Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVES: This study aims to clarify the association between alcohol intake and stroke severity at admission and discharge according to sex and stroke subtype in Japanese patients with acute stroke. MATERIALS AND METHODS: We analyzed the data of 199,599 patients registered in the Japan Stroke Data Bank from 1999 to 2018, including sex, age, stroke subtypes (cardioembolic ischemic, noncardioembolic ischemic, hypertensive hemorrhagic, nonhypertensive hemorrhagic, and subarachnoid hemorrhagic), dates of onset and admission, National Institutes of Health Stroke Scale score at admission, modified Rankin Scale score at discharge, and alcohol intake. Multivariable logistic regression analysis adjusted for stroke-related factors was performed to estimate the odds ratios of alcohol intake for stroke severity. RESULTS: In cardioembolic ischemic stroke, a significant protective effect of moderate intake on severity at admission was observed in both sexes. In noncardioembolic ischemic stroke, a significant protective effect on stroke severity at admission was found for each sex. At discharge, the results also showed a significant protective effect for each sex with moderate intake. For both subtypes of ischemic stroke, a J-shaped relationship between alcohol intake and stroke severity at admission and discharge was observed in women and men. In hypertensive hemorrhagic stroke, a significant protective effect was found in men at both admission and discharge. In women, heavy drinking had a significant harmful effect on stroke severity at admission. CONCLUSIONS: Habitual alcohol intake is associated with stroke severity at admission and discharge regardless of sex.

DOI： 10.1016/j.jstrokecerebrovasdis.2022.106513

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier {BV}  

BACKGROUND: The aim of this study is to evaluate in the relationships between alcohol intake and ischemic stroke severity in Japanese stroke patients. METHODS: Of a total of 101,165 registered cases of stroke in Japan, patient data of total strokes (n = 60,836), cardiogenic strokes (n = 11,894), and noncardiogenic strokes (n = 29,129) were extracted. The National Institutes of Health Stroke Scale (NIHSS) score at admission and the modified Rankin Scale (mRS) score at discharge were used. Significant alcohol consumption in regard to stroke severity at admission and discharge was identified by multivariate adjusted logistic regression analysis. RESULTS: Among all subject and males, nondrinkers had significantly poorer NIHSS scores of cardiogenic strokes as did those consuming greater than or equal to 60 g/day, whereas there was a significant difference in past heavy drinkers with noncardiogenic strokes. Among females, nondrinkers had a significance of cardiogenic stroke and non-cardiogenic strokes. Among all subjects and males, 20-39 g/day and 40-59 g/day were significantly associated with protective effects on mRS severity of cardiogenic strokes, whereas 40-59 g/day also had significant protective effects for noncardiogenic strokes. Among females, greater than or equal to 60 g/day had a significant protective effect for cardiogenic strokes. CONCLUSIONS: For males, alcohol intake of less than 60 g/day played a protective role in functional prognosis at discharge and showed a J-shape relationship. For females, although there was a limitation that the number of female drinkers was small, negative effects were shown at admission with less consumption than males.

DOI： 10.1016/j.jstrokecerebrovasdis.2019.02.034

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: A retrospective evaluation was made concerning thrombolytic therapy for ultra-acute ischemic stroke patients, using a recombinant tissue plasminogen activator (rt-PA), which is not yet approved as a drug for brain infarction in Japan. The evaluation was implemented using the database of patients that suffered acute strokes as collected by the Japanese Standard Stroke Registry Study (JSSRS). METHODS: The thrombolytic therapy group, selected from among the registered 6,090 cases of brain infarction patients, was divided into two groups, namely, a group of patients who were admitted in the hospital within 3 hours of the onset (86 cases, average age 69.6) and the other group who were admitted after 3 hours from the onset (28 cases, average age 66.8). Using a Multiple Logistic Regression Analysis adapted for modified Rankin scale (mRS) regarding each group, the clinical effects of thrombolytic therapy for functional outcome and presence or absence of dementia at the time of hospital discharge were examined. Among the 467 cases of patients (average age 74) who were admitted within 3 hours of the onset and for whom the NIH Stroke Scale (NIHSS) was between 6 and 29 at the time of admission, intravenous or intra-arterial thrombolytic therapy was conducted in 88 cases. Then, a case-control study and Multiple Logistic Regression Analysis was implemented for subject groups matched according to the gender, age and severity at the time of admission, and the effects on early-admitted patients were examined. Also, for two rehabilitation patient groups: one whose rehabilitation started within 7 days (216 cases; average age 73) and the other whose rehabilitation started after 7 days (56 cases, average age 76), the effects of early rehabilitation were examined using Multiple Logistic Regression Analysis. Moreover, the effects of thrombolytic therapy on a group of patients who were admitted early and for whom rehabilitation started early (215 cases; average age 73) were examined in the same way. RESULTS: In the comparison between the thrombolytic therapy groups, the functional outcome of the group of patients admitted within 3 hours of the onset at the time of discharge (mRS 0-1) was significantly better compared with that of the group after 3 hours from the onset (OR 2.79, 95% CI: 1.06-7.32). Regarding the comparison between the early admitted patients, the frequency of poor functional outcomes (mRS 2-6) at the time of discharge was significantly lower in the thrombolytic therapy group (OR 0.55, 95% CI 0.31-0.98), and the frequency of dementia was also significantly lower (OR 0.37, 95% CI 0.17-0.86). In the case control study, a significant difference was noted for the presence of dementia. In the group rehabilitation was started early, the frequency of poor functional outcomes was significantly lower (OR 0.33, 95% CI 0.11-0.98), and the frequency of dementia was also significantly lower (OR 0.41, 95% CI 0.19-0.89). As for the comparison of the groups admitted early and for which rehabilitation started early, the frequency of poor functional outcomes at the time of discharge was significantly lower in the thrombolytic therapy group (OR 0.38, 95% CI 0.16-0.86). CONCLUSIONS: From the present analysis, in spite of being a retrospective analysis based on comparatively small number of patient cases from the stroke database, it is concluded that the clinical application of thrombolytic therapy for ultra-acute ischemic strokes was effective. Moreover, it was demonstrated that, if it is possible to start rehabilitation early, a dramatic improvement of the effects might be expected.

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

International standard-based video-conferencing systems are widely used in telemedicine activities worldwide. Through our experiences with these systems, it is apparent that the image quality is high enough to conduct educational and conferential sessions. However, because the terminals are intended for common use, we evaluated their qualities. After having an international standard system evaluated by a general practitioner using medical images, we prepared non-medical graphic images to examine the characteristics of the video-conferencing equipment. ROC (Receiver Operation Characteristic) analysis was employed for the evaluation. We concluded that the international standard video-conferencing systems are of sufficient quality for medical presentations, and that their interactivity and the use of proper software will aid the understanding of images in specific medical areas.

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Authorship：Lead author,　Corresponding author   Language：Japanese   Publisher：(一財)厚生労働統計協会  

目的 脳卒中発症患者におけるアルコール摂取量と重症度の関係についての報告はほとんど見かけないことから,全国規模の脳卒中患者データベース(JSSRS)による患者データを用いて,脳梗塞発症患者の過去の飲酒量と入院時重症度,退院時重症度,そして退院時の認知症との関連を調べることを目的とした.方法 JSSRSの登録患者データ中,脳梗塞発症患者9,991例を対象として,過去のアルコール摂取量を,「0:ほとんど飲まない,1:機会飲酒,2:毎日1〜2合,3:毎日2〜3合,4:毎日3合以上,5:大酒家」と順序データ化し,アルコール摂取量と入院時重症度,退院時重症度,退院時の認知症発症の関係について,統計的手法により有意なアルコール摂取量を特定した.その際,多重比較の欠点を補うため,p<0.001を真の有意差とした.結果 (1)入院時重症度は,アルコール摂取量が「ほとんど飲まない,大酒家>機会飲酒,毎日3合以上>毎日1〜2合,毎日2〜3合」の順で良くない傾向があった(p<0.05).(2)退院時重症度は,アルコール摂取量が「ほとんど飲まない,大酒家>機会飲酒,毎日3合以上>毎日1〜2合,毎日2〜3合」の順で良くなかった(p<0.001).(3)退院時の認知症発症は,アルコール摂取量が「ほとんど飲まない,大酒家>機会飲酒,毎日3合以上>毎日1〜2合,毎日2〜3合」の順で高かった(p<0.001).結論 アルコール摂取量と入院時重症度の明確な関連はみられなかったが,退院時重症度と退院時の認知症の存在はアルコール摂取量との間にJカーブ(Uカーブ)現象を示し,適度な飲酒(毎日1〜3合まで)をしていた者は退院時の重症度や認知症への影響が有意に低かった.また,これらの者は在院日数も有意に短かった(著者抄録)

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Authorship：Lead author,　Corresponding author   Language：Japanese  

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Event date： 2009.3

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Event date： 2005.8

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Event date： 2002.11

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Type：Seminar, workshop

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