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2. Practical '1-2-3-4-Day' Rule for Starting Direct Oral Anticoagulants After Ischemic Stroke With Atrial Fibrillation: Combined Hospital-Based Cohort Study

Author

Shunsuke Kimura, Kazunori Toyoda, Sohei Yoshimura, Kazuo Minematsu, Masahiro Yasaka, Maurizio Paciaroni, David J. Werring, Hiroshi Yamagami, Takehiko Nagao, Shinichi Yoshimura, Alexandros Polymeris, Annaelle Zietz, Stefan T. Engelter, Bernd Kallmünzer, Manuel Cappellari, Tetsuya Chiba, Takeshi Yoshimoto, Masayuki Shiozawa, Takanari Kitazono, Masatoshi Koga, Kenichi Todo, Kazumi Kimura, Yoshiki Yagita, Eisuke Furui, Ryo Itabashi, Tadashi Terasaki, Yoshiaki Shiokawa, Teruyuki Hirano, Kenji Kamiyama, Jyoji Nakagawara, Shunya Takizawa, Kazunari Homma, Satoshi Okuda, Yasushi Okada, Keisuke Tokunaga, Tomoaki Kameda, Kazuomi Kario, Yoshinari Nagakane, Yasuhiro Hasegawa, Hisanao Akiyama, Satoshi Shibuya, Hiroshi Mochizuki, Yasuhiro Ito, Takahiro Nakashima, Hideki Matsuoka, Kazuhiro Takamatsu, Kazutoshi Nishiyama, Shoichiro Sato, Shoji Arihiro, Manabu Inoue, Masahito Takagi, Kanta Tanaka, Kazuyuki Nagatsuka, Takenori Yamaguchi, Yoichiro Hashimoto, Kiyohiro Houkin, Kazuo Kitagawa, Masayasu Matsumoto, Norio Tanahashi, Yasuo Terayama, Shinichiro Uchiyama, Etsuro Mori, Yutaka Furukawa, Takeshi Kimura, Yoshiaki Kumon, Ken Nagata, Shigeru Nogawa, Tomohiro Sakamoto, Toshinori Hirai, Kohsuke Kudo, Makoto Sasaki, Shotai Kobayashi, Toshimitsu Hamasaki, Michela Giustozzi, Monica Acciarresi, Giancarlo Agnelli, Valeria Caso, Fabio Bandini, Georgios Tsivgoulis, Shadi Yaghi, Karen L. Furie, Prasanna Tadi, Cecilia Becattini, Marialuisa Zedde, Azmil H Abdul-Rahim, Kennedy R Lees, Andrea Alberti, Michele Venti, Cataldo D’Amore, Maria Giulia Mosconi, Ludovica Anna Cimini, Paolo Bovi, Monica Carletti, Alberto Rigatelli, Jukka Putaala, Liisa Tomppo, Turgut Tatlisumak, Simona Marcheselli, Alessandro Pezzini, Loris Poli, Alessandro Padovani, Vieri Vannucchi, Sung-Il Sohn, Gianni Lorenzini, Rossana Tassi, Francesca Guideri, Maurizio Acampa, Giuseppe Martini, George Ntaios, George Athanasakis, Konstantinos Makaritsis, Efstathia Karagkiozi, Konstantinos Vadikolias, Chrissoula Liantinioti, Maria Chondrogianni, Nicola Mumoli, Franco Galati, Simona Sacco, Cindy Tiseo, Francesco Corea, Walter Ageno, Marta Bellesini, Giovanna Colombo, Giorgio Silvestrelli, Alfonso Ciccone, Alessia Lanari, Umberto Scoditti, Licia Denti, Michelangelo Mancuso, Miriam Maccarrone, Leonardo Ulivi, Giovanni Orlandi, Nicola Giannini, Tiziana Tassinari, Maria Luisa De Lodovici, Christina Rueckert, Antonio Baldi, Danilo Toni, Federica Letteri, Martina Giuntini, Enrico Maria Lotti, Yuriy Flomin, Alessio Pieroni, Odysseas Kargiotis, Theodore Karapanayiotides, Serena Monaco, Mario Maimone Baronello, Laszló Csiba, Lilla Szabó, Alberto Chiti, Elisa Giorli, Massimo Del Sette, Davide Imberti, Dorjan Zabzuni, Boris Doronin, Vera Volodina, Patrik Michel, Peter Vanacker, Kristian Barlinn, Lars-Peder Pallesen, Jessica Barlinn, Dirk Deleu, Gayane Melikyan, Faisal Ibrahim, Naveed Akhtar, Vanessa Gourbali, Luca Masotti, Adrian Parry-Jones, Chris Patterson, Christopher Price, Abduelbaset Elmarimi, Anthea Parry, Arumug Nallasivam, Azlisham Mohd Nor, Bernard Esis, David Bruce, Christine Roffe, Clare Holmes, David Cohen, David Hargroves, David Mangion, Dinesh Chadha, Djamil Vahidassr, Dulka Manawadu, Elio Giallombardo, Elizabeth Warburton, Enrico Flossman, Gunaratam Gunathilagan, Harald Proschel, Hedley Emsley, Ijaz Anwar, James Okwera, Janet Putterill, Janice O’Connell, John Bamford, John Corrigan, Jon Scott, Jonathan Birns, Karen Kee, Kari Saastamoinen, Kath Pasco, Krishna Dani, Lakshmanan Sekaran, Lillian Choy, Liz Iveson, Maam Mamun, Mahmud Sajid, Martin Cooper, Matthew Burn, Matthew Smith, Michael Power, Michelle Davis, Nigel Smyth, Roland Veltkamp, Pankaj Sharma, Paul Guyler, Paul O’Mahony, Peter Wilkinson, Prabel Datta, Prasanna Aghoram, Rachel Marsh, Robert Luder, Sanjeevikumar Meenakishundaram, Santhosh Subramonian, Simon Leach, Sissi Ispoglou, Sreeman Andole, Timothy England, Aravindakshan Manoj, Frances Harrington, Habib Rehman, Jane Sword, Julie Staals, Karim Mahawish, Kirsty Harkness, Louise Shaw, Michael McCormich, Nikola Sprigg, Syed Mansoor, Vinodh Krishnamurthy, Philippe A Lyrer, Leo H Bonati, David J Seiffge, Christopher Traenka, Nils Peters, Gian Marco De Marchis, Sebastian Thilemann, Nikolaos S Avramiotis, Henrik Gensicke, Lisa Hert, Benjamin Wagner, Fabian Schaub, Louisa Meya, Joachim Fladt, Tolga Dittrich, Urs Fisch, Bruno Bonetti, Giampaolo Tomelleri, Nicola Micheletti, Cecilia Zivelonghi, Andrea Emiliani, Kosmas Macha, Gabriela Siedler, Svenja Stoll, Ruihao Wang, Bastian Volbers, Stefan Schwab, David Haupenthal, and Luise Gaßmann

Subjects
Advanced and Specialized Nursing, acute ischemic stroke, Time Factors, Administration, Oral, Anticoagulants, Hemorrhage, cardioembolism, Hospitals, United States, Brain Ischemia, anticoagulation, atrial fibrillation, stroke prevention, Cohort Studies, Stroke, Treatment Outcome, Ischemic Attack, Transient, Atrial Fibrillation, Humans, Prospective Studies, Neurology (clinical), Cardiology and Cardiovascular Medicine, Ischemic Stroke
Abstract

Background: The “1-3-6-12-day rule” for starting direct oral anticoagulants (DOACs) in patients with nonvalvular atrial fibrillation after acute ischemic stroke or transient ischemic attack recommends timings that may be later than used in clinical practice. We investigated more practical optimal timing of DOAC initiation according to stroke severity. Methods: The combined data of prospective registries in Japan, Stroke Acute Management with Urgent Risk-factor Assessment and Improvement-nonvalvular atrial fibrillation (September 2011 to March 2014) and RELAXED (February 2014 to April 2016) were used. Patients were divided into transient ischemic attack and 3 stroke subgroups by the National Institutes of Health Stroke Scale score: mild (0–7), moderate (8–15), and severe (≥16). The early treatment group was defined as patients starting DOACs earlier than the median initiation day in each subgroup. Outcomes included a composite of recurrent stroke or systemic embolism, ischemic stroke, and severe bleeding within 90 days. Six European prospective registries were used for validation. Results: In the 1797 derivation cohort patients, DOACs were started at median 2 days after transient ischemic attack and 3, 4, and 5 days after mild, moderate, and severe strokes, respectively. Stroke or systemic embolism was less common in Early Group (n=785)—initiating DOACS within 1, 2, 3, and 4 days, respectively—than Late Group (n=1012) (1.9% versus 3.9%; adjusted hazard ratio, 0.50 [95% CI, 0.27–0.89]), as was ischemic stroke (1.7% versus 3.2%, 0.54 [0.27–0.999]). Major bleeding was similarly common in the 2 groups (0.8% versus 1.0%). On validation, both ischemic stroke (2.4% versus 2.2%) and intracranial hemorrhage (0.2% versus 0.6%) were similarly common in Early (n=547) and Late (n=1483) Groups defined using derivation data. Conclusions: In Japanese and European populations, early DOAC initiation within 1, 2, 3, or 4 days according to stroke severity seemed to be feasible to decrease the risk of recurrent stroke or systemic embolism and no increase in major bleeding. These findings support ongoing randomized trials to better establish the optimal timing of DOAC initiation.

Published
2022
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3. Small Vessel Disease and Ischemic Stroke Risk During Anticoagulation for Atrial Fibrillation After Cerebral Ischemia

Author

Houwei Du, Duncan Wilson, Gareth Ambler, Gargi Banerjee, Clare Shakeshaft, Hannah Cohen, Tarek Yousry, Rustam Al-Shahi Salman, Gregory Y.H. Lip, Henry Houlden, Martin M. Brown, Keith W. Muir, Hans Rolf Jäger, David J. Werring, Adrian Parry-Jones, Chris Patterson, Christopher Price, Abduelbaset Elmarimi, Anthea Parry, Arumug Nallasivam, Azlisham Mohd Nor, Bernard Esisi, David Bruce, Biju Bhaskaran, Christine Roffe, Claire Cullen, Clare Holmes, David Cohen, David Hargroves, David Mangion, Dinesh Chadha, Djamil Vahidassr, Dulka Manawadu, Elio Giallombardo, Elizabeth Warburton, Enrico Flossman, Gunaratam Gunathilagan, Harald Proschel, Hedley Emsley, Ijaz Anwar, Ilse Burger, James Okwera, Janet Putterill, Janice O’Connell, John Bamford, John Corrigan, Jon Scott, Jonathan Birns, Karen Kee, Kari Saastamoinen, Kath Pasco, Krishna Dani, Lakshmanan Sekaran, Lillian Choy, Liz Iveson, Maam Mamun, Mahmud Sajid, Martin Cooper, Mathew Burn, Matthew Smith, Michael Power, Michelle Davis, Nigel Smyth, Roland Veltkamp, Pankaj Sharma, Paul Guyler, Paul O’Mahony, Peter Wilkinson, Prabel Datta, Prasanna Aghoram, Rachel Marsh, Robert Luder, Sanjeevikumar Meenakishundaram, Santhosh Subramonian, Simon Leach, Sissi Ispoglou, Sreeman Andole, Timothy England, Aravindakshan Manoj, Harrington Frances, Habib Rehman, Jane Sword, Julie Staals, Karim Mahawish, Kirsty Harkness, Louise Shaw, Michael McCormick, Nikola Sprigg, Syed Mansoor, and Vinodh Krishnamurthy

Subjects
Male, medicine.medical_specialty, brain, Small vessel occlusion, Ischemia, Disease, Brain Ischemia, White matter, Recurrence, Internal medicine, Atrial Fibrillation, medicine, Humans, ischemic attack, transient, atrial fibrillation, anticoagulation, Aged, Ischemic Stroke, Aged, 80 and over, Advanced and Specialized Nursing, business.industry, Atrial fibrillation, Middle Aged, medicine.disease, medicine.anatomical_structure, Cerebral Small Vessel Diseases, Ischemic stroke, Cardiology, Female, Neurology (clinical), Small vessel, Cardiology and Cardiovascular Medicine, business, white matter
Abstract

Background and Purpose: The causes of recurrent ischemic stroke despite anticoagulation for atrial fibrillation are uncertain but might include small vessel occlusion. We investigated whether magnetic resonance imaging markers of cerebral small vessel disease (SVD) are associated with ischemic stroke risk during follow-up in patients anticoagulated for atrial fibrillation after recent ischemic stroke or transient ischemic attack. Methods: We analyzed data from a prospective multicenter inception cohort study of ischemic stroke or transient ischemic attack anticoagulated for atrial fibrillation (CROMIS-2 [Clinical Relevance of Microbleeds in Stroke Study]). We rated markers of SVD on baseline brain magnetic resonance imaging: basal ganglia perivascular spaces (number ≥11); cerebral microbleeds (number ≥1); lacunes (number ≥1); and white matter hyperintensities (periventricular Fazekas grade 3 or deep white matter Fazekas grade ≥2). We investigated the associations of SVD presence (defined as presence of ≥1 SVD marker) and severity (composite SVD score) with the risk of ischemic stroke during follow-up using a Cox proportional hazards model adjusted for congestive heart failure, hypertension, age >75, diabetes, stroke, vascular disease, age 65–74, female score. Results: We included 1419 patients (mean age: 75.8 years [SD, 10.4]; 42.1% female). The ischemic stroke rate during follow-up in patients with any SVD was 2.20 per 100-patient years (95% CI, 1.60–3.02), compared with 0.98 per 100 patient-years (95% CI, 0.59–1.62) in those without SVD ( P =0.008). After adjusting for congestive heart failure, hypertension, age >75, diabetes, stroke, vascular disease, age 65–74, female score, SVD presence remained significantly associated with ischemic stroke during follow-up (hazard ratio, 1.89 [95% CI, 1.01–3.53]; P =0.046); the risk of recurrent ischemic stroke increased with SVD score (hazard ratio per point increase, 1.33 [95% CI, 1.04–1.70]; P =0.023). Conclusions: In patients anticoagulated for atrial fibrillation after ischemic stroke or transient ischemic attack, magnetic resonance imaging markers of SVD are associated with an increased risk of ischemic stroke during follow-up; improved stroke prevention treatments are required in this population. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02513316.

Published
2021
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4. Practical “1-2-3-4-Day” Rule for Starting Direct Oral Anticoagulants After Ischemic Stroke With Atrial Fibrillation: Combined Hospital-Based Cohort Study

Author

Kimura, Shunsuke, primary, Toyoda, Kazunori, additional, Yoshimura, Sohei, additional, Minematsu, Kazuo, additional, Yasaka, Masahiro, additional, Paciaroni, Maurizio, additional, Werring, David J., additional, Yamagami, Hiroshi, additional, Nagao, Takehiko, additional, Yoshimura, Shinichi, additional, Polymeris, Alexandros, additional, Zietz, Annaelle, additional, Engelter, Stefan T., additional, Kallmünzer, Bernd, additional, Cappellari, Manuel, additional, Chiba, Tetsuya, additional, Yoshimoto, Takeshi, additional, Shiozawa, Masayuki, additional, Kitazono, Takanari, additional, Koga, Masatoshi, additional, Todo, Kenichi, additional, Kimura, Kazumi, additional, Yagita, Yoshiki, additional, Furui, Eisuke, additional, Itabashi, Ryo, additional, Terasaki, Tadashi, additional, Shiokawa, Yoshiaki, additional, Hirano, Teruyuki, additional, Kamiyama, Kenji, additional, Nakagawara, Jyoji, additional, Takizawa, Shunya, additional, Homma, Kazunari, additional, Okuda, Satoshi, additional, Okada, Yasushi, additional, Tokunaga, Keisuke, additional, Kameda, Tomoaki, additional, Kario, Kazuomi, additional, Nagakane, Yoshinari, additional, Hasegawa, Yasuhiro, additional, Akiyama, Hisanao, additional, Shibuya, Satoshi, additional, Mochizuki, Hiroshi, additional, Ito, Yasuhiro, additional, Nakashima, Takahiro, additional, Matsuoka, Hideki, additional, Takamatsu, Kazuhiro, additional, Nishiyama, Kazutoshi, additional, Sato, Shoichiro, additional, Arihiro, Shoji, additional, Inoue, Manabu, additional, Takagi, Masahito, additional, Tanaka, Kanta, additional, Nagatsuka, Kazuyuki, additional, Yamaguchi, Takenori, additional, Hashimoto, Yoichiro, additional, Houkin, Kiyohiro, additional, Kitagawa, Kazuo, additional, Matsumoto, Masayasu, additional, Tanahashi, Norio, additional, Terayama, Yasuo, additional, Uchiyama, Shinichiro, additional, Mori, Etsuro, additional, Furukawa, Yutaka, additional, Kimura, Takeshi, additional, Kumon, Yoshiaki, additional, Nagata, Ken, additional, Nogawa, Shigeru, additional, Sakamoto, Tomohiro, additional, Hirai, Toshinori, additional, Kudo, Kohsuke, additional, Sasaki, Makoto, additional, Kobayashi, Shotai, additional, Hamasaki, Toshimitsu, additional, Giustozzi, Michela, additional, Acciarresi, Monica, additional, Agnelli, Giancarlo, additional, Caso, Valeria, additional, Bandini, Fabio, additional, Tsivgoulis, Georgios, additional, Yaghi, Shadi, additional, Furie, Karen L., additional, Tadi, Prasanna, additional, Becattini, Cecilia, additional, Zedde, Marialuisa, additional, Abdul-Rahim, Azmil H, additional, Lees, Kennedy R, additional, Alberti, Andrea, additional, Venti, Michele, additional, D’Amore, Cataldo, additional, Giulia Mosconi, Maria, additional, Anna Cimini, Ludovica, additional, Bovi, Paolo, additional, Carletti, Monica, additional, Rigatelli, Alberto, additional, Putaala, Jukka, additional, Tomppo, Liisa, additional, Tatlisumak, Turgut, additional, Marcheselli, Simona, additional, Pezzini, Alessandro, additional, Poli, Loris, additional, Padovani, Alessandro, additional, Vannucchi, Vieri, additional, Sohn, Sung-Il, additional, Lorenzini, Gianni, additional, Tassi, Rossana, additional, Guideri, Francesca, additional, Acampa, Maurizio, additional, Martini, Giuseppe, additional, Ntaios, George, additional, Athanasakis, George, additional, Makaritsis, Konstantinos, additional, Karagkiozi, Efstathia, additional, Vadikolias, Konstantinos, additional, Liantinioti, Chrissoula, additional, Chondrogianni, Maria, additional, Mumoli, Nicola, additional, Galati, Franco, additional, Sacco, Simona, additional, Tiseo, Cindy, additional, Corea, Francesco, additional, Ageno, Walter, additional, Bellesini, Marta, additional, Colombo, Giovanna, additional, Silvestrelli, Giorgio, additional, Ciccone, Alfonso, additional, Lanari, Alessia, additional, Scoditti, Umberto, additional, Denti, Licia, additional, Mancuso, Michelangelo, additional, Maccarrone, Miriam, additional, Ulivi, Leonardo, additional, Orlandi, Giovanni, additional, Giannini, Nicola, additional, Tassinari, Tiziana, additional, De Lodovici, Maria Luisa, additional, Rueckert, Christina, additional, Baldi, Antonio, additional, Toni, Danilo, additional, Letteri, Federica, additional, Giuntini, Martina, additional, Lotti, Enrico Maria, additional, Flomin, Yuriy, additional, Pieroni, Alessio, additional, Kargiotis, Odysseas, additional, Karapanayiotides, Theodore, additional, Monaco, Serena, additional, Baronello, Mario Maimone, additional, Csiba, Laszló, additional, Szabó, Lilla, additional, Chiti, Alberto, additional, Giorli, Elisa, additional, Del Sette, Massimo, additional, Imberti, Davide, additional, Zabzuni, Dorjan, additional, Doronin, Boris, additional, Volodina, Vera, additional, Michel, Patrik, additional, Vanacker, Peter, additional, Barlinn, Kristian, additional, Pallesen, Lars-Peder, additional, Barlinn, Jessica, additional, Deleu, Dirk, additional, Melikyan, Gayane, additional, Ibrahim, Faisal, additional, Akhtar, Naveed, additional, Gourbali, Vanessa, additional, Masotti, Luca, additional, Parry-Jones, Adrian, additional, Patterson, Chris, additional, Price, Christopher, additional, Elmarimi, Abduelbaset, additional, Parry, Anthea, additional, Nallasivam, Arumug, additional, Mohd Nor, Azlisham, additional, Esis, Bernard, additional, Bruce, David, additional, Roffe, Christine, additional, Holmes, Clare, additional, Cohen, David, additional, Hargroves, David, additional, Mangion, David, additional, Chadha, Dinesh, additional, Vahidassr, Djamil, additional, Manawadu, Dulka, additional, Giallombardo, Elio, additional, Warburton, Elizabeth, additional, Flossman, Enrico, additional, Gunathilagan, Gunaratam, additional, Proschel, Harald, additional, Emsley, Hedley, additional, Anwar, Ijaz, additional, Okwera, James, additional, Putterill, Janet, additional, O’Connell, Janice, additional, Bamford, John, additional, Corrigan, John, additional, Scott, Jon, additional, Birns, Jonathan, additional, Kee, Karen, additional, Saastamoinen, Kari, additional, Pasco, Kath, additional, Dani, Krishna, additional, Sekaran, Lakshmanan, additional, Choy, Lillian, additional, Iveson, Liz, additional, Mamun, Maam, additional, Sajid, Mahmud, additional, Cooper, Martin, additional, Burn, Matthew, additional, Smith, Matthew, additional, Power, Michael, additional, Davis, Michelle, additional, Smyth, Nigel, additional, Veltkamp, Roland, additional, Sharma, Pankaj, additional, Guyler, Paul, additional, O’Mahony, Paul, additional, Wilkinson, Peter, additional, Datta, Prabel, additional, Aghoram, Prasanna, additional, Marsh, Rachel, additional, Luder, Robert, additional, Meenakishundaram, Sanjeevikumar, additional, Subramonian, Santhosh, additional, Leach, Simon, additional, Ispoglou, Sissi, additional, Andole, Sreeman, additional, England, Timothy, additional, Manoj, Aravindakshan, additional, Harrington, Frances, additional, Rehman, Habib, additional, Sword, Jane, additional, Staals, Julie, additional, Mahawish, Karim, additional, Harkness, Kirsty, additional, Shaw, Louise, additional, McCormich, Michael, additional, Sprigg, Nikola, additional, Mansoor, Syed, additional, Krishnamurthy, Vinodh, additional, Lyrer, Philippe A, additional, Bonati, Leo H, additional, Seiffge, David J, additional, Traenka, Christopher, additional, Peters, Nils, additional, De Marchis, Gian Marco, additional, Thilemann, Sebastian, additional, Avramiotis, Nikolaos S, additional, Gensicke, Henrik, additional, Hert, Lisa, additional, Wagner, Benjamin, additional, Schaub, Fabian, additional, Meya, Louisa, additional, Fladt, Joachim, additional, Dittrich, Tolga, additional, Fisch, Urs, additional, Bonetti, Bruno, additional, Tomelleri, Giampaolo, additional, Micheletti, Nicola, additional, Zivelonghi, Cecilia, additional, Emiliani, Andrea, additional, Macha, Kosmas, additional, Siedler, Gabriela, additional, Stoll, Svenja, additional, Wang, Ruihao, additional, Volbers, Bastian, additional, Schwab, Stefan, additional, Haupenthal, David, additional, and Gaßmann, Luise, additional

Published
2022
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5. Surgical Performance Determines Functional Outcome Benefit in the Minimally Invasive Surgery Plus Recombinant Tissue Plasminogen Activator for Intracerebral Hemorrhage Evacuation (MISTIE) Procedure

Author

Andras Buki, Ludwig Schuerer, Barbara A. Gregson, Joshua N. Goldstein, Jared Knopman, Alexandra D Baker, Ashutosh P Jadhav, Laszlo Csiba, Terry Quinn, Kristi Tucker, Gayane Yenokyan, E. Francois Aldrich, Richard E. Thompson, John Laidlaw, Steven Mayo, Alastair Wilson, Michael L. James, Krista Vermillion, Andreas Unterberg, Fernando Muñoz Hernandez, Karin Jonczak, Jesse Dawson, Alejandro Carrasco Gonzalez, Jamie Braun, Rishi Malhorta, Lisa Yanase, Hua Feng, Craig S. Anderson, Ying Cao, Michael Rosenblum, Roddy O'Kane, Jeffrey S. Schweitzer, Krishna K. Mohan, Robert Hoesch, Robert D. Ecker, Rong Hu, Cian O'Kelly, Nader Pouratian, Igor Rybinnik, Yi Huang, Julius Gene Latorre, Peter Brindley, Scott Janis, Huy Tran, Weimin Wang, Mohammed Rehman, Nataly Montano Vargas, Zhiyuan Yu, Tiffany R. Chang, Christianto B. Lumenta, Rosario Sarabia, Paul M. Vespa, David Antezana, Keith W. Muir, Ying Wang, Kennedy R. Lees, Thomas Kerz, Steven J. Barrer, Safdar Ansari, Elizabeth A. Sugar, Louis Tony Whitworth, Romuald Girard, Thomas A. Bergman, Myriha Wrencher, Gaurav Gupta, Krissia Rivera Perla, Judy Huang, Doug Anderson, Joshua Betz, Ryan S. Kitagawa, Mohammed Hussain, Marcelino Báguena, Sepideh Amin-Hanjani, Krisztian Tanczos, Avinash B. Kumar, Brian L. Hoh, W. David Freeman, Tracey Economas, Dheeraj Gandhi, Mary Leigh Gelea, Hiren C. Patel, Esther Jeon, Byron Willis, Gonzalo Tamayo, Saman Nekoovaght-Tak, Lior Ungar, Ahmed Maswadeh, Adrian R Parry-Jones, Marc D. Malkoff, Michael Abraham, Carlos Alarcon Alba, Michael R. Chicoine, George A. Lopez, Jeanne Teitelbaum, Scott McCaul, Walter Galicich, David Schel, Ryan Majkowski, Douglas Franz, Agnieszka Ardelt, Issam A. Awad, Yunke Li, Hasan Ali, Satish Krishnamurthy, Yi Hao, Geza Mezey, Amal Abou-Hamden, James Leiphart, Xuxia Yi, Darren Lovick, Colin P. Dierdeyn, Jack Jallo, Jennifer Houser, Vikram Madan, Julián Carrión-Penagos, Jean-Louis Caron, Paul J. Camarata, Nichol McBee, Ania Pollack, Lorenzo F. Munoz, Sarah Lenington, Lauren H Sansing, Kathrine Thomas, Alberto Torres Díaz, Joel D. MacDonald, J. Ricardo Carhuapoma, Pedro Enriquez, Janet Mighty, Salvatore Insinga, Ottó Major, Steven M. Greenberg, Jinbiao Luo, Jennifer Jaffe, W. Andrew Mould, Cully Cobb, Sagi Harnof, Robert F James, Yan Wang, Ali R. Zomorodi, David B. Seder, Ventatakrishna Rajajee, Arun Lakhanpal, Robert H. Brown, Yongge Xu, Karen Lane, Naureen Keric, A. David Mendelow, David Ledoux, Azmil Abdul-Rahim, Babak S. Jahromi, Janne Koskimäki, Chitra Venkatasubramanian, Dennis G. Vollmer, Charles C. Matouk, William C. Broaddus, Julio A. Chalela, Fred Rincon, Sean P. Polster, Kevin N. Sheth, Patrick Mitchell, Daryl R. Gress, Daniel F Hanley, Bing Cao, Indalecio Moran Chorro, Mario Zuccarello, Maged D Fam, Carolyn Koenig, Aditya S. Pandey, Patricia Lynn Money, Christiana E. Hall, Baltasar Sanchez, Kesava Reddy, Hartmut Vatter, Robert L. Dodd, Panos Varelas, James C. Torner, Michael Schneck, Christina Grabarits, Azam Ahmed, Diederik Bulters, Paul A. Nyquist, Michael N. Diringer, Jason M Davies, Radhika Avadhani, Ben Jonker, Katalin Szabo, Agnieszka Stadnik, Donald Seyfried, Brian T. Jankowitz, Joshua E. Medow, Erzsebet Ezer, Pál Barzó, Luisa Corral, Inam Kureshi, Ronald Reimer, David Altschul, Fuat Arikan, Alex Nee, Stacey Q Wolfe, Mohamed Okasha, Matthew B. Maas, Mark R. Harrigan, John Terry, Natalie Ullman, Dana Leifer, Yuhua Fan, Jiajun Wen, Gregory Thompson, Alejandro M Spiotta, Amanda J. Bistran-Hall, Fernando D. Testai, Noeleen Ostapkovich, Eugene Gu, Kyra J. Becker, David Miller, Carlos S. Kase, Carol B. Thompson, Shawn E. Wright, Wendy C. Ziai, Philipp Taussky, Peter Nakaji, Nicki Karlen, Halinder S. Mangat, Andrew P. Carlson, Shakeel A. Chowdhry, Azize Boström, Rachel Dlugash, Michael T. Stechison, Kate McArthur, Larami MacKenzie, Matthew R. Fusco, and Draga Jichici

Subjects
Male, medicine.medical_specialty, law.invention, 03 medical and health sciences, 0302 clinical medicine, Hematoma, Fibrinolytic Agents, Randomized controlled trial, Modified Rankin Scale, law, medicine, Humans, Minimally Invasive Surgical Procedures, cardiovascular diseases, Research—Human—Clinical Trials, Intraparenchymal hemorrhage, Stroke, Aged, Intracerebral hemorrhage, business.industry, Recovery of Function, Middle Aged, medicine.disease, Combined Modality Therapy, Surgery, Treatment Outcome, Tissue Plasminogen Activator, 030220 oncology & carcinogenesis, Emergency evacuation, Female, Neurology (clinical), business, Intracranial Hemorrhages, 030217 neurology & neurosurgery, Fibrinolytic agent
Abstract

Background Minimally invasive surgery procedures, including stereotactic catheter aspiration and clearance of intracerebral hemorrhage (ICH) with recombinant tissue plasminogen activator hold a promise to improve outcome of supratentorial brain hemorrhage, a morbid and disabling type of stroke. A recently completed Phase III randomized trial showed improved mortality but was neutral on the primary outcome (modified Rankin scale score 0 to 3 at 1 yr). Objective To assess surgical performance and its impact on the extent of ICH evacuation and functional outcomes. Methods Univariate and multivariate models were used to assess the extent of hematoma evacuation efficacy in relation to mRS 0 to 3 outcome and postulated factors related to patient, disease, and protocol adherence in the surgical arm (n = 242) of the MISTIE trial. Results Greater ICH reduction has a higher likelihood of achieving mRS of 0 to 3 with a minimum evacuation threshold of ≤15 mL end of treatment ICH volume or ≥70% volume reduction when controlling for disease severity factors. Mortality benefit was achieved at ≤30 mL end of treatment ICH volume, or >53% volume reduction. Initial hematoma volume, history of hypertension, irregular-shaped hematoma, number of alteplase doses given, surgical protocol deviations, and catheter manipulation problems were significant factors in failing to achieve ≤15 mL goal evacuation. Greater surgeon/site experiences were associated with avoiding poor hematoma evacuation. Conclusion This is the first surgical trial reporting thresholds for reduction of ICH volume correlating with improved mortality and functional outcomes. To realize the benefit of surgery, protocol objectives, surgeon education, technical enhancements, and case selection should be focused on this goal.

Published
2019
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6. SCIL-STROKE (Subcutaneous Interleukin-1 Receptor Antagonist in Ischemic Stroke)

Author

Nancy J. Rothwell, Calvin Heal, Craig J. Smith, Stephen J. Hopkins, Karen Hopkins, Andy Vail, Pippa J. Tyrrell, Adrian R Parry-Jones, Stuart M. Allan, Sylvia Scarth, Sharon Hulme, and Margaret E. Hoadley

Subjects
Male, 0301 basic medicine, Injections, Subcutaneous, medicine.medical_treatment, Ischemia, Brain Ischemia, Brain ischemia, 03 medical and health sciences, 0302 clinical medicine, Double-Blind Method, Fibrinolytic Agents, Modified Rankin Scale, Odds Ratio, medicine, Humans, Thrombolytic Therapy, Stroke, Aged, Aged, 80 and over, Inflammation, Advanced and Specialized Nursing, biology, Interleukin-6, business.industry, C-reactive protein, Thrombolysis, Middle Aged, medicine.disease, Clinical trial, Interleukin 1 Receptor Antagonist Protein, C-Reactive Protein, Treatment Outcome, 030104 developmental biology, Interleukin 1 receptor antagonist, Area Under Curve, Tissue Plasminogen Activator, Anesthesia, biology.protein, Female, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, 030217 neurology & neurosurgery
Abstract

Background and Purpose— The proinflammatory cytokine IL-1 (interleukin-1) has a deleterious role in cerebral ischemia, which is attenuated by IL-1 receptor antagonist (IL-1Ra). IL-1 induces peripheral inflammatory mediators, such as interleukin-6, which are associated with worse prognosis after ischemic stroke. We investigated whether subcutaneous IL-1Ra reduces the peripheral inflammatory response in acute ischemic stroke. Methods— SCIL-STROKE (Subcutaneous Interleukin-1 Receptor Antagonist in Ischemic Stroke) was a single-center, double-blind, randomized, placebo-controlled phase 2 trial of subcutaneous IL-1Ra (100 mg administered twice daily for 3 days) in patients presenting within 5 hours of ischemic stroke onset. Randomization was stratified for baseline National Institutes of Health Stroke Scale score and thrombolysis. Measurement of plasma interleukin-6 and other peripheral inflammatory markers was undertaken at 5 time points. The primary outcome was difference in concentration of log(interleukin-6) as area under the curve to day 3. Secondary outcomes included exploratory effect of IL-1Ra on 3-month outcome with the modified Rankin Scale. Results— We recruited 80 patients (mean age, 72 years; median National Institutes of Health Stroke Scale, 12) of whom 73% received intravenous thrombolysis with alteplase. IL-1Ra significantly reduced plasma interleukin-6 ( P P P =0.34. Exploratory mediation analysis suggested that IL-1Ra improved clinical outcome by reducing inflammation, but there was a statistically significant, alternative mechanism countering this benefit. Conclusions— IL-1Ra reduced plasma inflammatory markers which are known to be associated with worse clinical outcome in ischemic stroke. Subcutaneous IL-1Ra is safe and well tolerated. Further experimental studies are required to investigate efficacy and possible interactions of IL-1Ra with thrombolysis. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: ISRCTN74236229

Published
2018
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7. Small Vessel Disease and Ischemic Stroke Risk During Anticoagulation for Atrial Fibrillation After Cerebral Ischemia

Author

Du, Houwei, primary, Wilson, Duncan, additional, Ambler, Gareth, additional, Banerjee, Gargi, additional, Shakeshaft, Clare, additional, Cohen, Hannah, additional, Yousry, Tarek, additional, Al-Shahi Salman, Rustam, additional, Lip, Gregory Y.H., additional, Houlden, Henry, additional, Brown, Martin M., additional, Muir, Keith W., additional, Jäger, Hans Rolf, additional, Werring, David J., additional, Parry-Jones, Adrian, additional, Patterson, Chris, additional, Price, Christopher, additional, Elmarimi, Abduelbaset, additional, Parry, Anthea, additional, Nallasivam, Arumug, additional, Mohd Nor, Azlisham, additional, Esisi, Bernard, additional, Bruce, David, additional, Bhaskaran, Biju, additional, Roffe, Christine, additional, Cullen, Claire, additional, Holmes, Clare, additional, Cohen, David, additional, Hargroves, David, additional, Mangion, David, additional, Chadha, Dinesh, additional, Vahidassr, Djamil, additional, Manawadu, Dulka, additional, Giallombardo, Elio, additional, Warburton, Elizabeth, additional, Flossman, Enrico, additional, Gunathilagan, Gunaratam, additional, Proschel, Harald, additional, Emsley, Hedley, additional, Anwar, Ijaz, additional, Burger, Ilse, additional, Okwera, James, additional, Putterill, Janet, additional, O’Connell, Janice, additional, Bamford, John, additional, Corrigan, John, additional, Scott, Jon, additional, Birns, Jonathan, additional, Kee, Karen, additional, Saastamoinen, Kari, additional, Pasco, Kath, additional, Dani, Krishna, additional, Sekaran, Lakshmanan, additional, Choy, Lillian, additional, Iveson, Liz, additional, Mamun, Maam, additional, Sajid, Mahmud, additional, Cooper, Martin, additional, Burn, Mathew, additional, Smith, Matthew, additional, Power, Michael, additional, Davis, Michelle, additional, Smyth, Nigel, additional, Veltkamp, Roland, additional, Sharma, Pankaj, additional, Guyler, Paul, additional, O’Mahony, Paul, additional, Wilkinson, Peter, additional, Datta, Prabel, additional, Aghoram, Prasanna, additional, Marsh, Rachel, additional, Luder, Robert, additional, Meenakishundaram, Sanjeevikumar, additional, Subramonian, Santhosh, additional, Leach, Simon, additional, Ispoglou, Sissi, additional, Andole, Sreeman, additional, England, Timothy, additional, Manoj, Aravindakshan, additional, Frances, Harrington, additional, Rehman, Habib, additional, Sword, Jane, additional, Staals, Julie, additional, Mahawish, Karim, additional, Harkness, Kirsty, additional, Shaw, Louise, additional, McCormick, Michael, additional, Sprigg, Nikola, additional, Mansoor, Syed, additional, and Krishnamurthy, Vinodh, additional

Published
2021
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8. Clinical Risk Prediction Scores in Coronavirus Disease 2019: Beware of Low Validity and Clinical Utility

Author

Haamed Al Hassan, MB BCh, Eve Cocks, DN, Lara Jesani, MB BCh, Sally Lewis, MRCGP, Tamas Szakmany, MD, PhD, on behalf of the Gwent COVID-19 Group, A. Allen-Ridge, E. Baker, C. Bailey, T. Baumer, S. Beckett, S. Champanerkar, Y. Cheema, S. Cherian, E. Cocks, S. Cutler, E. Dawe, A. Dhadda, S. Dumont, N. Duric, S. Elgarf, T. Evans, E. Godfrey, L. Harding, D. Hepburn, A. E. Heron, L. Jesani, P. Jones, C. Killick, C. King, A. Kiss, J. Lavers, J. Lloyd-Evans, N. Mason, L. McClelland, B. Muthuswamy, J. Parry-Jones, E. Phillips, S. Pooley, B. Radford, O. Richards, A. Rimmer, G. Roberts, A. Roynon-Reed, A. Sieunarine, K. Sullivan, T. Szakmany, C. Thomas, E. Thomas, J. Tozer, T. West, and M. Winstanley

Subjects
validation, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Receiver operating characteristic, RC86-88.9, business.industry, Medical emergencies. Critical care. Intensive care. First aid, risk stratification, General Medicine, Disease, Nomogram, calibration, medicine.disease, Comorbidity, coronavirus disease 2019, Internal medicine, Risk stratification, medicine, Hospital discharge, business, Letter to the Editor, Clinical risk factor
Abstract

Several risk stratification tools were developed to predict disease progression in coronavirus disease 2019, with no external validation to date. We attempted to validate three previously published risk-stratification tools in a multicenter study. Primary outcome was a composite outcome of development of severe coronavirus disease 2019 disease leading to ICU admission or death censored at hospital discharge or 30 days. We collected data from 169 patients. Patients were 73 years old (59–82 yr old), 66 of 169 (39.1%) were female, 57 (33.7%) had one comorbidity, and 80 (47.3%) had two or more comorbidities. Area under the receiver operating characteristic curve (95% CI) for the COVID-GRAM score was 0.636 (0.550–0.722), for the CALL score 0.500 (0.411–0.589), and for the nomogram 0.628 (0.543–0.714).

Published
2020
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9. Cognitive Impairment Before Atrial Fibrillation–Related Ischemic Events: Neuroimaging and Prognostic Associations

Author

Banerjee, Gargi, primary, Chan, Edgar, additional, Ambler, Gareth, additional, Wilson, Duncan, additional, Cipolotti, Lisa, additional, Shakeshaft, Clare, additional, Cohen, Hannah, additional, Yousry, Tarek, additional, Al‐Shahi Salman, Rustam, additional, Lip, Gregory Y. H., additional, Muir, Keith W., additional, Brown, Martin M., additional, Jäger, Hans Rolf, additional, Werring, David J., additional, Shaw, Louise, additional, Harkness, Kirsty, additional, Sword, Jane, additional, Nor, Azlisham Mohd, additional, Sharma, Pankaj, additional, Kelly, Deborah, additional, Harrington, Frances, additional, Randall, Marc, additional, Smith, Matthew, additional, Mahawish, Karim, additional, Elmarim, Abduelbaset, additional, Esisi, Bernard, additional, Cullen, Claire, additional, Nallasivam, Arumug, additional, Price, Christopher, additional, Barry, Adrian, additional, Roffe, Christine, additional, Coyle, John, additional, Hassan, Ahamad, additional, Lovelock, Caroline, additional, Birns, Jonathan, additional, Cohen, David, additional, Sekaran, L., additional, Parry‐Jones, Adrian, additional, Parry, Anthea, additional, Hargroves, David, additional, Proschel, Harald, additional, Datta, Prabel, additional, Darawil, Khaled, additional, Manoj, Aravindakshan, additional, Burn, Mathew, additional, Patterson, Chris, additional, Giallombardo, Elio, additional, Smyth, Nigel, additional, Mansoor, Syed, additional, Anwar, Ijaz, additional, Marsh, Rachel, additional, Ispoglou, Sissi, additional, Chadha, Dinesh, additional, Prabhakaran, Mathuri, additional, Meenakishundaram, Sanjeevikumar, additional, O'Connell, Janice, additional, Scott, Jon, additional, Krishnamurthy, Vinodh, additional, Aghoram, Prasanna, additional, McCormick, Michael, additional, O'Mahony, Paul, additional, Cooper, Martin, additional, Choy, Lillian, additional, Wilkinson, Peter, additional, Leach, Simon, additional, Caine, Sarah, additional, Burger, Ilse, additional, Gunathilagan, Gunaratam, additional, Guyler, Paul, additional, Emsley, Hedley, additional, Davis, Michelle, additional, Manawadu, Dulka, additional, Pasco, Kath, additional, Mamun, Maam, additional, Luder, Robert, additional, Sajid, Mahmud, additional, Okwera, James, additional, Staals, Julie, additional, Warburton, Elizabeth, additional, Saastamoinen, Kari, additional, England, Timothy, additional, Putterill, Janet, additional, Flossman, Enrico, additional, Power, Michael, additional, Dani, Krishna, additional, Mangion, David, additional, Suman, Appu, additional, Corrigan, John, additional, Lawrence, Enas, additional, and Vahidassr, Djamil, additional

Published
2020
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11. SCIL-STROKE (Subcutaneous Interleukin-1 Receptor Antagonist in Ischemic Stroke)

Author

Smith, Craig J., primary, Hulme, Sharon, additional, Vail, Andy, additional, Heal, Calvin, additional, Parry-Jones, Adrian R., additional, Scarth, Sylvia, additional, Hopkins, Karen, additional, Hoadley, Margaret, additional, Allan, Stuart M., additional, Rothwell, Nancy J., additional, Hopkins, Stephen J., additional, and Tyrrell, Pippa J., additional

Published
2018
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12. Abstract WMP99: Hematoma Retraction in Spontaneous Intracerebral Hemorrhage: Frequency, Functional Significance and Relation to Perihematomal Edema

Author

Issam A. Awad, Adrian R Parry-Jones, Gayane Yenokyan, Robert Hurford, Nichol McBee, Santosh B. Murthy, Daniel F. Hanley, Craig S. Anderson, Wendy C. Ziai, and Rachel Dlugash

Subjects
Advanced and Specialized Nursing, Intracerebral hemorrhage, business.industry, medicine.disease, Logistic regression, Hematoma, Modified Rankin Scale, Hemostasis, medicine, Functional significance, Neurology (clinical), Perihematomal edema, Cardiology and Cardiovascular Medicine, business, Nuclear medicine, Stroke
Abstract

Background: The natural history of spontaneous intracerebral hematomas (ICH) is for variable degree of early hematoma retraction (HR), which may determine perihematomal brain edema (PHE), but such inter-relationships have not been rigorously studied. Methods: A pooled analysis of 760 computed tomography (CT) scans within 24±12 hours and 1197 CT scans within 72±12 hours of diagnostic CT (0-6 hours from symptom onset), from non-surgical ICH patients included in the Virtual International Stroke Trials Archive (VISTA), and INTERACT I, CLEAR III and MISTIE II clinical trials. Multivariable logistic regression was used to assess independent associations of HR and good 90-day functional outcome (modified Rankin scale [mRS] Results: Median (IQR) diagnostic ICH volume was 11.4 (6.1-22.8) mL. HR occurred at defined thresholds in 5.8% (3mL), 2.4% (6mL) and 2.8% (33%), and in 10.3%, 4.0% and 4.6%, at 24 and 72 hours, respectively. Median retraction volumes at 24/72 hours were -0.9[-2.2, -0.3] and -1.2[-2.9, -0.5) mL, respectively. Between 13.2% and 24% of patients met common hematoma expansion definitions. Clot retraction volume at 24/72 hours was significantly correlated with diagnostic ICH volume (Spearman’s rho: -0.65/-0.64; p5mL had good outcome (N = 20). Conclusion: HR is uncommon and continues to increase over first 72 hours after ICH. Greater HR is associated with more severe ICH, but with less PHE volume, and predicts a poor outcome. Further study is required to better understand these findings.

Published
2017
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13. C-reactive protein in intracerebral hemorrhage: Time course, tissue localization, and prognosis

Author

Laurentiu Mogoanta, Mario Di Napoli, Veronica Campi, Mark Slevin, Craig J. Smith, Aurel Popa Wagner, Daniel Agustin Godoy, Francesca Papa, Stephen J. Hopkins, Luca Masotti, Adrian R. Parry Jones, and Daniel Pirici

Subjects
Male, medicine.medical_specialty, Pathology, Time Factors, Neurology, Autopsy, Severity of Illness Index, Gastroenterology, Risk Factors, Internal medicine, Severity of illness, Journal Article, medicine, Humans, Longitudinal Studies, Prospective Studies, Prospective cohort study, Stroke, Cerebral Hemorrhage, Intracerebral hemorrhage, biology, business.industry, Research Support, Non-U.S. Gov't, Glasgow Outcome Scale, C-reactive protein, Brain, Middle Aged, Prognosis, medicine.disease, Multicenter Study, C-Reactive Protein, biology.protein, Female, Neurology (clinical), business
Abstract

OBJECTIVES: We examined the C-reactive protein (CRP) response after spontaneous intracerebral hemorrhage (sICH) and its relationship to outcome. We additionally characterized early brain localization of CRP.METHODS: In this prospective, multicenter, international, collaborative, longitudinal study with cross-sectional immunohistochemical analysis of brain tissue, 223 patients (M/F: 132/91) were recruited during the 2010 calendar year. CRP was evaluated at admission (median 93 minutes from symptom onset), 24 hours, 48 hours, and 72 hours after sICH. Brains of 5 subjects with sICH were compared to brains of 2 aged controls without evidence of brain pathology and 7 patients with ischemic stroke. Plasma CRP was measured over 72 hours following sICH and its relationship to 30-day mortality and functional outcome at 30 days (Glasgow Outcome Scale) was determined. CRP immunostaining patterns were analyzed in samples of sICH autopsy brains.RESULTS: Plasma CRP increased over the 48 hours from admission and was significantly (p < 0.001) related to hematoma volume at later time points. The predictive utility of CRP for morbidity and mortality were maintained when adjusted for other risk factors and improved at 48 hours and 72 hours when compared with admission values. Although an early CRP localization was present in both ischemic and hemorrhagic lesions, an intense and diffuse neuropil staining was only present in sICH patients and particularly evident proximal to the hemorrhagic areas.CONCLUSIONS: Plasma CRP production increases markedly over the 48 hours to 72 hours period following sICH and is related to outcome. CRP is also present in large amounts around the hemorrhagic lesion and within neurons and glia of patients who died within 12 hours of sICH.

Published
2012
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14. Cognitive Impairment Before Intracerebral Hemorrhage Is Associated With Cerebral Amyloid Angiopathy

Author

Banerjee, Gargi, primary, Wilson, Duncan, additional, Ambler, Gareth, additional, Osei-Bonsu Appiah, Karen, additional, Shakeshaft, Clare, additional, Lunawat, Surabhika, additional, Cohen, Hannah, additional, Yousry, Tarek, additional, Lip, Gregory Y.H., additional, Muir, Keith W., additional, Brown, Martin M., additional, Al-Shahi Salman, Rustam, additional, Jäger, Hans Rolf, additional, Werring, David J., additional, Shaw, Louise, additional, Sword, Jane, additional, Mohd Nor, Azlisham, additional, Sharma, Pankaj, additional, Veltkamp, Roland, additional, Kelly, Deborah, additional, Harrington, Frances, additional, Randall, Marc, additional, Smith, Matthew, additional, Mahawish, Karim, additional, Elmarim, Abduelbaset, additional, Esisi, Bernard, additional, Cullen, Claire, additional, Nallasivam, Arumug, additional, Price, Christopher, additional, Barry, Adrian, additional, Roffe, Christine, additional, Coyle, John, additional, Hassan, Ahamad, additional, Lovelock, Caroline, additional, Birns, Jonathan, additional, Cohen, David, additional, Sekaran, L., additional, Parry-Jones, Adrian, additional, Parry, Anthea, additional, Hargroves, David, additional, Proschel, Harald, additional, Datta, Prabel, additional, Darawil, Khaled, additional, Manoj, Aravindakshan, additional, Burn, Mathew, additional, Patterson, Chris, additional, Giallombardo, Elio, additional, Smyth, Nigel, additional, Mansoor, Syed, additional, Anwar, Ijaz, additional, Marsh, Rachel, additional, Ispoglou, Sissi, additional, Chadha, Dinesh, additional, Prabhakaran, Mathuri, additional, Meenakishundaram, Sanjeevikumar, additional, O’Connell, Janice, additional, Scott, Jon, additional, Krishnamurthy, Vinodh, additional, Aghoram, Prasanna, additional, McCormick, Michael, additional, O’Mahony, Paul, additional, Cooper, Martin, additional, Choy, Lillian, additional, Wilkinson, Peter, additional, Leach, Simon, additional, Caine, Sarah, additional, Burger, Ilse, additional, Gunathilagan, Gunaratam, additional, Guyler, Paul, additional, Emsley, Hedley, additional, Davis, Michelle, additional, Manawadu, Dulka, additional, Pasco, Kath, additional, Mamun, Maam, additional, Luder, Robert, additional, Sajid, Mahmud, additional, Okwera, James, additional, Staals, Julie, additional, Warburton, Elizabeth, additional, Saastamoinen, Kari, additional, England, Timothy, additional, Putterill, Janet, additional, Flossman, Enrico, additional, Power, Michael, additional, Dani, Krishna, additional, Mangion, David, additional, Suman, Appu, additional, Corrigan, John, additional, Lawrence, Enas, additional, and Vahidassr, Djamil, additional

Published
2018
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15. Interleukin-1 in Stroke

Author

Sobowale, Oluwaseun A., primary, Parry-Jones, Adrian R., additional, Smith, Craig J., additional, Tyrrell, Pippa J., additional, Rothwell, Nancy J., additional, and Allan, Stuart M., additional

Published
2016
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16. Ionotropic glutamate receptors and nitric oxide synthesis in the rat striatum

Author

Adrian R Parry-Jones, Stephen J. East, and Jonathan M. Brotchie

Subjects
Male, medicine.medical_specialty, Nerve Tissue Proteins, Kainate receptor, Striatum, AMPA receptor, Biology, Nitric Oxide, Nitroarginine, Receptors, N-Methyl-D-Aspartate, Nitric oxide, Rats, Sprague-Dawley, chemistry.chemical_compound, Glutamates, Receptors, Kainic Acid, Internal medicine, medicine, Animals, Receptors, AMPA, Enzyme Inhibitors, Cyclic GMP, General Neuroscience, Glutamate receptor, Rats, Neostriatum, Nitric oxide synthase, Endocrinology, Receptors, Glutamate, nervous system, chemistry, biology.protein, NMDA receptor, Calcium, Nitric Oxide Synthase, Ionotropic effect
Abstract

A population of interneurones in the rat striatum contain neuronal nitric oxide synthase (nNOS). The nitric oxide (NO)-cGMP pathway may modulate neurotransmission in this brain area but little is known about the physiological stimulator(s) of nNOS in striatal neurones. Exposure of intact striatal slices to N-methyl-D-aspartate (NMDA) (100 microM, 8 min) caused an almost two-fold increase in cGMP levels (EC50 approximately 25 microM), which was inhibited by the nNOS inhibitor N-omega-L-nitroarginine (IC50 approximately 70 nM) and by removing external Ca2+. Neither (S)-alpha-amino-3-hydroxy-5-methyl-4-isoxazole propionate (AMPA) nor the kainate receptor agonist (2S,4R)-4-methylglutamate increased basal cGMP levels. Thus, glutamatergic striatal inputs could stimulate a NO-cGMP pathway in the striatum via NMDA receptors but not via AMPA or kainate receptors.

Published
1996
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17. Post-traumatic stress disorder in children and adolescents

Author

Joanne Barton and William Parry-Jones

Subjects
Psychiatry and Mental health, business.industry, Child psychopathology, Stressor, Traumatic stress, Medicine, business, Clinical psychology
Abstract

Post-traumatic morbidity, including post-traumatic stress disorder, in children and adolescents attracts increasing attention in relation to diverse stressors. Continuing clinical description and research are needed to clarify the range and course of post-traumatic reactions, the developmental varia

Published
1995
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18. Edema Extension Distance

Author

Parry-Jones, Adrian R., primary, Wang, Xia, additional, Sato, Shoichiro, additional, Mould, W. Andrew, additional, Vail, Andy, additional, Anderson, Craig S., additional, and Hanley, Daniel F., additional

Published
2015
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21. C-Reactive Protein Predicts Hematoma Growth in Intracerebral Hemorrhage

Author

Di Napoli, Mario, primary, Parry-Jones, Adrian R., additional, Smith, Craig J., additional, Hopkins, Stephen J., additional, Slevin, Mark, additional, Masotti, Luca, additional, Campi, Veronica, additional, Singh, Puneetpal, additional, Papa, Francesca, additional, Popa-Wagner, Aurel, additional, Tudorica, Valerica, additional, and Godoy, Daniel Agustin, additional

Published
2014
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28. EPSTEIN-BARR VIRUS (EBV) ASSOCIATED B-CELL LYMPHOPROLIFERATIVE DISEASE FOLLOWING HLA IDENTICAL SIBLING MARROW TRANSPLANTATION FOR APLASTIC ANAEMIA IN A PATIENT WITH AN EBV SERONEGATIVE DONOR

Author

Parry-Jones, Nilima, primary, Haque, Tanzina, additional, Ismail, Medmat, additional, Jones, Lydia, additional, Hale, Geoff, additional, Waldmann, Herman, additional, Gordon-Smith, Edward C., additional, Crawford, Dorothy H., additional, and Marsh, Judith C. W., additional

Published
1999
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31. Gamma camera PET in staging non-small cell lung cancer (NSCLC)

Author

S. E. Old, D. Gilligan, D. R. Parry-Jones, R.A.R. Coulden, and K. K. Balan

Subjects
Oncology, medicine.medical_specialty, law, business.industry, Internal medicine, medicine, non-small cell lung cancer (NSCLC), Radiology, Nuclear Medicine and imaging, General Medicine, medicine.disease, business, Gamma camera, law.invention
Published
1999
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32. Gamma camera PET in lymphoma

Author

K. K. Balan, S. E. Old, C. S. Ng, R. E. Marcus, and D. R. Parry-Jones

Subjects
Physics, law, business.industry, medicine, Radiology, Nuclear Medicine and imaging, General Medicine, medicine.disease, Nuclear medicine, business, Gamma camera, law.invention, Lymphoma
Published
1999
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