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  • Ovid Technologies (Wolters Kluwer Health)  (17)
  • 1
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    Online Resource
    Brief Report: Willingness to Accept HIV-Infected and Increased Infectious Risk Donor Organs Among Transplant Candidates Living With HIV
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  JAIDS Journal of Acquired Immune Deficiency Syndromes Vol. 85, No. 1 ( 2020-09-1), p. 88-92
    Details
    In: JAIDS Journal of Acquired Immune Deficiency Syndromes, Ovid Technologies (Wolters Kluwer Health), Vol. 85, No. 1 ( 2020-09-1), p. 88-92
    Type of Medium: Online Resource
    ISSN: 1525-4135
    URL: Article
    DOI: 10.1097/QAI.0000000000002405
    RVK:
    XA 10000
    RVK:
    XA 51942
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 2038673-4
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  • 2
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    Ticagrelor Added to Aspirin in Acute Nonsevere Ischemic Stroke or Transient Ischemic Attack of Atherosclerotic Origin
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Stroke Vol. 51, No. 12 ( 2020-12), p. 3504-3513
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 51, No. 12 ( 2020-12), p. 3504-3513
    Abstract: Among patients with a transient ischemic attack or minor ischemic strokes, those with ipsilateral atherosclerotic stenosis of cervicocranial vasculature have the highest risk of recurrent vascular events. Methods: In the double-blind THALES (The Acute Stroke or Transient Ischemic Attack Treated With Ticagrelor and ASA for Prevention of Stroke and Death) trial, we randomized patients with a noncardioembolic, nonsevere ischemic stroke, or high-risk transient ischemic attack to ticagrelor (180 mg loading dose on day 1 followed by 90 mg twice daily for days 2–30) or placebo added to aspirin (300–325 mg on day 1 followed by 75–100 mg daily for days 2–30) within 24 hours of symptom onset. The present paper reports a prespecified analysis in patients with and without ipsilateral, potentially causal atherosclerotic stenosis ≥30% of cervicocranial vasculature. The primary end point was time to the occurrence of stroke or death within 30 days. Results: Of 11 016 randomized patients, 2351 (21.3%) patients had an ipsilateral atherosclerotic stenosis. After 30 days, a primary end point occurred in 92/1136 (8.1%) patients with ipsilateral stenosis randomized to ticagrelor and in 132/1215 (10.9%) randomized to placebo (hazard ratio 0.73 [95% CI, 0.56–0.96], P =0.023) resulting in a number needed to treat of 34 (95% CI, 19–171). In patients without ipsilateral stenosis, the corresponding event rate was 211/4387 (4.8%) and 230/4278 (5.4%), respectively (hazard ratio, 0.89 [95% CI, 0.74–1.08]; P =0.23, P interaction =0.245). Severe bleeding occurred in 4 (0.4%) and 3 (0.2%) patients with ipsilateral atherosclerotic stenosis on ticagrelor and on placebo, respectively ( P =NS), and in 24 (0.5%) and 4 (0.1%), respectively, in 8665 patients without ipsilateral stenosis (hazard ratio=5.87 [95% CI, 2.04–16.9], P =0.001). Conclusions: In this exploratory analysis comparing ticagrelor added to aspirin to aspirin alone, we found no treatment by ipsilateral atherosclerosis stenosis subgroup interaction but did identify a higher absolute risk and a greater absolute risk reduction of stroke or death at 30 days in patients with ipsilateral atherosclerosis stenosis than in those without. In this easily identified population, ticagrelor added to aspirin provided a clinically meaningful benefit with a number needed to treat of 34 (95% CI, 19–171). Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT03354429.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.120.032239
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 1467823-8
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  • 3
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    Abstract TP169: Factors Associated With Intracerebral Hematoma In Patients With Aneurysmal Subarachnoid Hemorrhage In Vietnam: A Multicenter Prospective Cohort Study
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Stroke Vol. 54, No. Suppl_1 ( 2023-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 54, No. Suppl_1 ( 2023-02)
    Abstract: Introduction: Early ICH expansion is associated with a higher rate of poor outcomes and death in aSAH patients, especially in limited-resource settings. This study aimed to investigate the impact of ICH expansion on the outcomes and the factors related to an ICH expansion in aSAH patients in an LMIC. Hypothesis: Understanding factors related to ICH after an aneurysmal rupture in different countries, particularly in limited-resource regions, is crucial for reducing poor outcomes and mortality. Methods: We performed a multicenter prospective cohort study of patients (≥18 years) presenting with aSAH at three central hospitals in Hanoi, Vietnam, from August 2019 to June 2021. We collected data on the demographics, baseline characteristics, management, and outcomes and compared these data between patients who had an ICH expansion (defined as ICH detected on an admission CT scan) and patients who did not. We assessed factors associated with ICH expansion on admission using logistic regression. Results: Of 415 patients, 198 (47.7%) were men, and the median age was 57.0 years (IQR: 48.0-67.0). ICH expansion accounted for 20.5% (85/415) of aSAH patients. There was a significant difference in the 90-day poor outcomes (43.5%; 37/85 and 29.1%; 96/330; p=0.011) and 90-day mortality (36.5%; 31/85 and 20.0%; 66/330; p=0.001) between patients who had ICH and patients who did not have ICH expansion. The multivariate analysis showed that systolic BP of 140 mmHg or more (OR: 2.674; 95% CI: 1.372-5.214), WFNS grades II (OR: 3.683; 95% CI: 1.250-10.858) to V (OR: 6.912; 95% CI: 2.553-18.709), and a ruptured MCA aneurysm (OR: 3.717; 95% CI: 1.848-7.477) were independent predictors of ICH expansion. Conclusions: In our study, ICH accounted for a substantial proportion of aSAH patients and contributed significantly to a high rate of poor outcomes and death. On admission, a higher systolic BP, a worse neurological status, and a ruptured MCA aneurysm were independent predictors of ICH expansion. This study indicates independent predictors of an early ICH expansion, such as a higher admission systolic BP and a worse initial neurological status, after aneurysmal ruptures that require only a clinical examination and, therefore, may be particularly valuable in resource-limited settings.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.54.suppl_1.TP169
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 1467823-8
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  • 4
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    Abstract TP242: Predictive Validity of the Modified World Federation of Neurosurgical Societies Subarachnoid Hemorrhage Grading System (Modified WFNS Scale) for the Outcome of Patients With Aneurysmal Subarachnoid Hemorrhage
    Ovid Technologies (Wolters Kluwer Health) ; 2024
    In:  Stroke Vol. 55, No. Suppl_1 ( 2024-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 55, No. Suppl_1 ( 2024-02)
    Abstract: Introduction: Evaluating the prognosis of aSAH patients who may be at risk of poor outcomes using grading systems is one way to make a better decision on treatment for these patients. This study compared the accuracy of modified WFNS, WFNS, and Hunt and Hess (H & H) scales in predicting the aSAH patient's outcome. Methods: From August 2019 to June 2021, we conducted a multicenter prospective cohort study on aSAH adult patients in three central hospitals in Hanoi, Vietnam. The primary outcome was the 90-day poor outcome, measured by scores of 4-6 on mRS. We calculated areas under the receiver operator characteristic (ROC) curve (AUROCs) to determine how well the grading scales could predict patient prognosis upon admission. We also used ROC curve analysis to find the best cut-off value for each scale. We made comparisons of AUROCs using Z-statistics and compared 90-day mean mRS scores among intergrades using the pairwise multiple-comparison test. Finally, we used logistic regression to identify factors associated with the 90-day poor outcome. Results: Of 415 patients, 32% had a 90-day poor outcome. Modified WFNS (AUROC: 0.839 [95% CI: 0.795-0.883]; cut-off value≥2.50), WFNS (AUROC: 0.837 [95% CI: 0.793-0.881] ; cut-off value≥3.5), and H & H scales (AUROC: 0.836 [95% CI: 0.791-0.881]; cut-off value≥3.5) were all good at predicting patient prognosis on day 90th after ictus. However, there were no significant differences between AUROCs of these scales. Only grades IV and V of modified WFNS (3.75±2.46 vs. 5.24±1.68, p=0.026), WFNS (3.75±2.46 vs. 5.24±1.68, p=0.026), and H & H scales (2.96±2.60 vs. 4.97±1.87, p 〈 0.001) showed a significant difference in the 90-day mean mRS scores. In the multivariable models, with the same set of confounding variables, modified WFNS grade of III-V (adjusted OR (AOR): 9.090; 95% CI: 3.494-23.648) was more strongly associated with increased risk of the 90-day poor outcome compared to WFNS grade of IV-V (AOR: 6.383; 95% CI: 2.661-15.310) or H & H grade of IV-V (AOR: 6.146; 95% CI: 2.584-14.620). Conclusions: In this study modified WFNS, WFNS, and H & H scales all had good discriminatory abilities for the prognosis of aSAH patients. Because of better effect size in predicting poor outcomes, the modified WFNS scale seems preferable to the WFNS and H & H scales.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.55.suppl_1.TP242
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2024
    detail.hit.zdb_id: 1467823-8
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  • 5
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    Impact of Evidence‐Based Stroke Care on Patient Outcomes: A Multilevel Analysis of an International Study
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Journal of the American Heart Association Vol. 8, No. 13 ( 2019-07-02)
    Details
    In: Journal of the American Heart Association, Ovid Technologies (Wolters Kluwer Health), Vol. 8, No. 13 ( 2019-07-02)
    Abstract: The uptake of proven stroke treatments varies widely. We aimed to determine the association of evidence‐based processes of care for acute ischemic stroke ( AIS ) and clinical outcome of patients who participated in the HEADPOST (Head Positioning in Acute Stroke Trial), a multicenter cluster crossover trial of lying flat versus sitting up, head positioning in acute stroke. Methods and Results Use of 8 AIS processes of care were considered: reperfusion therapy in eligible patients; acute stroke unit care; antihypertensive, antiplatelet, statin, and anticoagulation for atrial fibrillation; dysphagia assessment; and physiotherapist review. Hierarchical, mixed, logistic regression models were performed to determine associations with good outcome (modified Rankin Scale scores 0–2) at 90 days, adjusted for patient and hospital variables. Among 9485 patients with AIS, implementation of all processes of care in eligible patients, or “defect‐free” care, was associated with improved outcome (odds ratio, 1.40; 95% CI, 1.18–1.65) and better survival (odds ratio, 2.23; 95% CI , 1.62–3.09). Defect‐free stroke care was also significantly associated with excellent outcome (modified Rankin Scale score 0–1) (odds ratio, 1.22; 95% CI , 1.04–1.43). No hospital characteristic was independently predictive of outcome. Only 1445 (15%) of eligible patients with AIS received all processes of care, with significant regional variations in overall and individual rates. Conclusions Use of evidence‐based care is associated with improved clinical outcome in AIS . Strategies are required to address regional variation in the use of proven AIS treatments. Clinical Trial Registration URL : https://www.clinicaltrials.gov . Unique Identifier: NCT 02162017.
    Type of Medium: Online Resource
    ISSN: 2047-9980
    URL: Article
    DOI: 10.1161/JAHA.119.012640
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
    detail.hit.zdb_id: 2653953-6
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  • 6
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    Clinical Features Associated with Survival Outcome in African-American Patients with Hepatocellular Carcinoma
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  American Journal of Gastroenterology Vol. 114, No. 1 ( 2019-01), p. 80-88
    Details
    In: American Journal of Gastroenterology, Ovid Technologies (Wolters Kluwer Health), Vol. 114, No. 1 ( 2019-01), p. 80-88
    Type of Medium: Online Resource
    ISSN: 0002-9270 , 1572-0241
    URL: Article
    DOI: 10.1038/s41395-018-0261-y
    RVK:
    XA 18920
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
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  • 7
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    Causal Effect of Plasminogen Activator Inhibitor Type 1 on Coronary Heart Disease
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Journal of the American Heart Association Vol. 6, No. 6 ( 2017-11-06)
    Details
    In: Journal of the American Heart Association, Ovid Technologies (Wolters Kluwer Health), Vol. 6, No. 6 ( 2017-11-06)
    Abstract: Plasminogen activator inhibitor type 1 ( PAI ‐1) plays an essential role in the fibrinolysis system and thrombosis. Population studies have reported that blood PAI ‐1 levels are associated with increased risk of coronary heart disease ( CHD ). However, it is unclear whether the association reflects a causal influence of PAI ‐1 on CHD risk. Methods and Results To evaluate the association between PAI ‐1 and CHD , we applied a 3‐step strategy. First, we investigated the observational association between PAI ‐1 and CHD incidence using a systematic review based on a literature search for PAI ‐1 and CHD studies. Second, we explored the causal association between PAI ‐1 and CHD using a Mendelian randomization approach using summary statistics from large genome‐wide association studies. Finally, we explored the causal effect of PAI ‐1 on cardiovascular risk factors including metabolic and subclinical atherosclerosis measures. In the systematic meta‐analysis, the highest quantile of blood PAI ‐1 level was associated with higher CHD risk comparing with the lowest quantile (odds ratio=2.17; 95% CI: 1.53, 3.07) in an age‐ and sex‐adjusted model. The effect size was reduced in studies using a multivariable‐adjusted model (odds ratio=1.46; 95% CI : 1.13, 1.88). The Mendelian randomization analyses suggested a causal effect of increased PAI ‐1 level on CHD risk (odds ratio=1.22 per unit increase of log‐transformed PAI ‐1; 95% CI : 1.01, 1.47). In addition, we also detected a causal effect of PAI ‐1 on elevating blood glucose and high‐density lipoprotein cholesterol. Conclusions Our study indicates a causal effect of elevated PAI ‐1 level on CHD risk, which may be mediated by glucose dysfunction.
    Type of Medium: Online Resource
    ISSN: 2047-9980
    URL: Article
    DOI: 10.1161/JAHA.116.004918
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 2653953-6
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  • 8
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    Increased Prevalence of Metabolic Risk Factors in Asian Americans With Hepatocellular Carcinoma
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Journal of Clinical Gastroenterology Vol. 51, No. 4 ( 2017-04), p. 384-390
    Details
    In: Journal of Clinical Gastroenterology, Ovid Technologies (Wolters Kluwer Health), Vol. 51, No. 4 ( 2017-04), p. 384-390
    Abstract: We used metabolic risk factors to estimate the prevalence and clinical significance of nonalcoholic fatty liver disease in Asian Americans with hepatocellular carcinoma (HCC). Methods: This is a retrospective cohort study of 824 consecutive Asian HCC patients at Stanford University Medical Center from 1998 to 2015. Patients were subdivided as: Chinese, other East Asian (Japanese and Korean), South East Asian (Vietnamese, Thai, and Laotian), Maritime South East Asian (MSEA: Malaysian, Indonesian, Filipino, and Singaporean), and South West Asian (Indian, Pakistani, and Middle Eastern). Metabolic risk factors studied were body mass index, hypertension, type II diabetes, and hyperlipidemia. Results: Most patients were male (76%) with mean age 63 years. Metabolic risk factors were highly prevalent on presentation and increased over time ( P 〈 0.001), as did the prevalence of cryptogenic HCC ( P 〈 0.004). Compared with other Asian subgroups, MSEAs had the highest body mass index (26.3) and higher rates of type II diabetes (44% vs. 23% to 35%, P =0.004), hypertension (59% vs. 38% to 55%, P =0.04), and cryptogenic HCC (15% vs. 4% to 10%, P =0.01). They were more likely to be symptomatic on presentation (44% vs. 32% to 58%, P =0.07), less likely to present within Milan criteria (34% vs. 35% to 63%, P 〈 0.0001), and trended toward decreased 10-year survival rates compared with other ethnic subgroups (9% vs. 25% to 32%, P =0.07). Conclusions: Metabolic risk factors were increasingly prevalent among Asian Americans with HCC. MSEAs, who had the highest incidence of these risk factors, had more advanced tumor stage and trended toward worse survival.
    Type of Medium: Online Resource
    ISSN: 0192-0790
    URL: Article
    DOI: 10.1097/MCG.0000000000000689
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 2041558-8
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  • 9
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    Complications in Pediatric Regional Anesthesia
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Anesthesiology Vol. 129, No. 4 ( 2018-10-01), p. 721-732
    Details
    In: Anesthesiology, Ovid Technologies (Wolters Kluwer Health), Vol. 129, No. 4 ( 2018-10-01), p. 721-732
    Abstract: Complications in pediatric regional anesthesia are rare, so a large sample size is necessary to quantify risk. The Pediatric Regional Anesthesia Network contains data on more than 100,000 blocks administered at more than 20 children’s hospitals. This study analyzed the risk of major complications associated with regional anesthesia in children. Methods This is a prospective, observational study of routine clinical practice. Data were collected on every regional block placed by an anesthesiologist at participating institutions and were uploaded to a secure database. The data were audited at multiple points for accuracy. Results There were no permanent neurologic deficits reported (95% CI, 0 to 0.4:10,000). The risk of transient neurologic deficit was 2.4:10,000 (95% CI, 1.6 to 3.6:10,000) and was not different between peripheral and neuraxial blocks. The risk of severe local anesthetic systemic toxicity was 0.76:10,000 (95% CI, 0.3 to 1.6:10,000); the majority of cases occurred in infants. There was one epidural abscess reported (0.76:10,000, 95% CI, 0 to 4.8:10,000). The incidence of cutaneous infections was 0.5% (53:10,000, 95% CI, 43 to 64:10,000). There were no hematomas associated with neuraxial catheters (95% CI, 0 to 3.5:10,000), but one epidural hematoma occurred with a paravertebral catheter. No additional risk was observed with placing blocks under general anesthesia. The most common adverse events were benign catheter-related failures (4%). Conclusions The data from this study demonstrate a level of safety in pediatric regional anesthesia that is comparable to adult practice and confirms the safety of placing blocks under general anesthesia in children.
    Type of Medium: Online Resource
    ISSN: 0003-3022
    URL: Article
    DOI: 10.1097/ALN.0000000000002372
    RVK:
    XA 22600
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 2016092-6
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  • 10
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    Effects of Cirrhosis and Diagnosis Scenario in Metabolic‐Associated Fatty Liver Disease‐Related Hepatocellular Carcinoma
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Hepatology Communications Vol. 5, No. 1 ( 2021-01), p. 122-132
    Details
    In: Hepatology Communications, Ovid Technologies (Wolters Kluwer Health), Vol. 5, No. 1 ( 2021-01), p. 122-132
    Abstract: Metabolic‐associated fatty liver disease (MAFLD) is a major cause of liver‐related complications, including hepatocellular carcinoma (HCC). While MAFLD‐related HCC is known to occur in the absence of cirrhosis, our understanding of MAFLD‐related HCC in this setting is limited. Here, we characterize MAFLD‐related HCC and the impact of cirrhosis and screening on survival. This was a multicenter, retrospective, cohort study of MAFLD‐related HCC. MAFLD was defined based on the presence of race‐adjusted overweight, diabetes, or both hypertension and dyslipidemia in the absence of excess alcohol use or other underlying cause of liver disease. The primary outcome of interest was overall survival, and the primary dependent variables were cirrhosis status and prior HCC screening. We used Kaplan‐Meier methods to estimate overall survival and Cox proportional hazards models and random forest machine learning to determine factors associated with prognosis. This study included 1,382 patients from 11 centers in the United States and East/Southeast Asia. Cirrhosis was present in 62% of patients, but under half of these patients had undergone imaging within 12 months of HCC diagnosis. Patients with cirrhosis were more likely to have early stage disease but less often received curative therapy. After adjustment, cirrhosis was not associated with prognosis, but the presence of cancer‐related symptoms at diagnosis was associated with poorer prognosis. Conclusion: Cirrhosis was not associated with overall survival in this cohort of MAFLD‐related HCC, while diagnosis in the presence of symptoms was associated with poorer prognosis. The HCC surveillance rate in patients with MAFLD‐related HCC was disappointingly low in a multicenter cohort.
    Type of Medium: Online Resource
    ISSN: 2471-254X , 2471-254X
    URL: Article
    DOI: 10.1002/hep4.1606
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 2881134-3
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