ImportanceUse of oral vitamin K antagonists (VKAs) may place patients undergoing endovascular thr... more ImportanceUse of oral vitamin K antagonists (VKAs) may place patients undergoing endovascular thrombectomy (EVT) for acute ischemic stroke caused by large vessel occlusion at increased risk of complications.ObjectiveTo determine the association between recent use of a VKA and outcomes among patients selected to undergo EVT in clinical practice.Design, Setting, and ParticipantsRetrospective, observational cohort study based on the American Heart Association’s Get With the Guidelines–Stroke Program between October 2015 and March 2020. From 594 participating hospitals in the US, 32 715 patients with acute ischemic stroke selected to undergo EVT within 6 hours of time last known to be well were included.ExposureVKA use within the 7 days prior to hospital arrival.Main Outcome and MeasuresThe primary end point was symptomatic intracranial hemorrhage (sICH). Secondary end points included life-threatening systemic hemorrhage, another serious complication, any complications of reperfusion th...
The occurrence of a stroke while on antiplatelet agents presents a therapeutic dilemma. One of th... more The occurrence of a stroke while on antiplatelet agents presents a therapeutic dilemma. One of the main causes for recurrent strokes is antiplatelet resistance more commonly known as high on treatment platelet reactivity (HTPR). Prior studies have established that proteinuria is associated with HTPR following myocardial infarction. Here, we investigated whether dipstick proteinuria correlates with HTPR in patients presenting with stroke. We performed a retrospective cohort analysis of 102 patients admitted for a recurrent ischemic stroke that had either a VerifyNow aspirin or VerifyNow clopidogrel laboratory test performed to assess platelet reactivity. Dipstick proteinuria was defined as > 30 mg/dl (2+ or more). HTPR was defined as an aspirin resistance unit > 550 for aspirin and a P2Y12 reactivity unit > 208 for clopidogrel. Patients with proteinuria on dipstick were significantly more likely to have HTPR to either aspirin (p value 0.017) or clopidogrel (p value 0.017). A...
Background -Patients with minor acute ischemic stroke (AIS) or transient ischemic attack (TIA) ar... more Background -Patients with minor acute ischemic stroke (AIS) or transient ischemic attack (TIA) are at high risk for subsequent stroke, and more potent antiplatelet therapy in the acute setting is needed. However, the potential benefit of more intense antiplatelet therapy must be assessed in relation to the risk for major bleeding. The SOCRATES trial was the first trial with ticagrelor in patients with AIS or TIA, in which the efficacy and safety of ticagrelor were compared with aspirin. The main safety objective was assessment of PLATO-defined major bleeds on treatment, with special focus on intracranial hemorrhage (ICrH). Methods -An independent adjudication committee, blinded to study treatment, classified bleeds according to the PLATO, TIMI and GUSTO definitions. The definitions of ICrH and major bleeding excluded cerebral micro-bleeds and asymptomatic hemorrhagic transformations of cerebral infarctions so that the definitions better discriminated important events in the acute st...
JNCI: Journal of the National Cancer Institute, 1975
Adenocarcinomas of the pancreas were experimentally induced in rats after the implantation of 7,1... more Adenocarcinomas of the pancreas were experimentally induced in rats after the implantation of 7,12-dimethylbenz[alpha]anthracene (DMBA). Rats were anesthetized with Nembutal, the pancreas was exposed, and a 2- to 3-mm incision was made in the "head" of the pancreas approximately 1 cm from the duodenum. Crystalline DMBA (2-3 mg) was implanted and the incision was closed with silk suture. Eight % of animals developed tumors in the pancreas from 119 to 363 days after implantation (mean, 194 days). Ten animals developed tumors in less than 180 days. The adenocarcinomas were invasive, metastasized, and had pronounced ductal cell characteristics. The light-microscopic morphology of these pancreatic tumors was presented.
The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses, 2015
To determine correlation and predictive value between data obtained with the bispectral index (BI... more To determine correlation and predictive value between data obtained with the bispectral index (BIS) and diagnostic electroencephalogram (EEG) in determining degree of burst suppression during drug-induced coma. This study seeks to answer the question: "To what degree can EEG suppression and burst count as measured by diagnostic EEG during drug-induced coma be predicted from data obtained from the BIS such as BIS value, suppression ratio (SR), and burst count?" During drug-induced coma, cortical EEG is the gold standard for real-time monitoring and drug titration. Diagnostic EEG is, from setup through data analysis, labor intensive, costly, and difficult to maintain uniform clinician competency. BIS monitoring is less expensive, less labor-intensive, and easier to interpret data and establish/maintain competency. Validating BIS data versus diagnostic EEG facilitates effective brain monitoring during drug-induced coma at lower cost with similar outcomes. This is a prospectiv...
Although intraarterial shunting during carotid endarterectomy is a well-defined practice, its use... more Although intraarterial shunting during carotid endarterectomy is a well-defined practice, its use remains controversial. Complication rates associated with shunt placement remain low, but may be underreported. When complications secondary to routine intraarterial shunting occur, they can cause significant morbidity or even mortality, emphasizing the importance of meticulous technique to prevent adverse outcomes. We report a case of internal carotid artery dissection and pseuedoaneurysm due to the technical failure of a safety device of an intraarterial shunt used during carotid endarterectomy.
‘Compartmental descriptions can be as diverse as organisms within an ecosystem or small molecules... more ‘Compartmental descriptions can be as diverse as organisms within an ecosystem or small molecules within a subcellular organelle.’ Oxidative stress is frequently invoked to explain biological injury, but the lack of a clear definition for this term may mask underlying mechanisms rather than contribute to its understanding. The diverse and complex phenomena related to oxidative stress contribute to the problem of definition. Our goals are to review basic concepts of oxidation and introduce a qualitative compartmental kinetic model in an effort to help to clarify this definition and provide a framework for exploring the myriad inter-relationships. While oxidation and reduction formally refer
We describe a patient who developed pancerebellar syndrome as a result of hyperthermia that devel... more We describe a patient who developed pancerebellar syndrome as a result of hyperthermia that developed after cocaine use. The patient had long-standing schizophrenia and had been taking risperidone for 2 years, without evidence of abnormal movements. A literature review revealed a marked similarity between cocaine and neuroleptics in their ability to cause hyperthermia. Based on our observations and the compatible evidence from the literature, we suggest that cocaine use may cause hyperthermia and result in chronic pancerebellar dysfunction.
ImportanceUse of oral vitamin K antagonists (VKAs) may place patients undergoing endovascular thr... more ImportanceUse of oral vitamin K antagonists (VKAs) may place patients undergoing endovascular thrombectomy (EVT) for acute ischemic stroke caused by large vessel occlusion at increased risk of complications.ObjectiveTo determine the association between recent use of a VKA and outcomes among patients selected to undergo EVT in clinical practice.Design, Setting, and ParticipantsRetrospective, observational cohort study based on the American Heart Association’s Get With the Guidelines–Stroke Program between October 2015 and March 2020. From 594 participating hospitals in the US, 32 715 patients with acute ischemic stroke selected to undergo EVT within 6 hours of time last known to be well were included.ExposureVKA use within the 7 days prior to hospital arrival.Main Outcome and MeasuresThe primary end point was symptomatic intracranial hemorrhage (sICH). Secondary end points included life-threatening systemic hemorrhage, another serious complication, any complications of reperfusion th...
The occurrence of a stroke while on antiplatelet agents presents a therapeutic dilemma. One of th... more The occurrence of a stroke while on antiplatelet agents presents a therapeutic dilemma. One of the main causes for recurrent strokes is antiplatelet resistance more commonly known as high on treatment platelet reactivity (HTPR). Prior studies have established that proteinuria is associated with HTPR following myocardial infarction. Here, we investigated whether dipstick proteinuria correlates with HTPR in patients presenting with stroke. We performed a retrospective cohort analysis of 102 patients admitted for a recurrent ischemic stroke that had either a VerifyNow aspirin or VerifyNow clopidogrel laboratory test performed to assess platelet reactivity. Dipstick proteinuria was defined as > 30 mg/dl (2+ or more). HTPR was defined as an aspirin resistance unit > 550 for aspirin and a P2Y12 reactivity unit > 208 for clopidogrel. Patients with proteinuria on dipstick were significantly more likely to have HTPR to either aspirin (p value 0.017) or clopidogrel (p value 0.017). A...
Background -Patients with minor acute ischemic stroke (AIS) or transient ischemic attack (TIA) ar... more Background -Patients with minor acute ischemic stroke (AIS) or transient ischemic attack (TIA) are at high risk for subsequent stroke, and more potent antiplatelet therapy in the acute setting is needed. However, the potential benefit of more intense antiplatelet therapy must be assessed in relation to the risk for major bleeding. The SOCRATES trial was the first trial with ticagrelor in patients with AIS or TIA, in which the efficacy and safety of ticagrelor were compared with aspirin. The main safety objective was assessment of PLATO-defined major bleeds on treatment, with special focus on intracranial hemorrhage (ICrH). Methods -An independent adjudication committee, blinded to study treatment, classified bleeds according to the PLATO, TIMI and GUSTO definitions. The definitions of ICrH and major bleeding excluded cerebral micro-bleeds and asymptomatic hemorrhagic transformations of cerebral infarctions so that the definitions better discriminated important events in the acute st...
JNCI: Journal of the National Cancer Institute, 1975
Adenocarcinomas of the pancreas were experimentally induced in rats after the implantation of 7,1... more Adenocarcinomas of the pancreas were experimentally induced in rats after the implantation of 7,12-dimethylbenz[alpha]anthracene (DMBA). Rats were anesthetized with Nembutal, the pancreas was exposed, and a 2- to 3-mm incision was made in the "head" of the pancreas approximately 1 cm from the duodenum. Crystalline DMBA (2-3 mg) was implanted and the incision was closed with silk suture. Eight % of animals developed tumors in the pancreas from 119 to 363 days after implantation (mean, 194 days). Ten animals developed tumors in less than 180 days. The adenocarcinomas were invasive, metastasized, and had pronounced ductal cell characteristics. The light-microscopic morphology of these pancreatic tumors was presented.
The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses, 2015
To determine correlation and predictive value between data obtained with the bispectral index (BI... more To determine correlation and predictive value between data obtained with the bispectral index (BIS) and diagnostic electroencephalogram (EEG) in determining degree of burst suppression during drug-induced coma. This study seeks to answer the question: "To what degree can EEG suppression and burst count as measured by diagnostic EEG during drug-induced coma be predicted from data obtained from the BIS such as BIS value, suppression ratio (SR), and burst count?" During drug-induced coma, cortical EEG is the gold standard for real-time monitoring and drug titration. Diagnostic EEG is, from setup through data analysis, labor intensive, costly, and difficult to maintain uniform clinician competency. BIS monitoring is less expensive, less labor-intensive, and easier to interpret data and establish/maintain competency. Validating BIS data versus diagnostic EEG facilitates effective brain monitoring during drug-induced coma at lower cost with similar outcomes. This is a prospectiv...
Although intraarterial shunting during carotid endarterectomy is a well-defined practice, its use... more Although intraarterial shunting during carotid endarterectomy is a well-defined practice, its use remains controversial. Complication rates associated with shunt placement remain low, but may be underreported. When complications secondary to routine intraarterial shunting occur, they can cause significant morbidity or even mortality, emphasizing the importance of meticulous technique to prevent adverse outcomes. We report a case of internal carotid artery dissection and pseuedoaneurysm due to the technical failure of a safety device of an intraarterial shunt used during carotid endarterectomy.
‘Compartmental descriptions can be as diverse as organisms within an ecosystem or small molecules... more ‘Compartmental descriptions can be as diverse as organisms within an ecosystem or small molecules within a subcellular organelle.’ Oxidative stress is frequently invoked to explain biological injury, but the lack of a clear definition for this term may mask underlying mechanisms rather than contribute to its understanding. The diverse and complex phenomena related to oxidative stress contribute to the problem of definition. Our goals are to review basic concepts of oxidation and introduce a qualitative compartmental kinetic model in an effort to help to clarify this definition and provide a framework for exploring the myriad inter-relationships. While oxidation and reduction formally refer
We describe a patient who developed pancerebellar syndrome as a result of hyperthermia that devel... more We describe a patient who developed pancerebellar syndrome as a result of hyperthermia that developed after cocaine use. The patient had long-standing schizophrenia and had been taking risperidone for 2 years, without evidence of abnormal movements. A literature review revealed a marked similarity between cocaine and neuroleptics in their ability to cause hyperthermia. Based on our observations and the compatible evidence from the literature, we suggest that cocaine use may cause hyperthermia and result in chronic pancerebellar dysfunction.
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