Risk factors of hemorrhagic transformation after intravenous thrombolysis with rt-PA in acute cerebral infarction

BACKGROUND

Intravenous thrombolysis is considered to be the standard reperfusion therapy for acute ischemic stroke, but its application is limited by high risk of hemorrhagic transformation (HT) after thrombolysis.

AIM

This study aimed to identify risk factors of HT after intravenous thrombolysis.

METHODS

Patients with acute ischemic stroke receiving rt-PA thrombolysis from February 2013 to January 2018 were retrospectively reviewed. They were divided into HT group and non-HT group based on cranial computed tomography. Data of all patients were collected and analysed by univariate analysis and stepwise logistic regression analysis.

RESULTS

A total of 403 patients were enrolled and their age ranged from 13 to 86 years, with an average age of 67.01 ± 31.88 years. 136 (33.7%) patients were females. The average time from disease onset to thrombolysis was 52.05 ± 20.12 min, and 46 patients (11.4%) had HT after thrombolysis. We found significant differences in activated partial thromboplastin time, fibrinogen value, platelet value and smoking before thrombolysis between HT and non-HT group (P < 0.05).

CONCLUSION

Smoking, prolongation of activated partial thromboplastin time, low fibrinogen levels and low platelet counts are associated with the risk of HT and could help the selection of thrombolytic patients to avoid HT.

[In vivo characteristics of spinal kinematics in senile degenerative lumbar spondylolysis]

Objective: To investigate the in vivo kinematics of the lumbar degenerative spondylolysis (LDS) in senile patients. Methods: From March to October in 2014, nine L(4-5) LDS patients [mean age (74±9) years] and nine healthy volunteers [mean age, (54±4) years] were recruited. Combined fluoroscopy and CT scanning technique were used to obtain the three dimension kinematic data of the vertebral anatomical structures (vertebral body anterior margin, vertebral body posterior margin, facet joints and spinous process) in various postures (supine, standing, flexion and extension) under physical loads, and to compare the stability of different anatomical structures. The L(4-5) segmental disc angle was also measured in different postures. Paired-samples t test was applied to compare the displacement differences between the two groups. Results: During flexion-extension motion, all anatomical structures of the LDS group were slightly larger than those in normal group, but the statistical difference was not obvious (all P>0.05). For normal group, in anterior-posterior and cranial-caudal direction, sub-movement analysis showed that the anterior vertebral body margin at the flexion range of motion [(-1.07±0.84) mm, (-1.27±1.01) mm] were larger than the extension range of motion [(0.66±1.38) mm, (0.63±0.99) mm] (t=3.21, 4.03, both P<0.05). Whereas for LDS group, in anterior-posterior and cranial-caudal direction, sub-movement analysis showed that the anterior vertebral body margin at the extension range of motion [(1.46±1.26) mm, (1.17±0.54) mm] were significantly greater than the flexion range of motion [(-0.43±0.47) mm, (-0.45±1.24) mm] (t=4.22, 3.59, both P<0.05). The disc angles of the LDS group were all smaller than those in normal group, but the statistical difference was not obvious (all P>0.05). However, the disc angles were significantly different under different postures, the flexion were both the smallest in the normal group and LDS group. Conclusions: The senile LDS patients may not necessarily have instability, stability may also occur in these patients. Increasing extension range of motion is one of the kinematic characteristics in senile patients with LDS. The intervertebral stability should be taken into account, but if instability develops, surgical procedure should be suggested for elderly patients with LDS.

Anti-epidermal growth factor receptor (EGFR) monoclonal antibody combined with cisplatin and 5-fluorouracil in patients with metastatic nasopharyngeal carcinoma after radical radiotherapy: a multicentre, open-label, phase II clinical trial

BACKGROUND

We conducted a single-arm phase II trial to evaluate the efficacy and adverse effects (AEs) of an anti-epidermal growth factor receptor monoclonal antibody, nimotuzumab, combined with cisplatin and 5-fluorouracil (PF) as first-line treatment in recurrent metastatic nasopharyngeal carcinoma after radical radiotherapy.

METHODS

Patients who met the eligibility criteria were recruited from ten institutions (ClinicalTrials.gov; NCT01616849). A Simon optimal two-stage design was used to calculate the sample size. All patients received weekly nimotuzumab (200 mg) added to cisplatin (100 mg/m2 D1) and 5-fluorouracil (4 g/m2 continuous infusion D1-4) every 3-weekly for a maximum of six cycles. Primary end point was objective response rate (ORR). Secondary end points included disease control rate (DCR), progression-free survival (PFS), overall survival (OS) and AEs.

RESULTS

A total of 35 patients were enrolled (13 in stage 1 and 22 in stage 2). Overall ORR and DCR were 71.4% (25/35) and 85.7% (30/35), respectively. Median PFS and OS were 7.0 (95% CI 5.8-8.2) months and 16.3 (95% CI 11.4-21.3) months, respectively. Unplanned exploratory analyses suggest that patients who received ≥2400 mg nimotuzumab and ≥4 cycles of PF had superior ORR, PFS and OS than those who did not (88.9% versus 12.5%, P < 0.001; 7.4 versus 2.7 months, P = 0.081; 17.0 versus 8.0 months, P = 0.202). Favourable subgroups included patients with lung metastasis [HROS 0.324 (95% CI 0.146-0.717), P = 0.008] and disease-free interval of >12 months [HROS 0.307 (95% CI 0.131-0.724), P = 0.004], but no difference was observed for metastatic burden. The only major grade 3/4 AE was leukopenia (62.9%).

CONCLUSION

Combination nimotuzumab-PF chemotherapy demonstrates potential efficacy, and is well tolerated as first-line chemotherapy regimen in recurrent metastatic nasopharyngeal carcinoma.

Abstract P1-17-03: Statin use, site of recurrence, and survival among post-menopausal women taking bisphosphonates as adjuvant therapy for breast cancer (SWOG S0307)

Purpose: Statins may mediate suppression of molecular pathways conferring benefit in cancer. Statins have shown anti-tumor effects in preclinical studies and have been associated with decreased recurrence and improved disease-specific survival. While designed to target cholesterol biosynthesis, statins can also have liver, bone and brain effects. We collected data on statin use in the S0307 adjuvant bisphosphonate trial to test the hypothesis that statin use may decrease risk of recurrence to liver, bone and brain as well as second primary (contralateral) breast cancers, and may act synergistically with bisphosphonates to decrease the risk of recurrence to bone.

Patients and Methods: In S0307, 6097 patients diagnosed with Stage I-III breast cancer who had undergone surgery and were receiving adjuvant systemic therapy were randomized to receive zoledronic acid, clodronate, or ibandronate for 3 years. No significant difference was found in disease-free survival (DFS) among the 3 groups, including a sub-analysis of patients &gt; age 55. Statin use was infrequent in younger women in S0307, consequently we analyzed statin use in those &gt; age 55. Cox proportional hazard models were used to determine which variables were independently associated with DFS and to estimate hazard ratios (HR) and 95% confidence intervals (CI).

Results: Among women aged ≥ 55 years, 684 (27%) reported taking a statin at baseline and 1,848 did not. Both groups were similar in terms of hormone receptor and HER2 status (p = 0.82). Median age in the statin group was 64.3 versus 61.0 years in the no statin group, mean BMI 31.2 v. 29.5, mean tumor size 2.1cm v. 2.3cm, negative lymph nodes 60% v. 54%, Stage I disease 47% v. 36%, and receipt of chemotherapy 62% v. 71% (all p &lt; 0.01). In the statin group, 122 (17.8%) experienced a DFS event compared to 313 (16.9%) in the no statin group (HR 1.18, CI 0.95-1.46). No difference was observed by statin use in overall recurrence (p=0.28), distant recurrence (p=0.64), or recurrences to the bone (p=0.64), liver (p=0.38) or brain (p=0.65) at initial recurrence. There was no synergy between statin use and specific bisphosphonates.

Recurrence and statin useOutcomeGroup 1: On stan at baseline n=684Group 2: No statin at baseline n=1848DFS events122 (17.8%)313 (16.9%)Died without recurrence51 7.5%)97 (5.2%)Recurrence71 (10.4%)216 (11.7%)Contralateral breast cancer9 (1.3%)17 (0.9%)Distant recurrence48 (7%)157 (8.5%)Bone as 1st site of distant recurrence (% distant recurrence)31 (65%)76 (48%)Liver as 1st site of distant recurrence (% distant recurrence)6 (13%)24 (16%)Brain/CNS as 1st site of distant recurrence (% distant recurrence)5 (10%)17 (11%)

Conclusions: We found no evidence that statins reduce risk of second primary breast cancers or distant metastases among post-menopausal women with early-stage breast cancer. Despite promising preclinical data, they did not appear to act in synergy with a specific bisphosphonate. Though women in the statin group had less advanced disease at study entry, statin use was not associated with improved DFS. Results are limited by lack of information about type of statin used, adherence, or initiation of statin in control group.

Citation Format: Kizub D, Miao J, Stopeck A, Thompson P, Paterson AH, Clemons M, Dees EC, Ingle JN, Falkson CI, Barlow W, Hortobagyi GN, Gralow JR. Statin use, site of recurrence, and survival among post-menopausal women taking bisphosphonates as adjuvant therapy for breast cancer (SWOG S0307) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-17-03.

Predicting the hearing outcome in sudden sensorineural hearing loss via machine learning models

OBJECTIVE

Sudden sensorineural hearing loss (SSHL) is a multifactorial disorder with high heterogeneity, thus the outcomes vary widely. This study aimed to develop predictive models based on four machine learning methods for SSHL, identifying the best performer for clinical application.

DESIGN

Single-centre retrospective study.

SETTING

Chinese People's liberation army (PLA) hospital, Beijing, China.

PARTICIPANTS

A total of 1220 in-patient SSHL patients were enrolled between June 2008 and December 2015.

MAIN OUTCOME MEASURES

An advanced deep learning technique, deep belief network (DBN), together with the conventional logistic regression (LR), support vector machine (SVM) and multilayer perceptron (MLP) were developed to predict the dichotomised hearing outcome of SSHL by inputting six feature collections derived from 149 potential predictors. Accuracy, precision, recall, F-score and the area under the receiver operator characteristic curves (ROC-AUC) were exploited to compare the prediction performance of different models.

RESULTS

Overall the best predictive ability was provided by the DBN model when tested in the raw data set with 149 variables, achieving an accuracy of 77.58% and AUC of 0.84. Nevertheless, DBN yielded inferior performance after feature pruning. In contrast, the LR, SVM and MLP models demonstrated opposite trend as the greatest individual prediction powers were obtained when included merely three variables, with the ROC-AUC ranging from 0.79 to 0.81, and then decreased with the increasing size of input features combinations.

CONCLUSIONS

With the input of enough features, DBN can be a robust prediction tool for SSHL. But LR is more practical for early prediction in routine clinical application using three readily available variables, that is time elapse between symptom onset and study entry, initial hearing level and audiogram.

Photoexcited Muon Spin Spectroscopy: A New Method for Measuring Excess Carrier Lifetime in Bulk Silicon

We have measured excess carrier lifetime in silicon using photoexcited muon spin spectroscopy. Positive muons implanted deep in a wafer can interact with the optically injected excess carriers and directly probe the bulk carrier lifetime while minimizing the effect from surface recombination. The method is based on the relaxation rate of muon spin asymmetry, which depends on the excess carrier density. The underlying microscopic mechanism has been understood by simulating the four-state muonium model in Si under illumination. We apply the technique to different injection levels and temperatures, and demonstrate its ability for injection- and temperature-dependent lifetime spectroscopy.

Ultra-large non-volatile modulation of magnetic moments in PbZr0.2Ti0.8O3/MgO/La0.7Sr0.3MnO3 heterostructure at room temperature via interfacial polarization mediation

Multiferroic hybrid structures PbZr0.2Ti0.8O3 (PZT)/La0.7Sr0.3MnO3 (LSMO) and PZT/MgO/LSMO were epitaxially deposited on (001) Nb:SrTiO3 crystals. Crystallinity and ferroelectric domain structures were investigated for the PZT/LSMO heterostructure. Interestingly, relatively high non-volatile magnetoelectric coupling effects were observed in both heterostructures at room temperature. The change of chemical valence for Mn and Ti at the PZT/MgO/LSMO interface may play a dominant role rather than external strain or orbital reconstruction, which lead to a large modulation of the magnetization. Correspondingly, the transport behavior of the PZT/MgO/LSMO heterostructure is investigated to confirm the role of oxygen vacancies motion. Our result indicates that the PZT/MgO/LSMO heterostructure have a promising application for future high-density non-volatile memories.

Continuous blood purification in children with severe sepsis

This study aims to analyse the clinical effects of continuous blood purification (CBP) in children with severe sepsis to form a basis for CBP application in this context. One hundred and twenty children with severe sepsis treated in Binzhou People’s Hospital, Shandong, China, from June 2013 to June 2014 were divided into two groups, a treatment and a control group, depending on parental preference. The control group was treated conventionally, and the treatment group underwent CBP in addition to conventional therapy. Cardiovascular and respiratory parameters were measured on admission and after 72 h. This study also assayed interleukin (IL)-8 and tumour necrosis factor (TNF)-α levels, and monitored clinical outcomes and prognosis. The cardiovascular and respiratory parameters of the treatment group improved to a significantly greater extent than did those of the control group (all P less than 0.05). After treatment, the levels of IL-8, IL-6, IL-10, and TNF-α declined in both groups, but more so in the treatment group (all P<0.05). The white blood cell count and C-reactive protein level fell more in the treatment than control group, with statistical significance (both P less than 0.05). CBP remarkably improved the cardiovascular and respiratory functions of children with severe sepsis, probably by eliminating factors mediating inflammation.

Thrombolysis of deep vein thrombosis and inhibiting chemotaxis of macrophage by MCP-1 blockage

OBJECTIVE

Deep vein thrombosis (DVT) is one common vascular complication after trauma or surgery. Macrophage plays an important role in recanalization of thrombosis and monocyte chemotactic protein 1 (MCP-1) has a potent chemotactic role for macrophage. This study investigated the role of MCP-1 and macrophage in DVT thrombolysis.

MATERIALS AND METHODS

DVT mice model was established for evaluating thrombosis grades, and divided into DVT, DVT + MCP-1 recombinant protein, and DVT + MCP-1 neutralizing antibody groups. MCP-1 mRNA and protein expression, weight/length ratio of thrombosis were tested at 1, 5, 9 and 15 day after DVT. F4/80 protein expression in thrombosis on day 9 was measured to reflect infiltration of macrophage.

RESULTS

DVT model mice had thrombosis grade at 2.47 ± 0.22 whilst no thrombosis occurred in sham group. DVT group had gradually increased MCP-1 mRNA and protein expression, which reached the peak at day 9, followed by decreased expression. Thrombosis weight/length ratio showed decreasing trends. MCP-1 protein injection significantly elevated MCP-1 expression, decreased thrombosis weight/length ratio, and elevated macrophage infiltration. Injection of MCP-1 antibody remarkably decreased MCP-1 expression, elevated thrombosis weight/length ratio and macrophage infiltration.

CONCLUSIONS

MCP-1 up-regulation participates in macrophage chemotaxis and thrombolysis after DVT formation. The blockade of MCP-1 weakens its thrombolysis effects.

Polyphenols in Eucalyptus leaves improved the egg and meat qualities and protected against ethanol-induced oxidative damage in laying hens

Polyphenols in Eucalyptus leaves (PE) were value resources due to various pharmacological activities, but data on the effect on laying hens are very scare. This study was conducted to determine the effect of PE on the laying performance, egg traits, meat quality, antioxidant status and liver tissues of laying hens. One hundred and twenty 256-day-old Yueqinhuang laying hens were randomly assigned to four treatment groups (different levels of PE at 0, 0.5, 0.8 and 1.2 g/kg diet) for 63 days with 15 replicates per group. Addition of 0.8 g/kg PE not only improved the egg trait by increasing the eggshell thickness and decreasing MDA production and cholesterol content in the egg yolk, but also significantly enhanced meat quality of hens, as suggested by the increase pH_45 min (p < .01) and a* value, and decrease drip loss rate (p < .01). Meanwhile, under acute ethanol-induced oxidative damage condition, supplementation of 0.8 g/kg PE enhanced the serum antioxidant status by increasing enzymatic activities (GSH-PX, T-SOD, T-AOC), inhibited oxidative damage and provided protective effect to liver tissue. In conclusion, addition of 0.8 g/kg PE not only improved the egg traits and meat quality without obvious adverse effects, but also increased the serum antioxidant status of the hens and protected their liver tissue from ethanol-induced oxidative damage. This study indicated that PE could be utilized as an effective feed additive for laying hens to improve health performance and egg traits.