We aimed to develop a novel prediction model for early neurological deterioration (END) based on an interpretable machine learning (ML) algorithm for atrial fibrillation (AF)-related stroke and to ...evaluate the prediction accuracy and feature importance of ML models. Data from multicenter prospective stroke registries in South Korea were collected. After stepwise data preprocessing, we utilized logistic regression, support vector machine, extreme gradient boosting, light gradient boosting machine (LightGBM), and multilayer perceptron models. We used the Shapley additive explanation (SHAP) method to evaluate feature importance. Of the 3,213 stroke patients, the 2,363 who had arrived at the hospital within 24 h of symptom onset and had available information regarding END were included. Of these, 318 (13.5%) had END. The LightGBM model showed the highest area under the receiver operating characteristic curve (0.772; 95% confidence interval, 0.715-0.829). The feature importance analysis revealed that fasting glucose level and the National Institute of Health Stroke Scale score were the most influential factors. Among ML algorithms, the LightGBM model was particularly useful for predicting END, as it revealed new and diverse predictors. Additionally, the effects of the features on the predictive power of the model were individualized using the SHAP method.
Objective
There is no scale for rating the severity of autoimmune encephalitis (AE). In this study, we aimed to develop a novel scale for rating severity in patients with diverse AE syndromes and to ...verify the reliability and validity of the developed scale.
Methods
The key items were generated by a panel of experts and selected according to content validity ratios. The developed scale was initially applied to 50 patients with AE (development cohort) to evaluate its acceptability, reproducibility, internal consistency, and construct validity. Then, the scale was applied to another independent cohort (validation cohort, n = 38).
Results
A new scale consisting of 9 items (seizure, memory dysfunction, psychiatric symptoms, consciousness, language problems, dyskinesia/dystonia, gait instability and ataxia, brainstem dysfunction, and weakness) was developed. Each item was assigned a value of up to 3 points. The total score could therefore range from 0 to 27. We named the scale the Clinical Assessment Scale in Autoimmune Encephalitis (CASE). The new scale showed excellent interobserver (intraclass correlation coefficient ICC = 0.97) and intraobserver (ICC = 0.96) reliability for total scores, was highly correlated with modified Rankin scale (r = 0.86, p < 0.001), and had acceptable internal consistency (Cronbach α = 0.88). Additionally, in the validation cohort, the scale showed high interobserver reliability (ICC = 0.99) and internal consistency (Cronbach α = 0.92).
Interpretation
CASE is a novel clinical scale for AE with a high level of clinimetric properties. It would be suitable for application in clinical practice and might help overcome the limitations of current outcome scales for AE. ANN NEUROL 2019;85:352–358.
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.
We introduce the design and implementation of a new array, the Korea Biobank Array (referred to as KoreanChip), optimized for the Korean population and demonstrate findings from GWAS of blood ...biochemical traits. KoreanChip comprised >833,000 markers including >247,000 rare-frequency or functional variants estimated from >2,500 sequencing data in Koreans. Of the 833 K markers, 208 K functional markers were directly genotyped. Particularly, >89 K markers were presented in East Asians. KoreanChip achieved higher imputation performance owing to the excellent genomic coverage of 95.38% for common and 73.65% for low-frequency variants. From GWAS (Genome-wide association study) using 6,949 individuals, 28 associations were successfully recapitulated. Moreover, 9 missense variants were newly identified, of which we identified new associations between a common population-specific missense variant, rs671 (p.Glu457Lys) of ALDH2, and two traits including aspartate aminotransferase (P = 5.20 × 10
) and alanine aminotransferase (P = 4.98 × 10
). Furthermore, two novel missense variants of GPT with rare frequency in East Asians but extreme rarity in other populations were associated with alanine aminotransferase (rs200088103; p.Arg133Trp, P = 2.02 × 10
and rs748547625; p.Arg143Cys, P = 1.41 × 10
). These variants were successfully replicated in 6,000 individuals (P = 5.30 × 10
and P = 1.24 × 10
). GWAS results suggest the promising utility of KoreanChip with a substantial number of damaging variants to identify new population-specific disease-associated rare/functional variants.
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
Summary
In the current digital era, portable low‐power electronics have become an essential part of our daily life, from communication to traveling, surveillance, health care, education, and industry ...automation. However, conventional batteries cannot meet the requirements, such as portability and sustainability, of these systems; thus, new sustainable energy sources have been identified for energy harvesting for low‐power electronics. Herein, we report a simple method to enhance the energy harvesting performance by combining two different conventional materials. Polydimethylsiloxane (PDMS) and polytetrafluoroethylene (PTFE) were mixed to fabricate a high‐performance liquid‐solid contact‐based energy harvesting film. We optimized the energy harvesting performance by optimizing crucial factors such as the film thickness, charge transfer, and contact area as a function of the mixing ratio of PDMS and PTFE. Moreover, the addition of PTFE particles to PDMS changes the surface characteristics of the film by increasing the surface roughness and charge transfer performance and enhances the mechanical stability of the film. The device shows an output voltage of 50 V under normal operation with a power density of 67.5 μW/cm2 across a 2 MΩ resistance, which can light up 20 LEDs and charge a 1‐μF capacitor up to 22.5 V in under 40 seconds. These results show that the hybrid film can generate high‐power output per area with conventional materials and can be used for energy harvesting for different electronic devices. Furthermore, this study will provide new insights to improve the performance of conventional materials for energy harvesting by optimizing their properties, such as thickness and surface morphology, by mixing different materials.
Herein, we report a simple method to enhance the energy harvesting performance by combining two different conventional materials. Polydimethylsiloxane (PDMS) and polytetrafluoroethylene (PTFE) were mixed to fabricate a high‐performance liquid‐solid contact‐based energy harvesting film. We optimized the energy harvesting performance by optimizing crucial factors such as the film thickness, charge transfer, and contact area as a function of the mixing ratio of PDMS and PTFE.
A considerable portion of autoimmune encephalitis (AE) does not respond to conventional immunotherapies and subsequently has poor outcomes. We aimed to determine the efficacy of tocilizumab, an ...anti-interleukin-6 antibody, in rituximab-refractory AE compared with other treatment options. From an institutional cohort of AE, 91 patients with inadequate clinical response to first-line immunotherapy and following rituximab were retrospectively reviewed. Patients were grouped according to their further immunotherapy strategies. Thirty (33.0 %) patients were included in the tocilizumab group, 31 (34.0 %) in the additional rituximab group, and 30 (33.0 %) in the observation group. Outcomes were defined as the favorable modified Rankin Scale scores (≤2) at 1 and 2 months from the initiation of each treatment strategy and at the last follow-up. Favorable clinical response (improvement of the modified Rankin Scale scores by ≥ 2 points or achievement of the mRS scores ≤ 2) at the last follow-up was also analyzed. The tocilizumab group showed more frequent favorable mRS scores at 2 months from treatment initiation and at the last follow-up compared with those at the relevant time points of the remaining groups. The majority (89.5 %) of the patients with clinical improvement at 1 month from tocilizumab treatment maintained a long-term favorable clinical response. No serious adverse effects of rituximab or tocilizumab were reported. Therefore, we suggest that tocilizumab might be a good treatment strategy for treating AE refractory to conventional immunotherapies and rituximab. The tocilizumab-mediated clinical improvement manifests as early at 1 month after treatment initiation.
Industrialization and urbanization lead to increased generation of wastewater causing serious environmental pollution and deterioration of water quality. Membrane-based water treatment represents a ...major technological approach to addressing global water scarcity and environmental pollution issues. However, there has been relatively little progress in membrane technologies for water treatment mainly due to the inherent limitations of membrane materials and membrane fabrication techniques. In recent years, biomimetic membranes, such as the aquaporin membrane, have emerged as strong candidates for membrane-based water purification technology. Biomimetic approaches have the potential to overcome the problems associated with existing membranes including limited permeability, low selectivity, and excessive energy consumption. But industrial-scale defect-free biomimetic membrane fabrication remains a major challenge. Key factors that must be addressed to overcome this challenge include protein stability, membrane housing materials, and the surface chemistry and structural characteristics of the substrate. This paper reviews the state-of-the-art of membrane-based water purification technologies, summarizing the role and limitations of conventional membrane materials while evaluating the latest progress in the field of biomimetic membrane fabrication. We conclude that a thorough understanding of the relationship between substrate structure-surface properties and membrane performance is necessary for the further development and commercialization of aquaporin biomimetic membranes.
•A broad thematic view of membrane technology for water purification is discussed.•The inherent problems associated with conventional membranes limit their function.•Conventional membranes technologies and the fundamental problems associated with them are discussed.•Aquaporin biomimetic membranes have been emerging as a potential “all-in-one” solution for overcoming current obstacles.•Practical challenges associated with the implementation of biomimetic membranes are discussed.
This study aimed to investigate the effectiveness and safety of intravenous infusion of tirofiban after emergent angioplasty with or without stenting in patients with intracranial atherosclerotic ...stenosis-related large-vessel occlusion stroke.
We performed a retrospective case series study of 98 patients who underwent thrombectomy followed by angioplasty with or without stenting to treat intracranial atherosclerotic stenosis-related large-vessel occlusion. Patients were divided into 2 groups: those who received continuous intravenous infusion of tirofiban for 12 hours after procedure (intravenous tirofiban group, n=30) and those who did not receive postprocedural intravenous tirofiban (control group, n=68). The following treatment outcomes in the 2 groups were compared: early reocclusion of treated arteries on computed tomography angiography, parenchymal hematoma, symptomatic hemorrhage, and 90-day functional outcome.
Early reocclusion occurred in 18 patients (18.4%). The rate of early reocclusion was significantly lower in the intravenous tirofiban group than in the control group (3.3% versus 25%, P<0.001). The rates of parenchymal hematoma, symptomatic hemorrhage, 90-day good outcome, and mortality were not significantly different between the 2 groups. In multivariate logistic analysis, the only independent predictor of early reocclusion was no use of intravenous tirofiban (odds ratio, 9.212 95% CI, 1.155-73.495, P=0.036). A good outcome (90-day modified Rankin Scale score of 0-2) was significantly less frequent in patients with early reocclusion than in those without it (16.7% versus 72.5%, P<0.001).
The use of intravenous tirofiban for 12 hours was associated with decreased risk of early reocclusion of treated arteries, with no increased risk of hemorrhage after emergent angioplasty, with or without stenting, in patients with intracranial atherosclerotic stenosis-related large-vessel occlusion stroke. Early reocclusion was associated with a poor outcome in such cases.
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