Mechanical Thrombectomy for Acute Ischemic Stroke in Metastatic Cancer Patients: A Nationwide Cross-Sectional Analysis

BACKGROUND AND PURPOSE: Mechanical thrombectomy (MT) is the standard treatment for large vessel occlusion (LVO) acute ischemic stroke. Patients with active malignancy have an increased risk of stroke but were excluded from MT trials. METHODS: We searched the National Readmission Database for LVO patients treated with MT between 2016-2018 and compared the characteristics and outcomes of cancer-free patients to those with metastatic cancer (MC). Primary outcomes were all-cause in-hospital mortality and favorable outcome, defined as a routine discharge to home (regardless of whether home services were provided or not). Multivariate regression was used to adjust for confounders. RESULTS: Of 40,537 LVO patients treated with MT, 933 (2.3%) had MC diagnosis. Compared to cancer-free patients, MC patients were similar in age and stroke severity but had greater overall disease severity. Hospital complications that occurred more frequently in MC included pneumonia, sepsis, acute coronary syndrome, deep vein thrombosis, and pulmonary embolism (P\u3c0.001). Patients with MC had similar rates of intracerebral hemorrhage (20% vs. 21%) but were less likely to receive tissue plasminogen activator (13% vs. 23%, P\u3c0.001). In unadjusted analysis, MC patients as compared to cancer-free patients had a higher in-hospital mortality rate and were less likely to be discharged to home (36% vs. 42%, P=0.014). On multivariate regression adjusting for confounders, mortality was the only outcome that was significantly higher in the MC group than in the cancerfree group (P\u3c0.001). CONCLUSION: LVO patients with MC have higher mortality and more infectious and thrombotic complications than cancer-free patients. MT nonetheless can result in survival with good outcome in slightly over one-third of patients

Study on the short-term effects of increased alcohol and cigarette consumption in healthy young men's seminal quality

Many studies have reported a negative impact of lifestyle factors on testicular function, spermatozoa parameters and pituitary-gonadal axis. However, conclusions are difficult to draw, since studies in the general population are rare. In this study we intended to address the early and late short-term impact of acute lifestyle alterations on young men's reproductive function. Thirty-six healthy male students, who attended the Portuguese academic festivities, provided semen samples and answered questionnaires at three time-points. The consumption of alcohol and cigarette increased more than 8 and 2 times, respectively, during the academic festivities and resulted in deleterious effects on semen quality: one week after the festivities, a decrease on semen volume, spermatozoa motility and normal morphology was observed, in parallel with an increase on immotile spermatozoa, head and midpiece defects and spermatozoa oxidative stress. Additionally, three months after the academic festivities, besides the detrimental effect on volume, motility and morphology, a negative impact on spermatozoa concentration was observed, along with a decrease on epididymal, seminal vesicles and prostate function. This study contributed to understanding the pathophysiology underlying semen quality degradation induced by acute lifestyle alterations, suggesting that high alcohol and cigarette consumption are associated with decreased semen quality in healthy young men.publishe

Comparison between the efficacy of underwater treadmill and over-ground treadmill training program on knee joint during gait cycle of stroke patients

Introduction: Gait disorder is a common clinical problem for stroke survivors that impacts performance of activities of daily living.&nbsp;Objective: This study was conducted to compare between the efficacy of underwater Treadmill Training Program (TTP) and over-ground (TTP) in improving knee joint Range of Motion (ROM) during the gait cycle of stroke patients.&nbsp;Study design: Randomized control trial.&nbsp;Methods: Forty male patients suffering from post-stroke gait deficits were assigned randomly into two equal groups: study group (A): Received underwater treadmill training program. Control group (B) received over-ground treadmill training program. Patients of both groups were assessed for knee Range of Motion (ROM) during gait cycle using slow motion video and goniometer iPad application. Assessment was done before and after four weeks of treatment for both groups.&nbsp;Results: The comparison between groups post treatment showed a significant increase in knee flexion ROM in initial contact and pre-swing phase and increase in knee extension ROM in mid stance phase of the study group (A) compared with that of control group (B).&nbsp;Conclusion: Under water TTP is more effective than over-ground TTP on improving knee joint ROM during the gait cycle of stroke patients.</p

A Comparative Study on the Effect of Task Specific Training on Right Versus Left Chronic Stroke Patients

Functional impairment of the upper limb (UL) after stroke is a great problem. Finding methods that can improve UL function after stroke is a major concern to all medical service providers. This study was intended to compare the effect of upper limb task specific training (TST) on brain excitability of the affected hemisphere and motor function improvements in patients with left and right stroke. Forty male patients with mild impairment of UL functions were divided into two equal groups; G1 consisted of patients with left hemisphere affection (right side stroke) while G2 consisted of patients with right hemisphere affection (left side stroke). All patients received TST for the affected UL for one hour, three sessions per week for six consecutive weeks. Evaluation was performed twice, pre-, and post-treatment. Outcome measures used were Wolf Motor Function Test (WMFT) and Box and Block Test (BBT) as measures of UL motor function and Quantitative Electroencephalogram (QEEG) of motor and sensory areas of the affected hemisphere as a measure of brain reorganization post-stroke. Both groups showed improvement in motor function of the affected UL measured by WMFT and BBT with reported significant difference between them. G1 showed greater improvement in motor function of the affected UL post-treatment compared to G2. Additionally, there was a significant increase in peak frequency of motor and sensory areas with higher and significant excitability in G1 only. These findings imply that brain reorganization in the left hemisphere responded more to TST compared to the right hemisphere. Based on findings of the current study, we can recommend adding TST to the physical therapy program in stroke patients with left hemisphere lesions

Effect of underwater treadmill program on gait speed, balance and lower extremity function in stroke patients

Objective: The purpose of this study was to determine whether using an underwater treadmill program could enhance gait speed, balance and lower extremity function. Study design: Randomized control trial. Methods: Forty post-stroke male patients with abnormalities in gait and balance were divided randomly into two equal groups: Study group (A): was given a program for an underwater treadmill. A treadmill program on the ground was given to the control group (B). The ten-meter walk test was used to assess the gait speed of patients in both groups. Assessment of functional capacity utilizing the lower extremity functional scale and the Posturomed device for balance. For all groups, assessments were performed before and after the four-week therapy period. Results: Post treatment results revealed a significant increase in gait speed in both groups but no significant difference between them. More significant increase in balance and lower extremity function in the study group (A) than in control group (B) Conclusion: Underwater treadmill training program is an effective program in improving, balance, gait speed and lower extremity function in stroke patients

Short-term Outcomes of Hypertensive Crises in Patients with Orthostatic Hypotension

INTRODUCTION: Supine hypertension-orthostatic hypotension disease (SH-OH) poses a management challenge to clinicians. Data on short term outcomes of patients with OH who are hospitalized with hypertensive (HTN) crises is lacking METHODS: The Nationwide Readmission Database 2016-2019 was queried for all hospitalizations of HTN crises. Hospitalizations were stratified according to whether OH was present or not. We employed propensity score to match hospitalizations for patients with OH to those without, at 1:1 ratio. Outcomes evaluated were 30-days readmission with HTN crises or falls, as well as hospital outcomes of in-hospital mortality, acute kidney injury (AKI), acute congestive heart failure (CHF), acute coronary syndrome (ACS), type 2 myocardial infarction (T2MI), aortic dissection, stroke, length of stay (LOS), discharge to nursing home and hospitalization costs. RESULTS: We included a total of 9,451 hospitalization (4,735 in the OH group vs 4,716 in the control group). OH group was more likely to be readmitted with falls (Odds ratio [OR]:3.27, p\u3c0.01) but not with HTN crises(p=0.05). Both groups had similar likelihood of developing AKI (p=0.08), stroke/TIA (p=0.52), and aortic dissection(p=0.66). Alternatively, OH group were less likely to develop acute HF (OR:0.54, p\u3c0.01) or ACS (OR:0.39, p\u3c0.01) in the setting of HTN crises than non-OH group. OH group were more likely to have longer LOS and have higher hospitalization costs. CONCLUSION: Patients with OH who are admitted with HTN crises tend to have similar or lower HTN-related complications to non-OH group while having higher likelihood of readmission with falls, LOS and hospitalization costs. Further studies are needed to confirm such findings