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  • 1
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    Effect of SGLT2 Inhibitors on Stroke and Atrial Fibrillation in Diabetic Kidney Disease : Results From the CREDENCE Trial and Meta-Analysis
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Stroke Vol. 52, No. 5 ( 2021-05), p. 1545-1556
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 52, No. 5 ( 2021-05), p. 1545-1556
    Abstract: Chronic kidney disease with reduced estimated glomerular filtration rate or elevated albuminuria increases risk for ischemic and hemorrhagic stroke. This study assessed the effects of sodium glucose cotransporter 2 inhibitors (SGLT2i) on stroke and atrial fibrillation/flutter (AF/AFL) from CREDENCE (Canagliflozin and Renal Events in Diabetes With Established Nephropathy Clinical Evaluation) and a meta-analysis of large cardiovascular outcome trials (CVOTs) of SGLT2i in type 2 diabetes mellitus. Methods: CREDENCE randomized 4401 participants with type 2 diabetes mellitus and chronic kidney disease to canagliflozin or placebo. Post hoc, we estimated effects on fatal or nonfatal stroke, stroke subtypes, and intermediate markers of stroke risk including AF/AFL. Stroke and AF/AFL data from 3 other completed large CVOTs and CREDENCE were pooled using random-effects meta-analysis. Results: In CREDENCE, 142 participants experienced a stroke during follow-up (10.9/1000 patient-years with canagliflozin, 14.2/1000 patient-years with placebo; hazard ratio [HR], 0.77 [95% CI, 0.55–1.08] ). Effects by stroke subtypes were: ischemic (HR, 0.88 [95% CI, 0.61–1.28]; n=111), hemorrhagic (HR, 0.50 [95% CI, 0.19–1.32] ; n=18), and undetermined (HR, 0.54 [95% CI, 0.20–1.46]; n=17). There was no clear effect on AF/AFL (HR, 0.76 [95% CI, 0.53–1.10] ; n=115). The overall effects in the 4 CVOTs combined were: total stroke (HR pooled , 0.96 [95% CI, 0.82–1.12]), ischemic stroke (HR pooled , 1.01 [95% CI, 0.89–1.14]), hemorrhagic stroke (HR pooled , 0.50 [95% CI, 0.30–0.83]), undetermined stroke (HR pooled , 0.86 [95% CI, 0.49–1.51]), and AF/AFL (HR pooled , 0.81 [95% CI, 0.71–0.93]). There was evidence that SGLT2i effects on total stroke varied by baseline estimated glomerular filtration rate ( P =0.01), with protection in the lowest estimated glomerular filtration rate ( 〈 45 mL/min/1.73 m 2 ]) subgroup (HR pooled , 0.50 [95% CI, 0.31–0.79]). Conclusions: Although we found no clear effect of SGLT2i on total stroke in CREDENCE or across trials combined, there was some evidence of benefit in preventing hemorrhagic stroke and AF/AFL, as well as total stroke for those with lowest estimated glomerular filtration rate. Future research should focus on confirming these data and exploring potential mechanisms. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02065791.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.120.031623
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 1467823-8
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  • 2
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    Factors Affecting Eye Care–Seeking Behavior of Parents for Their Children
    Ovid Technologies (Wolters Kluwer Health) ; 2013
    In:  Optometry and Vision Science Vol. 90, No. 10 ( 2013-10), p. 1138-1142
    Details
    In: Optometry and Vision Science, Ovid Technologies (Wolters Kluwer Health), Vol. 90, No. 10 ( 2013-10), p. 1138-1142
    Type of Medium: Online Resource
    ISSN: 1040-5488
    URL: Article
    DOI: 10.1097/OPX.0000000000000010
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
    detail.hit.zdb_id: 2083924-8
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  • 3
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    Hyperbaric oxygen therapy in inflammatory bowel disease: a systematic review and meta-analysis
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  European Journal of Gastroenterology & Hepatology Vol. 33, No. 1S ( 2021-12), p. e564-e573
    Details
    In: European Journal of Gastroenterology & Hepatology, Ovid Technologies (Wolters Kluwer Health), Vol. 33, No. 1S ( 2021-12), p. e564-e573
    Abstract: Translational data suggest a potential role of hyperbaric oxygen therapy (HBOT) in a subset of patients with inflammatory bowel disease (IBD). We performed a systematic review and meta-analysis for the efficacy and safety of HBOT in IBD. Methods We searched Pubmed, Embase and CENTRAL to identify studies reporting the efficacy of HBOT in ulcerative colitis or Crohn’s disease. We pooled the response rates for HBOT in ulcerative colitis and Crohn’s disease separately. Results A total 18 studies were included in the systematic review and 16 in the analysis. The overall response rate of HBOT in ulcerative colitis was 83.24% (95% confidence interval: 61.90–93.82), while the response in Crohn’s disease was 81.89 (76.72–86.11). The results of randomized trials for HBOT as adjuvant therapy in ulcerative colitis were conflicting. The complete healing of fistula in fistulizing Crohn’s disease was noted 47.64% (22.05–74.54), while partial healing was noted in 34.29% (17.33–56.50%). Most of the adverse events were minor. Conclusion Observational studies suggest benefit of use of HBOT in ulcerative colitis flares and Crohn’s disease. However, adequately powered randomized trials are needed to draw a definite conclusion.
    Type of Medium: Online Resource
    ISSN: 0954-691X
    URL: Article
    DOI: 10.1097/MEG.0000000000002164
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 2030291-5
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  • 4
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    Safety and Outcome of Revascularization Treatment in Patients With Acute Ischemic Stroke and COVID-19 : The Global COVID-19 Stroke Registry
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Neurology Vol. 100, No. 7 ( 2023-02-14), p. e739-e750
    Details
    In: Neurology, Ovid Technologies (Wolters Kluwer Health), Vol. 100, No. 7 ( 2023-02-14), p. e739-e750
    Abstract: COVID-19–related inflammation, endothelial dysfunction, and coagulopathy may increase the bleeding risk and lower the efficacy of revascularization treatments in patients with acute ischemic stroke (AIS). We aimed to evaluate the safety and outcomes of revascularization treatments in patients with AIS and COVID-19. Methods This was a retrospective multicenter cohort study of consecutive patients with AIS receiving intravenous thrombolysis (IVT) and/or endovascular treatment (EVT) between March 2020 and June 2021 tested for severe acute respiratory syndrome coronavirus 2 infection. With a doubly robust model combining propensity score weighting and multivariate regression, we studied the association of COVID-19 with intracranial bleeding complications and clinical outcomes. Subgroup analyses were performed according to treatment groups (IVT-only and EVT). Results Of a total of 15,128 included patients from 105 centers, 853 (5.6%) were diagnosed with COVID-19; of those, 5,848 (38.7%) patients received IVT-only and 9,280 (61.3%) EVT (with or without IVT). Patients with COVID-19 had a higher rate of symptomatic intracerebral hemorrhage (SICH) (adjusted OR 1.53; 95% CI 1.16–2.01), symptomatic subarachnoid hemorrhage (SSAH) (OR 1.80; 95% CI 1.20–2.69), SICH and/or SSAH combined (OR 1.56; 95% CI 1.23–1.99), 24-hour mortality (OR 2.47; 95% CI 1.58–3.86), and 3-month mortality (OR 1.88; 95% CI 1.52–2.33). Patients with COVID-19 also had an unfavorable shift in the distribution of the modified Rankin score at 3 months (OR 1.42; 95% CI 1.26–1.60). Discussion Patients with AIS and COVID-19 showed higher rates of intracranial bleeding complications and worse clinical outcomes after revascularization treatments than contemporaneous non–COVID-19 patients receiving treatment. Current available data do not allow direct conclusions to be drawn on the effectiveness of revascularization treatments in patients with COVID-19 or to establish different treatment recommendations in this subgroup of patients with ischemic stroke. Our findings can be taken into consideration for treatment decisions, patient monitoring, and establishing prognosis. Trial Registration Information The study was registered under ClinicalTrials.gov identifier NCT04895462.
    Type of Medium: Online Resource
    ISSN: 0028-3878 , 1526-632X
    URL: Article
    DOI: 10.1212/WNL.0000000000201537
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
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  • 5
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    Students' participation in collaborative research should be recognised
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  International Journal of Surgery Vol. 39 ( 2017-03), p. 234-237
    Details
    In: International Journal of Surgery, Ovid Technologies (Wolters Kluwer Health), Vol. 39 ( 2017-03), p. 234-237
    Type of Medium: Online Resource
    ISSN: 1743-9191
    URL: Article
    DOI: 10.1016/j.ijsu.2017.01.114
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 2201966-2
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  • 6
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    Comparing the Safety and Efficacy of Two Commercially Available Single-Use Duodenoscopes : A Multicenter Study
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Journal of Clinical Gastroenterology Vol. 57, No. 8 ( 2022-08-24), p. 798-803
    Details
    In: Journal of Clinical Gastroenterology, Ovid Technologies (Wolters Kluwer Health), Vol. 57, No. 8 ( 2022-08-24), p. 798-803
    Abstract: Single-use disposable duodenoscopes (SDD) have been developed to mitigate infectious risks related to reusable duodenoscopes. The aim of this study is to compare the safety and efficacy of the two available SDDs in the United States. Methods: We conducted a comparative study of 2 SDD in consecutive ERCP procedures performed by expert endoscopists from 9 academic centers. Performance ratings, procedure details, and adverse events were collected. Results: A total of 201 patients were included: 129 patients underwent ERCP with Exalt (mean age 63, Males- 66 (51%), 72 with aScope Duodeno (mean age 65, males=30 (42%). A majority of endoscopists had performed 〉 2000 ERCPs in both groups (71% Exalt, 93% aScope Duodeno). Technical success was 92% in both groups (n=119 Exalt-group, n=66 aScope-Duodeno-group). The procedural complexity for the ERCP cases performed were: Grade 1: 35 cases (18%), Grade 2: 83 cases (41%), Grade 3: 65 cases (32%), and Grade 4: 18 cases (9%). Thirteen patients (10%) from the Exalt group and 16 patients (22%) from the aScope Duodeno group required conversion to a reusable duodenoscope. On a scale of 1 to 5, Exalt and aScope Duodeno, respectively, were rated: 2.31 versus 2.60 for location and visualization quality, 1.38 versus 1.57 for maneuverability based on papillary orientation, 1.48 versus 1.15 for suction/air control, and 2.31 versus 2.34 for elevator efficiency. None of the adverse events were related to the SDDs. Conclusions: The 2 SDDs were comparable. Further ongoing enhancements to these devices will improve maneuverability and clinical effectiveness.
    Type of Medium: Online Resource
    ISSN: 1539-2031
    URL: Article
    DOI: 10.1097/MCG.0000000000001752
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 2041558-8
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  • 7
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    Abstract 18861: Effects of Class III Antiarrhythmics on ICD Therapies and Clinical Outcomes: A Meta-analysis of Randomized Controlled Trials
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Circulation Vol. 132, No. suppl_3 ( 2015-11-10)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 132, No. suppl_3 ( 2015-11-10)
    Abstract: Introduction: Implantable cardioverter defibrillators (ICD) prolong survival in patients with heart failure, reduced left ventricular ejection fraction (LVEF 〈 = 35%) and/or sustained ventricular arrhythmias (VA) by terminating VA with either anti-tachycardia pacing (ATP) or shock. However, ICD therapies are associated with significant pain, psychological distress, and increased risk for hospitalization and mortality. Antiarrhythmic drugs are commonly used to reduce frequency of VA in patients with ICD. We attempt to study the effects of class III antiarrhythmics on the frequency of ICD therapies, hospitalization and mortality. Methods: PubMed database was queried to identify prospective randomized controlled trials comparing class III antiarrhytmics to placebo on a standard background medical therapy in patients with an ICD and prior history of sustained VA (spontaneous/ treated/ induced) and/or sudden cardiac death. Information on appropriate ICD therapy, hospitalization and mortality was extracted. Fixed effect analysis was used when I2 ≤ 25% and p 〉 0.1, otherwise random effect analysis was performed. Results: After reviewing 2931 articles, seven trials that studied Amiodarone, Sotalol, Azimilide or Celivarone were included. A total of 2117 patients (87% males, mean age 63.8 years, mean LVEF 32.8%) were analyzed. 50.6% of the patients had at least one appropriate ICD therapy delivered and 4.5% died during the follow up. Antiarrhythmic drug usage significantly reduced the number of patients receiving ICD therapy by 55% (OR=0.45, 95% confidence interval [CI] 0.26-0.77, P=.004). There was no significant difference in mortality between treatment and placebo arms. Only 2 of the 7 trials reported number of hospitalizations and the sample size was insufficient for analysis. Conclusions: Class III antiarrhythmics significantly reduced ICD therapy for VA with no significant change in mortality.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.132.suppl_3.18861
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
    detail.hit.zdb_id: 1466401-X
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  • 8
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    Matrix Metalloproteinase-12 Induces Blood–Brain Barrier Damage After Focal Cerebral Ischemia
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Stroke Vol. 46, No. 12 ( 2015-12), p. 3523-3531
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 46, No. 12 ( 2015-12), p. 3523-3531
    Abstract: Matrix metalloproteinases (MMPs) have a central role in compromising the integrity of the blood–brain barrier (BBB). The role of MMP-12 in brain damage after ischemic stroke remains unknown. The main objective of the current study is to investigate the effect of MMP-12 suppression at an early time point before reperfusion on the BBB damage in rats. Methods— Sprague–Dawley rats were subjected to middle cerebral artery occlusion and reperfusion. MMP-12 shRNA–expressing plasmids formulated as nanoparticles were administered at a dose of 1 mg/kg body weight. The involvement of MMP-12 on BBB damage was assessed by performing various techniques, including Evans blue dye extravasation, 2,3,5-triphenyltetrazolium chloride staining, immunoblot, gelatin zymography, and immunofluorescence analysis. Results— MMP-12 is upregulated ≈31-, 47-, and 66-fold in rats subjected 1–, 2-, or 4-hour ischemia, respectively, followed by 1-day reperfusion. MMP-12 suppression protected the BBB integrity by inhibiting the degradation of tight-junction proteins. Either intravenous or intra-arterial delivery of MMP-12 shRNA-expressing plasmid significantly reduced the percent Evans blue dye extravasation and infarct size. Furthermore, MMP-12 suppression reduced the endogenous levels of other proteases, such as tissue-type plasminogen activator and MMP-9, which are also known to be the key players involved in BBB damage. Conclusions— These results demonstrate the adverse role of MMP-12 in acute brain damage that occurs after ischemic stroke and, thereby, suggesting that MMP-12 suppression could be a promising therapeutic target for cerebral ischemia.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.115.011031
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
    detail.hit.zdb_id: 1467823-8
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  • 9
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    Abstract TP100: Post-Transcriptional Inactivation of MMP-12 Immediately After Reperfusion Facilitates Neurological Recovery After Ischemic Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Stroke Vol. 51, No. Suppl_1 ( 2020-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 51, No. Suppl_1 ( 2020-02)
    Abstract: Introduction: We recently showed in a rodent model of transient focal cerebral ischemia that matrix metalloproteinase-12 (MMP-12) induction in the ischemic brain promotes post-stroke blood-brain barrier disruption, apoptosis, demyelination, and infarction. The purpose of the present study is to investigate the role of elevated MMP-12 on post-stroke neurological function and to identify the time window of therapeutic opportunity for MMP-12 suppression. Methods: Adult male Sprague-Dawley rats were subjected to transient middle cerebral artery occlusion and reperfusion. Cohorts of rats (n =8-15/group) were administered with either MMP-12 shRNA or scrambled shRNA sequence (vehicle control) expressing plasmids (1 mg/Kg; intravenous) formulated as nanoparticles. The differences in sample size of various cohorts were attributed to the exclusion criteria followed, high mortality rate in vehicle control-treated group, and sample size required for statistical analysis. To assess the reflex, balance, sensory, and motor functions, rats from various cohorts were subjected to modified neurological severity scoring (mNSS), adhesive removal test, beam walk test and rotarod test at day 1, 3 and 5 of reperfusion. To assess the time window of therapeutic opportunity, various cohorts of rats were treated at 5 min, 3h, and 6h of reperfusion. Investigators blinded to study groups analyzed all outcome parameters. Results: The post-stroke percent survival rate in cohorts treated with MMP12shRNA expressing plasmids range from 82 to 89 as compared to 67 in vehicle control-treated group. The cohort of rats treated at 5 min of reperfusion with MMP-12snRNA expressing plasmids showed significantly better functional recovery as assessed by various neurological tests. However, delayed administration of MMP-12snRNA expressing plasmid (either at 3h or 6h of reperfusion) failed to promote any significant improvement in post-stroke neurological recovery. Conclusions: Post-stroke induction of MMP-12 in the ischemic brain contributes to neurological deficits and impedes recovery. MMP-12 targeting treatments immediately after reperfusion could offer substantial therapeutic benefits.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.51.suppl_1.TP100
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
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  • 10
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    Abstract 509: Accurate Measurement of Carotid Lumen Diameter and Narrowing Utilizing Ultrasound
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Arteriosclerosis, Thrombosis, and Vascular Biology Vol. 35, No. suppl_1 ( 2015-05)
    Details
    In: Arteriosclerosis, Thrombosis, and Vascular Biology, Ovid Technologies (Wolters Kluwer Health), Vol. 35, No. suppl_1 ( 2015-05)
    Abstract: Introduction: Ultrasound is often used for monitoring of carotid disease. In current clinical practice, degree of stenosis is an important predictor to assess stroke risk. Lumen narrowing from plaque is currently measured via techniques such as computed tomographic scan, magnetic resonance angiogram or conventional angiogram. Duplex ultrasound measures degree of stenosis based on peak systolic velocities and other parameters and only provides a wide range of level of stenosis. Pursuing lumen size measurement in ultrasound via manual quantification of lumen diameter is tedious. Furthermore, non-uniformity in plaque growth makes it more challenging and time-consuming. There has been an increasing interest in the automatic and robust delineation of the lumen boundaries of the carotids and to measure the lumen diameter via ultrasound given its non-invasive and safe approach. Methods: Deidentified carotid ultrasound images were obtained on patients retrospectively who underwent carotid ultrasound at Toho University Ohashi Medical Center, Tokyo, Japan. A higher order derivative Gaussian filter is applied on these images to highlight the edges. Using pixel classification, lumen region is detected and lumen boundaries are estimated. Results: Of the 202 patients with common carotid artery images, 155 were males and 47 were females.Mean age 69 ± 15.9 years. Mean HbA1c, LDL, HDL and Cholesterol of patients were 6.28±1.1 mg/dl, 101.27±31.6 mg/dl, 50.26±14.8 mg/dl and 175.04±38 mg/dl, respectively. Specialist trained in carotid ultrasound manually traced lumen diameter. Automated tracing and lumen measurements were obtained. The coefficient of correlation between automated diameter and manual diameter was: 0.88, 0.91 and 0.93. The mean diameter error between automated and manual tracing were: 0.50±0.37 mm, 0.36±0.34 mm and 0.30±0.28 mm. Precision of merit between automated diameter and manual diameter was: 93.28%, 95.33% and 96.32% corresponding to manual tracers. Conclusions: The automated lumen diameter measurement is near real time, quick, accurate, fully automated and reliable to assess carotid lumen diameter and narrowing.
    Type of Medium: Online Resource
    ISSN: 1079-5642 , 1524-4636
    URL: Article
    DOI: 10.1161/atvb.35.suppl_1.509
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
    detail.hit.zdb_id: 1494427-3
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