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Predicting long-term outcomes in acute intracerebral haemorrhage using delayed prognostication scores

Stroke & Vascular Neurology 2021年第4期6卷 536-541,I0013-I0025页

作者： Ronda Lun vignan yogendrakumar Tim Ramsay Michel Shamy Robert Fahed Magdy H Selim Dar Dowlatshahi Department of Medicine Division of NeurologyStroke ProgramOttawa HospitalOttawaOntarioCanada Clinical Epidemiology Program School of EpidemiologyPublic Health and Preventative MedicineOttawa Hospital Research InstituteOttawa UniversityOttawaOntarioCanada Ottawa Hospital Research Institute OttawaOntarioCanada Interventional Neuroradiology Rothschild FoundationParisÎle-de FranceFrance Department of Neurology Beth Israel Deaconess Medical CenterBostonMassachusettsUSA

Objective The concept of the‘self-fulfilling prophecy’is well established in intracerebral haemorrhage(ICH).The ability to improve prognostication and prediction of long-term outcomes during the first days of hospitalisation is important in guiding conversations around goals of *** previously demonstrated that incorporating delayed imaging into various prognostication scores for ICH improves the predictive accuracy of 90-day ***,delayed prognostication scores have not been used to predict long-term functional outcomes beyond 90 ***,setting and participants We analysed data from the ICH Deferoxamine trial to see if delaying the use of prognostication scores to 96 hours after ICH onset will improve performance to predict outcomes at 180 days.276 patients were *** and measurements We calculated the original ICH score(oICH),modified-ICH score(MICH),max-ICH score and the FUNC score on presentation(baseline),and on day 4(delayed).Outcomes assessed were mortality and poor functional outcome in survivors(defined as modified Rankin Scale of 4-5)at 180 *** generated receiver operating characteristic curves,and measured the area under the curve values(AUC)for mortality and functional *** compared baseline and delayed AUCs with non-parametric *** At 180 days,21 of 276(7.6%)*** of the survivors,54 of 255 had poor functional outcome(21.2%).The oICH,MICH and max-ICH performed significantly better at predicting 180-day mortality when calculated 4 days later compared with their baseline equivalents((0.74 vs 0.83,p=0.005),(0.73 vs 0.80,p=0.036),(0.74 vs 0.83,p=0.008),respectively).The delayed calculation of these scores did not significantly improve our accuracy for predicting poor functional *** Delaying the calculation of prognostication scores in acute ICH until day 4 improved prediction of 6-month mortality but not functional *** registration number *** Registry(NCT0

关键词： acute delayed score

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Identifying sex-specific differences in the carotid revascularisation literature:findings from a scoping review

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Stroke & Vascular Neurology 2021年第3期6卷 496-499,I0085-I0096页

作者： vignan yogendrakumar Michel Shamy Brian Dewar Dean A Fergusson Dar Dowlatshahi Candyce Hamel Sophia Gocan Mark Fedyk Jean-Louis Mas Peter Rothwell Virginia Howard Olena Bereznyakova On behalf of the WoW-CAD Investigators Department of Medicine Division of Neurology and Ottawa Hospital Research InstituteUniversity of OttawaOttawaOntarioCanada Epidemiology Program Ottawa Hospital Research InstituteOttawaOntarioCanada Stroke Prevention Clinic Ottawa HospitalOttawaOntarioCanada Bioethics Program UC Davis Department of MedicineSacramentoCaliforniaUSA Universite Paris Descartes Faculte de Medecine Site Cochin Parislle-de-FranceFrance Service de Neurologie Hôital Sainte-AnneParisFrance The University of Alabama at Birmingham School of Medicine BirminghamAlabamaUSA School of Public Health University of Alabama at BirminghamBirminghamAlabamaUSA 不详

Objective No systematic review of the literature has dedicated itself to looking at the management of symptomatic carotid stenosis in female *** this scoping review,we aimed to identify all randomised controlled trials(RCTs)that reported sex-specific outcomes for patients who underwent carotid revascularisation,and determine whether sufficient information is reported within these studies to assess short-term and long-term outcomes in female ***,setting and participants We systematically searched Medline,Embase,Pubmed and Cochrane libraries for RCTs published between 1991 and 2020 that included female patients and compared either endarterectomy with stenting,or any revascularisation(endarterectomy or stenting)with medical therapy in patients with symptomatic high-grade(>50%)carotid *** From 1537 references examined,27 eligible studies were ***-specific outcomes were reported in 13 *** patient characteristics of enrolled female patients were reported in 2 of those 13 *** outcomes reported included stroke and death,however,there was significant heterogeneity in the reporting of both periprocedural and long-term ***-specific differences relating to the degree of stenosis and time from index event to treatment are largely limited to studies comparing endarterectomy to medical *** events were not reported by *** Only half of the previously published RCTs and systematic reviews report sex-specific *** analyses on the results of carotid artery intervention for female patients with symptomatic stenosis are limited.

关键词： carotid stenosis finding

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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 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

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Hepatitis B down under:consensus recommendations from the Gastroenterological Society of Australia

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Hepatobiliary Surgery and Nutrition 2023年第5期12卷 768-771页

作者： vignan Manne Kris V.Kowdley Division of Gastroenterology and Hepatology University of NevadaLas Vegas Kirk Kerkorian School of MedicineLas VegasNVUSA Liver Institute Northwest Washington State University SeattleWAUSA

Chronic hepatitis B(CHB)represents a global public burden with an estimated 296 million people infected worldwide(1).It is a leading cause of morbidity and mortality related to chronic liver disease and hepatocellular carcinoma(HCC)(2-5).The prevalence of CHB can range from populations with low prevalence(8%).Current recommendations for screening use a prevalence of over 2%as the cutoff to start screening a population(2-5).Australia has a diverse population in which the prevalence of CHB differs between certain subgroups(6,7).

关键词： Chronic hepatitis B(CHB) guidelines Gastroenterological Society of Australia(GESA)

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Current perspectives into the evaluation and management of hepatitis B: a review

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Hepatobiliary Surgery and Nutrition 2019年第4期8卷 361-369页

作者： vignan Manne Eric Gochanour Kris V. Kowdley Liver Care Network Swedish Medical Center Seattle WA USA

Hepatitis B is a widespread disease which affects millions of people worldwide. Chronic hepatitis B (CHB) can lead to significant morbidity and mortality due to complications such as cirrhosis and hepatocellular carcinoma. The pathophysiology of hepatitis is critical to diagnosing CHB. Deciding which patients with CHB should be treated is an important decision as treatment can often lead to better outcomes in the appropriate patient population. The nucleos(t)ide analog inhibitors entecavir and tenofovir are currently the mainstay of treatment as they are able to successfully suppress the virus and lead to fewer complications. Novel therapies are currently being developed which may offer a potential cure for this disease in the future.

关键词： Chronic hepatitis B (CHB) hepatocellular carcinoma (HCC) tenofovir entecavir

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