ORCID Profile
0000-0001-8334-3911
Current Organisations
Auckland City Hospital
,
The University of Auckland
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Publisher: Elsevier BV
Date: 12-2021
DOI: 10.1016/J.CLAE.2021.01.004
Abstract: To examine the association between modifiable lifestyle factors and dry eye disease. Three hundred and twenty-two community residents (186 females, 136 males mean ± SD age, 41 ± 22 years) with no major systemic or ophthalmic conditions (other than dry eye disease) were recruited in a cross-sectional study. A lifestyle factor questionnaire was administered, and dry eye symptomology, ocular surface characteristics, and tear film quality were evaluated for each participant within a single clinical session, in accordance with the global consensus recommendations of the TFOS DEWS II reports. A total of 111 (34 %) participants fulfilled the TFOS DEWS II diagnostic criteria for dry eye disease. Multivariate regression analysis demonstrated that advancing age, female sex, East Asian ethnicity, and increased digital screen exposure time were positive risk factors for dry eye disease (all p < 0.05), while increased caffeine consumption was a protective factor (p = 0.04). Increased digital screen exposure time and reduced caffeine consumption were modifiable lifestyle factors associated with higher odds of dry eye disease. These findings might contribute to informing the design of future prospective research investigating the efficacy of preventative intervention and risk factor modification strategies.
Publisher: Elsevier BV
Date: 04-2021
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2019
DOI: 10.1161/STROKEAHA.119.027120
Abstract: Methods of identifying ischemic stroke patients with a greater probability of poor outcome following endovascular thrombectomy (EVT) might improve shared treatment decision-making between patients, families, and physicians. We used an objective, automated method to measure cerebral atrophy and investigated whether this was associated with outcome in EVT patients. Consecutive EVT patients from a single-center registry were studied. CT brain scans were segmented with a combination of a validated U-Net and Hounsfield unit thresholding. Intracranial cerebrospinal fluid (CSF) volume was used as a marker of cerebral atrophy and calculated as a proportion of total intracranial volume. The primary outcome was functional independence, defined as a 3-month modified Rankin Scale score of 0 to 2. Three-hundred sixty EVT patients were included. Functional independence was achieved in 204 (56.7%) patients. The mean±SD CSF volume was 9.0±4.7% of total intracranial volume. Multivariable regression demonstrated that increasing CSF volume was associated with reduced functional independence (OR=0.65 per 5% increase in CSF volume 95% CI, 0.48–0.89 P =0.007) and higher 3-month modified Rankin Scale scores (common OR, 1.59 per 5% increase in CSF volume 95% CI, 1.05–2.41 P =0.03). Cerebral atrophy determined by automated measurement of intracranial CSF volume is associated with functional outcome in patients undergoing EVT. If validated in future studies, this simple, objective, and automated imaging marker could potentially be incorporated into decision-support tools to improve shared treatment decision-making.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2022
Abstract: Our stroke network operates a hybrid organizational structure, with patients with potential large‐vessel occlusion taken to the local primary stroke center (PSC) during office hours, and directly bypassed to the endovascular thrombectomy–capable stroke center (EVT‐SC) after hours. We aimed to compare the 2 methods of transfer. Consecutive patients with anterior large‐vessel occlusion treated with EVT between August 2017 and February 2021 were identified. Patients who had EVT puncture within 6 hours of last known normal were included for analysis. Patients were grouped into method of presentation: direct bypass to EVT‐SC (“EVT‐SC direct”) or taken to local PSC with secondary transfer to EVT‐SC (“PSC‐transfer”). The primary outcome was 3‐month functional independence (modified Rankin scale score 0–2). Secondary outcomes included mortality at 7 days and at 3 months. A total of 259 patients (109 women mean±SD age, 66.8±15.2 years) were included there were 91 (35.1%) EVT‐SC direct and 168 (64.9%) PSC‐transfer patients. The EVT‐SC direct patients had shorter median times from last known normal to thrombolysis (120 versus 147 minutes P =0.004) and puncture (190 versus 230 minutes P .001). Multivariable logistic regression analysis found that EVT‐SC direct patients had greater 3‐month functional independence (odds ratio [OR], 2.04 [95% CI, 1.12–3.73] P =0.02) and lower 3‐month mortality (OR, 0.33 [95% CI, 0.12–0.91] P =0.03). For every 100 patients directly bypassed to EVT‐SC, there were 14 more patients functionally independent and 9 fewer who had died, at 3 months. In this comparison of 2 organizational paradigms in patients with a PSC as the closest stroke center, direct bypass to EVT‐SC resulted in significantly better process times and clinical outcomes compared with secondary transfers from PSCs.
Publisher: American Medical Association (AMA)
Date: 05-2019
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 23-08-2019
DOI: 10.1097/ANA.0000000000000639
Abstract: The choice of anesthetic technique for ischemic stroke patients undergoing endovascular thrombectomy is controversial. Intravenous propofol and volatile inhalational general anesthetic agents have differing effects on cerebral hemodynamics, which may affect ischemic brain tissue and clinical outcome. We compared outcomes in patients undergoing endovascular thrombectomy with general anesthesia who were treated with propofol or volatile agents. Consecutive endovascular thrombectomy patients treated using general anesthesia were identified from our prospective database. Baseline patient characteristics, anesthetic agent, and clinical outcomes were recorded. Functional independence at 3 months was defined as a modified Rankin Scale of 0 to 2. There were 313 patients (182 [58.1%] men mean±SD age, 64.7±15.9 y 257 [82%] anterior circulation), of whom 254 (81%) received volatile inhalational (desflurane or sevoflurane), and 59 (19%) received intravenous propofol general anesthesia. Patients with propofol anesthesia had more ischemic heart disease, higher baseline National Institutes of Health Stroke Scale scores, more basilar artery occlusion, and were less likely to be treated with intravenous thrombolysis. Multivariable logistic regression analysis showed that propofol anesthesia was associated with improved functional independence at 3 months (odds ratio=2.65 95% confidence interval, 1.14-6.22 P =0.03) and a nonsignificant trend toward reduced 3-month mortality (odds ratio=0.37 95% CI, 0.12-1.10 P =0.07). In stroke patients undergoing endovascular thrombectomy treated using general anesthesia, there may be a differential effect between intravenous propofol and volatile inhalational agents. These results should be considered hypothesis-generating and be tested in future randomized controlled trials.
Publisher: Elsevier BV
Date: 04-2020
Publisher: Elsevier BV
Date: 04-2022
Publisher: S. Karger AG
Date: 2020
DOI: 10.1159/000510505
Abstract: b i Background: /i /b In New Zealand, Māori and Pacific people have higher age-adjusted stroke incidence rates, younger age at first stroke, and higher mortality at 12 months than other ethnic groups. We aimed to determine if access to acute stroke reperfusion therapy with intravenous thrombolysis (IVT) or endovascular thrombectomy (EVT) is equitable among ethnic groups. b i Methods: /i /b Data were obtained from the Northern Region component of the New Zealand Stroke Registry over the 21 months between January 1, 2018 and September 30, 2019. Data recorded included demographic details, self-identified ethnicity, treatment times, and clinical outcomes. National hospital discharge coding of patients admitted with ischemic stroke and stroke unspecified was used to determine the proportion of patients treated by ethnic group. b i Results: /i /b There were 537 patients normally resident in the Northern Region who received reperfusion therapy: 281 received IVT alone, 123 received EVT after bridging IVT, and 133 received EVT alone. Of the 537 patients treated with IVT or EVT, there were 81 (15.1%) Māori, 78 (14.5%) Pacific, 57 (10.6%) Asian, and 341 (63.5%) NZ European/other ethnicity patients. There were no ethnic differences in treatment process times. When compared with NZ European/others, Māori and Pacific people were younger, and Māori had worse neurological impairment at admission. A higher proportion of Māori were treated with EVT with a trend to higher proportion treated with IVT. Day 90 modified Rankin Scale (mRS) for EVT-treated patients was similar apart from Asian patients who had worse outcome when compared with NZ European/others (mRS 3 vs. 2 i /i = 0.03). b i Conclusions: /i /b This study has shown equitable access to acute stroke reperfusion therapies and largely similar outcomes in different ethnic groups in northern New Zealand.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2022
Abstract: In patients with ischemic stroke, cardioembolism, predominantly caused by atrial fibrillation (AF), is a leading preventable cause of large‐vessel occlusion (LVO). Despite proven efficacy, inadequate oral anticoagulant (OAC) therapy continues to be a major problem in patients with AF, mechanical heart valves, and other potential sources of emboli. We aimed to determine rates of cardioembolic LVO, the adequacy of OAC, and the association of OACs with clinical outcomes in patients with LVO treated with endovascular thrombectomy (EVT). Consecutive patients with cardioembolism treated with EVT were included and had pre‐stroke indication for OACs and the adequacy of anticoagulation determined. The primary outcome was 3‐month functional independence (modified Rankin Scale score 0–2). Secondary outcomes included early neurological recovery (reduction in National Institutes of Health Stroke Scale score ≥8 points, or score of 0–1 at 24 hours), symptomatic intracranial hemorrhage, and 3‐month mortality and modified Rankin Scale score. There were 784 patients treated with EVT, of whom 416 (53.1% 231 men mean±SD age, 67.1±15.9) had cardioembolic LVO. Of those with cardioembolism, 221 (53.1%) had prevalent AF, 99 (23.8%) incident AF, 48 (11.5%) mechanical heart valves, 10 (2.4%) left ventricular thrombus, and 38 (9.1%) other cardioembolic causes. A total of 242 patients were identified as having a pre‐stroke indication for OACs, and 67 (27.7%) of these patients were considered adequately anticoagulated at time of LVO. In all 242 patients with cardioembolism with a pre‐stroke indication for OACs, adequate anticoagulation was not associated with EVT outcomes. However, adequate anticoagulation in patients with prevalent AF was associated with lower rates of internal carotid artery occlusion (6.8% versus 18.9% P =0.03) and higher rates of functional independence (odds ratio=1.94 95% CI, 1.02–3.78] P =0.04). Over half of patients treated with EVT were assessed as having a cardioembolic cause. Just over a quarter of patients with an indication for OACs at the time of LVO were adequately anticoagulated. These figures suggest that a substantial number of EVT procedures may have been avoided if more patients had been adequately anticoagulated.
Publisher: Wiley
Date: 14-11-2019
DOI: 10.1111/CEO.13671
Publisher: Informa UK Limited
Date: 03-03-2021
Publisher: Elsevier BV
Date: 07-2021
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2019
DOI: 10.1161/STROKEAHA.119.026738
Abstract: In ischemic stroke, baseline renal impairment is present in 20 to 35% of patients and may increase the risk of contrast-associated acute kidney injury (CA-AKI). We aimed to determine whether endovascular thrombectomy (EVT) patients with baseline renal impairment are at increased risk of CA-AKI. Consecutive EVT patients were identified from a prospective database. Patients were stratified by estimated glomerular filtration rate. The primary outcome was CA-AKI assessed at 24 to 72 hours following EVT, defined as an increase in serum creatinine of ≥26.5 µmol/L or 1.5× baseline serum creatinine. Secondary outcomes included requirement for renal replacement therapy and 3-month mortality. Three hundred thirty-three EVT patients (201 men mean±SD age 63.9±15.8 years) were included. The mean±SD iohexol contrast volume used in diagnostic and EVT imaging was 236±77 mL per patient. CA-AKI occurred in 11 (3.3%) patients none required renal replacement therapy, but 4 of 11 (36.4%) had died by 3 months. Propensity score–adjusted logistic regression showed that estimated glomerular filtration rate mL/(min·1.73 m 2 ) was a significant predictor of CA-AKI (odds ratio, 19.93 95% CI, 2.33–170.74 P =0.006). The dose of contrast was not associated with an increased risk of CA-AKI ( P .05). Multiple logistic regression adjusted for potential confounders demonstrated that CA-AKI was independently associated with increased mortality (odds ratio, 4.68 95% CI, 1.05–20.97 P =0.04). There is utility in obtaining baseline creatinine levels to identify patients at risk of CA-AKI and to establish a diagnosis of CA-AKI in patients with subsequent creatinine rises. However, contrast-requiring diagnostic imaging and EVT should not be delayed by waiting for the results of baseline renal function.
Publisher: Elsevier BV
Date: 10-2020
Publisher: Springer Science and Business Media LLC
Date: 21-09-2020
Publisher: Wiley
Date: 13-11-2018
DOI: 10.1111/CEO.13415
Publisher: American Medical Association (AMA)
Date: 10-2023
Publisher: Elsevier BV
Date: 04-2023
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2022
Abstract: Hyponatremia has been associated with worse outcomes in patients with ischemic stroke. Previous studies measured sodium levels at variable times after stroke onset. Patients treated with endovascular thrombectomy have sodium levels measured close to stroke onset. Our aim was to evaluate the association between admission sodium levels and outcome following endovascular thrombectomy. Consecutive patients undergoing endovascular thrombectomy with admission sodium levels were identified from a prospective registry. The primary outcome was functional independence, defined as a modified Rankin scale score of 0, 1, or 2 at 3 months. Secondary outcomes included early neurological recovery (reduction in National Institutes of Health Stroke Scale score ≥8 points from baseline or score of 0–1 at 24 hours), ordinal shift of modified Rankin scale scores at 3 months, symptomatic intracranial hemorrhage, 7‐day mortality, and 3‐month mortality. A total of 710 patients were included (42.5% women mean±SD age, 66.4±14.9 years). The mean±SD admission sodium level was 139±3 mmol/L. Multivariable logistic regression analysis demonstrated that higher admission sodium level (per 1‐mmol/L increase) was an independent predictor of functional independence (odds ratio [OR], 1.06 [95% CI, 1.01–1.11] P =0.03), early neurological recovery (OR, 1.07 [95% CI, 1.01–1.13] P =0.02), and 3‐month modified Rankin scale scores (OR, 0.94 [95% CI, 0.89–0.99] P =0.02). The Youden optimal prognostic cutoff for functional independence was an admission sodium level of ≥136 mmol/L ( P =0.04). There were no associations between sodium levels and symptomatic intracranial hemorrhage, 7‐day mortality, or 3‐month mortality. Admission sodium levels are an independent predictor of functional outcomes following endovascular thrombectomy. Whether admission sodium levels would be of value in decision‐support tools for endovascular thrombectomy should be evaluated in future studies.
Publisher: Elsevier BV
Date: 12-2022
DOI: 10.1016/J.CLAE.2022.101702
Abstract: To explore blinking patterns and sagittal eyelid misalignment in the East Asian eye. Forty-four participants (22 females age 26 ± 5 years 52% of East Asian ethnicity) were enrolled in this pilot study and sub ided, based on upper eyelid crease presence and extent, into single (n = 10), partial (n = 11) or double (n = 23) eyelid crease groups. Blinking was filmed surreptitiously with high-speed video simultaneously from an inferior temporal and frontal view. Spontaneous blink rate and type (incomplete, almost complete, or complete) were assessed over a 30 s period. Sagittal misalignment of the lids on closure was graded during complete spontaneous blinks, voluntary lid closure and voluntary maximal lid contraction (squeezing). A 0.15 µL drop of lissamine green was placed on the central lower lid margin and the number and type of blinks required to eliminate the drop informed complete palpebral apposition during blinking. Mean ± SD blink rates averaged 16.9 ± 10.5 blinks/minute. The proportion of incomplete blinks was 83 ± 22% in single, 58 ± 35% in partial and 59 ± 30% in double eyelid crease groups. The sagittal misalignment of the lid margins during blinking was limited to approximately one-third of the lid margin width this was similar for all lid morphologies and blink types. The lissamine green drop was eliminated only by voluntary maximal lid contraction, and was similar in all groups (p = 0.97). Incomplete blinking and sagittal lid misalignment of the central eyelid margin predominate in habitual blinking, irrespective of lid morphology.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2020
DOI: 10.1161/STROKEAHA.119.028160
Abstract: In ischemic stroke, body temperature is associated with functional outcome. However, the relationship between temperature and outcome may differ in the intraischemic and postischemic phases of stroke. We aimed to determine whether body temperature before or after endovascular thrombectomy (EVT) for large vessel occlusion stroke is associated with clinical outcomes. Consecutive EVT patients were identified from a prospective registry. Temperature measurements within 24 hours of admission were stratified into pre-EVT (preprocedural and intraprocedural) and post-EVT measurements, which served as surrogates for the intraischemic and postischemic phases of large vessel occlusion stroke, respectively. The primary outcome was functional independence, defined as a modified Rankin Scale score of 0, 1, or 2 at 3 months. Secondary outcomes included the ordinal shift of modified Rankin Scale scores at 3 months, symptomatic intracerebral hemorrhage, and mortality at 3 months. Four hundred thirty-two participants were included (59% men, mean±SD age 65.6±15.7 years). Multivariable logistic regression demonstrated that higher median pre-EVT temperature (per 1°C increase) was an independent predictor of reduced functional independence (odds ratio [OR], 0.66 [95% CI, 0.46–0.94] P =0.02), poorer modified Rankin Scale scores (common OR, 1.42 [95% CI, 1.08–1.85] P =0.01), and increased mortality (OR, 1.65 [95% CI, 1.02–2.69] P =0.04). Peak post-EVT temperature (per 1°C increase) was a significant predictor of elevated modified Rankin Scale scores (common OR, 1.39 [95% CI, 1.03–1.90] P =0.03) and higher mortality (OR, 1.66 [95% CI, 1.04–2.67] P =0.03). In patients with large vessel occlusion stroke treated with EVT, higher body temperatures during both the intraischemic and postischemic phases were associated with poorer clinical outcomes. Future research investigating the maintenance of normothermia or therapeutic hypothermia in patients needing to be transferred from primary to EVT-capable stroke centers could be considered.
Publisher: Elsevier BV
Date: 07-2022
Publisher: Elsevier BV
Date: 07-2020
Publisher: Springer Science and Business Media LLC
Date: 14-07-2022
DOI: 10.1038/S41598-022-16191-6
Abstract: The purpose of this study was to evaluate any alterations in the tear film and ocular surface beyond the early postoperative period following penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK). This cross-sectional, contralateral-eye study compared ocular surface and tear film parameters of eyes with a previous PK or DALK in one eye and no prior surgery in the contralateral eye. Overall, 14 (87.5%) participants underwent PK, and 2 (12.5%) underwent DALK using a mechanical dissection. The median time from surgery was 3.4 years (range 1.5 to 38.7 years). The indication for unilateral keratoplasty was keratoconus in 15 (94%) participants, and corneal scarring in 1 (6%) eye, secondary to microbial keratitis. Operated eyes exhibited poorer non-invasive tear film breakup time, lower corneal sensitivity, lower sub-basal nerve density and more severe fluorescein staining scores than unoperated fellow eyes (all Q 0.05). There were no significant differences in tear film lipid layer quality, tear meniscus height, conjunctival hyperaemia, lissamine green staining score, or meibography grade between operated and fellow eyes (all Q ≥ 0.20). Higher corneal esthesiometry threshold (lower corneal sensitivity) was correlated with shorter non-invasive tear film breakup time (Spearman’s rho = − 0.361, p = 0.04) and increased fluorescein staining score (Spearman’s rho = 0.417, p = 0.02). Keratoplasty can induce persistent changes in the ocular surface and tear film, including: increased fluorescein staining, decreased tear film breakup time, decreased corneal sub-basal nerve plexus density, and reduced corneal sensitivity.
Publisher: Elsevier BV
Date: 04-0005
Publisher: Wiley
Date: 07-2020
DOI: 10.1111/OPO.12691
Abstract: There is increasing clinical and research interest in the potential contribution of Demodex to ocular surface disease. The aim of this systematic review was to summarise and synthesise current clinical evidence relating to the aetiology, diagnosis and treatment of ocular Demodex . A comprehensive literature search was performed in OVID Medline, OVID Embase, and clinical trial registries, for studies published between 1990 and August 2019, examining Demodex on the ocular surface. The review included primary clinical research studies and systematic reviews of primary clinical research studies, where Demodex was considered in the context of the ocular surface and/or adnexa. Studies were categorised using the National Health and Medical Research Council evidence hierarchy. Risk of bias assessment was performed using validated tools for studies categorised as providing Level I or II evidence. A total of 87 studies were eligible for inclusion, including two systematic reviews. Most studies (60%) were observational, describing the prevalence of ocular Demodex in different clinical populations. There was a high degree of variability in the epidemiological data derived from cross‐sectional aetiology studies. There was mostly consistent evidence to support an association between ocular Demodex and chronic blepharitis. Seven diagnostic test‐accuracy studies were identified, which considered a range of techniques, including slit l examination for cylindrical eyelash collarettes and/or eyelash manipulation techniques, light microscopic evaluation of epilated eyelashes and in vivo confocal microscopy. There is currently no accepted gold‐standard diagnostic method for ocular Demodex. For intervention studies, there was one systematic review, 11 published randomised trials, six trial registry entries, and nine case series. Despite a number of recent trials, the appropriate treatment regimen for ocular Demodex (including the optimal criteria and timing of an intervention) is not clearly established. This comprehensive narrative synthesis has captured the landscape of clinical evidence relating to the prevalence, aetiology, diagnosis and treatment of ocular Demodex . There remain opportunities to enhance understanding of its role in ocular surface disease, best diagnostic approaches and optimal treatment protocols.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2020
DOI: 10.1161/STROKEAHA.119.027958
Abstract: Intracranial carotid artery calcification is associated with worse outcome in anterior circulation stroke patients who undergo endovascular thrombectomy. We investigated the association between vertebrobasilar artery calcification (VBAC) and outcome in patients undergoing endovascular thrombectomy for posterior circulation large vessel occlusion. Consecutive patients treated for posterior circulation large vessel occlusion from a prospective single-center registry were studied. VBAC was manually segmented on computed tomography brain scans. The associations between VBAC and VBAC volume, functional independence (90-day modified Rankin Scale score of 0–2), and 90-day mortality were assessed using propensity score–adjusted logistic regression. Sixty-four posterior circulation large vessel occlusion patients were included. Twenty-five (39.1%) patients had VBAC, and of these, the median (interquartile range) VBAC volume was 19.8 (6.65–23.4) mm 3 . VBAC was associated with reduced functional independence (OR, 0.19 [95% CI, 0.04–0.78] P =0.03) and increased mortality (OR, 9.44 [95% CI, 2.43–36.62] P =0.005). Larger VBAC volumes were a significant predictor of reduced functional independence and increased mortality. VBAC is an independent predictor of outcome in patients undergoing endovascular thrombectomy for posterior circulation large vessel occlusion. Considering the presence of VBAC might improve prognostication and shared treatment decision-making between patients, families, and physicians.
Publisher: Elsevier BV
Date: 02-2022
DOI: 10.1016/J.CLAE.2021.101450
Abstract: To explore the journey taken by patients in a range of different countries to manage their dry eye symptoms. Members of the general public who responded positively to the question "Do your eyes ever feel dry?" completed a questionnaire describing their demographics, the impact of their symptomology, the advice they have received and the management options they have tried. The Ocular Surface Disease Index (OSDI) questionnaire was also completed. A total of 916 in iduals (Canada = 235, Mexico = 127, New Zealand = 157, Taiwan = 246, UK = 151) of similar age distribution (median 38 years, IQR: 27-50) completed the survey. The reported duration of symptoms was longest in Canada (median 4 years, range 2-10) and least in Taiwan (2 years, range 1-3 p < 0.001), and similar trends were observed for symptom severity (p = 0.001). However, there was no statistically significant difference between countries with respect to the impact of symptoms on quality of life (median 3/10 p = 0.08). Less than half of the in iduals in any country had consulted with a health professional. About half had tried a treatment for their dry eye symptoms, with artificial tears being the most common treatment, followed by warm compresses, and both therapies were rated as reasonably effective (median 5-7/10). Many people with dry eye symptoms are not consulting health care professionals who can confirm the diagnosis, exclude differential diagnoses, and offer a wide range of treatments targeted at the dry eye subtype.
Publisher: Wiley
Date: 16-11-2017
DOI: 10.1111/CEO.13086
Publisher: BMJ
Date: 30-05-2019
DOI: 10.1136/NEURINTSURG-2019-015023
Abstract: In ischemic stroke, increased glycated hemoglobin (HbA1c) and glucose levels are associated with worse outcome following thrombolysis, and possibly, endovascular thrombectomy. To evaluate the association between admission HbA1c and glucose levels and outcome following endovascular thrombectomy. Consecutive patients treated with endovascular thrombectomy with admission HbA1c and glucose levels were included. The primary outcome was functional independence, defined as a modified Rankin Scale score of 0–2 at 3 months. Secondary outcomes included successful reperfusion (modified Thrombolysis in Cerebral Infarction 2b-3), early neurological improvement (reduction in National Institutes of Health Stroke Scale (NIHSS) score ≥8 points, or NIHSS score of 0–1 at 24 hours), symptomatic intracerebral hemorrhage (sICH), and mortality at 3 months. 223 patients (136 (61%) men mean±SD age 64.5±14.6) were included. The median (IQR) HbA1c and glucose were 39 (36-45) mmol/mol and 6.9 (5.8–8.4) mmol/L, respectively. Multiple logistic regression analysis demonstrated that increasing HbA1c levels (per 10 mmol/mol) were associated with reduced functional independence (OR=0.76 95% CI 0.60–0.96 p=0.02), increased sICH (OR=1.33 95% CI 1.03 to 1.71 p=0.03), and increased mortality (OR=1.26 95% CI 1.01 to 1.57 p=0.04). There were no significant associations between glucose levels and outcome measures (all p .05). HbA1c levels are an independent predictor of worse outcome following endovascular thrombectomy. The addition of HbA1c to decision-support tools for endovascular thrombectomy should be evaluated in future studies.
Publisher: Elsevier BV
Date: 10-2018
DOI: 10.1016/J.CLAE.2018.06.003
Abstract: To evaluate the patient-administered Optrex Eighty-seven participants aged 38 ± 17 years, (44 female) were screened for DED using the Tear Film and Ocular Surface Society Dry Eye Workshop II (TFOS DEWS II) diagnostic criteria. In addition to symptoms screening with the Ocular Surface Disease Index questionnaire (≥13 cut-off score for DED), these criteria required a sign of loss of homeostasis of the tear film in the form of a non-invasive tear breakup time (NIBUT) 8 (Tearlab), or ocular surface staining (>5 fluorescein corneal spots, >9 lissamine green spots or lid wiper staining [≥2 mm length & ≥25% width]) to confirm a diagnosis of DED. The self-administered Blink Test, which requires the participant to observe an image on a computer screen and report the length of time (in seconds) that they can refrain from blinking without discomfort, was repeated three times. Using a cut-off time of 10 s, the Blink Test demonstrated sensitivity of 66%, specificity of 88%, and an area under the curve of 0.77 (p < 0.001), in predicting a diagnosis of DED according to the TFOS DEWS II criteria. The correlation between the Blink Test and NIBUT was r = 0.47 (p < 0.001). When combined with the screening questionnaire, the sensitivity and specificity of the Blink Test increased to 71% and 90%, respectively. The Blink Test offers health professionals without advanced instrumentation, as well as patients, themselves, a rapid method of identifying possible DED.
Publisher: Elsevier BV
Date: 07-2021
Publisher: Elsevier BV
Date: 2018
DOI: 10.1016/J.JTOS.2017.10.005
Abstract: To compare the efficacy of a dedicated eyelid cleanser and diluted baby sh oo in the management of blepharitis. Forty-three participants with clinical blepharitis signs were enrolled in a prospective, randomized, double-masked, paired-eye trial. A dedicated eyelid cleanser (TheraTears Baseline measurements did not differ between treatments (all p > 0.05). The eyelid cleanser was preferred over baby sh oo by the majority of participants (p < 0.001). Improvements in the tear lipid layer, inferior lid wiper epitheliopathy (LWE), cylindrical collarettes, and MMP-9 expression were limited to the dedicated eyelid cleanser (all p < 0.05), and a greater decrease in SANDE symptoms score was also observed (p = 0.04). Meibomian gland capping and MUC5AC expression worsened with baby sh oo treatment (both p < 0.05). SPEED symptoms score, superior LWE, seborrhoeic lash crusting, and trichiasis decreased significantly following application of both treatments (all p 0.05). Clinical improvements in blepharitis occurred with both treatments. However, only the dedicated eyelid cleanser proved effective in reducing ocular surface inflammation, and was the preferred therapy. Long term impact of decreased goblet cell function secondary to baby sh oo treatment requires further exploration.
Publisher: SAGE Publications
Date: 16-06-2022
DOI: 10.1177/0271678X221107988
Abstract: Active conductive head cooling is a simple and non-invasive intervention that may slow infarct growth in ischemic stroke. We investigated the effect of active conductive head cooling on brain temperature using whole brain echo-planar spectroscopic imaging. A cooling cap (WElkins Temperature Regulation System, 2nd Gen) was used to administer cooling for 80 minutes to healthy volunteers and chronic stroke patients. Whole brain echo-planar spectroscopic imaging scans were obtained before and after cooling. Brain temperature was estimated using the Metabolite Imaging and Data Analysis System software package, which allows voxel-level temperature calculations using the chemical shift difference between metabolite (N-acetylaspartate, creatine, choline) and water resonances. Eleven participants (six healthy volunteers, five post-stroke) underwent 80 ± 5 minutes of cooling. The average temperature of the coolant was 1.3 ± 0.5°C below zero. Significant reductions in brain temperature (ΔT = –0.9 ± 0.7°C, P = 0.002), and to a lesser extent, rectal temperature (ΔT = –0.3 ± 0.1°C, P = 0.03) were observed. Exploratory analysis showed that the occipital lobes had the greatest reduction in temperature (ΔT = –1.5 ± 1.2°C, P = 0.002). Regions of infarction had similar temperature reductions to the contralateral normal brain. Future research could investigate the feasibility of head cooling as a potential neuroprotective strategy in patients being considered for acute stroke therapies.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 15-06-2021
DOI: 10.1212/WNL.0000000000012112
Abstract: To evaluate the safety and efficacy of intra-arterial thrombolysis (IAT) as an adjunct to endovascular thrombectomy (EVT) in ischemic stroke, we performed a systematic review and meta-analysis of the literature. Searches were performed using MEDLINE, Embase, and Cochrane databases for studies that compared EVT with EVT with adjunctive IAT (EVT + IAT). Safety outcomes included symptomatic intracerebral hemorrhage and mortality at 3 months. Efficacy outcomes included successful reperfusion (Thrombolysis in Cerebral Infarction score of 2b–3) and functional independence, defined as a modified Rankin Scale score of 0–2 at 3 months. Five studies were identified that compared combined EVT + IAT (IA alteplase or urokinase) with EVT only and were included in the random-effects meta-analysis. There were 1693 EVT patients, including 269 patients treated with combined EVT + IAT and 1,424 patients receiving EVT only. Pooled analysis did not demonstrate any differences between EVT + IAT and EVT only in rates of symptomatic intracerebral hemorrhage (odds ratio [OR]: 0.61, 95% confidence interval [CI]: 0.20–1.85 p = 0.78), mortality (OR: 0.77, 95% CI: 0.54–1.10 p = 0.15), or successful reperfusion (OR: 1.05, 95% CI: 0.52–2.15 p = 0.89). There was a higher rate of functional independence in patients treated with EVT + IAT, although this was not statistically significant (OR: 1.34, 95% CI: 1.00–1.80 p = 0.053). Adjunctive IAT appears to be safe. In specific situations, neurointerventionists may be justified in administering small doses of intra-arterial alteplase or urokinase as rescue therapy during EVT.
No related grants have been discovered for Michael T. M. Wang.