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Bendszus M, Fiehler J, Subtil F, Bonekamp S, Aamodt AH, Fuentes B, Gizewski ER, Hill MD, Krajina A, Pierot L, Simonsen CZ, Zeleňák K, Blauenfeldt RA, Cheng B, Denis A, Deutschmann H, Dorn F, Flottmann F, Gellißen S, Gerber JC, Goyal M, Haring J, Herweh C, Hopf-Jensen S, Hua VT, Jensen M, Kastrup A, Keil CF, Klepanec A, Kurča E, Mikkelsen R, Möhlenbruch M, Müller-Hülsbeck S, Münnich N, Pagano P, Papanagiotou P, Petzold GC, Pham M, Puetz V, Raupach J, Reimann G, Ringleb PA, Schell M, Schlemm E, Schönenberger S, Tennøe B, Ulfert C, Vališ K, Vítková E, Vollherbst DF, Wick W, Thomalla G. Endovascular thrombectomy for acute ischaemic stroke with established large infarct: multicentre, open-label, randomised trial. Lancet 2023; 402:1753-1763. [PMID: 37837989 DOI: 10.1016/s0140-6736(23)02032-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 09/12/2023] [Accepted: 09/18/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Recent evidence suggests a beneficial effect of endovascular thrombectomy in acute ischaemic stroke with large infarct; however, previous trials have relied on multimodal brain imaging, whereas non-contrast CT is mostly used in clinical practice. METHODS In a prospective multicentre, open-label, randomised trial, patients with acute ischaemic stroke due to large vessel occlusion in the anterior circulation and a large established infarct indicated by an Alberta Stroke Program Early Computed Tomographic Score (ASPECTS) of 3-5 were randomly assigned using a central, web-based system (using a 1:1 ratio) to receive either endovascular thrombectomy with medical treatment or medical treatment (ie, standard of care) alone up to 12 h from stroke onset. The study was conducted in 40 hospitals in Europe and one site in Canada. The primary outcome was functional outcome across the entire range of the modified Rankin Scale at 90 days, assessed by investigators masked to treatment assignment. The primary analysis was done in the intention-to-treat population. Safety endpoints included mortality and rates of symptomatic intracranial haemorrhage and were analysed in the safety population, which included all patients based on the treatment they received. This trial is registered with ClinicalTrials.gov, NCT03094715. FINDINGS From July 17, 2018, to Feb 21, 2023, 253 patients were randomly assigned, with 125 patients assigned to endovascular thrombectomy and 128 to medical treatment alone. The trial was stopped early for efficacy after the first pre-planned interim analysis. At 90 days, endovascular thrombectomy was associated with a shift in the distribution of scores on the modified Rankin Scale towards better outcome (adjusted common OR 2·58 [95% CI 1·60-4·15]; p=0·0001) and with lower mortality (hazard ratio 0·67 [95% CI 0·46-0·98]; p=0·038). Symptomatic intracranial haemorrhage occurred in seven (6%) patients with thrombectomy and in six (5%) with medical treatment alone. INTERPRETATION Endovascular thrombectomy was associated with improved functional outcome and lower mortality in patients with acute ischaemic stroke from large vessel occlusion with established large infarct in a setting using non-contrast CT as the predominant imaging modality for patient selection. FUNDING EU Horizon 2020.
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Affiliation(s)
- Martin Bendszus
- Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Jens Fiehler
- Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; eppdata GmbH, Hamburg, Germany
| | - Fabien Subtil
- Service de Biostatistique, Hospices Civils de Lyon, Lyon, France; Laboratoire de Biométrie et Biologie Évolutive, Université de Lyon, Villeurbanne, France
| | - Susanne Bonekamp
- Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | | | - Blanca Fuentes
- Department of Neurology and Stroke Center, Hospital La Paz Institute for Health Research-La Paz University Hospital-Universidad Autonoma de Madrid, Madrid, Spain
| | - Elke R Gizewski
- Department of Neuroradiology, Medical University Innsbruck, Innsbruck, Austria
| | - Michael D Hill
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Health Science Centre, University of Calgary & Foothills Medical Centre, Calgary, AB, Canada
| | - Antonin Krajina
- Department of Radiology, Faculty of Medicine in Hradec Kralove, Charles University, Czech Republic
| | - Laurent Pierot
- Department of Neuroradiology, Hôpital Maison-Blanche, Université Reims-Champagne-Ardenne, Reims, France
| | - Claus Z Simonsen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Kamil Zeleňák
- Clinic of Radiology, Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia
| | | | - Bastian Cheng
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Angélique Denis
- Service de Biostatistique, Hospices Civils de Lyon, Lyon, France; Laboratoire de Biométrie et Biologie Évolutive, Université de Lyon, Villeurbanne, France
| | - Hannes Deutschmann
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University Graz, Graz, Austria
| | - Franziska Dorn
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum Bonn, Bonn, Germany
| | - Fabian Flottmann
- Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Gellißen
- Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes C Gerber
- Institute of Neuroradiology, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany; Dresden Neurovascular Center, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
| | - Mayank Goyal
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Health Science Centre, University of Calgary & Foothills Medical Centre, Calgary, AB, Canada
| | - Jozef Haring
- Department of Neurology, Faculty Hospital Trnava, Trnava, Slovakia
| | - Christian Herweh
- Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Silke Hopf-Jensen
- Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, DIAKO Krankenhaus gGmbH, Flensburg, Germany
| | - Vi Tuan Hua
- Department of Neurology, Hôpital Maison-Blanche, Université Reims-Champagne-Ardenne, Reims, France
| | - Märit Jensen
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas Kastrup
- Klinik für Neurologie, Klinikum Bremen Mitte, Bremen, Germany
| | - Christiane Fee Keil
- Institut für Neuroradiologie, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Andrej Klepanec
- Department of Radiology, Faculty Hospital Trnava, Trnava, Slovakia
| | - Egon Kurča
- Clinic of Neurology, Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia
| | - Ronni Mikkelsen
- Department of Neuroradiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Stefan Müller-Hülsbeck
- Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, DIAKO Krankenhaus gGmbH, Flensburg, Germany
| | - Nico Münnich
- Klinikum Dortmund gGmbH, Klinikum der Universität Witten/Herdecke, Dortmund, Germany
| | - Paolo Pagano
- Department of Neuroradiology, Hôpital Maison-Blanche, Université Reims-Champagne-Ardenne, Reims, France
| | - Panagiotis Papanagiotou
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Klinikum Bremen Mitte, Bremen, Germany; Department of Radiology, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Gabor C Petzold
- Vascular Neurology Research Group, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany; Division of Vascular Neurology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Mirko Pham
- Institut für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Volker Puetz
- Department of Neurology, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany; Dresden Neurovascular Center, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
| | - Jan Raupach
- Department of Radiology, Faculty of Medicine in Hradec Kralove, Charles University, Czech Republic
| | - Gernot Reimann
- Klinikum Dortmund gGmbH, Klinikum der Universität Witten/Herdecke, Dortmund, Germany
| | | | - Maximilian Schell
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Eckhard Schlemm
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | | | - Bjørn Tennøe
- Department of Neuroradiology, Oslo University Hospital, Oslo, Norway
| | - Christian Ulfert
- Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Kateřina Vališ
- St Anne's University Hospital Brno, Brno, Czech Republic
| | - Eva Vítková
- Department of Neurology, Faculty of Medicine in Hradec Kralove, Charles University, Czech Republic
| | | | - Wolfgang Wick
- Neurologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Götz Thomalla
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
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Lekatz LA, Shukla P, Vasquez Hidalgo MA, O'Rourke S, Haring J, Dorsam GP, Grazul-Bilska AT, Vonnahme KA. Uterine kallikrein and arterial bradykinin activities and uterine arterial proliferation in response to acute estradiol-17β exposure in ovariectomized ewes. Domest Anim Endocrinol 2022; 81:106748. [PMID: 35842984 DOI: 10.1016/j.domaniend.2022.106748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/02/2022] [Accepted: 06/06/2022] [Indexed: 11/30/2022]
Abstract
Estradiol-17β (E2) increases kallikrein in rodent and human reproductive tissues. Kallikrein specific activity is increased in the porcine uterus when conceptus E2 is secreted at maternal recognition of pregnancy. When kallikrein acts on kininogen to liberate bradykinin, angiogenic and vasoactive factors are released. The uterus of ovariectomized ewes administered E2 undergoes rapid vascular changes via different patterns of angiogenic and vasoactive factors. Our hypothesis was that E2 would increase the specific activity and protein secretion of tissue kallikrein in endometrial explants culture media (ECM) and ewes exposed to E2 would have uterine arteries that would be more sensitive to the vasodilatory effects of bradykinin. Ovariectomized ewes received 100 mg of E2 implants for 0, 12, 24, or 48 h. After treatment, uterine weights were determined, and caruncles were processed for ECM. Uterine weights and uterine weight per ewe body weight were significantly greater in the 12 and 24 h ewes compared with the 0 h ewes, with the 48 h ewes being similar to the 24 h ewes. There were no statistically significant differences in caruncular tissue kallikrein protein secretion among the treatment groups. There was a tendency (P = 0.09) for duration of E2 exposure to influence tissue kallikrein specific activity where kallikrein activity was greater (P ≤ 0.05) in the 12 and 48 h ewes compared with the 0 h ewes, with 24 h ewes being intermediate (unprotected F test). Uterine arteries from ewes with E2 for 24 and 48 h had more sensitivity to bradykinin, via the bradykinin receptor 2, than uterine arteries from ewes with 0 or 12 h E2 exposure. We fail to reject our hypothesis as E2 did elicit a positive response in tissue kallikrein specific activity and bradykinin response. Further investigations are needed to determine how kallikrein and bradykinin may be involved in vascular remodeling of the ovine uterus.
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Affiliation(s)
- L A Lekatz
- Department of Animal Sciences, North Dakota State University, Fargo, ND 58108, USA
| | - P Shukla
- Department of Pharmaceutical Sciences, North Dakota State University, Fargo, ND 58108, USA
| | - M A Vasquez Hidalgo
- Department of Animal Sciences, North Dakota State University, Fargo, ND 58108, USA
| | - S O'Rourke
- Department of Pharmaceutical Sciences, North Dakota State University, Fargo, ND 58108, USA
| | - J Haring
- Department of Animal Sciences, North Dakota State University, Fargo, ND 58108, USA
| | - G P Dorsam
- Department of Microbiological Sciences, North Dakota State University, Fargo, ND 58108, USA
| | - A T Grazul-Bilska
- Department of Animal Sciences, North Dakota State University, Fargo, ND 58108, USA
| | - K A Vonnahme
- Department of Animal Sciences, North Dakota State University, Fargo, ND 58108, USA.
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Haring J, Mako M, Haršány J, Krastev G, Hoferica M, Klepanec A. Aspiration Thrombectomy in Patients with Large Vessel Occlusion and Mild Stroke: A Single-Center Experience. Med Sci Monit 2021; 27:e930014. [PMID: 34016941 PMCID: PMC8147007 DOI: 10.12659/msm.930014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate outcomes of patients with mild stroke, defined by National Institutes of Health Stroke Scale (NIHSS) score <6, caused by large vessel occlusion treated with aspiration thrombectomy. MATERIAL AND METHODS Data from the endovascular stroke registry of our center were retrospectively analyzed. Anterior or posterior circulation strokes with NIHSS score <6 upon admission were analyzed. The assessment of a good clinical outcome (modified Rankin scale score 0-2) at day 90 was the primary endpoint. Symptomatic intracranial hemorrhage, defined in European Cooperative Acute Stroke Study grade III, and mortality at day 90 were the safety measures. A successful endovascular procedure was defined as a Thrombolysis in Cerebral Infarction (TICI) score of 2b or 3. RESULTS We included 27 patients treated with immediate mechanical thrombectomy, 19 (70.4%) in the anterior circulation and 8 (29.6%) in the posterior circulation. The mean age was 69.8±12.3 years and 40.7% were male. Thirteen patients (48.1%) received bridging intravenous thrombolysis before endovascular thrombectomy. Twenty-five patients (92.6%) underwent the direct aspiration first-pass technique "ADAPT" as the first choice of endovascular procedure. Successful recanalization was achieved in 25 patients (92.6%). Twenty-one patients (77.8%) had a good functional outcome at the 3-month follow-up, 1 (3.7%) symptomatic intracranial hemorrhage was observed, and 2 patients (7.4%) died. CONCLUSIONS Immediate aspiration thrombectomy may be a safe and feasible first-line treatment option in patients suffering from mild stroke due to large vessel occlusion in the anterior and posterior circulation.
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Affiliation(s)
- Jozef Haring
- Department of Neurology, Faculty Hospital Trnava, Trnava, Slovakia.,Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
| | - Miroslav Mako
- Department of Neurology, Faculty Hospital Trnava, Trnava, Slovakia.,Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Bratislava, Slovakia
| | - Ján Haršány
- Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia.,Department of Radiology, Faculty Hospital Trnava, Trnava, Slovakia
| | - Georgi Krastev
- Department of Neurology, Faculty Hospital Trnava, Trnava, Slovakia
| | - Matúš Hoferica
- Department of Radiology, Faculty Hospital Trnava, Trnava, Slovakia
| | - Andrej Klepanec
- Department of Radiology, Faculty Hospital Trnava, Trnava, Slovakia
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Harsany J, Haring J, Hoferica M, Mako M, Janega P, Krastev G, Klepanec A. Aspiration thrombectomy as the first-line treatment of M2 occlusions. Interv Neuroradiol 2020; 26:383-388. [PMID: 32397859 DOI: 10.1177/1591019920925678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The aim of the present study was (i) to evaluate the safety and efficacy of aspiration thrombectomy in patients with M2 occlusions and (ii) to compare outcome of treatment of occlusion of different M2 segments. MATERIALS AND METHODS Between March 2016 and June 2019, 82 patients with acute ischemic stroke and isolated M2 occlusions were treated in cerebrovascular stroke center with aspiration thrombectomy as the first-line treatment. Functional outcomes of patients with different types of M2 occlusions were statistically compared. Multivariable logistic regression analysis was performed to determine the factors associated with good clinical outcome. RESULTS The mean age was 71.9 ± 13.4 years, 47.6% were men. Aspiration thrombectomy alone was utilized in 72.5% of patients, with 27.5% of patients being treated with a combination of aspiration thrombectomy and stent retriever. At the three-month follow-up, there was no statistically significant difference in functional outcome between different types of M2 occlusions (p = 0.662), however in the underpowered analysis because of the small sample size of patients, with good clinical outcome mRS 0-2 in 50% of all treated patients. Symptomatic intracranial hemorrhage was found in 6.1% of patients. Lower age (OR 0.932, 95% CI 0.878-0.988) and lower NIHSS score upon admission (OR 0.893, 95% CI 0.805-0.991) were independent predictors of good clinical outcome. CONCLUSION Aspiration thrombectomy appeared to be a safe and effective first-line treatment option for patients with M2 occlusion, being the first-line option for almost three-quarters of patients.
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Affiliation(s)
- Jan Harsany
- Department of Radiology, Faculty Hospital Trnava, Trnava, Slovakia
| | - Jozef Haring
- Department of Neurology, Faculty Hospital Trnava, Trnava, Slovakia
| | - Matus Hoferica
- Department of Radiology, Faculty Hospital Trnava, Trnava, Slovakia
| | - Miroslav Mako
- Department of Neurology, Faculty Hospital Trnava, Trnava, Slovakia
| | - Pavol Janega
- Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
| | - Georgi Krastev
- Department of Neurology, Faculty Hospital Trnava, Trnava, Slovakia
| | - Andrej Klepanec
- Department of Radiology, Faculty Hospital Trnava, Trnava, Slovakia
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Klepanec A, Harsany J, Haring J, Mako M, Hoferica M, Rusina M, Cisar J, Krastev G. Endovascular treatment of acute ischemic stroke in patients with recurrent intracranial large vessel occlusion. Interv Neuroradiol 2020; 26:376-382. [PMID: 32183596 DOI: 10.1177/1591019920911532] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Data on the treatment with recurrent mechanical thrombectomy of patients with acute ischemic stroke with recurrent large vessel occlusion are limited. We report our experience with recurrent mechanical thrombectomy for recurrent large vessel occlusion. METHODS During the period between May 2013 and August 2018, data on patients with recurrent large vessel occlusion were collected. Baseline clinical characteristics, recanalization technique, recanalization rates and clinical outcomes of patients with recurrent large vessel occlusion treated with mechanical thrombectomy were analyzed. Patients with recurrent large vessel occlusion treated with mechanical thrombectomy were compared with patients who underwent single mechanical thrombectomy. RESULTS During the study period, 7 of 474 patients (1.5%) were treated with mechanical thrombectomy for recurrent large vessel occlusion. The mean age of these patients was 64.4 (±7.9) years, and the mean time interval between thrombectomies was 47 (±48) h. The median baseline National Institutes of Health Stroke Scale (NIHSS) was 12 (range 5-24) before the first and 20 (range 3-34) before the second procedure; the mean NIHSS at discharge was 5 (range 2-25). Good clinical outcome after repeated mechanical thrombectomy defined as modified Rankin scale of 0-2 was achieved in 29% of patients at three months of follow-up. CONCLUSIONS Repeat mechanical thrombectomy is a rare procedure, but appears to be a feasible, safe and effective treatment option in patients with acute ischemic stroke and early recurrent large vessel occlusion.
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Affiliation(s)
- Andrej Klepanec
- Department of Radiology, Faculty Hospital Trnava, Trnava, Slovakia
| | - Jan Harsany
- Department of Radiology, Faculty Hospital Trnava, Trnava, Slovakia
| | - Jozef Haring
- Department of Neurology, Faculty Hospital Trnava, Trnava, Slovakia
| | - Miroslav Mako
- Department of Neurology, Faculty Hospital Trnava, Trnava, Slovakia
| | - Matus Hoferica
- Department of Radiology, Faculty Hospital Trnava, Trnava, Slovakia
| | - Matej Rusina
- Department of Radiology, Faculty Hospital Trnava, Trnava, Slovakia
| | - Juraj Cisar
- Department of Neurology, Faculty Hospital Trnava, Trnava, Slovakia
| | - Georgi Krastev
- Department of Neurology, Faculty Hospital Trnava, Trnava, Slovakia
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Klepanec A, Salat D, Harsany J, Hoferica M, Krastev G, Haring J, Mako M, Janega P, Janosikova L, Lehotska V. Neurointerventionalist and Patient Radiation Doses in Endovascular Treatment of Acute Ischemic Stroke. Cardiovasc Intervent Radiol 2020; 43:604-612. [PMID: 31974745 DOI: 10.1007/s00270-020-02412-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 01/08/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the patient and the neurointerventionalist radiation dose levels during endovascular treatment of acute ischemic stroke, and to analyze factors affecting doses. MATERIALS AND METHODS From October 2017 to January 2019, we prospectively collected patient radiation data and neurointerventionalist data from real-time dosimetry from all consecutive thrombectomies. Multivariate analysis was performed to analyze patient total dose area product (DAP) and neurointerventionalist dose variability in terms of clinical characteristics and the technical parameters of thrombectomies. Local dose reference levels (RL) were derived as the 75th percentile of the patient dose distributions. RESULTS A total of 179 patients were treated during the study period and included in this study. Local dose RL for thrombectomy was derived for total DAP to 34 Gy cm2, cumulative air kerma of 242 mGy and fluoroscopy time of 12 min. The mean neurointerventionalist dose for thrombectomy was 7.7 ± 7.4 µSv. Height (P = 0.018), weight (P = 0.004), body mass index (P = 0.015), puncture to recanalisation (P < 0.001), fluoro time (P < 0.001), number of passes (P < 0.001), thrombolysis in cerebral infarction 2b/3 recanalisation (P = 0.034) and aspiration thrombectomy (P < 0.001) were independent factors affecting patient total DAP, whereas baseline National Institutes of Health Stroke Scale (P = 0.043), puncture to recanalisation (P = 0.003), fluoroscopy time (P = 0.009) and number of passes (P = 0.009) were factors affecting the neurointerventionalist dose. CONCLUSION New reference patient doses lower than those in previously published studies were defined. However, the operator's doses were higher than those in the only available study reporting on operator's dose during cerebral interventions.
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Affiliation(s)
- Andrej Klepanec
- University Hospital Trnava, A. Zarnova 11, 917 75, Trnava, Slovakia.,University of Ss. Cyril and Methodius in Trnava, Namestie J. Herdu 2, 917 01, Trnava, Slovakia
| | - Dusan Salat
- University of Ss. Cyril and Methodius in Trnava, Namestie J. Herdu 2, 917 01, Trnava, Slovakia
| | - Jan Harsany
- University Hospital Trnava, A. Zarnova 11, 917 75, Trnava, Slovakia
| | - Matus Hoferica
- University Hospital Trnava, A. Zarnova 11, 917 75, Trnava, Slovakia
| | - Georgi Krastev
- University Hospital Trnava, A. Zarnova 11, 917 75, Trnava, Slovakia
| | - Jozef Haring
- University Hospital Trnava, A. Zarnova 11, 917 75, Trnava, Slovakia
| | - Miroslav Mako
- University Hospital Trnava, A. Zarnova 11, 917 75, Trnava, Slovakia
| | - Pavol Janega
- Faculty of Medicine, Comenius University in Bratislava, Špitálska 24, 813 72, Bratislava, Slovakia
| | - Lenka Janosikova
- University of Ss. Cyril and Methodius in Trnava, Namestie J. Herdu 2, 917 01, Trnava, Slovakia
| | - Viera Lehotska
- Faculty of Medicine, Comenius University in Bratislava, Heydukova 10, 812 50, Bratislava, Slovakia.
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Cutting C, Oliker A, Haring J, Dayan J, Smith D. Use of Three-Dimensional Computer Graphic Animation to Illustrate Cleft Lip and Palate Surgery. ACTA ACUST UNITED AC 2010. [DOI: 10.3109/10929080209146521] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Cutting C, Oliker A, Haring J, Dayan J, Smith D. Use of three-dimensional computer graphic animation to illustrate cleft lip and palate surgery. Comput Aided Surg 2003; 7:326-31. [PMID: 12731095 DOI: 10.1002/igs.10059] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Three-dimensional (3D) computer animation is not commonly used to illustrate surgical techniques. This article describes the surgery-specific processes that were required to produce animations to teach cleft lip and palate surgery. MATERIALS AND METHODS Three-dimensional models were created using CT scans of two Chinese children with unrepaired clefts (one unilateral and one bilateral). We programmed several custom software tools, including an incision tool, a forceps tool, and a fat tool. RESULTS Three-dimensional animation was found to be particularly useful for illustrating surgical concepts. Positioning the virtual "camera" made it possible to view the anatomy from angles that are impossible to obtain with a real camera. Transparency allows the underlying anatomy to be seen during surgical repair while maintaining a view of the overlaying tissue relationships. Finally, the representation of motion allows modeling of anatomical mechanics that cannot be done with static illustrations. The animations presented in this article can be viewed on-line at http://www.smiletrain.org/programs/virtual_surgery2.htm. CONCLUSIONS Sophisticated surgical procedures are clarified with the use of 3D animation software and customized software tools. The next step in the development of this technology is the creation of interactive simulators that recreate the experience of surgery in a safe, digital environment.
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Affiliation(s)
- C Cutting
- Institute of Reconstructive Plastic Surgery, New York University Medical Center, New York, New York 10016, USA.
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Abstract
Inoculation of mice with most neurotropic strains of the coronavirus mouse hepatitis virus results in an immune response-mediated demyelinating disease that serves as an excellent animal model for the human disease multiple sclerosis. Recent work has shown that either virus-specific CD4(+) or CD8(+) T cells are able to mediate demyelination and also that the antibody response is crucial for clearing infectious virus. Another exciting advance is the development of recombinant coronaviruses, which, for the first time, will allow genetic manipulation of the entire viral genome.
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Affiliation(s)
- J Haring
- Departments of Microbiology and Pediatrics, University of Iowa, Medical Laboratories 2042, Iowa City, IA 52242, USA.
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Haring J, Aurousseau M, Adnet JJ. [Experimental vaginitis in rats]. Bull Assoc Anat (Nancy) 1985; 69:343-9. [PMID: 3030469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The authors present an experimental model of vaginal inflammation in female rats, through local instillation of different substances causing inflammation of varying degrees. The inflammatory reaction was studied macroscopically, histologically and biochemically. Using polysiloxane as a protective substance of vaginal mucosa was found to be of therapeutic interest.
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Bernard E, Strauss B, Haring J, Davis JN. Sustained elevation of hippocampal cyclic 3'-5' adenosine monophosphate levels after medial septal lesions. J Neurochem 1983; 41:1171-6. [PMID: 6311979 DOI: 10.1111/j.1471-4159.1983.tb09068.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The cyclic 3'-5' adenosine monophosphate (cyclic AMP) content of the rat hippocampal formation doubles during the week following a medial septal lesion and remains elevated for at least 1 month, the longest time period studied. This elevation in cyclic AMP does not result from sympathetic ingrowth, as neither superior cervical ganglion stimulation nor ganglionectomy influences hippocampal cyclic AMP content after lesions. Interruption of the cholinergic septohippocampal pathway in the fornix did not elevate hippocampal cyclic AMP content. Further, treatment of septal-lesioned animals with oxotremorine or of normal animals with atropine did not influence hippocampal cyclic AMP content. Finally, neither locus ceruleus lesions nor treatment with propranolol affected hippocampal cyclic AMP content. We believe this to be the first report of a sustained elevation in hippocampal cyclic AMP content. Like other long-term events, it is likely to have profound effects on hippocampal function and represents a remarkable brain adaptation to remote injury.
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Haring J, Mesangeau D, Huet Y, Aurousseau M. Antiarrhythmic activity of cetiedil and its analogues. Int J Clin Pharmacol Ther Toxicol 1980; 18:467-81. [PMID: 6110633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Cetiedil), originally a molecule used for treatment of some vascular diseases, exhibits several pharmacological effects. The authors studied cetiedil's stabilizing effect on the membrane and the antagonism against calcium of Cetiedil and its analogues (amino 3-thienylacetic esters). After completion of numerous pharmacological tests giving evidence of antidysrhythmic effects of the molecule and more especially in the digitalic arrhythmias and ventricular fibrillation induced by calcium (where it is more active than other products tested), the authors conclude that Cetiedil might enter in group I of Vaughan and William's classification of antiarrhythmic drugs. It is like Verapamil an inhibitor of the calcium penetration. This especially interesting antidysrhythmic profile suggests clinica research to determine the special position of Cetiedil in the treatment of heart rhythm troubles.
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Maldonado J, Haring J, Lanza M. [Proper use of noxythiolin: an experimental rat study on interaction with lactic acid]. Therapie 1980; 35:409-12. [PMID: 6775385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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14
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Haring J. [Experiences with a new antiphlogistic and analgetic drug ("Eumotol") in orthopaedic and accident surgery patients (author's transl)]. Z Orthop Ihre Grenzgeb 1976; 114:75-8. [PMID: 946705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The Bumadizon-Ca ("Eumotol") which does not contain any hormones or steroid bodies was applicated in 130 orthopaedic and accident surgical patients as an antiphologistic an analgesic drug. In over 90 percent of these cases we could state a good antiphologistic and following analgesic effect. Even when applicated for longer terms there were no allergic, toxic or some what disturbing secondary effects. The compatibility of this drug proved generally to be good. In five cases only with gastritis and peptic ulcer we had to stop the application."Eumotol" is strictly forbidden to be applicated in patients with hypersensitivity against pyrzol bodies and in cases of leukopenia. When a decreased function of kidneys and liver is evident the drug should be only given under certain precantionary measures.
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Haring J. [Use of propanidid for the prevention of ventilation disorders due to extubation irritation]. Anaesthesist 1969; 18:416-7. [PMID: 5374293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Venegas H, Bitrán E, Cubillos J, Haring J, Astorquiza J. [Chronic cervicitis]. Rev Chil Obstet Ginecol 1965; 30:90-4. [PMID: 5869506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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