Publications by authors named "Ying Xian"

Background: Patients with premorbid dementia have been generally excluded from trials of stroke therapies, and their dementia diagnosis may affect the care received. There are few data on the quality of stroke care and outcomes in these patients.

Methods: We compared the quality of care and outcomes for acute ischemic stroke patients with versus without premorbid dementia using national data from the Get With The Guidelines-Stroke registry between July 1, 2020, and December 31, 2021.

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  • Clinical trials indicate that using a mobile stroke unit (MSU) for prehospital management can lead to better outcomes for acute ischemic stroke patients who may need thrombolysis, but real-world data is limited.
  • This study aimed to compare the effects of prehospital MSU management versus standard emergency services (EMS) on patient disability levels at the time of hospital discharge.
  • The analysis included over 19,000 patients treated across multiple hospitals, revealing that those managed in an MSU had improved functional outcomes compared to those receiving standard EMS care.*
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The study aimed to validate the protective effect of neuroglobin (Ngb) in a cell model of Parkinson's disease (PD) and explore its therapeutic potential. Lentivirus-Ngb (LvNgb) and siRNA-Ngb (siNgb) were used to achieve Ngb overexpression and knockdown, respectively, in a sporadic PD cell model. Apoptosis was evaluated by flow cytometry-based Annexin V/propidium iodide assays.

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Delayed graft function (DGF) is a type of acute renal failure that is closely linked to the immune system. The objective of this study is to investigate immune trends during the perioperative period of renal transplantation and compare the variations between patients with DGF and immediate graft function (IGF). A total of 48 kidney transplant patients were enrolled.

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Background: The Get With The Guidelines-Stroke program is a quality improvement initiative designed to enhance adherence to evidence-based stroke care. Since its inception in 2003, over 2800 hospitals in the United States have participated in the program.

Methods: We examined patient characteristics, adherence to performance measures, and in-hospital outcomes in patients hospitalized for acute ischemic stroke, subarachnoid hemorrhage, intracerebral hemorrhage, and transient ischemic attack in The Get With The Guidelines-Stroke hospitals from 2003 through 2022.

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Introduction: Migraine is an established risk factor for cerebral ischemic stroke, with an especially robust association in patients with migraine with aura. However, it is not known if migraine is a risk factor for retinal stroke (central or branch retinal artery occlusion; CRAO or BRAO).

Methods: We performed a retrospective, observational, cohort study using population-based data from the State Inpatient Databases and State Emergency Department Databases from New York (2006-2015), California (2003-2011), and Florida (2006-2015) to determine the association between hospital-documented migraine and retinal stroke.

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Objective: This study aimed to link intracellular adenosine triphosphate content in CD4 T lymphocytes (CD4 iATP) with sepsis patient mortality, seeking a new predictive biomarker for outcomes and enhanced management.

Methods: 61 sepsis patients admitted to the Intensive Care Unit between October 2021 and November 2022 were enrolled. iATP levels were gauged using whole blood CD4 T cells stimulated with mitogen PHA-L.

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  • - A study analyzed data from the Get With The Guidelines-Stroke registry to identify methods for predicting large vessel occlusion (LVO) strokes without neuroimaging, focusing on adult patients diagnosed with ischemic stroke between 2016 and 2021.
  • - Out of 416,022 patients, 30.1% had LVO, with a moderate predictive accuracy (AUC of 0.79) using clinical factors and the NIH Stroke Scale, indicating that current methods only slightly predict LVO status.
  • - The findings highlight a challenge in predicting LVO accurately without vascular imaging, as the predictive models, even when including various risk factors, showed limitations and moderate success rates.
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Background And Objectives: There are racial disparities in health care services received by patients with neurodegenerative diseases, but little is known about disparities in the last year of life, specifically in high-value and low-value care utilization. This study evaluated racial disparities in the utilization of high-value and low-value care in the last year of life among Medicare beneficiaries with dementia or Parkinson disease.

Methods: This was a retrospective, population-based cohort analysis using data from North and South Carolina fee-for-service Medicare claims between 2013 and 2017.

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  • Intracerebral hemorrhage (ICH) is a highly lethal form of stroke, especially in patients on anticoagulants, prompting the development of new reversal strategies for anticoagulation.
  • This study analyzes data from nearly 10,000 ICH patients treated at US hospitals to see how the timing of treatment (door-to-treatment or DTT times) affects patient outcomes after receiving reversal interventions.
  • Results showed that a large portion of patients received reversal therapy, and specific DTT times were correlated with inpatient mortality and functional status, highlighting the importance of timely intervention in improving outcomes.
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  • The study investigates the impact of the Target: Stroke (TS) initiative on thrombolysis treatment for ischemic stroke among different racial and ethnic groups in the U.S., covering data from 2003 to 2021.
  • Results show that while the overall thrombolysis rates increased significantly during the TS initiative, disparities remained, with Asian, Black, and Hispanic patients less likely to receive treatment compared to White patients.
  • The analysis included over 1.1 million patients, revealing improvements in treatment effectiveness (thrombolysis rates) and efficiency (door-to-needle times), but highlighting ongoing racial and ethnic inequalities in care.
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Intravenous thrombolysis is not recommended in anticoagulated patients receiving direct oral anticoagulants (DOACs) and a recent intake within the last 48 hours in US and European guidelines. However, three observational studies now suggest safety of thrombolysis in patients with recent intake of DOACs, and thus support previous experimental data. In this perspective, the current evidence and practical consequences are discussed.

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Central retinal artery occlusion (CRAO; retinal stroke or eye stroke) is an under-recognized, disabling form of acute ischemic stroke which causes severe visual loss in one eye. The classical risk factor for CRAO is ipsilateral carotid stenosis; however, nearly half of patients with CRAO do not have high-grade carotid stenosis, suggesting that other cardiovascular risk factors may exist for CRAO. Specifically, prior studies have suggested that cardioembolism, driven by underlying atrial fibrillation, may predispose patients to CRAO.

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Importance: Tongxinluo, a traditional Chinese medicine compound, has shown promise in in vitro, animal, and small human studies for myocardial infarction, but has not been rigorously evaluated in large randomized clinical trials.

Objective: To investigate whether Tongxinluo could improve clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI).

Design, Setting, And Participants: Randomized, double-blind, placebo-controlled clinical trial was conducted among patients with STEMI within 24 hours of symptom onset from 124 hospitals in China.

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  • This study evaluates the quality of care for acute ischemic stroke patients receiving reperfusion therapies at thrombectomy-capable stroke centers (TSCs), primary stroke centers (PSCs), and comprehensive stroke centers (CSCs) between 2018 and 2020.
  • It analyzed data from almost 85,000 patients, noting that the majority (73%) received endovascular thrombectomy (EVT) at CSCs, with CSCs also showing higher success rates in timely treatments and better clinical outcomes than PSCs.
  • Findings indicated that patients at CSCs and TSCs had better odds of being discharged home or to rehabilitation, alongside lower chances of in-hospital mortality compared to those treated
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  • The study aimed to analyze how hospital procedural volumes impact outcomes for acute ischemic stroke (AIS) patients receiving endovascular therapy (EVT).
  • It involved a large group of 60,727 AIS patients treated within 24 hours at 626 hospitals from 2016 to 2019, focusing on the relationships between procedural volume and patient outcomes.
  • Results indicated that higher procedural volumes at hospitals were linked to better chances of patient discharge to home, increased functional independence, and lower in-hospital mortality rates.
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Background: Given the swift advancements in artificial intelligence (AI), the utilisation of AI-based clinical decision support systems (AI-CDSSs) has become increasingly prevalent in the medical domain, particularly in the management of cerebrovascular disease.

Aims: To describe the design, rationale and methods of a cluster-randomised multifaceted intervention trial aimed at investigating the effect of cerebrovascular disease AI-CDSS on the clinical outcomes of patients who had a stroke and on stroke care quality.

Design: The GOLDEN BRIDGE II trial is a multicentre, open-label, cluster-randomised multifaceted intervention study.

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Background: Perforated peptic ulcer (PPU) is a common emergency surgical condition and a significant cause of morbidity and mortality worldwide. While advances in surgical techniques have improved outcomes for patients with PPU, many factors still affect postoperative hospital stay and overall prognosis. One potential factor is the serum albumin (SA) level, a widely utilized marker of nutritional status that has been associated with length of stay and complications in various surgical procedures.

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Introduction: The aim of the study was to assess factors associated with the perceived risk of developing Alzheimer's disease and related dementias (ADRD) and how the perceived risk of ADRD was related to cognitive function.

Methods: We conducted a retrospective cohort study using 5 waves of data from the Health and Retirement Study (2012-2022) that included adults aged 65 years or older with no previous diagnosis of ADRD at baseline. Cognitive function was measured at baseline and over time using a summary score that included immediate/delayed word recall, serial 7's test, objective naming test, backwards counting, recall of the current date, and naming the president/vice-president (range = 0-35).

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Background: Targeting the gut microbiota may become a new therapeutic to prevent and treat sepsis. Nonetheless, the causal relationship between specific intestinal flora and sepsis is still unclear.

Methods: A two-sample Mendelian randomization study was performed using the summary statistics of gut microbiota from the largest available genome-wide association study (n = 18,340).

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  • The thrombectomy-capable stroke center (TSC) is a new type of hospital accreditation for treating acute ischemic stroke patients, but there hasn't been much research on how it compares to primary stroke centers (PSC) and comprehensive stroke centers (CSC) in terms of quality and outcomes.
  • A study from 2018 to 2020 examined the treatment of patients with acute ischemic stroke who received endovascular or intravenous therapies at CSCs, TSCs, and PSCs, focusing on various metrics like treatment timing and patient outcomes.
  • The results showed that patients treated at CSCs and TSCs had better outcomes regarding timeliness and effectiveness of care compared to PSCs, including higher chances of going home or to rehabilitation and lower
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  • The use of oral vitamin K antagonists (VKAs) may increase the risk of complications for patients undergoing endovascular thrombectomy (EVT) due to acute ischemic stroke from large vessel occlusion.
  • This study retrospectively analyzed data from over 32,000 patients to explore the relationship between recent VKA use and outcomes during EVT.
  • Results indicated that while overall prior VKA use was not linked to a significantly higher risk of symptomatic intracranial hemorrhage (sICH), patients with higher INR levels (above 1.7) faced a considerably increased risk compared to those not taking VKAs.
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Importance: Reperfusion therapy is the most effective treatment for acute ischemic stroke but remains underused in China.

Objective: To evaluate the effect of a problem-oriented, culturally adapted, targeted quality improvement intervention on reperfusion therapy for patients with acute ischemic stroke in China.

Design, Setting, And Participants: In this stepped-wedge cluster randomized clinical trial, patients from 16 secondary and 33 tertiary hospitals in China with acute ischemic stroke within 6 hours of symptom onset were consecutively recruited between July 1, 2018, and June 30, 2020.

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  • * The research analyzed patient data from a national database, specifically focusing on the time it takes from hospital arrival to receiving IVT (door-to-needle time) and its correlation with outcomes like home time and one-year mortality.
  • * Findings suggest that longer delays in receiving IVT significantly increase the odds of not returning home post-treatment and raise the risk of mortality, particularly for those receiving the combined IVT+EVT treatment.
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