MD; for the FSR InvestigatorsBackground and Purpose-Diabetes mellitus is an established risk factor for stroke. However, it is uncertain whether prestroke glycemic control (PSGC) status affects clinical outcomes of acute ischemic stroke. The aim of this study was to elucidate the association between PSGC status and neurological or functional outcomes in patients with acute ischemic stroke. Methods-From the Fukuoka Stroke Registry (FSR), a multicenter stroke registry in Japan, 3627 patients with first-ever ischemic stroke within 24 hours after onset were included in the present analysis. The patients were categorized into 4 groups based on their PSGC status: excellent (hemoglobin [Hb] A1c on admission Ͻ6.2%), good (6.2-6.8%), fair (6.9 -8.3%) and poor (Ն8.4%). Study outcomes were neurological improvement (Ն4 points decrease in the National Institutes of Health Stroke Scale [NIHSS] score during hospitalization or 0 points on NIHSS score at discharge), neurological deterioration (Ն1 point increase in NIHSS score) and poor functional outcome (death or dependency at discharge, modified Rankin Scale 2-6). Results-The age-and sex-adjusted ORs for neurological improvement were lower, and those for neurological deterioration and a poor functional outcome were higher in patients with poorer PSGC status. After adjusting for multiple confounding factors, these trends were unchanged (all probability values for trends were Ͻ0.002). These findings were comparable in patients with noncardioembolic and cardioembolic infarctions. Conclusions-In ischemic stroke patients, HbA1c on admission was an independent significant predictor for neurological and functional outcomes. (Stroke. 2011;42:2788-2794.)

Background and Purpose-Several risk scores have been developed to predict the stroke risk after transient ischemic attack (TIA). However, the validation of these scores in different cohorts is still limited. The objective of this study was to elucidate whether these scores were able to predict short-term and long-term risks of stroke in patients with TIA. Methods-From the Fukuoka Stroke Registry, 693 patients with TIA were followed up for 3 years. Multivariable-adjusted Cox proportional hazards model was used to assess the hazard ratio of risk factors for stroke. The discriminatory ability of each risk score for incident stroke was estimated by using C-statistics and continuous net reclassification improvement. Results-The multivariable-adjusted Cox proportional hazards model revealed that dual TIA and carotid stenosis were both significant predictors for stroke after TIA, whereas abnormal diffusion-weighted image was not. ABCD3 (C-statistics 0.61) and ABCD3-I (C-statistics 0.66) scores improved the short-term predictive ability for stroke (at 7 days) compared with the ABCD2 score (C-statistics 0.54). Addition of intracranial arterial stenosis (at 3 years, continuous net reclassification improvement 30.5%; P<0.01) and exclusion of abnormal diffusion-weighted imaging (at 3 years, continuous net reclassification improvement 24.0%; P<0.05) further improved the predictive ability for stroke risk until 3 years after TIA. Conclusions-The present study demonstrates that ABCD3 and ABCD3-I scores are superior to the ABCD2 score for the prediction of subsequent stroke in patients with TIA. Addition of neuroimaging in the ABCD3 score may enable prediction of long-term stroke risk after TIA. (Stroke. 2014;45:418-425.)Key Words: ABCD2 score ◼ prognosis ◼ stroke ◼ transient ischemic attack

Therefore, BP variability in both the acute and subacute stages Background and Purpose-The relationship between blood pressure (BP) variability and functional outcome in patients with acute ischemic stroke remains unclear. This study aimed to elucidate whether in-hospital day-by-day BP variability is associated with functional outcome after acute ischemic stroke. Methods-Using the Fukuoka Stroke Registry, we included 2566 patients with a first-ever ischemic stroke who had been functionally independent before the onset and were hospitalized within 24 hours. BP was measured daily, and its variability was assessed by SD, coefficients of variance, and variations independent of mean. Poor functional outcome was assessed by modified Rankin Scale scores ≥3 at 3 months. Results-After adjustment for multiple confounding factors including age, sex, risk factors, stroke features, baseline severity, thrombolytic therapy, antihypertensive agents, and mean BP, day-by-day BP variability during the subacute stage (4-10 days after onset) was independently associated with a poor functional outcome (multivariable-adjusted odds ratios [95% confidence interval] in the top versus bottom quartile of systolic BP variability, 1.51 [1.09-2.08] for SD; 1.63 [1.20-2.22] for coefficients of variance; 1.64 [1.21-2.24] for variations independent of mean). Similar trends were also observed for diastolic BP variability. These trends were unchanged in patients who were not treated with antihypertensive drugs. In contrast, no association was found between indices of BP variability during the acute stage and functional outcome after adjusting for potential confounders. Conclusions-These data suggest that intraindividual day-by-day BP variability during the subacute stage is associated with the 3-month functional outcome after acute ischemic stroke. Fukuda et al Day-by-Day BP Variability and Stroke Outcome 1833may have clinical significance in functional outcome after acute stroke. An interval of BP fluctuations used in the previous studies ranged from beat-to-beat, hour-to-hour to day-to-night. However, the clinical significance of BP variability in cardiovascular diseases remains controversial. [14][15][16] Determinants and prognostic relevance for cardiovascular outcomes are probably different among short-term (beat-to-beat), short-term (for 24 hours), midterm (day-to-day), and long-term BP variability (visit-to-visit).15 BP fluctuations with longer intervals, including midterm and long-term BP variability, are of increasing clinical interest as predictors of end-organ damage, 17 cardiovascular events, 18-21 and mortality. 22 A recent study showed a possible association of visit-to-visit BP variability with longterm mortality after lacunar infarct. 23 However, the association between BP variability with a long interval and functional outcome after ischemic stroke is still unknown.In the present study, we calculated indices of day-by-day BP variability until the subacute stage and investigated their association with short-term clinical outcomes ...

LAC in elderly colorectal cancer patients had benefits in short-term outcomes compared with OC except operation time. The long-term outcomes and oncological clearance of LAC were similar to that of OC. These results support the assertion that LAC is an effective procedure for elderly patients with colorectal cancer.

Stroke is a major cause of long-term disability and death worldwide.1 Previous studies seemed to converge on the higher likelihood of poststroke disability in women than in men. [2][3][4][5][6][7][8][9][10] Because women have a longer life expectancy and the stroke incidence increases in older age groups, poststroke disability in women can become an important public health problem in many aging societies. 8 The reasons for sex differences in stroke outcomes remain unclear. Stroke characteristics and risk factors were shown to differ between women and men, 7,8 and these are probably underlying the differences in clinical outcomes. In addition, some studies indicated that medical management before and after stroke differed by sex. 3,10,11 If the differences are caused by insufficient medical management, the quality of care is important to reduce the sex differences in the functional outcome post stroke. However, if biological sex itself were a risk of poor functional outcome, a sex-specific strategy for stroke prevention would be needed.Accurate data on possible confounders are needed to elucidate whether sex differences in stroke outcomes result from background differences or there truly exist biological differences among the sexes in response to stroke. Moreover, to prove the generalizability, sex differences should be confirmed in different cohorts in the world because lifestyle, social environment, and healthcare systems are different depending on ethnic groups and countries. However, previous studies have been performed mainly in Europe and North America, and paucity of data from other parts of the world has been highlighted. 8Background and Purpose-Variable sex differences in clinical outcomes after stroke have been reported worldwide. This study aimed to elucidate whether sex is an independent risk factor of poor functional outcome after acute ischemic stroke. Methods-Using the database of patients with acute stroke registered in the Fukuoka Stroke Registry in Japan from 1999 to 2013, 6236 previously independent patients with first-ever ischemic stroke who were admitted within 24 hours of onset were included in this study. Baseline characteristics were assessed on admission. Study outcomes included neurological improvement, neurological deterioration, and poor functional outcome (modified Rankin Scale score, 3-6 at discharge). Logistic regression analyses were performed to evaluate the association between sex and clinical outcomes. Results-Overall, 2398 patients (38.5%) were women. Severe stroke (National Institutes of Health Stroke Scale score, ≥8)on admission was more prevalent in women than in men. The frequency of neurological improvement or deterioration during hospitalization was not different between the sexes. After adjusting for possible confounders, including age, stroke subtype and severity, risk factors, and poststroke treatments, it was found that female sex was independently associated with poor functional outcome at discharge (odds ratio, 1.30; 95% confidence interval, 1.08-1.57). There was h...