DIRECT-SAFE: A Randomized Controlled Trial of DIRECT Endovascular Clot Retrieval versus Standard Bridging Therapy

Peter J. Mitchell,Bernard Yan,Leonid Churilov,Richard J. Dowling,Steven Bush,Thang Nguyen,Bruce C.V. Campbell,Geoffrey A. Donnan,Zhongrong Miao,Stephen M, Davis 대한뇌졸중학회 2022 Journal of stroke Vol.24 No.1

Background and Purpose The benefit regarding co-treatment with intravenous (IV) thrombolysis before mechanical thrombectomy in acute ischemic stroke with large vessel occlusion remains unclear. To test the hypothesis that clinical outcome of ischemic stroke patients with intracranial internal carotid artery, middle cerebral artery or basilar artery occlusion treated with direct endovascular thrombectomy within 4.5 hours will be non-inferior compared with that of standard bridging IV thrombolysis followed by endovascular thrombectomy. Methods To randomize 780 patients 1:1 to direct thrombectomy or bridging IV thrombolysis with thrombectomy. An international-multicenter prospective randomized open label blinded endpoint trial (PROBE) (ClincalTrials.gov identifier: NCT03494920). Results Primary endpoint is functional independence defined as modified Rankin Scale (mRS) 0–2 or return to baseline at 90 days. Secondary end points include ordinal mRS analysis, good angiographic reperfusion (modified Thrombolysis in Cerebral Infarction score [mTICI] 2b–3), safety endpoints include symptomatic intracerebral hemorrhage and death. Conclusions DIRECT-SAFE will provide unique information regarding the impact of direct thrombectomy in patients with large vessel occlusion, including patients with basilar artery occlusion, with comparison across different ethnic groups.

Gas flows in the circumgalactic medium around simulated high-redshift galaxies

Mitchell, Peter D,Blaizot, Jé,ré,my,Devriendt, Julien,Kimm, Taysun,Michel-Dansac, Lé,o,Rosdahl, Joakim,Slyz, Adrianne Blackwell Publishing Ltd 2018 MONTHLY NOTICES- ROYAL ASTRONOMICAL SOCIETY Vol.474 No.4

Identifying with the L2 Self : Study Abroad Experiences of Japanese English Language Learners

Mitchell Fryer,Peter Roger 아시아영어교육학회 2017 The Journal of Asia TEFL Vol.14 No.3

A possible self is a combination of the self knowledge, thoughts and beliefs that we have regarding our future potential (Markus & Nurius, 1986). This study investigated the possible selves of eight Japanese niversity study abroad (SA) students. Dörnyei (2005) posited the L2 motivational self-system, comprised of the L2 ideal self as a construct for better understanding and predicting L2 motivation. Several studies and theoretical accounts indicate that discrepancies between current and ideal states can help predict motivation, as the possible self acts as a future self-guide (Dörnyei & Chan, 2013; Higgins, 1987; Ushioda & Dörnyei, 2012). The study identified several key contextual elements that contributed to changes in the participants’ L2 motivational self systems. These included ‘thrown in the deep end’ type interactions, good timing of interactions, conscious moves by the conversation partner to assist the participants, relaxed and positive atmosphere, opportunities to initiate and sustain interactions and one on one interactions that were in line with the participants’ own cultural identity. The findings suggest the contextual elements shaped the participants’ L2 ideal and feared self images and contributed to the identification of discrepancies between current and desired states which influenced study behaviours, goals and motivation over time.

Blueberry Intake Alters Skeletal Muscle and Adipose Tissue Peroxisome Proliferator-Activated Receptor Activity and Reduces Insulin Resistance in Obese Rats

E. Mitchell Seymour,Ignasia I. Tanone,Daniel E. Urcuyo-Llanes,Sarah K. Lewis,Ara Kirakosyan,Michael G. Kondoleon,Peter B. Kaufman,Steven F. Bolling 한국식품영양과학회 2011 Journal of medicinal food Vol.14 No.12

Metabolic syndrome can precede the development of type 2 diabetes and cardiovascular disease and includes phenotypes such as obesity, systemic inflammation, insulin resistance, and hyperlipidemia. A recent epidemiological study indicated that blueberry intake reduced cardiovascular mortality in humans, but the possible genetic mechanisms of this effect are unknown. Blueberries are a rich source of anthocyanins, and anthocyanins can alter the activity of peroxisome proliferatoractivated receptors (PPARs), which affect energy substrate metabolism. The effect of blueberry intake was assessed in obesity-prone rats. Zucker Fatty and Zucker Lean rats were fed a higher-fat diet (45% of kcal) or a lower-fat diet (10% of kcal)containing 2% (wt/wt) freeze-dried whole highbush blueberry powder or added sugars to match macronutrient and calorie content. In Zucker Fatty rats fed a high-fat diet, the addition of blueberry reduced triglycerides, fasting insulin, homeostasis model index of insulin resistance, and glucose area under the curve. Blueberry intake also reduced abdominal fat mass,increased adipose and skeletal muscle PPAR activity, and affected PPAR transcripts involved in fat oxidation and glucose uptake/oxidation. In Zucker Fatty rats fed a low-fat diet, the addition of blueberry also significantly reduced liver weight, body weight, and total fat mass. Finally, Zucker Lean rats fed blueberry had higher body weight and reduced triglycerides, but all other measures were unaffected. In conclusion, whole blueberry intake reduced phenotypes of metabolic syndrome in obesityprone rats and affected PPAR gene transcripts in adipose and muscle tissue involved in fat and glucose metabolism.

Altered Hyperlipidemia, Hepatic Steatosis, and Hepatic Peroxisome Proliferator-Activated Receptors in Rats with Intake of Tart Cherry

E. Mitchell Seymour,Andrew A.M. Singer,Ara Kirakosyan,Daniel E. Urcuyo-Llanes,Peter B. Kaufman,Steven F. Bolling 한국식품영양과학회 2008 Journal of medicinal food Vol.11 No.2

Elevated plasma lipids, glucose, insulin, and fatty liver are among components of metabolic syndrome, a phe-notypic pattern that typically precedes the development of Type 2 diabetes. Animal studies show that intake of anthocyaninsreduces hyperlipidemia, obesity, and atherosclerosis and that anthocyanin-rich extracts may exert these effects in associationwith altered activity of tissue peroxisome proliferator-activated receptors (PPARs). However, studies are lacking to test thiscorrelation using physiologically relevant, whole food sources of anthocyanins. Tart cherries are a rich source of anthocyanins,and whole cherry fruit intake may also affect hyperlipidemia and/or affect tissue PPARs. This hypothesis was tested in theDahl Salt-Sensitive rat having insulin resistance and hyperlipidemia. For 90 days, Dahl rats were pair-fed AIN-76a-based di-ets supplemented with either 1% (wt:wt) freeze-dried whole tart cherry or with 0.85% additional carbohydrate to matchmacronutrient and calorie provision. After 90 days, the cherry-enriched diet was associated with reduced fasting blood glu-cose, hyperlipidemia, hyperinsulinemia, and reduced fatty liver. The cherry diet was also associated with significantly en-hanced hepatic PPAR-. mRNA, enhanced hepatic PPAR-. target acyl-coenzyme A oxidase mRNA and activity, and in-creased plasma antioxidant capacity. In conclusion, physiologically relevant tart cherry consumption reduced several phenotypicrisk factors that are associated with risk for metabolic syndrome and Type 2 diabetes. Tart cherries may represent a wholefood research model of the health effects of anthocyanin-rich foods and may possess nutraceutical value against risk factorsfor metabolic syndrome and its clinical sequelae.

Evolution of Endovascular Therapy in Acute Stroke: Implications of Device Development

Adithya Balasubramaian,Peter Mitchell,Richard Dowling,Bernard Yan 대한뇌졸중학회 2015 Journal of stroke Vol.17 No.2

Intravenous thrombolysis is an effective treatment for acute ischaemic stroke. However, vascular recanalization rates remain poor especially in the setting of large artery occlusion. On the other hand, endovascular intra-arterial therapy addresses this issue with superior recanalization rates compared with intravenous thrombolysis. Although previous randomized controlled studies of intra-arterial therapy failed to demonstrate superiority, the failings may be attributed to a combination of inferior intra-arterial devices and suboptimal selection criteria. The recent results of several randomized controlled trials have demonstrated significantly improved outcomes, underpinning the advantage of newer intra-arterial devices and superior recanalization rates, leading to renewed interest in establishing intra-arterial therapy as the gold standard for acute ischaemic stroke. The aim of this review is to outline the history and development of different intra-arterial devices and future directions in research.

Blood Pressure May Be Associated with Arterial Collateralization in Anterior Circulation Ischemic Stroke before Acute Reperfusion Therapy

Beisi Jiang,Leonid Churilov,Lasheta Kanesan,Richard Dowling,Peter Mitchell,Qiang Dong,Stephen Davis,Bernard Yan 대한뇌졸중학회 2017 Journal of stroke Vol.19 No.2

Background and Purpose Leptomeningeal collaterals maintain arterial perfusion in acute arterialocclusion but may fluctuate subject to arterial blood pressure (ABP). We aim to investigate therelationship between ABP and collaterals as assessed by computer tomography (CT) perfusion inacute ischemic stroke. Methods We retrospectively analyzed acute anterior circulation ischemic stroke patients with CTperfusion from 2009 to 2014. Collateral status using relative filling time delay (rFTD) determined bytime delay of collateral-derived contrast opacification within the Sylvian fissure, from 0 seconds tounlimited count. The data were analyzed by zero-inflated negative binomial regression modelincluding an appropriate interaction examining in the model in terms of occlusion location andonset-to-CT time (OCT). Results Two hundred and seventy patients were included. We found that increment of 10 mm Hgin BP, the odds that a patient would have rFTD equal to 0 seconds increased by 27.9% in systolicBP (SBP) (P=0.001), by 73.9% in diastolic BP (DBP) (P<0.001) and by 68.5% in mean BP (MBP)(P<0.001). For patients with rFTD not necessarily equal to 0 seconds, every 10 mm Hg increase inBP, there was a 7% decrease in expected count of seconds for rFTD in SBP (P=0.002), 10% decreasefor rFTD in DBP and 11% decrease for rFTD in MBP. The arterial occlusion location and OCT showedno significant interaction in the BP-rFTD relationship (P>0.05). Conclusions In acute ischemic stroke, higher ABP is possibly associated with improvedleptomeningeal collaterals as identified by decreased rFTD.

Financial toxicity in patients with gynecologic malignancies: a cross sectional study

Burak Zeybek,Emily Webster,Natalia Pogosian,Joan Tymon-Rosario,Alan Balch,Gary Altwerger,Mitchell Clark,Gulden Menderes,Gloria Huang,Masoud Azodi,Elena S. Ratner,Peter E. Schwartz,Alessandro D. Santin 대한부인종양학회 2021 Journal of Gynecologic Oncology Vol.32 No.6

Objective: To evaluate financial toxicity and assess its risk factors among patients with gynecologic cancers. Methods: This is a cross sectional study that included 2 survey tools, as well as patient demographics, disease characteristics, and treatment regimen. Financial toxicity is measured by validated Comprehensive Score for Financial Toxicity (COST) tool. Participants were also asked to complete a 55-question-survey on attitudes and perspectives surrounding cost of care. Descriptive statistics was used to report patient demographics. Spearman's rank correlation was calculated to assess the relation between financial toxicity and patient/ disease related variables. Graphpad Prism Software Version 8.0 was used for analyses. Results: A total of 50 patients with various gynecologic malignancies were enrolled. Median COST score was 20.5 (range, 1–33). Sixty-five percent of the patients reported being in debt due to their cancer care and 4% filed bankruptcy. Correlation analysis showed that COST score was correlated with age (r=−0.3, p=0.028), malignancy type (r=0.3, p=0.039) and income (r=0.3, p=0.047). Ovarian cancer patients had significantly less financial toxicity (median COST score=23) when compared to patients with other gynecologic malignancies (median COST score=17, p=0.043). When scores were dichotomized into low (score ≥22) and high toxicity (score <22), 58% (29/50) of the patients were noted to have high financial toxicity. Enrollment to a clinical trial did not significantly alleviate financial burden. Conclusion: Financial toxicity is a significant burden even among highly insured gynecologic oncology patients. Age, malignancy type and income were correlated with high financial burden.