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  • 1
    Online Resource
    Online Resource
    Genomic Analysis of Non- NF2 Meningiomas Reveals Mutations in TRAF7 , KLF4 , AKT1 , and SMO
    American Association for the Advancement of Science (AAAS) ; 2013
    In:  Science Vol. 339, No. 6123 ( 2013-03), p. 1077-1080
    Details
    In: Science, American Association for the Advancement of Science (AAAS), Vol. 339, No. 6123 ( 2013-03), p. 1077-1080
    Abstract: We report genomic analysis of 300 meningiomas, the most common primary brain tumors, leading to the discovery of mutations in TRAF7 , a proapoptotic E3 ubiquitin ligase, in nearly one-fourth of all meningiomas. Mutations in TRAF7 commonly occurred with a recurrent mutation (K409Q) in KLF4 , a transcription factor known for its role in inducing pluripotency, or with AKT1 E17K , a mutation known to activate the PI3K pathway. SMO mutations, which activate Hedgehog signaling, were identified in ~5% of non- NF2 mutant meningiomas. These non- NF2 meningiomas were clinically distinctive—nearly always benign, with chromosomal stability, and originating from the medial skull base. In contrast, meningiomas with mutant NF2 and/or chromosome 22 loss were more likely to be atypical, showing genomic instability, and localizing to the cerebral and cerebellar hemispheres. Collectively, these findings identify distinct meningioma subtypes, suggesting avenues for targeted therapeutics.
    Type of Medium: Online Resource
    ISSN: 0036-8075 , 1095-9203
    URL: Article
    DOI: 10.1126/science.1233009
    RVK:
    TA 1000
    RVK:
    WA 15000
    Language: English
    Publisher: American Association for the Advancement of Science (AAAS)
    Publication Date: 2013
    detail.hit.zdb_id: 128410-1
    detail.hit.zdb_id: 2066996-3
    detail.hit.zdb_id: 2060783-0
    SSG: 11
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  • 2
    Online Resource
    Online Resource
    Abstract WP111: Deployment Of Portable, Bedside, Low-field Magnetic Resonance Imaging In The Emergency Department To Evaluate Patients With Acute Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Stroke Vol. 53, No. Suppl_1 ( 2022-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 53, No. Suppl_1 ( 2022-02)
    Abstract: Background and Aims: MRI is critical for diagnosing acute stroke and guiding candidate selection for potential reperfusion therapy. However, rapid stroke evaluation using MRI is often dissuaded by the time required for patients to travel to access-controlled, high-field (1.5-3T) systems. Advances in low-field MRI enable the acquisition of clinically valuable images at the bedside. We report neuroimaging in patients presenting to the Emergency Department (ED) with stroke symptoms using a low-field portable MRI (pMRI) device. Methods: A 64mT pMRI device was deployed in the Yale-New Haven Hospital ED from August 2020 to July 2021. Patients presenting as a “Stroke Code” or “Intracranial Hemorrhage Alert” with no MRI contraindications were scanned. Exams were performed at the bedside, in the vicinity of ED room equipment. Research staff acquired imaging via tablet, with images available immediately after acquisition. Sequences obtained and axial scan times (in minutes) included T1-weighted imaging (4:54), T2-weighted imaging (7:03), fluid-attenuated inversion recovery imaging (9:31), and diffusion-weighed imaging with apparent diffusion coefficient mapping (9:04). Patients’ demographic information, hours from the time of patients' last known normal (LKN) to time of scan, and discharge diagnoses (determined from final imaging interpretation) were assessed. Results: pMRI exams were obtained on 54 patients (28 females, 51.9%; median age 71 years, 20-98 years). Discharge diagnoses included ischemic stroke (42.6%) no intracranial abnormality (31.5%), intraparenchymal hemorrhage (7.4%), atherosclerosis (7.4%), tumor (5.6%), subdural hematoma (3.7%), and intraventricular hemorrhage (1.9%). Patient LKN times ranged from 2 to 144 hours (median of 12 hours; 3 patients with no LKN excluded). The pMRI did not interfere with ED equipment and no significant adverse events occurred. Conclusion: We report the use of a pMRI for bedside neuroimaging in the ED. This approach suggests that pMRI may be viable for supporting rapid diagnosis and treatment candidate selection in patients presenting with stroke symptoms to the ED.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.53.suppl_1.WP111
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 1467823-8
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  • 3
    Online Resource
    Online Resource
    Fixed Compared With Autoregulation-Oriented Blood Pressure Thresholds After Mechanical Thrombectomy for Ischemic Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Stroke Vol. 51, No. 3 ( 2020-03), p. 914-921
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 51, No. 3 ( 2020-03), p. 914-921
    Abstract: Loss of cerebral autoregulation in the acute phase of ischemic stroke leaves patients vulnerable to blood pressure (BP) changes. Effective BP management after endovascular thrombectomy may protect the brain from hypoperfusion or hyperperfusion. In this observational study, we compared personalized, autoregulation-based BP targets to static systolic BP thresholds. Methods— We prospectively enrolled 90 patients undergoing endovascular thrombectomy for stroke. Autoregulatory function was continuously measured by interrogating changes in near-infrared spectroscopy–derived tissue oxygenation (a cerebral blood flow surrogate) in response to changes in mean arterial pressure. The resulting autoregulatory index was used to trend the BP range at which autoregulation was most preserved. Percent time that mean arterial pressure exceeded the upper limit of autoregulation or decreased below the lower limit of autoregulation was calculated for each patient. Time above fixed systolic BP thresholds was computed in a similar fashion. Functional outcome was measured with the modified Rankin Scale at 90 days. Results— Personalized limits of autoregulation were successfully computed in all 90 patients (age 71.6±16.2, 47% female, mean National Institutes of Health Stroke Scale 13.9±5.7, monitoring time 28.0±18.4 hours). Percent time with mean arterial pressure above the upper limit of autoregulation associated with worse 90-day outcomes (odds ratio per 10% 1.84 [95% CI, 1.3–2.7] P =0.002), and patients with hemorrhagic transformation spent more time above the upper limit of autoregulation (10.9% versus 16.0%, P =0.042). Although there appeared to be a nonsignificant trend towards worse outcome with increasing time above systolic BP thresholds of 140 mm Hg and 160 mm Hg, the effect sizes were smaller compared with the personalized approach. Conclusions— Noninvasive determination of personalized BP thresholds for stroke patients is feasible. Deviation from these limits may increase risk of further brain injury and poor functional outcome. This approach may present a better strategy compared with the classical approach of maintaining systolic BP below a predetermined value, though a randomized trial is needed to determine the optimal approach for hemodynamic management.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.119.026596
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 1467823-8
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  • 4
    Online Resource
    Online Resource
    Direct carotid puncture for mechanical thrombectomy in acute ischemic stroke patients with prohibitive vascular access
    Journal of Neurosurgery Publishing Group (JNSPG) ; 2020
    In:  Journal of Neurosurgery Vol. 135, No. 1 ( 2020-08), p. 53-63
    Details
    In: Journal of Neurosurgery, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 135, No. 1 ( 2020-08), p. 53-63
    Abstract: While the benefit of mechanical thrombectomy (MT) for patients with anterior circulation acute ischemic stroke with large-vessel occlusion (AIS-LVO) has been clearly established, difficult vascular access may make the intervention impossible or unduly prolonged. In this study, the authors evaluated safety as well as radiographic and functional outcomes in stroke patients treated with MT via direct carotid puncture (DCP) for prohibitive vascular access. METHODS The authors retrospectively studied patients from their prospective AIS-LVO database who underwent attempted MT between 2015 and 2018. Patients with prohibitive vascular access were divided into two groups: 1) aborted MT (abMT) after failed transfemoral access and 2) attempted MT via DCP. Functional outcome was assessed using the modified Rankin Scale at 3 months. Associations with outcome were analyzed using ordinal logistic regression. RESULTS Of 352 consecutive patients with anterior circulation AIS-LVO who underwent attempted MT, 37 patients (10.5%) were deemed to have prohibitive vascular access (mean age [± SD] 82 ± 11 years, mean National Institutes of Health Stroke Scale [NIHSS] score 17 ± 5, with females accounting for 75% of the patients). There were 20 patients in the DCP group and 17 in the abMT group. The two groups were well matched for the known predictors of clinical outcome: age, sex, and admission NIHSS score. Direct carotid access was successfully obtained in 19 of 20 patients. Successful reperfusion (thrombolysis in cerebral infarction score 2b or 3) was achieved in 16 (84%) of 19 patients in the DCP group. Carotid access complications included an inability to catheterize the carotid artery in 1 patient, neck hematomas in 4 patients, non–flow-limiting common carotid artery (CCA) dissections in 2 patients, and a delayed, fatal carotid blowout in 1 patient. The neck hematomas and non–flow-limiting CCA dissections did not require any subsequent interventions and remained clinically silent. Compared with the abMT group, patients in the DCP group had smaller infarct volumes (11 vs 48 ml, p = 0.04), a greater reduction in NIHSS score (−4 vs +2.9, p = 0.03), and better functional outcome (shift analysis for 3-month modified Rankin Scale score: adjusted OR 5.2, 95% CI 1.02–24.5; p = 0.048). CONCLUSIONS DCP for emergency MT in patients with anterior circulation AIS-LVO and prohibitive vascular access is safe and effective and is associated with higher recanalization rates, smaller infarct volumes, and improved functional outcome compared with patients with abMT after failed transfemoral access. DCP should be considered in this patient population.
    Type of Medium: Online Resource
    ISSN: 0022-3085 , 1933-0693
    URL: Article
    DOI: 10.3171/2020.5.JNS192737
    RVK:
    XA 10000
    RVK:
    XA 55270
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 2020
    detail.hit.zdb_id: 2026156-1
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  • 5
    Online Resource
    Online Resource
    Low‐Field Portable Magnetic Resonance Imaging for Post‐Thrombectomy Assessment of Ongoing Brain Injury
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Stroke: Vascular and Interventional Neurology Vol. 3, No. 5 ( 2023-09)
    Details
    In: Stroke: Vascular and Interventional Neurology, Ovid Technologies (Wolters Kluwer Health), Vol. 3, No. 5 ( 2023-09)
    Abstract: Timely imaging is essential for patients undergoing mechanical thrombectomy (MT). Our objective was to evaluate the safety and feasibility of low‐field portable magnetic resonance imaging (pMRI) for bedside evaluation following MT. Methods Patients with suspected large‐vessel occlusion undergoing MT were screened for eligibility. All pMRI examinations were conducted in the standard ferromagnetic environment of the interventional radiology suite. Clinical characteristics, procedural details, and pMRI features were collected. Subsequent high‐field conventional MRI within 72±12 hours was analyzed. If a conventional MRI was not available for comparison, computed tomography within the same time frame was used for validation. Results Twenty‐four patients were included (63% women; median age, 76 years [interquartile range, 69–84 years]). MT was performed with a median access to revascularization time of 15 minutes (interquartile range, 8–19 minutes), and with a successful outcome as defined by a thrombolysis in cerebral infarction score of ≥2B in 90% of patients. The median time from the end of the procedure to pMRI was 22 minutes (interquartile range, 16–32 minutes). The median pMRI examination time was 30 minutes (interquartile range, 17–33 minutes). Of 23 patients with available subsequent imaging, 9 had infarct progression compared with immediate post‐MT pMRI and 14 patients did not have progression of their infarct volume. There was no adverse event related to the examination. Conclusion Low‐field pMRI is safe and feasible in a post‐MT environment and enables timely identification of ischemic changes in the interventional radiology suite. This approach can facilitate the assessment of baseline infarct burden and may help guide physiological interventions following MT.
    Type of Medium: Online Resource
    ISSN: 2694-5746
    URL: Article
    DOI: 10.1161/SVIN.123.000921
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 3144224-9
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  • 6
    Online Resource
    Online Resource
    Student mood and responses to standing desks in the college classroom
    American Journal of Health Studies ; 2021
    In:  American Journal of Health Studies Vol. 35, No. 4 ( 2021-04-29)
    Details
    In: American Journal of Health Studies, American Journal of Health Studies, Vol. 35, No. 4 ( 2021-04-29)
    Abstract: Physical activity enhances physical health, reduces disease, and resists metabolic syndrome and obesity, while sitting for extended periods of time has a negative effect on long term health outcomes. Thus, reducing sitting time has been identified as a health-enhancing goal. The purpose of this study was to explore perceptions and responses of college students to sitting versus standing in class. Five standing desks were placed in a classroom of traditional sitting desks. In a counterbalanced, within subjects design, 88 undergraduate students (age M=21.64, SD=6.55 years) participated in the study. Some participating students first stood at a desk for three consecutive class meetings and then sat for three classes while others sat for three consecutive classes and then stood for three. Surveys were administered at the beginning and end of each class and at the end of six consecutive class sessions. Results indicated that mood was signifi- cantly higher on standing than sitting days, the majority of participants had a favorable perception of the standing-in-class experience, and would use standing stations if the option was available. This study is one of few to examine the viability and response to adding standing desks in college classrooms, and indicates standing desks may be perceived favorably and could be utilized to reduce sitting time.
    Type of Medium: Online Resource
    ISSN: 1945-4511
    URL: Article
    DOI: 10.47779/ajhs.2020.257
    Language: Unknown
    Publisher: American Journal of Health Studies
    Publication Date: 2021
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  • 7
    Online Resource
    Online Resource
    Abstract WP320: Blood Pressure Reduction During Endovascular Stroke Therapy is Associated With Poor Functional Outcome
    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: Endovascular therapy (EVT) has been demonstrated to be beneficial regardless of baseline blood pressure (BP). However, questions concerning optimal BP management during EVT remain unanswered. Lowering BP may reduce penumbral perfusion resulting in increased infarct volume and poor outcomes. In this study, we examined the relationship between reductions in intra-procedural BP during EVT and functional outcome. Methods: We prospectively enrolled patients with acute large-vessel occlusion ischemic stroke undergoing EVT at Yale-New Haven Hospital. Baseline BP was measured at the start of EVT and monitored throughout the procedure. Reductions in BP were calculated as the difference between baseline systolic BP (SBP) and lowest SBP during the intervention. In addition, to distinguish between one time SBP reductions and sustained hypotension, we measured the area between baseline SBP and continuous measurements of intra-procedural SBP. Functional outcome was assessed using the modified Rankin scale (mRS) at discharge and 90 days. Associations between BP reduction and outcome were assessed using ordinal logistic regression. Results: 68 patients (mean age 73+/-16.7, 36F, mean NIHSS 17) were included in the study. Mean baseline BP was 152/82 mmHg. The median SBP reduction among patients with favorable outcome (mRS ≤2) was 23 mmHg (IQR 11-52) compared to 54 mmHg (IQR 28-86) in the group with poor outcome (p=0.03). A decrease in SBP from initial levels during EVT was independently associated with an increased likelihood for higher (worse) scores on the mRS at discharge (p=0.02) and 3 months (p=0.03) after adjusting for age and admission NIHSS. Every 10 mmHg reduction in SBP from baseline was associated with a 1.4 fold increase in the odds of an unfavorable outcome at 90 days. Conclusions: BP reduction during EVT may be harmful and lead to worse functional outcomes for patients affected by large-vessel stroke. Even modest, one time reductions in SBP, as frequently occurs during induction of anesthesia, appear to be associated with increased risk for worsened functional status. These results underline the importance of BP management during EVT, and highlight the need for further investigation of active BP management strategies to optimize clinical outcomes.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.49.suppl_1.WP320
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 1467823-8
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  • 8
    Online Resource
    Online Resource
    307 The Hospital Frailty Risk Score Independently Predicts Increased Complication Rates and Healthcare Resource Utilization After Endovascular Treatment of Ruptured Aneurysms
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Neurosurgery Vol. 68, No. Supplement_1 ( 2022-04), p. 67-68
    Details
    In: Neurosurgery, Ovid Technologies (Wolters Kluwer Health), Vol. 68, No. Supplement_1 ( 2022-04), p. 67-68
    Type of Medium: Online Resource
    ISSN: 0148-396X , 1524-4040
    URL: Article
    DOI: 10.1227/NEU.0000000000001880_307
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 1491894-8
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  • 9
    Online Resource
    Online Resource
    Epinephrine in cardiopulmonary resuscitation
    Elsevier BV ; 1991
    In:  The Journal of Emergency Medicine Vol. 9, No. 6 ( 1991-11), p. 487-495
    Details
    In: The Journal of Emergency Medicine, Elsevier BV, Vol. 9, No. 6 ( 1991-11), p. 487-495
    Type of Medium: Online Resource
    ISSN: 0736-4679
    URL: Article
    DOI: 10.1016/0736-4679(91)90222-2
    Language: English
    Publisher: Elsevier BV
    Publication Date: 1991
    detail.hit.zdb_id: 2006769-0
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  • 10
    Online Resource
    Online Resource
    Impact of Clot Location on Outcomes after Mechanical Thrombectomy for Anterior Circulation Acute Ischemic Stroke : A Meta-Analysis
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Neurosurgery Vol. 67, No. Supplement_1 ( 2020-12)
    Details
    In: Neurosurgery, Ovid Technologies (Wolters Kluwer Health), Vol. 67, No. Supplement_1 ( 2020-12)
    Type of Medium: Online Resource
    ISSN: 0148-396X
    URL: Article
    DOI: 10.1093/neuros/nyaa447_387
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 1491894-8
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