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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 Niroshan Siriwardena 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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COVID-19 Vaccine Acceptance and Hesitancy among Pregnant Women: A Knowledge, Attitude, and Perceived Risks Survey in Lusaka, Zambia

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Pharmacology & Pharmacy 2024年第5期15卷 147-166页

作者： Steward Mudenda Ruth Mbewe Manal Hadi Ghaffoori Kanaan Shafiq Mohamed Department of Pharmacy School of Health Sciences University of Zambia Lusaka Zambia Department of Agriculture Technical Institute of Suwaria Middle Technical University Baghdad Iraq Medicines Management and Pharmacy Services St. James University Hospital Leeds Teaching Hospitals NHS Trust Leeds United Kingdom

Introduction: The coronavirus disease 2019 (COVID-19) is an infectious disease of the respiratory tract caused by SARS-CoV-2. Since its emergence, there have been increased rates of transmission and spread, morbidity and mortality which led to the development of COVID-19 vaccines to address the pandemic. This study assessed acceptance, knowledge, attitude, and perceived risks regarding COVID-19 vaccines among pregnant women attending antenatal care at two First-Level Hospitals in Lusaka, Zambia. Materials and Methods: This was a cross-sectional study that was conducted among 241 pregnant women using a questionnaire from August 2023 to October 2023 in two First-Level Hospitals in Lusaka district, Zambia. The collected data were analyzed using IBM Statistical Package for Social Sciences (SPSS) version 22.0. Statistical analysis was performed using a Chi-square test. The statistical significance was set at a 95% confidence level. Results: Of the 241 participants, 107 (42.7%) were aged between 24 and 34 years. Overall, 64.3% accepted the COVID-19 vaccines, of which 122 (50.6%) were already vaccinated. Further, 203 (84.6%) of the pregnant women had good knowledge, and 199 (82.6%) had positive attitudes towards COVID-19 vaccines. However, 58.5% thought COVID-19 vaccines were not safe and could cause infertility. Alongside this, 70.1% thought that COVID-19 vaccines were harmful during pregnancy. Having good knowledge of COVID-19 vaccines was associated with age (p = 0.049), education status (p = 0.001), and employment status (p = 0.001). Having a positive attitude towards COVID-19 vaccines was associated with education status (p = 0.001) and employment status (p = 0.001). Conclusion: This study found that most pregnant women had good knowledge, and positive attitudes, and the majority accepted the COVID-19 vaccine. Encouragingly, most of the pregnant women who accepted the COVID-19 vaccines were already vaccinated. Most pregnant women thought that COVID-19 vaccines had sid

关键词： COVID-19 Vaccines Pregnant Women Vaccine Acceptance Vaccine Hesitancy Zambia

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Management of non-ST-segment elevation myocardial in-farction in patients aged≥80 years:a meta-analysis of ran-domized controlled trials

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Journal of Geriatric Cardiology 2022年第10期19卷 789-790页

作者： Connor J Matthews Joshua Kirby Jonathan M Blaxill John P Greenwood Abdul M Mozid Jennifer A Rossington Murugapathy Veerasamy Nancy Wassef Stephen B Wheatcroft Heerajnarain Bulluck Yorkshire Heart Centre Leeds General InfirmaryLeeds Teaching Hospitals NHS TrustLeedsUnited Kingdom leeds Institute of Cardiovascular and Metabolic Medicine University of LeedsLeedsUnited Kingdom

Coronary artery disease(CAD)is the major cause of morbidity and mortality in elderly patients.^([1])Despite this,elderly patients are under-represented in most trials of ***-ST-segment elevation myocardial infarction(NSTEMI)is a common cause of hospitalization among patients≥80 years of age,^([2])and with an aging global population,there is a pressing need to establish the optimal management strategy for these ***,we conducted a meta-analysis of all randomized control trials(RCTs)performed to date in patients≥80 years of age,comparing an initial invasive versus conservative strategy to provide insights into their optimal initial management strategy.

关键词： patients mortality analysis

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Targeting mechanisms in cognitive training for neurodegenerative diseases

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Neural Regeneration Research 2021年第3期16卷 500-501页

作者： Annalena Venneri Riccardo Manca Linford Fernandes Oliver Bandmann Matteo De Marco Department of Neuroscience University of SheffieldSheffieldUK Department of Neurology Leeds Teaching Hospitals NHS TrustUK

"Cognitive training"(CT)is a label used to describe paper-and-pen or computerized exercises designed to engage a desired set of mental skills for the purpose of enhancing neurocognitive *** the literature on the topic is considerably rich(on PubMed,for the sole 2018,the use of"cognitive training"as title keyword returns 123 results),very few studies pose the fundamental question:“How does CT work?”

关键词： desired considerably cognitive

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Colonic lesion characterization in inflammatory bowel disease:A systematic review and meta-analysis

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World Journal of Gastroenterology 2018年第10期24卷 1167-1180页

作者： Richard Lord Nicholas E Burr Noor Mohammed Venkataraman Subramanian Department of Gastroenterology Leeds Teaching Hospitals NHS TrustLeeds LS97TFUnited Kingdom University of leeds Leeds Institute of Biomedical and Clinical SciencesLeeds LS97TFUnited Kingdom

AIM To perform a systematic review and meta-analysis for the diagnostic accuracy of in vivo lesion characterization in colonic inflammatory bowel disease(IBD), using optical imaging techniques, including virtual chromoendoscopy(VCE), dye-based chromoendoscopy(DBC), magnification endoscopy and confocal laser endomicroscopy(CLE). METHODS We searched Medline, Embase and the Cochrane library. We performed a bivariate meta-analysis to calculate the pooled estimate sensitivities, specificities, positive and negative likelihood ratios(+LHR,-LHR), diagnostic odds ratios(DOR), and area under the SROC curve(AUSROC) for each technology group. A subgroup analysis was performed to investigate differences in real-time nonmagnified Kudo pit patterns(with VCE and DBC) and real-time *** We included 22 studies [1491 patients; 4674 polyps, of which 539(11.5%) were neoplastic]. Real-time CLE had a pooled sensitivity of 91%(95%CI: 66%-98%), specificity of 97%(95%CI: 94%-98%), and an AUSROC of 0.98(95%CI: 0.97-0.99). Magnification endoscopy had a pooled sensitivity of 90%(95%CI: 77%-96%)and specificity of 87%(95%CI: 81%-91%). VCE had a pooled sensitivity of 86%(95%CI: 62%-95%) and specificity of 87%(95%CI: 72%-95%). DBC had a pooled sensitivity of 67%(95%CI: 44%-84%) and specificity of 86%(95%CI: 72%-94%). CONCLUSION Real-time CLE is a highly accurate technology for differentiating neoplastic from non-neoplastic lesions in patients with colonic IBD. However, most CLE studies were performed by single expert users within tertiary centres, potentially confounding these results.

关键词： Inflammatory bowel disease dysplasia Lesion characterization Confocal laser endomicroscopy Narrow band imaging I-scan Fujinon intelligence chromoendoscopy

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Functional gastrointestinal disorders in inflammatory bowel disease: Time for a paradigm shift?

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World Journal of Gastroenterology 2020年第26期26卷 3712-3719页

作者： Dipesh H Vasant Alexander C Ford Gastroenterology Manchester University NHS Foundation TrustWythenshawe HospitalManchester M239LTUnited Kingdom Division of Diabetes Endocrinology and GastroenterologyUniversity of ManchesterManchester M239LTUnited Kingdom leeds Institute of Medical Research at St.James’s University of LeedsLeeds LS97TFUnited Kingdom leeds Gastroenterology Institute Leeds Teaching Hospitals NHS TrustLeeds LS97TFUnited Kingdom

Recent advances in biological therapies have revolutionalised and redefined treatment targets in inflammatory bowel disease(IBD).There is now a stronger emphasis on achieving the more stringent therapeutic goals of mucosal and histological healing,rather than clinical remission ***,the treatment of refractory“functional”gastrointestinal symptoms,often attributed as the aftermath of previous inflammation,has recently become more prominent in quiescent *** further expected advances in anti-inflammatory treatments on the horizon,the burden of such symptoms in quiescent disease,which have been relatively neglected,is set to become an even bigger *** this article,we highlight the current state of research and understanding in this field,including recent developments and clinical practice guidelines on the diagnosis and management of functional gastrointestinal symptoms,such as irritable bowel syndrome and functional anorectal and pelvic floor disorders,in patients with quiescent *** disorders are not only highly prevalent in these patients,they are often misdiagnosed,and are difficult to treat,with very few evidence-based ***,they are associated with substantial impairment in quality-of-life,considerable morbidity,and psychological *** is therefore an urgent need for a change in emphasis towards earlier recognition,positive diagnosis,and targeted treatment for patients with ongoing functional gastrointestinal symptoms in the absence of active *** article also highlights the need for further research to develop much needed evidence-based therapies.

关键词： Irritable bowel syndrome Inflammatory bowel disease Functional gastrointestinal disorders Faecal incontinence Pelvic floor dyssynergia

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A matched-pair analysis of laparoscopic versus open pancreaticoduodenectomy: oncological outcomes using leeds Pathology Protocol

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Hepatobiliary & Pancreatic Diseases International 2014年第4期13卷 435-441页

作者： Abdul R Hakeem Caroline S Verbeke Alison Cairns Amer Aldouri Andrew M Smith Krishna V Menon Department of HPB and Transplant Surgery St James's University Hospital NHS TrustLeeds Teaching Hospitals Beckett street Leeds LS9 7TF United Kingdom Division of Pathology Department of Laboratory Medicine Karolinska Institutet Stockholm Sweden Department of Histopathology St James's University Hospital NHS TrustLeeds Teaching Hospitals Beckett street Leeds LS9 7TF United Kingdom

BACKGROUND： Laparoscopic pancreaticoduodenectomy（LPD）is a safe procedure. Oncological safety of LPD is still a matter for debate. This study aimed to compare the oncological outcomes,in terms of adequacy of resection and recurrence rate following LPD and open pancreaticoduodenectomy（OPD）.METHODS： Between November 2005 and April 2009, 12LPDs（9 ampullary and 3 distal common bile duct tumors）were performed. A cohort of 12 OPDs were matched for age,gender, body mass index（BMI） and American Society of Anesthesiologists（ASA） score and tumor ***： Mean tumor size LPD vs OPD（19.8 vs 19.2 mm,P=0.870）. R0 resection was achieved in 9 LPD vs 8 OPD（P=1.000）. The mean number of metastatic lymph nodes and total number resected for LPD vs OPD were 1.1 vs 2.1（P=0.140）and 20.7 vs 18.5（P=0.534） respectively. Clavien complications grade I/II（5 vs 8）, III/IV（2 vs 6） and pancreatic leak（2 vs 1）were statistically not significant（LPD vs OPD）. The mean high dependency unit（HDU） stay was longer in OPD（3.7 vs 1.4 days,P〈0.001）. There were 2 recurrences each in LPD and OPD（logrank,P=0.983）. Overall mortality for LPD vs OPD was 3 vs 6（log-rank, P=0.283） and recurrence-related mortality was 2 vs *** was one death within 30 days in the OPD group secondary to severe sepsis and none in the LPD ***： Compared to open procedure, LPD achieved a similar rate of R0 resection, lymph node harvest and longterm recurrence for tumors less than 2 cm. Though technically challenging, LPD is safe and does not compromise oncological outcome.

关键词： pancreaticoduodenectomy minimally invasive laparoscopic open oncological outcomes resection margins pathology

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Accuracy between clinical and radiological diagnoses compared to surgical orbital biopsies

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International Journal of Ophthalmology(English edition) 2023年第4期16卷 616-622页

作者： Audrey Tang Helen Hoi-Lam Ng Taras Gout Bernard Chang Nabil El-Hindy George Kalantzis School of Medicine Faculty of Medicine and HealthUniversity of LeedsLeedsLS2.9 JTUnited Kingdom Department of Ophthalmology St.James’s University HospitalLeeds Teaching Hospitals NHS TrustBeckett StreetLeedsLS97TFUnited Kingdom

AIM:To assess the concordance between diagnosing orbital lesions by clinical examination,orbital imaging,and histological evaluation,in order to help guide future research and clinical ***:A retrospective analysis was undertaken at a large regional tertiary referral centre of all surgical orbital biopsies performed over a 5-year period,from 1st January 2015 until 31st December *** and concordance between clinical,radiological and histological diagnoses are reported as percentage sensitivity and positive predictive ***:A total of 128 operations involving 111 patients were ***,sensitivities of 47.7%for clinical and 37.3%for radiological diagnoses were found when compared to the histological gold *** lesions that have characteristic clinical and radiological features had the highest sensitivity at 71.4%and 57.1%,*** conditions showed the lowest sensitivity in both clinical(30.3%)and radiological(18.2%)*** PPV for inflammatory conditions were 47.6%for clinical and 30.0%for radiological ***:Accurate diagnoses are difficult to reach by relying on clinical examination and imaging *** orbital biopsy with histological diagnosis should remain the gold standard approach for definitively identifying orbital *** larger scale prospective studies would help further refine concordance and guide future research avenues.

关键词： orbital biopsy orbital lesion histological diagnosis radiological diagnosis clinical diagnosis

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Acute coronary syndromes： an old age problem

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Journal of Geriatric Cardiology 2012年第2期9卷 192-196页

作者： Alexander D Simms Philip D Batin John Kurian Nigel Durham Christopher P Gale Centre for Epidemiology and Biostatistics Level 8 Worsley Building University of Leeds Clarendon Way West Yorkshire Leeds LS2 9JT UK Hull and York Medical School York Teaching Hospital NHS Foundation Trust York Y031 8HE UK Department of Cardiology York Teaching Hospital NHS Foundation Trust York Y031 8HE UK Department of Cardiology Mid Yorkshire NHS Trust Wakefield WF1 4DG UK Department of Cardiology Bradford Teaching Hospital NHS Foundation Trust Bradford UK

The increasing population in older age will lead to greater numbers of them presenting with acute coronary syndromes （ACS）. This has implications on global healthcare resources and necessitates better management and selection for evidenced-based therapies. The elderly are a high risk group with more significant treatment benefits than younger ACS. Nevertheless, age related inequalities in ACS care are recognised and persist. This discrepancy in care, to some extent, is explained by the higher frequency of atypical and delayed presentations in the elderly, and less diagnostic electrocardiograms at presentation, potentiating a delay in ACS diagnosis. Under estimation of mortality risk in the elderly due to limited consideration for physiological tiailty, co-morbidity, cognitive/psychological impairment and physical disability, less input by cardiology specialists and lack of randomised, controlled trials data to guide management in the elderly may further confound the inequality of care. While these inequalities exist, there remains a substantial opportunity to improve age related ACS outcomes. The selection of elderly patients for specific therapies and medication regimens are unanswered. There is a growing need for randomised, controlled trial data to be more representative of the population and enroll those of advanced age with co-morbidity. A lack of reporting of adverse events, such as renal impairment post coronary angiography, in the elderly further limit risk benefit decisions. Substantial improvements in care of elderly ACS patients are required and should be advocated. Ultimately, these improvements are likely to lead to better outcomes post ACS. However, the improvement in outcome is not infinite and will be limited by non-modifiable factors of age-related risk.

关键词： Acute coronary syndromes Elderly patients Inequalities of care Evidenced-based treatments

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Clinical relevance of endoscopic assessment of inflammation in ulcerative colitis: Can endoscopic evaluation predict outcomes?

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World Journal of Gastroenterology 2016年第42期22卷 9324-9332页

作者： Noor Mohammed Venkataraman Subramanian leeds Institute of Biomedical and Clinical Sciences St James University Hospital University of Leeds Leeds LS2 9JT United Kingdom Department of Gastroenterology Centre for Digestive Diseases St James University Hospital Leeds Teaching Hospital NHS Trust Leeds LS9 7TF United Kingdom

Ulcerative colitis(UC) is a chronic inflammatory bowel condition characterised by a relapsing and remitting course. Symptom control has been the traditional mainstay of medical treatment. It is well known that histological inflammatory activity persists despite adequate symptom control and absence of endoscopic inflammation. Current evidence suggests that presence of histological inflammation poses a greater risk of disease relapse and subsequent colorectal cancer risk. New endoscopic technologies hold promise for developing endoscopic markers of mucosal inflammation. Achieving endoscopic and histological remission appears be the future aim of medical treatments for UC. This review article aims to evaluate the use of endoscopy as a tool in assessment of mucosal inflammation UC and its correlation with disease outcomes.

关键词： Ulcerative colitis Inflammation Endoscopy Disease activity indices Mucosal healing

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