1.Safety and efficacy of extending intravenous thrombolysis treatment for acute ischemic stroke in Taiwan
Neurology Asia 2019;24(3):209-214
Recombinant tissue plasminogen activator (rt-PA) is the most effective treatment for acute ischemic
stroke and the exclusion criteria of rt-PA has been revised to extend its application. However, in
Taiwan, National Health Insurance (NHI) did not follow the latest international consensus due to
safety concerns. The present study investigated whether extending the application of rt-PA in Taiwan
was safe and effective. The medical records from the Shuang Ho hospital stroke registry between
August 2009 and December 2016 were retrospectively reviewed. Post rt-PA intracranial hemorrhage
(ICH) and modified Rankin Scale (mRS) score at 3-month after stroke were the primary and secondary
outcomes, respectively. Differences were analyzed through Fisher’s exact test and Student’s t test. A
p-value of <0.05 was considered statistically significant. Overall, there were 243 patients categorized
into two groups: NHI exclusion criteria adherence (n = 160) and non-adherence (n = 83). There
was no significant difference in the risk of post rt-PA ICH (12.50% in adherence group, 4.82% in
non-adherence group, p=0.07). Among the non-adherence group, 10 patients breached the latest
international exclusion criteria and none of them experienced post rt-PA ICH. However, among
patients with moderately severe stroke, the odds of mRS < 2 at 3-month were significantly lower in
non-adherence group. This study demonstrated that extending administration of rt-PA in Taiwan was
safe but the functional outcome after moderate stroke was not as favorable as adherence group. Old
age, long onset-to-treatment time and less efficacy of lower dose of rt-PA were the possible factors
for the difference in outcome.
2.Intravesical PGE2 Administration in Conscious Rats as an Experimental Model of Detrusor Overactivity Observed by Simultaneous Registrations of Intravesical and Intraabdominal Pressures.
Long Hu JIN ; Jeong Uk HAN ; Chang Shin PARK ; Hwa Yeon SHIN ; Sang Min YOON ; Tack LEE
International Neurourology Journal 2010;14(2):69-77
PURPOSE: The urodynamic effects of intravesical PGE2 instillation on bladder function and detrusor overactivity (DO) during the filling phase were investigated in rats by measuring intraabdominal and intravesical pressures simultaneously. MATERIALS AND METHODS: Continuous cystometry was performed inconscious, female and male Sprague- Dawley rats. We investigated pressure-, volume-, and DO-related parameters. RESULTS: Intravesical instillation of PGE2 increased all pressure-related parameters and decreased volume-related ones, compared to the control cystometric ones. However, among the total number of intravesical pressure rises (IVPRs) above 2 cmH2O during the filling phase, only 33% in female rats and 38% in male rats after PGE2 instillation were identified as true DO during the filling phase. CONCLUSIONS: Our findings suggest that the rat model with intravesical PGE2 is inappropriate for observing the effects of some drugs or mechanisms on DO, because only approximately 30% of IVPRs were confirmed as true DO. However, this model of intravesical PGE2 instillation has some advantages for the observation of changes in pressure and volume parameters rather than in DO-related ones.
Administration, Intravesical
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Animals
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Dinoprostone
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Female
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Humans
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Male
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Models, Theoretical
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Rats
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Urinary Bladder
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Urodynamics
3.Artificial neural network-based analysis of the safety and efficacy of thrombolysis for ischemic stroke in older adults in Taiwan
Chen-Chih Chung ; You-Chia Chen ; Chien-Tai Hong ; Nai-Fang Chi ; Chaur-Jong Hu ; Han-Hwa Hu ; Lung Chan ; Hung-Wen Chiu
Neurology Asia 2020;25(2):109-117
Background: The risk and benefit of tissue plasminogen activator (tPA) for aged>80 years with acute
ischemic stroke (AIS) are controversial. In this study, we investigated the safety and efficacy of tPA
in this population and utilized the artificial neural network (ANN) to established outcome predictive
models. Methods: We retrospectively reviewed the stroke registry data of patients with AIS, aged >80
years who arrived at the hospital within 3 hours from the onset of symptoms. The characteristics and
the outcomes, presented as modified Rankin Scale (mRS), and mortality rate at 3 months between the
tPA-treated and non-tPA groups were analyzed. An ANN algorithm was applied to establish predictive
models. Results: A total of 80 patients aged>80 years with AIS were identified, and 49 of them received
tPA. After adequate training, our ANN models accurately predicted the outcomes with the area under
the receiver operating characteristic curves of 0.974, and a low error to predict the mRS score at 3
months. After applying our prediction model to those in the non-tPA group, we demonstrated the
potential benefits in those patients if they had undergone tPA therapy.
Conclusions: Our results show that ANN can be a potentially useful tool for predicting the treatment
outcomes of tPA. Such novel machine learning-based models may help with therapeutic decision
making in clinical settings.