Despite the recent acceptance of thrombectomy as the standard of care in patients with acute anterior circulation stroke, the benefits of thrombectomy remain uncertain for patients with acute basilar ...artery occlusion (BAO). This study aimed to evaluate the effectiveness and safety of thrombectomy and to identify predictors of outcomes in a large cohort of patients with acute BAO.
This study included 212 consecutive patients with acute BAO who underwent either stent-retriever or contact aspiration thrombectomy as the first-line approach between January 2011 and August 2017 at 3 stroke centers. Clinical and radiologic data were prospectively collected and stored in a database at each center. Multivariable ordinal logistic regression was performed to assess the association between each characteristic and 90-day modified Rankin scale scores. Reperfusion was successful in 91.5% (194/212) of patients; 44.8% (95/212) of patients achieved 90-day modified Rankin scale 0 to 2. The symptomatic hemorrhage rate was 1.9% (4/212) and mortality was 16% (34/212). In a multivariable ordinal regression, younger age, lower National Institute of Health stroke scale on admission, and absence of diabetes mellitus and parenchymal hematoma were significantly associated with a favorable shift in the overall distribution of 90-day modified Rankin scale scores. Treatment outcomes were similar between patients who received stent-retriever thrombectomy and contact aspiration thrombectomy as the first-line technique.
Endovascular thrombectomy was effective and safe for treating patients with acute BAO. Age, the baseline National Institute of Health stroke scale, diabetes mellitus, and parenchymal hematoma were associated with better outcomes. This study showed no superiority of the stent-retriever over the aspiration thrombectomy for treating acute BAO.
Hyperhomocysteinemia is a well-known risk factor for vascular disease. However, its action, mechanism, and role in the acute phase of stroke have not been determined. We tried to determine whether an ...association existed between elevated serum homocysteine levels and early neurological deterioration (END) in patients with acute ischemic stroke.
We performed a secondary analysis from the Cilostazol in Acute Ischemic Stroke Treatment (CAIST) trial, which was a double-blinded, randomized, multicenter trial, assessing the noninferiority of cilostazol over aspirin within 48 hours of an acute ischemic stroke. END was defined as an increase of ≥1 point in motor power or an increase of ≥2 points in the total National Institute of Health Stroke Scale score within 7 days.
The mean (±SD) serum homocysteine level was 11.4±4.7 μmol/L. Of the 396 patients studied, 57 (14.4%) patients worsened during the 7 days after inclusion. Most (68%) of the END cases occurred within the first 24 hours after treatment. High levels (>10.3 μmol/L) of serum homocysteine were independent predictors for END (third quartile odds ratio, 3.45; 95% confidence intervals, 1.25-9.50; P=0.016; fourth quartile odds ratio, 3.36; 95% confidence intervals 1.18-9.52; P=0.023) in multivariate analysis.
Patients with acute stroke with elevated serum homocysteine levels are at an increased risk for END.
Depression has been associated with poorer medical outcomes in acute coronary syndrome (ACS), but there are few data on the effects of antidepressant treatment on long-term prognosis.
To investigate ...the effect on long-term major adverse cardiac events (MACE) of escitalopram treatment of depression in patients with recent ACS.
Randomized, double-blind, placebo-controlled trial conducted among 300 patients with recent ACS and depression enrolled from May 2007 to March 2013, with follow-up completed in June 2017, at Chonnam National University Hospital, Gwangju, South Korea.
Patients were randomly assigned to receive either escitalopram in flexible dosages of 5, 10, 15, or 20 mg/d (n = 149) or matched placebo (n = 151) for 24 weeks.
The primary outcome was MACE, a composite of all-cause mortality, myocardial infarction (MI), and percutaneous coronary intervention (PCI). Four secondary outcomes were the individual MACE components of all-cause mortality, cardiac death, MI, and PCI. Cox proportional hazards models were used to compare the escitalopram and placebo groups by time to first MACE.
Among 300 randomized patients (mean age, 60 years; 119 women 39.3%), 100% completed a median of 8.1 (interquartile range, 7.5-9.0) years of follow-up. MACE occurred in 61 patients (40.9%) receiving escitalopram and in 81 (53.6%) receiving placebo (hazard ratio HR, 0.69; 95% CI, 0.49-0.96; P = .03). Comparing individual MACE outcomes between the escitalopram and placebo groups, respectively, incidences for all-cause mortality were 20.8% vs 24.5% (HR, 0.82; 95% CI, 0.51-1.33; P = .43), for cardiac death, 10.7% vs 13.2% (HR, 0.79; 95% CI, 0.41-1.52; P = .48); for MI, 8.7% vs 15.2% (HR, 0.54; 95% CI, 0.27-0.96; P = .04), and for PCI, 12.8% vs 19.9% (HR, 0.58; 95% CI, 0.33-1.04; P = .07).
Among patients with depression following recent acute coronary syndrome, 24-week treatment with escitalopram compared with placebo resulted in a lower risk of major adverse cardiac events after a median of 8.1 years. Further research is needed to assess the generalizability of these findings.
ClinicalTrials.gov Identifier: NCT00419471.
Objective
We evaluated the efficacy of endovascular thrombectomy (EVT) on the functional outcome of patients with acute basilar artery occlusion and low posterior circulation acute stroke prognosis ...early computed tomography score (PC‐ASPECTS).
Methods
We identified patients with acute ischemic stroke due to basilar artery occlusion and PC‐ASPECTS of 6 or less, presenting within 24 h between August 2008 and April 2022. The primary outcome was a favorable functional outcome, defined as a modified Rankin Scale (mRS) score of 0–3 at 90 days. The secondary outcomes included an mRS score of 0–2, a favorable shift in the ordinal mRS scale, the occurrence of symptomatic intracranial hemorrhage (sICH), and mortality at 90 days. We compared the outcome of patients treated with EVT and those without EVT, using the inverse probability of treatment weighting methods.
Results
Out of 566 patients, 55.5% received EVT. In the EVT group, 106 (33.8%) achieved favorable outcomes, compared to 56 patients (22.2%) in the conservative group. EVT significantly increased the likelihood of achieving a favorable outcome compared to conservative treatment (relative risk RR 1.39, 95% confidence interval CI, 1.11–1.74, p = 0.004). EVT was associated with a favorable shift in the mRS (RR 1.85, 95% CI, 1.49–2.29, p < 0.001) and reduced mortality without an increase in the risk of sICH. It did not have an impact on achieving an mRS score of 0–2.
Interpretation
Patients with acute basilar artery occlusion and a PC‐ASPECTS of 6 or less might benefit from EVT without an increasing sICH. ANN NEUROL 2024;95:788–799
Abstract
Low hemoglobin levels are known to be associated with hematoma expansion (HE) and poor functional outcome in patients with intracerebral hemorrhage (ICH). However, it is not yet known ...whether low hemoglobin itself causes HE directly or is merely a confounder. Thus, we investigated the mediation effect of the mean Hounsfield unit (HU) of hematoma on the relationship between low hemoglobin and expansion of ICH. Overall, 232 consecutive patients with ICH who underwent non-contrast computed tomography (NCCT) within 12 h since onset were included. The mean HU and hematoma volume on NCCT were investigated using semi-automated planimetry. HE was defined as an increase in hematoma volume > 33% or 6 mL. The respective associations among the hemoglobin level, mean HU, and HE were analyzed using multivariable regression analysis, adjusting for age, sex, and known HE predictors. Mediation analysis was performed to examine the potential causal association among the three. HE occurred in 34.5% of patients; hemoglobin levels were inversely associated with HE occurrence (adjusted odds ratio, 0.90;
p
= 0.03). The mean HU of the hematoma was lower in patients with HE than in patients without HE (58.5 ± 3.3 vs. 56.8 ± 3.0;
p
< 0.01). Hemoglobin levels on admission were linearly related to the mean HU (adjusted β, 0.33;
p
< 0.01) after adjusting for known HE predictors (time from onset to CT, antithrombotic use, hematoma volume). Causal mediation analysis showed a significant mediation effect of the mean HU on the association between hemoglobin levels and HE (
p
= 0.04). The proportion of indirect effect through the mean HU among the total effect was 19% (
p
= 0.05). The mediation effect became nonsignificant in the when the multivariable model was adjusted with additional covariates (baseline systolic blood pressure and hematoma location). The mean HU of the hematoma mediated the association between hemoglobin levels and HE occurrence. Therefore, the mean HU of the hematoma may be a potential marker of impaired hemostasis in patients with ICH.
Disturbances of semantic and phonemic fluency are common after brain damage, as a manifestation of language, executive, or memory dysfunction. Lesion-symptom mapping (LSM) studies can provide ...fundamental insights in shared and distinct anatomical correlates of these cognitive functions and help to understand which patients suffer from these deficits. We performed a multivariate support vector regression-based lesion-symptom mapping and structural disconnection study on semantic and phonemic fluency in 1231 patients with acute ischemic stroke. With the largest-ever LSM study on verbal fluency we achieved almost complete brain lesion coverage. Lower performance on both fluency types was related to left hemispheric frontotemporal and parietal cortical regions, and subcortical regions centering on the left thalamus. Distinct correlates for phonemic fluency were the anterior divisions of middle and inferior frontal gyri. Distinct correlates for semantic fluency were the posterior regions of the middle and inferior temporal gyri, parahippocampal and fusiform gyri and triangular part of the inferior frontal gyrus. The disconnectome-based analyses additionally revealed phonemic fluency was associated with a more extensive frontoparietal white matter network, whereas semantic fluency was associated with disconnection of the fornix, mesiotemporal white matter, splenium of the corpus callosum. These results provide the most detailed outline of the anatomical correlates of phonemic and semantic fluency to date, stress the crucial role of subcortical regions and reveal a novel dissociation in the left temporal lobe.
Development of an effective strategy for biofilm control in water-related system has become a matter of significant concern nowadays. Electrochemical monitoring, especially electrochemical impedance ...spectroscopy (EIS), is one of the efficient approaches to dealing with biofilm-related issues. However, currently used EIS methods without a redox probe intend to detect all effects generated from media components, bacteria, and bacterial metabolites, which used to make the signals from the attached bacteria and biofilm weakened. In this study, we tried improved EIS measurement to monitor bacterial adhesion and biofilm maturation using a double-layer capacitance. In this improved method, we minimized background signal by subtracting the interference of electrolyte caused by bacterial metabolism. Pseudomonas aeruginosa PA14 wild type and wspF mutant that form the biofilm of distinct nature were used for the model strains to test our method. During bacterial adhesion and biofilm maturation, EIS data were collected and equivalent circuit analysis was carried out to obtain constant phase element (CPE) values representing double-layer capacitance. Since the influence by the bacterial growth-related culture media condition was eliminated by adopting fresh electrolyte at the measurement, the contribution of attached bacteria and biofilm was exclusively measured. As a result, the bacterial adhesion at the early stage of biofilm development was specifically monitored from reduction in double-layer capacitance. Particularly, the plateau in double-layer capacitance appeared upon biofilm maturation, indicating that biofilm maturation could be expected beyond this point. In conclusion, this study found that measurement of double-layer capacitance based on EIS could provide a monitoring parameter suggesting bacterial adhesion and the initiation point of biofilm maturation.
▪
► Double-layer capacitance as a monitoring parameter for observing bacterial adhesion and biofilm maturation. ► Measurement using fresh electrolyte minimizes background signal caused by bacterial metabolism. ► Initial reduction in double-layer capacitance indicates bacterial adhesion. ► A plateau observed after reduction in double-layer capacitance denotes an initiation of biofilm maturation.
Annually, millions of new cancer cases are reported, leading to millions of deaths worldwide. Among the newly reported cases, breast and colon cancers prevail as the most frequently detected ...variations. To effectively counteract this rapid increase, the development of innovative therapies is crucial. Small molecules possessing pyridine and urea moieties have been reported in many of the currently available anticancer agents, especially VEGFR2 inhibitors. With this in mind, a rational design approach was employed to create hybrid small molecules combining urea and pyridine. These synthesized compounds underwent in vitro testing against breast and colon cancer cell lines, revealing potent submicromolar anticancer activity. Compound
, specifically, exhibited an impressive GI
value of 0.06 μM against the MCF7 cancer cell line, while compound
displayed the highest cytotoxic activity against the HCT116 cell line, with a GI
of 0.33 ± 0.042 μM. Notably, compounds
,
, and
demonstrated excellent safety profiles when tested on normal cells. Molecular docking, dynamic studies, and free energy calculations were employed to validate the affinity of these compounds as VEGFR2 inhibitors.
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