Publications by authors named "Churilov L"

Introduction: Young-onset neurocognitive symptoms result from a heterogeneous group of neurological and psychiatric disorders which present a diagnostic challenge. To identify such factors, we analysed the Biomarkers in Younger-Onset Neurocognitive Disorders cohort, a study of individuals <65 years old presenting with neurocognitive symptoms for a diagnosis and who have undergone cognitive and biomarker analyses.

Methods: Sixty-five participants (median age at assessment of 56 years, 45% female) were recruited during their index presentation to the Royal Melbourne Hospital Neuropsychiatry Centre, a tertiary specialist service in Melbourne, Australia, and categorized as either early-onset Alzheimer's disease ( = 18), non-Alzheimer's disease neurodegeneration ( = 23) or primary psychiatric disorders ( = 24).

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Objectives: Knowledge of the trajectory of post-stroke depression is important to identify high-risk patients, develop precise management programs and enhance prognosis. We aimed to characterise the course of depressive symptoms within the first year post-stroke and to evaluate associations with time.

Materials And Methods: Depressive symptoms were measured using the Montgomery-Åsberg Depression Rating Scale (MADRS) within the first week, and at 3 and 12 months post-stroke.

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Unlabelled: Comorbidities in tuberculosis patients are increasing annually. Autoimmune pathology may influence the diagnosis and treatment of tuberculosis (TB). However, the molecular mimicry between (Mtb) and human autoantigens is an important provocative factor in the development of autoimmunity on one hand.

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Background: Falls are common after stroke and can have serious consequences such as hip fracture. Prior research shows around half of individuals will fall within the 12 months post stroke and these falls are more likely to cause serious injury compared to people without stroke. However, there is limited research on risk factors collected in the immediate post-stroke period that may relate to falls risk.

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Background: Whether it is effective and safe to extend the time window of intravenous thrombolysis up to 24 hours after the last known well is unknown. We aimed to determine the efficacy and safety of tenecteplase in Chinese patients with acute ischemic stroke due to large/medium vessel occlusion within an extended time window.

Methods: Patients with ischemic stroke presenting 4.

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Background: Several social and biological factors are shown to differentially affect stroke outcomes between men and women. We evaluated whether clinical outcomes and endovascular thrombectomy (EVT) treatment effects differed between the sexes in patients presenting with large ischemic stroke.

Methods: The SELECT2 trial (A Randomized Controlled Trial to Optimize Patient's Selection for Endovascular Treatment in Acute Ischemic Stroke) was a randomized controlled trial assessing the efficacy and safety of EVT in patients with large strokes across the United States, Canada, Europe, Australia, and New Zealand between October 2019 and September 2022.

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Objective: To develop age-appropriate nonaGEnaRIan And cenTenarian suRgICal (GERIATRIC) risk tool for classifying patients who may or may not develop postoperative complications or die within their index hospital admission.

Background: There are no validated perioperative risk stratification tools for use in nonagenarian and centenarian patients-people aged 90 to 99 years and >100 years.

Methods: In this retrospective observational study, nonagenarians and centenarians undergoing any surgical procedure were profiled.

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Article Synopsis
  • Researchers studied 1485 patients undergoing invasive coronary angiography (ICA) to predict the likelihood of severe multivessel disease (MVD), which can impact decisions about transradial access (TRA) in coronary artery bypass grafting (CABG).
  • The predictive model showed a sensitivity of 70.3% and specificity of 71.8%, with a strong negative predictive value of 94.4%, indicating its effectiveness in identifying patients who may not have severe MVD.
  • Key indicators of severe MVD included abnormal test history, typical chest pain, and diabetes, while factors indicating the absence of severe MVD included female sex, atypical chest pain, and BMI, helping clinicians tailor access strategies for CABG based on individual patient
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A four-dimensional phase-contrast magnetic resonance imaging sequence with respiratory-controlled adaptive k-space reordering (ReCAR-4DPC) offers potential benefits of improved scan efficiency and motion robustness. The purpose of this study was to evaluate the reproducibility of flow measurement using this technique and to compare hemodynamic metrics obtained to two-dimensional phase contrast MRI (2DPC)-derived metrics of the thoracic aorta. ReCAR-4DPC was performed with identical scan parameters in 15 healthy volunteers (6M,9F, mean [range] 37 [23-47] years) and 11 patients with thoracic aortic dissection (6M,5F, 56 [31-81] years) and acquisition time was recorded.

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Aims: Individuals with diabetes frequently encounter sleep disturbances, which can detrimentally impact glycaemic management. We reviewed the relationship between sleep outcomes and glycaemic variability in adults with diabetes.

Methods: We systematically searched Medline, EMBASE and Cochrane Library (2002-March 2023) for studies evaluating sleep and glycaemic variability in adults with type 1 and type 2 diabetes.

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Article Synopsis
  • The ETERNAL-LVO trial examines the effectiveness and safety of tenecteplase for patients with large vessel occlusion (LVO) within 24 hours of stroke onset, compared to standard care.
  • The study is a randomized phase 3 trial involving patients with anterior circulation LVO and target mismatch on imaging, focusing on those who may need endovascular treatment.
  • Key outcomes include measuring disability at 3 months using the modified Rankin Scale, alongside safety assessments like the incidence of symptomatic intracerebral hemorrhage and overall mortality.
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  • This study analyzed decisions regarding decompressive hemicraniectomy (DHC) and early withdrawal of life-sustaining therapy (WLST) in patients with large vessel occlusion (LVO) and large ischemic strokes from the SELECT2 trial.* -
  • Among 352 patients, DHC was utilized in 55 patients, and WLST was chosen for 81, showing no significant differences in usage between those receiving endovascular thrombectomy (EVT) and those treated medically.* -
  • About 21% of DHC patients were able to walk independently after one year, indicating that DHC did not negatively impact the benefits of thrombectomy, while WLST generally resulted in poor outcomes.*
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Background: The safety and efficacy of sodium-glucose cotransporter 2 (SGLT2) inhibitors in hospitalized patients are unclear.

Purpose: To evaluate outcomes of inpatient SGLT2 inhibitor use.

Data Sources: MEDLINE, Embase, Emcare, and Cochrane databases were searched through 29 May 2024.

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  • Tranexamic acid, an antifibrinolytic agent, was tested in a study on patients with intracerebral hemorrhage who had ongoing bleeding (spot signs) to assess its effect on hematoma growth when administered within 4.5 hours of onset.
  • A systematic review and meta-analysis were conducted, evaluating randomized trials comparing tranexamic acid to a placebo, specifically including 162 participants with follow-up imaging.
  • Results showed that tranexamic acid treatment did not significantly reduce hematoma growth compared to placebo, with a slightly lower growth rate in the treatment group, but overall outcomes suggested continued monitoring and assessment of safety was needed.
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Background: Tenecteplase has been approved for acute ischemic stroke at a dose of 0.2 mg/kg by the Indian licensing authority. A registry to evaluate the safety of tenecteplase was mandated by the licensing authority.

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Article Synopsis
  • Endovascular thrombectomy (EVT) has proven safe and effective for patients suffering from large core strokes, but the effects of reperfusion quality and procedure details on outcomes are still unclear.
  • In the SELECT2 trial, findings indicated that 80% of patients experienced successful reperfusion, which correlates with better clinical outcomes, particularly in those who achieved near-complete reperfusion.
  • Longer procedure times negatively impacted patient outcomes, while the method of thrombectomy (aspiration vs stent-retriever) showed no significant differences in reperfusion success or functional recovery.
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Article Synopsis
  • Endovascular thrombectomy (EVT) is shown to be cost-effective for patients with extensive ischemic injury, providing better health outcomes and lower societal costs compared to standard care among various populations, including those in the US, Australia, and Spain.
  • The analysis utilized a Markov model to assess outcomes based on quality-adjusted life years (QALYs) and found significant cost savings, with reductions of $23,409 in the US, $10,691 in Australia, and $30,036 in Spain.
  • EVT remains cost-effective across different age groups and severity levels of strokes, indicating a need to adapt healthcare systems to increase thrombectomy access for patients with larger strokes.
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Objectives: To review evidence regarding the impact of physical activity interventions for preventing and managing type 2 diabetes in Aboriginal and Torres Strait Islander Australians.

Study Design: We searched for published reports of physical activity interventions for preventing and managing type 2 diabetes in Indigenous adults (18 years or older). There were no exclusion criteria regarding study type or duration, frequency, length, or intensity of physical activity, except that short term interventions were excluded.

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Background: Mobile stroke units have been shown to deliver faster patient care and improve clinical outcomes. However, costs associated with staffing limit their use to densely populated cities. Using the Melbourne mobile stroke unit, we aim to evaluate the safety, timeliness, and resource efficiency of a telemedicine model, where the neurologist assesses a patient remotely, via telemedicine, compared with an onboard neurologist model.

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Inclusion of adaptive design features in a clinical trial provides preplanned flexibility to dynamically modify a trial during its conduct while preserving validity and integrity. Adaptive trials are needed to accelerate the conduct of more efficient, informative, and ethical clinical research in the field of neurology. Stroke is a natural candidate for adoption of these innovative approaches to trial design.

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In post-COVID-19 syndrome, clinical presentation of the nerve fiber dysfunction plays an important role. The possibility of autoantigen cross-mimicry of human coronaviruses and the peripheral nervous system needs to be investigated. The bioinformatic analysis was applied to search for possible common protein sequences located in the immunoreactive epitopes.

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Article Synopsis
  • The no-reflow phenomenon may lead to poor patient outcomes after thrombectomy, with various imaging definitions leading to inconsistent prevalence rates.
  • An analysis of 131 patients showed significant variability in no-reflow prevalence (0.8-22.1%) and poor agreement between different imaging definitions regarding patient outcomes.
  • The definition based on >15% cerebral blood volume or flow asymmetry was most effective in predicting poor clinical outcomes 90 days post-treatment.
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  • The study investigates how sitting and standing positions affect cerebral blood flow (MCAv) in stroke patients within the first 48 hours and also 3-7 days post-stroke.
  • Using transcranial Doppler, researchers measured MCAv changes across different positions and compared results between stroke patients with and without occlusive disease, as well as healthy controls.
  • Findings revealed that affected hemisphere MCAv significantly decreased when patients with occlusive disease adjusted from a lying to an upright position, indicating potential harm and highlighting the need for careful monitoring of upright activity post-stroke.
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Endovascular thrombectomy (EVT) safety and efficacy in patients with large core infarcts receiving oral anticoagulants (OAC) are unknown. In the SELECT2 trial (NCT03876457), 29 of 180 (16%; vitamin K antagonists 15, direct OACs 14) EVT, and 18 of 172 (10%; vitamin K antagonists 3, direct OACs 15) medical management (MM) patients reported OAC use at baseline. EVT was not associated with better clinical outcomes in the OAC group (EVT 6 [4-6] vs MM 5 [4-6], adjusted generalized odds ratio 0.

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Background And Objectives: Neuroinflammation, particularly early astrocyte reactivity, is a significant driver of Alzheimer disease (AD) pathogenesis. It is unclear how the levels of astrocyte biomarkers change in patients across the AD continuum and which best reflect AD-related change. We performed a systematic review and meta-analysis of 3 blood astrocyte biomarkers (glial fibrillary acidic protein [GFAP], chitinase-3-like protein 1 [YKL-40], and S100B) in patients clinically diagnosed with AD.

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