Histopathological analysis of retrieved thrombi from patients with acute ischemic stroke with malignant tumors

2021 ◽  
pp. neurintsurg-2020-017195
Author(s):  
Yuko Kataoka ◽  
Kazutaka Sonoda ◽  
Jun C Takahashi ◽  
Hatsue Ishibashi-Ueda ◽  
Kazunori Toyoda ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Malignant Tumors ◽  
Characteristic Curve ◽  
Cerebral Arteries ◽  
Treatment Strategies ◽  
Area Under The Curve ◽  
Histopathological Analysis ◽  
Thrombotic Risk ◽  
Patients With Cancer ◽  
Auc Value

BackgroundThe procoagulant state in cancer increases the thrombotic risk, and underlying cancer could affect treatment strategies and outcomes in patients with ischemic stroke. However, the histopathological characteristics of retrieved thrombi in patients with cancer have not been well studied. This study aimed to assess the histopathological difference between thrombi in patients with and without cancer.MethodsWe studied consecutive patients with acute major cerebral artery occlusion who were treated with endovascular therapy between October 2010 and December 2016 in our single-center registry. The retrieved thrombi were histopathologically investigated with hematoxylin and eosin and Masson’s trichrome staining. The organization and proportions of erythrocyte and fibrin/platelet components were studied using a lattice composed of 10×10 squares.ResultsOf the 180 patients studied, 17 (8 women, age 76.5±11.5 years) had cancer and 163 (69 women, age 74.1±11.2 years) did not. Those with cancer had a higher proportion of fibrin/platelets (56.6±27.4% vs 40.1±23.9%, p=0.008), a smaller proportion of erythrocytes (42.1±28.3% vs 57.5±25.1%, p=0.019), and higher serum D-dimer levels (5.9±8.2 vs 2.4±4.3 mg/dL, p=0.005) compared with the non-cancer cases. Receiver operating characteristic curve analysis showed the cut-off ratio of fibrin/platelet components related to cancer was 55.7% with a sensitivity of 74.8%, specificity 58.8% and area under the curve (AUC) value of 0.67 (95% CI 0.53 to 0.81), and the cut-off ratio of erythrocyte components was 44.7% with a sensitivity of 71.2%, specificity 58.9% and AUC value of 0.66 (95% CI 0.51 to 0.80).ConclusionsThromboemboli of major cerebral arteries in patients with cancer were mainly composed of fibrin/platelet-rich components.

External Validation and Test-Retest Reliability of Postpartum Bonding Questionnaire in Spanish Mothers

2021 ◽  
Vol 24 ◽  
Author(s):  
Anna Torres-Giménez ◽  
Alba Roca-Lecumberri ◽  
Bàrbara Sureda ◽  
Susana Andrés-Perpiña ◽  
Bruma Palacios-Hernández ◽  
...  
Keyword(s):  
Mental Health ◽  
Maternal Mental Health ◽  
Characteristic Curve ◽  
External Validation ◽  
Area Under The Curve ◽  
Retest Reliability ◽  
Outpatient Unit ◽  
Auc Value ◽  
Postpartum Bonding ◽  
Test Retest Reliability

Abstract The aim of the present study was to validate the Spanish Postpartum Bonding Questionnaire (PBQ) against external criteria of bonding disorder, as well as to establish its test-retest reliability. One hundred fifty-six postpartum women consecutively recruited from a perinatal mental health outpatient unit completed the PBQ at 4–6 weeks postpartum. Four weeks later, all mothers completed again the PBQ and were interviewed using the Birmingham Interview for Maternal Mental Health to establish the presence of a bonding disorder. Receiver operating characteristic curve analysis revealed an area under the curve (AUC) value for the PBQ total score of 0.93, 95% CI [0.88, 0.98], with the optimal cut-off of 13 for detecting bonding disorders (sensitivity: 92%, specificity: 87%). Optimal cut-off scores for each scale were also obtained. The test-retest reliability coefficients were moderate to good. Our data confirm the validity of PBQ for detecting bonding disorders in Spanish population.

Optimal thresholds for ischemic penumbra predicted by computed tomography perfusion in patients with acute ischemic stroke treated with mechanical thrombectomy

2017 ◽  
Vol 10 (3) ◽  
pp. 279-284 ◽  
Author(s):  
Katsuharu Kameda ◽  
Junji Uno ◽  
Ryosuke Otsuji ◽  
Nice Ren ◽  
Shintaro Nagaoka ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Cerebral Blood Volume ◽  
Mechanical Thrombectomy ◽  
Ct Perfusion ◽  
Characteristic Curve ◽  
Mean Transit Time ◽  
Area Under The Curve ◽  
Ischemic Penumbra ◽  
Optimal Thresholds

Background and purposeOptimal thresholds for ischemic penumbra detected by CT perfusion (CTP) in patients with acute ischemic stroke (AIS) have not been elucidated. In this study we investigated optimal thresholds for salvageable ischemic penumbra and the risk of hemorrhagic transformation (HT).MethodsA total of 156 consecutive patients with AIS treated with mechanical thrombectomy (MT) at our hospital were enrolled. Absolute (a) and relative (r) CTP parameters including cerebral blood flow (aCBF and rCBF), cerebral blood volume (aCBV and rCBV), and mean transit time (aMTT and rMTT) were evaluated for their value in detecting ischemic penumbra in each of seven arbitrary regions of interest defined by the major supplying blood vessel. Optimal thresholds were calculated by performing receiver operating characteristic curve analysis in 47 patients who achieved Thrombolysis In Cerebral Infarction (TICI) grade 3 recanalization. The risk of HT after MT was evaluated in 101 patients who achieved TICI grade 2b–3 recanalization.ResultsAbsolute CTP parameters for distinguishing ischemic penumbra from ischemic core were as follows: aCBF, 27.8 mL/100 g/min (area under the curve 0.82); aCBV, 2.1 mL/100 g (0.75); and aMTT, 7.30 s (0.70). Relative CTP parameters were as follows: rCBF, 0.62 (0.81); rCBV, 0.83 (0.87); and rMTT, 1.61 (0.73). CBF was significantly lower in areas of HT than in areas of infarction (aCBF, p<0.01; rCBF, p<0.001).ConclusionsCTP may be able to predict treatable ischemic penumbra and the risk of HT after MT in patients with AIS.

Computer-aided classification of MRI for pathological complete response to neoadjuvant chemotherapy in breast cancer

2021 ◽  
Author(s):  
Shaolei Yan ◽  
Haiyong Peng ◽  
Qiujie Yu ◽  
Xiaodan Chen ◽  
Yue Liu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Pathological Complete Response ◽  
Characteristic Curve ◽  
Area Under The Curve ◽  
Complete Response ◽  
Automated Classification ◽  
General Applicability ◽  
Computer Aided ◽  
Auc Value

Background: To determine suitable optimal classifiers and examine the general applicability of computer-aided classification to compare the differences between a computer-aided system and radiologists in predicting pathological complete response (pCR) from patients with breast cancer receiving neoadjuvant chemotherapy. Methods: We analyzed a total of 455 masses and used the U-Net network and ResNet to execute MRI segmentation and pCR classification. The diagnostic performance of radiologists, the computer-aided system and a combination of radiologists and computer-aided system were compared using receiver operating characteristic curve analysis. Results: The combination of radiologists and computer-aided system had the best performance for predicting pCR with an area under the curve (AUC) value of 0.899, significantly higher than that of radiologists alone (AUC: 0.700) and computer-aided system alone (AUC: 0.835). Conclusion: An automated classification system is feasible to predict the pCR to neoadjuvant chemotherapy in patients with breast cancer and can complement MRI.

scholarly journals The Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios Predict Reperfusion and Prognosis after Endovascular Treatment of Acute Ischemic Stroke

2021 ◽  
Vol 11 (8) ◽  
pp. 696
Author(s):  
Sang-Hwa Lee ◽  
Min Uk Jang ◽  
Yerim Kim ◽  
So Young Park ◽  
Chulho Kim ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Characteristic Curve ◽  
Area Under The Curve ◽  
Predictive Ability ◽  
Primary Outcome Measure ◽  
Lymphocyte Ratio ◽  
Prognostic Effect ◽  
Reperfusion Rate

Background: Studies assessing the prognostic effect of inflammatory markers of blood cells on the outcomes of patients with acute ischemic stroke treated with endovascular treatment (EVT) are sparse. We evaluated whether the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) affect reperfusion status in patients receiving EVT. Methods: Using a multicenter registry database, 282 patients treated with EVT were enrolled in this study. The primary outcome measure was unsuccessful reperfusion rate after EVT defined by thrombolysis in cerebral infarction grades 0–2a. Logistic regression analysis was performed to analyze the association between NLR/PLR and unsuccessful reperfusion rate after EVT. Results: Both NLR and PLR were higher in the unsuccessful reperfusion group than in the successful reperfusion group (p < 0.001). Multivariate analysis showed that both NLR and PLR were significantly associated with unsuccessful reperfusion (adjusted odds ratio (95% confidence interval): 1.11 (1.04–1.19), PLR: 1.004 (1.001–1.01)). The receiver operating characteristic curve showed that the predictive ability of both NLR and PLR was close to good (area under the curve (AUC) of NLR: 0.63, 95% CI (0.54–0.72), p < 0.001; AUC of PLR: 0.65, 95% CI (0.57–0.73), p < 0.001). The cutoff values of NLR and PLR were 6.2 and 103.6 for unsuccessful reperfusion, respectively. Conclusion: Higher NLR and PLR were associated with unsuccessful reperfusion after EVT. The combined application of both biomarkers could be useful for predicting outcomes after EVT.

scholarly journals A novel clinical nomogram for predicting 3-month unfavorable outcomes of stroke patients treated with mechanical thrombectomy

2021 ◽  
Author(s):  
Xiao-Guang Zhang ◽  
Jia-Hui Wang ◽  
Wen-Hao Yang ◽  
Xiao-Qiong Zhu ◽  
Jie Xue ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Characteristic Curve ◽  
Treatment Strategies ◽  
Stroke Patients ◽  
Bridging Therapy ◽  
Vessel Occlusion ◽  
Discriminative Performance ◽  
Preoperative Creatinine

Abstract Background: Mechanical thrombectomy (MT) is an effective treatment for large-vessel occlusion in acute ischemic stroke, however, only some revascularized patients have a good prognosis. For stroke patients undergoing MT, predicting the risk of unfavorable outcomes and adjusting the treatment strategies accordingly can greatly improve prognosis. Therefore, we aimed to develop and validate a nomogram that can predict 3-month unfavorable outcomes for individual stroke patient treated with MT. Methods: We analyzed 238 patients with acute ischemic stroke who underwent MT from January 2018 to October 2020. The primary outcome was a 3-month unfavorable outcome, assessed using the modified Rankin Scale (mRS), 3-6. A nomogram was generated based on a multivariable logistic model. We used the area under the receiver-operating characteristic curve to evaluate the discriminative performance and used the calibration curve and Spiegelhalter’s Z-test to assess the calibration performance of the risk prediction model. Results: After multivariable logistic regression, six variables (gender, bridging therapy, postoperative mTICI, stroke-associated pneumonia, preoperative creatinine and Na) remained independent predictors of 3-month unfavorable outcomes in stroke patients treated with MT, thus forming a nomogram. The area under the nomogram curve was 0.848 with good calibration performance (P = 0.946 for the Spiegelhalter’s Z-test). Conclusions: A novel nomogram consisting of gender, bridging therapy, postoperative mTICI, stroke-associated pneumonia, preoperative creatinine and Na can predict the 3-month unfavorable outcomes in stroke patients treated with MT.

scholarly journals Serum anti-AP3D1 antibodies are risk factors for acute ischemic stroke related with atherosclerosis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Shu-Yang Li ◽  
Yoichi Yoshida ◽  
Eiichi Kobayashi ◽  
Masaaki Kubota ◽  
Tomoo Matsutani ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Characteristic Curve ◽  
Serum Antibody ◽  
Area Under The Curve ◽  
Intima Media Thickness ◽  
Expression Cloning ◽  
Ischemic Attack ◽  
Antibody Levels

AbstractAtherosclerosis has been considered as the main cause of morbidity, mortality, and disability worldwide. The first screening for antigen markers was conducted using the serological identification of antigens by recombinant cDNA expression cloning, which has identified adaptor-related protein complex 3 subunit delta 1 (AP3D1) as an antigen recognized by serum IgG antibodies of patients with atherosclerosis. Serum antibody levels were examined using the amplified luminescent proximity homogeneous assay-linked immunosorbent assay (AlphaLISA) using a recombinant protein as an antigen. It was determined that the serum antibody levels against AP3D1 were higher in patients with acute ischemic stroke (AIS), transient ischemic attack, diabetes mellitus (DM), cardiovascular disease, chronic kidney disease (CKD), esophageal squamous cell carcinoma (ESCC), and colorectal carcinoma than those in the healthy donors. The area under the curve values of DM, nephrosclerosis type of CKD, and ESCC calculated using receiver operating characteristic curve analysis were higher than those of other diseases. Correlation analysis showed that the anti-AP3D1 antibody levels were highly associated with maximum intima-media thickness, which indicates that this marker reflected the development of atherosclerosis. The results of the Japan Public Health Center-based Prospective Study indicated that this antibody marker is deemed useful as risk factors for AIS.

Automated DWI analysis can identify patients within the thrombolysis time window of 4.5 hours

Neurology ◽  
2018 ◽  
Vol 90 (18) ◽  
pp. e1570-e1577 ◽  
Author(s):  
Anke Wouters ◽  
Bastian Cheng ◽  
Soren Christensen ◽  
Patrick Dupont ◽  
David Robben ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Confidence Interval ◽  
Signal Intensity ◽  
Time Window ◽  
Characteristic Curve ◽  
Area Under The Curve ◽  
Automated Analysis ◽  
Stroke Onset ◽  
Derivation Cohort ◽  
Independent Cohort

ObjectiveTo develop an automated model based on diffusion-weighted imaging (DWI) to detect patients within 4.5 hours after stroke onset and compare this method to the visual DWI-FLAIR (fluid-attenuated inversion recovery) mismatch.MethodsWe performed a subanalysis of the “DWI-FLAIR mismatch for the identification of patients with acute ischemic stroke within 4.5 hours of symptom onset” (PRE-FLAIR) and the “AX200 for ischemic stroke” (AXIS 2) trials. We developed a prediction model with data from the PRE-FLAIR study by backward logistic regression with the 4.5-hour time window as dependent variable and the following explanatory variables: age and median relative DWI (rDWI) signal intensity, interquartile range (IQR) rDWI signal intensity, and volume of the core. We obtained the accuracy of the model to predict the 4.5-hour time window and validated our findings in an independent cohort from the AXIS 2 trial. We compared the receiver operating characteristic curve to the visual DWI-FLAIR mismatch.ResultsIn the derivation cohort of 118 patients, we retained the IQR rDWI as explanatory variable. A threshold of 0.39 was most optimal in selecting patients within 4.5 hours after stroke onset resulting in a sensitivity of 76% and specificity of 63%. The accuracy was validated in an independent cohort of 200 patients. The predictive value of the area under the curve of 0.72 (95% confidence interval 0.64–0.80) was similar to the visual DWI-FLAIR mismatch (area under the curve = 0.65; 95% confidence interval 0.58–0.72; p for difference = 0.18).ConclusionsAn automated analysis of DWI performs at least as good as the visual DWI-FLAIR mismatch in selecting patients within the 4.5-hour time window.

scholarly journals Score for Predicting Active Cancer in Patients with Ischemic Stroke: A Retrospective Study

2020 ◽  
Author(s):  
Jiwei Jiang ◽  
Jirui Wang ◽  
Meihui Cao ◽  
Jinming Zhao ◽  
Xiuli Shang
Keyword(s):  
Ischemic Stroke ◽  
Retrospective Study ◽  
Clinical Laboratory ◽  
Characteristic Curve ◽  
Elevated Serum ◽  
Area Under The Curve ◽  
Clinical Score ◽  
History Of ◽  
D Dimer ◽  
Active Cancer

Abstract Background: We aimed to examine the differences between the clinical characteristics of patients with ischemic stroke and active cancer and those without cancer and develop a clinical score for predicting occult cancer in patients with ischemic stroke.Methods: This retrospective study enrolled consecutive adult patients with acute ischemic stroke, who were admitted to our department between December 2017 and January 2019. The demographic, clinical, laboratory, and neuroimaging characteristics of patients with ischemic stroke with active cancer and those without cancer were compared. Multivariate analysis was performed to identify independent factors associated with active cancer. Subsequently, a predictive cancer-risk score was developed using the area under the receiver operating characteristic curve.Results: Fifty-three (6.63%) of 799 patients with ischemic stroke had active cancer. The absence of a history of hyperlipidemia [odds ratio (OR)=0.17, 95% confidence interval (CI): 0.06–0.48, P<0.01], elevated serum fibrinogen (OR=1.72, 95% CI: 1.33–2.22, P<0.01) and D-dimer levels (OR=1.43, 95% CI: 1.24–1.64, P<0.01), and stroke of undetermined etiology (OR=22.87, 95% CI: 9.91–52.78, P<0.01) were independently associated with active cancer. Thus, a score based on the absence of hyperlipidemia and serum fibrinogen ≥4.00 g/L and D-dimer ≥2.00 μg/mL predicted active cancer with an area under the curve of 0.83 (95% CI: 0.77–0.89, P<0.01). The probability of active cancer was 59% at a supposed prevalence of 6.63%, if all three independent factors were present in a patient with ischemic stroke.Conclusions: We devised a score to predict active cancer in patients with ischemic stroke based on the absence of a history of hyperlipidemia and elevated serum D-dimer and fibrinogen that highlights the importance of hypercoagulability in these patients and may help determine early intervention and management.

Abstract TP13: External Validation of Stroke Prognostication Scales - A Retrospective Cohort Study

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Nauman Jahangir ◽  
Nicholas Lanzotti ◽  
Kyle Gollon ◽  
Mehwish Farooqi ◽  
Michael Buhnerkempe ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Characteristic Curve ◽  
External Validation ◽  
Area Under The Curve ◽  
Predictive Ability ◽  
Scoring Systems ◽  
Predictive Performance ◽  
Discriminatory Ability ◽  
Single Center Study

Introduction: In recent years, many scoring models have been proposed to predict clinical outcomes after acute ischemic stroke. Aim of our study was to perform a comparative analysis of these scoring systems to assess predictive reliability. Method: This retrospective single center study included 166 community-based patients presenting with an acute ischemic stroke between 2015 and 2018 who had undergone mechanical thrombectomy with or without IV r-tPA administration prior to the procedure. Patients with unknown 90 day Modified Ranking Scale (mRS) were excluded from the study. We included SPAN-100, THRIVE, HIAT2, iScore , TPI, DRAGON, ASTRAL and HAT predictive models to our study. To predict MRS at 90 days, we first dichotomize mRS into two groups: scores of 0 and 1 and scores 2 and above. We then used logistic regression to find the association between a stroke score and the probability of having a 90-day mRS of 2 or above. Separate univariate logistic regressions were fit for each stroke score. We assessed the ability of each stroke score to predict 90-day mRS using the area-under-the-curve (AUC) of the receiver operating characteristic curve (ROC - plot of sensitivity against 1-specificity). AUC values range from 0.5 to 1 with values above 0.7 showing good discriminatory ability. Results: SPAN-100, HIAT2, iScore, and ASTRAL scores have similar predictive ability with AUC values over 0.7 (Table 1). The ASTRAL score had the highest predictive ability with a score above 31.5 indicating a high likelihood of a 90-day MRS ≥ 2 (Table 1). The TPI, DRAGON, and HAT scores all had AUCs below 0.65 indicating poor predictive performance in our data. Conclusion: The SPAN-100, HIAT2, iScore, and ASTRAL scores reliably predicts 90-day mRS of 2 or greater in patients with acute ischemic stroke.

scholarly journals 5’UTR Variant rs6017916 Regulates SRC Expression and Contributes to the Susceptibility to Ischemic Stroke in the Chinese Han Population

2021 ◽  
Author(s):  
Jialei Yang ◽  
Xiaoxiao Song ◽  
Yibing Yang ◽  
Yan Yan ◽  
Baoyun Liang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Mrna Expression ◽  
Genetic Association ◽  
Quantitative Polymerase Chain Reaction ◽  
Characteristic Curve ◽  
Area Under The Curve ◽  
Luciferase Reporter ◽  
Reporter System ◽  
Chinese Han ◽  
Luciferase Reporter System

Abstract Previous studies reported that the SRC protein was involved in a variety of pathological mechanisms related to ischemic stroke (IS). In this study, we conducted a genetic association study between rs6017916 within the 5’UTR region of SRC gene and IS susceptibility. A total of 533 IS patients and 531 healthy controls were recruited to participate in the current study. The sequenom MassARRAY technology platform was used for genotyping. The quantitative polymerase chain reaction (qPCR) was conducted to detect SRC mRNA expression. The dual luciferase reporter system was used to verify the regulation of rs6017916 on SRC mRNA expression. Results showed that SRC mRNA expression was significantly increased in IS patients than that in controls (P<0.001). Receiver operating characteristic curve (ROC) analysis demonstrated that the signature of SRC mRNA expression differentiated between controls and IS patients with an area under the curve (AUC) of 0.935 corresponding to a specificity of 0.820 and sensitivity of 0.920. Genetic association analysis showed that rs6017916 was significantly associated with IS susceptibility under multiple genetic models, including additive [OR (95% CI)=0.76 (0.60,0.96), Padj=0.019] and dominant [OR (95% CI)=0.75(0.58,0.98), Padj=0.031]. In addition, the dual luciferase reporter system showed that the minor allele C of rs6017916 inhibited luciferase activity compared with the major allele A. In summary, we report that SRC mRNA expression was significantly increased in IS patients and was a potential diagnostic biomarker. Moreover, the 5’UTR variant rs6017916 of SRC was significantly associated with IS susceptibility. And rs6017916 might affect the pathological process of IS by regulating SRC expression.

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