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Prehospital transdermal glyceryl trinitrate for ultra- acute ischaemic stroke: data from the RIGHT- 2 randomised sham- controlled ambulance trial

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Stroke & Vascular neurology 2024年第1期9卷 38-49,I0035-I0046页

作者： Jason Philip Appleton Lisa J Woodhouse Craig S Anderson Sandeep Ankolekar Lesley Cala Mark Dixon Timothy J England Kailash Krishnan Grant Mair Keith W Muir John Potter Christopher I Price Marc Randall Thompson G Robinson Christine Roffe Else C Sandset Jeffrey L Saver Angela Shone aloysius n.roshan.siriwarden. Joanna M Wardlaw nikola Sprigg Philip M Bath Stroke University Hospitals Birmingham NHS Foundation TrustBirminghamUK Institute of Applied HealthResearch University of Birmingham College of Medical and Dental SciencesBirminghamUK Stroke Trials Unit Mental Health and Clinical NeurosciencesUniversity of NottinghamNottinghamUK Faculty of Medicine The George Institute for Global HealthSydneyNew South WalesAustralia The George Institute China at Peking University Health Science Center BeijingChina neurology Royal Prince Alfred HospitalSydney Health PartnersSydneyNew South WalesAustralia Department of neurology King's College Hospital NHS Foundation TrustLondonUK Faculty of Health and Medical Sciences University of Western AustraliaCrawleyWestern AustraliaAustralia East Midlands Ambulance Service nHS Trust NottinghamUK Stroke Queen's Medical CentreNottingham University Hospitals NHS TrustNottinghamUK Centre for Clinical Brain Sciences Dementia Research InstituteUniveristy of EdinburghEdinburghUK Institute of neurology and Psychology University of GlasgowGlasgowUK Bob Champion Research and Education Building University of East AngliaNorwichUK Institute of neuroscience Newcastle UniversityNewcastle upon TyneUK Department of neurology Leeds Teaching Hospitals NHS TrustLeedsUK Department of Cardiovascular Sciences and nIHR Leicester Biomedical Research Centre University of LeicesterLeicesterUK Stroke Research in Stoke Institute for Science and Technology in MedicineKeele UniversityStoke-on TrentUK Department of neurology Oslo University HospitalOsloNorway Research and Development Norwegian Air Ambulance FoundationOsloNorway Department of neurology and Comprehensive Stroke Center David Geffen School of MedicineUCLALos AngelesCaliforniaUSA Research and Graduate Services University of NottinghamNottinghamUK Community and Health Research Unit University of LincolnLincolnUK

Background The effect of transdermal glyceryl trinitrate(GTn,a nitrovasodilator)on clinical outcome when administered before hospital admission in suspected stroke patients is ***,we assess the safety and efficacy of GTn in the prespecified subgroup of patients who had an ischaemic stroke within the Rapid Intervention with Glyceryl trinitrate in Hypertensive stroke Trial-2(RIGHT-2).Methods RIGHT-2 was an ambulance-based multicentre sham-controlled blinded-endpoint study with patients randomised within 4hours of *** primary outcome was a shift in scores on the modified Rankin scale(mRS)at day *** outcomes included death;a global analysis(Wei-Lachin test)containing Barthel Index,EuroQol-5D,mRS,telephone interview for cognitive status-modified and Zung depression scale;and neuroimaging-determined‘brain frailty’*** were reported as n(%),mean(SD),median[IQR],adjusted common OR(acOR),mean difference or Mann-Whitney difference(MWD)with 95%*** 597 of 1149(52%)patients had a final diagnosis of ischaemic stroke;age 75(12)years,premorbid mRS>2107(18%),Glasgow Coma Scale 14(2)and time from onset to randomisation 67[45,108]***‘brain frailty’was common:median score 2[2,3](range 0–3).At day 90,GTn did not influence the primary outcome(acOR for increased disability 1.15,95%CI 0.85 to 1.54),death or global analysis(MWD 0.00,95%CI-0.10 to 0.09).In subgroup analyses,there were non-significant interactions suggesting GTn may be associated with more death and dependency in participants randomised within 1hour of symptom onset and in those with more severe *** In patients who had an ischaemic stroke,ultra-acute administration of transdermal GTn in the ambulance did not improve clinical outcomes in a population with more clinical and radiological frailty than seen in previous in-hospital *** IS ALREADY KnOWn On THIS TOPIC⇒Transdermal glyceryl trinitrate(GTn)was associat-ed with less death and dependency in those w

关键词： Glasgow nitrate random

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Genetic and Agronomic Parameter Estimates of Growth, Yield and Related Traits of Maize (Zea mays L.) under Different Rates of nitrogen Fertilization

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American Journal of Plant Sciences 2024年第4期15卷 274-291页

作者： Prince Emmanuel norman Lansana Kamara aloysius Beah Kelvin Sahr Gborie Francess Sia Saquee Sheku Alfred Kanu Fayia Augustine Kassoh Yvonne Sylvia Gloria Ethel norman Abdul Salaam Kargbo Sierra Leone Agricultural Research Institute (SLARI) Freetown Sierra Leone School of Agriculture Njala University Njala Campus Njala Sierra Leone School of natural Resources Management Njala University Njala Campus Njala Sierra Leone Department of Agro Biotechnology Institute of Agriculture RUDN University Moscow Russia Faculty of Development Agriculture & natural Resources Management Eastern Technical University of Sierra Leone Kenema Sierra Leone

This study evaluated the genetic and agronomic parameter estimates of maize under different nitrogen rates. The trial was established at the njala Agricultural Research Centre experimental site during 2021 and 2022 in a split block design with three maize varieties (IWCD2, 2009EVDT, and DMR-ESR-Yellow) and seven nitrogen (0, 30, 60, 90, 120, 150 and 180 kg∙n∙ha−1) rates. Findings showed that cob diameter and anthesis silking time (ASI) had intermediate heritability, ASI had high genetic advance, ASI and grain yield had high genotypic coefficient of variation (GCV), while traits with high phenotypic coefficient of variation (PCV) were plant height, ASI, grain yield, number of kernel per cob, number of kernel rows, ear length, and ear height. The PCV values were higher than GCV, indicating the influence of the environment in the studied traits. nitrogen rates and variety significantly (p nfluenced grain yield production. Mean grain yields and economic parameter estimates increased with increasing nitrogen rates, with the 30 and 180 kg∙n∙ha−1 plots exhibiting the lowest and highest grain yields of 1238 kg∙ha−1 and 2098 kg∙ha−1, respectively. Variety and nitrogen effects on partial factor productivity (PFPn), agronomic efficiency (AEn), net returns (nR), value cost ratio (VCR) and marginal return (MR) indicated that these parameters were significantly affected (p n (41.3 kg grain kg−1∙n) and AEn (29.4 kg grain kg−1∙n) were obtained in the 30 kg∙n∙ha−1 plots, while the highest VCR (2.8) and MR (SLL 1.8 SLL−1 spent on n) were obtained in the 180 kg∙n∙ha−1. The significant influence of variety and nitrogen on traits suggests that increasing yields and maximizing profits require use of appropriate nitrogen fe

关键词： nitrogen Rates Genetic and Agronomic Estimates Introduced Genotypes Grain Yield Zea mays

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Analgesic and Anti-Inflammatory Activity of Total Crude Leaf Extract of <i>Phytolacca dodecandra</i>in Wistar Albino Rats

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neuroscience & Medicine 2019年第3期10卷 259-271页

作者： Loyce nakalembe Josephine n. Kasolo Edward nyatia aloysius Lubega Godfrey S. Bbosa Department of Pharmacology School of Medicine St Augustine International University Kampala Uganda Department of Medical Physiology Makerere University College of Health Sciences Kampala Uganda Department of Biotechnical and Diagnostic Sciences Makerere University College of Veterinary Medicine Animal Resources and Biosecurity Kampala Uganda Department of Pharmacology & Therapeutics Makerere University College of Health Sciences Kampala Uganda

Background: Pain is a common problem encountered in daily life among humans and animal and it is commonly managed conventionally using modern medicines and traditionally by use of medicinal plants. Phytolacca dodecandra is a common herb in Uganda, used traditionally to alleviate pain and inflammatory conditions. However, its activity in alleviating pain and inflammatory diseases has not been fully scientifically evaluated. Aim of Study: To evaluate the analgesic and anti-inflammatory activity of total crude leaf extracts of P. dodecandra in Wistar albino rats. Materials and Methods: It was a laboratory-based experimental study. Acetic acid-induced writhing test was used to determine the analgesic activity and the histamine-induced paw edema formation for anti-inflammatory activity of the extract. Twenty eight animals were divided into 7 groups each with 4 rats and two (2) sets of data were obtained from each animal per group as per guidance of the refinement rule of 3Rs. For analgesic activity, Group I was dosed with 1.0ml of normal saline (negative control), group II, III, IV, V, VI were dosed with 1000.0, 600.0, 150.0, 40.0 and 5.0 mg/kg bwt of extract respectively. Group VII was dosed 10.0 mg/kg bwt diclofenac sodium (na) drug (positive control). For anti-inflammatory activity, Group I was dosed with 1.0ml of normal saline (negative control), Group II, III, IV, V, VI were dosed with 1000.0, 600.0, 300.0, 40.0 and 5.0 mg/kg bwt of extract respectively. Group VII was dosed 10.0 mg/kg bwt diclofenac na. The percentage mean paw volume inhibition and percentage writhing protection were determined. Results: The mean percentage paw volume inhibitions were 29.1%, 74.2% and 32.3% at doses of 5.0, 40.0 mg/kg bwt and 10.0 mg/kg bwt diclofenac na respectively. The mean percentage writhing protection was 8.9%, 10.4%, 78.5% and 98.7% at doses of 150.0, 600.0, 1000.0 mg/kg of extract and 10.0 mg/kg bwt diclofenac na respectively. Conclusions: Total crude leaf extracts of P. dod

关键词： Phytolacca dodecandra Analgesic Anti-Inflammatory Total Crude Leaf Extract

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Randomized, Placebo-Controlled Trial of Transdermal Rivastigmine for the Treatment of Encephalopathy in Liver Cirrhosis (TREC Trial)

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Open Journal of Gastroenterology 2014年第6期4卷 255-264页

作者： Patrick P. Basu niraj James Shah Mark M. aloysius Robert S. Brown Columbia University College of Physicians & Surgeons New York USA James J. Peters VA Medical Center New York USA King’s County Hospital New York USA

Objectives: Cognitive dysfunction in patients with hepatic encephalopathy (HE) may be caused by alterations in cholinergic neurotransmission. The objective of the study was to evaluate the efficacy and safety of transdermal rivastigmine in improving cognitive function in patients with overt HE. Design: Randomized, controlled pilot study in which patients with grade 2 or 3 HE were treated with lactulose and randomized to receive either transdermal rivastigmine or placebo for 21 days. The modified encephalopathy scale (MES), object recognition test (ORT), trail test (TT), and serum ammonia were assessed at baseline weekly. Electroencephalography was performed at baseline and the final week of the study. Results: Patients were treated with lactulose (20 g/30 mL three times per day) and either transdermal rivastigmine (4.6 mg/d;n = 15) or placebo (n = 15). Transdermal rivastigmine significantly improved MES, ORT, and TT results compared with placebo (P ≤ 0.0001 at all 3 weeks for all 3 assessments). Serum ammonia improved in both treatment groups, although there was significantly greater improvement with placebo than rivastigmine after 2 weeks of treatment (P What is already known about this subject? ? Current approaches to the management of HE are primarily designed to reduce the levels of ammonia and other gut-derived toxins. ? Traditional strategies for HE treatment have included non-absorbable disaccharides (to decrease bowel transit time) or rifamixin (non-absorbable antibiotics to reduce ammoniogenic flora). ? no transdermal cholinomimetic agents have been used with oral lactulose to date, in HE. What are the new findings? ? Transdermal rivastigmine is safe for use in patients with grade 2 & 3 HE. ? Transdermal rivastigmine in combination with oral lactulose in this study is far superior to lactulose alone in improving cognitive function. How might it impact on clinical practice in the foreseeable future? ? Transdermal rivastigmine in combination with oral lactulo

关键词： Acetylcholinesterase Cholinergic Function Hepatic Encephalopathy Rivastigmine

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The effect of melatonin in functional heartburn: A randomized, placebo-controlled clinical trial

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Open Journal of Gastroenterology 2014年第2期4卷 56-61页

作者： Patrick P. Basu Hemanth Hempole nitya Krishnaswamy niraj J. Shah Mark M. aloysius Columbia University College of Physicians and Surgeons New York USA James J. Peters VA Medical Center Mount Sinai School of Medicine New York USA King’s County Hospital New York USA north Shore University Hospital at Forest Hills Forest Hills USA

Background: Melatonin is a safe and effective treatment for patients with functional pain and gastrointestinal disorders. Objective: To evaluate the efficacy and safety of melatonin for 3 months in patients with functional heartburn. Methods: In the randomized, placebo-controlled pilot study, patients with functional heartburn were treated with omeprazole 20 mg before breakfast and randomized to receive either melatonin 6 mg (n = 20), nortripty line 25 mg (n = 20), or placebo (n = 20) at bedtime for 3 months. Gastroesophageal Reflux Disease-Health-Related Quality of Life (GERD-HRQOL) scores were assessed at baseline and at the end of the study. Results: Melatonin improved GERD-HRQOL scores compared with nortriptyline (P = 0.0015) and placebo (P nts were reported by patients receiving melatonin compared with those receiving nortriptyline or placebo. Conclusions: Melatonin was a safe and effective treatment for functional heartburn.

关键词： Melatonin Functional Heartburn nortriptyline HRQOL

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Effects of Metoclopramide Orally Disintegrating Tablet in Optimizing Late Outpatient Endoscopy: A Randomized Double-Blind Placebo-Controlled Clinical Trial

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Open Journal of Gastroenterology 2014年第4期4卷 187-191页

作者： Patrick P. Basu niraj J. Shah Hemanth Hampole nitya Krishnaswamy Mark M. aloysius A Columbia University College of Physicians & Surgeons New York USA Forest Hills Hospital Forest Hills New York USA James Peters VA Medical Center New York USA Kings County Hospital Internal Medicine New York USA

Aims: Metoclopramide has been used as a gastro-kinetic agent but the safety and effects of different preparations of metoclopramide on preparation for outpatient endoscopy are largely unknown. The study aimed to evaluate the (1) Safety of using ODT (orally disintegrating tablet) or TT (traditional tablet) metoclopramide pre-endoscopy in non-fasting patients compared with placebo (2) Impact of ODT or TT metoclopramide on sedation and recovery times compared with placebo. Methods: A double blind randomized placebo-controlled trial with 3 arms;Metoclopramide ODT (n = 43), Metoclopramide TT (n = 43) and Placebo (n = 43). Results: Metoclopramide ODT had fewer adverse events compared with TT or placebo. Recovery time was significantly shorter with use of either metoclopramide versus placebo (P n time was also significantly shorter in the metoclopramide groups versus placebo (P nclusion: Metoclopramide ODT is safe and beneficial in endoscopic procedures requiring limited access to food and liquid.

关键词： Metoclopramide ODT Endoscopy

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Effect of Vitamin E and Alpha Lipoic Acid in nonalcoholic Fatty Liver Disease: A Randomized, Placebo-Controlled, Open-Label, Prospective Clinical Trial (VAIn Trial)

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Open Journal of Gastroenterology 2014年第5期4卷 199-207页

作者： Patrick P. Basu niraj J. Shah Mark M. aloysius Robert S. Brown Jr. Columbia University College of Physicians and Surgeons New York USA James J. Peters VA Medical Center Mount Sinai School of Medicine New York USA King’s County Hospital New York USA

Objective: Antioxidants, including alpha lipoic acid (ALA) and vitamin E, are efficacious for the treatment of nonalcoholic fatty liver disease (nAFLD). The objective was to evaluate the effects of ALA and vitamin E alone or combined as therapy for patients with nAFLD and nonalcoholic steatohepatitis (nASH). Design: Placebo-controlled, open-label, prospective study in which patients with nAFLD and nASH were randomized to treatment with ALA 300 mg (n = 40), vitamin E 700 IU (n = 40), ALA 300 mg plus vitamin E 700 IU (n = 40), or placebo (n = 35) daily for 6 months. Body mass index, homeostasis model assessment scores, fibrosis and steatosis markers, and diagnostic laboratory tests were assessed at baseline and at the end of the study. Results: Treatment with ALA and vitamin E alone or in combination, improved inflammatory cytokine levels, steatosis scores, homeostasis model assessment scores, and triglyceride levels after 6 months relative to baseline. Conclusion: Alpha lipoic acid and vitamin E, either alone or in combination, were effective treatments for patients with nAFLD and nASH.

关键词： Antioxidant Liver Disease Vitamin E Alphalipoic Acid

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A Study on the Safety of Liver Biopsy Inpatients with Von Willebrand’s Disease

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Open Journal of Gastroenterology 2015年第9期5卷 134-138页

作者： Patrick P. Basu niraj J. Shah Mark M. aloysius K. Rayapudi Robert Brown Division of Digestive and Liver Diseases and Center for Liver Disease and Transplantation Columbia University Medical Center New York USA King’s County Hospital Medical Center New York USA Liver Transplant Center University of North Carolina School of Medicine Carolinas Medical Center Charlotte USA James J Peters VA Medical Center at Icahn School of Medicine at Mount Sinai New York USA

Objectives: Liver biopsy remains the gold standard for diagnosis of chronic liver diseases. Outpatient percutaneous biopsy is generally safe with a mortality rate of 0.17% and hospitalization rate for bleeding of 3%. Von Willebrand disease (vWD) syndrome is the most common inherited hematological disorder with a prevalence of 1% - 3% globally. We sought to study whether vWD increases the risk of bleeding for liver biopsies. Methods: All patients (n = 120) who underwent outpatient percutaneous liver biopsies from 1997 to 2007 were analyzed. Demographics, PT/InR, platelet count, vW antigen and ristocetin induced platelet aggregation were studied. Results: no vWD patients had major bleeding that required transfusion, hospitalization or surgery but 9 (75%) had minor local bleeding and all had ecchymosis, which resolved spontaneously within 24 hours. Conclusions: Patients with vW factor deficiency can undergo percutaneous liver biopsy without major bleeding. Minor bleeding may occur at a slightly higher rate. vWD is not a contraindication to percutaneous liver biopsy.

关键词： Liver Biopsy vW Disease Safety Complications

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