Risultati per: Come si esegue la raccolta delle urine delle 24 ore

Stroke, Volume 54, Issue Suppl_1, Page ATP122-ATP122, February 1, 2023. Background:Systolic blood pressure variability (SBPV) has been associated with poor outcomes among patients with intracerebral hemorrhage (ICH). Intravenous nicardipine (IVN) is frequently used for blood pressure management among hospitalized ICH patients, however SBPV in response to IVN has not been characterized.Methods:Data for primary ICH patients who received IVN were retrieved from a stroke-specific bioinformatics pipeline. SBPV was quantified as the coefficient of variation (CV) of cuff-measured systolic blood pressure, and CV was calculated over the time periods 0-24 hrs prior to (Pre24), 0-24 hrs after (Post24), and 24-48 hrs after (Post48) initial IVN administration. Group differences were assessed using Friedman’s Test and Bonferroni-corrected Wilcoxon Signed-rank tests. Contributions of SBPV at each timepoint to poor in-hospital mortality or discharge to hospice (poor outcome) were assessed in separate multivariable logistic regression models adjusted for patient characteristics. Adjusted Odds ratios (aOR) and 95% confidence intervals (CI) are reported.Results:Data included 370 ICH patients with a median [interquartile range] age of 65 [54 – 76]. Patients included were 46.0% female, 41.1% Non-Hispanic White, 25.1% Non-Hispanic Black, 23.8% Hispanic, 8.1% Asian, and 1.9% other. Patients had a median CV of 9.2 [6.1-13.6] in the Pre24 period, 11.6 [9.46 – 13.9] in Post24, and 9.5 [7.6 – 12.1] in Post48. SPBV showed significant differences across timepoints (p=0.000), with Post24 showing elevated SBPV (vs. Pre24 (p=0.000) or Post48 (p=0.000), Figure 1A, B). In multivariable modelling, patients in the highest quartile of SPBV during the Post24 period showed increased risk of poor outcome: aOR (CI) 2.91 (1.06-8.01), Figure 1C.Conclusions:SBPV increases over the first 24 hours of IVN administration and patients with higher SPBV during this time are at higher risk for in-hospital mortality. SPBV management protocols need to be evaluated.

Stroke, Volume 54, Issue Suppl_1, Page ATMP61-ATMP61, February 1, 2023. Introduction:Lesion volume on MRI or CT provides evidence of tissue response to successful recanalization by endovascular therapy. The most appropriate time to estimate “infarct” volume remains unclear. Largely for convenience, 24-48 hours has been used in clinical trials and registry datasets which may be too early to determine the final infarct volume. The objective of this study was to quantify the comparability of lesion volume using MRI measured at 24 hours versus 5 days in acute stroke patients following successful recanalization.Methods:Patients were included if they consented to the prospective GUARDS study between April 2018 through February 2022, had LVO of the anterior circulation, were treated with EVT, achieved complete revascularization defined as TICI 2b/3, and imaged with MRI at 2 hours, 24 hours, and 5 days post EVT. Two independent readers measured lesion volumes using a semi-automated validated approach on DWI at 2 and 24 hours, and FLAIR at 5 days. Statistical comparisons of lesion volumes across time points were performed. Lesion growth was defined as change in lesion volume and percent change compared to lesion volume at 2 hours.Results:Sixty-nine patients met all study criteria and were included. Median age was 66 years, 55% female, median admit NIHSS of 18, 62% with M1 LVO, and 46% treated with IV thrombolysis. Post-EVT median lesion volumes were 24mL, 35mL, and 45mL respectively for 2-hour DWI, 24-hour DWI, and 5-day FLAIR. Lesion growth based on median percent change from the 2-hour DWI was 39% [21-96] and 52% [12-145] at 24 hours and 5 days. The difference in lesion growth based on percent change from 24 hours to 5 days was not significant (p=0.17). However, there was a significant difference based on change in lesion volume, 12mL [2-25] at 24 hours and 16mL at 5 days (p=0.029). Fifty-one (74%) patients had DWI volumes at 24 hours that were ≥80% of their FLAIR volumes at 5 days. However, 18 (26%) patients continued to have lesion growth beyond 24 hours, median lesion growth of 18mL,with 11 (61%) of those having lesion growth >20mL.Conclusions:Lesion growth >20mL continues in some patients beyond 24 hours, suggesting that infarct volume at 5 days should be used as the imaging outcome when assessing tissue response to recanalization.

Stroke, Volume 54, Issue Suppl_1, Page A24-A24, February 1, 2023. Importance:Clinical trials focusing on new mechanical thrombectomy (MT) technologies have been typically single-arm studies using historical comparison data to determine the safety and efficacy of the novel device. To date, there has not been a contemporaneous prospective, randomized, controlled study comparing standard to newer designed stent-retrievers.Objective:To evaluate the safety and efficacy of the pRESET (phenox Ltd) compared to the Solitaire (Medtronic Corp) thrombectomy devices in the treatment of large vessel occlusion strokes (LVOS).Methods:Multicenter, prospective, randomized, open-label, blinded endpoint, core lab adjudicated, non-inferiority trial that enrolled 340 patients from October 2019 to February 2022 across 19 US & 5 German sites. Patients aged ≥ 18 years with either anterior or posterior circulation LVOS were included up to 8 hours after symptom onset. Patients were randomly assigned in a 1:1 ratio to either pRESET or Solitaire for the first three device passes.The Primary Endpoint was the proportion of patients achieving a modified Rankin Scale score of 0-2, analyzed by intent to treat with a non-inferiority margin of 0.125 based on the lower bound 95% Confidence Interval. The Primary Safety Endpoint was the proportion of subjects with device- or procedure-related symptomatic intracerebral hemorrhage at 24 (-8/+12) hours as per the SITS-MOST criteria. Secondary Outcome Measures included the rates of (1) Successful Revascularization (defined as expanded Thrombolysis in Cerebrovascular Infarction [eTICI] ≥2b50 ≤3 passes of the assigned device; (2) eTICI ≥2c following the first pass of the assigned device; (3) 90-day mortality and (4) Distribution of 90-day mRS across the entire spectrum of disability (ordinal shift).Results:The study database was locked in August 2022. The analysis is ongoing and the final results will be presented at the 2023 International Stroke Conference.Conclusions and Relevance:PROST is the first randomized clinical trial aiming to compare a novel versus an established stent-retriever technology, establishing a new scientific benchmark for stroke device trials. (ClinicalTrials.gov: NCT03994822).

Stroke, Volume 54, Issue Suppl_1, Page ATP152-ATP152, February 1, 2023. Introduction:Higher blood pressure (BP) is thought to be detrimental in patients who undergo mechanical thrombectomy (MT), however, the impact of BP post-MT based on comorbidities like anemia has not been well studied. We aim to determine the association of 24-h post-MT BP parameters with clinical outcomes depending on the presenting anemia status.Methods:We conducted a retrospective chart review of patients who underwent MT at a comprehensive stroke center from 7/2014 to 12/2020. Patients were dichotomized into anemic and non-anemic groups based on the World Health Organization’s definition of anemia [hemoglobin

Stroke, Volume 54, Issue Suppl_1, Page AWMP49-AWMP49, February 1, 2023. Introduction:CT performed 24h post-treatment is widely used to assess radiological outcomes in stroke studies. Even without visible hyperattenuation, occult angiographic contrast may persist in the brain and confound Hounsfield Unit-based imaging metrics such as Net Water Uptake (NWU), a measure of cerebral edema based on tissue hypoattenuation. We aimed to assess (1) the presence of retained contrast post-thrombectomy on 24h CT by comparing NWU measurements with and without adjustment for iodine using dual energy CT (DECT), (2) factors associated with amount of retention, and (3) its impact on the accuracy of NWU.Methods:In a prospective study of patients with anterior circulation large vessel occlusion who had post-thrombectomy follow-up DECT performed 24h post-treatment from two Comprehensive Stroke Centres (November 2021 to May 2022), NWU was calculated by interside comparison of Hounsfield Units of the infarct lesion and its mirror homolog. Retained contrast was quantified by the difference in NWU values with and without adjustment for iodine. We tested correlation between NWU and tissue swelling using relative hemispheric volume (rHV) and midline shift (MLS). Patients with visible hyperdensities from hemorrhagic transformation or visible contrast retention, and bilateral infarcts were excluded.Results:Of 125 patients analysed (median age 71 [IQR 61-80], baseline NIHSS 16 [IQR 9.75-21]), reperfusion (eTICI 2b-3) was achieved in 120 patients (96.8%). NWU measured with iodine adjustment was significantly higher than NWU measured without adjustment (17.1% vs 10.8%, p

Stroke, Volume 54, Issue Suppl_1, Page ATP145-ATP145, February 1, 2023. Background:Multiple randomized controlled trials have shown that mechanical thrombectomy (MT) is superior to medical therapy. However, no robust evidence is available to assess the effectiveness of MT beyond the 24-hour window. In this study, we aimed to determine the safety and efficacy of MT in patients undergoing MT for stroke beyond 24 hours from last known normal (LKN).Methods:Retrospective review of a prospectively collected database for subjects who met extended window trial criteria, but underwent MT beyond 24 hours. Recorded variables included age, sex, NIHSS at baseline and at discharge, risk factors, level of occlusion, access site, thrombectomy method. Safety and efficacy outcomes included symptomatic intracerebral hemorrhage (sICH), procedural complications, number of passes, successful recanalization (TICI 2b-3), Δ NIHSS (baseline-discharge), favorable outcomes (mRS 0-2) at 90 days.Results:A total of 39 patients were included with a median age of 69 (IQR 61.5, 73.5); 54% were females. Hypertension was the most frequent risk factor in 76% of patients; 23 % of patients were smokers. Half of the patients had M1 occlusion (48.7%). Median preprocedural NIHSS was 11 (IQR 7.0, 19.5). Successful revascularization was achieved in 87%; median number of passes was 2 (IQR 1.0,3.0). Median ΔNIHSS was 3.0 (IQR -1.5, 8.0). Favorable outcome was achieved in 49% (95% CI: 34%-64%), and 95% were free of complications. A total of 3 patients (7.7%) had sICH. In an exploratory analysis, posterior circulation occlusion was associated with higher risk of poor mRS at 90 days (OR: 14.7, p = 0.016). Additionally, favorable discharge facility (home, home health, or rehab) was associated with a much lower risk of poor mRS at 90 days (OR: 0.11, p = 0.004).Conclusions:Our single center study of MT beyond 24 hours showed comparable clinical outcomes and safety profile to large MT trials within 24 hours, especially in anterior circulation occlusions. Posterior circulation occlusions were associated with worse outcomes, which warrants further investigation.

Stroke, Volume 54, Issue Suppl_1, Page AWP106-AWP106, February 1, 2023. Introduction:Magnetic susceptibility is a radiological contrast mechanism that may provide a measure of oxygenation and contribute to an understanding the pathophysiology of stroke. Currently, there are few studies that have explored magnetic susceptibility in ischemic tissue as a marker of tissue injury. Our study assesses day one ischemic tissue post-reperfusion for changes in magnetic susceptibility and evaluates its relationship with radiological markers of ischemic injury – apparent diffusion coefficient (ADC).Methods:In a prospective observational study, thirty-five ischemic stroke patients who underwent endovascular thrombectomy were scanned with MRI (24 – 72 hours after reperfusion) to obtain multi-echo Gradient Echo and DWI images. An experienced neuroradiologist manually delineated ischemic tissue ROIs (region of interest) on DWI images. Contralateral ROIs were obtained using an automated method. The cerebrospinal fluid and regions of haemorrhagic transformation were excluded from the ROIs. A Morphology Enabled Dipole Inversion (MEDI) pipeline was employed to generate Quantitative Susceptibility Mapping (QSM) images, and these were used to quantify magnetic susceptibility. Mean magnetic susceptibility and mean ADC values were measured in these ROIs, and these values were then correlated.Results:Mean magnetic susceptibility of the ischemic ROI was significantly higher than that of the contralateral ROI (0.71±11.72 ppb, -5.59±7.30 ppb; p = 0.003). Mean ADC values of the ROI in the ischemic hemisphere were significantly lower than those in the contralateral hemisphere (0.65±0.09 х 10-3mm2/s, 0.81±0.05 х 10-3mm2/s; p = 1.31 х 10-11). No significant correlation between susceptibility and ADC was found (ρ = -0.278, p = 0.106).Conclusion:Magnetic susceptibility in the ischemic tissue is measurable and is elevated when compared to the normal tissue. This may be attributed to the increased oxygen extraction fraction in the ischemic tissue. Further voxel wise analysis and larger longitudinal multi-parametric analysis correlating magnetic susceptibility with other imaging measures of tissue injury over time will help characterise the significance of lesional magnetic susceptibility changes in ischemic tissue.

Objective
To evaluate whether urine output (UO), rarely assessed in the literature, is associated with relevant neonatal outcomes in very preterm infants, and which UO threshold may be the most clinically relevant.

Design
Retrospective cohort study.

Setting
Two Level IV neonatal intensive care units.

Patients
Very preterm infants born between 240/7 and 296/7 weeks of gestation documented with eight UO measurements per day between postnatal day 1 and day 7.

Main outcome measures
Composite outcome defined as death before discharge, or moderate to severe bronchopulmonary dysplasia, or severe brain lesions. The association between this outcome and UO was studied using several UO thresholds.

Results
Among 532 infants studied, UO

Meno 20mila kg in un anno. Italia lontana da autosufficienza

Introduction
Alcohol use is a global driver of HIV infection and disease progression, mediated through risky behaviour and poor antiretroviral adherence. Most studies about the burden of alcohol use among people living with HIV (PLWH)/AIDS have been done in adult populations, but less is known about young people with HIV, especially in low-income and middle-income countries (LMICs), despite the high level of alcohol use in these settings. The aim of this review is to collate evidence on the prevalence of, and factors associated with, alcohol use disorder (AUD) among young adults (aged 15–24 years) living with HIV/AIDS in LMICs.

Methods and analysis
Two experienced librarians will conduct an independent article search in PubMed, PsycINFO, Embase and Web of Science databases, using relevant Medical Subject Headings terms and Boolean operators (‘AND’, ‘OR’). We will include English-language articles that were published in peer-reviewed journals from 1 January 2000, to 25 July 2022, that documented the prevalence of AUD among young people (15–24 years) living with HIV in LMICs. We shall exclude systematic review articles and qualitative studies. Two independent reviewers will screen the articles for eligibility and data will be extracted onto a preset Excel spreadsheet. Data analysis will be done using Stata V.14.0. Heterogeneity will be assessed by use of the I2 statistic and data will be pooled in meta-analyses where appropriate. Publication bias will be assessed using the funnel plot.

Ethics and dissemination
Ethical approval is not needed as this systematic review will be based on published studies. Findings from this study will be disseminated via submission for publication in a peer-reviewed journal, at conference presentations, and made available to health professionals, scientists and policy makers. Our data set can be made available on request.

Registration details
PROSPERO, CRD42022308955

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

New England Journal of Medicine, Volume 387, Issue 25, Page 2331-2343, December 2022.

Stroke, Volume 54, Issue 1, Page 124-131, January 1, 2023. Background:Management of extracranial internal carotid artery steno-occlusive lesion during endovascular therapy remains debated. Stent occlusion within 24 hours of endovascular therapy is a frequent event after acute carotid artery stenting, and we currently lack large population results. We investigated the incidence, predictors, and clinical impact of stent occlusion after acute carotid artery stenting in current clinical practice.Methods:Patients treated by endovascular therapy with acute carotid artery stenting between 2015 and 2019 in 5 large-volume endovascular-capable centers were retrospectively analyzed. Patients were separated in 2 groups according to the stent patency at 24 hours after carotid artery stenting. We compared baseline characteristics, treatment modalities, and clinical outcome depending on 24-hour stent patency. Primary end point was favorable outcome, defined as a modified Rankin Scale score 0–2 at 3 months.Results:A stent occlusion was observed in 47/225 patients (20.9%). Patients with stent patency had a lower baseline National Institutes of Health Stroke Scale (median [interquartile range]: 13 [7–17] versus 18 [12–21]) and had more often stroke of atherothrombotic origin (77.0% versus 53.2%). A higher stent patency rate was found for patients treated with P2Y12antagonists at the acute phase (odds ratio [OR]‚ 2.95 [95% CI‚ 1.10–7.91];P=0.026) and treated with angioplasty (OR‚ 2.42 [95% CI‚ 1.24–4.67];P=0.008). A better intracranial angiographic reperfusion was observed in patients with 24-hour stent patency compared with patients without stent patency (OR‚ 8.38 [95% CI‚ 3.07–22.78];P

Objectives
To describe the inpatient population, establish patterns in admission and mortality over a 4-year period in different cohorts and assess the prognostic ability and workload implications of introducing the National Early Warning Score 2 (NEWS2) and associated escalation protocol.

Design
Retrospective cohort analyses of medical and surgical inpatient admissions.

Setting
Large teaching hospital with tertiary inpatient care and a major trauma centre employing an electronic observations platform, initially with a local early warning score, followed by NEWS2 introduction in June 2019.

Participants
332 682 adult patients were admitted between 1 January 2016 and 31 December 2019.

Outcome measures
Mortality, workload and ability of early warning score to predict death within 24 hours.

Results
Admissions rose by 19% from 76 055 in 2016 to 90 587 in 2019. Total bed days rose by 10% from 433 382 to 477 485. Mortality fell from 3.7% to 3.1% and was significantly lower in patients discharged from a surgical specialty, 1.0%–1.2% (p

90,2% ha completato il ciclo primario. L’84% con primo booster