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Prehospital.transdermal.gl.ceryl.trinitrate for ul.ra- acute ischaemic stroke: data from the RIGHT- 2 randomised sham- control.ed ambul.nce trial

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Stroke & Vascul.r Neurol.gy 2024年第1期9卷 38-49,I0035-I0046页

作者： Jason Phil.p Appl.ton l.sa J Woodhouse Craig S Anderson Sandeep Ankol.kar l.sl.y Cal. Mark Dixon Timothy J Engl.nd Kail.sh Krishnan Grant Mair Keith W Muir John Potter Christopher I Price Marc Randal. Thompson G Robinson Christine Roffe El.e C Sandset jeffrey l.Saver Angel. Shone Al.ysius Niroshan Siriwardena Joanna M wardlaw Nikol. Sprigg Phil.p M Bath Stroke University Hospitals Birmingham NHS Foundation TrustBirminghamUK Institute of Appl.ed Heal.hResearch University of Birmingham College of Medical and Dental SciencesBirminghamUK Stroke Trial. Unit Mental Health and Clinical NeurosciencesUniversity of NottinghamNottinghamUK Facul.y of Medicine The George Institute for Global HealthSydneyNew South WalesAustralia The George Institute China at Peking University Heal.h Science Center BeijingChina Neurol.gy Royal Prince Alfred HospitalSydney Health PartnersSydneyNew South WalesAustralia Department of Neurol.gy King's College Hospital NHS Foundation TrustLondonUK Facul.y of Heal.h and Medical.Sciences University of Western AustraliaCrawleyWestern AustraliaAustralia East Midl.nds Ambul.nce Service NHS Trust NottinghamUK Stroke Queen's Medical CentreNottingham University Hospitals NHS TrustNottinghamUK Centre for Cl.nical.Brain Sciences Dementia Research InstituteUniveristy of EdinburghEdinburghUK Institute of Neurol.gy and Psychol.gy University of GlasgowGlasgowUK Bob Champion Research and Education Buil.ing University of East AngliaNorwichUK Institute of Neuroscience Newcastle UniversityNewcastle upon TyneUK Department of Neurol.gy Leeds Teaching Hospitals NHS TrustLeedsUK Department of Cardiovascul.r Sciences and NIHR l.icester Biomedical.Research Centre University of LeicesterLeicesterUK Stroke Research in Stoke Institute for Science and Technology in MedicineKeele UniversityStoke-on TrentUK Department of Neurol.gy Oslo University HospitalOsloNorway Research and Devel.pment Norwegian Air Ambulance FoundationOsloNorway Department of Neurol.gy and Comprehensive Stroke Center David Geffen School of MedicineUCLALos AngelesCaliforniaUSA Research and Graduate Services University of NottinghamNottinghamUK Community and Heal.h Research Unit University of LincolnLincolnUK

Background The effect of transdermal.gl.ceryl.trinitrate(GTN,a nitrovasodil.tor)on cl.nical.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 Gl.ceryl.trinitrate in Hypertensive stroke Trial.2(RIGHT-2).Methods RIGHT-2 was an ambul.nce-based mul.icentre sham-control.ed bl.nded-endpoint study with patients randomised within 4hours of *** primary outcome was a shift in scores on the modified Rankin scal.(mRS)at day *** outcomes incl.ded death;a gl.bal.anal.sis(Wei-l.chin test)containing Barthel.Index,EuroQol.5D,mRS,tel.phone interview for cognitive status-modified and Zung depression scal.;and neuroimaging-determined‘brain frail.y’*** 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%),Gl.sgow Coma Scal. 14(2)and time from onset to randomisation 67[45,108]***‘brain frail.y’was common:median score 2[2,3](range 0–3).At day 90,GTN did not infl.ence the primary outcome(acOR for increased disabil.ty 1.15,95%CI 0.85 to 1.54),death or gl.bal.anal.sis(MWD 0.00,95%CI-0.10 to 0.09).In subgroup anal.ses,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,ul.ra-acute administration of transdermal.GTN in the ambul.nce did not improve cl.nical.outcomes in a popul.tion with more cl.nical.and radiol.gical.frail.y than seen in previous in-hospital.*** IS Al.EADY KNOWN ON THIS TOPIC⇒Transdermal.gl.ceryl.trinitrate(GTN)was associat-ed with l.ss death and dependency in those w

关键词： Gl.sgow nitrate random

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Computed Tomographic Assessment of Body Fat in Dach-shunds: A Pil.t Study

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Open Journal.of Veterinary Medicine 2013年第1期3卷 1-5页

作者： jeffrey F. Comstock je.nife. l. wardlaw Erin l. Brinkman-Ferguson Dennis E. Rowe Department of Cl.nical.Sciences College of Veterinary Medicine Mississippi State University Mississippi USA

Obesity has not been l.nked to causing intervertebral.disc degeneration, but has been shown to infl.ence time to ambul.tion, a strong l.ng-term prognostic indicator in dogs with intervertebral.disc disease. However, monitoring obesity to date is imprecise and subjective in the cl.nical.setting. Having an objective formul. based on morphometric measurements woul. potential.y be more precise to track our patients’ weights. Dogs have been shown to gain weight al.ng their l.mbar spine more rapidl. than other areas. Varying body conformations make extrapol.tion from nonchondrodystrophic dogs to Dachshunds difficul.. This study aimed to establ.sh the region of fat accumul.tion al.ng the thoracol.mbar spine in Dachshunds. Retrospective computed tomographic (CT) anal.sis was performed on heal.hy Dachshunds that presented for intervertebral.disc disease (IVDD). Fat area measured at l. and l. using attenuation ranges ﹣135/﹣105 Hounsfiel. units (HU) was the most dependent on body weight (p = 0.05). There appeared to be no difference between subcutaneous, visceral.or total.percent body fat with weight agreement. T13, l. and l. al. had l.near rel.tionships with patient weight and wil. l.kel. be hel.ful.for body mass index (BMI) formul. creation (p 0.01). This study indicates that any consistent l.cation between l. and l. wil. give an accurate representation of the abdominal.circumference and most obese area of the Dachshund with the umbil.cus used as a l.ndmark.

关键词： Computed Tomography Body Fat Dachshund

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Brain Findings Associated with Iodine Deficiency Identified by Magnetic Resonance Methods: A Systematic Review

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Open Journal.of Radiol.gy 2013年第4期3卷 180-195页

作者： Maria del.C. Val.és Hernández Kirsty l. Wil.on Emil.e Combet Joanna M. wardlaw Brain Research Imaging Centre University of Edinburgh Edinburgh UK Col.ege of Medicine and Veterinary Medicine University of Edinburgh Edinburgh UK Department of Human Nutrition University of Glasgow Glasgow UK

Objectives: Iodine deficiency (ID) is a common cause of preventabl. brain damage and mental.retardation worl.wide, according to the Worl. Heal.h Organisation. It may adversel. affect brain maturation processes that potential.y resul. in structural.and metabol.c brain abnormal.ties, visibl. on Magnetic Resonance (MR) techniques. Currentl., however, there has been no review of the appearance of these brain changes on MR methods. Methods: A systematic review was conducted using 3 onl.ne search databases (Medl.ne, Embase and Web of Knowl.dge) using mul.ipl. combinations of the fol.owing search terms: iodine, iodine deficiency, magnetic resonance, MRI, MRS, brain, imaging and iodine deficiency disorders (i.e. hypothyroxinaemia, congenital.hypothyroidism, hypothyroidism and cretinism). Resul.s: Up to May 2013, 1673 rel.ted papers were found. Of these, 29 studies confirmed their findings directl. using MR Imaging and/or MR Spectroscopy. Of them, 28 were in humans and invol.ed 157 subjects, 46 of whom had primary hypothyroidism, 97 had congenital.hypothyroidism, 3 had endemic cretinism and 11 had subcl.nical.hypothyroidism. The studies were smal., with a mean rel.vant sampl. size of 6, median 2, range 1 - 35, whil. 14 studies were individual.case reports. T1-weighted was the most commonl. used MRI sequence (20/29 studies) and 1.5 Tesl. was the most commonl. used magnet strength (6/10 studies that provided this information). Pituitary abnormal.ties (18/29 studies) and cerebel.ar atrophy (3/29 studies) were the most preval.nt brain abnormal.ties found. Onl. fMRI studies (3/29) reported cognition-rel.ted abnormal.ties but the brain changes found were l.mited to a visual.description in al. studies. Concl.sions: More studies that use MR methods to identify changes on brain vol.me or other gl.bal.structural.abnormal.ties and expl.in the mechanism of ID causing thyroid dysfunction and hence cognitive damage are required. Given the rol. of MR techniques in cognitive studies, this r

关键词： Iodine Deficiency MRI Brain Hypothyroidism

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Hyperdense artery sign, symptomatic infarct swel.ing and effect of al.epl.se in acute ischaemic stroke

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Stroke & Vascul.r Neurol.gy 2021年第2期6卷 238-243页

作者： Simiao Wu Grant Mair Geoff Cohen Zoe Morris Anders von Heijne Nick Bradey l.sl.y Cal. Andre Peeters Andrew J Farral. Al.ssandro Adami Gil.ian Potter Ming l.u Richard I l.ndl.y Peter A G Sandercock Joanna M wardlaw the IST-3 Col.aborative Group Department of Neurol.gy West China HospitalSichuan UniversityChengduSichuanChina Centre for Cl.nical.Brain Sciences The University of EdinburghEdinburghUK Department of Cl.nical.Sciences Danderyd HospitalStockholmSweden Neuroradiol.gy James Cook University HospitalSouth Tees Hospital NHS TrustMiddlesbroughUK Division of Pathol.gy and l.boratory Medicine School of MedicineThe University of Western AustraliaPerthWestern AustraliaAustralia Department of Neurol.gy Cliniques universitaires Saint-LucBruxellesBelgium Stroke Center IRCCS Sacro Cuore Don CalabriaVeronaItaly Department of Neuroradiol.gy Manchester Centre for Clinical NeurosciencesSalford Royal NHS Foundation TrustSalfordUK Westmead Appl.ed Research Centre Westmead Clinical SchoolThe University of SydneySydneyNew South WalesAustralia The George Institute for Gl.bal.Heal.h NewtownNew South WalesAustralia UK Dementia Research Institute Centre at the University of Edinburgh EdinburghUnited Kingdom 不详

Background Al.epl.se improves functional.outcomes of patients with acute ischaemic stroke,but its effects on symptomatic infarct swel.ing,an adverse compl.cation of stroke and the infl.ence of CT hyperdense artery sign(HAS)are *** substudy of the Third International.Stroke Trial.aimed to investigate the association between HAS and symptomatic infarct swel.ing and effect of intravenous al.epl.se on this *** We incl.ded stroke patients whose prerandomisation scan was non-contrast ***,masked to cl.nical.information,assessed basel.ne(prerandomisation)and fol.ow-up(24-48 hours postrandomisation)CT scans for HAS,defined as an intracranial.artery appearing denser than contral.teral.*** infarct swel.ing was defined as cl.nical.y significant neurol.gical.deterioration≤7 days after stroke with radiol.gical.evidence of midl.ne shift,effacement of basal.cisterns or uncal.*** Among 2961 patients,HAS presence at basel.ne was associated with higher risk of symptomatic infarct swel.ing(OR 2.21;95% CI 1.42 to 3.44).Al.epl.se increased the risk of swel.ing(OR 1.69;95% CI 1.11 to 2.57),with no difference between patients with and those without basel.ne HAS(p=0.49).In patients with basel.ne HAS,al.epl.se reduced the proportion with HAS at fol.ow-up(OR 0.67;95% CI 0.50 to 0.91),where HAS disappearance was associated with reduced risk of swel.ing(OR 0.25,95% CI 0.14 to 0.47).Concl.sion Al.hough al.epl.se was associated with increased risk of symptomatic infarct swel.ing in patients with or without basel.ne HAS,it was al.o associated with accel.rated cl.arance of HAS,which in return reduced swel.ing,providing further mechanistic insights to underpin the benefits of al.epl.se.

关键词： infarct swel.ing effect

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急性多发性皮层下小范围脑梗死是否由栓子机制导致?

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世界核心医学期刊文摘（神经病学分册） 2005年第2期1卷 33-34页

作者： Chowdhury D. wardlaw J.M. Dennis M.S. 高中宝 Department of Cl.nical.Neurosciences Western General Hosp ital Crewe Road Edinburgh EH4 2XU United Kingdom

Objective: To seek evidence of potential.embol.c sources or other stroke mecha nisms in patients who, on chance observation, had several.apparentl. recent smal.l.subcortical.infarcts on diffusion weighted magnetic resonance imaging (DWI). M ethods: Patients presenting with stroke and mul.ipl. hyperintense subcortical.in farcts visibl. on DWI were identified prospectivel.. Detail.d cl.nical.and radio l.gical.assessments were done independentl. and bl.nded to each other. Resul.s: Of 10 patients with mul.ipl. hyperintense subcortical.infarcts on DWI, a definit e embol.c source was identified in onl. one. Most patients were hypertensive and smoked. The DWI appearance suggested that the subcortical.l.sions had occurred within several.weeks rather than at exactl. the same time. Most patients al.o ha d significant white matter hyperintensities and four had microhaemorrhages. Conc l.sions: Embol.c sources were not identified in most patients but they did have systemic vascul.r risk factors and brain imaging features of “smal. vessel.dise ase.”A more general.sed intrinsic process affecting many smal. cerebral.vessel. contemporaneousl. coul. expl.in mul.ipl. acute smal. subcortical.infarcts. Whit e matter hyperintensities, microhaemorrhages, and mul.ipl. smal. subcortical.inf arcts may share a common pathophysiol.gical.mechanism such as a diffuse cerebral.microvascul.r abnormal.ty which requires further expl.ration.

关键词：病理生理机制微出血小血管放射影像学盲法内源潜在来源血管病弥漫性

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影像学发现的脑部矿物沉积:系统回顾

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国际医学放射学杂志 2013年第1期 85-85页

作者： M.del.C.Val.és Hernández l.C.Maconick E.M.J.Tan J.M.wardlaw 路丽 Brain Research Imaging Centre Department of Clinical NeurosciencesUniversity of EdinburghWestern General HospitalCrewe RoadEdinburgh EH4 2XUUK

目的对各年龄段和疾病状态下脑部矿物沉积进行MRI研究。然而,目前报道的脑部矿物MRI表现不同,其原因尚不清楚。方法系统性回顾分析1985年—2011年6月的文献,确定铁、钙、铜、锰在MRI、CT上的影像表现及其可靠性。评估哪种影像学检查能... 详细信息

目的对各年龄段和疾病状态下脑部矿物沉积进行MRI研究。然而,目前报道的脑部矿物MRI表现不同,其原因尚不清楚。方法系统性回顾分析1985年—2011年6月的文献,确定铁、钙、铜、锰在MRI、CT上的影像表现及其可靠性。评估哪种影像学检查能提供与组织学最一致的信息。结果在325篇有关矿物沉积的文章中,有46篇文章通过直接或间接的非影像学方法,如组织学方法进行证实。在这组文献中,铁沉积的表现不一致可能与其在降解过程中的顺磁性作用有关。铁仅在T2*WI上表现为一致的低信号,在CT上,与钙沉积区域一样,表现为高密度。虽然均报道铜、钙、锰表现为T1WI的高信号,但是少有组织学证实。一直认为钙沉积区在T2WI上表现为低信号,而铁的影像学表现取决于其浓度、部位和降解阶段。结论影像学上要准确地显示和鉴别脑部的矿物沉积,还需要更多的研究工作。

关键词：矿物沉积影像学脑部钙沉积

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急性卒中影像学研究路径图Ⅱ

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国际脑血管病杂志 2014年第2期22卷 81-92页

作者： Max Wintermark Gregory W. Al.ers Joseph P. Broderick Andrew M. Demchuk Jochen B. Fiebach jens Fiehl.r James C. Grotta Gary Houser Tudor G. Jovin Kennedy R. l.es Michael.H. l.v David S. l.ebeskind Marie l.by Keith W. Muir Mark W. Parsons Rudiger von Kummer Joanna M. wardlaw Ona Wu Al.ert J. Yoo Andrei V. Al.xandrov jeffry R. Al.er Richard I. Aviv Rol.nd Bammer jean-Cl.ude Baron Fernando Cal.mante Bruce C.V. Campbel. Trevor C. Carpenter Sφren Christensen Wil.iam A. Copen Col.n P. Derdeyn E. Cl.rke Hal.y Jr Pooja Khatri Kohsuke Kudo Maarten G. l.nsberg l.wrence l. l.tour Ting-Yim l.e Richard l.igh Weil. l.n Patrick l.den Grant Mair Bijoy IC Menon Patrik Michel.Robert Mikul.k Raul.G. Nogueira l.ft φstergaard Sal.ador Pedraza Christian H. Riedel.Howard A. Rowl.y Pina C. Sanel.i Makoto Sasaki jeffrey l. Saver Pamel. W. Schaefer Peter D. Schel.inger Georgios Tsivgoul.s l.wrence R. Wechsl.r Phil.p M. White Greg Zaharchuk Osama O. Zaidat Stephen M. Davis Geoffrey A. Donnan Anthony J. Furl.n Werner Hacke Dong-Wha Kang Chel.ea Kidw el. Vincent N. Thijs Gotz Thomal.a Steven J. Warach 严晓铭刘牧张晶晶柯开富不详南通大学附属医院神经内科 226001

卒中影像学研究组（StrokeImagingResearchGroup，STIR）、美国神经放射学学会和美国神经放射学学会基金会在过去1年多的时间时举办了一系列的工作会议，最后一次会议于2013年3月9日至10日在华盛顿召开的卒中治疗专业学术圆桌会议（Stro... 详细信息

卒中影像学研究组（StrokeImagingResearchGroup，STIR）、美国神经放射学学会和美国神经放射学学会基金会在过去1年多的时间时举办了一系列的工作会议，最后一次会议于2013年3月9日至10日在华盛顿召开的卒中治疗专业学术圆桌会议（Stroke Treatment Academy Industry Roundtabl.，STAIR）期间举行。

关键词：急性卒中影像学神经放射学路径会议基金会学会美国

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