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Background: The aim of this study was to examine the frequency and risk factors of gastrointestinal (GI) hemorrhage in acute ischemic stroke patients in Taiwan. Method: 920 patients admitted for acute ischemic stroke from January 2001 to October 2005 were included in the study. We reviewed the available medical records for any episode of GI hemorrhage, possible precipitating factors and administration of ulcer prophylaxis. Results: Seventy-two patients (7.8%) experienced GI hemorrhage; these patients were of an older age (74.7 vs. 69.0 years, p < 0.001), had a longer acute ward stay (30.4 vs. 12.9 days, p < 0.001) and higher mortality rate (odds ratio 9.61, CI 4.53–20.42) than patients without GI hemorrhage. In multivariate logistic regression analysis, the important risk factors of GI hemorrhage included sepsis, previous history of GI hemorrhage, severe stroke, renal insufficiency and abnormal liver function. Of the 779 patients who had a 0–1 risk factor, 26 (3.3%) experienced GI hemorrhage; of the 27 patients with more than 2 risk factors, 17 (63%) suffered GI hemorrhage. Conclusion: This study of Asians revealed a higher frequency of GI hemorrhage after acute ischemic stroke than that reported in previous studies, and the frequency of GI hemorrhage was positively correlated with the number of risk factors present. We suggest that identifying stroke patients with a high risk of hemorrhage may allow clinicians to set up ulcer prophylactic protocols for the patients most likely to benefit, especially in an Asian population.

Background and PurposeAdditional folic acid (FA) treatment appears to have a neutral effect on reducing vascular risk in countries that mandate FA fortification of food (e.g., USA and Canada). However, it is uncertain whether FA therapy reduces stroke risk in countries without FA food fortification. The purpose of this study was to comprehensively evaluate the efficacy of FA therapy on stroke prevention in countries without FA food fortification. MethodsPubMed, EMBASE, and clinicaltrials.gov from January 1966 to August 2016 were searched to identify relevant studies. Relative risk (RR) with 95% confidence interval (CI) was used as a measure of the association between FA supplementation and risk of stroke, after pooling data across trials in a random-effects model. ResultsThe search identified 13 randomized controlled trials (RCTs) involving treatment with FA that had enrolled 65,812 participants, all of which stroke was reported as an outcome measure. After all 13 RCTs were pooled, FA therapy versus control was associated with a lower risk of any future stroke (RR, 0.85; 95% CI, 0.77 to 0.95). FA alone or combination of FA and minimal cyanocobalamin (≤0.05 mg/day) was associated with a lower risk of future stroke (RR, 0.75; 95% CI, 0.66 to 0.86) whereas combination of FA and cyanocobalamin (≥0.4 mg/day) was not associated with a lower risk of future stroke (RR, 0.95; 95% CI, 0.86 to 1.05). ConclusionsFA supplement reduced stroke in countries without mandatory FA food fortification. The benefit was found mostly in patients receiving FA alone or combination of FA and minimal cyanocobalamin.

BackgroundCritical stroke causes high morbidity and mortality. We examined if variables in the early stage of critical stroke could predict in-hospital mortality.MethodsWe recruited 611 ischemic and 805 hemorrhagic stroke patients who were admitted within 24 h after the symptom onset. Data were analyzed with independent t test and Chi square test, and then with multivariate logistic regression analysis.ResultsIn ischemic stroke, National Institutes of Health Stroke Scale (NIHSS) score (OR 1.08; 95 % CI 1.06–1.11; P < 0.01), white blood cell count (OR 1.11; 95 % CI 1.05–1.18; P < 0.01), systolic blood pressure (BP) (OR 0.49; 95 % CI 0.26–0.90; P = 0.02) and age (OR 1.03; 95 % CI 1.00–1.05; P = 0.03) were associated with in-hospital mortality. In hemorrhagic stroke, NIHSS score (OR 1.12; 95 % CI 1.09–1.14; P < 0.01), systolic BP (OR 0.25; 95 % CI 0.15–0.41; P < 0.01), heart disease (OR 1.94; 95 % CI 1.11–3.39; P = 0.02) and creatinine (OR 1.16; 95 % CI 1.01–1.34; P = 0.04) were related to in-hospital mortality. Nomograms using these significant predictors were constructed for easy and quick evaluation of in-hospital mortality.ConclusionVariables in acute stroke can predict in-hospital mortality and help decision-making in clinical practice using nomogram.

The benefits and risks associated with intensive low-density lipoprotein cholesterol (LDL-C)-lowering statin-based therapies to lessen the risk of recurrent stroke have not been established.OBJECTIVE To conduct a meta-analysis of randomized clinical trials to evaluate the association of more intensive vs less intensive LDL-C-lowering statin-based therapies with outcomes for patients with ischemic stroke.

In many surgery assistance systems, cumbersome equipment or complicated algorithms are often introduced to build the whole system. To build a system without cumbersome equipment or complicated algorithms, and to provide physicians the ability to observe the location of the lesion in the course of surgery, an augmented reality approach using an improved alignment method to image-guided surgery (IGS) is proposed. The system uses RGB-Depth sensor in conjunction with the Point Cloud Library (PCL) to build and establish the patient’s head surface information, and, through the use of the improved alignment algorithm proposed in this study, the preoperative medical imaging information obtained can be placed in the same world-coordinates system as the patient’s head surface information. The traditional alignment method, Iterative Closest Point (ICP), has the disadvantage that an ill-chosen starting position will result only in a locally optimal solution. The proposed improved para-alignment algorithm, named improved-ICP (I-ICP), uses a stochastic perturbation technique to escape from locally optimal solutions and reach the globally optimal solution. After the alignment, the results will be merged and displayed using Microsoft’s HoloLens Head-Mounted Display (HMD), and allows the surgeon to view the patient’s head at the same time as the patient’s medical images. In this study, experiments were performed using spatial reference points with known positions. The experimental results show that the proposed improved alignment algorithm has errors bounded within 3 mm, which is highly accurate.

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