Search Results for: Come stress e attacchi di cuore sono collegati

This systematic review and network meta-analysis evaluates psychiatric interventions in pediatric posttraumatic stress disorder.

Objectives
To evaluate the effect of delivery hospital busyness on the postnatal condition and the perinatal mortality among small preterm infants born at ≤32+0 gestational weeks.

Design
The daily delivery volume distribution is defined as lowest 10% (‘quiet’) and highest 10% (‘busy’) delivery-volume days, and days between (80%) as optimal delivery-volume days. We analysed differences in the incidence of selected adverse outcomes between quiet and busy days compared with optimal delivery-volume days by logistic regression followed by crude (ORs) and adjusted ORs (aORs) with 99% CIs.

Setting
A population-based cohort study based on prospectively collected real-world data from five university hospitals and 21 non-tertiary-level delivery hospitals in Finland, 2006-2016.

Participants
4323 small preterm infants.

Primary outcome measures
Umbilical cord pH ≤7.05, Apgar score 0–3 points at the age of 1 min, Apgar score 0–3 points at age 5 min, birth asphyxia (International Classification of Diseases-10 code), resuscitation with intubation.

Secondary outcome measures
Perinatal mortality comprising stillbirths and early neonatal deaths (

Objectives
Population ageing and the rise in chronic diseases place continual stress on healthcare systems. Scarce resources often impede equitable access to healthcare, particularly in rural areas, resulting in prolonged waiting times and heightened risks of morbidity and mortality. Telemedicine has emerged as a promising solution, offering remote and equitable care that could potentially bridge access gaps and enhance health outcomes. This systematic review aims to quantitatively examine the impact of telemedicine implementation on waiting times, defined as the time passed from the booking of a visit for an outpatient to the administration of the service.

Design
A systematic review was conducted using studies on telemedicine interventions that specifically addressed waiting times. Bias assessment was performed with three tools: ROBINS-I (“Risk of Bias In Non-Randomized Studies of Interventions”), AXIS (“Appraisal tool for Cross-Sectional Studies”) and RoB-2 (“Risk of Bias-2”). A weighted mean approach was used to synthesise results, with medians synthesised using a median approach.

Data sources
Articles in English were retrieved from the PubMed and Scopus databases.

Eligibility criteria
Studies were excluded if they did not specifically address waiting times related to telemedicine interventions. Only studies that considered waiting times defined as the time passed from the booking of a visit for an outpatient to the administration of the service and any telemedicine intervention were included.

Data extraction and synthesis
A total of 53 records were included, encompassing 270 388 patients in both the experimental and control groups. The weighted mean reduction in waiting times was calculated, and bias was assessed. No record was evaluated to be at high risk of bias, with 69.8% of studies evaluated at low risk and 26.4% at moderate risk (3.8% were surveys). Results were synthesised using a weighted mean approach for studies reporting means, and a median approach for studies reporting medians.

Results
Overall, a weighted mean reduction of 25.4 days in waiting times was observed. Focusing on clinical specialties (n=114 042), the weighted mean reduction amounted to 34.7 days, while in surgical patients (n=156 346), telemedicine was associated with a weighted mean of 17.3 days saved.

Conclusions
The implementation of telemedicine solutions may significantly improve waiting times, potentially leading to more efficient and equitable healthcare systems.

PROSPERO registration number
CRD42023490822.

Al via CVrisk-IT in tutta Italia. Filippo Magnini testimonial

Al via CVrisk-IT in tutta Italia. Filippo Magnini testimonial

Il campione di nuoto testimonial del progetto Rete Cardiologica

Stroke, Volume 56, Issue Suppl_1, Page AWP186-AWP186, February 1, 2025. Background and Purpose:Primary aldosteronism (PA) is characterized by the autonomous overproduction of aldosterone leading to the risk of occurrence of acute ischemic stroke (AIS), but the exact prevalence of PA is unknown in patients with AIS. PA induces oxidative stress and inflammation through vascular endothelial cells, which may damage small vessel disease (SVD). We conducted a prospective study to investigate the prevalence of screening and definite diagnosis of PA in patients with AIS. Next, we aimed to reveal whether SVD markers could be associated with PA.Methods:We screened consecutive patients with AIS who participated in our prospective study to investigate the prevalence of PA and followed up for PA evaluation from October 2020 to December 2022. Inclusion criteria were patients with AIS hospitalized and diagnosed with hypertension. Exclusion criteria were patients taking medications affecting renin, aldosterone, and catecholamines. The screening criteria for PA was defined as the aldosterone-to-renin ratio > 200. Final diagnosis of PA was judged by endocrinologist if one of the captopril challenge test, saline infusion test, and furosemide-upright test was positive following discharge. We evaluated total SVD score based on white matter hyperintensities (separately scored by periventricular hyperintensity [PVH] and deep and subcortical white matter hyperintensity), cerebral microbleeds (CMBs; categorized into deep, lobar, and infratentorial lesions), enlarged perivascular spaces (separately scored in basal ganglia and centrum semiovale), and old lacunes on MRI.Results:We included 120 patients with AIS (93 [78%] male, median age 62 years, Figure 1). The screening for PA was positive in 33 (28%) patients and 8 (7%) patients were finally diagnosed with definite PA. In Poisson regression analysis with a robust variance estimator, total SVD score was related to positive PA screening (prevalence ratio [PR] 1.261, 95% CI 1.021-1.556,p= 0.031) and definite PA diagnosis (PR 1.946, 95% CI 1.229-3.082,p= 0.005, Figure 2). In terms of each SVD marker, severe PVH, and deep and lobar CMBs were associated with positive PA screening and definite PA diagnosis (Figure 3).Conclusions:Twenty-eight percent of patients with AIS were positive for PA screening, and then about a quarter of them were confirmed as definite PA. SVD burden, especially PVH, and deep and lobar CMBs, might be associated with positive screening and definite diagnosis of PA.

Stroke, Volume 56, Issue Suppl_1, Page ATP310-ATP310, February 1, 2025. Introduction:Intracerebral Hemorrhage (ICH) is associated with a high case fatality and survivors of ICH are at increased risk for ICH recurrence. Roughly 20-30% of patients with ICH take a statin at the time of ICH onset. The role of statins, whether protective or deleterious, in the setting of ICH remains unclear. The SPARCL (Stroke Prevention by Aggressive Reduction of Cholesterol Level) study amongst others, have suggested that statin use may increase risk of ICH in those with prior history ICH, due to increased erythrocyte fragility and inhibition of platelet aggregation. However subsequent observational studies refuted these findings citing statins improve endothelial function and reduce oxidative stress thus theoretically. We reviewed relevant studies discussing the relationship between statin use and risk of ICH.Methods:A comprehensive search strategy utilizing the key terms “statin use” and “intracerebral hemorrhage” was performed utilizing four electronic databases: Cochrane, Embase, Google Scholar, PubMed. The search was conducted by two authors (PM and CO). Following the search, articles citing a correlation between statin use and risk of intracerebral hemorrhage were included. Below is a table citing selected studies from our review (Table 1).Discussion:There continues to be mixed evidence regarding statin use and risk of ICH. Current clinical guidelines do not provide a formal recommendation on statin use restriction in those with prior ICH. However, contrary to the SPARCL study, newer studies have suggested there is neither a statistically nor clinically significant relationship between LDL-C and ICH incidence. Our review also uncovered that one’s genetic signature may play a mediating role in this relationship as evidenced namely by the Honolulu Heart study, which analyzed a relatively monogenic study population. This implies a more nuanced relationship and we posit the burgeoning use of polygenic risk scoring may provide more utility here as well. Ultimately consideration of statin therapy should be determined by weighing one’s atherogenicity versus propensity to develop ICH. An optimal LDL-C goal has yet to be determined however many studies suggest targeting between 70-160 mg/dL is optimal. Additional studies should assess the role of other lipid lowering agents in the setting of ICH such as bempedoic acid and PCSK9 inhibitors, as well as discern optimal ranges for newer Apo-B and Lp(a) lipid biomarkers.

Stroke, Volume 56, Issue Suppl_1, Page AWP176-AWP176, February 1, 2025. Introduction:Informed consent for clinical trials in the acute stroke setting is challenging. There is a need for context-appropriate approaches to consent, but few data exist regarding implementation of innovative approaches. In the Multi-Arm Optimization of Stroke Thrombolysis (MOST) trial (NCT03735979), a consent process was designed in collaboration with patient advisors that included a short consent form and a companion information sheet. This approach was implemented at all study sites, and participants’ experiences were assessed using a post-enrollment survey.Methods:All participants enrolled in MOST were eligible for the survey. The person who provided consent for enrollment (patient or surrogate) was asked to fill out the survey. The survey was adapted from a prior survey of patients’ and surrogates’ experiences with consent in acute care research and was cognitively pre-tested. Descriptive statistics were tabulated. Likert scale responses on a scale of 1-5 with 1 being strongly agree and 5 being strongly disagree and on a scale of 1-5 with 1 being extremely helpful and 5 being not helpful at all were collapsed into agree (1-2)/not agree (3-5) and helpful (1-2)/not helpful (3-5), respectively.Results:There were 195 completed surveys out of 514 enrollments in the MOST trial (overall capture rate 37.9%). Seventeen surveys were excluded due to mismatch between who consented to MOST and who completed the survey (total n=178 analyzable surveys). Patients completing the survey (or for whom a surrogate completed the survey) were similar to the overall enrolled population in terms of age, sex, race, and stroke severity (Table 1). The average age of survey respondents was 60.1 years, with 42.1% being male and 61.8% being surrogates (Table 2). Overall patients’ and surrogates’ experiences were positive. Post-enrollment communication and consent materials were viewed favorably (Table 3). Open-ended feedback was positive; participants acknowledged that time stress was intrinsic to the situation, encouraged simplicity, and offered few suggestions for improvement.Conclusions:A patient-centered consent process in an acute stroke trial was positively viewed by both patients and surrogates. Embedding assessments of patients’ and surrogates’ experiences within clinical trials offers an important opportunity for understanding the impact of innovation regarding consent.

Stroke, Volume 56, Issue Suppl_1, Page A81-A81, February 1, 2025. Background:Cerebral aneurysm rupture has a poor prognosis, and a growing aneurysm is prone to rupture. Although hemodynamics is thought to play an important role in aneurysm growth, it is not well understood what hemodynamic environments are involved. We therefore conducted the NHO CFD ABO Study, a prospective observational study to clarify the aneurysm growth risk associated with hemodynamics.Methods:Computational fluid dynamics analysis was performed using the unique arterial geometry and flow velocities of the enrolled patients. Hemodynamic metrics were compared by multivariate analysis between aneurysms that grew more than 1 mm and those that did not during the 3-year observation period, using known growth risks as confounding factors.Results:A total of 481 patients were enrolled, and 26 growth aneurysms and 176 non-growth aneurysms met the criteria. For aneurysms

Stroke, Volume 56, Issue Suppl_1, Page AWP193-AWP193, February 1, 2025. Introduction:Intracranial atherosclerotic disease (ICAD) is a common cause of primary and secondary stroke. Understanding plaque evolution can help in risk stratification and in selecting proper therapies.Hypothesis:In this study, we hypothesized that vessel wall radiomics and hemodynamic features correlate with longitudinal change in plaque volume.Methods:Patients with ICAD and history of cerebral ischemia were included. Time-of-flight MRA, high-resolution vessel wall imaging (proton density-weighted, PD, and contrast-enhanced T1-weighted, T1CE) and phase-contrast MR-based volumetric flow (NOVA) were collected at multiple time points. MRA was used to segment lumen and perform computational fluid dynamics (CFD). NOVA flow rate used as boundary conditions. Plaques were segmented on PD images from each time point. PD and T1CE scans were co-registered and radiomics features (RFs) were extracted from the first time point from both image types. Plaques were compared between consecutive time points and classified as progressing, stable, or regressing, based on volume change (those

Stroke, Volume 56, Issue Suppl_1, Page AWMP111-AWMP111, February 1, 2025. Background:Stroke or traumatic brain injury (TBI), due to damage to the cerebral motor cortex, often results in significant motor dysfunction and disabilities. Cell replacement therapy emerges as a prospective alternative treatment, promising to restore the impaired neural circuits and facilitate functional recovery. The current study aimed to systemically identify new factors capable of enhancing the efficacy of cell transplantation with human-induced pluripotent stem cell-derived cerebral organoids (hiPSC-COs). Earlier research demonstrated the effectiveness of delaying the transplantation procedure by 1 week and we hypothesized in this study that brain tissues 1 week after brain damage possess a more favorable environment for cell transplantation when compared to immediately after injury.Methods and Results:Using rodent models, we made a transcriptomic comparison to differentiate gene expression between these two temporal states in order to discern novel factors that could potentiate the therapeutic impact of cell transplantation. Ultimately, 7 candidate genes coding for secreted and extracellular proteins (apolipoprotein D, cathepsin D, cathepsin S, lysozyme 2, secreted phosphoprotein 1, granulin, and secreted protein acidic and cysteine rich) were selected through the transcriptome analysis. In controlled in vitro conditions, recombinant human progranulin (rhPGRN) bolstered the survival rate of dissociated neurons sourced from hiPSC-COs by approximately 25% under oxidative stress. Further experiments revealed that this increase in viability was attributable to a reduction in apoptosis via Akt phosphorylation. In addition, rhPGRN pretreatment before in vivo transplantation experiments augmented the number of engrafted cells about 3.3 times compared to the control group and facilitated neurite elongation along the host brain’s corticospinal tracts in rodent models. Subsequent histological assessments at 3 months post-transplantation revealed an elevated presence of graft-derived subcerebral projection neurons—crucial elements for reconstituting neural circuits—in the rhPGRN-treated group.Conclusion:Our data highlight the potential of PGRN as a neurotrophic factor suitable for incorporation into hiPSC-CO-based cell therapies for stroke or TBI.

Stroke, Volume 56, Issue Suppl_1, Page ATP321-ATP321, February 1, 2025. Introduction:The African Rigorous Innovative Stroke Epidemiological Surveillance (ARISES) study is focused on developing an integrated mHealth community-based interactive Stroke Information and Surveillance System. This is the first paper to qualitatively investigate and contrast community beliefs, attitudes, and practices related to stroke prevention, risk factors and care from alternative/complementary medicine providers/healers, orthodox/modern medicine/health care providers, community members and leaders in Nigeria.Methods:Six focus groups with community members and leaders (n=57) and key informant interviews with health providers (n=24) from alternative/complementary medicine providers and orthodox/modern medicine providers were conducted to qualitatively explore beliefs, attitudes, practices, and recommendations related to stroke in urban (Ibadan) and rural (Ibarapa) communities in Nigeria. The Health Belief Model and Social Ecological Model guided the questions and thematic analysis of the qualitative data.Results:Participants perceived stroke as disabling though manageable but with odds of repeat stroke for survivors. High blood pressure, stress, sleep issues, heredity, and lifestyle factors were some stroke risk factors perceived by participants from both sites although God, witchcraft/evil people were reported by rural participants. Hospital visits and consumption of herbal concoction, self-medication and visit to church for prayers were some actions taken to manage stroke by both urban and rural participants. Low literacy levels, limited funds, fear of and distance to hospitals, and absence of insurance were some barriers to uptake of recommendations from orthodox medicine practitioners which are drivers to unorthodox practitioners. To improve stroke care and prevention across communities, free risk factor screening, indigenous stroke awareness programs via print, audio-visual and electronic media were suggested by all participants.Conclusion:Diverse beliefs and practices are related to stroke risk factors, prevention and care and barriers with obtaining care. There is need to work across systems to improve stroke prevention and care in communities.

Stroke, Volume 56, Issue Suppl_1, Page ATMP51-ATMP51, February 1, 2025. Introduction:Strokes lead to acute deficits with wide-ranging severity. Genetic variation may explain some of these inter-subject differences. The current report examined the relationship that candidate genetic variants have with acute injury and acute behavioral deficits. We hypothesized that variants known to be associated with poorer stroke recovery would also be associated with more a severe acute presentation.Methods:Infarcts were outlined on clinical scans acquired during acute stroke admission as part of the STRONG (“Stroke, sTress, RehabilitatiON, and Genetics”) study and resampled to MNI152 brain standard space. Multivariable linear regression modeling was used to examine association with genetic measures known to be related to stroke outcome: 3 single nucleotide polymorphisms (SNPs): BDNF (rs6265), ACE (rs4291), and FAAH (rs324420), plus ApoE e4 and ApoE e2; a dopamine polygene score was also explored. Acute injury (infarct volume) and acute deficits (NIHSS score, grip strength, and acute stress disorder inventory (ASDI)) were each examined as the dependent measure in separate models that used age, gender, and ancestry as covariates. To understand where in the brain these relationships occurred, voxel lesion symptom mapping (VLSM) was used to test for associations between acute injury and each genetic measure.Results:In 448 subjects (age 63.4±14.4 yr (mean±SD), 43.1% females), lesion volume ranged from 0.46 to 535.13 cc and involved cortical grey matter in 63% of patients. Larger lesion volume was associated with presence of the ACE SNP (β=8.77, p=0.03); lower NIHSS score, with ApoE e4 (β=-1.69, p=0.04); greater grip strength, with ApoE e2 SNPs (β=6.78, p=0.03); and higher ASDI, with the ACE SNP (β=0.56, p=0.05). VLSM revealed that acute injury to the postcentral gyrus was significantly more likely in the presence of the ACE SNP (z=-3.5), and that acute injury to the calcarine fissure was significantly more likely in the presence of the BDNF SNP (z=-2.53).Conclusions:Genetic variants known to be associated with differences in stroke recovery are also related to acute stroke deficits and injury. In particular, a common variant in the gene for ACE was associated with differences in lesion volume and location, findings that may suggest a personalized medicine approach to acute therapy. Measures of genetic variability may be useful to understand inter-subject differences in acute injury and symptom severity, and may have therapeutic implications.

Stroke, Volume 56, Issue Suppl_1, Page ATMP71-ATMP71, February 1, 2025. Background:Intracerebral hemorrhage (ICH) is the second most prevalent type of stroke, but carries the greatest degree of mortality and morbidity. In addition to the primary injury due to mechanical stress and mass effect on adjacent brain regions, uncontrolled inflammation in the peri-hematomal area constitutes a secondary insult that can exacerbate tissue damage, leading to cerebral edema, neuronal death, and thus worse clinical outcomes. Prior efforts at controlling ICH-related inflammation reported mixed outcomes, likely reflecting our poor understanding of the evolving inflammatory cascade following ICH. In this investigation we sought to better characterize the cellular immune response in the acute period following ICH.Methods:Surgical candidates for minimally invasive hematoma evacuation were approached for participation in this study. We collected evacuated clots, and small biopsies from peri-hematomal brain, and matched peripheral blood immediately preceding surgical evacuation, and on days 1, 3, and 5-7 post-surgery. We then isolated all immune cells from each compartment and performed transcriptomic profiling by single cell RNA-sequencing, from 6 patients operated on at time points ranging from 4 to 29 hours after time of last known well.Results:Data from 5 male and 1 female patient 46-79 years old are reported. Our data analyses showed an evolving inflammatory cascade consisting primarily of neutrophils and macrophages that is very similar in the blood and clot compartments. Importantly, the time elapsed between ICH incidence and surgical evacuation is positively correlated with the emergence of an inflammatory osteopontin-expressing macrophage population in the blood clot, and a unique microglial signature in the peri-hematomal brain. We also found that the presence of a fibrin-laden blood clot in the brain initiates an early and evolving gene signature in neutrophils and microglia in the brain parenchyma, that is distinct from the inflammatory responses identified in peripheral blood.Conclusions:Our findings show that rapid surgical evacuation of the hematoma within the first 4-5 hours limits the inflammatory insult, and highlight key immune cell populations involved in the inflammatory response post-ICH. We also identified key pathways driving these inflammatory responses, thereby providing novel potential therapeutic targets for patients with ICH.

Stroke, Volume 56, Issue Suppl_1, Page ATP366-ATP366, February 1, 2025. Introduction:In stroke clots, neutrophil extracellular traps (NETs) promote thrombosis, enhance clot stability, and decrease clot amenability to thrombectomy and thrombolysis.Objective:We examine the relationship between NET enrichment and clot mechanical characteristics, radiomics, and histological microstructure.Methods:White blood cells (WBCs) were concentrated from human donor whole blood. Platelet-rich plasma and red blood cells (RBCs) were isolated by centrifugation and mixed with WBCs to produce 0%, 20%, and 40% RBC clot analogs. Lipopolysaccharide (LPS) was added (0μL, 2μL, 6μL into 1mL dH2O) to enrich clots with varying NET amounts. CaCl2 induced clotting. Clots were incubated while rotating at 37°C. Clot analogs were assessed mechanically by uniaxial stretch tester and stress-strain curves, radiomically through high-resolution microCT and radiomic feature analysis, and histologically through whole-slide imaging of H&E-stained tissue and immunofluorescence (Citrullinated Histone Antibody and DAPI counterstain) to quantify NETs. Statistical analysis assessed what mechanical, radiomic, and histological features were significantly different among clots of various NET enrichment. unsupervised clustering was performed on radiomic and histological features to identify signatures unique to NET-enriched clots.Results:LPS addition produced clots with increasing NET enrichment and microstructural complexity. For fibrin-platelet rich clots (0% RBC), NET enrichment produced significant increase in mechanical stiffness, measured by breaking strength (max load) and Young’s Modulus. For each percent composition, radiomic and histomic profiling clustered clot analogs well by NET-enrichment, with NET-enriched clots demonstrating distinct radiomic and histological feature trends. See Figure 1.Conclusion:NET enrichment produces mechanically stiffer clot analogs with distinct microstructure, radiomic, and histological profiles.