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Engelter S.T.,University of Basel | Soinne L.,University of Helsinki | Ringleb P.,University of Heidelberg | Sarikaya H.,University of Zurich | And 19 more authors.
Neurology | Year: 2011

Objective: To examine whether prior statin use affects outcome and intracranial hemorrhage (ICH) rates in stroke patients receiving IV thrombolysis (IVT). Methods: In a pooled observational study of 11 IVT databases, we compared outcomes between statin users and nonusers. Outcome measures were excellent 3-month outcome (modified Rankin scale 0-1) and ICH in 3 categories. We distinguished all ICHs (ICHall), symptomatic ICH based on the criteria of the ECASS-II trial (SICHECASS-II), and symptomatic ICH based on the criteria of the National Institute of Neurological Disorders and Stroke (NINDS) trial (SICHNINDS). Unadjusted and adjusted odds ratios (OR) with 95% confidence intervals were calculated. Results: Among 4,012 IVT-treated patients, 918 (22.9%) were statin users. They were older, more often male, and more frequently had hypertension, hypercholesterolemia, diabetes, coronary heart disease, and concomitant antithrombotic use compared with nonusers. Fewer statin users (35.5%) than nonusers (39.7%) reached an excellent 3-month outcome (ORunadjusted 0.84 [0.72-0.98], p = 0.02). After adjustment for age, gender, blood pressure, time to thrombolysis, and stroke severity, the association was no longer significant (0.89 [0.74-1.06], p = 0.20). ICH occurred by trend more often in statin users (ICHall 20.1% vs 17.4%; SICHNINDS 9.2% vs 7.5%; SICHECASS-II 6.9% vs 5.1%). This difference was statistically significant only for SICHECASS-II (OR = 1.38 [1.02-1.87]). After adjustment for age, gender, blood pressure, use of antithrombotics, and stroke severity, the ORadjusted for each category of ICH (ICHall 1.15 [0.93-1.41]; SICHECASS-II 1.32 [0.94-1.85]; SICHNINDS 1.16 [0.87-1.56]) showed no difference between statin users and nonusers. Conclusion: In stroke patients receiving IVT, prior statin use was neither an independent predictor of functional outcome nor ICH. It may be considered as an indicator of baseline characteristics that are associated with a less favorable course. © 2011 by AAN Enterprises, Inc. Source


Almansa C.,Mayo Clinic Florida | Bertani H.,Nuovo Ospedale Civile S. Agostino Estense | Noh K.W.,Tacoma Digestive Disease Center | Wallace M.B.,Mayo Clinic Florida | And 2 more authors.
Digestive and Liver Disease | Year: 2011

Introduction: Doppler transabdominal ultrasound is a validated screening test for chronic mesenteric ischaemia, but gas and obesity are limitations. Endoscopic ultrasound has been proposed as a comprehensive test to evaluate chronic upper abdominal pain and is capable of Doppler measurement. We aim to evaluate the accuracy of Doppler endoscopic ultrasound (D-EUS) as a single screening test to rule out chronic mesenteric ischaemia in patients with abdominal pain and compare it with Doppler transabdominal ultrasound (D-TUS). Methods: We enrolled all patients ≥50 years with chronic upper abdominal pain and vascular risk referred for endoscopic ultrasound. All were scheduled for D-EUS and D-TUS plus a confirmatory test if one of the previous resulted positive. We estimated the accuracy of both techniques comparing them using McNemar test. Results: 68 patients completed the study. Fifty-three (78%) underwent D-EUS, D-TUS, and a confirmatory test. Fifteen (38%) underwent follow-up after negative results. Three (4%) in the D-EUS group and 14 in the D-TUS (21%) were excluded due to artefacts. D-EUS presented a sensitivity of 63%, specificity of 84%, whilst D-TUS presented a sensitivity of 80% and a specificity of 78%. Specificity of D-EUS was not significantly different to D-TUS. Conclusions: These results support the role of Doppler endoscopic ultrasound to exclude chronic mesenteric ischaemia as cause of chronic abdominal pain. © 2011 Editrice Gastroenterologica Italiana S.r.l. Source


de Biase D.,University of Bologna | Visani M.,University of Bologna | Morandi L.,University of Bologna | Marucci G.,University of Bologna | And 33 more authors.
PLoS ONE | Year: 2012

miRNAs are small molecules involved in gene regulation. Each tissue shows a characteristic miRNAs epression profile that could be altered during neoplastic transformation. Glioblastoma is the most aggressive brain tumour of the adult with a high rate of mortality. Recognizing a specific pattern of miRNAs for GBM could provide further boost for target therapy. The availability of fresh tissue for brain specimens is often limited and for this reason the possibility of starting from formalin fixed and paraffin embedded tissue (FFPE) could very helpful even in miRNAs expression analysis. We analysed a panel of 19 miRNAs in 30 paired samples starting both from FFPE and Fresh/Frozen material. Our data revealed that there is a good correlation in results obtained from FFPE in comparison with those obtained analysing miRNAs extracted from Fresh/Frozen specimen. In the few cases with a not good correlation value we noticed that the discrepancy could be due to dissection performed in FFPE samples. To the best of our knowledge this is the first paper demonstrating that the results obtained in miRNAs analysis using Real-Time PCR starting from FFPE specimens of glioblastoma are comparable with those obtained in Fresh/Frozen samples. © 2012 de Biase et al. Source


Visani M.,University of Bologna | de Biase D.,University of Bologna | Marucci G.,University of Bologna | Taccioli C.,University College London | And 32 more authors.
PLoS ONE | Year: 2013

Glioblastoma is the most aggressive brain tumor that may occur in adults. Regardless of the huge improvements in surgery and molecular therapy, the outcome of neoplasia remains poor. MicroRNAs are small molecules involved in several cellular processes, and their expression is altered in the vast majority of tumors. Several studies reported the expression of different miRNAs in glioblastoma, but one of the most critical point in understanding glioblastoma miRNAs profile is the comparison of these studies. In this paper, we focused our attention on the non-neoplastic references used for determining miRNAs expression. The aim of this study was to investigate if using three different non-neoplastic brain references (normal adjacent the tumor, commercial total RNA, and epileptic specimens) could provide discrepant results. The analysis of 19 miRNAs was performed using Real-Time PCR, starting from the set of samples described above and the expression values compared. Moreover, the three different normal RNAs were used to determine the miRNAs profile in 30 glioblastomas. The data showed that different non-neoplastic controls could lead to different results and emphasize the importance of comparing miRNAs profiles obtained using the same experimental condition. © 2013 Visani et al. Source


Desai A.P.,Gastroenterology | Tyberg A.,Gastroenterology | Kedia P.,Gastroenterology | Smith M.S.,Temple University | And 15 more authors.
Surgical Endoscopy and Other Interventional Techniques | Year: 2016

Background: Per-oral endoscopic myotomy (POEM) has emerged as an endoscopic treatment of achalasia. There are no pre-procedural imaging modalities to predict the safest and the most efficacious approach. Aim: To evaluate the use of optimal coherence tomography (OCT) in providing a pre-procedural esophageal assessment. Methods: Patients undergoing POEM from July 2013 to November 2015 were captured in a multicenter, international registry. Patients who underwent OCT pre-POEM (“OCT arm”) were compared to patients without pre-POEM OCT (“control arm”). OCT images were assessed for the degree of vascularity and the thickness of the circular muscular layer, and an approach was determined. Results: A total of 84 patients were captured in the registry. Fifty-one patients underwent pre-POEM OCT. Using OCT as a guide, 24 (47 %) of patients underwent anterior POEM while 27 (53 %) underwent posterior POEM. Technical success was achieved in 96 % of patients. Significantly less bleeding occurred in the OCT arm when compared to the control group [4 (8 %) vs. 14 (43 %), p = 0.0001]. As a result, procedural time was significantly lower in the OCT group as compared to the control group (85.8 vs. 121.7 min, p = 0.000097). Conclusion: Pre-POEM OCT results in a reduction in procedural bleeding which contributes to a reduction in overall procedural time. Clinical trial registration: NCT01438385. © 2016 Springer Science+Business Media New York Source

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