CT perfusion core and ASPECT score prediction of outcomes in DEFUSE 3.
CT 灌注核心和方面评分预测 DEFUSE 3 的结局。
- 作者列表："Kim-Tenser M","Mlynash M","Lansberg MG","Tenser M","Bulic S","Jagadeesan B","Christensen S","Simpkins A","Albers GW","Marks MP
BACKGROUND:The role of Alberta Stroke Program Early CT Score (ASPECTS) for thrombectomy patient selection and prognostication in late time windows is unknown. AIMS:We compared baseline ASPECTS and core infarction determined by CT perfusion (CTP) as predictors of clinical outcome in the Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke 3 (DEFUSE) 3 trial. METHODS:We included all DEFUSE 3 patients with baseline non-contrast CT and CTP imaging. ASPECTS and core infarction were determined by the DEFUSE 3 core laboratory. Primary outcome was functional independence (modified Rankin Scale (mRS) ≤2). Secondary outcomes included ordinal mRS shift at 90 days and final core infarction volume. RESULTS:Of the 142 patients, 85 patients (60%) had ASPECTS 8-10 and 57 (40%) had ASPECTS 5-7. Thirty-one patients (36%) with ASPECTS 8-10 and 11 patients (19%) with ASPECTS 5-7 were functionally independent at 90 days (p = 0.03). In the primary and secondary logistic regression analysis, there was no difference in ordinal mRS shift (p = 0.98) or functional independence (mRS ≤ 2; p = 0.36) at 90 days between ASPECTS 8-10 and ASPECTS 5-7 patients. Similarly, primary and secondary logistic regression analyses found no difference in ordinal mRS shift (p = 1.0) or functional independence (mRS ≤ 2; p = 0.87) at 90 days between patients with baseline small core ( < 50 ml) versus medium core (50-70 ml). CONCLUSIONS:Higher ASPECTS (8-10) correlated with functional independence at 90 days in the DEFUSE trial. ASPECTS and core infarction volume did not modify the thrombectomy treatment effect, which indicates that patients with a target mismatch profile on perfusion imaging should undergo thrombectomy regardless of ASPECTS or core infarction volume in late time windows.
背景: Alberta 卒中项目早期 CT 评分 (ASPECTS) 在晚期时间窗血栓切除术患者选择和预后中的作用尚不清楚。 目的: 我们比较了基线方面和 CT 灌注 (CTP) 确定的核心梗死，作为缺血性卒中 3 (DEFUSE) 3 试验影像学评价后血管内治疗临床结局的预测因素。 方法: 我们纳入了所有 3 例基线无对比 CT 和 CTP 成像的患者。ASPECTS 和核心梗死由 DEFUSE 3 core 实验室确定。主要结局为功能独立性 (改良 Rankin 量表 (mRS) ≤ 2)。次要结局包括 90 天的有序 mRS 移位和最终核心梗死体积。 结果: 142 例患者中，85 例 (60%) 方面 8-10，57 例 (40%) 方面 5-7。第 8-10 个方面的 31 例患者 (36%) 和第 5-7 个方面的 11 例患者 (19%) 在 90 d 时功能独立 (p = 0.03)。在原发性和继发性 logistic 回归分析中，有序 mRS 移位 (p = 0.98) 或功能独立性 (mrp ≤ 2; P = 0.36) 无差异在方面 8-10 和方面 5-7 患者之间的 90 天。同样，原发性和继发性 logistic 回归分析发现，有序 mRS 移位 (p = 1.0) 或功能独立性 (mrp ≤ 2; P = 0.87) 无差异在基线小核心 (<50 ml) 与中等核心 (50-70 ml) 患者之间的 90 天。 结论: 在 DEFUSE 试验中，较高的方面 (8-10) 与 90 天的功能独立性相关。ASPECTS 和核心梗死体积没有改变血栓切除术治疗效果，这表明在灌注成像上具有目标不匹配特征的患者应该接受血栓切除术，而不管 ASPECTS 或核心梗死体积在晚期时间窗。
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.