Background and purpose
High blood pressure (BP) at presentation is associated with poor outcomes in acute ischaemic stroke, but serial BP measurements may better delineate the clinical implications ...of BP. The aim was to investigate the association between various BP parameters and functional outcomes in acute ischaemic stroke patients treated with endovascular thrombectomy (EVT).
Methods
This study reports a retrospective analysis of a prospective registry of a comprehensive stroke centre. Patients treated with EVT due to large vessel occlusion in the anterior circulation were enrolled. BP was measured hourly during the first 24 h after admission. Associations of various BP parameters, including BP variability, with functional outcomes at 3 months, including good outcomes (modified Rankin Scale score of 0–2), were analysed.
Results
Of the 378 enrolled patients (mean age 70 ± 11 years, male 54.2%), 313 (82.8%) achieved successful reperfusion after EVT, and 149 (39.4%) had good outcomes at 3 months. Higher mean systolic BP each 10 mmHg increase, odds ratio 0.82 (0.69–0.97) and higher systolic successive variation (SV) each 10% increase, odds ratio 0.37 (0.18–0.76) were associated with a reduced likelihood of achieving good outcomes. In addition, reperfusion status after EVT moderated the influence of higher systolic SV on good outcomes (Pint = 0.05).
Conclusion
The results showed that a higher mean systolic BP and systolic SV during the first 24 h of EVT reduced the likelihood of good outcomes at 3 months. The effects of these parameters on outcomes are more substantial amongst patients with successful reperfusion after EVT, suggesting that different BP control strategies should be employed according to reperfusion status.
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Background and purpose
The objective of this study was to investigate the association between body mass index (BMI) and both initial stroke severity at presentation and functional outcomes after ...acute ischaemic stroke (AIS) in patients with non‐valvular atrial fibrillation (NVAF).
Methods
Patients were categorized on the basis of their BMI into underweight (BMI <18.5, n = 111), normal (18.5 ≤ BMI <25, n = 1036) and overweight to obese (BMI ≥25, n = 472) groups. Initial stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS) score and functional outcomes were assessed using the modified Rankin Scale score at discharge. The differences in stroke severity and functional outcomes were compared between groups using robust log‐linear regression with a Poisson distribution and binary logistic regression analysis.
Results
A total of 1619 AIS patients with NVAF from six hospitals were included. Compared with the NIHSS scores median 5, interquartile range (IQR) 2–14 of normal‐weight patients, the NIHSS scores (median 9, IQR 4–19) of underweight patients were more likely to be higher, whereas those of overweight to obese patients were lower (median 4, IQR 1–12) (P < 0.001). In terms of functional outcomes after stroke, underweight patients had a higher risk of poor functional outcomes (odds ratio 1.78, 95% confidence interval 1.09–2.56, P = 0.01) but overweight to obese patients had no significant difference in functional outcomes compared with normal‐weight patients.
Conclusion
An inverse association was found between BMI and stroke severity in AIS patients with NVAF. This suggests the presence of an obesity paradox for short‐term outcomes in patients with NVAF.
Background and purpose
The rate at which the chance of a good outcome of endovascular stroke therapy (EVT) decays with time when eligible patients are selected by baseline diffusion‐weighted magnetic ...resonance imaging (DWI‐MRI) and whether ischaemic core size affects this rate remain to be investigated.
Methods
This study analyses a prospective multicentre registry of stroke patients treated with EVT based on pretreatment DWI‐MRI that was categorized into three groups: small Diffusion‐Weighted Imaging Alberta Stroke Program Early Computed Tomography Score (DWI‐ASPECTS) (8–10), moderate (5–7) and large (<5) cores. The main outcome was a good outcome at 90 days (modified Rankin Scale 0–2). The interaction between onset‐to‐groin puncture time (OTP) and DWI‐ASPECTS categories regarding functional outcomes was investigated.
Results
Ultimately, 985 patients (age 69 ± 11 years; male 55%) were analysed. Potential interaction effects between the DWI‐ASPECTS categories and OTP on a good outcome at 90 days were observed (Pinteraction = 0.06). Every 60‐min delay in OTP was associated with a 16% reduced likelihood of a good outcome at 90 days amongst patients with large cores, although no associations were observed amongst patients with small to moderate cores. Interestingly, the adjusted rates of a good outcome at 90 days steeply declined between 65 and 213 min of OTP and then remained smooth throughout 24 h of OTP (Pnonlinearity = 0.15).
Conclusions
Our study showed that the probability of a good outcome after EVT nonlinearly decreased, with a steeper decline at earlier OTP than at later OTP. Discrepant effects of OTP on functional outcomes by baseline DWI‐ASPECTS categories were observed. Thus, different strategies for EVT based on time and ischaemic core size are warranted.
The aim of this study is to develop a novel method for the accurate diagnosis of the infection status of viral diseases, which requires discriminated and quantitative detection of different ...anti-virus immunoglubulin subtypes. Considering hepatitis A as a representative model disease, viral antigen nanoparticles (vAgNPs) were designed and synthesized by genetically presenting hepatitis A virus (HAV) antigens on the surface of human heavy chain ferritin (hFTH) nanoparticles to detect anti-HAV antibodies with discriminating immunoglobulin subtypes M and G (IgM and IgG, respectively). The vAgNPs also display multi-copies of hexa-histidine peptide (H6) on their surface to chemisorb gold ions (Au3+), which is vital for the autonomous generation of quantitatively meaningful detection signals. The quantitative level of anti-HAV IgM or IgG in 30 patient sera was successfully analyzed using the vAgNPs of HAV, which was performed through label-free one-step-immunoassay based on the self-enhancement of optical signals from gold nanoparticles clustered on the viral antigen nanoparticles. The diagnostic performance was compared with that of enzyme-linked immunosorbent assay (ELISA), which did not enable accurate quantitative assay due to the poor linearity between the antibody concentration and detection signal. Furthermore, these vAgNP-based immunoassays did not produce any false negative/positive signals, indicating 100% sensitivity and 100% specificity.
Open-circuit voltage (OCV) is widely used to estimate the state-of-charge (SoC) in many SoC estimation algorithms. However, the relationship between the OCV and SoC cannot be exactly same for all ...batteries. Because the conventional OCV–SoC differs among batteries, there is a problem in that the relationship of the OCV–SoC should be measured to estimate accurately the SoC. Therefore, a modified OCV–SoC relationship based on the conventional OCV–SoC is proposed. Problems resulting from the defects of the extended Kalman filter (EKF) can be avoided by preventing the relationship from varying. Also, in order to improve the performance of the algorithm, measurement noise models of the Kalman filter are applied. Thus, the measurement noise models allow the Kalman filter to overcome defects from the simplified battery modelling and to separate the sequence for estimation of the state and weight filter. The SoC and the capacity of a lithium-ion battery are estimated using the dual EKF with the proposed method.
Background and purpose
Hemorrhagic transformation (HT) is one of the most problematic complications to arise from intravenous thrombolysis (IVT). This study was conducted to assess whether micro‐ and ...macroalbuminuria could be associated with HT after IVT in patients with acute ischaemic stroke, and to investigate whether the value of urinary albumin‐to‐creatinine ratios would correlate with the degree of HT.
Methods
This was a retrospective study of stroke patients who had undergone IVT within 3 h of symptom onset. Albuminuria assessment was based on random morning spot urine collection with patients in a fasting state, the first morning after IVT. Multiple logistic regression analysis was used to evaluate whether the presence of micro‐ and macroalbuminuria might be independent predictors of HT.
Results
One‐hundred and fifty‐four patients were included in the study. Fifty‐one patients had HT. The presence of micro‐ or macroalbuminuria was associated with HT after adjustment for variables with clinical significance (adjusting for age, atrial fibrillation, platelet counts, baseline National Institutes of Health Stroke Scale score, hypertension and diabetes mellitus; odds ratio, 2.542; 95% confidence interval, 1.106–5.841; P = 0.028). There were significant relationships between the presence of micro‐ and macroalbuminuria and types of HT.
Conclusion
In conclusion, the results of this study suggest that the presence of micro‐ and macroalbuminuria after IVT could be a predictor of severe HT in patients with acute ischaemic stroke.
This paper describes the application of an extended Kalman filter (EKF) combined with a per-unit (p.u.) system to the identification of suitable battery model parameters for the high-accuracy ...state-of-charge (SOC) estimation and state-of-health (SOH) prediction of a Li-Ion degraded battery. Variances in electrochemical characteristics among Li-Ion batteries caused by aging differences result in erroneous SOC estimation and SOH prediction when using the existing EKF algorithm. To apply the battery model parameters varied by the aging effect, based on the p.u. system, the absolute values of the parameters in the equivalent circuit model in addition to the discharging/charging voltage and current are converted into dimensionless values relative to a set of base value. The converted values are applied to dynamic and measurement models in the EKF algorithm. In particular, based on two methods such as direct current internal resistance measurement and the statistical analysis of voltage pattern, each diffusion resistance ( R Diff ) can be measured and used for offline and online SOC estimations, respectively. All SOC estimates are within ±5% of the values estimated by ampere-hour counting. Moreover, it is shown that R Diff is more sensitive than other model parameters under identical experimental conditions and, hence, implementable for SOH prediction.
Paclitaxel is currently only available as an intravenous (i.v.) formulation. DHP107 is a novel oral formulation of lipid ingredients and paclitaxel. DHP107 demonstrated comparable efficacy, safety, ...and pharmacokinetics to i.v. paclitaxel as a second-line therapy in patients with advanced gastric cancer (AGC). DREAM is a multicenter, open-label, prospective, randomized phase III study of patients with histologically/cytologically confirmed, unresectable/recurrent AGC after first-line therapy failure.
Patients were randomized 1:1 to DHP107 (200mg/m2 orally twice daily days 1, 8, 15 every 4weeks) or i.v. paclitaxel (175mg/m2 day 1 every 3weeks). Patients were stratified by Eastern Cooperative Oncology Group performance status, disease status, and prior treatment; response was assessed (Response Evaluation Criteria in Solid Tumors) every 6weeks. Primary end point: non-inferiority of progression-free survival (PFS); secondary end points: overall response rate (ORR), overall survival (OS), and safety. For the efficacy analysis, sequential tests for non-inferiority were carried out, first with a non-inferiority margin of 1.48, then with a margin of 1.25.
Baseline characteristics were balanced in the 236 randomized patients (n=118 per arm). Median PFS (per-protocol) was 3.0 (95% CI 1.7–4.0) months for DHP107 and 2.6 (95% CI 1.8–2.8) months for paclitaxel (hazard ratio HR=0.85; 95% CI 0.64–1.13). A sensitivity analysis on PFS using independent central review showed similar results (HR=0.93; 95% CI 0.70–1.24). Median OS (full analysis set) was 9.7 (95% CI 7.1−11.5) months for DHP107 versus 8.9 (95% CI 7.1–12.2) months for paclitaxel (HR=1.04; 95% CI 0.76–1.41). ORR was 17.8% for DHP107 (CR 4.2%; PR 13.6%) versus 25.4% for paclitaxel (CR 3.4%; PR 22.0%). Nausea, vomiting, diarrhea, and mucositis were more common with DHP107; peripheral neuropathy was more common with paclitaxel. There were only few Grade≥3 adverse events, most commonly neutropenia (42% versus 53%); febrile neutropenia was reported infrequently (5.9% versus 2.5%). No hypersensitivity reactions occurred with DHP107 (paclitaxel 2.5%).
DHP107 as a second-line treatment of AGC was non-inferior to paclitaxel for PFS; other efficacy and safety parameters were comparable. DHP107 is the first oral paclitaxel with proven efficacy/safety for the treatment of AGC.
NCT01839773.
This paper investigates a practical universal modeling of multi-cell battery strings in series and parallel connections to show high an accuracy SOC (state-of-charge) estimation based on the EKF ...(extended Kalman filter) if cell-to-cell variations are taken into account and settled by the screening process. Through the screening process for the selection of the cells that have similar electrochemical characteristics, this study describes an effort to provide each equivalent circuit model for multi-cell battery strings in series, parallel, and series/parallel connections. Three circuit-based multi-cell battery models are validated against the experimental data of the discharging/charging behavior in terms of the discharging/charging voltage, discharge capacity, OCV (open-circuit voltage), and internal resistances when compared with the experimental data of a single cell. According to the relation between a multi-cell battery string and a single cell, these models can be easily developed from a single cell model, the validity of which was demonstrated regarding its high accuracy in predicting cell performance. The proposed multi-cell battery model has been extensively validated by the model-based SOC estimation using the EKF for a Li-Ion cell. If the model parameters of a single cell are correctly measured and used in the multi-cell battery model, the accuracy in the SOC estimation of a multi-cell battery string could be significantly improved.
•Differences in electrochemical characteristics inevitably result in cell-to-cell variation.•The purpose of the screening process to discriminate cells with similar electrochemical characteristics.•Screening process-based modeling of the multi-cell battery string is newly investigated.•The proposed approach has been extensively validated by the model-based SOC estimation via EKF.
Differences in electrochemical characteristics among Li-ion cells inevitably result in state-of-charge (SOC) imbalance when the existing voltage balancing technique is used. This paper presents a new ...approach based on a screening process for improved voltage/SOC balancing of a Li-ion series battery pack. Two kinds of screening processes, capacity screening and resistance screening, are implemented in an orderly manner. The capacity screening process matches open-circuit voltage (OCV)-SOC relation for achievement of voltage/SOC balancing. In the resistance screening process, pulse-type discharging/charging currents are applied to various SOC points to select the cells with similar voltage variance. Through two screening processes, the cells that have similar electrochemical characteristics are finally selected, and can be used for stable configuration of a Li-ion series battery pack. The proposed screening process has been validated by extensive experimental results and SOC estimation results based on extended Kalman filter.
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