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Endovascular thrombectomy for stroke: current best practice and future goals

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Stroke & Vascular Neurology 2016年第1期1卷 16-22页

作者： Bruce C V Campbell Geoffrey A Donnan peter J mitchell Stephen M Davis Department of Medicine and Neurology Melbourne Brain Centre at the Royal Melbourne HospitalUniversity of MelbourneParkvilleVictoriaAustralia The Florey Institute of Neuroscience and Mental Health University of MelbourneParkvilleVictoriaAustralia Department of Radiology Royal Melbourne HospitalUniversity of MelbourneParkvilleVictoriaAustralia

Endovascular thrombectomy for large vessel ischaemic stroke substantially reduces disability,with recent positive randomised trials leading to guideline changes *** review discusses in detail the evidence provided by recent randomised trials and metaanalyses,the remaining areas of uncertainty and the future directions for *** data from existing trials have demonstrated the robust benefit of endovascular thrombectomy for internal carotid and proximal middle cerebral artery *** remains for more distal occlusions where the efficacy of alteplase is greater,less tissue is at risk and the safety of endovascular procedures is less *** artery occlusion was excluded from the trials,but with a dire natural history and proof of principle that rapid reperfusion is effective,it seems reasonable to continue treating these patients pending ongoing trial *** has been no evidence of heterogeneity in treatment effect in clinically defined subgroups by age,indeed,those aged>80 years have at least as great an overall reduction in disability and reduced *** there was no heterogeneity across the range of baseline stroke severities included in the *** that routine use of general anaesthesia reduces the benefit of endovascular thrombectomy is increasing and conscious sedation is generally preferred unless severe agitation or airway compromise is *** impact of time delays has become clearer with description of onset to imaging and imaging to reperfusion *** in the onset to imaging reduce the proportion of patients with salvageable brain ***,in the presence of favourable imaging,rapid treatment appears beneficial regardless of the onset to imaging time *** to reperfusion delays lead to decay in the clinical benefit achieved,particularly in those with less robust collateral *** brain imaging options to assess prognosis have various advantages and disadvan

关键词： routine epoch benefit

Complications, imaging results, and midterm clinical outcomes of pipeline embolisation device in the treatment of cerebral aneurysms

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World Journal of Neuroscience 2014年第1期4卷 58-67页

作者： Hamed Asadi Timothy Phillips Richard Dowling Bernard Yan peter mitchell Melbourne Brain Centre Department of Medicine Royal Melbourne Hospital University of Melbourne Parkville Australia Neurological Intervention & Imaging Service of Western Australia Perth Australia

Background: The introduction of pipeline embolisation device (PED) has improved the feasibility of endovascular treatment of intracranial aneurysms. The device allows for endoluminal reconstruction across the aneurysm neck but is permeable enough that flow is preserved across the pressure gradients into sidebranch arteries. In spite of higher rates of aneurysm occlusion, there is lack of data concerning medium to long-term clinical and imaging results. Methods: This study was a prospective single center analysis of complications, imaging results, and medium term clinical outcomes after PED treatment of intracranial aneurysms. We included cases over a 17-month period in a tertiary interventional neuroradiology center. We collected data on demographics, vascular risk factors, clinical presentation, angiographic results post treatment, angiographic follow-up and clinical follow-up. Results: Thirty-three patients were included, 25 females and 8 males, with mean age of 55 years;3 presented with acute subarachnoid hemorrhage and 30 for elective treatment. Thirty-seven aneurysms were treated: 35 Internal Carotid Artery (ICA), 1 basilar trunk fusiform, and 1 vertebral artery intradural dissecting aneurysms. No deaths have occurred. Five patients suffered transient neurological complications (15%). Overall aneurysm occlusion was demonstrated in 85% of patients at the end of one year. Discussion:?Overall, the technique of flow diversion and endoluminal reconstruction differs greatly from the established endosaccular packing techniques of standard coiling, balloon remodeling, or stent assisted coiling. Our midterm follow-up confirms that, the rates of clinically significant complications compare favorably with published data on stent assisted coiling, potentially making these devices a truly revolutionizing technique.

关键词： Cerebral Aneurysm Flow Diverting Stents Pipline Embolisation Device Endovascular Treatment

多发性硬化脑内Gd-DTPA强化病灶出现前5个月表现正常脑组织区域的DTI研究

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多发性硬化脑内Gd-DTPA强化病灶出现前5个月表现正常脑组织区域的...

Tranexamic acid for intracerebral haemorrhage within 2 hours of onset: protocol of a phase Ⅱ randomised placebo-controlled double-blind multicentre trial

中华医学会第16次全国放射学学术大会

作者：刘亚欧 Helmut Butzueken Scott Kolbe peter mitchell Gary Egan 李坤成首都医科大学宣武医院

目的应用DTI观察多发性硬化脑内Gd-DTPA强化病灶出现前5个月表现正常脑组织区域是否已经发生异常改变,探讨MS病灶产生的机理。方法自2007年12月至2008年10月收集22例在澳大利亚皇家墨尔本医院神经内科就诊的临床确诊多发性硬化(Multiple...

目的应用DTI观察多发性硬化脑内Gd-DTPA强化病灶出现前5个月表现正常脑组织区域是否已经发生异常改变,探讨MS病灶产生的机理。方法自2007年12月至2008年10月收集22例在澳大利亚皇家墨尔本医院神经内科就诊的临床确诊多发性硬化(Multiple Sclerosis,MS)患者,并随访5个月,患者于入组和随访时均在澳大利亚皇家墨尔本医

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Stroke & Vascular Neurology 2022年第2期7卷 158-165页

作者： Nawaf Yassi Henry Zhao Leonid Churilov Bruce C V Campbell Teddy Wu Henry Ma Andrew Cheung Timothy Kleinig Helen Brown Philip Choi Jiann-Shing Jeng Annemarei Ranta Hao-Kuang Wang Geoffrey C Cloud Rohan Grimley Darshan Shah Neil Spratt Der-Yang Cho Karim Mahawish Lauren Sanders John Worthington Ben Clissold Atte Meretoja Vignan Yogendrakumar Mai Duy Ton Duc Phuc Dang Nguyen Thai My Phuong Huy-Thang Nguyen Chung Y Hsu Gagan Sharma peter J mitchell Bernard Yan Mark W Parsons Christopher Levi Geoffrey A Donnan Stephen M Davis Department of Medicine and Neurology Melbourne Brain Centre at The Royal Melbourne HospitalThe University of MelbourneParkvilleVictoriaAustralia Population Health and Immunity Division Walter and Eliza Hall Institute of Medical ResearchParkvilleVictoriaAustralia Ambulance Victoria MelbourneVictoriaAustralia Melbourne Medical School The University of MelbourneMelbourneVictoriaAustralia Stroke Division The Florey Institute of Neuroscience and Mental HealthParkvilleVictoriaAustralia Department of Neurology Christchurch HospitalChristchurchNew Zealand Department of Neurology Monash Medical CentreMonash UniversityClaytonVictoriaAustralia Department of Interventional Neuroradiology Liverpool HospitalLiverpoolNew South WalesAustralia Department of Neurology Royal Adelaide HospitalAdelaideSouth AustraliaAustralia Department of Neurology Princess Alexandra HospitalWoolloongabbaQueenslandAustralia Department of Neurology Box Hill HospitalEastern HealthBox HillVictoriaAustralia Stroke Centre and Department of Neurology National Taiwan University HospitalTaipeiTaiwan Department of Medicine Dunedin School of MedicineUniversity of OtagoWellingtonNew Zealand Department of Neurosurgery E-Da HospitalYanchaoKaohsiungTaiwan Department of Neurology Alfred HospitalMelbourneVictoriaAustralia Department of Clinical Neuroscience Monash University Central Clinical SchoolMelbourneVictoriaAustralia Department of Medicine Sunshine Coast University HospitalNambourQueenslandAustralia Department of Neurology Gold Coast University HospitalSouthportQueenslandAustralia Department of Neurology John Hunter HospitalThe University of NewcastleNewcastleNew South WalesAustralia Department of Neurosurgery China Medical University HospitalTaichungTaiwan Department of Internal Medicine Palmerston North HospitalPalmerston NorthNew Zealand Department of Neurology St Vincent's HospitalFitzroyVictoriaAustralia Department of Neurology Royal Prince Alfred HospitalCamperdownNew South WalesAustra

Rationale Haematoma growth is common early after intracerebral haemorrhage(ICH),and is a key determinant of *** acid,a widely available antifibrinolytic agent with an excellent safety profile,may reduce haematoma *** and design Stopping intracerebral haemorrhage with tranexamic acid for hyperacute onset presentation including mobile stroke units(STOP-MSU)is a phase Ⅱ double-blind,randomised,placebo-controlled,multicentre,international investigator-led clinical trial,conducted within the estimand statistical *** In patients with spontaneous ICH,treatment with tranexamic acid within 2 hours of onset will reduce haematoma expansion compared with *** size estimates A sample size of 180 patients(90 in each arm)would be required to detect an absolute difference in the primary outcome of 20%(placebo 39%vs treatment 19%)under a two-tailed significance level of *** adaptive sample size re-estimation based on the outcomes of 144 patients will allow a possible increase to a prespecified maximum of 326 *** Participants will receive 1 g intravenous tranexamic acid over 10 min,followed by 1 g intravenous tranexamic acid over 8 hours;or matching *** efficacy measure The primary efficacy measure is the proportion of patients with haematoma growth by 24±6 hours,defined as either≥33%relative increase or≥6 mL absolute increase in haematoma volume between baseline and follow-up CT *** We describe the rationale and protocol of STOP-MSU,a phase Ⅱ trial of tranexamic acid in patients with ICH within 2 hours from onset,based in participating mobile stroke units and emergency departments.

关键词： placebo centre absolute

Evidence for Placental HPV Infection in Both HIV Positive and Negative Women

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Journal of Cancer Therapy 2015年第15期6卷 1276-1289页

作者： Chrispin Chisanga Dawn Eggert Charles D. mitchell Charles Wood peter C. Angeletti Nebraska Center for Virology School of Biological Sciences University of Nebraska-Lincoln Lincoln NE USA University of Miami Miller School of Medicine Miami FL USA

Human papillomaviruses (HPVs) have previously been reported to infect epithelial trophoblast cells of the placenta. To investigate this possibility, 200 placental samples from Zambian women were separated into HIV+ and HIV- groups and tested for HPV by redundant primer PCR, using GP5+/GP6+ and CPI/CPII primer sets. Three HPV genotypes (HPV6, 16 and 90) were detected in placental samples. Whereas, 20 different HPV genotypes were detected in vaginal sampling of the same patients, suggesting that compartment specific sub-populations of HPV may exist. The incidence of HPV16 in placental samples was almost 2-fold greater in HIV+ women compared to HIV- (p = 0.0241). HPV16 L1 expression, detected by immunochemistry, was significantly higher in HIV+ than HIV- samples (p = 0.0231). HPV16 DNA was detected in the nuclei of trophoblast cells by in situ hybridization. Overall, these results suggest that HPVs infect the placenta and that HIV significantly influences these infections.

关键词： Human Papillomaviruses (HPVs) HPV Genotypes

Controlling and Evaluating the Structure and Morphology of Polymers on Multiple Scales

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Journal of Materials Science and Chemical Engineering 2015年第12期3卷 48-60页

作者： Geoffrey R. mitchell Ana Tojeira Thomas Gkourmpis James J. Holt peter Harris Marilena Pezzuto Centre for Rapid and Sustainable Product Development Institute Polytechnic of Leiria Marinha Grande Portugal Innovation & Technology Borealis AB Stenungsund Sweden Department of Physics University of Reading Whiteknghts Reading UK Centre for Advanced Microscopy University of Reading Whiteknights Reading UK CNR-Istituto di Chimica e Tecnologia dei Polimeri Pozzuoli Italy

Crystalline polymers spontaneously form hierarchical structures although the precise manner in which these scales of structure are interconnected especially terms of the formation and evolution of the complete structure remains unclear. We have set out to control these scales of structure by introducing additional components which self-assemble in to nano-scale units which then direct the crystallisation of the polymer matrix. In other words, we first assemble a low concentration top-level structure which is designed to template or direct the sub-sequent crystallisation of the matrix polymer. This top level structure takes on the role of controlling the structure. We have set out to both establish the design principles of such structures and to develop experimental procedures which allow us to follow the formation of such complex hierarchical polymer structures. In particular we focus of the relationships between these different levels of structure and time sequence of events required for the structure to evolve in the targeted manner. In this programme, we have exploited time-resolving small-angle X-ray scattering and electron microscopy together with neutron scattering to probe and quantify the different scales of structure and their evolution. We highlight new neutron scattering instrumentation which we believe have great potential in the growing field of hierarchical structures in polymers. The addition of small quantities of nanoparticles to conventional and sustainable thermoplastics leads to property enhancements with considerable potential in a number of areas Most engineered nano-particles are highly stable and these exist as nano-particles prior to compounding with the polymer resin, they remain as nano- particles during the active use as well as in the subsequent waste and recycling streams. In this work we also explore the potential for constructing nano-particles within the polymer matrix during processing from organic compounds selected to provide nano

关键词： Component Semi-Crystalline Polymers Morphology Texture Nucleation Growth Shear Flow

Cardiovascular magnetic resonance: Diagnostic utility and specific considerations in the pediatric population

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World Journal of Clinical Pediatrics 2016年第1期5卷 1-15页

作者： Frances M mitchell Sanjay K Prasad Gerald F Greil peter Drivas Vassilios S Vassiliou Claire E Raphael CMR Unit Royal Brompton Hospital Department of Pediatrics UT Southwestern Medical Center Children’s Medical Center Radiology Department the Royal Adelaide Hospital

Cardiovascular magnetic resonance is a non-invasive imaging modality which is emerging as important tool for the investigation and management of pediatric cardiovascular disease. In this review we describe the key technical and practical differences between scanning children and adults, and highlight some important considerations that must be taken into account for this patient population. Using case examples commonly seen in clinical practice, we discuss the important clinical applications of cardiovascular magnetic resonance, and briefly highlight key future developments in this field.

关键词： Cardiology Pediatrics Imaging Diagnosis Cardiovascular magnetic resonance

Ciclesonide Use in COVID-19: Not All Steroids Are the Same

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Pharmacology & Pharmacy 2021年第1期12卷 10-24页

作者： Michel Tagliati Marianna Leopoulou Jo Ann LeQuang Charles E. Wollmuth Joseph V. Pergolizzi Kailyn mitchell peter Magnusson Proactive Health Inc. Stockholm Sweden Cardiology Clinic Athens General Hospital “Elpis” Athens Greece NEMA Research Inc. Naples Florida USA Centre for Research and Development Region Gavleborg/Uppsala University Gavle Sweden Department of Medicine Cardiology Research Unit Karolinska Institutet Stockholm Sweden

Introduction: The inflammatory mechanisms of COVID-19 suggest that corticosteroids may be beneficial, but their benefits must outweigh their potential risks. The RECOVERY trial results suggest that dexamethasone 6 mg/day (but not other steroids) may confer mortality benefits on ventilated COVID-19 patients. Methods: This is a narrative review of the literature about the use of ciclesonide and dexamethasone for COVID-19 patients. Literature is being created rapidly and this review is offered as a state-of-the-science narration. Results: The SARS-CoV-2 virus is an RNA virus whose RNA is transcribed via open reading frames, making its elimination difficult. Coronaviruses have evolved multiple strategies for proteolytic activation of the spike;viral replication occurs entirely in the cytoplasm. In this connection, the RNA-cleaving endoribonuclease (NSP-15 also known as EndoU) may play a key role by facilitating viral double-stranded RNA recognition by the host’s macrophages. Furthermore, the virus is able to undergo RNA recombination rapidly, enabling it to evade host

关键词： Ciclesonide Coronavirus COVID-19 Dexamethasone SARS-CoV-2

Using data from‘visible’populations to estimate the size and importance of‘hidden’populations in an epidemic:A modelling technique

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Infectious Disease Modelling 2020年第1期5卷 798-813页

作者： Anna M.Foss Holly J.Prudden Kate M.mitchell Michael Pickles Reynold Washington Anna E.Phillips Michel Alary Marie-Claude Boily Stephen Moses Charlotte H.Watts peter T.Vickerman Department of Global Health and Development and Centre for Mathematical Modelling of Infectious Diseases London School of Hygiene and Tropical Medicine15-17 Tavistock PlaceLondonWC1H 9SHUK Department of Infectious Disease Epidemiology School of Public HealthImperial College LondonMedical School BuildingSt Mary’s CampusNorfolk PlaceLondonW21PGUK St John’s Research Institute 100 Feet RoadJohn NagarKoramangalaBangalore560034KarnatakaIndia Department of Community Health Sciences Max Rady College of MedicineRady Faculty of Health SciencesUniversity of ManitobaS113-750 Bannatyne AvenueWinnipegManitobaR3E 0W3Canada Centre de recherche du CHU de Québec-UniversitéLaval 1050 Chemin Ste-FoyQuébec(Qc)G1S 4L8Canada Département de médecine sociale et préventive Facultéde médecineUniversitéLaval1050avenue de la MédecineQuébec(Qc)G1V 0A6Canada

We used reported behavioural data from cisgender men who have sex with men and transgender women(MSM/TGW)in Bangalore,mainly collected from‘hot-spot’locations that attract MSM/TGW,to illustrate a technique to deal with potential issues with the representativeness of this sample.A deterministic dynamic model of HIV transmission was developed,incorporating three subgroups of MSM/TGW,grouped according to their reported predominant sexual role(insertive,receptive or versatile).Using mathematical modelling and data triangulation for‘balancing’numbers of partners and role preferences,we compared three different approaches to determine if our technique could be useful for inferring characteristics of a more‘hidden’insertive MSM subpopulation,and explored their potential importance for the HIV *** for 2009 across all three approaches suggest that HIV prevalence among insertive MSM was likely to be less than half that recorded in the surveys(4.5e6.5%versus 13.1%),but that the relative size of this subgroup was over four times larger(61e69%of all MSM/TGW versus 15%).We infer that the insertive MSM accounted for 10e20%of all prevalent HIV infections among urban males aged *** modelling can be used with data on‘visible’MSM/TGW to provide insights into the characteristics of‘hidden’MSM.A greater understanding of the sexual behaviour of all MSM/TGW is important for effective HIV *** broadly,a hidden subgroup with a lower infectious disease prevalence than more visible subgroups,has the potential to contain more infections,if the hidden subgroup is considerably larger in size.

关键词： HIV Infectious diseases Mathematical modelling Men who have sex with men Transgender women India