المؤلفون: Pillai, Presaad, Bush, Steven J, Kusuma, Yohanna, Churilov, Leonid, Dowling, Richard J, Luu, Vu Dang, Davis, Stephen M, Mitchell, Peter J, Yan, Bernard

مصطلحات موضوعية: Ischemic stroke

الوصف: Background First pass effect (FPE), defined as single-pass complete or near complete reperfusion during endovascular thrombectomy (EVT) for large vessel occlusion (LVO) strokes, is a critical performance metric. Atrial fibrillation (AF)-related strokes have different clot composition compared with non-AF strokes, which may impact thrombectomy reperfusion results. We compared FPE rates in AF and non-AF stroke patients to evaluate if AF-related strokes had higher FPE rates. Methods We conducted a post-hoc analysis of the DIRECT-SAFE trial data, including patients with retrievable clots on the initial angiographic run. Patients were categorized into AF and non-AF groups. The primary outcome was the presence or absence of FPE (single-pass, single-device resulting in complete/near complete reperfusion) in AF and non-AF groups. We used multivariable logistic regression to examine the association between FPE and AF, adjusting for thrombolysis pre-thrombectomy and clot location. Results We included 253 patients (67 with AF, 186 without AF). AF patients were older (mean age: 74 years vs 67.5 years, p=0.001), had a higher proportion of females (55% vs 40%, p=0.044), and experienced more severe strokes (median National Institutes of Health Stroke Scale (NIHSS) score: 17 vs 14, p=0.009) than non-AF patients. No differences were observed in thrombolytic agent usage, time metrics, or clot location. AF patients achieved a higher proportion of FPE compared with non-AF patients (55.22% vs 37.3%, adjusted odds ratio 2.00 (95% CI 1.13 to 3.55), p=0.017). Conclusions AF-related strokes in LVO patients treated with EVT were associated with FPE. This highlights the need for preparedness for multiple passes and potential adjuvant/rescue therapy in non-AF-related strokes.

وصف الملف: text/html

العلاقة: http://jnis.bmj.com/cgi/content/short/16/7/652Test; http://dx.doi.org/10.1136/jnis-2023-020512Test

الإتاحة: https://doi.org/10.1136/jnis-2023-020512Test
http://jnis.bmj.com/cgi/content/short/16/7/652Test

المؤلفون: Sobowale, Oluwaseun A., Hostettler, Isabel C., Wu, Teddy Y., Heal, Calvin, Wilson, Duncan, Shah, Darshan G., Strbian, Daniel, Putaala, Jukka, Tatlisumak, Turgut, Vail, Andy, Sharma, Gagan, Davis, Stephen M., Werring, David J., Meretoja, Atte, Allan, Stuart M., Parry-Jones, Adrian R.

المصدر: Frontiers in Neurology ; volume 15 ; ISSN 1664-2295

مصطلحات موضوعية: Neurology (clinical), Neurology

الوصف: Background The relationship between baseline perihematomal edema (PHE) and inflammation, and their impact on survival after intracerebral hemorrhage (ICH) are not well understood. Objective Assess the association between baseline PHE, baseline C-reactive protein (CRP), and early death after ICH. Methods Analysis of pooled data from multicenter ICH registries. We included patients presenting within 24 h of symptom onset, using multifactorial linear regression model to assess the association between CRP and edema extension distance (EED), and a multifactorial Cox regression model to assess the association between CRP, PHE volume and 30-day mortality. Results We included 1,034 patients. Median age was 69 (interquartile range [IQR] 59–79), median baseline ICH volume 11.5 (IQR 4.3–28.9) mL, and median baseline CRP 2.5 (IQR 1.5–7.0) mg/L. In the multifactorial analysis [adjusting for cohort, age, sex, log-ICH volume, ICH location, intraventricular hemorrhage (IVH), statin use, glucose, and systolic blood pressure], baseline log-CRP was not associated with baseline EED: for a 50% increase in CRP the difference in expected mean EED was 0.004 cm (95%CI 0.000–0.008, p = 0.055). In a further multifactorial analysis, after adjusting for key predictors of mortality, neither a 50% increase in PHE volume nor CRP were associated with higher 30-day mortality (HR 0.97; 95%CI 0.90–1.05, p = 0.51 and HR 0.98; 95%CI 0.93–1.03, p = 0.41, respectively). Conclusion Higher baseline CRP is not associated with higher baseline edema, which is also not associated with mortality. Edema at baseline might be driven by different pathophysiological processes with different effects on outcome.

الإتاحة: https://doi.org/10.3389/fneur.2024.1359760Test

المؤلفون: Ng, Felix C, Yassi, Nawaf, Sharma, Gagan, Brown, Scott B, Goyal, Mayank, Majoie, Charles BLM, Jovin, Tudor G, Hill, Michael D, Muir, Keith W, Saver, Jeffrey L, Guillemin, Francis, Demchuk, Andrew M, Menon, Bijoy K, San Roman, Luis, Liebeskind, David S, White, Philip, Dippel, Diederik WJ, Davalos, Antoni, Bracard, Serge, Mitchell, Peter J, Wald, Michael J, Davis, Stephen M, Sheth, Kevin N, Kimberly, W Taylor, Campbell, Bruce CV, Collaborators, for the HERMES

المصدر: Stroke. 52(11)

مصطلحات موضوعية: Biomedical Imaging, Heart Disease, Cardiovascular, Neurosciences, Heart Disease - Coronary Heart Disease, Stroke, Clinical Research, Brain Disorders, Brain Edema, Brain Infarction, Endovascular Procedures, Humans, Reperfusion, Reperfusion Injury, Thrombectomy, edema, infarction, ischemic stroke, reperfusion, thrombectomy, HERMES Collaborators, Cardiorespiratory Medicine and Haematology, Clinical Sciences, Neurology & Neurosurgery

الوصف: Background and purposeWhether reperfusion into infarcted tissue exacerbates cerebral edema has treatment implications in patients presenting with extensive irreversible injury. We investigated the effects of endovascular thrombectomy and reperfusion on cerebral edema in patients presenting with radiological evidence of large hemispheric infarction at baseline.MethodsIn a systematic review and individual patient-level meta-analysis of 7 randomized controlled trials comparing thrombectomy versus medical therapy in anterior circulation ischemic stroke published between January 1, 2010, and May 31, 2017 (Highly Effective Reperfusion Using Multiple Endovascular Devices collaboration), we analyzed the association between thrombectomy and reperfusion with maximal midline shift (MLS) on follow-up imaging as a measure of the space-occupying effect of cerebral edema in patients with large hemispheric infarction on pretreatment imaging, defined as diffusion-magnetic resonance imaging or computed tomography (CT)-perfusion ischemic core 80 to 300 mL or noncontrast CT-Alberta Stroke Program Early CT Score ≤5. Risk of bias was assessed using the Cochrane tool.ResultsAmong 1764 patients, 177 presented with large hemispheric infarction. Thrombectomy and reperfusion were associated with functional improvement (thrombectomy common odds ratio =2.30 [95% CI, 1.32–4.00]; reperfusion common odds ratio =4.73 [95% CI, 1.66–13.52]) but not MLS (thrombectomy β=−0.27 [95% CI, −1.52 to 0.98]; reperfusion β=−0.78 [95% CI, −3.07 to 1.50]) when adjusting for age, National Institutes of Health Stroke Score, glucose, and time-to-follow-up imaging. In an exploratory analysis of patients presenting with core volume >130 mL or CT-Alberta Stroke Program Early CT Score ≤3 (n=76), thrombectomy was associated with greater MLS after adjusting for age and National Institutes of Health Stroke Score (β=2.76 [95% CI, 0.33–5.20]) but not functional improvement (odds ratio, 1.71 [95% CI, 0.24–12.08]).ConclusionsIn patients presenting with large hemispheric infarction, thrombectomy and reperfusion were not associated with MLS, except in the subgroup with very large core volume (>130 mL) in whom thrombectomy was associated with increased MLS due to space-occupying ischemic edema. Mitigating cerebral edema-mediated secondary injury in patients with very large infarcts may further improve outcomes after reperfusion therapies.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/62v6q4kmTest

المؤلفون: Thimm, Terra N., Kiefer, Christopher S., Aloi, Mara S., Davenport, Moira, Kilpatrick, Jared, Bush, Jeffrey S., Jennings, Lindsey, Davis, Stephen M., Quedado, Kimberly D., Shaver, Erica B.

المصدر: Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health. 22(5)

مصطلحات موضوعية: resident selection, medical education, medical student performance evaluation

الوصف: Introduction: Although emergency medicine (EM) residency program directors (PD) have multiple sources to evaluate each applicant, some programs await the release of the medical student performance evaluation (MSPE) to extend interview offers. While prior studies have demonstrated that MSPE content is variable and selectively positive, no prior work has evaluated the impact of the MSPE on the likelihood to invite (LTI) applicants for a residency interview. This study aimed to evaluate how information in the MSPE impacted LTI, with the hypothesis that changes in LTI would be relatively rare based on MSPE review alone.  Methods: We conducted a prospective, observational study analyzing applications to three EM residency programs during the 2019-2020 match cycle. Reviewers assessed applications and rated the LTI on a five-point Likert scale where LTI was defined as follows: 1 = definitely no; 2 = probably no; 3 = unsure; 4 = probably yes; and 5 = definitely yes. The LTI was recorded before and after MSPE review. A change in LTI was considered meaningful when it changed the overall trajectory of the applicant’s likelihood to receive an invitation to interview.  Results: We reviewed a total of 877 applications with the LTI changing ≥1 point on the Likert scale 160 (18.2%) times. The LTI was meaningfully impacted in a minority of applications – 48 total            (5.5 %, p< 0.01) – with only 1 (0.11%) application changing from 1 or 2 (definitely/probably no) to 4 or 5 (probably/definitely yes) and 34 (3.8%) changing from 3 (unsure) to 4 or 5 (probably/definitely yes). Thirteen (1.5%) applications changed from 4 or 5 (probably/definitely yes) to 3 (unsure or probably/definitely no). Conclusion: Review of the MSPE resulted in a meaningful change in LTI in only 5.5% of applications. Given the time required for program leadership to review all parts of the variably formatted MSPEs, this finding supports a more efficient application review, where the PD’s focus is on succinct and objective aspects of the application, such as the Standardized Letter of Evaluation.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/3sv6w2jfTest

المؤلفون: Flint, Alexander C., Chan, Sheila L., Edwards, Nancy J., Rao, Vivek A., Klingman, Jeffrey G., Nguyen-Huynh, Mai N., Yan, Bernard, Mitchell, Peter J., Davis, Stephen M., Campbell, Bruce C.V., Dippel, Diederik W., Roos, Yvo B.W.E.M., van Zwam, Wim H., Saver, Jeffrey L., Kidwell, Chelsea S., Hill, Michael D., Goyal, Mayank, Demchuk, Andrew M., Bracard, Serge, Bendszus, Martin, Donnan, Geoffrey A.

المصدر: Flint , A C , Chan , S L , Edwards , N J , Rao , V A , Klingman , J G , Nguyen-Huynh , M N , Yan , B , Mitchell , P J , Davis , S M , Campbell , B C V , Dippel , D W , Roos , Y B W E M , van Zwam , W H , Saver , J L , Kidwell , C S , Hill , M D , Goyal , M , Demchuk , A M , Bracard , S , Bendszus , ....

مصطلحات موضوعية: /dk/atira/pure/sustainabledevelopmentgoals/good_health_and_well_being, name=SDG 3 - Good Health and Well-being

الوصف: Introduction: The THRIVE score and the THRIVE-c calculation are validated ischemic stroke outcome prediction tools based on patient variables that are readily available at initial presentation. Randomized controlled trials (RCTs) have demonstrated the benefit of endovascular treatment (EVT) for many patients with large vessel occlusion (LVO), and pooled data from these trials allow for adaptation of the THRIVE-c calculation for use in shared clinical decision making regarding EVT. Methods: To extend THRIVE-c for use in the context of EVT, we extracted data from the Virtual International Stroke Trials Archive (VISTA) from 7 RCTs of EVT. Models were built in a randomly selected development cohort using logistic regression that included the predictors from THRIVE-c: age, NIH Stroke Scale (NIHSS) score, presence of hypertension, diabetes mellitus, and/or atrial fibrillation, as well as randomization to EVT and, where available, the Alberta Stroke Program Early CT Score (ASPECTS). Results: Good outcome was achieved in 366/787 (46.5%) of subjects randomized to EVT and in 236/795 (29.7%) of subjects randomized to control (P < 0.001), and the improvement in outcome with EVT was seen across age, NIHSS, and THRIVE-c good outcome prediction. Models to predict outcome using THRIVE elements (age, NIHSS, and comorbidities) together with EVT, with or without ASPECTS, had similar performance by ROC analysis in the development and validation cohorts (THRIVE-EVT ROC area under the curve (AUC) = 0.716 in development, 0.727 in validation, P = 0.30; THRIVE-EVT + ASPECTS ROC AUC = 0.718 in development, 0.735 in validation, P = 0.12). Conclusion: THRIVE-EVT may be used alongside the original THRIVE-c calculation to improve outcome probability estimation for patients with acute ischemic stroke, including patients with or without LVO, and to model the potential improvement in outcomes with EVT for an individual patient based on variables that are available at initial presentation. Online calculators for THRIVE-c estimation are ...

العلاقة: https://pure.eur.nl/en/publications/76327e4a-34ca-4cba-84b4-a3ba14843d06Test

الإتاحة: https://doi.org/10.1177/17474930221092262Test
https://pure.eur.nl/en/publications/76327e4a-34ca-4cba-84b4-a3ba14843d06Test
http://www.scopus.com/inward/record.url?scp=85130069865&partnerID=8YFLogxKTest
https://cris.maastrichtuniversity.nl/files/187337595/Zwam-2022-outcome-prediction-in-large-vessel.pdfTest

المؤلفون: Yassi, Nawaf, Zhao, Henry, Churilov, Leonid, Campbell, Bruce C., Wu, Teddy, Ma, Henry, Cheung, Andrew, Kleinig, Timothy, Brown, Helen, Choi, Philip, Jeng, Jiann-Shing, Ranta, Annemarei, Wang, Hao-Kuang, Cloud, Geoffrey C., Grimley, Rohan, Shah, Darshan, Spratt, Neil, Cho, Der-Yang, Mahawish, Karim, Sanders, Lauren, Worthington, John, Clissold, Ben, Meretoja, Atte, Yogendrakumar, Vignan, Ton, Mai Duy, Dang, Duc Phuc, Phuong, Nguyen Thai My, Nguyen, Huy-Thang, Hsu, Chung Y., Sharma, Gagan, Mitchell, Peter J., Yan, Bernard, Parsons, Mark W., Levi, Christopher, Donnan, Geoffrey A., Davis, Stephen M.

المساهمون: Clinicum, Neurologian yksikkö, HUS Neurocenter

مصطلحات موضوعية: stroke, hemorrhage, CT, ACTIVATED FACTOR-VII, SUBARACHNOID HEMORRHAGE, STROKE UNIT, MANAGEMENT, GROWTH, 3112 Neurosciences, 3124 Neurology and psychiatry

الوصف: Rationale Haematoma growth is common early after intracerebral haemorrhage (ICH), and is a key determinant of outcome. Tranexamic acid, a widely available antifibrinolytic agent with an excellent safety profile, may reduce haematoma growth. Methods and design Stopping intracerebral haemorrhage with tranexamic acid for hyperacute onset presentation including mobile stroke units (STOP-MSU) is a phase II double-blind, randomised, placebo-controlled, multicentre, international investigator-led clinical trial, conducted within the estimand statistical framework. Hypothesis In patients with spontaneous ICH, treatment with tranexamic acid within 2 hours of onset will reduce haematoma expansion compared with placebo. Sample size estimates A sample size of 180 patients (90 in each arm) would be required to detect an absolute difference in the primary outcome of 20% (placebo 39% vs treatment 19%) under a two-tailed significance level of 0.05. An adaptive sample size re-estimation based on the outcomes of 144 patients will allow a possible increase to a prespecified maximum of 326 patients. Intervention Participants will receive 1 g intravenous tranexamic acid over 10 min, followed by 1 g intravenous tranexamic acid over 8 hours; or matching placebo. Primary efficacy measure The primary efficacy measure is the proportion of patients with haematoma growth by 24 +/- 6 hours, defined as either >= 33% relative increase or >= 6 mL absolute increase in haematoma volume between baseline and follow-up CT scan. Discussion We describe the rationale and protocol of STOP-MSU, a phase II trial of tranexamic acid in patients with ICH within 2 hours from onset, based in participating mobile stroke units and emergency departments. ; Peer reviewed

وصف الملف: application/pdf

العلاقة: Medical Research Future Fund, Australia (APP1152282).; Yassi , N , Zhao , H , Churilov , L , Campbell , B C , Wu , T , Ma , H , Cheung , A , Kleinig , T , Brown , H , Choi , P , Jeng , J-S , Ranta , A , Wang , H-K , Cloud , G C , Grimley , R , Shah , D , Spratt , N , Cho , D-Y , Mahawish , K , Sanders , L , Worthington , J , Clissold , B , Meretoja , A , Yogendrakumar , V , Ton , M D , Dang , D P , Phuong , N T M , Nguyen , H-T , Hsu , C Y , Sharma , G , Mitchell , P J , Yan , B , Parsons , M W , Levi , C , Donnan , G A & Davis , S M 2022 , ' Tranexamic acid for intracerebral haemorrhage within 2 hours of onset : protocol of a phase II randomised placebo-controlled double-blind multicentre trial ' , Stroke and vascular neurology , vol. 7 , pp. e001070 . https://doi.org/10.1136/svn-2021-001070Test; 4deb3ec8-b2dc-46cc-be14-2240dd35d22b; http://hdl.handle.net/10138/353479Test; 000725047900001

الإتاحة: http://hdl.handle.net/10138/353479Test

المؤلفون: Bagot, Kathleen L., Purvis, Tara, Hancock, Shaun, Zhao, Henry, Coote, Skye, Easton, Damien, Campbell, Bruce C. V., Davis, Stephen M., Donnan, Geoff A., Foster, Shane, Langenberg, Francesca, Smith, Karen, Stephenson, Michael, Bernard, Stephen, McGowan, Sharon, Yan, Bernard, Mitchell, Peter, Middleton, Sandy, Cadilhac, Dominique A.

مصطلحات موضوعية: stroke, ambulances, evaluation studies, program sustainability

الوصف: Background Internationally, Mobile Stroke Unit (MSU) ambulances have changed pre-hospital acute stroke care delivery. MSU clinical and cost-effectiveness studies are emerging, but little is known about important factors for achieving sustainability of this innovative model of care. Methods Mixed-methods study from the Melbourne MSU (operational since November 2017) process evaluation. Participant purposive sampling included clinical, operational and executive/management representatives from Ambulance Victoria (AV) (emergency medical service provider), the MSU clinical team, and receiving hospitals. Sustainability was defined as ongoing MSU operations, including MSU workforce and future model considerations. Theoretically-based on-line survey with Unified Theory of Acceptance and Use of Technology (UTAUT), Self Determination Theory (SDT, Intrinsic Motivation), and open-text questions targeting barriers and benefits was administered (June-September 2019). Individual/group interviews were conducted, eliciting improvement suggestions and requirements for ongoing use. Descriptive and regression analyses (quantitative data) and directed content and thematic analysis (open text and interview data) were conducted. Results There were 135 surveys completed. Identifying that the MSU was beneficial to daily work (β = 0.61), not experiencing pressure/tension about working on the MSU (β = 0.17) and thinking they did well working within the team model (β = 0.17) were significantly associated with wanting to continue working within the MSU model [R2 = 0.76; F(15, 60) = 12.76, P < .001]. Experiences varied between those on the MSU team and those working with the MSU. Advantages were identified for patients (better, faster care) and clinicians (interdisciplinary learning). Disadvantages included challenges integrating into established systems, and establishing working relationships. Themes identified from 35 interviews were MSU team composition, MSU vehicle design and layout, personnel recruitment and rostering, communication ...

وصف الملف: application/pdf

العلاقة: https://acuresearchbank.acu.edu.au/item/8z76z/sustaining-a-new-model-of-acute-stroke-care-a-mixed-method-process-evaluation-of-the-melbourne-mobile-stroke-unitTest; https://acuresearchbank.acu.edu.au/download/1a6bff714256c4e755d89d13a4eadfd6436c2d06f3d19c4bd6dcb58754aaa625/799516/OA_Bagot_2023_Sustaining_a_new_model_of_acute.pdfTest; https://doi.org/10.34172/ijhpm.2023.7716Test; Bagot, Kathleen L., Purvis, Tara, Hancock, Shaun, Zhao, Henry, Coote, Skye, Easton, Damien, Campbell, Bruce C. V., Davis, Stephen M., Donnan, Geoff A., Foster, Shane, Langenberg, Francesca, Smith, Karen, Stephenson, Michael, Bernard, Stephen, McGowan, Sharon, Yan, Bernard, Mitchell, Peter, Middleton, Sandy and Cadilhac, Dominique A. (2023). Sustaining a new model of acute stroke care : A mixed-method process evaluation of the Melbourne Mobile Stroke Unit. International Journal of Health Policy and Management. 12(1), pp. 1-13. https://doi.org/10.34172/ijhpm.2023.7716Test

الإتاحة: https://doi.org/10.34172/ijhpm.2023.7716Test
https://acuresearchbank.acu.edu.au/download/1a6bff714256c4e755d89d13a4eadfd6436c2d06f3d19c4bd6dcb58754aaa625/799516/OA_Bagot_2023_Sustaining_a_new_model_of_acute.pdfTest

المؤلفون: Floyd, Jessica, Mallow, Jennifer, Wang, Kesheng, Davis, Stephen M., Carpenter, Roger, Theeke, Laurie

المصدر: BMC Pulmonary Medicine ; volume 23, issue 1 ; ISSN 1471-2466

مصطلحات موضوعية: Pulmonary and Respiratory Medicine

الوصف: Background Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the world with nearly 90% of cases caused by tobacco smoking. Nearly 40% of people with COPD are diagnosed with depression which impacts quality of life and smoking cessation. The purpose of this study was to describe factors influencing smoking behaviors and readiness to change in people with comorbid COPD and depression. Methods A descriptive cross-sectional design was used. A convenience sample of 222 participants self-reported and/or had a documented diagnosis of COPD. Participants completed study measures which included the PHQ-9 for depressive symptoms, assessment of smoking behaviors using The Cigarette Dependence Scale, report of readiness to change using The Smoking Stage of Change Questionnaire, The Smoking Decisional Balance Questionnaire, and The Processes of Change Questionnaire. Electronic and paper questionnaires were used. Data was stored in RedCap and analyzed using SPSS version 26. Based on variable type, descriptive and comparative analyses were conducted using ANOVA, t-test, chi-square, Pearson correlation, linear regression, and multiple linear regression to determine the relationships between smoking behaviors, COPD, and depressive symptoms. Results Only 18 participants were classified as having no depressive symptoms. Participants who smoked had high nicotine dependence and wanted to quit smoking. Overall, participants saw more cons to smoking and were engaged in the processes of change. The majority of participants were in the maintenance or contemplation stage. Cigarette dependence could decrease by 9% if depressive symptoms are treated. Conclusions There is a need to assess COPD patients for depression and to assess COPD patients’ smoking behaviors and readiness to change. Adequate treatment of depression could promote an individual to move through the stages of change from chronic contemplation to action, thus improving smoking cessation efforts for individuals with COPD. ...

الإتاحة: https://doi.org/10.1186/s12890-023-02621-2Test

المؤلفون: Liu, Chin-Fu, Zhao, Yi, Yedavalli, Vivek, Leigh, Richard, Falcao, Vitor, Wintermark, Max, Warach, Steven J., Albers, Gregory W., Davis, Stephen M., Grotta, James C., Hacke, Werner, Kang, Dong-Wha, Kidwell, Chelsea, Koroshetz, Walter J., Lees, Kennedy, Lev, Michael H., Liebeskind, David S., Sorensen, A. Gregory, Thijs, Vincent N., Thomalla, Götz, Wardlaw, Joanna M., Luby, Marie, Miller, Michael I., Hillis, Argye E., Faria, Andreia V.

المساهمون: U.S. Department of Health & Human Services | NIH | National Institute of Biomedical Imaging and Bioengineering, U.S. Department of Health & Human Services | NIH | National Institute on Deafness and Other Communication Disorders

المصدر: Communications Medicine ; volume 3, issue 1 ; ISSN 2730-664X

الوصف: Background Although artificial intelligence systems that diagnosis among different conditions from medical images are long term aims, specific goals for automation of human-labor, time-consuming tasks are not only feasible but equally important. Acute conditions that require quantitative metrics, such as acute ischemic strokes, can greatly benefit by the consistency, objectiveness, and accessibility of automated radiological reports. Methods We used 1,878 annotated brain MRIs to generate a fully automated system that outputs radiological reports in addition to the infarct volume, 3D digital infarct mask, and the feature vector of anatomical regions affected by the acute infarct. This system is associated to a deep-learning algorithm for segmentation of the ischemic core and to parcellation schemes defining arterial territories and classically-identified anatomical brain structures. Results Here we show that the performance of our system to generate radiological reports was comparable to that of an expert evaluator. The weight of the components of the feature vectors that supported the prediction of the reports, as well as the prediction probabilities are outputted, making the pre-trained models behind our system interpretable. The system is publicly available, runs in real time, in local computers, with minimal computational requirements, and it is readily useful for non-expert users. It supports large-scale processing of new and legacy data, enabling clinical and translational research. Conclusion: The generation of reports indicates that our fully automated system is able to extract quantitative, objective, structured, and personalized information from stroke MRIs.

الإتاحة: https://doi.org/10.1038/s43856-023-00327-4Test
https://www.nature.com/articles/s43856-023-00327-4.pdfTest
https://www.nature.com/articles/s43856-023-00327-4Test

المؤلفون: Bladin, Christopher F., Wah Cheung, Ngai, Dewey, Helen M., Churilov, Leonid, Middleton, Sandy, Thijs, Vincent, Ekinci, Elif, Levi, Christopher R., Lindley, Richard, Donnan, Geoffrey A., Parsons, Mark W., Meretoja, Atte, Tiainen, Marjaana, Choi, Philip M.C., Cordato, Dennis, Brown, Helen, Campbell, Bruce C.V., Davis, Stephen M., Cloud, Geoffrey, Grimley, Rohan, Lee-Archer, Matthew, Ghia, Darshan, Sanders, Lauren, Markus, Romesh, Muller, Claire, Salvaris, Patrick, Wu, Teddy, Fink, John

المصدر: Stroke ; volume 54, issue 12, page 2962-2971 ; ISSN 0039-2499 1524-4628

الوصف: BACKGROUND: Hyperglycemia in acute ischemic stroke reduces the efficacy of stroke thrombolysis and thrombectomy, with worse clinical outcomes. Insulin-based therapies are difficult to implement and may cause hypoglycemia. We investigated whether exenatide, a GLP-1 (glucagon-like peptide-1) receptor agonist, would improve stroke outcomes, and control poststroke hyperglycemia with minimal hypoglycemia. METHODS: The TEXAIS trial (Treatment With Exenatide in Acute Ischemic Stroke) was an international, multicenter, phase 2 prospective randomized clinical trial (PROBE [Prospective Randomized Open Blinded End-Point] design) enrolling adult patients with acute ischemic stroke ≤9 hours of stroke onset to receive exenatide (5 µg BID subcutaneous injection) or standard care for 5 days, or until hospital discharge (whichever sooner). The primary outcome (intention to treat) was the proportion of patients with ≥8-point improvement in National Institutes of Health Stroke Scale score (or National Institutes of Health Stroke Scale scores 0–1) at 7 days poststroke. Safety outcomes included death, episodes of hyperglycemia, hypoglycemia, and adverse event. RESULTS: From April 2016 to June 2021, 350 patients were randomized (exenatide, n=177, standard care, n=173). Median age, 71 years (interquartile range, 62–79), median National Institutes of Health Stroke Scale score, 4 (interquartile range, 2–8). Planned recruitment (n=528) was stopped early due to COVID-19 disruptions and funding constraints. The primary outcome was achieved in 97 of 171 (56.7%) in the standard care group versus 104 of 170 (61.2%) in the exenatide group (adjusted odds ratio, 1.22 [95% CI, 0.79–1.88]; P =0.38). No differences in secondary outcomes were observed. The per-patient mean daily frequency of hyperglycemia was significantly less in the exenatide group across all quartiles. No episodes of hypoglycemia were recorded over the treatment period. Adverse events of mild nausea and vomiting occurred in 6 (3.5%) exenatide patients versus 0 (0%) standard care ...

الإتاحة: https://doi.org/10.1161/strokeaha.123.044568Test