Abstract T P98: Effect of Atrial Fibrillation and/or Large Artery Atherosclerosis on Stroke Recurrence and Long-term Outcome in Japanese Minor Stroke ~Fukuoka Strok Registry~

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Shigeru Fujimoto ◽  
Masato Ohsaki ◽  
Masaya Kumamoto ◽  
Takao Ishitsuka ◽  
Takanari Kitazono
Keyword(s):  
Scale Score ◽  
Minor Stroke ◽  
Stroke Recurrence ◽  
Large Artery ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Good Outcome ◽  
Group A ◽  
Group D

Background & Purpose: Atrial fibrillation (AF) and large artery atherosclerosis (LAA) can be associated with a bad outcome even in minor stroke. We investigated stroke recurrence and outcome in Japanese minor stroke patients with AF and/or LAA. Subjects & Methods: Among the consecutive 6246 stroke patients who were admitted to the 7 stroke centers within 7 days after the onset, 3725 patients with acute ischemic stroke with the initial NIH stroke scale score of 7 or less and prior modified Rankin scale (mRS) of 0 or 1 were included in the present study. In accordance with AF and intracranial or extracranial LAA (stenosis of 50% or more in diameter), they were classified into 4 subgroups: patients without both AF and LAA (Group A, n=2154), patients with only AF (Group B, n=475), patients with only LAA (Group C, n=937), and patients with both AF and LAA (Group D, n=159). We observed stroke recurrence and outcome during one year. Results: On the multivariate analysis, age (OR, 0.94; 95%CI 0.93~0.95), initial NIH stroke scale score (OR, 0.70; 95%CI, 0.67~0.74), chronic kidney disease (OR, 0.72; 95%CI, 0.55~0.95), initial HbA1c value (OR 0.87, 95%CI 0.79~0.95), and LAA (OR 0.70, 95%CI 0.55~0.88) had a negative association with a good outcome. Acute stroke recurrences within 3 weeks after the onset were observed in 2.0%, 2.5%, 6.1%, and 9.4% in Group A-D patients respectively (p<0.0001). Stroke recurrences during 1 year were observed 7.0%, 10.7%, 11.6%, and 13.8% in Group A-D patients respectively (p<0.0001). A good outcome (mRS of 0-1) 1 year after the onset was observed in 77.0%, 6.4%, 67.9%, and 65.8% in Group A-D patients respectively (p<0.0001). With regard to the Kaplan-Meier method, there was a significant difference in stroke recurrence among the 4 subgroups, and stroke recurrences were most frequent in Group D (p<0.0001, Log-rank test). Conclusions: In Japanese minor stroke, age, NIH stroke scale score, chronic kidney disease, HbA1c, and LAA were significant predictors for the long-term outcome. In patients with both AF and LAA, stroke recurrences were most frequent, especially in the acute phase, and a long-term good outcome was least frequent consequently.

Abstract TP448: High Residual Platelet Reactivity (hrpr) for Adenosine Diphosphate (adp) Stimuli is a Determinant Factor for Long-term Outcomes in Acute Ischemic Stroke With Anti-platelet Agents

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Jae-Kwan Cha ◽  
Eun-Kyu Kim
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Primary Endpoint ◽  
Platelet Reactivity ◽  
Large Artery ◽  
Vascular Events ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Platelet Aggregometry

Background and Purpose: High residual platelet activation (HRPA) after ADP stimuli has associated with recurrent vascular events in acute atherothrombosis with the use of antiplatelet agents (APAs). However, there has been little evidence supporting this association in acute ischemic stroke (AIS). In this study, we evaluated the influences of HRPR after ADP stimuli on the 1-year incidence of recurrent cardiovascular events and mortality in AIS with APAs. Methods: We conducted an observational, referral center cohort study on 968 AIS patients with APAs from January 2010 to December 2013 who were evaluated using optical platelet aggregometry (OPA). All patients received the dual APA combination of aspirin and clopidogrel or aspirin alone. We evaluated their platelet function 5 days after hospital admission using OPA. HRPR after ADP stimuli was defined as platelet aggregation of 70% or greater according to OPA after 10 μM ADP stimuli. Results: The primary endpoint was a composite of all causes of death, myocardial infarction, and stroke at the 1-year follow-up. The secondary endpoints were each component of the primary endpoint. The event rate of primary endpoint was 11.3% (109/968). Its rate was significantly higher in the patients with HRPR (16.7%) than in those without (9.7%). HPRP was independently associated with the primary endpoint (OR=1.97, CI 1.22 to 3.18, p<0.01). According to the AIS subtype, the presence of HRPR was independently significant for the occurrence of the primary endpoint in the large artery atherosclerosis (LAA) subtype only (OR=2.26, CI 1.15 to 4.45, P=0.02). Conclusions: In this study, the presence of HRPR after ADP stimuli is associated with a poor long-term outcome after acute ischemic stroke. In particular, the influence of this factor might be more prominent in LAA compared with other types of AIS.

scholarly journals Polymorphism of the complement 5 gene is associated with large artery atherosclerosis stroke in Chinese patients

2016 ◽  
Vol 74 (11) ◽  
pp. 881-886 ◽  
Author(s):  
Hui Wu ◽  
Yingfeng Weng ◽  
Lan Zheng ◽  
Huanyin Li ◽  
Qi Gong ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Chinese Patients ◽  
Large Artery ◽  
Nucleotide Polymorphism ◽  
Term Outcome ◽  
Single Nucleotide ◽  
Long Term Outcome ◽  
Risk Predictors ◽  
The Complement System

ABSTRACT The complement system has been confirmed to play an increasingly important role in ischemic stroke (IS). This study aimed to determine whether the single-nucleotide polymorphism of the complement 5 (C5) gene independently influences the occurrence, severity, and long-term outcome of IS in Chinese patients. Methods C5 rs17611 genetic variants were investigated in 494 IS patients and 330 control individuals .Ischemic stroke was classified into subtypes and patients were assessed 90 days post-stroke with the modified Rankin Scale to determine stroke outcome. Results The presence of C5 polymorphism was associated with the incidence of large artery atherosclerosis (LAA)-subtype IS (n =2 00; p = 0.031), which even persisted after adjustment for covariates (OR = 1.518; 95%CI = 1.093–2.018; p = 0.013). However, no association was found between genotypes and the severity and outcome of stroke (p = 0.978; p = 0.296). Conclusions The C5 polymorphism might contribute to the risk of LAA-subtype IS independently of other known risk predictors.

Long-term outcome in neuroZika

Neurology ◽  
2019 ◽  
Vol 92 (21) ◽  
pp. e2406-e2420 ◽  
Author(s):  
Annie Lannuzel ◽  
Jean-Louis Fergé ◽  
Quentin Lobjois ◽  
Aissatou Signate ◽  
Benoit Rozé ◽  
...  
Keyword(s):  
Scale Score ◽  
Cranial Nerve ◽  
Biological Fluid ◽  
Modified Rankin Scale ◽  
Neurologic Manifestations ◽  
Full Spectrum ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Cranial Nerve Palsies

ObjectiveTo characterize the full spectrum, relative frequency, and prognosis of the neurologic manifestations in Zika virus (ZIKV) postnatal infection.MethodsWe conducted an observational study in consecutive ZIKV-infected patients presenting with neurologic manifestations during the French West Indies 2016 outbreak.ResultsEighty-seven patients, including 6 children, were enrolled. Ninety-five percent of all cases required hospitalization. Guillain-Barré syndrome was the most frequent manifestation (46.0%) followed by encephalitis or encephalomyelitis (20.7%), isolated single or multiple cranial nerve palsies (9.2%), other peripheral manifestations (6.9%), and stroke (1.1%). Fourteen patients (16.1%), including one child, developed a mixed disorder involving both the central and peripheral nervous system. Mechanical ventilation was required in 21 cases, all of whom had ZIKV RNA in at least one biological fluid. Two adult patients died due to neuroZika. Clinical follow-up (median 14 months; interquartile range, 13–17 months) was available for 76 patients. Residual disability (modified Rankin Scale score ≥2) was identified in 19 (25.0%) patients; in 6 cases (7.9%), disability was severe (modified Rankin Scale score ≥4). Among patients with ZIKV RNA detected in one biological fluid, the risk of residual disability or death was higher (odds ratio 9.19; confidence interval 1.12–75.22; p = 0.039).ConclusionsNeuroZika spectrum represents a heterogeneous group of clinical neurologic manifestations. During an outbreak, clinicians should consider neuroZika in patients presenting with cranial nerve palsies and a mixed neurologic disorder. Long-term sequelae are frequent in NeuroZika. ZIKV reverse-transcription PCR status at admission can inform prognosis and should therefore be taken into consideration in the management of hospitalized patients.

Comparison of the long-term outcome of cemented Charnley low-friction arthroplasty with hybrid arthroplasty in patients with congenital hip disease

2019 ◽  
Vol 101-B (9) ◽  
pp. 1050-1057
Author(s):  
Kalliopi Lampropoulou-Adamidou ◽  
George Hartofilakidis
Keyword(s):  
Operating Time ◽  
Long Term Results ◽  
Low Friction ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Significant Difference ◽  
Hip Disease ◽  
Group A ◽  
Group B

Aims To our knowledge, no study has compared the long-term results of cemented and hybrid total hip arthroplasty (THA) in patients with osteoarthritis (OA) secondary to congenital hip disease (CHD). This is a demanding procedure that may require special techniques and implants. Our aim was to compare the long-term outcome of cemented low-friction arthroplasty (LFA) and hybrid THA performed by one surgeon. Patients and Methods Between January 1989 and December 1997, 58 hips (44 patients; one man, 43 woman; mean age 56.6 years (25 to 77)) with OA secondary to CHD were treated with a cemented Charnley LFA (group A), and 55 hips (39 patients; two men, 37 women; mean age 49.1 years (27 to 70)) were treated with a hybrid THA (group B), by the senior author (GH). The clinical outcome and survivorship were compared. Results At all timepoints, group A hips had slightly better survivorship than those in group B without a statistically significant difference, except for the 24-year survival of acetabular components with revision for aseptic loosening as the endpoint, which was slightly worse. The survivorship was only significantly better in group A compared with group B when considering reoperation for any indication as the endpoint, 15 years postoperatively (74% vs 52%, p = 0.018). Conclusion We concluded that there was not a substantial difference at almost any time in the outcome of cemented Charnley LFAs compared with hybrid THAs when treating patients with OA of the hip secondary to CHD. We believe, however, that after improvements in the design of components used in hybrid THA, this could be the method of choice, as it is technically easier with a shorter operating time. Cite this article: Bone Joint J 2019;101-B:1050–1057.

Long-Term Outcome Of Acute Promyelocytic Leukemia (APL) With Lower Initial Leukocyte Counts By Using All-Trans Retinoic Acid (ATRA) Alone For Remission Induction Therapy: Japan Adult Leukemia Study Group (JALSG) APL97 Study

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 3950-3950 ◽  
Author(s):  
Takaaki Ono ◽  
Akihiro Takeshita ◽  
Katsuji Shinagawa ◽  
Yuji Kishimoto ◽  
Hitoshi Kiyoi ◽  
...  
Keyword(s):  
Induction Therapy ◽  
Research Funding ◽  
Low Risk ◽  
Late Relapse ◽  
Remission Induction ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Group A ◽  
Leukocyte Counts

Abstract Background ATRA and anthracycline-based chemotherapy is a standard remission induction therapy for APL, leading to complete remission (CR) rate of 90% or more. (Asou et al, 2007; Ades et al, 2010; Avvisati et al, 2011). As reported in many APL studies including the JALSG study, risk adopted strategy according to initial leukocyte counts has demonstrated successful results. However, the long-term outcome of the patients with initial leukocyte counts < 3,000/µl received ATRA alone in the induction therapy and followed by post remission chemotherapies, remains to be elucidated. Furthermore, it is controversial whether concomitant chemotherapy is needed for such a very low risk group. In the JALSG-APL97 study, patients with initial leukocyte counts < 3,000/µl received ATRA alone until remission (Group AA), except for patients with leukocytosis during the ATRA therapy who received additional chemotherapy (Group AD). Here, we reported the long-term outcome of this study based on risk adopted therapy, particularly, focusing on the outcome of the very low risk group. Methods The treatment schedule of JALSG-APL97 study was initially reported by Asou et al. in 2007. In brief, patient groups were defined as: leukocytes < 3000/µl (Group A: ATRA alone), 3000/µl ≤ leukocytes < 10,000/µl (Group B: ATRA plus IDA/Ara-C: 2+5), and leukocytes ≥ 10,000/µl (Group C: ATRA plus IDA/Ara-C: 3+5). Patients who experienced leukocytosis received additional chemotherapy (Group D). After 3 courses of consolidation chemotherapy, patients achieved molecular CR were allocated to an intensive chemotherapy group or observation. The CR rate, overall survival (OS), event-free survival (EFS), and cumulative incidence of relapse (CIR) were analyzed for each group. Results Two hundred and seventy-one newly diagnosed APL patients, ranging from 15 to 70 years of age, were evaluable. The number of patients in each group was 150 (A), 69 (B), 52 (C) and 70 (D), respectively. Of 150 patients in Group A, 83 achieved CR with ATRA alone (AA), and 67 were added chemotherapy due to leukocytosis during ATRA therapy (AD). In Group A, B, C and D, CR rates were 95.2%, 97.0%, 90.4% and 97.1%, respectively (P = 0.30); OS (Figure 1) 90.1%, 77.3%, 73.1% and 71.4%, respectively (P = 0.02); EFS (Figure 2) 71.1%, 63.6%, 55.7% and 64.3%, respectively (P = 0.26); CIR 23.5%, 27.6%, 34.5% and 20.4% (P = 0.51), respectively. Initial leukocyte counts in Group AA were significantly lower compared to those in Group AD (median leukocyte counts; 900/µl vs. 1,100/µl, P = 0.03). The median administration period of ATRA was similar between Group AA and AD (46 days vs. 43 days, P = 0.57). Differentiation syndrome was more frequent in Group AA (28.0% vs. 14.9%, P = 0.04). The CR rate and early death rate were not different between two groups (95.2% vs. 95.5%, P = 0.92 and 3.6% vs. 4.5%, P = 0.79, respectively). OS was significantly inferior (90.1% vs. 73.1%, P = 0.005) and non-relapse mortality after post-remission therapy was significantly higher in Group AD (5% vs. 16%, P = 0.04), compared to Group AA, while EFS was not different between two groups (71.1% vs. 65.7%, P = 0.33). The cumulative incidence of late relapse occurred more than 2 years after CR was significantly higher in Group AA compared to Group AD (17.5% vs. 3.9%, P = 0.04). Conclusions Risk adopted therapy according to initial leukocyte counts is totally useful in this study as well as previous reports including us. OS was favorable in APL patients with initial leukocyte counts < 3,000/µl, achieved CR by using ATRA alone for remission induction therapy, whereas EFS in this group was still unsatisfactory in the long-term follow up. It could be explained by the high frequency of late relapse. Ades et al reported better long-term outcomes in patients concomitantly treated with ATRA and chemotherapy rather than in those treated with ATRA followed by chemotherapy in their APL patients with initial leukocyte counts < 5000/µL. However, very low risk patients (Group AA) could be put into the separate category, and therapeutic approaches to reduce the late relapse in this group should be discussed. Additionally, the genetic profile studies will provide us informative data in relation to initial leukocyte counts and leukocytosis during ATRA therapy. Disclosures: Kiyoi: Bristol-Myers Squibb: Research Funding; Chugai Pharmaceutical Co., Ltd.: Research Funding; Novartis Pharma: Research Funding; Kyowa Hakko Kirin Co. Ltd.: Research Funding.

No Evidence That PTEN Abnormalities Impact on Outcome in Pediatric Patients with T-Cell Acute Lymphoblastic Leukemia (T-ALL) Treated on the MRC UKALL2003 Trial

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 1077-1077
Author(s):  
Sarah Jenkinson ◽  
Amy A Kirkwood ◽  
Nicholas Goulden ◽  
Ajay J. Vora ◽  
Chris Mitchell ◽  
...  
Keyword(s):  
Induction Therapy ◽  
Pediatric Patients ◽  
Response To Therapy ◽  
Heteroduplex Analysis ◽  
Pten Gene ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Good Outcome ◽  
Significant Difference

Abstract Although outcome has improved for pediatric patients with T-ALL, ≈25% of cases relapse and prognosis post-relapse remains poor. Molecular characterisation at diagnosis can provide additional information for risk-stratification. We previously reported that patients with double NOTCH1 or NOTCH1+FBXW7 mutations (NOTCH1±FBXW7Double) have a very good outcome and should not be considered for more intensive therapy in first remission, even if slow responders or MRD-positive after induction therapy. However, recent studies have suggested that this may be modulated by the presence of coincident abnormalities such as in the PTEN gene. Truncating mutations and genomic loss of this gene have been described in T-ALL, but their prognostic impact in patients is unclear, with reports of either no effect or reduced event-free survival (EFS). Furthermore, subgroup analysis has shown that the adverse impact of a PTEN mutation is either not seen in the presence of a NOTCH1 mutation or, conversely, that it ablates the benefit of a NOTCH1 mutation. In order to determine whether these abnormalities impact on the good outcome seen in NOTCH1±FBXW7Double cases in our cohort, and whether they can refine stratification of cases with single NOTCH1 mutations (NOTCH1Single) or wild-type NOTCH1 (NOTCH1WT), we investigated PTEN genotype in samples from 145 patients treated on the MRC UKALL2003 trial and correlated this with outcome in the different subgroups. The entire coding region (exons 1-9) of the PTEN gene was screened for mutations using heteroduplex analysis. Samples with abnormal chromatograms were further investigated. Mutations were detected in 21 patients (14%); 17 (81%) had exon 7 mutations, 2 exon 6+7, and 2 exon 5 mutations. All were small insertions, deletions or indels; 89% were predicted to lead to C-terminal truncation and loss of protein function, 11% were in-frame size changes. Exon 7 mutant levels were quantified by size analysis in 19 patients; median total mutant level was 48% of all PTEN alleles (range, 10%-96%). Of note, in the 21 mutated cases, only 7 (33%) had a single mutation; 8 had 2, 3 had 3, and 3 had 4 mutations. Based on total mutant level, 11 cases were considered to have monoallelic (heterozygous) mutations and 10 cases biallelic (homozygous/hemizygous or compound heterozygous) mutations. To investigate loss of genomic material, Illumina CytoSNP-850k SNP array analysis was performed on all samples. Partial or complete loss of the PTEN gene was detected in 15 patients (10%), 12 with heterozygous and 3 homozygous loss. This data was consistent with quantitative analysis of the relative allele levels of two common intronic SNPs (rs1903858 and rs555895) studied in 76 informative patients, which indicated that in 2 of 6 informative cases with heterozygous loss, only the 3’ end of the gene was deleted. Putting together the mutation and SNP data, 32 patients (22%) had abnormalities in the PTEN gene (PTENABN), 19 (59%) scored as monoallelic (PTENMONO), and 13 (41%) biallelic (PTENBI). There was no significant difference according to overall PTEN genotype in either early response to therapy (P>.99) or MRD status at day 29 of induction therapy (P=.28). Long-term outcome also did not significantly differ, EFS at 5 years was 78% in PTENABN and 85% in PTENWT patients (P=.37), overall survival (OS) 81% and 91% respectively (P=.1). These results did not change if grouped according to PTEN type, EFS 74% in PTENMONO and 85% in PTENBI patients (P=.46), although the number of patients in these groups was very small. The incidence of PTEN abnormalities did not differ according to NOTCH1/FBXW7 genotype, 59% PTENABN patients had a NOTCH1/FBXW7 mutation compared to 67% PTENWT patients (P=.7). There was no evidence that PTEN genotype impacted on the favorable outcome of the NOTCH1±FBXW7Double group, none of the 5 PTENABNNOTCH1±FBXW7Double patients relapsed and all remain alive. Similarly, no significant difference was observed in the NOTCH1Single and NOTCH1WT patients. In conclusion, although we found that loss of PTEN through either gene mutation or genomic deletion was relatively common in pediatric T-ALL patients, including total loss of PTEN in nearly one-half of mutated patients, this appeared to have no effect on either response to treatment or long-term outcome with current therapies, and therefore screening of PTEN is not warranted in pediatric T-ALL for potential use in risk-adapted therapy. Disclosures No relevant conflicts of interest to declare.

Coexisting Small Vessel Disease Predicts Poor Long-Term Outcome in Stroke Patients with Intracranial Large Artery Atherosclerosis

2010 ◽  
Vol 30 (5) ◽  
pp. 433-439 ◽  
Author(s):  
Jian Hui Fu ◽  
Yang Kun Chen ◽  
Xiang Yan Chen ◽  
Vincent Mok ◽  
Ka Sing Wong
Keyword(s):  
Small Vessel Disease ◽  
Small Vessel ◽  
Large Artery ◽  
Stroke Patients ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Vessel Disease

Long term outcome and predictors of ischemic stroke recurrence in adult moyamoya disease

2015 ◽  
Vol 359 (1-2) ◽  
pp. 381-388 ◽  
Author(s):  
Hyun Jin Noh ◽  
Suk Jae Kim ◽  
Jong Soo Kim ◽  
Seung-Chyul Hong ◽  
Keon Ha Kim ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Moyamoya Disease ◽  
Stroke Recurrence ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Adult Moyamoya Disease

scholarly journals Uncomplicated moderate coronary artery dissections after balloon angioplasty: good outcome without stenting

Heart ◽  
2001 ◽  
Vol 86 (2) ◽  
pp. 193-198
Author(s):  
M Albertal ◽  
G Van Langenhove ◽  
E Regar ◽  
I P Kay ◽  
D Foley ◽  
...  
Keyword(s):  
Adverse Events ◽  
Balloon Angioplasty ◽  
Major Adverse Cardiac Events ◽  
Cardiac Events ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Adverse Cardiac Events ◽  
Group A ◽  
Group B

OBJECTIVETo study the relation between moderate coronary dissections, coronary flow velocity reserve (CFVR), and long term outcome.METHODS523 patients undergoing balloon angioplasty and sequential intracoronary Doppler measurements were examined as part of the DEBATE II trial (Doppler endpoints balloon angioplasty trial Europe). After successful balloon angioplasty, patients were randomised to stenting or no further treatment. Dissections were graded at the core laboratory by two observers and divided into four categories: none, mild (type A-B), moderate (type C), severe (types D to F). Patients with severe dissections (n = 128) or without available reference vessel CFVR (n = 139) were excluded. The remaining 256 patients were divided into two groups according to the presence (group A, n = 45) or absence (group B, n = 211) of moderate dissection.RESULTSFollowing balloon angioplasty, there was no difference in CFVR between the two groups. At 12 months follow up, a higher rate of major adverse cardiac events was observed overall in group A than in group B (10 (22%)v 23 (11%), p = 0.041). However, the risk of major adverse events was similar in the subgroups receiving balloon angioplasty (group A, 6 (19%) v group B, 16 (16%), NS). Among group A patients, the adverse events risk was greater in those randomised to stenting (odds ratios 6.603v 1.197, p = 0.046), whereas there was no difference in risk if the group was analysed according to whether the CFVR was < 2.5 or ⩾ 2.5 after balloon angioplasty.CONCLUSIONSModerate dissections left untreated result in no increased risk of major adverse cardiac events. Additional stenting does not improve the long term outcome.

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