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1

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Effects of Alteplase for Acute Stroke on the Distribution of Functional Outcomes : A Pooled Analysis of 9 Trials

Lees, Kennedy R. ; Emberson, Jonathan ; Blackwell, Lisa ; [weitere]

Ovid Technologies (Wolters Kluwer Health) ; 2016

In: Stroke Vol. 47, No. 9 ( 2016-09), p. 2373-2379

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In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 47, No. 9 ( 2016-09), p. 2373-2379

Kurzfassung: Thrombolytic therapy with intravenous alteplase within 4.5 hours of ischemic stroke onset increases the overall likelihood of an excellent outcome (no, or nondisabling, symptoms). Any improvement in functional outcome distribution has value, and herein we provide an assessment of the effect of alteplase on the distribution of the functional level by treatment delay, age, and stroke severity. Methods— Prespecified pooled analysis of 6756 patients from 9 randomized trials comparing alteplase versus placebo/open control. Ordinal logistic regression models assessed treatment differences after adjustment for treatment delay, age, stroke severity, and relevant interaction term(s). Results— Treatment with alteplase was beneficial for a delay in treatment extending to 4.5 hours after stroke onset, with a greater benefit with earlier treatment. Neither age nor stroke severity significantly influenced the slope of the relationship between benefit and time to treatment initiation. For the observed case mix of patients treated within 4.5 hours of stroke onset (mean 3 hours and 20 minutes), the net absolute benefit from alteplase (ie, the difference between those who would do better if given alteplase and those who would do worse) was 55 patients per 1000 treated (95% confidence interval, 13–91; P =0.004). Conclusions— Treatment with intravenous alteplase initiated within 4.5 hours of stroke onset increases the chance of achieving an improved level of function for all patients across the age spectrum, including the over 80s and across all severities of stroke studied (top versus bottom fifth means: 22 versus 4); the earlier that treatment is initiated, the greater the benefit.

Materialart: Online-Ressource

ISSN: 0039-2499 , 1524-4628

URL: Article

DOI: 10.1161/STROKEAHA.116.013644

RVK:

XA 10000

Sprache: Englisch

Verlag: Ovid Technologies (Wolters Kluwer Health)

Publikationsdatum: 2016

ZDB Id: 1467823-8

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2

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Intravenous nicardipine for Japanese patients with acute intracerebral hemorrhage: an individual participant data analysis

Toyoda, Kazunori ; Yoshimura, Sohei ; Fukuda-Doi, Mayumi ; [weitere]

Springer Science and Business Media LLC ; 2023

In: Hypertension Research Vol. 46, No. 1 ( 2023-01), p. 75-83

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In: Hypertension Research, Springer Science and Business Media LLC, Vol. 46, No. 1 ( 2023-01), p. 75-83

Kurzfassung: The effects of acute systolic blood pressure levels achieved with continuous intravenous administration of nicardipine for Japanese patients with acute intracerebral hemorrhage on clinical outcomes were determined. A systematic review and individual participant data analysis of articles were performed based on prospective studies involving adults developing hyperacute intracerebral hemorrhage who were treated with intravenous nicardipine. Outcomes included death or disability at 90 days, defined as the modified Rankin Scale score of 4–6, and hematoma expansion, defined as an increase 6 mL or more from baseline to 24 h computed tomography. Of the total 499 Japanese patients (age 64.9 ± 11.8 years, 183 women, initial BP 203.5 ± 18.3/109.1 ± 17.2 mmHg) studied, death or disability occurred in 35.6%, and hematoma expansion occurred in 15.6%. Mean hourly systolic blood pressure during the initial 24 h was positively associated with death or disability (adjusted odds ratio 1.25, 95% confidence interval 1.03–1.52 per 10 mmHg) and hematoma expansion (1.49, 1.18–1.87). These odds ratios were relatively high as compared to the reported ones for overall global patients of this individual participant data analysis [1.12 (95% confidence interval 1.00–1.26) and 1.16 (1.02–1.32), respectively]. In conclusion, lower levels of systolic blood pressure by continuous intravenous nicardipine were associated with lower risks of hematoma expansion and 90-day death or disability in Japanese patients with hyperacute intracerebral hemorrhage. The impact of systolic blood pressure lowering on better outcome seemed to be stronger in Japanese patients than the global ones.

Materialart: Online-Ressource

ISSN: 0916-9636 , 1348-4214

URL: Article

DOI: 10.1038/s41440-022-01046-4

Sprache: Englisch

Verlag: Springer Science and Business Media LLC

Publikationsdatum: 2023

ZDB Id: 2110941-2

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3

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Intravenous alteplase for stroke with unknown time of onset guided by advanced imaging: systematic review and meta-analysis of individual patient data

Thomalla, Götz ; Boutitie, Florent ; Ma, Henry ; [weitere]

Elsevier BV ; 2020

In: The Lancet Vol. 396, No. 10262 ( 2020-11), p. 1574-1584

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In: The Lancet, Elsevier BV, Vol. 396, No. 10262 ( 2020-11), p. 1574-1584

Materialart: Online-Ressource

ISSN: 0140-6736

URL: Article

DOI: 10.1016/S0140-6736(20)32163-2

RVK:

XA 10000

Sprache: Englisch

Verlag: Elsevier BV

Publikationsdatum: 2020

ZDB Id: 2067452-1

ZDB Id: 3306-6

ZDB Id: 1476593-7

SSG: 5,21

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4

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Cardiovascular Prognosis in Drug-Resistant Hypertension Stratified by 24-Hour Ambulatory Blood Pressure: The JAMP Study

Kario, Kazuomi ; Hoshide, Satoshi ; Narita, Keisuke ; [weitere]

Ovid Technologies (Wolters Kluwer Health) ; 2021

In: Hypertension Vol. 78, No. 6 ( 2021-12), p. 1781-1790

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In: Hypertension, Ovid Technologies (Wolters Kluwer Health), Vol. 78, No. 6 ( 2021-12), p. 1781-1790

Kurzfassung: Resistant hypertension is an important cardiovascular risk factor. This analysis of the JAMP study (Japan Ambulatory Blood Pressure Monitoring Prospective) data investigated the effects of uncontrolled resistant hypertension diagnosed using ambulatory blood pressure (BP) monitoring on the risk of heart failure (HF) and overall cardiovascular events. The JAMP study patients with hypertension and no HF history were included. They had true resistant hypertension (24-hour BP ≥130/80 mm Hg), pseudoresistant hypertension (24-hour BP 〈 130/80 mm Hg), well-controlled nonresistant hypertension (24-hour BP 〈 130/80 mm Hg), or uncontrolled nonresistant hypertension (24-hour BP ≥130/80 mm Hg). The primary end point was total cardiovascular events, including atherosclerotic cardiovascular disease (fatal/nonfatal stroke and fatal/nonfatal coronary artery disease), and HF. During 4.5±2.4 years of follow-up the overall incidence per 1000 person-years was 10.1 for total cardiovascular disease, 4.1 for stroke, 3.5 for coronary artery disease, and 2.6 for HF. The adjusted risk of total cardiovascular and HF events was significantly increased in patients with true resistant versus controlled nonresistant hypertension (hazard ratio, 1.66 [95% CI, 1.12–2.48] ; P =0.012 and 2.24 [95% CI, 1.17–4.30]; P =0.015, respectively) and versus uncontrolled nonresistant hypertension (1.51 [1.03–2.20]; P =0.034 and 3.03 [1.58–5.83]; P 〈 0.001, respectively). The findings were robust in a sensitivity analysis using a slightly different definition of resistant hypertension. True resistant hypertension diagnosed using ambulatory BP monitoring is a significant independent risk factor for cardiovascular disease events, especially for HF. This highlights the importance of diagnosing and effectively treating resistant hypertension. Registration: URL: https://www.umin.ac.jp/ctr ; Unique identifier: UMIN000020377.

Materialart: Online-Ressource

ISSN: 0194-911X , 1524-4563

URL: Article

DOI: 10.1161/HYPERTENSIONAHA.121.18198

Sprache: Englisch

Verlag: Ovid Technologies (Wolters Kluwer Health)

Publikationsdatum: 2021

ZDB Id: 2094210-2

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5

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A New Assessment of Esophageal Varices by Endoscopic Ultrasonography Using a 15/20‐Megahertz Ultrasonic Probe

NISHIZONO, Masatoshi ; SAKATA, Junichiro ; OHASHI, Tsuyoshi ; [weitere]

Wiley ; 1994

In: Digestive Endoscopy Vol. 6, No. 4 ( 1994-10), p. 320-325

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In: Digestive Endoscopy, Wiley, Vol. 6, No. 4 ( 1994-10), p. 320-325

Kurzfassung: Abstract: We examined esophageal varices using the new technique of endoscopic ultrasonography (EUS) that employed a high‐resolution 15/20 MHz ultrasonic probe. EUS employing the direct contact method, in which the forceps‐channel probe was in direct contact with the lumen, was used in patients with esophageal varices (58 cases) and in control patients without varices (32 cases). Findings were also compared with additional EUS employing the conventional balloon method which was performed on 21 of the patients with esophageal varices. The direct contact method visualized all the varices (endoscopic Grade 1 varices; 2.0 ± 0.7 mm in diameter (mean ± SD) and 11.9 ± 3.1 cm in length, endoscopic Grade 2 or 3 varices; 5.8 ± 3.2 mm in diameter and 16.3 ± 3.0 cm in length). In the 21 patients who underwent EUS by the two different methods, varices were displayed by both methods in 9 cases (7 endoscopic Grade 2 varices, and 2 Grade 3 varices). In the other 12 cases (8 endoscopic Grade 1 varices, and 4 Grade 2 varices) varices were displayed only by the direct contact method, and not by the balloon method. The direct contact method can be regarded as a useful technique for the evaluation of esophageal varices.

Materialart: Online-Ressource

ISSN: 0915-5635 , 1443-1661

URL: Issue

URL: Article

DOI: 10.1111/den.1994.6.issue-4

DOI: 10.1111/j.1443-1661.1994.tb00692.x

Sprache: Englisch

Verlag: Wiley

Publikationsdatum: 1994

ZDB Id: 2020071-7

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6

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Safety and efficacy of eculizumab in anti-acetylcholine receptor antibody-positive refractory generalised myasthenia gravis (REGAIN): a phase 3, randomised, double-blind, placebo-controlled, multicentre study

Howard, James F ; Utsugisawa, Kimiaki ; Benatar, Michael ; [weitere]

Elsevier BV ; 2017

In: The Lancet Neurology Vol. 16, No. 12 ( 2017-12), p. 976-986

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In: The Lancet Neurology, Elsevier BV, Vol. 16, No. 12 ( 2017-12), p. 976-986

Materialart: Online-Ressource

ISSN: 1474-4422

URL: Article

DOI: 10.1016/S1474-4422(17)30369-1

Sprache: Englisch

Verlag: Elsevier BV

Publikationsdatum: 2017

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7

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Diaphragm pacing implantation in Japan for a patient with cervical spinal cord injury: A case report

Yokota, Kazuya ; Masuda, Muneaki ; Koga, Ryuichiro ; [weitere]

Ovid Technologies (Wolters Kluwer Health) ; 2022

In: Medicine Vol. 101, No. 26 ( 2022-07-1), p. e29719-

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In: Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 101, No. 26 ( 2022-07-1), p. e29719-

Kurzfassung: Traumatic cervical spinal cord injury (SCI) is a devastating condition leading to respiratory failure that requires permanent mechanical ventilation, which is the main driver of increased medical costs. There is a great demand for establishing therapeutic interventions to treat respiratory dysfunction following severe cervical SCI. Patient concerns and diagnosis: We present a 24-year-old man who sustained a cervical displaced C2–C3 fracture with SCI due to a traffic accident. As the patient presented with tetraplegia and difficulty in spontaneous breathing following injury, he was immediately intubated and placed on a ventilator with cervical external fixation by halo orthosis. The patient then underwent open reduction and posterior fusion of the cervical spine 3 weeks after injury. Although the patient showed significant motor recovery of the upper and lower limbs over time, only a slight improvement in lung capacity was observed. Interventions and outcomes: At 1.5 years after injury, a diaphragmatic pacing stimulator was surgically implanted to support the patient’s respiratory function. The mechanical ventilator support was successfully withdrawn from the patient 14 weeks after implantation. We observed that both the vital capacity and tidal volume of the patient were significantly promoted following implantation. The patient finally returned to daily life without any mechanical support. Lessons: The findings of this report suggest that diaphragmatic pacing implantation could be a promising treatment for improving respiratory function after severe cervical SCI. To our knowledge, this is the first SCI patient treated with a diaphragm pacing implantation covered by official medical insurance in Japan.

Materialart: Online-Ressource

ISSN: 1536-5964

URL: Article

DOI: 10.1097/MD.0000000000029719

Sprache: Englisch

Verlag: Ovid Technologies (Wolters Kluwer Health)

Publikationsdatum: 2022

ZDB Id: 2049818-4

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8

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Acute stroke rehabilitation for gait training with cyborg type robot Hybrid Assistive Limb: A pilot study

Yokota, Chiaki ; Yamamoto, Yukio ; Kamada, Masatoshi ; [weitere]

Elsevier BV ; 2019

In: Journal of the Neurological Sciences Vol. 404 ( 2019-09), p. 11-15

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In: Journal of the Neurological Sciences, Elsevier BV, Vol. 404 ( 2019-09), p. 11-15

Materialart: Online-Ressource

ISSN: 0022-510X

URL: Article

DOI: 10.1016/j.jns.2019.07.012

Sprache: Englisch

Verlag: Elsevier BV

Publikationsdatum: 2019

ZDB Id: 1500645-1

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9

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Effect of cyborg-type robot Hybrid Assistive Limb on patients with severe walking disability in acute stroke: A randomized controlled study

Yokota, Chiaki ; Tanaka, Kenta ; Omae, Katsuhiro ; [weitere]

Elsevier BV ; 2023

In: Journal of Stroke and Cerebrovascular Diseases Vol. 32, No. 4 ( 2023-04), p. 107020-

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In: Journal of Stroke and Cerebrovascular Diseases, Elsevier BV, Vol. 32, No. 4 ( 2023-04), p. 107020-

Materialart: Online-Ressource

ISSN: 1052-3057

URL: Article

DOI: 10.1016/j.jstrokecerebrovasdis.2023.107020

Sprache: Englisch

Verlag: Elsevier BV

Publikationsdatum: 2023

ZDB Id: 2052957-0

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10

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Clinical outcomes and learning curve of a laparoscopic adrenalectomy in 103 consecutive cases at a single institute

ETO, MASATOSHI ; HARANO, MASAHIKO ; KOGA, HIROFUMI ; [weitere]

Wiley ; 2006

In: International Journal of Urology Vol. 13, No. 6 ( 2006-06), p. 671-676

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In: International Journal of Urology, Wiley, Vol. 13, No. 6 ( 2006-06), p. 671-676

Kurzfassung: Objective: We examined the clinical outcomes and the learning curve for a laparoscopic adrenalectomy (LA) in 103 consecutive cases performed by three surgeons at our institute, according to the type of adrenal disorder. Patients and Methods: One hundred and three patients with adrenal tumors, including 38 cases of primary aldosteronism, 33 cases of Cushing syndrome (including preclinical Cushing syndrome), 15 cases of pheochromocytoma, and nine cases of non‐functioning adenoma were evaluated, while focusing on the approaches, intraoperative and postoperative data, and the learning curve of LA, according the type of adrenal disorder. Results: There was no significant difference in the operation time, estimated blood loss, incidence of conversion to open surgery and blood transfusion, or postoperative recovery among the patients treated by LA for aldosteronoma, Cushing adenoma, pheochromocytoma, and non‐functioning adenoma. In the cases of aldosteronoma and Cushing adenoma, the learning curve for the operation time and blood loss in each operator tended to decrease as the number of operations increased. On the other hand, in the cases treated by LA for pheochromocytoma, no trends in either the operation time or blood loss were observed. However, there has been neither any conversion to open surgery nor blood transfusion in cases treated by LA since 1998 (our 42nd case), even after the changes in the operators. Conclusions: Our results clearly indicate that LA is becoming safer than before, probably due to improvements in the technique, education, and training of surgeons, in addition to the increased number of cases now treated by LA.

Materialart: Online-Ressource

ISSN: 0919-8172 , 1442-2042

URL: Issue

URL: Article

DOI: 10.1111/iju.2006.13.issue-6

DOI: 10.1111/j.1442-2042.2006.01383.x

Sprache: Englisch

Verlag: Wiley

Publikationsdatum: 2006

ZDB Id: 2009793-1

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