Letter by Scheitz et al regarding article, "Randomized controlled trial of early versus delayed statin therapy in patients with acute ischemic stroke: ASSORT trial (administration of statin on acute ischemic stroke patient)"

No abstract available

Una intervención breve de Terapia de Aceptación y Compromiso en internos varones con propensión a la violencia llevada a cabo por terapeutas noveles

Acceptance and mindfuln ess -oriented cognitive and behavioral therapies, such as Acceptance and Commitment Therapy (ACT) are implemented in a wide range of different populations, but are not commonly used currently in correctional facilities. Objective: This study aimed to assess an intervention based on ACT in comparison with a treatment as usual condition (TAU) among inmates. Method: We compared 10 group sessions of ACT ( n = 9) with TAU ( n = 8) among male prisoners charged with violent crimes, administered by novice ACT therapists . Results : At post - intervention, ACT was more effective in enhancing values -consistent behaviors than TAU as measured by the Valued Living Questionnaire. Depression, anxiety and psychological flexibility did not change after any of the treatments. These r esu lts were maintained at three -month follow -up. Conclusions: A brief ACT intervention delivered by inexperienced ACT therapists can be effective in increasing values -behavior c onsistency among male inmates. ACT may be a viable and cost -effective intervention alternative in penitentiary contexts

Are you suffering from a large arterial occlusion? Please raise your arm!

Background and purpose: Triage tools to identify candidates for thrombectomy are of utmost importance in acute stroke. No prognostic tool has yet gained any widespread use. We compared the predictive value of various models based on National Institutes of Health Stroke Scale (NIHSS) subitems, ranging from simple to more complex models, for predicting large artery occlusion (LAO) in anterior circulation stroke. Methods: Patients registered in the SITS international Stroke Register with available NIHSS and radiological arterial occlusion data were analysed. We compared 2042 patients harbouring an LAO with 2881 patients having no/distal occlusions. Using binary logistic regression, we developed models ranging from simple 1 NIHSS-subitem to full NIHSS-subitems models. Sensitivities and specificities of the models for predicting LAO were examined. Results: The model with highest predictive value included all NIHSS subitems for predicting LAO (area under the curve (AUC) 0.77), yielding a sensitivity and specificity of 69% and 76%, respectively. The second most predictive model (AUC 0.76) included 4-NIHSS-subitems (level of consciousness commands, gaze, facial and arm motor function) yielding a sensitivity and specificity of 67% and 75%, respectively. The simplest model included only deficits in arm motor-function (AUC 0.72) for predicting LAO, yielding a sensitivity and specificity of 67% and 72%, respectively. Conclusions: Although increasingly more complex models yield a higher discriminative performance for predicting LAO, differences between models are not large. Assessing grade of arm dysfunction along with an established stroke-diagnosis model may serve as a surrogate measure of arterial occlusion-status, thereby assisting in triage decisions

Early recurrent ischemic lesions in patients with cryptogenic stroke and patent foramen ovale: an observational study

Background: Randomized controlled trials indicate that patent foramen ovate (PFO) closure reduces risk of stroke recurrence in patients with cryptogenic stroke and PFO. However, the optimal time point for PFO closure is unknown and depends on the risk of stroke recurrence. Objective: We aimed to investigate risk of early new ischemic lesions on cerebral magnetic resonance imaging (MRI) in cryptogenic stroke patients with and without PFO. Methods: Cryptogenic stroke patients underwent serial MRI examinations within 1 week after symptom onset to detect early new ischemic lesions. Diffusion-weighted imaging (DWI) lesions were delineated, co-registered, and analyzed visually for new hyperintensities by raters blinded to clinical details. A PFO was classified as stroke-related in patients with PFO and a Risk of Paradoxical Embolism (RoPE) score >5 points. Results: Out of 80 cryptogenic stroke patients, risk of early recurrent DWI lesions was not significantly different in cryptogenic stroke patients with and without PFO. Similar results were observed in patients <= 60 years of age. Patients with a stroke-related PFO even had a significantly lower risk of early recurrent ischemic lesions compared to all other patients with cryptogenic stroke (unadjusted odds ratio 0.23 [95% confidence interval 0.06-0.87], P = 0.030). Conclusion: Our data argue against a high risk of early stroke recurrence in patients with cryptogenic stroke and PFO

Clinical selection strategies to identify ischemic stroke patients with large anterior vessel occlusion: results from SITS-ISTR (Safe Implementation of Thrombolysis in Stroke International Stroke Thrombolysis Registry)

Background and Purpose—The National Institutes of Health Stroke Scale (NIHSS) correlates with presence of large anterior vessel occlusion (LAVO). However, the application of the full NIHSS in the prehospital setting to select patients eligible for treatment with thrombectomy is limited. Therefore, we aimed to evaluate the prognostic value of simple clinical selection strategies. Methods—Data from the Safe Implementation of Thrombolysis in Stroke International Stroke Thrombolysis Registry (January 2012–May 2014) were analyzed retrospectively. Patients with complete breakdown of NIHSS scores and documented vessel status were included. We assessed the association of prehospital stroke scales and NIHSS symptom profiles with LAVO (internal carotid artery, carotid-terminus or M1-segment of the middle cerebral artery). Results—Among 3505 patients, 23.6% (n=827) had LAVO. Pathological finding on the NIHSS item best gaze was strongly associated with LAVO (adjusted odds ratio 4.5, 95% confidence interval 3.8–5.3). All 3 face–arm–speech–time test (FAST) items identified LAVO with high sensitivity. Addition of the item gaze to the original FAST score (G-FAST) or high scores on other simplified stroke scales increased specificity. The NIHSS symptom profiles representing total anterior syndromes showed a 10-fold increased likelihood for LAVO compared with a nonspecific clinical profile. If compared with an NIHSS threshold of ≥6, the prehospital stroke scales performed similarly or even better without losing sensitivity. Conclusions—Simple modification of the face–arm–speech–time score or evaluating the NIHSS symptom profile may help to stratify patients’ risk of LAVO and to identify individuals who deserve rapid transfer to comprehensive stroke centers. Prospective validation in the prehospital setting is required

A Score for Risk of Thrombolysis-Associated Hemorrhage Including Pretreatment with Statins

Background: Symptomatic intracranial hemorrhage (sICH) after intravenous thrombolysis with recombinant tissue-plasminogen activator (rt-PA) for acute ischemic stroke is associated with a poor functional outcome. We aimed to develop a score assessing risk of sICH including novel putative predictors—namely, pretreatment with statins and severe renal impairment. Methods: We analyzed our local cohort (Berlin) of patients receiving rt-PA for acute ischemic stroke between 2006 and 2016. Outcome was sICH according to ECASS-III criteria. A multiple regression model identified variables associated with sICH and receiver operating characteristics were calculated for the best discriminatory model for sICH. The model was validated in an independent thrombolysis cohort (Basel). Results: sICH occurred in 53 (4.0%) of 1,336 patients in the derivation cohort. Age, baseline National Institutes of Health Stroke Scale, systolic blood pressure on admission, blood glucose on admission, and prior medication with medium- or high-dose statins were associated with sICH and included into the risk of intracranial hemorrhage score. The validation cohort included 983 patients of whom 33 (3.4%) had a sICH. c-Statistics for sICH was 0.72 (95% CI 0.66–0.79) in the derivation cohort and 0.69 (95% CI 0.60–0.77) in the independent validation cohort. Inclusion of severe renal impairment did not improve the score. Conclusion: We developed a simple score with fair discriminating capability to predict rt-PA- related sICH by adding prior statin use to known prognostic factors of sICH. This score may help clinicians to identify patients with higher risk of sICH requiring intensive monitoring

Derry, Londonderry, Legenderry - a city in transition

Diese Arbeit beschäftigt sich mit dem Wandlungsprozess der geteilten Stadt Derry/Londonderry in Nordirland aus einer räumlichen Perspektive. Der jahrhundertealte Konflikt zwischen der protestantischen/unionistischen/loyalistischen Bevölkerung und der katholischen/nationalistischen/republikanischen Bevölkerung hat einen stark segregierten öffentlichen Raum geschaffen, der den Friedensbemühungen der nordirischen Gesellschaft im Wege steht. Ausgehend vom Lefebvre’schen Raumkonzept, das Raum als eine triadische Dialektik begreift zwischen der physisch, durch Sinne wahrnehmbaren Dimension von Raum, der konzipierten, diskursiven Dimension des Raumes sowie der Dimension der Symbole und Bedeutungen, versucht diese Arbeit die Verschränkung von Raum und gesellschaftlichen Prozessen abzubilden. Sie untersucht wie visuelle Veränderungen des Raumes dazu beitragen die Beziehungen zwischen antagonistischen Gruppen zu verbessern, um in Folge der Frage nachzugehen ob und wie die Produktion eines gemeinsamen Raumes, ein „shared space“, möglich ist. Der Fokus gilt dabei der Transformation von territorialisierten Wohngegenden in Derry/Londonderry durch die Entfernung beziehungsweise Ersetzung von konflikthaften und abgrenzenden visuellen Botschaften in Form von „murals“ (Wandmalereinen), Markierungen von Gehsteigen, Graffiti und Flaggen. Am Beispiel von vier Fallstudien wird gezeigt welche unterschiedlichen Verhandlungsprozesse stattfinden, wenn dominante Symbole des kollektiven Gedächtnisses und der Identität/Alterität in Frage gestellt werden. Da in Nordirland Identitätszuschreibungen stark über räumliche Kategorien erfolgen, kann die erfolgreiche Veränderung der dominanten Symbole in territorialisierten Wohngegenden dazu beitragen, neue Identitäten außerhalb des Protestanten/Katholiken Antagonismus zu entwickeln. Im Prozess der visuell-repräsentativen Neuerfindung einer Nachbarschaft werden soziale Beziehungen neu verhandelt und räumliche Praktiken des öffentlichen, kollektiven Gedenkens verändern sich. Weiters zeigen die Fallstudien, welche neuen Raumkonzepte eingeführt werden und wie diese von verschiedenen Akteuren und Akteurinnen aufgenommen werden.This thesis looks at the transition process of the segregated city Derry/Londonderry in Northern Ireland from a spatial perspective. The centuries-old conflict between the Protestant/unionist/loyalist population and the Catholic/nationalist/republican population has created deep societal division of public space which is seen as a major inhibitor in Northern Irish society’s peacebuilding aspirations. Applying Henri Lefebvre’s concept of space, which understands space as a triad dialectic between the physical dimension of space, which can be perceived by the senses, the conceptual, discursive dimension of space and the dimension of symbols and meanings, this thesis tries to portray the interconnection of space and societal processes. Moreover, it investigates how visual transformations of space contribute to the improvement of the tensed community relations between the antagonists, in order to follow up the question if the production of a “shared space” is possible. The thesis focuses on the transformation of the territorialised residential areas in Derry/Londonderry through the removal respectively replacement of contentious visual displays in form of murals, kerb paintings, graffiti and flags. Four case studies give an insight into the negotiation processes that take place when dominant symbols of collective memory and identity/alterity are questioned. The case studies show that a successful re-imaging process of territorialised residential estates can free people from the dominant identity ascriptions which are often based on spatial categories. This can contribute to the development of new identifications outside the Protestant/Catholic antagonism. In this re-imaging process social relations are negotiated and spatial practices of public collective commemorations are transformed. Moreover, the case studies reveal what kind of new concepts of space are introduced into society and how they are perceived by various actors

Cardiovascular MRI Compared to Echocardiography to Identify Cardioaortic Sources of Ischemic Stroke: A Systematic Review and Meta-Analysis

Background: To compare the diagnostic yield of echocardiography and cardiovascular MRI (CMR) to detect structural sources of embolism, in patients with ischemic stroke with a secondary analysis of non-stroke populations. Methods and Results: We searched MEDLINE/Embase (from 01.01.2000 to 24.04.2021) for studies including CMR to assess prespecified sources of embolism. Comparison included transthoracic and/or transesophageal echocardiography. Two authors independently screened studies, extracted data and assessed bias using the QUADAS-2 tool. Estimates of diagnostic yield were reported and pooled. Twenty-seven studies with 2,525 patients were included in a study-level analysis. Most studies had moderate to high risk of bias. Persistent foramen ovale, complex aortic plaques, left ventricular and left atrial thrombus were the most common pathologies. There was no difference in the yield of left ventricular thrombus detection between both modalities for stroke populations (4 studies), but an increased yield of CMR in non-stroke populations (28.1 vs. 16.0%, P < 0.001, 10 studies). The diagnostic yield in stroke patients for detection of persistent foramen ovale was lower in CMR compared to transoesophageal echocardiography (29.3 vs. 53.7%, P < 0.001, 5 studies). For both echocardiography and CMR the clinical impact of the management consequences derived from many of the diagnostic findings remained undetermined in the identified studies. Conclusions: Echocardiography and CMR seem to have similar diagnostic yield for most cardioaortic sources of embolism except persistent foramen ovale and left ventricular thrombus. Randomized controlled diagnostic trials are necessary to understand the impact on the management and potential clinical benefits of the assessment of structural cardioaortic stroke sources. Registration: PROSPERO: CRD42020158787