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Aim: This study investigated demographic and clinical risk factors associated with severity in acute ischemic stroke (AIS) patients with a history of coronary artery disease (CAD). Materials & methods: Multivariate logistic regression models were used to determine specific factors associated with worsening or improving neurologic functions among AIS patients with CAD treated in the telestroke. Results: AIS patients with CAD, peripheral vascular disease (OR: 3.995; 95% CI: 1.035–15.413; p = 0.044) and hypertension (OR: 6.056; 95% CI: 1.207–30.374; p = 0.029) were associated with worsening neurologic functions. Conclusion: Our findings suggest the need to develop strategic management to improve the care of AIS patients with a history of CAD that present with hypertension and peripheral vascular disease in the telestroke network.

Introduction Patients are at risk for different outcomes following stroke based on their diastolic blood pressure on admission. In this study, we determine differences in risk factors between patients with DBP < 80 and > = 80 mmHg and then determine which of these risk factors are associated with worsening neurologic outcomes after rtPA administration. Methods A retrospective analysis was performed by looking at demographics, history, and clinical factors that are known risk factors for acute ischemic stroke. Data were obtained from a stroke registry that includes patient data from between 2010 and 2016. Univariate analysis was performed based on presenting diastolic blood pressure group. Patients who did not receive rtPA were excluded from further study and then patients were further divided by NIHSS > = 7 or > 7. Logistic regression was used to further evaluate variables. Odds Ratios with 95% Confidence Intervals (C.I.) were calculated and used to predict worsening neurologic outcomes for stroke patients based on their blood‐pressure group. Results In the population of stroke patients with diastolic blood pressure < 80 mmHg, increasing age (OR = 1.025, 95% C.I. = 1.011 – 1.039 . P‐value = < 0.001), and elevated blood glucose levels (OR = 1.003, 95% C.I. = 1 – 1.006, P‐value = 0.03) were associated with worsening neurologic outcomes. In the diastolic blood pressure group > = 80 mmHg, increasing age (OR = 1.026, 95% C.I. = 1.012 – 1.04. P‐value = < 0.001), history of drug or alcohol abuse (OR = 2.11, 95% C.I. = 1.116 – 3.988, P‐value = 0.022), hypertension (OR = 1.572, 95% C.I. = 1.01 – 2.449, P‐value = 0.035), and increasing heart rate (OR = 1.012, 95% C.I. = 1.012 – 1.022, P‐value = 0.024) were associated with worsening neurologic outcomes. Conclusions This study found that there are significant differences in the clinical factors between patients with a DBP < or > = 80 mmHg with acute ischemic stroke and these groups also had different risk factors for severe stroke after rtPA administration. In both groups, increasing age was associated with worsening neurologic outcomes, while direct admission was associated with improving outcomes. In the DBP < 80 mmHg group, elevated blood glucose levels were associated with worsening neurologic outcomes. In the DBP > = 80 mmHg group, a history of alcohol or drug use and increased heart rate were associated with worsening neurologic outcomes.

It is well known that post-stroke depression might be a negative factor for stroke recovery, however there is limited evidence to establish the link between pre-stroke depression and stroke outcome such motor recovery. The objective is to determine clinical risk factors in ischemic stroke patients with pre-stroke depression that are associated functional ambulatory outcome.Data from acute ischemic patients from a regional stroke registry were collected for consecutive recombinant tissue plasminogen activator(rtPA)-treated acute ischemic stroke patients between January 2010 and June 2016. Logistic regression model was used to predict risk factors that served as predictive variables, while the increase or reduce odds of improvement in ambulatory outcome was considered as the primary outcome. Multicollinearity and possible interactions among the independent variables were analyzed using the variance inflation factor.A total of 1446 patients were eligible for recombinant tissue plasminogen activator (rtPA) and 596 of these patients received rtPA. Of the 596 ischemic stroke patients, 286 patients presented with recent pre-stroke depression, 310 had no pre-stroke depression. Carotid artery stenosis (OR = 11.577, 95% CI, 1.281-104.636, P = 0.029) and peripheral vascular disease (OR = 18.040, 95% CI, 2.956-110.086, P = 0.002) were more likely to be associated with increase odds of improvement in ambulation in patients with no pre-stroke depression treated with rtPA, while antihypertensive medications (OR = 0.192, 95% CI, 0.035-1.067, P = 0.050),previous TIA (OR = 0.177, 95% CI, 0.038-0.818, P = 0.027), and congestive heart failure (OR = 0. 0.160, 95% CI, 0.030-0.846, P = 0.031) were associated with reduced odds of improvement in ambulation. In addition, carotid artery stenosis (OR = 0.078, 95% CI, 0.10-0.614, P = 0.015, congestive heart failure (OR = 0.217, 95% CI, 0.318-0.402, P = 0.030), previous TIA (OR = 0.444, 95% CI, 0.517-0.971, P = 0.012), higher NIHSS scores ((OR = 0.887, 95% CI, 0.830-0.948, P 0.001), and antihypertensive medications (OR = 0.810, 95% CI, 0.401-0.529, P = 0.019) were associated with the reduced odd of improvement in ambulation in an ischemic stroke population with pre-stroke depression treated with rtPA.Our findings indicate that more risk factors were associated with the decreased odds of an improvement in ambulation following thrombolytic therapy in an ischemic stroke population with pre-stroke depression when compared with those without pre-stroke depression. This finding maybe helpful in the development of management strategies to increase the use of thrombolytic therapy for pre-stroke depressed ischemic stroke to increased their eligibility for rtPA.

The implementation of an integrated medical neuroscience course by technologically pivoting an in-person neuroscience course to online using an adaptive blended method may provide a unique approach for teaching a medical neuroscience course during the Covid-19 pandemic. An adaptive blended learning method was developed in response to the requirements necessitated by the Covid-19 pandemic. This model combined pedagogical needs with digital technology using online learning activities to implement student learning in a medical neuroscience course for year one medical students. This approach provided medical students with an individually customized learning opportunity in medical neuroscience. The students had the complete choice to engage the learning system synchronously or asynchronously and learn neuroscience materials at different locations and times in response to the demands required to deal with the pandemic. Students' performance in summative and formative examinations of the adaptive blended learning activities were compared with the previous performance obtained the previous year when the contents of the medical neuroscience course were implemented using the conventional "face-to-face" learning approach. While the cohort of our students in 2019 and 2020 changed, the contents, sessions, volume of material, and assessment were constant. This enabled us to compare the results of the 2019 and 2020 classes. Overall, students' performance was not significantly different between the adaptive blended learning and the in-person approach. More students scored between 70% and 79% during the adaptive blended learning compared with in-class teaching, while more students scored between 80% and 89% during the in-person learning than during the adaptive blended learning. Finally, the percentage of students that scored >90% was not significantly different for both Years 2019 and 2020. The adaptive blended learning approach was effective in enhancing academic performance for high-performing medical students. It also permitted the early identification of underachieving students, thereby serving as an early warning sign to permit timely intervention.

Background The COVID-19 pandemic revealed existing gaps in the medical educational system that is heavily dependent on the presence of medical students and teachers in laboratory and class for instruction. This affects continuity in the implementation of the neuroanatomy component of the medical neuroscience laboratory activities during COVID-19. We hypothesized that pivoting wet laboratory neuroanatomy activities to online using an adaptive flexible blended method might represent an effective approach in the implementation of laboratory neuroanatomy activities during a pandemic. Methods The current study describes an adaptive flexible blended learning approach that systematically mixes virtual face-to-face interaction activities with the online learning of brain structures, and the discussion of clinical cases. Learning materials are delivered through both synchronous and asynchronous modes, and Year 1 medical students learn neuroanatomy laboratory activities at different locations and different times. Student performances in the adaptive flexible blended learning approach were compared with the learning of similar activities during an in-person implementation of neuroscience laboratory activities. Results The results of using this adaptive flexible blended learning approach provided an autonomous independent learning, self-study approach that broadened student performance such that we have more students scoring between 80 and 89%, whereas the in-person learning resulted in most of the students scoring > 90% in the medical neuroscience laboratory activities. Conclusion An adaptive flexible blended learning approach that combined virtual face-to-face instruction using digital technology with online learning of neuroscience laboratory activities provided a unique educational experience for Year 1 medical students to learn neuroscience laboratory activities during the COVID-19 pandemic.

PURPOSE: Empathy tends to decline during medical education, typically beginning in the third year of medical school and often continuing throughout residency and the physician’s medical career. The purpose of this study was to determine if first year medical student empathy is affected by small group interactions with patients with neurological disorders, and to investigate if changes in empathy persisted over time. MATERIALS AND METHODS: Eighty first year medical students participating in a Neuroscience Module interacted with a variety of neurological patients in a small group informational session. Prior to the experience, participants completed the Jefferson Scale of Physician Empathy–Student (JSPE-S) version. After the experience, students completed a post-test JSPE-S questionnaire, and a final post-post-test JSPE-S questionnaire was completed 5 weeks later. Empathy scores were compared with a repeated measures MANOVA. The relationship between gender and empathy, and the effect of the age of the neurological patients on empathy scores were also examined. RESULTS: Empathy scores for seventy-one students who completed the JSPE-S questionnaires were analyzed. Students had significantly higher empathy immediately after the patient interaction experience, and the change in empathy was sustained over the course of 5 weeks (p = 0.015). The age of the neurological patients had a significant effect on empathy scores. There was no significant difference between empathy scores and gender. CONCLUSIONS: This study supports the incorporation of a group patient interaction experience into the medical school curriculum as an inexpensive and practical method of enhancing medical student empathy in a non-clinical setting.

Background This study aims to identify predictors of improvement or deficit progression in ischemic stroke patients with pre-stroke depression and to evaluate the impact of identified predictors on pre-ischemic stroke depressed patients that received thrombolytic therapy. Methods We performed logistic regression analysis to determine demographic and clinical risk factors that are independently associated with clinical improvement or deficits in ischemic stroke patients with pre-stroke depression that received thrombolytic therapy. Multicollinearity effect in the regression models was controlled using variance inflation factors and the fitness of the models was determined using the Hosmer-Lemeshow test. Results A total of 5469 ischemic stroke patients were identified of which 4748 patients were not diagnosed with depression while 721 were diagnosed with pre-stroke depression. After controlling for all variables with multivariate analysis, we found that the female gender (OR = 2.545, 95 % CI, 1.167–5.553, P = 0.019), coronary artery disease (OR = 2.935, 95 % CI, 1.296–6.645, P = 0.01), heart rate (OR = 1.025, 95 % CI, 1.001–1.049, P = 0.044), and improvement in ambulation (OR = 2.161, 95 % CI, 1.076–4.343, P = 0.03) were associated with neurological deficits while antidepressant medication (OR = 0.226, 95 % CI, 0.075‐0.686, P = 0.009), and direct admission (OR = 0.212, 95 % CI, 0.071‐0.636, P = 0.006) were associated with improvements in pre-stroke depressed patients who received recombinant tissue plasminogen activator (rtPA). Conclusions Our findings indicate that neurological deficits or improvements in hemispheric ischemic stroke patients with pre-stroke depression are associated with baseline stroke severity and that a stratification based on NIHSS scores.

The two-hit model has been proposed to explain the effects of diabetes on mothers who are already in a putative subclinical damaged state and then undergo neuronal damage during the delivery process. However, the anatomical and pathophysiological mechanisms are not well understood. Our overarching hypothesis in this review paper is that pregnant women who are diabetic have a damaged peripheral nervous system, constituting the “first hit” hypothesis. The delivery process itself—the “second hit”—can produce neurological damage to the mother. Women with diabetes mellitus (DM) are at risk for neurological damage during both hits, but the cumulative effects of both “hits” pose a greater risk of neurological damage and pathophysiological changes during delivery. In our analysis, we introduce the different steps of our concept paper. Subsequently, we describe each of the topics. First, we outline the mechanisms by which diabetes acts as a detrimental variable in neuropathy by focusing on the most common form of diabetic neuropathy, diabetic distal symmetrical polyneuropathy, also known as distal sensorimotor neuropathy. The possible role of macrosomia in causing diabetic neuropathy and obstetric neurological injury is discussed. Second, we describe how vaginal delivery can cause various obstetrical neurological syndromes and pathophysiological changes. Third, we highlight the risk of obstetric neuropathy and discuss anatomical sites at which lesions may occur, including lesions during delivery. Fourth, we characterize the pathophysiological pathways involved in the causation of diabetic neuropathy. Finally, we highlight diabetic damage to sensory vs. motor nerves, including how hyperglycemia causes different types of damage depending on the location of nerve cell bodies.

Introduction: This study investigates gender differences among stroke patients treated in the telestroke network using specific risk factors that contribute to stroke severity. Methods: We examined gender differences in stroke severity among 454 patients hospitalized with acute ischemic stroke (AIS). The logistic regression model was used to predict clinical risk factors associated with stroke severity in men and women AIS patients. Results: In the adjusted analysis among women patients, increasing age (odds ratio [OR] = 1.05, 95% CI: 1.017–1.085, p = 0.003) and higher heart rate (OR = 1.031, 95% CI: 1.005–1.058, p = 0.021) were associated with worsening neurological functions, while direct admission (OR = 0.191, 95% CI: 0.079–0.465, p < 0.001) was associated with improving neurologic functions. Among men, hypertension (OR = 3.077, 95% CI: 1.060–8.931, p = 0.039) and higher international normalized ratio (INR) (OR = 21.959, 95% CI: 1.489–323.912, p = 0.024) were associated with worsening neurologic functions, while Caucasian (OR = 0.181, 95% CI: 0.062–0.526, p = 0.002) and obesity (OR = 0.449, 95% CI: 0.203–0.99, p = 0.047) were associated with neurologic improvement. Conclusion: Increasing age and heart rate in women, hypertension and greater INR in men contribute to worsening neurologic functions. There is a need to develop strategies to improve the care of both men and women in the telestroke network.

ObjectiveThe current study investigates sex differences associated with pharmacological and demographic characteristics in Alzheimer patients (AD) with dementia (ADD) or mild cognitive impairment (MCI).MethodA retrospective analytical approach was used to analyze data from 45,696 AD patients with MCI or ADD. The univariate analysis was used to determine differences in demographic, and pharmacological characteristics for male and female ADD and MCI-AD patients. Multivariate analysis was used to predict specific pharmacological and demographic factors that are associated with male and female MCI and ADD patients.ResultIn the adjusted analysis for male patients, Hispanics [0.166,0.020 – 1.355, P = 0.094] or African Americans [OR = 2.380, 95% CI,2.120 – 2.674, P < 0.001], were more likely to have MCI-AD and be treated with galantamine [OR = 0.559, 95% CI, 0.382 – 0.818, P = 0.003], donepezil [OR = 1.639, 95% CI,1.503 – 1.787, P < 0.001], rivastigmine [OR = 1.394, 95% CI,1.184 – 1.642, P < 0.001], olanzapine [OR = 2.727, 95% CI,2.315 – 3.212, P < 0.001], risperidone [OR = 2.973, 95% CI,2.506 – 3.526, P < 0.001], present with increasing age [1.075,1.071 – 1.079, P < 0.001], and are on tobacco use [OR = 1.150, 95% CI,1.054 – 1.254, P = 0.002]. For female patients, buspirone [OR = 0.767, 95% CI, 0.683 – 0.861, P < 0.001] and a history of alcohol (ETOH) use [OR = 0.484, 95% CI, 0.442 – 0.529, P < 0.001] were associated with MCI-AD. Increasing age [OR = 1.096, 95% CI, 1.093 – 1.100, P < 0.001], donepezil [OR = 2.185, 95% CI, 2.035 – 2.346, P < 0.001], memantine [OR = 2.283, 95% CI, 2.104 – 2.477, P < 0.001] aripiprazole [OR = 1.807, 95% CI, 1.544 – 2.113, P < 0.001] olanzapine [OR = 2.289, 95% CI, 1.986 – 2.640, P < 0.001] risperidone [OR = 2.548, 95% CI, 2.246 – 2.889, P < 0.001] buspirone [OR = 0.767, 95% CI, 0.683 – 0.861, P < 0.001] escitalopram [OR = 1.213, 95% CI,1.119 – 1.315, P < 0.001] African Americans [OR = 1.395, 95% CI, 1.268 – 1.535, P < 0.001] and tobacco use [OR = 1.150, 95% CI, 1.073 – 1.233, P < 0.001] were associated with ADD.ConclusionOur findings reveal that MCI-AD patients were more likely to be Hispanics or African American males treated with rivastigmine, olanzapine and citalopram. African American females were associated with ADD and more likely to be treated with buspirone and presented with a history of ETOH. This finding suggests the need for a pharmacological treatment approach encompassing sex-sensitive strategies for MCI-AD and ADD patients.

Background: Whether gender differences exist in late-onset of Alzheimer’s disease (LOAD) treated with cholinesterase inhibitors (ChEIs) is not fully understood. This study investigated demographic and pharmacological characteristics in LOAD patients to determine gender differences in LOAD patients treated with ChEIs alone and ChEIs with other medications. Methods: This 5-year retrospective data analysis included 9290 LOAD AD patients with 2949 men patients and 6341 women. Potential predictors of demographic and pharmacological characteristics associated gender differences in patients treated with and without ChEIs therapy were determined using univariate analysis, while multivariable models adjusted for demographic and pharmacological variables. Results: In the adjusted analysis, men patients with LOAD that presented with a history of alcohol use (ETOH) (OR = 1.339, 95% CI, 1.072–1.672, p = 0.010), treated with second generation antipsychotics (SGAs) (OR = 1.271, 95% CI, 1.003–1.610, p = 0.047), citalopram (OR = 5.103, 95% CI, 3.423–7.607, p < 0.001), memantine (OR = 4.409, 95% CI, 3.704–5.249, p < 0.001), and buspirone (OR = 2.166, 95% CI, 1.437–3.264, p < 0.001) were more likely to receive ChEIs therapy, whereas older men were less likely to be treated with ChEIs therapy. Women who were African Americans (OR = 1.387, 95% CI, 1.168–1.647, p < 0.001), that received memantine (OR = 3.412, 95% CI, 3.034–3.837, p < 0.001), selective serotonin reuptake inhibitor (SSRIs) (OR = 1.143, 95% CI, 1.016–1.287, p = 0.026), and a history of ETOH (OR = 2.109, 95% CI, 1.724–2.580, p < 0.001) were more likely to receive ChEIs therapy, whereas older women were less likely to receive ChEIs therapy. Conclusion: In both men and women patients, those with increasing age were less likely to be treated with ChEI therapy, while patients treated with memantine were also likely to receive ChEI therapy. Our findings highlight the importance for clinicians to optimize ChEI in LOAD to improve treatment effectiveness and eliminate gender differences in ChEI therapy.

Introduction : Alzheimer dementia (AD) has been reported in both men and women. However, factors contributing to gender differences are not fully understood. We tested the hypothesis that specific pharmacological, demographic, and risk factors contribute to gender difference in AD. Methods : A retrospective analytical approach was used to analyze data from 12,632 AD patients, comprising 4,584 men and 8,048 women. Univariate and multivariate analyses determined the factors contributing to the gender difference in AD patients. Results : About 36% of AD patients were men, and 64% were women. Citalopram (OR = 1.187, 95% CI, 1.044 – 1.350, P = 0.009) was associated with men, while escitalopram (OR = 1.213, 95% CI, 1.119 – 1.315, P Conclusions : Our findings reveal similarities and differences in factors associated with both men and women AD patients, suggesting the development of management strategies for the care of AD.

Introduction : Several studies have investigated gender differences in patients with Lewy Body Dementia (LBD), however, whether the observed differences are associated with demographic and pharmacological factors is not fully understood. The current study tested the hypothesis that specific demographic or pharmacological factors may contribute to the observed gender difference. Methods : A 5‐year data collected from a regional registry from 608 LBD patients including 332 men and 276 women were analyzed. Factors associated with men and women patients with LBD were determined using the logistic regression model. Multicollinearity was evaluated using variance inflation factors (VIFs), with values greater than five suggestive of multicollinearity Results : The results indicate that Caucasian men (94.3% vs 83.3%) were more likely to present with LBD. In the adjusted analysis, increasing age (OR = 1.042, 95% CI, 1.025‐ 1.058, P ˂ 0.001) was more likely to be associated with women with LBD, while olanzapine (OR = 2.871, 95% CI, 1.902‐4.334, P˂ 0.001), buspirone (OR = 2.388, 95% CI, 1.527‐3.735, P˂ 0.001), escitalopram (OR = 1.444, 95% CI, 1.079‐1.932, P = 0.014) and tobacco use (OR = 1.424, 95% CI, 1.075‐1.887, P = 0.014) were associated with men with LBD Conclusions : More men presented with LBD compared to women. Our findings reveal specific demographic and pharmacological factors that contribute to gender differences among LBD patients.

Introduction : Age is the single most important risk factor for stroke and an estimated 75% of all strokes occur in people >65 years of age. In addition, adults >75 years’ experience more hospitalization stays and higher mortality rates with an estimated 50% in the occurrence of all strokes. Several comorbidities have been linked to an increased risk and severity of acute ischemic stroke (AIS). How these factors differentially contribute to the severity of stroke in patients ages >65 and Methods : This retrospective data analysis study was conducted using the data collected from the PRISMA Health Stroke Registry between 2010 and 2016. Baseline clinical and demographic data for patients ages >65 and Results : Adjusted multivariate analysis showed that AIS population of patients >65 and Conclusions : Age is a strong risk factor for AIS, and aged stroke patients have higher morbidity and worsening functional recovery than younger patients. In this study, we observed differences in stroke risk factor profiles for >65 and 65 and

This meeting abstract was removed due to the OA licensing requirements of this journal. The full abstract is listed here : https://www.svin.org/files/SVIN_2021_Abstracts_for_Web.pdf

Implementing educational activities, such as a wet lab with cadaveric brain dissection, is known to have a direct impact on medical students' motivation. These activities demonstrate the clinical relevance of concepts taught in the classroom setting. The correlation between motivation and academic performance is not clear. First year medical students participated in wet lab activities. The wet lab included cadaveric dissection of the surface and internal anatomy of the brain, as well as discussions facilitated by the neuroscience faculty and clinicians. Discussions were centered around the clinical relevance of the neuroanatomical features dissected during the wet laboratory activities. Following completion of the laboratory activities, students completed a survey, which was used to assess the students' motivation for learning neuroanatomy based on the Attention, Relevance, Confidence, Satisfaction (ARCS) model of motivation. These results were then correlated with performance on a laboratory examination that tested three-dimensional and cross-sectional knowledge of neuroanatomy and practical skills including the use of imaging techniques. The total mean score of motivation was generally high for all categories of ARCS model of motivation (4.26/5) and was highest for Relevance (4.46/5). When these results were correlated with students' performance on the lab examination, a positive correlation between students' motivation and lab examination scores was found (R2 = 0.877). Implementation of the neuroanatomy cadaveric dissection lab led to increased student motivation, which was positively correlated with students' academic performance. Clin. Anat. 32:128-135, 2019. © 2019 Wiley Periodicals, Inc.

Fundamental signs of epigenetic effects are variations in the expression of genes or phenotypic traits among isogenic mates. Therefore, genetically identical animals are in high demand for epigenetic research. There are many genetically identical animals, including natural parthenogens and inbred laboratory lineages or clones. However, most parthenogenetic animal taxa are very small in combined epigenetic and drug addiction research. Orconectes rusticus has a unique phylogenetic position, with 2–3 years of life span, which undergoes metamorphosis that creates developmental stages with distinctly different morphologies, unique lifestyles, and broad behavioral traits, even among isogenic mates reared in the same environment offer novel inroads for epigenetics studies. Moreover, the establishment of crayfish as a novel system for drug addiction with evidence of an automated, operant self-administration and conditioned-reward, withdrawal, reinstatement of the conditioned drug-induced reward sets the stage to investigate epigenetic mechanisms of drug addiction. We discuss behavioral, pharmacological and molecular findings from laboratory studies that document a broad spectrum of molecular and, behavioral evidence including potential hypotheses that can be tested with the crayfish model for epigenetic study in drug addiction research.

To investigate clinical risk factors that were associated with gender differences in thrombolysis therapy in stroke patients with incidence of obesity. Retrospective data of obese acute ischemic stroke patients were extracted from a stroke registry between January 2010 and June 2016. Gender differences in exclusion from rtPA or thrombolysis therapy were determined following an adjustment for differences in demographics, clinical risk factors using multiple regression analysis. Significant interactions between variables in the regression models were determined using variance inflation factors. A total of 1105 obese stroke patients were admitted, 549 were excluded from rtPA of which 51.7% were males and 48.3% were females. Among obese male stroke patients, age > 80 years (OR = 1.029, 95% CI, 1.005–1.054, P = 0.016), a history of peripheral vascular disease (OR = 3.008, 95% CI, 0.989–9.153, P = 0.052), and an elevated diastolic blood pressure (OR = 1.018, 95% CI, 1.001–1.035, P = 0.038) were associated with exclusion from rtPA therapy. In obese female stroke patients, coronary artery disease was associated with exclusion from rtPA (OR = 2.478, 95% CI, 1.270–4.836, P = 0.008) while antihypertensive therapy was associated with inclusion for rtPA (OR = 0.326, 95% CI, 0.139–0.764). Elderly obese male stroke patients with elevated diastolic blood pressure, history of peripheral vascular disease, and obese female stroke patients with a history of coronary artery disease were more likely to be excluded from rtPA.

The objective of this study is to determine whether a school-based program that allows middle school students to actively take responsibility of their learning can act as an effective intervention to promote stroke awareness and healthy lifestyle. Middle school students in grades 6, 7, and 8 (ages 11–14) were divided into small groups and participated in a series of interactive learning activities, centered on motivating middle school kids to learn and recognize signs and symptoms of stroke and to learn healthy lifestyle choices. A total of 127 sixth, 113 seventh, and 98 eighth grade students participated in the intervention program. ANOVA found a significant difference in the baseline knowledge of all stroke and healthy life parameters evaluated in the pre-and post-intervention between the 6th, 7th, and 8th grades. Post-hoc analysis revealed a significant change in the performance (P

BACKGROUND: The integration of patient encounters into the first year of the medical school curriculum is known to be of vital importance in the development of critical thinking and communication skills. We investigated whether exposure of first year medical students to patient encounters during a first year medical school neuroscience course result in a high level of motivation associated with the clinical encounter, and whether this high level of motivation translates to higher academic performance as measured by their performance on formative and summative examinations. METHODS: First year medical students interacted with patients presenting with different neurological disorders in a small group informal session. Following the small group interactions with patients, students participated in a large group debriefing session involving discussions with peers, biomedical sciences faculty, and clinicians. Students then completed a survey designed to assess their motivation in correspondence with the Attention, Relevance, Confidence, and Satisfaction (ARCS) model of motivation. These results were then correlated with students’ performance in the neuroscience examinations. RESULTS: The total mean score was high for all categories of the ARCS model of motivation (4.26/5) and was highest for Relevance (4.46/5). When these motivation scores were correlated with students’ performance on the formative and summative examinations, a significant positive correlation was found between motivation and performance on both the formative (r = 0.85) and summative (r = 0.95) neuroscience examinations. CONCLUSION: Encounters with patients presenting with neurological disorders during a first year medical neuroscience course result in a high level of motivation associated with the clinical encounter, and this was positively correlated with their academic performance.

BackgroundAtrial Fibrillation (AF) is a common cardiac arrhythmia and has been identified as a major risk factor for acute ischemic stroke (AIS). Gender differences in the disease process, causative mechanisms and outcomes of AF have been investigated. In the current study, we determined whether there is a gender-based disparity in AIS patients with baseline AF, and whether such a discrepancy is associated with specific risk factors and comorbidities.MethodsBaseline factors including comorbidities, risk and demographic factors associated with a gender difference were examined using retrospective data collected from a registry from January 2010 to June 2016 in a regional stroke center. Univariate analysis was used to differentiate between genders in terms of clinical risk factors and demographics. Variables in the univariate analysis were further analyzed using logistic regression. The adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for each factor were used to predict the increasing odds of an association of a specific comorbidity and risk factor with the male or female AIS with AF.ResultsIn the population of AIS patients with AF, a history of drug and alcohol use (OR = 0.250, 95% CI, 0.497–1.006,P = 0.016), sleep apnea (OR = 0.321, 95% CI, 0.133–0.777,P = 0.012), and higher serum creatinine (OR = 0.693, 95% CI, 0.542–0.886P = 0.003) levels were found to be significantly associated with the male gender. Higher levels of HDL-cholesterol (OR = 1.035, 95% CI, 1.020–1.050,P P = 0.012), and the inability to ambulate on admission to hospital (OR = 2.258, 95% CI, 1.368–3.727,P = 0.001) were associated with females.ConclusionOur findings reveal that in the AIS patients with atrial fibrillation, migraines, HDL, LDL and poor ambulation were associated with females, while drugs and alcohol, sleep apnea, and serum creatinine level were associated with male AIS patients with AF. Further studies are necessary to determine whether gender differences in risk factor profiles and commodities require consideration in clinical practice when it comes to AF as a risk factor management in AIS patients.

Differences in baseline clinical risk factors have been proposed to contribute to gender differences in stroke outcome, how these clinical risk factors contribute to gender difference in acute ischemic stroke (AIS) patients with obstructive sleep apnea is yet to be fully investigated. This study explored the clinical characteristics associated with gender differences in AIS population with a baseline obstructive sleep apnea(OSA).A retrospective study was conducted using data from 5469 patients with an ischemic stroke event from a regional stroke center collected from January 2010 to June 2016. Multivariate logistic regression was used to determine factors associated with gender differences in the obstructive sleep apnea-ischemic stroke population.A total of 170 AIS patients presented with a baseline OSA, and 101 were men and 69 were women. In the AIS with OSA (AIS-OSA) population, patients presenting with peripheral vascular disease (PVD) (OR = 4.892, 95% CI,1.248 - 19.2, P = 0.023), depression (OR = 3.804, 95% CI, 1.369 - 10.6, P = 0.01), higher BMI (OR = 1.103, 95% CI, 1.036 - 1.18, P = 0.002), and higher HDL levels (OR = 1.125, 95% CI, 1.067 - 1.19, P = 0.001) were associated with increasing odds of being women, and no clinical risk factor was associated with men AIS-OSA patients.A gender specific difference was observed in pre-stroke demographic and risk factors for AIS patients with OSA. Women AIS patients with OSA were more likely to present with PVD and depression and have higher HDL and BMI levels when compared to men within the same population. In addition, more men AIS presented with OSA when compared with women AIS patients. Further studies to explore management strategies to eliminate gender differences will improve outcomes for men and women AIS with OSA.

Background: The aim of this study is to identify clinical risk factors in acute ischemic stroke ( AIS) pretreated with anti-hypertensive (anti-HTN) medications with a subsequent thrombolytic therapy that are associated with potential worsening or improving neurological functions. Methods: We analyzed retrospectively collected data from consecutive AIS patients with a combined anti-HTN medications and recombinant tissue plasminogen activator (rtPA) therapy for AIS. We used logistic regression model to identify demographic and clinical risk factors that are associated with improving or worsening neurologic functions in AIS patients with a combined anti-HTN and thrombolytic therapy. The overall correct classification of the logistic regression models was determined using the Hosmer-Lemeshow test, while the area under the receiver operating characteristic curve was used to test the sensitivity of the model. The variance inflation factor was used to check for multicollinearity. Results: In the adjusted analysis, patients with increasing age (Odd ratio (OR)=1.035, 95% CI, 1.022-1.049, P P =0.002) with a history of substance abuse (OR = 2.315, 95% CI, 1.107-4.842, P = 0.026) were associated with worsening neurologic functions. However, Caucasians (OR = 0.535, 95% CI, 0.361-0.793, P = 0.002) with dyslipidemia (OR = 0.655, 95% CI, 0.479-0.897, P = 0.008), obesity (OR = 0.642, 95% CI, 0.472-0.873, P = 0.005), high-density lipoproteins (HDL; OR = 0.988, 95% CI, 0.976-1.000, P = 0.045), and with a direct admission (OR = 0.509, 95% CI, 0.341-0.761, P = 0.001) were associated with improving neurologic function in AIS patients with a combined anti-HTN medications and rtPA therapy. Conclusion: Our findings reveal specific demographic and clinical risk factors that are associated with worsening or improving neurological functions in AIS pretreated anti-HTN medications with a subsequent thrombolytic therapy. This finding suggests the development of management strategies to manage identified clinical risk factors in AIS patients pretreated with anti-HTN medications prior to thrombolytic therapy.

Patients who have suffered an acute ischemic stroke (AIS) and are smokers may have a better outcome following thrombolytic therapy when compared with non-smokers. While this finding is controversial, data on baseline clinical risk factors to predict treatment efficacy of thrombolytic therapy using ambulatory status in patients who suffered AIS and are smokers is not common.Between 2010 and 2016, retrospective data on patients who have suffered an AIS and received recombinant tissue plasminogen activator (rtPA) were obtained from Greenville health system registry. Assessment of clinical risk factors and the likelihood of an improvement in post-stroke ambulation among smokers and non-smokers was carried out using multivariate logistic regression.Of 1001 patients, 70.8% were smokers and 29.2% non-smokers. Among the smokers and non-smokers, 74.6% and 84.6% improvement in ambulation respectively at discharge. The odds of improved ambulation decrease among smokers as age group increases compared to those below 50 [(60-69 years, aOR, 0.30, 95% C.I, 0.108-0.850, p0.05), (70-79 years aOR, 0.27, 95% C.I, 0.096-0.734, p0.05), (80+ years aOR, 0.16, 95% C.I, 0.057-0.430, P0.01). Patients with National Institute of Health Stroke Scale Score (NIHSS) score7 (reference7) were 91% less likely to have improved ambulation among smokers and non-smokers (aOR, 0.09, 95% C.I, 0.055-0.155, P = 0.01), and (aOR, 0.08, 95% C.I, 0.027-0.214, P = 0.01) respectively. Atrial fibrillation was an independent predictor of decreased improvement in ambulation only among smokers (aOR, 0.58, 95% C.I, 0.356-0.928 P0.05).Our findings suggest that elderly smokers with atrial fibrillation would benefit more from aggressive management of atrial fibrillation than non-smokers.

Aim: This study investigated the clinical factors associated with functional ambulatory outcomes and gender differences in prestroke depressive patients. Materials & methods: Clinical risk factors associated with improved functional outcomes with recombinant tissue plasminogen activator-treated cohorts were determined using binary logistic regression. Results: In the adjusted analysis, improvement in ambulation was associated with male patients that had higher National Institute of Health stroke scale score (p = 0.04), a stroke history (p = 0.026), lower serum creatinine levels (p = 0.049) and were taking cholesterol reducing medication (p = 0.014). Improvement in females was associated with taking antidepressants (p = 0.027) and having lower National Institute of Health stroke scale score (p = 0.002). Conclusion: Our findings indicate gender disparities between male and female prestroke depressive patients.

Aim: The aim of this study was to determine the predictive value of clinical presentations on functional ambulation following thrombolytic therapy. Materials & methods: Logistic regression analysis was used to determine associations between functional ambulation and thrombolytic therapy. Results & conclusion: In the results, Hispanic ethnicity (odds ratio (OR): 2.808; p = 0.034; 95% CI: 1.08–7.30), high National Institute of Health Stroke Scale (NIHSS) (OR: 1.112; p ≤ 0.001; 95% CI: 1.06–1.17), weakness/paresis (OR: 1.796; p = 0.005; 95% CI: 1.19–2.71), Broca’s aphasia (OR: 1.571; p = 0.003; 95% CI = 1.16–2.12) and antihypertensive medication (OR: 1.530; p = 0.034; 95% CI: 1.03–2.26) were associated with an improved ambulation in patients without thrombolytic therapy. In thrombolytic treated patients, Broca’s aphasia was associated with improved functional outcome.

Men and women differ in their clinical risk factors with respect to various predictors of severity in acute ischemic stroke (AIS). High cholesterol is a risk factor for AIS and the mechanism by which high cholesterol levels lead to an AIS is well established. However, the specific relationship between demographic, clinical risk factors, total cholesterol, and the resulting gender difference in AIS patients is yet to be investigated. This study recruited AIS patients between January 2000 and June 2016 classified into normal, borderline or high total cholesterol (TC). Normal was defined as ≤200 mg/dl, borderline 200 to 239 mg/dl and high ≥240 mg/dl based on Adult Treatment Panel III (ATP III) Guidelines for the classification of TC levels. The logistic regression model was used to predict clinical risk factors associated within men and women AIS patients with different levels of TC. A total of 3532 AIS patients presented with normal TC, 760 patients with borderline TC and 427 patients with high TC. The high total cholesterol group was more likely to be women with increasing age (OR = 1.028, 95% CI, 1.006-1.052, P = .014), body mass index (BMI) (OR = 1.052, 95% CI, 1.004-1.102, P = .033), and high-density lipoprotein cholesterol (HDL-C) (OR = 1.039, 95% CI, 1.019-1.060, P

The benefits of a special stroke care unit (SSCU) over a non-specialized stroke care unit (NSSCU) is well documented in the literature. However, there are concerns that the benefits seen in the SSCU do not consider clinical risk factors that affect thrombolysis therapy.Retrospective data were collected from a stroke registry between January 1, 2010-June 30, 2016. Univariate analysis determined differences in exclusion criteria between the SSCU and NSSCU, while multivariable binary logistic regression adjusted for confounding variables.Of the 1,446 acute ischemic stroke patients eligible for rtPA, 34.0% of patients were admitted to the NSSCU, while 58.02% were admitted to the SSCU. For patients excluded from receiving rtPA in the SSCU: age80 (OR = 1.024-1.037, p =0.001), altered level of consciousness (OR = 1.551-2.363, p = 0.041), risk of mortality (OR = 1.090-1.166, p = 0.012), previous stroke (OR = 1.638-2.338, p = 0.007) were the exclusion criteria from rtPA. In the NSSCU, age80 (OR = 1.026-1.046, p = 0.012), history of atrial fibrillation (OR = 2.494-4.629, p = 0.004), diabetes (OR = 2.377-5.576, p = 0.047) and previous stroke (OR = 2.782-4.785, p =0.001) were associated with exclusion from rtPA.More patients are likely to be excluded from rtPA in the NSSCU if they present with history of atrial fibrillation, diabetes, and in the SSCU if they present with altered level of consciousness and are at risk of mortality. Improvement in the management of baseline clinical risk factors would improve thrombolysis use for better patient outcomes in specialized and non specialized stroke units.

The treatment outcomes in the use of rt-PA have been reported. Some studies reported worse outcome in women than men, while others presented opposing data. Using data from a hospital-based stroke registry, we investigated evidence of gender difference and determined exclusion criteria in a stroke population with incidence of hypertension.In a stroke population of women and men with incident of hypertension from a stroke registry, demographics and clinical factors were compared. Univariate analysis was used to determine gender differences, while multivariable models adjusted for demographic and clinical variables.Among the 669 stroke patients with incident of hypertension that were excluded from rt-PA treatment, 362 were female and 307 were male. Female patients with increasing age (OR = 0.956-0.984, P 0.001), diabetes mellitus (OR = 0.095-0.559, P = 0.001), higher NIH stroke scale score (OR = 1.019-1.090, P = 0.002), previous stroke (OR = 0.337-0.850, P = 0.008), diabetes medication (OR = 1.200-7.724, P = 0.019), and INR (OR = 0.033-0.597, P = 0.008) are more likely to be excluded. Male patients with a history of a previous stroke (OR = 0.265-0.704, P = 0.001), risk of mortality (OR = 0.803-0.950, P = 0.002), higher NIH stroke scale score(OR = 1.101-1.276, P 0.001), cholesterol reducing medication (OR = 1.191-2.910, P = 0.006), weakness at presentation(OR = 1.207-4.421, P = 0.011), and INR (OR = 0.016-0.243, P 0.001) are more likely to be excluded.Women have a worse outcome than men in an untreated acute ischemic stroke population, but when treated, women have a better treatment outcome compared to men. In a hypertensive stroke population, the clinical variables for the exclusion criteria for women and men are significantly different, even after adjustment for confounding variables.

In a stroke population, women have a worse outcome than men when untreated. In contrast, there is no significant difference in treated patients. In this study, we determined whether clinical variables represent a promising approach to assist in the evaluation of gender differences in a stroke population.We analyzed data from ischemic stroke patients' ≥18 years-old from the stroke registry on rtPA administration and identified gender differences in clinical factors within inclusion and exclusion criteria in a stroke population that received rtPA. Multivariate analysis was used to adjust for patient demographic and clinical variables.Of the 241 eligible stroke patients' thrombolytic therapy, 49.4% were females and 50.6% were males. Of the 422 patients that did not receive rtPA, more women (235) were excluded from rtPA than men (187) (P0.05). In the male population, exclusion from rtPA was associated with history of a previous stroke (P0.05, OR=2.028), hypertension (P0.05, OR=0.519), and NIH stroke score (P0.0001, OR=0.893). In female stroke patients, exclusion from rtPA was associated with previous history of stroke (P0.05, OR=2.332), diabetes (P0.05, OR=1.88) and NIH stroke score (P0.05, OR=0.916).Despite similarities in different areas of stroke care for both men and women, more women with diabetes, previous history of stroke and higher NIH scores are more likely to be excluded from thrombolytic therapy. Men with a previous history of stroke, hypertension and higher NIH scores are more likely to be excluded rtPA even after adjustment for confounding variables.

Background: The goal of this study is to elucidate clinical characteristics in patients with acute ischemic stroke (AIS) that are associated with a potential improvement or worsening neurologic function who previously were taking an anti-hypertensive medication and then received recombinant tissue plasminogen activator (rtPA). Methods: The binary logistical regression model was developed to identify clinical determinants that are associated with an improving or worsening neurologic function in AIS patients taking an anti-HTN medication who received thrombolytic therapy. The area under the receiver operating curve was used to determine the sensitivity of the model. Results: In the adjusted analysis for AIS population on combined rtPA and an anti-HTN medication therapy, increasing age (Odd ratio; OR = 1.035, 95% CI, 1.022–1.049, P

Students’ perceptions of the effectiveness of their interaction with patients is known to be correlated with their performance in the clinical rotations. Whether such an experience is correlated with the academic performance in a year one neuroscience course is not clear. Year one medical students were allowed to interact in small groups with patients suffering from neurological diseases. The small group sessions were followed by a large group debriefing session to discuss their experience following the patient interaction. Students were administered two structured surveys, a pre-test and a post-test, to evaluate their pre-session expectations and post-session satisfaction with their interaction with patients. The post-test survey results were correlated by objective with formative and summative examination scores. There was a positive correlation between students’ perceptions of the effectiveness of their interaction with patients and their performance on the formative examination (R2 = 0.315). The correlation was higher and significant (R2 = 0.774) between students’ interaction with patients and the summative examination. For students’ perception of the interaction with patients, questions on integration of the nervous system (OR = 3.449, p = 0.002), analytical and imaging modalities (OR = 1.513, p = 0.045), and abnormalities in the nervous system (OR = 2.117, p = 0.034) were significantly associated with students’ satisfaction of their interaction with patients. When a similar analysis was performed on the summative examination, five learning objectives revealed significant association: integrated functions of the nervous system (OR = 3.617, p = 0.005), structure of the nervous system (OR = 1.961, p = 0.021), analytical and imaging modalities (OR = 2.212, p = 0.031), orientation of anatomical features (OR = 1.512, p = 0.037), and abnormalities in the nervous system (OR = 2.413, p = 0.002). Interaction with patients with neurological diseases was positively correlated with the students’ academic performance.

Background Most of the exclusion criteria in a stroke population are attributed to demographic, more specific or relative contraindications indicating that thrombolysis maybe beneficial more to a stroke population with less restrictive criteria. Methods We analyzed a three year data set from a large stroke registry on rt-PA administration based on the US Food and Drug Administration (FDA) package insert, explicitly for the use of tissue-type plasminogen activator in acute ischemic stroke. We identified absolute and relative contraindications including specific clinical rationales for exclusion. Results A total of 663 ischemic stroke patients were eligible to receive rt-PA. Out of the 663 acute ischemic stroke patients, 241 received rt-PA and 422 were excluded based on specific absolute and relative exclusionary contraindications. Patients older than 80 years and those with mild or rapidly improving stroke symptoms, and higher NIHSS significantly influenced the decision to exclude stroke patients from rt-PA. Conclusion Contraindications differ with individual patients’ representing commonly encountered clinical situations that support most of the exclusion criteria in both the old FDA package insert and AHA guideline.

Background: Stroke is known to affect both men and women, however, incidence and outcomes differ between them. Therefore, the discovery of novel, sex-specific, blood-based biomarkers for acute ischemic stroke (AIS) patients has the potential to enhance the understanding of the etiology of this deadly disease in the content of sex. The objective of this study was to identify serum metabolites associated with male and female AIS patients. Methods: Metabolites were measured with the use of untargeted, reverse-phase ultra-performance liquid chromatography-tandem mass spectrometry quantification from blood specimens collected from AIS patients. Samples were collected from 36 patients comprising each of 18 men and women with matched controls. Metabolic pathway analysis and principal component analysis (PCA) was used to differentiate metabolite profiles for male and female AIS patients from the control, while logistic regression was used to determine differences in metabolites between male and female AIS patients. Results: In female AIS patients, 14 distinct altered metabolic pathways and 49 corresponding metabolites were identified, while 39 metabolites and 5 metabolic pathways were identified in male patients. Metabolites that are predictive of ischemic stroke in female patients were 1-(1-enyl-palmitoyl)-2-arachidonoyl-GPC (P-16:0/20:4) (AUC = 0.914, 0.765–1.000), 1-(1-enyl-palmitoyl)-2-palmitoyl-GPC (P-16:0/16:0) (AUC = 0.840, 0.656–1.000), and 5,6-dihydrouracil (P-16:0/20:2) (AUC = 0.815, 0.601–1.000). Significant metabolites that were predictive of stroke in male patients were 5alpha-androstan-3alpha,17beta-diol disulfate (AUC = 0.951, 0.857–1.000), alpha-hydroxyisocaproate (AUC = 0.938, 0.832–1.000), threonate (AUC = 0.877, 0.716–1.000), and bilirubin (AUC = 0.817, 0.746–1.000). Conclusions: In the current study, the untargeted serum metabolomics platform identified multiple pathways and metabolites associated with male and female AIS patients. Further research is necessary to characterize how these metabolites are associated with the pathophysiology in male and female AIS patients.

The complexity of the material being taught in clinical neuroscience within the medical school curriculum requires creative pedagogies to teach medical students effectively. Many clinical teaching strategies have been developed and are well described to address these challenges. However, only a few have been evaluated to determine their impact on the performance of students studying clinical neuroscience. Interactive, 2-hour, self-directed small-group interactive clinical case-based learning sessions were conducted weekly for 4 weeks to integrate concepts learned in the corresponding didactic lectures. Students in the small groups analyzed cases of patients suffering from neurological disease that were based on eight learning objectives that allowed them to evaluate neuroanatomical data and clinical findings before presenting their case analysis to the larger group. Students' performances on the formative quizzes and summative tests were compared to those of first-year medical students in the previous year for whom the self-directed, small-group interactive clinical sessions were not available. There was a significant improvement in the summative performance of first-year medical students with self-directed clinical case learning in the second year (Y2) of teaching clinical neuroscience (P < 0.05) when compared with first-year students in the first year (Y1) for whom the self-directed learning approach was not available. Student performance in the formative assessments between Y1 and Y2 was not significantly different (P = 0.803). A target of ≥70% student scoring above 80% in the final summative examination was met. The current study revealed evidence for the impact and educational outcomes of a self-directed, clinical teaching strategy in a clinical neuroscience curriculum for first-year medical students. Anat Sci Educ 11: 478-487. © 2017 American Association of Anatomists.

The worth of crayfish as a model system for studies of addiction was not previously recognized because a drug-reward phenomenon had not been documented in this model system. In our previous experiments, we demonstrate that the crayfish natural reward pathways are sensitive to human drugs of abuse. This finding supports crayfish as a suitable model to characterize specific behaviors that are relevant in drug addiction research, and the current study builds on our previous findings. The aim of the present study was to investigate unconditioned neurobehavioral effects of repeated treatment regimens using cocaine, morphine, and methamphetamine for three consecutive days. We analyzed mobility, immobility and characterized stereotypic behaviors following intracardial infusions of 2.0μg/g or 10.0μg/g doses of cocaine, morphine, and methamphetamine for three days. The results showed that systemic cocaine, morphine, and methamphetamine increased mobility at a low dose of 2.0μg/g more effectively than a high dose of 10.0μg/g, while simultaneously showing that the high dose exerted a more prominent effect in increasing immobility. Moreover, systemic cocaine, morphine, and methamphetamine injections have discerning effects towards a group of defined unconditioned stereotyped behavioral patterns associated with each drug, rather than a shared universal behavioral effect. These findings provide insight into the behavioral and pharmacological basis responsible for the unconditioned effects of these drugs in crayfish.

Background and Purpose Thrombolysis therapy remains the gold standard in acute ischemic stroke treatment, and rates of treatment with rtPA in ischemic stroke patients with comorbid depression has yet to be fully investigated. This study aims to examine clinical risk factors associated with inclusion or exclusion for rtPA in acute ischemic stroke populations with pre-stroke depression in the telestroke versus a non-telestroke setting. Methods We collected retrospective data from a regional stroke registry for pre-stroke depressed ischemic stroke patients from January 2010 to June 2016. Logistic regression was used to determine demographic and baseline clinical risk factors associated with inclusion and exclusion from rtPA. Results . In the adjusted analysis, increasing age (OR = 1.064, 95% CI, 1.006-1.125, P = 0.029), improved ambulation (OR = 3.513, 95% CI, (0.855–14.436, P = 0.018) and sleep apnea (OR = 4.458, 95% CI, 0.731–27.182, P = 0.05) were associated with inclusion for rtPA, while Caucasian race (OR = 0.119, 95% CI, 0.0168–0.908, P = 0.040), systolic blood pressure (OR = 0.945, 95% CI, 0.906–0.985, P = 0.008), and direct admission (OR = 0.028, 95% CI, 0.003–0.317, P = 0.004) were associated with exclusion from rtPA. In the telestroke setting, INR (OR = 1.016, 95% CI, 0–5.393, P = 0.163) was not significantly associated with rtPA inclusion or exclusion. Conclusion Identifying contraindicators associated with exclusion from rtPA is significant to improve the use thrombolytic therapy in the telestroke and non telestroke settings.

Melatonin is a multifunctional signalling molecule that is secreted by the mammalian pineal gland, and also found in a number of organisms including plants and bacteria. Research has continued to uncover an ever-increasing number of processes in which melatonin is known to play crucial roles in mammals. Amongst these functions is its contribution to cell multiplication, differentiation and survival in the brain. Experimental studies show that melatonin can achieve these functions by influencing transcription factors which control neuronal and glial gene expression. Since neuronal survival and differentiation are processes that are important determinants of the pathogenesis, course and outcome of neurodegenerative disorders; the known and potential influences of melatonin on neuronal and glial transcription factors are worthy of constant examination. In this review, relevant scientific literature on the role of melatonin in preventing or altering the course and outcome of neurodegenerative disorders, by focusing on melatonin’s influence on transcription factors is examined. A number of transcription factors whose functions can be influenced by melatonin in neurodegenerative disease models have also been highlighted. Finally, the therapeutic implications of melatonin’s influences have also been discussed and the potential limitations to its applications have been highlighted.

Background. Specific clinical risk factors that may be associated with ambulatory outcome following thrombolysis therapy in ischemic stroke patients with pre-stroke depression is not fully understood. This was investigated. Methods. Multivariate analyses were performed to identify predictors of functional ambulatory outcomes. Patient demographics and clinical risk factors served as predictive variables, while improvement or no improvement in ambulatory outcome was considered as the primary outcome. Results. A total of 595 of these patients received rtPA of which 310 patients presented with pre-stroke depression, 217 had no improvement in functional outcome, while 93 patients presented with an improvement in functional outcome. Carotid artery stenosis (OR= 11.577, 95% CI, 1.281 – 104.636, P=0.029) and peripheral vascular disease (OR= 18.040, 95% CI, 2.956-110.086, P=0.002) were more likely to be associated with an improvement in ambulation. Antihypertensive medications (OR= 7.810, 95% CI, 1.401 –43.529, P=0.019),previous TIA (OR= 0.444, 95% CI, 0.517 –0.971, P=0.012), and congestive heart failure (OR= 0.217, 95% CI, 0.318 –0.402, P=0.030) were associated with a no improvement in ambulation. Conclusion. After adjustment for covariates, more clinical risk factors were associated with no improvement when compared with improvement in functional outcome following thrombolysis therapy in an acute ischemic stroke population with pre-stroke depression.

Gender differences in the use of recombinant tissue-type plasminogen activator (r-tPA) in stroke are complicated. In this study, we investigated gender differences using r-tPA exclusion criterion in a stroke population.We analyzed the data from ischemic stroke patients aged 18 years or older from the Greenville Health System stroke registry on r-tPA administration between January 2010 and December 2013. We identified exclusion criterion and used specific clinical factors to determine gender differences in stroke patients receiving r-tPA.Of the 633 patients who were eligible to receive r-tPA, less than half received r-tPA (n = 241) whereas 422 were not able to receive r-tPA. Of the 241 patients who received r-tPA, 49.4% were female and 50.6% were male. Of the 422 patients who did not receive r-tPA, more women (235) were excluded from r-tPA than men (187) (P .05). There were no gender differences in warning signs and contraindications in female versus male stroke patients (P .005). There were however gender differences in age group as more women (38%; n = 235) were more likely to be excluded if they are more than 80 years old than men (19%, n = 187).Within a large stroke population, exclusion criteria for r-tPA in women and men were similar with regard to race, initial National Institutes of Health Stroke Scale score, warning signs, and contraindications, but were different in the age group population exclusion criterion for intravenous r-tPA. We observed that intracerebral hemorrhage and match on computed tomography perfusion/magnetic resonance imaging or visible infarct greater than one third of the middle cerebral artery distribution were absolute criteria for exclusion.

The objective of this study was to characterize the comorbidities in a population of patients with an acute ischaemic stroke, comparing patients that received recombinant tissue plasminogen activator (rt-PA) to those that did not receive rt-PA.In a retrospective sample of 663 patients admitted for acute ischaemic stroke, this study analysed the effects of co-morbid conditions in the use of rt-PA. It determined non-cerebrovascular risk factors (comorbidities) that differentiate patients who received rt-PA from those who did not receive rt-PA.Patients with a history of carotid stenosis, CHF and previous strokes are significantly (p0.05) associated with high risk of not receiving rt-PA. A significant number of patients with a history of hypertension and smoking received rt-PA (p0.05).The findings indicate that certain risk factors including carotid stenosis, CHF and previous stroke history impact the treatment of patients with acute ischaemic stroke, specifically the decision to administer rt-PA. Treatment with rt-PA is dependent on stroke severity and onset to treatment time, but the findings suggest that rt-PA use may also depend on patient comorbidities.

This study evaluated the effects of concurrent ciprofloxacin administration on the disposition of quinine in healthy volunteers. Quinine (600-mg single dose) was administered either alone or with the 11th dose of ciprofloxacin (500 mg every 12 hours for 7 days) to 15 healthy volunteers in a crossover fashion. Blood samples collected at predetermined time intervals were analyzed for quinine and its major metabolite, 3-hydroxquinine, using a validated high-performance liquid chromatographic method. Administration of quinine plus ciprofloxacin resulted in significant increases (P < 0.05) in the total area under the concentration-time curve, maximum plasma concentration (Cmax), and terminal elimination half-life (T1/2b) of quinine compared with values with quinine dosing alone (AUC: 27.93 ± 8.04 vs. 41.62 ± 13.98 h·mg/L; Cmax: 1.37 ± 0.24 vs. 1.64 ± 0.38 mg/L; T1/2b: 16.28 ± 2.66 vs. 21.43 ± 3.22 hours), whereas the oral plasma clearance markedly decreased (23.17 ± 6.49 vs. 16.00 ± 5.27 L/h). In the presence of ciprofloxacin, there was a pronounced decrease in the ratio of AUC (metabolite)/AUC (unchanged drug) and highly significant decreases in Cmax and AUC of the metabolite (P < 0.05). Ciprofloxacin may increase the adverse effects of concomitantly administered quinine, which can have serious consequences on the patient. Thus, a downward dosage adjustment of quinine seems to be necessary when concurrently administered with ciprofloxacin.

Background In acute ischemic stroke patients, telestroke technology provides sustainable approaches to improve the use of thrombolysis therapy. How this is achieved as it relates to inclusion or exclusion of clinical risk factors for thrombolysis is not fully understood. We investigated this in a population of hypertensive stroke patients. Methods Structured data from a regional stroke registry that contained telestroke and non telestroke patients with a primary diagnosis of acute ischemic stroke with history of hypertension were collected between January 2014 and June 2016. Clinical risk factors associated with inclusion or exclusion for recombinant tissue plasminogen activator (rtPA) in the telestroke and non telestroke were identified using multiple regression analysis. Associations between variables and rtPA in the regression models were determined using variance inflation factors while the fitness of each model was determined using the ROC curve to predict the power of each logistic regression model. Results The non telestroke admitted more patients (62% vs 38%), when compared with the telestroke. Although the telestroke admitted fewer patients, it excluded 11% and administered thrombolysis therapy to 89% of stroke patients with hypertension. In the non telestroke group, adjusted odd ratios showed significant associations of NIH stroke scale score (OR = 1.059, 95% CI, 1.025–1.093, P

Background. The purpose of this study was to develop models to predict the recovery of ambulatory functions taking into account the capability of the motor system to functionally reorganize in response to thrombolysis therapy. Methods. We predicted ambulatory functions recovery using retrospective data from a stroke registry of acute ischemic stroke patients who received thrombolysis therapy. Multivariate regression was used to construct the models. Multicollinearity and significant interactions were examined using variance inflation factors, while a Cox & Snell classification were applied to check the fitness of each model. Results. The models correctly predicted clinical variables that were associated with an improvement or non-improvement in functional ambulatory outcome. Broca’s aphasia (OR = 2.270, P = 0.002, CI =1.34-3.83) was associated with improved functional outcome at discharge, while patients aged 80 years or older (OR = 0.942, P = Conclusion. Prognostic models that can predict improved functional ambulatory outcome in thrombolysis therapy can be beneficial in the care of stroke patients. Our models predicted improved functional recovery of Broca’s aphasia after thrombolysis therapy, suggesting a future potential to evaluate motor speech area after stroke.

There are concerns that specific risk factors may alter the benefits of thrombolysis in stroke patients with controlled contraindications including hypertension. The objective of this study was to evaluate the association between clinical risk factors and outcomes in ischemic stroke patients that received thrombolysis therapy pretreated with antihypertensive medications. Using data obtained from a stroke registry, a non-randomized retrospective data analysis was conducted on patients with the primary diagnosis of acute ischemic stroke with hypertension pretreated with antihypertensive medications. The association between clinical risk factors and functional ambulatory outcome was determined using logistic regression while odd ratios (OR) were used to predict the odds of achieving improved ambulatory outcome in thrombolysis treatment status. Improved or poor functional ambulatory outcome was considered as the end point in our analysis. A total of 4665 acute ischemic stroke patients were identified, of whom 1446 (31.0%) were eligible for thrombolysis, while 3219 were not, and 595 received rtPA, of whom 288 were on antihypertensive medications, while 233 were not. In the rtPA group with antihypertensive (anti-HTN) medication, only NIHSS score (OR = 1.094, 95% CI, 1.094-1.000, P = 0.005) was associated with improved functional outcome while patients with congestive heart failure (OR = 0.385, 95% CI, 0.385-0.159, P = 0.035) and patients with a history of previous TIA (OR = 0.302, 95% CI, 0.302-0.113, P = 0.017) were more likely to be associated with poor functional outcomes. Congestive heart failure and TIA are independent predictors of functional outcomes in stroke patients pretreated with antihypertensive medications prior to thrombolysis therapy.

Background Clinical risk factors related to not administering thrombolysis to acute ischemic stroke patients with incidence dyslipidemia is not clear. This issue was investigated in telestroke and non-telestroke settings. Methods We analyzed retrospective data collected from a stroke registry to compare exclusion risk factors in the telestroke and non-telestroke. We performed multivariate analysis was performed to identify risk factors that may result in exclusion from rtPA. Variance inflation factors were used to examine multicollinearity and significant interactions between independent variables in the model, while Hosmer-Lemeshow test, Cox & Snell were used to determine the fitness of the regression models. Results A greater number of patients with acute ischemic stroke with incidence dyslipidemia were treated in the non-telestroke (285) when compared with the telestroke network (187). Although non-telestroke admitted more patients than the telestroke, the telestroke treated more patients with rtPA (89.30%) and excluded less (10.70%), while the non-telestroke excluded from rtPA (61.40%). In the non-telestroke, age (adjusted OR, 0.965; 95% CI, 0.942–0.99), blood glucose level (adjusted OR, 0.995; 95% CI, 0.99–0.999), international normalized ratio (adjusted OR, 0.154; 95% CI, 0.031–0.78),congestive heart failure(CHF) (adjusted OR, 0.318; 95% CI, 0.109–0.928), previous stroke (adjusted OR, 0.405; 95% CI, 0.2–0.821) and renal insufficiency (adjusted OR, 0.179; 95% CI, 0.035–0.908) were all directly linked to exclusion from rtPA. In the telestroke, only body mass index (adjusted OR, 0.911; 95% CI, 0.832–0.997) significantly excluded acute ischemic stroke patients with incidence dyslipidemia from thrombolysis therapy. Conclusion Despite having more patients with acute ischemic stroke that present incidence dyslipidemia, the non-telestroke patients had more clinical risk factors that excluded more patients from rtPA when compared with telestroke. Future studies should focus on how identified clinical risk factors can be managed to improve the use of rtPA in the non-telestroke setting. Moreover, the optimization of the risk-benefit ratio of rtPA by the telestroke technology can be advanced to the non-telestroke setting to improve the use of thrombolysis therapy.