Impact of slice thickness on clinical utility of automated Alberta Stroke Program Early Computed Tomography Scores.
切片厚度对自动 Alberta 卒中项目早期计算机断层扫描评分临床效用的影响。
- 作者列表："Neuberger U","Nagel S","Pfaff J","Ringleb PA","Herweh C","Bendszus M","Möhlenbruch MA","Kickingereder P
OBJECTIVES:The clinical utility of electronically derived ASPECTS (e-ASPECTS) to quantify signs of acute ischemic infarction could be demonstrated in multiple studies. Here, we aim to clinically validate the impact of CT slice thickness (ST) on the performance of e-ASPECTS software. METHODS:A consecutive series of n = 258 patients (06/2016 and 01/2019) with middle cerebral artery occlusion and subsequent treatment with mechanical thrombectomy was analyzed. The e-ASPECTS score and acute infarct volumes were calculated from baseline non-contrast CT with a software using 1-mm slice thickness (ST) (defined as ground truth) and axial reconstructions with 2-10-mm ST and correlated with baseline stroke severity (NIHSS) as well as clinical outcome (mRS) using logistic regressions. RESULTS:In comparison with the ground truth, significant differences were seen in e-ASPECTS scores with ST > 6 mm (p ≤ 0.031) and infarct volumes with ST > 4 mm (p ≤ 0.001). There was a significant correlation of lower e-ASPECTS and higher acute infarct volumes with increasing baseline NIHSS values for all ST (p ≤ 0.001, respectively), with values derived from 1 mm yielding the highest correlation for both parameters (rho, - 0.38 and 0.31, respectively). Similarly, lower e-ASPECTS and higher acute infarct volumes from all ST were significantly associated with poor outcome after 90 days (p ≤ 0.05, respectively) with values derived from 1-mm ST yielding the highest effects for both parameters (OR, 0.69 [95% CI 0.50-0.88] and 1.27 [95% CI 1.10-1.50], respectively). CONCLUSIONS:The e-ASPECTS software generates robust values for e-ASPECTS and acute infarct volumes when using ST ≤ 4 mm with ST = 1 mm yielding the best performance for predicting baseline stroke severity and clinical outcome after 90 days. KEY POINTS:• Clinical utility of automatically derived ASPECTS from computed tomography scans was shown in patients with acute ischemic stroke and treatment with mechanical thrombectomy. • Thin slices (= 1 mm) had the highest clinical utility in comparison with thicker slices (2-10 mm) by having the strongest correlation with baseline stroke severity and independent effects on clinical outcome after 90 days. • Automatically calculated acute infarct volumes possess clinical utility beyond ASPECTS and should be considered in future studies.
目的: 电子衍生的方面 (e-ASPECTS) 量化急性缺血性梗死体征的临床效用可以在多项研究中得到证明。在此，我们旨在临床验证 CT 层厚 (ST) 对 e-ASPECTS 软件性能的影响。 方法: 对连续 258 例 (06/2016 例和 01/2019 例) 大脑中动脉闭塞患者进行分析，随后采用机械取栓治疗。使用 1mm 层厚 (ST) (定义为地面实况) 软件从基线非对比 CT 计算 e-ASPECTS 评分和急性梗死体积使用 2-10mm ST 进行轴向重建，并使用 logistic 回归分析与基线卒中严重程度 (NIHSS) 以及临床结局 (mRS) 相关。 结果: 与基础结果相比，ST> 6毫米 (p ≤ 0.031) 的 e 方面评分和 ST> 4毫米 (p ≤ 0.001) 的梗死体积存在显著差异。对于所有 ST，较低的 e-ASPECTS 和较高的急性梗死体积与基线 NIHSS 值增加显著相关 (分别为 p ≤ 0.001), 从 1毫米得出的值产生了两个参数的最高相关性 (分别为 rho 、-0.38 和 0.31)。同样，所有 ST 的较低的 e-ASPECTS 和较高的急性梗死体积与 90 天后的不良结局显著相关 (分别为 p ≤ 0.05) 来自 1mm ST 的值对这两个参数产生的效果最高 (OR 分别为 0.69 [95% CI 0.50-0.88] 和 1.27 [95% CI 1.10-1.50])。 结论: 当使用 ST ≤ 4毫米且 ST = 1毫米时，e-ASPECTS 软件会为 e-ASPECTS 和急性梗死体积生成稳健值，从而产生预测基线卒中严重程度和 90 后临床结局的最佳性能几天。 要点: • 在急性缺血性卒中患者和机械血栓切除术治疗中显示了计算机断层扫描自动衍生方面的临床效用。•与较厚的切片 (2-1毫米) 相比，薄片 (= 10毫米) 的临床效用最高通过与基线卒中严重程度和 90 天后临床结局的独立影响具有最强的相关性。•自动计算的急性梗死体积具有超出方面的临床效用，应在未来的研究中考虑。
METHODS:BACKGROUND:People with stroke are not meeting recommended levels of physical activity. The modifiable factors associated with post-stroke physical activity levels need to be identified to develop targeted interventions. OBJECTIVE:The objective of this study was to investigate the factors at discharge from inpatient rehabilitation that are associated with physical activity levels at 3 months following discharge. DESIGN:This was a prospective cohort study. METHODS:Sixty-four people with stroke completed baseline assessments at discharge from inpatient rehabilitation and 55 completed the follow-up 3 months later. The candidate factors (i.e. gait speed, balance, strength, cognition, mood and motivation) were measured at discharge. The primary outcome measure at follow-up was walking related activity (measured by wrist-worn accelerometer). Secondary outcome measures were physical activity participation (Activity Card Sort) and intensity of physical activity (International Physical Activity Questionnaire - Short 7 days). Adjusted separate multivariable linear regression models or proportional odds regression models were used to evaluate the associations between candidate factors and physical activity. RESULTS:Gait speed and balance were associated with all aspects of physical activity. Higher level of intrinsic motivation was also associated with higher physical activity participation. Anxiety demonstrated a significant non-linear relationship with physical activity participation. LIMITATIONS:Inclusion of fatigue and individual muscle strength could have provided further insights into associations with steps per day. CONCLUSION:The results demonstrated that better physical function at discharge from inpatient rehabilitation was associated with future increased levels of physical activity. Additionally, higher levels of motivation impacted on increased physical activity participation. The influence of anxiety on physical activity participation requires further exploration. Mixed-method study designs can be utilized to further understand the factors associated with post-stroke physical activity.
METHODS:Cerebral ischemia-reperfusion (I/R) is characterized by initial transient cerebral ischemia followed by reperfusion. Various pathophysiological processes are involved in brain injury and functional recovery during cerebral I/R. There are few studies on dynamic metabolic process after cerebral I/R. The present study was to observe dynamic alteration of brain injury, functional recovery, and metabolites after cerebral I/R in rats and discover potential metabolic markers. The cerebral I/R model was established by middle cerebral artery occlusion (MCAO) for 90 min, following reperfusion in rats. The results of cerebral infarction area, cerebral edema, and behavior test showed that there were dynamic changes in brain injury and functional recovery at different periods after cerebral I/R. Further analysis showed that the brain injury was severe on the first day of cerebral I/R, and there was a significant functional recovery from the 7th day of cerebral I/R, followed by an aggravation trend of brain injury from the days 7 to 28. Furthermore, Matrix-assisted laser desorption ionization mass spectrometry imaging analysis showed that the expression of ATP, glucose, and citric acid on 7th day was the highest during cerebral I/R, which indicated that energy metabolism and oxidative phosphorylation played important roles during cerebral I/R. In addition, the untargeted metabolomic results showed that the level of isocitric acid, the ratio of oxyglutaric acid/glutamic acid, and the level of pyruvic acid associated with the TCA cycle were also the highest on the 7th day during cerebral I/R, which indicated that the transient spontaneous recovery of ischemic brain on the 7th day after ischemia-reperfusion might be related to oxidative phosphorylation and energy metabolism in the brain in this period. In conclusion, the results suggest that some small molecule metabolites participate in the brain injury and functional recovery during cerebral I/R, which is of great significance to the development of therapeutic drugs and diagnostic markers.
METHODS:The aims of this study were to study the effects of miR-2 on cerebral ischemia–reperfusion rats and to explore its further mechanism. Rats were assigned into sham, model, miR-22 control and miR-22 groups. Observation of neurological behaviors at 24 h after operation found that neurological functions were severely damaged in the model and miR-22 control groups and these damages were improved by miR-22. RT-PCR indicated that miR-22 mRNA level in the brain tissue was significantly decreased in the model and miR-22 control groups, but increased in the miR-22 group. TTC staining showed increased percentage of cerebral infarction volume in the model and miR-22 control groups and this increase was reduced by miR-22. Immunohistochemistry showed increased densities of CD34^+ and VEGF^+ microvessels in the cortex in the model and miR-22 control groups, which were further increased in the miR-22 group. ELISA showed increased serum VEGF and Ang-1 levels in the model and miR-22 control groups, which were also further increased in the miR-22 group. Western blot analysis showed increased phosphorylation level of PI3K and Akt in brain tissue in the model and miR-22 control groups, which were further increased in the miR-22 group. Administration of LY294002, a specific PI3K pathway inhibitor, significantly reversed all the effects of miR-22 on rats in the model group. miR-22 exerts its neuroprotective and angiogenic functions via the PI3K/Akt signaling pathway, at least partly, in rats under cerebral ischemia–reperfusion.