Multiple Recurrent Acute Ischemic Strokes Treated by Thrombectomy in a Patient with Acute Pulmonary Embolism

BACKGROUND: Thrombectomy is recommended to treat for an acute ischemic stroke (AIS) patient with anterior large vessel occlusion. However, there were neither detailed guidelines nor systematic reviews of acute ischemic stroke patients having multiple times or re-occluded arteries. CASE REPORT: In our case report, we struggled a multiple (4-times) AIS patient underwent by one intravenous r-tpA and 3 remaining of endovascular treatment of thrombectomy. Especially, the finding of both pulmonary embolism and cerebral arteries occlusion in this patient made us difficult to decide the appropriate treatment plan. The patient was considered having multiple cardiac thrombi pumping out to the brain and pulmonary vessels even in treatment with NOAC (New Oral Anticoagulant). Our priority, normally, was to recanalize the brain vessels compared to the pulmonary arteries. CONCLUSION: In conclusion, based on this noticed case study, we want to share our experiences on the diagnosis of ischemic stroke, the strategy in treatment and prevention with anticoagulant therapy

Tranexamic acid for intracerebral haemorrhage within 2 hours of onset : protocol of a phase II randomised placebo-controlled double-blind multicentre trial

Rationale Haematoma growth is common early after intracerebral haemorrhage (ICH), and is a key determinant of outcome. Tranexamic acid, a widely available antifibrinolytic agent with an excellent safety profile, may reduce haematoma growth. Methods and design Stopping intracerebral haemorrhage with tranexamic acid for hyperacute onset presentation including mobile stroke units (STOP-MSU) is a phase II double-blind, randomised, placebo-controlled, multicentre, international investigator-led clinical trial, conducted within the estimand statistical framework. Hypothesis In patients with spontaneous ICH, treatment with tranexamic acid within 2 hours of onset will reduce haematoma expansion compared with placebo. Sample size estimates A sample size of 180 patients (90 in each arm) would be required to detect an absolute difference in the primary outcome of 20% (placebo 39% vs treatment 19%) under a two-tailed significance level of 0.05. An adaptive sample size re-estimation based on the outcomes of 144 patients will allow a possible increase to a prespecified maximum of 326 patients. Intervention Participants will receive 1 g intravenous tranexamic acid over 10 min, followed by 1 g intravenous tranexamic acid over 8 hours; or matching placebo. Primary efficacy measure The primary efficacy measure is the proportion of patients with haematoma growth by 24 +/- 6 hours, defined as either >= 33% relative increase or >= 6 mL absolute increase in haematoma volume between baseline and follow-up CT scan. Discussion We describe the rationale and protocol of STOP-MSU, a phase II trial of tranexamic acid in patients with ICH within 2 hours from onset, based in participating mobile stroke units and emergency departments.Peer reviewe

Current Opinions on Optimal Management of Basilar Artery Occlusion: After the BEST of BASICS Survey

Background The best management of basilar artery occlusion (BAO) remains uncertain. The BASICS (Basilar Artery International Cooperation Study) and the BEST (Basilar Artery Occlusion Endovascular Intervention Versus Standard Medical Treatment) trials reported neutral results. We sought to understand physicians’ approaches to BAOs and whether further BAO randomized controlled trials were warranted. Methods We conducted an online international survey from January to March 2022 to stroke neurologists and neurointerventionalists. Survey questions were designed to examine clinical and imaging parameters under which clinicians would offer (or rescind) a patient with BAO to endovascular therapy (EVT) or best medical management versus enrollment into a randomized clinical trial. Results Of >3002 invited participants, 1245 responded (41.4% response rate) from 73 countries, including 54.7% stroke neurologists and 43.6% neurointerventionalists. More than 95% of respondents would offer EVT to patients with BAO, albeit in various clinical circumstances. There were 70.0% of respondents who indicated that the BASICS and BEST trials did not change their practice. Only 22.1% of respondents would perform EVT according to anterior circulation occlusion criteria. The selection of patients for BAO EVT by clinical severity, timing, and imaging modality differed according to geography, specialty, and country income level. Over 80% of respondents agreed that further randomized clinical trials for BAO were warranted. Moreover, 45.6% of respondents indicated they would find it acceptable to enroll all trial‐eligible patients into the medical arm of a BAO trial, whereas 26.3% would not enroll. Conclusion Most stroke physicians continue to believe in the efficacy of EVT in selected patients with BAO in spite of BEST and BASICS. There is no consensus on which selection criteria to use, and few clinicians would use anterior circulation occlusion criteria for BAOs. Further randomized clinical trials for BAO are warranted

Safety and efficacy of fluoxetine on functional outcome after acute stroke (AFFINITY): a randomised, double-blind, placebo-controlled trial

Background Trials of fluoxetine for recovery after stroke report conflicting results. The Assessment oF FluoxetINe In sTroke recoverY (AFFINITY) trial aimed to show if daily oral fluoxetine for 6 months after stroke improves functional outcome in an ethnically diverse population. Methods AFFINITY was a randomised, parallel-group, double-blind, placebo-controlled trial done in 43 hospital stroke units in Australia (n=29), New Zealand (four), and Vietnam (ten). Eligible patients were adults (aged ≥18 years) with a clinical diagnosis of acute stroke in the previous 2–15 days, brain imaging consistent with ischaemic or haemorrhagic stroke, and a persisting neurological deficit that produced a modified Rankin Scale (mRS) score of 1 or more. Patients were randomly assigned 1:1 via a web-based system using a minimisation algorithm to once daily, oral fluoxetine 20 mg capsules or matching placebo for 6 months. Patients, carers, investigators, and outcome assessors were masked to the treatment allocation. The primary outcome was functional status, measured by the mRS, at 6 months. The primary analysis was an ordinal logistic regression of the mRS at 6 months, adjusted for minimisation variables. Primary and safety analyses were done according to the patient's treatment allocation. The trial is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12611000774921. Findings Between Jan 11, 2013, and June 30, 2019, 1280 patients were recruited in Australia (n=532), New Zealand (n=42), and Vietnam (n=706), of whom 642 were randomly assigned to fluoxetine and 638 were randomly assigned to placebo. Mean duration of trial treatment was 167 days (SD 48·1). At 6 months, mRS data were available in 624 (97%) patients in the fluoxetine group and 632 (99%) in the placebo group. The distribution of mRS categories was similar in the fluoxetine and placebo groups (adjusted common odds ratio 0·94, 95% CI 0·76–1·15; p=0·53). Compared with patients in the placebo group, patients in the fluoxetine group had more falls (20 [3%] vs seven [1%]; p=0·018), bone fractures (19 [3%] vs six [1%]; p=0·014), and epileptic seizures (ten [2%] vs two [<1%]; p=0·038) at 6 months. Interpretation Oral fluoxetine 20 mg daily for 6 months after acute stroke did not improve functional outcome and increased the risk of falls, bone fractures, and epileptic seizures. These results do not support the use of fluoxetine to improve functional outcome after stroke

Reproductivity and egg quality of H’Mong chicken

This study was carried out at the experimental farm of Vienam National University of Agriculture (VNUA) during six months from August, 2016 to February, 2017. H'mong chickens were raised in three plots in order to observe reproductive performane and egg quality. The results showed that productive performance of H'mong chickens was low in comparison with other local breeds. On average, the first egg laying age was 151.67 days when their body weight was 1323.8 grams. Twenty two to forty two week-old hens resulted in the average reproductive performane as 24,12 eggs/hen, laying rate as 17.23 percents, and FCR as 6.58 kg/10 eggs. Egg quality of H'mong chickens conformed to all standards of high-quality local eggs

Impact of Farming Models on the Reproductive Performance and Egg Quality of Vietnamese Local Chicken Breeds: Ho and Dong Tao

peer reviewe

Current State of Stroke Care in Vietnam

Stroke is the leading cause of death and disability in Vietnam. This review aims to assess the current status of the stroke care system and quality criteria in the acute phase at stroke hospitals. In 2016, the Ministry of Health in Vietnam issued Circular 47, a mandate to build stroke units in Vietnam. The ANGELS program, which is supporting the World Stroke Organization to gain its goals, was implemented in 18 stroke‐ready hospitals in Vietnam to help address quality of stroke patient care in 2017. From the results achieved, we will continue to improve policies, strive to reach stroke benchmark goals, as well as plan to implement solutions in the future to build a better stroke system of care infrastructure in Vietnam

Clinical epidemiology and mortality on patients with acute respiratory distress syndrome (ARDS) in Vietnam.

BackgroundThe clinical epidemiology and disease prognosis in patients with acute respiratory distress syndrome (ARDS) have not yet been fully elucidated in Vietnam.MethodsWe conducted a retrospective observational study at a national tertiary hospital in Hanoi, Vietnam. Participants were adult patients (age ≥18 years) who were admitted and diagnosed with ARDS during 2015-2017. Data on patients' general and clinical conditions, radiographic findings, ventilator settings, gas exchange, and treatment methods were collected and compared between survivors and non-survivors. Risk factors for mortality were assessed using logistic regression analysis.ResultsAmong 126 eligible patients with ARDS admitted to the central tertiary hospital in Vietnam, we observed high mortality (57.1%). Of the total patients, 91.3% were transferred from local hospitals with a diagnosis of severe pneumonia and then diagnosed with ARDS at the central hospital. At the time of admission, 53.2% of patients had severe ARDS, 37.3% had moderate ARDS, and 9.5% had mild ARDS. The mean (standard deviation) sequential organ failure assessment (SOFA) score was 9.5 (3.4) in non-survivors and 7.4 (3.4) in survivors (p = 0.002). Although there was no significant difference in PaO2/FiO2 on admission between non-survivors and survivors, that on day 3 after admission was significantly different (p = 0.002). Logistic regression revealed that PaO2/FiO2 on day 3 [odds ratio (OR), 1.010; 95% confidence interval (CI), 1.003-1.017], length of stay in a local hospital before admission to the central hospital (OR, 1.122; 95% CI, 1.042-1.210) due to stable condition, and SOFA score on Day 1 (OR, 0.842; 95% CI, 0.708-1.002) were independent factors in patient survival.ConclusionsPatients with ARDS admitted the central tertiary hospital had severe illness and high mortality. Most patients were transferred from local hospitals. Improvements in human, medical, and sociological resources in local will contribute to reducing the mortality of ARDS in Vietnam

Post‐Market Registry of Stroke Patients Treated With Medtronic Neurothrombectomy Devices in Southeast Asia: PROSPR‐SEA

Background Southeast Asia accounts for approximately 10% of stroke‐related mortalities worldwide, yet there are limited data regarding mechanical thrombectomy (MT) outcomes in this region. PROSPR‐SEA (Post‐Market Registry of Stroke Patients Treated With Medtronic Neurothrombectomy Devices to Collect Real‐World Data in Southeast Asia) assessed post‐market clinical outcomes of MT using the Solitaire Revascularization Device in southeast Asia. Methods PROSPR‐SEA is a prospective, multicenter, nonrandomized, observational registry of patients who underwent MT using Solitaire as first line treatment at 1 of 10 centers in Vietnam, Thailand, and Singapore between January 2018 and July 2019. The primary end point was functional independence (modified Rankin scale 0–2) at 90 days. Safety end points included symptomatic intracerebral hemorrhage, emboli in new territory at 24 hours, and all‐cause mortality at 90 days. Secondary end points were successful revascularization (modified thrombolysis in cerebral infarction ≥2b), workflow metrics, National Institutes of Health Stroke Scale score at discharge, and patient disposition at 90 days. Results A total of 183 patients (64.9±13.7, 49.7% [91/183] female) were included in the study and underwent MT; 79.2% (145/183) had occlusions in the middle cerebral artery. Median baseline National Institutes of Health Stroke Scale was 15.0 (range 1–31) and median baseline Alberta Stroke Program Early CT Score was 8.0 (range 0–10). Functional independence at 90 days was achieved in 62.2% (112/180). Mean puncture‐to‐revascularization time was 53.3±53.9 minutes, and mean onset‐to‐revascularization time was 330.0±110.4 minutes. Revascularization was successful in 94.0% (172/183) of patients. Median National Institutes of Health Stroke Scale improved at discharge (−8.0, range −22, 25) and 90 days (−13.0, range −22, 0). Within 24 hours, symptomatic intracerebral hemorrhage occurred in 7.7% (14/183) and emboli in new territory in 3.3% (6/183). At 90 days, the all‐cause mortality rate was 7.7% (14/183). Most patients were discharged to home by 90 days (84.1%, 154/183). Conclusion PROSPR‐SEA demonstrated high rates of positive functional outcomes and procedural success with a low mortality rate and indicates that the technical and clinical outcomes of landmark MT trials using Solitaire as the first‐line device are reproducible in real‐world southeast Asian settings