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Ligot N, Elands S, Damien C, Jodaitis L, Sadeghi Meibodi N, Mine B, Bonnet T, Guenego A, Lubicz B, Naeije G. Stroke Core Volume Weighs More Than Recanalization Time for Predicting Outcome in Large Vessel Occlusion Recanalized Within 6 h of Symptoms Onset. Front Neurol 2022; 13:838192. [PMID: 35265032 PMCID: PMC8898898 DOI: 10.3389/fneur.2022.838192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 01/28/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction Current guidelines suggest that perfusion imaging should only be performed > 6 h after symptom onset. Pathophysiologically, brain perfusion should matter whatever the elapsed time. We aimed to compare relative contribution of recanalization time and stroke core volume in predicting functional outcome in patients treated by endovascular thrombectomy within 6-h of stroke-onset. Methods Consecutive patients presenting between January 2015 and June 2021 with (i) an acute ischaemic stroke due to an anterior proximal occlusion, (ii) a successful thrombectomy (TICI >2a) within 6-h of symptom-onset and (iii) CT perfusion imaging were included. Core stroke volume was automatically computed using RAPID software. Two linear regression models were built that included in the null hypothesis the pre-treatment NIHSS score and the hypoperfusion volume (Tmax > 6 s) as confounding variables and 24 h post-recanalization NIHSS and 90 days mRS as outcome variables. Time to recanalization was used as covariate in one model and stroke core volume as covariate in the other. Results From a total of 377 thrombectomies, 94 matched selection criteria. The Model null hypothesis explained 37% of the variability for 24 h post-recanalization NIHSS and 42% of the variability for 90 days MRS. The core volume as covariate increased outcome variability prediction to 57 and 56%, respectively. Time to recanalization as covariate marginally increased outcome variability prediction from 37 and 34% to 40 and 42.6%, respectively. Conclusion Core stroke volume better explains outcome variability in comparison to the time to recanalization in anterior large vessel occlusion stroke with successful thrombectomy done within 6 h of symptoms onset. Still, a large part of outcome variability prediction fails to be explained by the usual predictors.
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Affiliation(s)
- Noemie Ligot
- Department of Neurology, CUB Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Sophie Elands
- Department of Neurology, CUB Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Charlotte Damien
- Department of Neurology, CUB Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Lise Jodaitis
- Department of Neurology, CUB Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Niloufar Sadeghi Meibodi
- Department of Radiology, CUB Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Benjamin Mine
- Department of Interventional Neuroradiology, CUB Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Thomas Bonnet
- Department of Interventional Neuroradiology, CUB Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Adrien Guenego
- Department of Interventional Neuroradiology, CUB Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Boris Lubicz
- Department of Interventional Neuroradiology, CUB Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Gilles Naeije
- Department of Neurology, CUB Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
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Damien C, Elands S, Van Den Berge D, Bier JC. Effects of a Psychoeducational Program on Caregivers of Patients with Dementia. Dement Geriatr Cogn Disord 2021; 49:138-145. [PMID: 32920556 DOI: 10.1159/000509169] [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: 12/19/2019] [Accepted: 06/01/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The number of demented patients has increased significantly in recent years. The many challenges that dementia causes increase the stress of their caregivers and lead to shortening the time to institutionalization compared to the general population. A psychoeducational program for these accompanying persons was set up in Brussels. This type of program resulted in a 557-day delay in institutionalization in New York City. The objective of our study was to check whether our program also has such an impact, but also to see its potential effect on the psychobehavioral disorders of patients and the burden of caregivers. METHODS We recruited two groups without randomization: psychoeducated caregivers and caregivers interested in the program and contacted regularly (every 6 months) without having participated. They were all contacted by telephone and responded to the NCPI and Zarit Burden Scale (ZBS) questionnaires. RESULTS We could not demonstrate any significant impact, either on the institutionalization delay (p = 0.960), on the frequency of psychobehavioral disorders in demented patients (p > 0.05), or on the burden of caregivers (p = 0.403). However, the survival rate among the demented patients with psychoeducated caregivers was significantly higher than that among the demented patients with nonpsychoeducated caregivers (p < 0.001). CONCLUSIONS Our small-sample, nonrandomized study did not reveal any differences in institutionalization delay, caregiver burden, or perception of psychobehavioral disorders related to our psychoeducational program. A new study should be carried out on the impact of psychoeducation on the survival of demented patients, in view of our preliminary analyses.
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Affiliation(s)
- Charlotte Damien
- Department of Neurology, Université Libre de Bruxelles/Hopital Erasme, Brussels, Belgium
| | - Sophie Elands
- Department of Neurology, Université Libre de Bruxelles/Hopital Erasme, Brussels, Belgium
| | - Delphine Van Den Berge
- Department of Neurology, Université Libre de Bruxelles/Hopital Erasme, Brussels, Belgium
| | - Jean-Christophe Bier
- Department of Neurology, Université Libre de Bruxelles/Hopital Erasme, Brussels, Belgium,
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Elands S, Casimir P, Bonnet T, Mine B, Lubicz B, Sjøgård M, Ligot N, Naeije G. Early Venous Filling Following Thrombectomy: Association With Hemorrhagic Transformation and Functional Outcome. Front Neurol 2021; 12:649079. [PMID: 33776899 PMCID: PMC7987949 DOI: 10.3389/fneur.2021.649079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 02/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose: Previous studies have noted the angiographic appearance of early venous filling (EVF) following recanalisation in acute ischemic stroke. However, the prognostic implications of EVF as a novel imaging biomarker remain unclear. We aimed to evaluate the correlation between EVF with (i) the risk of subsequent reperfusion hemorrhage (RPH) and (ii) the association of EVF on both the NIHSS score at 24 h and functional outcome as assessed with the Modified Rankin Scale (mRS) score at 90 days. Methods: We conducted a retrospective cohort study of patients presenting with an acute ischemic stroke due to a proximal large-vessel occlusion of the anterior circulation treated by thrombectomy. Post-reperfusion digital subtraction angiography was reviewed to look for EVF as evidenced by the contrast opacification of any cerebral vein before the late arterial phase. Results: EVF occurred in 22.4% of the 147 cases included. The presence of EVF significantly increased the risk of RPH (p = 0.0048), including the risk of symptomatic hemorrhage (p = 0.0052). The presence of EVF (p = 0.0016) and the absence of RPH (p = 0.0021) were independently associated with a better outcome as defined by the NIHSS difference at 24 h, most significantly in the EVF+RPH- group. No significant relationship was however found between either EVF or RPH and a mRS score ≤ 2 at 90 days. Conclusion: Early venous filling on angiographic imaging is a potential predictor of reperfusion hemorrhage. The absence of subsequent RPH in this sub-group is associated with better outcomes at 24 h post-thrombectomy than in those with RPH.
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Affiliation(s)
- Sophie Elands
- Department of Neurology, Erasmus Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Pierre Casimir
- Department of Neurology, Erasmus Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Thomas Bonnet
- Department of Interventional Neuroradiology, Erasmus Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Benjamin Mine
- Department of Interventional Neuroradiology, Erasmus Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Boris Lubicz
- Department of Interventional Neuroradiology, Erasmus Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Martin Sjøgård
- Laboratoire de Cartographie Fonctionnelle du Cerveau, Neuroscience Institute (ULB-Neuroscience Institute), Université Libre de Bruxelles, Brussels, Belgium
| | - Noémie Ligot
- Department of Neurology, Erasmus Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Gilles Naeije
- Department of Neurology, Erasmus Hospital, Université Libre de Bruxelles, Brussels, Belgium
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Wang JW, Smith P, Sarker SJ, Elands S, Oliveira A, Barratt C, Thorn C, Holme T, Lynch M. Can Waterlow score predict 30-day mortality and length of stay in acutely admitted medical patients (aged ≥65 years)? Evidence from a single centre prospective cohort study. BMJ Open 2019; 9:e032347. [PMID: 31727661 PMCID: PMC6886901 DOI: 10.1136/bmjopen-2019-032347] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE This study aimed to explore the potential for the Waterlow score (WS) to be used as a predictor of 30-day mortality and length of hospital stay (LHS) in acutely admitted medical patients aged 65 years and older. DESIGN Prospective observational cohort study. SETTING UK District General Hospital. SUBJECTS 834 consecutive patients aged 65 years and older admitted acutely to medical specialties between 30 May and 22 July 2014. METHODS Admission WS (range 4-64) assessment paired with the patient's status at 30 days in terms of mortality and their LHS. PRIMARY OUTCOMES 30-day mortality and length of inpatient stay. RESULTS 834 consecutive acute medical admissions had their WS recorded. 30-day mortality was 13.1% (109 deaths). A significant difference in the distribution of WS (p<0.001) was seen between those who survived (median 12) and those who died (median 16) within 30 days, particularly within respiratory (p<0.001), stroke (p<0.001), cardiology (p<0.016), non-respiratory infections (p<0.018) and trauma (p<0.044) subgroups. Odds of dying within 30 days increased threefold for every 10-unit increase in the WS (p<0.001, 95% CI 2.1 to 4.3). LHS was also positively linearly associated with the WS in those who survived 30 days (median=5, IQR=10; r=0.32, p<0.01). A five-unit increase in WS was associated with approximately 5 days increase in LHS. On the other hand, quadratic regression showed this relationship was curvilinear and negative (concave) for those who died within 30 days where a five-unit increase in WS was associated with an approximately 10 days decrease in LHS. CONCLUSION This study demonstrates an association between a high WS and both 30-day mortality and LHS. This is particularly significant for mortality in patients in the respiratory, stroke and cardiac subcategories. The WS, a nursing-led screening tool that is carried out on virtually all admissions to UK hospitals, could have additional use at the time of patient admission as a risk assessment tool for 30-day mortality as well as a predictor of LHS.
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Affiliation(s)
| | - Phillip Smith
- Lee Haynes Research Institute, Lister Hospital, Stevenage, UK
| | - Shah-Jalal Sarker
- Research Department of Medical Education, University College London, London, UK
| | - Sophie Elands
- Respiratory Medicine, Lister Hospital, Stevenage, UK
| | | | - Claire Barratt
- Borthwick Research Centre, Lister Hospital, Stevenage, UK
| | - Chris Thorn
- General Surgery, Lister Hospital, Stevenage, UK
| | - Tom Holme
- General Surgery, Lister Hospital, Stevenage, UK
| | - Mary Lynch
- Cardiology, Lister Hospital, Stevenage, UK
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Shendi A, Al Midani A, Elands S, Collier S, Harber M. SP710URINARY TRACT INFECTIONS AFTER KIDNEY TRANSPLANTATION: A RETROSPECTIVE SINGLE CENTRE STUDY. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.sp710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ali Shendi
- Internal Medicine Department, Zagazig University, Zagazig - Sharkia, Egypt
| | - Ammar Al Midani
- UCL centre for Nephrology, Royal Free Hospital, London, United Kingdom
| | - Sophie Elands
- Urology department, Royal Free NHS Foundation trust, London, United Kingdom
| | - Sophie Collier
- Microbiology Department, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Mark Harber
- UCL centre for Nephrology, Royal Free NHS Foundation Trust, London, United Kingdom
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Elands S, Vasdev N, Tay A, Adshead JM. Robot-Assisted Laparoscopic Bladder Diverticulectomy and Ureteral Re-Implantation for a Diverticulum Containing High Grade Transitional Cell Carcinoma. Curr Urol 2015; 8:104-8. [PMID: 26889127 DOI: 10.1159/000365699] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 10/23/2014] [Indexed: 12/30/2022] Open
Abstract
We present a case of an 84-year-old man presenting with painless visible hematuria. Further investigation revealed a primary G3pT1 transitional cell carcinoma confined to a bladder diverticulum. In view of bladder-sparing therapy, he underwent a robot-assisted laparoscopic bladder diverticulectomy with ureteral re-implantation. This report demonstrates a minimally invasive approach offering radical treatment without having to recur to partial or radical cystectomy. We discuss the operative steps, the significance of this case with a review of the literature, and the future potential this may represent for the treatment of tumor-containing bladder diverticula.
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Affiliation(s)
- Sophie Elands
- Hertfordshire and South Bedfordshire Robotic Urological Cancer Centre, Department of Urology, Lister Hospital, Stevenage, UK
| | - Nikhil Vasdev
- Hertfordshire and South Bedfordshire Robotic Urological Cancer Centre, Department of Urology, Lister Hospital, Stevenage, UK
| | - Andrea Tay
- Hertfordshire and South Bedfordshire Robotic Urological Cancer Centre, Department of Urology, Lister Hospital, Stevenage, UK
| | - James M Adshead
- Hertfordshire and South Bedfordshire Robotic Urological Cancer Centre, Department of Urology, Lister Hospital, Stevenage, UK
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