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Early anticoagulation in patients with stroke and atrial fibrillation is associated with fewer ischaemic lesions at 1 month: the ATTUNE study

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stroke & Vascular Neurology 2024年第1期9卷 30-37,I0034页

作者： Angelos sharobeam Longting Lin Christina Lam Carlos Garcia-Esperon Yash Gawarikar Ronak Patel matthew Lee-Archer Andrew Wong michael Roizman Amanda Gilligan Andrew Lee Kee meng Tan susan Day Christopher Levi s.ephen m davis.mark pars.ns.bernard yan melbourne Brain Centre at Royal melbourne Hospital ParkvilleVictoriaAustralia University of New south Wales south Western sydney Clinical school LiverpoolNew South WalesAustralia Department of Neurology John Hunter HospitalNewcastleNew South WalesAustralia Department of Neurology Calvary Public HospitalCanberraAustralian Capital TerritoryAustralia Department of Neurology Northern Hospital EppingEppingVictoriaAustralia Department of Neurology Royal Brisbane and Women's HospitalHerstonQueenslandAustralia The University of Queensland school of medicine HerstonQueenslandAustralia Neurosciences Clinical Institute Epworth HealthcareRichmondVirginiaAustralia Department of Neurology Austin HealthUniversity of MelbourneHeidelbergVictoriaAustralia Flinders University College of medicine and Public Health AdelaideSouth AustraliaAustralia Department of Neurology Gold Coast University HospitalSouthportQueenslandAustralia The University of sydney Northern Clinical school St LeonardsNew South WalesAustralia Department of Neurology and Neurophysiology Liverpool HospitalLiverpoolNew South WalesAustralia

Background The optimal time to commence anticoagulation in patients with atrial fibrillation(AF)after ischaemic stroke or transient ischaemic attack(TIA)is unclear,with guidelines differing in recommendations.A limitation of previous studies is the focus on clinically overt stroke,rather than radiologically obvious diffusion-weighted imaging ischaemic *** aimed to quantify silent ischaemic lesions and haemorrhages on mRI at 1month in patients commenced on early(s)vs late(≥4days)*** hypothesised that there would be fewer ischaemic lesions and more haemorrhages in the early anticoagulant group at 1-month *** A prospective multicentre,observational cohort study was performed at 11 Australian stroke *** and mRI data were collected at baseline and follow-up,with blinded imaging assessment performed by two *** of commencement of anticoagulation was at the discretion of the treating stroke *** We recruited 276 patients of whom 208 met the eligibility *** average age was 74.2 years(sD±10.63),and 79(38%)patients were *** National Institute of Health stroke scale score was 5(IQR 1–12).median baseline ischaemic lesion volume was 5mL(IQR 2–17).There were a greater number of new ischaemic lesions on follow-up mRI in patients commenced on anticoagulation≥4days after index event(17%vs 8%,p=0.04),but no difference in haemorrhage rates(22%vs 32%,p=0.10).Baseline ischaemic lesion volume of≤5mL was less likely to have a new haemorrhage at 1month(p=0.02).There was no difference in haemorrhage rates in patients with an initial ischaemic lesion volume of>5mL,regardless of anticoagulation *** Commencing anticoagulations after stroke or TIA is associated with fewer ischaemic lesions at 1month in AF *** is no increased rate of haemorrhage with early *** results suggest that early anticoagulation after mild-to-moderate acute ischaemic stroke associated w

关键词： patients lesions ischaemic

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

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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 s.ephen 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

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The Training and Performance of Emergency Physicians as Anesthetists for International medical surgical Response Teams: The Emergency Physician’s General Anesthesia syllabus (EP GAs)

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Open Journal of Anesthesiology 2014年第2期4卷 53-61页

作者： Richard skupski mark Walsh manar Jbara Donald Zimmer Bhavesh m. Patel michael T. mcCurdy James Lantry Braxton Fritz Patrick davis Harsha musunuru Anne Newbold Art Toth Richard Frechette Tiffany Alexander madhura sundararajan John Lovejoy Dan Hottinger Joe Capannari Rachel Kurcz Gerard bernard Harold Previl Department of Anesthesia and Trauma services Memorial Hos-pital of South Bend South Bend USA Department of Anesthesia and Trauma services Memorial Hos-pital of South Bend South Bend USA sacred Heart Hospital Milot Haiti Department of Anesthesia and Trauma services Memorial Hos-pital of South Bend South Bend USA st. Damien and st. Luc’s Hospital Port au Prince Haiti Department of Anesthesia and Trauma services Memorial Hos-pital of South Bend South Bend USA st. Damien and st. Luc’s Hospital Port au Prince Haiti sacred Heart Hospital Milot Haiti Department of Anesthesia and Trauma services Memorial Hos-pital of South Bend South Bend USA st. Damien and st. Luc’s Hospital Port au Prince Haiti mayo Clinic—Emergency medicine Residency Program Rochester USA sacred Heart Hospital Milot Haiti st. Damien and st. Luc’s Hospital Port au Prince Haiti st. Damien and st. Luc’s Hospital Port au Prince Haiti University of maryland school of medicine Baltimore USA st. Damien and st. Luc’s Hospital Port au Prince Haiti University of maryland school of medicine Baltimore USA. st. Damien and st. Luc’s Hospital Port au Prince Haiti mayo Clinic—Critical Care medicine Scottsdale USA

Background: The availability of an anesthesiologist is often a limiting factor in the number of operations that can be performed by International medical surgical Response Teams (ImsuRT). Because emergency physicians (EPs) possess skills in airway control, management of moderate and deep sedation, and ventilator management, we propose that with proper training in general anesthesia, EPs can serve as anesthetists for ImsuRT with anesthesiologist supervision. methods: During a 10-week period, a board-certified EP administered general anesthesia to 60 patients prior to a surgical medical mission trip. The breakdown of surgical cases was: 11 orthopedic, 2 genitourinary, 20 ear, nose, and throat, 8 obstetrics and gynecological, 13 general surgery, and 6 vascular. A simplified protocol for induction, maintenance, and emergence was adhered to for all cases. Results: Fourteen orthopedic cases using general anesthesia were performed in a one-week period in Haiti. These cases involved open reduction and internal fixation (ORIF), hemiarthoplasty, hardware removal, tendon transfer and external fixation of fractured bone. Conclusion: We demonstrate the feasibility of a model curriculum to train EPs in the basics of anesthesia. The EP can safely and effectively deliver general anesthesia for major cases on surgical medical mission trips under the auspices of an anesthesiologist in an austere environment.

关键词： Emergency Physicians General Anesthesia syllabus International medical surgical Response Teams Anesthetists Induction maintenance Emergence Anesthesia

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small P values may not yield robust findings:an example using REsT-meta-PD

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science Bulletin 2021年第21期66卷 2148-2152,M0003页

作者： Xi-Ze Jia Na Zhao Hao-ming Dong Jia-Wei sun marek Barton Roxana Burciu Nicolas Carrière Antonio Cerasa Bo-Yu Chen Jun Chen s.ephen Coombes Luc Defebvre Christine Delmaire Kathy Dujardin Fabrizio Esposito Guo-Guang Fan Federica Di Nardo Yi-Xuan Feng Brett W.Fling saurabh Garg moran Gilat martin Gorges shu-Leong Ho Fay BHorak Xiao Hu Xiao-Fei Hu Biao Huang Pei-Yu Huang Ze-Juan Jia Christina Jones Jan Kassubek Lenka Krajcovicova Ajay Kurani Jing Li Qing Li Ai-Ping Liu Bo Liu Hu Liu Wei-Guo Liu Renaud Lopes Yu-Ting Lou Wei Luo Tara madhyastha Ni-Ni mao Grainne mcAlonan martin J.mcKeown shirley Pang Andrea Quattrone Irena Rektorova Alessia sarica Hui-Fang shang James m.shine Priyank shukla Tomas slavicek Xiao-Peng song Gioacchino Tedeschi Alessandro Tessitore David Vaillancourt Jian Wang Jue Wang Z.Jane Wang Lu-Qing Wei Xia Wu Xiao-Jun Xu Lei yan Jing yang Wan-Qun yang Nai-Lin Yao De-Long Zhang Jiu-Quan Zhang min-ming Zhang yan-Ling Zhang Cai-Hong Zhou Chao-Gan yan Xi-Nian Zuo mark Hallett Tao Wu Yu-Feng Zang Center for Cognition and Brain Disorders the Affiliated HospitalHangzhou Normal UniversityHangzhou 310015China Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments Hangzhou 311121China National Basic science Data Center Beijing 100190China state Key Laboratory of Cognitive Neuroscience and Learning&mcGovern Institute for Brain Research Beijing Normal UniversityBeijing 100875China school of Information and Electronics Technology Jiamusi UniversityJiamusi 154007China Neuroscience Program Central European Institute of TechnologyCEITECMasaryk UniversityBrno 62500Czech Republic Department of Applied Physiology and Kinesiology University of FloridaGainesville FL 32611USA Univ.Lille InsermCHU LilleU1172-LilNCog-Lille Neuroscience&CognitionLille F-59000France The Institute for Biomedical Research and Innovation National Research CouncilMangone CS 87050Italy Department of Radiology The First Affiliated Hospital of China Medical UniversityShenyang 110001China Department of Radiology Guangdong Provincial Hospital of Chinese MedicineGuangzhou 510120China Department of medicine Surgery and DentistryScuola Medica SalernitanaUniversity of SalernoFiscianoSA 132-84084Italy Department of Advanced medical and surgery sciences University of Campania“Luigi Vanvitelli”Caserta 81100Italy Eye Center of the 2nd Affiliated Hospital Medical College of Zhejiang UniversityHangzhou 310020China Zhejiang Provincial Key Lab of Ophthalmology Hangzhou 310020China Department of Health and Exercise science Colorado State UniversityFort Collins CO 80523USA Pacific Parkinson’s Research Centre University of British ColumbiaVancouver BC V6E 2M6Canada Department of medicine(Neurology)University of British Columbia Vancouver BC V6T 1B7Canada Brain and mind Center The University of SydneySydney NSW 2006Australia Department of Neurology Ulm UniversityUlm 89081Germany Division of Neurology Department of MedicineQueen Mary HospitalUniversity of Hong KongHong Kong 999077China Department of

Thousands of resting state functional magnetic resonance imaging(Rs-f mRI)articles have been published on brain *** precise localization of abnormal brain activity,a voxel-level comparison is *** of the large number of voxels in the brain,multiple comparison correction(mCC)must be performed to reduce false positive rates,and a smaller P value(usually including either liberal or stringent mCC)is widely recommended[1].

关键词：帕金森病 precise correction

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