Prevalence of PTSD in Survivors of Stroke and Transient Ischemic Attack: A Meta-Analytic Review

Background and Purpose

Posttraumatic stress disorder (PTSD) is common in survivors of acute life-threatening illness, but little is known about the burden of PTSD in survivors of stroke and transient ischemic attack (TIA). This study estimated the prevalence of stroke or TIA-induced posttraumatic stress disorder (PTSD) using systematic review and meta-analysis.

Methods

Potentially relevant peer-reviewed journal articles were identified by searching the Ovid MEDLINE, PsycINFO, PILOTS Database, The Cochrane Library and Scopus from inception to January 2013; all searches were conducted on January 31, 2013. Observational cohort studies that assessed PTSD with specific reference to a stroke or TIA that occurred at least 1 month prior to the PTSD assessment were included. PTSD rates and characteristics of the study and sample were abstracted from all included studies. The coding of all articles included demographics, sample size, study country, and method and timing of PTSD assessment.

Results

Nine studies (N = 1,138) met our inclusion criteria. PTSD rates varied significantly across studies by timing of PTSD assessment (i.e., within 1 year of stroke/TIA versus greater than 1 year post-stroke/TIA; 55% of heterogeneity explained; Q ₁ = 10.30; P = .001). Using a random effects model, the estimated rate of PTSD following stroke or TIA was 23% (95% CI, 16%–33%) within 1 year of the stroke or TIA and 11% (95% CI, 8%–14%) after 1 year.

Conclusions

Although PTSD is commonly thought to be triggered by external events such as combat or sexual assault, these results suggest that 1 in 4 stroke or TIA survivors develop significant PTSD symptoms due to the stroke or TIA. Screening for PTSD in a large population-based prospective cohort study with cardiovascular outcome assessments is needed to yield definitive prevalence, and determine whether stroke or TIA-induced PTSD is a risk factor for subsequent cardiovascular events or mortality.     

Rehabilitation Profiles of Older Adult Stroke Survivors Admitted to Intermediate Care Units: A Multi-Centre Study

BackgroundStroke is a major cause of disability in older adults, but the evidence around post-acute treatment is limited and heterogeneous. We aimed to identify profiles of older adult stroke survivors admitted to intermediate care geriatric rehabilitation units.MethodsWe performed a cohort study, enrolling stroke survivors aged 65 years or older, admitted to 9 intermediate care units in Catalonia-Spain. To identify potential profiles, we included age, caregiver presence, comorbidity, pre-stroke and post-stroke disability, cognitive impairment and stroke severity in a cluster analysis. We also proposed a practical decision tree for patient’s classification in clinical practice. We analyzed differences between profiles in functional improvement (Barthel index), relative functional gain (Montebello index), length of hospital stay (LOS), rehabilitation efficiency (functional improvement by LOS), and new institutionalization using multivariable regression models (for continuous and dichotomous outcomes).ResultsAmong 384 patients (79.1±7.9 years, 50.8% women), we identified 3 complexity profiles: a) Lower Complexity with Caregiver (LCC), b) Moderate Complexity without Caregiver (MCN), and c) Higher Complexity with Caregiver (HCC). The decision tree showed high agreement with cluster analysis (96.6%). Using either linear (continuous outcomes) or logistic regression, both LCC and MCN, compared to HCC, showed statistically significant higher chances of functional improvement (OR = 4.68, 95%CI = 2.54–8.63 and OR = 3.0, 95%CI = 1.52–5.87, respectively, for Barthel index improvement ≥20), relative functional gain (OR = 4.41, 95%CI = 1.81–10.75 and OR = 3.45, 95%CI = 1.31–9.04, respectively, for top Vs lower tertiles), and rehabilitation efficiency (OR = 7.88, 95%CI = 3.65–17.03 and OR = 3.87, 95%CI = 1.69–8.89, respectively, for top Vs lower tertiles). In relation to LOS, MCN cluster had lower chance of shorter LOS than LCC (OR = 0.41, 95%CI = 0.23–0.75) and HCC (OR = 0.37, 95%CI = 0.19–0.73), for LOS lower Vs higher tertiles.ConclusionOur data suggest that post-stroke rehabilitation profiles could be identified using routine assessment tools and showed differential recovery. If confirmed, these findings might help to develop tailored interventions to optimize recovery of older stroke patients.     

Population-Based Stroke Atlas for Outcome Prediction: Method and Preliminary Results for Ischemic Stroke from CT

Background and Purpose

Knowledge of outcome prediction is important in stroke management. We propose a lesion size and location-driven method for stroke outcome prediction using a Population-based Stroke Atlas (PSA) linking neurological parameters with neuroimaging in population. The PSA aggregates data from previously treated patients and applies them to currently treated patients. The PSA parameter distribution in the infarct region of a treated patient enables prediction. We introduce a method for PSA calculation, quantify its performance, and use it to illustrate ischemic stroke outcome prediction of modified Rankin Scale (mRS) and Barthel Index (BI).

Methods

The preliminary PSA was constructed from 128 ischemic stroke cases calculated for 8 variants (various data aggregation schemes) and 3 case selection variables (infarct volume, NIHSS at admission, and NIHSS at day 7), each in 4 ranges. Outcome prediction for 9 parameters (mRS at 7th, and mRS and BI at 30th, 90th, 180th, 360th day) was studied using a leave-one-out approach, requiring 589,824 PSA maps to be analyzed.

Results

Outcomes predicted for different PSA variants are statistically equivalent, so the simplest and most efficient variant aiming at parameter averaging is employed. This variant allows the PSA to be pre-calculated before prediction. The PSA constrained by infarct volume and NIHSS reduces the average prediction error (absolute difference between the predicted and actual values) by a fraction of 0.796; the use of 3 patient-specific variables further lowers it by 0.538. The PSA-based prediction error for mild and severe outcomes (mRS = [2]–[5]) is (0.5–0.7). Prediction takes about 8 seconds.

Conclusions

PSA-based prediction of individual and group mRS and BI scores over time is feasible, fast and simple, but its clinical usefulness requires further studies. The case selection operation improves PSA predictability. A multiplicity of PSAs can be computed independently for different datasets at various centers and easily merged, which enables building powerful PSAs over the community.     

Biofeedback and Dance Performance: A Preliminary Investigation

Alpha-theta neurofeedback has been shown to produce professionally significant performance improvements in music students. The present study aimed to extend this work to a different performing art and compare alpha-theta neurofeedback with another form of biofeedback: heart rate variability (HRV) biofeedback. Twenty-four ballroom and Latin dancers were randomly allocated to three groups, one receiving neurofeedback, one HRV biofeedback and one no intervention. Dance was assessed before and after training. Performance improvements were found in the biofeedback groups but not in the control group. Neurofeedback and HRV biofeedback benefited performance in different ways. A replication with larger sample sizes is required.     

昌黎海区文昌鱼初步调查

描述了秦皇岛昌黎海区文昌鱼栖息的自然生态环境,测定了文昌鱼的种群结构、生物学特征等,并进一步对秦皇岛文昌鱼的分类地位进行了研究。结果认为,秦皇岛文昌鱼与厦门文昌鱼及青岛文昌鱼同属于一个种,从亲缘关系上,秦皇岛文昌鱼与青岛文昌鱼要更近些。     

普雄原鲵初步调查

普雄原鲵Pseudohynobius puxiongensis是依据1965年获得的单号标本描述订立的新种,目前仅见于我国大凉山极狭窄区域,是该高寒地区唯一的五趾小鲵科动物。调查小组根据相似分布区及访问线索,于2007—2014年间相继发现普雄原鲵个体(包括成体、幼体和卵袋)和3处栖息地。实地调查面积超过60 km2,其中潜在分布区约400 000 m2,发现普雄原鲵实际生存面积仅3425 m2。3处栖息地海拔2770~3000 m,地处彝族聚集区和牧区草场,主要生境是高山草甸和灌丛、高原山涧、小浸沟及其水坑、小水潭。栖息地分布有茂密的箭竹林、杜鹃丛和草丛等,较好地提供了荫蔽的环境。本次调查发现普雄原鲵成体20尾,幼体157尾,卵袋16对;3处栖息地的种群数量和种群密度相差较大。各栖息地受到不同程度的人为干扰和牲畜干扰。较之其他同类动物,普雄原鲵野外种群数量极其稀少。     

Cutaneous Mucormycosis in Tornado Survivors

A total of 18 suspected cases of cutaneous mucormycosis were identified in survivors of the May 2011 tornado in Joplin, Missouri. Apophysomyces trapeziformis was identified in 13 of the patients with microbiologically or histologically proven infection by DNA sequencing. Apophysomyces are classically associated with necrotizing skin and soft-tissue infections following traumatic inoculation of the fungal spores. Although cases of Apophysomyces infection were previously reported in survivors of tsunamis and volcanic eruptions, this is believed to be the first reported case series of cutaneous mucormycosis in tornado survivors.     

福建桐山溪鱼类资源调查初报

2011年对福建东北部入海河流桐山溪中的鱼类资源进行了调查.结果表明,桐山溪有淡水及河口鱼类47种,隶属10目16科39属.鱼类组成以鲤形目为主,有3科25属27种,占总种数的57.4％;鲈形目有5科7属7种,占总种数的14.9％;鲀形目有1科1属3种,占总种数的6.4％;鳗鲡目、鲇形目和鲽形目各有1科1属2种,分别占总种数的4.3％;合鳃目、鲑形目、脂鲤目和雀鳝目各有1科1属1种,分别占总种数的2.1％.47种鱼类中,25种为常见种,占总种数的53.2％;花鳗鲡Anguilla marmorata和条纹小鲃Puntius semifasciolatus为稀有种,占总数的4.3％;短盖巨脂鲤Colossoma brachypomus和眼斑雀鳝Lepisosteus oculatus为外来种,占总数的4.3％;其余18种为偶见种,占总数的38.2％.花鳗鲡是国家二级重点保护野生动物,台湾名古屋吻鰕虎鱼Rhinogobius nagoyae formosanus为中国大陆的新纪录种.     

急性缺血性中风早期中小剂量溶栓治疗的初步研究

目的 研究用中、小剂量尿激酶（UK）溶栓治疗急性缺血性中风的临床效果,寻找一个安全的适合静脉溶栓的UK剂量和方法。方法 净急性缺血性中风患者分为两组：溶栓组18例,中小剂量UK溶栓,视病情变化予以追加。常规治疗组（对照组）12例,除不用UK外,其它治疗措施相同。每例患者于治疗前后进行欧洲卒中量表（ESS）评分,以评价疗效。结果 溶栓组溶栓后2h、6h、1天、2天、3天、7天和14天的ESS评分均比溶栓前升高,无并发出血现象,溶栓组治疗后第1天、第2天、第3天、第7天和第14天ESS评分与治疗前ESS评分的差值明显高于常规治疗组治疗后第1天、第2天、第3天、第7天和第14天ESS评分与治疗前ESS评分的差值。结论 用中小剂量UK溶栓,实行剂量个体化,效果较好,且副作用小。     

Conductance channels in neutral lipid bilayers

Summary A model channel for the conduction of ions (positive or negative but not both) through a lipid bilayer is presented. The transition-state theory is used to relate the current with voltage and ionic concentrations. Sites within the channel are considered to act cooperatively so that the ion is subjected to a ligand field in which it has complete freedom along the channel axis. The ions in the channel are treated as an ionic gas. Effects due to space-charges within the channel arising from the conducting ions are considered whereas surface-charge effects are neglected.The ionic specificity of the channel is indicated and the theory compared to that in which equilibrium free energy changes are the dominant influence.     

A Preliminary Genetic Investigation of VOLVOX CARTERI

A preliminary genetic analysis of a number of genetic variants of Volvox carteri f. nagariensis is presented. Techniques are outlined for mutagenesis of Volvox, isolation of mutants and routine genetic analysis. All of the mutants show simple Mendelian segregation patterns and have been tentatively placed in 14 linkage groups.     

Startle Responses in Motor Vehicle Accident Survivors: A Pilot Study

The aim of the present study was to investigate startle responses in motor vehicle accident (MVA) survivors to trauma-related, startle, and neutral sounds. Participants were 17 MVA survivors, 11 of whom participated in a controlled treatment study comparing cognitive-behavioral treatment (CBT) and supportive therapy (ST) versus a waitlist condition. Though participants differed significantly in their pretreatment clinical status and symptom severity, these differences were not reflected by group differences in EMG (at orbicularis oculi) to the stimuli at the initial assessment. Some cue-specificity was found, as all participants showed larger startle responses to trauma-related sounds, compared to startle and neutral sounds. At posttreatment, a significant reduction in EMG reactivity to all stimuli was observed in participants who received active treatment (either CBT or ST), compared to waitlist controls. The use of startle responses as a PTSD treatment outcome index is discussed.     

潮汕地区农药植物资源初探

潮汕地区农药植物资源十分丰富。初步调查统计共有 88科 2 39种 ,其中蕨类植物 4种 ,裸子植物 6种 ,被子植物2 2 9种 ,这些农药植物均具有杀虫作用。本文对潮汕地区农药植物的研究和合理开发利用提出了若干建议     

温州蜜柑裂果因子调查初报

通过对1990年温州蜜柑裂果的调查,初步探明了不同品系,不同的基砧、中间砧及砧木高度,树体在园中所处的位置,树体的不同部位、树势,结果枝上的裂果顺序,灌溉条件,气象要素的变化,果实某些指标的差异等因子与裂果的关系。据此,提出防止裂果措施。     

嵊山岛海洋药用生物资源状况调查

对嵊山岛礁生物资源以及邻近海域的微藻资源调查,共发现121种潮间带生物,其中有28种海洋药用生物,包括红条毛肤石鳖(Acanthochiton rubrolineatus)、马粪海胆(Hem icentiotus pulcherrimus)、海萝(Gloiopeltis furcata)等,其中多数是海洋中药或可制成中成药,嵊山岛丰富的海绵资源具有筛选天然活性物质的潜力。嵊山岛邻近海域的产毒藻类包括产麻痹性贝毒(PSP)的链状亚历山大藻(Alexandrium catenatum)、塔玛亚历山大藻(Alexandrium tamarens),产腹泻性贝毒(DSP)的倒卵形鳍藻(D inophysis forti)、具尾鳍藻(D inophysis caudata);产记忆缺失性贝毒(ASP)的尖刺拟菱形藻(Pseudo-Nitzschia pungens)、多列拟菱形藻(Pseudo-Nitzschia multiseries)和多纹拟菱形藻(Pseudo-Nitzschia multistriata);产神经性贝毒(NSP)的短凯伦藻(Kerina breve)以及红色裸甲藻(Gymnodinium sangium)、米氏凯伦藻(Kerina m ikim oto)、环状异甲藻(Heterocapsa circularisqua-ma)等能产生生理活性物质的藻类,其中嵊山岛邻近海域产石房蛤毒素和神经毒素的有毒藻类可能具有药用开发价值。     

海南儋州地区果园蜘蛛种类调查研究初报

通过调查研究,共发现海南儋州地区果园蜘蛛48种,隶属12科,35属。其中,有15种分布于荔枝园,32种分布于芒果园,2种分布于龙眼园,1种分布于番石榴上。拟盲幽灵蛛Pholcus opilionoides与梅氏新园蛛Neoscona melloteei在芒果和荔枝上都有分布。有6个标本只鉴定到属。