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1. Prehospital transdermal glyceryl trinitrate in patients with ultra-acute presumed stroke (RIGHT-2): an ambulance-based, randomised, sham-controlled, blinded, phase 3 trial

Author

Philip M Bath, Polly Scutt, Craig S Anderson, Jason P Appleton, Evind Berge, Lesley Cala, Mark Dixon, Timothy M England, Peter J Godolphin, Diane Havard, Lee Haywood, Trish Hepburn, Kailash Krishnan, Grant Mair, Alan A Montgomery, Keith Muir, Stephen J Phillips, Stuart Pocock, John Potter, Chris Price, Marc Randall, Thompson G Robinson, Christine Roffe, Peter M Rothwell, Else C Sandset, Nerses Sanossian, Jeffrey L Saver, Angela Shone, A Niroshan Siriwardena, Joanna M Wardlaw, Lisa J Woodhouse, Graham Venables, Nikola Sprigg, Pierre Amarenco, Shannon Amoils, Malcolm Jarvis, Peter Sandercock, Kjell Asplund, Colin Baigent, Sandeep Ankolekar, Harriet Howard, Christopher Lysons, Gemma Walker, Hayley Gregory, James Kirby, Jennifer Smithson, Joanne Keeling, Nadia Frowd, Robert Gray, Richard Dooley, Wim Clarke, Patricia Robinson, Zhe Kang Law, Sheila Hodgson, Adam Millington, Eleni Sakka, David Buchanan, Jeb Palmer, D Shaw, H Cobb, R Johnson, T Payne, R Spaight, A Spaight, M A Sajid, A Whileman, E Hall, H Cripps, J Toms, R Gascoyne, S Wright, M Cooper, A Palfreman, A Rajapakse, I Wynter, K Musarrat, A Mistri, C Patel, C Stephens, S Khan, S Patras, M Soliman, A Elmarimi, C Hewitt, E Watson, I Wahishi, J Hindle, L Perkin, M Wills, S Arif, S Leach, S Butler, D O'Kane, C Smith, J O'Callaghan, W Sunman, A Buck, B Jackson, C Richardson, G Wilkes, J Clarke, L Ryan, O Matias, D Mangion, A Hardwick, C Constantin, I Thomas, K Netherton, S Markova, A Hedstrom, B Rushton, C Hyde, J Scott, M Blair, M Maddula, R Donnelly, S Keane, S Johnson, H McKenzie, A Banerjee, D Hutchinson, H Goodhand, J Hill, K Mellows, M Cheeseman, V McTaggart, T Foster, L Prothero, P Saksena, A O'Kelly, H Wyllie, C Hacon, H Nutt, J North, K Goffin, J Potter, A Wiltshire, G Ravenhill, K Metcalf, L Ford, M Langley, W Davison, S Subramonian, F Magezi, I Obi, N Temple, N Butterworth-Cowin, P Oqwusu-Agyei, A F M Azim, A Nicolson, J Imam, J White, L Wood, R Fothergill, N Thompson, J Lazarus, H Werts, L Sztriha, C Ho, E McKenzie, E Owoyele, J Lim, J Aeron-Thomas, M Dockey, N Sylvester, P Rao, B M Bloom, E Erumere, G Norman, I Skene, L Cuenoud, L Howaniec, O Boulton, P Daboo, R Michael, S Al-Saadi, T Harrison, H Syed, L Argandona, S Amiani, R Perry, A Ashton, A Banaras, C Hogan, C Watchurst, E Elliott, N Francia, N Oji, R Erande, S Obarey, S Feerick, S Tshuma, E England, H Pocock, K Poole, S Manchanda, I Burn, S Dayal, K McNee, M Robinson, R Hancock, A South, C Holmes, A Steele, L B Guthrie, M Oborn, A Mohd Nor, B Hyams, C Eglinton, D Waugh, E Cann, N Wilmhurst, S Piesley, S Shave, D Dutta, M Obeid, D Ward, J Turfrey, J Glass, K Bowstead, L Hill, P Brown, S Beames, S O'Connell, V Hughes, R Whiting, J Gagg, M Hussain, M Harvey, D Karunatilake, B Pusuluri, A Witcher, C Pawley, J Allen, J Foot, J Rowe, C Lane, S Ragab, B Wadams, J Dube, B Jupp, A Ljubez, C Bagnall, G Hann, L Tucker, M Kelton, S Orr, F Harrington, A James, A Lydon, G Courtauld, K Bond, L Lucas, T Nisbett, J Kubie, A Bowring, G Jennings, K Thorpe, N Mason, S Keenan, L Gbadomishi, D Howcroft, H Newton, J Choulerton, J Avis, L Shaw, P Paterson, P Kaye, S Hierons, S Lucas, P Clatworthy, B Faulkner, L Rannigan, R Worner, B Bhaskaran, A Saulat, H Bearne, J Garfield-Smith, K Horan, P Fitzell, S Szabo, M Haley, D Simmons, D Cotterill, G Saunders, H Dymond, S Beech, K Rashed, A Tanate, C Buckley, D Wood, L Matthews, S Board, T Pitt-Kirby, N Rees, C Convery, P Jones, C Bryant, H Tench, M Dixon, R Loosley, S Coetzee, S Jones, T Sims, M Krishnan, C Davies, L Quinn, L Connor, M Wani, S Storton, S Treadwell, T Anjum, C Somashekar, A Chandler, C Triscott, L Bevan, M Sander, S Buckle, W Sayed, K Andrews, L Hughes, R Hughes, M Ward, A Pretty, A Rosser, B Davidson, G Price, I Gunson, J Lumley-Holmes, J Miller, M Larden, M Jhamat, P Horwood, R Boldy, C Jenkins, F Price, M Harrison, T Martin, N Ahmad, A Willberry, A Stevens, K Fotherby, A Barry, A Remegoso, F Alipio, H Maquire, J Hiden, K Finney, R Varquez, S Ispoglou, A Hayes, D Gull, R Evans, E Epstein, S Hurdowar, J Crossley, J Miles, K Hird, R Pilbery, C Patterson, H Ramadan, K Stewart, O Quinn, R Bellfield, S Macquire, W Gaba, A Nair, A Wilson, C Hawksworth, I Alam, J Greig, P Gomes, P Rana, Z Ahmed, P Anderston, A Neal, D Walstow, R Fong, S Brotheridge, A Bwalya, A Gillespie, C Midgley, C Hare, H Lyon, L Stephenson, M Broome, R Worton, S Jackson, R Rayessa, A Abdul-Hamid, C Naylor, E Clarkson, A Hassan, E Veraque, L Finch, L Makawa, M Carpenter, P Datta, A Needle, L Jackson, H J Brooke, J Ball, T Lowry, S Punnoose, R Walker, V Murray, A Ali, C Kamara, C Doyle, E Richards, J Howe, K Dakin, K Harkness, R Lindert, P Wanklyn, P Willcoxson, P Clark-Brown, and R Mir

Subjects
Male, Emergency Medical Services, A300 Clinical Medicine, Vasodilator Agents, Ambulances, 030204 cardiovascular system & hematology, Administration, Cutaneous, Article, law.invention, Nitroglycerin, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, Modified Rankin Scale, law, Humans, Medicine, Single-Blind Method, Prospective Studies, 030212 general & internal medicine, Prospective cohort study, Stroke, Aged, B740 Adult Nursing, Intention-to-treat analysis, business.industry, General Medicine, Middle Aged, medicine.disease, Clinical trial, Treatment Outcome, Blood pressure, Anesthesia, Hypertension, Cohort, B780 Paramedical Nursing, Female, business
Abstract

Background: High blood pressure is common in acute stroke and is a predictor of poor outcome; however, large trials of lowering blood pressure have given variable results, and the management of high blood pressure in ultra-acute stroke remains unclear. We investigated whether transdermal glyceryl trinitrate (GTN; also known as nitroglycerin), a nitric oxide donor, might improve outcome when administered very early after stroke onset.Methods: We did a multicentre, paramedic-delivered, ambulance-based, prospective, randomised, sham-controlled, blinded-endpoint, phase 3 trial in adults with presumed stroke within 4 h of onset, face-arm-speech-time score of 2 or 3, and systolic blood pressure 120 mm Hg or higher. Participants were randomly assigned (1:1) to receive transdermal GTN (5 mg once daily for 4 days; the GTN group) or a similar sham dressing (the sham group) in UK-based ambulances by paramedics, with treatment continued in hospital. Paramedics were unmasked to treatment, whereas participants were masked. The primary outcome was the 7-level modified Rankin Scale (mRS; a measure of functional outcome) at 90 days, assessed by central telephone follow-up with masking to treatment. Analysis was hierarchical, first in participants with a confirmed stroke or transient ischaemic attack (cohort 1), and then in all participants who were randomly assigned (intention to treat, cohort 2) according to the statistical analysis plan. This trial is registered with ISRCTN, number ISRCTN26986053.Findings: Between Oct 22, 2015, and May 23, 2018, 516 paramedics from eight UK ambulance services recruited 1149 participants (n=568 in the GTN group, n=581 in the sham group). The median time to randomisation was 71 min (IQR 45–116). 597 (52%) patients had ischaemic stroke, 145 (13%) had intracerebral haemorrhage, 109 (9%) had transient ischaemic attack, and 297 (26%) had a non-stroke mimic at the final diagnosis of the index event. In the GTN group, participants' systolic blood pressure was lowered by 5·8 mm Hg compared with the sham group (pvs 3 [2–5]; n=558, in the sham group; 1·04 [0·84–1·29]; p=0·69). We found no difference in secondary outcomes, death (treatment-related deaths: 36 in the GTN group vs 23 in the sham group [p=0·091]), or serious adverse events (188 in the GTN group vs 170 in the sham group [p=0·16]) between treatment groups.Interpretation: Prehospital treatment with transdermal GTN does not seem to improve functional outcome in patients with presumed stroke. It is feasible for UK paramedics to obtain consent and treat patients with stroke in the ultra-acute prehospital setting.Funding: British Heart Foundation.

Published
2019

2. Rivaroxaban or aspirin for patent foramen ovale and embolic stroke of undetermined source: a prespecified subgroup analysis from the NAVIGATE ESUS trial

Author

Scott E Kasner, Balakumar Swaminathan, Pablo Lavados, Mukul Sharma, Keith Muir, Roland Veltkamp, Sebastian F Ameriso, Matthias Endres, Helmi Lutsep, Steven R Messé, J David Spence, Krassen Nedeltechev, Kanjana Perera, Gustavo Santo, Veronica Olavarria, Arne Lindgren, Shrikant Bangdiwala, Ashkan Shoamanesh, Scott D Berkowitz, Hardi Mundl, Stuart J Connolly, Robert G Hart, N Abdelhamid, D Abdul Rahman, M Abdul-Saheb, P Abreu, M Abroskina, F Abu Ahmad, S Accassat, M Acciaresi, A Adami, N Ahmad, F Ahmed, M Alberto Hawkes, F Alemseged, A Ali, R Altavilla, L Alwis, P Amarenco, S Amaro, LE Amaya Sanchez, A Amelia Pinto, SF Ameriso, H Amin, T Amino, AK Amjad, E Anagnostou, G Andersen, C Anderson, DC Anderson, M Andrea Falco, F Andres Mackinnon, D Andreu, M Androulakis, M Angel Gamero, G Angel Saredo, R Angeles Diaz, M Angels Font, S Anticoli, A Arauz, AA Arauz Gongora, P Araya, JF Arenillas Lara, S Arias Rivas, M Arnold, S Augustin, W Avelar, E Azevedo, V Babikian, A Bacellar, K Badalyan, HJ Bae, EM Baez Martinez, H Bagelmann, P Bailey, Z Bak, M Baker, A Balazs, D Baldaranov, I Balogun, T Balueva, Z Bankuti, M Bar, A Baranowska, J Bardutzky, S Barker Trejo, J Barlinn, F Baronnet, C Barroso, M Barteys, T Bartolottiova, A Barulin, M Bas, S Bashir, V Basile, R Bathe-Peters, R Bathula, C Batista, H Batur Caglayan, P Baumgartner, R Bazan, O Bazhenova, M Beaudry, J Beer, Y Behnam, C Beilei, A Beinlich, Y Bejot, A Belkin, OR Benavente, A Benjamin, V Berardi, D Bereczki, SD Berkowitz, J Berlingieri, W Berrios, J Berrouschot, M Bhandari, M Bhargavah, H Bicker, T Bicsak, M Bilik, D Bindila, J Birchenall, L Birnbaum, T Black, D Blacker, D Blacquiere, C Blanc-Labarre, C Blank, B Blazejewska-Hyzorek, S Bloch, E Bodiguel, E Bogdanov, L Boos, L Borcsik, N Bornstein, S Bouly, G Braga, I Bragado, MC Bravi, C Brokalaki, W Brola, R Brouns, D Bruce, J Brzoska-Mizgalska, B Buck, M Buksinska-Lisik, J Burke, M Burn, G Bustamante, L Cabrejo, K Cai, S Cajaraville, M Calejo, D Calvet, J Campillo, E Campos Costa, P Camps, H Can Alaydin, E Candeloro, C Canepa, CG Cantu Brito, M Cappellari, C Carcel, P Cardona Portela, F Cardoso, M Carek, M Carletti, J Carlos Portilla, P Caruso, I Casado-Naranjo, P Castellini, D Castro, F Castro Meira, A Cavallini, N Cayuela Caudevilla, S Cenciarelli, C Cereda, P Cerrone, A Chakrabarti, P Chaloulos-Iakovidis, A Chamorro, D Chandrasena, DI Chang, C Che, J Chembala, J Chen, Z Chen, T Chen, H Chen, X Chen, G Chen, L Chen, S Chen, B Cheripelli, M Chin, E Chiquete Anaya, M Chorazy, H Christensen, T Christensen, L Christian, F Chu, CS Chung, W Clark, R Clarke, S Claverie, E Clemente Agostoni, B Clissold, J Coelho, D Cohen, S Colakoglu, D Collas, R Condurso, SJ Connolly, D Consoli, C Constantin, AB Constantino Silva, L Contardo, A Corlobe, M Correia, C Correia, E Cortijo Garcia, B Coull, S Coutts, S Coveney, P Cras, R Crols, S Crozier, A Csanyi, L Csiba, K Csontos, R Csuha, L Cui, L Cunha, S Curtze, M Czerska, A Czlonkowska, M Czurko, M Czuryszkiewicz, M Dagnino, C Dai, A Daineko, G Dalek, D Damgaard, A Danese, K Dani, V Danku, W Dario Toledo, A Dávalos, A De Havenon, J De Keyser, N De Klippel, J De La Torre, A De Pauw, A De Smedt, R De Torres, MM De Vries Basson, J Dearborn, R Deganutto, M Degeorgia, I Deguchi, A Del Giudice, C Delcourt, R Delgado-Mederos, G Della Marca, B Delpont, S Deltour, DL Demets, M Dennis, J Desai, J Devine, I Dhollander, MT Di Mascio, M Diaconu, F Diaz Otero, J Dietzel, E Diez-Tejedor, N Ding, J Ding, M Diomedi, P Dioszeghy, M Distefano, V Domigo, E Dorodnicov, D Dossi, F Doubal, I Druzenko, P Du, J Du, T Duman, Y Duodu, D Dutta, L Dylewicz, J Eckstein, E Ehrensperger, S Ehrlich, G Einer Allende, B Elena Halac, S Elyas, M Endres, JM Engelbrecht, S Engelter, M Epinat, F Eren, M Esbjornsson, B Escribano, I Escudero, B Esisi, B Essa, M Esterbauer, N Evans, D Eveson, S Fabio, L Fang, S Fanta, M Fares, M Fatar, K Faust, A Favate, F Fazekas, M Federica Denaro, A Fedin, P Felipe Amaya, J Feng, K Ferencova, M Fernanda Gilli, MD Fernandez, PN Fernandez Pirrone, J Fernandez Vera, J Ferrari, A Ferreira, G Ferreira Junior, M Fidler, D Field, T Field, C Figueroa, J Fiksa, A Filipov, A Firstenfeld, L Fisch, U Fischer, M Fisselier, U Fiszer, F Fluri, G Fortea, K Fotherby, A Fraczek, E France, G Freitas, S Frey, M Frick, A Friedman, M Friedrich, G Frisullo, W Fryze, B Fuentes Gimeno, H Fujigasaki, K Fukuyama, A Furlan, G Furlanis, J Furnace, M Gabriel, E Gabriel Reich, RJ Gagliardi, F Galati, E Galli Giqueauk, A Gallina, E Gallinella, J Gallo, S Gangadharan, Y Gao, R Garcia Lopez, A Garcia Pastor, SM Garcia Sanchez, M Garnauf, P Garnier, D Gasecki, K Gasic, K Gasiorek, S Gasser, M Gaugg, M Gebreyohanns, K Gebura, J Geng, M Geniz Clavijo, K Georg Haeusler, R Geran, M Geremek, Z Gerocs, D Ghia, D Giannandrea, F Giatsidis, JA Gien Lopez, A Gil Nunez, L Gimenez, E Giralt, A Glabinski, D Gladstone, M Gliem, M Gluszkiewicz, R Goddeau, E Gogoleva, M Gokce, D Goldemund, K Golikov, A Gomes Neto, M Gomez Schneider, M Gomez-Choco, M Gomis, JF Gongora-Rivera, Y Gonysheva, L Gonzalez, ME Gonzalez Toledo, M Gottschal, I Gozdzik, S Grabowski, S Graf, D Green, D Greer, T Gregorio, S Greisenegger, I Greshnova, M Griebe, M Grzesik, J Guan, S Guarda, A Gueguen, C Guidoux, P Guillermo Povedano, B Guillon, V Guiraudg, G Gunathilagan, N Guryanova, V Gusev, G Gustavo Persi, R Gutiérrez, P Guyler, N Gyuker, V Hachinski, A Hajas, H Hallevi, G Hankey, GJ Hankey, L Hanouskova, L Hao, K Haraguchi, Y Haralur Sreekantaiah, S Haratz, D Hargroves, K Harkness, P Harmel, M Harrasser, RG Hart, M Harvey, R Hasan, Y Hasegawa, A Hassan, M Hattori, A Hatzitolios, M Hauk, T Hayashi, H Hayhoe, VS Hedna, M Heine, V Held, S Hellwig, J Henkner, N Henninger, S Hermans, J Hernandez, D Herrero, M Hervieu-Begue, R Herzig, L Hicken, M Hieber, M Hill, M Hirose, MC Hobeanu, B Hobson, M Hochstetter, J Hoe Heo, M Hoffmann, C Holmstedt, P Hon, KS Hong, Y Honma, A Horev, G Horgan, L Horvath, M Horvath, C Hoyer, D Huang, H Huang, B Huber, J Huhtakangas, M Hussain, S Igarashi, AM Iglesias Mohedano, J Ignacio Tembl, M Impellizzeri, Y Inanc, P Ioli, A Irina Aniculaesei, K Ishida, R Itabashi, H Iversen, A Jagolino, K Jakab, S Jander, H Janka, J Jankovych, J Jansen, L Jasek, M Javier Alet, L Javor, X Jin, P Jing, B Joachim, M Joan Macleod, M Johnson, J Jose Martin, C Joyner, K Judit Szabo, A Jun-Oconnell, R Jura, B Kaczorowska, J Kadlcikova, T Kahles, N Kakaletsis, I Kakuk, K Kalinowska, K Kaminska, C Kaneko, I Kanellos, P Kapeller, K Kapica-Topczewska, O Karasz, M Karlinski, JE Karlsson, K Kasa, E Kashaeva, SE Kasner, M Kaste, J Kasza, A Katalin Iljicsov, M Katsurayama, S Kaur, M Kawanishi, S Kaygorodtseva, K Ke, A Kei, J Keilitz, J Kellner, P Kelly, S Kelly, D Kemlink, M Kerekgyarto, I Keskinarkaus, D Khairutdinova, A Khanna, A Khaw, M Kholopov, C Khoumri, S Kirpicheva, H Kirshner, K Kitagawa, S Kittner, R Kivioja, F Klein, D Kleindorfer, T Kleinig, P Klivenyi, S Knecht, Y Kobayashi, A Kobayashi, M Koch, L Koehler, M Koivu, V Kolianov, I Koltsov, T Kondo, I Konkov, S Kopecky, E Korompoki, J Korpela, K Kosarz-Lanczek, A Koutroubi, K Kovacs, T Kovacs, H Kovacs, K Kowalczyk, M Kowalska, D Krajickova, M Kral, C Krarup Hansen, J Kraska, S Krebs, V Krejci, C Kremer, R Kreuzpointer, M Krzyzanowska, D Kucken, A Kulakowska, J Kunzmann, N Kurenkova, A Kuris, I Kurkowska-Jastrzebska, N Kurtenkova, O Kurushina, G Kusnick, M Kustova, T Kuwashiro, J Kwan Cha, A Lago, M Lagutenko, B Lajos, J Lambeck, C Lamy, A Landolfi, S Lanfranconi, W Lang, LB Lara Lezama, B Lara Rodriguez, T Largo, A Lasek-Bal, L Latte, V Lauer, P Lavados, R Le Bouc, R Leal Cantu, H Lechner, K Lecouturier, S Leder, J Lee, BC Lee, A Leger, E Leira, I Leisse, R Leker, G Lembo, L Lenskaya, J Leyden, G Li, M Li, S Li, J Li, G Liamis, H Liang, Z Liang, N Ligot, H Lin, R Lindert, A Lindgren, M Linna, T Litwin, K Liu, X Liu, L Llull, B Lohninger, M Longoni, C Loomis, D Lopes, M Lopez Fernandez, N Lopez Garza, A Lord, S Louw, R Lovasz, T Lowenkopf, Z Lu, SC Lubke-Detring, R Luder, S Lujan, B Luo, L Lupinogina, G Luschin, H Lutsep, A Lvova, J Ly, G.M. Grosse, H Ma, C Ma, M Machado, C Machado, S Macher, J Machetanz, F Macian-Montoro, E Mackey, A Mackey, G Maclean, J Maestre-Moreno, A Magadan, T Magyar, A Mahagney, A Majid, A Majjhoo, K Makaritsis, J Mandzia, M Mangas Guijarro, D Mangion, E Manios, S Mann, L Manning, C Manno, J Manuel Garcia, V Maqueda, M Mar Castellanos, M Mar Freijo, C Marando, S Marcela Lepera, J Marcos Couto, G Maria Bruera, L Maria Greco, A Maria Lorenzo, S Maria Obmann, A Maria Roa, C Marini, I Marinkovic, G Mario Sumay, C Mario Torres, M Marko, S Markova, H Markus, R Marsh, E Marsili, M Marta Esnaola, J Marta Moreno, J Marti-Fabregas, S Martina Angelocola, P Martínez Sánchez, N Martinez-Majander, S Martins, O Marzelik, S Mastrocola, G Matamala, A Matoltsy, B Matosevic, S Matsumoto, A Maud, G Mauri Cabdevila, Z May, Y Mayasi, A Mayr, T Mazzoli, K Mcarthur, L Mccullough, CE Medina Pech, F Medlin, M Mehdiratta, S Mehta, D Mehta, B Mehta, M Melis, E Melnikova, B Mendez, T Mendonca, JJ Mengual Chirifie, N Menon, A Mensch, E Meseguer, S Messe, K Metcalf, N Meyer, F Michas, N Micheletti, R Mikulik, H Milionis, B Miller, T Milling, C Minelli, J Minhas, M Minns, D Mircea, S Mishra, A Mismas, A Mistri, N Mitrovic, H Miyake, B Modrau, A Moey, C Molina, J Molina, A Molis, J Moller, S Molnar, F Moniche, C Monosi, V Monzani, M Moonis, R Morais, L Morales, A Morales, D Morar-Precup, F Moreton, C Moro, E Morozova, M Morton, T Morvan, E Morvan, T Motko, A Mowla, E Mozhejko, G Muddegowda, O Mudhar, T Mueller, C Muhl, KW Muir, H Mundl, S Munoz, C Murphy, S Murphy, A Murtuzova, T Musuka, J Mutzenbach, M Myint, W Mysliwy, M Naccarato, G Naeije, Y Nagakane, I Natarajan, D Navaratnam, A Nave, B Nazliel, K Nedeltchev, J Nel, H Nell, R Nemeth, L Nemeth, O Neto, K Ng, J Ngeh, L Nicolas Chialvo, T Nieminen, M Nikkanen, J Nikl, M Nikoforova, S Nishino, Y Nishiyama, X Njovane, S Nogawa, F Nombela, B Norrving, K Nosek, B Nowak, E Nowakowska-Sledz, G Ntaios, H Numminen, F Nunez, M Obadia, S Oberndorfer, A Obrezan, J Ochiai, W Oczkowski, MJ O'Donnell, A Odyniec, K Oh, M Ohira, Y Okamoto, M Okpala, S Okubo, L Olah, V Olavarria, J Oleszek, N Onat Demirci, V Ondar, G Ongun, K Ooyama, V Orosz, R Ortiz, G Osseby, E Österlund-Tauriala, C Ovesen, S Ozcekic Demirhan, J Ozdoba-Rot, S Ozturk, E Ozyurt, M Pablo Grecco, G Pablo Povedano, M Paciaroni, C Padiglioni, J Pagola, W Palasik, G Panczel, L Panos, G Papadopoulos, E Papadopoulou, A Papagiannis, V Papavasileiou, M Papina, JR Pardo De Donlebun, V Parisi, JM Park, J Pasten, N Patel, O Pavlik, M Pawelczyk, WF Peacock, H Pei, T Peisker, LF Pena Sedna, A Penn, S Pentek, E Pepper, L Pereira, K Perera, Y Perez, S Perez, P Perez Leguizamon, M Pernicka, R Perry, A Persico, Y Pesant, S Peska, D Peters, G Peters, L Pettigrew, T Phan, S Philippi, T Phinney, F Pico, A Pidal, B Piechowski-Jozwiak, A Pieroni, S Pineiro, V Piras, N Pizova, J Polanco, M Polin, A Polyakov, E Polychronopoulou, A Polymeris, D Popov, A Poppe, P Postorino, C Pozzerese, M Pradhan, L Prats, E Prazdnichkova, B Prendl, M Pretorius, P Profice, S Prokopenko, E Pudov, V Pujol Lereis, G Punzo Bravo, F Purroy, J Qiu, X Qu, V Quenardelle, H Quesada Garcia, L Radrizzani, A Radtke, T Raffelsberger, JM Ramirez Moreno, C Ramos-Estebanez, A Rani, P Rapantova, K Rashed, A Rasheed Nihara, J Rasmussen, L Redondo Robles, M Reif, P Reiner, P Rekova, A Renu, M Repetto, P Reyes, S Reyes Morales, JH Rha, J Ribeiro, S Ricci, C Richard, R Rigual, C Rinaldi, C Riveira Rodriguez, B Rizzato, TG Robinson, A Rocco, M Rodrigues, G Rodriguez, A Rodriguez Campello, F Rodriguez Lucci, M Rodriguez Yanez, C Roesler, C Roffe, R Roine, S Roine, A Roldan, F Romana Pezzella, M Romano, JS Roos, C Rosso, C Rostrup Kruuse, Y Roth, R Roukens, L Roveri, D Rozanski, J Rozniecki, C Rozsa, S Rudilosso, G Ruiz Ares, A Ruiz Franco, G Rum, J Ruuskanen, I Rybinnik, K Ryota, J Saarinen, V Saavedra, C Sabben, A Sabet, D Sagris, J Sahlas, N Sakai, P Salamanca, P Salgado, S Salig, T Salletmayr, M Salnikov, O Samoshkina, Y Samson, D Sanak, M Sànchez Cerón, P Santalucia, M Santamaria Cadavid, P Santiago, G Santo, B Sanz Cuesta, J Sargento, A Sarraj, K Sas, A Sas, O Satoshi, S Satsoglou, N Sattar, S Savitz, C Savopoulos, J Saw, M Sawicka, R Sawyer, T Scandura, N Schillinger, J Schindler, F Schlachetzki, I Schneider, R Schuppner, J Schurig, CJ Schwarzbach, M Sebejova, G Seidel, L Sekaran, D Selcuk, J Selvarajah, A Semerano, J Semjen, D Semushina, S Sen, M Seok Park, J Serena, O Serhat Tokgoz, W Serles, F Serrano, M Sevin, L Seynaeve, S Shah, N Shamalov, T Shang, M Sharma, A Sharrief, M Shazam Hussain, I Shchukin, W Shen, E Shepeleva, I Shinsuke, A Shmonin, A Shoamanesh, A Shuaib, A Shulga, G Sibolt, I Sibon, I Sicilia, M Siebert, E Sieczkowska, C Sila, AA Silva, D Silva, P Silva, Y Silva, M Silvestrini, Z Simony, A Simpkins, B Singh, D Sinha, I Sipos, O Skoda, P Skowron, M Skowronska, B Sliwinska, J Slonkova, A Smolkin, A Smyth, P Sobolewski, A Sobota, SI Sohn, M Soldatov, I Solganov, L Soloveva, E Solovyeva, N Sonntag, P Soors, M Sorgun, C Soriano, D Spence, K Spengos, L Sposato, G Staaf, K Stadler, L Stakhovskaya, K Stamatelopoulos, S Steinert, I Stetkarova, M Stiehm, R Stocker, J Stoinski, A Stoll, G Stotts, A Stumpp, P Sucapane, T Suenaga, X Sun, S Sundararajan, J Sung Kim, H Suzuki, N Svaneborg, G Szasz, W Szczuchniak, S Szczyrba, N Szegedi, A Szekely, Z Szewczyk, G Szilagyi, S Szlufik, K Szoboszlai, L Szpisjak, R Sztajzel, L Sztriha, SE Ta Wil, J Taggeselle, K Takamatsu, M Takao, W Taki, S Takizawa, M Talahma, A Tamayo, J Tan, D Tanne, A Tapanainen, T Tapiola, J Tarasiuk, T Tatlisumak, A Tayal, S Tcvetkova, P Teal, J Tejada Garcia, H Tejada Meza, D Tenora, M Terceno, A Terentiou, S Tezcan, D Thaler, A Thomson, E Thouvenot, M Tiainen, I Timberg, S Timsit, A Tinchon, D Tirschwell, C Togay Isikay, K Tokunaga, M Tolino, C Toloza, G Tomelleri, K Tomoyuki, LM Tomppo, Z Tong, L Tong, D Toni, J Torres, C Tossavainen, G Toth, A Tountopoulou, E Touze, M Tovar, K Toyoda, S Trillo, A Trommer, D Tropepi, D Tryambake, H Tu, S Tuetuencue, R Tumova, O Tumpula, G Turc, A Tutaj, J Tynkkynen, S Uchiyama, U Uchwat, L Uhrinyakova, R Ulku Acar, D Uluduz Ugurlu, X Urra, S Urui, M Usero Ruiz, D Vaclavik, K Vahedi, A Valikovics, J Valpas, P Van Acker, W Van Daele, G Vanderschueren, L Vanina Jure, R Varela, Z Varga, J Varvat, N Varvyanskaya, A Vasco Salgado, P Vasko, L Vass, S Vassilopoulou, I Vastagh, P Vazquez, L Vecsei, R Veltkamp, M Venti, M Verdugo, V Verocai, M Veronica Marroquin, C Veronica Simonsini, T Veverka, M Vigl, A Vila, C Vilar, JA Villanueva Osorio, J Virta, E Vitkova, B Voglsperger, J Volna, PA Von Weitzel-Mudersbach, N Vora, I Voznyuk, A Wach-Klink, A Wacongne, D Walters, Y Wang, J Wang, L Wang, X Wang, W Wang, N Wang, D Wang, H Wang, W Warnack, K Wartenberg, R Waters, M Waters, T Webb, J Weber, G Weiss, K Weissenborn, JI Weitz, B Weller, G Wen, G Weng, P Werner, D Werring, P Wester, W Whiteley, R Whiting, T Wijeratne, C Willems, L Wilson, C Wilson, T Winder, J Windt, A Winkler, A Winska-Tereszkiewicz, A Wisniewska, M Wittayer, A Wlodek, A Wojnarowska-Arendt, M Wolf, V Wolff, C Wolter, A Wong, H Wook Nah, H Worthmann, W Wu, S Wu, S Wunderlich, H Wurzinger, DG Wyse, B Xiao, W Xiaopeng, A Ximenez-Carrillo, L Xiong, Y Xiong, W Xiong, Y Xu, J Xu, Z Xu, B Yalo, T Yamada, M Yamasaki, L Yang, Y Yang, X Yang, Q Yang, B Yang, J Yang, I Yasuhiro, M Yee Lam, C Yegappan, S Yip, E Ylikallio, P Ylikotila, A Yongwon Jin, BW Yoon, Y Yoshida, L Yperzeele, H Yuan, H Yuasa, J Zalewska, C Zanferrari, E Zapata, D Zboznovits, I Zelenka, C Zhang, B Zhang, S Zhang, M Zhang, X Zhang, J Zhang, L Zhao, O Zhirnova, L Zhou, J Zielinska-Turek, I Zinchenko, M Ziomek, A Zitzmann, R Zweifler, J Zwiernik, Yperzeele, Laetitia, and NAVIGATE ESUS Investigators

Subjects
Male, International Cooperation, 030204 cardiovascular system & hematology, antiplatelet therapy, law.invention, Neurology (clinical), ischemic stroke, anticoagulation, Cohort Studies, 0302 clinical medicine, Randomized controlled trial, Rivaroxaban, law, Stroke, education.field_of_study, Aspirin, Anticoagulant, Settore BIO/14, Middle Aged, 3. Good health, Treatment Outcome, N/A, Cardiology, Platelet aggregation inhibitor, Settore MED/26 - Neurologia, Female, medicine.drug, medicine.medical_specialty, medicine.drug_class, MEDLINE, Population, Foramen Ovale, Patent, Subgroup analysis, Article, Statistics, Nonparametric, 03 medical and health sciences, Double-Blind Method, Internal medicine, medicine, Humans, education, Aged, business.industry, medicine.disease, Human medicine, business, 030217 neurology & neurosurgery, Platelet Aggregation Inhibitors, Factor Xa Inhibitors
Abstract

Background: \ud Patent foramen ovale (PFO) is a contributor to embolic stroke of undetermined source (ESUS). Subgroup analyses from previous studies suggest that anticoagulation could reduce recurrent stroke compared with antiplatelet therapy. We hypothesised that anticoagulant treatment with rivaroxaban, an oral factor Xa inhibitor, would reduce the risk of recurrent ischaemic stroke compared with aspirin among patients with PFO enrolled in the NAVIGATE ESUS trial.\ud \ud Methods: \ud NAVIGATE ESUS was a double-blinded, randomised, phase 3 trial done at 459 centres in 31 countries that assessed the efficacy and safety of rivaroxaban versus aspirin for secondary stroke prevention in patients with ESUS. For this prespecified subgroup analysis, cohorts with and without PFO were defined on the basis of transthoracic echocardiography (TTE) and transoesophageal echocardiography (TOE). The primary efficacy outcome was time to recurrent ischaemic stroke between treatment groups. The primary safety outcome was major bleeding, according to the criteria of the International Society of Thrombosis and Haemostasis. The primary analyses were based on the intention-to-treat population. Additionally, we did a systematic review and random-effects meta-analysis of studies in which patients with cryptogenic stroke and PFO were randomly assigned to receive anticoagulant or antiplatelet therapy.\ud \ud Findings: \ud Between Dec 23, 2014, and Sept 20, 2017, 7213 participants were enrolled and assigned to receive rivaroxaban (n=3609) or aspirin (n=3604). Patients were followed up for a mean of 11 months because of early trial termination. PFO was reported as present in 534 (7·4%) patients on the basis of either TTE or TOE. Patients with PFO assigned to receive aspirin had a recurrent ischaemic stroke rate of 4·8 events per 100 person-years compared with 2·6 events per 100 person-years in those treated with rivaroxaban. Among patients with known PFO, there was insufficient evidence to support a difference in risk of recurrent ischaemic stroke between rivaroxaban and aspirin (hazard ratio [HR] 0·54; 95% CI 0·22–1·36), and the risk was similar for those without known PFO (1·06; 0·84–1·33; pinteraction=0·18). The risks of major bleeding with rivaroxaban versus aspirin were similar in patients with PFO detected (HR 2·05; 95% CI 0·51–8·18) and in those without PFO detected (HR 2·82; 95% CI 1·69–4·70; pinteraction=0·68). The random-effects meta-analysis combined data from NAVIGATE ESUS with data from two previous trials (PICSS and CLOSE) and yielded a summary odds ratio of 0·48 (95% CI 0·24–0·96; p=0·04) for ischaemic stroke in favour of anticoagulation, without evidence of heterogeneity.\ud \ud Interpretation: \ud Among patients with ESUS who have PFO, anticoagulation might reduce the risk of recurrent stroke by about half, although substantial imprecision remains. Dedicated trials of anticoagulation versus antiplatelet therapy or PFO closure, or both, are warranted.\ud \ud Funding: \ud Bayer and Janssen.

Published
2018

3. Potentiation of Hemostimulating Effects of Erythropoietin with Pegylated Hyaluronate-Endo-β-N-Acetylhexosaminidase

Author

M. Iu. Minakova, E. V. Udut, A. A. Bekarev, E. V. Simanina, G. N. Zyuz’kov, L. A. Stavrova, T. Iu. Khrichkova, A. V. Artamonov, T. S. Markova, A. M. Dygai, V. V. Zhdanov, L. A. Miroshnichenko, P. G. Madonov, A. V. Chaikovsky, and R. V. Gurto

Subjects
Male, Enzyme-Linked Immunosorbent Assay, Pharmacology, Statistics, Nonparametric, General Biochemistry, Genetics and Molecular Biology, Carboplatin, Polyethylene Glycols, law.invention, Hemoglobins, Mice, chemistry.chemical_compound, law, Hyaluronidase, hemic and lymphatic diseases, medicine, Animals, Nanotechnology, Secretion, Erythropoietin, chemistry.chemical_classification, Dose-Response Relationship, Drug, Anemia, Drug Synergism, Long-term potentiation, General Medicine, Recombinant Proteins, beta-N-Acetylhexosaminidases, Haematopoiesis, Enzyme, chemistry, Biochemistry, Erythrocyte Count, Mice, Inbred CBA, Recombinant DNA, Female, medicine.drug
Abstract

Pegylated hyaluronate-endo-β-N-acetylhexosaminidase considerably potentiates the hemostimulating effects of erythropoietin due to intensification of proliferation and differentiation of erythroid precursors against the background of enhanced secretion of hemopoietins by nonadherent hemopoiesis-inducing environment cells and elevation of serum erythropoietin concentration. The use of the enzyme allows 10-fold reduction of the maximum effective erythropoietin dose.

Published
2012

4. A comparison of measured and calculated free 25(OH) vitamin D levels in clinical populations

Author

S. Markova, Janice B. Schwartz, Blanca Lizaola, Daniel D. Bikle, P. Weyland, Lynn Kane, Naomi E. Stotland, Jennifer C. Lai, and Norah A. Terrault

Subjects
Liver Cirrhosis, Adult, Male, medicine.medical_specialty, Cirrhosis, Vitamin D-binding protein, Endocrinology, Diabetes and Metabolism, Clinical Biochemistry, Clinical Sciences, Third trimester, Biochemistry, Paediatrics and Reproductive Medicine, Endocrinology & Metabolism, Endocrinology, Clinical Research, Pregnancy, Internal medicine, medicine, Vitamin D and neurology, Humans, In patient, Vitamin D, Aged, medicine.diagnostic_test, business.industry, Endocrine Care, Biochemistry (medical), Albumin, Middle Aged, medicine.disease, Serum samples, Immunoassay, Female, business
Abstract

ObjectiveOur goal was to compare direct quantitation of circulating free 25-hydroxyvitamin D (25(OH)D)levels to calculated free 25(OH)D levels and their relationships to intact PTH (iPTH), a biomarker of 25(OH)D effect, in humans with a range of clinical conditions.Patients and methodsSerum samples and clinical data were collected from 155 people: 111 without cirrhosis or pregnancy (comparison group), 24 cirrhotic patients with albumin

Published
2014

5. Self-concept in early stage dementia: profile, course, correlates, predictors and implications for quality of life

Author

Linda, Clare, Christopher J, Whitaker, Sharon M, Nelis, Anthony, Martyr, Ivana S, Markova, Ilona, Roth, Robert T, Woods, and Robin G, Morris

Subjects
Aged, 80 and over, Male, Quality of Life, Humans, Regression Analysis, Dementia, Female, Longitudinal Studies, Middle Aged, Self Concept, Aged
Abstract

Although it is increasingly accepted that people with dementia retain a sense of self, there is a need for empirical evidence regarding the nature of the self-concept in early stage dementia, how this changes over time and how it relates to quality of life.Self-concept was assessed using the short form of the Tennessee Self-concept Scale in 95 individuals with early stage dementia; 63 were reassessed after 12 months, and 45 were seen again at 20 months. Participants also completed measures of mood, cognitive functioning and quality of life. Caregivers provided proxy ratings of self-concept, completed measures of symptoms and distress at symptoms and rated their own levels of stress and well-being.Self-ratings of self-concept were close to the average range for the standardization sample, and the distribution did not differ significantly from expected values. Although caregiver ratings were slightly lower, discrepancies were small. There were no significant changes over time in self-ratings or informant ratings or discrepancies. At Time 1, self-ratings were predicted by anxiety, depression and memory, caregiver ratings were predicted by caregiver distress and by depression in the person with dementia and discrepancies were predicted by caregiver distress. These models remained predictive at later time points. Self-rated self-concept predicted quality of life, with the relationship only partially mediated by depression and anxiety.Self-concept appears largely intact in early stage dementia, but in view of the association between self-concept and quality of life, a preventive approach focused on supporting self-concept may offer benefits as dementia progresses.

Published
2012

6. The influence of psychological, social and contextual factors on the expression and measurement of awareness in early-stage dementia: testing a biopsychosocial model

Author

Linda, Clare, Sharon M, Nelis, Anthony, Martyr, Judith, Roberts, Christopher J, Whitaker, Ivana S, Markova, Ilona, Roth, Robert T, Woods, and Robin G, Morris

Subjects
Aged, 80 and over, Male, Analysis of Variance, Awareness, Middle Aged, Models, Psychological, Neuropsychological Tests, Self Concept, Cross-Sectional Studies, Memory, Activities of Daily Living, Humans, Regression Analysis, Dementia, Female, Social Behavior, Aged
Abstract

Insufficient attention has been paid to the influence of psychological and social factors on discrepancy-based measures of awareness.The present study tested a biopsychosocial model of awareness in early-stage dementia by gathering evidence regarding the relative contributions of neuropsychological, individual psychological and social factors to the level of scoring on measures used to index awareness.Awareness was assessed in relation to memory, activities of daily living and social functioning in 101 individuals with early-stage dementia participating in the Memory Impairment and Dementia Awareness (MIDAS) Study. People with dementia (PwD) and carers also completed measures of individual psychological and social variables, and PwD completed measures of neuropsychological functioning.Scores on discrepancy-based indices of awareness and on the self-ratings and informant ratings contributing to these indices were associated with a range of factors including neuropsychological functioning of PwD, individual traits and dispositions and current affective functioning of PwD, socio-demographic characteristics of PwD and carers, carer well-being and carer perceptions of PwD and of quality of relationship with PwD. Patterns of association varied across domains of functioning.The findings support the relevance of a biopsychosocial approach to understanding the factors that influence unawareness of impairment in dementia.

Published
2010

7. [Secondary abdominal pregnancy in 19 w.g.--diagnosis and therapy]

Author

S, Markova and S, Georgioski

Subjects
Treatment Outcome, Pregnancy, Pregnancy Trimester, Second, Pregnancy, Abdominal, Humans, Female, Gestational Age, Pregnancy, Tubal
Abstract

Preserving of tubal pregnancy after first trimester is rare and very often ends fatal. Nevertheless new methods of diagnosis and therapy of ectopic pregnancy, in industrial countries it remains on first place as reason for mother mortality in first three months of pregnancy and represents 10% of all mother mortality.

Published
2009

8. [Rear cases of tubal pregnancy during second trimester--diagnostic and therapeutic problems]

Author

S, Markova, S, Bozhinova, and S, Georgievski

Subjects
Adult, Fatal Outcome, Pregnancy, Pregnancy Trimester, Second, Humans, Female, Pregnancy, Tubal
Abstract

The lack of space abilities predetermine the fate of tubal pregnancy. Very often it disturbs in first few weeks. Preserving the tubal pregnancy after first trimester is very rear and often ends fatal. During 1970 in France the extrauterine pregnancy is met once on every 100 births. Now it is 2% from all births. In our country the relative part of ectopic pregnancy for last 20 years has grown twice. The authors represent two cases of tubal pregnancy, developed until second trimester, one of them ended fatal. The difficulties during diagnosing, characteristics of clinic and therapeutic problems are shown. Analysis are made on tendency of growing frequency of ectopic pregnancy, nevertheless modern diagnostic methods and also its role for maternal mortality.

Published
2008

9. [Peculiarities of maternal mortality in the University Hospital of Pleven for period 1977-2001]

Author

S, Markova, B, Stambolov, T, Veselinova, and R, Ivanova

Subjects
Hospitals, University, Maternal Mortality, Pregnancy, Pregnancy Outcome, Humans, Female, Bulgaria, Retrospective Studies
Abstract

The authors report retrospective investigation of causes for maternal mortality in the Department of Obstetric and Gynecology in Hospital in Pleven for the period 1977-2001 and comparison between indexes for a different period of time. Objects of investigation were patient histories necropsy report and forensic expertise. Vital births were 73922 for a period of 25 years in Pleven. Dead pregnant and maternity were 45 and the rate of maternal mortality was 60,07/per 100 000 vital births. Causes of maternal mortality were divided in immediate 40 cases (88,88%) and indirect--5 cases (11,11%). The hemorrhage was the most common cause of maternal mortality--18 cases (45%). The authors mention that the absolute number of maternal losses is comparatively constant but the rate of maternal mortality in creases because of tendency of decrease of birthrate and concentration of pathology in Department of Obstetric and Gynecology in Pleven.

Published
2007

11. [Characteristics of maternal mortality in the university hospital of Pleven for the period of 1977-2001 years]

Author

S, Markova, B, Stambolov, T, Veselinova, and R, Ivanova

Subjects
Adult, Hospitals, University, Pregnancy Complications, Maternal Mortality, Pregnancy, Humans, Female, Hospitals, Maternity, Bulgaria
Abstract

The authors report retrospective investigation of causes for maternal mortality in the Department of Obstetric and Gynecology in Hospital in Pleven for the period 1977-2001 and comparison between indexes for a different period of time. Objects of investigation were patient histories necropsy report and forensic expertise. Vital births were 73922 for a period of 25 years in Pleven. Dead pregnant and materinity were 45 and the rate of maternal mortality was 60,07/per 100 000 vital births. Causes of maternal mortality were divided in immediate 40 cases (88,88%) and indirect - 5 cases (11,11%). The hemorrhage was the most common cause of maternal mortality - 18 cases (45%). The authors mention that the absolute number of maternal losses is comparatively constant but the rate of maternal mortality in creases because of tendency of decrease of birthrate and concentration of pathology in Department of Obstertic and Gynecology in Pleven.

Published
2005

12. [Use of recombinant factor VIIa for the control of massive bleeding caused by uterine hypotonia in post-placental period]

Author

S, Tanchev, V, Platikanov, S, Markova, N, Slavov, A, Bogdanova, and D, Dimitrova

Subjects
Adult, Postpartum Hemorrhage, Uterus, Factor VIIa, Factor VII, Hemostatics, Recombinant Proteins, Treatment Outcome, Pregnancy, Injections, Intravenous, Humans, Muscle Hypotonia, Female, Blood Coagulation
Abstract

We report our clinical opinion for recombinant activated factor VII (NovoSeven, Novo Nordisk, Copenhagen, Denmark) administration in puerperae with massive haemorrhage caused by uterine hypotonia. Four women with severe bleeding in post-placental period received NovoSeven in bolus IV. The blood loss and laboratory changes in hematology and haemostasis parameters are monitored. The right time of application and the mean effective dose of the medication are discussed. The bleeding was ceased in all cases. Decrease in values of Hb, Er and PTT was noted. The mean administered dose of 72 micrograms/kg BW was effective. The laboratory values showed tendency for improvement on the 24 hour after administration and normal levels on discharge. The use of recombinant factor VIIA in puerperae with severe bleeding in the postplacental period is effective and safe enough and could be an alternative to the extreme surgical procedures.

Published
2004

13. [Pros and cons of magnesium sulfate as a tocolytic]

Author

S, Bozhinova, S, Markova, Ts, Tsvetkov, V, Penkov, and I, Ivanova

Subjects
Adult, Hospitals, Maternity, Abortion, Spontaneous, Magnesium Sulfate, Uterine Contraction, Obstetric Labor, Premature, Tocolytic Agents, Pre-Eclampsia, Pregnancy, Humans, Female, Prospective Studies, Uterine Hemorrhage, Bulgaria
Abstract

Magnesium sulphate (MgSO4) is with a proved effectiveness in cases of praeclampsia/eclampsia, but its use as a tocolytic is discussed in the last few years. That is why we had for an object to study its effect as a tocolytic in cases of abortions and premature labours. The study is prospective and if is made in I-st obstetric clinic of High Medical School--Pleven. Treatment with Cormagnesin was carried out to pregnant women for suppressing the uterine activity. Cormagnesin 200 (1 amp-10 ml) contains 1000 mg MgSO4, and Cormagnesin 400 (1 amp-10 ml) contains 2000 mg MgSO4. The medicine was administered in dosage of 4 or 5 g for 30 min, and after that if there were any uterine contractions the infusion was carried on with additional 5 g MgSO4 for 6 to 12 h. The total dosage was from 4 to 60 g MgSO4. The authors reported on very good effect in cases with pains and increased uterine tone--18 (36.73%), as well as in cases with pains and irregular uterine contractions 5 (10.21%), while the treatment was without any effect in cases with uterine contractions on 15-20 min, increased uterine tone, bleeding and Pelvic score 1-3 points in spite of high dosages of MgSO4 and longer duration of treatment. The authors made the conclusion, that the subjective complaints should not be accepted as an indication for administration of MgSO4, and MgSO4 should be administered in cases with increased uterine tone and irregular uterine contractions. Every genital bleeding and suspicion for placental abruption should be defined more precisely, because lately diagnosed placental abruption and unjustified expectation for suppression of uterine activity by MgSO4, may lead to increase of perinatal morbidity and mortality. In spite of the controversial data about MgSO4 as a tocolytic, its administration is justified and necessary.

Published
2003

14. [Two cases of diagnosis of right ventricular myocardial infarction]

Author

I G, Fomina, V F, Marinin, N E, Gaĭdamakina, I E, Makarov, N E, Artamoshina, G A, Anastasian, and Z S, Markova

Subjects
Male, Ventricular Dysfunction, Right, Myocardial Infarction, Humans, Female, Middle Aged
Abstract

Right ventricular myocardial infarction (RVMI) occurs rather rarely, under the mask of various diseases and is not easy to detect. Hypo-vate prognosis. Intravital diagnosis of RVMI was successful in 4 patients. Location of the lesion and its extent were determined. This article reports two cases of the four. The disease onset manifested with dyspnea, dry cough, attacks of night asphyxia then symptoms of right ventricular failure arose and intensified. The clinical picture, typical ECG signs suggested the RVMI diagnosis. However, its verification, precise localization and estimation of the lesion size were possible only after balanced radioventriculography.

Published
2002

15. [Inheritance of Wolff-Parkinson-White syndrome and evolution of its clinical symptoms in families of patients in a prospective trial]

Author

I G, Fomina, L V, Logunova, N P, Kuleshov, and Z S, Markova

Subjects
Adult, Aged, 80 and over, Male, Adolescent, Middle Aged, Severity of Illness Index, Pedigree, Child, Preschool, Humans, Female, Wolff-Parkinson-White Syndrome, Prospective Studies, Child, Aged
Abstract

Medicogenetic examination was conducted in families of 46 patients (21 women and 25 men aged 16-74 years) with Wolff-Parkinson-White (WPW) syndrome. A total of 256 relatives were investigated (136 women and 120 men aged 2 to 85 years). As a result, the diagnosis of preexcitation syndrome and phenomenon was made initially in 75(29.3%) of the relatives: WPW syndrome, Clerc-Levy-Cristesco (CLC) syndrome, CLC phenomenon was made in 6(2.3%), 27(10.6%) and 42(16.4%) relatives, respectively. Additional conduction pathways in the families with WPW syndrome are inherited by the autosome-dominant type with penetrability 0.94(94%) and clinical polymorphism. Prospective observation of the families revealed evolution of the clinical symptoms (development of arrhythmia) in the relative with CLC or WPW phenomenon in unfavorable exo- and endogenic factors. WPW syndrome evolution in the patients ran with aggravation of arrhythmia though 12 patients showed improvement.

Published
2001

16. [Hyaluricht in obstetric practice]

Author

S, Tanchev, S, Markova, and A, Bogdanova

Subjects
Wound Healing, Cesarean Section, Episiotomy, Anti-Infective Agents, Local, Humans, Surgical Wound Infection, Female, Hyaluronic Acid
Published
2001

17. [Changes in the level of fructose-2,6-biphosphate in peripheral blood lymphocytes in patients with diabetes mellitus]

Author

B F, Korovkin, N F, Beliaeva, S A, Kraevoĭ, M A, Golubev, V K, Gorodetskiĭ, M S, Markova, and O L, Kol'chenko

Subjects
Adult, Male, Diabetes Mellitus, Type 2, Fructosediphosphates, Humans, Female, Lymphocytes, Middle Aged, Aged
Abstract

Variation of fructose 2,6-bisphosphate (F-2,6-P2) content in the peripheral blood lymphocytes of patients with diabetes mellitus (type II) was investigated. The 2.5-fold increase of F-2,6-P2 level compared with to the control group was observed in untreated patients with early stage of the disease. In patients using of peroral antidiabetic drugs that corrected diabetes F-2,6-P2 level was approached to the normal one. At the same time F-2,6-P2 content decreases in patients with severe (noncorrected) diabetes mellitus. The possible mechanisms of regulation of lymphocyte F-2,6-P2 concentration in normal conditions and diabetes mellitus are discussed.

Published
1999

18. [Prestarium treatment of essential hypertension]

Author

I M, Kakhnovskiĭ, S I, Sivkov, E N, Gavrilova, O L, Belaia, A S, Sivkov, Z S, Markova, I E, Markov, and N E, Gaĭdamakina

Subjects
Adult, Male, Indoles, Angiotensin-Converting Enzyme Inhibitors, Blood Pressure, Middle Aged, Renal Circulation, Electrocardiography, Treatment Outcome, Hypertension, Perindopril, Humans, Female, Vascular Resistance, Aged, Follow-Up Studies, Glomerular Filtration Rate
Abstract

The aim of the study was to assess prestarium effects on central and renal hemodynamics, blood lipids in hypertensive subjects. Prestarium was given in a daily dose 4-6 mg to 30 patients with essential hypertension stage II free of cardiac decompensation and renal failure. Echocardiography, tetrapolar chest rheoplethysmography with assessment of hemodynamics, radionuclide tracing of renal blood flow, tests for cholesterol and blood electrolytes were made before treatment, on treatment weeks 2-3 and 12. It was found that prestarium lowers blood pressure and total peripheral vascular resistance. Myocardial conductivity was not affected, whereas renal circulation activated. Low-density lipoproteins cholesterol fell. No significant changes in electrolytes were seen. The drug was well tolerated. In view of good clinical effect and tolerance prestarium is recommended for treatment of essential hypertension stage II in the absence of cardiac decompensation and renal dysfunction.

Published
1998

19. [Gopten (trandolapril) in the treatment of chronic heart failure in patients with ischemic heart disease]

Author

I M, Kakhnovskiĭ, I G, Fomina, E L, Ostroumov, V M, Lepeshkov, N E, Gaĭdamakina, O V, Kaveshnikova, Z S, Markova, and E L, Lugovaia

Subjects
Adult, Heart Failure, Male, Indoles, Chronic Disease, Myocardial Ischemia, Drug Evaluation, Humans, Angiotensin-Converting Enzyme Inhibitors, Female, Middle Aged, Myocardial Contraction, Aged
Abstract

To investigate clinical efficacy of angiotensin-converting enzyme inhibitor trandolapril and its effects on myocardial function.20 patients with ischemic heart disease (IHD) aged 33-74 years with chronic cardiac failure NYHA class II-IV. 4 of them survived myocardial infarction. In addition to the routine tests, the patients underwent echocardiography, radionuclide ventriculography. Trandolapril was given once a day for 28 days in a dose 2 mg, then a repeat examination was performed.Trandolapril produced a subjective effect in 80% of patients. There was also improvement of hemodynamic parameters, an increase in the ejection fraction, sensitivity to nitroglycerin, decline of asynchrony. The drug was well tolerated.Trandolapril (Gopten) is effective in IHD patients with chronic cardiac failure.

Published
1998

20. [Minilaparotomy in surgical treatment of calculous cholecystitis]

Author

A M, Shulutko, A I, Danilov, Z S, Markova, and L V, Kornev

Subjects
Adult, Aged, 80 and over, Male, Laparotomy, Cholelithiasis, Humans, Female, Middle Aged, Aged, Retrospective Studies
Abstract

A set of instruments devised by the CAN company was used in performing cholecystectomy in 15 patients. It proved adequate for the operative situation and allowed surgical manipulations to be carried out through a 30-50 mm minilaparotomy. Cases in which the approach had to be widened or intraoperative complications occurred were not encountered. The indices of external respiration function and the volumetric parameters decrease a little but are rapidly restored during the postoperative period. This confirms the mild traumatic character of the operation and is consistent with the absence of pulmonary complications and negligible manifestation of postoperative intestinal paresis.

Published
1997

21. [Cardiac monitoring in bronchial asthma patients taking salben]

Author

I M, Kakhnovskiĭ, V F, Marinin, L A, Sorokina, and Z S, Markova

Subjects
Adult, Male, Arrhythmias, Cardiac, Middle Aged, Asthma, Bronchodilator Agents, Administration, Inhalation, Chronic Disease, Electrocardiography, Ambulatory, Drug Evaluation, Humans, Albuterol, Female, Powders, Sympathomimetics, Aged
Published
1996

22. [The volumetric blood flow in the carotid arteries of healthy subjects]

Author

V A, Parfenov and Z S, Markova

Subjects
Adult, Male, Aging, Sex Characteristics, Blood Volume, Body Surface Area, Heart Ventricles, Middle Aged, Carotid Arteries, Echocardiography, Reference Values, Regional Blood Flow, Humans, Ventricular Function, Female, Head, Aged
Abstract

Using ultrasonic duplex scanning, volumetric blood flow (VBF) in the common carotid artery (CCA) was studied in 119 healthy subjects (73 males and 46 females), aged 20-75. With age, mean linear flow rate seems to undergo slowing down, while CCA diameter becomes wider. However, VBF in CCA in the middle-aged and elderly subjects decreased insignificantly. Males have larger CCA diameters and, consequently, greater VBF. A correlation exists between head circumference measured horizontally 2 cm above the superciliary arches and CCA diameter. This explains higher VBF in CCA in subjects with greater head circumference.

Published
1994

23. [Hemodynamic changes in patients with large postoperative ventral hernias]

Author

I M, Kakhnovskiĭ, N V, Antropova, A S, Solomatin, Z S, Markova, and T I, Vdovina

Subjects
Adult, Male, Time Factors, Hemodynamics, Blood Pressure, Middle Aged, Hernia, Ventral, Postoperative Complications, Heart Rate, Case-Control Studies, Humans, Female, Vascular Resistance, Postoperative Period, Blood Flow Velocity, Aged
Abstract

Hemodynamic parameters have been analyzed in 68 inpatients with large postoperative ventral hernia. Most of the patients showed normodynamic circulation. The artificial rise of the intra-abdominal pressure in the course of the preoperative preparation induced hypodynamic response of the cardiovascular system. Early after the surgery, the patients had hypodynamic circulation. As compared to induced abdominal hypertension, this hypodynamia was less pronounced indicating adaptation of the cardiac activity to preoperative hypertension. This is confirmed by the absence of complications related to high intraabdominal pressure in early postoperative period.

Published
1994

28. [Diagnostic value of studying the indicators of blood lipid composition and the status of intravascular microcirculation in patients with diabetes mellitus associated with ischemic heart disease]

Author

G A, Golubiatnikova, T V, Koroleva, V I, Kalmykova, V F, Nastenko, and E S, Markova

Subjects
Adult, Male, Lipid Peroxides, Microcirculation, Coronary Disease, Middle Aged, Lipids, Diabetes Complications, Coronary Circulation, Diabetes Mellitus, Humans, Female, Diabetic Angiopathies, Aged
Abstract

A comprehensive study of blood lipid composition and microcirculatory indices was performed in 88 patients with diabetes mellitus (DM) combined with coronary heart disease (CHD). A "syndrome" of mutual aggravation was shown to develop in the combination of DM and CHD. As a result of it the above indices were changed depending on clinical signs of each of the two diseases. Lipid metabolic and microcirculatory derangements depended mostly on a degree of compensation of carbohydrate metabolism. a DM type, the presence of diabetic angiopathies and CHD gravity.

Published
1988

31. [Acute abdomen in twin interstitial pregnancy]

Author

S, Bozhinova, B, Stambolov, N, Slavov, and S, Markova

Subjects
Abdomen, Acute, Adult, Uterine Rupture, Pregnancy, Twins, Humans, Female, Shock, Emergencies, Pregnancy, Multiple, Pregnancy, Ectopic
Published
1988

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