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  1. Article ; Online: Management of Intracerebral Hemorrhage: Update and Future Therapies.

    Kirshner, Howard / Schrag, Matthew

    Current neurology and neuroscience reports

    2021  Volume 21, Issue 10, Page(s) 57

    Abstract: Purpose of review: Intracerebral hemorrhage (ICH) represents about 15% of all strokes in the USA, but almost 50% of fatal strokes. There are many causes of ICH, but the most common are hypertension and cerebral amyloid angiopathy. This review will ... ...

    Abstract Purpose of review: Intracerebral hemorrhage (ICH) represents about 15% of all strokes in the USA, but almost 50% of fatal strokes. There are many causes of ICH, but the most common are hypertension and cerebral amyloid angiopathy. This review will discuss new advances in the treatment of intracerebral hemorrhage.
    Recent findings: The treatment of ICH focuses on management of edema, aggressive blood pressure reduction, and correction of coagulopathy. Early initiation of supportive medical therapies, including blood pressure management, in a neurological intensive care unit reduces mortality, but at present there is no definitive, curative therapy analogous to mechanical thrombectomy for ischemic stroke. Nonetheless, new medical and surgical approaches promise more successful management of ICH patients, especially new approaches to surgical management. In this review, we focus on the current standard of care of acute ICH and discuss emerging therapies that may alter the landscape of this devastating disease.
    MeSH term(s) Blood Pressure ; Cerebral Amyloid Angiopathy/complications ; Cerebral Amyloid Angiopathy/therapy ; Cerebral Hemorrhage/therapy ; Humans ; Hypertension/therapy ; Intensive Care Units
    Language English
    Publishing date 2021-10-02
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2057363-7
    ISSN 1534-6293 ; 1528-4042
    ISSN (online) 1534-6293
    ISSN 1528-4042
    DOI 10.1007/s11910-021-01144-9
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  2. Article ; Online: Re: Flaxel et al.: Retinal and ophthalmic artery occlusions Preferred Practice Pattern® (Ophthalmology. 2020;127:P259-P287).

    Mac Grory, Brian / Schrag, Matthew

    Ophthalmology

    2020  Volume 127, Issue 8, Page(s) e59–e60

    MeSH term(s) Humans ; Ophthalmic Artery ; Retina ; Retinal Artery Occlusion/diagnosis
    Language English
    Publishing date 2020-07-07
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 392083-5
    ISSN 1549-4713 ; 0161-6420
    ISSN (online) 1549-4713
    ISSN 0161-6420
    DOI 10.1016/j.ophtha.2020.04.022
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  3. Article ; Online: Management of Intracerebral Hemorrhage: JACC Focus Seminar.

    Schrag, Matthew / Kirshner, Howard

    Journal of the American College of Cardiology

    2020  Volume 75, Issue 15, Page(s) 1819–1831

    Abstract: Intracerebral hemorrhage (ICH) accounts for a disproportionate amount of stroke-related morbidity and mortality. Although chronic hypertension and cerebral amyloid angiopathy are the underlying cerebral vasculopathies accounting for the majority of ICH, ... ...

    Abstract Intracerebral hemorrhage (ICH) accounts for a disproportionate amount of stroke-related morbidity and mortality. Although chronic hypertension and cerebral amyloid angiopathy are the underlying cerebral vasculopathies accounting for the majority of ICH, there are a broad range of potential causes, and effective management requires accurate identification and treatment of the underlying mechanism of hemorrhage. Magnetic resonance imaging and vascular imaging techniques play a critical role in identifying disease mechanisms. Modern treatment of ICH focuses on rapid stabilization, often requiring urgent treatment of mass effect, aggressive blood pressure reduction and correction of contributing coagulopathies to achieve hemostasis. We discuss management of patients with ICH who continue to require long-term anticoagulation, the interaction of ICH with neurodegenerative diseases, and our approach to prognostication after ICH. We close this review with a discussion of novel medical and surgical approaches to ICH treatment that are being tested in clinical trials.
    MeSH term(s) Anticoagulants/adverse effects ; Antihypertensive Agents/therapeutic use ; Brain Neoplasms/complications ; Cerebral Amyloid Angiopathy/complications ; Cerebral Hemorrhage/diagnosis ; Cerebral Hemorrhage/etiology ; Cerebral Hemorrhage/therapy ; Coagulants/therapeutic use ; Diagnosis, Differential ; Drainage ; Humans ; Hypertension/complications ; Intracranial Arteriovenous Malformations/complications ; Prognosis
    Chemical Substances Anticoagulants ; Antihypertensive Agents ; Coagulants
    Language English
    Publishing date 2020-04-16
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Review
    ZDB-ID 605507-2
    ISSN 1558-3597 ; 0735-1097
    ISSN (online) 1558-3597
    ISSN 0735-1097
    DOI 10.1016/j.jacc.2019.10.066
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  4. Article ; Online: Physiology and Clinical Relevance of Enlarged Perivascular Spaces in the Aging Brain.

    Bown, Corey W / Carare, Roxana O / Schrag, Matthew S / Jefferson, Angela L

    Neurology

    2021  Volume 98, Issue 3, Page(s) 107–117

    Abstract: Perivascular spaces (PVS) are fluid-filled compartments that are part of the cerebral blood vessel wall and represent the conduit for fluid transport in and out of the brain. PVS are considered pathologic when sufficiently enlarged to be visible on MRI. ... ...

    Abstract Perivascular spaces (PVS) are fluid-filled compartments that are part of the cerebral blood vessel wall and represent the conduit for fluid transport in and out of the brain. PVS are considered pathologic when sufficiently enlarged to be visible on MRI. Recent studies have demonstrated that enlarged PVS (ePVS) may have clinical consequences related to cognition. Emerging literature points to arterial stiffening and abnormal protein aggregation in vessel walls as 2 possible mechanisms that drive ePVS formation. We describe the clinical consequences, anatomy, fluid dynamics, physiology, risk factors, and in vivo quantification methods of ePVS. Given competing views of PVS physiology, we detail the 2 most prominent theoretical views and review ePVS associations with other common small vessel disease markers. Because ePVS are a marker of small vessel disease and ePVS burden is higher in Alzheimer disease, a comprehensive understanding about ePVS is essential in developing prevention and treatment strategies.
    MeSH term(s) Aging ; Alzheimer Disease/complications ; Alzheimer Disease/diagnostic imaging ; Biomarkers ; Brain/diagnostic imaging ; Cerebral Small Vessel Diseases/complications ; Cerebral Small Vessel Diseases/diagnostic imaging ; Humans ; Magnetic Resonance Imaging/methods
    Chemical Substances Biomarkers
    Language English
    Publishing date 2021-11-22
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 207147-2
    ISSN 1526-632X ; 0028-3878
    ISSN (online) 1526-632X
    ISSN 0028-3878
    DOI 10.1212/WNL.0000000000013077
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  5. Article ; Online: Response by Mac Grory et al to Letter Regarding Article, "Thrombolytic Therapy for Acute Central Retinal Artery Occlusion".

    Mac Grory, Brian / Lavin, Patrick / Kirshner, Howard / Schrag, Matthew

    Stroke

    2020  Volume 51, Issue 5, Page(s) e96

    MeSH term(s) Humans ; Retinal Artery Occlusion ; Thrombolytic Therapy
    Language English
    Publishing date 2020-04-17
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 80381-9
    ISSN 1524-4628 ; 0039-2499 ; 0749-7954
    ISSN (online) 1524-4628
    ISSN 0039-2499 ; 0749-7954
    DOI 10.1161/STROKEAHA.120.029609
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  6. Article ; Online: Targeting lysyl-oxidase (LOX) may facilitate intramural periarterial drainage for the treatment of Alzheimer's disease.

    Kelly, Louise / Sharp, Matthew Macgregor / Thomas, Isabelle / Brown, Christopher / Schrag, Matthew / Antunes, Lissa Ventura / Solopova, Elena / Martinez-Gonzalez, José / Rodríguez, Cristina / Carare, Roxana Octavia

    Cerebral circulation - cognition and behavior

    2023  Volume 5, Page(s) 100171

    Abstract: Alzheimer's disease is the commonest form of dementia. It is likely that a lack of clearance of amyloid beta (Aβ) results in its accumulation in the parenchyma as Aβ oligomers and insoluble plaques, and within the walls of blood vessels as cerebral ... ...

    Abstract Alzheimer's disease is the commonest form of dementia. It is likely that a lack of clearance of amyloid beta (Aβ) results in its accumulation in the parenchyma as Aβ oligomers and insoluble plaques, and within the walls of blood vessels as cerebral amyloid angiopathy (CAA). The drainage of Aβ along the basement membranes of blood vessels as intramural periarterial drainage (IPAD), could be improved if the driving force behind IPAD could be augmented, therefore reducing Aβ accumulation. There are alterations in the composition of the vascular basement membrane in Alzheimer's disease. Lysyl oxidase (LOX) is an enzyme involved in the remodelling of the extracellular matrix and its expression and function is altered in various disease states. The expression of LOX is increased in Alzheimer's disease, but it is unclear whether this is a contributory factor in the impairment of IPAD in Alzheimer's disease. The pharmacological inhibition of LOX may be a strategy to improve IPAD and reduce the accumulation of Aβ in the parenchyma and within the walls of blood vessels.
    Language English
    Publishing date 2023-06-23
    Publishing country Netherlands
    Document type Journal Article ; Review
    ISSN 2666-2450
    ISSN (online) 2666-2450
    DOI 10.1016/j.cccb.2023.100171
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  7. Article ; Online: Identifying Oncology Clinical Trial Candidates Using Artificial Intelligence Predictions of Treatment Change: A Pilot Implementation Study.

    Kehl, Kenneth L / Mazor, Tali / Trukhanov, Pavel / Lindsay, James / Galvin, Matthew R / Farhat, Karim S / McClure, Emily / Giordano, Antonio / Gandhi, Leena / Schrag, Deborah / Hassett, Michael J / Cerami, Ethan

    JCO precision oncology

    2024  Volume 8, Page(s) e2300507

    Abstract: Purpose: Precision oncology clinical trials often struggle to accrue, partly because it is difficult to find potentially eligible patients at moments when they need new treatment. We piloted deployment of artificial intelligence tools to identify such ... ...

    Abstract Purpose: Precision oncology clinical trials often struggle to accrue, partly because it is difficult to find potentially eligible patients at moments when they need new treatment. We piloted deployment of artificial intelligence tools to identify such patients at a large academic cancer center.
    Patients and methods: Neural networks that process radiology reports to identify patients likely to start new systemic therapy were applied prospectively for patients with solid tumors that had undergone next-generation sequencing at our center. Model output was linked to the MatchMiner tool, which matches patients to trials using tumor genomics. Reports listing genomically matched patients, sorted by probability of treatment change, were provided weekly to an oncology nurse navigator (ONN) coordinating recruitment to nine early-phase trials. The ONN contacted treating oncologists when patients likely to change treatment appeared potentially trial-eligible.
    Results: Within weekly reports to the ONN, 60,199 patient-trial matches were generated for 2,150 patients on the basis of genomics alone. Of these, 3,168 patient-trial matches (5%) corresponding to 525 patients were flagged for ONN review by our model, representing a 95% reduction in review compared with manual review of all patient-trial matches weekly. After ONN review for potential eligibility, treating oncologists for 74 patients were contacted. Common reasons for not contacting treating oncologists included cases where patients had already decided to continue current treatment (21%); the trial had no slots (14%); or the patient was ineligible on ONN review (12%). Of 74 patients whose oncologists were contacted, 10 (14%) had a consult regarding a trial and five (7%) enrolled.
    Conclusion: This approach facilitated identification of potential patients for clinical trials in real time, but further work to improve accrual must address the many other barriers to trial enrollment in precision oncology research.
    MeSH term(s) Humans ; Neoplasms/drug therapy ; Neoplasms/genetics ; Artificial Intelligence ; Precision Medicine ; Medical Oncology ; Pilot Projects
    Language English
    Publishing date 2024-03-21
    Publishing country United States
    Document type Journal Article
    ISSN 2473-4284
    ISSN (online) 2473-4284
    DOI 10.1200/PO.23.00507
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  8. Article ; Online: IV Thrombolysis for central retinal artery occlusion - Real-world experience from a comprehensive stroke center.

    Stretz, Christoph / Paddock, John E / Burton, Tina M / Bakaeva, Tatiana / Freeman, Melissa / Choudhury, Aparna / Yaghi, Shadi / Furie, Karen L / Schrag, Matthew / MacGrory, Brian C

    Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association

    2024  Volume 33, Issue 4, Page(s) 107610

    Abstract: Objectives: Central retinal artery occlusion (CRAO) is a stroke of the retina potentially amenable to intravenous thrombolysis (IVT). We aimed to determine feasibility of an emergency treatment protocol and risk profile of IVT for CRAO in a ... ...

    Abstract Objectives: Central retinal artery occlusion (CRAO) is a stroke of the retina potentially amenable to intravenous thrombolysis (IVT). We aimed to determine feasibility of an emergency treatment protocol and risk profile of IVT for CRAO in a comprehensive stroke center (CSC).
    Methods: We performed a retrospective, observational cohort study including patients with acute CRAO admitted to a CSC over 4 years. Patients are offered IVT if they present with acute vision loss of ≤ 20/200 in the affected eye, have no other cause of vision loss (incorporating a dilated ophthalmologic exam), and meet criteria akin to acute ischemic stroke. We collected socio-demographic data, triage data, time from onset to presentation, IVT candidacy, and rates of symptomatic intracranial hemorrhage (sICH)- or extracranial hemorrhage.
    Results: 36 patients presented within the study period, mean (standard deviation (SD)) age of 70.7 (10), 52 % female, and median time (Q1, Q3) to ED presentation of 13.5 (4.3, 18.8) h. Patients within 4.5 h from onset presented more commonly directly to our ED (66.6 % vs 37.1 %, p = 0.1). Nine patients (25 %) presented within the 4.5 h window. Of those eligible, 7 (77 %) received IVT. There were no events of intracranial or extracranial hemorrhage.
    Conclusions: Our study confirmed that IVT for acute CRAO is feasible. We found a high rate of treatment with IVT of those eligible. However, because 75 % of patients presented outside the treatment window, continued educational efforts are needed to improve rapid triage to emergency departments to facilitate evaluation for possible candidacy with IVT.
    MeSH term(s) Female ; Humans ; Male ; Brain Ischemia/therapy ; Fibrinolytic Agents/adverse effects ; Intracranial Hemorrhages/chemically induced ; Ischemic Stroke/etiology ; Retinal Artery Occlusion/diagnosis ; Retinal Artery Occlusion/drug therapy ; Retrospective Studies ; Stroke/diagnosis ; Stroke/drug therapy ; Thrombolytic Therapy/adverse effects ; Thrombolytic Therapy/methods ; Treatment Outcome ; Middle Aged ; Aged ; Aged, 80 and over
    Chemical Substances Fibrinolytic Agents
    Language English
    Publishing date 2024-01-30
    Publishing country United States
    Document type Observational Study ; Journal Article
    ZDB-ID 1131675-5
    ISSN 1532-8511 ; 1052-3057
    ISSN (online) 1532-8511
    ISSN 1052-3057
    DOI 10.1016/j.jstrokecerebrovasdis.2024.107610
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  9. Article ; Online: Response by Mac Grory et al. to Letter regarding "Structural and Functional Imaging of the Retina in Central Retinal Artery Occlusion - Current Approaches and Future Directions".

    Mac Grory, Brian / Schrag, Matthew / Poli, Sven / Boisvert, Chantal / Biousse, Valérie / Feng, Wuwei

    Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association

    2021  Volume 30, Issue 10, Page(s) 105999

    MeSH term(s) Diagnostic Imaging ; Humans ; Retina/diagnostic imaging ; Retinal Artery Occlusion/diagnostic imaging
    Language English
    Publishing date 2021-07-15
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 1131675-5
    ISSN 1532-8511 ; 1052-3057
    ISSN (online) 1532-8511
    ISSN 1052-3057
    DOI 10.1016/j.jstrokecerebrovasdis.2021.105999
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  10. Article ; Online: Well-being beyond the bladder. How do we improve the overall health of patients with bladder cancer?

    Mossanen, Matthew / Brown, Justin C / Schrag, Deborah

    BJU international

    2018  Volume 121, Issue 4, Page(s) 489–491

    MeSH term(s) Humans ; Urinary Bladder Neoplasms
    Language English
    Publishing date 2018-03-30
    Publishing country England
    Document type Editorial ; Comment
    ZDB-ID 1462191-5
    ISSN 1464-410X ; 1464-4096 ; 1358-8672
    ISSN (online) 1464-410X
    ISSN 1464-4096 ; 1358-8672
    DOI 10.1111/bju.14158
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