1.Relationship between strength exertion and subjective muscle-fatigue sensation in the relative sustained static hand gripping.
YOSHINORI NAGASAWA ; SHINICHI DEMURA ; YOSHINOBU YOSHIMURA ; SHUNSUKE YAMAJI ; MASAKATSU NAKADA ; JINZABURO MATSUZAWA
Japanese Journal of Physical Fitness and Sports Medicine 2000;49(4):495-502
The purpose of this study was to examine the individual differences in relative grip-strengthendurance (RGE) variables and relations between force, endurance time and level of subjective musclefatigue sensation (SMS) of RGE. Endurance time and SMS during grip-strength exertion using various relative demand values to the maximal grip-strength-value (MAX) were analyzed. Subjects were 23 healthy adults (male 10 and female 13) . Four demand values of 25, 35, 50 and 75% were selected as relative demand values to MAX. The grip-strength-exertion value was input into a personal computer using the system of grip-strength with a strain-gauge (Yagami : ED-D 100 R) . The results are summarized as follows:
1) Muscle group related to grip-strength exertion recovered up to about 60% of initial within 10-15 sec after grip-strength exertion stopped regardless of the degree of relative demand values.
2) The SMS in any relative demand values reached a peak after continuing relative demand values became impossible, and the tendency is stronger with a higher demand value.
3) With about 25% relative demand values, physiological muscle fatigue and SMS advanced at almost the same time, and the grip-strength exertion was possible for a little while after the SMS reached a peak.
4) With the lower relative demand values under 50%, the influence of SMS appeared stronger by extending the endurance time and the decline-delay of grip-strength-exertion.
5) With relative demand values over 50%, continuing relative demand values became impossible within a short time, and the peak SMS appeared earlier than that of relative demand values. On the other hand, the continuing the lower relative demand values was possible to some extent, and individual differences in the continuance and peak arrival-times of SMS were large.
2.Mode of Imaging Study and Endovascular Therapy for a Large Ischemic Core: Insights From the RESCUE-Japan LIMIT
Fumihiro SAKAKIBARA ; Kazutaka UCHIDA ; Shinichi YOSHIMURA ; Nobuyuki SAKAI ; Hiroshi YAMAGAMI ; Kazunori TOYODA ; Yuji MATSUMARU ; Yasushi MATSUMOTO ; Kazumi KIMURA ; Reiichi ISHIKURA ; Manabu INOUE ; Kumiko ANDO ; Atsushi YOSHIDA ; Kanta TANAKA ; Takeshi YOSHIMOTO ; Junpei KOGE ; Mikiya BEPPU ; Manabu SHIRAKAWA ; Takeshi MORIMOTO ;
Journal of Stroke 2023;25(3):388-398
Background:
and Purpose Differences in measurement of the extent of acute ischemic stroke using the Alberta Stroke Program Early Computed Tomographic Score (ASPECTS) by non-contrast computed tomography (CT-ASPECTS stratum) and diffusion-weighted imaging (DWI-ASPECTS stratum) may impact the efficacy of endovascular therapy (EVT) in patients with a large ischemic core.
Methods:
The RESCUE-Japan LIMIT (Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism Japan–Large IscheMIc core Trial) was a multicenter, open-label, randomized clinical trial that evaluated the efficacy and safety of EVT in patients with ASPECTS of 3–5. CT-ASPECTS was prioritized when both CT-ASPECTS and DWI-ASPECTS were measured. The effects of EVT on the modified Rankin Scale (mRS) score at 90 days were assessed separately for each stratum.
Results:
Among 183 patients, 112 (EVT group, 53; No-EVT group, 59) were in the CT-ASPECTS stratum and 71 (EVT group, 40; No-EVT group, 31) in the DWI-ASPECTS stratum. The common odds ratio (OR) (95% confidence interval) of the EVT group for one scale shift of the mRS score toward 0 was 1.29 (0.65–2.54) compared to the No-EVT group in CT-ASPECTS stratum, and 6.15 (2.46–16.3) in DWI-ASPECTS stratum with significant interaction between treatment assignment and mode of imaging study (P=0.002). There were significant interactions in the improvement of the National Institutes of Health Stroke Scale score at 48 hours (CT-ASPECTS stratum: OR, 1.95; DWIASPECTS stratum: OR, 14.5; interaction P=0.035) and mortality at 90 days (CT-ASPECTS stratum: OR, 2.07; DWI-ASPECTS stratum: OR, 0.23; interaction P=0.008).
Conclusion
Patients with ASPECTS of 3–5 on MRI benefitted more from EVT than those with ASPECTS of 3–5 on CT.
3.Thrombectomy in Stroke Patients With Low Alberta Stroke Program Early Computed Tomography Score: Is Modified Thrombolysis in Cerebral Infarction (mTICI) 2c/3 Superior to mTICI 2b?
Sameh Samir ELAWADY ; Brian Fabian SAWAY ; Hidetoshi MATSUKAWA ; Kazutaka UCHIDA ; Steven LIN ; Ilko MAIER ; Pascal JABBOUR ; Joon-Tae KIM ; Stacey Quintero WOLFE ; Ansaar RAI ; Robert M. STARKE ; Marios-Nikos PSYCHOGIOS ; Edgar A SAMANIEGO ; Adam ARTHUR ; Shinichi YOSHIMURA ; Hugo CUELLAR ; Jonathan A. GROSSBERG ; Ali ALAWIEH ; Daniele G. ROMANO ; Omar TANWEER ; Justin MASCITELLI ; Isabel FRAGATA ; Adam POLIFKA ; Joshua OSBUN ; Roberto CROSA ; Charles MATOUK ; Min S. PARK ; Michael R. LEVITT ; Waleed BRINJIKJI ; Mark MOSS ; Travis DUMONT ; Richard WILLIAMSON JR. ; Pedro NAVIA ; Peter KAN ; Reade De LEACY ; Shakeel CHOWDHRY ; Mohamad EZZELDIN ; Alejandro M. SPIOTTA ; Sami Al KASAB ;
Journal of Stroke 2024;26(1):95-103
Background:
and Purpose Outcomes following mechanical thrombectomy (MT) are strongly correlated with successful recanalization, traditionally defined as modified Thrombolysis in Cerebral Infarction (mTICI) ≥2b. This retrospective cohort study aimed to compare the outcomes of patients with low Alberta Stroke Program Early Computed Tomography Score (ASPECTS; 2–5) who achieved mTICI 2b versus those who achieved mTICI 2c/3 after MT.
Methods:
This study utilized data from the Stroke Thrombectomy and Aneurysm Registry (STAR), which combined databases from 32 thrombectomy-capable stroke centers between 2013 and 2023. The study included only patients with low ASPECTS who achieved mTICI 2b, 2c, or 3 after MT for internal carotid artery or middle cerebral artery (M1) stroke.
Results:
Of the 10,229 patients who underwent MT, 234 met the inclusion criteria. Of those, 98 (41.9%) achieved mTICI 2b, and 136 (58.1%) achieved mTICI 2c/3. There were no significant differences in baseline characteristics between the two groups. The 90-day favorable outcome (modified Rankin Scale score: 0–3) was significantly better in the mTICI 2c/3 group than in the mTICI 2b group (adjusted odds ratio 2.35; 95% confidence interval [CI] 1.18–4.81; P=0.02). Binomial logistic regression revealed that achieving mTICI 2c/3 was significantly associated with higher odds of a favorable 90-day outcome (odds ratio 2.14; 95% CI 1.07–4.41; P=0.04).
Conclusion
In patients with low ASPECTS, achieving an mTICI 2c/3 score after MT is associated with a more favorable 90-day outcome. These findings suggest that mTICI 2c/3 is a better target for MT than mTICI 2b in patients with low ASPECTS.
4.Endovascular Therapy in the Extended Time Window for Large Vessel Occlusion in Patients With Pre-Stroke Disability
Kanta TANAKA ; Hiroshi YAMAGAMI ; Muhammad M. QURESHI ; Kazutaka UCHIDA ; James E. SIEGLER ; Raul G. NOGUEIRA ; Shinichi YOSHIMURA ; Nobuyuki SAKAI ; Nicolas MARTINEZ-MAJANDER ; Simon NAGEL ; Jelle DEMEESTERE ; Volker PUETZ ; Diogo C. HAUSSEN ; Mohamad ABDALKADER ; Marta OLIVE-GADEA ; Mahmoud H. MOHAMMADEN ; João Pedro MARTO ; Anne DUSART ; Simon WINZER ; Liisa TOMPPO ; Francois CAPARROS ; Hilde HENON ; Flavio BELLANTE ; João Nuno RAMOS ; Santiago ORTEGA-GUTIERREZ ; Sunil A. SHETH ; Stefania NANNONI ; Johannes KAESMACHER ; Lieselotte VANDEWALLE ; Sergio SALAZAR-MARIONI ; Mudassir FAROOQUI ; Pekka VIRTANEN ; Rita VENTURA ; Syed ZAIDI ; Alicia C. CASTONGUAY ; Ajit S. PURI ; Behzad FARZIN ; Hesham E. MASOUD ; Piers KLEIN ; Jessica JESSER ; Manuel REQUENA ; Tomas DOBROCKY ; Daniel P.O. KAISER ; Erno PELTOLA ; Davide STRAMBO ; Markus A. MÖHLENBRUCH ; Eugene LIN ; Peter A. RINGLEB ; Osama O. ZAIDAT ; Charlotte CORDONNIER ; Daniel ROY ; Robin LEMMENS ; Marc RIBO ; Daniel STRBIAN ; Urs FISCHER ; Patrik MICHEL ; Jean RAYMOND ; Thanh N. NGUYEN
Journal of Stroke 2024;26(2):269-279
Background:
and Purpose We compared the outcomes of endovascular therapy (EVT) in an extended time window in patients with large-vessel occlusion (LVO) between patients with and without pre-stroke disability.
Methods:
In this prespecified analysis of the multinational CT for Late Endovascular Reperfusion study (66 participating sites, 10 countries between 2014 and 2022), we analyzed data from patients with acute ischemic stroke with a pre-stroke modified Rankin Scale (mRS) score of 0–4 and LVO who underwent EVT 6–24 hours from the time last seen well. The primary outcome was the composite of functional independence (FI; mRS score 0–2) or return to the pre-stroke mRS score (return of Rankin, RoR) at 90 days. Outcomes were compared between patients with pre-stroke disability (pre-stroke mRS score 2–4) and those without (mRS score 0–1).
Results:
A total of 2,231 patients (median age, 72 years; median National Institutes of Health Stroke Scale score, 16) were included in the present analysis. Of these, 564 (25%) had pre-stroke disability. The primary outcome (FI or RoR) was observed in 30.7% of patients with pre-stroke disability (FI, 16.5%; RoR, 30.7%) compared to 44.1% of patients without (FI, 44.1%; RoR, 13.0%) (P<0.001). In multivariable logistic regression analysis with inverse probability of treatment weighting, pre-stroke disability was not associated with significantly lower odds of achieving FI or RoR (adjusted odds ratio 0.73, 95% confidence interval 0.43–1.25). Symptomatic intracranial hemorrhage occurred in 6.3% of both groups (P=0.995).
Conclusion
A considerable proportion of patients with late-presenting LVO and pre-stroke disability regained pre-stroke mRS scores after EVT. EVT may be appropriate for patients with pre-stroke disability presenting in the extended time window.