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  • 1
    Online Resource
    Online Resource
    Intensive vs Conventional Blood Pressure Lowering After Endovascular Thrombectomy in Acute Ischemic Stroke : The OPTIMAL-BP Randomized Clinical Trial
    American Medical Association (AMA) ; 2023
    In:  JAMA Vol. 330, No. 9 ( 2023-09-05), p. 832-
    Details
    In: JAMA, American Medical Association (AMA), Vol. 330, No. 9 ( 2023-09-05), p. 832-
    Abstract: Optimal blood pressure (BP) control after successful reperfusion with endovascular thrombectomy (EVT) for patients with acute ischemic stroke is unclear. Objective To determine whether intensive BP management during the first 24 hours after successful reperfusion leads to better clinical outcomes than conventional BP management in patients who underwent EVT. Design, Setting, and Participants Multicenter, randomized, open-label trial with a blinded end-point evaluation, conducted across 19 stroke centers in South Korea from June 2020 to November 2022 (final follow-up, March 8, 2023). It included 306 patients with large vessel occlusion acute ischemic stroke treated with EVT and with a modified Thrombolysis in Cerebral Infarction score of 2b or greater (partial or complete reperfusion). Interventions Participants were randomly assigned to receive intensive BP management (systolic BP target & amp;lt;140 mm Hg; n = 155) or conventional management (systolic BP target 140-180 mm Hg; n = 150) for 24 hours after enrollment. Main Outcomes and Measures The primary outcome was functional independence at 3 months (modified Rankin Scale score of 0-2). The primary safety outcomes were symptomatic intracerebral hemorrhage within 36 hours and death related to the index stroke within 3 months. Results The trial was terminated early based on the recommendation of the data and safety monitoring board, which noted safety concerns. Among 306 randomized patients, 305 were confirmed eligible and 302 (99.0%) completed the trial (mean age, 73.0 years; 122 women [40.4%]). The intensive management group had a lower proportion achieving functional independence (39.4%) than the conventional management group (54.4%), with a significant risk difference (−15.1% [95% CI, −26.2% to −3.9%] ) and adjusted odds ratio (0.56 [95% CI, 0.33-0.96]; P  = .03). Rates of symptomatic intracerebral hemorrhage were 9.0% in the intensive group and 8.1% in the conventional group (risk difference, 1.0% [95% CI, −5.3% to 7.3%]; adjusted odds ratio, 1.10 [95% CI, 0.48-2.53] ; P  = .82). Death related to the index stroke within 3 months occurred in 7.7% of the intensive group and 5.4% of the conventional group (risk difference, 2.3% [95% CI, −3.3% to 7.9%]; adjusted odds ratio, 1.73 [95% CI, 0.61-4.92] ; P  = .31). Conclusions and Relevance Among patients who achieved successful reperfusion with EVT for acute ischemic stroke with large vessel occlusion, intensive BP management for 24 hours led to a lower likelihood of functional independence at 3 months compared with conventional BP management. These results suggest that intensive BP management should be avoided after successful EVT in acute ischemic stroke. Trial Registration ClinicalTrials.gov Identifier: NCT04205305
    Type of Medium: Online Resource
    ISSN: 0098-7484
    URL: Article
    DOI: 10.1001/jama.2023.14590
    RVK:
    XA 10000
    Language: English
    Publisher: American Medical Association (AMA)
    Publication Date: 2023
    detail.hit.zdb_id: 2958-0
    detail.hit.zdb_id: 2018410-4
    SSG: 5,21
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  • 2
    Online Resource
    Online Resource
    Can Patient Triaging with Clinical Scoring Systems Reduce CT Use in Adolescents and Young Adults Suspected of Having Appendicitis?
    Radiological Society of North America (RSNA) ; 2021
    In:  Radiology Vol. 300, No. 2 ( 2021-08), p. 350-358
    Details
    In: Radiology, Radiological Society of North America (RSNA), Vol. 300, No. 2 ( 2021-08), p. 350-358
    Type of Medium: Online Resource
    ISSN: 0033-8419 , 1527-1315
    URL: Article
    DOI: 10.1148/radiol.2021203884
    RVK:
    XA 10000
    Language: English
    Publisher: Radiological Society of North America (RSNA)
    Publication Date: 2021
    detail.hit.zdb_id: 80324-8
    detail.hit.zdb_id: 2010588-5
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  • 3
    Online Resource
    Online Resource
    Immediate and Long-Term Outcomes of Reperfusion Therapy in Patients With Cancer
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Stroke Vol. 52, No. 6 ( 2021-06), p. 2026-2034
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 52, No. 6 ( 2021-06), p. 2026-2034
    Abstract: Patients with acute stroke are often accompanied by comorbidities, such as active cancer. However, adequate treatment guidelines are not available for these patients. The purpose of this study was to evaluate the association between cancer and the outcomes of reperfusion therapy in patients with stroke. Methods: We compared treatment outcomes in patients who underwent reperfusion therapy, using a nationwide reperfusion therapy registry. We divided the patients into 3 groups according to cancer activity: active cancer, nonactive cancer, and without a history of cancer. We investigated reperfusion processes, 24-hour neurological improvement, adverse events, 3-month functional outcome, and 6-month survival and related factors after reperfusion therapy. Results: Among 1338 patients who underwent reperfusion therapy, 62 patients (4.6%) had active cancer, 78 patients (5.8%) had nonactive cancer, and 1198 patients (89.5%) had no history of cancer. Of the enrolled patients, 969 patients received intravenous thrombolysis and 685 patients underwent endovascular treatment (316 patients received combined therapy). Patients with active cancer had more comorbidities and experienced more severe strokes; however, they showed similar 24-hour neurological improvement and adverse events, including cerebral hemorrhage, compared with the other groups. Although the functional outcome at 3 months was poorer than the other groups, 36.4% of patients with active cancer showed functional independence. Additionally, 52.9% of the patients with determined stroke etiology showed functional independence despite active cancer. During the 6-month follow-up, 46.6% of patients with active cancer died, and active cancer was independently associated with poor survival (hazard ratio, 3.973 [95% CI, 2.528–6.245]). Conclusions: In patients with active cancer, reperfusion therapy showed similar adverse events and short-term outcomes to that of other groups. While long-term prognosis was worse in the active cancer group than the nonactive cancer groups, not negligible number of patients had good functional outcomes, especially those with determined stroke mechanisms.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.120.032380
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 1467823-8
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  • 4
    Online Resource
    Online Resource
    Comparison of Microscopy, Nested-PCR, and Real-Time-PCR Assays Using High-Throughput Screening of Pooled Samples for Diagnosis of Malaria in Asymptomatic Carriers from Areas of Endemicity in Myanmar
    American Society for Microbiology ; 2014
    In:  Journal of Clinical Microbiology Vol. 52, No. 6 ( 2014-06), p. 1838-1845
    Details
    In: Journal of Clinical Microbiology, American Society for Microbiology, Vol. 52, No. 6 ( 2014-06), p. 1838-1845
    Abstract: Asymptomatic infection is an important obstacle for controlling disease in countries where malaria is endemic. Because asymptomatic carriers do not seek treatment for their infections, they can have high levels of gametocytes and constitute a reservoir available for new infection. We employed a sample pooling/PCR-based molecular detection strategy for screening malaria infection in residents from areas of Myanmar where malaria is endemic. Blood samples ( n = 1,552) were collected from residents in three areas of malaria endemicity (Kayin State, Bago, and Tanintharyi regions) of Myanmar. Two nested PCR and real-time PCR assays showed that asymptomatic infection was detected in about 1.0% to 9.4% of residents from the surveyed areas. The sensitivities of the two nested PCR and real-time PCR techniques were higher than that of microscopy examination (sensitivity, 100% versus 26.4%; kappa values, 0.2 to 0.5). Among the three regions, parasite-positive samples were highly detected in subjects from the Bago and Tanintharyi regions. Active surveillance of residents from regions of intense malaria transmission would reduce the risk of morbidity and mitigate transmission to the population in these areas of endemicity. Our data demonstrate that PCR-based molecular techniques are more efficient than microscopy for nationwide surveillance of malaria in countries where malaria is endemic.
    Type of Medium: Online Resource
    ISSN: 0095-1137 , 1098-660X
    URL: Article
    DOI: 10.1128/JCM.03615-13
    RVK:
    XA 10000
    Language: English
    Publisher: American Society for Microbiology
    Publication Date: 2014
    detail.hit.zdb_id: 1498353-9
    SSG: 12
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  • 5
    Online Resource
    Online Resource
    Impact of Renal Function on Short-Term Outcome After Reperfusion Therapy in Patients With Ischemic Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Stroke Vol. 53, No. 12 ( 2022-12), p. 3622-3632
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 53, No. 12 ( 2022-12), p. 3622-3632
    Abstract: A high and low estimated glomerular filtration rate (eGFR) could affect outcomes after reperfusion therapy for ischemic stroke. This study aimed to determine whether renal function based on eGFR affects mortality risk in patients with ischemic stroke within 6 months following reperfusion therapy. Methods: This prospective registry–based cohort study included 2266 patients who received reperfusion therapy between January 2000 and September 2019 and were registered in the SECRET (Selection Criteria in Endovascular Thrombectomy and Thrombolytic Therapy) study or the Yonsei Stroke Cohort. A high and low eGFR were based on the Chronic Kidney Disease Epidemiology Collaboration equation and defined, respectively, as the 5th and 95th percentiles of age- and sex-specific eGFR. Occurrence of death within 6 months was compared among the groups according to their eGFR such as low, normal, or high eGFR. Results: Of the 2266 patients, 2051 (90.5%) had a normal eGFR, 110 (4.9%) a low eGFR, and 105 (4.6%) a high eGFR. Patients with high eGFR were younger or less likely to have hypertension, diabetes, or atrial fibrillation than the other groups. Active cancer was more prevalent in the high-eGFR group. During the 6-month follow-up, there were 24 deaths (22.9%) in the high-eGFR group, 37 (33.6%) in the low-eGFR group, and 237 (11.6%) in the normal-eGFR group. After adjusting for variables with P 〈 0.10 in the univariable analysis, 6-month mortality was independently associated with high eGFR (hazard ratio, 2.22 [95% CI, 1.36–3.62]; P =0.001) and low eGFR (HR, 2.29 [95% CI, 1.41–3.72]; P =0.001). These associations persisted regardless of treatment modality or various baseline characteristics. Conclusions: High eGFR as well as low eGFR were independently associated with 6-month mortality after reperfusion therapy. Kidney function could be considered a prognostic factor in patients with ischemic stroke after reperfusion therapy.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.122.039129
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 1467823-8
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  • 6
    Online Resource
    Online Resource
    Abstract 167: Roles of adipocytes and M2-macrophages in high-fat diet-stimulated lymph node metastasis of B16F10 melanoma
    American Association for Cancer Research (AACR) ; 2014
    In:  Cancer Research Vol. 74, No. 19_Supplement ( 2014-10-01), p. 167-167
    Details
    In: Cancer Research, American Association for Cancer Research (AACR), Vol. 74, No. 19_Supplement ( 2014-10-01), p. 167-167
    Abstract: The tumor microenvironment consists of a number of distinct cell types including tumor cells, fibroblasts, endothelial cells, immune cells, and adipocytes, and produces a wide variety of factors, which contribute to tumor progression. We previously observed that high-fat diet (HFD) feeding stimulates solid tumor growth and lymph node (LN) metastasis in mice subcutaneously injected with B16F10 melanoma cells. We also observed that HFD feeding increases the number of lipid vacuoles and M2-macrophage (M2-Mϕ)s as well as the expression of various cytokines/growth factors in tumor tissues. In the present study, we noted that HFD increased the expression of CCR7 in the tumor. The concentrations of CCL19 and CCL21, the CCR7 ligands, were significantly higher in the LN than those in tumor, and HFD feeding increased the concentrations of these ligands in the LN with negligible changes in the tumor tissue creating higher concentration gradients of these two ligands between the LN and tumor. In order to explore the interactions between tumor cells, adipocytes, lymphatic endothelial cell (LEC)s, and/or M2-Mϕs, we established in vitro co-culture models involving 3 distinct cell types. The mRNA levels of cytokines and growth factors were increased in B16F10 cells and M2-Mϕs when B16F10 cells, M2-Mϕs, and/or mature adipocyte (MA)s were co-cultured in a transwell system. Among these cytokines/growth factors, the mRNA levels of MCP-1 were synergistically increased in B16F10 cells when co-cultured with M2-Mϕs and MAs. The migration of monocytes was tremendously elevated when media conditioned by B16F10 cells/M2-Mϕs/MAs co-cultures was used as a chemoattractant. Furthermore, MAs increased the expression of CCR7 mRNA in B16F10 cells and the expression of CCL19 and CCL21 mRNAs in LECs. These results indicate that in HFD-fed mice, adipocytes induce MCP-1 expression and monocyte infiltration which play important roles in solid tumor growth and LN metastasis. Additionally, adipocyte-stimulated activation of CCL19, CCL21/CCR7 axis in lymphatic endothelial cells and tumor cells helps tumor cells to enter the lymphatic vessels and increased ligand concentration gradients between the LN and tumor facilitate tumor cell migration to the LN. Citation Format: Han Jin Cho, Jae In Jung, Yoo Jin Jung, Ki Won Lee, Mi-Kyung Sung, Jung Han Yoon Park. Roles of adipocytes and M2-macrophages in high-fat diet-stimulated lymph node metastasis of B16F10 melanoma. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 167. doi:10.1158/1538-7445.AM2014-167
    Type of Medium: Online Resource
    ISSN: 0008-5472 , 1538-7445
    URL: Article
    DOI: 10.1158/1538-7445.AM2014-167
    RVK:
    XA 36000
    RVK:
    XA 10000
    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2014
    detail.hit.zdb_id: 2036785-5
    detail.hit.zdb_id: 1432-1
    detail.hit.zdb_id: 410466-3
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  • 7
    Online Resource
    Online Resource
    High-fat diet-induced obesity increases lymphangiogenesis and lymph node metastasis in the B16F10 melanoma allograft model: Roles of adipocytes and M2-macrophages : High-fat diet, lymphangiogenesis and lymph node metastasis
    Wiley ; 2015
    In:  International Journal of Cancer Vol. 136, No. 2 ( 2015-01-15), p. 258-270
    Details
    In: International Journal of Cancer, Wiley, Vol. 136, No. 2 ( 2015-01-15), p. 258-270
    Type of Medium: Online Resource
    ISSN: 0020-7136
    URL: Article
    DOI: 10.1002/ijc.28983
    RVK:
    XA 10000
    Language: English
    Publisher: Wiley
    Publication Date: 2015
    detail.hit.zdb_id: 218257-9
    detail.hit.zdb_id: 1474822-8
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  • 8
    Online Resource
    Online Resource
    Abstract WP393: The Impact of Prior Antithrombotics on Stroke Severity in Patients With Nonvalvular Atrial Fibrillation
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Stroke Vol. 49, No. Suppl_1 ( 2018-01-22)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 49, No. Suppl_1 ( 2018-01-22)
    Abstract: Background and purpose: In this study, we investigated the stroke severity was associated with the prior antithrombotic medication including novel Vitamin K antagonist oral anticoagulants (NOACs) in patients with nonvalvular atrial fibrillation (NVAF). Methods: We included 801 consecutive acute ischemic stroke or transient ischemic attack patients with NVAF who were admitted to 6 hospitals between August 2013 and January 2017 in the present study. Stroke severity was assessed using the National Institute of Health Stroke Scale (NIHSS). Prior antithrombotics before index stroke were categorized into 5 groups: no antithrombotics, only antiplatelet, warfarin with international normalized ratio (INR) 〈 2, warfarin with INR ≥2, and NOACs. We investigated whether there were differences in initial stroke severity according to the prior antithrombotics in stroke patients with NVAF. Results: A total of 801 acute ischemic stroke or transient ischemic stroke patients with NVAF were enrolled. Among the 801 patients, the 34 (4.2%) had been treated with warfarin with INR ≥2, 146 (18.2%) with warfarin with INR ≥2, 70 (8.7%) with NOACs, 347 (43.3%) with only antiplatelet, and 204 (25.5%) without any antithrombotics. The median NIHSS score was 5 (IQR 1-14). Compared with the no antithrombotics group (9.5, IQR 2-16), the NIHSS was lower in the warfarin with INR ≥2 (4, 1-7.3) and the only antiplatelet group (4, IQR 1-12), while the warfarin with INR 〈 2 (6, IQR 2-14) or the NOACs group (4, IQR 1-15) had similar stroke severity. Multivariate analysis adjusting the CHA2DS2-VASc score showed stroke severity was milder in patients with warfarin with INR ≥2 (b -4.680, SE 1.399, p=0.001), those with antiplatelet only (b -2.528, SE 0.667, p 〈 0.001), or those with NOACs (b -2.290, SE 1.049, p=0.029), compared with those without any antithrombotics. Conclusions: Our data indicate that the prior anticoagulation was related with milder initial stroke severity in patients with NVAF.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.49.suppl_1.WP393
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 1467823-8
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  • 9
    Online Resource
    Online Resource
    Abstract T MP88: Computerized In-hospital Alert System Reduces Time Delay to Reperfusion Therapy for In-hospital Stroke Patients
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Stroke Vol. 46, No. suppl_1 ( 2015-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 46, No. suppl_1 ( 2015-02)
    Abstract: Introduction: Stroke may occur while patients are being admitted (in-hospital stroke [IHS]). Although patients with IHS are potentially good candidates for fast reperfusion therapy, many patients are often not treated rapidly as are expected. Hypothesis: A code stroke program using computerized physician order entry (CPOE) will be effective in reducing time delay to reperfusion therapy in patients with IHS. Methods: We developed a code stroke program for IHS, based on CPOE. The program included protocols for stroke recognition, activation and notification, imaging, preparation of tissue-type plasminogen activator (tPA), and regular education of medical staffs. We implemented this program for cardiology and cardiovascular surgery wards because in our previous study, about one-half of all IHS occurred in them. We compared time intervals from symptom onset to evaluations and reperfusion treatment before and after the program implementation in patients with IHS that developed inside or outside the program. Results: The program launched at November 2008. All consecutive patients who received reperfusion therapy due to IHS that developed outside the neurology department from July 2002 to June 2014 were included for this study. Among total 59 IHS patients enrolled, 20 patients were treated before and 39 patients after implementation of the program (24 patients inside the program [cardiology/cardiovascular surgery wards], 15 patients outside the program). In cases treated inside the program, time intervals from symptom onset to brain image (98.5 min vs 37 min; P 〈 0.001), symptom recognition to neurology notification (29.5 min vs 15 min; P=0.008), and symptom onset to IV tPA (130 min vs 65 min; P 〈 0.001) or to arterial puncture (270 min vs 165 min; P 〈 0.001) were reduced significantly after the program implementation. However, in cases treated outside the program. time intervals from symptom onset to evaluation, notification, and IV tPA, except symptom onset to arterial puncture (270 vs 207.5 min, P=0.025), were not reduced. Conclusions: The computerized in-hospital alert system, which was developed for IHS, was effective to reduce time delay to evaluation and reperfusion treatment. More widespread implementation of the program for patients with IHS is warranted.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.46.suppl_1.tmp88
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
    detail.hit.zdb_id: 1467823-8
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  • 10
    Online Resource
    Online Resource
    Modern Outcome and Risk Analysis of Surgically Resected Occult N2 Non-Small Cell Lung Cancer
    Elsevier BV ; 2014
    In:  The Annals of Thoracic Surgery Vol. 97, No. 6 ( 2014-06), p. 1920-1925
    Details
    In: The Annals of Thoracic Surgery, Elsevier BV, Vol. 97, No. 6 ( 2014-06), p. 1920-1925
    Type of Medium: Online Resource
    ISSN: 0003-4975
    URL: Article
    DOI: 10.1016/j.athoracsur.2014.03.004
    RVK:
    XA 23980
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2014
    detail.hit.zdb_id: 1499869-5
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