Multiple Sclerosis in Patients with Intracranial Aneurysms: Coincidence or Correlation?
Clin Neurol Neurosurg. 2020 Apr 20;195:105864
Authors: Walker M, Young CC, Levitt MR, Saal-Zapata G
PMID: 32361026 [PubMed - as supplied by publisher]
Letter: Considerations for Performing Emergent Neurointerventional Procedures in a COVID-19 Environment.
Neurosurgery. 2020 May 02;:
Authors: Pandey AS, Ringer AJ, Rai A, Kan PT, Jabbour PM, Siddiqui A, Levy E, Snyder KV, Riina HA, Tanweer O, Levitt MR, Kim LJ, Veznedaroglu E, Binning M, Arthur AS, Mocco J, Schirmer CM, Thompson BG, Langer D, Endovascular Neurosurgery Research Group (ENRG)
PMID: 32358606 [PubMed - as supplied by publisher]
Pilchard orthomyxovirus (POMV). II. Causative agent of salmon orthomyxoviral necrosis, a new disease of farmed Atlantic salmon Salmo salar.
Dis Aquat Organ. 2020 Apr 30;139:51-68
Authors: Godwin SE, Morrison RN, Knowles G, Cornish MC, Hayes D, Carson J
Abstract
Since 2012, an orthomyxo-like virus has been consistently linked to epizootics in marine farmed Atlantic salmon in Tasmania, Australia. Here we describe the properties of the virus, designated the pilchard orthomyxovirus (POMV), in cell culture and present data verifying its direct role in a disease of Atlantic salmon. In infected cells, viral RNA was detectable in both the nucleus and cytoplasm, consistent with the replication cycle of an orthomyxovirus. Viral replication in vitro was temperature-dependent (within a range of 10-20°C), and yields of virus were typically in excess of 107 TCID50 ml-1. In controlled infection trials, cell culture-derived POMV produced significant morbidity in Atlantic salmon fry, pre-smolt and post-smolt. In all cases, the development of disease was rapid, with moribund fish detected within 5 d of direct exposure to POMV, and maximum cumulative morbidity occurring within 4 wk. The experimentally infected fish developed a characteristic suite of gross and microscopic pathological changes, which were consistent with those observed in Atlantic salmon overtly affected by POMV-associated disease on sea farms. These included necrotic lesions across multiple organs that were directly associated with the presence of the virus. Together, our observations indicate that POMV is an endemic virus likely transmitted from wild fish to farmed Atlantic salmon in Tasmania. The virus is pathogenic to Atlantic salmon in freshwater and marine environments and causes a disease that we have named salmon orthomyxoviral necrosis.
PMID: 32351236 [PubMed - indexed for MEDLINE]
Medication treatment for opioid use disorder in expectant mothers (MOMs): Design considerations for a pragmatic randomized trial comparing extended-release and daily buprenorphine formulations.
Contemp Clin Trials. 2020 Apr 27;:106014
Authors: Winhusen T, Lofwall M, Jones HE, Wilder C, Lindblad R, Schiff DM, Wexelblatt S, Merhar S, Murphy SM, Greenfield SF, Terplan M, Wachman EM, Kropp F, Theobald J, Lewis M, Matthews AG, Guille C, Silverstein M, Rosa C
Abstract
Opioid use disorder (OUD) in pregnant women has increased significantly in recent years. Maintaining these women on sublingual (SL) buprenorphine (BUP) is an evidence-based practice but BUP-SL is associated with several disadvantages that an extended-release (XR) BUP formulation could eliminate. The National Drug Abuse Treatment Clinical Trials Network (CTN) is conducting an intent-to-treat, two-arm, open-label, pragmatic randomized controlled trial, Medication treatment for Opioid-dependent expectant Mothers (MOMs), to compare mother and infant outcomes of pregnant women with OUD treated with BUP-XR, relative to BUP-SL. A second aim is to determine the relative economic value of utilizing BUP-XR. Approximately 300 pregnant women with an estimated gestational age (EGA) of 6-30 weeks, recruited from 12 sites, will be randomized in a 1:1 ratio to BUP-XR or BUP-SL, balancing on site, EGA, and BUP-SL status (taking/not taking) at the time of randomization. Participants will be provided with study medication and attend weekly medication visits through 12 months postpartum. Participants will be invited to participate in two sub-studies to evaluate the: 1) mechanisms by which BUP-XR may improve mother and infant outcomes; and 2) effects of prenatal exposure to BUP-XR versus BUP-SL on infant neurodevelopment. This paper describes the key design decisions for the main trial made during protocol development. This Investigational New Drug (IND) trial uniquely uses pragmatic features where feasible in order to maximize external validity, hence increasing the potential to inform clinical practice guidelines and address multiple knowledge gaps for treatment of this patient population.
PMID: 32353544 [PubMed - as supplied by publisher]
Exposure to the environmental pollutant bisphenol A diglycidyl ether (BADGE) causes cell over-proliferation in Drosophila.
Environ Sci Pollut Res Int. 2020 Jul;27(20):25261-25270
Authors: Williams MJ, Cao H, Lindkvist T, Mothes TJ, Schiöth HB
Abstract
Bisphenol A diglycidyl ether (BADGE), a derivative of bisphenol A (BPA), is widely used in the manufacture of epoxy resins as well as a coating on food containers. Recent studies have demonstrated the adverse effects of BADGE on reproduction and development in rodents and amphibians, but how BADGE affects biological activity is not understood. To gain a better understanding of the biological effects of BADGE exposure during development, we used the model organism Drosophila melanogaster and performed whole transcriptome sequencing. Interestingly, when Drosophila are raised on food containing BADGE, genes having significantly increased transcript numbers are enriched for those involved in regulating cell proliferation, including DNA replication and cell cycle control. Furthermore, raising larvae on BADGE-containing food induces hemocyte (blood cell) over-proliferation. This effect can be stimulated with even lower concentrations of BADGE if the hemocytes are already primed for cell proliferation by the expression of dominant active Ras GTPase. We conclude that chronic exposure to the xenobiotic BADGE throughout development can induce cell proliferation.
PMID: 32347502 [PubMed - indexed for MEDLINE]
Predicted loss and gain of function mutations in ACO1 are associated with erythropoiesis.
Commun Biol. 2020 Apr 23;3(1):189
Authors: Oskarsson GR, Oddsson A, Magnusson MK, Kristjansson RP, Halldorsson GH, Ferkingstad E, Zink F, Helgadottir A, Ivarsdottir EV, Arnadottir GA, Jensson BO, Katrinardottir H, Sveinbjornsson G, Kristinsdottir AM, Lee AL, Saemundsdottir J, Stefansdottir L, Sigurdsson JK, Davidsson OB, Benonisdottir S, Jonasdottir A, Jonasdottir A, Jonsson S, Gudmundsson RL, Asselbergs FW, Tragante V, Gunnarsson B, Masson G, Thorleifsson G, Rafnar T, Holm H, Olafsson I, Onundarson PT, Gudbjartsson DF, Norddahl GL, Thorsteinsdottir U, Sulem P, Stefansson K
Abstract
Hemoglobin is the essential oxygen-carrying molecule in humans and is regulated by cellular iron and oxygen sensing mechanisms. To search for novel variants associated with hemoglobin concentration, we performed genome-wide association studies of hemoglobin concentration using a combined set of 684,122 individuals from Iceland and the UK. Notably, we found seven novel variants, six rare coding and one common, at the ACO1 locus associating with either decreased or increased hemoglobin concentration. Of these variants, the missense Cys506Ser and the stop-gained Lys334Ter mutations are specific to eight and ten generation pedigrees, respectively, and have the two largest effects in the study (EffectCys506Ser = -1.61 SD, CI95 = [-1.98, -1.35]; EffectLys334Ter = 0.63 SD, CI95 = [0.36, 0.91]). We also find Cys506Ser to associate with increased risk of persistent anemia (OR = 17.1, P = 2 × 10-14). The strong bidirectional effects seen in this study implicate ACO1, a known iron sensing molecule, as a major homeostatic regulator of hemoglobin concentration.
PMID: 32327693 [PubMed - in process]
Health and economic outcomes of treatment with extended-release naltrexone among pre-release prisoners with opioid use disorder (HOPPER): protocol for an evaluation of two randomized effectiveness trials.
Addict Sci Clin Pract. 2020 Apr 22;15(1):15
Authors: Murphy SM, Jeng PJ, Poole SA, Jalali A, Vocci FJ, Gordon MS, Woody GE, Polsky D
Abstract
BACKGROUND: Persons with an opioid use disorder (OUD) who were incarcerated face many challenges to remaining abstinent; concomitantly, opioid-overdose is the leading cause of death among this population, with the initial weeks following release proving especially fatal. Extended-release naltrexone (XR-NTX) is the most widely-accepted, evidence-based OUD pharmacotherapy in criminal justice settings, and ensures approximately 30 days of protection from opioid overdose. The high cost of XR-NTX serves as a barrier to uptake by many prison/jail systems; however, the cost of the medication should not be viewed in isolation. Prison/jail healthcare budgets are ultimately determined by policymakers, and the benefits/cost-offsets associated with effective OUD treatment will directly and indirectly affect their overall budgets, and society as a whole.
METHODS: This protocol describes a study funded by the National Institute of Drug Abuse (NIDA) to: evaluate changes in healthcare utilization, health-related quality-of-life, and other resources associated with different strategies of XR-NTX delivery to persons with OUD being released from incarceration; and estimate the relative "value" of each strategy. Data from two ongoing, publicly-funded, randomized-controlled trials will be used to evaluate these questions. In Study A, (XR-NTX Before vs. After Reentry), participants are randomized to receive their first XR-NTX dose before release, or at a nearby program post-release. In Study B, (enhanced XR-NTX vs. XR-NTX), both arms receive XR-NTX prior to release; the enhanced arm receives mobile medical (place of residence) XR-NTX treatment post-release, and the XR-NTX arm receives referral to a community treatment program post-release. The economic data collection instruments required to evaluate outcomes of interest were incorporated into both studies from baseline. Moreover, because the same instruments are being used in both trials on comparable populations, we have the opportunity to not only assess differences in outcomes between study arms within each trial, but also to merge the data sets and test for differences across trials.
DISCUSSION: Initiating XR-NTX for OUD prior to release from incarceration may improve patient health and well-being, while also producing downstream cost-offsets. This study offers the unique opportunity to assess the effectiveness and cost-effectiveness of multiple strategies, according to different stakeholder perspectives.
PMID: 32321570 [PubMed - in process]
Changes to management of a non-pandemic illness during the COVID-19 pandemic: case study of invasive management of acute coronary syndrome.
N Z Med J. 2020 04 24;133(1513):101-106
Authors: Coffey S, Moynagh A, Green B, Edmond J, Wilkins GT, Pemberton J, Wilkins B, Williams MJ, Arnold B
Abstract
The coronavirus 2019 (COVID-19) pandemic requires significant changes to standard operating procedures for non-COVID-19 related illnesses. Balancing the benefit from standard evidence-based treatments with the risks posed by COVID-19 to patients, healthcare workers and to the population at large is difficult due to incomplete and rapidly changing information. In this article, we use management of acute coronary syndromes as a case study to show how these competing risks and benefits can be resolved, albeit incompletely. While the risks due to COVID-19 in patients with acute coronary syndromes is unclear, the benefits of standard management are well established in this condition. As an aid to decision making, we recommend systematic estimation of the risks and benefits for management of any condition where there is likely to be an increase in non-COVID-19 related mortality and morbidity due to changes in routine care.
PMID: 32325474 [PubMed - indexed for MEDLINE]
Daratumumab, Lenalidomide, Bortezomib, & Dexamethasone for Transplant-eligible Newly Diagnosed Multiple Myeloma: GRIFFIN.
Blood. 2020 Apr 23;:
Authors: Voorhees PM, Kaufman JL, Laubach JP, Sborov DW, Reeves B, Rodriguez C, Chari A, Silbermann R, Costa LJ, Anderson LD, Nathwani N, Shah N, Efebera YA, Holstein SA, Costello C, Jakubowiak A, Wildes T, Orlowski RZ, Shain KH, Cowan AJ, Murphy SP, Lutska Y, Pei H, Ukropec J, Vermeulen J, de Boer C, Hoehn D, Lin T, Richardson PG
Abstract
Lenalidomide, bortezomib, and dexamethasone (RVd) followed by autologous stem cell transplantation (ASCT) is standard frontline therapy for transplant-eligible patients with newly diagnosed multiple myeloma (NDMM). This study evaluated addition of daratumumab (D) to RVd in ASCT-eligible NDMM patients. Patients (N=207) were randomized 1:1 to receive RVd ±D induction (4 cycles), ASCT, RVd ±D consolidation (2 cycles), and lenalidomide ±D maintenance (26 cycles). At the primary endpoint analysis, the stringent complete response (sCR) rate by the end of post-ASCT consolidation favored D-RVd over RVd (42.4% vs 32.0%; odds ratio, 1.57; 95% confidence interval [CI], 0.87-2.82; 1-sided P=0.068) and met the prespecified 1-sided alpha of 0.10. With longer follow-up (median, 22.1 months), responses continued to deepen; rates of sCR improved for D-RVd versus RVd (62.6% vs 45.4%; P=0.0177), as did rates of minimal residual disease negativity (10-5 threshold) in the intent-to-treat population (51.0% vs 20.4%; P<0.0001). Four (3.8%) and 7 (6.8%) patients in the D-RVd and RVd groups progressed, respectively, and 24-month progression-free survival rates were 95.8% (D-RVd) and 89.8% (RVd). Grade 3/4 hematologic adverse events were more common with D-RVd. More infections occurred with D-RVd, but rates of grade 3/4 infections were similar. Median CD34+ cell yield was 8.2´106/kg for D-RVd and 9.4´106/kg for RVd, although plerixafor use was more common in the D-RVd arm. There was no difference in median times to neutrophil or platelet engraftment. In summary, daratumumab with RVd induction and consolidation improved depth of response in patients with transplant-eligible NDMM, with no new safety concerns. Clinicaltrials.gov NCT02874742.
PMID: 32325490 [PubMed - as supplied by publisher]
The importance of reporting house dust mite endotoxin abundance: impact on the lung transcriptome.
Am J Physiol Lung Cell Mol Physiol. 2020 06 01;318(6):L1229-L1236
Authors: Pascoe CD, Jha A, Basu S, Mahood T, Lee A, Hinshaw S, Falsafi R, Hancock REW, Mookherjee N, Halayko AJ
Abstract
The abundance of lipopolysaccharide (LPS) in house dust mite (HDM) preparations is broad and mirrors the variability seen in the homes of people with asthma. LPS in commercially available stocks ranges from 31 to 5,2000 endotoxin units. The influence of vastly different LPS loads on the mechanisms that define the immune and inflammatory phenotype of HDM-challenged mice has not been defined. This aim of the study was to understand the lung phenotype of mice challenged with HDM extract containing high or low levels of LPS. Female BALB/c mice were sensitized for 2 wk with commercial HDM extract containing either high (36,000 endotoxin units; HHDM) or low (615 endotoxin units; LHDM) levels of LPS. Lung phenotype was characterized by measuring lung function, total and differential cell counts, cytokine abundance, and the lung transcriptome by RNA-sequencing. LPS levels in HDM stocks used for preclinical asthma research in mice remain poorly reported. In 2019, only 14% of papers specified LPS concentration in HDM lots. Specific differences existed in airway responsiveness between mice challenged with HHDM or LHDM. HHDM- and LHDM-induced cytokine profiles of bronchial lavage were significantly different and the lung transcriptome was differentially enriched for genes involved in DNA damage repair or cilium movement, following HHDM or LHDM challenge, respectively. The abundance of LPS in commercially available HDM influences the phenotype of allergic airways inflammation in mice. Failure to report the level of LPS in HDM extracts used in animal models of airway disease will lead to inconsistency in reproducibility and reliability of published data.
PMID: 32320279 [PubMed - indexed for MEDLINE]
Identification of reference markers for characterizing honey bee (Apis mellifera) hemocyte classes.
Dev Comp Immunol. 2020 Apr 19;:103701
Authors: Gábor E, Cinege G, Csordás G, Rusvai M, Honti V, Kolics B, Török T, Williams MJ, Kurucz É, Andó I
Abstract
Cell mediated immunity of the honey bee (Apis mellifera) involves the activity of several hemocyte populations, currently defined by morphological features and lectin binding characteristics. The objective of the present study was to identify molecular markers capable of characterizing subsets of honey bee hemocytes. We developed and employed monoclonal antibodies with restricted reactions to functionally distinct hemocyte subpopulations. Melanizing cells, known as oenocytoids, were defined by an antibody to prophenoloxidase, aggregating cells were identified by the expression of Hemolectin, and phagocytic cells were identified by a marker expressed on granulocytes. We anticipate that this combination of antibodies not only allows for the detection of functionally distinct hemocyte subtypes, but will help to further the exploration of hematopoietic compartments, as well as reveal details of the honey bee cellular immune defense against parasites and microbes.
PMID: 32320738 [PubMed - as supplied by publisher]
Evaluating angioarchitectural characteristics of glial and metastatic brain tumors with conventional magnetic resonance imaging.
J Clin Neurosci. 2020 Jun;76:46-52
Authors: Abecassis IJ, Cordy B, Durfy S, Andre JB, Levitt MR, Ellenbogen RG, Silbergeld DL, Ko AL
Abstract
Primary and metastatic brain tumors can overlap in traditional imaging features detected on preoperative conventional magnetic resonance imaging (MRI). The research objective was to determine whether morphological vascular characteristics present in routine preoperative imaging using traditional MRI sequences are predictive of primary versus metastatic brain tumors; secondarily to determine association of conventional and vascular-related imaging parameters with intraoperative blood loss, pathological invasion, and World Health Organization (WHO) tumor grade. A retrospective review analyzed 100 consecutive intracranial tumor surgeries, 50 WHO grade II-IV gliomas and 50 intracranial metastases. Two blinded expert readers independently evaluated preoperative MRIs, obtained via standard morphological imaging sequences, for adjacent or intra-tumoral arterial aneurysm, peritumoral venous ectasia, prominence, or engorgement ("aberrant peritumoral vessels"), and prominent intra-tumoral flow voids. Multivariate analysis was performed to develop models predictive of glioma and glioblastoma (GBM). Aberrant peritumoral vessels and prominent intra-tumoral flow voids were statistically significant predictors of glioma in univariate analyses (p = 0.048, p = 0.001, respectively) and when combined in multivariate analysis (OR = 5.23, p = 0.001), particularly for GBM (OR = 9.08, p < 0.001). Multivariate modeling identified prominent intra-tumoral flow voids and FLAIR invasion as the strongest combined predictors of gliomas and GBM. Aberrant peritumoral vessels and larger tumor volume predicted higher intraoperative blood loss in all analyses. No vascular-related parameters predicted pathological invasion on multivariate analysis. Aberrant peritumoral vessels and prominent intra-tumoral flow voids were predictive of gliomas, specifically GBM. These vascular characteristics, evaluated on routine clinical preoperative MRI imaging, may aid in distinguishinggliomafrom brainmetastases andmay predict intraoperative blood loss.
PMID: 32312627 [PubMed - indexed for MEDLINE]
Neurointervention for emergent large vessel occlusion during the covid-19 pandemic.
J Neurointerv Surg. 2020 Apr 20;:
Authors: Fiorella D, Fargen KM, Leslie-Mazwi TM, Levitt M, Probst S, Bergese S, Hirsch JA, Albuquerque FC
PMID: 32312799 [PubMed - as supplied by publisher]
Stochastic growth pattern of untreated human glioblastomas predicts the survival time for patients.
Sci Rep. 2020 04 20;10(1):6642
Authors: Ma Z, Niu B, Phan TA, Stensjøen AL, Ene C, Woodiwiss T, Wang T, Maini PK, Holland EC, Tian JP
Abstract
Glioblastomas are highly malignant brain tumors. Knowledge of growth rates and growth patterns is useful for understanding tumor biology and planning treatment logistics. Based on untreated human glioblastoma data collected in Trondheim, Norway, we first fit the average growth to a Gompertz curve, then find a best fitted white noise term for the growth rate variance. Combining these two fits, we obtain a new type of Gompertz diffusion dynamics, which is a stochastic differential equation (SDE). Newly collected untreated human glioblastoma data in Seattle, US, re-verify our model. Instead of growth curves predicted by deterministic models, our SDE model predicts a band with a center curve as the tumor size average and its width as the tumor size variance over time. Given the glioblastoma size in a patient, our model can predict the patient survival time with a prescribed probability. The survival time is approximately a normal random variable with simple formulas for its mean and variance in terms of tumor sizes. Our model can be applied to studies of tumor treatments. As a demonstration, we numerically investigate different protocols of surgical resection using our model and provide possible theoretical strategies.
PMID: 32313150 [PubMed - indexed for MEDLINE]
Applications of Benchtop NMR in the Organic Chemistry Instructional Laboratory.
Magn Reson Chem. 2020 Apr 19;:
Authors: Morrison RW, Zhang M
Abstract
The instructional organic chemistry laboratory has been substantially improved through the implementation of benchtop NMR analysis. When used in conjunction with unknown reaction components in multi-outcome experiments, NMR analysis transforms the laboratory exercise into an investigative inquiry wherein students elucidate structures for their products and thereby deduce their unknown reaction components. This analytical approach closely models the research laboratory and is a valuable preparatory tool for undergraduate researchers. Three newly developed multi-outcome experiments based upon the Diels-Alder cycloaddition, the synthesis of carboxylic amides, and the Friedel-Crafts alkylation are herein described to illustrate the utility of benchtop NMR analysis in the instructional laboratory.
PMID: 32307736 [PubMed - as supplied by publisher]
Basic science review of birth tissue uses in ophthalmology.
Taiwan J Ophthalmol. 2020 Jan-Mar;10(1):3-12
Authors: Tighe S, Mead OG, Lee A, Tseng SCG
Abstract
The birth tissue is predominantly comprised of amniotic membrane (AM) and umbilical cord (UC), which share the same cell origin as the fetus. These versatile biological tissues have been used to treat a wide range of conjunctival and corneal conditions since 1940. The therapeutic benefits of the birth tissue stem from its anti-inflammatory and anti-scarring properties that orchestrate regenerative healing. Although the birth tissue also contains many cytokines, growth factors, and proteins, the heavy chain 1-hyaluronic acid/pentraxin 3 (HC-HA/PTX3) matrix has been identified to be a major active tissue component responsible for AM/UC's multifactorial therapeutic actions. HC-HA/PTX3 complex is abundantly present in fresh and cryopreserved AM/UC, but not in dehydrated tissue. In this review, we discuss the tissue anatomy, the molecular mechanism of action based on HC-HA/ PTX3 to explain their therapeutic potentials, and the various forms available in ophthalmology.
PMID: 32309118 [PubMed]
Factors associated with age of death in sudden unexpected infant death.
Acta Paediatr. 2020 Apr 18;:
Authors: Allen K, Anderson TM, Chajewska U, Ramirez JM, Mitchell EA
Abstract
AIM: This study aimed to systematically analyze the pregnancy, birth, and demographic-related factors associated with age of death in sudden unexpected infant death (SUID).
METHODS: Data were analyzed from the Centers for Disease Control and Prevention';s Cohort Linked Birth/Infant Death dataset (2011-2013; 11,737,930 live births). SUID was defined as deaths from sudden infant death syndrome, ill-defined causes, or accidental suffocation and strangulation in bed. There were 9,668 SUID deaths (7-364 days; gestation >28 weeks; 0.82/1000 live births). The odds of death at different ages were compared to determine which variables significantly affect the SUID age of death.
RESULTS: 43 features indicated a significant change in age of death with two main patterns: 1) younger chronologic age at death was associated with maternal smoking and factors associated with lower socioeconomic status, and 2) older age associated with low birthweight, prematurity and admission to the neonatal intensive care unit. However, when age was corrected for gestation, these factors were associated with younger age.
CONCLUSION: Factors that varied with age of death are well-documented risk factors for SUID. The majority of these risk factors were associated with younger age at death after allowing for gestational age at birth.
PMID: 32304589 [PubMed - as supplied by publisher]
Cardiac-cerebral-renal associations in pediatric traumatic brain injury: Preliminary findings.
J Clin Neurosci. 2020 Jun;76:126-133
Authors: Lele AV, Alunpipatthanachai B, Clark-Bell C, Watanitanon A, Min Xu M, Anne Moore RVT, Zimmerman JJ, Portman MA, Chesnut RM, Vavilala MS
Abstract
OBJECTIVE: The clinical epidemiology of organ outcomes in pediatric traumatic brain injury (TBI) has not been examined. We describe associated markers of cerebral, cardiac and renal injury after pediatric TBI.
DESIGN: Prospective observational study.
PATIENTS: Children 0-18 years who were hospitalized with TBI.
MEASUREMENTS: Measures of myocardial (at least one elevated plasma troponin [cTnI] ≥ 0.4 ng/ml) and multiorgan (hemodynamic variables, cerebral perfusion, and renal) function were examined within the first ten days of hospital admission and within 24 h of each other.
MAIN RESULTS: Data from 28 children who were 11[IQR 10.3] years, male (64.3%), with isolated TBI (67.9%), injury severity score (ISS) 25[10], and admission Glasgow coma score (GCS) 11[9] were examined. Overall, 50% (14 children) had elevated cTnI, including those with isolated TBI (57.9%; 11/19), polytrauma (33.3%; 3/9), mild TBI (57.1% 8/14), and severe TBI (42.9%; 6/11). Elevated cTnI occurred within the first six days of admission and across all age groups, in both sexes, and regardless of TBI lesion type, GCS, and ISS. Age-adjusted admission tachycardia was associated with cTnI elevation (AUC 0.82; p < 0.001). Reduced urine output occurred more commonly in patients with isolated TBI (27.3% elevated cTnI vs. 0% normal cTnI).
CONCLUSIONS: Myocardial injury commonly occurs during the first six days after pediatric TBI irrespective of injury severity, age, sex, TBI lesion type, or polytrauma. Age-adjusted tachycardia may be a clinical indicator of myocardial injury, and elevated troponin may be associated with cardio-cerebro-renal dysfunction.
PMID: 32299773 [PubMed - indexed for MEDLINE]
Society of NeuroInterventional Surgery recommendations for the care of emergent neurointerventional patients in the setting of COVID-19.
J Neurointerv Surg. 2020 06;12(6):539-541
Authors: Fraser JF, Arthur AS, Chen M, Levitt M, Mocco J, Albuquerque FC, Ansari SA, Dabus G, Jayaraman MV, Mack WJ, Milburn J, Mokin M, Narayanan S, Puri AS, Siddiqui AH, Tsai JP, Klucznik RP
PMID: 32295835 [PubMed - indexed for MEDLINE]
Early repatriation post-thrombectomy: a model of care which maximises the capacity of a stroke network to treat patients with large vessel ischaemic stroke.
J Neurointerv Surg. 2020 Dec;12(12):1166-1171
Authors: Griffin E, Murphy S, Sheehan M, Power S, Brennan P, O'Hare A, Looby S, McWilliams S, Moynihan B, Williams D, Boyle K, O'Neill D, Collins R, Dolan E, Cassidy T, Harbison J, O'Connor M, Alderson J, Thornton J
Abstract
BACKGROUND AND PURPOSE: Healthcare systems are challenged to provide access to thrombectomy in acute stroke patients. Either the "drip and ship" or "mothership" models result in increased numbers of patients in the endovascular stroke centre (ESC). We describe our approach for a "drip, ship, retrieve and leave" model repatriating patients immediately or within 24 hours of thrombectomy.
METHODS: We included consecutive patients who underwent thrombectomy from January 2016 to June 2018. Patients from local region primary stroke centres (PSC) are immediately repatriated and those from remote region PSCs are admitted for 24 hours before repatriation. Key parameters recorded included clinical, radiological and timeline data as well as 90-day modified Rankin Scale (mRS). Patients who stayed beyond the intended time period in the ESC were analysed.
RESULTS: From January 2016 to June 2018, 435 patients were transferred, with 352 patients in the local region group and 83 in the remote region group. The median NIHSS was 16 with a median ASPECTS of 9. Good functional outcome was seen in 47% of patients with a mortality rate of 19%. The local region group that were repatriated at the intended time period had a 90-day mRS 0-2 of 47% compared with 20% of those admitted to the ESC (P=0.006). Mortality rates were 20% and 27% respectively (P=0.377). The remote region group, repatriated at 24 hours' post-emergency endovascular thrombectomy had 90-day mRS 0-2 of 65% compared with 41% in the group admitted (P=0.042). Mortality rates were 4% and 22% respectively (P=0.007).
CONCLUSION: This model enables the treatment of large numbers of patients with large vessel occlusion acute ischaemic stroke with thrombectomy within a national stroke service and system of care which would not otherwise be facilitated.
PMID: 32295836 [PubMed - indexed for MEDLINE]
