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Su S.-H.,Tongji University | Xu W.,Emergency | Hai J.,Tongji University | Yu F.,Tongji University | And 3 more authors.
Journal of Clinical Neuroscience | Year: 2014

Detected unruptured intracranial aneurysms (UIA) are becoming more common with the increased utilization of CT angiography, MR angiography and digital subtraction angiography. A proportion of patients with UIA remain untreated. We investigated to assess cognitive function, depression, anxiety and quality of life (QoL) in Chinese patients with untreated UIA. Thirty one Chinese patients with untreated UIA and 25 healthy controls were identified and matched for variables including age, sex, and living area. Cognitive function was evaluated with the Montreal Cognitive Assessment (MoCA). Depression, anxiety and QoL were screened with the Self-Rating Depression Scale, Self-Rating Anxiety Scale, and Short Form-36, respectively. Non-parametric tests were used for comparisons between groups. No patient had cognitive dysfunction at 1 month or 1 year after detection of UIA. However, a significant decrease of overall MoCA subscores was found in 30 (97%) of 31 patients 5 years after UIA discovery, suggestive of mild cognitive impairment. A significant decrease in depression and anxiety was found in patients over time. QoL in patients was reduced most prominently in psychosocial function and social activities 1 year after detection of UIA, but these improved to within normal limits at the end of the follow-up period. For Chinese patients with untreated UIA, depression, anxiety and reduced QoL may be short-term complications. Mild cognitive impairment may be a long-term complication. © 2014 Elsevier Ltd. All rights reserved.

Su S.-H.,Tongji University | Xu W.,Emergency | Hai J.,Tongji University | Wu Y.-F.,Tongji University | Yu F.,Tongji University
Scientific Reports | Year: 2014

Aneurysmal subarachnoid hemorrhage (aSAH)-induced cerebral vasospasm and delayed ischemic neurological deficit (DIND) are the major causes of morbidity and mortality in patients with aSAH. The effects of statins-use for patients with aSAH remain controversial. Here,a total of 249 patients from six randomized controlled trials(RCTs) were subjected to meta-analysis. No significant decrease was found in the incidence of vasospasm(RR, 0.80; 95% CI, 0.54-1.17), with substantial heterogeneity (I2 = 49%, P = 0.08), which was verified by the further sensitivity analysis and subgroup meta-analysis. Furthermore, no significant difference was presented in the incidence of poor neurological outcome(RR, 0.94; 95% CI, 0.77-1.16), and potential side effects(RR, 2.49; 95% CI, 0.75-8.33). Nevertheless, significant difference was reported in the occurrence of DIND(RR, 0.58; 95% CI, 0.37-0.92) and mortality(RR, 0.30; 95% CI, 0.14-0.64). At present, although statins-use in the patients with aSAH should not be considered standard care at present, statins-use may have the potential effects in the prevention of mortality in patients with aSAH.

Su S.-H.,Tongji University | Xu W.,Emergency | Li M.,Shanghai JiaoTong University | Zhang L.,Shanghai JiaoTong University | And 3 more authors.
Brain, Behavior, and Immunity | Year: 2014

The pathogenesis of persistent unfavourable outcomes following mild traumatic brain injury (mTBI) are not fully understood. Low-grade systemic inflammation might contribute to the development of persistent unfavourable outcomes in patients with mTBI. We used plasma high-sensitivity C-reactive protein (CRP) levels as the biomarker of systemic inflammation to investigate whether elevated CRP levels were associated with persistent adverse outcomes in these patients. A total of 213 consecutive patients with mTBI were identified in our study. Plasma high-sensitivity CRP levels were measured at baseline, 1. month, 2. months and 3. months after initial traumatic brain injury. The study endpoints included persistent postconcussion syndrome (PCS), persistent psychological problems (depression and anxiety), persistent physiological problems (frequent headache, nausea, insomnia, dizziness and fatigue) and persistent cognitive impairment, which were screened by International Classification of Diseases (ICD-10), diagnostic and statistical manual of mental disorders (DSM-IV), Beck anxiety inventory (BAI), Beck depression inventory (BDI) and montreal cognitive assessment (MoCA) 3. months post-injury. The associations between baseline CRP levels and persistent unfavourable outcomes were estimated from multiple regression models adjusting for various confounding covariates. Elevated baseline CRP levels were associated with a significant increase in the incidence of persistent PCS (odds ratio [OR], 2.719; 95% confidence interval [CI], 1.609-4.594; p= 0.000), persistent psychological problems (OR, 1.535; 95% CI, 1.063-2.216; p= 0.022), and persistent cognitive impairment (OR, 1.687; 95% CI, 1.135-2.507; p= 0.010). However, elevated CRP levels were not associated with persistent physiological problems (OR, 1.330; 95% CI, 0.905-1.956; p= 0.146). Furthermore, three adjusted models did not essentially affect the OR of elevated CRP levels for these persistent unfavourable outcomes. Among patients with mTBI, baseline elevated CRP levels may be an independent predictor of persistent persistent PCS, psychological problems and cognitive impairment. © 2014 Elsevier Inc.

Smith G.,Monash University | Mcd Taylor D.,Emergency | Morgans A.,Policy and Research | Morgans A.,Monash University | Cameron P.,Monash University
EMA - Emergency Medicine Australasia | Year: 2015

Objective: To evaluate the effect of changes to the pre-hospital management of patients with supraventricular tachycardia (SVT) following intervention with a revised Clinical Practice Guideline (CPG). The major CPG revisions were removal of verapamil, addition of adenosine and an emphasis on Valsalva manoeuvre. Method: We undertook a retrospective case study using data collected by paramedics. All adult patients attended by paramedics from the periods 14 February 2012 to 14 September 2012 (old CPG) and 14 February 2013 to 14 September 2013 (revised CPG) were included. Patients were excluded if SVT was not recorded during initial assessment on a hardcopy ECG. Management guided by the old and revised CPGs was compared: reversion effectiveness, elements of therapy associated with reversion effectiveness and adverse events. Logistic regression determined patient factors significantly associated with reversion. Results: Patients were predominantly women, aged approximately 57 years old and most lived in the Victorian metropolitan region. Vagal manoeuvre use and effectiveness decreased in the post-intervention group. Fewer patients in the post-intervention group (141/420, 33.6%) remained in SVT on arrival at hospital compared with the pre-intervention group (205/403, 50.8%). Initial heart rate >170/min and longer scene time were 2.6 and 1.05 times more likely to result in reversion, respectively. Conclusion: The revised CPG improved pre-hospital SVT reversion success. This expansion of practice has not demonstrated improvements to utilisation or effectiveness of the Valsalva manoeuvre. Adenosine is effective and safe for pre-hospital use. © 2015 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Smith G.,Monash University | Mcd Taylor D.,Emergency | Morgans A.,Policy and Research | Morgans A.,Monash University | Cameron P.,Monash University
EMA - Emergency Medicine Australasia | Year: 2014

Objective: The present study examined patient demographics, characteristics and the effectiveness of current prehospital supraventricular tachycardia (SVT) management by ambulance paramedics in Victoria, Australia. Method: We conducted a retrospective study of all Victorian patients attended by paramedics between 14 February 2012 and 13 February 2013, where SVT was the initial or final diagnosis. Patients were excluded if SVT was not captured on ECG, incomplete data were recorded, or SVT began after initial assessment. Data were extracted from the VACIS® clinical data warehouse. Accuracy of paramedic SVT diagnosis was examined. Results: Nine hundred and thirty-three patients were enrolled, including 882 (94.5%) adults and 564 (60.5%) women. Mean adult and paediatric (<18 years) patient ages were 57.5 (SD 18.1) and 10.0 (SD 4.5) years, respectively. Median ambulance response time was 11.0 (IQR 8.0) min. Paramedics correctly identified SVT in 119/123 (96.7%, 95% CI: 91.5, 99.0) of adult ECG strips examined. There were 273/882 (31.0%) patients who spontaneously reverted while in paramedic care. Valsalva manoeuvre was undertaken by 212/882 (24.0%) patients and reverted the SVT in 99/358 (27.7%) attempts. Verapamil was administered to 38/882 (4.3%) patients and reverted 33 (86.8%). Aramine was administered to 43/882 (4.9%) patients and 35 reverted following administration (81.4%). Synchronised cardioversion (70 J) reverted four patients at first attempt. Ultimately, 438 (49.7%) patients remained in SVT on arrival at hospital. Conclusion: Patient characteristics associated with SVT are more likely to be middle-aged women with a history of hypertension and hypercholesterolaemia. Therapies were underutilised leading to reduced clinical guideline effectiveness. Where therapies were instigated, reversion rates are greater than previously reported. © 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

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