Introduction
Atrial fibrillation is an independent risk factor of thromboembolism. Women with atrial fibrillation are at a higher overall risk for stroke compared to men with atrial fibrillation. The ...aim of this study was to evaluate for sex differences in patients with acute stroke and atrial fibrillation, regarding risk factors, treatments received and outcomes.
Methods
Data were analyzed from the “Recurrence and Cerebral Bleeding in Patients with Acute Ischemic Stroke and Atrial Fibrillation” (RAF-study), a prospective, multicenter, international study including only patients with acute stroke and atrial fibrillation. Patients were followed up for 90 days. Disability was measured by the modified Rankin Scale (0–2 favorable outcome, 3–6 unfavorable outcome).
Results
Of the 1029 patients enrolled, 561 were women (54.5%) (p < 0.001) and younger (p < 0.001) compared to men. In patients with known atrial fibrillation, women were less likely to receive oral anticoagulants before index stroke (p = 0.026) and were less likely to receive anticoagulants after stroke (71.3% versus 78.4%, p = 0.01). There was no observed sex difference regarding the time of starting anticoagulant therapy between the two groups (6.4 ± 11.7 days for men versus 6.5 ± 12.4 days for women, p = 0.902). Men presented with more severe strokes at onset (mean NIHSS 9.2 ± 6.9 versus 8.1 ± 7.5, p < 0.001). Within 90 days, 46 (8.2%) recurrent ischemic events (stroke/TIA/systemic embolism) and 19 (3.4%) symptomatic cerebral bleedings were found in women compared to 30 (6.4%) and 18 (3.8%) in men (p = 0.28 and p = 0.74). At 90 days, 57.7% of women were disabled or deceased, compared to 41.1% of the men (p < 0.001). Multivariate analysis did not confirm this significance.
Conclusions
Women with atrial fibrillation were less likely to receive oral anticoagulants prior to and after stroke compared to men with atrial fibrillation, and when stroke occurred, regardless of the fact that in our study women were younger and with less severe stroke, outcomes did not differ between the sexes.
The aim of this study was to investigate for a possible association between both prestroke CHA
DS
-VASc score and the severity of stroke at presentation, as well as disability and mortality at 90 ...days, in patients with acute stroke and atrial fibrillation (AF).
This prospective study enrolled consecutive patients with acute ischemic stroke, AF, and assessment of prestroke CHA
DS
-VASc score. Severity of stroke was assessed on admission using the National Institutes of Health Stroke Scale (NIHSS) score (severe stroke: NIHSS ≥10). Disability and mortality at 90 days were assessed by the modified Rankin Scale (mRS <3 or ≥3). Multiple logistic regression was used to correlate prestroke CHA
DS
-VASc and severity of stroke, as well as disability and mortality at 90 days.
Of the 1020 patients included in the analysis, 606 patients had an admission NIHSS score lower and 414 patients higher than 10. At 90 days, 510 patients had mRS ≥3. A linear correlation was found between the prestroke CHA
DS
-VASc score and severity of stroke (P = .001). On multivariate analysis, CHA
DS
-VASc score correlated with severity of stroke (P = .041) and adverse functional outcome (mRS ≥3) (P = .001). A logistic regression with the receiver operating characteristic graph procedure (C-statistics) evidenced an area under the curve of .60 (P = .0001) for severe stroke. Furthermore, a correlation was found between prestroke CHA
DS
-VASc score and lesion size.
In patients with AF, in addition to the risk of stroke, a high CHA
DS
-VASc score was independently associated with both stroke severity at onset and disability and mortality at 90 days.
This paper introduces an open, interoperable, and cloud-computing-based citizen engagement platform for the management of administrative processes of public administrations, which also increases the ...engagement of citizens. The citizen engagement platform is the outcome of a 3-year Italian national project called PRISMA (Interoperable cloud platforms for smart government). The aim of the project is to constitute a new model of digital ecosystem that can support and enable new methods of interaction among public administrations, citizens, companies, and other stakeholders surrounding cities. The platform has been defined by the media as a flexible (enable the addition of any kind of application or service) and open (enable access to open services) Italian "cloud" that allows public administrations to access to a vast knowledge base represented as linked open data to be reused by a stakeholder community with the aim of developing new applications ("Cloud Apps") tailored to the specific needs of citizens. The platform has been used by Catania and Syracuse municipalities, two of the main cities of southern Italy, located in the Sicilian region. The fully adoption of the platform is rapidly spreading around the whole region (local developers have already used available application programming interfaces (APIs) to create additional services for citizens and administrations) to such an extent that other provinces of Sicily and Italy in general expressed their interest for its usage. The platform is available online and, as mentioned above, is open source and provides APIs for full exploitation.
The left ventricular subendocardial and subepicardial layers of six perfused rabbit hearts were tested for enzymatic and non-enzymatic antioxidant defences and for lipid peroxidation. The ...subendocardium showed significantly lower catalase activity and contents of non-protein thiol compounds and vitamin E associated with a higher degree of lipid peroxidation. The activities of Cu,Zn- and Mn-superoxide dismutases, glutathione reductase, gamma-glutamylcysteine synthetase and gamma-glutamyl transpeptidase showed no significant transmural differences, and Se-independent glutathione peroxidase activity was not detectable in either layer. Comparable results were observed in another group of six unperfused rabbit hearts. In five H2O2-perfused rabbit hearts, lipid peroxidation was higher, and myocardial creatine phosphokinase activity lower, in the subendocardium than in the subepicardium. In this group, only the subendocardium had significantly higher lipid peroxidation levels than the control hearts. Thus, a lower antioxidant capacity and a greater oxidative stress are present in the rabbit subendocardium. These findings could provide insight into the problem of subendocardial vulnerability to free radical-mediated processes, such as occurs in ischaemia-reperfusion injury.
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