The prognosis of patients with stage I non-small cell lung cancer (NSCLC) is often uncertain. This study aims to investigate a new prognostic tool to classify stage I NSCLC patients more accurately.
...CD68 and CD163 macrophages were quantified by immunohistochemical analyses of the center of the tumor and the invasive margin of the 339 tumors, which were used to construct the macrophage immunoscore (MI). Cox proportional hazards models determined the effects of multiple factors on disease-free survival (DFS) and overall survival (OS). One nomogram was developed to predict DFS and OS of stage I patients.
The multivariate Cox analysis identified MI (P<0.001), lymphocyte-to-monocyte ratio (LMR, P=0.006), and TNM stage (P=0.046) as independent prognostic factors for DFS. Compared with MI, TNM stage, and LMR alone, the nomogram improved the prediction accuracy of both DFS and OS in terms of the Harrell concordance index in the training cohort (0.812, P<0.001 for DFS; 0.810, P<0.001 for OS) and the external validation cohort (0.796, P<0.001 for DFS; 0.791, P<0.001 for OS). In addition, net reclassification (Nomogram
TNM-stage, P<0.001 for DFS and OS) and the integrated discrimination (Nomogram
TNM stage, P<0.001 for DFS and OS) also validated this improvement.
The immunoscore-based prognostic nomogram could effectively predict DFS and OS of stage I NSCLC patients and enhance the predictive value of the TNM stage system.
A recent randomized controlled trial DIRECT-MT (Direct Intra-Arterial Thrombectomy to Revascularize AIS Patients With Large Vessel Occlusion Efficiently in Chinese Tertiary Hospitals) compared the ...safety and efficacy of mechanical thrombectomy (MT) versus combined intravenous thrombolysis (IVT) and MT for acute large vessel occlusion. The current study utilized a prospective, nationwide registry to validate the results of the DIRECT-MT trial in a real-world practice setting.
Subjects were selected from a prospective cohort of acute large vessel occlusion patients undergoing endovascular treatment at 111 hospitals from 26 provinces in China (ANGEL-ACT registry Endovascular Treatment Key Technique and Emergency Work Flow Improvement of Acute Ischemic Stroke) between November 2017 and March 2019. All patients eligible for IVT and receiving MT were reviewed and then grouped according to whether prior IVT or not (MT and combined IVT+MT). After a 1:1 propensity score matching, the outcome measures including the 90-day modified Rankin Scale, successful recanalization, door-to-puncture time, symptomatic intracranial hemorrhage, and intraprocedural embolization were compared.
A total of 1026 patients, 600 in the MT group and 426 in the combined group, were included. Among 788 patients identified after matching, there were no significant differences in the 90-day modified Rankin Scale (median, 3 versus 3 points; P=0.82) and successful recanalization (86.6% versus 89.3%; P=0.23) between the two groups; however, patients of the MT group had a shorter door-to-puncture time (median, 112 versus 136 minutes; β=−45.02 95% CI, −68.31 to −21.74), lower rates of symptomatic intracranial hemorrhage (5.5% versus 10.1%; odds ratio, 0.52 95% CI, 0.30–0.91), and embolization (4.6% versus 8.1%; odds ratio, 0.54 95% CI, 0.30–0.98) than those of the combined group.
This matched-control study largely confirmed the findings of the DIRECT-MT trial in a real-world practice setting, suggesting that MT may carry similar effectiveness to combined IVT+MT for acute large vessel occlusion patients, despite MT alone seems to be associated with a shorter in-hospital delay until procedure, lower risks of symptomatic intracranial hemorrhage, and embolization.
URL: https://www.clinicaltrials.gov; Unique identifier: NCT03370939
In patients undergoing mechanical thrombectomy (MT), adjunctive antithrombotic might improve angiographic reperfusion, reduce the risk of distal emboli and reocclusion but possibly expose patients to ...a higher intracranial hemorrhage risk. This study evaluated the safety and efficacy of combined MT plus eptifibatide for acute ischemic stroke.
This was a propensity-matched analysis of data from 2 prospective trials in Chinese populations: the ANGEL-ACT trial (Endovascular Treatment Key Technique and Emergency Workflow Improvement of Acute Ischemic Stroke) in 111 hospitals between November 2017 and March 2019, and the EPOCH trial (Eptifibatide in Endovascular Treatment of Acute Ischemic Stroke) in 15 hospitals between April 2019 and March 2020. The primary efficacy outcome was good outcome (modified Rankin Scale score 0-2) at 3 months. Secondary efficacy outcomes included the distribution of 3-month modified Rankin Scale scores and poor outcome (modified Rankin Scale score 5-6) and successful recanalization. The safety outcomes included any intracranial hemorrhage, symptomatic intracranial hemorrhage, and 3-month mortality. Mixed-effects logistic regression models were used to account for within-hospital clustering in adjusted analyses.
Eighty-one combination arm EPOCH subjects were matched with 81 ANGEL-ACT noneptifibatide patients. Compared with the no eptifibatide group, the eptifibatide group had significantly higher rates of successful recanalization (91.3% versus 81.5%;
=0.043) and 3-month good outcomes (53.1% versus 33.3%;
=0.016). No significant difference was found in the remaining outcome measures between the 2 groups. All outcome measures of propensity score matching were consistent with mixed-effects logistic regression models in the total population.
This matched-control study demonstrated that MT combined with eptifibatide did not raise major safety concerns and showed a trend of better efficacy outcomes compared with MT alone. Overall, eptifibatide shows potential as a periprocedural adjunctive antithrombotic therapy when combined with MT. Further randomized controlled trials of MT plus eptifibatide should be prioritized.
URL: https://www.
gov; Unique identifier: NCT03844594 (EPOCH), NCT03370939 (ANGEL-ACT).
The role of stroke etiology subtype in patients with acute large vessel occlusion on the occurrence of hemorrhagic transformation (HT) after endovascular treatment is poorly studied, and which ...factors mediate their relationship remains largely unknown. We utilized nationwide registry data to explore the association of stroke subtype (cardioembolism versus large artery atherosclerosis) with HT and to identify the possible mediators.
A total of 1015 subjects were selected from the ANGEL-ACT registry (Endovascular Treatment Key Technique and Emergency Work Flow Improvement of Acute Ischemic Stroke)-a prospective consecutive cohort of acute large vessel occlusion patients undergoing endovascular treatment at 111 hospitals in China between November 2017 and March 2019-and divided into large artery atherosclerosis (n=538) and cardioembolism (n=477) according to the Trial of ORG 10172 in Acute Stroke Treatment criteria. The types of HT included any intracerebral hemorrhage (ICH), parenchymal hematoma, and symptomatic ICH within 24 hours after endovascular treatment. The association between stroke subtype and HT was analyzed using a logistic regression model. Mediation analysis was done to assess how much of the effect of stroke subtype on HT was mediated through the identified mediators.
Stroke subtype (cardioembolism versus large artery atherosclerosis) was associated with increased risk of any ICH (29.8% versus 16.5%; odds ratio, 2.03 95% CI, 1.22-3.36), parenchymal hematoma (14.3% versus 5.4%; odds ratio, 2.90 95% CI, 1.38-6.13), and symptomatic ICH (9.9% versus 4.7%; odds ratio, 2.59 95% CI, 1.09-6.16) after adjustment for potential confounders. The more thrombectomy passes in cardioembolism patients had a significant mediation effect on the association of stroke subtype with increased risk of HT (any ICH, 15.9%; parenchymal hematoma, 13.4%; symptomatic ICH, 14.2%, respectively).
Stroke subtype is an independent risk factor for HT within 24 hours following endovascular treatment among acute large vessel occlusion patients. Mediation analyses propose that stroke subtype contributes to HT partly through thrombectomy pass, suggesting a possible pathomechanistic link.
URL: https://www.
gov; Unique identifier: NCT03370939.
The aim of this study was to identify the diffuse axonal injury (DAI) of rat through screening out differentially expressed proteins which may represent potential biomarkers by matrix-assisted laser ...desorption/ionization time-of-flight (MALDI-TOF) imaging mass spectrometry (IMS), which could make a contribution for the research of forensic pathology.
A total of 15 brainstem sections of rats (10 with and 5 without DAI) were conducted by MALDI-TOF IMS. Specific protein expression patterns were obtained for normal and DAI regions within the tissue sections. "Supervised Neural Network" algorithm was used to classify the DAI group from the normal group.
Applying a "Supervised Neural Network" algorithm, we were able to distinguish between normal and DAI regions with an overall cross-validation, a sensitivity and specificity of 95.67%, 99.34%, and 92.01%, respectively. Additionally, 4 distinctively overexpressed peaks were identified: 7059 and 1518 Da for DAI sections, and 5077 and 4327 Da for normal sections.
This study reveals the value of MALDI-TOF IMS to classify between normal and injured tissues and identify candidates for DAI biomarkers which will provide data to eventually understand the pathological mechanisms relevant to DAI, which is a great help in forensic pathology.
Abstract
Background and objective
The effect of atrial fibrillation (AF) on outcomes of endovascular treatment (EVT) for acute ischemic stroke (AIS) is controversial. This study aimed to investigate ...the association of AF with outcomes after EVT in AIS patients.
Methods
Subjects were selected from ANGEL-ACT registry (Endovascular Treatment Key Technique and Emergency Work Flow Improvement of Acute Ischemic Stroke) - a prospective consecutive cohort of AIS patients undergoing EVT at 111 hospitals in China between November 2017 and March 2019, and then grouped according to having a history of AF or not. After 1:1 propensity score matching, the outcome measures including the 90-day modified Rankin Scale (mRS) score, successful recanalization after final attempt, symptomatic intracranial hemorrhage (ICH) within 24 h, and death within 90 days were compared.
Results
A total of 1755 patients, 550 with AF and 1205 without AF, were included. Among 407 pairs of patients identified after matching, no significant differences were found in the mRS score (median: 3 vs. 3 points;
P
= 0.29), successful recanalization (87.2 vs. 85.3%;
P
= 0.42), symptomatic ICH (9. 4 vs. 9.1%;
P
= 0.86) and death (16.3 vs. 18.4%;
P
= 0.44) between patients with and without AF.
Conclusion
The findings of this matched-control study show comparable outcomes of EVT in Chinese AIS patients with and without AF, which do not support withholding EVT in patients with both AIS and AF.
Trial registration
NCT03370939
First registration date: 28/09/2017
First posted date: 13/12/2017
Parenchymal hemorrhage (PH) is a troublesome complication after endovascular treatment (EVT).
To investigate the incidence, independent predictors, and clinical impact of PH after EVT in patients ...with acute ischemic stroke (AIS) due to anterior circulation large vessel occlusion (LVO).
Subjects were selected from the ANGEL-ACT Registry. PH was diagnosed according to the European Collaborative Acute Stroke Study classification. Logistic regression analyses were performed to determine the independent predictors of PH, as well as the association between PH and 90-day functional outcome assessed by modified Rankin Scale (mRS) score.
Of the 1227 enrolled patients, 147 (12.0%) were diagnosed with PH within 12-36 hours after EVT. On multivariable analysis, low admission Alberta Stroke Program Early CT score (ASPECTS)(adjusted OR (aOR)=1.13, 95% CI 1.02 to 1.26, p=0.020), serum glucose >7 mmol/L (aOR=1.82, 95% CI 1.16 to 2.84, p=0.009), and neutrophil-to-lymphocyte ratio (NLR; aOR=1.05, 95% CI 1.02 to 1.09, p=0.005) were associated with a high risk of PH, while underlying intracranial atherosclerotic stenosis (ICAS; aOR=0.42, 95% CI 0.22 to 0.81, p=0.009) and intracranial angioplasty/stenting (aOR=0.37, 95% CI 0.15 to 0.93, p=0.035) were associated with a low risk of PH. Furthermore, patients with PH were associated with a shift towards to worse functional outcome (mRS score 4 vs 3, adjusted common OR (acOR)=2.27, 95% CI 1.53 to 3.38, p<0.001).
In Chinese patients with AIS caused by anterior circulation LVO, the risk of PH was positively associated with low admission ASPECTS, serum glucose >7 mmol/L, and NLR, but negatively related to underlying ICAS and intracranial angioplasty/stenting.
NCT03370939.
The paper studies a new calibration method based on the framework of automatic test system. The method uses IVI (Interchangeable Virtual Instruments) as the hardware basis of the system to discuss ...the fast and intelligent automatic calibration of the test equipment. It intelligently analyzes the correlation of system parameters for highly complex calibrated instruments using a stepwise regression, and accurately selects high correlation factors for the calibration of each parameter. And it performs accurate multistage segmentation of the calibrated parameters using the M5 model tree algorithm to ensure calculating the linear regression equation under the least mean square and realizing the fitting and calibration of each parameter; and calibration results are then configured as a file to the folder set by the calibrated instrument to replace the original calibration file. It does not require highly experienced engineers to perform a large number of analyses, but automatically tests, autonomously analyzes, automatically calculates, generates and gives calibration files. The system is fast, intelligent, and efficient. In the paper, the self-made pulse generator is taken as an example, and the amplitude of the pulse generator is calibrated. The calibrated system error is less than 1.5%.
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