phase. When the single-axis foot was used, knee
  flexion thrust declined from 9.9 +/- 3.7 degrees to 7.2 +/- 3.8 degrees and ankle
  plantar flexion decreased from 9.9 +/- 2.8 degrees to 7.0 +/- 2.1 degrees during the
  early stance phase. Conclusions: In transtibial amputees, significant gait
  abnormalities were observed during barefoot walking using the solid ankle cushion
  heel foot. These gait patterns improved, however, with use of a single-axis prosthetic
  foot, which permits a further plantar flexion after the initial contact
Keywords:                   abnormalities/amputees/analysis/ankle/barefoot/foot/gait/gait
  analysis/GENU RECURVATUM/knee/knee joint/Korea/loss/lower/motion/motion
  analysis/PA/patients/patterns/single-axis foot/solid ankle cushion heel foot/stance
  phase/STROKE/transtibial Amputee/USA/use/walking/when
Harjai, K.J., Stone, G.W., Boura, J., Grines, L., Garcia, E., Brodie, B., Cox, D., O'Neill,
  W.W. and Grines, C. (2003), Effects of prior beta-blocker therapy on clinical
  outcomes after primary coronary angioplasty for acute myocardial infarction.
  American Journal of Cardiology, 91 (6), 655-660.
Abstract: We hypothesized that pretreatment with beta blockers may improve clinical
  outcomes after primary angioplasty for acute myocardial infarction. We pooled
  clinical, angiographic, and outcomes data on 2,537 patients enrolled in the Primary
  Angioplasty in Myocardial Infarction (PAMI), PAMI-2, and Stent PAMI trials. We
  classified patients into a beta group (n = 1,132) if they received beta-blocker therapy
  before primary angioplasty or a no-beta group (n = 1,405) if they did not. We
  evaluated procedural complications and in-hospital and 1-year outcomes (death and
  major adverse cardiac events [death, reinfarction, target vessel revascularization, or
  stroke]) between groups. Beta patients were younger, had higher systolic blood
  pressure and heart rate, and were more likely to be in Killip class I at admission.
  They had lower left ventricular ejection fraction, greater door-to-balloon time,
  greater likelihood of having a left anterior descending artery culprit lesion, but a
  similar incidence of Thrombolysis In Myocardial Infarction 3 flow after angioplasty
  (92.6% vs 92.7%, p = 0.91). The p group had less procedural complications (23% vs
  34%, p <0.0001) and a lower incidence of death (1.8% vs 3.7%, p = 0.0035) and
  major adverse cardiac events (5.5% vs 7.8%. p = 0.027) during hospitalization. At 1
  year, mortality remained lower in 13 patients (4.9% vs 6.7%, log-rank p = 0.055).
  After adjustment for baseline differences, 13 patients had significantly lower in
  hospital mortality (odds ratio 0.41; 95% confidence interval 0.20 to 0.84; p < 0.0148)
  and nonsignificantly lower 1-year mortality (odds ratio 0.72; 95% confidence
  interval 0.47 to 1.08; p = 0. 11). Thus, pretreatment with 13 blockers has an
  independent beneficial effect on short-term clinical outcomes in patients undergoing
  primary angioplasty for acute myocardial infarction. (C) 2003 by Excerpta, Medica,
Keywords:               acute/acute              myocardial/acute              myocardial
  infarction/adjustment/angioplasty/artery/beneficial            effect/BENEFIT/beta/beta
  blocker/beta blockers/beta-blocker/beta-blockers/blood/blood pressure/BLOOD-
  FLOW/cardiac/clinical/clinical                    outcomes/complications/CONSCIOUS
  DOGS/coronary/coronary                          angioplasty/death/effect/ejection/ejection
  fraction/flow/heart/heart                                           rate/hospital/hospital
  mortality/hospitalization/IMMEDIATE/incidence/infarction/left/left ventricular/left
  ventricular      ejection     fraction/lesion/lower/MI/mortality/myocardial/myocardial
  infarction/NEW-YORK/odds                 ratio/outcomes/PAMI/patients/pressure/primary
  PATIENTS/STREPTOKINASE/SURVIVAL/systolic/systolic blood/systolic blood
  pressure/therapy/THROMBOLYTIC THERAPY/trials/USA/ventricular/ventricular
  ejection/ventricular ejection fraction
Healey, J.S. and Connolly, S.J. (2003), Atrial fibrillation: Hypertension as a causative
  agent, risk factor for complications, and potential therapeutic target. American
  Journal of Cardiology, 91 (10), 9G-14G.
Abstract: Atrial fibrillation and hypertension are 2 prevalent, and often coexistent,
  conditions in the North American population. Their incidence increases with
  advancing age, and they are responsible for considerable morbidity and mortality.
  Although the relation between the 2 conditions has long been known, the treatment
  of hypertension is not currently a focus in the clinical management of atrial
  fibrillation. Hypertension is associated with left ventricular hypertrophy, impaired
  ventricular filling, left atrial enlargement, and slowing of atrial conduction
  velocity.,These changes in cardiac structure and physiology favor the development of
  atrial fibrillation, and they increase the risk of thromboembolic complications.
  Conventional therapy of atrial fibrillation has focused on interventions to control
  heart rate and rhythm and the prevention of stroke through the use of anticoagulant
  medications. In patients with atrial fibrillation, aggressive treatment of hypertension
  may reverse the structural changes in the heart, reduce thromboembolic
  complications, and retard or prevent the occurrence of atrial fibrillation. Specific
  pharmocotherapy could potentially play a major role in the primary and secondary
  prevention of atrial fibrillation and its complications. (C) 2003 by Excerpta Medica,
Keywords:       age/anticoagulant/ANTIHYPERTENSIVE              TREATMENT/atrial/atrial
  rate/HEART-FAILURE/hypertension/hypertrophy/incidence/left/left ventricular/left
  ventricular                                         hypertrophy/LEFT-VENTRICULAR
  HYPERTROPHY/management/morbidity/morbidity                                             and
  American/occurrence/patients/physiology/population/prevention/primary                  and
  secondary prevention/RANDOMIZED TRIAL/risk/risk factor/secondary/secondary
  prevention/SINUS RHYTHM/SIZE/slowing/stroke/structural/structure/SYSTEMIC
  complications/treatment/USA/use/ventricular/ventricular                 filling/ventricular
Hoksbergen, A.W.J., Majoie, C.B.L., Hulsmans, F.J.H. and Legemate, D.A. (2003),
  Assessment of the collateral function of the circle of Willis: Three-dimensional
  time-of-flight MR angiography compared with transcranial color-coded duplex
  sonography. American Journal of Neuroradiology, 24 (3), 456-462.
Abstract: BACKGROUND AND PURPOSE: Identification of the intracranial
  collaterals assists in identifying patients with severe occlusive disease of the internal
   carotid arteries who are at lower risk of transient ischemic attacks (TIAs) and stroke.
   We investigated the usefulness of MR angiography in identifying functional
   collaterals of the circle of Willis. METHODS: MR angiography of the circle of
   Willis was performed in 50 healthy volunteers. Visibility was used as the criterion to
   define the intracranial collaterals as being functional. Two observers independently
   assessed the MR angiograms. Results were compared with those of transcranial color
   duplex sonography (TCCD), and results of carotid compression tests were the
   standard of reference for the identification of functional intracranial collaterals.
   RESULTS: With MR angiograms, reviewer 1 achieved a sensitivity of 85%, a
   specificity of 81%, a positive predictive value of 95%, and a negative predictive
   value of 55%. Reviewer 2 achieved a sensitivity of 87%, a specificity of 67%, a
   positive predictive value of 92%, and a negative predictive value of 53%.
   Interobserver agreement on MR angiograms was moderate (kappa = 0.57, 95%
   confidence interval: 0.42, 0.72). CONCLUSION: Visible collaterals of the circle of
   Willis on MR angiograms are able to supply collateral flow in the presence of carotid
   artery obstruction. However, the low negative predictive value of MR angiography
   indicates that, if collaterals are not visible, supplementary TCCD investigation is
Keywords:                                  agreement/angiography/arteries/artery/BASAL
   CEREBRAL-ARTERIES/BLOOD-FLOW/carotid/carotid                             arteries/carotid
   artery/carotid artery obstruction/CAROTID-ARTERY OCCLUSION/circle of
   Willis/collateral                                      flow/color/COMMUNICATING
   ARTERY/compression/compression                     tests/CONTRAST                  CINE
   MR/DISEASE/DOPPLER                                      ULTRASOUND/duplex/duplex
   carotid/intracranial/investigation/ischemic/ischemic       attacks/lower/MAGNETIC-
   angiography/Netherlands/obstruction/occlusive disease/patients/positive predictive
   /transcranial/transcranial color-coded duplex sonography/transient/transient ischemic
Ikai, T., Kamikubo, T., Takehara, I., Nishi, M. and Miyano, S. (2003), Dynamic
   postural control in patients with hemiparesis. American Journal of Physical Medicine
   & Rehabilitation, 82 (6), 463-469.
Abstract: Objective: Decreased postural stability is a common problem associated with
   hemiparesis secondary to stroke. The purpose of this study was to evaluate dynamic
   postural control in patients with hemiparesis and in normal subjects matched for age.
   Design: Quantitative posturography (EquiTest System) was performed to assess the
   response of subjects to sudden perturbations. A total of 59 patients with hemiparesis
   and 98 healthy volunteers were evaluated. All the patients were able to walk inside
   their house without lower limb orthoses. Both the patients and the healthy volunteers
   were subjected to forward and backward perturbations while standing on a movable
   force platform. Balance responses were analyzed in terms of weight symmetry,
   latency, amplitude (relative response strength), and strength symmetry. They were
   also subjected to toes-up and toes-down perturbations to evaluate their response to a
   disruptive balance force. Results: The response latency to perturbations was longer
   and the response strength was weaker on the paretic side of patients with hemiparesis.
   The dynamic postural control was impaired in patients with hemiparesis as compared
   with healthy subjects. Conclusion: The results suggest that patients with hemiparesis
   tend to fall easily and that the risk of falls toward the paretic side is high
Keywords: age/amplitude/balance/common/control/DIAGNOSIS/dynamic postural
   subjects/PA/patients/patients        with       hemiparesis/perturbation/postural/postural
   ability/STANDING BALANCE/strength/stroke/sudden/symmetry/USA/weight
Ilkiw, J.E. and Pascoe, P.J. (2003), Cardiovascular effects of propofol alone and in
   combination with ketamine for total intravenous anesthesia in cats. American Journal
   of Veterinary Research, 64 (7), 913-917.
Abstract: Objective-To compare cardiovascular effects of equipotent infusion doses of
   propofol alone and in combination with ketamine administered with and without
   noxious stimulation in cats. Animals-6 cats. Procedure-Cats were anesthetized with
   propofol (loading dose, 6.6 mg/kg; constant rate infusion [CRI] 0.22 mg/kg/min) and
   instrumented for blood collection and measurement of blood pressures and cardiac
   output. Cats were maintained at this CRI for a further 60 minutes, and blood samples
   and measurements were taken. A noxious stimulus was applied for 5 minutes, and
   blood samples and measurements were obtained. Propofol concentration was
   decreased to 0.14 mg/kg/min, and ketamine (loading dose, 2 mg/kg; CRI, 23
   mug/kg/min) was administered. After a further 60 minutes, blood samples and
   measurements were taken. A second 5-minute noxious stimulus was applied, and
   blood samples and measurements were obtained. Results-Mean arterial pressure,
   central venous pressure, pulmonary arterial occlusion pressure, stroke index, cardiac
   index, systemic vascular resistance index, pulmonary vascular resistance index,
   oxygen delivery index, oxygen consumption index, oxygen utilization ratio, partial
   pressure of oxygen in mixed venous blood, pH of arterial blood, Paco(2), arterial
   bicarbonate concentration, and base deficit values collected during propofol were not
   changed by the addition of ketamine and reduction of propofol. Compared with
   propofol, ketamine and reduction of propofol significantly increased mean
   pulmonary arterial pressure and venous admixture and significantly decreased PaO2.
   Conclusions and Clinical Relevance-Administration of propofol by CRI for
   maintenance of anesthesia induced stable hemodynamics and could prove to be
   clinically useful in cats
Keywords:                addition/anesthesia/arterial/arterial               occlusion/arterial
   pressure/bicarbonate/blood/cardiac/cardiac                                    index/cardiac
   output/cardiovascular/cardiovascular                effects/cats/central            venous
   /loading/measurement/occlusion/oxygen/oxygen                          consumption/oxygen
   delivery/partial        pressure/pH/pressure/pressures/propofol/pulmonary/pulmonary
   arterial                         pressure/resistance/stimulation/STIMULI/stroke/stroke
   index/SURGERY/systemic/systemic                                                    vascular
   resistance/USA/utilization/vascular/vascular resistance/venous pressure
Iso, H., Sato, S., Kitamura, A., Naito, Y., Shimamoto, T. and Komachi, Y. (2003), Fat
   and protein intakes and risk of intraparenchymal hemorrhage among middle-aged
   Japanese. American Journal of Epidemiology, 157 (1), 32-39.
Abstract: The authors examined the relation between low intakes of saturated fat and
   animal protein and risk of intraparenchymal hemorrhage in a 14-year prospective
   study (ending in 1997) of 4,775 Japanese aged 40-69 years who undertook a single
   24-hour dietary recall. Compared with the highest quartile of energy- adjusted
   saturated fat intake (median, 17 g/day), multivariate relative risks, after adjustment
   for age, sex, community, total energy intake, and known cardiovascular risk factors,
   were 0.77 (95% confidence interval (CI): 0.42, 1.42) for the second quartile (12
   g/day), 0.66 (95% CI: 0.34, 1.25) for the third quartile (8 g/day), and 0.30 (95% CI:
   0.12, 0.71) for the lowest quartile (5 g/day); p for trend=0.005. An inverse relation
   was observed among both hypertensives and non hypertensives; the respective
   relative risks with a one standard deviation increase in saturated fat intake (15.4
   g/day) were 0.72 (95% CI: 0.52, 1.00) and 0.36 (95% CI: 0.14, 0.95). Intake of
   animal protein tended to correlate inversely with risk; the relative risk with a one
   standard deviation increase in animal protein intake (17.6 g/day) was 0.79 (95% CI:
   0.61, 1.02); p=0.07. Results are similar to those recently reported for US women and
   together help to explain the high rate of this stroke subtype in Asian countries, where
   intakes of these nutrients are low
   ascular             risk/cardiovascular           risk           factors/cerebrovascular
   accident/community/CORONARY                HEART-DISEASE/DIETARY/energy/energy
   ARTERIONECROSIS/PROGRAM/prospective/prospective                      studies/prospective
   study/protein/protein       intake/proteins/QUESTIONNAIRE/relative          risk/risk/risk
Johnsen, S.P., Overvad, K., Stripp, C., Tjonneland, A., Husted, S.E. and Sorensen, H.T.
   (2003), Intake of fruit and vegetables and the risk of ischemic stroke in a cohort of
   Danish men and women. American Journal of Clinical Nutrition, 78 (1), 57-64.
Abstract: Background: Previous studies have suggested that a high dietary intake of
   fruit and vegetables is associated with a reduced risk of ischemic stroke. The
   magnitude of the effect is uncertain, and only one study reported data on the intake
   of specific fruit and vegetables and the risk of stroke. Objective: We examined
   whether the intake of fruit and vegetables is associated with a reduced risk of
   ischemic stroke, with particular attention paid to specific fruit and vegetables and
   subtypes of ischemic stroke. Design: In a prospective cohort study of 54 506 men
   and women who were included in the Danish Diet, Cancer, and Health study from
   1993 to 1997, estimated total intakes of fruit and vegetables (in g/d) were extracted
   from a semiquantitative food-frequency questionnaire completed at baseline. Data
   about subjects hospitalized with ischemic stroke were obtained from the Danish
   National Registry of Patients and were verified later by record reviews. The
   follow-up for ischemic stroke ended on the date of a first hospital admission for
   stroke or transient ischemic attack, the date of death or emigration, or the end of the
   study, whichever came first. Results: We identified 266 cases of ischemic stroke
   involving hospitalization during 168 388 person-years of follow-up (median
   follow-up: 3.09 y; range: 0.02-5.10 y). After adjustment for potential confounders,
   persons in the top quintile of fruit and vegetable intake (median: 673 g/d) had a risk
   ratio of ischemic stroke of 0.72 (95% CI: 0.47, 1.12) relative to persons in the bottom
   quintile of intake (median: 147 g/d) (P for trend = 0.04). When comparing the top
   quintile with the bottom quintile, an inverse association was most evident for fruit
   intake (risk ratio: 0.60; 95% Cl: 0.38, 0.95; P for trend = 0.02). Similar risk estimates
   were seen for most types of fruit and vegetables, although the risks were significant
   only for citrus fruit. Conclusion: An increased intake of fruit may reduce the risk of
   ischemic stroke
Keywords:                               adjustment/and                                Health
   EASE/cerebrovascular disorders/CEREBROVASCULAR-DISEASE/cohort/cohort
   intake/effect/epidemiology/follow          up/follow-up/FOOD              FREQUENCY
   QUESTIONNAIRE/food-frequency                     questionnaire/fruit/fruit           and
   vegetables/hospital/hospitalization/ischemic/ischemic                    attack/ischemic
   INTAKE/nutrition/prospective/prospective              cohort/prospective           cohort
   study/prospective             study/questionnaire/range/reviews/risk/risk              of
   stroke/risks/stroke/subtypes/transient/transient                                ischemic
Jung, W.S., Choi, D.J., Cho, K.H., Lee, K.S., Moon, S.K., Kim, Y.S., Bae, H.S. and
   Choi, B.O. (2003), Safety and efficacy assessment of Chungpyesagan-tang for acute
   ischemic stroke. American Journal of Chinese Medicine, 31 (2), 181-190.
Abstract: Chungpyesagan-tang is one of the most well-known traditional herbal
   formulations frequently used for treatment of acute stroke in Korea. Therefore, this
   study aims to assess the clinical safety and efficacy of Chungpyesagan-tang on acute
   ischemic stroke. We recruited acute cerebral infarction subjects within 1 week after
   onset time. Then, we prescribed Chungpyesagan-tang to an Oriental medical
   treatment group (OM- group) for 2 weeks and enrolled a Western medical treatment
   group (WM-group) which received only Western biomedical care as a control. In this
   study, the OM-group was composed of 75 subjects. However, 14 of them dropped
   out, as two had progressive stroke while 12 complained of diarrhea. Thus, 61 cases
   were included in the analysis and compared to the 76 cases of the WM-group. The
   improvement of OM-group was better than that of the WM-group according to the
   National Institute of Health Stroke Scale (NIHSS), but not by the Modified Barthel
   Index (MBI). There were no definite abnormalities on laboratory safety assessment.
   Therefore, we suggest that Chungpyesagan- tang may have therapeutic effects, acting
   to reduce the severity of stroke and improving functional recovery without definite
   hepatic or renal toxicity when given for the first 2 weeks after a stroke
Keywords: abnormalities/acute/acute cerebral infarction/acute ischemic/acute ischemic
   stroke/acute                                stroke/analysis/assessment/Barthel/Barthel
   al/functional                                    recovery/infarction/ischemic/ischemic
Kamal, A.K., Dyke, J.P., Katz, J.M., Liberato, B., Filippi, C.G., Zimmerman, R.D. and
   Ulug, A.M. (2003), Temporal evolution of diffusion after spontaneous supratentorial
   intracranial hemorrhage. American Journal of Neuroradiology, 24 (5), 895-901.
Abstract: Background and purpose: The evolution of apparent diffusion coefficient
   abnormalities during supratentorial intracranial hemorrhage in normal appearing
   brain tissue has not been described. Recent investigations using diffusion imaging
   have revealed increased apparent diffusion coefficient in perihematomal tissue. We
   report brain tissue abnormalities beyond the visibly abnormal region ipsilateral and
  contralateral to the hematoma. This preliminary effort should generate meaningful
  clinical prognostic indicators for moderate size hemorrhages in large scale studies.
  Methods. Using the neurology patient encounter database at a tertiary care hospital,
  we retrospectively identified patients who presented with acute focal neurologic
  deficits, had ct scans of the head that confirmed spontaneous intracranial hemorrhage,
  and had a mr images obtained within the first 6 hr to 30 days postictus. The regions
  identified as targets of this investigation were the hemorrhage and surrounding t2
  signal intensity abnormality and the visibly normal supratentorial cerebral tissue.
  Results: Ninety-five patients were admitted during a period of 25 months. Fifteen
  patients met the criteria for the study. Elevated whole brain diffusion was shown as
  early as 6 hr after intracranial hemorrhage. This increase in diffusion was comparable
  in both hemispheres. Diffusion values in the lesion (Hematoma plus t2 signal
  intensity abnormality) Increased slowly with peak increases noted 2 to 3 days after
  the ictus. Conclusion: Diffuse early cerebral response occurs in normal appearing
  brain tissue both ipsilateral and contralateral to the visibly abnormal hematoma,
  manifested by increased apparent diffusion coefficient. This response is present
  before the local response is fully developed. Supratentorial intracranial hemorrhage
  results in an early diffuse brain response with increased apparent diffusion
  coefficient in normal appearing brain
Keywords:                       abnormalities/acute/apparent                     diffusion
  ion                         coefficient/diffusion                     imaging/EDEMA
  DEVELOPMENT/evolution/EXPERIMENTAL                                 INTRACEREBRAL
Kevorkian, C.G., Kaldis, T., Mahajan, G. and Graves, D.E. (2003), Rehabilitation of
  postcardiac surgery stroke patients - Progress, outcomes, and comparisons with other
  stroke patients. American Journal of Physical Medicine & Rehabilitation, 82 (7),
Abstract: Objective: To examine the demographics, progress, and functional outcomes
  of all postcardiac surgery stroke patients admitted to the rehabilitation unit of an
  acute, tertiary general hospital over a 5-yr period and to compare this cohort with an
  age-matched control group of other stroke patients admitted during the same period.
  Design: A retrospective chart review of 47 postcardiac surgery stroke and a matched
  control group of other stroke patients admitted to the rehabilitation unit. Results: The
  mean age of the postcardiac surgery stroke patients was 70.80 +/- 8.37 yr, with 60%
  of patients being male. Their average length of stay on the rehabilitation unit was
  15.64 +/- 11.96 days. Mean admit FIM total score was 65.64 +/- 16.33, with a
  discharge FIM total score of 86.77 +/- 18.93. Mean admit FIM motor score was
  41.47 +/- 9.45, with a discharge FIM motor of 60.74 +/- 13.20. The other stroke
  group had significantly greater admit FIM total (P = 0.03), admit motor (P = 0.001),
  and discharge motor (P = 0.025) scores. FIM efficiency and motor and cognitive
  gains were comparable between the two groups. Length of stay on the rehabilitation
  unit was approximately 2 days less (P = 0.224) for the other stroke cohort. Ultimately,
  39 (83%) of the postcardiac surgery stroke patients were discharged to the
  community compared with 45 (96%) of the other stroke patients (P = 0.19).
  Conclusions: The majority of postcardiac surgery stroke patients successfully
  completed a comprehensive inpatient rehabilitation program. They had lower admit
  FIM total scores and admit and discharge FIM motor scores than the other stroke
  group and were almost as likely to ultimately return to the community
Keywords:            acute/age/cardiac           surgery/CARDIAC              SURGICAL
  DETERMINANTS/efficiency/FIM/FIM                          efficiency/functional/functional
  rehabilitation/LENGTH/length                                                           of
  tion/rehabilitation       program/review/RISK-FACTORS/score/STAY/stroke/stroke
Kimmerly, D.S. and Shoemaker, J.K. (2003), Hypovolemia and MSNA discharge
  patterns: assessing and interpreting sympathetic responses. American Journal of
  Physiology-Heart and Circulatory Physiology, 284 (4), H1198-H1204.
Abstract: We previously demonstrated that diuretic-induced hypovolemia resulted in an
  enhanced baroreflex-mediated increase in integrated muscle sympathetic nerve
  activity (MSNA) and vasomotor tone during lower body negative pressure (LBNP)
  (Am J Physiol Heart Circ Physiol 282: H645-H655, 2002). The purpose of this study
  was to perform a retrospective analysis of these data and examine the ability of
  relative MSNA burst amplitude distributions to highlight differences in baseline
  sympathetic nerve discharge patterns. An additional purpose was to determine
  whether differential responses in MSNA burst frequency and burst amplitude affect
  conclusions regarding sympathetic reflex control. MSNA, stroke volume (SV,
  Doppler), and estimated central venous pressure (CVP, dependent arm technique)
  were measured during LBNP within the placebo (Normo) and diuretic (Hypo; 100
  mg/day spironolactone for 3 days) conditions (n = 8). Compared with Normo,
  MSNA burst frequency at rest was elevated, and there was a rightward shift in the
  median of the relative burst amplitude distribution (P < 0.05) in Hypo. During LBNP,
  the larger rise in total MSNA during Hypo versus Normo was due to greater
  increases in relative burst amplitude with no difference in the burst frequency
  response. The MSNA burst frequency response to LBNP was shifted to a higher
  position on the same MSNA-CVP curve during Hypo compared with Normo. In
  contrast, the Hypo burst amplitude response was shifted to a new curve with a slope
  that was similar to the Normo relationship. These data support the use of probability
  distribution analysis to examine intraindividual differences in baseline and
  reflex-mediated increases in MSNA burst amplitude. Furthermore, the differential
  effect of hypovolemia on the responses of burst frequency and amplitude during
  graded LBNP suggests that burst frequency data alone may not adequately represent
  reflex control of sympathetic outflow
Keywords:                    ability/activity/affect/amplitude/analysis/ANESTHETIZED
  CATS/arm/baroreflex/BURST                 AMPLITUDE/Canada/central                venous
  ultrasound/effect/frequency/HANDGRIP/HUMAN                                     MUSCLE
  body negative pressure/microneurography/muscle/muscle sympathetic nerve
  volume/support/sympathetic/sympathetic                nerve/sympathetic            nerve
  activity/technique/USA/use/VASCULAR-RESISTANCE/venous pressure/volume
Kimura, M., Tateno, A. and Robinson, R.G. (2003), Treatment of poststroke
  generalized anxiety disorder comorbid with poststroke depression - Merged analysis
  of nortriptyline trials. American Journal of Geriatric Psychiatry, 11 (3), 320-327.
Abstract: The existence of anxiety disorders plays an important role in the prognosis
  and associated impairment among patients with poststroke depression. The authors
  examined the efficacy of nortriptyline treatment for patients with comorbid
  generalized anxiety disorder (GAD) and depression after stroke. Methods: Data from
  three studies were merged to provide 27 patients with comorbid GAD and depression,
  who participated in double-blind treatment studies comparing nortriptyline (N=13)
  and placebo (N=14). Severity of anxiety was measured with the Hamilton Rating
  Scale for Anxiety (Ham A), and severity of depression was measured with the
  Hamilton Rating Scale for Depression (Ham-D). Activities of daily living were
  assessed by use of the Johns Hopkins Functioning Inventory (JHFI). Results: There
  were no significant differences between the nortriptyline and placebo groups in
  demographic characteristics, stroke type, and neurological findings. Patients
  receiving nortriptyline treatment showed significantly greater improvement on the
  Ham A, Ham-D, and JHFI than patients receiving placebo. The anxiety symptoms
  showed earlier improvement than depressive symptoms inpatients treated with
  nortriptyline. Conclusions: These findings suggest that poststroke GAD comorbid
  with poststroke depression may be effectively treated with nortriptyline, and data
  indicate the need for a trial specifically designed to examine treatment of anxiety
Keywords:                   analysis/anxiety/anxiety             disorders/COGNITIVE
  depression/prognosis/RECOVERY/stroke/STROKE                         PATIENTS/stroke
Kowey, P.R., Yan, G.X., Winkel, E. and Kao, W. (2003), Pharmacologic and
  nonpharmacologic options to maintain sinus rhythm: Guideline-based and new
  approaches. American Journal of Cardiology, 91 (6A), 33D-38D.
Abstract: Atrial fibrillation is a common arrhythmia in patients with heart failure and is
  responsible for substantial morbidity and mortality. Restoration and preservation of
  sinus rhythm, therefore, has a premium. Of the numerous treatment options available,
  many must be avoided because of their potential for adverse effects or because of
  limited proof of efficacy in defined populations. Published guidelines provide help
  by synthesizing clinical trial data into a recommended approach. This article
  summarizes current information regarding the best methods applicable to patients
  with left ventricular dysfunction for rate control, sinus rhythm restoration and
  maintenance, and stroke prevention. New and evolving therapies and how they might
  fit into the evolving treatment paradigm are also briefly reviewed. (C) 2003 by
  Excerpta Medica, Inc
Keywords: adverse effects/approach/arrhythmia/CATHETER ABLATION/CHRONIC
  /heart/heart       failure/information/INTRAVENOUS            AMIODARONE/left/left
  ventricular/left                                                             ventricular
  dysfunction/MANAGEMENT/methods/morbidity/morbidity                                  and
  mortality/mortality/NEW-YORK/PA/patients/prevention/rate                   control/sinus
  rhythm/stroke/stroke prevention/treatment/trial/USA/ventricular
Kroeker, C.A.G., Shrive, N.G., Belenkie, I. and Tyberg, J.V. (2003), Pericardium
  modulates left and right ventricular stroke volumes to compensate for sudden
  changes in atrial volume. American Journal of Physiology-Heart and Circulatory
  Physiology, 284 (6), H2247-H2254.
Abstract: The pericardium may modulate acute compensatory changes in stroke
  volumes seen with sudden changes in cardiac volume, but such a mechanism has
  never been clearly demonstrated. In eight open-chest dogs, we measured left and
  right ventricular pressures, diameters, stroke volumes, and pericardial pressures
  during rapid (similar to300 ms) systolic infusions or withdrawals of similar to25 ml
  blood into and out of the left atrium and right atrium. Control beats, the
  infusion/withdrawal beat, and 4-10 subsequent beats were studied. With infusions,
  ipsilateral ventricular end-diastolic transmural pressure, diameter, and stroke volume
  increased. With the pericardium closed, there was a compensatory decrease in
  contralateral transmural pressure, diameter, and stroke volume, mediated by opposite
  changes in transmural end-diastolic pressures. The sum of the ipsilateral increase and
  contralateral decrease in stroke volume approximated the infused volume.
  Corresponding changes were seen with blood withdrawals. This direct ventricular
  interaction was diminished when pericardial pressure was <5 mmHg and absent
  when the pericardium was opened. Pericardial constraint appears essential for
  immediate biventricular compensatory responses to acute atrial volume changes
Keywords:          acute/atrial/atrium/blood/Canada/cardiac/cardiac        output/cardiac
  atrium/mechanism/orthostatic                             hypotension/ORTHOSTATIC
  roke                                      volume/sudden/systolic/transmural/transmural
  pressure/USA/ventricular/ventricular interaction/volume/when
Kudo, K., Terae, S., Katoh, C., Oka, M., Shiga, T., Tamaki, N. and Miyasaka, K. (2003),
  Quantitative cerebral blood flow measurement with dynamic perfusion CT using the
  vascular-pixel elimination method: Comparison with (H2O)-O-15 positron emission
  tomography. American Journal of Neuroradiology, 24 (3), 419-426.
Abstract: Background and purpose: Blood vessels are usually conspicuous on dynamic
  ct perfusion images. The presence of large vessels may lead to overestimation of the
  quantitative value of cerebral blood flow (Cbf). We evaluated the efficacy of the
  vascular-pixel elimination (Vpe) Method in quantitative ct perfusion imaging, in
  comparison with positron emission tomography (Pet). Methods: Five healthy
  volunteers underwent ct perfusion and pet studies. A four-channel multi-detector row
  ct scanner was used. Dynamic cine scanning was performed after bolus injection of
  an intravenous contrast agent. Ct-cbf was calculated by the central volume principle
  and deconvolution method. Pet was performed after infusion of o-15-labeled water.
  Pet-cbf was calculated by using a nonlinear least squares method. Average cbf values
  of the whole section, gray matter, and white matter with both ct and pet were
  compared after image registration. The comparison was performed with and without
  vpe. In the vpe method, the vascular pixels were defined by the cerebral blood
  volume value of the pixel. The threshold of vpe was changed from 5 to 20 ml/100 g.
  Pixel-by-pixel correlation between ct-cbf and pet-cbf and linear regression analysis
  were also performed. Results: Without vpe, ct-cbf was overestimated in all subjects.
  As the vpe threshold decreased, ct-cbf decreased and the correlation coefficient
  increased. The best correlation was observed at a vpe threshold of 8 ml/100 g in four
  of the five subjects. Average ct-cbf values, without vpe, of the whole section, gray
  matter, and white matter were 59.01, 66.73, And 42.53 Ml/100 g/min, respectively.
  With vpe (Threshold, 8 ml/100 g), Average ct-cbf values of the whole section, gray
  matter, and white matter were 45.56, 52.75, And 30.38, Respectively. The
  corresponding pet-cbf values were 46.86, 50.89, And 38.20 Ml/100 g/min,
  respectively. Conclusion: Vascular pixels should be excluded from the calculation of
  ct- cbf to avoid overestimation of the cbf values. If vascular pixels are excluded, cbf
  calculation with ct perfusion imaging is considerably accurate
Keywords:      ACUTE         ISCHEMIC       STROKE/analysis/blood/blood          flow/blood
  volume/bolus/cerebral/cerebral              blood           flow/cerebral           blood
  volume/comparison/COMPUTED-                           TOMOGRAPHY/contrast/contrast
  agent/correlation/CT/deconvolution/efficacy/emission/flow/gray             matter/healthy
  (H2O)-O-15/Japan/lead/linear                         regression/measurement/NORMAL
  VALUES/perfusion/perfusion CT/perfusion imaging/positron/positron emission
  tomography/quantitative/regression/regression                analysis/SUSCEPTIBILITY
  s/VOLUME/water/white matter
Lanini, B., Bianchi, R., Romagnoli, I., Coli, C., Binazzi, B., Gigliotti, F., Pizzi, A.,
  Grippo, A. and Scano, G. (2003), Chest wall kinematics in patients with hemiplegia.
  American Journal of Respiratory and Critical Care Medicine, 168 (1), 109-113.
Abstract: Owing to difficulties in measuring ventilation symmetry, good evidence of
  different right/left respiratory movements has not yet been provided. We investigated
  VT differences between paretic and healthy sides during quiet breathing, voluntary
  hyperventilation, and hypercapnic stimulation in patients with hemiparesis. We
  studied eight patients with hemiparesis and nine normal sex- and age-matched
  subjects. Right- and left- sided VT was reconstructed using optoelectronic
  plethysmography. In control subjects, no asymmetry was found in the study
  conditions. VTs of paretic and healthy sides were similar during quiet breathing, but
  paretic VT was lower during voluntary hyperventilation in six patients and higher
  during hypercapnic stimulation in eight patients (p = 0.02). The ventilatory response
  to hypercapnic stimulation was higher on the par tic than on the healthy side (p =
  0.012). In conclusion, hemiparetic stroke produces asymmetric ventilation with an
  increase in carbon dioxide sensitivity and a decrease in voluntary ventilation on the
  paretic side
Keywords:                          breathing/breathing                       pattern/carbon
  dioxide/CARBON-DIOXIDE/CARE/control/control                 of     breathing/CORTICAL
  /movements/NEW-YORK/normal/patients/patients                                         with
Lee, S., Colditz, G.A., Berkman, L.F. and Kawachi, I. (2003), Caregiving and risk of
  coronary heart disease in US women - A prospective study. American Journal of
  Preventive Medicine, 24 (2), 113-119.
Abstract: Background: A growing number of women provide care to disabled or ill
  relatives. Many studies have linked caregiving to psychiatric morbidity, lower
  perceived health status, elevated blood pressure, and poorer immune function.
  However, no studies have examined the association between caregiving and
  cardiovascular disease incidence. Methods: We conducted the study in 54,412
  women from the Nurses' Health Study, a prospective cohort of female registered
  nurses residing in 11 U.S. states. These women were aged 46 to 71 years and did not
  have diagnosed coronary heart disease (CHD), stroke, or cancer at baseline (1992).
  We collected information on caregiving responsibilities in 1992 and coronary heart
  disease between baseline (June 1, 1992) and return of the 1996 questionnaire. Results:
  During 4 years of follow-up, we documented 321 incident cases of CHD (231
  nonfatal cases of myocardial infarction and 90 CHD deaths). In multivariate analyses
  controlling for age, smoking, exercise, alcohol intake, body mass index, history of
  hypertension, diabetes mellitus, and other covariates, caregiving for disabled or ill
  spouse for greater than or equal to9 hours per week was associated with increased
  risk of CHD (RR, 1.82; 95% confidence interval, 1.08- 3.05). However, caregiving
  for disabled or ill parents or disabled or ill others was not significantly associated
  with increased risks of CHD. Conclusion: These data indicate that high levels of
  caregiving burden for ill spouses may increase the risk of CHD among women
Keywords: age/aged/alcohol/alcohol intake/association/blood/blood pressure/body mass
  disease/caregiving/CHD/cohort/coronary/coronary              heart/coronary         heart
  disease/diabetes/diabetes                       mellitus/disease/exercise/female/follow
  up/follow-up/function/HEALTH/health                                    status/heart/heart
  dial                         infarction/NEW-YORK/nonfatal/nurses/parents/perceived
  health/pressure/prospective/prospective                               cohort/prospective
Lee, W.S., Huang, W.P., Yu, W.C., Chiou, K.R., Ding, P.Y.A. and Chen, C.H. (2003),
  Estimation of preload recruitable stroke work relationship by a single-beat technique
  in humans. American Journal of Physiology-Heart and Circulatory Physiology, 284
  (2), H744-H750.
Abstract: The slope of the preload recruitable stroke work relationship (M-w) is a highly
  linear, load-insensitive contractile index. To investigate whether M-w can be
  determined from a single steadystate beat, 45 patients were studied during cardiac
  catheterization. Single-beat M-w (SBMw) was calculated directly from the baseline
  stroke work and baseline left ventricular (LV) end-diastolic volume (EDVB), and the
  volume-axis intercept (V-w) was estimated as k x EDVB + (k - 1) x LVwall, where k
  is the ratio of the epicardial shell volumes corresponding to V-w and EDVB and
  LVwall is the wall volume. The mean of individual k values was 0.72 +/- 0.04,
  which correlated with LV mass significantly (r = 0.60, P < 0.001). SBMw calculated
  from a constant k of 0.7 predicted M-w well (r = 0.88, P < 0.0001), and the
  prediction improved slightly when k was estimated from individual LV mass (r =
  0.93, P < 0.0001). Subgroup analyses revealed that the single-beat technique also
  worked in patients with small or large LV mass or volume or with regional wall
  motion abnormalities. The absolute change in SBMw after dobutamine infusion also
  correlated with that in M-w. In conclusion, M-w can be estimated from a steady-state
  beat without alteration of preload
Keywords:                                                     abnormalities/ADVANCED
  ventricular/motion/patients/prediction/preload/preload          recruitable        stroke
  work/PRESSURE-VOLUME                                       RELATIONS/SARCOMERE
  CONTRACTILE PERFORMANCE/volume/wall motion/when/work
Lee, Z.I., Byun, W.M., Jang, S.H., Ahn, S.H., Moon, H.K. and Chang, Y.M. (2003),
  Diffusion tensor magnetic resonance imaging of microstructural abnormalities in
  children with brain injury. American Journal of Physical Medicine & Rehabilitation,
  82 (7), 556-559.
Abstract: We present two pediatric cases demonstrating that diffusion tensor imaging is
  more efficient at revealing microstructural abnormalities of the brain than
  conventional magnetic resonance imaging because it enables measurements; of the
  directionality and integrity of white matter fiber tracts. One patient suffered from left
  hemiparesis, and the other had right hemiparesis. However, whereas conventional
  magnetic resonance imaging showed only the findings of traumatic contusional
  hemorrhages in the left temporal and parietal lobes of the first patient and focal
  encephalomalacia in the left anterior thalamus of the second patient, diffusion tensor
  imaging successfully disclosed microstructural abnormalities in the right cerebral
  peduncle of the midbrain of the first patient and in the posterior limb of the left
  internal capsule of the second. Theses two cases demonstrate that diffusion tensor
  imaging is more capable than magnetic resonance imaging at detecting the
  microstructural pathologic lesions that are responsible for clinical motor weakness,
  especially when conventional magnetic resonance imaging has failed to detect subtle
  structural abnormalities
Keywords:      abnormalities/ANISOTROPY/BLUNT-HEAD                  TRAUMA/brain/brain
  injury/cerebral/children/clinical/diffusion/diffusion       tensor/diffusion       tensor
  AL CAPSULE/Korea/left/magnetic/magnetic resonance/magnetic resonance
  imaging/microstructural                                     abnormality/motor/MOTOR
  hite matter/WHITE-MATTER
Lesley, W.S., Chaloupka, J.C. and Weigele, J.B. (2003), Preliminary experience with
  endovascular reconstruction for the management of carotid blowout syndrome.
  American Journal of Neuroradiology, 24 (5), 975-981.
Abstract: PURPOSE. Permanent balloon occlusion (PBO) of the carotid artery has been
  previously shown to be an effective means to treat carotid blowout syndrome (CBS).
  However, despite the effectiveness of this endovascular technique, concern remains
  regarding its potential for producing delayed cerebral ischemic complications in 15%
  to 20% of patients. This significant limitation of carotid PBO led our group to
  evaluate an alternative management strategy, consisting of endovascular
  reconstruction of the carotid artery (ERCA) in patients thought to be at particularly
  high risk for carotid occlusion (ie, provocative balloon test occlusion, angiographic
  documented incomplete circle of Willis, or contralateral carotid artery occlusion).
   METHODS: We reviewed all cases of CBS referred to our service, in which ERCA
   was chosen as a management strategy for patients thought to be at high risk for PBO,
   based on previously defined criteria. RESULTS: Sixteen carotid blowout events
   occurred in 12 patients with CBS who were deemed to be at high risk for cerebral
   ischemic complications, which were managed with ERCA by using a variety of stent
   devices and techniques. Adjunctive embolization of carotid pseudoaneurysms was
   performed in five of these patients by using platinum coils or acrylic glue.
   Hemostasis was achieved in all cases, although one patient with traumatic CBS and
   three patients with aggressive head and neck cancer-related CBS, required
   retreatment with ERCA. Recurrent CBS rates were similar to those reported in other
   studies using PBO. Overall, no treatment-related strokes or deaths occurred.
   CONCLUSION: CBS managed with ERCA can be performed safely and with
   efficacy of outcomes at least equivalent to those previously reported in association
   with conventional carotid PBO, therefore representing an excellent alternative
   endovascular technique for patients who are at increased risk of stroke after PBO
Keywords: artery/ARTERY STENT PLACEMENT/association/balloon/balloon
   occlusion/BALLOON TEST OCCLUSION/carotid/carotid artery/carotid artery
   occlusion/carotid occlusion/CBS/cerebral/circle of Willis/complications/COVERED
   ar/experience/HEAD/head                                                            and
   UDOANEURYSM/reconstruction/risk/risk                                                 of
   stroke/RUPTURE/stent/strategy/stroke/strokes/syndrome/TECHNICAL                 CASE-
Liu, S.M., Sesso, H.D., Manson, J.E., Willett, W.C. and Buring, J.E. (2003), Is intake of
   breakfast cereals related to total and cause- specific mortality in men? American
   Journal of Clinical Nutrition, 77 (3), 594-599.
Abstract: Background: Prospective studies suggested that substituting whole-grain
   products for refined-grain products lowers the risks of type 2 diabetes and
   cardiovascular disease (CVD) in women. Although breakfast cereals are a major
   source of whole and refined grains, little is known about their direct association with
   the risk of premature mortality. Objective: We prospectively evaluated the
   association between whole- and refined-grain breakfast cereal intakes and total and
   CVD- specific mortality in a cohort of US men. Design: We examined 86 190 US
   male physicians aged 40-84 y in 1982 who were free of known CVD and cancer at
   baseline. Results: During 5.5 y, we documented 3114 deaths from all causes,
   including 1381 due to CVD (488 myocardial infarctions and 146 strokes).
   Whole-grain breakfast cereal intake was inversely associated with total and
   CVD-specific mortality, independent of age; body mass index; smoking; alcohol
   intake; physical activity; history of diabetes, hypertension, or high cholesterol; and
   use of multivitamins. Compared with men who rarely or never consumed
   whole-grain cereal, men in the highest category of whole-grain cereal intake (greater
   than or equal to 1 serving/d) had multivariate-estimated relative risks of total and
   CVD-specific mortality of 0.83 (95% CI: 0.73, 0.94; P for trend < 0.001) and 0.80
   (0.66, 0.97; P for trend < 0.001), respectively. In contrast, total and refined-grain
   breakfast cereal intakes were not significantly associated with total and
   CVD-specific mortality. These findings persisted in analyses stratified by history of
   type 2 diabetes, hypertension, and high cholesterol. Conclusions: Both total mortality
   and CVD-specific mortality were inversely associated with whole-grain but not
   refined- grain breakfast cereal intake. These prospective data highlight the
  importance of distinguishing whole-grain from refined-grain cereals in the
  prevention of chronic diseases
Keywords:        activity/age/aged/alcohol/alcohol       intake/association/body      mass
  index/cancer/cardiovascular/cardiovascular                        disease/cardiovascular
  hronic                                            diseases/cohort/contrast/CORONARY
  FIBER/disease/diseases/history/hypertension/index/IOWA                        WOMENS
  WOMEN/physical/physical                 activity/physicians/Physicians'           Health
  Study/prevention/prospective/prospective                              study/refined-grain
  cereals/RISK/risks/smoking/stratified/strokes/type                  2/type              2
  diabetes/US/USA/use/VEGETABLE                                      INTAKE/whole-grain
  cereals/WHOLE-GRAIN INTAKE/women
Maeshima, S., Ueyoshi, A., Osawa, A., Ishida, K., Kunimoto, K., Shimamoto, Y.,
  Matsumoto, T. and Yoshida, M. (2003), Mobility and muscle strength contralateral
  to hemiplegia from stroke - Benefit from self-training with family support. American
  Journal of Physical Medicine & Rehabilitation, 82 (6), 456-462.
Abstract: Objective: To determine whether patient exercise with the support of family
  members maximizes mobility and improves muscle strength in the nonparetic lower
  limb after stroke. Design: Comparison of improvement at 2 wk between conventional
  exercise sessions and a program also including the participation of family members.
  Subjects were 60 patients rendered nonambulatory by severe hemiparesis from their
  first stroke. Of these, 42 had family members participating in their therapy. Lower
  limb strength was measured on the nonparetic side using an isokinetic machine,
  Mobility status was assessed using the Rivermead Mobility Index. Patients were
  evaluated at the first inpatient gym session and again at 1 and 2 wk. Results: At the
  first evaluation,. lower limb strength and the Rivermead Mobility Index score did not
  differ between the two groups. Reevaluations were conducted at 1 and 2 wk after the
  first evaluation. Patients' strength and mobility improved more when family
  members participated. Conclusion: Family participation is an important contributor
  to stroke rehabilitation
Keywords:                                                evaluation/exercise/family/family
  strength/PA/participation/patient/patients/REHABILITATION/Rivermead Mobility
Mahon, B.R., Nesbit, G.M., Barnwell, S.L., Clark, W., Marotta, T.R., Weill, A., Teal,
  P.A. and Qureshi, A.I. (2003), North American clinical experience with the EKOS
  MicroLysUS infusion catheter for the treatment of embolic stroke. American Journal
  of Neuroradiology, 24 (3), 534-538.
Abstract: BACKGROUND AND PURPOSE: We present early experience with the
  EKOS MicroLysUS infusion catheter for acute embolic stroke treatment in North
  America. This study was designed to demonstrate the safety of the device and to
  determine if sonography accelerates thrombolysis and improves clinical outcomes.
  METHODS: Fourteen patients aged 40-77 years with anterior- or
  posterior-circulation occlusion presented with cerebral ischemia 3-6 or 4-13 hours
  after symptom onset, respectively. Patients were treated with the catheter and
  simultaneous intraarterial thrombolysis. Procedural and clinical information,
  including time to lysis, degree of recanalization, National Institute of Health Stroke
  Scale (NIHSS) score, and modified Rankin Scale (mRS) score was recorded before
  treatment and afterward (immediately and at 24 hours, 1 week, 1 month, and 3
  months). RESULTS: Ten patients presented with acute anterior-circulation emboli;
  four patients, with posterior-circulation emboli (NIHSS score, 9-23 [mean. 18.2] and
  11-27 [mean, 18.75], respectively). Three deaths occurred at 24 hours: two from
  hemorrhage and one from cerebral swelling. Deaths also occurred at 1 week and 1
  month after treatment. Thrombolysis in Myocardial Ischemia grade 2-3 flow was
  achieved in eight patients in the first hour. Average time to recanalization was 46
  minutes. Mean NIHSS scores in eight of nine survivors at 90 days were 5 in the
  anterior- circulation group and 3 in the posterior-circulation group; mean mRS scores
  at 90 days were 2 and 3, respectively. No catheter-related adverse events occurred.
  CONCLUSION: Use of the EKOS MicroLysUS infusion catheter is feasible in the
  treatment of acute ischemic stroke. Further studies to evaluate its efficacy are
Keywords:       acute/acute      ischemic/ACUTE           ISCHEMIC       STROKE/adverse
  events/aged/anterior        circulation/catheter/cerebral/cerebral     ischemia/cerebral
  swelling/circulation/clinical/clinical                                experience/clinical
  thrombolysis/ischemia/ischemic/ischemic                stroke/NIHSS           score/North
  ke/stroke treatment/THERAPY/thrombolysis/treatment/TRIAL/USA/week
Mattioli, A.V., Bonatti, S., Bonetti, L., Borella, P. and Mattioli, G. (2003), Left atrial
  size and function after spontaneous cardioversion of atrial fibrillation and their
  relation to n-terminal atrial natriuretic peptide. American Journal of Cardiology, 91
  (12), 1478-1481
Keywords:                atrial/atrial             fibrillation/atrial            natriuretic
  peptide/cardioversion/ECHOCARDIOGRAPHIC                           FEATURES/EJECTION
  FORCE/fibrillation/function/Italy/natriuretic         peptide/NEW-YORK/RISK/SINUS
McFarlane, S.I., Kumar, A. and Sowers, J.R. (2003), Mechanisms by which
  angiotensin-converting enzyme inhibitors prevent diabetes and cardiovascular
  disease. American Journal of Cardiology, 91 (12), 30H-37H.
Abstract: Angiotensin-converting enzyme (ACE) inhibitors are the first- line therapeutic
  agents for treating hypertension in patients with the cardiometabolic syndrome and
  those with diabetes. ACE inhibitor therapy reduces both microvascular and
  macrovascular complications in diabetes and appears to improve insulin sensitivity
  and glucose metabolism. Several recent studies indicate that ACE inhibitor therapy
  reduces the development of type 2 diabetes in persons with essential hypertension, a
  population with a high prevalence of insulin resistance. ACE inhibitor therapy has
  been shown to improve surrogates of cardiovascular disease (eg, vascular compliance,
  endothelial- derived nitric oxide production, vascular relaxation and plasma markers
  of inflammation, oxidative stress, and thrombosis) and reduce cardiovascular disease,
  renal disease progression, and stroke. This article explores potential mechanism by
  which ACE inhibition reduces the development of diabetes, improves these surrogate
  markers, and reduces cardiovascular disease and renal disease. (C) 2003 by Excerpta
  Medica, Inc
Keywords:                              ACE/ACE                              inhibition/ACE
  inhibitor/ACE-INHIBITION/ACE-inhibitor/angiotensin                            converting
  enzyme/angiotensin        converting      enzyme       inhibitors/angiotensin-converting
  enzyme/angiotensin-converting           enzyme       inhibitors/ANTIHYPERTENSIVE
  progression/endothelial/essential/essential                hypertension/glucose/glucose
  bitors/insulin/insulin                                              resistance/INSULIN
  AL-INFARCTION/NEW-YORK/NF-                    KAPPA-B/nitric       oxide/nitric   oxide
  production/oxidative          stress/patients/plasma/PLASMA            FIBRINOLYTIC
  markers/syndrome/therapeutic/therapy/thrombosis/type                  2/type           2
  diabetes/USA/vascular/VASCULAR SMOOTH-MUSCLE
Moore, D.F., Ye, F., Schiffmann, R. and Butman, J.A. (2003), Increased signal intensity
  in the pulvinar on T1-weighted images: A pathognomonic MR imaging sign of Fabry
  disease. American Journal of Neuroradiology, 24 (6), 1096-1101.
Abstract: Background and purpose: Fabry disease is a multisystem x-linked disorder
  characterized clinically by angiokeratoma, corneal and lenticular abnormalities,
  acroparesthesia, and renal and cardiac dysfunction and stroke. We sought to describe
  novel neuroimaging characteristics of fabry disease. Methods: Neuroradiologic
  records of 104 hemizygous patients with fabry disease evaluated between 1994 and
  2002 were reviewed. In total, 94 mr studies consisting of t1- and t2-weighted images
  were examined for the presence of hyperintensity on the t1- weighted images.
  Additional ct, gradient-echo (T2*-weighted), And fat-suppression mr studies were
  reviewed to characterize further the t1 abnormality in selected patients. In some
  patients, cerebral blood flow (Cbf) Was quantified by using arterial spin tagging
  (Ast). Results: Overall, 22 patients (Similar to23%) Demonstrated pulvinar
  hyperintensity on t1- weighted images; The frequency increased with age to over
  30% by age 50 years. Susceptibility-weighted t2* studies demonstrated a
  low-signal-intensity abnormality in the pulvinar in the more severe cases, whereas ct
  demonstrated the pulvinar to be mineralized. Ct attenuation corresponded with an
  increasing signal intensity on t1-weighted images. Posterior circulation cbf was
  found to be elevated on individual ast studies, especially in the thalamus. Conclusion:
  Hyperintensity in the pulvinar on t1-weighted images is a common finding in fabry
  disease, likely reflecting the presence of calcification. Although other minreralizing
  abnormalities may result in calcification of deep gray nuclei, exclusive involvement
  of the pulvinar may be distinctively characteristic to fabry disease. Increased cbf in
  the posterior circulation, particularly the thalamus, suggests that the dystrophic
  calcification is secondary to cerebral hyperperfusion and selective vulnerability of
  the pulvinar and adjacent thalamic nuclei. The finding of isolated pulvinar
  hyperintensity on t1-weighted images should suggest fabry disease, particularly
  when seen in conjunction with other nonspecific neuroradiologic manifestations of
  the disease
Keywords:         abnormalities/age/arterial/arterial      spin       tagging/blood/blood
  flow/calcification/cardiac/cardiac dysfunction/cerebral/cerebral blood flow/cerebral
Mukherjee, P., Kang, H.C., Videen, T.O., McKinstry, R.C., Powers, W.J. and Derdeyn,
  C.P. (2003), Measurement of cerebral blood flow in chronic carotid occlusive disease:
  Comparison of dynamic susceptibility contrast perfusion MR imaging with positron
  emission tomography. American Journal of Neuroradiology, 24 (5), 862-871.
Abstract: Background and purpose: Our purpose was to evaluate the accuracy of
  cerebral blood flow (Cbf) Measurements obtained by using dynamic susceptibility
  contrast-enhanced mr imaging, including the influence of arterial input function (Aif)
  Selection, compared with those obtained by using [O-15]-H2o positron emission
  tomography (Pet) For patients with chronic carotid occlusion. Methods: Mr images
  and pet scans were obtained of seven patients with unilateral carotid occlusion and
  were co-registered for region of interest analysis. Pet cbf maps were generated by
  using the autoradiographic method. Mr imaging cbf maps were calculated by
  deconvolution of the susceptibility time curve with a proximal middle cerebral artery
  aif and were converted to absolute flow rates either by assuming a constant
  contralateral white matter cbf value of 22 ml/100 ml/min or by using individually
  determined pet white matter cbf values. Results: Although cbf values measured by
  pet and mr imaging were positively correlated for every patient, the slopes and y
  intercepts of the regression lines varied widely among patients. The correlation was
  better when individual white matter cbf values measured by pet were used to scale
  the white matter cbf values measured by mr imaging (R = 0.84, P < .0001) Than
  when constant contralateral cbf values were assumed (R = 0.54, P < .0001). The
  choice of aif ipsilateral or contralateral to the occluded carotid artery made no
  statistically significant difference (P > .05) To the correlation coefficient, slope, or y
  intercept of the mr imaging versus pet cbf regressions for six of the seven patients.
  Conclusion. Although linearly correlated with cbf values measured by pet, dynamic
  susceptibility contrast- enhanced mr imaging was not accurate for measuring
  absolute cbf values. Aif selection relative to the side of carotid occlusion did not
  significantly affect calculated mr imaging cbf values for six of the seven patients
Keywords: accuracy/affect/analysis/arterial/arterial input function/artery/blood/blood
  flow/carotid/carotid           artery/carotid         occlusion/carotid         occlusive
  disease/cerebral/cerebral                       artery/cerebral                     blood
  flow/chronic/contrast/correlation/deconvolution/disease/dynamic             susceptibility
  STROKE/imaging/middle cerebral/middle cerebral artery/MR/MR imaging/O-15
  RADIOTRACERS/occlusion/occlusive                                       disease/OXYGEN
  UTILIZATION/patient/patients/perfusion/perfusion                MR/perfusion          MR
  imaging/positron/positron                                                        emission
  hy/TRACER                                                                         BOLUS
Mullenix, P.S., Tollefson, D.F.J., Olsen, S.B., Hadro, N.C. and Andersen, C.A. (2003),
  Intraoperative duplex ultrasonography as an adjunct to technical excellence in 100
  consecutive carotid endarterectomies. American Journal of Surgery, 185 (5),
Abstract: Purpose: To evaluate the relationship of intraoperative duplex ultrasonography
  (duplex) results to neurologic outcomes and restenosis among patients undergoing
  carotid endarterectomy (CEA). Methods: One hundred consecutive CE-As were
  performed at a military medical center over 29 months. Prospectively acquired
  demographics, duplex results, revisions, and surgical outcomes were reviewed.
  Results: Thirty-four percent (34 of 100) of sites were abnormal by completion duplex.
  Of these, 70% (24 of 34) were B-mode flap type defects located in the common
  carotid artery (CCA), internal carotid artery (ICA), or external carotid artery (ECA).
  Twenty-one percent of the defects (7 of 34) were technically unacceptable and
  immediately revised. Subsequently, 3 perioperative neurologic events occurred, 2
  strokes and I transient ischemic attack.(TIA), all among patients with an identified
  but unrepaired defect involving the ICA or CCA. This association of unrepaired
  defect with early stroke or TIA was significant (P = 0.02). No significant association
  (P > 0.05) between unrepaired defects and late ipsilateral stroke or TIA or restenosis
  was identified. Conclusions: Intraoperative duplex scanning is. a useful adjunct to
  CEA that can identify correctable mechanical problems Residual elevated velocities
  or B-mode flaps 2 rum or greater in the ICA warrant consideration for immediate
  repair. Findings not requiring revision include flaps < 2 mm, as isolated ECA
  defects.. Prospectively validated duplex criteria are needed to further define which
  defects require immediate repair. (C) 2003 Excerpta Medica, Inc. All rights reserved
Keywords: artery/ARTERY STENOSIS/association/BIFURCATION/carotid/carotid
  artery/carotid endarterectomy/carotid stenosis/CEA/common/common carotid
  artery/criteria/duplex/duplex         scanning/endarterectomy/external          carotid
  artery/internal/internal carotid/internal carotid artery/intraoperative/intraoperative
  duplex                 ultrasound/ischemic/mechanical/medical/neurologic/neurologic
Nakatani, T., Naganuma, T., Uchida, J., Masuda, C., Wada, S., Sugimura, T. and
  Sugimura, K. (2003), Silent cerebral infarction in hemodialysis patients. American
  Journal of Nephrology, 23 (2), 86-90.
Abstract: Background. Cerebrovascular diseases are very common in hemodialysis (HD)
  patients. Silent cerebral infarction (SCI) has not been investigated in HD patients
  although it may be a significant risk factor for cerebrovascular diseases. Hypothesis:
  Chronic renal failure may be an independent risk factor for SCI and cerebrovascular
  diseases. Methods: Cranial magnetic resonance imaging (MRI) was performed on
  123 HD patients without symptomatic cerebrovascular disease and on 52 control
  subjects. We investigated the prevalence of SCI and performed cross-sectional study
  using multiple logistic analysis to assess the relationship between SCI and the risk
  factors. Results: The prevalence of SCI was significantly higher in HD patients than
  in the healthy control group (60 patients (48.8%) vs. 5 patients (9.6%), chi(2) = 22.4,
  p < 0.0001). Multiple logistic regression analysis with all subjects showed that
  independent risk factors of SCI were chronic renal failure, hypertension, smoking
  and age (R-2 = 0.468, p < 0.0001). In only the HD patient group, age and smoking
  were shown to be independent risk factors of SCI (R-2 = 0.378, p < 0.0001) while
  HD duration and hypertension were not. Conclusions: The findings of the present
  study indicate that chronic renal failure maintained by hemodialysis increases the
  prevalence of SCI and that age and smoking habits are also significantly associated
  with SCI in HD patients. Copyright (C) 2003 S. Karger AG, Basel
Keywords:                          age/analysis/ATHEROSCLEROSIS/cerebral/cerebral
  infarction/cerebrovascular/cerebrovascular                     disease/cerebrovascular
  diseases/chronic/chronic          renal         failure/common/control/cross-sectional
  /Japan/logistic     regression/magnetic/magnetic       resonance/magnetic     resonance
  analysis/renal/renal        failure/RENAL-FAILURE/resonance            imaging/risk/risk
  factor/risk factors/RISK-FACTORS/SCI/silent cerebral infarction/smoking/STROKE
Narushima, K., Chan, K.L., Kosier, J.T. and Robinson, R.G. (2003), Does cognitive
  recovery after treatment of poststroke depression last? A 2-year follow-up of
  cognitive function associated with poststroke depression. American Journal of
  Psychiatry, 160 (6), 1157-1162.
Abstract: Objective: Cognitive impairment is common after stroke and may be caused
  by poststroke depression. Remission of poststroke major depression after treatment
  has been associated with improvement in cognitive function. The current study was
  designed to examine how long that cognitive improvement lasts and to compare
  depressed patients' cognitive status with that of nondepressed patients with
  comparable lesions. Method: Seventeen patients with poststroke depression and
  cognitive impairment who had early and sustained remission of their depression
  during a double-blind treatment study were compared with 42 nondepressed stroke
  patients who remained nondepressed throughout the follow-up. Mood and cognitive
  function were followed-up over 2 years with the Hamilton Depression Rating Scale
  and Mini-Mental State Examination (MMSE). Results: In the patients with early and
  sustained remission of depression, there was rapid improvement of cognitive
  function, which was maintained over 2 years, Their initial MMSE score of 23.3 (SD
  = 4.2) improved to 26.6 (SD = 3.5) at 3 months and was 26.1 (SD = 3.6) at 2 years.
  The nondepressed patients showed essentially no change in cognitive function over 2
  years (initial MMSE score: mean = 26.3, SD = 3.1; score at 2-year follow-up: mean
  = 25.7, SD = 4.1). Conclusions: Cognitive function, once improved after remission
  of poststroke depression, is likely to remain stable over the next 2 years in the
  absence of subsequent reinjury to the central nervous system. Cognitive impairment
  due to poststroke depression is reversible and can be quantified separately from
  cognitive impairment on the basis of the location and extent of ischemic brain
Keywords: brain/brain damage/brain-damage/central nervous system/CLINICAL
  DETERMINANTS/cognitive/cognitive                                      function/cognitive
  DEPRESSION/IA/IMPAIRMENT/ischemic/ischemic brain damage/ISCHEMIC
  STROKE/location/MAJOR                      DEPRESSION/Mini-Mental                  State
  system/patients/poststroke/poststroke                depression/recovery/REVERSIBLE
  DEMENTIA/RISK-                                     FACTORS/score/status/stroke/stroke
Nasser, W.K. (2003), Medical events in the life of William K. Nasser, MD. American
  Journal of Cardiology, 91 (1), 116-+.
Abstract: As An Indiana cardiologist, I have survived 3 open-heart procedures, a stroke,
  a near-fatal boating accident, and a liver transplant while building one of the largest
  private cardiology groups, in the country. Forty-one years after my first open-heart
  procedure, I am probably the longest survivor of an aortic valve replacement in the
  world. If I had to do it all over again, I would not change a thing
Keywords:                   aortic/aortic                valve/aortic               valve
New, D.I., Chesser, A.M.S., Thuraisingham, R.C. and Yaqoob, M.M. (2003), Cerebral
   artery responses to pressure and flow in uremic hypertensive and spontaneously
   hypertensive rats. American Journal of Physiology-Heart and Circulatory
   Physiology, 284 (4), H1212-H1216.
Abstract: Impaired cerebral blood flow autoregulation is seen in uremic hypertension,
   whereas in nonuremic hypertension autoregulation is shifted toward higher perfusion
   pressure. The cerebral artery constricts in response to a rise in either lumen pressure
   or flow; we examined these responses in isolated middle cerebral artery segments
   from uremic Wistar-Kyoto rats (WKYU), normotensive control rats (WKYC), and
   spontaneously hypertensive rats (SHR). Pressure-induced (myogenic) constriction
   developed at 100 mmHg; lumen flow was then increased in steps from 0 to 98
   mul/min. Some vessels were studied after endothelium. ablation. Myogenic
   constriction was significantly lower in WKYU (28 +/- 2.9%) compared with both
   WKYC (39 +/- 2.5%, P = 0.035) and SHR (40 +/- 3.1%, P = 0.018). Flow caused
   constriction of arteries from all groups in an endothelium-independent manner. The
   response to flow was similar in WKYU and WKYC, whereas SHR displayed
   increased constriction compared with WKYU (P < 0.001) and WKYC (P < 0.001).
   We conclude that cerebral myogenic constriction is decreased in WKYU, whereas
   flow-induced constriction is enhanced in SHR
Keywords:                      ablation/arteries/artery/AUTOREGULATION/blood/blood
   flow/BLOOD-FLOW/cerebral/cerebral                      artery/cerebral             blood
   constriction/hypertension/hypertensive/hypertensive                    rats/lower/middle
   cerebral/middle                           cerebral                      artery/myogenic
   hypertensive/spontaneously          hypertensive      rats/STROKE/TRANSCRANIAL
   DOPPLER/USA/vessels/Wistar-Kyoto rats
Nilsen, D.M., Kaminski, T.R. and Gordon, A.M. (2003), The effect of body orientation
   on a point-to-point movement in healthy elderly persons. American Journal of
   Occupational Therapy, 57 (1), 99-107.
Abstract: OBJECTIVE. Upper limb retraining during the early phases of neurological
   rehabilitation often involves having individuals practice reaching in body
   orientations that reduce the effect of gravity on various joint motions (e.g, shoulder
   flexion, elbow extension). However, the efficacy of these training techniques has not
   been determined. The purpose of this study was to determine the effects of reducing
   gravity through a change in body orientation from sitting to side-lying on the
   kinematics of a point-to-point movement in healthy elderly persons. METHOD. Nine
   healthy, right-hand-dominant women 62 to 66 years of age pointed to a target in two
   different body orientations-sitting and side-lying. A 2-dimensional kinematic
   analysis of the movement was performed to compare the trajectory of the hand and
   the interjoint coordination under the two conditions. RESULTS. Regardless of body
   orientation relative to gravity, participants produced straight hand paths and smooth,
   bell-shaped velocity profiles. However, they moved slower in side-lying, and the
   pattern of interjoint coordination varied. The shoulder and elbow moved less,
   whereas the scapula made a greater contribution to the overall movement.
   Furthermore, the temporal coordination of the joints was modified as a consequence
   of body position. CONCLUSION. The results indicate that point-to-point arm
   movements made against gravity differ from those made in a gravity-reduced plane,
   particularly at the joint level, illustrating that movement organization is sensitive to
  this contextual difference. The effect of minimizing gravity on upper limb movement
  needs to be explored in patient populations to determine whether training patients in
  gravity-reduced orientations is efficacious
Keywords: ACCURACY/age/analysis/arm/arm movement/arm movements/body
  ARM                                    MOVEMENTS/needs/neurological/neurological
  ing/trajectory/upper limb/USA/velocity/women
Oelschlager, B.K., Barreca, M., Chang, L. and Pellegrini, C.A. (2003), The use of small
  intestine submucosa in the repair of paraesophageal hernias: Initial observations of a
  new technique. American Journal of Surgery, 186 (1), 4-8.
Abstract: Background: Recent reports suggest that when laparoscopy is used to repair
  paraesophageal hernias recurrence rates reach 20% to 40%. Tension-free hernia
  closure with synthetic mesh reduces recurrence but occasionally results in
  esophageal injury-We hypothesized that reinforcement of the hiatal closure with
  small intestine submucosa (SIS) mesh, in some unusually large hernias, might reduce
  recurrence rates without causing injury to the esophagus. Methods: From January
  2001 to March 2002 we treated 18 large paraesophageal hernias via a laparoscopic
  approach. In 9 of the largest hernias (one type II and 8 type III, of which 1 was
  recurrent) the repair was reinforced with SIS mesh (Surgisis, Cook Surgical) and
  represent the subjects of this study. Nissen fundoplication with gastropexy was
  performed in all patients. Clinical follow- up ranged from 3 to 16 months (median 8).
  Every patient was evaluated with barium esophagram or endoscopy or both 1 to 8
  months (median 2) postoperatively. Results: The presenting symptoms were
  postprandial pain/fullness (9 of 9), heartburn (4 of 9), anemia (4 of 9), dysphagia Q
  of 9), regurgitation Q of 9), and chest pain Q of 9). One patient died of a
  hemorrhagic stroke within 30 days,of the operation. Postoperatively, presenting
  symptoms resolved (83%) or improved (17%) in each of the remaining 8 patients.
  One patient required endoscopic dilation for mild dysphagia. Seven of 8 patients had
  a normal barium esophagram without evidence of hernia. One morbidly obese (body
  mass index = 47) patient had a small (2 cm.) sliding hiatal hernia postoperatively.
  There were no other complications, and specifically no perforations or mesh erosions.
  Conclusions: These observations suggest that the use of SIS in the repair of
  paraesophageal hernias is safe and may reduce recurrence. Longer follow-up and a
  randomized study are needed to validate these results. (C) 2003 Excerpta Medica, Inc.
  All rights reserved
Keywords:               anemia/approach/body                mass             index/chest
  up/follow-up/hemorrhagic/hemorrhagic                                      stroke/hiatal
  fundoplication/normal/Pacific/pain/paraesophageal hernia/paraesophageal hernia
  gitation/repair/results/SI/small/small                                        intestinal
Ohkuma, H., Suzuki, S., Kikkawa, T. and Shimamura, N. (2003), Neuroradiologic and
  clinical features of arterial dissection of the anterior cerebral artery. American
  Journal of Neuroradiology, 24 (4), 691-699.
Abstract: BACKGROUND AND PURPOSE: Case reports of nontraumatic arterial
  dissection of the anterior cerebral artery (ACA) have recently increased. The aim of
  this study was to investigate the neuroradiologic and clinical features of ACA
  dissection based on a series of collected cases. METHODS: The cases of 18 patients
  with a diagnosis of ACA dissection based on clinical signs and neuroradiologic
  findings from 46 stroke centers during a 5-year period were collected. The
  neuroradiologic and clinical records were analyzed. RESULTS: The mean patient
  age was 52.8 +/- 9.8 years. Five cases presented with subarachnoid hemorrhage, nine
  with cerebral ischemia, and four with both ischemic symptoms and subarachnoid
  hemorrhage. In cases presenting with ischemia, the main site of the lesion was the
  A2 portion and the main angiographic finding was stenosis with or without dilation.
  Follow-up angiography showed progression of the stenosis in the acute stage and
  resolution of the stenosis in the chronic stage. Hyperintensity around the flow void
  due to intramural hematoma on T1-weighted MR images was often seen during the
  second week. In all cases, the findings of MR angiography corresponded to the
  findings of cerebral angiography. Eight of nine cases showed a good prognosis. In
  three of the patients with bleeding, in whom the site of the lesion was at the A1
  portion, a diffuse thick subarachnoid hemorrhage was present and surgical treatment
  was required but resulted in a poor prognosis. In the other patients with bleeding, in
  whom the site of the lesion was at the distal ACA, the prognosis was good and no
  rebleeding or need for surgical treatment occurred. CONCLUSION. ACA dissection
  presenting with ischemia has several identifiable neuroradiologic and clinical
  characteristics, which suggests that it may be classified as a unique clinical entity
Keywords:                                   acute/age/ANEURYSMS/ANGIOGRAPHIC
  FINDINGS/angiography/anterior                 cerebral             artery/arterial/arterial
  dissection/artery/bleeding/cerebral/cerebral angiography/cerebral artery/cerebral
  ischemia/chronic/CIRCULATION/clinical/clinical                    characteristics/clinical
  features/clinical                  signs/diagnosis/dilation/dissection/flow/FOLLOW-
  UP/hematoma/hemorrhage/INFARCTION/INTRACRANIAL                            VERTEBRAL
  L                 ANGIOGRAPHY/stenosis/stroke/subarachnoid/SUBARACHNOID
  HEMORRHAGE/surgical/surgical treatment/symptoms/treatment/USA/week
Page, S.J., Elovic, E., Levine, P. and Sisto, S.A. (2003), Modified constraint-induced
  therapy and botulinum toxin A - A promising combination. American Journal of
  Physical Medicine & Rehabilitation, 82 (1), 76-80.
Abstract: Modified constraint-induced therapy and chemodenervation with botulinum
  toxin A are each efficacious in managing stroke- induced motor disorders; however,
  the application of these two promising modalities in combination is yet to be
  examined. This case study describes a 44-yr-old man who experienced a right middle
  cerebral artery infarct 14 mo before participating in modified constraint-induced
  therapy. After modified constraint- induced therapy completion, the patient exhibited
  substantial improvement in affected upper limb use and function but retained
  difficulty with finger extension secondary to hypertonicity and spasticity in the
  forearm flexor muscles. Selective chemodenervation of these muscles with
  botulinum toxin A greatly improved the patient's self-reported hand function and his
  scores using objective measures. The authors of this paper present this case to raise
   the idea of increasing treatment efficacy by combining these two modalities
Keywords:         artery/botulinum        toxin/botulinum     toxin     A/cerebral/cerebral
   function/hemiplegia/hypertonicity/induced/INDUCED                          MOVEMENT
   THERAPY/infarct/limb                 use/middle         cerebral/middle           cerebral
   ASTICITY/stroke/stroke                                                outcome/STROKE
   REHABILITATION/therapy/treatment/upper limb/USA/use
Penado, S., Cano, M., Acha, O., Hernandez, J.L. and Riancho, J.A. (2003), Atrial
   fibrillation as a risk factor for stroke recurrence. American Journal of Medicine, 114
   (3), 206-210.
Abstract: BACKGROUND: Although atrial fibrillation is a well-known risk, factor for
   ischemic stroke, the extent to which it increases the risk of stroke recurrence,
   particularly in elderly patients, is less certain. METHODS: We performed a
   retrospective cohort study of 915 patients aged 50 to 94 years who were admitted
   with an ischemic stroke. The rates of recurrent strokes and recurrent severe strokes
   were estimated with the Kaplan-Meier method. The effects of atrial fibrillation on
   stroke risk were analyzed with proportional hazards models. RESULTS: Of the 829
   patients who survived the initial hospitalization, 163 (20%) had a stroke during
   follow- up. Of the 203 patients with-atrial fibrillation during index hospitalization
   who were not anticoagulated, 54 (27%) had recurrent strokes, compared with 18%
   (19/103) among those with atrial fibrillation who were anticoagulated and 17%
   (90/523) among those without atrial fibrillation. The age-adjusted hazard ratio for
   recurrent stroke among those with atrial fibrillation who were not treated with
   anticoagulants was 2.1 (95% confidence interval [Cl]: 1.4 to 2.9; P <0.001), whereas
   the hazard ratio for recurrent severe stroke was 2.4 (95% CI: 1.6 to 3.6; P <0.001).
   The increased risk was observed even inpatients aged greater than or equal to80
   years and persisted during the follow-up for more than 5 years. CONCLUSION:
   Atrial fibrillation was an independent risk factor for stroke recurrence over a wide
   age range. (C) 2003 by Excerpta Medica Inc
Keywords:                      age/aged/anticoagulants/ANTICOAGULATION/atrial/atrial
   fibrillation/CEREBRAL                                  INFARCTION/COHORT/cohort
   study/effects/elderly/elderly                                 patients/fibrillation/follow
   ON/PROGNOSIS/proportional hazards models/range/recurrence/recurrent/recurrent
   stroke/risk/risk factor/risk of stroke/severe/severe stroke/Spain/stroke/stroke
Pikus, L., Levine, M.S., Yang, Y.X., Rubesin, S.E., Katzka, D.A., Laufer, I. and Gefter,
   W.B. (2003), Videofluoroscopic studies of swallowing dysfunction and the relative
   risk of pneumonia. American Journal of Roentgenology, 180 (6), 1613-1616.
Abstract: Objective. The purpose of our investigation was to determine the relationship
   between the degree of swallowing dysfunction observed on barium studies and the
   likelihood of developing pneumonia in a large series of patients. Materials and
   Methods. The findings on videofluoroscopic swallowing studies in 381 patients were
   used to classify these patients into one of five groups: those with normal. swallowing;
   those with abnormal swallowing but no laryngeal penetration or tracheobronchial
   aspiration; those with laryngeal penetration; those with tracheobronchial aspiration;
   an. with silent tracheobronchial aspiration. Clinical data were also reviewed to
   determine how many patients had developed pneumonia during the 6 months before
  or after the barium studies. The data were then analyzed to determine whether the
  risk of developing pneumonia increased significantly with each level of swallowing
  dysfunction seen on barium studies. Results. No significant difference was found in
  the frequency of pneumonia in patients with abnormal swallowing but no laryngeal
  penetration or tracheobronchial aspiration compared with patients with normal
  swallowing on barium studies (p=0.85). In contrast, patients with laryngeal
  penetration, tracheobronchial aspiration, or silent tracheobronchial aspiration were
  approximately four times (p=0.008), 10 times (p<0.0001), and 13 times (p<0.0001),
  respectively, more likely to develop pneumonia than those with normal swallowing.
  Conclusion. Our findings indicate that the likelihood of developing pneumonia is
  directly related to the degree of swallowing dysfunction seen on videofluoroscopic
  studies. Patients with no laryngeal penetration-regardless of whether they had normal
  or abnormal swallowing-have the lowest risk of developing pneumonia. Patients with
  laryngeal penetration, tracheobronchial aspiration, or silent tracheobronchial
  aspiration are, in increasing order of magnitude, significantly more likely to develop
  pneumonia than patients with normal swallowing
Keywords:                     aspiration/ASPIRATION                        FOLLOWING
Pypendop, B.H., Ilkiw, J.E., Imai, A. and Bolich, J.A. (2003), Hemodynamic effects of
  nitrous oxide in isoflurane-anesthetized cats. American Journal of Veterinary
  Research, 64 (3), 273-278.
Abstract: Objective-To determine the hemodynamic effects of nitrous oxide in
  isoflurane-anesthetized cats. Animals-12 healthy adult domestic shorthair cats.
  Procedure Cats were anesthetized by administration of isoflurane in oxygen. After
  instruments were inserted, end-tidal isoflurane concentration was set at 1.25 times
  the individual minimum alveolar concentration, and nitrous oxide was administered
  in a Latinsquare design at 0, 30, 50, and 70%. Each concentration was administered
  for 25 minutes before measurements were obtained to allow for stabilization. Heart
  rate; systemic and pulmonary arterial pressures; central venous pressure; pulmonary
  artery occlusion pressure;- cardiac output, body temperature, arterial and
  mixed-venous pH, Pco(2), Po-2, and hemoglobin concentrations; PCV-1 and total
  protein and lactate concentrations were measured before and during noxious
  stimulation for each nitrous oxide concentration. Arterial and mixed-venous
  bicarbonate concentrations and oxygen saturation, cardiac index, stroke index,
  rate-pressure product, systemic and pulmonary vascular resistance indices, left and
  right ventricular stroke work indices, arterial and mixed-venous oxygen contents,
  oxygen delivery, oxygen consumption, oxygen extraction ratio, alveolar-to-arterial
  oxygen difference, and venous admixture were calculated. Results-Arterial pressure,
  central venous pressure, pulmonary arterial pressure, rate-pressure product, systemic
  and pulmonary vascular resistance indices, arterial Pco(2), and PCV increased during
  administration of 70% nitrous oxide. Arterial and mixed-venous pH, mixed-venous
  Po-2, and alveolar-to-arterial oxygen difference decreased during administration of
  70% nitrous oxide. Results before and during noxious stimulation were similar.
  Conclusions and Clinical Relevance-Administration of 70% nitrous oxide to
  isoflurane- anesthetized cats resulted in improved arterial pressure, which was related
  to a vasoconstrictive effect
Keywords:              adult/arterial/arterial          pressure/artery/bicarbonate/body
  temperature/cardiac/cardiac         index/cardiac     output/cats/central       venous
  NIMUM ALVEOLAR CONCENTRATION/nitrous oxide/occlusion/oxygen/oxygen
  consumption/oxygen delivery/oxygen extraction/oxygen extraction ratio/oxygen
  saturation/pH/POTENCY/pressure/pressures/protein/pulmonary/pulmonary arterial
  pressure/pulmonary       artery/resistance/RESPONSES/right/stimulation/stroke/stroke
  index/stroke work/systemic/temperature/USA/vascular/vascular resistance/venous
Reddan, D.N., O'Shea, J.C., Sarembock, I.J., Williams, K.A., Pieper, K.S., Santoian, E.,
  Owen, W.F., Kitt, M.M. and Tcheng, J.E. (2003), Treatment effects of eptifibatide in
  planned coronary stent implantation in patients with chronic kidney disease (ESPRIT
  trial). American Journal of Cardiology, 91 (1), 17-21.
Abstract: The role of platelet glycoprotein IIb/IIIa inhibitor therapy in patients with
  mild renal impairment is not well characterized. Our objective was to explore the
  associations of creatinine clearance (CrCl) with outcomes in a trial of eptifibatide
  therapy in patients who underwent percutaneous coronary intervention (PCI). We
  analyzed 48-hour and 30-day outcomes of patients enrolled in the Enhanced
  Suppression of the Platelet IIb/IIIa Receptor with Integrilin Therapy (ESPRIT) trial.
  Patients were randomly assigned to placebo, or eptifibatide as an adjunct to stent
  implantation (1,755 with CrCl greater than or equal to60 ml/min and 289 with CrCl
  <60 ml/min). CrCl was calculated using the Cockcroft and Gault formula, and the
  associations of CrCl with outcomes were evaluated using logistic regression models.
  Patients with CrCl <60 ml/min were more likely. to be older, women, hypertensive,
  and have a history of coronary artery bypass surgery, stroke, or peripheral vascular
  disease. The interaction of eptifibatide. with CrCl had borderline significance for the
  30-day outcome (p = 0.109). Treatment effect trended toward a greater magnitude in
  patients with lower CrCl (60 ml/min) (odds ratio 0.53, confidence interval 0.34 to
  0.83) compared with those with higher CrCl (90 ml/min) (odds ratio 0.68, confidence
  interval 0.49 to 0.94). An accompanying increase in, bleeding risk also was not
  apparent with lower CrCl. The treatment effect of eptifibatide is realized regardless
  of renal function and trends toward being greater in patients with mild renal
  impairment. (C) 2003 by Excerpta Medica, Inc
Keywords: ANGIOPLASTY/artery/bleeding/bypass/bypass surgery/chronic/chronic
  kidney disease/clearance/CLINICAL-TRIALS/coronary/coronary artery/coronary
  artery bypass/coronary artery bypass surgery/coronary intervention/coronary
  ENTION/kidney/kidney                                                   disease/logistic
  ratio/older/outcome/outcomes/patients/percutaneous coronary/percutaneous coronary
  intervention/peripheral/peripheral                                             vascular
  disease/placebo/platelet/regression/renal/renal                          function/renal
  CREATININE/STAGE                                        RENAL-DISEASE/stent/stent
Romano, C., Chinali, M., Pasanisi, F., Greco, R., Celentano, A., Rocco, A., Palmieri, V.,
  Signorini, A., Contaldo, F. and de Simone, G. (2003), Reduced hemodynamic load
  and cardiac hypotrophy in patients with anorexia nervosa. American Journal of
  Clinical Nutrition, 77 (2), 308-312.
Abstract: Background: Anorexia nervosa is associated with lower left ventricular mass
  (LVM) and systolic dysfunction. Whether these abnormalities reflect chronic
  protein-energy malnutrition or are primarily related to lower cardiac workload is
  unclear. Objective: The objective of the study was to verify whether low LVM in
  anorexia nervosa is explained by low hemodynamic load. Design: Ninety-one
  women with anorexia nervosa [(x) over bar +/- SD age: 20.5 +/- 6.1 y; body mass
  index (in kg/m(2)): 15.6 +/- 1.9; group 1] and 62 normal-weight female control
  subjects (age: 22.5 +/- 5.5 y; body mass index: 20.9 +/- 1.2; group 2) underwent
  Doppler echocardiography. LVM was evaluated as the percentage predicted by body
  height, sex, and stroke work (systolic blood pressure X stroke volume). Results: The
  left ventricular chamber dimension was smaller and the chamber walls were thinner
  in group I than in group 2, which resulted in significantly lower LVM and LVM
  indexes (P < 0.0001). Ejection fraction, heart rate, stroke volume, and cardiac output
  were significantly (P < 0.007) lower in group 1, but peripheral resistance was
  substantially higher (P < 0.0001). The deviation of LVM from predicted values was
  lower and the proportion of subjects with inadequate LVM was significantly higher
  in group 1 than in group 2 (P < 0.0001). This difference was attenuated after
  adjustment for body weight and heart rate. There were no relations between LVM
  and laboratory tests in group 1. Conclusions: Anorexia nervosa is a condition of low
  hemodynamic load that leads to low LVM. Even with adjustment for stroke work,
  however, LVM is lower than would be predicted by height, because of the effect of
  body weight reduction (ie, wasting of lean body mass)
Keywords: ABNORMALITIES/ABSENCE/adjustment/age/anorexia nervosa/BIRTH-
  WEIGHT/blood/blood           pressure/body      height/body      mass       index/body
  weight/BODY-SIZE/cardiac/cardiac                                           load/cardiac
  rate/hemodynamic/HYPERTENSION/HYPERTROPHY/II/inadequate                             left
  ventricular mass/index/Italy/left/left ventricular/left ventricular hypotrophy/left
  ventricular                                              mass/LEFT-VENTRICULAR
  resistance/pressure/resistance/sex/stroke/stroke volume/stroke work/systolic/systolic
  blood/systolic blood pressure/systolic dysfunction/tests/USA/ventricular/ventricular
Sakoh, M. and Gjedde, A. (2003), Neuroprotection in hypothermia linked to
  redistribution of oxygen in brain. American Journal of Physiology-Heart and
  Circulatory Physiology, 285 (1), H17-H25.
Abstract: Hypothermia improves the outcome of acute ischemic stroke, traumatic injury,
  and inflammation of brain tissue. We tested the hypothesis that hypothermia reduces
  the energy metabolism of brain tissue to a level that is commensurate with the
  prevailing blood flow and hence allows adequate distribution of oxygen to the entire
  tissue. To determine the effect of 32degreesC hypothermia on brain tissue, we
  measured the sequential changes of physiological variables by means of PET in pigs.
  Cerebral blood flow and oxygen consumption (cerebral metabolic rate of oxygen)
  declined to 50% of the baseline in 3 and 5 h, respectively, thus elevating the oxygen
  extraction fraction to 140% of the baseline at 3 h. The results are consistent with the
  claim that cooling of the brain to 32degreesC couples both energy metabolism and
  blood flow to a lower rate of work of the entire tissue
Keywords: acute/acute ischemic/acute ischemic stroke/ACUTE STROKE/ARTERY
  OCCLUSION/blood/blood flow/brain/cerebral/cerebral blood flow/CEREBRAL
  BLOOD-FLOW/cerebral                       metabolic               rate               of
  /ischemic                stroke/lower/metabolic                rate/metabolism/MILD
  HYPOTHERMIA/Neuroprotection/outcome/oxygen/oxygen                consumption/oxygen
  extraction/oxygen                                                            extraction
  CHEMIC                     HYPOTHERMIA/results/SEVERE                          HEAD-
Saur, D., Kucinski, T., Grzyska, U., Eckert, B., Eggers, C., Niesen, W., Schoder, V.,
  Zeumer, H., Weiller, C. and Rother, J. (2003), Sensitivity and interrater agreement of
  CT and diffusion- weighted MR imaging in hyperacute stroke. American Journal of
  Neuroradiology, 24 (5), 878-885.
Abstract: BACKGROUND AND PURPOSE: Previous acute stroke studies found
  diffusion-weighted (DW) imaging superior to CT for detection of early ischemic
  signs (EIS). However, these findings were confounded by a large time interval in
  favor of DW imaging. We compared DW images and CT scans obtained with a short
  time delay in patients with acute stroke to define the sensitivity and interrater
  agreement of both imaging techniques. METHODS: CT scans and DW images were
  obtained within 6 hours of symptom onset in 46 patients with acute stroke. Three
  neuroradiologists and three neurologists reviewed the images for EIS in five regions
  of the middle cerebral artery (MCA) territory and estimated the extent of EIS (< or >
  one-third of the MCA territory). RESULTS: The mean delay between imaging with
  both modalities was 24.5 minutes (range, 10-41 minutes). Forty-five of 46 patients
  had an ischemic stroke. EIS were seen on 33 of 45 CT scans (73% sensitivity; 95%
  confidence interval [Cl]: 58- 85%) and on 42 of 45 DW images (93% sensitivity;
  94% CI: 82- 99%). Interrater agreement was moderate (kappa = 0.57) for CT and
  excellent (kappa = 0.85) for DW imaging. CT studies had a moderate interrater
  agreement for estimation of EIS greater than one-third of the MCA territory (kappa =
  0.40), whereas DW imaging showed good results (kappa = 0.68). Sensitivity for
  detection of greater than one-third of the MCA territory was equally poor (57%, 95%
  CI: 29-82%) for both CT and DW imaging. CONCLUSION. DW imaging helped
  identify EIS with higher sensitivity than that of CT. The interrater variability of the
  one-third rule was high for CT, and thus the clinical applicability of CT is limited.
  Our results support the application of stroke MR imaging for the treatment of
  patients with acute stroke
Keywords:              acute/ACUTE               ISCHEMIC                STROKE/acute
  artery/CEREBRAL-ARTERY                          INFARCTION/clinical/COMPUTED-
  weighted/diffusion             weighted              MR             imaging/diffusion-
  stroke/imaging/ischemic/ischemic stroke/MAGNETIC-RESONANCE/MCA/middle
  cerebral/middle                          cerebral                          artery/MR/MR
  oke                                     studies/support/techniques/THROMBOLYTIC
Saxonhouse, S.J. and Curtis, A.B. (2003), Risks and benefits of rate control versus
  maintenance of sinus rhythm. American Journal of Cardiology, 91 (6A), 27D-32D.
Abstract: There are 2 fundamental approaches to managing patients with recurrent atrial
  fibrillation (AF): to restore and maintain sinus rhythm with cardioversion and/or
  antiarrhythmic drugs, or to control the ventricular rate only. Over the past few years,
  there have been several important prospective clinical trials comparing rate control
  with rhythm control in patients with recurrent AF. The Pharmacological Intervention
  in Atrial Fibrillation (PIAF) trial was the first prospective randomized study to test
  the hypothesis of equivalency between the 2 management strategies for AF. The trial
  demonstrated that rate control was not inferior to rhythm control with respect to
  symptoms, quality of life, or number of hospitalizations in patients with persistent
  AF. The Strategies of Treatment in Atrial Fibrillation (STAF) trial was a pilot study
  that enrolled approximately 200 patients with AF who were randomized to either
  ventricular rate control or cardioversion and maintenance of sinus rhythm. The
  results, showed that over a 1- year period there was little difference in outcome in
  terms of morbidity or symptoms. In the Atrial Fibrillation Follow-up Investigation of
  Rhythm Management (AFFIRM) trial, patients with AF and risk factors for stroke
  were randomized to either rhythm control or, rate control, with both groups receiving
  anticoagulation with warfarin. There was no difference in the composite end point of
  death, disabling stroke or anoxic encephalopathy, major bleeding, or cardiac arrest
  between the 2 arms. In addition, no major differences were noted in functional status
  or quality of life. The Rate Control Versus Electrical Cardioversion (RACE) trial
  also reached a similar conclusion. Thus, rate control is an acceptable primary
  strategy for management of patients with recurrent AF. (C) 2003 by Excerpta Medica,
Keywords:                        addition/AF/AFFIRM/AMIODARONE/antiarrhythmic
  drugs/anticoagulation/arms/atrial/atrial                           fibrillation/ATRIAL-
  arrest/CARDIOVERSION/clinical/clinical                      trials/CLINICAL-TRIALS
  lation/functional/functional status/HIGHLIGHTS/IMPLANTATION/maintenance of
  T                     PACEMAKER/prospective/quality/quality                            of
  life/QUINIDINE/RACE/randomized/rate                   control/recurrent/results/risk/risk
  factors/risk    factors for stroke/risk-factors/SCIENTIFIC              SESSIONS/sinus
Schaefer, P.W., Ozsunar, Y., He, J., Hamberg, L.M., Hunter, G.J., Sorensen, A.G.,
  Koroshetz, W.J. and Gonzalez, R.G. (2003), Assessing tissue viability with MR
  diffusion and perfusion imaging. American Journal of Neuroradiology, 24 (3),
Abstract: Background and purpose: Diffusion- (Dw) And perfusion-weighted (Pw) Mr
  imaging reflect neurophysiologic changes during stroke evolution. We sought to
  determine parameters that distinguish regions of brain destined for infarction from
  those that will survive despite hypoperfusion. Methods: Dw and pw images were
  obtained in 30 patients at 1-12 hours after symptom onset. Relative cerebral blood
  volume (Rcbv), Flow (Rcbf), Mean transit time (Mtt), Apparent diffusion coefficient
  (Adc), Dw image signal intensity, and fractional anisotropy (Fa) Lesion-
  contralateral normal region ratios were obtained in the following regions: 1) Infarct
  core with hyperintensity on dw image, abnormality on rcbf and mtt images, and
  follow-up abnormality; 2) Infarcted penumbra with normal dw image, abnormal rcbf
  and mtt images, and follow-up abnormality; And 3) Hypoperfused tissue that
  remained viable, with normal dw image, abnormal rcbf and mtt images, and normal
  follow-up. Results: Rcbf ratios for regions 1, 2, and 3 were 0.32 +/- 0.11, 0.46 +/-
  0.13, And 0.58 +/- 0.12, Respectively, and were significantly different. Dw image
  intensity and adc ratios were significantly different among all regions, but were more
  similar than rcbf ratios. Rcbv and fa ratios were not significantly different between
  regions 2 and 3. No mtt ratios were significantly different. No region of interest with
  an rcbf ratio less than 0.36, An rcbv ratio less than 0.53, An adc ratio less than 0.85,
  A dw image intensity ratio greater than 1.23, Or an fa ratio greater than 1.10
  Remained viable. No region of interest with an rcbf ratio greater than 0.79 Infarcted.
  Conclusions: Differences among mean ratios of three regions investigated were
  greatest for. The rcbf ratio. The rcbf ratio may be the most useful parameter in
  differentiating viable tissue that is likely to infarct without intervention, from tissue
  that will survive despite hypoperfusion. Adc, dw intensity, fa, and rcbv ratios may
  provide adjunctive information
Keywords:       anisotropy/blood/blood        volume/BRAIN/cerebral/cerebral         blood
  volume/CEREBRAL BLOOD-FLOW/changes/COEFFICIENT/diffusion/diffusion
  and          perfusion/diffusion         and          perfusion        imaging/diffusion
  coefficient/EVOLUTION/follow up/follow-up/fractional anisotropy/HYPERACUTE
  n/ISCHEMIC                                                  PENUMBRA/METABOLIC
  imaging/perfusion weighted/perfusion-weighted/SIGNAL INTENSITY/stroke/tissue
  viability/USA/viability/VOLUME/WEIGHTED MRI
Sepehrdad, R., Chander, P.N., Oruene, A., Rosenfeld, L., Levine, S. and Stier, C.T.
  (2003), Amiloride reduces stroke and renal injury in stroke-prone hypertensive rats.
  American Journal of Hypertension, 16 (4), 312-318.
Abstract: Background: We previously reported that the mineralocorticoid receptor
  antagonists spironolactone and eplerenone markedly reduce proteinuria and vascular
  injury in saline-drinking stroke-prone spontaneously hypertensive rats (SHRSP).
  Presently, we examined whether amiloride, an epithelial sodium channel blocker,
  would also protect against pathology in these rats. Methods: In acute studies,
  saline-drinking SHRSP (n = 5) were instrumented with radiotelemetry blood pressure
  (BP) probes and housed in metabolic cages. Mean arterial pressure and electrolyte
  excretion were quantified over the 24-h period after oral administration of vehicle or
  amiloride at 1, 3, 10, and 30 mg/kg. In a survival study, 8.5-week-old SHRSP were
  either untreated (control, n = 7) or given amiloride (1 mg/kg/day, n = 8) in their 1%
  NaCl drinking solution. Systolic BP, proteinuria, body weight, and renal and brain
  histopathology were assessed. Results: Acute amiloride treatment did not alter urine
  output, urinary electrolyte excretion, and sodium-to-potassium ratio or body weight.
  The mean arterial pressure was unaffected except for a 16-mm Hg reduction at 30
  mg/kg (P <.01). Six of eight SHRSP chronically treated with amiloride survived
  through 20 weeks of age, whereas all control SHRSP died by 16.4 weeks (P <.0001).
  Amiloride delayed proteinuria (119 +/- 24 v 15 +/- 2 mg/day, P <.002) with no
  significant effect on systolic BP (228 +/- 6 v 217 +/- 4 mm. Hg) at 12 weeks of age.
   Conclusions: These findings suggest that interference with sodium channel function,
   perhaps at sites other than the kidney epithelium, may play a role in protecting
   against the evolution of cerebral and renal vascular injury in saline-drinking SHRSP.
   Am J Hypertens 2003;16: 312-318 (C) 2003 American Journal of Hypertension, Ltd
Keywords:                           acute/age/ALDOSTERONE/amiloride/arterial/arterial
   pressure/blocker/blood/blood                                             pressure/body
   rats/injury/kidney/malignant                nephrosclerosis/mean                arterial
   um/sodium                 channel/SODIUM-CHANNEL/spironolactone/spontaneously
   hypertensive/spontaneously hypertensive rats/stroke/stroke prone/stroke prone
   spontaneously            hypertensive          rats/stroke-prone         spontaneously
   hypertensive/stroke-prone                   spontaneously                 hypertensive
   injury/vehicle/weeks of age/weight
Serebruany, V.L., Malinin, A.I. and Sane, D.C. (2003), Rapid platelet inhibition after a
   single capsule of Aggrenox (R): Challenging a conventional full-dose aspirin
   antiplatelet advantage? American Journal of Hematology, 72 (4), 280-281.
Abstract: Aggrenox(R) is a novel combination of 25 mg of aspirin with 200 mg of
   sustained release dipyridamole. In a recent large trial (ESPS-2), Aggrenox(R) was
   twice as effective for secondary stroke prevention as either aspirin or dipyridamole
   alone, suggesting superior platelet inhibition for combination therapy. We sought to
   compare the time course of platelet inhibition with Aggrenox(R) compared with
   escalating doses of non-enteric coated aspirin. Data from 10 healthy volunteers were
   analyzed. Fasting subjects sequentially ingested aspirin in the following order: 325
   mg, 81 mg, 25 mg, and then one pill of Aggrenox(R) after a 3-week interval for
   aspirin washout. Platelet function was assessed at baseline, 15, 30, 60, and 120 min
   post-medication with 5 muM epinephrine and 5 muM ADP using conventional
   aggregometry. Aspirin provided significant (P < 0.01) reduction of platelet
   aggregation at 15 min post 325 mg, 30 min post 81 mg, and unexpectedly within 60
   min after taking 25 mg of aspirin. A single pill of Aggrenox(R) also inhibited platelet
   aggregation within 1 hr after administration. Aspirin inhibits platelets remarkably
   fast. Both Aggrenox(R) and a matching dose of aspirin (25 mg) exhibit significant
   antiplatelet properties within 60 min after ingestion. These findings could be relevant
   for the optimal balance between the reduction of vascular events via sufficient and
   rapid platelet inhibition and low risk of bleeding complications associated with the
   Aggrenox(R) therapy. (C) 2003 Wiley-Liss, Inc
Keywords:                      ACETYLSALICYLIC-ACID/ADP/aggregation/Aggrenox
   aggregation/platelets/prevention/risk/secondary/secondary                        stroke
   prevention/STROKE/stroke                                       prevention/therapy/time
   course/trial/USA/vascular/vascular events
Sesso, H.D., Gaziano, J.M., Liu, S. and Buring, J.E. (2003), Flavonoid intake and the
   risk of cardiovascular disease in women. American Journal of Clinical Nutrition, 77
   (6), 1400-1408.
Abstract: Background: Despite emerging evidence of the role of flavonoids in
  cardiovascular disease (CVD) prevention, the association remains unclear. Objective:
  We examined whether flavonoids and selected flavonols and flavones or their food
  sources are associated with CVD risk. Design: Women (n = 38 445) free of CVD and
  cancer participated in a prospective study with a mean follow-up of 6.9 y. On the
  basis of a food-frequency questionnaire, total flavonoids and selected flavonols and
  flavones were categorized into quintiles, and food sources were categorized into 4
  groups. Relative risks were computed for important vascular events (519 events;
  excluding revascularizations) and CVD (729 events),, including myocardial
  infarction, stroke, revascularization, and CVD death. Results: The mean flavonoid
  intake was 24.6 +/- 18.5 mg/d, primarily as quercetin (70.2%). For both CVD and
  important vascular events, no significant linear trend was observed across quintiles
  of flavonoid intake (P = 0.63 and 0.80, respectively). No individual flavonol or
  flavone was associated with CVD. Broccoli and apple consumption were associated
  with nonsignificant reductions in CVD risk: 25-30% and 13-22%, respectively. A
  small proportion of women (n = 1185) consuming greater than or equal to4 cups (946
  ML) tea/d had a reduction in the risk of important vascular events but with a
  nonsignificant linear trend (P = 0.07). Conclusions: Flavonoid intake was not
  strongly associated with a reduced risk of CVD. The nonsignificant inverse
  associations for broccoli, apples, and tea with CVD were not mediated by flavonoids
  and warrant further study
Keywords:                                                               ANTIOXIDANT
  FLAVONOLS/association/cancer/cardiovascular/cardiovascular disease/CATECHIN
  up/follow-up/food-frequency                  questionnaire/HEALTH/infarction/MALE
  PROTEIN/stroke/tea/TEA CONSUMPTION/USA/vascular/vascular events/women
Seul, K.H., Han, J.H., Kang, K.Y., Kim, S.Z. and Kim, S.H. (2003), Regulation of ANP
  secretion by cardiac Na+/Ca2+ exchanger using a new controlled atrial model.
  American Journal of Physiology-Regulatory Integrative and Comparative
  Physiology, 284 (1), R31-R40.
Abstract: The myocardial interstitium is important in regulating cardiac function.
  Between the atrial lumen and the pericardial space are transmural pathways, and
  movement of interstitial fluid (ISF) through these pathways is one of the main
  driving forces regulating translocation of substances from the interstitium into the
  blood. To define how ISF translocation from the interstitial space into the luminal
  space is regulated by each component of atrial hemodynamics, we devised a new
  rabbit atrial model in which each physical parameter could be controlled
  independently. Using this system, we also defined the physiological role of the
  cardiac Na+/Ca2+ exchanger on secretion of atrial natriuretic peptide (ANP) by
  depletion of extracellular Na+ ([Na+](o)). Increases in stroke volume and atrial
  end-systolic volume increased ISF translocation and ANP secretion. However, an
  increase in atrial rate did not influence ISF translocation but, rather, increased ANP
  secretion. Gradual depletion of [Na+](o) caused gradual increases in ANP secretion
  and intracellular Ca2+ ([Ca2+](i)), which were blocked in the presence of Ca2+-free
  buffer and Ni2+, but not in the presence of KB-R7943, diltiazem, mibefradil,
  caffeine, or monensin. Amiloride and its analog blocked an increase in ANP
  secretion but not an increase in [Ca2+](i) by [Na+](o) depletion. Therefore, we
  suggest that ANP secretion and ISF translocation may be differently controlled by
  each physical factor. These results also suggest that the increase in ANP secretion in
  response to [Na+](o) depletion may involve inhibition of Na+/Ca2+ and Na+/H+
  exchangers but not an increase in [Ca2+](i)
Keywords:                           ANP/atrial/atrial                        natriuretic
  EXCHANGE/natriuretic                                peptide/NATRIURETIC-PEPTIDE
  SECRETION/pathways/PERFUSED                                                  RABBIT
Shimada, Y., Yang, Q., Yokoyama, K., Goto, H., Kasahara, Y., Sekiya, N., Hikiami, H.
  and Terasawa, K. (2003), Choto-san prevents occurrence of stroke and prolongs life
  span in stroke-prone spontaneously hypertensive rats. American Journal of Chinese
  Medicine, 31 (1), 79-85.
Abstract: The effects of long-term oral administration of Choto-san (Diao-Teng-San in
  Chinese) extract on the occurrence of stroke and life span were investigated in
  stroke-prone spontaneously hypertensive rats (SHR-SPs). Twenty-four rats were
  ramdomized into three groups. From 8 weeks of age, 0.1% and 0.3% Choto-san
  groups were given water containing 0.1% (150 mg/kg/day) and 0.3% (450 mg/kg/day)
  Choto-san extract, respectively. A control group was given only water. The mean
  survival times of the control group, 0.1% and 0.3% Choto-san groups were 122.1,
  159.8 and 176.8 days, respectively. The percent survivals of both the 0.1% and 0.3%
  Choto-san groups were significantly enhanced compared to the control
  (Kaplan-Meier analysis followed by log- rank test; 0.1% Choto-san: p < 0.05; 0.3%
  Choto-san: p < 0.05). Furthermore, the cumulative percent occurrence of
  neurological and behavioral signs accompanying stroke in the 0.3% Choto-san group
  was significantly inhibited compared to the control (p < 0.05). These results
  suggested that Choto-san prevents the occurrence of stroke and prolongs the life span
  of SHR-SPs
  ypertensive rats/INDUCED NEURONAL DEATH/Japan/Japanese/Kampo/life
  span/neurological/occurrence/oral/oral               administration/PRINCIPLES/rank
  hypertensive/spontaneously hypertensive rats/STEMS/stroke/stroke prone/stroke
  prone        spontaneously     hypertensive       rats/stroke-prone     spontaneously
  hypertensive/stroke-prone                  spontaneously                 hypertensive
  rats/survival/UNCARIA-SINENSIS/water/weeks of age/WORLD
Shimizu, M., Yamamoto, M., Miyachi, H., Shinohara, Y. and Ando, Y. (2003), Simple,
  rapid, and automated method for detection of hyperaggregability of platelets using a
  hematology analyzer. American Journal of Hematology, 72 (4), 282-283.
Abstract: Estimation of hyperaggregability of platelets is important for diagnosis and
  prevention of vascular events. We have developed and evaluated a simple and rapid
  method for detection of a hyperaggregable state of platelets by using An Abbott
  CELL- DYN(R) 4000 hematology analyzer. Citrated blood samples were collected
  from 62 patients with chronic cerebral infarction (CCI), of whom 19 patients were
  treated with ticlopidine, and from 9 healthy subjects. Platelet clumps were detected
  in the scatter plots for white blood cell populations with the hematology analyzer.
  Platelet clumps were positive in 20 of 43 (46.5%) CCI patients who were not treated
  with anti-platelet agents but not at all in 9 healthy subjects and in 19 CCI patients
  treated with ticlopidine. The detection of platelet clumps in citrated blood by the
  hematology analyzer was proved useful in detecting a platelet hyperaggregability in
  CCI patients. This method is simple, rapid, and automated and thus should be
  suitable for routine clinical use for monitoring indications and the efficacy of
  anti-platelet drugs. (C) 2003 Wiley-Liss, Inc
Keywords:           AGENTS/AGGREGATION/anti-platelet                  agents/anti-platelet
  therapy/antiplatelet/antiplatelet                                    agents/antiplatelet
  drugs/blood/CELL/cerebral/cerebral           infarction/chronic/chronic        cerebral
  events/white blood cell
Smith, W.S., Roberts, H.C., Chuang, N.A., Ong, K.C., Lee, T.J., Johnston, S.C. and
  Dillon, W.P. (2003), Safety and feasibility of a CT protocol for acute stroke:
  Combined CT, CT angiography, and CT perfusion imaging in 53 consecutive
  patients. American Journal of Neuroradiology, 24 (4), 688-690.
Abstract: By combining non-contrast-enhanced CT imaging, CT perfusion imaging, and
  cranial-to-chest CT angiography (CTA), the entire cerebrovascular axis can be
  imaged during acute stroke. To our knowledge, the safety and feasibility of this
  technique have not been previously reported. In a consecutive series of 53 patients
  with suspected acute stroke, renal failure was not observed. Median imaging time
  was 27 minutes (range, 9-67 minutes). Image quality was degraded by motion in
  1.3% of vessels studied. Dynamic CT perfusion data were successfully obtained in
  52 patients (98% of patients). High-speed, multisection, helical CT scanners allow
  rapid, safe imaging of the entire neurovascular axis in patients with acute stroke by
  use of combined CT imaging, CT perfusion imaging, and CTA
Keywords:                                                                     acute/acute
  ed/COUNCIL/CT/CT                                                       angiography/CT
  motion/patients/perfusion/perfusion                   imaging/quality/range/renal/renal
  failure/safety/stroke/technique/TIME/TRANSIENT                             ISCHEMIC
Soeda, A., Sakai, N., Sakai, H., Iihara, K., Yamada, N., Imakita, S. and Nagata, I.
  (2003), Thromboembolic events associated with Guglielmi detachable coil
  embolization of asymptomatic cerebral aneurysms: Evaluation of 66 consecutive
  cases with use of diffusion-weighted MR imaging. American Journal of
  Neuroradiology, 24 (1), 127-132.
Abstract: Background and purpose: Although guglielmi detachable coil (Gdc)
  Endovascular treatment of intracranial aneurysms has become an accepted alternative
  to surgery, the main complication continues to be thromboembolic events. We sought
  to determine the frequency and radiologic appearance of thromboembolic events
  during gdc embolization for asymptomatic cerebral aneurysms by using
  diffusion-weighted (Dw) Mr imaging and to determine whether aneurysmal anatomic
  factors or use of the balloon-assisted technique affected the frequency. Methods: In
  74 patients, 79 asymptomatic cerebral aneurysms were treated with gdc
  embolizations at the national cardiovascular center from 1999 to 2001. Thirty-nine of
  these aneurysms (49%) Were treated with the balloon-assisted technique. Dw
  imaging was performed in 66 patients at 2-5 days after gdc embolization. All dw
  images were reviewed by two radiologists for depiction of abnormalities. Results:
  Dw images showed hyperintense lesions in 40 patients (61%), With 16 of these
  patients (40%) Incurring neurologic deteriorations. Fifteen of the symptomatic
  patients (94%) Fully recovered by discharge, and the remaining one experienced
  permanent deficits. Hyperintense lesions were detected more frequently in wide-neck
  (73%) Or large (100%) Aneurysms and in procedures that used the balloon-assisted
  technique (73%) Than in small aneurysms (50%) Or in procedures with the simple
  gdc method (49%). The occurrence of new lesions was significantly associated with
  use of the balloon-assisted technique and with aneurysm diameter in multivariate
  analysis (P < .05). Conclusion. In our experience, thromboembolic events related to
  the use of gdc embolization are relatively common, especially in wide-neck or large
  aneurysms or in association with the balloon-assisted technique. Although permanent
  deficits are rare, the high rate of thromboembolic events suggests that improvements
  in the technique such as the addition of antiplatelet agents and the development of
  new embolic materials are mandatory
Keywords: abnormalities/addition/analysis/aneurysm/aneurysms/antiplatelet/antiplatelet
  weighted/diffusion weighted MR imaging/diffusion-weighted/diffusion-weighted
  MR/diffusion-weighted                                                             MR
  detachable coil/imaging/intracranial/INTRACRANIAL ANEURYSMS/ISCHEMIC
  STROKE/Japan/MR/MR                                               imaging/multivariate
  c/thromboembolic events/treatment/USA/use/WIDE-NECKED ANEURYSMS
Spillane, K.S., Shelton, J.E. and Hasty, M.F. (2003), Stroke-induced trismus in a
  pediatric patient - Long-term resolution with botulinum toxin A. American Journal
  of Physical Medicine & Rehabilitation, 82 (6), 485-488.
Abstract: We present a case of prolonged resolution of stroke-induced trismus after
  botulinum toxin A treatment in a 9(1)/(2)-yr-old boy. The patient had an idiopathic
  right posterior fossa hemorrhage with resultant spastic quadriparesis, ataxia,
  dysarthria, and dysphagia. He developed right-sided trismus with only fair response
  to stretch. Several months after discharge, the patient had worsening trismus with an
  interincisal distance of only 0.4-0.7 cm and difficulty with oral hygiene and eating.
  The patient was treated with botulinum toxin A to the masseter muscles with
  minimal response. Four months later, he received botulinum toxin A to the bilateral
  masseter and temporalis muscles and to the right medial and lateral pterygoid
  muscles, with more improvement. His third and last botulinum toxin A treatment was
  to the bilateral masseter, temporalis, lateral, and medial pterygoid muscles in larger
  doses. He had an excellent response, maintaining an interincisal distance of 2.5 cm 1
  yr later, with significant improvement in speaking and chewing
Keywords:              ataxia/bilateral/botulinum           toxin/botulinum           toxin
Steen, R.G., Miles, M.A., Helton, K.J., Strawn, S., Wang, W., Xiong, X.P. and Mulhern,
   R.K. (2003), Cognitive impairment in children with hemoglobin SS sickle cell
   disease: Relationship to MR imaging findings and hematocrit. American Journal of
   Neuroradiology, 24 (3), 382-389.
Abstract: Background and purpose: Children with hemoglobin ss sickle cell disease are
   known to suffer cognitive impairment if they have silent infarct, but recent evidence
   suggests that patients with hemoglobin ss sickle cell disease may be impaired even if
   they are free of infarction. We test a hypothesis that cognitive impairment in children
   with hemoglobin ss sickle cell disease is associated with low hematocrit and mr
   imaging abnormalities. Methods: A cohort of 49 patients was examined, all of whom
   had hemoglobin ss sickle cell disease but no history of clinical stroke. The wechsler
   scales, which are standardized and age- adjusted, were used to assess cognitive
   function. Patients also underwent mr imaging examination of the brain, and
   hematocrit was measured in a subset of 45 patients. Mr images were evaluated by at
   least two readers, and abnormal imaging findings were evaluated by at least three
   readers. Any lesion was sufficient to be classified as abnormal, with lesions defined
   to include lacunar infarction, encephalomalacia, or leukoencephalopathy. Hematocrit
   data were used if obtained within 3 months of psychometric testing and if there were
   no confounding events in the patients' charts. Wechsler test scores were then
   evaluated in relation to imaging findings and hematocrit values. Results: Patients
   with imaging abnormalities had more cognitive impairment than did patients with
   normal imaging findings in verbal intelligence quotient (P < .02) And verbal
   comprehension (P < .01). Patients with low hematocrit had cognitive impairment
   shown by many performance measures, including full-scale intelligence quotient (P
   < .006), Verbal comprehension (P < .006), And freedom from distractibility (P < .02).
   Multivariate analysis showed that mr imaging and hematocrit were independent
   predictors of full-scale intelligence quotient. Conclusion: Focal brain injury, revealed
   by mr imaging, is associated with cognitive impairment, but our data suggest that
   diffuse brain injury may also contribute to impairment. These findings show that
   impairment is multifactorial and suggest that chronic brain hypoxia is part of the
   pathophysiology of sickle cell disease
Keywords:       ABNORMALITIES/age/analysis/ANEMIA/brain/brain                hypoxia/brain
   injury/children/chronic/clinical/cognitive/cognitive                  function/cognitive
   cell/sickle cell disease/silent infarct/stroke/testing/USA
Stein, J., Shafqat, S., Doherty, D., Frates, E.P. and Furie, K.L. (2003), Family member
   knowledge and expectations for functional recovery after stroke. American Journal
   of Physical Medicine & Rehabilitation, 82 (3), 169-174.
Abstract: Objective: To assess the stroke knowledge and expectations for recovery
   among the family members of stroke patients in an acute rehabilitation hospital.
   Design: Survey study of 50 family members of stroke patients undergoing inpatient
   rehabilitation at a single urban rehabilitation hospital. Results: Sixty percent of
   participants were able to identify whether their family member had sustained a
   cerebral hemorrhage or infarct; 48% were able to identify at least one treatment
   provided to their family member for his or her stroke. The average length of stay
   predicted by participants closely matched the average patient length of stay.
   Participants tended to overestimate the functional abilities of their family member
   with a stroke, both on initial assessment and discharge. This overestimation was
   more substantial for discharge functional ability than for initial assessment.
   Participants were able to predict discharge location with substantial accuracy (82%
   agreement, kappa = 0.41). Conclusions: The knowledge of stroke etiology and
   functional outcome of family members of individuals undergoing rehabilitation after
   stroke shows significant limitations. Participants' ability to predict functional
   outcome on discharge was worse than their knowledge of current functional status.
   Participant predictions of length of stay and discharge disposition were areas of
   relative strength. Further efforts are needed to enhance the knowledge level of family
   members of patients undergoing rehabilitation after stroke
   hemorrhage/discharge disposition/disposition/EDUCATION/etiology/family/family
   members/functional/functional             ability/functional          outcome/functional
   recovery/functional status/health education/hemorrhage/hospital/infarct/inpatient
   rehabilitation/knowledge/length                                                        of
   stay/location/outcome/PA/patient/patients/RANDOMIZED                    CONTROLLED
   TRIAL/recovery/recovery           after     stroke/rehabilitation/rehabilitation    after
   stroke/status/strength/stroke/stroke patients/treatment/USA
Stephens, R.E., Addington, W.R. and Widdicombe, J.G. (2003), Effect of acute
   unilateral middle cerebral artery infarcts on voluntary cough and the laryngeal cough
   reflex. American Journal of Physical Medicine & Rehabilitation, 82 (5), 379-383.
Abstract: Objective: The purpose of this study was to assess the effect of acute
   unilateral middle cerebral artery (MCA) infarctions in right-handed subjects on their
   ability to elicit voluntary cough (VC), and separately to assess the laryngeal cough
   reflex using the reflex cough test. Design: This prospective, clinical study involved
   30 right-handed, alert subjects with no previous history of stroke or asthma and with
   an infarction of the MCA distribution as seen on computed tomographic or magnetic
   resonance images. Subjects could follow verbal commands. A total of 16 subjects
   had right MCA infarcts and 14 had left MCA infarcts. VC responses and reflex
   cough test results were compared with the side of the infarct. The reflex cough test
   used nebulized tartaric acid. Results: The laryngeal cough reflex was normal in all 30
   subjects, irrespective of side of MCA infarction, and none developed aspiration
   pneumonia. Eleven of the 14 subjects who had a left MCA infarct had an abnormal
   VC (78.6%) and showed cough apraxia. All 16 subjects with right infarcts produced
   a VC. Subjects with left infarcts were more likely to have an abnormal VC than those
   subjects with right lesions (P < 0.001). Conclusions: VC is of limited use in
   screening subjects for aspiration pneumonia risk. A normal laryngeal cough reflex
   indicated a neurologically protected airway
Keywords:                          ability/acute/airway/apraxia/artery/aspiration/aspiration
   pneumonia/asthma/BRONCHIAL                        RESPONSIVENESS/cerebral/cerebral
   artery/clinical/clinical           study/computed              tomographic/cough/cough
   NHALED                            TARTARIC                            ACID/INTERNAL
   resonance/MCA/METHACHOLINE/middle                      cerebral/middle         cerebral
   SA/use/voluntary cough
Stier, C.T., Chander, P.N., Rosenfeld, L. and Powers, C.A. (2003), Estrogen promotes
   microvascular pathology in female stroke- prone spontaneously hypertensive rats.
   American Journal of Physiology-Endocrinology and Metabolism, 285 (1),
Abstract: Estrogen produces both beneficial and adverse effects on cardiovascular
   health via mechanisms that remain unclear. Stroke-prone spontaneously hypertensive
   rats (SHRSP) maintained on Stroke-Prone Rodent Diet and 1% NaCl drinking water
   (starting at 8 wk of age) rapidly develop stroke and malignant nephrosclerosis that
   can be prevented, despite continued hypertension, by drugs targeting angiotensin II
   and aldosterone actions. This study evaluated estrogen's effects in the SHRSP model.
   Female SHRSP that were sham operated (SHAM), ovariectomized (OVX) at 4 wk of
   age, or OVX and treated with estradiol benzoate (E-2, 30 mug-kg(-1).wk(-1)) were
   studied. In a survival protocol, OVX rats lived significantly longer (15.1 +/- 0.3 wk)
   compared with SHAM (13.6 +/- 0.2 wk) or OVX+E-2 rats (12.4 +/- 0.2 wk). In a
   protocol in which animals were matched for age, at 11.5 wk, terminal systolic blood
   pressure and urine protein excretion were elevated in SHAM and OVX+E-2 rats
   compared with OVX rats; blood urea nitrogen, renal microvascular and glomerular
   lesions, and plasma renin concentration were elevated in OVX+E-2 relative to
   SHAM or OVX rats. In a survival protocol using intact female SHRSP, treatment
   with an antiestrogen (tamoxifen, 7 prolonged survival by >2 wk
   compared with controls (P < 0.01). The data indicate that estrogen promotes
   microangiopathy in the kidney and stroke in saline-drinking SHRSP
Keywords:              adverse            effects/age/aldosterone/angiotensin/angiotensin
   II/animals/antiestrogen/blood/blood                  pressure/blood                urea
   nal microangiopathy/renin/SHR/SHRSP/spontaneously hypertensive/spontaneously
   hypertensive rats/stroke/stroke prone/stroke prone spontaneously hypertensive
   rats/stroke- prone spontaneously hypertensive/stroke- prone spontaneously
   hypertensive         rats/survival/systolic/systolic       blood/systolic        blood
Tamura, H., Takahashi, S., Kurihara, N., Yamada, S., Hatazawa, J. and Okudera, T.
   (2003), Practical visualization of internal structure of white matter for image
   interpretation: Staining a spin-echo T2-weighted image with three echo-planar
   diffusion-weighted images. American Journal of Neuroradiology, 24 (3), 401-409.
Abstract: Background and purpose: To our knowledge, no method satisfactory for
   clinical use has been developed to visualize white matter fiber tracts with
   diffusion-weighted mr imaging. The purpose of this study was to determine whether
  superposition of a spin-echo t2-weighted image and a color- coded image derived
  from three orthogonal diffusion-weighted images could show fiber tract architecture
  of the brain with an image quality appropriate for accurate reading with a computer
  monitor. Methods: Mr images from 50 consecutive cases were reviewed. Three
  diffusion-weighted images per section were acquired with three orthogonal
  motion-probing gradients. These images were registered to a corresponding
  spin-echo t2-weighted image. A color-coded image was synthesized from three
  diffusion-weighted images by assigning red, green, or blue to each
  diffusion-weighted image and then adding a spin-echo t2- weighted image with a
  weighting factor. The ability of the superposed image to delineate the white matter
  pathways was evaluated on the basis of the known anatomy of these pathways and
  qualitatively compared with that of the spin-echo t2- weighted image. Results: The
  main white matter fiber pathways, in particular the superior longitudinal fascicle,
  corpus callosum, tapetum, optic radiation, and internal capsule, were more clearly
  and easily identified on the superposed image than on the spin-echo t2-weighted
  image. The time required to produce the superposed image was approximately 40
  minutes. Conclusion: Superposition of a spin-echo t2-weighted image and a
  color-coded image created from three orthogonal diffusion- weighted images showed
  structures of the brain that were not clearly visible on the spin-echo t2-weighted
  image alone. Such superposition presents images that are easy to interpret correctly
Keywords: ability/ACUTE STROKE/anatomy/ANISOTROPY/appropriate/AXONAL
  PROJECTIONS/brain/clinical/color/computer/corpus callosum/diffusion/diffusion
  weighted/diffusion weighted image/diffusion weighted images/diffusion-
  weighted/diffusion-weighted/diffusion-weighted                image/diffusion-weighted
  images/echo                                       planar/fiber/HUMAN-BRAIN/image
  capsule/Japan/knowledge/longitudinal/monitor/MR-IMAGES/MYELIN                   FIBER
  echo/structure/tract/TRACTS/USA/use/WATER DIFFUSION/white matter
Torroni, A., Campos, Y., Rengo, C., Sellitto, D., Achilli, A., Magri, C., Semino, O.,
  Garcia, A., Jara, P., Arenas, J. and Scozzari, R. (2003), Mitochondrial DNA
  haplogroups do not play a role in the variable phenotypic presentation of the A3243G
  mutation. American Journal of Human Genetics, 72 (4), 1005-1012.
Abstract: Thirty-five mitochondrial (mt) DNAs from Spain that harbor the mutation
  A3243G in association with either MELAS ( mitochondrial myopathy,
  encephalopathy, lactic acidosis, and strokelike episodes) syndrome or a wide array of
  disease phenotypes ( ranging from diabetes and deafness to a mixture of chronic
  progressive external ophthalmoplegic symptoms and strokelike episodes) were
  studied by use of high-resolution restriction fragment length polymorphism analysis
  and control- region sequencing. A total of 34 different haplotypes were found,
  indicating that all instances of the A3243G mutation are probably due to independent
  mutational events. Haplotypes were distributed into 13 haplogroups whose
  frequencies were close to those of the general Spanish population. Moreover, there
  was no statistically significant difference in haplogroup distribution between patients
  with MELAS and those with disease phenotypes other than MELAS. Overall, these
  data indicate that the A3243G mutation harbors all the evolutionary features
  expected from a severely deleterious mtDNA mutation under strong negative
  selection, and they reveal that European mtDNA backgrounds do not play a
  substantial role in modulating the mutation's phenotypic expression
Keywords:                                                               A3243G/A3243G
   istribution/DNA/ENCEPHALOPATHY/general/HEREDITARY                              OPTIC
   NEUROPATHY/high                                                   resolution/HUMAN
   MUTATION/mitochondrial/mitochondrial                      myopathy/mtDNA/mtDNA
   MUTATION/polymorphism/population/presentation/progressive/restriction fragment
   length                                polymorphism/selection/Spain/STROKE-LIKE
   EPISODES/symptoms/syndrome/TRANSFER                                  RNALEU(UUR)
Trebst, C., Staugaitis, S.M., Kivisakk, P., Mahad, D., Cathcart, M.K., Tucky, B., Wei,
   T., Rani, M.R.S., Horuk, R., Aldape, K.D., Pardo, C.A., Lucchinetti, C.F., Lassmann,
   H. and Ransohoff, R.M. (2003), CC chemokine receptor 8 in the central nervous
   system is associated with phagocytic macrophages. American Journal of Pathology,
   162 (2), 427-438.
Abstract: CC chemokine receptor 8 (CCR8) has been detected in vitro on type 2 helper
   and regulatory lymphocytes, which might exert beneficial functions in multiple
   sclerosis (MS) and on macrophages and microglia, possibly promoting tissue injury
   in MS lesions. To discriminate the relevant expression pattern in vivo, we defined the
   cell types that expressed CCR8 in MS lesions and determined the relationship of
   CCR8 expression and demyelinating activity. CCR8 was not expressed on T cells but
   was associated with phagocytic macrophages and activated microglia in MS lesions
   and directly correlated with demyelinating activity. To identify factors associated
   with CCR8 expression, the study was extended to other central nervous system (CNS)
   pathologies. CCR8 was consistently expressed on phagocytic macrophages and
   activated microglia in stroke and progressive multifocal leukoencephalopathy, but
   not expressed on microglia in pathologies that lacked phagocytic macrophages such
   as senile change of the Alzheimer's type. CCR8 was up-regulated by macrophage
   differentiation and activating stimuli in vitro. In summary CNS CCR8 expression
   was associated with phagocytic macrophages and activated microglial cells in human
   CNS diseases, suggesting that CCR8 may be a feasible target for therapeutic
   intervention in MS. CCR8 expression may also indicate a selective program of
   mono-nuclear phagocyte gene expression
Keywords: activity/Alzheimer's type/BRAIN-LESIONS/CELLS/central nervous
   ALLERGIC                         ENCEPHALOMYELITIS/EXPRESSION/gene/gene
   expression/human/I-309/IDENTIFICATION/in                                       vitro/in
   s/microglia/microglial                      cells/MONOCYTE/MS/multiple/multiple
   sclerosis/MULTIPLE-SCLEROSIS                              LESIONS/nervous/nervous
   system/PATHOLOGY/progressive/receptor/stroke/therapeutic/type 2/USA
Tsushima, Y., Aoki, J. and Endo, K. (2003), Brain microhemorrhages detected on
   T2*-weighted gradient-echo MR images. American Journal of Neuroradiology, 24
   (1), 88-96.
Abstract: BACKGROUND AND PURPOSE: Multifocal microhemorrhages have been
   reported to be commonly found in the brain of patients with systemic hypertension
   and spontaneous brain hemorrhage. The factors associated with these lesions
   detected on T2*-weighted gradient-echo images were examined to determine
   whether these lesions serve to indicate different types of microangiopathy and to
  predict a patient's risk for symptomatic hemorrhage. METHODS: The study
  population consisted of 2164 patients who underwent 2416 consecutive brain MR
  imaging studies performed during 3 years. The patients with intracerebral
  hemorrhages due to vascular malformations, neoplasms, trauma, or intracranial
  surgery and those with incomplete medical records were excluded; 2019 cases were
  analyzed. RESULTS: The overall incidence of microhemorrhages was 9.8%,
  predominantly in the lentiform nucleus (n = 96), thalamus (n = 88), and cortical-
  subcortical region (n = 93). Presence of microhemorrhages had the highest
  significant correlation with history of hemorrhagic stroke (P < .0001); advancing age,
  hypertension, and prominent white matter hyperintensity on T2-weighted images had
  the next highest significant correlation. Cortical-subcortical microhemorrhages were
  more frequently observed in patients who had previous lobar hemorrhagic stroke (P
  < .005). Among 139 patients with microhemorrhages who could be clinically
  followed up for more than 1 month, four (2.9%) had new hemorrhagic stroke.
  CONCLUSION: The presence of microhemorrhages may be not only a direct marker
  of bleeding-prone small-vessel diseases but also an indicator of different types of
  microangiopathy and a predictor of further hemorrhagic stroke
Keywords:                   ABNORMALITIES/age/APOLIPOPROTEIN-E/brain/brain
  hemorrhage/CEREBRAL                                                        AMYLOID
  T                                                                 INTRACEREBRAL
  mus/trauma/USA/vascular/vascular malformations/white matter
Unger, T. (2003), The ongoing telmisartan alone and in combination with Ramipril
  Global Endpoint Trial program. American Journal of Cardiology, 91 (10), 28G-34G.
Abstract: The renin-angiotensin system evolved to maintain volume homeostasis and
  blood pressure and to prevent ischemia during acute volume loss. But in the present
  age, these mechanisms are redundant, and the clinical significance of angiotensin II
  results from its pathologic effects, which are mediated by the angiotensin II type 1
  (AT,) receptor. Activation of AT, receptors has been linked to pathologic processes
  that contribute to atherosclerosis and ischemic events, including oxidative stress,
  inflammatory processes, low-density lipoprotein cholesterol trafficking, and
  prothrombotic states. The Ongoing Telmisartan Alone and in Combination with
  Ramipril Global Endpoint Trial (ONTARGET) program will compare the efficacy of
  the angiotensin II receptor blocker (ARB) telmisartan, the angiotensin-converting
  enzyme (ACE) inhibitor ramipril, and combination therapy with telmisartan plus
  ramipril for reducing cardiovascular risk. The ARB telmisartan is distinguished by its
  long duration of action, which compares favorably with some other ARBs and
  conventional antihypertensives. Ramipril was shown in the Heart Outcomes
  Prevention Evaluation (HOPE) study to reduce the risk for myocardial infarction (MI)
  and other cardiovascular events in patients at high risk for cardiovascular events but
  without heart failure or a low ejection fraction. The ONTARGET program consists
  of 2 randomized, double-blind, multicenter international trials: a principal trial,
  ONTARGET, and a parallel trial, Telmisartan Randomized Assessment Study in
  ACE- I Intolerant Patients with Cardiovascular Disease (TRANSCEND). The
  treatment arms for the principal ONTARGET study are telmisartan 80 mg, ramipril
  10 mg, and combination therapy with telmisartan 80 mg plus ramipril 10 mg; for the
  parallel study TRANSCEND, the treatment arms are telmisartan 80 mg and placebo.
  Both trials will assess cardiovascular outcomes in patients at high risk using the same
  criteria as that of the HOPE study, with a single exception: the TRANSCEND trial
  will enroll patients who do not tolerate ACE inhibitor treatment. The primary end
  points in both ONTARGET and TRANSCEND are death caused by cardiovascular
  disease, acute MI, stroke, and hospitalization because of congestive heart failure. The
  secondary end points include newly diagnosed heart failure, revascularization,
  new-onset type 2 diabetes mellitus, nephropathy, cognitive decrease and dementia,
  and newly diagnosed atrial fibrillation; these will be used for hypothesis generation.
  (C) 2003 by Excerpta Medica, Inc
Keywords:       ACE/ACE        inhibitor/ACE-inhibitor/action/acute/acute      MI/ACUTE
  BLOOD-PRESSURE/angiotensin/angiotensin              converting       enzyme/angiotensin
  II/angiotensin II receptor/angiotensin II receptor blocker/angiotensin-converting
  fibrillation/blocker/blood/blood                pressure/cardiovascular/cardiovascular
  disease/cardiovascular        events/cardiovascular       risk/cholesterol/CIRCADIAN
  therapy/congestive/congestive                heart               failure/CONVERTING
  mellitus/disease/duration/effects/efficacy/ejection/ejection                 fraction/end
  DYSFUNCTION/lipoprotein/loss/low                density          lipoprotein/low-density
  lipoprotein/low-density                                                        lipoprotein
  al                            infarction/nephropathy/NEW-YORK/outcomes/oxidative
  R          ANTAGONIST                IRBESARTAN/receptors/renin               angiotensin
  system/results/revascularization/risk/secondary/stress/stroke/SUDDEN CARDIAC
  DEATH/telmisartan/therapy/TO-                                              MODERATE
  HYPERTENSION/treatment/trial/trials/type 2/type 2 diabetes/type 2 diabetes
Vaughan, C.J. (2003), Prevention of stroke and dementia with statins: Effects beyond
  lipid lowering. American Journal of Cardiology, 91 (4A), 23B-29B.
Abstract: Stroke is a major cause of mortality and morbidity. The epidemiologic
  association between elevated serum cholesterol and stroke risk is controversial.
  However, recent secondary prevention studies with 3-hydroxy-3-methylglutaryl
  coenzyme A reductase inhibitors (statins) have demonstrated a significant reduction
  in ischemic stroke without an increase in hemorrhagic stroke. Statins probably
  reduce stroke by a variety of mechanisms, including modulation of precerebral
  atherothrombosis in the aorta and the carotid artery, thus preventing plaque
  disruption and artery-to-artery thromboembolism. Statins also improve endothelial
  homeostasis by increasing the bioavailability of nitric oxide, which orchestrates the
  paracrine antiatherosclerotic functions of the endothelium. Studies in experimental
  models of ischemic stroke show that statin therapy reduces brain infarct size and
  improves neurologic outcome by directly upregulating brain endothelial nitric oxide
  synthase. Putative anti-inflammatory actions of statins may also contribute to
  neuroprotection and stroke prevention. Although the clinical benefit of statins largely
  depends on lowering low-density lipoprotein cholesterol, accumulating data indicate
  that many of the pleiotropic effects of statins are attributable to the cellular
  consequences of depletion of intermediates in the cholesterol biosynthetic pathway
  (isoprenoids). These molecules play fundamental roles in cell growth, signal
  transduction, and mitogenesis: In addition to reducing stroke risk, emerging data
  suggest that statins may reduce dementia. Further studies are needed to fully address
  the role of statins in the prevention of stroke in patients without established vascular
  disease and the role of cholesterol modulation in the treatment of dementia. (C) 2003
  by Excerpta Medica, Inc
Keywords:          3-hydroxy-3-methylglutaryl          coenzyme         A         reductase
  ability/brain/brain               infarct/carotid/carotid              artery/CAROTID
  REDUCTION/clinical/COA                                                    REDUCTASE
  INHIBITORS/dementia/depletion/disease/effects/endothelial/endothelial nitric oxide
  models/growth/hemorrhagic/hemorrhagic                  stroke/homeostasis/infarct/infarct
  size/inhibitors/INTERVENTION                                  TRIAL/ischemic/ischemic
  stroke/isoprenoids/lipid/lipid-lowering/lipoprotein/low                           density
  lipoprotein/low-density                lipoprotein/low-density                lipoprotein
  FARCTION/neurologic/neurologic             outcome/neuroprotection/NEW-YORK/nitric
  oxide/nitric                       oxide                      synthase/NITRIC-OXIDE
  prevention/serum/serum           cholesterol/signal        transduction/size/statin/statin
  therapy/statins/stroke/stroke                                          prevention/stroke
  risk/therapy/thromboembolism/treatment/USA/vascular/vascular disease
Vinik, A.I. and Vinik, E. (2003), Prevention of the complications of diabetes. American
  Journal of Managed Care, 9 (3), S63-S80.
Abstract: For patients with diabetes mellitus (DM), chronic complications can be
  devastating. Cardiovascular illness, the major cause of morbidity and mortality
  among these patients, encompasses macrovascular disease, with heart attacks, strokes,
  and gangrene; and microvascular disease, with retinopathy, nephropathy, and
  neuropathy (somatic and autonomic). Macrovascular events occur earlier in
  individuals with DM than in people without DM, and the underlying pathologies are
  often more diffuse and severe. Diabetic arteriopathy, which encompasses endothelial
  dysfunction, inflammation, hypercoagulability, changes in blood flow, and platelet
  abnormalities, contributes to the early evolution of these events. Efforts are under
  way to determine interventions that may have the potential to prevent or halt the
  complications of DM. Tight glucose and blood pressure (BP) control is known to
  improve the vascular status of patients with DM by varying degrees. Use of
  anti-inflammatory drugs and lowering low- density lipoprotein cholesterol (LDLC)
  levels are also useful. An emerging understanding of the importance of small, dense
  LDL-C and the anti-inflammatory effects of statins has provided new algorithms for
  primary prevention of macrovascular disease. Antiplatelet agents have also been
  shown to be effective in the secondary prevention of cardiovascular events. In the
  ideal world every risk factor would be addressed and each person with DM would
  have excellent glycemic control, low to normal BP, and a low LDL level, and would
  be taking an angiotensin-converting enzyme (ACE) inhibitor, together with a statin,
  aspirin, and clopidogrel. Under these near-perfect conditions, the emerging epidemic
  of macrovascular disease could be contained. Microvascular disease, however, is a
  consequence of hyperglycemia. For every 1% reduction in glycosylated hemoglobin
  it is possible to achieve a 22% to 35% reduction in the microvascular complications.
  BP control is vital and the liberal use of ACE inhibitors and angiotensin receptor
  blockers to slow the progression of renal disease should drastically reduce the,
  incidence of blindness, dialysis, and amputations. This article provides an overview
  of prevention of macrovascular disease such as stroke, myocardial infarction, and
  peripheral arterial. disease and microvascular complications such as retinopathy,
  nephropathy, and neuropathy in patients with DM
Keywords:                                                       abnormalities/ACE/ACE
  inhibitors/AI/algorithms/amputations/angiotensin/angiotensin                 converting
  enzyme/angiotensin                receptor            blockers/angiotensin-converting
  lood/blood             flow/blood           pressure/BP/cardiovascular/cardiovascular
  mplications                       of                    diabetes/control/CORONARY
  protein/low               density            lipoprotein/macrovascular/macrovascular
  disease/MELLITUS/microvascular/microvascular              complications/microvascular
  disease/morbidity/morbidity        and      mortality/mortality/myocardial/myocardial
  prevention/progression/receptor/renal/renal                disease/retinopathy/risk/risk
Vo, K.D., Santiago, F., Lin, W.L., Hsu, C.Y., Lee, Y. and Lee, J.M. (2003), MR
  imaging enhancement patterns as predictors of hemorrhagic transformation in acute
  ischemic stroke. American Journal of Neuroradiology, 24 (4), 674-679.
Abstract: BACKGROUND AND PURPOSE: Early parenchymal gadolinium
  enhancement on T1-weighted MR images is predictive of hemorrhagic
  transformation (HT) in rodent focal ischemia models, but its value in humans is
  unknown. We sought to investigate gadolinium enhancement in acute ischemic
  stroke patients to determine their association with subsequent HT. METHODS: We
  retrospectively examined 22 patients with ischemic stroke who underwent MR
  imaging within 4.9 hours (+/-1.4) of symptom onset. Patients receiving intravenous
  tissue plasminogen activator (tPA) (n = 6) were included. Twenty-one patients
  underwent repeat MR studies at 48 hours, 13 underwent additional MR imaging at I
  week, and one underwent follow-up head CT at 24 hours. Initial images were
  analyzed for enhancement patterns (vascular, meningeal, parenchymal). Follow-up
  T2- and T2*-weighted images were evaluated for hemorrhage. RESULTS: In all
  patients, initial MR images showed vascular enhancement in the vascular territory of
  the stroke lesion: 19 with vascular enhancement alone and three with vascular and
  parenchymal enhancement. All three patients with both enhancement patterns had
  HT: two large and symptomatic, and one asymptomatic (petechial hemorrhage).
  They received tPA before MR imaging. None of the patients without early
  parenchymal enhancement developed symptomatic hemorrhage. Six (32%) patients
  with vascular enhancement alone had petechial hemorrhage at follow-up imaging. In
  this limited sample, initial mean volumes on diffusion-weighted images, National
  Institute of Health Stroke Scale scores, and intervals from stroke onset to imaging
  did not differ between patients with vascular and parenchymal enhancement versus
  those with vascular enhancement alone. CONCLUSION. Early parenchymal
  enhancement of stroke lesions may be a good predictor of subsequent symptomatic
  HT may help identify patients at risk, especially after thrombolytic therapy
Keywords:         acute/acute     ischemic/acute       ischemic      stroke/APPARENT
  OCCLUSION/COMPUTED                   TOMOGRAPHIC              FINDINGS/CT/diffusion
  weighted/diffusion        weighted       images/diffusion-weighted/diffusion-weighted
  images/EMBOLIC                     STROKE/focal/focal                  ischemia/follow
  c                                      stroke/lesion/MICROBLEEDS/models/MR/MR
  activator/predictive/predictor/predictors/RISK/stroke/stroke               onset/stroke
  patients/therapy/thrombolytic/THROMBOLYTIC THERAPY/tissue plasminogen
  activator/TISSUE-PLASMINOGEN ACTIVATOR/tPA/USA/vascular/week
Wecht, J.M., De Meersman, R.E., Weir, J.P., Spungen, A.M. and Bauman, W.A. (2003),
  Cardiac homeostasis is independent of calf venous compliance in subjects with
  paraplegia. American Journal of Physiology-Heart and Circulatory Physiology, 284
  (6), H2393-H2399.
Abstract: The purpose of this study was to examine cardiac hemodynamics during acute
  head-up tilt (HUT) and calf venous function during acute head-down tilt (HDT) in
  subjects with paraplegia compared with sedentary nondisabled controls. Nineteen
  paraplegic males (below T6) and nine age-, height-, and weight-matched control
  subjects participated. Heart rate, stroke volume, and cardiac output were assessed
  using the noninvasive acetylene uptake method. Venous vascular function of the calf
  was assessed using venous occlusion plethysmography. After supine measurements
  were collected, the table was moved to 10degrees HDT followed by the three levels
  of HUT (10, 35, and 75degrees) in random order. Cardiac hemodynamics were
  similar between the groups at all positions. Calf circumference was significantly
  reduced in the paraplegic group compared with the control group (P < 0.001).
  Venous capacitance and compliance were significantly reduced in the paraplegic
  compared with control group at supine and HDT. Neither venous capacitance (P =
  0.37) nor compliance (P = 0.19) increased from supine with 10&DEG; HDT in the
  paraplegic group. A significant linear relationship was established between supine
  venous compliance and supine cardiac output in the control group (r = 0.80, P < 0.02)
  but not in the paraplegic group. The findings of reduced calf circumference and
  similar venous capacitance at supine rest and 10degrees HDT in the paraplegic group
  imply that structural changes may have limited venous dispensability in individuals
  with chronic paraplegia. Furthermore, the lack of a relationship between supine
  venous compliance and supine cardiac output suggests that cardiac homeostasis does
  not rely on venous compliance in subjects with paraplegia
Keywords:                                                    acute/age/calf/cardiac/cardiac
  RCISE/function/head down tilt/head up tilt/head-up tilt/HEART/HEMODYNAMIC-
  keletal      muscle      mass      atrophy/spinal       cord     injury/SPINAL-CORD
  capacitance/venous compliance/volume
Wikholm, G. (2003), Transarterial embolectomy in acute stroke. American Journal of
  Neuroradiology, 24 (5), 892-894.
Abstract: BACKGROUND AND PURPOSE: An embolus causing cerebral ischemia is
  a major cause of death and disability, and the search for methods to reestablish blood
  flow is of major importance. A technique for the emergent primary treatment of
  cerebral emboli causing stroke is presented in detail. METHODS: The method
  developed implies the mechanical extraction of the embolus with a standard vascular
  retrieval snare via the endovascular route without the use of thrombolytic agents.
  RESULTS: Five consecutive patients were treated to extract an embolus. All patients
  had substantial improvement in their clinical status. No revascularization
  hemorrhages occurred. CONCLUSION: In this small series, the embolectomy
  method described was reproducible, rapid, and safe. It may offer an alternative to
  other methods of vascular recanalization
Keywords: acute/acute stroke/blood/blood flow/cause/cause of death/cerebral/cerebral
Wong, A.M.K., Leong, C.P., Su, T.Y., Yu, S.W., Tsai, W.C. and Chen, C.P.C. (2003),
  Clinical trial of acupuncture for patients with spinal cord injuries. American Journal
  of Physical Medicine & Rehabilitation, 82 (1), 21-27.
Abstract: Objective: To examine whether electrical acupuncture therapy through
  adhesive surface electrodes and concomitant auricular acupuncture therapy could
  improve the neurologic or functional recovery in acute traumatic spinal cord injury
  patients. Design: A total of 100 acute traumatic spinal cord injury patients with
  American Spinal Injury Association (ASIA) impairment grading of A and B were
  recruited into this study. They were randomly divided into the acupuncture and
  control groups. In the acupuncture group, electrical acupuncture therapy via the
  adhesive surface electrodes were applied to the bilateral Hou Hsi (SI3) and Shen Mo
  (B62) acupoints. In auricular acupuncture, four acupoints related to the spinal cord
  were selected for stimulation at the antihelix, helix, and lower portion of the ear-back
  areas. Acupuncture therapy was initiated early in the emergency room setting or soon
  after spinal surgical intervention. Rehabilitation therapy was also provided to the
  patients during acupuncture therapy. In the control group, only rehabilitation therapy
  was provided to the patients. Neurologic and functional scores were assessed during
  the time of admission, hospital discharge, and 1-yr postinjury follow-up. Results:
  There were significant improvements in neurologic (sensory and motor), functional,
  and FIM(TM) scores in the acupuncture group compared with the initial admission
  period when assessed during the time of hospital discharge and the 1-yr postinjury
  follow-up. A greater percentage of patients in the acupuncture group recovered to a
  higher ASIA impairment grading. Conclusion: The use of concomitant auricular and
  electrical acupuncture therapies, when implemented early in acute spinal cord injury,
  can contribute to significant neurologic and functional recoveries
Keywords: acupuncture/acute/American Spinal Injury Association/ASIA/auricular
  acupuncture/bilateral/control/electrical    acupuncture/electrodes/emergency/follow
  A/patients/period/recovery/rehabilitation/rehabilitation           therapy/spinal/spinal
  cord/spinal       cord      injuries/spinal     cord       injury/stimulation/STROKE
Marriage, B.J., Clandinin, M.T., MacDonald, I.M. and Glerum, D.M. (2003), The use of
  lymphocytes to screen for oxidative phosphorylation disorders. Analytical
  Biochemistry, 313 (1), 137-144.
Abstract: Biochemical analysis of oxidative phosphorylation (OXPHOS) disorders is
  traditionally carried out on muscle biopsies, cultured fibroblasts, and transformed
  lymphocytes. Here we present a new screening technique using lymphocytes to
  identify OXPHOS dysfunction and initially avoid an invasive diagnostic procedure.
  Lymphocytes represent an easily obtainable source of tissue that presents advantages
  over the use of fibroblasts or lymphoblast cell lines. The time delay in culturing skin
  fibroblasts and the interactions between cell transformation and mitochondrial
  activity are avoided in this methodology. The method requires a small amount of
  blood (<5 mL); can be completed in a few hours, and allows for repeated
  measurements. Our assay has been adapted from published methods utilizing
  cultured fibroblasts and transformed lymphocytes, and our data suggest that
  measurement of ATP synthesis in lymphocytes is an effective screening tool for
  diagnosing OXPHOS disorders. This method may also provide an objective tool for
  monitoring response to treatment and evaluating progression of disease. (C) 2003
  Elsevier Science (USA). All rights reserved
Keywords:                                           activity/analysis/ATP/blood/BRAIN
  MITOCHONDRIA/Canada/COMPLEX-I                  DEFICIENCY/CULTURED                SKIN
  TARY                                                                            OPTIC
  MUTATION/procedure/progression/PROGRESSIVE                                 EXTERNAL
  EPISODES/synthesis/technique/TRANSFER                                  RNALEU(UUR)
Dinkelmann, S. and Northoff, H. (2003), Artificial oxygen carriers - A critical analysis
  of current developments. Anasthesiologie Intensivmedizin Notfallmedizin
  Schmerztherapie, 38 (1), 47-54
  FLUOSOL/CELL-FREE                                  HEMOGLOBIN/CROSS-LINKED
  HEMOGLOBIN/NITRIC-              OXIDE/oxygen/oxygen          carriers/RECOMBINANT
Albahrani, M.J., Swaminathan, M., Phillips-Bute, B., Smith, P.K., Newman, M.F.,
  Mathew, J.P. and Stafford-Smith, M. (2003), Postcardiac surgery complications:
  Association of acute renal dysfunction and atrial fibrillation. Anesthesia and
  Analgesia, 96 (3), 637-643.
Abstract: Postoperative creatinine increase is associated with adverse outcome after
  cardiac surgery. Although postoperative stroke and renal dysfunction are associated
  after cardiac surgery, suggesting a common systemic insult, a similar assessment of
  atrial fibrillation and renal dysfunction has not been performed. Therefore, we tested
  the hypothesis that patients with new-onset atrial fibrillation complicating coronary
  bypass surgery have a greater postoperative creatinine increase. Data were obtained
  for 453 elective coronary bypass surgery patients with no history of atrial fibrillation.
  Multivariate regression analyses of factors associated with peak fractional change in
  creatinine demonstrated a two-way interaction between age and atrial fibrillation
  (variable estimate, -1.1; P = 0.002). Similar results were obtained in a secondary
  multivariate model analyzing factors associated with peak postoperative creatinine
  (variable estimate, -0.01; P = 0.04). We confirmed our hypothesis that patients with
  new-onset atrial fibrillation are more likely to have acute renal dysfunction after
  cardiac surgery. The association of atrial fibrillation and creatinine increase
  diminishes with advancing age. These data are consistent with a common
  pathophysiology that contributes in an age-dependent fashion to the etiology of both
  acute renal dysfunction and. atrial fibrillation after coronary bypass surgery
Keywords:            acute/adverse        outcome/age/assessment/association/atrial/atrial
  fibrillation/bypass/BYPASS GRAFT-SURGERY/bypass surgery/C-REACTIVE
  BYPASS/common/complications/coronary/coronary                bypass/coronary     bypass
  e/postoperative                    stroke/PREDICTORS/regression/renal/RESOURCE
Welsby, I.J., Ryan, J.M., Booth, J.V., Flanagan, E., Messier, R.H. and Borel, C.O.
  (2003), The bispectral index in the diagnosis of perioperative stroke: A case report
  and discussion. Anesthesia and Analgesia, 96 (2), 435-437
Keywords:                  ARREST/CAROTID                     ENDARTERECTOMY/case
  report/diagnosis/index/PA/perioperative stroke/stroke/THERAPY/USA
Wiesenack, C., Prasser, C., Rodig, G. and Keyl, C. (2003), Stroke volume variation as
  an indicator of fluid responsiveness using pulse contour analysis in mechanically
  ventilated patients. Anesthesia and Analgesia, 96 (5), 1254-1257.
Abstract: Assessment of cardiac performance and adequate fluid replacement of a
  critically ill patient are important goals of a clinician. We designed this study to
  evaluate the ability of stroke volume variation (SVV), derived from pulse contour
  analysis, and frequently used preload variables (central venous pressure and
  pulmonary capillary wedge pressure) to predict the response of stroke volume index
  and cardiac index to volume replacement in normoventilated cardiac surgical patients.
  We studied 20 patients undergoing elective coronary artery bypass grafting. After the
  induction of anesthesia, hemodynamic measurements were performed before (T1)
  and subsequent to volume replacement by infusion of 6% hydroxyethyl starch
  200/0.5 (7 mL/kg) with a rate of 1 mL . kg(-1) . min(-1). Except for heart rate, all
  hemodynamic variables changed significantly (P < 0.01) after volume loading.
  Linear regression analysis between SVV at baseline (T1) and DeltaSVV after volume
  application showed a significant correlation (r = -0.97; P < 0.01), whereas linear
  regression analysis between SVV (T1) and percentage changes of stroke volume
  index (r = 0.19) and cardiac index (r = 0.17) did not reveal a significant relationship
  between variables. The results of our study suggest that SVV derived from pulse
  contour analysis cannot serve as an indicator of fluid responsiveness in
  normoventilated cardiac surgical patients
Keywords:              ability/analysis/anesthesia/artery/bypass/capillary/cardiac/cardiac
  index/cardiac            performance/CARDIAC-SURGERY/central                        venous
  pressure/changes/coronary/coronary artery/coronary artery bypass/coronary artery
  bypass      grafting/correlation/critically    ill/critically     ill    patient/fluid/fluid
  replacement/fluid                 responsiveness/Germany/grafting/GUIDE/heart/heart
  rate/hemodynamic/hemodynamic             variables/hydroxyethyl         starch/index/linear
  e/pulse      contour      analysis/regression/regression        analysis/RESPIRATORY
  SHOCK/stroke/stroke        volume/stroke      volume        variation/surgical/SYSTOLIC
  PRESSURE VARIATION/T1/THERAPY/USA/venous pressure/volume/volume
  loading/volume replacement/wedge pressure
Hogue, C.W., De Wet, C.J., Schechtman, K.B. and Davila-Roman, V.G. (2003), The
  importance of prior stroke for the adjusted risk of neurologic injury after cardiac
  surgery for women and men. Anesthesiology , 98 (4), 823-829.
Abstract: Background: Women arc at higher risk for stroke after cardiac surgery than
  men. Prior analysis of risk profiles for perioperative stroke that have mostly
  combined data from women and men may fail to identify gender-specific risks. The
  purpose of this study was to evaluate whether patient gender impacts adjusted risk
  for stroke after cardiac surgery. Methods. Demographic and perioperative data were
  prospectively collected from 2,972 patients undergoing cardiac surgery. Carotid
  artery ultrasound examination was performed before surgery for patients aged 65 yr
  or older or when there was a history of transient ischemic attacks or prior stroke.
  Epiaortic ultrasound was performed at the time of surgery in all patients to assess for
  atherosclerosis of the ascending aorta. Results: Strokes occurred after surgery in 30
  women and 18 men (P < 0.0001). Based on multivariate logistic regression analysis,
  a history of a stroke was the strongest predictor of new stroke for both women and
  men. Low cardiac output syndrome, atherosclerosis of the ascending aorta, and
  diabetes mellitus were significantly associated with stroke for women but not for
  men. Analysis on the data from all patients using a gender- interaction term found
  that the risk for stroke associated with patient age, atherosclerosis of the aorta,
  diabetes, and duration of cardiopulmonary bypass was not affected by gender. The
  prior stroke-gender interaction, however, was significant (P = 0.017), suggesting that
  a prior cerebrovascular event was a more important predictor of stroke for men than
  women. Conclusions: These data show that prior stroke before surgery is strongly
  and independently associated with susceptibility for stroke after cardiac surgery,
  particularly for men. Other risk factors for perioperative stroke, though, do not
  appear to be influenced by patient gender
Keywords:                                                                            ACUTE
  GRAFT-SURGERY/cardiac/cardiac                                                output/cardiac
  surgery/cardiopulmonary/cardiopulmonary bypass/cerebrovascular/cerebrovascular
  PREDICTOR/injury/interaction/ischemic/ischemic                            attacks/logistic
  stroke/predictor/regression/regression                                  analysis/risk/risk
  PATIENTS/susceptibility/syndrome/transient/transient                            ischemic
Kakinohana, M., Marsala, M., Carter, C., Davison, K. and Yaksh, T.L. (2003),
  Neuraxial morphine may trigger transient motor dysfunction after a noninjurious
  interval of spinal cord ischemia - A clinical and experimental study. Anesthesiology,
  98 (4), 862-870.
Abstract: Background: A patient underwent repair of a thoracoabdominal aortic
  aneurysm. Epidural morphine, 4 mg, was given for pain relief. After anesthesia, the
  patient displayed lower extremity paraparesis. This effect was reversed by naloxone.
  The authors sought to confirm these observations using a rat spinal ischemia model
  to define the effects of intrathecal morphine administered at various times after
  reflow on behavior and spinal histopathology. Methods: Spinal cord ischemia was
  induced for 6 min using an intraaortic balloon. Morphine or saline, 30 mug, was
  injected intrathecally at 0.5, 2, or 24 h after reflow. in a separate group, spinal cord
  temperature was decreased to 27degreesC before ischemia. After ischemia, recovery
  of motor function was assessed periodically using the motor deficit index (0 =
  complete recovery; 6 = complete paraplegia). Results: After ischemia, all rats
  showed near- complete recovery of function by 4-6 h. intrathecal injection of
  morphine at 0.5 or 2 h of reflow (but not at 24 h) but not saline caused a development
  of hind limb dysfunction and lasted for 4.5 h (motor deficit index score = 4-6). This
  effect was reversed by intrathecal naloxone (30 mug). Intrathecal morphine
  administered after hypothermic ischemia was without effect. Histopathological
  analysis in animals that received intrathecal morphine at 0.5 or 2 h after ischemia
  (but not at 24 h) revealed dark-staining a motoneurons and interneurons. Intrathecal
  saline or spinal hypothermia plus morphine was without effect. Conclusions: These
  data indicate that during the immediate reflow following a noninjurious interval of
  spinal ischemia, intrathecal morphine potentiates motor dysfunction. Reversal by
  naloxone suggests that this effect results from an opioid receptor-mediated
  potentiation of a transient block of inhibitory neurons initiated by spinal ischemia
Keywords:             AMINO-ACID/analysis/anesthesia/aneurysm/animals/aortic/aortic
  /effect/effects/experimental/experimental                       study/extremity/FOCAL
  MORPHINE/ischemia/lower/model/morphine/motor/motor                          deficit/motor
  relief/paraplegia/patient/PHARMACOLOGY/RAT/rats/recovery/recovery                       of
  function/repair/results/saline/score/spinal/spinal cord/spinal cord ischemia/spinal
Yano, T., Anraku, S., Nakayama, R. and Ushijima, K. (2003), Neuroprotective effect of
  urinary trypsin inhibitor against focal cerebral ischemia-reperfusion injury in rats.
  Anesthesiology, 98 (2), 465-473.
Abstract: Background: Acute inflammatory reactions cause neuronal damage in cerebral
  ischemia-reperfusion. Urinary trypsin Inhibitor (UTI), a serine protease inhibitor, is
  cytoprotective against ischemia-reperfusion injury in the liver, intestine, kidney,
  heart, and lung through its antiinflammatory activity. Neuroprotective action of UTI
  on transient global cerebral ischemia has been documented. This is the first study to
  determine whether UTI is neuroprotective against transient focal cerebral ischemia.
  Methods: Adult male Wistar rats were randomly assigned to the following treatment
  groups: 0.9% saline (control, n = 9); 100,000 U/kg UTI (n = 9); and 300,000 U/kg
  UTI (n = 9). Treatments were performed intravenously 10 min before right middle
  cerebral artery occlusion for 2 h and subsequent reperfusion. Ninety-six hours after
  the onset of reperfusion, the motor neurologic deficit and the cerebral infarct size
  were evaluated. Furthermore, immunohistochemical staining for myeloperoxidase
  and nitrotyrosine to count infiltrating neutrophils and nitrated cells, respectively, was
  performed on the brain sections. Results: Infarct volume in the 300,000 U/kg UTI
  group was smaller than in the 100,000 U/kg UTI and saline control groups (P < 0.05).
  Treatment with 300,000 U/kg UTI showed a trend to improve neurologic outcome
  but did not reach statistical significance (P = 0.0693). The significant decrease in
  neutrophil infiltration was observed in the ischemic hemisphere treated with 300,000
  U/kg UTI compared with saline control (P < 0.05). Nitrotyrosine deposition in the
  ischemic hemisphere was significantly reduced in the 300,000 U/kg UTI group
  compared with saline control and 100,000 U/kg UTI groups (P < 0.05). Conclusions.
  Intravenous pretreatment with 300,000 U/kg UTI reduces focal ischemia-reperfusion
  injury in the rat brain, potentially opening a novel therapeutic avenue for the
  treatment of cerebral ischemia
Keywords:                action/activity/ACUTE                 STROKE/artery/ARTERY
  OCCLUSION/brain/BRAIN INJURY/cause/cerebral/cerebral artery/cerebral artery
  occlusion/cerebral                    infarct/cerebral                 ischemia/cerebral
  ischemia-reperfusion/control/DAMAGE/deposition/effect/focal/focal                cerebral
  ischemia/focal         cerebral        ischemia-reperfusion/global/global        cerebral
  INJURY/ischemic/Japan/kidney/LIVER/lung/male/middle cerebral/middle cerebral
  artery/middle                                 cerebral                             artery
  occlusion/motor/myeloperoxidase/neurologic/neurologic                  deficit/neurologic
  LEUKOCYTES/protease/rat/rat brain/rats/reperfusion/right/saline/serine protease
  INHIBITORS/size/statistical/therapeutic/transient/transient          focal       cerebral
  global/treatment/trypsin/ULINASTATIN/urinary/USA/volume/Wistar/Wistar rats
Kolovou, G.D., Daskalova, D.C., Hatzivassiliou, M., Yiannakouris, N., Pilatis, N.D.,
  Elisaf, M., Mikhailidis, D.P., Cariolou, M.A. and Cokkinos, D.V. (2003), The
  epsilon 2 and 4 alleles of apolipoprotein E and ischemic vascular events in the Greek
  population - Implications for the interpretation of similar studies. Angiology, 54 (1),
Abstract: The authors investigated whether apolipoprotein (apo) E polymorphism has an
  allelic and/or genotypic impact on the risk of an ischemic vascular event (IVE) in
   Greek patients with cardiovascular diseases (CVD). They compared apo E
   polymorphisms in 1) a group of 165 patients with IVE [IVE(+)], of whom 107 had
   survived a myocardial infarction and 58 an ischemic stroke; 2) a group of 165
   patients, matched with the first group for age and gender, with angiographically
   confirmed coronary artery disease but without IVE [IVE(-)]; 3) a group of 240
   healthy younger individuals with no family history of CVD. The apo epsilon2 allele
   was 5.2-fold less frequent in the IVE(+) group compared to the IVE(-) group (1.2%
   vs 6.2%, p=0.001). The frequency of the epsilon2 allele in healthy subjects was 8.1%,
   which is 6.7-fold higher than in the IVE(+) group (p < 0.001), and more than twice
   as high compared to all CVD patients (p=0.001). No significant differences in
   epsilon4 allele frequencies were observed between IVE(+) and IVE(-) patients (9.8%
   vs 8.4%) or between patients with CVD and healthy subjects (9.1% vs 10.2%). The
   epsilon4 allele was not associated with an increased risk for CVD or IVE. In contrast,
   an inverse and beneficial association of the epsilon2 allele with IVE was observed
   among Greek patients with CVD. These results suggest that the epsilon4 and
   epsilon2 alleles have a variable significance in terms of predicting the risk of
   vascular events in different populations. Therefore, it is important to carry out "local"
Keywords: age/allele frequencies/ANGIOTENSIN-II/apolipoprotein/apolipoprotein
   artery/coronary                                                                    artery
   disease/CORONARY-HEART-DISEASE/CVD/disease/diseases/E GENOTYPE/E
   PLATELETS/impact/infarction/ischemic/ischemic             stroke/myocardial/myocardial
   ar/vascular event/vascular events
Oliviero, U., Scherillo, G., Casaburi, C., Di Martino, M., Di Gianni, A., Serpico, R.,
   Fazio, S. and Sacca, L. (2003), Prospective evaluation of hypertensive patients with
   carotid kinking and coiling: An ultrasonographic 7-year study. Angiology, 54 (2),
Abstract: The aim of this study was to determine the incidence of vascular events during
   a 7-year follow-up evaluation in a group of 34 hypertensive patients with kinking of
   the internal carotid artery and 36 well-matched hypertensive control subjects. The
   carotid intima-media thickness (IMT) was measured at three points of the carotid
   bifurcation and at three points of carotid kinking on the ultrasonographic posterior
   wall. The mean IMT measured in the segment of the angular bending was lower than
   the mean values detected at the bifurcation in normal subjects and in hypertensives
   without carotid elongation (p < 0.01). At the carotid bifurcation of the same side of
   the kinking, there was an arterial IMT that was significantly lower as compared to
   the contralateral axis and to the measurements obtained in other hypertensive
   subjects. During a 7-year follow-up study, 10 vascular events occurred in the
   hypertensives with carotid kinking and 14 in the controls, without significant
   differences between the 2 groups. In hypertensives with carotid kinking, the mean
   IMT measured on the angular bending and at the ipsilateral carotid bifurcation was
   significantly lower than the values obtained at the contralateral bifurcation and in the
   other hypertensive subjects. In the 7-year follow-up study, moreover, the presence of
   carotid kinking does not impact the incidence of vascular events in the hypertensive
  population. Thus, the presence of carotid kinking in hypertensive subjects may not be
  considered a further risk factor for ischemic events
  RISK/CARDIOVASCULAR-DISEASE/carotid/carotid                               artery/carotid
  bifurcation/carotid       intima       media       thickness/carotid      intima-media
  thickness/control/controls/evaluation/follow                    up/follow-up/follow-up
  study/HEAD/hypertensive/II/impact/IMT/incidence/internal/internal carotid/internal
  carotid       artery/intima      media       thickness/intima-media/INTIMA-MEDIA
  lar/vascular events
Devereux, R.B., Roman, M.J., Liu, J.E., Lee, E.T., Wang, W.Y., Fabsitz, R.R., Welty,
  T.K. and Howard, B.V. (2003), An appraisal of Echocardiography as an
  epidemiological tool: The strong heart study. Annals of Epidemiology, 13 (4),
Abstract: PURPOSE: Despite the prognostic importance of left ventricular (LV) mass
  (LVM) by M-mode echocardiography, concern exists about bias introduced by
  missing data. The American Society of Echocardiography has made
  recommendations for linear measurements of LV wall thickness and internal
  dimension used to calculate LVM, but it is unknown whether their substitution for
  suboptimal M-modes improves measurement yield and reduces bias. METHODS:
  LVM measurement yield and associations of missing data with risk factors were
  assessed in 3487 American Indian participants in Strong Heart Study (SHS) Phase II
  and compared to data from other large-scale studies. RESULTS: In SHS, LVM was
  measurable in 3188 (91%) participants compared to 4947/6148 (80%) Framingham
  participants studied by classic M- mode technique, with less decrease in
  measurement yield with age in SHS. In univariate SHS analyses, missing LVM was
  significantly associated with male gender, older age, greater height, body mass index,
  fat-free mass, waist/hip ratio, fibrinogen and, marginally, diabetes but not smoking,
  blood pressure, or lipids. In logistic regression analysis, missing LVM was
  independently associated with male gender, older age, greater body mass index and
  lower forced expiratory volume (FEV1) (with a low multiple R-2 [.04]), but not other
  risk factors. Doppler stroke volume, a measure of hemodynamic volume toad, was
  measurable in 96% of SHS participants; missing values were weakly associated with
  older age, higher creatinine and lower FEV1. During 48 +/- 11 months of follow-up,
  inability to measures LV mass or stroke volume was not associated with higher rates
  of cardiovascular events or death (p = 0.25 to 0.96). CONCLUSIONS:
  Improvements in echocardiographic methods have increased the yield of LVM in
  middle,aged and older adults and allow even more consistent assessment of cardiac
  volume load. Despite small persistent biases, due to associations of missing LVM
  and Doppler stroke volume data with male gender, greater obesity, lower FEV1 and
  (for LVM only) older age, individuals with missing measurement are not at higher
  risk of cardiovascular events. (C) 2003 Elsevier Science Inc. Alt rights reserved
Keywords: adults/age/AMERICAN- INDIANS/analysis/assessment/bias/blood/blood
  pressure/body mass index/cardiac/cardiac volume/cardiovascular/cardiovascular
  nternal/left/left      ventricular/LEFT-VENTRICULAR                 MASS/lipids/logistic
  analysis/RELIABILITY/risk/risk          factors/risk-factors/small/smoking/stroke/stroke
  FUNCTION/technique/thickness/toad/USA/ventricular/VOLUME/wall thickness
Bauduer, F., Ducout, L. and Freyburger, G. (2003), Assessment of the 20210 G to A
  prothrombin variant in a sample of patients from the French Basque Country with
  various thrombophilic conditions. Annals of Hematology, 82 (6), 353-356.
Abstract: We investigated the distribution of the prothrombin variant G20210A
  (PT20210A) in a sample of 103 patients (mean age: 34.5 years) living in the French
  Basque Country and presenting with conditions known to be significantly associated
  with this peculiar mutation according to a literature review. These patients suffered
  from repeated personal or familial venous thromboses, stroke at young age, or
  repetitive maternal-fetal disorders (abortions, preeclampsia, fetal growth retardation).
  Five patients (4.8%) were found to be carriers: two homozygotes and three
  heterozygotes (one also heterozygote for factor V Leiden). Of note, two presented
  with mesenteric venous thrombosis. The distribution of PT20210A among our
  sample was comparable to data from Western European series albeit a tendency for
  lower mutation prevalence was observed in our subgroup with obstetrical disorders.
  In addition, no significant difference in PT20210A frequency was evidenced between
  autochthonous Basques and individuals from other origins
Keywords: addition/age/Basques/DISEASE/disorders/distribution/factor V/factor V
  Leiden/familial/fetal/fetal                      growth/fetal                    growth
  retardation/France/frequency/GENE/growth/GROWTH RESTRICTION/II G20210A
  evalence/prothrombin/prothrombin                        gene                  G20210A
Yasaka, M., Oomura, M., Ikeno, K., Naritomi, H. and Minematsu, K. (2003), Effect of
  prothrombin complex concentrate on INR and blood coagulation system in
  emergency patients treated with warfarin overdose. Annals of Hematology, 82 (2),
Abstract: We investigated the effect of prothrombin complex concentrate (PCC) on the
  international normalized ratio (INR) and blood coagulation system in two emergent
  patients treated with warfarin for secondary prevention of cardioembolic stroke due
  to nonvalvular atrial fibrillation. An 80-year-old woman developed massive
  subcutaneous hemorrhage and swelling on her right upper extremity with weak
  pulsation of the right radial artery and had an INR above 10. An 83-year-old man had
  pleural effusion with an INR value of 6.69 and pleural puncture was immediately
  required. We administered 500 IU of PCC to the two patients (17.2 IU/kg and 12.5
  IU/kg) with 10 mg of vitamin K. The INR decreased to 1.12 and 1.85, respectively,
  with an increase of plasma levels of protein C and coagulant factors IIa, VIIa, IXa,
  and Xa 10 min after administration. The plasma levels of the thrombin-antithrombin
  III complex increased (from 4.0 to 12.0 mug/l and from 0.5 to 28.9 mug/l,
  respectively, normal value <3.0), but prothrombin fragment 1+2 increased minimally
  10 min after administration (from 0.4 to 1.1 nmol/ml and from 0.4 to 0.7 nmol/ml,
  respectively, normal value 0.4-1.4 nmol/ml). Plasma levels of D-dimer remained
  unchanged. The massive subcutaneous hemorrhage in the former patient improved in
  14 days. Anticoagulation was restarted in the latter patient after 14 days of PCC
  administration. There were no embolic episodes during the month after PCC
  administration. In conclusion, a small amount of PCC may be effective in
  immediately correcting increased INR levels with increased plasma levels of protein
  C and coagulant factors IIa, VIIa, IXa, and Xa and may partially activate the
  coagulation system without any effects on plasma levels of D-dimer
Keywords: artery/atrial/atrial fibrillation/blood/blood coagulation/blood coagulation
  system/cardioembolic/cardioembolic                       stroke/coagulation/coagulation
  international                    normalized                     ratio/INTRACRANIAL
  HEMORRHAGE/Japan/NEW-YORK/nonvalvular/nonvalvular                                 atrial
  fibrillation/NONVALVULAR                     ATRIAL-FIBRILLATION/normal/ORAL
  C/prothrombin/prothrombin          complex       concentrate/prothrombin      fragment
  1+2/radial/radial                                     artery/right/secondary/secondary
  extremity/USA/vitamin/warfarin/warfarin overdose
Tonelli, M., Moye, L., Sacks, F.M., Kiberd, B. and Curhan, G. (2003), Pravastatin for
  secondary prevention of cardiovascular events in persons with mild chronic renal
  insufficiency. Annals of Internal Medicine, 138 (2), 98-104.
Abstract: Background: Cardiovascular disease is a common cause of morbidity and
  death in persons with renal insufficiency. Although 3-hydroxy-3methylglutaryl
  coenzyme A reductase inhibitors (statins) are effective for secondary prevention of
  cardiovascular events in the general population, they have not been specifically
  studied in chronic renal insufficiency. Objective: To determine whether pravastatin is
  effective and safe for secondary prevention of cardiovascular events in persons with
  chronic renal insufficiency. Design: Post hoc subgroup analysis of a randomized,
  double-blind, placebo- controlled trial. Setting: The Cholesterol and Recurrent
  Events (CARE) study, a randomized trial of pravastatin versus placebo in 4159
  participants with previous myocardial infarction and total plasma cholesterol levels
  less than 6.21 mmol/L (<240 mg/dL). Participants: 1711 participants with chronic
  renal insufficiency defined by creatinine clearance less than or equal to 75 mL/min,
  using the Cockcroft-Gault equation. Measurements: The primary outcome was death
  from coronary disease or symptomatic nonfatal myocardial infarction. Results: After
  a median follow-up of 58.9 months, the incidence of the primary end point was lower
  in participants receiving pravastatin than in those receiving placebo (adjusted hazard
  ratio, 0.72 [95% Cl, 0.55 to 0.95]; P = 0.02). Pravastatin was associated with lower
  adjusted hazard ratios for major coronary events (0.72 [Cl, 0.59 to 0.88]; P = 0.001)
  and coronary revascularization (0.65 [Cl, 0.50 to 0.83]; P = 0.001), but not total
  mortality (0.81 [Cl, 0.61 to 1.08]; P = 0.14) or stroke (0.62 [Cl, 0.39 to 1.00]; P =
  0.051). Tests for interaction suggested that the observed benefit was independent of
  the presence and severity of renal insufficiency. Incidence of side effects was similar
  in persons receiving pravastatin and those receiving placebo. Conclusions: These
  data suggest that pravastatin is effective and appears safe for secondary prevention of
  cardiovascular events in persons with mild chronic renal insufficiency. Since statins
  may be underused in this setting, physicians should consider prescribing them for
  patients with chronic renal insufficiency and known coronary disease
Keywords:                                  analysis/Canada/cardiovascular/cardiovascular
  events/CARE/cause/cholesterol/CHOLESTEROL LEVELS/chronic/chronic renal
  insufficiency/clearance/common/controlled trial/coronary/coronary disease/coronary
  wer/major                                                                       coronary
  ized                                                                    trial/renal/renal
  prevention/SERUM                                                    CREATININE/side
Annoni, J.M., Ptak, R., Caldara-Schnetzer, A.S., Khateb, A. and Pollermann, B.Z.
  (2003), Decoupling of autonomic and cognitive emotional reactions after cerebellar
  stroke. Annals of Neurology, 53 (5), 654-658.
Abstract: Emotional blunting can be found after cerebellar lesions. However, the
  mechanism of such a modification is not clear. We present a patient with emotional
  flattening and increased risk taking after left cerebellar infarct who had an impaired
  autonomic reactivity to negative as compared with positive reinforcement. This
  impairment was demonstrated by the patient's undifferentiated skin conductance
  responses to negative and positive reinforcement, whereas controls produced larger
  skin conductance responses after negative feedback. The cooccurrence of emotional
  flattening and undifferentiated autonomic reactions to positively and negatively
  valenced stimuli strengthens the role of the cerebellum in the modulation of the
  autonomic responses
Keywords:                                               ATROPHY/autonomic/cerebellar
Calabresi, P., Cupini, L.M., Centonze, D., Pisani, F. and Bernardi, G. (2003),
  Antiepileptic drugs as a possible neuroprotective strategy in brain ischemia. Annals
  of Neurology, 53 (6), 693-702.
Abstract: Several new antiepileptic drugs (AEDs) have been introduced for clinical use
  recently. These new AEDs, as did the classic AEDs, target multiple cellular sites
  both pre- and postsynaptically. The major common. goal of the pharmacological
  treatment using AEDs is to counteract abnormal brain excitability by either
  decreasing excitatory transmission or enhancing neuronal inhibition. Interestingly, an
  excessive release of excitatory amino acids and a reduced neuronal inhibition also
  occur in brain ischemia. Thus, recently, the use of AEDs as a possible
  neuroprotective strategy in brain ischemia. is receiving increasing attention, and
  many AEDs have been tested in animal models of stroke, providing encouraging
  results. Experimental studies utilizing global or focal ischemia. in rodents have
  provided insights into the possible neuroprotective action of the various AEDs.
  However, the implication of these studies in the treatment of acute stroke in humans
  is not always direct. In fact, various clinical studies with drugs targeting the same
  voltage- and ligand-gated channels modulated by most of the AEDs failed to show
  neuroprotection. The differential mechanisms that underlie the development of focal
  ischemic injury in experimental animal models versus human stroke require further
  investigation to open a new therapeutic perspective for neuroprotection that might be
  applicable in the future
Keywords:         action/acute/ACUTE          STROKE/amino           acids/animal/animal
  models/antiepileptic                                        drugs/attention/brain/brain
  studies/common/development/drugs/excitability/excitatory                          amino
  acids/experimental/focal/FOCAL                         CEREBRAL-ISCHEMIA/focal
  oprotection/neuroprotective/NEW-YORK/RANDOMIZED                        CONTROLLED
  TRIAL/RAT                                                   MODEL/REMACEMIDE
  HYDROCHLORIDE/results/rodents/strategy/STRIATAL                                  SPINY
  NEURONS/stroke/targeting/therapeutic/TRANSIENT                           FOREBRAIN
Chen, J.L., Zhang, Z.G., Li, Y., Wang, Y., Wang, L., Jiang, H., Zhang, C.L., Lu, M.,
  Katakowski, M., Feldkamp, C.S. and Chopp, M. (2003), Statins induce angiogenesis,
  neurogenesis, and synaptogenesis after stroke. Annals of Neurology, 53 (6), 743-751.
Abstract: We demonstrate that the 3-hydroxy-3-methyl-glutaryl-coenzyme A
  (HMG-CoA) reductase inhibitors atorvastatin and simvastatin enhance functional
  outcome and induce brain plasticity when administered after stroke to rats. With
  atorvastatin treatment initiated 1 day after stroke, animals exhibited significant
  increases in vascular endothelial growth factor, cyclic guanosine monophosphate,
  angiogenesis, endogenous cell proliferation and neurogenesis, and an increase in the
  synaptic protein, synaptophysin. Atorvastatin-induced angiogenesis in a tube
  formation assay was reduced by an antibody against the vascular endothelial growth
  factor receptor 2 (FIK-1) and by the nitric oxide synthase inhibitor,
  N-mono-methyl-L-arginine (L-NAME). Atorvastatin also induced phosphorylation
  of Akt and Erk in cultured primary cortical neurons. These data indicate that
  atorvastatin induced brain plasticity and has neurorestorative activity after
  experimental stroke
Keywords:        activity/AKT/angiogenesis/animals/antibody/atorvastatin/BRAIN/brain
  plasticity/cell proliferation/CELLS/cortical/cortical neurons/cyclic guanosine
  monophosphate/endothelial/endothelial           growth         factor/ENDOTHELIAL
  GROWTH-FACTOR/experimental/experimental stroke/EXPRESSION/FLK-1/KDR
  ACTIVATION/FOCAL                 CEREBRAL-           ISCHEMIA/functional/functional
  outcome/growth/growth            factor/growth       factor       receptor/HMG-COA
  W-YORK/nitric         oxide/nitric     oxide    synthase/nitric     oxide       synthase
  vascular endothelial growth factor/when
Eggers, J., Koch, B., Meyer, K., Konig, I. and Seidel, G. (2003), Effect of ultrasound on
  thrombolysis of middle cerebral artery occlusion. Annals of Neurology, 53 (6),
Abstract: We studied the effect of transcranial 2MHz Doppler ultrasound (US) on the
  recanalization and outcome of stroke patients suffering from acute middle cerebral
  artery occlusion. All patients underwent intravenous recombinant tissue-type
   plasminogen activator thrombolysis. Eleven patients were randomly selected for
   continuous US monitoring (C-US) over 1 hour; 14 patients were selected for the
   control group. The C-US group showed a higher grade of recanalization after 1 hour
   but also a higher number of intraparenchymal bleedings. Overall, a favorable
   functional outcome occurred more frequently in the C- US group (Barthel index, p =
   0.037) after 3 months
Keywords: acute/artery/Barthel/Barthel index/cerebral/cerebral artery/cerebral artery
   outcome/Germany/index/intravenous/LOW-FREQUENCY/middle cerebral/middle
   cerebral                    artery/middle                 cerebral                 artery
   nogen      activator/RECANALIZATION/recombinant              tissue-type    plasminogen
   activator/RECOVERY/STROKE/stroke                             patients/thrombolysis/tissue
   type/TISSUE-PLASMINOGEN ACTIVATOR/tissue-type/tissue-type plasminogen
Fisher, M. and Ratan, R. (2003), New perspectives on developing acute stroke therapy.
   Annals of Neurology, 53 (1), 10-20.
Abstract: The development of additional acute stroke therapies to complement and
   supplement intravenous recombinant tissue-type plasminogen activator within the
   first 3 hours after stroke onset remains an important and pressing need. Much has
   been teamed about the presumed target of acute stroke therapy, the ischemic
   penumbra, and clinically available imaging modalities such as magnetic resonance
   imaging and computed tomography hold great promise for at least partially
   identifying this region of potentially salvageable ischemic tissue. Understanding the
   biology of ischemia-related cell injury has also evolved rapidly. New treatment
   approaches to improve outcome after focal brain ischemia will likely be derived by
   looking at naturally occurring adaptive mechanisms such as those related to ischemic
   preconditioning and hibernation. Many clinical trials previously performed with a
   variety of neuroprotective and thrombolytic drugs provide many lessons that will
   help to guide future acute stroke therapy trials and enhance the likelihood of success
   in future trials. Combining knowledge from these three areas provides optimism that
   additional acute stroke therapies can be developed to maximize beneficial functional
   outcome in the greatest proportion of acute stroke patients possible
Keywords: acute/ACUTE ISCHEMIC STROKE/acute stroke/acute stroke
   therapy/BRAIN/brain          ischemia/CEREBRAL          BLOOD-FLOW/clinical/clinical
   trials/complement/computed                  tomography/development/drugs/EFFICACY
   TRIAL/focal/focal                    brain                ischemia/functional/functional
   penumbra/ischemic                         preconditioning/knowledge/magnetic/magnetic
   resonance/magnetic                                                             resonance
   PERFUSION-WEIGHTED                                       MRI/plasminogen/plasminogen
   activator/preconditioning/RANDOMIZED CONTROLLED TRIAL/recombinant
   tissue-type plasminogen activator/resonance imaging/RT-PA STROKE/stroke/stroke
   onset/stroke       patients/stroke    therapy/therapy/thrombolytic/THROMBOLYTIC
   THERAPY/tissue                                          type/TISSUE-PLASMINOGEN
   ACTIVATOR/tissue-type/tissue-type                                           plasminogen
Ganesan, V., Prengler, M., McShane, M.A., Wade, A.M. and Kirkham, F.J. (2003),
  Investigation of risk factors in children with arterial ischemic stroke. Annals of
  Neurology, 53 (2), 167-173.
Abstract: We present data on the known risk factors encountered in children presenting
  with a first arterial ischemic stroke to a single tertiary center over 22 years. Two
  hundred twelve patients (54% male; median age, 5 years) were identified. One
  hundred fifteen (54%) were previously healthy. Cerebral arterial imaging was
  undertaken in 185 patients (87%) and was abnormal in 79%. Of 104 previously
  healthy patients investigated with echocardiography, only 8 had abnormal studies.
  Genetic or acquired conditions causing thrombophilia were rare. Forty percent of
  patients were anemic, and 21% either had elevated total plasma homocysteine or
  were homozygous for the t-MTHFR mutation. Trauma and previous varicella zoster
  infection were significantly more common in the previously healthy group. There
  was a significant association between cerebral arterial abnormalities and systolic
  blood pressure greater than 90th percentile and a trend for an association with
  varicella within the previous year. Clinical history and examination usually identify
  underlying risk factors and precipitating triggers for arterial ischemic stroke in
  childhood. Cerebral arterial imaging is usually abnormal, but echocardiography and
  prothrombotic screening are commonly negative
Keywords:                              abnormalities/age/arterial/association/blood/blood
  factors/risk-factors/screening/stroke/systolic/systolic      blood/systolic       blood
Kang, D.W., Latour, L.L., Chalela, J.A., Dambrosia, J. and Warach, S. (2003), Early
  ischemic lesion recurrence within a week after acute ischemic stroke. Annals of
  Neurology, 54 (1), 66-74.
Abstract: Previous observations suggested that multiple ischemic lesions on
  diffusion-weighted imaging (DWI) are. common in acute stroke patients. We
  hypothesized that a source of these multiple lesions was the recurrence of ischemic
  lesions within a week after a clinically symptomatic stroke. We analyzed 99 acute
  ischemic stroke patients scanned within 6 hours of onset and at subsequent times
  within the first week. Ischemic lesion recurrence was defined as any new lesion
  separate from the index lesion. Recurrent lesions occurring outside initial perfusion
  deficit were termed 'distant lesion recurrence'. We estimated the hazard ratio (HR) of
  recurrence associated with clinical and imaging characteristics using log-rank test.
  Any lesion recurrence was found in 34%, with distant lesion recurrence in 15%,
  while clinical recurrence was evident in 2%. Initial multiple DWI lesions were
  associated with any lesion recurrence (HR, 2.83; 95% confidence interval [CI],
  1.65-10.29; p = 0.002) and with distant lesion recurrence MR, 5.99; 95% Cl,
  4.05-64-07; P < 0.0001). Large-artery atherosclerosis was the most frequent stroke
  subtype associated with any lesion recurrence (p = 0.026). These results may indicate
  a prolonged state of increased ischemic risk over the first week and suggest DWI as a
  possible surrogate measure for recurrent stroke
Keywords: acute/acute ischemic/acute ischemic stroke/acute stroke/ARTERIAL
  BYPASS/CARDIOVASCULAR                                           HEALTH/CEREBRAL
  INFARCTION/clinical/common/DIAGNOSIS/diffusion                       weighted/diffusion
  weighted                               imaging/diffusion-weighted/diffusion-weighted
  imaging/DIFFUSION-WEIGHTED                                          MR/DWI/HUMAN
   BRAIN/imaging/index/ischemic/ischemic               lesions/ischemic          risk/ischemic
   CTORS/recurrence/recurrent/recurrent                      stroke/results/risk/stroke/stroke
   patients/stroke subtype/SUBTYPE/USA/week
Lee, J.M., Vo, K.D., An, H.Y., Celik, A., Lee, Y., Hsu, C.Y. and Lin, W.L. (2003),
   Magnetic resonance cerebral metabolic rate of oxygen utilization in hyperacute
   stroke patients. Annals of Neurology, 53 (2), 227-232.
Abstract: The purpose of this study was to explore the feasibility of obtaining magnetic
   resonance-measured cerebral metabolic rate of oxygen utilization (MR-CMRO2) in
   acute ischemic stroke patients. Seven stroke patients were serially imaged: 4.5 +/- 0.9
   hours (tp1), 3 to 5 days (tp2), and I to 3 months (tp3) after symptom onset.
   Diffusion-weighted, perfusion-weighted, and multiecho gradient-echo/spin-echo
   images were acquired; cerebral blood flow and oxygen extraction fraction maps were
   obtained from which CMRO2 was calculated as the product of cerebral blood flow
   and oxygen extraction fraction. The final infarct lesions obtained from tp3
   T2-weighted images and the "penumbra" obtained from the tp1 perfusion-weighted
   image- defined lesion were coregistered onto tp1 CMRO2 maps. CMRO2 values in
   the region of brain that eventually infarcted were reduced to 0.40 +/- 0.24 of the
   respective region on the contralateral hemisphere. The "salvaged penumbra" defined
   by the area of mismatch between the final infarct and the tp1 perfusion-weighted
   lesion demonstrated an average CMRO2 value of 0.55 +/- 0.11 of the contralateral
   hemisphere. Although our results are preliminary and require further evaluation, the
   ability to obtain in vivo measurements of MR-CMRO2 noninvasively potentially can
   provide information for determining brain tissue viability in acute ischemic stroke
Keywords:        ability/acute/acute    ischemic/acute        ischemic       stroke/ARTERY
   OCCLUSION/blood/blood            flow/BLOOD-FLOW/brain/cerebral/cerebral              blood
   flow/cerebral          metabolic         rate         of         oxygen/CONTROLLED
   MEASUREMENT/hyperacute/hyperacute                     stroke/IMAGING                BOLUS
   TRACKING/in                              vivo/infarct/information/ischemic/ISCHEMIC
   CEREBROVASCULAR-DISEASE/ischemic                        stroke/lesion/magnetic/metabolic
   rate/mismatch/NEW-YORK/oxygen/oxygen                  extraction/oxygen           extraction
   fraction/patients/PERFUSION                                                 MRI/perfusion
   patients/tissue viability/USA/utilization/viability
Liolitsa, D., Rahman, S., Benton, S., Carr, L.J. and Hanna, M.G. (2003), Is the
   mitochondrial complex IND5 gene a hot-spot for MELAS causing mutations? Annals
   of Neurology, 53 (1), 128-132.
Abstract: We identified two novel heteroplasmic mitochondrial DNA point mutations in
   the gene encoding the ND5 subunit of complex L a 12770A-->G transition identified
   in a patient with MELAS (mitochondrial encephalomyopathy with lactic acidosis and
   stroke-like episodes) and a 13045A-->C transversion in a patient with a
   MELAS/Leber's hereditary optic neuropathy/Leigh's overlap syndrome. Biochemical
   analysis of muscle homogenates showed normal or very mildly reduced complex I
   activity Histochemistry was normal. Our observations add to the evidence that
   mitochondrial ND5 protein coding gene mutations frequently associate with the
   MELAS phenotype, and it highlights the role of complex I dysfunction in MELAS
Keywords:                            activity/analysis/and                         stroke-like
  mic/lactic      acidosis/MELAS/mitochondrial/mitochondrial            DNA/mitochondrial
  encephalomyopathy/mitochondrial                                       encephalomyopathy
Sawaki, L., Yaseen, Z., Kopylev, L. and Cohen, L.G. (2003), Age-dependent changes in
  the ability to encode a novel elementary motor memory. Annals of Neurology, 53 (4),
Abstract: In healthy individuals, motor training elicits cortical plasticity that encodes the
  kinematic details of the practiced movements and is thought to underlie recovery of
  function after stroke. The influence of age on this form of plasticity is incompletely
  understood. We studied 55 healthy subjects and identified a substantial decrease in
  training-dependent plasticity as a function of age in the absence of differences in
  training kinematics. These results suggest that the ability of the healthy aging motor
  cortex to reorganize in response to training decreases with age
Keywords:                              ability/age/aging/changes/CORTEX/cortical/cortical
  plasticity/function/INDUCED                                                  MOVEMENT
  cortex/motor                                                                memory/motor
  training/movements/NEW-YORK/NIH/PLASTICITY/recovery/recovery                              of
Tyler, K., York, G.K., Steinberg, D.A., Okun, M.S., Steinbach, M., Satran, R., Fine, E.J.,
  Manteghi, T., Bleck, T.P., Swanson, J.W., Mishra, S., Meador, K.J., Clifford, D.B.,
  Toole, J.F. and Melson, L. (2003), PART 2: History of 20th century neurology:
  Decade by decade. Annals of Neurology, 53 S27-S45
Zheng, Z.G., Jiang, Q., Zhang, R.L., Zhang, L., Wang, L., Zhang, L.J., Arniego, P., Ho,
  K.L. and Chopp, M. (2003), Magnetic resonance imaging and neurosphere therapy of
  stroke in rat. Annals of Neurology, 53 (2), 259-263.
Abstract: We intracisternally transplanted subventricular zone (SVZ) cells labeled by
  ferromagnetic particles into stroked rats. Migration of transplanted cells was
  noninvasively tracked using magnetic resonance imaging (MRI). We found that
  transplanted cells selectively migrated towards the ischemic parenchyma at a mean
  speed of 65 +/- 14.6 mum/hr in living rats. Migration of transplanted cells in the
  brain was also measured histopathologically. Rats transplanted with SVZ cells
  exhibited significant improvement of neurological function. Our data suggest that
  intracisternal transplantation of SVZ cells provides an avenue for cell therapy of
  stroke and that MRI can be used to track grafted cells in the brain
Keywords:                    brain/CELLS/function/imaging/ischemic/magnetic/magnetic
  resonance/magnetic          resonance          imaging/MI/MRI/neurological/neurological
  imaging/speed/stroke/stroked/subventricular zone/therapy/transplantation/USA
Galli, J., Valenza, V., D'Alatri, L., Reale, F., Gajate, A.S., Di Girolamo, S. and Paludetti,
  G. (2003), Postoperative dysphagia versus neurogenic dysphagia: Scintigraphic
  assessment. Annals of Otology Rhinology and Laryngology, 112 (1), 20-28.
Abstract: In order to differentiate the features of dysphagia that occur after supraglottic
  horizontal laryngectomy from those that occur during neurologic diseases, we
  divided 38 subjects into 3 groups and submitted them to oropharyngoesophageal
  scintigraphy. Group 1 (control group) included 15 healthy volunteeers; group 2
  comprised 8 patients who had residual dysphagia at least I year after supraglottic
  laryngectomy; and group 3 included 15 patients with various neurologic and
  neuromuscular disorders. In group 1, the mean values (+/-2 SD) of selected
  semiquantitative parameters were consistent with those reported in the literature for
  normal subjects. In group 2, oral, pharyngeal, and esophageal transit times were not
  significantly altered, and moderate tracheobronchial post- deglutitive aspiration was
  present (maximum value, 6.7%; mean value, 2.04%). The pharyngeal retention index
  was significantly increased (p = .0003) as compared to normal subjects in all cases
  (maximum value, 40%; mean value, 23%) and was associated in all cases with slight
  but consistent postdeglutitive aspiration. In group 3, the oral and esophageal phases
  were significantly prolonged and the retention indices were significantly increased.
  Statistical analysis documented a significant increase in oral transit time (p = .003),
  esophageal transit time (p = .01), oral retention index (p = .006), pharyngeal
  retention index (p = .0007), and esophageal retention index (p = .009) as compared to
  normal subjects. The swallowing pattern was also altered by 1) an early loss of the
  bolus from the oral cavity; 2) bolus fragmentation due to double or triple deglutition,
  reduced lingual propulsion, or the return of a small part of the bolus into the oral
  cavity during deglutition; and/or 3) double pharyngeal peaks in the activity-time
  curves. Tracheobronchial aspiration (maximum value, 90%; mean value, 9.70%) was
  present in some cases, mainly in patients affected by post-stroke dysphagia. On the
  basis of the obtained results and considering the low doses of radiation delivered to
  the patient (0.043 Gy), the limited invasiveness, and the excellent patient tolerance,
  scintigraphy appears to be clinically valid in the functional study of swallowing and
  in identifying different deglutition disorders
  SCINTIGRAPHY/functional/HEAD/HORIZONTAL                              SUPRAGLOTTIC
  LARYNGECTOMY/index/Italy/lingual/loss/MODIFIED                                 BARIUM
  dysphagia/neurologic/neuromuscular/neuromuscular               disorders/normal/normal
Carroll, C.A., Coen, M.M. and Piepho, R.W. (2003), Economic impact of ramipril on
  hospitalization of high-risk cardiovascular patients. Annals of Pharmacotherapy,
  37 (3), 327-331.
Abstract: OBJECTIVE: To estimate differences in direct costs attributable to avoided
  hospitalizations. and procedures during the years of the HOPE (Heart Outcomes
  Prevention Evaluation). study after the cost of treatment with ramipril or alternative
  angiotensin- converting enzyme inhibitor therapy was taken into account.
  METHODS: A decision analytical model was developed to estimate the. economic
  impact of reductions in hospitalizations and/or procedures both at annual increments
  and over the first 4 years of the HOPE study. The analysis compared the number of
  cardiovascular events per endpoint per year in the.. intervention and placebo group
  with hospitalization and procedural costs. Cost data were derived from the literature
  and inflated,to the appropriate index year using the consumer- price index.
  RESULTS: For approximately 9000 patients studied, the gross estimated savings in
  direct costs for 297 events avoided were more than $5 million over 4 years. After the
  cost of treatment was,deducted for both groups, the. net estimated savings were
  $871000 over 4 years. CONCLUSIONS: The results demonstrate that the use of
  ramipril provides cost-effective treatment for high-risk cardiovascular patients with
  an ejection fraction >40%
Keywords: AIRE/analysis/angiotensin/angiotensin converting enzyme/angiotensin
  converting          enzyme        inhibitor/angiotensin-      converting       enzyme
  inhibitor/appropriate/cardiovascular/cardiovascular              disease/cardiovascular
  rvention/LEFT-VENTRICULAR                    DYSFUNCTION/model/MYOCARDIAL-
McKenney, J.M. (2003), Potential nontraditional applications of statins. Annals of
  Pharmacotherapy, 37 (7-8), 1063-1071.
Abstract: OBJECTIVE: To review the current evidence for use of
  hydroxymethylglutaryl coenzyme A reductase inhibitors (statins) in nontraditional
  lipid-related applications, including acute coronary syndromes, peripheral arterial
  disease, stroke, and renal disease, and to describe ongoing trials evaluating the role
  of statins in these conditions. DATA SOURCES: Clinical literature was identified by
  a MEDLINE search (1990-November 2002) using 1 of the following search terms:
  acute coronary syndrome(s), angina pectoris, atherosclerosis, atorvastatin, clinical
  trials, diabetes mellitus, end-stage renal disease, fluvastatin, lovastatin, myocardial
  infarction, peripheral arterial disease, pravastatin, simvastatin, statins, and stroke.
  Treatment guidelines issued by professional and governmental organizations, such as
  the American Diabetes Association, American Heart Association, National
  Cholesterol Education Program, National Kidney Foundation, and National Stroke
  Foundation, were reviewed. STUDY SELECTION AND DATA EXTRACTION:
  Articles identified from the data sources were included if they pertained to the
  conditions described in the objectives and provided unique information concerning
  use of statins. DATA SYNTHESIS: Substantial evidence exists for the use of statins
  in acute coronary syndromes. Meta-analyses of data from major clinical trials
  indicate that statins prevent first and recurrent stroke, and large-scale trials are
  underway to evaluate the efficacy of statins in this setting. Accumulating evidence
  suggests that statins may be beneficial in reducing the morbidity and mortality
  associated with peripheral arterial disease and end-stage renal disease, and results
  from ongoing trials may confirm these benefits. Statins may also have a future role in
  amelioration of other conditions associated with atherosclerosis, such as diabetes
  mellitus. CONCLUSIONS: A large body of evidence supports the evaluation of
  statins in clinical settings beyond primary and secondary prevention of morbidity and
  mortality associated with coronary atherosclerosis
Keywords:         acute/acute      coronary       syndromes/ACUTE           CORONARY
  SYNDROMES/American Heart Association/angina/angina pectoris/arterial/arterial
  PROGRESSION/atorvastatin/AVERAGE                                      CHOLESTEROL
  LEVELS/benefits/clinical/clinical                           trials/CO/coronary/coronary
  atherosclerosis/diabetes/diabetes      mellitus/disease/efficacy/end     stage     renal
  disease/end-stage/end-stage                                                        renal
  ymethylglutaryl coenzyme A/infarction/information/inhibitors/morbidity/morbidity
  and                                         mortality/mortality/myocardial/myocardial
  infarction/MYOCARDIAL-INFARCTION/peripheral/peripheral                           arterial
  disease/PERIPHERAL ARTERIAL-DISEASE/pravastatin/prevention/primary and
  secondary prevention/RANDOMIZED CONTROLLED TRIAL/recurrent/recurrent
  stroke/renal/renal                  disease/RENAL-                      TRANSPLANT
  secondary/secondary               prevention/SELECTION/ST-                  SEGMENT
Skurnik, Y.D., Tchemiak, A., Edlan, K. and Sthoeger, Z. (2003), Ticlopidine-induced
  cholestatic hepatitis. Annals of Pharmacotherapy, 37 (3), 371-375.
Abstract: OBJECTIVE: To report 2 cases of ticlopidine-induced cholestatic hepatitis,
  investigate its mechanism, and compare the observed main characteristics with those
  of the published cases. CASE SUMMARIES: Two patients developed prolonged
  cholestatic hepatitis after receiving ticlopidine following percutaneous coronary
  angioplasty, with complete remission during the follow-up period. T-cell stimulation
  by therapeutic concentration of ticlopidine was demonstrated in vitro in the patients,
  but not in healthy controls. DISCUSSION: Cholestatic hepatitis is a rare
  complication of the antiplatelet agent ticlopidine; several cases have been reported
  but few in the English literature. Our patients developed jaundice following
  treatment with ticlopidine and showed the clinical and laboratory characteristics of
  cholestatic hepatitis, which resolved after discontinuation of the drug. Hepatitis may
  develop weeks after discontinuation of the drug and may run a prolonged course, but
  complete remission was observed in all reported cases. An objective causality
  assessment revealed that the adverse drug event was probably related to the use of
  ticlopidine. The mechanisms of this ticlopidine-induced cholestasis are unclear.
  Immune mechanisms may be involved in the drug's hepatotoxicity, as suggested by
  the T-cell stimulation study reported here. CONCLUSIONS: Cholestatic hepatitis is
  a rare adverse effect of ticlopidine that may be immune mediated. Patients receiving
  the drug should be monitored with liver function tests along with complete blood cell
  counts. This complication will be observed even less often in the future as ticlopidine
  is being replaced by the newer antiplatelet agent clopidogrel
Keywords:                                             angioplasty/antiplatelet/antiplatelet
Medina, G., Casaos, D., Jara, L.J., Vera-Lastra, O., Fuentes, M., Barile, L. and Salas, M.
  (2003), Increased carotid artery intima-media thickness may be associated with
  stroke in primary antiphospholipid syndrome. Annals of the Rheumatic Diseases, 62
  (7), 607-610.
Abstract: Objective: To investigate the prevalence and clinical significance of carotid
  artery intima-media thickness (IMT) in patients with primary antiphospholipid
  syndrome (APS). Methods: 28 patients with primary APS with at least a five year
  follow up, and 28 healthy subjects, matched by age and sex, were included in the
  study. Colour Doppler with high resolution B mode carotid ultrasonography and
  spectral analysis were performed in patients and controls. Information on
  cardiovascular risk factors and the clinical course were collected. Results: The mean
  (SD) age of patients and controls (12 male, 16 female in each group) was 40 (8.5)
  years; the mean (SD) disease duration 7.7 (3) years. Carotid artery IMT was found in
  23/28 patients (2.6 (1.14) mm) and 7/28 controls (1.2 (0.44)) (p = 0.0001). A
  decrease in the lumen diameter was also found in 11/28 patients with primary APS
  without carotid atherosclerotic plaque, and 2/28 controls (p = 0.004).
  Hyperlipidaemia, diabetes, smoking, obesity, and hypertension were not associated
  with carotid artery IMT. Patients with carotid artery IMT had arterial vascular
  disease more often than patients without: 9/23 v 0/5 (p < 0.009). These patients had
  stroke (seven patients), myocardial infarction (one), and mesenteric thrombosis (one).
  Subjects with IMT had a threefold higher risk for stroke than those without IMT
  (95% CI 0.78 to 14.3). Conclusions: Patients with primary APS have a high
  prevalence of carotid artery IMT and a decreased lumen diameter. IMT in primary
  APS may be associated with stroke. Patients with primary APS with IMT must be
  considered as carriers of atherosclerosis
Keywords:                 age/analysis/ANTIBODIES/antiphospholipid/antiphospholipid
  sclerotic plaque/BRITISH/cardiovascular/cardiovascular risk/cardiovascular risk
  factors/CARDIOVASCULAR RISK-FACTORS/carotid/carotid artery/carotid artery
  intima         media          thickness/carotid         ultrasonography/clinical/clinical
  up/follow-up/high          resolution/hypertension/IMT/infarction/intima          media
  infarction/obesity/patients/plaque/PREVALENCE/primary                   antiphospholipid
  syndrome/resolution/risk/risk                  factors/risk-factors/sex/smoking/spectral
  kness/thrombosis/ultrasonography/ULTRASOUND/vascular/vascular disease
Albers, J., Boese, J.M., Vahl, C.F. and Hagl, S. (2003), In vivo validation of cardiac
  spiral computed tomography using retrospective gating. Annals of Thoracic Surgery,
  75 (3), 885-889.
Abstract: Background. Cardiac functional assessment represents the basis for
  diagnostics and cardiac operation planning. Spiral computed tomography (CT)
  combines the advantages of three-dimensional imaging and high temporal resolution
  when using gating techniques. However, in vivo validation data of this novel
  imaging technology are lacking. The purpose of this study was to validate in vivo the
  new imaging method using retrospective gating and to evaluate the clinical
  usefulness of the achieved temporal resolution. Methods. In domestic pigs (n = 10,
  weight 35 to 40 kg) a flowmeter was placed surgically on the ascending aorta. Flow
  velocity integrated over systole served as the gold standard for left ventricular (LV)
  stroke volume (LVSV-FM). CT signal, projection data, pacemaker signal, and flow
  velocity were recorded simultaneously at constant heart rate (pacemaker, 90 beats
  per minute). End-systolic and end-diastolic frames were calculated by retrospective
  gating. LV volumes were traced, the difference representing CT stroke volume
  (LVSV-CT). Image data were three-dimensionally reconstructed using ray- tracing.
  Results. Temporal resolution was 170 ms. Correlation of stroke volumes was high (r
  = 0.94, mean difference 1.75 mL). Intraobserver (0.49 mL, for LVEDV, 0.31 for
  LVESV) and interobserver variability (p = 0.21 and p = 0.06, respectively) were low.
  Postprocessing resulted in four-dimensional beating- heart models useful for
  operation planning. Conclusions. Spiral CT using retrospective gating was validated
  in vivo. Clinically acceptable temporal resolution and accuracy in determining
  cardiac stroke volumes were found. As a true volumetric imaging modality the
  method may now play an important role in computer- assisted diagnostics and
  surgery. (C) 2003 by The Society of Thoracic Surgeons
Keywords:                accuracy/aorta/ascending              aorta/assessment/beating
  heart/cardiac/clinical/computed tomography/computer/computer assisted/computer-
  assisted/CT/diagnostics/DOPPLER/flow/flow               velocity/functional/functional
  assessment/Germany/gold/HEART/heart rate/imaging/in vivo/integrated/left/left
Albert, A.A., Beller, C.J., Walter, J.A., Arnrich, B., Rosendahl, U.P., Priss, H. and
  Ennker, J. (2003), Preoperative high leukocyte count: A novel risk factor for stroke
  after cardiac surgery. Annals of Thoracic Surgery, 75 (5), 1550-1557.
Abstract: Background. Stroke after cardiac surgery is a devastating complication. The
  relationship between white blood cell count (WBC) and perioperative
  cerebrovascular accident (CVA) has not been investigated. An effort was made to
  identify how preoperative WBC may relate to CVA development during or after
  cardiac surgery. Methods. Prospective data were collected from 7,483 patients who
  underwent coronary artery bypass grafting or valvular surgery or both. WBC was
  determined preoperatively and postoperatively. Differentiation of WBC was
  examined only preoperatively. Results. There were a total of 125 CVAs (10 transient
  ischemic attacks [TIAs], 115 strokes). WBC was significantly higher preoperatively
  and directly postoperatively in patients with stroke. Qualitative changes in
  preoperative WBC were also found in these patients (chi(2); p < 0.001). The
  predictive power of the stepwise logistic regression model for CVA was greater
  when preoperative WBC was included. The risk for perioperative CVA increased
  starting at preoperative WBC of 9 x 10(9)/L (p = 0.044) and progressed in higher
  WBC ranges. WBC had a significant impact on CVA outcome (analysis of variance,
  P = 0.001). Conclusions. Our studies have established the correlation between high
  preoperative WBC and stroke during or after cardiac surgery. Furthermore, elevated
  preoperative WBC was related to the clinical outcome of CVA. Preoperative
  measures aimed at preventing or treating conditions such as infections that may
  cause elevated WBC may be beneficial in the prevention of stroke during or after
  cardiac surgery. (C) 2003 by The Society of Thoracic Surgeons
Keywords:                               analysis/analysis                              of
  surgery/cause/cerebrovascular/cerebrovascular        accident/changes/clinical/clinical
  outcome/complication/coronary/coronary artery/coronary artery bypass/coronary
  artery                                                                          bypass
  A/ischemic/ischemic attacks/leukocyte/leukocyte count/logistic regression/logistic
  regression          model/model/NEW-YORK/outcome/patients/patients                with
  stroke/power/predictive/prevention/PROTEIN/regression/regression model/risk/risk
  factor/stroke/strokes/surgery/transient/transient ischemic attacks/USA/when/white
  blood cell count
Athanasiou, T., Al Ruzzeh, S., Del Stanbridge, R., Casula, R.P., Glenville, B.E. and
  Amrani, M. (2003), Is the female gender an independent predictor of adverse
  outcome after off-pump coronary artery bypass grafting? Annals of Thoracic Surgery,
  75 (4), 1153-1160.
Abstract: Background. The female gender is an independent predictor of adverse
  outcome after conventional coronary artery bypass grafting using cardiopulmonary
  bypass. The aim of this study is to assess the effect of the female gender on the
  outcome after off-pump coronary artery bypass (OPCAB) surgery. Methods. This
  study is a retrospective review of 413 consecutive patients (181 women and 232 men)
  who underwent OPCAB between January 1999 and May 2001. Adverse outcomes
  were divided into minor adverse outcomes (MINAO), major adverse outcomes
  (MAJAO), and prolonged length of stay (PLOS) more than 7 days. MINAO included
  atrial fibrillation, respiratory complications except adult respiratory distress
  syndrome, and any wound infection except mediastinitis. MAJAO included stroke,
  myocardial infarction, renal failure, adult respiratory distress syndrome, mediastinitis,
  low cardiac output, mechanical ventilation more than 24 hours, intensive therapy unit
  stay more than 24 hours, gastrointestinal complications, cardiorespiratory arrest, and
  mortality within 30 days. Preoperative and intraoperative variables were evaluated as
  predictors of MINAO, MAJAO, and PLOS by univariate and multivariate analyses.
  Results. The groups were matched for age and Parsonnet score-predicted mortality.
  However, the women had a higher incidence of chronic obstructive airway disease (P
  = 0.04), diabetes (p = 0.01), obesity (p = 0.000), peripheral vascular disease (p =
  0.000), hypertension (p = 0.000), unstable angina (p = 0.005), history of previous
  failed nonsurgical intervention (p = 0.02), and nonelective operation (p = 0.000).
  There were a fewer number of grafts performed in the female group (2.8 vs 3.4, p =
  0.000), with the circumflex territory being revascularised less frequently (p = 0.001).
  Univariate analysis identified the female gender to be a predictor of only MINAO (p
  = 0.001) and PLOS (P = 0.000). However, with multivariate analysis, female gender
  was not found to be an independent predictor of MINAO, MAJAO, or PLOS.
  Conclusions. In OPCAB, the female gender is not an independent predictor of
  MINAO, MAJAO, or PLOS. (C) 2003 by The Society of Thoracic Surgeons
Keywords:                                                                    adult/adverse
  fibrillation/BEATING                                     HEART/bypass/cardiac/cardiac
  BYPASS/chronic/complications/coronary/coronary               artery/coronary       artery
  bypass/coronary                                artery                             bypass
  therapy/intervention/intraoperative/length          of         stay/major        adverse
  outcomes/mechanical/mechanical                    ventilation/men/mortality/multivariate
  analysis/myocardial/myocardial                               infarction/MYOCARDIAL
  REVASCULARIZATION/NEW-YORK/obesity/obstructive/off pump/off pump
  coronary artery bypass/off-pump/off-pump coronary artery bypass/off-pump
  coronary                                   artery                                 bypass
  grafting/ON-PUMP/outcome/outcomes/patients/peripheral/peripheral                vascular
  angina/USA/vascular/vascular disease/ventilation/WOMEN/wound
Bucerius, J., Gummert, J.F., Borger, M.A., Walther, T., Doll, N., Onnasch, J.F., Metz,
  S., Falk, V. and Mohr, F.W. (2003), Stroke after cardiac surgery: A risk factor
  analysis of 16,184 consecutive adult patients. Annals of Thoracic Surgery, 75 (2),
Abstract: Background. Stroke remains a devastating complication after cardiac surgical
  procedures despite advances in perioperative monitoring and management. The
  purpose of this study was to determine the predictors of stroke in a large,
  contemporary cardiac surgery population. Methods. Prospective data on 113,184
  consecutive patients undergoing cardiac surgery (coronary artery bypass grafting
  [CABG], n = 8,917; beating heart CABG, n = 1,842; aortic valve surgery, n = 1,830;
  mitral valve surgery, n = 708; double or triple valve surgery, n = 381; CABG and
  valve surgery, n = 2,506) between April 1996 and August 2001 were subjected to
  univariate and multivariate analysis. Stroke was defined as any new permanent
  (manifest stroke) or temporary neurologic deficit or deterioration (transient ischemic
  attack or prolonged reversible ischemic neurologic deficit) and was confirmed by
  computed tomography or magnetic resonance imaging whenever possible. Results.
  Overall incidence of stroke was 4.6% and varied between surgical procedures
  (CABG 3.8%; beating-heart CABG 1.9%; aortic valve surgery 4.8%; mitral valve
  surgery 8.8%; double or triple valve surgery 9.7%; CABG and valve surgery 7.4%).
  Of 63 patient- specific and treatment variables, 54 were found to have a significant
  univariate association with postoperative stroke. Multivariable analysis revealed 10
  variables that were independent predictors of stroke: history of cerebrovascular
  disease, peripheral vascular disease, diabetes, hypertension, previous cardiac surgery,
  preoperative infection urgent operation, CPB time more than 2 hours, need for
  intraoperative hemofiltration, and high transfusion requirement. Beating heart CABG
  was associated with a lower incidence of stroke in this multivariable analysis.
  Conclusions. Identification of predictors for stroke is important for understanding the
  pathogenesis of this devastating complication as well as for developing preventative
  strategies. Although retrospective analyses can be subject to selection bias we
  believe beating heart CABG is associated with a lower incidence of stroke and may
  therefore improve patient outcomes. (C) 2003 by The Society of Thoracic Surgeons
Keywords: adult/adult patients/analysis/aortic/aortic valve/artery/association/beating
  heart/bias/bypass/CABG/cardiac/cardiac               surgery/cardiac            surgical
  procedures/cerebrovascular/cerebrovascular              disease/complication/computed
  tomography/coronary/coronary artery/coronary artery bypass/coronary artery bypass
  grafting/CORONARY-ARTERY                 BYPASS/deterioration/diabetes/disease/factor
  attack/lower/magnetic/magnetic               resonance/magnetic               resonance
  imaging/management/mitral                         valve/mitral                     valve
  surgery/monitoring/MORBIDITY/multivariate                analysis/neurologic/neurologic
  operative                   monitoring/peripheral/peripheral                    vascular
  disease/population/postoperative/postoperative              stroke/predictors/resonance
  imaging/risk/risk factor/selection/selection bias/stroke/surgery/surgical/SURGICAL
  PATIENTS/surgical procedures/tomography/transfusion/transient/transient ischemic
  attack/treatment/understanding/USA/vascular/vascular disease
Canver, C.C. and Chanda, J. (2003), Intraoperative and postoperative risk factors for
  respiratory failure after coronary bypass. Annals of Thoracic Surgery, 75 (3),
Abstract: Background. Unlike preoperative events, the influence of intraoperative or
  postoperative events on respiratory failure after coronary artery bypass grafting
  (CABG) remains unclear. The purpose of this study was to identify intraoperative
  and postoperative risk factors that predispose respiratory impairment after CABG.
  Methods. A single institutional database combined with a mandatory report
  submitted to the Cardiac Surgery Registry of the New York State Department of
  Health was used. A total of 8,802 consecutive patients who underwent primary
  CABG with or without a concomitant cardiac operation from January 1993 through
  December 2000 were included. Respiratory failure was defined as the need for
  postoperative mechanical ventilatory support longer than 72 hours. Univariate and
  multivariate logistic regression model was used in the analysis. Results. Of 8,802
  consecutive patients (6,234 males and 2,568 females) who underwent CABG with or
  without a concomitant operation, 491 patients (5.6%) suffered from postoperative
  respiratory failure. Although univariate analysis identified 39 statistically significant
  preoperative risk factors for post-CABG respiratory failure, only six preoperative
  risk factors were statistically significant by multivariate analysis (p < 0.001). CPB
  time (in 30 minutes increments) was the only validated intraoperative variable that
  increased the risk of postrespiratory failure (odds ratio [OR], 1.2; p less than 0.0001).
  Postoperative events contributing significantly to an increased risk of post-CABG
  respiratory failure were (1) sepsis and endocarditis (OR, 90.4; p < 0.0001), (2)
  gastrointestinal bleeding with or without infarction and perforation (OR, 38.8; p <
  0.0001), (3) renal failure (OR, 30.7; p < 0.0001), (4) deep sternal wound infection
  (OR, 11.3; p < 0.0001), (5) new stroke, intraoperative at 24 hours (OR, 9.3; p <
  0.0001), and (6) bleeding that required reoperation (OR, 5.5; p < 0.0001). All
  perioperative variables together accounted for only 28.6% (R-2) of the variation.
  Conclusions. Respiratory function after CABG is readily influenced by postoperative
  occurrence of extracardiac organ or system complications. (C) 2003 by The Society
  of Thoracic Surgeons
  mplications/coronary/coronary artery/coronary artery bypass/coronary artery bypass
  DYSFUNCTION/logistic                       regression/logistic                 regression
  model/mechanical/mechanical                                                   ventilatory
  PREDICTION/PROLONGED                                                    MECHANICAL
  VENTILATION/regression/regression                                      model/renal/renal
  failure/reoperation/respiratory         impairment/REVASCULARIZATION/risk/risk
Carrington, R.A.J., Huang, Y.F., Kawaguchi, O., Yuasa, T., Shirota, K., Martin, D. and
  Hunyor, S.N. (2003), Direct compression of the failing heart reestablishes maximal
  mechanical efficiency. Annals of Thoracic Surgery, 75 (1), 190-196.
Abstract: Background. In failing hearts, homeostatic mechanisms contrive to maximize
  stroke work and maintain normal arterial blood pressure at the expense of energetic
  efficiency. In contrast dobutamine reestablishes maximal mechanical efficiency by
  promoting energetically optimal loading conditions. However, dobutamine also
  wastefully increases nonmechanical oxygen consumption. We investigated whether
  direct mechanical cardiac compression would reestablishes maximal mechanical
  efficiency without the oxygen-wasting effect. Methods. The pressure-volume
  relationship and myocardial oxygen consumption were derived in sheep using left
  ventricular pressure and volume from manometer-tipped and conductance catheters,
  and coronary flow from Transonics flow probe. Results. Propranolol hydrochloride
  and atropine sulfate were administered to reduce ejection fraction to 21% when
  ventricular elastance fell to 1.35 mm Hg/mL and mechanical efficiency to 79% of
  maximal. Low-pressure direct mechanical compression of the failing heart restored
  mechanical efficiency to 94% of maximal and realigned optimal left ventricular
  end-systolic pressure with operating left ventricular end-systolic pressure without
  altering nonmechanical oxygen consumption. Conclusions. We conclude that direct
  cardiac compression restores mechanical efficiency to normal maximum without
  wasting energy on additional nonmechanical activity. (C) 2003 by The Society of
  Thoracic Surgeons
Keywords:                   activity/ACTUATION/arterial/arterial                    blood
  fraction/elastance/energy/FAILURE/flow/flow                         probe/heart/left/left
  work/sulfate/USA/ventricular/VENTRICULAR                                       ASSIST
Castella, M., Buckberg, G.D. and Tan, Z.T. (2003), Blood cardioplegic protection in
  profoundly damaged hearts: Role of Na+-H+ exchange inhibition during
  pretreatment or during controlled reperfusion supplementation. Annals of Thoracic
  Surgery, 75 (4), 1238-1245.
Abstract: Background. Inhibition of the Na+/H+ exchanger before ischemia protects
  against ischemia-reperfusion injury, but use as pretreatment before blood
  cardioplegic protection or as a supplement to controlled blood cardioplegic
  reperfusion was not previously tested in jeopardized hearts. Methods. Control studies
  tested the safety of glutamate-aspartate-enriched blood cardioplegic solution in 4
  Yorkshire-Duroc pigs undergoing 30 minutes of aortic clamping without prior
  unprotected ischemia. Twenty-four pigs underwent 30 minutes of unprotected
  normothermic global ischemia to create a jeopardized heart. Six of these hearts
  received normal blood reperfusion, and the other 18 jeopardized hearts underwent 30
  more minutes of aortic clamping with cardioplegic protection. In 12 of these, the
  Na+/H+ exchanger inhibitor cariporide was used as intravenous pretreatment (n = 6)
  or added to the cardioplegic reperfusate (n = 6). Results. Complete functional,
  biochemical, and endothelial recovery occurred after 30 minutes of blood
  cardioplegic arrest without preceding unprotected ischemia. Thirty minutes of
  normothermic ischemia and normal blood reperfusion produced 33% mortality and
  severe left ventricular dysfunction in survivors (preload recruitable stroke work, 23%
  +/- 6% of baseline levels), with raised creatine kinase MB, conjugated dienes,
  endothelin-1, myeloperoxiclase activity, and extensive myocardial edema. Blood
  cardioplegia was functionally protective, despite adding 30 more minutes of ischemia;
  there was no mortality, and left ventricular function improved (preload recruitable
  stroke work, 58% +/- 21%, p < 0.05 versus normal blood reperfusion), but adverse
  biochemical and endothelial variables did not change. In contrast, Na+/H+ exchanger
  inhibition as either pretreatment or added during cardioplegic reperfusion improved
  myocardial recovery (preload recruitable stroke work, 88% +/- 9% and 80% +/- 7%,
  respectively, p < 0.05 versus without cariporide) and comparably restored injury
  variables. Conclusions. Na+/H+ exchanger blockage as either pretreatment or during
  blood cardioplegic reperfusion comparably delays functional, biochemical, and
  endothelial injury in jeopardized hearts. (C) 2003 by The Society of Thoracic
Keywords: activity/aortic/blood/cardioplegia/CARIPORIDE/contrast/creatine/creatine
  mia        reperfusion/ischemia-reperfusion/ischemia-reperfusion         injury/left/left
  ventricular/left           ventricular            dysfunction/left          ventricular
  function/mortality/myocardial/myocardial                       edema/MYOCARDIAL
  exchanger/NEW-YORK/normal/normothermic/pigs/preload/preload                  recruitable
  EXCHANGER/stroke/stroke work/supplementation/USA/use/ventricular/ventricular
Chachques, J.C., Argyriadis, P.G., Fontaine, G., Hebert, J.L., Frank, R.A., D'Attellis, N.,
  Fabiani, J.N. and Carpentier, A.F. (2003), Right ventricular cardiomyoplasty:
  10-year follow-up. Annals of Thoracic Surgery, 75 (5), 1464-1468.
Abstract: Background. Chronically depressed right ventricular (RV) function presents
  an unsolved therapeutic challenge in cardiac surgery. Despite recent advances in
  medical and surgical therapies, prognosis remains poor and patient's quality of life
  and mortality are frequently unacceptable. The aim of this study is to present the first
  clinical report and long-term results of RV dynamic cardiomyoplasty applied in
  patients with RV failure caused by isolated RV cardiomyopathies. Methods. Seven
  consecutive patients (5 males, 2 females; mean age, 40 +/- 9 years; range, 15 to 63
  years) from a series of 113 cardiomyoplasty procedures performed at Broussais and
  Pompidou Hospitals were evaluated. The mean duration of follow-up was 10 +/- 3.5
  years. All patients had predominant RV dysfunction, associated with tricuspid
  regurgitation in 6 patients. The cause of RV failure was arrhythmogenic
  cardiomyopathy (4 patients), ischemic (2 patients), and Uhl's disease (1 patient), and
  endomyocardial fibrosis (1 patient). Six patients were in preoperative New York
  Heart Association functional class III and 1 was in intermittent class III/IV. The
  mean preoperative ejection fraction (measured by isotopic technique) was 18% +/-
  5.7% for the right ventricle and 40% +/- 13% for the left ventricle. Right ventricular
  dynamic cardiomyoplasty consists of wrapping the RV free walls with the left
  latissimus dorsi muscle flap. The distal part of the latissimus dorsi muscle is fixed to
  the diaphragm and then electrostimulated. Six patients required associated tricuspid
  valve surgery. Results. There were no perioperative deaths. The mean duration of
  follow-up was 10 +/- 3.5 years. Six patients are alive with a remarkable quality of
  life, 4 are in New York Heart Association functional class I and 2 are in class II. One
  patient who was in New York Heart Association functional class 11 died in
  postoperative year 7 caused by stroke. At last follow-up, mean RV ejection fraction
  was 33% +/- 11.8% and left ventricular ejection fraction was 52% +/- 12.6%.
  Conclusions. The results of this long-term study demonstrate hemodynamic and
  functional improvements after RV cardiomyoplasty without perioperative mortality,
  no long-term malignant arrhythmias, and RV dysfunction related deaths. We believe
  that RV cardiomyoplasty, associated with tricuspid valve surgery when required,
  could be an effective treatment for severe RV failure. (C) 2003 by The Society of
  Thoracic Surgeons
Keywords:                                                 age/arrhythmias/cardiac/cardiac
  mic/latissimus dorsi muscle/left/left ventricle/left ventricular/left ventricular ejection
  ve/prognosis/PROSTHESES/quality/quality                                                 of
  regurgitation/tricuspid                                     valve/TRICUSPID-VALVE
  REPLACEMENT/USA/ventricular/ventricular                ejection/ventricular       ejection
Doty, J.R., Wilentz, R.E., Salazar, J.D., Hruban, R.H. and Cameron, D.E. (2003),
  Atheroembolism in cardiac surgery. Annals of Thoracic Surgery, 75 (4), 1221-1226.
Abstract: Background. Atheroembolism is a recognized complication of cardiac surgery,
  but its incidence and various outcomes have not been completely described. A
  retrospective study was undertaken to better characterize the syndrome. Methods.
  Records of 49,377 autopsies and surgical specimens from the Johns Hopkins
  Hospital between 1973 and 1995 were reviewed. Three hundred twenty-seven
  patients (0.7%) had an identifiable atheroembolism on histologic examination. Of
  these patients, 29 (0.2%) had undergone a cardiac surgical procedure within 30 days
  of autopsy or surgical resection. Patient charts and pathology specimens were
  reviewed for operative findings, postoperative outcomes, and histology. Results. Six
  of the 29 patients (21%) had atheroembolism to the heart, 7 patients (24%) had
  embolism to the central nervous system, 19 patients (66%) had embolism to the
  gastrointestinal tract, 14 patients (48%) had embolism to one or both kidneys, and 5
  patients (17%) had embolism to a lower extremity. Sixteen patients (55%) had
  atheroembolism in two or more areas. In 6 patients (21%), death was directly
  attributable to atheroembolism, including intraoperative cardiac failure from
  coronary embolism (n = 3), massive stroke (n = 2), and extensive gastrointestinal
  embolization (n = 1). Conclusions. Atheroembolism in cardiac surgery has a broad
  spectrum of clinical presentations, including devastating injuries and death. Although
  the true incidence is probably underestimated in this retrospective study, the high
  attendant mortality and morbidity of atheroembolism have been documented.
  Improvements in outcome are likely to be associated with preoperative identification
  of patients at high risk, modifications of perfusion technique, and interventions to
  minimize secondary thrombosis and progressive organ ischemia. (C) 2003 by The
  Society of Thoracic Surgeons
Keywords:                                                                   ASCENDING
  failure/cardiac             surgery/CATHETERIZATION/central                      nervous
  system/CHOLESTEROL                                                              EMBOLI
Dowling, R.D., Gray, L.A., Etoch, S.W., Laks, H., Marelli, D., Samuels, L., Ebtwhistle,
  J., Couper, G., Vlahakes, G.J. and Frazier, O.H. (2003), The AbioCor implantable
  replacement heart. Annals of Thoracic Surgery, 75 (6), S93-S99.
Abstract: The AbioCor implantable replacement heart (IRH) is the first available totally
  implantable artificial heart. We recently initiated a multicenter trial of this device in
  patients with severe, irreversible biventricular failure. Patients who were not
  candidates for other therapies, including transplantation, were evaluated. All
  candidates were adults with inotrope- dependent biventricular failure, whose 30-day
  predicted mortality was higher than 70%. A three-dimensional computerized fit study
  predicted fit of the AbioCor thoracic unit in all recipients. At operation, the internal
  battery controller and transcutaneous energy transfer unit were placed. The AbioCor
  thoracic unit was placed in an orthotopic position after incision of the ventricals.
  There were 2 intaroperative deaths (due to intraoperative bleeding or aprotinin
  reaction). Four late deaths were recorded, 1 from multisystem organ failure and 3
  cerebrovascular accidents. Autopsy revealed thrombus on the atrial struts of the 3
  patients with cerebrovascular accident. Blood pumps and valves were clean on all
  patients. Significant morbidity was observed, primarily related to preexisting severity
  of illness. However, 3 patients recovered to the point of being able to take multiple
  trips outside of the hospital. Two patients were discharged from the hospital, with 1
  patient being discharged home for more than 7 months. No significant device
  malfunctions or multi-system organ failure device- related infections were noted. The
  AbioCor IRH may be effective therapy for patients with end-stage heart failure.
  Many milestones have been achieved in the initial trial in humans, including the
  successful discharge of a patient to home and no significant device malfunctions. The
  occurrence of stroke is likely related to the presence of thrombus on the atrial struts
  and may be decreased as these atrial struts have been removed for future clinical
  implants. (C) 2003 by The Society of Thoracic Surgeons
  ar accident/cerebrovascular accidents/clinical/computerized/end-stage/energy/energy
Emery, R.W., Van Nooten, G.J. and Tesar, P.J. (2003), The initial experience with the
  ATS medical mechanical cardiac valve prosthesis. Annals of Thoracic Surgery, 75
   (2), 444-452.
Abstract: Background. From May 1994 through October 2000, a total of 1,146 patients
   underwent valve replacement with the ATS Medical mechanical cardiac valve
   prosthesis under a study protocol approved by international ethics committees
   (non-United States participants) or under a United States Food and Drug
   Administration-approved Investigational Device Exemption study. The study took
   place at 19 domestic and three international centers. Methods. As required by the
   Food and Drug Administration's Heart Valve Guidance Document, only isolated
   implants were included in the study (double-valve implants were excluded), with
   operative and follow-up data collected from each center. Results. Aortic valve
   replacement (AVR) was conducted in 801 patients (309 with coronary bypass) and
   mitral valve replacement (MVR) in 345 patients (78 with coronary bypass). Overall
   operative (:5 30 days post implant) mortality was 2.1% (17 AVR 2.1%, 7 MVR =
   2.0%), 7 of which (AVR = 4, MVR 3) were valve related. In 2,086 patient-years
   (1,459 AVR patient-years, 627 MVR patient-years) of follow-up, there were an
   additional 50 patient deaths of these, 18 were valve related, 9 due to anticoagulant
   related bleeding, 5 sud- den/unexplained, and 1 each after stroke, thrombosis,
   prosthetic valve endocarditis, and thromboembolism. Late (>30 days post implant)
   valve-related complications included: transient and chronic thromboembolism (27
   AVR (linearized rate 1.85%/patient-year) and 20 MVR (3.19%/patient-year), of
   which 11/47 (0.53%/patient-year) had chronic deficits, thrombosis (1 AVR =
   0.07%/patient-year and 4 MVR = 0.64%/patient-year), paravalvular leak (10 AVR =
   0.69%/patient-year and 8 MVR = 1.28%/patient-year), anticoagulant related
   hemorrhage (34 AVR = 2.33%/patient-year and 8 MVR = 1.28%/patient-year),
   prosthetic valve endocarditis (3 AVR = 0.21%/patientyear and 2 MVR =
   0.32%/patient-year), and structural valve failure or dysfunction (0%).
   Echocardiographic gradients were proportional to valve size and did not significantly
   change over the follow- up period. Conclusions. This study documented the ATS
   Medical mechanical cardiac valve prosthesis to be a valuable addition to the
   surgeon's armamentarium in the treatment of cardiac valvular disease. (C) 2003 by
   The Society of Thoracic Surgeons
   up/follow-up/hemorrhage/implant/mechanical/medical/mitral valve/mitral valve
   rombosis/transient/treatment/United States/USA/valvular disease
Frumento, R.J., O'Malley, C.M.N. and Bennett-Guerrero, E. (2003), Stroke after cardiac
   surgery: A retrospective analysis of the effect of aprotinin dosing regimens. Annals
   of Thoracic Surgery, 75 (2), 479-483.
Abstract: Background. Half-dose aprotinin (HDA) appears to be equivalent to full-dose
   aprotinin (FDA) in its ability to prevent bleeding. However, data regarding the
   potential effect of aprotinin use and dosage on other outcomes such as the occurrence
   of perioperative stroke are limited. It has been postulated that the higher level of
   kallikrein inhibition obtained with FDA dosing may be required for end-organ
   protection. Therefore, we performed a retrospective study in cardiac surgery patients
   at high risk for developing stroke to determine the relative effects of FDA and HDA
   regimens on the incidence of postoperative stroke. Methods. Records of 1,524
  patients undergoing cardiac surgery over a 15-month period were reviewed. Patients
  at high risk for stroke were selected if they met all of the following predefined
  criteria: age greater than 70 years, history of hypertension, history of diabetes
  mellitus, history of stroke or transient ischemic attack, and presence of aortic
  atheroma. A validated preoperative stroke risk index was calculated for each patient.
  Postoperative stroke required confirmation by computed tomography or magnetic
  resonance imaging. Patients were divided into three groups according to whether
  they were administered no aprotinin, HAD, or FDA. Results. A total of 149 patients
  fulfilled the criteria for being at high risk for stroke. Stroke risk index was very
  similar (P = 0.56) in the three groups: those who received no aprotinin and served as
  a control group (124 +/- 15, n = 56), those who were given HDA (123 12, n = 67),
  and those who received FDA (122 11 n 26). Preoperative and intraoperative
  characteristics were also similar between the three study groups. Overall, the
  incidence of stroke was 16% (24/149). The incidence of stroke differed (p < 0.05)
  among the three groups: no aprotinin 16% (9/56), HDA 22% (15/67), and FDA 0%
  (0/26). Conclusions. In this retrospective study of cardiac surgery patients at high
  risk for postoperative stroke, the administration of FDA but not HDA was associated
  with a lower incidence of stroke. (C) 2003 by The Society of Thoracic Surgeons
Keywords:                                                 ability/age/analysis/aortic/aortic
  surgery/CARDIOPULMONARY                                              BYPASS/computed
  tomography/control/CORONARY-BYPASS SURGERY/criteria/diabetes/diabetes
  /ischemic/ischemic attack/lower/magnetic/magnetic resonance/magnetic resonance
  d/perioperative      stroke/postoperative/postoperative      stroke/protection/resonance
  imaging/retrospective                                           study/RISK/stroke/stroke
  risk/surgery/tomography/transient/transient ischemic attack/USA/use
Goto, T., Baba, T., Matsuyama, K., Honma, K., Ura, M. and Koshiji, T. (2003), Aortic
  atherosclerosis and postoperative neurological dysfunction in elderly coronary
  surgical patients. Annals of Thoracic Surgery, 75 (6), 1912-1918.
Abstract: Background. Arteriosclerosis of the ascending aorta is an important risk factor
  for cerebral embolism. However, the association between arteriosclerosis of the
  ascending aorta and neurologic dysfunction after coronary artery surgery has not
  been evaluated prospectively. Methods. We examined whether varying degrees of
  arteriosclerosis in the ascending aorta, assessed by epiaortic ultrasonography,
  increased the incidence of neuropsychologic dysfunction and stroke in 463 elderly
  patients (greater than or equal to 60 years old) after coronary artery surgery. Results.
  Patients with severe arteriosclerosis (n = 76) had higher rates of postoperative
  neuropsychologic dysfunction (26%) and intraoperative stroke (10.5%); the
  moderately atherosclerotic patients (n = 57) had rates of 7% and 1.8%, respectively;
  whereas control patients (almost normal or mild arteriosclerosis, n = 330) had rates
  of 8% and 1.2%, respectively (all p < 0.001). Univariate analysis indicated that
  multiple small infarctions or broad infarctions, cerebral arterial stenosis, circulatory
  arrest, maximal thickness of intima around the site of aortic manipulation, and
  deformities due to clamp or cannulation were associated significantly with
  intraoperative strokes in patients with severe arteriosclerosis. Conclusions. Severe
  arteriosclerosis of the ascending aorta significantly increased the risk of
  postoperative neuropsychologic dysfunction and stroke after coronary artery bypass
  grafting. If a thick plaque is noted near the manipulation site, a nontouch method of
  the ascending aorta should be applied to reduce the incidence of neurologic
  dysfunction. (C) 2003 by The Society of Thoracic Surgeons
Keywords:                                            analysis/aorta/aortic/arterial/arterial
  nnulation/CARDIAC-SURGERY/cerebral/cerebral embolism/circulatory/circulatory
  arrest/control/coronary/coronary artery/coronary artery bypass/coronary artery
  bypass                                             grafting/dysfunction/elderly/elderly
Grega, M.A., Borowicz, L.M. and Baumgartner, W.A. (2003), Impact of single clamp
  versus double clamp technique on neurologic outcome. Annals of Thoracic Surgery,
  75 (5), 1387-1391.
Abstract: Background. Atherosclerotic disease of the aorta has been identified as a risk
  factor for neurologic complications following coronary artery bypass grafting
  (CABG) due to the use of aortic clamping and manipulation. We reviewed a change
  from double clamp to single clamp technique to determine its impact on neurologic
  outcomes. Methods. Patients undergoing isolated CABG by a single surgeon were
  identified as having double clamp technique (DCT) (aortic cross clamp + sidebiting
  clamp) or single clamp technique (SCT) (aortic cross clamp only). Data were
  collected by study personnel and clinicians to determine stroke and neurologic injury
  (confusion, delirium, seizure, altered mental status, and agitation) outcomes for 461
  patients. Results. Two hundred seventy-two patients had DCT and 189 patients had
  SCT performed. There were no differences in mean age, previous stroke,
  hypertension, or diabetes. Intraoperatively, patients with SCT had shorter bypass
  times (115 minutes vs 128 minutes, p = 0.001), longer aortic cross clamp time (89
  minutes vs 80 minutes, p = 0.001), fewer coronary grafts (2.8 vs 3.1, p = 0.001), and
  had higher mean arterial blood pressure on cardiopulmonary bypass (76 mm Hg vs
  69 mm Hg, p = 0.001). Postoperatively, the SCT group had fewer strokes (1.1% vs
  2.9%, NS), and neurologic injuries (3.2% vs 9.6%, p = 0.008). By multivariate
  analysis, the factors that were related to neurologic injury were DCT (p = 0.04), age
  (p 0.001), and number of coronary grafts (p = 0.03). Conclusions. This experience
  suggests that the use of the SCT may be important in reducing neurologic injury
  following CABG. (C) 2003 by The Society of Thoracic Surgeons
Keywords:                 age/analysis/AORTA/aortic/arterial/arterial                blood
  bypass/complications/coronary/coronary artery/coronary artery bypass/coronary
  artery                     bypass                     grafting/CORONARY-ARTERY
  manipulation/mental/multivariate                         analysis/neurologic/neurologic
  complications/neurologic              injury/neurologic             outcome/neurologic
Hatsuoka, S., Sakamoto, T., Stock, U.A., Nagashima, M. and Mayer, J.E. (2003), Effect
  of L-arginine or nitroglycerine during deep hypothermic circulatory arrest in
  neonatal lambs. Annals of Thoracic Surgery, 75 (1), 197-203.
Abstract: Background. The role of nitric oxide (NO) in ischemia- reperfusion injury
  remains controversial. This study evaluated the effects Of L-arginine (NO precursor)
  or nitroglycerine (NO donor) on cardiac and lung function after deep hypothermic
  circulatory arrest in neonatal lambs. Methods. Three groups of anesthetized lambs
  underwent cardiopulmonary bypass, deep hypothermic circulatory arrest (120
  minutes at 18degreesC), and rewarming (40 minutes). During reperfusion, L-arginine
  (5 mg/kg per minute), nitroglycerine (2 mug/kg per minute), or saline (control group)
  was infused for 100 minutes. All animals were separated from cardiopulmonary
  bypass and observed for 3 additional hours. Preload recruitable stroke work, cardiac
  index, pulmonary vascular resistance, alveolar-arterial oxygen difference, and lung
  compliance plasma nitrate/nitrite levels (NO metabolites) were measured before and
  after cardiopulmonary bypass. Malondialdehyde in heart tissue and lung tissue was
  measured 3 hours after cardiopulmonary bypass. Results. Recovery of preload
  recruitable stroke work and cardiac index were significantly higher in the L-arginine
  and nitroglycerine groups than in the control group (p < 0.05). Pulmonary vascular
  resistance was significantly lower in the L-arginine and nitroglycerine groups than in
  the control group (p < 0.05). Levels of NO metabolites and issue malondialdehyde
  did not differ among groups. Conclusions. L-arginine and nitroglycerine improved
  recovery of left ventricular function and reduced pulmonary vascular resistance after
  deep hypothermic circulatory arrest. The mechanism of beneficial action could
  involve increased NO levels, but we did not find higher levels of NO metabolites
  compared with controls. Tissue malondialdehyde levels were not affected by
  L-arginine or nitroglycerine. These results show that, at these dosage levels,
  provision of substrate for NO production or provision of an NO donor were
  beneficial to the recovery of myocardial and pulmonary vascular function. (C) 2003
  by The Society of Thoracic Surgeons
Keywords:                            action/ADHESION/animals/bypass/cardiac/cardiac
  index/cardiopulmonary/cardiopulmonary                   bypass/circulatory/circulatory
  DYSFUNCTION/FLOW CONDITIONS/function/heart/hypothermic/hypothermic
  circulatory arrest/index/injury/ISCHEMIA/ischemia reperfusion/L-arginine/left/left
  ventricular/left                 ventricular                  function/lower/lung/lung
  K/nitric           oxide/NITRIC-OXIDE               RELEASE/nitroglycerine/NO/NO
  donor/oxygen/PEROXYNITRITE/plasma/preload/preload                recruitable     stroke
  work/SUPEROXIDE/USA/vascular/vascular                resistance/ventricular/ventricular
Immer, F.F., Berdat, P.A., Immer-Bansi, A.S., Eckstein, F.S., Muller, S., Saner, H. and
  Carrel, T.P. (2003), Benefit to quality of life after off-pump versus on-pump
  coronary bypass surgery. Annals of Thoracic Surgery, 76 (1), 27-31.
Abstract: Background. Whether the clinical outcome of off-pump coronary artery
  bypass graft (OPCABG) surgery is superior to on-pump coronary artery bypass graft
  (CABG) surgery is still a matter of debate. However with the considerable reduction
  of mortality associated with CABG surgery in recent years, more subtle outcome
  indicators such as quality of life (QOL) become more important. The aim of this
  study was to compare midterm QOL after OPCABG with that after CABG
   procedures and with an age- and sex-matched standard population. Methods. Quality
   of life was assessed using the Short-Form 36 Health Survey Questionnaire for 504
   consecutive patients after CABG (n = 438) and OPCABG (n = 66) operated on
   between June 1999 and November 2000 at our institution. Results. Except for
   single-vessel disease, which was more frequent in OPCABG compared with CABG
   procedures (13.6% versus 6.8%; p <0.01), the preoperative variables were similar.
   Median EuroSCORE (European System for Cardiac Operative Risk Evaluation) was
   3.2 +/- 1.3 in the CABG group compared with 3.0 +/- 0.8 in the OPCABG group (p =
   not significant). After a mean follow-up of 10.8 +/- 0.5 months physical role function
   (73.5 +/- 38.3 versus 45.3 +/- 41.6; p <0.01) and emotional role function (75.3 +/-
   40.3 versus 61.0 +/- 43.9; p <0.01) were significantly better in OPCABG than in
   CABG patients. Compared with a standard population, OPCABG patients were
   significantly impaired in emotional role function and CABG patients in physical and
   emotional role function. Conclusions. Midterm QOL after myocardial
   revascularization is fairly well preserved compared with an age-and sex-matched
   standard population and is superior after OPCABG compared with CABG. Whether
   this is only due to avoidance of cardiopulmonary bypass remains to be elucidated. (C)
   2003 by The Society of Thoracic Surgeons
Keywords:               age/artery/ARTERY                BYPASS/BRAIN/bypass/bypass
   surgery/CABG/cardiopulmonary/CARDIOPULMONARY BYPASS/clinical/clinical
   outcome/coronary/coronary artery/coronary artery bypass/coronary artery bypass
   graft/coronary      bypass/coronary    bypass     surgery/disease/EuroSCORE/follow
   al/myocardial revascularization/NEW-YORK/off pump/off pump coronary artery
   bypass/off-pump/off-pump                         coronary                         artery
   bypass/outcome/OUTCOMES/patients/physical/population/quality/quality                  of
Johnsson, P., Backstrom, M., Bergh, C., Jonsson, H., Luhrs, C. and Alling, C. (2003),
   Increased S100B in blood after cardiac surgery is a powerful predictor of late
   mortality. Annals of Thoracic Surgery, 75 (1), 162-168.
Abstract: Background. Long-term outcome in patients who suffered stroke after
   undergoing a cardiac operation has been investigated sparingly, but increased
   long-term mortality has been reported. S100B is a biochemical marker of brain cell
   ischemia and blood- brain barrier dysfunction. The aim of this investigation was to
   record the long-term mortality in consecutive patients undergoing cardiac operations
   and to explore whether increased concentrations of S100B in blood had a predictive
   value for mortality. Methods. Prospectively collected clinical variables, including
   S100B, in 767 patients who survived more than 30 days after a cardiac operation,
   were analyzed with actuarial survival analysis and 678 patients were analyzed with
   Cox multiple regression analysis. Results. Forty-nine patients (6.4%) were dead at
   follow-up (range, 18 to 42 months); 11.5% (88 of 767 patients) had elevated S100B
   2 days after operation (range, 38 to 42 hours). The probability for death at follow-up
   was 0.239 if the S100B level was more than 0.3 mug/L, and 0.041 if it was less than
   0.3 mug/L. The clinical variables independently associated with mortality were
   preoperative renal failure, preoperative low left ventricular ejection fraction,
   emergency operation, severe postoperative central nervous system complication, and
   elevated S100B values, which turned out to be the most powerful predictor.
   Conclusions. Even slightly elevated S100B values in blood 2 days after cardiac
   operation imply a bad prognosis for outcome, and especially so in combination with
   any central nervous system complication. (C) 2003 by The Society of wThoracic
Keywords: actuarial survival/analysis/biochemical marker/blood/blood brain
  barrier/blood-                           brain                        barrier/brain/brain
  barrier/BRAIN-DAMAGE/BYPASS/cardiac/cardiac                  surgery/central     nervous
  fraction/emergency/failure/follow            up/follow-up/investigation/ischemia/left/left
  ventricular/left ventricular ejection fraction/Lung/marker/mortality/multiple/multiple
  regression                                                     analysis/nervous/nervous
  tive                               value/predictor/prognosis/range/regression/regression
  analysis/RELEASE/renal/renal                   failure/S-100            PROTEIN/S100-
  analysis/Sweden/TERM/USA/ventricular/ventricular ejection/ventricular ejection
Lee, J.D., Lee, S.J., Tsushima, W.T., Yamauchi, H., Lau, W.T., Popper, J., Stein, A.,
  Johnson, D., Lee, D., Petrovitch, H. and Dang, C.R. (2003), Benefits of off-pump
  bypass on neurologic and clinical morbidity: A prospective randomized trial. Annals
  of Thoracic Surgery, 76 (1), 18-25.
Abstract: Background. Neurologic and clinical morbidity after coronary artery bypass
  grafting (CABG) can be significant. By avoiding cardiopulmonary bypass, off-pump
  CABG (OPCAB) may reduce morbidity. Methods. Sixty patients (30 CABG and 30
  OPCAB) were prospectively randomized. Neurocognitive testing was performed
  before the operation and 2 weeks and 1 year after the operation. Neurologic testing to
  detect stroke and Tc-99m-HMPAO whole-brain single photon emission computed
  tomography scanning to assess cerebral perfusion were performed before the
  operation and 3 days afterward. Bilateral middle cerebral artery transcranial Doppler
  scanning was performed intraoperatively to detect cerebral microemboli. All
  examiners were blinded to treatment group. Clinical morbidity and costs were
  compared. Results. Coronary artery bypass grafting was associated with more
  cerebral microemboli (575 +/- 278.5 CABG versus 16.0 +/- 19.5 OPCAB (median
  +/- semiinterquartile range) and significantly reduced cerebral perfusion after the
  operation to the bilateral occipital, cerebellar, precunei, thalami, and left temporal
  lobes (p less than or equal to 0.01). Cerebral perfusion with OPCAB was unchanged.
  Compared with base line, OPCAB patients performed better on the Rey Auditory
  Verbal Learning Test (total and recognition scores) at both 2 weeks and at 1 year (p
  less than or equal to 0.05), whereas CABG performance was statistically unchanged
  for all cognitive measures. Patients who underwent CABG had more chest tube
  drainage (1389 +/- 1256 mL CABG versus 789 +/- 586 mL OPCAB, p = 0.02) and
  required more blood (3.9 +/- 5.8 U CABG versus 1.2 +/- 2.2 U OPCAB, p = 0.02),
  fresh frozen plasma (3.0 +/- 6.0 U CABG versus 0.5 +/- 2.2 U OPCAB, p = 0.03),
  and hours of postoperative use of dopamine (16.3 +/- 21.2 hours CABG versus 7.3
  +/- 9.7 hours OPCAB, p = 0.04). These differences culminated in higher costs for
  CABG ($23,053 +/- $5,320 CABG versus $17,780 +/- $4,390 OPCAB, p < 0.0001).
  One stroke occurred with CABG, compared with none with OPCAB (p = NS). One
  OPCAB patient died because of a pulmonary embolus (p = NS). Conclusions.
  Compared with CABG, OPCAB may reduce neurologic and clinical morbidity as
  well as cost. (C) 2003 by The Society of Thoracic Surgeons
Keywords:        artery/bilateral/blood/bypass/CABG/cardiopulmonary/cardiopulmonary
  bypass/cerebral/cerebral                artery/cerebral            microemboli/cerebral
  perfusion/clinical/cognitive/computed                     tomography/coronary/coronary
  artery/coronary           artery        bypass/coronary          artery         bypass
  computed/emission-computed/grafting/left/microemboli/middle            cerebral/middle
  cerebral artery/morbidity/neurologic/NEW-YORK/off pump/off-pump/off-pump
  ospective/pulmonary/randomized/randomized trial/range/recognition/single photon
  emission         computed          tomography/stroke/STROKES/SURGERY/temporal
Mack, M.J., Emery, R.W., Ley, L.R., Cole, P.A., Leonard, A., Edgerton, J.R., Dewey,
  T.M., Magee, M.J. and Flavin, T.S. (2003), Initial experience with proximal
  anastomoses performed with a mechanical connector. Annals of Thoracic Surgery,
  75 (6), 1866-1870.
Abstract: Background. The Symmetry Bypass System Aortic Connector (St Jude
  Medical, Inc) is a novel device for the construction of sutureless proximal
  anastomoses. The connector allows attachment of saphenous vein grafts to the aorta
  without requiring aortic clamping. We report our initial clinical experience with this
  device. Methods. In a 2-month period from May to July 2001, a total of 139
  consecutive proximal anastomoses were performed in 67 patients using the connector.
  All procedures were performed on a beating heart without cardiopulmonary bypass
  or any aortic clamping. Intraoperative variables and postoperative results were
  prospectively collected and retrospectively analyzed. Results. Of 139 consecutive
  proximal anastomoses 138 (99.3%) were successfully completed with the device.
  One anastomosis required suture revision because of misdeployment. Six
  anastomoses (4.3%) required an additional suture for leak. Predeployment problems
  included connector loading/preparation malfunction in 10 grafts (7.2%), five because
  of human error and five technical failure. There was no operative mortality,
  perioperative myocardial infarction, or stroke. Vessels bypassed included the
  circumflex system (n = 59), right coronary artery and branches (n = 48), diagonal
  branch (n = 26), and left anterior descending coronary artery (n = 6). At a mean
  follow-up of 7 months, survival was 94.1% and survival free of major adverse
  cardiac and cerebrovascular events (MACCE) was 88.1%. Conclusions. Initial
  clinical experience with a sutureless proximal saphenous vein graft to aorta
  anastomosis performed with a mechanical connector demonstrates safety, reliability,
  and ease of use. Surmounting a brief learning curve improves the subtleties of device
  loading and deployment. Further benefits will be determined in an ongoing
  randomized study. (C) 2003 by The Society of Thoracic Surgeons
Keywords:                         anastomoses/anastomosis/aorta/aortic/artery/BEATING
  bypass/cerebrovascular/cerebrovascular                         events/clinical/clinical
  experience/coronary/coronary                          artery/CORONARY-ARTERY
  BYPASS/DEVICE/experience/failure/follow                   up/follow-up/graft/GRAFT
  vein/SAPHENOUS-VEIN/stroke/SURGERY/survival/USA/use/vein/vein graft
Malhotra, S.P., Thelitz, S., Riemer, R.K., Reddy, V.M., Suleman, S. and Hanley, F.L.
  (2003), Fetal myocardial protection is markedly improved by reduced cardioplegic
  calcium content. Annals of Thoracic Surgery, 75 (6), 1937-1941.
Abstract: Background. Fetal cardiac surgery holds a clear therapeutic benefit in the
  treatment of lesions that increase in complexity due to pathologic blood flow patterns
  during development. Fetal and neonatal myocardial physiology differ substantially,
  particularly in the regulation of myocardial calcium concentration. To examine issues
  of calcium homeostasis and fetal myocardial protection, a novel isolated
  biventricular working fetal heart preparation was developed. Methods. Hearts from
  20 fetal lambs, 115 to 125 days gestation, were harvested and perfused with standard
  Krebs-Henseleit (K-H) solution. The descending aorta was ligated distal to the ductal
  insertion and the branch pulmonary arteries were ligated to mimic fetal
  cardiovascular physiology. Hearts were arrested for 30 minutes with normocalcemic
  (n = 8), hypocalcemic (n = 6), or hypercalcemic (n = 6) cold crystalloid cardioplegia
  before reperfusion with K-H solution. Results. Compared with normocalcemic
  cardioplegia, hypocalcemic cardioplegia improved preservation of left ventricular
  (LV) systolic function (88% +/- 2.2% vs 64% +/- 15% recovery of end-systolic
  elastance, p = 0.02), diastolic function (12% +/- 21% vs 38% +/- 11% increase in
  end-diastolic stiffness, p = 0.04), and myocardial contractility (97% +/- 9.6% vs
  75.2% +/- 13% recovery of preload recruitable stroke work [PRSW], p = 0.04). In
  contrast, the fetal myocardium was sensitive to hypercalcemic arrest with poor
  preservation of LV systolic function (37.5% +/- 8.4% recovery of elastance),
  diastolic function (86% +/- 21% increased stiffness), and overall contractility (32%
  +/- 13% recovery of PRSW). Myocardial water content was reduced in hearts
  arrested with hypocalcemic cardioplegia (79% +/- 1.8% vs 83.7% +/- 0.9%, p =
  0.0006). Conclusions. This study demonstrates the sensitivity of the fetal
  myocardium to cardioplegic calcium concentration. Hypocalcemic cardioplegia
  provides superior preservation of systolic, diastolic, and contractile function of the
  fetal myocardium. (C) 2003 by The Society of Thoracic Surgeons
Keywords:              aorta/arteries/blood/blood           flow/calcium/cardiac/cardiac
  surgery/cardioplegia/cardiovascular/cardiovascular                physiology/contractile
  function/elastance/end-systolic                                     elastance/fetal/fetal
  ventricular/LIFE/myocardial/myocardial                          contractility/myocardial
  BLOOD/patterns/physiology/preload/preload                  recruitable            stroke
  sitivity/standard/stiffness/stroke/stroke                work/surgery/systolic/systolic
  function/therapeutic/treatment/USA/ventricular/water/water content/work
Marty-Ane, C.H., Berthet, J.P., Branchereau, P., Mary, H. and Alric, P. (2003),
  Endovascular repair for acute traumatic rupture of the thoracic aorta. Annals of
  Thoracic Surgery, 75 (6), 1803-1807.
Abstract: Background. We report endovascular treatment of acute traumatic rupture of
  the thoracic aorta as a potential alternative to open surgery for high-risk patients.
  Methods. Between January 2001 and July 2002, 9 patients with acute traumatic
  rupture of the thoracic aorta were treated with a stent-graft. In all cases the
  endovascular management was selected because of age, associated polytrauma, or
  comorbidities. Preoperative workup included chest computed tomography scan,
  transoesophageal echography, and angiography. The devices used were the Excluder
  and the Talent stent-grafts. Results. Eight patients underwent immediate repair and 1
  patient was treated within 5 days of the accident because of delayed diagnosis of
  aortic rupture after surgical management of spleen rupture. The stent-graft was
   successfully expanded in all patients through the common femoral artery (n = 7) or
   the common iliac artery (n = 2). There was no perioperative death, renal failure, or
   neurologic complication (paraplegia or stroke). In 1 patient the computed
   tomography scan at 7 days postoperatively showed proximal endoleak requiring
   placement of a second stent-graft. Follow-up ranged from 4 to 20 months. All spiral
   computed tomography scans performed during follow-up revealed no evidence of
   endoleak, migration, or alteration of the stent-graft. Conclusions. Endovascular repair
   in the acute phase of traumatic rupture of the thoracic aorta is technically feasible
   and safe, and may represent an alternative to open surgery for high-risk patients.
   (Ann Thorac Surg 2003;75:1803-7) (C) 2003 by The Society of Thoracic Surgeons
Keywords:              acute/age/ANEURYSMS/angiography/aorta/aortic/artery/BLUNT
   management/endovascular               treatment/failure/femoral          artery/follow
Parolari, A., Alamanni, F., Cannata, A., Naliato, M., Bonati, L., Rubini, P., Veglia, F.,
   Tremoli, E. and Biglioli, P. (2003), Off-pump versus on-pump coronary artery
   bypass: Meta-analysis of currently available randomized trials. Annals of Thoracic
   Surgery, 76 (1), 37-40.
Abstract: Background. Off-pump coronary artery bypass (OPCAB) challenges the
   conventional on-pump coronary artery bypass grafting (CABG) as the standard of
   surgical therapy for coronary disease. The aim of this study is to assess the
   differences in clinical outcomes between CABG and OPCAB by meta-analysis of
   data published in randomized trials. Methods. A literature search (Medline, Pubmed,
   Cochrane Controlled Trials Register, and the Cochrane Medical Editors Trial
   Amnesty of unpublished clinical trials) was done for the period starting from January
   1990 until May 2002 and was supplemented with a manual bibliographic review for
   all peer-reviewed English language publications. A systematic overview
   (meta-analysis) of the randomized trials was done to define the risk of the composite
   end point (death, stroke, or myocardial infarction) in CABG versus OPCAB. Results.
   A literature search yielded nine comparable randomized studies, for a total of 1090
   patients, of whom 558 and 532 were randomly assigned to CABG and OPCAB,
   respectively. Meta- analysis of these studies showed a trend, albeit not statistically
   significant, toward reduction in the risk of the composite end point for patients who
   had OPCAB (odds ratio 0.48; 95% confidence interval 0.21 to 1.09; P = 0.08).
   Conclusions. Cumulative analysis of the few prospective randomized studies
   currently available found a potential clinical benefit of OPCAB, indicating that the
   avoidance of extracorporeal circulation might result in improved clinical outcomes.
   Further evidence, however, from large randomized trials is needed to assess potential
   advantages of OPCAB in terms of early outcomes. (C) 2003 by The Society of
   Thoracic Surgeons
Keywords: analysis/artery/BEATING-HEART/bypass/CABG/CARDIOPULMONARY
   BYPASS/circulation/clinical/clinical outcomes/clinical trials/coronary/coronary
   artery/coronary artery bypass/coronary artery bypass grafting/coronary
  GERY/surgical/surgical therapy/therapy/trials/USA
Sharony, R., Grossi, E.A., Saunders, P.C., Schwartz, C.F., Ciuffo, G.B., Baumann, F.G.,
  Delianides, J., Applebaum, R.M., Ribakove, G.H., Culliford, A.T., Galloway, A.C.
  and Colvin, S.B. (2003), Aortic valve replacement in patients with impaired
  ventricular function. Annals of Thoracic Surgery, 75 (6), 1808-1814.
Abstract: Background. Patients with reduced ventricular function undergoing aortic
  valve replacement have increased operative risks, but the impact of valvular
  pathophysiology and other risk factors has not been clearly defined. Methods. From
  June 1992 through June 2002, 1,402 consecutive patients underwent isolated aortic
  valve surgery with or without coronary artery bypass grafting; of these patients, 416
  had an ejection fraction less than 40% and are the subject of this report. These
  patients (mean age, 68.6) had severe stenosis (62.5%), severe regurgitation (30.3%),
  or mixed disease (7.2%). Aortic valve replacement plus coronary artery bypass
  grafting was performed in 48.4% of patients, and 27% had previous cardiac surgery.
  Follow-up included echocardiography and survival analysis. Results. Hospital
  mortality was 10.1% (42 of 416), with no difference between aortic stenosis (9.6%)
  and regurgitation (11.1%). Multivariate analysis revealed that age (P = 0.002) and
  renal disease (odds ratio = 4.2; 95% confidence interval, 1.9 to 9.3; p = 0.001) were
  independently associated predictors of mortality. Valvular pathophysiology had no
  impact on mortality. Peripheral vascular disease, multivessel coronary disease, and
  renal disease were associated risks for any postoperative complication. Peripheral
  vascular disease (odds ratio = 12.3, p = 0.02), history of cerebrovascular disease
  (odds ratio = 4.8, p = 0.038), and diabetes (odds ratio = 2.7, p = 0.04) were
  associated risks for stroke. The ejection fraction was more than 40% in 52% of the
  patients who had postoperative echocardiography (mean follow-up, 6 months).
  Actuarial survival revealed no difference between pathophysiologic groups.
  Conclusions. Aortic valve surgery in patients with impaired ventricular function
  carries an acceptable operative risk that can be stratified by age and comorbidities.
  The type of valvular pathophysiology does not significantly affect mortality. (Ann
  Thorac Surg 2003;75:1808- 14) (C) 2003 by The Society of Thoracic Surgeons
Keywords: affect/age/analysis/aortic/aortic stenosis/aortic valve/aortic valve
  disease/comorbidities/complication/coronary/coronary        artery/coronary      artery
  bypass/coronary                artery            bypass              grafting/coronary
  ction/ejection                  fraction/ELDERLY                    PATIENTS/follow
  SURVIVAL/mortality/NEW-YORK/odds                                   ratio/OPERATIVE
  l analysis/USA/vascular/vascular disease/ventricular/ventricular function
Shroyer, A.L.W., Coombs, L.P., Peterson, E.D., Eiken, M.C., Delong, E.R., Chen, A.,
   Ferguson, T.B., Grover, F.L. and Edwards, F.H. (2003), The society of thoracic
   surgeons: 30-day operative mortality and morbidity risk models. Annals of Thoracic
   Surgery, 75 (6), 1856-1864.
Abstract: Background. Although 30day risk-adjusted operative mortality (ROM) has
   been used for quality assessment, it is not sufficient to describe the outcomes after
   coronary artery bypass grafting (CABG) surgery. Risk-adjusted major morbidity may
   differentially impact quality of care (as complications occur more frequently than
   death) and enhance a surgical team's ability to assess their quality. This study
   identified the preoperative risk factors associated with several complications and a
   composite outcome (the presence of any major morbidity or 30-day operative
   mortality or both). Methods. For CABG procedures, the 1997 to 1999 Society of
   Thoracic Surgeons (STS) National Adult Cardiac Surgery Database was used to
   develop ROM and risk-adjusted morbidity (ROMB) models. Risk factors were
   selected using standard STS univariate screening and multivariate logistic regression
   approaches. Risk model performance was assessed. Across STS participating sites,
   the association of observed-to-expected (O/E) ratios for ROM and ROMB was
   evaluated. Results. The 30-day operative death and major complication rates for STS
   CABG procedures were 3.05% and 13.40%, respectively (503,478 CABG
   procedures), including stroke (1.63%), renal failure (3.53%), reoperation (5.17%),
   prolonged ventilation (5.96%), and sternal infection (0.63%). Risk models were
   developed (c-indexes for stroke [0.72], renal failure [0.76], reoperation [0.64],
   prolonged ventilation [0.75], sternal infection [0.66], and the composite endpoint
   [0.71]). Only a slight correlation was found, however, between ROMB and ROM
   indicators. Conclusions. Used in combination, ROMB and ROM may provide the
   surgical team with additional information to evaluate the quality of their care as well
   as valuable insights to allow them to focus on areas for improvement. (C) 2003 by
   The Society of Thoracic Surgeons
Keywords:                          ability/artery/assessment/association/bypass/BYPASS
   /complication/complications/coronary/coronary             artery/coronary         artery
   bypass/coronary                                artery                            bypass
   regression/model/models/morbidity/mortality/NEW-YORK/operative mortality and
   morbidity/outcome/outcomes/performance/quality/quality                                of
   care/regression/renal/renal           failure/reoperation/risk/risk         factors/risk
Srinivasan, A.K., Grayson, A.D., Pullan, D.M., Fabri, B.M. and Dihmis, W.C. (2003),
   Effect of preoperative aspirin use in off-pump coronary artery bypass operations.
   Annals of Thoracic Surgery, 76 (1), 41-45.
Abstract: Background. The effect of preoperative aspirin use until the day of operation
   on mortality rate and bleeding risks in patients who had on-pump coronary artery
   bypass operation has been well documented. However, the effect of aspirin use in
   patients undergoing off-pump coronary artery bypass operation (OPCAB) with
   regard to postoperative blood loss and morbidity has not been studied. We aimed to
   determine the effects of continuing aspirin therapy preoperatively. Methods. We
   performed a retrospective study of 340 patients who had first- time OPCAB between
   January 1998 and September 2001. A propensity score for receiving aspirin until the
   day of operation was constructed from core patient characteristics. All aspirin users
  (n = 170) were matched with unique 170 nonaspirin users by identical propensity
  score. The primary outcome measures were in-hospital mortality rate and
  hemorrhage-related outcomes (postoperative blood loss in the intensive care unit,
  reexploration for bleeding, and blood product requirements). Secondary outcome
  measures were stroke, myocardial infarction, gastrointestinal bleeding, and sternal
  wound infections. Results. There were no differences in patient characteristics
  between aspirin users and nonaspirin users. The average postoperative blood loss
  (845 mL versus 775 mL; P = 0.157) and the rate of reexploration for bleeding (3.5%
  versus 3.5%; p > 0.99) were similar in aspirin users and nonaspirin users. We found
  no significant difference between blood product requirements for the two groups.
  Similarly, we found no significant difference in the incidence of the secondary
  outcomes. Conclusions. Preoperative aspirin did not increase bleeding-related
  complications, mortality rate, or other morbidities in patients who had off-pump
  coronary artery operation. (C) 2003 by The Society of Thoracic Surgeons
Keywords:        ANTIPLATELET            THERAPY/artery/aspirin/bleeding/blood/blood
  loss/bypass/complications/coronary/coronary              artery/coronary           artery
  POSTOPERATIVE                                                      ASPIRIN/in-hospital
  mortality/incidence/infarction/infections/intensive          care/intensive          care
  unit/loss/morbidity/MORTALITY/mortality                     rate/myocardial/myocardial
  infarction/NEW-YORK/off             pump/off         pump         coronary         artery
  bypass/off-pump/off-pump          coronary        artery       bypass/outcome/outcome
  FT PATENCY/wound
Tanoue, Y., Ando, H., Fukumura, F., Umesue, M., Uchida, T., Taniguchi, K. and
  Tanaka, J. (2003), Ventricular energetics in endoventricular circular patch plasty for
  dyskinetic anterior left ventricular aneurysm. Annals of Thoracic Surgery, 75 (4),
Abstract: Background. The endoventricular circular patch plasty (Dor procedure)
  applies to patients with a left ventricular dysfunction due to an ischemic dilated
  ventricle. In the present study, we analyzed left ventricular energetics in patients who
  underwent the Dor procedure. Methods. We measured left ventricular contractility
  (end-systolic elastance; Ees), afterload (effective arterial elastance; Ea), and
  efficiency (ventriculoarterial coupling; Ea/Ees, and the ratio of stroke work and
  pressure-volume area; SW/PVA) based on the cardiac catheterization data before and
  after the Dor procedure in 8 patients with a postinfarction dyskinetic anterior left
  ventricular aneurysm. Concomitant procedures included coronary artery bypass
  grafting in all patients, mitral valve repair in one patient, and cryoablation in one
  patient. End-systolic elastance (Ees) and Ea were approximated as follows: Ees =
  mean arterial pressure/minimal left ventricular volume, and Ea = maximal left
  ventricular pressure/ (maximal left ventricular volume-minimal left ventricular
  volume), and thereafter Ea/Ees and SW/PVA were calculated. The left ventricular
  volume was normalized with the body surface area. Results. End-systolic elastance
  (Ees) increased after the Dor procedure (from 1.15 +/- 0.60 to 1.86 +/- 0.84 mm Hg
  m m(2). mL(-1), p < 0.01), thus resulting in an improvement in Ea/Ees and SW/PVA
  (from 2.94 +/- 1.11 to 1.64 +/- 0.49, p < 0.01, and from 0.426 +/- 0.110 to 0.559 +/-
  0.082, p < 0.01, respectively), even though Ea did not substantially change (from
  2.96 +/- 0.78 to 2.74 +/- 0.55 mm Hg. m(2) - mL(-1), p = 0.4). Conclusions. Left
  ventricular contractility and efficiency improves after the Dor procedure in patients
  with a dyskinetic anterior left ventricular aneurysm. However, afterload does not
  change. The use of appropriate afterload-reducing therapy thus plays an especially
  important role in the management of patients who undergo the Dor procedure. (C)
  2003 by The Society of Thoracic Surgeons
Keywords:                                  afterload/aneurysm/appropriate/arterial/arterial
  catheterization/catheterization/contractility/coronary/coronary artery/coronary artery
  bypass/coronary artery bypass grafting/coupling/cryoablation/dysfunction/effective
  arterial                                 elastance/EFFICIENCY/elastance/end-systolic
  elastance/energetics/grafting/ischemic/Japan/left/left ventricular/left ventricular
  aneurysm/left ventricular dysfunction/left ventricular energetics/left ventricular
  volume/management/mitral           valve/NEW-YORK/patient/patients/pressure-volume
  work/SURGERY/therapy/USA/use/ventricular/ventricular                 aneurysm/ventricular
  contractility/ventricular         energetics/ventricular         volume/ventriculoarterial
Yau, T.M., Tomita, S., Weisel, R.D., Jia, Z.Q., Tumiati, L.C., Mickle, D.A.G. and Li,
  R.K. (2003), Beneficial effect of autologous cell transplantation on infarcted heart
  function: Comparison between bone marrow stromal cells and heart cells. Annals of
  Thoracic Surgery, 75 (1), 169-176.
Abstract: Background. Cell transplantation may restore function after myocardial
  infarction, but the optimal cell type remains controversial. We compared autologous
  bone marrow stromal cells (BMCs) with autologous heart cells (HCs) in a porcine
  myocardial infarction model. Methods. Yorkshire pigs underwent coil occlusion of
  the left anterior descending artery. Bone marrow stromal cells were obtained from
  sternal marrow and HCs were obtained by left ventricular biopsy, then cultured for 4
  weeks. Four weeks after infarction, a Tc-99m-sestamibi single- photon emission
  tomography (Tc-99m-MIBI SPECT) scan was performed and the pigs were then
  transplanted with BMCs (n = 7), HCs (n = 7), or culture medium (n = 14). Four
  weeks after transplantation, 99-Tc-MIBI SPECT scanning was repeated to evaluate
  regional perfusion. Pressure-volume loops were constructed from micromanometer
  and conductance catheter data to evaluate left ventricular function. Hearts were
  evaluated histologically. Results. Bone marrow stromal cells and HCs engrafted
  within the infarct and assumed a myocyte morphology. SPECT MIBI scans showed
  increased perfusion in the infarct in cell-transplanted pigs, while perfusion decreased
  in the control pigs. Heart cell transplantation improved preload- recruitable stroke
  work and HC and BMC transplantation both shifted the end-systolic pressure-volume
  relation to the left. Both BMCs and HCs prevented thinning and expansion of the
  infarct region, and some BMCs differentiated into endothelial cells in newly formed
  blood vessels perfusing the infarct. Conclusions. Both BMCs and HCs engrafted in
  the infarct region and improved let ventricular function by preventing infarct
  thinning. Bone marrow stromal cells demonstrated greater plasticity in vivo, and may
  offer a practical alternative to HC transplantation to restore function and perfusion
  after a myocardial infarction. (C) 2003 by The Society of Thoracic Surgeons
Keywords: artery/biopsy/blood/blood vessels/bone marrow/bone marrow stromal
  cells/Canada/catheter/cell                     transplantation/conductance/conductance
  catheter/control/effect/emission/end-systolic                            pressure-volume
  relation/endothelial/endothelial           cells/function/heart/heart         function/in
  vivo/infarct/infarction/left/left               ventricular/left               ventricular
  e/preload/preload           recruitable         stroke          work/pressure-volume
  relation/SPECT/stroke/stroke                                              work/stromal
Dhume, A.S., Soundararajan, K., Hunter, W.J. and Agrawal, D.K. (2003), Comparison
  of vascular smooth muscle cell apoptosis and fibrous cap morphology in
  symptomatic and asymptomatic carotid artery disease. Annals of Vascular Surgery,
  17 (1), 1-8.
Abstract: The biological cascades that lead to carotid plaque disruptions and symptoms
  are largely unknown. Certain cellular events within the plaque might be responsible
  for destabilizing the plaque, though the popular belief is that the plaque size is
  directly related to symptoms. The aim of our study was to assess the morphology of
  the fibrous cap and apoptosis in the plaque and compare these two pathological
  features in symptomatic and asymptomatic carotid artery disease. Our work was
  carried out in plaques obtained following carotid endarterectomy performed for
  symptomatic disease (including hemispheric transient ischemic attacks, amaurosis
  fugax, or stroke) or asymptomatic high-grade severe stenosis. Scion images of
  Gomori's stained sections were used to measure fibrous cap thickness and area.
  TUNEL assay was performed to assess the extent of apoptosis. The results indicated
  that the area of the fibrous cap did not significantly correlate with the presence of
  symptoms. There was a higher percentage of apoptotic nuclei and the thinner fibrous
  cap in symptomatic plaques than in asymptomatic plaques. This finding suggests that
  these factors might be involved in destabilizing plaque, causing rupture and leading
  to symptomatic carotid disease
Keywords: amaurosis fugax/apoptosis/apoptotic/artery/asymptomatic/asymptomatic
  carotid artery disease/carotid/carotid artery/carotid artery disease/carotid
  disease/carotid endarterectomy/carotid plaque/CASPASES/cellular/CEREBRAL
  ATHEROSCLEROTIC                                         PLAQUES/ischemic/ischemic
  -YORK/plaque/results/RISK/rupture/severe/size/smooth/smooth                     muscle
  cell/STENOSIS/STROKE/symptomatic                                                carotid
  disease/symptoms/thickness/transient/transient                                ischemic
  attacks/TUNEL/USA/vascular/vascular smooth muscle/vascular smooth muscle
Quinones-Baldrich, W.J., Marelli, D. and Esmailian, F. (2003), Distal aortic arch
  replacement for aneurysmal disease: The value of preparatory carotid subclavian
  reconstruction. Annals of Vascular Surgery , 17 (2), 148-151.
Abstract: Between November 2000 and January 2002, two patients with aneurysms that
  involved the distal part of the aortic arch including the left subclavian artery were
  treated at our institution. Patient 1 had an aneurysm of 5.8 cm extending to the
  proximal descending aorta. Patient 2 had a 6.8 cm type II thoracoabdominal
  aneurysm extending proximal to the aortic bifurcation. Both patients had left
  subclavian-to-carotid transposition in preparation for distal aortic arch replacement.
  Complete replacement of the descending thoracic and abdominal aorta was carried
  out in patient 2. Both cases were done with distal aortic perfusion, spinal catheter
  drainage, and dual lumen endotracheal anesthesia. There was no mortality. There
   were no cerebrovascular complications in spite of the fact that patient 1 required
   aortic cross-clamping between the innominate and left carotid artery. There was no
   paraplegia, renal failure, or mesenteric or lower extremity complications. Patient 1
   had postoperative vocal cord palsy, eventually requiring medialization procedure. He
   recovered normal voice. Both patients remain alive and well at the time of last
   follow-up (7 to 20 months). Carotid subclavian reconstruction in preparation for
   distal aortic arch replacement facilitates the performance of the proximal
   anastomosis and attempts to maintain flow through the left vertebral system during
   aortic cross-clamping. This may reduce the risk of stroke during distal aortic arch
Keywords:                                                            abdominal/abdominal
   aorta/anastomosis/anesthesia/aneurysm/aneurysms/aorta/aortic/aortic arch/aortic arch
   low/follow                                             up/follow-up/II/left/lower/lower
   failure/REPAIR/risk/risk of stroke/spinal/stroke/subclavian artery/thoracic/USA
Rockman, C.B., Jacobowitz, G.R., Adelman, M.A., Lamparello, P.J., Gagne, P.J.,
   Landis, R. and Riles, T.S. (2003), The benefits of carotid endarterectomy in the
   octogenarian: A challenge to the results of carotid angioplasty and stenting. Annals of
   Vascular Surgery, 17 (1), 9-14.
Abstract: Proponents of carotid angioplasty and stenting (CAS) believe that this
   technique would be preferred over carotid endarterectomy (CEA) for the high-risk
   patient. Presumably this would include patients over 80 years of age. However, a
   recent large series of patients undergoing CAS revealed a 16% incidence of nonfatal
   strokes and deaths for patients over the age of 80; these results were significantly
   worse than those for younger patients undergoing CAS. The objective of this study
   was to reassess results of CEA in patients over 80, and to compare surgical results
   with the published results of CAS in this patient group. A review was conducted of a
   prospectively maintained database of all carotid surgery performed at our institution.
   Primary CEA that took place from 1997 through 1999 were included for analysis (n
   = 698). Our institutional results were compared with representative results from a
   recently published large series of CAS. Our analysis showed that CEA can be
   performed safely in the octogenarian, and results are equivalent to those of younger
   patients. CEA appears to have significantly better results in the octogenarian than
   CAS. The reasons for the poor outcomes of CAS in the octogenarian are unclear. The
   results of CAS in the older patient population are worrisome, and this "less invasive"
   technique may prove to be an inferior alternative in this patient group
Keywords:            age/AGE             80/analysis/angioplasty/angioplasty           and
   stenting/benefits/carotid/carotid      angioplasty/carotid      endarterectomy/carotid
Steinmetz, E.F., Berry, P., Shames, M.L., Buckley, C., Goeddel, L.A. and Thompson,
   R.W. (2003), "Grape cluster" aneurysm of the right subclavian artery: An unusual
   manifestation of fibromuscular dysplasia. Annals of Vascular Surgery, 17 (3),
Abstract: Aneurysmal lesions affecting the intrathoracic portion of the subclavian artery
  are rare. We present a patient who had a right hemispheric stroke and transient
  ischemic attacks caused by a complex right subclavian artery aneurysm with unusual
  morphological features. Successful surgical repair of this lesion is described along
  with pathological, studies demonstrating fibromuscular dysplasia. The occurrence of
  such lesions and their management is reviewed
Keywords:                        aneurysm/artery/dysplasia/fibromuscular/fibromuscular
  dysplasia/hemispheric                            stroke/intrathoracic/ischemic/ischemic
  avian       artery/surgical/THORACIC          OUTLET/transient/transient       ischemic
Warren, J.A., Jordan, W.D., Heudebert, G.R., Whitley, D. and Wirthlin, D.J. (2003),
  Determining patient preference for treatment of extracranial carotid artery stenosis:
  Carotid angioplasty and stenting versus carotid endarterectomy. Annals of Vascular
  Surgery, 17 (1), 15-21.
Abstract: Revascularization of extracranial carotid artery stenosis (ECAS) continues to
  be the subject of spirited academic debate. Conflicting studies in the literature have
  fostered uncertainty among patients choosing between CEA and CAS. We obtained
  preference-based utilities from prospective patients being evaluated for ECAS and
  incorporated them into a decision analytic model. Patients being evaluated for ECAS
  in an outpatient setting were interviewed prior to their initial visit with a vascular
  surgeon. Patient preference data were elicited using probability trade-off (PTO)
  assessment and time trade-off (TTO) method. Decision analysis was performed to
  compare CEA with CAS. Morbidity and mortality rates were obtained from recent
  literature reports from the same institution. Our results showed that when patients are
  informed, they prefer and will more often choose CEA over CAS for
  revascularization of ECAS. Among patients preferring CAS, they expect no more
  than a 46% increase in the rate of stroke and/or death. Future clinical studies on true
  stroke rates for CAS will be required to further refine this analysis
Keywords:                       analysis/angioplasty/angioplasty                      and
  stenting/artery/assessment/CANCER/carotid/carotid             artery/carotid      artery
  stenosis/carotid endarterectomy/CEA/clinical/clinical studies/death/decision analytic
Middleton, S., Harris, J., Lusby, R. and Ward, J. (2003), Vascular disease risk factor
  management 4 years after carotid endarterectomy: are opportunities missed? Anz
  Journal of Surgery, 73 (4), 225-231.
Abstract: Background: Because a large percentage of patients surviving carotid
  endarterectomy (CEA) subsequently die from a vascular cause, the aim of the present
  paper was to determine risk factor management for a cohort of patients 4 years after
  their CEA. Methods: Surviving patients who had a CEA within the region
  administered by the Central Sydney Area Health Service in 1995 were asked to
  complete a self-administered questionnaire to determine vascular risk factors. Results:
  Of the 181 patients eligible to participate, 162 returned questionnaires (response rate:
  90%). While 106 (65.4%) patients recalled that they had been diagnosed with high
  blood pressure either before or after their CEA, only 79.2% recalled that their latest
  blood pressure reading was 'about right for my age'. Nearly one in five (16.7%) who
  had had their cholesterol level checked in the last 12 months (n = 120) indicated that
  the reading was 'too high'. Only 76.5% reported taking medications to 'thin the blood'.
  Almost one-fifth of patients (17.3%) were current smokers. Only 35.2% of patients
  participated in a level of physical activity sufficient to confer a health benefit.
  Further, 30.2% of patients were overweight and 14.8% were obese. The majority of
  patients (98.1%) reported having a regular general practitioner (GP). Of these, 98.7%
  had visited their GP at least once within the previous 6 months. Conclusions:
  Vascular risk factor management following CEA is suboptimal, inviting the
  implementation and evaluation of strategies to improve outcomes
Keywords: activity/age/ASIA/audit/AUSTRALIA/blood/blood pressure/carotid/carotid
  valuation/general/GENERAL-PRACTICE/health/high blood pressure/LIFE-STYLE
  activity/pressure/questionnaire/questionnaires/reading/right/risk/risk         factor/risk
  factors/risk-factors/SECONDARY                PREVENTION/STROKE/stroke                 risk
  factors/vascular/vascular risk/vascular risk factors/vascular surgery
Avent, J.R. and Austermann, S. (2003), Reciprocal scaffolding: A context for
  communication treatment in aphasia. Aphasiology , 17 (4), 397-404.
Abstract: Background: The goal of social approaches to aphasia treatment is to improve
  life quality. This study explored the potential therapeutic value of increasing
  participation in life through natural language use with communicative partners
  during shared learning activities. Reciprocal Scaffolding Treatment (RST), based on
  an apprenticeship model of learning where novices are taught skills by a more skilled
  partner, was developed to provide an individual with aphasia an opportunity to use
  pre- stroke knowledge and vocabulary during teaching interactions. Aims: The
  purposes of the study were to determine whether an individual with aphasia in the
  role as a teacher would improve language production and whether changes in quality
  of life were evident as a result of the experience. Methods & Procedures: A
  descriptive case study approach was used to compare RST and peer discourse group
  treatment. The participant was a former physicist with moderate aphasia. He was
  placed in a preschool classroom to teach science to 4- and 5-year-old children.
  Correct information unit (CIU) analysis and type token ratio (TTR) scores were used
  to compare language samples. Journal entries were used to document psychosocial
  and quality of life changes. Outcomes & Results: Results indicated better verbal
  word retrieval skills within the classroom (RST) as compared to discourse group
  treatment. While involved in the teaching experience, the participant's lesson plans
  improved in detail and clarity. Journal entries showed improvements in quality of life.
  Conclusions: These findings show how the re-application of prestroke vocational
  skills can enhance quality of life and improve language performance. While these
  results support a social approach to aphasia treatment, additional research is needed
  n/performance/production/quality/quality                                                 of
Davidson, B., Worrall, L. and Hickson, L. (2003), Identifying the communication
  activities of older people with aphasia: Evidence from naturalistic observation.
  Aphasiology, 17 (3), 243-264.
Abstract: Background: Increasingly there is a call from clinicians and researchers for
  measures that document the impact of aphasia on a person's everyday
  communication. Do existing assessments of communication disability adequately
  sample communication activities relevant to our clients? Communication skills and
  networks change with age. A need exists to determine the everyday communication
  activities of older people and in particular those with aphasia. Aims: The primary
  aim of this study was to describe and compare the everyday communication activities
  of older people with aphasia and healthy older people who are living in the
  community. A secondary aim was to investigate the content validity of the American
  Speech- Language Hearing Association Functional Assessment of Communication
  Skills for Adults (ASHA FACS, 1997) for older Australians. Methods & Procedures:
  Naturalistic observation was the method of choice for detailing the everyday
  communication of 15 older people with chronic aphasia following stroke and a
  matched group of 15 healthy older people who were living in the community.
  Researchers, in the role of participant observer, took field notes for 8 hours, over
  three occasions within a week. A total of 240 hours of observation have been coded
  in terms of communication activity, topic, communication partners, and place of
  communication. A brief 5-day diary served to check the representativeness of the
  observational data. After each hour of observation, the researcher checked which
  ASHA FACS items had been observed. Outcomes & Results: Naturalistic
  observation provided a rich, rigorous, and systematic methodology for detailing the
  dynamics and complexities of authentic communication. The most common
  communication activities for both groups were conversations at home and in social
  groups. Real-life communication was revealed to serve the dual purposes of
  transaction and interaction. Results indicate that older people with aphasia engage in
  similar communication activities to healthy older people although differences were
  evident in the frequency of communication and in specific activities such as story
  telling, writing, commenting, and acknowledging. ASHA FACS items were
  generally relevant to older Australians living in the community. Conclusions: This
  study demonstrated that communication activity is multifaceted in terms of the type
  of communication and contextual factors. The observational data describe the effects
  of aphasia on a person's everyday communication activity and reveal the impact of
  aphasia on the social functions of communication including sharing information,
  maintaining and establishing relationships, and telling one's story. Functional
  communication assessment requires a greater focus on the interactional and uniquely
  interpersonal aspects of social communication
Doyle, P.J., Mcneil, M.R. and Hula, W.D. (2003), The Burden of Stroke Scale (BOSS):
  Validating patient-reported communication difficulty and associated psychological
  distress in stroke survivors. Aphasiology, 17 (3), 291-304.
Abstract: Background: The Burden of Stroke Scale (BOSS) (Doyle et al., 2002) is a
  health-status assessment instrument designed to measure patient-reported difficulty
  in multiple domains of functioning, psychological distress associated with specific
  functional limitations, and general well-being in stroke survivors. Aims: This study
  was designed to examine the discriminative and concurrent validity of the BOSS
  Communication Difficulty (CD) and Communication-Associated Psychological
  Distress (CAPD) scales. A secondary purpose was to provide a preliminary
  examination of the relationships between the BOSS CD and CAPD scales and
  aspects of subjective well-being, including the frequency with which participants
  reported experiencing general positive and negative emotional states. Methods &
  Procedures: The BOSS was administered as a face-to-face interviewer-assisted
  survey to 281 medically stable, community-dwelling stroke survivors selected from
  five collaborating centres in the USA. Prior to administration of the BOSS, all
  subjects were rated for severity of communication impairment using the Boston
  Diagnostic Aphasia Examination (BDAE) Severity Rating Scale (Goodglass, Kaplan,
  & Baressi, 2001) and were administered Subtest 8 of the Revised Token Test (RTT),
  (McNeil & Prescott, 1978). The discriminant validity of the BOSS CD and CAPD
  scales was examined by comparing scores in stroke survivors with (N = 135) and
  without (N = 146) communication impairment, and within the communicatively
  impaired sample when classified according to BDAE ratings and RTT performance.
  Concurrent validity of the BOSS CD and CAPD scales was examined by correlating
  BOSS scores with BDAE ratings and RTT performance. Finally, correlations
  between the BOSS CAPD, BOSS CD, Positive Mood, and Negative Mood scales
  were calculated. Outcomes & Results: Statistical analyses revealed significant
  differences between communicatively impaired and non-communicatively impaired
  subjects on the BOSS CD and CAPD scales, as well as significant differences
  between communicatively impaired subjects of differing severity levels classified
  both by BDAE severity ratings and RTT performance. Correlational analyses
  revealed moderately strong relationships among the BOSS CD scale, BDAE severity
  ratings, and RTT performance. Finally, correlations among the BOSS CAPD, CD,
  Positive Mood, and Negative Mood scales revealed true covarying relationships of
  moderate strength between the BOSS CAPD and CD scales, and also between the
  CAPD and Negative Mood Scales. Conclusions: These findings provide preliminary
  support for the discriminant and construct validity of the BOSS Communication
  Difficulty (CD) and Communication Associated Distress (CAPD) Scales, and
  provide an empirical rationale for further research into the relationships between
  functional status, patient- reported health perceptions, and subjective well-being in
  stroke survivors with communication disorders
Keywords:        assessment/assessment         instrument/communication/communication
  disorders/concurrent                                                   validity/construct
  l/functional            limitations/functional          status/general/HEALTH/health
  gth/stroke/stroke                                                  survivors/subjective
Engell, B., Hutter, B.O., Willmes, K. and Huber, W. (2003), Quality of life in aphasia:
  Validation of a pictorial self- rating procedure. Aphasiology, 17 (4), 383-396.
Abstract: Methods & Procedures: Quality of life was assessed for stroke patients with
  aphasia in postacute and chronic stages by means of the Aachen Life Quality
  Inventory (ALQI), a German adaptation of the Sickness Impact Profile (SIP). A
  modified written version of the ALQI was given to relatives, and a newly developed
  pictorial version designed to minimise language demands was given to aphasic
  patients. Ratings of 24 patient- relative pairs were assessed. Outcomes & Results:
  Overall the two versions were found to be highly parallel and internally consistent,
  and they could be separated equally well along physical and psychosocial dimensions.
   In addition to rating complaints, patients were asked to score the burden caused by
   them; high intercorrelations between complaints and burden were found. The
   physical subscore was influenced by presence and degree of hemiparesis, and the
   psychosocial subscore by patients' mood state as rated by the relatives. Age had an
   impact on relatives' ratings of language and cognition as well as on physical
   functions. Patients and relatives differed in rating of psychosocial and cognitive
   complaints. Relatives took a more functional perspective, patient ratings were more
   dependent upon degree and quality of the aphasic impairment
   score/SICKNESS IMPACT PROFILE/STATE/stroke/stroke patients/STROKE
Hilari, K., Wiggins, R.D., Roy, P., Byng, S. and Smith, S.C. (2003), Predictors of
   health-related quality of life (HRQL) in people with chronic aphasia. Aphasiology,
   17 (4), 365-381.
Abstract: Background: In recent years, quality of life measures have been used
   increasingly to evaluate the effectiveness of services or interventions. For people
   with chronic disabilities, research has focused on identifying the main predictors of
   their health- related quality of life (HRQL), in order to address the issue of how to
   meet their needs in rehabilitation in a more holistic way. Aims: This study assessed
   the main predictors of HRQL in people with chronic aphasia following stroke. We
   investigated the relationship between HRQL and various demographic and
   stroke-related variables and other variables that have been associated with HRQL in
   stroke survivors (e.g., emotional distress, daily activities, social support). Methods: A
   cross- sectional design was adopted. A cluster sampling framework was used to
   recruit participants with chronic aphasia (>1 year) from three different sites.
   Questionnaires and assessments on the different variables were administered to all
   participants by a speech and language therapist, in an interview format. Multiple
   regression analysis was used to assess what were the main predictors of HRQL in
   people with aphasia. Results: Of 95 participants, 83 (87%) were able to self-report on
   all the assessments. Emotional distress, involvement in home and outdoors activities,
   extent of communication disability, and number of comorbid conditions explained
   52% of the variance in HRQL (adjusted R-2 =.52). Stroke type (infarct vs
   haemorrhage), time post-onset, and demographic variables (gender, ethnicity, marital
   status, employment status, and socioeconomic status) were not significantly
   associated with HRQL in these participants. Conclusions: Increased distress, reduced
   involvement in activities, increased communication disability, and comorbidity
   predict poorer HRQL in people with chronic aphasia after stroke. Service providers
   need to take these factors into account when designing intervention programmes
Keywords:                                    analysis/aphasia/chronic/cluster/COGNITIVE
   ender/haemorrhage/HANDICAP/health/health-related                      quality           of
   status/needs/OF-LIFE/order/predictors/PSYCHOLOGY/quality/quality                        of
   al/social         support/socioeconomic          status/speech/status/stroke/STROKE
   PATIENTS/stroke survivors/support/SURVIVORS/when
Inglis, A.L. (2003), Taking expectations to task in aphasic sentence comprehension:
   Investigations of off-line performance. Aphasiology, 17 (3), 265-289.
Abstract: Background: A major weakness of off-line assessments of "asyntactic"
   comprehension is that the task is transparently related to the comprehension
   performance that is the researcher's interest. Not only might the patient recruit
   problem-solving strategies, but his/her conception of the task may have confounding
   effects on performance. Aim: This study investigates the nature of individual
   differences in two patients' performance on two off-line comprehension tasks
   (selected for their low task demands) by manipulating task variables. Methods &
   Procedures: The two single-case studies investigate, in a test-hypothesis-retest
   experimental design, performance on auditory meaning classification and actor
   identification. Both participants (NJ and CV) exhibited agrammatism following a
   stroke, although CV's was milder. McNemar exact (Binomial) probabilities were
   calculated on non- canonical versus canonical comparisons, whereas the Binomial
   test and chi(2) probabilities gauged departures from chance. Outcomes & Results:
   The two patients departed from baseline for different reasons: CV showed
   unexpected learning, and maintenance of that learning, on one task, despite washout
   periods; NJ's fall from baseline was only reinstated with manipulation of the
   instructions in between washout periods, and he failed to generalise to the second
   task on a subset of the items. Conclusions: It was surmised that strong induction
   skills in CV made for easy abstraction of "rules" from the sentence stimuli, unlike
   weak induction skills in NJ which led to bias and failure to detect rules despite
   feedback on practice items. The findings have relevance for treatment outcomes and
   extend Berndt and Mitchum's (1998) claim that only minimal intervention is needed
   for strongly analytical candidates-it may be as minimal as feedback to exemplars
Keywords:                                            AGRAMMATISM/ASYNTACTIC
   tment/treatment outcomes/weakness
Mackenzie, C. and Paton, G. (2003), Resumption of driving with aphasia following
   stroke. Aphasiology, 17 (2), 107-122.
Abstract: Background: Fitness to drive may be compromised by a variety of medical
   conditions, including stroke. Driving may legally be resumed 1 month after stroke if
   clinical recovery is deemed satisfactory. Advice available for patients and medical
   practitioners is unclear and inconsistent as to whether return to driving is influenced
   by aphasia. Information on the opinions of medical practitioners and aphasia
   therapists regarding resumption of driving with aphasia, the return to driving
   experience of people with aphasia, and their road sign recognition ability, has been
   largely anecdotal. Aims: (1) To determine the views and practice of medical
   practitioners and aphasia therapists on return to driving with aphasia caused by
   stroke and the experience and effects for aphasic people of resuming or not resuming
  driving. (2) To assess the road sign recognition ability of aphasic people who had
  returned to driving or wished to do so in relation to a comparable non- stroke
  population. Methods and Procedures: People with aphasia following stroke ( n = 18)
  who had returned to driving or wished to do so, medical practitioners ( n = 11), and
  aphasia therapists ( n = 18) were interviewed to determine the patient experience and
  medical practitioners' and therapists' views on driving with aphasia. Road sign
  recognition was assessed in the aphasic and a matched non-brain-damaged control
  group ( n = 18). Outcome and Results : The majority of medical practitioners and
  aphasia therapists thought that in some cases driving with aphasia was
  contra-indicated. Reading comprehension was the communication aspect considered
  to be most important for driving fitness. The aphasic group was significantly less
  proficient than the control group in road sign recognition and in understanding
  written and spoken road sign descriptions. Few aphasic drivers described new
  driving problems and most now drove less, more carefully, and for reduced distances.
  Those who had not returned to driving felt social activity and wellbeing had been
  affected. Conclusions : Despite difficulties with road sign recognition and related
  reading and auditory comprehension, people with aphasia are driving, including
  some whose communication loss is severe. Where relevant, practice in recognition of
  road signs and written road information might be included in speech and language
  therapy management
Reich, S., Chou, T.L. and Patterson, K. (2003), Acquired dysgraphia in Chinese: Further
  evidence on the links between phonology and orthography. Aphasiology, 17 (6-7),
Abstract: Background: How similar is the "architecture" of language function in
  different languages? In the domain of reading and writing, the relationship between
  orthographic and phonological units of the language differs dramatically between
  alphabetic and logographic writing systems. It is therefore appropriate to ask whether
  an architecture assumption, such as direct links between word pronunciations and
  their written forms, developed in the course of research on English and other
  alphabetic writing systems, applies to logographic Chinese. Aims: We describe a
  native Cantonese speaker, TUA, with an acquired dysgraphia following a right
  hemisphere stroke. The study was designed to identify the conditions under which
  TUA succeeded or failed to produce the correct orthographic form of words in his
  native language, and thereby to draw inferences about his impaired and intact writing
  procedures with further implications for normal writing. Methods & Procedures:
  Nine different single-word tests were administered to TUA, mainly of writing to
  dictation but also of written picture naming and other relevant skills. Almost all
  monosyllabic words in Cantonese are homophones and, in the majority of our tests,
  the target words were lower-frequency homophones, with the intended alternative
  disambiguated by a semantic cue. Outcomes & Results: TUA made few errors in
  writing high-frequency words to dictation, but had error rates as high as 60-70% on
  lower- frequency homophonic target words. The majority of his errors were
  homophones of, or at least closely phonologically related to, the target item. This
  deficit in writing to dictation co- existed with adequate ability to define the correct
  lower- frequency homophonic alternative, and with the unusual pattern of more
  correct responses in written picture naming than in writing to dictation of the same
  target items. Although TUA's poor performance in writing was accompanied by
  several nonlinguistic impairments (e.g., in visual memory, sequencing, and
  visuo-constructional ability), his dysgraphia had a predominantly linguistic nature
  and did not invite an account in terms of these additional cognitive impairments.
  Conclusions: We propose that TUA had a disrupted ability to activate
  lower-frequency orthographic representations, especially under conditions of
  response competition from a higher-frequency written word with the same
  pronunciation. This pattern is compatible with a proposal of direct activation of
  orthography by phonology, at least for higher-frequency words, in Chinese
  rformance/PSYCHOLOGY/reading/research/right/right hemisphere/right hemisphere
  stroke/skills/stroke/tests/visual/VISUAL WORD RECOGNITION/writing
Ross, K.B. and Wertz, R.T. (2003), Quality of life with and without aphasia.
  Aphasiology, 17 (4), 355-364.
Abstract: Background: Although the social approach to managing aphasia is designed to
  improve the quality of life (QOL) of the aphasic person, the influence of being
  aphasic on different facets of QOL is unknown. Aims: To delineate socially valid
  therapy targets, we examined 24 facets of QOL proposed by the World Health
  Organisation (WHO) to determine which facets differentiate QOL between aphasic
  and nonaphasic people. Methods & Procedures: A prospective, observational, non-
  randomised group design was employed. Two measures-the WHO QOL Instrument,
  Short Form (WHOQOL-BREF) and the Psychosocial Well- Being Index (PWI)-were
  administered to 18 adults with chronic aphasia and 18 nonaphasic adults. Indices of
  determination (ID) and degrees of overlap (DO) were calculated to determine which
  of the 24 facets were best in differentiating between the aphasic and nonaphasic
  groups. Outcomes & Results: Facets within three domains-level of independence,
  social relationships, and environment-were best in distinguishing QOL between the
  aphasic and nonaphasic groups. Conclusion: Therapy that focuses on
  situation-specific communication and societal participation appears to be most
  appropriate for enhancing the QOL of people with chronic aphasia
  OLOGY/PSYCHOSOCIAL                        ADJUSTMENT/quality/quality                     of
Ulatowska, H.K., Olness, G.S., Wertz, R.T., Samson, A.M., Keebler, M.W. and Goins,
  K.E. (2003), Relationship between discourse and Western Aphasia Battery
  performance in African Americans with aphasia. Aphasiology, 17 (5), 511-521.
Abstract: Background: There is a need for discourse research with African Americans
  who have aphasia, highlighted by ethnic group differences in stroke prevalence, and
  potential ethnic group differences in dialect. Identification of ethnic dialect is critical
  to differentiate communication changes associated with pathology from normal
  communicative differences associated with ethnicity. Also, preliminary research on
  adults with aphasia indicates an uncertain relationship between discourse
  performance and standardised test performance. Aims: This study was designed to
  assess: (1) the relationship between performance on a standardised language measure
  and discourse performance, and (2) the use of ethnic dialect and discourse features,
  in the narrative productions of African-American adults with moderate aphasia on a
  variety of discourse tasks. Methods & Procedures: We investigated the discourse of
  12 African Americans with scores in the moderate severity range on the Western
  Aphasia Battery, Aphasia Quotient (WAB-AQ). Each subject produced a fable retell,
  a story derived from a picture sequence, two stories derived from single pictures, and
  a topic-elicited personal narrative of a frightening experience. Analysis consisted of
  ratings of discourse quality (coherence, reference, and emplotment); a measure of
  discourse quantity (number of propositions); and a tally of the presence or absence of
  ethnic dialect and discourse features. Outcomes & Results: The correlation between
  WAB-AQ and discourse quality was statistically significant on the picture sequence
  task and one single-picture task, but not on the other discourse tasks. There was a
  significant relationship between WAB-AQ and overall quality ratings of coherence,
  reference, and emplotment. The correlation between WAB-AQ and discourse
  quantity was not significant for any task, and discourse quality was not significantly
  correlated with discourse quantity. Ethnic features appeared most often on one
  single-picture task and the personal narrative. No ethnic dialect features occurred on
  the fable retell. Conclusions: These findings suggest the need to supplement
  standardised assessment of aphasia with assessment of discourse performance, using
  less structured discourse tasks, such as a personal narrative task. Less structured
  discourse tasks may also be optimal for eliciting natural ethnic patterns of
  communication. The lack of relationship between narrative quantity and narrative
  quality may not generalise to individuals with aphasia that is severe or mild. This
  study contributes towards development of a discourse assessment tool for culturally
  and linguistically diverse populations that may supplement information provided by
  standardised testing
Keywords:                     adults/African/African                   American/African
  ke/stroke prevalence/testing/USA/use/Western Aphasia Battery
Adams, C. (2003), Quality of life for Caregivers and stroke survivors in the immediate
  discharge period. Applied Nursing Research, 16 (2), 126-130.
Abstract: Caregiver burnout leads to a decline in caregivers' quality of life and in the
  quality of care they can deliver. A sample of 22 Stroke survivors and informal care
  givers from a 500-bed metropolitan teaching hospital were interviewed using a
  questionnaire. Pre- (at discharge) and post- (1 month later) test scores were tested
  using Wilcoxon rank tests. Associations between activities of daily living and quality
  of life were tested with Spearman's correlation coefficient. Over the month,
  caregivers' scores for relationships, social companionship. and daily emotional
  Support decreased (but not significantly). Short hospital stays affected the
  recruitment for this study and contributed to problems for ward staff in implementing
  discharge plans. More innovative discharge planning is needed if caregivers' needs
  are to be met. (C) 2003 Elsevier Inc. All rights reserved
Keywords: activities of daily living/ALZHEIMERS-DISEASE/Australia/BARTHEL
  ADL                INDEX/burnout/CARE/caregivers/CO/correlation/decline/discharge
  planning/hospital/INDEPENDENCE/needs/PA/period/quality/quality of care/quality
  of                         life/questionnaire/recruitment/social/SQUARE/stroke/stroke
  survivors/teaching/tests/USA/WEST/Western Australia
Padin, S. (2003), Design considerations for a highly segmented mirror. Applied Optics,
  42 (16), 3305-3312.
Abstract: Design issues for a 30-m highly segmented mirror are explored, with
  emphasis on parametric models of simple, inexpensive segments. A mirror with
  many small segments offers cost savings through quantity production and permits
  high-order active and adaptive wave-front corrections. For a 30-m f/1.5 paraboloidal
  mirror made of spherical, hexagonal glass segments, with simple warping harnesses
  and three-point supports, the maximum segment diameter is similar to100 mm, and
  the minimum segment thickness is similar to5 mm. Large-amplitude, low-order
  gravitational deformations in the mirror cell can be compensated if the segments are
  mounted on a plate floating on astatic supports. Because gravitational deformations
  in the plate are small, the segment actuators require a stroke of only a few tens of
  micrometers, and the segment positions can be measured by a wave-front sensor. (C)
  2003 Optical Society of America
Keywords:                                                      actuators/cost/DC/LARGE
Bearden, T.S., Cassisi, J.E. and Pineda, M. (2003), Neurofeedback training for a patient
  with thalamic and cortical infarctions. Applied Psychophysiology and Biofeedback,
  28 (3), 241-253.
Abstract: One year after a left posterior and thalamic stroke, a 52-year- old male
  participant was treated with 14 weeks of theta reduction neurofeedback training.
  Imaging studies revealed left temporal, parietal, occipital, and bilateral thalamic
  infarctions along the distribution of the posterior cerebral artery. Neuropsychological
  testing demonstrated severe verbal memory, naming, visual tracking, and fine motor
  deficits. Additionally, alexia without agraphia was present. A pretraining quantitative
  electroencephalograph (QEEG) found alpha attenuation, lack of alpha reactivity to
  eye opening, and excessive theta activity from the left posterior head region.
  Neurofeedback training to inhibit 4-8 Hz theta activity was conducted for 42 sessions
  from left hemisphere sites. Over the course of the training, significant reductions in
  theta amplitude occurred from the training sites as assessed from the postsession
  baseline periods. Posttraining, a relative normalization of the QEEG was observed
  from the left posterior head region
Keywords:             activity/agraphia/alexia/amplitude/artery/bilateral/cerebral/cerebral
  otor      deficits/MS/neurofeedback/neurotherapy/NEW-YORK/old/patient/posterior
  stroke/tracking/training/USA/verbal memory/visual
Dunmall, K.M. and Schreer, J.F. (2003), A comparison of the swimming and cardiac
  performance of fanned and wild Atlantic salmon Salmo salar, before and after
  gamete stripping. Aquaculture, 220 (1-4), 869-882.
Abstract: Farmed Atlantic salmon, Salmo salar, frequently escape from the aquaculture
  industry and interact with wild populations. The impact of these interactions on the
  wild populations will depend, in part, on differences in their performances. This
  study compared the swimming and cardiac performance of farmed salmon (Aquagen)
  with their founder population from the River Namsen both before and after gamete
   stripping. Cardiac output (CO), heart rate (HR), and stroke volume (SV), which were
   measured by placing Doppler flow probes around the ventral aorta of the fish,
   increased with exercise, but the response did not significantly differ between farmed
   and wild salmon. Similarly, the swimming performance of wild salmon never
   significantly differed from the farmed salmon. The overall similarity in swimming
   and cardiac performance between farmed and wild Atlantic salmon observed in the
   present study suggests that cultured salmon may have the ability to be competitive
   with the wild salmon in native waters. (C) 2003 Elsevier Science B.V. All rights
Keywords:                                                    ability/aorta/cardiac/cardiac
   formance/PERFUSED TROUT HEART/population/RAINBOW-TROUT/Salmo
   salar/stroke/stroke volume/swimming/swimming and cardiac performance/swimming
Hilsabeck, R.C., Thompson, M.D., Irby, J.W., Adams, R.L., Scott, J.G. and Gouvier,
   W.D. (2003), Partial cross-validation of the Wechsler Memory Scale-Revised
   (WMS-R) General Memory-Attention/Concentration Malingering Index in a
   nonlitigating sample. Archives of Clinical Neuropsychology, 18 (1), 71-79.
Abstract: The Wechsler Memory Scale-Revised (WMS-R) malingering indices
   proposed by Mittenberg, Azrin, Millsaps, and Heilbronner [Psychol Assess 5 (1993)
   34.] were partially cross-validated in a sample of 200 nonlitigants. Nine diagnostic
   categories were examined, including participants with traumatic brain injury (TBI),
   brain tumor, stroke/vascular, senile dementia of the Alzheimer's type (SDAT),
   epilepsy, depression/anxiety, medical problems, and no diagnosis. Results showed
   that the discriminant function using WMS-R subtests misclassified only 6.5% of the
   sample as malingering, with significantly higher misclassification rates of SDAT and
   stroke/vascular groups. The General Memory Index-Attention/Concentration Index
   (GMI-ACI) difference score misclassified only 8.5% of the sample as malingering
   when a difference score of greater than 25 points was used as the cutoff criterion. No
   diagnostic group was significantly more likely to be misclassified. Results support
   the utility of the GMI-ACI difference score, as well as the WMS-R subtest
   discriminant function score, in detecting malingering. (C) 2002 National Academy of
   Neuropsychology. Published by Elsevier Science Ltd. All rights reserved
Keywords:             Alzheimer's           type/ARCH/brain/brain             injury/brain
   SDAT/support/TBI/traumatic/traumatic                                              brain
Fugelseth, D., Satas, S., Steen, P.A. and Thoresen, M. (2003), Cardiac output,
   pulmonary artery pressure, and patent ductus arteriosus during therapeutic cooling
   after global hypoxia- ischaemia. Archives of Disease in Childhood, 88 (3), 223-228.
Abstract: Objective: To assess by Doppler echocardiography the effects of 24 hours of
   whole body mild hypothermia compared with normothermia on cardiac output (CO),
   pulmonary artery pressure (PAP), and the presence of a persistent ductus arteriosus
   (PDA) after a global hypoxic-ischaemic insult in unsedated newborn animals. Design:
   Thirty five pigs (mean (SD) age 26.6 (12.1) hours and weight 1.6 (0.3) kg) were
  anaesthetised with halothane, mechanically ventilated, and subjected to a 45 minute
  global hypoxic-ischaemic insult. At the end of hypoxia, halothane was stopped; the
  pigs were randomised to either normathermia (39degreesC) or hypothermia
  (35degreesC) for 24 hours. Rewarming was carried out for 24-30 hours followed by
  42 hours of normothermia. Unanaesthetised pigs were examined with a VingMed
  CFM 750 ultrasound scanner before and 3, 24, 30, and 48 hours after the
  hypoxic-ischaemic insult. Aortic valve diameter, forward peak flow velocities across
  the four valves, and the occurrence of a PDA were measured. Tricuspid regurgitation
  (TR) velocity was used to estimate the PAP. Stroke volume was calculated from the
  aortic flow. Results: Twelve animals (seven normothermic, five hypothermic) had a
  PDA on one or more examinations, which showed no association with cooling or
  severity of insult. There were no differences in stroke volume or TR velocity
  between the hypothermic and normothermic animals at any time point after the insult.
  CO was, however, 45% lower at the end of cooling in the subgroup of hypothermic
  pigs that had received a severe insult compared with the pigs with mild and moderate
  insults. CO and TR velocity were transiently increased three hours after the insult:
  0.38 (0.08) v 0.42 (0.08) litres/min/kg (p = 0.007) for CO; 3.0 (0.42) v 3.4 (0.43) m/s
  (p < 0.0001) for TR velocity (values are mean (SD)). Conclusions: The introduction
  of mild hypothermia while the pigs were unsedated did not affect the incidence of
  PDA nor did it lead to any changes in MABP or PAP. Stroke volume was also
  unaffected by temperature, but hypothermic piglets subjected to a severe
  hypoxic-ischaemic insult had reduced CO because the heart rate was lower. Global
  hypoxia-ischaemia leads to similar transient increases in CO and estimated PAP in
  unseclated normothermic and hypothermic pigs. There were no signs of metabolic
  compromise in any subgroup, suggesting that 24 hours of mild hypothermia had no
  adverse cardiovascular effect
Keywords:                                                  affect/age/animals/aortic/aortic
  y/pulmonary                      artery/regurgitation/severe/SI/SQUARE/stroke/stroke
  volume/temperature/therapeutic/transient/ultrasound/UNSEDATED                NEWBORN
Shaffer, L., Rich, P.M., Pohl, K.R.E. and Ganesan, V. (2003), Can mild head injury
  cause ischaemic stroke? Archives of Disease in Childhood, 88 (3), 267-269.
Abstract: Five cases of ischaemic stroke preceded by minor head trauma in children are
  described. All patients had striatocapsular infarction. Three had no cerebrovascular
  abnormality; two had turbulent flow in the proximal middle cerebral artery. None of
  the patients had evidence of arterial dissection or any other risk factors for stroke. All
  made an excellent neurological recovery. Possible mechanisms include mechanical
  disruption to the flow in the perforating branches of the middle cerebral artery,
  intimal trauma and subsequent thrombosis, or arterial spasm induced by trauma. The
  specific susceptibility in affected children remains unexplained; both genetic and
  environmental factors (for example, previous chickenpox) may be implicated
Keywords:                 ARCH/arterial/arterial                 dissection/artery/BASAL
  YSTONIA/ENGLAND/environmental/flow/genetic/head                               injury/head
  trauma/induced/INFARCTION/injury/INTERNAL CAPSULE/ischaemic/ischaemic
  stroke/LESIONS/LONDON/mechanical/mechanisms/middle                       cerebral/middle
  cerebral artery/mild/mild head injury/neurological/patients/recovery/risk/risk
  factors/risk                                  factors                                  for
Denti, L., Cecchetti, A., Annoni, V., Merli, M.F., Ablondi, F. and Valenti, G. (2003),
  The role of lipid profile in determining the risk of ischemic stroke in the elderly: a
  case-control study. Archives of Gerontology and Geriatrics, 37 (1), 51-62.
Abstract: In this study, we investigated the association of lipids with ischemic stroke
  and its different subtypes in elderly patients. In particular, lipid parameters not
  extensively investigated so far in previous case-control studies specifically focused
  in the old population, such as lipoprotein Lp (a) and Apoproteins AI (ApoAI) and B
  (ApoB), have been taken into account. Seventy nine patients (mean age 83 +/- 7.4,
  range 67-99), consecutively admitted to a Geriatric Ward between January 1998 and
  June 2000 with acute stroke (first event) were studied. A complete clinical and
  laboratory assessment, including neurological evaluation, head CT scan, carotid
  ultrasonography and ECG, was employed to define the clinical and etiologic stroke
  subtype, according to standardized criteria. Fasting blood samples were collected
  within 48 h from admission, for determination of total cholesterol (TC), triglycerides
  (TG), High Density Lipoprotein-cholesterol (HDL-C), Lp (a), ApoAI and ApoB;
  Low Density Lipoprotein-Cholesterol (LDL-C) was estimated by Friedwald formula.
  Eighty eight age and sex-matched outpatients, referred to the hospital for
  non-inflammatory disorders of joints and musculoskeletal system, served as controls.
  Patients showed HDL-C and HDL-C/ApoAI ratio significantly lower than controls,
  with higher LDL-C/HDL-C ratio. Analysis on quartiles of lipoprotein concentrations
  showed also a significant increase in odds of stroke for LDL-C concentrations over
  100 mg/dl, in absence of a linear relationship between LDL-C levels and risk.
  Multiple logistic regression, adjusting for non-lipid risk factors for stroke, confirmed
  the independent association of low HDL-C and HDL- C/ApoAI with all strokes, as
  well as with each subtype. In conclusion, these data suggest that lipids give some
  contribution to stroke risk even in the elderly, with a more prevalent role for HDL
  than LDL, and that lipid profile assessment must be taken into account in estimating
  the individual risk of stroke. (C) 2003 Elsevier Science Ireland Ltd. All rights
Keywords:                                                                       acute/acute
  SCULAR                    HEALTH/carotid/carotid                   ultrasonography/case
  control/case-control/case-control                                    studies/case-control
  D/ischemic/ischemic                                         stroke/Italy/LDL/lipid/lipid
  regression/lower/MORTALITY/musculoskeletal system/neurological/neurological
  evaluation/old/OLDER            ADULTS/patients/population/range/regression/risk/risk
  factors/risk              factors              for            stroke/risk               of
   stroke/risk-factors/SCI/SERUM-CHOLESTEROL/stroke/stroke                       risk/stroke
   subtype/strokes/subtypes/the                                                elderly/total
Ginsberg, J.S., Chan, W.S., Bates, S.M. and Kaatz, S. (2003), Anticoagulation of
   pregnant women with mechanical heart valves. Archives of Internal Medicine, 163
   (6), 694-698.
Abstract: The management of pregnant women with mechanical heart valves is
   challenging. Recently, based on small numbers of patients and poor-quality data,
   correspondence from Aventis Pharmaceuticals Inc has described treatment "failures"
   and concerns about teratogenicity with the use of the low- molecular-weight heparin
   (LMWH) enoxaparin. The company issued a "Warning" that enoxaparin should not
   be used in patients with prosthetic heart valves and a "Precaution" about potential
   teratogenicity. This has created a huge problem for physicians managing pregnant
   women with prosthetic heart valves because the alternatives, unfractionated heparin
   and warfarin, are problematic. There have been case reports of failures (including
   death from thrombosed valves) with unfractionated heparin, whereas the package
   insert for warfarin states that the drug is contraindicated during pregnancy because of
   potential teratogenicity. Initially, LMWHs appeared suitable for pregnant patients
   with prosthetic heart valves. Unfortunately, the company correspondence,
   presumably supported by the Food and Drug Administration (FDA), raises
   medicolegal concerns with use of any LMWH. We believe that pharmaceutical
   companies and the FDA should not endorse scientifically unsupported claims that
   eliminate acceptable therapeutic options. This correspondence has created
   considerable confusion among patients and treating physicians and is likely to lead to
   frivolous lawsuits and preclude the performance of properly designed trials in
   pregnant women. We believe a consensus conference among experts in the field to
   identify key unresolved issues and a commitment by the FDA and industry to
   perform appropriate studies are now critical
Keywords:                                                   appropriate/ARCH/Canada/case
   S/heart/heart valves/heparin/lead/low molecular weight/low molecular weight
   heparin/management/mechanical/mechanical                  heart        valves/molecular
Jackson, V.A., Sesso, H.D., Buring, J.E. and Gaziano, M. (2003), Alcohol consumption
   and mortality in men with preexisting cerebrovascular disease. Archives of Internal
   Medicine, 163 (10), 1189-1193.
Abstract: Background: In counseling patients with a history of stroke, clinicians have
   limited information regarding the risks and benefits of alcohol consumption.
   Objective: To examine the relationship between alcohol intake and risks of total and
   cardiovascular mortality in men with a history of stroke. Methods: The study
   population consisted of 112528 men from the enrollment cohort of the Physicians'
   Health Study, 1320 of whom reported a baseline history of stroke. Men provided
   Self- reported data on alcohol consumption, which was classified into 1 of 4
   categories: rarely or never drink, very light (<1 drink per week), light (1-6 drinks per
   week), or moderate (&GE;1 drink per day). Cox proportional hazards models were
   used to assess the relative risks of mortality associated with alcohol consumption,
   after adjustment for major coronary risk factors. Results: During a mean follow-up of
   41/2 years, 369 men died, 267 of whom died of cardiovascular disease. Compared
   with men with a history of stroke who drank rarely or never, those with a very light
   to moderate alcohol intake had multivariate relative risks for total mortality of 0.88
   (95% confidence interval [CI], 0.60-1.28), 0.64 (95% CI, 0.48-0.85), and 0.71 (95%
   CI, 0.54-0.94), respectively (P = .03 for trend); and relative risks for cardiovascular
   mortality of 0.89 (95% CI, 0.58-1.36), 0.56 (95% CI, 0.40-0.79), and 0.64 (95% CI,
   0.46- 0.88) P = .008 for trend). Compared with age-adjusted models, adjustment for
   major coronary risk factors did not significantly change risk estimates for total or
   cardiovascular mortality. Conclusions: These data indicate a possible inverse
   association between light to moderate alcohol intake and risks of total and
   cardiovascular mortality in men with a history of stroke. More data are needed to
   confirm or refute these results
Keywords:                   adjustment/alcohol/alcohol               consumption/alcohol
   CAROTENE/cardiovascular/cardiovascular                           disease/cardiovascular
   HEART-DISEASE/coronary                                  risk/counseling/DEPRESSIVE
   INFARCTION/patients/population/proportional                                     hazards
   factors/risk-factors/risks/STATE/stroke/US MALE PHYSICIANS/USA/VA/week
Jousilahti, P., Tuomilehto, J., Rastenyte, D. and Vartiainen, E. (2003), Headache and the
   risk of stroke - A prospective observational cohort study among 35056 Finnish men
   and women. Archives of Internal Medicine, 163 (9), 1058-+.
Abstract: Background: Previous studies have shown an increased risk of stroke among
   patients with migraine. However, very few data are available on the possible
   association between chronic unspecified headache and the risk of stroke. Methods: A
   prospective cohort study including 35056 randomly selected Finnish men and
   women aged 25 to 64 years at baseline who participated in a cardiovascular risk
   factor survey in 1972, 1977, 1982, or 1987. Self-reported headache, smoking,
   diabetes, blood pressure, weight, height, serum cholesterol level, and oral
   contraceptive use were recorded at baseline. During the follow-up, 2167 incident
   stroke events were ascertained with computer-based record linkage. Results: Women
   reported headache twice as often as men (16.7% vs 8.9%). Among men, the
   headache- associated hazard ratios (95% confidence intervals) for stroke were 4.08
   (2.10-7.93), 1.86 (1.33-2.59), and 1.24 (1.05-1.47) during 1, 5; and a maximum of 23
   years of follow-up, respectively. Adjustment for the other risk factors decreased the
   hazard ratios only slightly. Among women, there was also a direct but statistically
   nonsignificant association between headache and the risk of stroke. Conclusions:
   Chronic headache is an independent predictor of stroke among men. Since the
   association between headache and the risk of stroke was particularly strong during a
   short follow-up, chronic headache may be a marker of the underlying disease process
   leading to acute stroke. The sex difference observed in this association may be due to
   a higher prevalence and a more heterogeneous etiology of headache in women
   compared with men
Keywords:          acute/acute        stroke/aged/ARCH/association/AURA/blood/blood
   pressure/cardiovascular/cardiovascular             risk/cardiovascular              risk
   ce/prospective/prospective cohort/prospective cohort study/record linkage/risk/risk
   factor/risk factors/risk of stroke/risk-factors/serum/serum cholesterol/sex/sex
Semplicini, A., Maresca, A., Boscolo, G., Sartori, M., Rocchi, R., Giantin, V., Forte,
   P.L. and Pessina, A.C. (2003), Hypertension in acute ischemic stroke - A
   compensatory mechanism or an additional damaging factor? Archives of Internal
   Medicine, 163 (2), 211-216.
Abstract: Background: In acute ischemic stroke, a transient blood pressure (BP)
   elevation is common, but the best management is still unknown. Therefore, we
   investigated retrospectively the relationship between BP after ischemic stroke and
   neurological outcome (evaluated by means of the National Institutes of Health Stroke
   Scale score at day 7). Methods: The medical records of 92 consecutive patients with
   acute ischemic stroke, aged 47 to 96 years, were examined. Blood pressure was
   measured on admission, 4 times during the first 24 hours, 3 times daily for the first 4
   days, and twice daily on day 7 (or at discharge). Antihypertensive treatment was
   given according to American Heart Association guidelines. Results: The region
   damaged by the stroke was total anterior in 16 patients (17%), partial anterior in 30
   (33%), lacunar in 34 (37%), and posterior circulation in 12 (13%). Stroke
   pathogenesis was cardioembolic in 28 (30%), atherothrombotic in 29 (32%), and
   lacunar in 34 (37%). The systolic BP range was 140 to 220 mm Hg; diastolic BP, 70
   to 110 mm Hg. Initial BP was higher in the group with lacunar infarction than in the
   other groups (P<.05). The patients with the best outcome had the highest BP during
   the first 24 hours. The neurological outcome was strongly influenced by baseline
   stroke severity (NTH Scale score) and admission BP. Better initial neurological
   conditions and higher initial BP resulted in better neurological outcomes.
   Conclusions: The outcome of stroke is influenced by the type of stroke and initial BP.
   Lacunar stroke and the highest BP on admission carry the best prognosis, whereas
   the reverse is true for posterior circulation infarction and low BP. We found no
   evidence that, within the present BP range, hypertension is harmful and that its
   lowering is beneficial
Keywords: acute/acute ischemic/acute ischemic stroke/aged/American Heart
   ines/hypertension/infarction/ischemic/ischemic             stroke/Italy/lacunar/lacunar
   stroke severity/systolic/transient/treatment/TRIAL/USA
Stenestrand, U. and Wallentin, L. (2003), Fibrinolytic therapy in patients 75 years and
   older with ST- segment-elevation myocardial infarction - One-year follow-up of a
   large prospective cohort. Archives of Internal Medicine, 163 (8), 965-971.
Abstract: Background: Fibrinolytic therapy reportedly may not be beneficial in acute
  ST-segment-elevation myocardial infarction (STEMI) in patients who are 75 years
  and older. Methods: The association between fibrinolytic therapy and 1-year
  mortality and bleeding complications in an unselected large cohort of patients with
  STEMI was evaluated by means of propensity and Cox regression analysis adjusting
  for multiple factors known to influence fibrinolytic therapy as well as survival. The
  Register of Information and Knowledge About Swedish Heart Intensive Care
  Admissions recorded every patient admitted to a coronary care unit in 64 hospitals
  during 1995 through 1999. One-year mortality was obtained by merging with the
  National Cause of Death Register. Results: A total of 6891 patients 75 years and
  older with first registry-recorded STEMI were included, of whom 3897 received
  fibrinolytic therapy and 2994 received no such treatment. Fibrinolytic therapy was
  associated with a 13% adjusted relative reduction in the composite of mortality and
  cerebral bleeding complications after 1 year (95% confidence interval, 0.80-0.94; P
  =.00 1). This effect seemed homogeneous among all subgroups based on age, sex,
  coronary risk factors, and previous disease manifestations. Conclusions: Fibrinolytic
  therapy in patients with STEMI who are 75 years and older is associated with a
  reduction in the composite of mortality and cerebral bleedings after 1 year. These
  results from an unselected coronary care unit population support the use of
  fibrinolytic therapy in elderly patients
Keywords:                      acute/AGE/analysis/ARCH/association/bleeding/bleeding
  risk/disease/effect/elderly/ELDERLY                PATIENTS/fibrinolytic/fibrinolytic
  therapy/follow                                                 up/follow-up/GUSTO-I
  SCORES/prospective/prospective                            cohort/regression/regression
  erapy/THROMBOLYTIC THERAPY/treatment/USA/use
Tan, Z.S., Seshadri, S., Beiser, A., Wilson, P.W.F., Kiel, D.P., Tocco, M., D'Agostino,
  R.B. and Wolf, P.A. (2003), Plasma total cholesterol level as a risk factor for
  Alzheimer disease - The Framingham study. Archives of Internal Medicine, 163 (9),
Abstract: Background: Previous studies examining the association of plasma cholesterol
  levels with the risk for development of Alzheimer disease (AD) have been
  inconclusive. We examined the impact of baseline and lifetime plasma total
  cholesterol levels averaged across many years on the risk for AD in a large,
  population-based cohort. Methods: Five thousand two hundred nine subjects from the
  Framingham Study original cohort underwent biennial evaluation for cardiovascular
  risk factors since 1950, with estimations of serum total cholesterol levels at 19 of
  these 25 biennial examinations. The study sample consisted of 1026 subjects from
  this cohort who were alive and free of stroke and dementia at examination cycle 20
  (1988-1989) and had undergone apolipoprotein E (APOE) genotyping. The main
  outcome measure was incident AD diagnosed using standard criteria,according to
  average total cholesterol levels across biennial examination cycles 1 to 15 and
  baseline total cholesterol level measured at the 20th biennial examination cycle.
  Results: Alzheimer disease developed in 77 subjects from 1992 to 2000. After
  adjustment for age, sex, APOE genotype, smoking, body mass index (calculated as
  weight in kilograms divided by the square of height in meters), coronary heart
  disease, and diabetes, we found no significant association between the risk for
  incident AD and average cholesterol level at biennial examination cycles 1 to 15
  (hazard ratio per 10- mg/dL [0.3-mmol/L] rise, 0.95; 95% confidence interval, 0.87-
  1.04) or baseline total cholesterol level at examination 20 (hazard ratio, 0.97; 95%
  confidence interval, 0.90-1.05). Conclusion: In this large, population-based cohort,
  baseline and long-term average serum total cholesterol levels were not associated
  with the risk for incident AD
Keywords: AD/adjustment/age/ALLELE/Alzheimer/Alzheimer disease/APOE/APOE
  E/APOLIPOPROTEIN-E/ARCH/association/body                                         mass
  index/cardiovascular/cardiovascular               risk/cardiovascular             risk
  factors/CHICAGO/cholesterol/cohort/coronary/coronary          heart/coronary     heart
  ham                            Study/FREQUENCY/genotype/genotyping/heart/heart
  INHIBITORS/risk/risk                                                       factor/risk
Thomas, R.J., Palumbo, P.J., Melton, L.J., Roger, V.L., Ransom, J., O'Brien, P.C. and
  Leibson, C.L. (2003), Trends in the mortality burden associated with diabetes
  mellitus - A population-based study in Rochester, Minn, 1970- 1994. Archives of
  Internal Medicine, 163 (4), 445-451.
Abstract: Background: The prevalence of diabetes mellitus (DM) has increased
  markedly in recent decades, but trends in the mortality burden associated with DM
  are unclear. Therefore, we analyzed population-based longitudinal data to address
  this issue. Methods: The community-based medical records of all Rochester residents
  45 years and older who died between January 1, 1970, and December 31, 1994, were
  reviewed to identify those who met the standardized criteria for DM before death.
  Trends over successive quinquenniums were assessed for the proportion of all deaths
  in the community of persons with prevalent DM, for mortality rates for persons with
  and without DM, and for the distribution of causes of death among decedents with
  and without DM. Results: Of 10 152 total deaths in 1970-1994, 1384 (13.6%) met
  the criteria for prevalent DM. Between 19701974 and 1990-1994, the proportion of
  decedents with DM increased by 48.2%. Mortality rates for persons with and without
  DM declined by 13.8% and 21.4%, respectively. This disparity in mortality trends
  was most apparent for older women and younger men. There were temporal declines
  in the proportion of all persons dying of cardiovascular disease, but temporal
  declines in persons dying of cerebrovascular disease were found only in decedents
  without DM. Conclusions: The mortality burden associated with DM increased
  significantly between 1970 and 1994, probably due to increases in DM incidence and
  smaller declines in mortality for persons with DM relative to those without DM. In
  the absence of improved DM prevention and treatment, the steady declines in
  mortality observed for the general population since the 1960s will likely begin to
  slow or even reverse
Keywords: ARCH/burden/cardiovascular/cardiovascular disease/causes/causes of
  death/cerebrovascular/cerebrovascular          disease/CHICAGO/community/COST-
  EFFECTIVENESS/criteria/death/DEATH                 CERTIFICATES/diabetes/diabetes
Tu, J.V. and Gong, Y.Y. (2003), Trends in treatment and outcomes for acute stroke
  patients in Ontario, 1992-1998. Archives of Internal Medicine, 163 (3), 293-297.
Abstract: Background: Several interventions have been shown to be of benefit to
  patients with stroke (hereafter referred to as stroke patients) in clinical trials, but the
  net effect of these interventions in the general stroke population has not been
  established. The purpose of this study was to evaluate temporal trends in the
  characteristics, treatments, and outcomes of acute stroke patients in the province of
  Ontario. Methods: We conducted a population-based retrospective cohort study using
  linked administrative databases of all 91419 patients discharged with a
  most-responsible diagnosis of acute stroke from acute care hospitals in Ontario from
  April 1, 1992, to March 31, 1999 (fiscal years 1992-1998). Results: The average age
  and proportion of stroke patients with co-existing diseases increased over time. The
  proportion of elderly patients 65 years and older who. received warfarin sodium
  (Coumadin) and statins increased during the study period (14.6% to 19.6% [P = .001]
  and 2.7% to 15.0% [P < .001], respectively). Declines in the median length of stay
  (11 to 8 days [P < .001]) and risk-adjusted in-hospital mortality (21.9% to 18.9% [P
  < .001]) were significant, but the 30-day mortality rates for acute stroke stayed
  relatively constant (19.7% to 19.0% [P = .18]). We found a moderate decline in
  risk-adjusted 1-year mortality (34.1% to 32.0% [P < .001]) and stroke readmission
  rates (12.1% to 9.9% [P = .001]). Conclusions: Improvements in the outcomes of
  stroke patients have occurred in Ontario during the 1990s, despite an increasing
  proportion of elderly stroke patients with multiple comorbidities. Increasing use of
  secondary prevention medications may explain this trend
Keywords: acute/acute care/acute stroke/age/ARCH/Canada/CHICAGO/clinical/clinical
  patients/general/hospitals/in-hospital                mortality/length                   of
  stay/mortality/multiple/older/outcomes/patients/patients                              with
  econdary        prevention/sodium/STATE/statins/stroke/stroke          patients/temporal
  trends/treatment/trends/trials/USA/use/warfarin/warfarin sodium
Tzourio, C., Anderson, C., Chapman, N., Woodward, M., Neal, B., MacMahon, S. and
  Chalmers, J. (2003), Effects of blood pressure lowering with perindopril and
  indapamide therapy on dementia and cognitive decline in patients with
  cerebrovascular disease. Archives of Internal Medicine, 163 (9), 1069-1075.
Abstract: Background: High blood pressure and stroke are associated with increased
  risks of dementia and cognitive impairment. This study aimed to determine whether
  blood pressure lowering would reduce the risks of dementia and. cognitive decline
  among individuals with cerebrovascular disease. Methods: The Perindopril
  Protection Against Recurrent Stroke Study (PROGRESS) was a randomized,
  double-blind, placebo-controlled trial conducted among 6105 people with prior
  stroke or transient ischemic attack. Participants were assigned to either active
  treatment (perindopril for all participants and indapamide for those with neither an
  indication for nor a contraindication to a diuretic) or matching placebo(s). The
  primary outcomes for these analyses were dementia, (using DSM- IV criteria) and
  cognitive decline (a decline of 3 or more points in the Mini-Mental State
  Examination score). Results: During a mean follow-up of 3.9 years, dementia was
  documented in 193 (6.3%) of the 3051 randomized participants in the actively treated
  group and 217 (7.1%) of the 3054 randomized participants in the placebo group
  (relative risk reduction, 12% [95% confidence interval, -8% to 28%]; P=.2).
  Cognitive decline occurred in 9.1% of the actively treated group and 11.0% of the
  placebo group (risk reduction, 19% [95% confidence interval, 4% to 32%]; P=.01).
  The risks of the composite outcomes of dementia with recurrent stroke and of
  cognitive decline with recurrent stroke were reduced by 34% (95% confidence
  interval, 3% to 55%) (P=.03) and 45% (95% confidence interval, 21% to 61%)
  (P<.001), respectively, with no clear effect on either dementia or cognitive decline in
  the absence of,recurrent stroke. Conclusions: Active treatment was associated with
  reduced risks of dementia and cognitive decline associated with recurrent stroke.
  These findings further support the recommendation that blood pressure lowering
  with perindopril and indapamide therapy be considered for all patients with
  cerebrovascular disease
  pressure/blood            pressure            lowering/cerebrovascular/cerebrovascular
  disease/CHICAGO/cognitive/cognitive                                   decline/cognitive
  attack/LIFE/Mini-Mental                                                              State
  d/recurrent/recurrent                                                     stroke/relative
  STOLIC               HYPERTENSION/therapy/transient/transient                   ischemic
van Walraven, C., Hart, R.G., Wells, G.A., Petersen, P., Koudstaal, P.J., Gullov, A.L.,
  Hellemons, B.S.P., Koefed, B.G. and Laupacis, A. (2003), A clinical prediction rule
  to identify patients with atrial fibrillation and a low risk for stroke while taking
  aspirin. Archives of Internal Medicine, 163 (8), 936-943.
Abstract: Background: We sought to derive and internally validate a simple and easily
  applied clinical prediction rule to identify patients with nonvalvular atrial fibrillation
  (AF) whose stroke risk while taking aspirin is, irrespective of age, low enough that
  oral anticoagulation therapy is unnecessary. Methods: We included 2501 patients
  with AF treated with aspirin during participation in 6 clinical trials. Patients were
  randomly divided into derivation and validation sets. Recursive partitioning was used
  to identify patients in the derivation set whose risk for stroke (ischemic or
  hemorrhagic) or transient ischemic attack was comparable to that observed in an age-
  and sex-matched cohort from the Framingham Heart Study. The derived prediction
  rules were tested on the validation set. Results: Overall, 166 patients (6.6%) had an
  event during 4688.6 person-years (PYs) of observation for an incident rate of 3.5
  events per 100 PYs. Patients in the derivation set classified as low risk (no previous
  stroke or transient ischemic attack, no treated hypertension or systolic blood pressure
  equal to or exceeding 140 mm Hg, no symptomatic coronary artery disease, and no
  diabetes) experienced 1.0 events per 100 PYs, compared with an age- and
  sex-matched rate of 1.2 events per 100 PYs. In the validation set, low-risk patients
  experienced 1.1 events per 100 PYs (expected rate of 1.2 events per 100 PYs).
  Low-risk patients made up 24% of the cohort and 16% of patients older than 75 years.
  Low-risk patients who were randomized to therapeutic oral anticoagulation therapy
  experienced 1.5 events per 100 PYs. Conclusion: Irrespective of age, patients with
  AF and none of these 4 clinical features and who take aspirin have stroke rates
  comparable to those of age-matched community cohorts and would not benefit
  substantially from anticoagulation
Keywords:               AF/age/ANTICOAGULATION/ARCH/artery/aspirin/atrial/atrial
  fibrillation/blood/blood pressure/Canada/CHICAGO/clinical/clinical features/clinical
  trials/cohort/community/COMPLICATIONS/coronary/coronary                  artery/coronary
  /ischemic/ischemic         attack/low       risk        patients/METHODOLOGICAL
  STANDARDS/nonvalvular/nonvalvular atrial fibrillation/observation/older/oral/oral
  anticoagulation/OTTAWA                                                           ANKLE
  DOMIZED                TRIAL/risk/SECULAR               TRENDS/STATE/stroke/stroke
  risk/systolic/systolic                      blood/systolic                         blood
  pressure/therapeutic/THERAPY/transient/transient                                ischemic
Wannamethee, S.G., Camargo, C.A., Manson, J.A.E., Willett, W.C. and Rimm, E.B.
  (2003), Alcohol drinking patterns and risk of type 2 diabetes mellitus among younger
  women. Archives of Internal Medicine, 163 (11), 1329-1336.
Abstract: Objective: To examine the relationship between alcohol consumption and the
  incidence of type 2 diabetes mellitus among relatively young and middle-aged
  women. Methods: In a prospective study, 109 690 women, aged 25 to 42 years,
  without a history of coronary heart disease, stroke, cancer, or diabetes mellitus
  completed a detailed lifestyle and medical history questionnaire in 1989. During 10
  years of follow-up, we documented 935 incident cases of type 2 diabetes mellitus.
  Results: We found a nonlinear relationship between alcohol consumption and risk of
  type 2 diabetes mellitus after adjustment for multiple confounders, including body
  mass index, smoking, physical activity, and family history of diabetes mellitus
  (quadratic trend P=.003). Compared with lifelong abstainers, the adjusted relative
  risks (95% confidence intervals) were 0.80 (0.66-0.96) for those consuming 0.1 to
  4.9 g/d, 0.67 (0.50-0.89) for those consuming 5.0 to 14.9 g/d, 0.42 (0.20-0.90) for
  those consuming 15.0 to 29.9 g/d, and 0.78 (0.34-1.78) for those consuming 30.0 g/d
  or more. Further adjustment for dietary factors, including glycemic load, trams- fatty
  acid, polyunsaturated fat, and total fiber intake, did not appreciably alter these
  findings. The inverse association with light to moderate drinking was most apparent
  in women who reported wine or beer drinking. Women who reported 30.0 g/d or
  more of liquor intake showed a significantly increased risk of diabetes mellitus
  compared with those who did not report liquor intake (adjusted relative risk, 2.50;
  95% confidence interval, 1:00-6.23). Conclusion: Light to moderate alcoholic
  beverage consumption may be associated with a lower risk of type 2 diabetes
  mellitus among women aged 25 to 42 years, although this benefit.may not- persist at
  higher levels
Keywords:                                       activity/adjustment/aged/alcohol/alcohol
  consumption/ARCH/association/beer/body                                              mass
  heart/coronary                       heart                     disease/diabetes/diabetes
   mellitus/dietary/disease/drinking/England/family/family                 history/fat/fatty
   acid/fiber/follow                  up/follow-up/GLUCOSE-TOLERANCE/glycemic
   load/HEALTH/heart/heart                      disease/history/incidence/index/INSULIN
   activity/POPULATION/prospective/prospective study/QUESTIONNAIRE/relative
   risk/risk/risks/SEX/smoking/STATE/stroke/type 2/type 2 diabetes/type 2 diabetes
Afsar, N., Fak, A.S., Metzger, J.T., Van Melle, G., Kappenberger, L. and
   Bogousslavsky, J. (2003), Acute stroke increases QT dispersion in patients without
   known cardiac diseases. Archives of Neurology, 60 (3), 346-350.
Abstract: Background: Electrocardiographic changes are well known to appear with
   acute cerebrovascular events. Objective: To investigate if QT dispersion (QTd) is
   increased in patients who have an acute stroke and if this increase could be related to
   lesion extent and/or localization. Design: The study group consisted of 36 patients
   who had an acute stroke and no history or signs of cardiovascular disease. An
   age-matched control group (n=19) free of cardiovascular disease was also included.
   Simultaneous 12-lead electrocardiograms (ECGs) were recorded within the first 24
   hours (24h-ECG) and after 72 hours (72h- ECG) from stroke onset. QT dispersion
   was assessed both manually and automatically with assessors blinded to the clinical
   data. Results: QT dispersion, corrected QTd, and automated QTd were significantly
   increased in the 24h-ECG compared with the 72h-ECG (60 [range, 20-80]
   milliseconds vs 40 [range, 0-80] milliseconds, P<.005; mean [SD], 56 [19] vs 36 [21]
   milliseconds, P<.001; and 50 [range, 14-94] vs 34 [range, 0-84] milliseconds, P<.005,
   respectively). However, QTd in the 72h-ECG was similar to Q Td in the control
   group. While in the 24h-ECG corrected QTd was significantly greater in patients
   with large infarcts and large hemorrhages (mean [SD], 70 [20] vs 51 [20]
   milliseconds, P<.05), in the 72h-ECG corrected QTd was greater in patients with
   right- vs left-sided lesions (mean [SD], 39 [18] vs 24 [18] milliseconds, P<.05).
   Conclusions: QT dispersion is increased in the first 24 hours in patients with acute
   stroke and no cardiovascular disease compared with the control group. Although this
   finding seems to be related to the size of the lesion rather than to the localization or
   type of stroke, after 72 hours specific lesion localization could also influence the
Keywords:                                                                       acute/acute
Bisschops, R.H.C., Klijn, C.J.M., Kappelle, L.J., van Huffelen, A.C. and van der Grond,
   J. (2003), Association between impaired carbon dioxide reactivity and ischemic
   lesions in arterial border zone territories in patients,with unilateral internal carotid
   artery occlusion. Archives of Neurology, 60 (2), 229-233.
Abstract: Context: Ischemic lesions in patients with internal carotid artery (ICA)
   steno-occlusive disease can be categorized on the basis of their location and
   presumed cause: external border zone infarcts, internal border zone infarcts, cortical
   infarcts, lacunar infarcts, and periventricular lesions. Objective: To evaluate the
  association between the prevalence and size of ischemic lesions and cerebral
  vasomotor reactivity in patients with unilateral occlusion of the ICA. Design:
  Cross-sectional study. Setting: Referral center. Patients: Seventy consecutive patients
  were included in this study. All patients had a transient or minor disabling retinal or
  cerebral ischemia that was associated with unilateral occlusion of the ICA. Ischemic
  lesions on magnetic resonance imaging were identified on hard copies, and volume
  measurements were obtained by a magnetic resonance workstation. Vasomotor
  reactivity was assessed with transcranial Doppler ultrasonography with carbon
  dioxide challenge. Main Outcome Measures: Prevalence and size of ischemic lesions.
  Results: In the hemisphere ipsilateral to the ICA occlusion, we found an increased
  prevalence of internal border zone infarcts (P = .01), external borders zone infarcts (P
  < .001), and territorial infarcts (P = .02) compared with the contralateral hemisphere.
  Hemispheres with a carbon dioxide reactivity less than or equal to 18% demonstrated
  a significant increase in prevalence (P = .007) and volume (P = .003) of internal
  border zone infarcts compared with hemispheres with a carbon dioxide reactivity
  greater than or equal to 19%. No association between carbon dioxide reactivity and
  any other type of ischemic lesion was found. Conclusion: In patients with an ICA
  occlusion, only internal border zone infarcts demonstrate a significant association
  with diminished cerebral hemodynamics
Keywords:          ARCH/arterial/artery/association/BLOOD-FLOW/border                 zone
  infarcts/BRAIN/carbon            dioxide/carotid/carotid     artery/carotid        artery
  occlusion/cause/cerebral/cerebral hemodynamics/cerebral ischemia/CEREBRAL
  occlusion/imaging/infarcts/internal/internal carotid/internal carotid artery/internal
  carotid     artery    occlusion/ischemia/ischemic/ischemic       lesions/lacunar/lacunar
  INFARCTS/magnetic/magnetic                     resonance/magnetic             resonance
  nance imaging/size/STATE/STROKE/territorial infarcts/transcranial/transcranial
  Doppler/transcranial                                                            Doppler
  ultrasonography/transient/ultrasonography/USA/vasomotor reactivity/volume
Chaturvedi, S. (2003), Should the multicenter carotid endarterectomy trials be repeated?
  Archives of Neurology, 60 (5), 774-775
Keywords:                                                           ARCH/carotid/carotid
Chaves, C.J., Staroselskaya, I., Linfante, I., Llinas, R., Caplan, L.R. and Warach, S.
  (2003), Patterns of perfusion-weighted imaging in patients with carotid artery
  occlusive disease. Archives of Neurology, 60 (2), 237-242.
Abstract: Background: The importance of hemodynamic factors in the pathophysiology
  of stroke and transient ischemic attacks in patients with internal carotid artery (ICA)
  stenosis or occlusion remains controversial. Objective: To investigate whether
  perfusion-weighted imaging (PWI) could identify pathophysiologically meaningful
  categories in patients with symptomatic and asymptomatic ICA occlusive disease.
  Methods: Thirty-eight consecutive patients with occlusion (22 patients) or severe
  stenosis (16 patients) of the ICA, determined by ultrasonography or magnetic
  resonance angiography, were identified from the Beth Israel Deaconess Medical
  Center Stroke Database, Boston, Mass. Thirty-five patients were symptomatic (29
  who had strokes and 6 who had transient ischemic attacks) and 3 were asymptomatic.
  All symptomatic patients underwent PWI within the first 24 hours after symptom
  onset. The patterns of PWI were analyzed according to the degree of ICA stenosis
  and the clinical presentation. Results: Three patterns of perfusion abnormalities were
  identified: extensive hypoperfusion involving the middle cerebral arterial and/or
  anterior cerebral arterial territories (25 patients), localized perfusion deficits
  involving predominantly the ipsilateral border zone areas (8 patients), and normal
  perfusion (5 patients). All 3 patterns were found whether or not the ICA was
  occluded. Patients who had acute stroke most frequently had extensive perfusion
  deficits involving 1 or 2 territories while patients who had transient ischemic attacks
  often had hypoperfusion affecting the border zone regions. All asymptomatic patients
  had normal perfusion. Conclusions: In our sample the pattern of PWI related to the
  clinical presentation but not to the degree of ICA disease (occlusive vs severe
  stenosis). Our study findings add further support to the hypothesis that hypoperfusion
  is a major contributing factor in the pathophysiology of carotid artery occlusive
Keywords:                                                        abnormalities/acute/acute
  FACTORS/hypoperfusion/imaging/internal/internal             carotid/internal     carotid
  artery/ischemic/ischemic attacks/magnetic/magnetic resonance/magnetic resonance
  angiography/middle                                  cerebral/normal/occlusion/occlusive
  disease/pathophysiology/patients/patterns/perfusion/perfusion                  weighted
  transient ischemic attacks/ultrasonography/USA
Cooper, E.C. and Jan, L.Y. (2003), M-channels - Neurological diseases,
  neuromodulation, and drug development. Archives of Neurology, 60 (4), 496-500.
Abstract: Efforts in basic neuroscience and studies of rare hereditary neurological
  diseases are partly motivated by the hope that such work can lead to better
  understanding of and treatments for the common neurological disorders. An example
  is the progress that has resulted from identification of the genes that cause benign
  familial neonatal convulsions (BFNCs). Benign familial neonatal convulsions is a
  rare idiopathic, generalized epilepsy syndrome. In 1998, geneticists discovered that
  BFNC is caused by mutations in a novel potassium channel subunit, KCNQ2.
  Further work quickly revealed the sequences of 3 related brain channel genes
  KCNQ3, KCNQ4, and KCNQ5. Mutations in 2 of these genes were shown to cause
  BFNC (KCNQ3) and hereditary deafness (KCNQ4). Physiologists soon discovered
  that the KCNQ genes encoded subunits of the M-channel, a widely expressed
  potassium channel that mediates effects of modulatory neurotransmitters and controls
  repetitive neuronal discharges. Finally, pharmacologists discovered that the
  biological activities of 3 classes of compounds in development as treatments for
  Alzheimer disease, epilepsy, and stroke were mediated in part by effects on brain
  KCNQ channels. Cloned human KCNQ channels can now be used for
  high-throughput screening of additional drug candidates. Ongoing studies in humans
  and animal models will refine our understanding of KCNQ channel function and may
  reveal additional targets for therapeutic manipulation
Keywords:                   Alzheimer/Alzheimer                     disease/animal/animal
  development/effects/EPILEPSY/familial/FAMILIAL                           NEONATAL
  neurological/neurological                                       diseases/neurological
Cordoliani-Mackowiak, M.A., Henon, H., Pruvo, J.P., Pasquier, F. and Leys, D. (2003),
  Poststroke dementia - Influence of hippocampal atrophy. Archives of Neurology, 60
  (4), 585-590.
Abstract: Background: The prevalence of dementia is increased after stroke. Medial
  temporal lobe atrophy (MTLA) is associated with Alzheimer disease, and with
  prestroke dementia in patients who have had a stroke.. Objective: To determine the
  influence of MTLA on the long-term risk of dementia after stroke, after excluding
  the patients who had prestroke dementia. Methods: The study was conducted in 144
  consecutive patients who had a stroke, who were aged 40 years or older (66 women
  and 78 men; median age, 72 years), and who had an informant Questionnaire on
  Cognitive Decline in the Elderly score lower than 104. On admission to the hospital
  all patients underwent a noncontrast computed tomographic scan including temporal
  lobe-positioned slices. A cut-off of 11.5 mm was used to differentiate patients with
  MTLA from those without MTLA. Patients were followed up with clinical and
  cognitive assessments over a 3-year period. Results: Three years after stroke, 34
  patients (23.6%) had developed new-onset dementia. The cumulative proportion of
  survivors without dementia was 57.6% in patients with MTLA and 80.8% in patients
  without MTLA (P=.02). The unadjusted relative risk of poststroke dementia
  associated with MTLA was 2.3 (95% confidence interval, 1.1-4.7). However, using
  the Cox proportional hazards model, MTLA did not seem to be an independent
  predictor of poststroke dementia. Independent predictors of poststroke dementia were
  increasing age, diabetes mellitus, severity of the clinical deficit at admission, and
  severity of leukoaraiosis on computed tomography. Conclusions: Patients who had a
  stroke and MTLA more frequently develop dementia than patients without MTLA,
  but our study does not suggest that MTLA independently contributes to dementia. A
  longer follow-up may be necessary to reevaluate the influence of MTLA
Keywords:                                               age/aged/Alzheimer/Alzheimer
  FREQUENCY/CHICAGO/clinical/cognitive/computed                 tomographic/computed
  tomographic scan/computed tomography/COMPUTED- TOMOGRAPHY/Cox
  proportional                 hazards               model/dementia/diabetes/diabetes
  mellitus/differentiate/disease/follow up/follow-up/France/hospital/HOSPITALIZED
  COHORT/INFORMANT                       INTERVIEW/leukoaraiosis/lower/men/MILD
  COGNITIVE            IMPAIRMENT/model/older/patients/period/poststroke/poststroke
  dementia/predictor/predictors/PREEXISTING           DEMENTIA/prevalence/relative
  risk/risk/score/STATE/stroke/STROKE           PATIENTS/Stroke           Unit/temporal
  lobe/TEMPORAL-LOBE                       ATROPHY/tomography/USA/VASCULAR
DeKosky, S.T. (2003), How should we design studies for stroke prevention? Archives of
  Neurology, 60 (5), 778-779
Keywords:                 ARCH/CHICAGO/design/PA/prevention/STATE/stroke/stroke
Kang, K., Chu, K., Kim, D.E., Jeong, S.W., Lee, J.W. and Roh, J.K. (2003), POEMS
  syndrome associated with ischemic stroke. Archives of Neurology, 60 (5), 745-749.
Abstract: Background: A syndrome variously combining peripheral neuropathy,
  visceromegaly, endocrinopathy, monoclonal gammopathy, and skin changes
  (POEMS syndrome) is a rare variant of plasma cell dyscrasia with multisystemic
  manifestations. Acute ischemic strokes in patients with POEMS syndrome have
  rarely been reported, and the pathophysiologic mechanism of this disease is unknown.
  Fibrinogen is reported to be an independent risk factor for cerebrovascular disease
  and is correlated with the interleukin 6 level in the plasma. The serum level of
  interleukin 6 is high in the active stage of POEMS syndrome. Objective: To describe
  the neuroimaging findings and fibrinogen levels in patients with POEMS syndrome.
  Design: Case series. Setting: The neurology department of a tertiary referral center.
  Methods: Three patients with an acute cerebral infarction associated with POEMS
  syndrome underwent magnetic resonance imaging, diffusion-weighted imaging,
  magnetic resonance angiography, transcranial Doppler ultrasonography, and serum
  fibrinogen level and serum C- reactive protein level analysis. The serum fibrinogen
  level before the stroke was collected retrospectively from the hospital medical
  records. Results:, There was an elevated fibrinogen level in all of the patients. In 2
  patients, unilateral or bilateral end artery border-zone infarcts were observed on the
  brain magnetic resonance imaging scan. The serum fibrinogen level was high before
  the stroke in 2 patients. Conclusions: The POEMS syndrome can be associated with
  stroke, particularly end artery border-zone infarctions. We suggest that an elevated
  fibrinogen level might play a role in the pathogenesis of stroke
Keywords:                                acute/acute                                cerebral
  infarction/analysis/angiography/ARCH/artery/bilateral/border                         zone
  infarcts/borderzone      infarcts/brain/brain     magnetic      resonance/C-      reactive
  protein/cerebral/cerebral                     infarction/cerebrovascular/cerebrovascular
  disease/changes/CHICAGO/diffusion                  weighted/diffusion            weighted
  imaging/diffusion-weighted/diffusion-weighted           imaging/disease/Doppler/Doppler
  leukin                6/interleukin-6/ischemic/ischemic                   stroke/ischemic
  strokes/Korea/magnetic/magnetic                 resonance/magnetic              resonance
  angiography/magnetic             resonance          imaging/mechanism/medical/medical
  pathogenesis/pathogenesis              of            stroke/patients/peripheral/peripheral
  neuropathy/plasma/PROTEIN/records/referral/resonance                     imaging/risk/risk
  Doppler/transcranial Doppler ultrasonography/ultrasonography/USA
Knopman, D.S., Rocca, W.A., Cha, R.H., Edland, S.D. and Kokmen, E. (2003),
  Survival study of vascular dementia in Rochester, Minnesota. Archives of
  Neurology, 60 (1), 85-90.
Abstract: Objective: To investigate the relationship between features and definitions of
  vascular dementia (VaD) and survival. Design: We used the medical records linkage
  system of the Rochester Epidemiology Project to identify incident cases of dementia
  in Rochester from January 1, 1985, through December 31, 1989. Dementia and
  Alzheimer disease were defined using the criteria of the Diagnostic and Statistical
  Manual of Mental Disorders, Fourth Edition. Vascular dementia was defined by ad
  hoc criteria, including imaging. Each patient with dementia was matched by age and
  sex to a referent subject free of dementia. Patients with dementia and referent
  subjects were followed from the onset of dementia (or index year) through death,
  censoring, or the end of the study. Results: We included 479 patients with incident
  dementia and 479 referent subjects. Overall, patients with VaD had worse mortality
  than referent subjects (relative risk [RR], 2.7; 95% confidence interval [CI], 1.9-3.9).
  Among patients with VaD, those with dementia temporally related to a stroke had a
  worse relative mortality (RR, 4.5; 95% CI, 2.7- 7.4) than those with only imaging
  evidence of bilateral infarctions in gray matter structures (RR, 2.4; 95% CI, 1.5- 3.8).
  Relative mortality estimates varied by using 3 sets of published diagnostic criteria for
  VaD. Patients with VaD had a higher RR of death (RR, 2.7; 95% CI, 1.9-3.9) than
  patients with dementia overall,(RR, 1.8; 95% CI, 1. 6-2. 1) or patients with
  Alzheimer disease (RR, 1.4; 95% CI, 1.2-1.7). Conclusions: The relative mortality of
  patients with VaD varied depending on the set of diagnostic criteria used. A temporal
  relationship to a stroke was the strongest predictive feature for poor survival in
  patients with dementia
Keywords:                                                      AGE/Alzheimer/Alzheimer
  NITY/criteria/death/dementia/diagnostic/diagnostic                  criteria/disease/gray
  matter/imaging/index/ISCHEMIC                        STROKE/linkage/medical/medical
  ENCE/relative risk/RISK/sex/STATE/stroke/survival/USA/VaD/vascular/vascular
Knopman, D.S., Parisi, J.E., Boeve, B.F., Cha, R.H., Apaydin, H., Salviati, A., Edland,
  S.D. and Rocca, W.A. (2003), Vascular dementia in a population-based autopsy
  study. Archives of Neurology, 60 (4), 569-575.
Abstract: Background: The validity of the clinical diagnosis of vascular dementia (VaD)
  remains suboptimal. Objective: To investigate clinicopathologic correlations in VaD.
  Methods: We used the medical records-linkage system of the Rochester
  Epidemiology Project to identify incident cases of dementia in Rochester, Minn,
  from January 1, 1985, through December 31, 1989. Dementia and Alzheimer disease
  (AD) were defined by the criteria of the Diagnostic and Statistical Manual of Mental
  Disorders, Fourth Edition. Vascular dementia was defined by criteria including
  imaging results. Pathological characteristics of AD were quantified by means of
  standard scoring methods for neurofibrillary tangles and neuritic plaques. Vascular
  pathological findings were assessed by expert neuropathological opinion. Results: Of
  419 patients with dementia who died before the study, neuropathological
  examination results were available in 89 (21%) with median age at onset of 80 years
  (range, 50-96 years; 52 [58%] women). Pathological diagnoses were AD in 45
  patients (5 1 V, pure VaD in 12 (13%), combined AD and VaD in 11 (12%), and
  other diagnoses in the remaining 21 patients. Criteria for VaD that required either a
  temporal relationship between a stroke and dementia onset or worsening, or bilateral
  infarctions in specified locations demonstrated on imaging results (Mayo Clinic
  criteria) had 75% sensitivity and 81% specificity for pure VaD (positive likelihood
  ratio, 3.9; 95% confidence interval, 2.2-6.7). Five cases of pure VaD lacked the
  temporal relationship and accounted for the imperfect sensitivity of the criteria.
  Conclusions: In this population- based autopsy study, the presence of vascular
  pathological characteristics in the absence of major AD pathological findings was
  common. Pure VaD without overt clinical strokes remains a challenge for
  antemortem diagnosis
Keywords:             AD/age/age              at             onset/Alzheimer/Alzheimer
  RATES/INFARCTION/INTERNATIONAL                                   WORKSHOP/LEWY
  s/USA/VaD/validity/vascular/vascular dementia/women
Lee, H., Whitman, G.T., Lim, J.G., Yi, S.D., Cho, Y.W., Ying, S. and Baloh, R.W.
  (2003), Hearing symptoms in migrainous infarction. Archives of Neurology, 60 (1),
Abstract: Background: In case reports, migraine headaches have been associated with
  fluctuating low-frequency hearing loss and sudden, unilateral hearing loss. Auditory
  symptoms associated with migrainous infarction have not previously been
  emphasized. Objective: To describe migrainous infarction presenting with acute
  auditory symptoms. Design: Case reports. Setting: Tertiary care hospitals. Patients: A
  40-year-old man with a history of migraine suddenly developed bilateral hearing loss
  associated with severe, throbbing, occipital headache, tinnitus, vertigo, speech
  disturbance, and right hemiparesis. An early audiogram showed profound,
  down-sloping, sensorineural-type hearing loss bilaterally. Sixteen days later, a
  follow-up pure tone audiogram documented marked improvement in both sides to a
  pure tone average of 30 dB. Right hemiparesis and dysarthria also improved steadily
  for 2 months. A 25-year-old woman with a history of migraine with aura suddenly
  developed hyper-acusis, unilateral hearing loss, and migraine headache early in
  migrainous infarction. Magnetic resonance imaging documented infarcts in the pons
  and cerebellum. Conclusions: In these patients, acute auditory symptoms are a part of
  the prodrome of migrainous infarction. We speculate that these symptoms may have
  resulted from migraine-associated vasospasm. Migrainous infarction should be
  considered in the differential diagnosis of acute auditory symptoms, including
  sudden, bilateral hearing loss
Keywords:                                               acute/ARCH/aura/bilateral/case
  reports/cerebellum/CHICAGO/diagnosis/differential          diagnosis/dysarthria/follow
  headache/migraine                   with                 aura/patients/pons/resonance
Moore, W.S. (2003), Resolved: NASCET and ACAS need not be repeated - The
  affirmative position. Archives of Neurology, 60 (5), 775-778
Keywords:                                                     ACAS/ARCH/CAROTID
Oberstein, S.A.J.L., van den Boom, R., Middelkoop, H.A.M., Ferrari, M.D., Knaap,
  Y.M., van Houwelingen, H.C., Breuning, M.H., van Buchem, M.A. and Haan, J.
  (2003), Incipient Cadasil. Archives of Neurology , 60 (5), 707-712.
Abstract: Background: Cerebral autosomal dominant arteriopathy with subcortical
  infarcts and leukoencephalopathy (CADASIL) is caused by mutations in the
  NOTCH3 gene. Knowledge of disease expression in young adult NOTCH3 mutation
  carriers (MCs) is limited. Objective: To characterize clinical, neuropsychological,,
  and radiological status in NOTCH3 MCs younger than 35 years. Design: Clinical
  characterization and blinded survey comparing MCs with non-MCs. Setting: Referral
  center. Participants: Individuals younger than 35 years who were at a 50% risk of a
  NOTCH3 mutation, from our CADASIL database. Thirteen individuals, from 8
  families, met the criteria. Methods: Comprehensive clinical, genetic,
  neuropsychological, and radiological investigations. Magnetic resonance images
  were scored according to a standardized white matter hyperintensities rating scale.
  Results: Six individuals, from 5 families, were MCs. Clinical symptoms consisted of
  migraine (with aura), stroke, and strokelike episodes. We did not find evidence for
  psychiatric disturbances, functional disability, or cognitive dysfunction, compared
  with non-MCs. Radiologically, a characteristic magnetic resonance imaging lesion
  pattern emerged for all MCs. This comprised white matter hyperintensities in the
  anterior temporal lobes, the frontal lobes, and the periventricular frontal caps.
  Conclusions: Migraine (with aura) and stroke can present in NOTCH3 MCs younger
  than 35 years; however, more importantly, physical function and cognition are intact.
  Possible subtle cognitive dysfunction needs to be assessed in a larger study. White
  matter hyperintensities on magnetic resonance imaging are characteristic, and are
  consistently visualized from the age of 21 years and onward. Awareness of the
  clinical-and radiological features of CADASIL in those younger than 35 years should
  increase early diagnosis and allow for customized counseling of young adults from
  families with CADASIL
Keywords:                             adult/adults/age/ARCH/arteriopathy/aura/autosomal
  diagnosis/frontal/frontal            lobes/function/functional/gene/genetic/HOSPITAL
  UKOENCEPHALOPATHY CADASIL/magnetic/magnetic resonance/magnetic
  hological/NOTCH3/NOTCH3                                 MUTATIONS/physical/physical
  function/psychiatric/rating                                              scale/resonance
  INFARCTS/subcortical                                infarcts                         and
  leukoencephalopathy/survey/symptoms/temporal                 lobes/the         NOTCH3
  gene/USA/White/white          matter/white      matter     hyperintensities/young/young
  adult/young adults
Oh, S.H., Lee, J.G., Na, S.J., Park, J.H., Choi, Y.C. and Kim, W.J. (2003), Prediction of
  early clinical severity and extent of neuronal damage in anterior-circulation
  infarction using the initial serum neuron-specific enolase level. Archives of
  Neurology, 60 (1), 37-41.
Abstract: Context: Prompt and precise measurement of neuronal damage in acute
  cerebral infarction is important to determine the prognosis of functional outcome. A
  feasible biochemical marker such as the neuron-specific enolase (NSE) level has
  been used to detect various diseases involving the central nervous system. Objective:
  To determine whether the initial serum NSE level is a useful marker for predicting
  the severity of clinical neurological deficits and the extent of neuronal damage in
  acute anterior-circulation infarction. Design: Case- control study with
  biochemical-clini-coradiological correlation. Setting: Tertiary cafe center.
  Participants: Eighty-one patients and 77 age- and sex matched control subjects. Main
  Outcome Measures: Patients with anterior- circulation infarction underwent
  intravenous serum NSE sampling within 24 hours after symptom onset. Recent
  infarction was confirmed by T2-weighted and diffusion-weighted magnetic
  resonance imaging of the brain about 1 week after the onset of stroke. Volumetric
  analysis of infarction was also performed. The National Institutes of Health Stroke
  Scale score was measured on admission to the hospital and I week after symptom
  onset. Results: The patients' initial serum NSE levels were statistically significantly
  higher than the controls (P<.05). The initial serum NSE level highly correlated with
  the volume of infarction seen on T2-weighted magnetic resonance imaging of the
  brain (r=0.62, P<.001) and with the National Institutes of Health Stroke Scale score
  obtained on hospital admission (r=0.42, P=.002) and on the seventh day after the
  onset of stroke (r=0.44, P<.001). Conclusion: The initial serum NSE level is a
  reliable pre- dictor for the extent of neuronal damage and the severity of clinical
  neurological deficits in acute anterior-circulation infarction
Keywords:         acute/acute       cerebral        infarction/ACUTE          ISCHEMIC
  STROKE/age/analysis/anterior                             circulation/ARCH/biochemical
  marker/BLOOD/BRAIN/central                   nervous            system/cerebral/cerebral
  ls/correlation/deficits/diffusion      weighted/diffusion-weighted/diffusion-weighted
  magnetic            resonance/diffusion-weighted            magnetic          resonance
  resonance/magnetic resonance imaging/marker/MARKERS/measurement/MIDDLE
  CEREBRAL-ARTERY/MRI/N-ACETYL-                            ASPARTATE/nervous/nervous
  system/neurological/neurological deficits/neuron specific enolase/neuron-specific
  enolase/neuronal/neuronal          damage/NSE/outcome/patients/prognosis/resonance
Rossetti, A.O., Ghika, J.A., Vingerhoets, F., Novy, J. and Bogousslavsky, J. (2003),
  Neurogenic pain and abnormal movements contralateral to an anterior parietal artery
  stroke. Archives of Neurology, 60 (7), 1004-1006.
Abstract: Background: Unlike delayed pain syndrome, acute central pain is a very rare
  symptom in acute stroke. In addition, the incidence of hemiballismus in acute
  cerebrovascular diseases is less than 1%. To our knowledge, the association of these
  2 clinical conditions has not been previously described. Patient and Methods: After
  observing one patient with hemiballismus accompanied by ipsilateral acute limb pain
  at stroke onset, we retrospectively examined more than 4000 patients in the Lausanne
  Stroke Registry for hemiballismus-hemichorea occurring together with acute
  ipsilateral pain. Results: Of the 29 subjects with hemiballismus-hemichorea, the
  observed patient was the only one to have acute pain at the onset of stroke. Magnetic
  resonance imaging showed acute infarction in the territory of the right anterior
  parietal artery, whereas the basal ganglia, thalamus, and subthalamic region were
  intact. Conclusions: The syndrome of acute limb pain associated with hemiballismus
  may result from disconnection of the parietal lobe from deeper structures. In contrast
  with isolated hemiballismus, we suggest that the simultaneous occurrence of this
  movement disorder with ipsilateral pain is specific for an anterior parietal artery
Keywords:            abnormal            movements/acute/acute            infarction/acute
  stroke/addition/ARCH/artery/association/basal                            ganglia/central
  e                          Stroke                         Registry/movement/movement
  lobe/patient/patients/REGISTRY/resonance            imaging/right/STATE/stroke/stroke
Russmann, H., Vingerhoets, F., Ghika, J., Maeder, P. and Bogousslavsky, J. (2003),
  Acute infarction limited to the lenticular nucleus - Clinical, etiologic, and
  topographic features. Archives of Neurology , 60 (3), 351-355.
Abstract: Background: Chronic diseases involving the putamen and globus pallidus
  induce parkinsonism and other movement disorders. Sensory and motor dysfunction
  from deep middle cerebral artery infarction is usually due to an involvement of the
  internal capsule. The clinical picture associated with isolated infarction of the
  lenticular nucleus is less well established. Objective: To analyze clinical features,
  topographic correlations, and cause of purely lenticular ischemic infarction. Patients
  and Methods: We reviewed 820 consecutive patients with deep hemispheral infarct
  included in the Lausanne Stroke Registry between 1986 and 1998 and selected those
  with isolated lenticular involvement on computed tomography or magnetic resonance
  imaging. Results: Thirteen patients had pure lenticular infarction. All had
  faciobrachiocrural hemisyndrome, while none showed acute or delayed parkinsonism
  or abnormal movement. Nine patients had a lesion restricted to the putamen. Two of
  them had ataxic motor hemisyndrome and 7 had sensorimotor hemisyndrome (with
  ataxia in 4, left hemineglect in 1, and deep pain in the arm and leg in 1). Four
  patients had a lesion of putamen. and globus pallidus externus. Three of them had
  motor hemisyndrome (with nonfluent aphasia in 2 and ataxia in 1) and 1 had ataxic
  sensorimotor hemisyndrome. All infarcts were in the territory of the medial
  perforating branches of the medial cerebral artery. Presumed cause of stroke was
  small-artery disease in 5, artery-to-artery embolism in 4, cardioembolism in 3 and
  undetermined in 1. Conclusions: Acute lenticular infarction induces mainly
  hemiparesis but no movement disorder. Associated sensory deficits, aphasia, and
  hemineglect underline clinically the function of the lenticular nucleus in connection
  with the prefrontal, temporal, and parietal cortices
Keywords:                 acute/APHASIA/ARCH/arm/ARTERIAL                           FLOW
  VELOCITY/artery/artery-to-artery                               embolism/ataxia/BASAL
  GANGLIA/BRAIN/cardioembolism/cause/cerebral/cerebral artery/cerebral artery
  infarction/CHICAGO/clinical/clinical           features/clinical       picture/computed
  on/infarcts/internal/internal            capsule/ischemic/Lausanne                Stroke
  Registry/left/leg/lenticular               nucleus/lesion/LESIONS/magnetic/magnetic
  resonance/magnetic        resonance     imaging/middle       cerebral/middle     cerebral
  artery/middle        cerebral       artery       infarction/motor/movement/movement
  disorder/movement                     disorders/MOVEMENT-DISORDERS/nonfluent
  aphasia/pain/parietal/parkinsonism/patients/PURE                             SENSORY
Urban, P.P., Marx, J., Hunsche, S., Gawehn, J., Vucurevic, G., Wicht, S., Massinger, C.,
  Stoeter, P. and Hopf, H.C. (2003), Cerebellar speech representation - Lesion
   topography in dysarthria as derived from cerebellar ischemia and functional
   magnetic resonance imaging. Archives of Neurology, 60 (7), 965-972.
Abstract: Background: Lesion topography and the pathophysiological background of
   dysarthria due to focal cerebellar lesions have not yet been fully clarified. Objectives:
   To investigate the lesion topography of dysarthria due to cerebellar ischemia and
   evaluate brainstem functions. Design: Case studies. Patients: Eighteen right-handed
   patients with sudden-onset dysarthria and cerebellar ischemia with and without
   brainstem involvement and 19 healthy, right-handed, monolingual, German-speaking
   volunteers. Methods: In patients, we used multimodal electrophysiologic techniques
   to investigate brainstem functions. Functional magnetic resonance imaging (MRI)
   was performed in the 19 healthy volunteers. Activation tasks consisted of repetitive
   vertical silent movements of the tongue and lips at a self-paced rhythm. Results:
   Cerebellar lesions and additional signs of brainstem involvement were observed in
   11 patients with posterior inferior cerebellar artery, anterior inferior cerebellar artery,
   and superior cerebellar artery infarctions, respectively. In all other patients with
   isolated cerebellar infarction (n = 7), only the superior cerebellar artery territory (6
   right-sided, I left-sided) was affected, and the common lesion site was the rostral
   paravermal region of the anterior lobe. Functional MRI in healthy volunteers
   indicated that the cerebellar representation of the tongue and orofacial muscles
   corresponds to that of the area involved in patients with cerebellar dysarthria.
   Conclusions: The results of this study demonstrate that articulatory movements of the
   tongue and orofacial muscles are involved in the activation of the rostral paravermal
   area of the anterior lobe. This location corresponds to the area involved in cerebellar
   ischemia in patients with dysarthria. Lesions in the upper paravermal area of the right
   cerebellar hemisphere, the site of coordination of articulatory movements of the
   tongue and orofacial muscles, may lead to the development of dysarthria that is
   unrelated to (often concomitant) brainstem infarctions
Keywords:                  activation/anterior              inferior               cerebellar
   artery/ARCH/ARTERY/brainstem/cerebellar                           infarction/CEREBRAL
   BLOOD-FLOW/CHICAGO/CLUMSY                                                          HAND
   LS/focal/functional/functional magnetic resonance/functional magnetic resonance
   STROKE/LATERAL                                                            MEDULLARY
   SYNDROME/lead/lesion/location/magnetic/magnetic resonance/magnetic resonance
   imaging/MOTOR                 CORTEX/movements/MRI/muscles/patients/POSITRON
   EMISSION                                                    TOMOGRAPHY/resonance
Vilensky, J.A. and Gilman, S. (2003), Using extirpations to understand the human
   motor cortex - Horsley, Foerster, and Bucy. Archives of Neurology, 60 (3), 446-451.
Abstract: During the last part of the 19th century and through the middle of the 20th
   century, surgeons sometimes extirpated parts of the human motor cortex to control
   abnormal involuntary movements. This procedure can be traced directly to Victor
   Horsley, who pioneered the first successful surgery of this type in 1886. Although
   many neurosurgeons followed Horsley's lead in performing this procedure, few used
   their results, as he did, to formulate concepts on the role of the motor cortex in
   movement control. Otfrid Foerster and Paul Bucy were the principal exceptions. We
   reviewed the surgical procedures these 3 notable neurosurgeons performed on the
  motor cortex and the hypotheses they subsequently developed on the functions of the
  motor cortex. We also evaluated these writings relative to contemporary views of
  motor cortex function
Keywords:        ARCH/CHICAGO/control/cortex/DISORDERS/function/human/human
  motor                                                          cortex/lead/motor/motor
Andrews, A.W. and Bohannon, R.W. (2003), Short-term recovery of limb muscle
  strength after acute stroke. Archives of Physical Medicine and Rehabilitation, 84 (1),
Abstract: Objectives: To document, by using norm-referenced strength measures, the
  recovery of limb muscle strength of patients undergoing stroke rehabilitation and to
  examine the relation between comorbidities and the recovery of strength after stroke.
  Design: Retrospective analysis of data from a consecutive convenience sample of
  patients examined clinically between 1994 and 1997, Setting: Acute inpatient
  rehabilitation unit. Participants: Fifty patients with stroke who were able to follow
  commands and were examined during acute rehabilitation by a single examiner
  (AWA). Interventions: Stroke rehabilitation emphasizing early movement, exercise
  with resistance, and daily functional activities. Main Outcome Measure: The strength
  at discharge of 7 muscle actions (shoulder abduction, elbow flexion, elbow extension,
  wrist extension, hip flexion, knee extension, ankle dorsiflexion) measured bilaterally
  with a hand-held dynamometer and compared with norm-referenced values. Results:
  Differences in strength between admission and discharge were significant for all
  muscle actions on the weaker side and for 4 of the 7 muscle actions on the stronger
  side. At discharge, the bilateral strength of all muscle actions was weaker than
  predicted by data from healthy individuals of comparable age, sex, and weight
  (F>17.000. P<.001). Strength did not differ between subjects who did and did not
  have a previous stroke or comorbidities. Conclusions: Subjects undergoing inpatient
  rehabilitation soon after stroke experienced an increase in limb muscle strength
  bilaterally. This increase was not influenced by previous stroke or comorbidities
Keywords:                acute/acute               stroke/age/analysis/ankle/ARCH/ARM
  rehabilitation/knee/movement/muscle/muscle strength/PA/patients/patients with
  stroke/recovery/recovery                                                             of
Azouvi, P., Olivier, S., de Montety, G., Samuel, C., Louis-Dreyfus, A. and Tesio, L.
  (2003), Behavioral assessment of unilateral neglect: Study of the psychometric
  properties of the Catherine Bergego Scale. Archives of Physical Medicine and
  Rehabilitation, 84 (1), 51-57.
Abstract: Objective: To assess the psychometric properties of a scale for spatial neglect
  in everyday life. Design: Validation study. Setting: A neurologic rehabilitation unit
  in a university hospital. Participants: Eighty-three consecutive right- hemisphere
  stroke patients. Interventions: Not applicable, Main Outcome Measures: The
  Catherine Bergego Scale (CBS) was used to assess neglect behavior and anosognosia.
  Its sensitivity was compared with that of 3 conventional tests. The inner structure of
  the scale was studied by principal component analysis. In addition, linearity,
  unidimensionality, and reliability of the scale were tested through Rasch analysis.
  Results: Behavioral assessment correlated significantly to, but was more sensitive
  than, conventional tests. Anosognosia correlated significantly with neglect severity,
  although individual dissociations occurred. Factorial analysis disclosed a single
  underlying factor, explaining 65.8% of total valiance. Rasch analysis also revealed
  that the 10 items defined a common, single ability continuum with widespread
  measurement range and quite regular item distribution, and showed a satisfactory
  reliability. Conclusion: Behavioral assessment proved to be more sensitive than
  conventional paper and pencil tasks. Both conventional statistics and Rasch analysis
  suggest that the CBS is reliable and valid, and that the 10 items define a
  homogeneous construct
Keywords:                                                                   ability/ACUTE
  logy/PA/patients/principal               component                 analysis/psychometric
  analysis/RECOVERY/rehabilitation/reliability/right/right                hemisphere/right
  hemisphere              stroke/sensitivity/spatial/spatial           behavior/SPATIAL
  NEGLECT/SQUARE/statistics/stroke/stroke                 patients/structure/tests/unilateral
Baer, G.D., Smith, M.T., Rowe, P.J. and Masterton, L. (2003), Establishing the
  reliability of mobility milestones as an outcome measure for stroke. Archives of
  Physical Medicine and Rehabilitation, 84 (7), 977-981.
Abstract: Objective: To establish intrarater, interrater, and test-retest reliability of a
  standardized measure of mobility, "mobility milestones," incorporating sitting
  balance, standing balance, and walking ability. Design: Repeated-measures reliability
  study by using video data of patients with stroke. Setting: Physiotherapy and
  rehabilitation departments in Scotland. Participants: Forty physiotherapists recruited
  from within the Lothian region: 20 senior physiotherapists with at least 3 years of
  experience working with neurologic patients and 20 staff grade physiotherapists with
  less than 12 months of experience working with neurologic patients. Intervention:
  Videotape comprising 40 clips (36 original clips. 4 repeated clips) of stroke patients
  of differing levels of ability attempting the mobility milestones was produced. After
  a short training session in the interpretation and application of the mobility
  milestones, each physiotherapist viewed the tape separately and scored whether the
  milestone had been achieved or not. This was repeated at a separate test session 2
  weeks later. Main Outcome Measure: Score for each mobility milestone. Results:
  Kappa statistics were used to determine interrater reliability and showed good
  (.61-80) to very good (.81-1.0) reliability for 3 of 4 milestones. Intraclass correlation
  coefficients (ICCs) were used to determine intrarater reliability of the 4 repeated
  clips and showed 75% of all subjects had high (ICC2.1=.91-1.0) reliability. The
  ICC2.1 for test-retest reliability showed a similar pattern, with 76% of subjects
  showing good (.81-90) or high (.91-1.0) reliability. Conclusions: The mobility
  milestones showed favorable levels of reliability when used by experienced or novice
  physiotherapists. The milestones can be adopted as a simple clinical outcome
  measure for use with stroke. Further research is required to establish reliability levels
  when the measure is used by different rehabilitation professionals
Keywords:         ability/ARCH/balance/cerebrovascular            accident/clinical/clinical
  RATER             RELIABILITY/LIFE/measure/mobility/neurologic/outcome/outcome
  assessment        (health     care)/outcome        measure/PA/patients/patients       with
  stroke/professionals/RANDOMIZED                                           CONTROLLED
  of                                                        results/research/SAMPLE-SIZE
  patients/training/UNIT TREATMENT/USA/use/walking/WEST/when
Bode, R.K., Lai, J.S., Cella, D. and Heinemann, A.W. (2003), Issues in the development
  of an item bank. Archives of Physical Medicine and Rehabilitation, 84 (4), S52-S60.
Abstract: Objective: To describe and illustrate 2 issues involved in the development of
  an item bank that can be used to improve measurement across settings and over time.
  Design: Secondary (psychometric) analysis of data collected on existing quality of
  life (QOL) instruments. Setting: Five cancer clinics in hospital settings in various
  parts of the United States; 523 solo or group practices in 3 major US cities; and an
  inpatient rehabilitation hospital in a large metropolitan area. Participants: Illustration
  1: 399 persons being treated for or having a history of cancer, 170 persons being
  treated for human immunodeficiency virus (HIV), 328 persons with stroke assessed
  during and after acute rehabilitation, and 433 persons being treated for multiple
  sclerosis. Illustration 2: 1714 persons with cancer and/or HIV participating in a
  large-scale multisite study, 3429 persons with prevalent treatable chronic health
  conditions, and 125 persons with stage IV metastatic breast cancer. Interventions:
  Not applicable. Main Outcomes Measures: QOL as measured by 10 different
  instruments. Results: The illustrations show that (1) core items, which functioned
  similarly across 4 diagnostic groups, can be identified and used to construct
  instruments measuring physical function that are tailored to each of these groups, and
  (2) items from 3 separate datasets can be linked to create a dataset that can serve as
  an initial pain item bank. Conclusion: The methodology exists to develop item banks
  to develop better measures of QOL
Keywords:                                             acute/analysis/ARCH/BLACK/breast
  cancer/CANCER/chronic/CO/development/diagnostic/FORM                             HEALTH
  SURVEY/function/health/history/HIV/hospital/human/human                 immunodeficiency
  virus/INDEPENDENCE/inpatient                      rehabilitation/measurement/MEDICAL
  OUTCOMES/methodology/multiple/multiple                                  sclerosis/OF-LIFE
  INSTRUMENT/OLDER/PA/PAIN/physical/physical                            function/PHYSICAL
  HEALTH/QUALITY/quality              of     life/rehabilitation/SQUARE/stroke/SURVEY
  SF-36/United States/US/USA/WEST
Brashear, A., Mcafee, A.L., Kuhn, E.R. and Ambrosius, W.T. (2003), Treatment with
  botulinum toxin type B for upper-limb spasticity. Archives of Physical Medicine and
  Rehabilitation, 84 (1), 103-107.
Abstract: Objective: To determine if botulinum toxin type B (Myo-Bloc) decreases
  spasticity. Design: Investigator-initiated trial, open-label, single-treatment session.
  Setting: Single site, Participants: Ten patients With stable upper-limb spasticity and
  an Ashworth Scale score of 2 or higher at the elbow, wrist, and fingers. Interventions:
  Total dose of 10,000U of botulinum toxin type B injected into 5 major muscles.
  Main Outcome Measures: The Ashworth Scale, goniometry, and functional
  assessments were performed at injection and weeks 4, 8, and 12. The principal
  investigator (PI) global assessment of change (GAC) and the patient GAC Were
  done at Weeks 4, 8, and 12 postinjection. The safety of the procedure was measured
  by adverse events and vital signs. Results: Improvements in Ashworth Scale scores
  were observed at weeks 4, 8, and 12 postinjection. At Week 4, the mean changes (in
  Ashworth score) were elbow. -1.0 (P=.016); wrist, -1.7 (P=.004) finger, -1.35
  (P=.02); at week 8: elbow, -.83 (P=.016); wrist, -1.00 (P=.016) finger, -.94 (P=.08);
  and at Week 12: elbow, -.61 (P=.07); wrist, - 1.00 (P=.016); and finger. -.89 (P=.10).
  The PI GAC improved at all visits. Nine of the 10 subjects reported dry mouth at
  week 4, with resolution by week 12. No changes were seen on the functional
  measures. Conclusions: Botulinum toxin type B may be useful in treatment of
Keywords:        adverse       events/ARCH/assessment/botulinum            toxin/botulinum
  treatment/trial/upper limb/upper limb spasticity/USA/week/WEST/wrist
Diamond, P.T., Gale, S.D. and Evans, B.A. (2003), Relationship of initial Hematocrit
  level to discharge destination and resource utilization after ischemic stroke: A pilot
  study. Archives of Physical Medicine and Rehabilitation, 84 (7), 964-967.
Abstract: Objective: To examine the association between initial hematocrit level at the
  time of ischemic stroke, discharge destination, and resource utilization. Design: Case
  series. Setting: University hospital. Participants: A total of 1012 consecutive patients
  with ischemic stroke admitted to a university health system between August 3, 1995,
  and June 24, 1999. Interventions: Not applicable. Main Outcome Measures: Length
  of stay, hospital cost, and discharge disposition. Results: Of 1012 patients presenting
  with ischemic stroke, 58% were discharged home, 10% were discharged home with
  home care services, 15% were discharged to a rehabilitation hospital, 11% were
  discharged to a skilled or intermediate care facility, and 6% died. After adjusting for
  age, sex, race, and comorbidities, a significant association (P=.009) existed between
  discharge outcome and initial hematocrit level. The probability of achieving an
  equivalent or less favorable outcome increased at both high and low hematocrit
  levels, with a minimum probability at a hematocrit level of approximately 45%.
  Conclusions: An association exists between hematocrit level at the time of ischemic
  stroke and discharge outcome. Midrange hematocrit levels appear to be associated
  with discharge to home rather than to an inpatient rehabilitation unit or to a nursing
  facility. Further study is indicated to examine the relationship among hematocrit
  level, stroke severity, and outcome
Keywords:                        age/ARCH/association/CO/comorbidities/cost/discharge
  destination/discharge      disposition/discharge      to     home/disposition/favorable
  outcome/FOCAL                  CEREBRAL-ISCHEMIA/health/hematocrit/home/home
  care/home care services/hospital/HYDROXYETHYL STARCH/HYPERVOLEMIC
  rehabilitation/intermediate/intermediate                         care/ischemic/ischemic
  stroke/ISOVOLEMIC                                 HEMODILUTION/MULTICENTER
  TRIAL/nursing/outcome/PA/patient discharge/patients/race/rehabilitation/resource
  utilization/sex/SQUARE/stroke/stroke                                   severity/treatment
Duncan, P.W., Bode, R.K., Lai, S.M. and Perera, S. (2003), Rasch analysis of a new
  stroke-specific outcome scale: The Stroke Impact Scale. Archives of Physical
  Medicine and Rehabilitation, 84 (7), 950-963.
Abstract: Objectives: To assess multiple psychometric characteristics of a new stroke
  outcome measure, the Stroke Impact Scale (SIS), using Rasch analysis, and to
  identify and remove misfitting items from the 8 domains that comprise the SIS.
  Design: Secondary analysis of 3-month outcomes for the Glycine Antagonist in
  Neuroprotection (GAIN) Americas randomized stroke trial. Setting: A multicenter
  randomized trial performed in 132 centers in the United States and Canada.
  Participants: A total of 696 individuals with stroke who were community-dwelling
  and independent prior to acute stroke. Interventions: Not applicable. Main Outcome
  Measures: Rasch analysis was performed using WINSTEPS, version 3.31, to
  evaluate 4 psychometric characteristics of the SIS: (1) unidimensionality or fit (the
  extent to which items measure a single construct), (2) targeting (the extent to which
  the items are of appropriate difficulty for the sample), (3) item difficulty (the
  ordering of items from least to most difficult to perform), and (4) separation (the
  extent to which the items distinguish distinct levels of functioning within the sample).
  Results: (1) Within each domain, most of the items measured a single construct. Only
  3 items misfit the constructs and were deleted ("add and subtract numbers," "get up
  from a chair," "feel emotionally connected") and 2 items ("handle money," "manage
  money") misfit the combined physical domain. These items were deleted to create
  SIS, version 3.0. (2) Overall, the items are well targeted to the sample. The physical
  and participation domains have a wide range of items that capture difficulties that
  most individuals with stroke experience in physical and role functions, while the
  memory, emotion, and communication domains include items that capture limitations
  in the most impaired patients. (3) The order of items from less to more difficult was
  clinically meaningful. (4) The individual physical domains differentiated at least 3
  (high, average, low) levels of functioning and the composite physical domain
  differentiated more than 4 levels of functioning. However, because difficulties with
  communication, memory, and emotion were not as frequently reported and
  difficulties with hand function were more frequently reported, these domains only
  differentiated 2 (high, low) to 3 (high, average, low) strata of patients. Time from
  stroke onset to administration of the SIS had little effect on item functioning.
  Conclusion: Rasch analysis further established the validity of the SIS. The domains
  are unidimensional, the items have an excellent range of difficulty, and the domain
  scores differentiated patients into multiple strata. The activities of daily
  living/instrumental activities of daily living, mobility, strength, composite physical,
  and participation domains have the most robust psychometric characteristics. The
  composite physical domain is most able to discriminate difficulty in function in
  individuals after stroke, while the communication, memory, and emotion domain
  items only capture limitations in function in the more impaired groups of patients
Keywords:            activities            of            daily          living/acute/acute
  INDEPENDENCE                                               MEASURE/GAIN/hand/hand
  onset/stroke     outcome/stroke       trial/targeting/treatment    outcome/trial/United
Eskes, G.A., Butler, B., McDonald, A., Harrison, E.R. and Phillips, S.J. (2003), Limb
  activation effects in hemispatial neglect. Archives of Physical Medicine and
  Rehabilitation, 84 (3), 323-328.
Abstract: Objective: To assess the efficacy of passive and active limb movement to
  improve visual scanning in patients with hemispatial neglect. Design: Before-after
  trial: behavioral analyses of a case series. Setting: Stroke rehabilitation unit in a
  tertiary care hospital. Participants: Nine individuals with right-hemisphere stroke
  (mean time poststroke, 19.5mo) and left-sided neglect, as assessed by the
  Sunnybrook Bedside Neglect Battery. Intervention: Active left limb movement
  (button push; n=3) or passive left limb movement (n=8) with functional electric
  stimulation (FES) administered during visual scanning testing. Main Outcome
  Measures: Performance on visual scanning tests involving naming of letters and
  numbers. Results: Both active and passive movement significantly improved target
  detection on the left side, but not on the right side, on the visual scanning task.
  Positive results were seen in 2 of 3 active movement patients and 6 of 8 passive
  movement patients. Conclusions: Both active and FES-stimulated passive
  movements are potential techniques for the treatment of hemispatial neglect
Keywords:               activation/ARCH/Canada/CO/detection/effects/efficacy/electric
  stimulation/FES/functional/functional                                           electric
  ments/neglect/neuropsychology/PA/passive                             movement/passive
  BRAIN-DAMAGE/right             hemisphere/right       hemisphere      stroke/SPATIAL
  REHABILITATION/techniques/testing/tests/treatment/trial/UNILATERAL LEFT
Fasoli, S.E., Krebs, H.I., Stein, J., Frontera, W.R. and Hogan, N. (2003), Effects of
  robotic therapy on motor impairment and recovery in chronic stroke. Archives of
  Physical Medicine and Rehabilitation, 84 (4), 477-482.
Abstract: Objective: To examine whether robotic therapy can reduce motor impairment
  and enhance, recovery of the hemiparetic ann in persons with chronic stroke. Design:
  Pre-posttest design. Setting: Rehabilitation hospital, outpatient care. Participants:
  Volunteer sample of 20 persons diagnosed with a single, unilateral stroke within the
  past 1 to 5 years, with persistent hemiparesis. Interventions: Robotic therapy was
  provided 3 times weekly for 6 weeks. Subjects able to reach robot targets were
  randomly assigned to sensorimotor or progressive-resistive robotic therapy groups.
  Robotic therapy consisted of goal-directed, planar reaching tasks to exercise the
  hemiparetic shoulder and elbow. Main Outcome Measures: The Modified Ashworth
  Scale, Fugl-Meyer test of upper-extremity function, Motor Status Scale (MSS) score,
  and Medical Research Council motor power score. Results: Evaluations by a single
  blinded therapist revealed statistically significant gains from admission to discharge
  (P<.05) on the Fugl-Meyer test, MSS score, and motor power score. Secondary
  analyses revealed group differences: the progressive-resistive therapy group
  experienced nonspecific improvements on wrist and hand MSS scores that were not
  observed in the sensorimotor group. Conclusions: Robotic therapy may complement
  other treatment approaches by reducing motor impairment in persons with moderate
  to severe chronic impairments
Keywords:        ACQUISITION/ARCH/cerebrovascular                accident/chronic/chronic
  DENCE/INDUCED               MOVEMENT              THERAPY/Modified           Ashworth
  very of function/rehabilitation/REHABILITATION/RELIABILITY/robot/robotic
  reatment/upper extremity/USA/WEST/wrist
Foxx-Orenstein, A., Kolakowsky-Hayner, S., Marwitz, J.H., Cifu, D.X., Dunbar, A.,
  Englander, J. and Francisco, G. (2003), Incidence, risk factors, and outcomes of fecal
  incontinence after acute brain injury: Findings form the traumatic brain injury model
  systems national database. Archives of Physical Medicine and Rehabilitation, 84 (2),
Abstract: Objective: To investigate the incidence, risk factors, and outcome in patients
  with fecal incontinence after acute brain injury. Design: A retrospective study of the
  incidence of and risk factors contributing to fecal incontinence, and outcomes at
  admission to and discharge from inpatient rehabilitation and at 1-year follow-up.
  Setting: Medical centers in the federally sponsored Traumatic Brain Injury Model
  Systems (TBIMS). Participants: A total of 1013 consecutively enrolled rehabilitation
  inpatients from 17 TBIMS centers who were admitted to acute care within 24 hours
  of traumatic brain injury and seen at 1-year postinjury between 1990 and 2000.
  Interventions: Not applicable. Main Outcome Measures: Incidence of fecal
  incontinence, length of coma, length of posttraumatic amnesia (PTA), admission
  Glasgow Coma Scale (GCS) score, length of stay (LOS), FIM(TM) instrument
  scores, disposition at discharge and follow-up, and incidences of pelvic fracture,
  frontal contusion, and urinary tract infection (UTI). Results: The incidence of fecal
  incontinence was 68% at admission to inpatient rehabilitation, 12.4% at
  rehabilitation discharge, and 5.2% at 1-year follow-up. Analysis of variance and chi-
  square analyses revealed statistically significant associations between the incidence
  of fecal incontinence at rehabilitation admission and admission GCS score, length of
  coma and PTA, LOS, and incidence of UTI and frontal contusion. Fecal incontinence
  at rehabilitation discharge was significantly associated with several variables,
  including age, discharge disposition, admission GCS score, length of coma, PTA,
  LOS, FIM scores, and incidence of pelvic fracture and frontal contusion. Significant
  associations were also found between fecal incontinence at 1- year follow-up and age,
  discharge and current 1-year disposition, admission GCS score, length of coma, LOS,
  FIM scores, and incidence of UTI (P<.05). Although logistic regression analyses
  were significant (P<.001), and predicted continence with 100% accuracy,
  demographics, injury characteristics, medical complications, and functional
  outcomes did not predict incontinence at discharge and at 1-year follow- up.
  Conclusions: Fecal incontinence is a significant problem after brain injury. Certain
  factors may increase its likelihood. Further studies evaluating mechanisms of fecal
  incontinence and treatment or control interventions would be useful
Keywords: accuracy/acute/acute care/age/amnesia/ARCH/brain/brain injuries/brain
  disposition/disposition/fecal                                  incontinence/FIM/follow
  up/follow-up/fracture/frontal/functional/functional       outcomes/Glasgow        Coma
  rehabilitation/inpatients/instrument/length                of              stay/logistic
  etrospective        study/risk/risk      factors/risk-factors/score/SQUARE/STROKE
  REHABILITATION/tract/traumatic/traumatic            brain     injury/treatment/treatment
  outcome/urinary/urinary tract infection/USA/VA/WEST
Hesse, S., Schulte-Tigges, G., Konrad, M., Bardeleben, A. and Werner, C. (2003),
  Robot-assisted arm trainer for the passive and active practice of bilateral forearm and
  wrist movements in hemiparetic subjects. Archives of Physical Medicine and
  Rehabilitation, 84 (6), 915-920.
Abstract: Objective To determine Whether use of a robotic arm trainer for bilateral
  exercise in daily repetitive training for a 3-week period reduced spasticity and
  improved motor control in the arm of severely affected, chronic hemiparetic subjects.
  Design: Before-after trial. Setting: Community rehabilitation center in Germany.
  Participants: Consecutive sample of 12 chronic hemiparetic patients; minimum
  stroke interval 6 months; patients could maximally protract the affected shoulder,
  hold the extended arm, or slightly flex and extend the elbow. Interventions:
  Additional daily therapy of 15 minutes with the arm trainer for 3 weeks; the 1 degree
  of freedom trainer enabled the bilateral passive and active practice of a forearm
  pronation and supination and wrist dorsiflexion and volarflexion; impedance control
  guaranteed a smooth movement. Main Outcome Measures : Patients' impressions, the
  Modified Ashworth Scale (MAS) score (range, 0-5) to assess spasticity, and the arm
  section of the Rivermead Motor Assessment (RMA) score (range, 0-15) to assess
  motor control were rated before therapy, after each 3-week interval, and at follow-up
  3 months later. Results: All patients had favorable impressions: the extremity felt
  more vivid, and 8 subjects noticed a reduction in spasticity, an ease of hand hygiene,
  and pain relief. The MAS score of the wrist and fingers joints decreased significantly
  (P<.0125) from a median of 3 (2-3) and 3 (3-4) to 2 (1-2) and 2.5 (2-3). The RMA
  score minimally increased in 5 cases without improvement in functional tasks. The
  median RMA score before therapy was 2.0 (1-2) and 10 (1-3.75) after therapy. There
  were no side effects. At follow-up, the effects had waned. Conclusions: The arm
  trainer made possible intensive bilateral elbow and wrist training of severely affected
  stroke patients. Future studies should address the treatment effect in subacute stroke
  patients and determine the optimum treatment intensity. (C) 2003 by the American
  Congress of Rehabilitation Medicine and the American Academy of Physical
  Medicine and Rehabilitation
  cise/extremity/fingers/follow                        up/follow-up/functional/functional
  control/IMPROVES/INDEPENDENCE/intensity/Modified                              Ashworth
  Scale/motor/motor control/movement/movements/orthotic devices/PA/pain/pain
  patients/STROKE           REHABILITATION/subacute            stroke/THERAPY/TOXIN
Hurvitz, E.A., Conti, G.E. and Brown, S.H. (2003), Changes in movement
  characteristics of the spastic upper extremity after botulinum toxin injection.
  Archives of Physical Medicine and Rehabilitation, 84 (3), 444-454.
Abstract: Objective: To examine the longitudinal effects of botulinum toxin injection on
  movement characteristics of the spastic upper extremity in children by using motor
  control testing (MCT) techniques and standard clinical measures. Design: Open-
  label clinical trial. Setting: Motor control laboratory at an academic medical center.
  Participants: A convenience sample of 9 subjects (5 boys, 4 girls; age range, 7-16y)
  with cerebral injury (stroke or cerebral palsy) and asymmetric upper- extremity
  function because of spasticity. Eight subjects had right-sided involvement.
  Interventions: Botulinum toxin injection to the involved upper extremity, involving
  elbow, wrist, and finger flexors, depending on clinical presentation. Main Outcome
  Measures: Clinical measures included range of motion (ROM), the Ashworth Scale,
  FIM(TM) instrument, Pediatric Evaluation of Disability Inventory, portions of the
  Bruininks- Oseretsky Test of Motor Proficiency, and the Purdue pegboard. MCT
  consisted of visually guided reaching, bilateral finger-to- nose movements, hand
  tapping, and isometric pinch force tasks. Kinematic assessments were made before
  and at 2, 4, 6, 12, 18, and 24 weeks after botulinum toxin injection. Results: All
  subjects had increased ROM and decreased Ashworth values throughout the testing
  period. In motor control tasks, improvement typically occurred earlier in the least
  complex movements, such as hand tapping, with 6 of 9 subjects showing a maximum,
  although transient, unilateral tapping speed by 6 weeks. A similar time course was
  observed for pinch force tasks. Improvement in more complex, forward-reaching
  tasks occurred much later (week 12 or later) or did not occur at all. As with the hand
  tasks, improved reach performance declined toward the end of the testing period. All
  subject showed minimal or no improvement in bilateral finger-to-nose movements.
  Neither maximum changes in ROM or Ashworth values correlated with
  improvements in functional elbow extension during sit and reach tasks, with 3
  subjects with normal active ROM showing late onset or no change in reach.
  Conclusions: Although botulinum toxin reduced tone and increased ROM of the
  spastic upper extremity, the time course and degree of motor improvement appears to
  depend on the complexity of the task. Future research should focus on the value of
  adjunct therapy, such as task-specific training, in addition to. botulinum toxin
  treatments to facilitate functional improvement of the spastic upper extremity
Keywords:                     A                   TOXIN/addition/age/ARCH/arm/ARM
  MOVEMENTS/bilateral/botulinum              toxin/cerebral/cerebral       injury/cerebral
  palsy/changes/children/clinical/clinical                              trial/CO/complex
  onal/GONIOMETRIC                             MEASUREMENTS/hand/HEMIPLEGIC
  TROLLED                TRIAL/presentation/PRIMARY                SOMATOSENSORY
  CORTEX/range/range                                                                    of
  TROKE PATIENTS/tapping/task-specific training/techniques/testing/therapy/time
  course/training/transient/trial/upper                         extremity/UPPER-LIMB
  SPASTICITY/USA/visually guided reaching/week/WEST/wrist
Iwata, M., Kondo, I., Sato, Y., Satoh, K., Soma, M. and Tsushima, E. (2003), An
  ankle-foot orthosis with inhibitor bar: Effect on hemiplegic gait. Archives of Physical
  Medicine and Rehabilitation, 84 (6), 924-927.
Abstract: Objective: To test whether an inhibitor bar attached to an ankle-foot orthosis
  (AFO) improves walking ability in hemiplegic stroke patients with tonic toe flexion
  reflex (TTFR). Design: Before-after trial. Setting: Rehabilitation hospital in Japan.
  Participants: Nine patients with TTFR were assigned to the TTFR group, and 8
  patients without TTFR were assigned to the control group. Intervention: Inhibitor bar
  attached to an AFO. Main Outcome Measure: Gait was analyzed by measuring the
  number of steps and the time required to walk 10m at a maximal walking speed.
  Results: In the TTFR group, use of an inhibitor bar for 2 weeks significantly
  increased the maximal walking speed, stride length, and cadence by 13.8% (P=.0045),
  8.0% (P=.0398), and 6.1% (P=.0056), respectively. There were no significant
  changes in the control group. Conclusion: An inhibitor bar improved walking ability
  of hemiplegic patients with TTFR, and its use with an AFO is recommended. (C)
  2003 by the American Congress of Rehabilitation Medicine and the American
  Academy of Physical Medicine and Rehabilitation
Keywords:                                         ability/ADULT/ARCH/cerebrovascular
  disorders/changes/CO/control/gait/hemiplegic/hemiplegic             patients/hemiplegic
  stroke/hospital/INDEPENDENCE/inhibitor/Japan/muscle spasticity/orthosis/orthotic
  RE/stroke/stroke patients/trial/USA/use/walking/walking speed/WEST
Kelly, P.J., Furie, K.L., Shafqat, S., Rallis, N., Chang, Y.C. and Stein, J. (2003),
  Functional recovery following rehabilitation after hemorrhagic and ischemic stroke.
  Archives of Physical Medicine and Rehabilitation, 84 (7), 968-972.
Abstract: Objectives: To quantify recovery after rehabilitation therapy and to identify
  factors that predicted functional outcome in survivors of intracerebral hemorrhage
  (ICH) compared with cerebral infarction. Design: Retrospective study of consecutive
  ICH and cerebral infarction admissions to a rehabilitation hospital over a 4-year
  period. Setting: Free-standing urban rehabilitation hospital. Participants: A total of
  1064 cases met the inclusion criteria (545 women, 519 men; 871 with cerebral
  infarction, 193 with ICH). Interventions: Not applicable. Main Outcome Measures:
  Functional status was measured using the FIM(TM) instrument, recorded at
  admission and discharge. Recovery was quantified by the change in FIM total score
  (DeltaFIM total score). Outcome measures were total discharge FIM score and
  DeltaFIM total score. Univariate and multivariate analyses were performed. Results:
  Total admission FIM score was higher in patients with cerebral infarction than in
  patients with ICH (59 vs 51, P=.0001). No difference in total discharge FIM score
  was present. Patients with ICH made a significantly greater recovery than those with
  cerebral infarction (DeltaFIM total score, 28 vs 23.3; P=.002). On multivariate
  analysis, younger age, longer length of stay, and admission FIM cognitive subscore
  independently predicted total discharge FIM and DeltaFIM total score. The severity
  of disability at admission, indicated by total admission FIM score, independently
  predicted total discharge FIM score, but not DeltaFIM total score. The ICH patients
  with the most severely disabling strokes had significantly greater recovery than
  cerebral infarction patients with stroke of similar severity. Conclusions: The patients
  with ICH had greater functional impairment than the cerebral infarction patients at
  admission, but made greater gains. Patients with the most severely disabling ICH
  improved more than those with cerebral infarction of comparable severity. Initial
  severity of disability, age, and duration of therapy best predicted functional outcome
  after rehabilitation
Keywords:            age/analysis/ARCH/cerebral/cerebral             hemorrhage/cerebral
  HEMORRHAGE/ischemic/ischemic              stroke/length     of    stay/men/multivariate
  analysis/outcome/PA/patients/patients                                              with
  ment outcome/USA/WEST/women
Kim, S.H., Pohl, P.S., Luchies, C.W., Stylianou, A.P. and Won, Y. (2003), Ipsilateral
  deficits of targeted movements after stroke. Archives of Physical Medicine and
  Rehabilitation, 84 (5), 719-724.
Abstract: Objective: To test the hypotheses that targeted movements of both the
  ipsilateral and the contralateral extremities of stroke survivors would be prolonged
  compared with those from a control group without stroke, and that the ipsilateral
  deficit would occur in movements toward small, but not large, targets. Design:
  Descriptive study. Setting: Motor performance laboratory. Participants: Convenience
  sample of right-handed individuals including 10 who were more than 6 months
  poststroke with Fugl-Meyer Motor Assessment scores greater than 75% for the upper
  (UEs) and lower (LEs) extremities, and a comparison group of 20 age-matched
  adults without stroke. Interventions: Not applicable. Main Outcome Measures: The
  average time required for the stylus, held with the hand or strapped to the foot, to
  travel from leaving I target to contacting the second target (ie, movement time) and
  the average time the stylus rested on the target (ie, dwell time). Results: Regardless
  of target size, movement and dwell times for both UEs of the stroke group were
  prolonged compared with those of the comparison group. Regardless of target size,
  dwell time for both LEs of the stroke group was prolonged compared with that of the
  comparison group. Conclusions: After stroke, the ipsilateral extremities may show
  subtle deficits in targeted movements
Keywords:              ACTIVATION/ADULTS/ARCH/ASYMMETRY/cerebrovascular
  ll/SQUARE/STRENGTH/stroke/stroke                                     survivors/UPPER
Kong, K.H. and Chuo, A.M. (2003), Incidence and outcome of orthostatic hypotension
  in stroke patients undergoing rehabilitation. Archives of Physical Medicine and
  Rehabilitation, 84 (4), 559-562.
Abstract: Objectives: To document the incidence and outcome of orthostatic
  hypotension in stroke patients undergoing rehabilitation and to determine clinical
  variables associated with it. Design: Cohort study. Setting: Inpatient setting of a
  tertiary rehabilitation center. Participants: Seventy-one stroke patients (41 men, 30
  women; mean age, 58.4+/-10.7 y) with a first clinical stroke, admitted for
  rehabilitation within 4 weeks of the stroke. Interventions: Not applicable. Main
  Outcome Measures: Patients' blood pressure was measured in supine position and on
  tilting at 90degrees within 3 days of admission. Orthostatic hypotension was defined
  as a drop in systolic blood pressure (SBP) of 20mmHg or more. Results: Orthostatic
  hypotension was present in 37 (52.1%) patients, of whom 13 had severe hypotension
  (standing SBP, less than or equal to 100mmHg). Twelve (32.4%) patients with
  orthostatic hypotension were positive for hypotensive symptoms and signs, with 2
  patients experiencing near syncope. Orthostatic hypotension was significantly
  associated with older patients, a lower admission functional status (as measured on
  the Modified Barthel Index), and more severe hemiparesis. It was, however, not
  related with the site of stroke or the use of antihypertensives. On discharge,
  orthostatic hypotension had resolved in 23 patients. The presence of orthostatic
  hypotension did not influence functional outcome or the length of stay in
  rehabilitation. Conclusion: Orthostatic hypotension was common in stroke patients
  undergoing inpatient rehabilitation. It should be suspected in older patients who have
  more severe hemiparesis and a lower functional status
Keywords:         age/antihypertensives/ARCH/Barthel/Barthel           Index/blood/blood
  rehabilitation/length           of         stay/lower/men/older/orthostatic/orthostatic
  patients/supine/supine position/symptoms/syncope/systolic/systolic blood/systolic
  blood pressure/USA/use/VARIABILITY/WEST/women
Lannin, N.A., Horsley, S.A., Herbert, R., McCuskey, A. and Cusiek, A. (2003),
  Splinting the hand in the functional position after brain impairment: A randomized,
  controlled trial. Archives of Physical Medicine and Rehabilitation, 84 (2), 297-302.
Abstract: Objective: To evaluate the effects of 4 weeks of hand splinting on the length
  of finger and wrist flexor muscles, hand function, and pain in people with acquired
  brain impairment. Design: Randomized, assessor-blinded trial. Setting:
  Rehabilitation center in Australia. Participants: Twenty-eight adults with acquired
  brain impairment, all within 6 months of the first injury. There was 1 withdrawal.
  Interventions: Subjects in both experimental (n=17) and control (n=11) groups
  participated in routine therapy-motor training for upper-limb use and upper-limb
  stretches-5 days a week. The experimental group also wore an immobilizing hand
  splint in the functional position (10degrees-30degrees wrist extension) for a
  maximum of 12 hours each night for the duration of the 4-week intervention period.
  Main Outcome Measures: The length of the wrist and extrinsic finger flexor muscles
  was evaluated by measuring the torque-controlled range of wrist extension with the
  fingers extended. Functional hand use was evaluated with the Motor Assessment
  Scale. Pain was evaluated with a visual analog scale. Results: The effects of splinting
  were statistically nonsignificant and clinically unimportant. At follow-up, estimates
  of treatment effects slightly favored the control group: range of motion at the wrist
  favored controls by 2 (95% confidence interval [CI], -7.2degrees to 3.2degrees),
  function favored controls by 0.2 points (95% CI, -2.7 to 2.3), and pain favored the
  experimental group by 1 cm (95% CI, -4.6 to 2.2). Conclusions: An overnight
  splint-wearing regimen with the affected hand in the functional position does not
  produce clinically beneficial effects in adults with acquired brain impairment
Keywords:                                               adults/ARCH/Australia/beneficial
  up/follow-up/function/functional/hand/hand        function/hemiplegia/IMMOBILIZED
  cles/occupational therapy/PA/PAIN/period/position/randomized/range/range of
  KE/training/treatment/treatment                                       effects/trial/upper
  limb/USA/use/VALIDITY/visual/visual analog scale/week/WEST/withdrawal/wrist
Lebiedowska, M.K. and Fisk, J.R. (2003), Quantitative evaluation of reflex and
  voluntary activity in children with spasticity. Archives of Physical Medicine and
  Rehabilitation, 84 (6), 828-837.
Abstract: Objective: To determine whether increased reflexes are related to functional
   impairment in children with spasticity. Design: Descriptive measurement study.
   Setting: Rehabilitation department in Poland. Participants: Sixteen able-bodied
   children and 29 children with spasticity. Interventions: Not applicable. Main
   Outcome Measures: Measurement of modulation function of knee tendon reflexes by
   isometric knee extension, maximum isometric knee flexion, and extension torques,
   and scoring of ambulation in patients. Results: In able-bodied children, the reflex
   modulation function increased with voluntary knee extension, reached maximum at
   5% to 20% of voluntary extension, and then decreased. The reflex modulation
   function in patients fell into 2 major categories. In the majority of affected limbs, the
   modulation function was inverse, with maximum reflex response at relaxation, and
   decreased with an increase of voluntary extension. In the remaining limbs, the shape
   of the reflex modulation function was normal, although other parameters changed.
   Isometric torques decreased more in flexion (65%) than in extension (39%). A torque
   decrease was a result of cocontraction more often during knee flexion (65%) than in
   knee extension (24%). The larger the reflexes, the more flexion torque decreased and
   ambulation deteriorated. This pattern occurred in patients with inverse modulation
   function but not in those with normal modulation function. The reciprocal inhibition
   from knee flexors to extensors could be affected in patients with inverse modulation
   function and cocontraction during flexion, whereas other mechanisms occurred in
   other patients. Conclusions: The experimental design has potential as a quantitative
   measure of abnormal control in children with spasticity and can lead to more precise
   treatment selection criteria. (C) 2003 by the American Congress of Rehabilitation
   Medicine and the American Academy of Physical Medicine and Rehabilitation
   d                               children/ELBOW                                 FLEXOR
   spasticity/normal/PA/patients/Poland/quantitative/RECIPROCAL                           IA
   INHIBITION/reciprocal                                         inhibition/RECURRENT
   ORD/SQUARE/STROKE/TENDON                                                           JERK
Lin, C.C., Ju, M.S. and Lin, C.W. (2003), The pendulum test for evaluating spasticity of
   the elbow joint. Archives of Physical Medicine and Rehabilitation, 84 (1), 69-74.
Abstract: Objective: To develop a modification of the pendulum test to allow evaluation
   of elbow spasticity. Design: The main difficulties of directly applying the
   conventional pendulum test to the elbow were the small inertia of the forearm and
   the uncomfortable posture, We designed an experimental apparatus similar to a clock
   pendulum and developed an elbow biomechanic model to measure objectively
   spasticity of the elbow joint. The model consisted of linear stiffness and damping and
   gravity contribution. Setting: A referral medical center in Taiwan. Participants:
   Eleven stable stroke patients and 11 able-bodied subjects. Interventions: A
   custom-designed accessory apparatus to facilitate the pendulum test in elbow joints.
   Main Outcome Measures: By using an optimization technique, we estimated
   parameters of the proposed elbow biomechanic model as the candidate indicators of
   spasticity. Results: The stiffness constant remained relatively consistent in all groups.
   Both the damping coefficient and damping ratio increased in the affected side of
  stroke patients and tended to increase with the severity of spasticity. Damping ratio
  had marginally better differentiation capability than the damping coefficient.
  Conclusions: The damping ratio derived from the proposed model differentiated
  spasticity from normotonus and increased as spasticity increased
May, L.A., Butt, C., Minor, L., Kolbinson, K. and Tulloch, K. (2003), Measurement
  reliability of functional tasks for persons who self-propel a manual wheelchair.
  Archives of Physical Medicine and Rehabilitation, 84 (4), 578-583.
Abstract: Objective: To evaluate the reliability of 4 functional tasks relevant to
  wheelchair seating. Design: Within-subject and between-rater comparisons. Setting:
  Rehabilitation center in Canada. Participants: Two separate convenience samples of
  10 male wheelchair users. Interventions: Not applicable. Main Outcome Measures:
  The 4 functional tasks were timed forward wheeling, ramp ascent, forward vertical
  reach distance, and ramp descent, scored by an ordinal performance scale. To
  determine test-retest reliability, the participants performed each task twice on the
  same day. To determine inter-rater reliability, 5 experienced therapists independently
  scored each participant. The ramp descent task was replaced with a 1-stroke push
  distance task due to difficulties with the interpretation of the ordinal performance
  scale. Results: Testing of all tasks was completed within 45 minutes, allowing for
  rest periods. There were no adverse incidents. One individual with C6 quadriplegia 4
  months after spinal cord injury was unable to complete the ramp ascent. Estimates
  for test-retest reliability of all 4 functional tasks were excellent (r=.99). Interrater
  reliability was calculated for all tasks except the 1-stroke push and found to be
  excellent (intraclass correlation coefficient =.99). Conclusions: The final 4 functional
  tasks are practical, safe, and reliable tests that may be used for clinical evaluation of
  wheelchair seating. Further research involving comparative assessments of
  wheelchair seating options is required to determine the discriminative ability of the
Keywords:                                            ability/ARCH/Canada/clinical/clinical
  tasks/INDEPENDENCE/injury/inter-rater/male/manual/outcome assessment (health
  care)/PA/PERFORMANCE/POSTURE/rehabilitation/reliability/reproducibility of
  results/research/spinal/spinal        cord/spinal       cord     injury/SPINAL-CORD
Mazer, B.L., Sofer, S., Korner-Bitensky, N., Gelinas, I., Hanley, J. and
  Wood-Dauphinee, S. (2003), Effectiveness of a visual attention retraining program
  on the driving performance of clients with stroke. Archives of Physical Medicine and
  Rehabilitation, 84 (4), 541-550.
Abstract: Objective: To compare the effectiveness of a visual attention retraining
  program using the Useful Field of View (UFOV) with a traditional visuoperception
  treatment program on the driving performance of clients with stroke. Design:
  Randomized controlled trial. Setting: Rehabilitation hospital located in Quebec,
  Canada. Participants: Ninety-seven individuals referred for driving evaluation after a
  stroke. Interventions: Participants were randomized to receive 20 sessions of either
  UFOV training of visual processing speed, divided attention, and selective attention
  or traditional computerized visuoperception retraining. Main Outcome Measures:
  Subjects were evaluated with an on-road driving evaluation, visuoperception tests,
  and the Test of Everyday Attention. An occupational therapist unaware of group
  assignment conducted all evaluations. Results: Eighty-four participants completed
  the outcome evaluation. There were no significant differences between groups on
  any of the outcome measures. There was, however, almost a 2-fold increase (52.4%
  vs 28.6%) in the rate of success on the on-road driving evaluation after UFOV
  training for subjects with right-sided lesions. Conclusions: Rehabilitation that targets
  visual attention skills was not significantly more beneficial than traditional
  perceptual training in improving the outcome of an on-road driving evaluation.
  However, results suggest a potential improvement for subjects with right-sided
  lesions, indicating that training must target specific skills
Keywords: ACCIDENTS/ARCH/attention/automobile driving/Canada/cerebrovascular
  disorders/CO/computerized/controlled                      trial/DRIVERS/driving/driving
  onal/OLDER               ADULTS/outcome/outcome                  measures/PA/perceptual
  training/performance/QUESTIONNAIRE/randomized/Randomized                      controlled
  L FIELD/VISION/visual/visual attention/WEST
McElligott, J.M., Greenwald, B.D. and Watanabe, T.K. (2003), Congenital and acquired
  brain injury. 4. New frontiers: Neuroimaging, neuroprotective agents,
  cognitive-enhancing agents, new technology, and complementary medicine. Archives
  of Physical Medicine and Rehabilitation, 84 (3), S18-S22.
Abstract: This self-directed learning module explores the clinical application of new and
  evolving research frontiers in the field of neuroimaging, neuroprotective agents, and
  cognition- enhancing medications as applied to patients with brain injury. The
  current and potential clinical applications of robotic technology, virtual reality, and
  telemedicine in the field of physical medicine and rehabilitation is explored. The
  evidence to support a growing interest in and application of complementary medicine
  techniques in brain injury and other disorders is reviewed. Overall Article Objectives:
  (a) To explore the current research and potential clinical applications of medical and
  technologic advances in neuroprotective agents, cognition-enhancing agents,
  neuroimaging, virtual reality, robotics, and telemedicine as applicable to brain injury
  and (b) to identify the evidence to support an expanding use of complementary
  medicine in brain injury
Keywords:         acquired        brain      injury/ARCH/brain/brain         injuries/brain
  NE/USA/use/virtual reality/VIRTUAL-REALITY/WEST
Musicco, M., Emberti, L., Nappi, G. and Caltagirone, C. (2003), Early and long-term
  outcome of rehabilitation in stroke patients: The role of patient characteristics, time
  of initiation, and duration of interventions. Archives of Physical Medicine and
  Rehabilitation, 84 (4), 551-558.
Abstract: Objective: To determine whether and how patient characteristics and the time
  of initiation and duration of rehabilitation influence early and long-term patient
   outcome after cerebrovascular accident. Design: A cohort study. Setting: Twenty
   rehabilitation hospitals and wards located throughout Italy. Participants: A total of
   1716 stroke patients (874 men, 842 women) consecutively admitted to Italian
   hospital rehabilitation centers in 1997 and 1998. Patients had moderate to severe
   disability (FIM(TM) instrument score, less than or equal to90). Interventions: Not
   applicable. Main Outcome Measures: Three negative patient outcomes were
   considered: death, early failure (premature, unwanted interruption of rehabilitation
   program; absence of any improvement at hospital discharge), and late failure in terms
   of severe disability (Barthel Index score, <40) or poor quality of life (Medical
   Outcomes Study 36-Item Short-Form Health Survey; questionnaire score, <80) 6
   months after admission. The strength of the association between the considered
   variables and the outcomes was calculated with the odds ratio (OR). Results: The
   less disabled and younger patients had better survival and early and long-term
   outcomes. The presence of dementia and pressure ulcers on admission was
   associated with worse outcomes (OR for any failure or death=1.31; 95% confidence
   interval [CI], 1.03- 1.67; OR= 1.63; 95% Cl, 1.12-2.37, respectively). Patients who
   initiated the rehabilitative procedures early (within 7d after stroke) had better
   long-term outcomes than did those who initiated the rehabilitation after more than 1
   month (OR=2.12; 95% Cl, 1.35-3.34) or from 15 to 30 days after the acute
   cerebrovascular event (OR=2.11; 95% Cl, 1.37-3.26). Conclusions: This study's
   results support the idea that recovery after stroke is greatly influenced by the clinical
   and demographic characteristics of the patients and that early rehabilitation
   intervention may have a relevant role
Keywords:                                         acute/ARCH/association/Barthel/Barthel
   Index/CARE/cerebrovascular/cerebrovascular                      accident/cerebrovascular
   event/clinical/CO/cohort/cohort                study/death/dementia/disability/disabled
   tervention/Italy/long-term             outcome/long-term             outcomes/men/odds
   ratio/outcome/outcomes/PA/patient/patients/pressure/pressure ulcers/quality/quality
   of life/questionnaire/recovery/recovery after stroke/rehabilitation/rehabilitation
Otiniano, M.E., Du, X.L.L., Ottenbacher, K. and Markides, K.S. (2003), The effect of
   diabetes combined with stroke on disability, self-rated health, and mortality in older
   Mexican Americans: Results from the Hispanic EPESE. Archives of Physical
   Medicine and Rehabilitation, 84 (5), 725-730.
Abstract: Objective: To examine how diabetes in combination with stroke affects
   functional activities of daily living (ADLs) and instrumental activities of daily living
   (IADLs), self-rated health, and 5-year mortality in elderly Mexican Americans with
   or without other comorbid conditions. Design: Longitudinal study. Setting: Five
   southwestern states. Participants: A total of 3050 subjects of age 65 years or older, of
   whom 23% had diabetes and 6% had a stroke. Interventions: Not applicable. Main
   Outcome Measures: ADL and IADL disabilities, self-rated health, and 5-year
   mortality. Results: Subjects with both diabetes and stroke but without other comorbid
   conditions had almost 18 times higher risk of having any ADL disability (odds ratio
   [OR] = 18.8; 95 % confidence interval [CI], 3.3-105.2) and 10 times higher risk of
   having any IADL disability (OR = 10.6; 95% CI, 1.1-101.5), compared with subjects
   without either of the 2 conditions. The risk of disability was further increased if the
   subject had a comorbid condition (hypertension, heart attack, cancer, hip fracture,
   arthritis). The risk of fair or poor self-rated health was 3.5 (95% CI, 1.4-8.6) and the
   hazard ratio for 5-year mortality was 2.4 (95% CI, 1.7-3.4) in people with both
   diseases. Conclusions: Diabetes and stroke in combination is strongly associated with
   a higher risk of disabilities, poor self-rated health, and 5- year mortality in elderly
   Mexican Americans. The effect on outcomes appears to follow an additive model.
   Information on disability risk and morbidity and mortality should be useful to
   rehabilitation professionals in discharge planning and allocation of therapy resources
Keywords:                          activities                   of                    daily
   al activities of daily living/Mexican/Mexican Americans/model/morbidity/morbidity
   and                mortality/mortality/NORTHERN                    MANHATTAN/odds
Shah, M.K. and Black-Schaffer, R.M. (2003), Upper-extremity deep vein thrombosis
   and paralysis: A case report. Archives of Physical Medicine and Rehabilitation, 84
   (3), 458-459.
Abstract: Upper-extremity deep venous thrombosis (DVT) has been understudied in the
   rehabilitation population. Patients undergoing rehabilitation often have many risk
   factors that predispose them to DVT. It is important to recognize upper- extremity
   DVT, because recent studies have shown it to pose a significant risk for pulmonary
   embolus and death. This is the first reported association of an upper-extremity DVT
   with paralysis
Keywords: ADMISSION/ARCH/arm/arteriovenous malformations/association/BRAIN
   INJURY/case report/cerebral hemorrhage/cerebrovascular accident/CO/death/deep
   extremity/USA/vein/VENOUS THROMBOSIS/venous thrombosis/WEST
Stevens, J.A. and Stoykov, M.E.P. (2003), Using motor imagery in the rehabilitation of
   hemiparesis. Archives of Physical Medicine and Rehabilitation, 84 (7), 1090-1092.
Abstract: Objective: To examine the effectiveness of using motor imagery training in
   the rehabilitation of hemiparesis. Design: A before-after trial with clinical and
   behavioral analyses of single cases. Setting: Academic-affiliated rehabilitation
   hospital. Participants: Two survivors of embolic middle cerebral artery stroke that
   resulted in chronic hemiparesis. Intervention: A motor imagery training program
   consisting of imagined wrist movements (extension, pronation-supination) and
   mental simulations of reaching and object manipulation making use of a mirror box
   apparatus. Twelve 1-hour experimental sessions were delivered, 3 times a week for 4
   consecutive weeks. Main Outcome Measures: Two clinical assessments, grip
   strength, 4 wrist functionality measurements, and 3 timed performance tests. All
   outcome measures were recorded before training began, at 3 times during the
   intervention month, with 2 additional long-term measurements. Results: Performance
   of the paretic limb improved after the imagery intervention, indicated by increases in
   assessment scores and functionality and decreases in movement times. The
   improvements over baseline performance remained stable over a 3-month period.
   Conclusions: These results demonstrate the potential for using motor imagery as a
   cognitive strategy for functional recovery from hemiparesis. The intervention targets
   the cognitive level of action processing while its effects may be realized in overt
   behavioral performance
Keywords:                                action/ARCH/artery/assessment/cerebral/cerebral
   tional/functional     recovery/hemiparesis/hospital/imagery/IMAGINED             HAND
   cerebral/middle cerebral artery/middle cerebral artery stroke/mirror/motor/motor
   imagery/movement/movements/object                      manipulation/outcome/outcome
Stineman, M.G., Ross, R., Maislin, G., Fiedler, R.C. and Granger, C.V. (2003), Risks of
   acute hospital transfer and mortality during stroke rehabilitation. Archives of
   Physical Medicine and Rehabilitation , 84 (5), 712-718.
Abstract: Objective: To identify demographic, medical, and functional factors
   associated with transfer of stroke patients to acute hospital services and/or mortality
   during stroke rehabilitation. Design: Two case-control studies in which logistic
   regression was used to control for clinical traits associated with differences in
   likelihood. Setting: A total of 542 US inpatient and rehabilitation units. Participants:
   A total of 64,471 patients discharged during 1995. Interventions: Not applicable.
   Main Outcome Measures: Transfer to an acute hospital service and death. Results:
   There were 5847 (9.1%) acute hospital transfers and 320 (0.5%) deaths. Greater
   disability at admission was associated with higher odds of both acute hospitalization
   and mortality. Cardiopulmonary arrest, chest pain, gastrointestinal problems,
   bleeding disorders, hypercoagulable states, and acute renal difficulties increased the
   relative odds of acute hospitalization from 3.1 (95% confidence interval [CI], 2.3-4.2)
   to 12.7 (95% Cl, 9.2-17.6). The likelihood of mortality for patients 85 years of age or
   older was more than 2-fold (2.5; 95% Cl, 1.7-3.6) that of patients 65 years of age or
   younger for blacks, it was nearly 2-fold (1.7; 95% Cl, 1.3-2.3) compared with whites,
   after adjusting for clinical differences. Conclusion: Higher likelihoods of mortality
   among older patients versus younger, black patients versus white, and patients with
   more rather than less disability at admission suggest the need for greater vigilance in
   monitoring medical status
Keywords: acute/age/ARCH/BLACKS/bleeding/case control/case-control/case-control
   studies/cerebrovascular disorders/chest pain/clinical/CO/continuity of patient
   ONAL                                                                INDEPENDENCE
   NFARCTION/logistic                                      regression/medical/MEDICAL
   TES/regression/rehabilitation/renal/risk         factors/SQUARE/status/stroke/stroke
   patients/stroke rehabilitation/SYSTEM/transfers/US/USA/WEST/whites
Treger, I., Froom, P., Ring, H. and Friedman, G. (2003), Association between
   apollipoprotein E4 and rehabilitation outcome in hospitalized ischemic stroke
   patients. Archives of Physical Medicine and Rehabilitation, 84 (7), 973-976.
Abstract: Objective: To determine the value of apolipoprotein E4 (APOE*E4) allele in
  predicting discharge impairment and disability in ischemic stroke patients after acute
  rehabilitation. Design: Prospective study comparing results of rehabilitation in
  patients with different APOE genotypes. Setting: Acute neurologic rehabilitation
  department in Israel. Participants: One hundred one consecutive patients 75 years old
  or less with a first ischemic stroke. Interventions: Not applicable. Main Outcome
  Measure: Impairment, as measured by the National Institutes of Health Stroke Scale
  (NIHSS), and disability, as assessed with the FIM(TM) instrument. Results: On
  admission, there was no significant difference in the FIM or NIHSS measurements
  between the apo E4 group and other patients, but the prevalence of aphasia was 2.07
  times more frequent in those with the APOE*E4 genotype (95% confidence interval,
  0.98- 4.4). A logistic regression model demonstrated that score measurements on
  admission were highly predictive of the NIHSS score at discharge (receiver operator
  curve=96.1%), whereas the presence of the APOE*E4 genotype did not add
  significantly to the model in predicting poorer rehabilitation treatment outcome as
  measured by the FIM or the NIHSS. Conclusions: The presence of the apo E4 allele
  did not predict a poorer outcome of rehabilitation treatment after ischemic stroke, but
  it was associated with an increased prevalence of aphasia. Further studies are
  warranted to confirm this association
  T-DISEASE/disability/E                                                   ALLELES/E
  BRAL HEMORRHAGE/ischemic/ischemic stroke/logistic regression/logistic
  regression                                            model/model/neurologic/NIHSS
  model/rehabilitation/rehabilitation                             outcome/results/RISK
  FACTOR/score/SQUARE/stroke/stroke                         patients/treatment/treatment
Wang, Y., Lim, L.L.Y., Heller, R.F., Fisher, J. and Levi, C.R. (2003), A prediction
  model of 1-year mortality for acute ischemic stroke patients. Archives of Physical
  Medicine and Rehabilitation, 84 (7), 1006-1011.
Abstract: Objective: To develop a prediction model for 1-year mortality in patients with
  acute ischemic stroke, with the model to be at least as useful and accurate as other
  previously developed prediction models. Design: Retrospective cohort study. Setting:
  Neurology department at an Australian tertiary teaching hospital. Participants: Four
  hundred forty consecutive patients diagnosed with acute ischemic stroke between
  July 1, 1995, and June 30, 1997. Interventions: Two hundred twenty-three (51%)
  patients were randomly assigned to the derivation sample to develop a prediction
  model using the Cox proportional hazards model. The model was then validated in a
  validation sample of 217 (49%) patients. Main Outcome Measure: One-year
  mortality. Results: Eight clinical predictors were included in the final model:
  unconsciousness (3 points), dysphagia (7 points), urinary incontinence (9 points),
  both sides affected (4 points), hyperthermia (4 points), ischemic heart disease (3
  points), peripheral vascular disease (3 points), and diabetes mellitus (2 points).
  Patients with scores of 10 or higher were allocated to the high-risk group, which had
  a 1-year mortality rate of 76%, compared with a 1-year mortality rate of 8% in the
  low-risk group. There was no statistically significant difference in terms of
  sensitivity, specificity, and positive predictive value in the validation sample.
  Conclusion: We developed a predictive model for 1-year mortality in acute ischemic
  stroke patients. The model is easy to use and is comparable in its accuracy with other
  predictive models
Keywords:             accuracy/acute/acute             ischemic/acute             ischemic
  study/Cox             proportional            hazards           model/diabetes/diabetes
  mic        heart       disease/ischemic        stroke/model/models/mortality/mortality
  heral      vascular     disease/positive      predictive     value/prediction/prediction
  model/predictive/predictive           value/predictors/PREVALENCE/PROGNOSTIC
  SCORE/projections                                                                    and
  RE/stroke/stroke                          patients/SURVIVAL/teaching/urinary/urinary
  incontinence/USA/use/validation/validation            of       results/vascular/vascular
Wee, J.Y., Wong, H. and Palepu, A. (2003), Validation of the Berg Balance Scale as a
  predictor of length of stay and discharge destination in stroke rehabilitation. Archives
  of Physical Medicine and Rehabilitation, 84 (5), 731-735.
Abstract: Objective: To validate the utility of the Berg Balance Scale (BBS) in
  predicting length of stay (LOS) and discharge destination for patients admitted to a
  stroke rehabilitation unit. Design: Prospective study. Setting: Provincial tertiary
  inpatient stroke unit for a primarily geriatric population. Participants: A total of 313
  of the 325 patients admitted consecutively between April 1998 and August 2000.
  Interventions: Not applicable. Main Outcome Measures: LOS and discharge
  destination. Results: Admission BBS scores correlated negatively with LOS (r=-.53,
  controlling for age). Logistic regression confirmed that the following were
  independent predictors of being discharged home rather than to an institution
  (adjusted odds ratio, 95% confidence interval): admission BBS (1.09, 1.06-1.12) and
  the presence of family supports (15.0, 7.2-31.3). These results generally concur with
  previously published results, obtained at a different stroke rehabilitation setting.
  Conclusions: This study validates the use of the BBS scores in assisting to estimate
  approximate LOS and eventual discharge destination. Age did not correlate
  significantly with the outcomes measured in this study, which was conducted in a
  geriatric population
Keywords:          age/ARCH/Berg            Balance         Scale/Canada/cerebrovascular
  destination/equilibrium/family/geriatric/home/INDEPENDENCE/length of stay/odds
  ratio/outcomes/outcomes                research/PA/patients/population/POSTSTROKE
  sults/SQUARE/stroke/stroke rehabilitation/stroke unit/USA/use/utility/WEST
Yelnik, A.P., Colle, F.M., Bonan, I.V. and Lamotte, D.R. (2003), Disabling
  Overactivity of the extensor hallucis longus after stroke: Clinical expression and
  efficacy of botulinum toxin type A. Archives of Physical Medicine and
  Rehabilitation, 84 (1), 147-149.
Abstract: Objectives: To describe the clinical characteristics of persistent extension of
  the great toe related to overactivity of the extensor hallucis longus (EHL) after a
    stroke and to explore the efficacy of treatment with botulinum toxin type A. Design:
    Case series. Setting: A physical medicine and rehabilitation department in France.
    Participants: Eleven patients with hemiplegia disabled by overactivity of the EHL
    were classified according to the different ways in which that overactivity was
    triggered. Disability was related to pain in 5 patients. to shoe difficulties in 10
    patients, and to varus foot in 6 patients. Intervention: Injection of botulinum toxin
    type A into the EHL. Main Outcome Measures: Efficacy was assessed on day 15 by
    triggering of pain, shoe difficulties, and varus deformity and by patients' subjective
    assessment on day 15, at 3 months, and at 6 months. Results: On day 15. EHL
    overactivity disappeared after 16 of the 18 injections in 10 patients; subjective
    assessment was very good for pain and shoe difficulties and remained good or very
    good at 3 months for 8 patients who received 12 injections. Conclusion: Botulinum
    toxin type A is effective in treating disability related to poststroke overactivity of the
Keywords: ARCH/assessment/botulinum toxin/botulinum toxin type A/clinical/clinical
Illuminati, G., Calio, F.G., Papaspyropoulos, V., Montesano, G. and D'Urso, A. (2003),
    Revascularization of the internal carotid artery for isolated, stenotic, and
    symptomatic kinking. Archives of Surgery , 138 (2), 192-197.
Abstract: Hypothesis: The operation for isolated, stenotic, and symptomatic kinking of
    the internal carotid artery is safe and effective in preventing stroke and relieving the
    symptoms of cerebral ischemia. Design: A consecutive sample clinical study with a
    mean follow-up of 44 months. Setting: The surgical department of an academic
    tertiary care center and an affiliated secondary care center. Patients: Fifty-four
    patients with a mean age of 67 years underwent 55 revascularizations of the internal
    carotid artery. The surgical procedures consisted of the following: shortening and
    reimplantation in the common carotid artery in 36 cases, bypass grafting in 15 cases,
    and transposition into the external carotid artery in 4 cases. Main Outcome Mesaures:
    Cumulative survival, primary patency, and stroke-free and neurologic symptom-free
    rates expressed by standard life-table analysis. Results: No patients died in the
    postoperative period. The postoperative stroke rate was 1.8%. The cumulative rates
    (SEs) at 5 years were as follows: survival, 70% (10.2%); primary patency, 89%
    (7.8%); overall stroke free, 92% (6.8%); ipsilateral stroke free, 96% (5.3%);
    neurologic symptom free, 90% (7.5%); and ipsilateral symptom free, 93% (6.5%).
    Conclusion: Revascularization of the internal carotid artery for the treatment of
    isolated, stenotic, and symptomatic kinking is safe and effective in preventing stroke
    and relieving symptoms of cerebrovascular insufficiency
Keywords: age/analysis/ARCH/artery/bypass/carotid/carotid artery/cerebral/cerebral
    study/CLINICAL-SIGNIFICANCE/common/common                                          carotid
    artery/ELONGATION/external                          carotid                 artery/follow
    up/follow-up/grafting/internal/internal               carotid/internal             carotid
    tive/postoperative                  stroke/secondary/standard/STATE/STROKE/stroke
Cabral, N.L., Moro, C., Silva, G.R., Scola, R.H. and Werneck, L.C. (2003), Study
  comparing the stroke unit outcome and conventional ward treatment - A randomized
  study in Joinville, Brazil. Arquivos de Neuro-Psiquiatria, 61 (2A), 188-193.
Abstract: Background and Purpose: To assess the impact of a stroke unit (SU) on acute
  phase treatment when compared to a conventional general ward treatment (GW).
  Method: Seventy-four patients with acute stroke were randomized between a SU and
  conventional general ward (GW). We compared both groups regarding the length of
  hospital stay, lethality and functional and clinical status within 6 months, using the
  Scandinavian scale and Barthel index. Results: Thirty-five and thirty-nine patients
  were allocated at SU and GW, respectively. Lethality on the 10th day at SU and GW
  achieved 8.5% and 12.8% respectively (p = 0.41), whereas 30-days mortality rates
  achieved 14.2% and 28.2% (p = 0.24), 17.4% and 28.7% on the 3rd month (p = 0.39),
  and 25.7% and 30.7% on the 6th month (p = 0.41). Thirty-day survival curve
  achieved 1.8 log rank (p = 0.17), with a trend for lower lethality in the SU. In order
  to save one death in 6 months in SU, NNT (the number need to treat) was 20; to get
  one more home independent patient NNT was 15. No significant difference was
  found between the length of hospital stay and morbidity. Conclusion: No significant
  benefit was found in SU patients compared to GW group. However, an evident
  benefit in absolute numbers was observed in lethality, survival curve and NNT in
  thirty days period after stroke. Further collaborative studies or incresead number of
  patients are required to define the role of SU
Keywords: acute/ACUTE ISCHEMIC STROKE/acute stroke/Barthel/Barthel
  index/Brazil/cerebrovascular                                   disorders/clinical/clinical
  status/death/functional/general/home/hospital/hospital                               units
  team/impact/index/length                            of                           hospital
  mized/status/stroke/stroke care/stroke therapy/stroke unit/survival/treatment/when
Conforto, A.B., Marie, S.K.N., Cohen, L.G. and Scaff, M. (2003), Transcranial
  magnetic stimulation. Arquivos de Neuro-Psiquiatria, 61 (1), 146-152.
Abstract: Transcranial magnetic stimulation (TMS) allows non-invasive study and
  modulation of cortical excitability in humans. Changes in cortical excitability in
  physiological and pathological conditions can be tracked by measurements such as
  motor threshold, motor evoked potentials, recruitment curves, intracortical
  facilitation and inhibition. The central motor conduction time can estimate neural
  transmission in central motor pathways. Changes in areas of representation in
  sensorimotor cortex can be studied with cortical mapping. Modulation of cortical
  processing can be used to evaluate different brain functions. Therapeutic use in
  depression, Parkinson's disease and epilepsy has raised great interest over the past
  decade. Noninvasive cortical. mapping may be achieved by combining TMS to other
  neurophysiological/neuroimaging techniques. TMS has great potential both as an
  investigational and as a therapeutical tool in Neurology and Psychiatry
Keywords:              brain/brain            mapping/Brazil/cortex/cortical/CORTICAL
  potentials/excitability/HUMAN                  BRAIN/HUMAN                      MOTOR
  stimulation/mapping/MECHANISMS/modulation/motor/motor                             evoked
  potentials/neural/neural                             plasticity/noninvasive/Parkinson's
  cortex/stimulation/STROKE/techniques/threshold/TMS/transcranial               magnetical
Leopoldino, J.F.S., Fukujima, M.M., Silva, G.S. and do Prado, G.F. (2003), Time of
   presentation of stroke patients in Sao Paulo hospital. Arquivos de Neuro-Psiquiatria,
   61 (2A), 186-187.
Abstract: With the advent of time-dependent thrombolytic therapy for ischemic stroke it
   has become increasingly important for stroke patients to arrive at the hospital quickly.
   This study investigated the time that our patients took since the recognition of the
   symptoms until the stroke diagnosis in a hospital in the city of Sao Paulo. We
   concluded that in our hospital medical personnel and paramedics did not consider
   stroke as a medical emergency before neurological evaluation. Social problems as
   lack of access to an effective emergency medical service are another important factor
   that was responsible for patient's delay. Our study was important in order to identify
   the problems that stroke patients face in our country until the diagnosis is established
Keywords:            Brazil/CARE/delay/diagnosis/emergency/emergency                medical
   patients/symptoms/therapy/thrombolytic/thrombolytic therapy/time of presentation
Piske, R.L., Ferreira, M.S., Campos, C.M.S., Teixeira, J.A.N., Piske, L.E.B., Fonseca,
   N.C., Neves, J.I.C. and Mourao, G.S. (2003), The cerebral protection technique in
   angioplasty plus stenting of carotid: An effective procedure against cerebral
   embolism. Arquivos de Neuro-Psiquiatria, 61 (2A), 296-302.
Abstract: Objective: To describe the cerebral protection technique used in the
   angioplasty and stenting to treat stenotic lesions of carotid artery bifurcation,
   showing its efficiency in avoiding cerebral emboli during the procedure. Method:
   Forty two patients (47 arteries) were treated with the cerebral protection technique,
   which consists in the temporary occlusion of the internal carotid artery, above the
   stenotic lesion, performing the aspiration and flushing of glucose solution into the
   internal carotid artery after the delivery of the stent and the angioplasty, to remove
   any atherosclerotic plaque's fragments. Results: The angioplasty was efficient in all
   cases. There were no cerebral emboli in the patients in whom the complete cerebral
   protection technique was used, showing its efficiency. Distal embolism occurred in
   one patient, during pre angioplasty and before the use of cerebral protection.
   Conclusion: The cerebral protection technique was efficient to avoid cerebral emboli
   in the procedures performed. This data is in agreement with the literature and the use
   of this technique increases the indications of carotid angioplasty
Keywords: agreement/angioplasty/angioplasty and stenting/arteries/artery/ARTERY
   STENOSIS/aspiration/atherosclerotic/atherosclerotic                  disease/BALLOON
   ANGIOPLASTY/Brazil/carotid/carotid angioplasty/carotid artery/cerebral/cerebral
   CE/glucose/indications/internal/internal              carotid/internal            carotid
Santos, A.J., Malheiros, S.M.F., Borges, L.R.R., Dzik, C., Nalli, D.G. and Gabbai, A.A.
   (2003), Ischemic stroke after chemotherapy with cisplatin, etoposide and bleomycin:
   case report. Arquivos de Neuro-Psiquiatria, 61 (1), 129-133.
Abstract: A 20-year-old man with a germ cell tumor who experienced an ischemic
   stroke as a complication of cisplatin/etoposide/bleomycin based chemotherapy is
   reported. The previously reported cases are reviewed as well as the different
   physiopathologic mechanisms associated with vascular toxicity of this regimen
Keywords:                ANTINEOPLASTIC                    AGENTS/bleomycin/Brazil/case
   MIA/ischemic/ischemic stroke/LUNG-CANCER/mechanisms/stroke/TESTICULAR
Souza, D.R.S., Campos, B.F., de Arruda, E.F., Yamamoto, L.J., Trindade, D.M. and
   Tognola, W.A. (2003), Influence of the polymorphism of apolipoprotein E in
   cerebral vascular disease. Arquivos de Neuro-Psiquiatria, 61 (1), 7-13.
Abstract: The genetic heterogeneity of apolipoprotein E (apo E) has been associated
   with lipid profile and atherothrombotic stroke, however this association remains
   inconclusive. Objective: To evaluate the relationship between the isoforms of apo E
   and atherothrombotic stroke, by ascertaining the frequency of its alleles and
   genotypes associated with the lipid profile in patients with stroke. Method: A total of
   207 individuals were divided into two groups, consisting of 107 patients with stroke
   and 100 individuals without clinical symptoms of the disease. Blood samples were
   taken from patients and controls for molecular investigation of the apo E (epsilon2,
   epsilon3 and epsilon4 alleles) for the analysis of the lipid profile. Results: The
   epsilon3 allele was the most common and its prevalence was significantly higher in
   patients (0.93) compared to the controls (0.86; p = 0.024). The epsilon2 allele was
   rarely seen specifically in patients (0.02 versus 0.05 in controls, p = 0.191). The
   epsilon4 allele was not associated with stroke showing a reduced frequency in
   patients (0.05) when compared to controls (0.09; p = 0.011). Although higher
   average levels of lipid profile were found in patients when compared to controls,
   with statistical significance for the values of total cholesterol (TC) (203.6 mg/dL +/-
   57.98 and 181.9 mg/dL +/- 68.47 respectively; p = 0.003) and low-density
   lipoprotein cholesterol (LDLc) (131.4 mg/dL +/- 52.60 and 116 mg/dL +/- 56.38,
   respectively; p = 0.014), these were independent of the presence of the epsilon4
   allele. in control group the higher TC and LDLc values occurred in the absence of
   the epsilon4 allele, confirming the conflicting effect of the alleles of apo E on the
   plasmatic lipids and atherothrombotic stroke. Conclusion: The isoforms of apo E
   cannot be regarded as an isolated risk factor for stroke and do not show association
   with lipid profile in this study
Keywords:                                            analysis/apolipoprotein/apolipoprotein
   stroke/cerebral/cerebral            vascular           disease/CEREBROVASCULAR-
   /ISCHEMIC STROKE/LDLc/lipid/lipid profile/lipids/LIPOPROTEIN/low density
   lipoprotein/low-density                lipoprotein/low-density               lipoprotein
   cholesterol/patients/patients                                                      with
   factor/statistical/stroke/symptoms/total cholesterol/vascular/vascular disease/when
Jerrard-Dunne, P., Markus, H.S., Steckel, D.A., Buehler, A., von Kegler, S. and Sitzer,
   M. (2003), Early carotid atherosclerosis and family history of vascular disease -
   Specific effects on arterial sites have implications for genetic studies.
   Arteriosclerosis Thrombosis and Vascular Biology, 23 (2), 302-306.
Abstract: Objective-Carotid artery intima-media thickness (IMT) is an intermediate
  phenotype for atherosclerosis. In a community population (n=5400), we determined
  whether a parental history of myocardial infarction (MI) or stroke is associated with
  increased IMT and whether associations differ at specific sites in the carotid arterial
  tree. Methods and Results-Using regression modeling, the proportion of IMT that
  remains unexplained after controlling for vascular risk factors was determined. A
  parental history of stroke was associated with both increased common carotid artery
  (CCA) and increased internal carotid artery (ICA)-IMT, but in young individuals
  (less than or equal to60 years of age), the association was stronger with ICA-IMT,
  with an odds ratio (95% CI) for ICA-IMT in the highest quartile of 2.31 (1.67 to
  3.21), P<0.001, compared with 1.53 (1.07 to 2.20), P=0.019, for CCA-IMT. In
  contrast, a parental history of MI was associated with increased CCA-IMT both
  overall and in young individuals but not with ICA-IMT, with an odds ratio (95% CI)
  for increased CCA-IMT of 2.51 (1.94 to 3.25), P<0.001, compared with 1.03 (0.78 to
  1.35), P=0.861, for ICA-IMT. Conclusions-IMT has a significant familial component
  that is independent of conventional risk factors. Associations for stroke and MI differ
  at specific sites in the carotid arterial tree. Although commonly used aggregate
  CCA/ICA-IMT measures may be appropriate for candidate gene studies investigating
  stroke risk, these results suggest that CCA-IMT alone may be a better marker for MI
  gene/CARDIOVASCULAR- DISEASE/carotid/carotid arteries/carotid artery/carotid
  atherosclerosis/common/common            carotid    artery/community/COMMUNITY
  carotid/internal               carotid               artery/intima              media
  risk/thickness/ultrasound/USA/vascular/vascular disease/vascular risk/vascular risk
  factors/WALL THICKNESS/young
Schindler, T.H., Hornig, B., Buser, P.T., Olschewski, M., Magosaki, N., Pfisterer, M.,
  Nitzsche, E.U., Solzbach, U. and Just, H. (2003), Prognostic value of abnormal
  vasoreactivity of epicardial coronary arteries to sympathetic stimulation in patients
  with normal coronary angiograms. Arteriosclerosis Thrombosis and Vascular
  Biology, 23 (3), 495-501.
Abstract: Objective-We aimed to evaluate prospectively whether patients with normal
  coronary angiogram but abnormal epicardial vasoreactivity to cold pressor test (CPT)
  are at increased risk for cardiovascular events. Methods and Results-Vasoreactivity
  in response to CPT and dilation of epicardial arteries to intracoronary application of
  nitroglycerin were assessed quantitatively (percent change of luminal area,
  DeltaLA%) in 130 patients with normal coronary angiograms. Cardiovascular events
  (cardiovascular death, acute coronary syndrome, myocardial infarction, percutaneous
  transluminal coronary angioplasty, coronary bypass grafting, ischemic stroke, or
  peripheral revascularization) were assessed as clinical outcome parameters over a
  mean follow-up period of 45+/-9 months. Based on their vascular responses to CPT,
  patients were assigned into the following 3 groups: group 1, patients with normal
   vasodilator response (DeltaLA >0%; n=37); group 2, patients with moderate
   vasoconstrictor response (DeltaLA between 0% and -15%; n=42); and group 3,
   patients with severe vasoconstrictor response (DeltaLA less than or equal to-15%;
   n=51). Although patients from groups 2 and 3 had significantly increased
   vasoconstrictor response to CPT (group 2, DeltaLA -6+/-3% and group 3, DeltaLA
   -24+/-6% versus group 1, DeltaLA 11+/-9%; Pless than or equal to0.0001), they
   showed normal endothelial- independent epicardial vasodilation to intracoronary
   application of nitroglycerin similar to patients from group 1 (DeltaLA 39+/-16% and
   34+/-14% versus 41+/-14%; P=NS, respectively). During follow-up, none of the
   patients from group 1 developed cardiac events. However, 7 cardiovascular events
   occurred in group 2 and 30 occurred in group 3 in 4 and 22 patients, respectively
   (Pless than or equal to0.0001, univariate by log-rank test). After adjustment for
   known risk factors for coronary artery disease, impaired epicardial coronary
   vasoreactivity to CPT remained significantly associated with the risk of developing
   cardiovascular events (P=0.040, multivariate by Cox regression model).
   Conclusions-In patients with normal coronary angiogram, abnormal vasoreactivity of
   epicardial coronary arteries in response to sympathetic stimulation is associated with
   the risk of developing cardiovascular events
Keywords:                                acute/acute                             coronary
   bypass/C-REACTIVE                                                PROTEIN/C-reactive
   outcome/coronary/coronary            angiograms/coronary         angioplasty/coronary
   arteries/coronary artery/coronary artery disease/coronary bypass/coronary bypass
   grafting/coronary          disease/death/dilation/disease/endothelial/ENDOTHELIAL
   DYSFUNCTION/endothelium/follow                                        up/follow-up/free
   RONARY                                              ULTRASOUND/ischemic/ischemic
   STRESS/PA/patients/percutaneous                     transluminal              coronary
Sironi, L., Cimino, M., Guerrini, U., Calvio, A.M., Lodetti, B., Asdente, M., Balduini,
   W., Paoletti, R. and Tremoli, E. (2003), Treatment with statins after induction of
   focal ischemia in rats reduces the extent of brain damage. Arteriosclerosis
   Thrombosis and Vascular Biology, 23 (2), 322-327.
Abstract: Objective-In the present study, MRI has been used to investigate therapeutic
   intervention with statins in a model of permanent focal cerebral ischemia in rat.
   Methods and Results- Brain ischemia was induced in rats by the permanent occlusion
   of middle cerebral artery (MCAO) and the brain infarct size followed up in alive
   animals 2, 24, and 48 hours after MCAO, using the trace of apparent diffusion
   coefficient [Tr(D)] maps and T2-weighted images. In vehicle-treated rats, the infarct
   volumes increased by 38.5% and 89% after 24 and 48 hours, respectively, compared
   with the damage detected at 2 hours after MCAO. Treatment with simvastatin (20
   mg/kg) after MCAO prevented the increase in brain infarct volume occurring at 24
   hours and induced a 46.6% reduction after 48 hours. This effect was similar to that
  observed when simvastatin was administered before the induction of focal ischemia.
  T2W-MRI images confirmed these findings. The neuroprotective effects of
  simvastatin were paralleled by an increase in endothelial NO synthase
  immunoreactivity, detectable in the brain of simvastatin-treated rats.
  Conclusions-Statins, in addition to their preventive effect on cerebral ischemia, exert
  a neuroprotective role in the attenuation of brain damage after acute stroke
Keywords:        acute/ACUTE           STROKE/addition/animals/apparent           diffusion
  coefficient/artery/BLOOD-FLOW/brain/brain damage/brain infarct/brain infarct
  volume/brain-damage/cerebral/cerebral         artery/cerebral    ischemia/CEREBRAL-
  ARTERY                           OCCLUSION/COA                            REDUCTASE
  coefficient/effect/effects/endothelial/endothelial nitric oxide synthase/focal/focal
  cerebral        ischemia/focal         ischemia/induced/infarct/infarct      size/infarct
  cerebral/middle       cerebral      artery/model/MRI/neuroprotective/NITRIC-OXIDE
  SYNTHASE/NO/NO                synthase/occlusion/PA/permanent         focal      cerebral
  EVOLUTION/therapeutic/trace/USA/volume/WATER DIFFUSION/when
Nieto, J.J. and Torres, A. (2003), Midpoints for fuzzy sets and their application in
  medicine. Artificial Intelligence in Medicine, 27 (1), 81-101.
Abstract: Using Kosko's hypercube, we identify a fuzzy set with a point in a unit
  hypercube. A non-fuzzy or crisp subset of a set is a vertex of the hypercube. We
  introduce some new ideas: the definition of the fuzzy segment joining two given
  fuzzy subsets of a set, the set of midpoints between those two fuzzy subsets, and the
  set of equidistant points from given points. We present some basic properties and
  relations between these concepts and provide a complete description of fuzzy
  segments and midpoints. In the majority of cases, there is no unique midpoint; one
  has an infinite set of possibilities to choose from. This situation is totally different
  from classical Euclidean geometry, where, for two given points, there is a unique
  midpoint. We use the obtained results to study two sets of medical data and present
  two applications in medicine: the fuzzy degree of two concurrent food and drug
  addictions, and a fuzzy representation of concomitant causal mechanisms of stroke.
  (C) 2002 Elsevier Science B.V. All rights reserved
Keywords:         addiction/AI/definition/DISORDERS/drug/fuzzy              midpoint/fuzzy
  segment/fuzzy                set/hamming               distance/HYPERCUBES/Kosko's
  applications/NETHERLANDS/results/Spain/stroke/SUBSTANCE USE/use
Andrade, A., Fonseca, J., Legendre, D., Nicolosi, D., Biscegli, J., Pinotti, M., Ohashi, Y.
  and Nose, Y. (2003), Improvement on the auxiliary total artificial heart (ATAH) left
  chamber design. Artificial Organs, 27 (5), 452-456.
Abstract: The auxiliary total artificial heart (ATAH) is an electromechanically driven
  artificial heart with reduced dimensions, which is able to be implanted in the right
  thoracic or abdominal cavities of an average human patient without removing the
  natural heart or the heart neurohumoral inherent control mechanism for the arterial
  pressure. This device uses a brushless direct current motor and a mechanical actuator
  (roller screw) to move two diaphragms. The ATAH's beating frequency is regulated
  through the change of the left preload, based on Frank-Starling's law, assisting the
  native heart in obtaining adequate blood flow. The ATAH left and right stroke
  volumes are 38 ml and 34 ml, respectively, giving approximately 5 L/min of cardiac
  output at 160 bpm. Flow visualization studies were performed in critical areas on the
  ATAH left chamber. A closed circuit loop was used with water and glycerin (37%) at
  25degreesC. Amberlite particles (80 mesh) were illuminated by a 1 mm planar
  helium-neon laser light. With left mean preload fixed at 10 mm Hg and the afterload
  at 100 mm Hg, the heart rate varied from 60 to 200 bpm. Two porcine valves were
  used on the inlet and outlet ports. The flow pattern images were obtained using a
  color micro-camera and a video recorder. Subsequently, these images were digitized
  using a PC computer. A persistent stagnant flow was detected in the left chamber
  inlet port. After improvement on the left chamber design, this stagnant flow
Keywords: abdominal/actuator/afterload/arterial/arterial pressure/artificial/blood/blood
  flow/Brazil/cardiac/cardiac              output/color/computer/control/design/flow/flow
  rate/human/laser/law/left/mechanical/mechanism/mock                          circulation
  acic/total artificial heart/USA/valves/ventricle assist device/VENTRICULAR
Nakatani, T., Naganuma, T., Uchida, J., Masuda, C., Wada, S., Sugimura, T. and
  Sugimura, K. (2003), Asymptomatic occlusive lesions of cerebral arteries in japanese
  hemodialysis patients. Artificial Organs , 27 (3), 281-284.
Abstract: While cerebrovascular diseases (CVD) are very common in hemodialysis (HD)
  patients, the prevalence and risk factors of asymptomatic occlusive lesions (AOL) of
  cerebral arteries in HD patients have not yet been elucidated. We performed cerebral
  magnetic resonance angiography (MRA) on 123 HD patients without symptomatic
  cerebrovascular disease and on 52 control subjects. On the basis of these images, we
  investigated the prevalence and risk factors of AOL. Stenosis greater than 25%
  narrowing of the cerebral arteries was found in 27 HD patients. The prevalence of
  AOL of cerebral arteries in HD patients was significantly higher than in the control
  group [27 (22.0%) versus 4 patients (7.7%), chi.(2) =4.2, p =0.0411]. Multiple
  logistic regression analysis showed that independent risk factors of AOL of cerebral
  arteries were uremic state, dyslipidemia, and age in all subjects and dyslipidemia and
  age in HD patients (R.(2) =0.162, p =0.0004; R.(2) =0.138, p=0.0145, respectively).
  Our findings suggest that chronic renal failure maintained by hemodialysis increases
  the prevalence of AOL, and that age and dyslipidemia are also significantly
  associated with AOL in HD patients
Keywords: age/analysis/angiography/arteries/asymptomatic/asymptomatic occlusive
  arteries/cerebrovascular/cerebrovascular                        disease/cerebrovascular
  diseases/chronic/chronic                                                           renal
  Japan/logistic     regression/magnetic/magnetic        resonance/magnetic     resonance
  analysis/renal/renal failure/risk/risk factors/RISK-FACTORS/STROKE/USA
Fukunaga, K., Funakubo, A. and Fukui, Y. (2003), Newly developed ventricular assist
  device with linear oscillatory actuator. Asaio Journal, 49 (3), 333-339.
Abstract: The goal of this study was to develop a new direct electromagnetic left
  ventricular assist device (DEM-LVAD) with a linear oscillatory actuator (LOA). The
  DEM-LVAD is a pulsa- tile pump with a pusher plate. The pusher plate is driven
  directly by the mover of the LOA. The LOA provides reciprocating motion without
  using any movement converter such as a roller screw or a hydraulic system. It
  consists of a stator with a single winding excitation coil and a mover with two
   permanent magnets. The simple structure of the LOA is based on fewer parts to bring
   about high reliability and smaller size. The mover moves back and forth when
   forward and backward electric current is supplied to the excitation coil. The pump
   housings have been designed using three-dimensional computer aided design
   software and fabricated with the aid of computer aided manufacturing technology.
   Monostrut valves (Bjork-Shiley #21) were used for the prototype. The DEM-LVAD
   dimension is 96 mm in diameter and 50 mm thick with a mass of 0.62 kg and a
   volume of 280 ml. An in vitro test (afterload 100 mm Hg; preload 10 mm Hg; input
   power 10 W) demonstrated more than 6 L/minute maximum output and 15%
   maximum efficiency at 130 beats per minute (bpm). Dynamic stroke volume ranged
   between 40 and 60 ml. The feasibility of the DEM-LVAD was confirmed
Keywords:           actuator/afterload/BYPASS/CARDIOMYOPATHY/CENTRIFUGAL
   BLOOD        PUMP/computer/design/efficiency/FLOW/goal/in            vitro/Japan/left/left
   ventricular/left                            ventricular                            assist
   ke                volume/structure/technology/TERM                     CIRCULATORY
   SUPPORT/three-dimensional/USA/valves/ventricular/ventricular                       assist
Stutz, W.R. (2003), Productivity and quality improvements through orbital forming.
   Assembly Automation, 23 (2), 147-152.
Abstract: Orbital forming is an efficient and precise process to assemble component
   parts. It provides strength, an attractive finished appearance, and batch-to-batch
   uniformity. Orbital forming machines can produce high-torque assemblies and also
   freely swinging joints, and any degree of built-in resistance in between. These
   machines quietly flare and form all malleable materials, including many engineering
   thermoplastics, and work safely on delicate and brittle parts. The machine controls
   provide infinitely variable cycle times (speed), forming pressure and tool stroke on
   the micrometer dial with resolution to 0.001 in
Keywords:                                             assembly/controls/ENGLAND/metal
Bjerregaard, P., Young, T.K. and Hegele, R.A. (2003), Low incidence of cardiovascular
   disease among the Inuit - what is the evidence? Atherosclerosis, 166 (2), 351-357.
Abstract: Background: The notion that the incidence of ischemic heart disease (IHD) is
   low among the Inuit subsisting on a traditional marine diet has attained axiomatic
   status. The scientific evidence for this is weak and rests on early clinical evidence
   and uncertain mortality statistics. Methods: We reviewed the literature and
   performed new analyses of the mortality statistics from Greenland, Canada, and
   Alaska. Findings: The evidence for a low mortality from IHD among the Inuit is
   fragile and rests on unreliable mortality statistics. Mortality from stroke, however, is
   higher among the Inuit than among other western populations. Based on the
   examination of 15 candidate gene polymorphisms, the Inuit genetic architecture does
   not obviously explain putative differences in cardiovascular disease prevalence.
   Interpretation: The mortality from all cardiovascular diseases combined is not lower
   among the Inuit than in white comparison populations. If the mortality from IHD is
   low, it seems not to be associated with a low prevalence of general atherosclerosis. A
   decreasing trend in mortality from IHD in Inuit populations undergoing rapid
   westernization supports the need for a critical rethinking of cardiovascular
   epidemiology among the Inuit and the role of a marine diet in this population. (C)
   2002 Elsevier Science Ireland Ltd. All rights reserved
Keywords:               3            CANADIAN                POPULATIONS/ALASKAN
  e gene/cardiovascular/cardiovascular disease/cardiovascular diseases/cardiovascular
  eneral/genetic/GENETIC-VARIATION/GREENLAND                         ESKIMOS/heart/heart
  disease/incidence/Inuit/IRELAND/ischemic/ischemic                                   heart
  disease/lower/marine/marine                     diet/MORTALITY/mortality/PLASMA-
Dwyer, T., Emmanuel, S.C., Janus, E.D., Wu, Z.S., Hynes, K.L. and Zhang, C.M.
  (2003), The emergence of coronary heart disease in populations of Chinese descent.
  Atherosclerosis, 167 (2), 303-310.
Abstract: Most countries in oriental Asia have not yet experienced the 'western'
  coronary heart disease (CHD) epidemic despite substantial economic development.
  An exception has been Singapore. We compared mortality and CHD risk factors in
  Singapore with two Oriental locations, Hong Kong and mainland China, which have
  not experienced the CHD epidemic. Mortality data from World Health Statistics
  Annuals age standardised for each location and were supplemented by local data.
  Risk factor data was obtained from population-based surveys using similar protocols
  in each location. Measures included diet, blood lipids, blood pressure, height and
  weight. CHD mortality in the year chosen for comparison, 1994, was significantly
  higher for Singapore Chinese males [108 (95.2-119.1)] than Chinese males in Hong
  Kong [44.3 (40.2-48.2)] or China [45.5 (44.2-46.8)]. Female CHD mortality was also
  relatively higher in Singapore Chinese. The only CHD risk factor markedly higher in
  Singapore Chinese was serum cholesterol; Singapore males [5.65 (5.55- 5.75)],
  females [5.60 (5.50-5.70)], Hong Kong males [5.21 (5.11-5.31)], females [5.20
  (5.10-5.29)] and China males [4.54 (4.46-4.62)], females [4.49 (4.42-4.55)]. Dietary
  differences in saturated fat consumption were consistent with this. Although there
  was little difference in total fat intake, a higher consumption of dietary saturated fat
  and lower consumption of polyunsaturated fat, accompanied by higher serum
  cholesterol, appear to explain the relatively high CHD mortality in Singapore
  compared with Hong Kong and mainland China. Differences in body mass index,
  blood pressure and smoking between locations did not explain the differences in
  CHD mortality. (C) 2003 Elsevier Science Ireland Ltd. All rights reserved
Keywords: age/Asia/ATHEROSCLEROSIS/Australia/Beijing/blood/blood lipids/blood
  pressure/BLOOD-PRESSURE/body                                                        mass
  /coronary         heart/coronary       heart     disease/development/diet/diet        and
  cholesterol/dietary/disease/economic/economic                          development/fat/fat
  consumption/heart/heart                  disease/Hong                kong/HONG-KONG
  -based/pressure/PREVALENCE/regional                 differences/risk/risk      factor/risk
Fortunato, G., Rubba, P., Panico, S., Trono, D., Tinto, N., Mazzaccara, C., De Michele,
  M., Iannuzzi, A., Vitale, D.F., Salvatore, F. and Sacchetti, L. (2003), A paraoxonase
  gene polymorphism, PON 1 (55), as an independent risk factor for increased carotid
  intima-media thickness in middle-aged women. Atherosclerosis, 167 (1), 141-148.
Abstract: Paraoxonase (PON) gene polymorphisms have been proposed as genetic
  markers of risk for cardiovascular disease (CVD). Sporadic results suggest they are
  correlated with intima-media thickness (IMT), an indicator of preclinical
  atherosclerotic disease. We have investigated whether polymorphisms PON 1 (M/L)
  55, (Q/R) 192, PON 2 (S/C) 311 are related to site-specific carotid plaques in 310
  middle-aged women. Subjects were also investigated for physical and biochemical
  parameters including oxidative markers to evaluate their effect on development of
  atherosclerotic plaques (IMT > 1.2 mm) identified by high resolution B-mode
  ultrasound. We demonstrate that PON 1 (LL + ML) 55 is associated with plaques
  both at the bifurcation (OR = 2.40; 95% Cl 1.00-5.90) and at the common carotid
  artery (OR = 2.75; 95% CI 1.01-7.50), and to the total number of plaques at any site
  (P < 0.05). This polymorphism is an independent parameter with respect to other
  variables that are significantly associated with plaques, i.e. systolic blood pressure
  (OR = 2.06; 95% CI 1.11-3.81) and oxidized low-density lipoprotein (LDL)
  antibodies (OR = 1.96; 95% Cl 1.05-3.69) in cases of common carotid plaques, and
  lipid peroxides (OR = 1.86; 95% CI 1.00-3.50) in cases of bifurcation plaques. In
  conclusion, PON 1 (LL + ML) 55 but not PON 1 (Q/R) 192 or PON 2 (S/C) 311,
  appears to be an independent risk factor for increased carotid IMT in middle-aged
  women. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved
Keywords:                                                     antibodies/artery/ARTERY
  disease/atherosclerotic plaques/blood/blood pressure/cardiovascular/cardiovascular
  disease/carotid/carotid artery/carotid atherosclerosis/carotid intima media
  thickness/carotid intima-media thickness/carotid plaques/CO/common/common
  carotid                                                            artery/CORONARY
  polymorphism/genetic/GLN-ARG192                                POLYMORPHISM/high
  resolution/II/IMT/intima          media           thickness/intima-media/intima-media
  in/low                          density                         lipoprotein/low-density
  markers/paraoxonase/physical/polymorphism/polymorphisms/PON               1    and     2
  polymorphisms/pressure/resolution/results/risk/risk                 factor/SCI/SERUM
  PARAOXONASE/STROKE/systolic/systolic                     blood/systolic           blood
Gerdes, V.E.A., Verkooyen, R.P., Kwa, V.I.H., de Groot, E., van Gorp, E.C.M., ten
  Cate, H., Brandjes, D.P.M. and Buller, H.R. (2003), Chlamydial LPS antibodies,
  intima-media thickness and ischemic events in patients with established
  atherosclerosis. Atherosclerosis, 167 (1), 65-71.
Abstract: Background: Chlamydia pneumoniae has been associated with cardiovascular
  disease. However, studies on the presence of chlamydial antibodies and intima-media
  thickness (IMT) or future ischemic events are inconclusive. We examined the
  relation between circulating antibodies to chlamydial lipopolysaccharide (cLPS Ab),
  IMT and the occurrence of ischemic events during follow-up in patients with
  manifest atherosclerotic disease. Methods: IgG and IgA antibodies against cLPS
  were determined in 273 out of 307 consecutive patients with a recent ischemic stroke
  (IS, n = 90), a recent myocardial infarction (MI, n = 87) or peripheral arterial disease
  (PAD, n = 96). B-mode ultrasound IMT measurement of carotid and femoral arteries
  was performed and ischemic events, IS or MI, during follow-up were registered.
  Results: IgG and IgA were found in 66 and 46% of the patients, respectively. We did
  not detect any difference in IMT between patients with or without antibodies:
  IgA-0.97(0.28) mm versus IgA + 0.95(0.26) mm, P = 0.63, IgG-0.96(0.28) mm
  versus IgG+0.96(0.26) mm, P = 0.98. During follow-up with a mean duration of 3.5
  years the combined endpoint, MI or IS, was similar in patients with or without
  antibodies (IgA -24% vs. IgA + 19%, IgG - 23% vs. IgG + 22%). However, a lower
  frequency of MI was observed in IgA positive patients (IgA - 13% vs. IgA + 8%).
  The number of ischemic events in the 12 patients who used anti-chlamydial
  antibiotics was similar compared with those who did not use antibiotics. Conclusion:
  In patients with manifest atherosclerotic disease no association between the presence
  of cLPS Ab and IMT could be detected. In addition, no influence of cLPS Ab on the
  number of ischemic events was observed, the frequency of MI during followup in
  IgA positive patients was even lower. (C) 2002 Published by Elsevier Science
  Ireland Ltd
Keywords:                                                                         ACUTE
  disease/arteries/ARTERY                DISEASE/ASSOCIATION/ASYMPTOMATIC
  CAROTID          ATHEROSCLEROSIS/atherosclerosis/atherosclerotic/atherosclerotic
  media                                             thickness/intima-media/intima-media
  ial      infarction/Netherlands/occurrence/patients/peripheral/peripheral        arterial
Hoy, A., Leininger-Muller, B., Poirier, O., Siest, G., Gautier, M., Elbaz, A., Amarenco,
  P. and Visvikis, S. (2003), Myeloperoxidase polymorphisms in brain infarction.
  Association with infarct size and functional outcome. Atherosclerosis, 167 (2),
Abstract: Myeloperoxidase (MPO) has been shown to contribute to several diseases and
  more particularly to atherosclerosis through excessive ROS production via the
  MPO/H2O2/Cl- oxidation system. The aim of this study was to determine whether
  there is an association between MPO polymorphisms and brain infarction (131), one
  of the main consequences of atherosclerosis. We investigated MPO G-463A and
  G-129A polymorphisms in 450 patients with BI confirmed by magnetic resonance
  imaging (MRI) and 450 controls of the GENIC (Genetique de l'Infarctus Cerebral)
  Study. Genotype determination of MPO was performed by polymerase chain reaction
  and allele-specitic oligonucleotide hybridization (ASO). Genotype distributions for
  each of both MPO polymorphisms were found to be similar between cases and
  controls overall, and according to etiologic subtypes or gender. The frequency of the
  A allele of the G-463A polymorphism was 22% (95% confidence interval, 19.4 to
  24.9) and the frequency of the A allele of the G-129A polymorphism was 6.8% (95%
  confidence interval, 5.3 to 8.6). The odds ratio (OR) for BI in carriers of the A allele
  of the G-129A polymorphism was 0.92 (95% confidence interval, 0.61 to 1.39), and
  the OR for BI in carriers of the A allele of the G-463A polymorphism was 1.15 (95%
  confidence interval, 0.88 to 1.52). No association between the main risk factors for
  BI such as hypertension, cholesterol, diabetes and MPO polymorphisms was found.
  In analyses restricted to cases, we identified an association between the A allele of
  the G-129A polymorphism and the size of the brain infarct (P = 0.01). Furthermore,
  the A allele of the G-463A polymorphism was associated with a poorer functional
  short-term outcome as evaluated by the Rankin score (P = 0.02). In conclusion, MPO
  polymorphisms were associated with the extent of brain damage and the functional
  outcome rather than with the risk of developing a BI. (C) 2002 Published by Elsevier
  Science Ireland Ltd
Keywords: association/ATHEROSCLEROSIS/brain/brain damage/brain infarct/brain
  size/infarction/INJURY/IRELAND/ISCHEMIC                 STROKE/magnetic/magnetic
  resonance/magnetic                                                         resonance
  imaging/MRI/MULTIPLE-SCLEROSIS/myeloperoxidase/NADPH OXIDASE/odds
  ratio/outcome/OXIDATION/PATHOGENESIS/patients/polymerase                        chain
  LEUKOCYTES/POPULATION/production/resonance                         imaging/RISK/risk
Mack, W.J., Hameed, A.B., Xiang, M., Roy, S., Slater, C.C., Stanczyk, F.Z., Lobo, R.A.,
  Liu, C., Liu, C. and Hodis, H.N. (2003), Does elevated body mass modify the
  influence of postmenopausal estrogen replacement on atherosclerosis progression:
  results from the estrogen in the prevention of atherosclerosis trial. Atherosclerosis,
  168 (1), 91-98.
Abstract: Objective: To determine whether the estrogen-related reduction in
  atherosclerosis progression demonstrated in the estrogen in the prevention of
  atherosclerosis trial (EPAT) is modified by body mass index (BMI). Study Design:
  Subgroup analyses were performed using data from EPAT, a randomized,
  double-blind, placebo-controlled trial designed to determine whether unopposed
  17beta-estradiol administered for a 2-year treatment period reduces the progression
  of subclinical atherosclerosis in healthy postmenopausal women. The primary trial
  endpoint was the rate of change of common carotid artery intima-media thickness
  (IMT). In this subgroup analysis, the sample was divided into 122 women with BMI
  < 30 kg/m(2) and 77 women with BMI greater than or equal to 30 kg/m(2) Statistical
  analysis was performed using mixed general linear models to evaluate whether the
  treatment effects on IMT progression rates differed in the two BMI groups. Results:
  There was no significant difference in the estradiol treatment effect on IMT
  progression rates between postmenopausal women with BMI < 30 vs. greater than or
  equal to 30 kg/m(2) (P = 0.52). In the 77 subjects who did not use lipid-lowering
  therapy, there was significant improvement in IMT with estradiol treatment that was
  evident in both BMI groups (P = 0.48 for differences between BMI groups).
  Conclusions: in contrast to the epidemiological observation that obese
  postmenopausal women do not derive benefit from estrogen replacement therapy,
  results of this study indicate that estradiol treatment is beneficial in preventing
  progression of atherosclerosis regardless of initial BMI. Condensation: Estradiol
  treatment is beneficial in preventing progression of atherosclerosis in
  postmenopausal women not receiving lipid-lowering therapy, regardless of their
  initial body mass index. (C) 2003 Published by Elsevier Science Ireland Ltd
Keywords: analysis/artery/atherosclerosis/BMI/body mass index/cardiovascular
  disease/carotid/carotid        artery/carotid      artery        intima         media
  thickness/CAROTID-ARTERY/CO/common/common                                      carotid
  DISEASE/effect/effects/estradiol/estrogen/estrogen              replacement/estrogen
  replacement                  therapy/general/IMT/index/intima                  media
  THICKNESS/intima-media-thickness/IRELAND/lipid                              lowering
  women/prevention/progression/randomized/randomized                            clinical
Neureiter, D., Heuschmann, P., Stintzing, S., Kolominsky-Rabas, P., Barbera, L., Jung,
  A., Ocker, M., Maass, M., Faller, G. and Kirchner, T. (2003), Detection of
  Chlamydia pneumoniae but not of Helicobacter pylori in symptomatic atherosclerotic
  carotids associated with enhanced serum antibodies, inflammation and apoptosis rate.
  Atherosclerosis, 168 (1), 153-162.
Abstract: Background and purpose: Numerous seroepidemiological and pathological
  studies linked Chlamydia pneumoniae and Helicobacter pylori with atherosclerosis.
  However, analyses of these infectious agents in the pathogenesis of stroke are either
  lacking or contradictory. Therefore, we evaluated the detection rate of C.
  pneumoniae and H. pylori in normal carotids vs. atherosclerotic carotids and
  compared these findings with serology, plaque morphology, inflammatory cell
  infiltrates and apoptosis rate. Methods: The study was performed on 40
  morphological normal carotids from autopsy and 20 advanced atherosclerotic
  carotids from endarterectomy after stroke. Serum IgG antibody titre was measured
  by enzyme immunoassay (H. pylori) and microimmuno-fluorescence (MIF)
  technique (C. pneumoniae). Immunohistochemistry (IHC) and Western blotting were
  performed to identify C. pneumaniae, H. pylori, to characterize plaque morphology
  (macrophages and smooth muscle cells) and the inflammatory infiltrate (T- and B
  cells) and to detect apoptosis (TUNEL staining). Results: C. pneumoniae was found
  significantly more frequently in atherosclerotic than in normal carotids (P = 0.001),
  which correlated with elevated C pneumoniae IgG-antibody titres (P = 0.048).
  Although H. pylori was not detected in carotids, elevated H. pylori antibody titres
  were significantly associated with the degree of atherosclerosis (P = 0.001). The C.
  pneumoniae infected carotids displayed a slightly enhanced infiltrate of T cells and
  apoptosis rate, but no morphological changes. Conclusion: C. pneumoniae but not H.
  pylori, was detected by IHC primarily in symptomatic carotids, without specific
  morphological differences. Correlation of C. pneumoniae in-situ-detection and IgG
  antibodies suggested a possible connection between respiratory-tract and
  endovascular infection. The C. pneumoniae associated T-lymphocytes and apoptosis
  rate indicate an immune-mediated inflammatory process, involving vascular walls.
  (C) 2003 Elsevier Science Ireland Ltd. All rights reserved
  opsy/C                                                pneumoniae/changes/Chlamydia
  r/enzyme         immunoassay/Germany/Helicobacter           pylori/immune-mediated
  nesis of stroke/plaque/RISK FACTOR/SCI/serology/serum/smooth/smooth muscle
  cells/SMOOTH-MUSCLE                                                   CELLS/stroke/T
  lymphocytes/T-lymphocytes/technique/TUNEL/vascular/Western blotting
Scarabin, P.Y., Arveiler, D., Amouyel, P., Dos Santos, C., Evans, A., Luc, G., Ferrieres,
  J. and Juhan-Vague, L. (2003), Plasma fibrinogen explains much of the difference in
  risk of coronary heart disease between France and Northern Ireland. The PRIME
  study. Atherosclerosis, 166 (1), 103-109.
Abstract: The incidence of coronary heart disease is higher in Northern Ireland than in
  France. These differences have not been adequately explained. We have investigated
  the associations of plasma fibrinogen concentration and factor VII activity with the
  incidence of coronary heart disease in a prospective cohort study involving 10 600
  men aged 50-59 living in four regions (Lille, Strasbourg, and Toulouse in France,
  Belfast in Northern Ireland). Baseline fibrinogen and factor VII were measured in
  9489 men free of coronary heart disease at entry (7167 in France and 2322 in
  Northern Ireland). Over 5 years of follow- up, 161 participants developed myocardial
  infarction (MI) or coronary death (100 in France and 61 in Belfast) and 151
  developed angina pectoris (94 in France and 57 in Belfast). The risk of future
  coronary events was 1.9 times higher in Belfast than in France (95% confidence
  interval: 1.5-2.4). Baseline mean levels of fibrinogen were significantly higher in
  Belfast than in France and they were higher in participants who experienced
  coronary events compared with those who did not in both countries. The
  age-adjusted relative risk of coronary heart disease associated with a rise of one
  standard deviation in fibrinogen level was 1.56 (95% confidence interval: 1.29- 1.95,
  P < 0.0001) in the whole cohort. This association remained significant after
  adjustment for other cardiovascular risk factors (relative risk:1.36; 95% confidence
  interval: 1.14-1.68; P <0.0001). There was no clear geographical variation in factor
  VII and no significant association between factor VII levels and the risk of coronary
  events was observed. Classic risk factors explained 25% of the excess risk of
  coronary heart disease in Belfast compared with France, while fibrinogen alone
  accounted for 30%. These findings add to the epidemiological evidence that elevated
  fibrinogen is a major risk factor for coronary heart disease. (C) 2002 Elsevier
  Science Ireland Ltd. All rights reserved
Keywords:       ACTIVATED          FACTOR-VII/activity/adjustment/aged/angina/angina
  risk/cardiovascular                                                                risk
  I/cohort/cohort           study/coronary/coronary         heart/coronary          heart
  disease/death/disease/factor                                     VII/fibrinogen/follow
  up/France/HEALTHY-MEN/heart/heart                              disease/HEMOSTATIC
  infarction/MYOCARDIAL-             INFARCTION/Northern          Ireland/plasma/plasma
  cohort/prospective cohort study/PROTEIN/relative risk/risk/risk factor/risk
Schmidt-Trucksass, A., Sandrock, M., Cheng, D.C., Muller, H.M., Baumstark, M.W.,
  Rauramaa, R., Berg, A. and Huonker, M. (2003), Quantitative measurement of
  carotid intima-media roughness - effect of age and manifest coronary artery disease.
  Atherosclerosis, 166 (1), 57-65.
Abstract: Atherosclerotic changes of the common carotid artery (CCA) may appear like
  irregularities of the intima-media thickness (abbreviated as IM roughness) in B-mode
  ultrasound. The purposes of the present study were to investigate whether the CCA
  IM roughness changes with age and differs between individuals presumed to be
  healthy and patients with coronary artery-disease (CAD). Methods and results: Based
  on a new automatic identification (AI) program, the segmental intima- media
  thickness (IMT) and IM roughness of the CCA far wall were measured in B-mode
  images of 15 younger and 22 older volunteers presumed to be healthy, and 46
  patients with known CAD. The mean and maximum CCA IMT were lowest in the
  young group (0.55+/-0.05; 0.65+/-0.06 mm), higher in the older group (0.77+/-0.16;
  0.87+/-0.18 mm) and highest in CAD patients (0.88+/-0.18; 1.01+/-0.27 mm) (P <
  0.01 among all groups). The CCA IM roughness was greatest by far in the CAD
  patients (0.075+/-0.02 mm; P < 0.0 1 vs. both groups) and increased only slightly
  with age (younger: 0.035+/-0.008 mm; older: 0.040+/- 0.014 mm; P < 0.05). Areas
  under the curve (AUC) of receiver- operating characteristic curves (ROC) predicting
  patients with CAD were higher for the CCA IM roughness (0.80) than for the mean
  (0.66) and maximum IMT (0.71). Conclusions: It is suggested that the CCA IM
  roughness increases with age, and helps to discriminate between individuals
  presumed to be healthy and patients with manifest CAD better than the CCA mean
  and maximum IMT. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved
  EROTIC        PLAQUES/B-MODE             ULTRASONOGRAPHY/CAD/carotid/carotid
  artery/changes/CO/COLESTIPOL-NIACIN THERAPY/common/common carotid
  artery/coronary/coronary                       artery/coronary                   artery
  disease/disease/effect/Germany/identification/IMT/intima                         media
  thickness/older/patients/receiver                                             operating
Asztalos, B.F. and Schaefer, E.J. (2003), HDL in atherosclerosis: actor or bystander?
  Atherosclerosis Supplements, 4 (1), 21-29.
Abstract: Despite dramatic improvement in treatments for reducing risk for coronary
  heart disease (CHD), it is still the leading cause of mortality in the developed world.
  In the past decade, a major improvement in reducing low-density lipoprotein (LDL)
  cholesterol has been achieved with 3-hydroxy-3-methylglutaryl coenzyme A
  (HMG-CoA) reductase inhibitors (statins). This approach has been shown to be
  beneficial in both primary and secondary prevention of CHD. On the other hand,
  while a reduced high-density lipoprotein (HDL) cholesterol level is an independent
  CHD risk factor, no HDL cholesterol goal has yet been established. The Helsinki
  Heart Study and the Veterans Affairs High-density Lipoprotein Intervention Trial
  documented that increasing HDL cholesterol with gemfibrozil significantly decreases
  coronary events or stroke in CHD patients either with elevated non-HDL cholesterol
  or normal LDL cholesterol levels plus low HDL cholesterol. Investigations with
  statins have focused on their efficacy not only in significantly decreasing total
  cholesterol, LDL cholesterol, and triglyceride levels but also in increasing HDL
  cholesterol concentrations. The two different classes of drugs (statins and fibrates)
  have different effects on the various HDL subspecies. As new members of these drug
  classes and other novel drugs are emerging, there is interest in clarifying whether
  HDL is only a bystander (an indicator for other CHD risk factors) or it has an active
  role in the development of CHD. If HDL has an active role, there is a need to
  determine if any HDL subspecies are protective. It is now clear that HDL plays a
  pivotal role in cellular cholesterol efflux via the interaction of apolipoprotein A-I
  with the ATP binding cassette transporter A-1. Thereafter the cholesterol is esterified
  by lecithin: cholesterol acyltransferase; HDL is remodeled by cholesterol ester
  transfer protein (CETP) and hepatic lipase. The cholesterol in HDL can either be
  transferred to apolipoprotein B-containing particles via CETP or delivered directly to
  the liver with the help of scavenger receptor B1. (C) 2003 Elsevier Science Ireland
  Ltd. All rights reserved
Keywords:              A-I/apolipoprotein/APOLIPOPROTEIN                   A-I/ARTERY
  DISEASE/atherosclerosis/ATP/BINDING                                        CASSETTE
  CONCENTRATIONS/cholesterol ester/CO/coronary/coronary heart/coronary heart
  W-UP/gemfibrozil/goal/hand/HDL/HDL                                     cholesterol/HDL
  L          CHOLESTEROL/LDL-cholesterol/lipase/lipoprotein/lipoproteins/liver/low
  mary       and      secondary      prevention/protein/receptor/risk/risk     factor/risk
  prevention/statin/statins/stroke/TANGIER-                               DISEASE/total
  cholesterol/triglyceride/USA/Veterans Affairs
Tsai, J.H., Chiang, H.L., Hsu, Y.C., Weng, H.C. and Yang, C.Y. (2003), The speciation
  of volatile organic compounds (VOCs) from motorcycle engine exhaust at different
  driving modes. Atmospheric Environment, 37 (18), 2485-2496.
Abstract: This study investigated the emissions of volatile organic compound (VOC)
  from motorcycle engine exhaust at different driving modes on a dynamometer. The
  speciations and the ozone formation potential of VOC samples also had been
  investigated by GC/MS and maximum increment reactivity (MIR), respectively.
  Both brand new and in-use motorcycles were tested in this study. The tested
  motorcycles include 2-stroke and 4-stroke engines. There are totally 48 VOC
  compounds identified in this study. Only the VOC species with C-3-C-9 were
  identified successfully. Experimental results indicated that isopentane, toluene, m,
  p-xylene, n-pentane, 2-methylpentane, 3- methylpentane, benzene, n-heptane and
  methylheptane were the major VOC speciations in the motorcycle engine exhaust.
  The amount of VOC emissions of the in-use 2-stroke motorcycles was 5 times that of
  the new 2-stroke motorcycles and the in-use 4- stroke motorcycles was 15 times that
  of the new 4-stroke motorcycles during the whole cycle. The amount of VOC
  speciation concentration during idle and deceleration stages was higher than those
  during the acceleration and cruising modes. However, the emission rate of VOCs at
  various driving modes tested on a dynamometer had not been precised enough due to
  the inconsistent variation of volume efficiency of motorcycle engine. These data
  shows a clear distinct emission rate of VOC at various driving modes. Besides,
  alkanes and aromatics were the major VOC speciation groups in the, motorcycle
  engine exhaust. The amount of VOCs contributed from 23% to 76% THC for the
  four types motorcycle. Great variation of VOC/THC were found among new and
  in-use motorcycle. The ozone formation potential of a 2-strokes engine was higher
  than that of a 4-stroke engine. The ozone formation potential of in- use motorcycles
   were also clear higher than those of new motorcycles. (C) 2003 Elsevier Science Ltd.
   All rights reserved
Keywords:                                            acceleration/benzene/driving/driving
   INCREMENTAL                              REACTIVITIES/MIR/motorcycle/motorcycle
   engine/NUMBER/ozone                  formation          potential/PHOTOCHEMICAL
   OZONE/reactivity/results/stroke/Taiwan/use/volatile organic compound/volatile
   organic compounds/volume
Joubran, L., Jackson, W.R., Campi, E.M., Robinson, A.J., Wells, B.A., Godfrey, P.D.,
   Callaway, J.K. and Jarrott, B. (2003), Arylpropanolamines incorporating an
   antioxidant function as neuroprotective agents. Australian Journal of Chemistry, 56
   (6), 597-605.
Abstract: A series of arylpropanolamines containing dipyrrolidinylpyrimidines as an
   antioxidant function have been synthesized and evaluated as dual function
   neuroprotective agents. Their in vitro efficacy as sodium channel blocking agents
   and antioxidants has been evaluated and compared with those of the ethanolamine
   derivative ( 1), which has been shown to be neuroprotective in a rat model of stroke.
   The ability of the present compounds to displace H-3-BTX toxin from sodium-ion
   channels in a rat brain membrane fraction was shown to be largely independent of
   the substituents on the aryl ring, which suggests that this activity may be mainly
   associated with the aminopyrimidine moiety. Structure - activity relationships for
   antioxidant efficacy were less clear, but the unsymmetrical pyrimidines were
   consistently more active than their symmetrical isomers. A brief theoretical
   investigation of this observation is reported
   agents/observation/rat/rat                         brain/RAT-BRAIN/sodium/sodium
Norris, R.T., Richards, R.B., Creeper, J.H., Jubb, T.F., Madin, B. and Kerr, J.W. (2003),
   Cattle deaths during sea transport from Australia. Australian Veterinary Journal, 81
   (3), 156-161.
Abstract: Objective To establish the death rate and the causes of death in cattle exported
   by sea from Australia. Procedure Cattle deaths on voyages from Australia to all
   destinations between 1995 and 2000 were analysed retrospectively. On four voyages
   to the Middle East between December 1998 and April 2001, cattle that died were
   examined to determine the cause of death. Results The death rate was 0.24% among
   4 million cattle exported, and a greater proportion of deaths occurred on voyages to
   the Middle East (0.52%, P < 0.05) than to south eastAsia (0.13%). The risk of death
   on voyages to the Middle East was three times greater for cattle exported from
   southern ports in Australia compared to northern ports. The main causes of death
   were heat stroke, trauma and respiratory disease. Conclusion Cattle have a low risk
   of death during sea transport from Australia. The risk of death can be reduced on
   voyages to the Middle East by preferentially exporting cattle from northern ports,
   and selecting those with a higher Bos indicus content whenever possible
Keywords:         Australia/cattle/cause/cause      of       death/causes/causes        of
  stroke/HEAT-STRESS/MELBOURNE/respiratory                            disease/risk/SHEEP
Coutard, M., Mertes, P., Mairose, P., Osborne-Pellegrin, M. and Michel, J.B. (2003),
  Arterial sympathetic innervation and cerebrovascular diseases in original rat models.
  Autonomic Neuroscience-Basic & Clinical, 104 (2), 137-145.
Abstract: The role of the arterial sympathetic innervation in cerebrovascular pathology
  was investigated in new experimental models using Brown Norway (BN) and
  Long-Evans (LE) rats. The BN rat is susceptible to intracerebral hemorrhage (ICH)
  within the cerebral cortex when rendered hypertensive whereas the LE rat is prone to
  cerebral aneurysms (CAs) in arteries of the circle of Willis with hypertension and
  carotid ligation. Noradrenaline (NA) content, determined by high performance liquid
  chromatography (HPLC), was lower both in the caudal and cerebral arteries in the
  BN than in the LE rat. Denervation of cerebral arteries by superior cervical
  ganglionectomy did not increase ICH lesion incidence in BN hypertensive rats. A
  possible link between the level of caudal artery NA content and the occurrence of
  ICH lesions and CAs was studied in rats from two distinct BNXLE crosses:
  back-cross (BC) rats (F1XBN) and F2 rats (F1XF1) which respectively display, with
  hypertension and carotid ligation, a high incidence of either ICH lesions or CAs. In
  BC rats, the level of caudal artery NA content was not related to ICH lesion
  occurrence. However, in F2 rats a low caudal artery NA content was associated with
  a high incidence of ruptured CAs. Thus, a low arterial sympathetic innervation may
  participate in mechanisms leading to rapture of CAs. (C) 2003 Elsevier Science B.V.
  All rights reserved
Keywords: aneurysms/arterial/arteries/artery/carotid/CATECHOLAMINES/CAUDAL
  ARTERY/cerebral/CEREBRAL               ANEURYSMS/cerebral            aneurysms/cerebral
  arteries/cerebral cortex/cerebrovascular/cerebrovascular diseases/cerebrovascular
  pathology/cervical/chromatography/circle                                              of
  rats/incidence/INTERNAL            ELASTIC         LAMINA/intracerebral/intracerebral
  HYPERTENSIVE                                 RATS/STROKE/sympathetic/sympathetic
Krebs, H.I., Palazzolo, J.J., Dipietro, L., Volpe, B.T. and Hogan, N. (2003),
  Rehabilitation robotics: Performance-based progressive robot- assisted therapy.
  Autonomous Robots, 15 (1), 7-20.
Abstract: In this paper we describe the novel concept of performance- based progressive
  robot therapy that uses speed, time, or EMG thresholds to initiate robot assistance.
  We pioneered the clinical application of robot-assisted therapy focusing on
  stroke-the largest cause of disability in the US. We have completed several clinical
  studies involving well over 200 stroke patients. Research to date has shown that
  repetitive task-specific, goal-directed, robot-assisted therapy is effective in reducing
  motor impairments in the affected arm after stroke. One research goal is to determine
  the optimal therapy tailored to each stroke patient that will maximize his/her
  recovery. A proposed method to achieve this goal is a novel performance-based
  impedance control algorithm, which is triggered via speed, time, or EMG. While it is
  too early to determine the effectiveness of the algorithm, therapists have already
  noted one very strong benefit, a significant reduction in arm tone
Keywords: adaptive algorithm/algorithm/arm/BRAIN-INJURY/cause/clinical/clinical
  mpedance/impedance                                      control/MAP/motor/MOTOR
  sive/PYRAMIDAL                                                      NEURONS/RAT
  neurorehabilitation/robotics/speed/stroke/STROKE/stroke                 patient/stroke
Loureiro, R., Amirabdollahian, F., Topping, M., Driessen, B. and Harwin, W. (2003),
  Upper limb robot mediated stroke therapy - GENTLE/s approach. Autonomous
  Robots, 15 (1), 35-51.
Abstract: Stroke is a leading cause of disability in particular affecting older people.
  Although the causes of stroke are well known and it is possible to reduce these risks,
  there is still a need to improve rehabilitation techniques. Early studies in the
  literature suggest that early intensive therapies can enhance a patient's recovery.
  According to physiotherapy literature, attention and motivation are key factors for
  motor relearning following stroke. Machine mediated therapy offers the potential to
  improve the outcome of stroke patients engaged on rehabilitation for upper limb
  motor impairment. Haptic interfaces are a particular group of robots that are
  attractive due to their ability to safely interact with humans. They can enhance
  traditional therapy tools, provide therapy "on demand" and can present accurate
  objective measurements of a patient's progression. Our recent studies suggest the use
  of tele- presence and VR-based systems can potentially motivate patients to exercise
  for longer periods of time. The creation of human- like trajectories is essential for
  retraining upper limb movements of people that have lost manipulation functions
  following stroke. By coupling models for human arm movement with haptic
  interfaces and VR technology it is possible to create a new class of robot mediated
  neuro rehabilitation tools. This paper provides an overview on different approaches
  to robot mediated therapy and describes a system based on haptics and virtual reality
  visualisation techniques, where particular emphasis is given to different control
  strategies for interaction derived from minimum jerk theory and the aid of virtual and
  mixed reality based exercises
Keywords: ability/approach/arm/arm movement/ARM MOVEMENTS/assistive
  /jerk/manipulation/models/motivation/motor/motor                   impairment/motor
  ATION/risks/robot/robot mediated therapy/robots/stroke/stroke patients/stroke
  MODEL/TRAJECTORY                   FORMATION/TRIAL/upper              limb/use/virtual
  environments/virtual reality/VR
Fox, W.C., Hall, C., Hall, E., Kolkhorst, F. and Lockette, W. (2003), Cardiovascular
  baroreceptors mediate susceptibility to hypothermia. Aviation Space and
  Environmental Medicine, 74 (2), 132-137.
Abstract: Background. The maintenance of excessively high peripheral blood flow
  through dilated blood vessels during immersion in cold water could explain some
  individuals' predisposition to hypothermia. We hypothesized that interpersonal
  differences in vascular reactivity could account for contrasting susceptibility to
  hypothermia. Method: Twenty-two highly fit, volume replete subjects undergoing
  Navy SEAL training were recruited for this study. Vascular reactivity in these
  trainees was determined in a thermal-neutral environment by measuring changes in
  forearm blood flow (FBF) while decreasing their BP with the application of lower
  body negative pressure (LBNP). FBF was also measured during exposure of these
  subjects to ice cold water. BP, heart rate, stroke volume, and skin temperatures were
  also recorded. Results. Changes in FBF induced by a fall in BP correlated with an
  individual's reduction in FBF caused by ice water immersion (n = 17, r = 0.84, p <
  0.001). A subject's decrement in BP induced with LBNP correlated inversely with
  the fall in skin temperature in response to cold water immersion (n = 19, r = 0.70, p <
  0.001). Finally, we found that sodium excretion also correlated with cold-induced
  decrements in peripheral blood flow (n = 7, r = 0.83, p < 0.05). Conclusions: It is
  suggested that contrasting cardiovascular baroreceptor sensitivity and vascular
  responsiveness contribute to individual differences in susceptibility to hypothermia.
  Furthermore, the trend toward dietary salt restrictions may not be salutary in the
  Navy SEAL who must frequently operate in cold ambient environments
Keywords: baroreceptor/baroreceptor sensitivity/baroreceptors/blood/blood flow/blood
  VASOCONSTRICTION/dietary/environment/exposure/flow/forearm                        blood
  flow/heart/heart                                rate/humans/hypothermia/ice/individual
  differences/induced/LBNP/lower/lower                      body                  negative
  pressure/MODULATION/NORMOTENSIVE                           HUMANS/ORTHOSTATIC
  temperature/sodium/SODIUM-INTAKE/SPACE/special                 operations/stroke/stroke
  reactivity/vascular           resistance/VASODILATOR/vessels/volume/water/water
Kraemer, W.J., Armstrong, L.E. and Watson, G. (2003), The effects of exertional
  heatstroke and exercise-heat acclimation on plasma beta-endorphin concentrations.
  Aviation Space and Environmental Medicine, 74 (7), 758-762.
Abstract: Introduction: It has been suggested that a proopiomelanocortin peptide
  beta-endorphin may play an important role in temperature regulation and therefore
  have specific heat stroke response patterns. Methods: The purpose of this study was
  to examine the response patterns of plasma beta-endorphin at baseline, during a 7-d
  exercise-heat acclimation period (HA; 90 min (.) d(-1), 40degreesC), and during a
  6-h exercise-heat tolerance test (HTT; 6 h, 40degreesC) performed before and after
  HA. Subjects were nine previously diagnosed heatstroke patients (P) and eight
  matched controls (C). No differences between the two groups were observed at rest,
  prior to HTT. Results: Plasma beta-endorphin concentration in P significantly
  increased above resting values at 2, 4, and 6 h of HTT and were significantly greater
  than C responses. During HA tests, a significantly higher beta-endorphin
  concentration was observed in P before exercise on day 1 and day 7, but not on clay
  4. A significant increase occurred after exercise in both groups, on all days of HA; no
  differences were observed between the groups on clays 4 and 7. Discussion: These
  results demonstrate that the opioid peptide responses in individuals with recent
  exertional heatstroke were greater than control subjects during the initial 6-h HTT.
  Decreased physical training among P may have contributed to these results. However,
  7 d of HA abolished these between-group differences by reducing the magnitude of
  beta-endorphin responses in P, indicative of an adaptation of pituitary function
Moran, D.S., Heled, Y., Shani, Y. and Epstein, Y. (2003), Hypothermia and local cold
  injuries in combat and non-combat situations - The Israeli experience. Aviation
  Space and Environmental Medicine, 74 (3), 281-284.
Abstract: Introduction: Cold weather has been recognized in the Israel Defense Forces
  (IDF) as a potential medical and operational threat to the soldier. Although
  regulations have been issued to cope with this situation, every year about 20 cases of
  hypothermia (T-core < 35&DEG;C) and peripheral cold injuries are reported.
  Methods: This study was aimed at following cold weather injuries (CI) in the IDF in
  the period 1994-2001. 136 cases were reported to our institute during this period. All
  patients were from the general population of young (20 &PLUSMN; 2 yr), male
  soldiers in the IDF. All were classified a priori as healthy, active subjects. Results.
  Of these patients, 51% were diagnosed with mild hypothermia and 49% with
  peripheral Cl. Among those soldiers who suffered from peripheral Cl, less than 5%
  were diagnosed with frostbite. Most of the cases (76%) occurred in the winter
  months; however, 10% occurred in the spring, 13% in autumn, and 2 cases (1%)
  were reported in the summer. The majority of all CI cases occurred during routine
  scheduled training (51%), and 15% occurred during routine duties. Of the cases, 34%
  occurred during combat operations (mainly ambushing and surveillance). Discussion:
  The present study provides data on Cl cases in an army where the awareness of the
  hazards involved in hostile environments is extensive, and in which detailed
  regulations aimed to prevent these injuries are common practice. The Israeli
  experience indicates that Cl is preventable in most instances by following a few
  simple regulations and providing proper education to the soldiers and their
  commanding officers
Keywords:           awareness/cold         intensity/common/education/EXERTIONAL
  hypothermia/patients/period/peripheral/peripheral                                 cold
Gros-Louis, J., White, D.J., King, A.P. and West, M.J. (2003), Female brown-headed
  cowbirds' (Molothrus ater) social assortment changes in response to male song: a
  potential source of public information. Behavioral Ecology and Sociobiology, 53 (3),
Abstract: In many species, females' behavior appears to be influenced by that of other
  females, particularly regarding mate choice. Females theoretically can reduce the
  costs associated with independent male assessment by observing conspecifics.
  Studies of brown-headed cowbirds suggest that females pay attention to other
  females' behavior. Group-housed females modify their song preferences, whereas
  females housed in pairs do not. What information is available to females in a group
  environment? To address this question, we studied two groups of juvenile (i.e.
  hatch-year birds) and adult female cowbirds in a naturalistic group setting. We used a
  longitudinal ABA design, consecutively introducing and removing males that
   differed in age, amount of song production and stage of song development, to isolate
   the male characteristics that related to changes in female behavior. Juvenile and adult
   females assorted by age class when singing adult males were in the aviary, but not
   when singing juveniles or silent males of any age class were in the aviary. Results
   from playback tests confirmed that adult male song alone influenced female age class
   assortment. Videotape analysis from playback tests revealed that females also wing
   stroked in response to male song. Other females sometimes approached females who
   wing stroked and observed them. We hypothesize that group-level changes in social
   organization and individual females' responses can serve as visual signals for other
   osts/COTTON-TOP                                             TAMARINS/COURTSHIP
   -YORK/NONINDEPENDENT                                                             MATE
   information/SEXUAL                                           SELECTION/social/social
   assortment/stroked/tests/USA/visual/when/wing/Wing stroke
Jolkkonen, J., Gallagher, N.P., Zilles, K. and Sivenius, J. (2003), Behavioral deficits
   and recovery following transient focal cerebral ischemia in rats: glutamatergic and
   GABAergic receptor densities. Behavioural Brain Research, 138 (2), 187-200.
Abstract: The neurobiologic mechanisms underlying the recovery process following
   stroke are poorly understood. The present study investigated glutamatergic and
   gamma-amino butyric acid (GABA)- ergic receptor densities following experimental
   stroke in rats exposed to different environmental housing or pharmacologic
   interventions. About 2 days after transient (120 min) middle cerebral artery (MCA)
   occlusion, the rats were singly housed in standard cages or were moved to an
   enriched environment and treated for 10 days with either 0.9% NaCl or with the
   alpha(2)- adrenoceptor antagonist, atipamezole (1.0 mg/kg, s.c.). The limb-placing,
   foot-slip, and watermaze tests were used to assess behavioral deficits and recovery
   following ischemia. The rats were decapitated on day 25 after the operation and their
   brains     were     processed      for     [H-3]MK-801,      [H-3]D,L,-alpha-amino-3-
   hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA), [H- 3]kainate, and
   [H-3]muscimol autoradiography. Receptor binding site densities were different
   between sham-operated rats and ischemic rats only in the lesion core and lateral
   ventroposterior thalamic nucleus. Ischemic rats housed in an enriched environment
   and treated with atipamezole had better performance in the limb-placing test. The
   deficit in the water- maze test was most pronounced in ischemic rats housed in
   standard cages. There were a number of correlations between the behavioral data and
   receptor binding densities in ischemic rats. For example, recovery in the limb-placing
   test correlated with [H-3]AMPA receptor binding sites in the contralateral frontal
   cortex (r = 0.616, P < 0.05), hindlimb cortex (r = 0.649, P < 0.05), and parietal cortex
   (r = 0.674, P < 0.05) in ischemic rats housed in an enriched environment. There were
   similar correlations between limb-placing recovery and [H- 3]kainate binding sites in
   the contralateral cortices in ischemic rats housed in standard cages. In addition, there
   were particularly strong clustered correlations between swimming speed in the
   water-maze test and [H-3]AMPA receptor binding sites in the hippocampal
   subregions in the ischemic rats housed in an enriched environment. The present
   results suggest that transient focal cerebral ischemia does not induce significant
  long-term changes in glutamatergic and GABAergic receptors in areas remote from
  the infarct area. The correlational data, however, suggest an important role for the
  contralateral cortex in the behavioral outcome and maintenance of the recovered state
  of ischemic rats, depending on housing conditions. In addition, attenuation of spatial
  learning deficits observed in ischemic rats housed in an enriched environment might
  be due to an increase in the swimming speed through hippocampal AMPA
  receptor-mediated mechanisms. (C) 2002 Elsevier Science B.V. All rights reserved
Keywords:                                addition/AMPA/ANTAGONIST/artery/ARTERY
  deficits/BRAIN/cerebral/cerebral                                            artery/cerebral
  ischemia/changes/cortex/CORTICAL INFARCTION/DAMAGE/deficits/enriched
  al/experimental      stroke/Finland/focal/focal      cerebral     ischemia/frontal/frontal
  cortex/functional                                                     recovery/GABA(A)
  receptor/GLUCOSE-UTILIZATION/infarct/ionotropic                                  glutamate
  cerebral/middle           cerebral           artery/middle         cerebral           artery
  orimotor             deficit/spatial/spatial           learning/spatial            learning
  deficit/speed/standard/stroke/swimming/swimming                         speed/SYNAPTIC
  PLASTICITY/tests/transient/transient focal cerebral ischemia/water/water maze
Braun, C.M., Dumont, M., Duval, J., Hamel, I. and Godbout, L. (2003), Opposed left
  and right brain hemisphere contributions to sexual drive: A multiple lesion case
  analysis. Behavioural Neurology, 14 (1-2), 55-61.
Abstract: Brain topographical studies of normal men have have shown that sexual
  excitation is asymmetric in the brain hemispheres. Group studies of patients with
  unilateral epileptic foci and other studies of patients with unilateral brain lesions
  have come to the same conclusion. The present study reviewed previously published
  single case reports of patients with frank hypo or hypersexuality subsequent to a
  unilateral brain lesion. Hyposexual patients tended to have left hemisphere lesions
  (primarily of the temporal lobe), and hypersexual patients tended to have right
  hemisphere lesions (primarily of the temporal lobe) (p < 0.05). We interpret this
  double dissociation as part of a more general phenomenon of psychic tone similarly
  dissociated with regard to hemispheric control. including mood, psychomotor
  baseline, speech rate, and even immunity. The behavioral significance of this psychic
  tone is to modulate approach versus avoidance behavior
Keywords:         analysis/approach/BEHAVIOR/brain/brain                lesions/Canada/case
  mal/patients/right/right                                      hemisphere/SECONDARY
  MANIA/single-case/speech/STROKE/temporal                        lobe/TEMPORAL-LOBE
Capone, J.G., Sala, S.D., Spinnler, H. and Venneri, A. (2003), Upper and lower face and
  ideomotor apraxia in patients with Alzheimer's disease. Behavioural Neurology, 14
  (1-2), 1-8.
Abstract: Introduction: Apraxia of face movement in Alzheimer's disease (AD) has been
  rarely investigated. This study aimed at investigating the frequency of lower (mouth,
  tongue and throat) and upper (eyes and eyebrows) face apraxia, in AD and its
   relationship with limb apraxia and severity of dementia. Methods: Fifty seven
   patients with AD were tested with a new standardised test of face apraxia including
   upper and lower face movements, which uses an item-difficulty weigthed scoring
   procedure, the IMA test, a test of ideomotor apraxia and the M.O.D.A.. a means to
   assess dementia severity. Results: Thirteen (23%) and 19 (33%) participants were
   below cut-off respectively on the upper and lower face apraxia test. Both sections of
   the Face Apraxia Test correlated significantly with the Ideomotor Apraxia Test.
   However, double dissociations between different types of apraxia were observed.
   Both the upper and lower face apraxia tests correlated significantly with the measure
   of dementia severity. Conclusions: The finding show that a proportion of AD patients
   fails face apraxia tests. Their face apraxia is interlinked with ideomotor limb apraxia,
   although dissociations are possible. Severity of dementia deterioration accounts for a
   good proportion of the variability of AD patients' performance on face apraxia tests
Keywords:                                                       AD/AGNOSIA/Alzheimer's
   ssociations/face       apraxia/frequency/ideornotor         apraxia/IMPAIRMENT/limb
   AL                     DYSPRAXIA/patients/performance/procedure/PROGRESSIVE
   LOSS/RIGHT-HEMISPHERE/Scotland/SPEECH                                OUTPUT/STROKE
Giles, G.I., Collins, C.A., Stone, T.W. and Jacob, C. (2003), Electrochemical and in
   vitro evaluation of the redox-properties of kynurenine species. Biochemical and
   Biophysical Research Communications, 300 (3), 719-724.
Abstract: Kynurenines are formed as part of the tryptophan metabolism and are known
   to exhibit pro- and anti-oxidant activities in vitro. The mapping of these biological
   redox-systems and identification of potential in vivo targets are therefore of great
   interest in cellular physiology. Here the redox-behavior of different kynurenines and
   anthranilic acids is evaluated electrochemically and compared to that of simple
   model compounds. Electrochemical results are correlated with the activity of these
   compounds in redox-bioassays where 3- hydroxyanthranilic acid and
   3-hydroxykynurenine have significant redox-activity. The specific electrochemical
   redox- behavior of these two compounds, indicating a particular redox- mechanism
   involving the hydroxyl group, can be used to rationalize these findings. The results
   indicate that tryptophan metabolites can undergo a range of complex redox- reactions
   in vivo whose precise nature critically depends on structural details. As a
   consequence, some of the kynurenines have the potential to contribute to neuronal
   damage in brain disorders and stroke. (C) 2002 Elsevier Science (USA). All rights
Keywords:                                                    3-HYDROXYANTHRANILIC
   EXCITANT/England/evaluation/identification/in vitro/in vivo/kynurenines/LIPID-
   ronal       damage/OXIDATION/oxidation               potential/physiology/QUINOLINIC
Shimamura, M., Morishita, R., Endoh, M., Oshima, K., Aoki, M., Waguri, S.,
   Uchiyama, Y. and Kaneda, Y. (2003), HVJ-envelope vector for gene transfer into
   central nervous system. Biochemical and Biophysical Research Communications,
   300 (2), 464-471.
Abstract: To overcome some problems of virus vectors, we developed a novel non-viral
  vector system, the HVJ-envelope vector (HVJ-E). In this study, we investigated the
  feasibility of gene transfer into the CNS using the HVJ-E both in vitro and in vivo.
  Using the Venus reporter gene, fluorescence could be detected in cultured rat
  cerebral cortex neurons and glial cells. In vivo, the reporter gene (Venus) was
  successfully transfected into the rat brain by direct injection into the thalamus,
  intraventricular injection, or intrathecal injection. without inducing immunological
  change. When the vector was injected after transient occlusion of the middle cerebral
  artery, fluorescence due to EGFP gene or luciferase activity could be detected only in
  the injured hemisphere. Finally. luciferase activity was markedly enhanced by the
  addition of 50 U/ml heparin (P < 0.01). Development of efficient HVJ-E for gene
  transfer into the CNS will be useful for research and clinical gene therapy. (C) 2002
  Elsevier Science (USA). All rights reserved
  nervous system/cerebral/cerebral artery/cerebral cortex/CEREBRAL-ARTERY
  GROWTH-FACTOR/fluorescence/gene/gene                therapy/gene      transfer/GERBIL
  BRAIN/glial                    cells/hemisphere/heparin/HVJ/in                  vitro/in
  vivo/IN-VIVO/intrathecal/intraventricular/ISCHEMIA/Japan/middle cerebral/middle
  cerebral       artery/nervous/nervous        system/neuron/neurons/occlusion/RAT/rat
Takeo, C., Nakamura, S., Tanaka, T., Uchida, D., Noguchi, Y., Nagao, T., Saito, Y. and
  Tatsuno, I. (2003), Rat cerebral endothelial cells express trk C and are regulated by
  neurotrophin-3. Biochemical and Biophysical Research Communications, 305 (2),
Abstract: Cerebral endothelial cells (CEC) are critical for formation of the vascular
  system in the mammalian central nervous system (CNS). We focused on the
  neurotrophin (NT) for its possible involvement in signaling for the regulation of CEC
  to control formation and maintenance of the vascular system in CNS in comparison
  of rat cerebral endothelial cells (RCEC) with rat aortic endothelial cells (RAEC). We
  found that (1) trk C, a receptor for neurotrophin-3 (NT-3), is dominantly expressed in
  RCEC but trk B, a receptor for brain-derived neurotrophic factor, is dominantly
  expressed in RAEC; (2) NT-3 inhibited the proliferation of RCEC; and (3) NT-3
  stimulated the production of nitric oxide (NO) with increases in protein expression of
  endothelial NO synthase. These data indicated that NT may regulate and/or maintain
  the functions of the brain microvasculature through tile regulation of CEC. (C) 2003
  Elsevier Science (USA). All rights reserved
Keywords:              ANGIOGENESIS/aortic/BLOOD-BRAIN-BARRIER/brain/brain
  microvasculature/brain-derived          neurotrophic       factor/central       nervous
  system/cerebral/cerebral endothelial cells/CNS/comparison/control/CULTURED
  NERVOUS-SYSTEM/endothelial/endothelial                 cells/INDUCTION/ISCHEMIC
  system/neurotrophic/neurotrophic              factor/neurotrophin/neurotrophin-3/nitric
  oxide/NITRIC-                         OXIDE                       SYNTHASE/NO/NO
  OTH-MUSCLE CELLS/trk/USA/vascular
Woodside, K.J., Hernandez, A., Smith, F.W., Xue, X.Y., Hu, M.D., Daller, J.A. and
  Hunter, G.C. (2003), Differential gene expression in primary and recurrent carotid
  stenosis. Biochemical and Biophysical Research Communications, 302 (3), 509-514.
Abstract: Apoptosis of the cellular components of complex atherosclerotic plaque may
  lead to plaque instability and rupture. In this study, five primary plaques and one
  recurrent fibrointimal lesion obtained from patients undergoing carotid
  endarterectomy for symptomatic carotid stenosis greater than or equal to 70% were
  analyzed by immunohistochemistry and cDNA microarray to identify gene
  expression patterns that may determine plaque susceptibility or resistance to
  apoptosis. Immunohistochemistry showed expression of active caspase 3, an effector
  of apoptosis, in macrophages and lymphocytes surrounding the lipid core, in smooth
  muscle cells in the fibrous cap, and media of primary plaques as well as in occasional
  smooth muscle cells in the recurrent lesion. Among the genes demonstrating
  increased expression in primary plaques were IGFR2, DR4, DAPK1, Bak, and ERK1
  and 2 and those showing decreased expression included the TNF receptors I and 2,
  akt1, and IGFBP3. When comparing the recurrent lesion to the normal tissue, the
  expression of 13 genes was decreased by Mold, includin