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Talmasov D, Kelly S, Ecker S, Olivera A, Lord A, Gurin L, Ishida K, Melmed K, Torres J, Zhang C, Frontera J, Lewis A. Relationship Between Hemorrhage Type and Development of Emotional and Behavioral Dyscontrol After Hemorrhagic Stroke. J Neuropsychiatry Clin Neurosci 2024:appineuropsych20230114. [PMID: 38650464 DOI: 10.1176/appi.neuropsych.20230114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
OBJECTIVE Emotional and behavioral dyscontrol (EBD), a neuropsychiatric complication of stroke, leads to patient and caregiver distress and challenges to rehabilitation. Studies of neuropsychiatric sequelae in stroke are heavily weighted toward ischemic stroke. This study was designed to compare risk of EBD following intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH) and to identify risk factors for EBD following hemorrhagic stroke. METHODS The authors conducted a prospective cohort study of patients hospitalized for nontraumatic hemorrhagic stroke between 2015 and 2021. Patients or legally authorized representatives completed the Quality of Life in Neurological Disorders (Neuro-QOL) EBD short-form inventory 3 months after hospitalization. Univariable and multivariable analyses identified risk factors for EBD after hemorrhagic stroke. RESULTS The incidence of EBD was 21% (N=15 of 72 patients) at 3 months after hemorrhagic stroke. Patients with ICH were more likely to develop EBD; 93% of patients with EBD (N=14 of 15) had ICH compared with 56% of patients without EBD (N=32 of 57). The median Glasgow Coma Scale (GCS) score at hospital admission was lower among patients who developed EBD (13 vs. 15 among those without EBD). Similarly, admission scores on the National Institutes of Health Stroke Scale (NIHSS) and the Acute Physiology and Chronic Health Evaluation II (APACHE II) were higher among patients with EBD (median NIHSS score: 7 vs. 2; median APACHE II score: 17 vs. 11). Multivariable analyses identified hemorrhage type (ICH) and poor admission GCS score as predictors of EBD 3 months after hemorrhagic stroke. CONCLUSIONS Patients with ICH and a low GCS score at admission are at increased risk of developing EBD 3 months after hemorrhagic stroke and may benefit from early intervention.
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Affiliation(s)
- Daniel Talmasov
- Departments of Neurology and Psychiatry, Columbia University, New York (Talmasov); Department of Neurology, New York University Langone Medical Center (Kelly, Ecker, Olivera, Lord, Gurin, Ishida, Melmed, Torres, Zhang, Frontera, Lewis)
| | - Sean Kelly
- Departments of Neurology and Psychiatry, Columbia University, New York (Talmasov); Department of Neurology, New York University Langone Medical Center (Kelly, Ecker, Olivera, Lord, Gurin, Ishida, Melmed, Torres, Zhang, Frontera, Lewis)
| | - Sarah Ecker
- Departments of Neurology and Psychiatry, Columbia University, New York (Talmasov); Department of Neurology, New York University Langone Medical Center (Kelly, Ecker, Olivera, Lord, Gurin, Ishida, Melmed, Torres, Zhang, Frontera, Lewis)
| | - Anlys Olivera
- Departments of Neurology and Psychiatry, Columbia University, New York (Talmasov); Department of Neurology, New York University Langone Medical Center (Kelly, Ecker, Olivera, Lord, Gurin, Ishida, Melmed, Torres, Zhang, Frontera, Lewis)
| | - Aaron Lord
- Departments of Neurology and Psychiatry, Columbia University, New York (Talmasov); Department of Neurology, New York University Langone Medical Center (Kelly, Ecker, Olivera, Lord, Gurin, Ishida, Melmed, Torres, Zhang, Frontera, Lewis)
| | - Lindsey Gurin
- Departments of Neurology and Psychiatry, Columbia University, New York (Talmasov); Department of Neurology, New York University Langone Medical Center (Kelly, Ecker, Olivera, Lord, Gurin, Ishida, Melmed, Torres, Zhang, Frontera, Lewis)
| | - Koto Ishida
- Departments of Neurology and Psychiatry, Columbia University, New York (Talmasov); Department of Neurology, New York University Langone Medical Center (Kelly, Ecker, Olivera, Lord, Gurin, Ishida, Melmed, Torres, Zhang, Frontera, Lewis)
| | - Kara Melmed
- Departments of Neurology and Psychiatry, Columbia University, New York (Talmasov); Department of Neurology, New York University Langone Medical Center (Kelly, Ecker, Olivera, Lord, Gurin, Ishida, Melmed, Torres, Zhang, Frontera, Lewis)
| | - Jose Torres
- Departments of Neurology and Psychiatry, Columbia University, New York (Talmasov); Department of Neurology, New York University Langone Medical Center (Kelly, Ecker, Olivera, Lord, Gurin, Ishida, Melmed, Torres, Zhang, Frontera, Lewis)
| | - Cen Zhang
- Departments of Neurology and Psychiatry, Columbia University, New York (Talmasov); Department of Neurology, New York University Langone Medical Center (Kelly, Ecker, Olivera, Lord, Gurin, Ishida, Melmed, Torres, Zhang, Frontera, Lewis)
| | - Jennifer Frontera
- Departments of Neurology and Psychiatry, Columbia University, New York (Talmasov); Department of Neurology, New York University Langone Medical Center (Kelly, Ecker, Olivera, Lord, Gurin, Ishida, Melmed, Torres, Zhang, Frontera, Lewis)
| | - Ariane Lewis
- Departments of Neurology and Psychiatry, Columbia University, New York (Talmasov); Department of Neurology, New York University Langone Medical Center (Kelly, Ecker, Olivera, Lord, Gurin, Ishida, Melmed, Torres, Zhang, Frontera, Lewis)
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Vinograd I, Souliou SM, Haghighirad AA, Lacmann T, Caplan Y, Frachet M, Merz M, Garbarino G, Liu Y, Nakata S, Ishida K, Noad HML, Minola M, Keimer B, Orgad D, Hicks CW, Le Tacon M. Using strain to uncover the interplay between two- and three-dimensional charge density waves in high-temperature superconducting YBa 2Cu 3O y. Nat Commun 2024; 15:3277. [PMID: 38627407 PMCID: PMC11021565 DOI: 10.1038/s41467-024-47540-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 04/05/2024] [Indexed: 04/19/2024] Open
Abstract
Uniaxial pressure provides an efficient approach to control charge density waves in YBa2Cu3Oy. It can enhance the correlation volume of ubiquitous short-range two-dimensional charge-density-wave correlations, and induces a long-range three-dimensional charge density wave, otherwise only accessible at large magnetic fields. Here, we use x-ray diffraction to study the strain dependence of these charge density waves and uncover direct evidence for a form of competition between them. We show that this interplay is qualitatively described by including strain effects in a nonlinear sigma model of competing superconducting and charge-density-wave orders. Our analysis suggests that strain stabilizes the 3D charge density wave in the regions between disorder-pinned domains of 2D charge density waves, and that the two orders compete at the boundaries of these domains. No signatures of discommensurations nor of pair density waves are observed. From a broader perspective, our results underscore the potential of strain tuning as a powerful tool for probing competing orders in quantum materials.
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Affiliation(s)
- I Vinograd
- Institute for Quantum Materials and Technologies, Karlsruhe Institute of Technology, Kaiserstr. 12, D-76131, Karlsruhe, Germany
- 4th Physical Institute - Solids and Nanostructures, University of Göttingen, D-37077, Göttingen, Germany
| | - S M Souliou
- Institute for Quantum Materials and Technologies, Karlsruhe Institute of Technology, Kaiserstr. 12, D-76131, Karlsruhe, Germany
| | - A-A Haghighirad
- Institute for Quantum Materials and Technologies, Karlsruhe Institute of Technology, Kaiserstr. 12, D-76131, Karlsruhe, Germany
| | - T Lacmann
- Institute for Quantum Materials and Technologies, Karlsruhe Institute of Technology, Kaiserstr. 12, D-76131, Karlsruhe, Germany
| | - Y Caplan
- Racah Institute of Physics, The Hebrew University, Jerusalem, 91904, Israel
| | - M Frachet
- Institute for Quantum Materials and Technologies, Karlsruhe Institute of Technology, Kaiserstr. 12, D-76131, Karlsruhe, Germany
| | - M Merz
- Institute for Quantum Materials and Technologies, Karlsruhe Institute of Technology, Kaiserstr. 12, D-76131, Karlsruhe, Germany
- Karlsruhe Nano Micro Facility (KNMFi), Karlsruhe Institute of Technology, Kaiserstr. 12, D-76131, Karlsruhe, Germany
| | - G Garbarino
- ESRF, The European Synchrotron, 71, avenue des Martyrs, CS 40220, F-38043, Grenoble Cedex 9, France
| | - Y Liu
- Max Planck Institute for Solid State Research, Heisenbergstraße 1, D-70569, Stuttgart, Germany
| | - S Nakata
- Max Planck Institute for Solid State Research, Heisenbergstraße 1, D-70569, Stuttgart, Germany
| | - K Ishida
- Max Planck Institute for Chemical Physics of Solids, Nöthnitzer Str. 40, D-01187, Dresden, Germany
- Institute for Materials Research, Tohoku University, Sendai, 980-8577, Japan
| | - H M L Noad
- Max Planck Institute for Chemical Physics of Solids, Nöthnitzer Str. 40, D-01187, Dresden, Germany
| | - M Minola
- Max Planck Institute for Solid State Research, Heisenbergstraße 1, D-70569, Stuttgart, Germany
| | - B Keimer
- Max Planck Institute for Solid State Research, Heisenbergstraße 1, D-70569, Stuttgart, Germany
| | - D Orgad
- Racah Institute of Physics, The Hebrew University, Jerusalem, 91904, Israel
| | - C W Hicks
- Max Planck Institute for Chemical Physics of Solids, Nöthnitzer Str. 40, D-01187, Dresden, Germany
- School of Physics and Astronomy, University of Birmingham, Birmingham, B15 2TT, UK
| | - M Le Tacon
- Institute for Quantum Materials and Technologies, Karlsruhe Institute of Technology, Kaiserstr. 12, D-76131, Karlsruhe, Germany.
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3
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Melmed KR, Lewis A, Kuohn L, Marmo J, Rossan-Raghunath N, Torres J, Muralidharan R, Lord AS, Ishida K, Frontera JA. Association of Neighborhood Socioeconomic Status With Withdrawal of Life-Sustaining Therapies After Intracerebral Hemorrhage. Neurology 2024; 102:e208039. [PMID: 38237088 DOI: 10.1212/wnl.0000000000208039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/07/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Mortality after intracerebral hemorrhage (ICH) is common. Neighborhood socioeconomic status (nSES) is an important social determinant of health (SDoH) that can affect clinical outcome. We hypothesize that SDoH, including nSES, contribute to differences in withdrawal of life-sustaining therapies (WLSTs) and mortality in patients with ICH. METHODS We performed a retrospective study of patients with ICH at 3 tertiary care hospitals between January 2017 and December 2022 identified through the Get with the Guidelines Database. We collected data on age, clinical severity, race/ethnicity, median household income, insurance, marital status, religion, mortality before discharge, and WLST from the electronic medical record. We assessed for associations between SDoH and WLST, mortality, and poor discharge mRS using Mann-Whitney U tests and χ2 tests. We performed multivariable analysis using backward stepwise logistic regression. RESULTS We identified 868 patients (median age 67 [interquartile range (IQR) 55-78] years; 43% female) with ICH. Of them, 16% were Black non-Hispanic, 17% were Asian, and 15% were of Hispanic ethnicity; 50% were on Medicare and 22% on Medicaid, and the median (IQR) household income was $81,857 ($58,669-$122,078). Mortality occurred in 17% of patients, and of them, 84% of patients had WLST. Patients from zip codes with higher median household incomes had higher incidence of WLST and mortality (p < 0.01). Black non-Hispanic race was associated with lower WLST and discharge mortality (p ≤ 0.01 for both). In multivariable analysis adjusting for age and clinical severity scores, patients who lived in zip codes with high-income levels were more likely to have WLST (adjusted odds ratio [aOR] 1.88; 95% CI 1.29-2.74) and mortality before discharge (aOR 1.5; 95% CI 1.06-2.13). DISCUSSION SDoH, including nSES, are associated with WLST after ICH. This has important implications for the care and management of patients with ICH.
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Affiliation(s)
- Kara R Melmed
- From the Departments of Neurology and Neurosurgery (K.R.M., A.L.), and Neurology (L.K., J.T., R.M., A.S.L., K.I., J.A.F.), NYU Langone Health and NYU Grossman School of Medicine; and Department of Neurology (J.M., N.R.-R.), NYU Langone Health, New York
| | - Ariane Lewis
- From the Departments of Neurology and Neurosurgery (K.R.M., A.L.), and Neurology (L.K., J.T., R.M., A.S.L., K.I., J.A.F.), NYU Langone Health and NYU Grossman School of Medicine; and Department of Neurology (J.M., N.R.-R.), NYU Langone Health, New York
| | - Lindsey Kuohn
- From the Departments of Neurology and Neurosurgery (K.R.M., A.L.), and Neurology (L.K., J.T., R.M., A.S.L., K.I., J.A.F.), NYU Langone Health and NYU Grossman School of Medicine; and Department of Neurology (J.M., N.R.-R.), NYU Langone Health, New York
| | - Joanna Marmo
- From the Departments of Neurology and Neurosurgery (K.R.M., A.L.), and Neurology (L.K., J.T., R.M., A.S.L., K.I., J.A.F.), NYU Langone Health and NYU Grossman School of Medicine; and Department of Neurology (J.M., N.R.-R.), NYU Langone Health, New York
| | - Nirmala Rossan-Raghunath
- From the Departments of Neurology and Neurosurgery (K.R.M., A.L.), and Neurology (L.K., J.T., R.M., A.S.L., K.I., J.A.F.), NYU Langone Health and NYU Grossman School of Medicine; and Department of Neurology (J.M., N.R.-R.), NYU Langone Health, New York
| | - Jose Torres
- From the Departments of Neurology and Neurosurgery (K.R.M., A.L.), and Neurology (L.K., J.T., R.M., A.S.L., K.I., J.A.F.), NYU Langone Health and NYU Grossman School of Medicine; and Department of Neurology (J.M., N.R.-R.), NYU Langone Health, New York
| | - Rajanandini Muralidharan
- From the Departments of Neurology and Neurosurgery (K.R.M., A.L.), and Neurology (L.K., J.T., R.M., A.S.L., K.I., J.A.F.), NYU Langone Health and NYU Grossman School of Medicine; and Department of Neurology (J.M., N.R.-R.), NYU Langone Health, New York
| | - Aaron S Lord
- From the Departments of Neurology and Neurosurgery (K.R.M., A.L.), and Neurology (L.K., J.T., R.M., A.S.L., K.I., J.A.F.), NYU Langone Health and NYU Grossman School of Medicine; and Department of Neurology (J.M., N.R.-R.), NYU Langone Health, New York
| | - Koto Ishida
- From the Departments of Neurology and Neurosurgery (K.R.M., A.L.), and Neurology (L.K., J.T., R.M., A.S.L., K.I., J.A.F.), NYU Langone Health and NYU Grossman School of Medicine; and Department of Neurology (J.M., N.R.-R.), NYU Langone Health, New York
| | - Jennifer A Frontera
- From the Departments of Neurology and Neurosurgery (K.R.M., A.L.), and Neurology (L.K., J.T., R.M., A.S.L., K.I., J.A.F.), NYU Langone Health and NYU Grossman School of Medicine; and Department of Neurology (J.M., N.R.-R.), NYU Langone Health, New York
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4
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von Oiste GG, Sangwon KL, Chung C, Narayan V, Raz E, Shapiro M, Rutledge C, Nelson PK, Ishida K, Torres JL, Rostanski SK, Zhang C, Yaghi S, Riina H, Oermann EK, Nossek E. Use of Carotid Web Angioarchitecture for Stroke Risk Assessment. World Neurosurg 2024; 182:e245-e252. [PMID: 38006939 DOI: 10.1016/j.wneu.2023.11.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 11/19/2023] [Indexed: 11/27/2023]
Abstract
OBJECTIVE To examine the usefulness of carotid web (CW), carotid bifurcation and their combined angioarchitectural measurements in assessing stroke risk. METHODS Anatomic data on the internal carotid artery (ICA), common carotid artery (CCA), and the CW were gathered as part of a retrospective study from symptomatic (stroke) and asymptomatic (nonstroke) patients with CW. We built a model of stroke risk using principal-component analysis, Firth regression trained with 5-fold cross-validation, and heuristic binary cutoffs based on the Minimal Description Length principle. RESULTS The study included 22 patients, with a mean age of 55.9 ± 12.8 years; 72.9% were female. Eleven patients experienced an ischemic stroke. The first 2 principal components distinguished between patients with stroke and patients without stroke. The model showed that ICA-pouch tip angle (P = 0.036), CCA-pouch tip angle (P = 0.036), ICA web-pouch angle (P = 0.036), and CCA web-pouch angle (P = 0.036) are the most important features associated with stroke risk. Conversely, CCA and ICA anatomy (diameter and angle) were not found to be risk factors. CONCLUSIONS This pilot study shows that using data from computed tomography angiography, carotid bifurcation, and CW angioarchitecture may be used to assess stroke risk, allowing physicians to tailor care for each patient according to risk stratification.
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Affiliation(s)
- Grace G von Oiste
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA
| | - Karl L Sangwon
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA.
| | - Charlotte Chung
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA
| | - Vinayak Narayan
- Department of Radiology, NYU Langone Health, New York, New York, USA
| | - Eytan Raz
- Department of Radiology, NYU Langone Health, New York, New York, USA
| | - Maksim Shapiro
- Department of Radiology, NYU Langone Health, New York, New York, USA
| | - Caleb Rutledge
- Department of Radiology, NYU Langone Health, New York, New York, USA
| | - Peter Kim Nelson
- Department of Radiology, NYU Langone Health, New York, New York, USA
| | - Koto Ishida
- Department of Neurology, NYU Langone Health, New York, New York, USA
| | - Jose L Torres
- Department of Neurology, NYU Langone Health, New York, New York, USA
| | - Sara K Rostanski
- Department of Neurology, NYU Langone Health, New York, New York, USA
| | - Cen Zhang
- Department of Neurology, NYU Langone Health, New York, New York, USA
| | - Shadi Yaghi
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Howard Riina
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA
| | - Eric K Oermann
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA
| | - Erez Nossek
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA
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Tokunaga Y, Sakai H, Kambe S, Opletal P, Tokiwa Y, Haga Y, Kitagawa S, Ishida K, Aoki D, Knebel G, Lapertot G, Krämer S, Horvatić M. Longitudinal Spin Fluctuations Driving Field-Reinforced Superconductivity in UTe_{2}. Phys Rev Lett 2023; 131:226503. [PMID: 38101342 DOI: 10.1103/physrevlett.131.226503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/29/2023] [Accepted: 10/18/2023] [Indexed: 12/17/2023]
Abstract
Our measurements of ^{125}Te NMR relaxations reveal an enhancement of electronic spin fluctuations above μ_{0}H^{*}∼15 T, leading to their divergence in the vicinity of the metamagnetic transition at μ_{0}H_{m}≈35 T, below which field-reinforced superconductivity appears when a magnetic field (H) is applied along the crystallographic b axis. The NMR data evidence that these fluctuations are dominantly longitudinal, providing a key to understanding the peculiar superconducting phase diagram in H∥b, where such fluctuations enhance the pairing interactions.
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Affiliation(s)
- Y Tokunaga
- ASRC, Japan Atomic Energy Agency Tokai, Ibaraki 319-1195, Japan
| | - H Sakai
- ASRC, Japan Atomic Energy Agency Tokai, Ibaraki 319-1195, Japan
| | - S Kambe
- ASRC, Japan Atomic Energy Agency Tokai, Ibaraki 319-1195, Japan
| | - P Opletal
- ASRC, Japan Atomic Energy Agency Tokai, Ibaraki 319-1195, Japan
| | - Y Tokiwa
- ASRC, Japan Atomic Energy Agency Tokai, Ibaraki 319-1195, Japan
| | - Y Haga
- ASRC, Japan Atomic Energy Agency Tokai, Ibaraki 319-1195, Japan
| | - S Kitagawa
- Department of Physics, Graduate School of Science, Kyoto University, Kyoto 606-8502, Japan
| | - K Ishida
- Department of Physics, Graduate School of Science, Kyoto University, Kyoto 606-8502, Japan
| | - D Aoki
- IMR, Tohoku University, Ibaraki 311-1313, Japan
- Université Grenoble Alpes, CEA, Grenoble-INP, IRIG, Pheliqs, 38000 Grenoble, France
| | - G Knebel
- Université Grenoble Alpes, CEA, Grenoble-INP, IRIG, Pheliqs, 38000 Grenoble, France
| | - G Lapertot
- Université Grenoble Alpes, CEA, Grenoble-INP, IRIG, Pheliqs, 38000 Grenoble, France
| | - S Krämer
- Laboratoire National des Champs Magnétiques Intenses, LNCMI-CNRS (UPR3228), EMFL, Université Grenoble Alpes, UPS and INSA Toulouse, Boîte Postale 166, 38042 Grenoble Cedex 9, France
| | - M Horvatić
- Laboratoire National des Champs Magnétiques Intenses, LNCMI-CNRS (UPR3228), EMFL, Université Grenoble Alpes, UPS and INSA Toulouse, Boîte Postale 166, 38042 Grenoble Cedex 9, France
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6
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Dogra S, Wang X, Gee JM, Gupta A, Veraart J, Ishida K, Qiu D, Dehkharghani S. Diaschisis Profiles in the Cerebellar Response to Hemodynamic Stimuli: Insights From Dynamic Measurement of Cerebrovascular Reactivity to Identify Occult and Transient Maxima. J Magn Reson Imaging 2023; 58:1462-1469. [PMID: 36995159 DOI: 10.1002/jmri.28648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/31/2023] [Accepted: 01/31/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Crossed cerebellar diaschisis (CCD) refers to depressions in perfusion and metabolism within the cerebellar hemisphere contralateral to supratentorial disease. Prior investigation into CCD in cerebrovascular reactivity (CVR) has been limited to terminal CVR estimations (CVRend ). We recently have demonstrated the presence of unsustained CVR maxima (CVRmax ) using dynamic CVR analysis, offering a fully dynamic characterization of CVR to hemodynamic stimuli. PURPOSE To investigate CCD in CVRmax from dynamic blood oxygen level-dependent (BOLD) MRI, by comparison with conventional CVRend estimation. STUDY TYPE Retrospective. POPULATION A total of 23 patients (median age: 51 years, 10 females) with unilateral chronic steno-occlusive cerebrovascular disease, without prior knowledge of CCD status. FIELD STRENGTH/SEQUENCE A 3-T, T1-weighted magnetization-prepared rapid gradient-echo (MPRAGE) and acetazolamide-augmented BOLD imaging performed with a gradient-echo echo-planar imaging (EPI) sequence. ASSESSMENT A custom denoising pipeline was used to generate BOLD-CVR time signals. CVRend was established using the last minute of the BOLD response relative to the first-minute baseline. Following classification of healthy versus diseased cerebral hemispheres, CVRmax and CVRend were calculated for bilateral cerebral and cerebellar hemispheres. Three independent observers evaluated all data for the presence of CCD. STATISTICAL TESTS Pearson correlations for comparing CVR across hemispheres, two-proportion Z-tests for comparing CCD prevalence, and Wilcoxon signed-rank tests for comparing median CVR. The level of statistical significance was set at P ≤ 0.05. RESULTS CCD-related changes were observed on both CVRend and CVRmax maps, with all CCD+ cases identifiable by inspection of either map. Diseased cerebral and contralateral cerebellar hemispheric CVR correlations in CCD+ patients were stronger when using CVRend (r = 0.728) as compared to CVRmax (r = 0.676). CVR correlations between healthy cerebral hemispheres and contralateral cerebellar hemispheres were stronger for CVRmax (r = 0.739) than for CVRend (r = 0.705). DATA CONCLUSION CCD-related alterations could be observed in CVR examinations. Conventional CVRend may underestimate CVR and could exaggerate CCD. EVIDENCE LEVEL 4. TECHNICAL EFFICACY Stage 3.
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Affiliation(s)
- Siddhant Dogra
- Department of Radiology, New York University Langone Health, New York, New York, USA
| | - Xiuyuan Wang
- Department of Radiology, Weill Cornell Medical College, New York, New York, USA
| | - James Michael Gee
- Department of Radiology, New York University Langone Health, New York, New York, USA
| | - Alejandro Gupta
- Department of Radiology, New York University Langone Health, New York, New York, USA
| | - Jelle Veraart
- Department of Radiology, New York University Langone Health, New York, New York, USA
| | - Koto Ishida
- Department of Neurology, New York University Langone Health, New York, New York, USA
| | - Deqiang Qiu
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia, USA
| | - Seena Dehkharghani
- Department of Radiology, New York University Langone Health, New York, New York, USA
- Department of Neurology, New York University Langone Health, New York, New York, USA
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7
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Noad HML, Ishida K, Li YS, Gati E, Stangier V, Kikugawa N, Sokolov DA, Nicklas M, Kim B, Mazin II, Garst M, Schmalian J, Mackenzie AP, Hicks CW. Giant lattice softening at a Lifshitz transition in Sr 2RuO 4. Science 2023; 382:447-450. [PMID: 37883549 DOI: 10.1126/science.adf3348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 09/16/2023] [Indexed: 10/28/2023]
Abstract
The interplay of electronic and structural degrees of freedom in solids is a topic of intense research. More than 60 years ago, Lifshitz discussed a counterintuitive possibility: lattice softening driven by conduction electrons at topological Fermi surface transitions. The effect that he predicted, however, was small and has not been convincingly observed. Using a piezo-based uniaxial pressure cell to tune the ultraclean metal strontium ruthenate while measuring the stress-strain relationship, we reveal a huge softening of the Young's modulus at a Lifshitz transition of a two-dimensional Fermi surface and show that it is indeed driven entirely by the conduction electrons of the relevant energy band.
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Affiliation(s)
- H M L Noad
- Max Planck Institute for Chemical Physics of Solids, 01187 Dresden, Germany
| | - K Ishida
- Max Planck Institute for Chemical Physics of Solids, 01187 Dresden, Germany
| | - Y-S Li
- Max Planck Institute for Chemical Physics of Solids, 01187 Dresden, Germany
| | - E Gati
- Max Planck Institute for Chemical Physics of Solids, 01187 Dresden, Germany
| | - V Stangier
- Institut für Theorie der Kondensierten Materie, Karlsruher Institut für Technologie, 76131 Karlsruhe, Germany
| | - N Kikugawa
- National Institute for Materials Science, Tsukuba, Ibaraki 305-0003, Japan
| | - D A Sokolov
- Max Planck Institute for Chemical Physics of Solids, 01187 Dresden, Germany
| | - M Nicklas
- Max Planck Institute for Chemical Physics of Solids, 01187 Dresden, Germany
| | - B Kim
- Department of Physics, Kunsan National University, Gunsan 54150, Korea
- Department of Physics, Kyungpook National University, Daegu 41566, Korea
| | - I I Mazin
- Department of Physics and Astronomy, George Mason University, Fairfax, VA 22030, USA
- Quantum Science and Engineering Center, George Mason University, Fairfax, VA 22030, USA
| | - M Garst
- Institut für Theoretische Festkörperphysik, Karlsruher Institut für Technologie, 76131 Karlsruhe, Germany
- Institut für QuantenMaterialien und Technologien, Karlsruher Institut für Technologie, 76131 Karlsruhe, Germany
| | - J Schmalian
- Institut für Theorie der Kondensierten Materie, Karlsruher Institut für Technologie, 76131 Karlsruhe, Germany
- Institut für QuantenMaterialien und Technologien, Karlsruher Institut für Technologie, 76131 Karlsruhe, Germany
| | - A P Mackenzie
- Max Planck Institute for Chemical Physics of Solids, 01187 Dresden, Germany
- Scottish Universities Physics Alliance, School of Physics and Astronomy, University of St Andrews, St Andrews KY16 9SS, UK
| | - C W Hicks
- Max Planck Institute for Chemical Physics of Solids, 01187 Dresden, Germany
- School of Physics and Astronomy, University of Birmingham, Birmingham B15 2TT, UK
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8
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Olivera A, Ecker S, Lord A, Gurin L, Ishida K, Melmed K, Torres J, Zhang C, Frontera J, Lewis A. Factors Associated With Anxiety After Hemorrhagic Stroke. J Neuropsychiatry Clin Neurosci 2023; 36:36-44. [PMID: 37667629 DOI: 10.1176/appi.neuropsych.20220218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
OBJECTIVE A significant number of patients develop anxiety after stroke. The objective of this study was to identify risk factors for anxiety after hemorrhagic stroke that may facilitate diagnosis and treatment. METHODS Patients admitted between January 2015 and February 2021 with nontraumatic hemorrhagic stroke (intracerebral [ICH] or subarachnoid [SAH] hemorrhage) were assessed telephonically 3 and 12 months after stroke with the Quality of Life in Neurological Disorders Anxiety Short Form to evaluate the relationships between poststroke anxiety (T score >50) and preclinical social and neuropsychiatric history, systemic and neurological illness severity, and in-hospital complications. RESULTS Of 71 patients who completed the 3-month assessment, 28 (39%) had anxiety. There was a difference in Glasgow Coma Scale (GCS) scores on admission between patients with anxiety (median=14, interquartile range [IQR]=12-15) and those without anxiety (median=15, IQR=14-15) (p=0.034), and the incidence of anxiety was higher among patients with ICH (50%) than among those with SAH (20%) (p=0.021). Among patients with ICH, anxiety was associated with larger median ICH volume (25 cc [IQR=8-46] versus 8 cc [IQR=3-13], p=0.021) and higher median ICH score (2 [IQR=1-3] versus 1 [IQR=0-1], p=0.037). On multivariable analysis with GCS score, hemorrhage type, and neuropsychiatric history, only hemorrhage type remained significant (odds ratio=3.77, 95% CI=1.19-12.05, p=0.024). Of the 39 patients who completed the 12-month assessment, 12 (31%) had anxiety, and there was a difference in mean National Institutes of Health Stroke Scale scores between patients with (5 [IQR=3-12]) and without (2 [IQR=0-4]) anxiety (p=0.045). There was fair agreement (κ=0.38) between the presence of anxiety at 3 and 12 months. CONCLUSIONS Hemorrhage characteristics and factors assessed with neurological examination on admission are associated with the development of poststroke anxiety.
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Affiliation(s)
- Anlys Olivera
- Departments of Neurology (all authors), Psychiatry (Olivera, Gurin), Neurosurgery (Lord, Melmed, Frontera, Lewis), and Rehabilitation Medicine (Gurin), NYU Langone Medical Center, New York
| | - Sarah Ecker
- Departments of Neurology (all authors), Psychiatry (Olivera, Gurin), Neurosurgery (Lord, Melmed, Frontera, Lewis), and Rehabilitation Medicine (Gurin), NYU Langone Medical Center, New York
| | - Aaron Lord
- Departments of Neurology (all authors), Psychiatry (Olivera, Gurin), Neurosurgery (Lord, Melmed, Frontera, Lewis), and Rehabilitation Medicine (Gurin), NYU Langone Medical Center, New York
| | - Lindsey Gurin
- Departments of Neurology (all authors), Psychiatry (Olivera, Gurin), Neurosurgery (Lord, Melmed, Frontera, Lewis), and Rehabilitation Medicine (Gurin), NYU Langone Medical Center, New York
| | - Koto Ishida
- Departments of Neurology (all authors), Psychiatry (Olivera, Gurin), Neurosurgery (Lord, Melmed, Frontera, Lewis), and Rehabilitation Medicine (Gurin), NYU Langone Medical Center, New York
| | - Kara Melmed
- Departments of Neurology (all authors), Psychiatry (Olivera, Gurin), Neurosurgery (Lord, Melmed, Frontera, Lewis), and Rehabilitation Medicine (Gurin), NYU Langone Medical Center, New York
| | - Jose Torres
- Departments of Neurology (all authors), Psychiatry (Olivera, Gurin), Neurosurgery (Lord, Melmed, Frontera, Lewis), and Rehabilitation Medicine (Gurin), NYU Langone Medical Center, New York
| | - Cen Zhang
- Departments of Neurology (all authors), Psychiatry (Olivera, Gurin), Neurosurgery (Lord, Melmed, Frontera, Lewis), and Rehabilitation Medicine (Gurin), NYU Langone Medical Center, New York
| | - Jennifer Frontera
- Departments of Neurology (all authors), Psychiatry (Olivera, Gurin), Neurosurgery (Lord, Melmed, Frontera, Lewis), and Rehabilitation Medicine (Gurin), NYU Langone Medical Center, New York
| | - Ariane Lewis
- Departments of Neurology (all authors), Psychiatry (Olivera, Gurin), Neurosurgery (Lord, Melmed, Frontera, Lewis), and Rehabilitation Medicine (Gurin), NYU Langone Medical Center, New York
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9
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Inda-Webb ME, Jimenez M, Liu Q, Phan NV, Ahn J, Steiger C, Wentworth A, Riaz A, Zirtiloglu T, Wong K, Ishida K, Fabian N, Jenkins J, Kuosmanen J, Madani W, McNally R, Lai Y, Hayward A, Mimee M, Nadeau P, Chandrakasan AP, Traverso G, Yazicigil RT, Lu TK. Sub-1.4 cm 3 capsule for detecting labile inflammatory biomarkers in situ. Nature 2023; 620:386-392. [PMID: 37495692 DOI: 10.1038/s41586-023-06369-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 06/26/2023] [Indexed: 07/28/2023]
Abstract
Transient molecules in the gastrointestinal tract such as nitric oxide and hydrogen sulfide are key signals and mediators of inflammation. Owing to their highly reactive nature and extremely short lifetime in the body, these molecules are difficult to detect. Here we develop a miniaturized device that integrates genetically engineered probiotic biosensors with a custom-designed photodetector and readout chip to track these molecules in the gastrointestinal tract. Leveraging the molecular specificity of living sensors1, we genetically encoded bacteria to respond to inflammation-associated molecules by producing luminescence. Low-power electronic readout circuits2 integrated into the device convert the light emitted by the encapsulated bacteria to a wireless signal. We demonstrate in vivo biosensor monitoring in the gastrointestinal tract of small and large animal models and the integration of all components into a sub-1.4 cm3 form factor that is compatible with ingestion and capable of supporting wireless communication. With this device, diseases such as inflammatory bowel disease could be diagnosed earlier than is currently possible, and disease progression could be more accurately tracked. The wireless detection of short-lived, disease-associated molecules with our device could also support timely communication between patients and caregivers, as well as remote personalized care.
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Affiliation(s)
- M E Inda-Webb
- Synthetic Biology Group, MIT Synthetic Biology Center, Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
- Research Laboratory of Electronics, Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - M Jimenez
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
- The Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Q Liu
- Electrical and Computer Engineering Department, Boston University, Boston, MA, USA
| | - N V Phan
- The Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - J Ahn
- The Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - C Steiger
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
- The Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - A Wentworth
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
- The Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - A Riaz
- Electrical and Computer Engineering Department, Boston University, Boston, MA, USA
| | - T Zirtiloglu
- Electrical and Computer Engineering Department, Boston University, Boston, MA, USA
| | - K Wong
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - K Ishida
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
- The Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - N Fabian
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
- The Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Division of Comparative Medicine, MIT, Cambridge, MA, USA
| | - J Jenkins
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
- The Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - J Kuosmanen
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
- The Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - W Madani
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
- The Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - R McNally
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Y Lai
- Synthetic Biology Group, MIT Synthetic Biology Center, Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
- Research Laboratory of Electronics, Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - A Hayward
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
- The Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Division of Comparative Medicine, MIT, Cambridge, MA, USA
| | - M Mimee
- Department of Microbiology, Biological Sciences Division and Pritzker School of Molecular Engineering, The University of Chicago, Chicago, IL, USA
| | | | - A P Chandrakasan
- Department of Electrical Engineering and Computer Science, MIT, Cambridge, MA, USA
| | - G Traverso
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA.
- The Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA.
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - R T Yazicigil
- Electrical and Computer Engineering Department, Boston University, Boston, MA, USA.
| | - T K Lu
- Synthetic Biology Group, MIT Synthetic Biology Center, Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA.
- Research Laboratory of Electronics, Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA, USA.
- Senti Biosciences, South San Francisco, CA, USA.
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10
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Čulo M, Licciardello S, Ishida K, Mukasa K, Ayres J, Buhot J, Hsu YT, Imajo S, Qiu MW, Saito M, Uezono Y, Otsuka T, Watanabe T, Kindo K, Shibauchi T, Kasahara S, Matsuda Y, Hussey NE. Expanded quantum vortex liquid regimes in the electron nematic superconductors FeSe 1-xS x and FeSe 1-xTe x. Nat Commun 2023; 14:4150. [PMID: 37438333 DOI: 10.1038/s41467-023-39730-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/21/2023] [Indexed: 07/14/2023] Open
Abstract
The quantum vortex liquid (QVL) is an intriguing state of type-II superconductors in which intense quantum fluctuations of the superconducting (SC) order parameter destroy the Abrikosov lattice even at very low temperatures. Such a state has only rarely been observed, however, and remains poorly understood. One of the key questions is the precise origin of such intense quantum fluctuations and the role of nearby non-SC phases or quantum critical points in amplifying these effects. Here we report a high-field magnetotransport study of FeSe1-xSx and FeSe1-xTex which show a broad QVL regime both within and beyond their respective electron nematic phases. A clear correlation is found between the extent of the QVL and the strength of the superconductivity. This comparative study enables us to identify the essential elements that promote the QVL regime in unconventional superconductors and to demonstrate that the QVL regime itself is most extended wherever superconductivity is weakest.
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Affiliation(s)
- M Čulo
- High Field Magnet Laboratory (HFML-EMFL) and Institute for Molecules and Materials, Radboud University, Toernooiveld 7, 6525, ED, Nijmegen, Netherlands.
- Institut za fiziku, Bijenička cesta 46, HR-10000, Zagreb, Croatia.
| | - S Licciardello
- High Field Magnet Laboratory (HFML-EMFL) and Institute for Molecules and Materials, Radboud University, Toernooiveld 7, 6525, ED, Nijmegen, Netherlands
| | - K Ishida
- Department of Advanced Materials Science, University of Tokyo, Kashiwa, Chiba, 277-8561, Japan
| | - K Mukasa
- Department of Advanced Materials Science, University of Tokyo, Kashiwa, Chiba, 277-8561, Japan
| | - J Ayres
- H. H. Wills Physics Laboratory, University of Bristol, Tyndall Avenue, Bristol, BS8 1TL, UK
| | - J Buhot
- H. H. Wills Physics Laboratory, University of Bristol, Tyndall Avenue, Bristol, BS8 1TL, UK
| | - Y-T Hsu
- High Field Magnet Laboratory (HFML-EMFL) and Institute for Molecules and Materials, Radboud University, Toernooiveld 7, 6525, ED, Nijmegen, Netherlands
- Center for Theory and Computation, National Tsing Hua University, No. 101, Section. 2, Kuang-Fu Road, Hsinchu, 30013, Taiwan
| | - S Imajo
- Institute for Solid State Physics, University of Tokyo, Kashiwa, Chiba, 277-8581, Japan
| | - M W Qiu
- Department of Advanced Materials Science, University of Tokyo, Kashiwa, Chiba, 277-8561, Japan
| | - M Saito
- Department of Advanced Materials Science, University of Tokyo, Kashiwa, Chiba, 277-8561, Japan
| | - Y Uezono
- Graduate School of Science and Technology, Hirosaki University, Hirosaki, Aomori, 036-8561, Japan
| | - T Otsuka
- Graduate School of Science and Technology, Hirosaki University, Hirosaki, Aomori, 036-8561, Japan
| | - T Watanabe
- Graduate School of Science and Technology, Hirosaki University, Hirosaki, Aomori, 036-8561, Japan
| | - K Kindo
- Institute for Solid State Physics, University of Tokyo, Kashiwa, Chiba, 277-8581, Japan
| | - T Shibauchi
- Department of Advanced Materials Science, University of Tokyo, Kashiwa, Chiba, 277-8561, Japan
| | - S Kasahara
- Research Institute for Interdisciplinary Science, Okayama University, 3-1-1 Tsushimanaka, Kita-Ku, Okayama, 700-8530, Japan
| | - Y Matsuda
- Department of Physics, Kyoto University, Sakyo-Ku, Kyoto, 606-8502, Japan
| | - N E Hussey
- High Field Magnet Laboratory (HFML-EMFL) and Institute for Molecules and Materials, Radboud University, Toernooiveld 7, 6525, ED, Nijmegen, Netherlands.
- H. H. Wills Physics Laboratory, University of Bristol, Tyndall Avenue, Bristol, BS8 1TL, UK.
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11
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Gee JM, Wang X, Dogra S, Veraart J, Ishida K, Dehkharghani S. White Matter Cerebrovascular Reactivity: Effects of Microangiopathy and Proximal Occlusions on the Dynamic BOLD Response. medRxiv 2023:2023.05.29.23290700. [PMID: 37398412 PMCID: PMC10312885 DOI: 10.1101/2023.05.29.23290700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Introduction Cerebral microangiopathy often manifests as white matter hyperintensities (WMH) on T2-weighted MR images and is associated with elevated stroke risk. Large vessel steno-occlusive disease (SOD) is also independently associated with stroke risk, however, the interaction of microangiopathy and SOD is not well understood. Cerebrovascular reactivity (CVR) describes the capacity of cerebral circulation to adapt to changes in perfusion pressure and neurovascular demand, and its impairment portends future infarctions. CVR can be measured with blood oxygen level dependent (BOLD) imaging following acetazolamide stimulus (ACZ-BOLD). We studied CVR differences between WMH and normal-appearing white matter (NAWM) in patients with chronic SOD, hypothesizing additive influences upon CVR measured by novel, fully dynamic CVR maxima ( CVR max ). Methods A cross sectional study was conducted to measure per-voxel, per-TR maximal CVR ( CVR max ) using a custom computational pipeline in 23 subjects with angiographically-proven unilateral SOD. WMH and NAWM masks were applied to CVR max maps. White matter was subclassified with respect to the SOD-affected hemisphere, including: i. contralateral NAWM; ii. contralateral WMH iii. ipsilateral NAWM; iv. ipsilateral WMH. CVR max was compared between these groups with a Kruskal-Wallis test followed by a Dunn-Sidak post-hoc test for multiple comparisons. Results 19 subjects (age 50±12 years, 53% female) undergoing 25 examinations met criteria. WMH volume was asymmetric in 16/19 subjects with 13/16 exhibiting higher volumes ipsilateral to SOD. Pairwise comparisons of CVR max between groups was significant with ipsilateral WMH CVR max lower than contralateral NAWM (p=0.015) and contralateral WMH (p=0.003) when comparing in-subject medians and lower than all groups when comparing pooled voxelwise values across all subjects (p<0.0001). No significant relationship between WMH lesion size and CVR max was detected. Conclusion Our results suggest additive effects of microvascular and macrovascular disease upon white matter CVR, but with greater overall effects relating to macrovascular SOD than to apparent microangiopathy. Dynamic ACZ-BOLD presents a promising path towards a quantitative stroke risk imaging biomarker. BACKGROUND Cerebral white matter (WM) microangiopathy manifests as sporadic or sometimes confluent high intensity lesions in MR imaging with T2-weighting, and bears known associations with stroke, cognitive disability, depression and other neurological disorders 1-5 . Deep white matter is particularly susceptible to ischemic injury owing to the deprivation of collateral flow between penetrating arterial territories, and hence deep white matter hyperintensities (WMH) may portend future infarctions 6-8 . The pathophysiology of WMH is variable but commonly includes a cascade of microvascular lipohyalinosis and atherosclerosis together with impaired vascular endothelial and neurogliovascular integrity, leading to blood brain barrier dysfunction, interstitial fluid accumulation, and eventually tissue damage 9-14 . Independent of the microcirculation, cervical and intracranial large vessel steno-occlusive disease (SOD) often results from atheromatous disease and is associated with increased risk of stroke owing to thromboembolic phenomena, hypoperfusion, or combinations thereof 15-17 . White matter disease is more common in the affected hemisphere of patients with asymmetric or unilateral SOD, producing both macroscopic WMH detectable by routine structural MRI, as well as microstructural changes and altered structural connectivity detected by advanced diffusion microstructural imaging 18, 19 . An improved understanding of the interaction of microvascular disease (i.e., WMH) and macrovascular steno-occlusion could better inform stroke risk stratification and guide treatment strategies when coexistent. Cerebrovascular reactivity (CVR) is an autoregulatory adaptation characterized by the capacity of the cerebral circulation to respond to physiological or pharmacological vasodilatory stimuli 20-22 . CVR may be heterogeneous and varies across tissue type and pathological states 1, 16 . Alterations in CVR are associated with elevated stroke risk in SOD patients, although white matter CVR, and in particular the CVR profiles of WMH, are only sparsely studied and not fully understood 1, 23-26 . We have previously employed blood oxygen level dependent (BOLD) imaging following a hemodynamic stimulus with acetazolamide (ACZ) in order to measure CVR (i.e. ACZ-BOLD) 21, 27, 28 . Despite the emergence of ACZ-BOLD as a technique for clinical and experimental use, poor signal-to-noise characteristics of the BOLD effect have generally limited its interpretation to coarse, time-averaged assessment of the terminal ACZ response at arbitrarily prescribed delays following ACZ administration (e.g. 10-20 minutes) 29 . More recently, we have introduced a dedicated computational pipeline to overcome historically intractable signal-to-noise ratio (SNR) limitations of BOLD, enabling fully dynamic characterization of the cerebrovascular response, including identification of previously unreported, unsustained or transient CVR maxima ( CVR max ) following hemodynamic provocation 27, 30 . In this study, we compared such dynamic interrogation of true CVR maxima between WMH and normal appearing white matter (NAWM) among patients with chronic, unilateral SOD in order to quantify their interaction and to assess the hypothesized additive effects of angiographically-evident macrovascular stenoses when intersecting microangiopathic WMH.
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12
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Dogra S, Wang X, Gupta A, Veraart J, Ishida K, Qiu D, Dehkharghani S. Acetazolamide-augmented BOLD MRI to Assess Whole-Brain Cerebrovascular Reactivity in Chronic Steno-occlusive Disease Using Principal Component Analysis. Radiology 2023; 307:e221473. [PMID: 36916889 PMCID: PMC10140639 DOI: 10.1148/radiol.221473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 01/12/2023] [Accepted: 02/10/2023] [Indexed: 03/16/2023]
Abstract
Background Exhaustion of cerebrovascular reactivity (CVR) portends increased stroke risk. Acetazolamide-augmented blood oxygenation level-dependent (BOLD) MRI has been used to estimate CVR, but low signal-to-noise conditions relegate its use to terminal CVR (CVRend) measurements that neglect dynamic features of CVR. Purpose To demonstrate comprehensive characterization of acetazolamide-augmented BOLD MRI response in chronic steno-occlusive disease using a computational framework to precondition signal time courses for dynamic whole-brain CVR analysis. Materials and Methods This study focused on retrospective analysis of consecutive patients with unilateral chronic steno-occlusive disease who underwent acetazolamide-augmented BOLD imaging for recurrent minor stroke or transient ischemic attack at an academic medical center between May 2017 and October 2020. A custom principal component analysis-based denoising pipeline was used to correct spatially varying non-signal-bearing contributions obtained by a local principal component analysis of the MRI time series. Standard voxelwise CVRend maps representing terminal responses were produced and compared with maximal CVR (CVRmax) as isolated from binned (per-repetition time) denoised BOLD time course. A linear mixed-effects model was used to compare CVRmax and CVRend in healthy and diseased hemispheres. Results A total of 23 patients (median age, 51 years; IQR, 42-61, 13 men) who underwent 32 BOLD examinations were included. Processed MRI data showed twofold improvement in signal-to-noise ratio, allowing improved isolation of dynamic characteristics in signal time course for sliding window CVRmax analysis to the level of each BOLD repetition time (approximately 2 seconds). Mean CVRmax was significantly higher than mean CVRend in diseased (5.2% vs 3.8%, P < .01) and healthy (5.5% vs 4.0%, P < .01) hemispheres. Several distinct time-signal signatures were observed, including nonresponsive; delayed/blunted; brisk; and occasionally nonmonotonic time courses with paradoxical features in normal and abnormal tissues (ie, steal and reverse-steal patterns). Conclusion A principal component analysis-based computational framework for analysis of acetazolamide-augmented BOLD imaging can be used to measure unsustained CVRmax through twofold improvements in signal-to-noise ratio. © RSNA, 2023 Supplemental material is available for this article.
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Affiliation(s)
- Siddhant Dogra
- From the Departments of Radiology (S. Dogra, A.G., J.V., S. Dehkharghani) and Neurology (K.I., S. Dehkharghani), New York University Langone Health, 660 First Ave, New York, NY 10016; Department of Radiology, Weill Cornell Medical College, New York, NY (X.W.); and Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (D.Q.)
| | - Xiuyuan Wang
- From the Departments of Radiology (S. Dogra, A.G., J.V., S. Dehkharghani) and Neurology (K.I., S. Dehkharghani), New York University Langone Health, 660 First Ave, New York, NY 10016; Department of Radiology, Weill Cornell Medical College, New York, NY (X.W.); and Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (D.Q.)
| | - Alejandro Gupta
- From the Departments of Radiology (S. Dogra, A.G., J.V., S. Dehkharghani) and Neurology (K.I., S. Dehkharghani), New York University Langone Health, 660 First Ave, New York, NY 10016; Department of Radiology, Weill Cornell Medical College, New York, NY (X.W.); and Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (D.Q.)
| | - Jelle Veraart
- From the Departments of Radiology (S. Dogra, A.G., J.V., S. Dehkharghani) and Neurology (K.I., S. Dehkharghani), New York University Langone Health, 660 First Ave, New York, NY 10016; Department of Radiology, Weill Cornell Medical College, New York, NY (X.W.); and Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (D.Q.)
| | - Koto Ishida
- From the Departments of Radiology (S. Dogra, A.G., J.V., S. Dehkharghani) and Neurology (K.I., S. Dehkharghani), New York University Langone Health, 660 First Ave, New York, NY 10016; Department of Radiology, Weill Cornell Medical College, New York, NY (X.W.); and Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (D.Q.)
| | - Deqiang Qiu
- From the Departments of Radiology (S. Dogra, A.G., J.V., S. Dehkharghani) and Neurology (K.I., S. Dehkharghani), New York University Langone Health, 660 First Ave, New York, NY 10016; Department of Radiology, Weill Cornell Medical College, New York, NY (X.W.); and Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (D.Q.)
| | - Seena Dehkharghani
- From the Departments of Radiology (S. Dogra, A.G., J.V., S. Dehkharghani) and Neurology (K.I., S. Dehkharghani), New York University Langone Health, 660 First Ave, New York, NY 10016; Department of Radiology, Weill Cornell Medical College, New York, NY (X.W.); and Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (D.Q.)
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Yashi M, Suzuki I, Ishida K, Imasato N, Shimoda H, Nakamura G, Hidetoshi K, Takei K, Nishihara D, Kijima T, Kamai T. Nodal tumor burden provides independent predictive value for biochemical recurrence in patients with node-positive prostate cancer after definitive surgery. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00708-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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14
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Dogra S, Wang X, Gee JM, Gupta A, Veraart J, Ishida K, Qiu D, Dehkharghani S. Abstract 137: Diaschisis Profiles In The Hemodynamic Response To Hemodynamic Stimuli: Implications For Cerebellar Normalization In Patients With Steno-occlusive Disease. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Introduction:
Cerebellar hemispheres are commonly used as global references for internal normalization in hemodynamic analysis, including cerebrovascular reactivity (CVR) experiments. We have reported blood oxygen level-dependent (BOLD) MRI coupled acetazolamide for CVR; however, the influence of crossed cerebellar diaschisis (CCD) is understudied in this setting. Importantly, poor signal-to-noise traditionally limits BOLD-CVR to estimation of arbitrary exam conclusions (CVR
end
). We developed a custom computational pipeline for dynamic CVR analysis, permitting unprecedented, dynamic
maximal
CVR (CVR
max
) estimates. We describe CCD in a population of patients with chronic unilateral steno-occlusive disease (uSOD) using CVR
max
.
Methods:
32 acetazolamide-challenge BOLD MRI exams in 23 patients with uSOD were examined using a custom denoising and preprocessing strategy for CVR time-signal analysis.
BOLD
pre
and
BOLD
post
were defined as the average of the respective first and last one-minute BOLD data. CVR
end
was calculated as %CVR=100*(
BOLD
post
–
BOLD
pre
)/
BOLD
pre
. CVR
max
was the maximal, denoised per-voxel value.
CVR
end
and CVR
max
maps were produced. Cerebellar hemispheres ipsilateral and contralateral to the diseased cerebral hemisphere were visually compared for CCD. Pearson correlations were calculated to study CVR
max
and CVR
end
in cerebral and cerebellar hemispheres.
Results:
CCD could be observed in CVR
end
and CVR
max
maps (Figure 1). Significant correlations were observed between healthy cerebral and contralateral cerebellar hemispheres (r=0.5992, p=0.0011 for CVR
max
, r=0.5034, p=0.0054 for CVR
end
). CVR
max
(r=0.4114, p=0.0215) but not CVR
end
(r=-0.085, p=0.6611) showed correlations between diseased cerebral and contralateral cerebellar hemispheres.
Conclusion:
We present novel CVR
max
estimation from dynamic BOLD-MRI, revealing CCD otherwise unrecognized by conventional BOLD-CVR.
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Affiliation(s)
- Siddhant Dogra
- Dept of Radiology, New York Univ Langone Health, New York, NY
| | - Xiuyuan Wang
- Dept of Radiology, Weill Cornell Med College, New York, NY
| | - James M Gee
- Dept of Radiology, New York Univ Langone Health, New York, NY
| | - Alejandro Gupta
- Dept of Radiology, New York Univ Langone Health, New York, NY
| | - Jelle Veraart
- Dept of Radiology, New York Univ Langone Health, New York, NY
| | - Koto Ishida
- Dept of Neurology, New York Univ Langone Health, New York, NY
| | - Deqiang Qiu
- Dept of Radiology and Imaging Sciences, Emory Univ, Atlanta, GA
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15
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Schwamm LH, Kamel H, Granger CB, Piccini JP, Katz JM, Sethi PP, Sidorov EV, Kasner SE, Silverman SB, Merriam TT, Franco N, Ziegler PD, Bernstein RA, Abi-Samra F, Acosta I, Al Balushi A, Al-Awwad A, Alimohammad R, Alkahalifah M, Allred J, Alsorogi M, Arias V, Aroor S, Arora R, Asdaghi N, Asi K, Assar M, Badhwar N, Banchs J, Bansal S, Barrett C, Beaver B, Beldner S, Belt G, Bernabei M, Bernard M, Bhatt N, Black J, Bledsoe D, Bonaguidi H, Bonyak K, Boyd C, Cajavilca C, Caprio F, Carter J, Chancellor B, Chang C, Chaudhary G, Chaudhary S, Cheung P, Ching M, Chinitz L, Chiu D, Chokhawala H, Choudhuri I, Choudry S, Clayton S, Cross J, Cucchiara B, Culpepper A, Daniels J, Dash S, Del Brutto V, Deline C, Delpirou Nouh C, Deo R, Dhamoon M, Dillon G, Donsky A, Doshi A, Downey A, Dukkipati S, Epstein L, Etherton M, Fara M, Fayad PB, Felberg R, Flaster M, Frankel D, Furer S, Gadhia R, Gadient P, Garabelli P, Gibson D, Glotzer T, Goltz D, Gordon D, Graner S, Graybeal D, Grimes MR, Guerrero W, Hanna J, Hao Q, Hasabnis S, Hasan R, Heist EK, Horowitz D, Hourihane JM, Hussein H, Ishida K, Ismail H, Jadonath R, Jamal S, Jamnadas P, Jia J, Johnson M, Jung R, Kalafut M, Kalia J, Kandel A, Kasner S, Katz L, Katz J, Kaur G, Kearney M, Khatib S, Kim S, Kim C, Kipta J, Koch S, Koruth J, Kreger H, Krueger K, Kurian C, LaFranchise E, Lambrakos L, Langan MN, Lee R, Libman R, Lillemoe K, Logan W, Lord A, Lubitz S, Luciano J, Lynch J, Maccaro PC, Magadan A, Magun R, Malik M, Malik A, Manda S, Marulanda-Londono E, Matos Diaz I, Mattera B, McCall-Brown A, Mcclelland N, Meisel K, Memon Z, Mendelson S, Mendoza I, Merriam T, Messe S, Miles WM, Miller M, Mir O, Mitrani R, Morin D, Morris K, Moussavi M, Mowla A, Moye S, Mullen M, Mullins S, Neisen K, Nguyen C, Niazi I, Olson N, Olsovsky G, Ortiz G, Ostrander M, Pakala A, Parker B, Parker M, Passman R, Patel A, Patel A, Pickett RA(D, Polin G, Radoslovich G, Ramano J, Rami T, Ramirez D, Rasmussen J, Ray B, Reddy V, Reddy R, Reeves R, Regenhardt R, Rempe D, Rogers P, Rogers J, Rowe S, Rowley C, Ruff I, Sackett M, Sajjad R, Salem R, Saltzman M, Santangeli P, Saucedo S, Sawyer R, Schaller R, Seeger S, Sethi P, Shang T, Sharma J, Sharma R, Sheinart K, Shukla G, Shultz J, Sidorov E, Silverman S, Simonson J, Singh D, Skalabrin E, Sloane K, Smith M, Smith W, Soik D, Stavrakis S, Stein L, Steinberg JS, Sur N, Switzer D, Talpur N, Tansy A, Tempro K, Thavapalan V, Thomas A, Thomas K, Torres J, Torres L, Tuhrim S, Uddin P, Vidal G, Viswanathan A, Volpi J, Ward K, Weinberger J, Whang W, Wilder M, Willner J, Wright P, Yuan Q, Zhang C, Zhu D, Zide K, Zimmerman J, Zweifler R. Predictors of Atrial Fibrillation in Patients With Stroke Attributed to Large- or Small-Vessel Disease: A Prespecified Secondary Analysis of the STROKE AF Randomized Clinical Trial. JAMA Neurol 2023; 80:99-103. [PMID: 36374508 PMCID: PMC9664367 DOI: 10.1001/jamaneurol.2022.4038] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Importance The Stroke of Known Cause and Underlying Atrial Fibrillation (STROKE AF) trial found that approximately 1 in 8 patients with recent ischemic stroke attributed to large- or small-vessel disease had poststroke atrial fibrillation (AF) detected by an insertable cardiac monitor (ICM) at 12 months. Identifying predictors of AF could be useful when considering an ICM in routine poststroke clinical care. Objective To determine the association between commonly assessed risk factors and poststroke detection of new AF in the STROKE AF cohort monitored by ICM. Design, Setting, and Participants This was a prespecified analysis of a randomized (1:1) clinical trial that enrolled patients between April 1, 2016, and July 12, 2019, with primary follow-up through 2020 and mean (SD) duration of 11.0 (3.0) months. Eligible patients were selected from 33 clinical research sites in the US. Patients had an index stroke attributed to large- or small-vessel disease and were 60 years or older or aged 50 to 59 years with at least 1 additional stroke risk factor. A total of 496 patients were enrolled, and 492 were randomly assigned to study groups (3 did not meet inclusion criteria, and 1 withdrew consent). Patients in the ICM group had the index stroke within 10 days before insertion. Data were analyzed from October 8, 2021, to January 28, 2022. Interventions ICM monitoring vs site-specific usual care (short-duration external cardiac monitoring). Main Outcomes and Measures The ICM device automatically detects AF episodes 2 or more minutes in length; episodes were adjudicated by an expert committee. Cox regression multivariable modeling included all parameters identified in the univariate analysis having P values <.10. AF detection rates were calculated using Kaplan-Meier survival estimates. Results The analysis included the 242 participants randomly assigned to the ICM group in the STROKE AF study. Among 242 patients monitored with ICM, 27 developed AF (mean [SD] age, 66.6 [9.3] years; 144 men [60.0%]; 96 [40.0%] women). Two patients had missing baseline data and exited the study early. Univariate predictors of AF detection included age (per 1-year increments: hazard ratio [HR], 1.05; 95% CI, 1.01-1.09; P = .02), CHA2DS2-VASc score (per point: HR, 1.54; 95% CI, 1.15-2.06; P = .004), chronic obstructive pulmonary disease (HR, 2.49; 95% CI, 0.86-7.20; P = .09), congestive heart failure (CHF; with preserved or reduced ejection fraction: HR, 6.64; 95% CI, 2.29-19.24; P < .001), left atrial enlargement (LAE; HR, 3.63; 95% CI, 1.55-8.47; P = .003), QRS duration (HR, 1.02; 95% CI, 1.00-1.04; P = .04), and kidney dysfunction (HR, 3.58; 95% CI, 1.35-9.46; P = .01). In multivariable modeling (n = 197), only CHF (HR, 5.06; 95% CI, 1.45-17.64; P = .05) and LAE (HR, 3.32; 1.34-8.19; P = .009) remained significant predictors of AF. At 12 months, patients with CHF and/or LAE (40 of 142 patients) had an AF detection rate of 23.4% vs 5.0% for patients with neither (HR, 5.1; 95% CI, 2.0-12.8; P < .001). Conclusions and Relevance Among patients with ischemic stroke attributed to large- or small-vessel disease, CHF and LAE were associated with a significantly increased risk of poststroke AF detection. These patients may benefit most from the use of ICMs as part of a secondary stroke prevention strategy. However, the study was not powered for clinical predictors of AF, and therefore, other clinical characteristics may not have reached statistical significance. Trial Registration ClinicalTrials.gov Identifier: NCT02700945.
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Affiliation(s)
- Lee H. Schwamm
- Department of Neurology, Massachusetts General Hospital, Boston
| | - Hooman Kamel
- Department of Neurology, Weill Cornell Medicine, New York, New York,Deputy Editor, JAMA Neurology
| | - Christopher B. Granger
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Jonathan P. Piccini
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Jeffrey M. Katz
- Department of Neurology and Radiology, North Shore University Hospital, Manhasset, New York
| | - Pramod P. Sethi
- Guilford Neurology Associates, Moses H. Cone Hospital, Greensboro, North Carolina
| | - Evgeny V. Sidorov
- Department of Neurology, The University of Oklahoma Health Sciences Center, Oklahoma City
| | - Scott E. Kasner
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | | | - Noreli Franco
- Clinical Department, Medtronic, Minneapolis, Minnesota
| | | | - Richard A. Bernstein
- Davee Department of Neurology, Feinberg School of Medicine of Northwestern University, Chicago, Illinois
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16
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Krieger P, Zhao A, Croll L, Irvine H, Torres J, Melmed KR, Lord A, Ishida K, Frontera J, Lewis A. Tachycardia is associated with mortality and functional outcome after thrombectomy for acute ischemic stroke. J Stroke Cerebrovasc Dis 2022; 31:106450. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/02/2022] [Accepted: 03/12/2022] [Indexed: 10/18/2022] Open
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17
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Ecker S, Lord A, Gurin L, Olivera A, Ishida K, Melmed K, Torres J, Zhang C, Frontera J, Lewis A. Psychological Outcome after Hemorrhagic Stroke is Related to Functional Status. J Stroke Cerebrovasc Dis 2022; 31:106492. [PMID: 35594604 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/07/2022] [Accepted: 04/03/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND To identify opportunities to improve morbidity after hemorrhagic stroke, it is imperative to understand factors that are related to psychological outcome. DESIGN/METHODS We prospectively identified patients with non-traumatic hemorrhagic stroke (intracerebral or subarachnoid hemorrhage) between January 2015 and February 2021 who were alive 3-months after discharge and telephonically assessed 1) psychological outcome using the Quality of Life in Neurological Disorders anxiety, depression, emotional and behavioral dyscontrol, fatigue and sleep disturbance inventories and 2) functional outcome using the modified Rankin Scale (mRS) and Barthel Index. We also identified discharge destination for all patients. We then evaluated the relationship between abnormal psychological outcomes (T-score >50) and discharge destination other than home, poor 3-month mRS score defined as 3-5 and poor 3-month Barthel Index defined as <100. RESULTS 73 patients were included; 41 (56%) had an abnormal psychological outcome on at least one inventory. There were 41 (56%) patients discharged to a destination other than home, 44 (63%) with poor mRS score and 28 (39%) with poor Barthel Index. Anxiety, depression, emotional and behavioral dyscontrol and sleep disturbance were all associated with a destination other than home, poor mRS score, and poor Barthel Index (all p<0.05). Fatigue was related to poor mRS score and poor Barthel Index (p=0.005 and p=0.006, respectively). CONCLUSION Multiple psychological outcomes 3-months after hemorrhagic stroke are related to functional status. Interventions to improve psychological outcome and reduce morbidity in patients with poor functional status should be explored by the interdisciplinary team.
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Affiliation(s)
- Sarah Ecker
- NYU Langone Medical Center, Department of Neurology, NY 10016, New York
| | - Aaron Lord
- NYU Langone Medical Center, Department of Neurology, NY 10016, New York; NYU Langone Medical Center, Department of Neurosurgery, NY 10016, New York
| | - Lindsey Gurin
- NYU Langone Medical Center, Department of Neurology, NY 10016, New York; NYU Langone Medical Center, Department of Psychiatry, NY 10016, New York; NYU Langone Medical Center, Department of Rehabilitation Medicine, NY 10016, New York
| | - Anlys Olivera
- NYU Langone Medical Center, Department of Neurology, NY 10016, New York; NYU Langone Medical Center, Department of Psychiatry, NY 10016, New York
| | - Koto Ishida
- NYU Langone Medical Center, Department of Neurology, NY 10016, New York
| | - Kara Melmed
- NYU Langone Medical Center, Department of Neurology, NY 10016, New York; NYU Langone Medical Center, Department of Neurosurgery, NY 10016, New York
| | - Jose Torres
- NYU Langone Medical Center, Department of Neurology, NY 10016, New York
| | - Cen Zhang
- NYU Langone Medical Center, Department of Neurology, NY 10016, New York
| | - Jennifer Frontera
- NYU Langone Medical Center, Department of Neurology, NY 10016, New York; NYU Langone Medical Center, Department of Neurosurgery, NY 10016, New York
| | - Ariane Lewis
- NYU Langone Medical Center, Department of Neurology, NY 10016, New York; NYU Langone Medical Center, Department of Neurosurgery, NY 10016, New York.
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18
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Kinjo K, Manago M, Kitagawa S, Mao ZQ, Yonezawa S, Maeno Y, Ishida K. Superconducting spin smecticity evidencing the Fulde-Ferrell-Larkin-Ovchinnikov state in Sr 2RuO 4. Science 2022; 376:397-400. [PMID: 35446631 DOI: 10.1126/science.abb0332] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Translational symmetry breaking is antagonistic to static fluidity but can be realized in superconductors, which host a quantum-mechanical coherent fluid formed by electron pairs. A peculiar example of such a state is the Fulde-Ferrell-Larkin-Ovchinnikov (FFLO) state, induced by a time-reversal symmetry-breaking magnetic field applied to spin-singlet superconductors. This state is intrinsically accompanied by the superconducting spin smecticity, spin density-modulated fluidity with spontaneous translational-symmetry breaking. Detection of such spin smecticity provides unambiguous evidence for the FFLO state, but its observation has been challenging. Here, we report the characteristic "double-horn" nuclear magnetic resonance spectrum in the layered superconductor Sr2RuO4 near its upper critical field, indicating the spatial sinusoidal modulation of spin density that is consistent with superconducting spin smecticity. Our work reveals that Sr2RuO4 provides a versatile platform for studying FFLO physics.
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Affiliation(s)
- K Kinjo
- Department of Physics, Graduate School of Science, Kyoto University, Kyoto, Japan
| | - M Manago
- Department of Physics, Graduate School of Science, Kyoto University, Kyoto, Japan
| | | | - Z Q Mao
- Department of Physics, Pennsylvania State University, State College, PA, USA
| | - S Yonezawa
- Department of Physics, Graduate School of Science, Kyoto University, Kyoto, Japan
| | - Y Maeno
- Department of Physics, Graduate School of Science, Kyoto University, Kyoto, Japan
| | - K Ishida
- Department of Physics, Graduate School of Science, Kyoto University, Kyoto, Japan
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19
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Aoki D, Brison JP, Flouquet J, Ishida K, Knebel G, Tokunaga Y, Yanase Y. Unconventional superconductivity in UTe 2. J Phys Condens Matter 2022; 34:243002. [PMID: 35203074 DOI: 10.1088/1361-648x/ac5863] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 02/24/2022] [Indexed: 06/14/2023]
Abstract
The novel spin-triplet superconductor candidate UTe2was discovered only recently at the end of 2018 and already attracted enormous attention. We review key experimental and theoretical progress which has been achieved in different laboratories. UTe2is a heavy-fermion paramagnet, but following the discovery of superconductivity, it has been expected to be close to a ferromagnetic instability, showing many similarities to the U-based ferromagnetic superconductors, URhGe and UCoGe. This view might be too simplistic. The competition between different types of magnetic interactions and the duality between the local and itinerant character of the 5fUranium electrons, as well as the shift of the U valence appear as key parameters in the rich phase diagrams discovered recently under extreme conditions like low temperature, high magnetic field, and pressure. We discuss macroscopic and microscopic experiments at low temperature to clarify the normal phase properties at ambient pressure for field applied along the three axis of this orthorhombic structure. Special attention will be given to the occurrence of a metamagnetic transition atHm= 35 T for a magnetic field applied along the hard magnetic axisb. Adding external pressure leads to strong changes in the magnetic and electronic properties with a direct feedback on superconductivity. Attention is paid on the possible evolution of the Fermi surface as a function of magnetic field and pressure. Superconductivity in UTe2is extremely rich, exhibiting various unconventional behaviors which will be highlighted. It shows an exceptionally huge superconducting upper critical field with a re-entrant behavior under magnetic field and the occurrence of multiple superconducting phases in the temperature-field-pressure phase diagrams. There is evidence for spin-triplet pairing. Experimental indications exist for chiral superconductivity and spontaneous time reversal symmetry breaking in the superconducting state. Different theoretical approaches will be described. Notably we discuss that UTe2is a possible example for the realization of a fascinating topological superconductor. Exploring superconductivity in UTe2reemphasizes that U-based heavy fermion compounds give unique examples to study and understand the strong interplay between the normal and superconducting properties in strongly correlated electron systems.
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Affiliation(s)
- D Aoki
- IMR, Tohoku University, Oarai, Ibaraki, 311-1313, Japan
| | - J-P Brison
- Univ. Grenoble Alpes, CEA, Grenoble INP, IRIG, PHELIQS, F-38000 Grenoble, France
| | - J Flouquet
- Univ. Grenoble Alpes, CEA, Grenoble INP, IRIG, PHELIQS, F-38000 Grenoble, France
| | - K Ishida
- Department of Physics, Kyoto University, Kyoto 606-8502, Japan
| | - G Knebel
- Univ. Grenoble Alpes, CEA, Grenoble INP, IRIG, PHELIQS, F-38000 Grenoble, France
| | - Y Tokunaga
- ASRC, Japan Atomic Energy Agency, Tokai, Ibaraki 319-1195, Japan
| | - Y Yanase
- Department of Physics, Graduate School of Science, Kyoto University, Kyoto 606-8502, Japan
- Institute for Molecular Science, Okazaki 444-8585, Japan
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20
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Yang D, Gutierrez J, Cutting SM, Raz E, Gurel K, Torres JL, Mac Grory B, Scher E, Pirooz S, de Havenon AH, Ishida K, Furie K, Elkind MS, Yaghi S. Abstract TP96: Mild Luminal Stenosis Of Parent Artery And Neurologic Deterioration After Acute Lacunar Stroke. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.tp96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Neurologic deterioration (ND) occurs in a quarter of acute lacunar infarcts and may lead to severe disability, but underlying pathophysiology of ND remains poorly understood. We sought to identify risk factors and clinical characteristics associated with ND.
Methods:
This retrospective observational study included consecutive patients with acute lacunar stroke admitted to New York University Langone Health and Brown University (NYU/Brown). Lacunar stroke was defined as a subcortical infarct <1.5 cm on CT or <2 cm on diffusion-weighted imaging without significant stenosis (>50%) in the parent vessel and no cardioembolic source. We defined ND as any neurologic deterioration referable to the lacunar stroke and not related to a medical or non-cerebrovascular neurological complication. We used logistic regression analyses to determine associations between ND and luminal stenosis (<50%) vs no luminal stenosis, after adjustment for key confounders. Furthermore, we attempted to validate findings using the Columbia University (CU) stroke registry and perform a meta-analysis combining the derivation and validation groups due to expected small samples and event rates.
Results:
The NYU/Brown sample included 205 patients, of whom 41 (20%) had ND. In adjusted models, we found no definite association between luminal stenosis and ND (aOR 1.74, 95% CI 0.73-4.14). From CU, 361 total patients were included, of whom 59 (16%) had ND. In adjusted models, we found an association between luminal stenosis and ND (aOR 2.28 95% CI 1.15-4.50). Meta-analysis of both cohorts found luminal stenosis associated with ND (RR [95% CI]: 1.75 [1.23-2.49]).
Conclusions:
In this multi-center study, luminal stenosis (<50%) may be associated with ND following an acute lacunar infarct. Larger studies using high-resolution vascular imaging modalities such as vessel wall imaging are needed to validate our findings.
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Affiliation(s)
| | | | | | | | | | | | | | - Erica Scher
- Interventional Neuro Associates, Bergenfield, NJ
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21
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Melmed KR, Rossan-Raghunath N, Worley S, Dessy A, Bauman K, Floyd K, Palaychuk N, Lewis A, Ishida K, Frontera J, Lord A, Torres J. Abstract WMP56: Delay To Stroke Diagnosis In Patients That Require The Use Of An Interpreter. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.wmp56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Delay to stroke diagnosis can postpone appropriate treatment leading to worse outcomes. We hypothesize that interpreter use can contribute to a delay to treatment.
Methods:
We identified consecutive patients between January 2019 and June 2021 with acute stroke (hemorrhagic or ischemic) using the Get with the Guidelines Database (GWTG). We determined the requirement for interpreter via chart review. We assessed time from last known well (LKW) to CT. We also looked at time to treatment, defined as the time from LKW to tPA administration or groin puncture. Finally, we assessed the difference in outcomes in patients using discharge modified Rankin Score (mRS). We compared these values for patients that did and did not require the use of an interpreter.
Results:
We identified 2,576 patients from GWTG and found 1,306 patients (mean age 69±16, 48% female) with acute stroke notifications. The majority (78%) of these patients were diagnosed with ischemic stroke. For patients presenting with an acute stroke, 27% required interpreter use. For patients who required an interpreter, Spanish (28%), Russian (21%) and Cantonese (18%) were the most common primary language. Compared to patients who spoke English, patients with interpreter requirements were older (73±13 years vs 68±16 years) and had a higher median NIHSS admission score (8[3-18] vs 4[2-13]), p<.05 for both. There was no difference in arrival time to stroke code activation. However median time to CT [IQR] from LKW was longer for patients who required an interpreter (334 minutes [121-955] vs. 274 minutes [106-765], p=.03). Patients who required an interpreter were less likely to get tPA (15% vs 24%, p=.05), and had a longer time between LKW and treatment (60 minutes [36-85] vs 48 [31-75], p=.02). Patients who required an interpreter had a higher discharge mRS (3 [1-4] vs 2 [1-4], p=.02).
Discussion:
Interpreter requirement was associated with longer time to stroke diagnosis, reflecting a pre-hospital delay in the identification of stroke symptoms, despite the higher NIHSS. These patients were less likely to receive tPA and had a higher discharge mRS. Interpreter requirement merits consideration for systemic changes that might prevent this health care administration disparity.
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22
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Palaychuk N, Changa A, Dogra S, Wei J, Lewis A, Lord A, Ishida K, Zhang C, Czeisler BM, Torres JL, Frontera J, Dehkharghani S, Melmed KR. Abstract TP99: Hemorrhagic Conversion Of Ischemic Stroke Is Associated With Hematoma Expansion. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.tp99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives:
Hemorrhagic conversion of ischemic stroke (HCIS) is a common complication of cerebral ischemia and is associated with worse stroke outcomes. Differentiation between HCIS and other causes of intracerebral hemorrhage (ICH) can be challenging in practice. We sought to determine whether imaging features of hematoma expansion (HE) can be used to discriminate HCIS from other etiologies of ICH.
Materials and Methods:
We performed a retrospective review of patients admitted to two large urban hospitals between 2015-2020 with non-traumatic ICH and at least two head CTs within the initial 24 hours and brain MRI prior to discharge to assist with etiology identification. ICH etiology was determined by expert consensus. HE was defined as ≥6 mL and/or ≥33% growth between the first and second scan. Clinical and imaging covariates were studied using univariable and multivariable regression to assess the relationship between cause of intracerebral hemorrhage and HE. We evaluated whether HE was associated with functional status on discharge.
Results:
258 patients (median age 66 [51-76], 43% female) met our inclusion criteria including 37 (14%) with HCIS as the presumed cause of hemorrhage. Etiology for ICH was hypertensive in 29%, vascular in 27%, and cerebral amyloid angiopathy in 13%. HE occurred in 11/37 (30%) patients with HCIS, and in 33/221(15%) patients with other causes (p= 0.04). History of anticoagulation use was more frequent in patients with HCIS (24% vs 11%, p= 0.04), although there was no significant difference in admission INR or platelet count. There was no difference in age, admission systolic blood pressure, admission hematoma size or ICH score between groups. HCIS was significantly associated with HE (OR 2.4, CI 1.08-5.34, p=0.03) on univariable analysis. When controlling for hematoma size and anticoagulant use, the relationship between HCIS and HE remained significant (aOR 2.68, CI 1.17-6.13, p=0.02). Patients with HCIS had a higher modified Rankin scale on discharge when compared to those with ICH due to other causes ((mRS 5 [4-5.5] vs. mRS 4 [2-4], p<0.001).
Conclusion:
HE within the first 24 hours is more common in HCIS than in other etiologies of ICH. Imaging signatures of HE may be contributory towards determining ICH etiology.
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Raz E, Shapiro M, Shepherd TM, Nossek E, Yaghi S, Gold DM, Ishida K, Rucker JC, Belinsky I, Kim E, Grory BM, Mir O, Hagiwara M, Agarwal S, Young MG, Galetta SL, Nelson PK. Central Retinal Artery Visualization with Cone-Beam CT Angiography. Radiology 2021; 302:419-424. [PMID: 34783593 DOI: 10.1148/radiol.2021210520] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background There are multiple tools available to visualize the retinal and choroidal vasculature of the posterior globe. However, there are currently no reliable in vivo imaging techniques that can visualize the entire retrobulbar course of the retinal and ciliary vessels. Purpose To identify and characterize the central retinal artery (CRA) using cone-beam CT (CBCT) images obtained as part of diagnostic cerebral angiography. Materials and Methods In this retrospective study, patients with catheter DSA performed between October 2019 and October 2020 were included if CBCT angiography included the orbit in the field of view. The CBCT angiography data sets were postprocessed with a small field-of-view volume centered in the posterior globe to a maximum resolution of 0.2 mm. The following were evaluated: CRA origin, CRA course, CRA point of penetration into the optic nerve sheath, bifurcation of the CRA at the papilla, visualization of anatomic variants, and visualization of the central retinal vein. Descriptive statistical analysis was performed. Results Twenty-one patients with 24 visualized orbits were included in the analysis (mean age, 55 years ± 15; 14 women). Indications for angiography were as follows: diagnostic angiography (n = 8), aneurysm treatment (n = 6), or other (n = 7). The CRA was identified in all orbits; the origin, course, point of penetration of the CRA into the optic nerve sheath, and termination in the papilla were visualized in all orbits. The average length of the intraneural segment was 10.6 mm (range, 7-18 mm). The central retinal vein was identified in six of 24 orbits. Conclusion Cone-beam CT, performed during diagnostic angiography, consistently demonstrated the in vivo central retinal artery, demonstrating excellent potential for multiple diagnostic and therapeutic applications. © RSNA, 2021 Online supplemental material is available for this article.
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Affiliation(s)
- Eytan Raz
- From the Departments of Radiology (E.R., M.S., T.M.S., O.M., M.H., M.G.Y., P.K.N.), Neurology (M.S., S.Y., D.M.G., K.I., J.C.R., S.A., S.L.G.), Neurosurgery (E.N., P.K.N.), and Ophthalmology (J.C.R., I.B., E.K., S.L.G.), Bernard and Irene Schwartz Neurointerventional Section (E.R., M.S., P.K.N.), NYU Langone Health, 660 First Ave, 7th Floor, New York, NY 10016; Department of Neurology, Brown University, Providence, RI (S.Y.); and Department of Neurology, Duke University School of Medicine, Durham, NC (B.M.G.)
| | - Maksim Shapiro
- From the Departments of Radiology (E.R., M.S., T.M.S., O.M., M.H., M.G.Y., P.K.N.), Neurology (M.S., S.Y., D.M.G., K.I., J.C.R., S.A., S.L.G.), Neurosurgery (E.N., P.K.N.), and Ophthalmology (J.C.R., I.B., E.K., S.L.G.), Bernard and Irene Schwartz Neurointerventional Section (E.R., M.S., P.K.N.), NYU Langone Health, 660 First Ave, 7th Floor, New York, NY 10016; Department of Neurology, Brown University, Providence, RI (S.Y.); and Department of Neurology, Duke University School of Medicine, Durham, NC (B.M.G.)
| | - Timothy M Shepherd
- From the Departments of Radiology (E.R., M.S., T.M.S., O.M., M.H., M.G.Y., P.K.N.), Neurology (M.S., S.Y., D.M.G., K.I., J.C.R., S.A., S.L.G.), Neurosurgery (E.N., P.K.N.), and Ophthalmology (J.C.R., I.B., E.K., S.L.G.), Bernard and Irene Schwartz Neurointerventional Section (E.R., M.S., P.K.N.), NYU Langone Health, 660 First Ave, 7th Floor, New York, NY 10016; Department of Neurology, Brown University, Providence, RI (S.Y.); and Department of Neurology, Duke University School of Medicine, Durham, NC (B.M.G.)
| | - Erez Nossek
- From the Departments of Radiology (E.R., M.S., T.M.S., O.M., M.H., M.G.Y., P.K.N.), Neurology (M.S., S.Y., D.M.G., K.I., J.C.R., S.A., S.L.G.), Neurosurgery (E.N., P.K.N.), and Ophthalmology (J.C.R., I.B., E.K., S.L.G.), Bernard and Irene Schwartz Neurointerventional Section (E.R., M.S., P.K.N.), NYU Langone Health, 660 First Ave, 7th Floor, New York, NY 10016; Department of Neurology, Brown University, Providence, RI (S.Y.); and Department of Neurology, Duke University School of Medicine, Durham, NC (B.M.G.)
| | - Shadi Yaghi
- From the Departments of Radiology (E.R., M.S., T.M.S., O.M., M.H., M.G.Y., P.K.N.), Neurology (M.S., S.Y., D.M.G., K.I., J.C.R., S.A., S.L.G.), Neurosurgery (E.N., P.K.N.), and Ophthalmology (J.C.R., I.B., E.K., S.L.G.), Bernard and Irene Schwartz Neurointerventional Section (E.R., M.S., P.K.N.), NYU Langone Health, 660 First Ave, 7th Floor, New York, NY 10016; Department of Neurology, Brown University, Providence, RI (S.Y.); and Department of Neurology, Duke University School of Medicine, Durham, NC (B.M.G.)
| | - Doria M Gold
- From the Departments of Radiology (E.R., M.S., T.M.S., O.M., M.H., M.G.Y., P.K.N.), Neurology (M.S., S.Y., D.M.G., K.I., J.C.R., S.A., S.L.G.), Neurosurgery (E.N., P.K.N.), and Ophthalmology (J.C.R., I.B., E.K., S.L.G.), Bernard and Irene Schwartz Neurointerventional Section (E.R., M.S., P.K.N.), NYU Langone Health, 660 First Ave, 7th Floor, New York, NY 10016; Department of Neurology, Brown University, Providence, RI (S.Y.); and Department of Neurology, Duke University School of Medicine, Durham, NC (B.M.G.)
| | - Koto Ishida
- From the Departments of Radiology (E.R., M.S., T.M.S., O.M., M.H., M.G.Y., P.K.N.), Neurology (M.S., S.Y., D.M.G., K.I., J.C.R., S.A., S.L.G.), Neurosurgery (E.N., P.K.N.), and Ophthalmology (J.C.R., I.B., E.K., S.L.G.), Bernard and Irene Schwartz Neurointerventional Section (E.R., M.S., P.K.N.), NYU Langone Health, 660 First Ave, 7th Floor, New York, NY 10016; Department of Neurology, Brown University, Providence, RI (S.Y.); and Department of Neurology, Duke University School of Medicine, Durham, NC (B.M.G.)
| | - Janet C Rucker
- From the Departments of Radiology (E.R., M.S., T.M.S., O.M., M.H., M.G.Y., P.K.N.), Neurology (M.S., S.Y., D.M.G., K.I., J.C.R., S.A., S.L.G.), Neurosurgery (E.N., P.K.N.), and Ophthalmology (J.C.R., I.B., E.K., S.L.G.), Bernard and Irene Schwartz Neurointerventional Section (E.R., M.S., P.K.N.), NYU Langone Health, 660 First Ave, 7th Floor, New York, NY 10016; Department of Neurology, Brown University, Providence, RI (S.Y.); and Department of Neurology, Duke University School of Medicine, Durham, NC (B.M.G.)
| | - Irina Belinsky
- From the Departments of Radiology (E.R., M.S., T.M.S., O.M., M.H., M.G.Y., P.K.N.), Neurology (M.S., S.Y., D.M.G., K.I., J.C.R., S.A., S.L.G.), Neurosurgery (E.N., P.K.N.), and Ophthalmology (J.C.R., I.B., E.K., S.L.G.), Bernard and Irene Schwartz Neurointerventional Section (E.R., M.S., P.K.N.), NYU Langone Health, 660 First Ave, 7th Floor, New York, NY 10016; Department of Neurology, Brown University, Providence, RI (S.Y.); and Department of Neurology, Duke University School of Medicine, Durham, NC (B.M.G.)
| | - Eleanore Kim
- From the Departments of Radiology (E.R., M.S., T.M.S., O.M., M.H., M.G.Y., P.K.N.), Neurology (M.S., S.Y., D.M.G., K.I., J.C.R., S.A., S.L.G.), Neurosurgery (E.N., P.K.N.), and Ophthalmology (J.C.R., I.B., E.K., S.L.G.), Bernard and Irene Schwartz Neurointerventional Section (E.R., M.S., P.K.N.), NYU Langone Health, 660 First Ave, 7th Floor, New York, NY 10016; Department of Neurology, Brown University, Providence, RI (S.Y.); and Department of Neurology, Duke University School of Medicine, Durham, NC (B.M.G.)
| | - Brian Mac Grory
- From the Departments of Radiology (E.R., M.S., T.M.S., O.M., M.H., M.G.Y., P.K.N.), Neurology (M.S., S.Y., D.M.G., K.I., J.C.R., S.A., S.L.G.), Neurosurgery (E.N., P.K.N.), and Ophthalmology (J.C.R., I.B., E.K., S.L.G.), Bernard and Irene Schwartz Neurointerventional Section (E.R., M.S., P.K.N.), NYU Langone Health, 660 First Ave, 7th Floor, New York, NY 10016; Department of Neurology, Brown University, Providence, RI (S.Y.); and Department of Neurology, Duke University School of Medicine, Durham, NC (B.M.G.)
| | - Osman Mir
- From the Departments of Radiology (E.R., M.S., T.M.S., O.M., M.H., M.G.Y., P.K.N.), Neurology (M.S., S.Y., D.M.G., K.I., J.C.R., S.A., S.L.G.), Neurosurgery (E.N., P.K.N.), and Ophthalmology (J.C.R., I.B., E.K., S.L.G.), Bernard and Irene Schwartz Neurointerventional Section (E.R., M.S., P.K.N.), NYU Langone Health, 660 First Ave, 7th Floor, New York, NY 10016; Department of Neurology, Brown University, Providence, RI (S.Y.); and Department of Neurology, Duke University School of Medicine, Durham, NC (B.M.G.)
| | - Mari Hagiwara
- From the Departments of Radiology (E.R., M.S., T.M.S., O.M., M.H., M.G.Y., P.K.N.), Neurology (M.S., S.Y., D.M.G., K.I., J.C.R., S.A., S.L.G.), Neurosurgery (E.N., P.K.N.), and Ophthalmology (J.C.R., I.B., E.K., S.L.G.), Bernard and Irene Schwartz Neurointerventional Section (E.R., M.S., P.K.N.), NYU Langone Health, 660 First Ave, 7th Floor, New York, NY 10016; Department of Neurology, Brown University, Providence, RI (S.Y.); and Department of Neurology, Duke University School of Medicine, Durham, NC (B.M.G.)
| | - Shashank Agarwal
- From the Departments of Radiology (E.R., M.S., T.M.S., O.M., M.H., M.G.Y., P.K.N.), Neurology (M.S., S.Y., D.M.G., K.I., J.C.R., S.A., S.L.G.), Neurosurgery (E.N., P.K.N.), and Ophthalmology (J.C.R., I.B., E.K., S.L.G.), Bernard and Irene Schwartz Neurointerventional Section (E.R., M.S., P.K.N.), NYU Langone Health, 660 First Ave, 7th Floor, New York, NY 10016; Department of Neurology, Brown University, Providence, RI (S.Y.); and Department of Neurology, Duke University School of Medicine, Durham, NC (B.M.G.)
| | - Matthew G Young
- From the Departments of Radiology (E.R., M.S., T.M.S., O.M., M.H., M.G.Y., P.K.N.), Neurology (M.S., S.Y., D.M.G., K.I., J.C.R., S.A., S.L.G.), Neurosurgery (E.N., P.K.N.), and Ophthalmology (J.C.R., I.B., E.K., S.L.G.), Bernard and Irene Schwartz Neurointerventional Section (E.R., M.S., P.K.N.), NYU Langone Health, 660 First Ave, 7th Floor, New York, NY 10016; Department of Neurology, Brown University, Providence, RI (S.Y.); and Department of Neurology, Duke University School of Medicine, Durham, NC (B.M.G.)
| | - Steven L Galetta
- From the Departments of Radiology (E.R., M.S., T.M.S., O.M., M.H., M.G.Y., P.K.N.), Neurology (M.S., S.Y., D.M.G., K.I., J.C.R., S.A., S.L.G.), Neurosurgery (E.N., P.K.N.), and Ophthalmology (J.C.R., I.B., E.K., S.L.G.), Bernard and Irene Schwartz Neurointerventional Section (E.R., M.S., P.K.N.), NYU Langone Health, 660 First Ave, 7th Floor, New York, NY 10016; Department of Neurology, Brown University, Providence, RI (S.Y.); and Department of Neurology, Duke University School of Medicine, Durham, NC (B.M.G.)
| | - Peter Kim Nelson
- From the Departments of Radiology (E.R., M.S., T.M.S., O.M., M.H., M.G.Y., P.K.N.), Neurology (M.S., S.Y., D.M.G., K.I., J.C.R., S.A., S.L.G.), Neurosurgery (E.N., P.K.N.), and Ophthalmology (J.C.R., I.B., E.K., S.L.G.), Bernard and Irene Schwartz Neurointerventional Section (E.R., M.S., P.K.N.), NYU Langone Health, 660 First Ave, 7th Floor, New York, NY 10016; Department of Neurology, Brown University, Providence, RI (S.Y.); and Department of Neurology, Duke University School of Medicine, Durham, NC (B.M.G.)
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Matsumoto T, Takayama K, Ishida K, Hayashi S, Hashimoto S, Kuroda R. Corrigenda. Bone Joint J 2021; 103-B:1641. [PMID: 34587812 DOI: 10.1302/0301-620x.103b10.bjj-2021-00021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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25
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Esenwa C, Cheng NT, Luna J, Willey J, Boehme AK, Kirchoff-Torres K, Labovitz D, Liberman AL, Mabie P, Moncrieffe K, Soetanto A, Lendaris A, Seiden J, Goldman I, Altschul D, Holland R, Benton J, Dardick J, Fernandez-Torres J, Flomenbaum D, Lu J, Malaviya A, Patel N, Toma A, Lord A, Ishida K, Torres J, Snyder T, Frontera J, Yaghi S. Biomarkers of Coagulation and Inflammation in COVID-19-Associated Ischemic Stroke. Stroke 2021; 52:e706-e709. [PMID: 34428931 PMCID: PMC8547586 DOI: 10.1161/strokeaha.121.035045] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Charles Esenwa
- Department of Neurology (C.E., N.T.C., K.K.-T., D.L., A.L.L., P.M., K.M., A.S., A. Lendaris, J.S.), Montefiore Medical Center
| | - Natalie T Cheng
- Department of Neurology (C.E., N.T.C., K.K.-T., D.L., A.L.L., P.M., K.M., A.S., A. Lendaris, J.S.), Montefiore Medical Center
| | - Jorge Luna
- Department of Neurology, Columbia University Medical Center (J.L., J.W., A.K.B.)
| | - Joshua Willey
- Department of Neurology, Columbia University Medical Center (J.L., J.W., A.K.B.)
| | - Amelia K Boehme
- Department of Neurology, Columbia University Medical Center (J.L., J.W., A.K.B.)
| | - Kathryn Kirchoff-Torres
- Department of Neurology (C.E., N.T.C., K.K.-T., D.L., A.L.L., P.M., K.M., A.S., A. Lendaris, J.S.), Montefiore Medical Center
| | - Daniel Labovitz
- Department of Neurology (C.E., N.T.C., K.K.-T., D.L., A.L.L., P.M., K.M., A.S., A. Lendaris, J.S.), Montefiore Medical Center
| | - Ava L Liberman
- Department of Neurology (C.E., N.T.C., K.K.-T., D.L., A.L.L., P.M., K.M., A.S., A. Lendaris, J.S.), Montefiore Medical Center
| | - Peter Mabie
- Department of Neurology (C.E., N.T.C., K.K.-T., D.L., A.L.L., P.M., K.M., A.S., A. Lendaris, J.S.), Montefiore Medical Center
| | - Khadean Moncrieffe
- Department of Neurology (C.E., N.T.C., K.K.-T., D.L., A.L.L., P.M., K.M., A.S., A. Lendaris, J.S.), Montefiore Medical Center
| | - Ainie Soetanto
- Department of Neurology (C.E., N.T.C., K.K.-T., D.L., A.L.L., P.M., K.M., A.S., A. Lendaris, J.S.), Montefiore Medical Center
| | - Andrea Lendaris
- Department of Neurology (C.E., N.T.C., K.K.-T., D.L., A.L.L., P.M., K.M., A.S., A. Lendaris, J.S.), Montefiore Medical Center
| | - Johanna Seiden
- Department of Neurology (C.E., N.T.C., K.K.-T., D.L., A.L.L., P.M., K.M., A.S., A. Lendaris, J.S.), Montefiore Medical Center
| | - Inessa Goldman
- Department of Radiology (I.G.), Montefiore Medical Center
| | - David Altschul
- Department of Neurosurgery (D.A., R.H.), Montefiore Medical Center
| | - Ryan Holland
- Department of Neurosurgery (D.A., R.H.), Montefiore Medical Center
| | - Joshua Benton
- Albert Einstein College of Medicine (J.B., J.D., J.F.T., D.F., J.L., A.M., N.P., A.T.)
| | - Joseph Dardick
- Albert Einstein College of Medicine (J.B., J.D., J.F.T., D.F., J.L., A.M., N.P., A.T.)
| | | | - David Flomenbaum
- Albert Einstein College of Medicine (J.B., J.D., J.F.T., D.F., J.L., A.M., N.P., A.T.)
| | - Jenny Lu
- Albert Einstein College of Medicine (J.B., J.D., J.F.T., D.F., J.L., A.M., N.P., A.T.)
| | - Avinash Malaviya
- Albert Einstein College of Medicine (J.B., J.D., J.F.T., D.F., J.L., A.M., N.P., A.T.)
| | - Nikunj Patel
- Albert Einstein College of Medicine (J.B., J.D., J.F.T., D.F., J.L., A.M., N.P., A.T.)
| | - Aureliana Toma
- Albert Einstein College of Medicine (J.B., J.D., J.F.T., D.F., J.L., A.M., N.P., A.T.)
| | - Aaron Lord
- Department of Neurology, New York University School of Medicine (A. Lord, K.I., J.T., T.S., J.F., S.Y.)
| | - Koto Ishida
- Department of Neurology, New York University School of Medicine (A. Lord, K.I., J.T., T.S., J.F., S.Y.)
| | - Jose Torres
- Department of Neurology, New York University School of Medicine (A. Lord, K.I., J.T., T.S., J.F., S.Y.)
| | - Thomas Snyder
- Department of Neurology, New York University School of Medicine (A. Lord, K.I., J.T., T.S., J.F., S.Y.)
| | - Jennifer Frontera
- Department of Neurology, New York University School of Medicine (A. Lord, K.I., J.T., T.S., J.F., S.Y.)
| | - Shadi Yaghi
- Department of Neurology, New York University School of Medicine (A. Lord, K.I., J.T., T.S., J.F., S.Y.)
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Haynes J, Kronenburg A, Raz E, Rostanski S, Yaghi S, Ishida K, Shapiro M, Nelson PK, Tanweer O, Langer DJ, Riina HA, Eichel R, Nossek E. Superficial Temporal Artery to Middle Cerebral Artery Cranial Bypass for Nonmoyamoya Steno-Occlusive Disease in Patients Who Failed Optimal Medical Treatment: A Case Series. Oper Neurosurg (Hagerstown) 2021; 20:444-455. [PMID: 33475724 DOI: 10.1093/ons/opaa458] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 11/11/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In the post-Carotid Occlusion Surgery Study (COSS) era, multiple reviews suggested subset groups of patients as potential candidates for superficial temporal artery to middle cerebral artery (STA-MCA) bypass. Among them are patients with recurrent strokes despite optimal medical therapy. There is a paucity of data on the outcome of bypass in these specific patients. OBJECTIVE To examine the safety and efficacy of direct STA-MCA bypass in patients with nonmoyamoya, symptomatic steno-occlusive disease with impaired distal perfusion, who failed optimal medical management or endovascular treatment. METHODS A retrospective review was performed to identify patients with cerebrovascular steno-occlusive disease who underwent bypass after symptomatic recurrent or rapidly progressive strokes, despite optimal conservative or endovascular treatment. RESULTS A total of 8 patients (mean age 60 ± 6 yr) underwent direct or combined direct/indirect STA-MCA bypass between 2016 and 2019. All anastomoses were patent. One bypass carried slow flow. There were no procedure-related permanent deficits. One patient developed seizures which were controlled by medications. A total of 7 out of 8 patients were stable or improved clinically at last follow-up (mean 27.3 ± 13.8 mo) without recurrent strokes. One patient did not recover from their presenting stroke, experienced severe bilateral strokes 4 mo postoperatively, and subsequently expired. Modified Rankin Scale (mRS) improved in 6 patients (75%), remained stable in 1 patient (12.5%), and deteriorated in 1 (12.5%). Good long-term functional outcome was achieved in 5 patients (63%, mRS ≤ 2). CONCLUSION Patients with symptomatic, hypoperfused steno-occlusive disease who fail optimal medical or endovascular treatment may benefit from cerebral revascularization. Direct or combined STA-MCA bypass was safe and provided favorable outcomes in this small series.
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Affiliation(s)
- Joseph Haynes
- School of Medicine and Dentistry, University of Rochester, Rochester, New York
| | - Annick Kronenburg
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Eytan Raz
- Department of Radiology, Section of Neurointerventional Radiology, NYU Langone Health, New York, New York
| | - Sara Rostanski
- Department of Neurology, NYU Langone Health, New York, New York
| | - Shadi Yaghi
- Department of Neurology, NYU Langone Health, New York, New York
| | - Koto Ishida
- Department of Neurology, NYU Langone Health, New York, New York
| | - Maksim Shapiro
- Department of Radiology, Section of Neurointerventional Radiology, NYU Langone Health, New York, New York
| | - Peter Kim Nelson
- Department of Radiology, Section of Neurointerventional Radiology, NYU Langone Health, New York, New York
| | - Omar Tanweer
- Department of Neurosurgery, NYU Langone Health, New York, New York
| | - David J Langer
- Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York
| | - Howard A Riina
- Department of Neurosurgery, NYU Langone Health, New York, New York
| | - Roni Eichel
- Department of Neurology, Shaare Zedek Medical Center, Affiliated Teaching Hospital of the Hebrew University Medical Faculty, Jerusalem, Israel
| | - Erez Nossek
- Department of Neurosurgery, NYU Langone Health, New York, New York
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Melmed KR, Carroll E, Lord AS, Boehme AK, Ishida K, Zhang C, Torres JL, Yaghi S, Czeisler BM, Frontera JA, Lewis A. Systemic Inflammatory Response Syndrome is Associated with Hematoma Expansion in Intracerebral Hemorrhage. J Stroke Cerebrovasc Dis 2021; 30:105870. [PMID: 34077823 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/26/2021] [Accepted: 05/02/2021] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Systemic inflammatory response syndrome (SIRS) and hematoma expansion are independently associated with worse outcomes after intracerebral hemorrhage (ICH), but the relationship between SIRS and hematoma expansion remains unclear. MATERIALS AND METHODS We performed a retrospective review of patients admitted to our hospital from 2013 to 2020 with primary spontaneous ICH with at least two head CTs within the first 24 hours. The relationship between SIRS and hematoma expansion, defined as ≥6 mL or ≥33% growth between the first and second scan, was assessed using univariable and multivariable regression analysis. We assessed the relationship of hematoma expansion and SIRS on discharge mRS using mediation analysis. RESULTS Of 149 patients with ICH, 83 (56%; mean age 67±16; 41% female) met inclusion criteria. Of those, 44 (53%) had SIRS. Admission systolic blood pressure (SBP), temperature, antiplatelet use, platelet count, initial hematoma volume and rates of infection did not differ between groups (all p>0.05). Hematoma expansion occurred in 15/83 (18%) patients, 12 (80%) of whom also had SIRS. SIRS was significantly associated with hematoma expansion (OR 4.5, 95% CI 1.16 - 17.39, p= 0.02) on univariable analysis. The association remained statistically significant after adjusting for admission SBP and initial hematoma volume (OR 5.72, 95% CI 1.40 - 23.41, p= 0.02). There was a significant indirect effect of SIRS on discharge mRS through hematoma expansion. A significantly greater percentage of patients with SIRS had mRS 4-6 at discharge (59 vs 33%, p=0.02). CONCLUSION SIRS is associated with hematoma expansion of ICH within the first 24 hours, and hematoma expansion mediates the effect of SIRS on poor outcome.
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Affiliation(s)
- Kara R Melmed
- Department of Neurology, NYU Langone University School of Medicine, New York, New York, USA; Department of Neurosurgery, NYU Langone Medical Center, New York, New York, USA.
| | - Elizabeth Carroll
- Department of Neurology, NYU Langone University School of Medicine, New York, New York, USA
| | - Aaron S Lord
- Department of Neurology, NYU Langone University School of Medicine, New York, New York, USA
| | - Amelia K Boehme
- Department of Epidemiology and Neurology, Columbia University Irving Medical Center, New York, New York, USA
| | - Koto Ishida
- Department of Neurology, NYU Langone University School of Medicine, New York, New York, USA
| | - Cen Zhang
- Department of Neurology, NYU Langone University School of Medicine, New York, New York, USA
| | - Jose L Torres
- Department of Neurology, NYU Langone University School of Medicine, New York, New York, USA
| | - Shadi Yaghi
- Department of Neurology, Brown University School of Medicine, Providence, RI, USA
| | - Barry M Czeisler
- Department of Neurology, NYU Langone University School of Medicine, New York, New York, USA; Department of Neurosurgery, NYU Langone Medical Center, New York, New York, USA
| | - Jennifer A Frontera
- Department of Neurology, NYU Langone University School of Medicine, New York, New York, USA
| | - Ariane Lewis
- Department of Neurology, NYU Langone University School of Medicine, New York, New York, USA; Department of Neurosurgery, NYU Langone Medical Center, New York, New York, USA
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Kurose R, Satoh T, Murakami K, Kurose A, Satoh YI, Ishibashi Y, Ishida K, Ogasawara K, Morikawa A, Sawai T. AB0045 THE RELATIONSHIP BETWEEN CD14 AND VIMENTIN-POSITIVE SYNOVIAL DENDRITIC-SHAPED CELLS AND SYNOVITIS IN RHEUMATOID ARTHRITIS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Inflammation in rheumatoid arthritis (RA) is caused by multiple cell types, including infiltrating inflammatory cells, such as lymphocytes, neutrophils, macrophages, and spindle-shaped fibroblasts. Especially, we are focusing on fibroblast-like synoviocytes (FLSs). In our previous study, we have reported that FLSs were positive for multiple markers including CD14, CD68 and HLA-DR, and were dendritic-shaped cells constituting nursing phenomenon between lymph or plasma cells. In addition, in our recent study, we found that CD14+FLSs were positive for vimentin (VIM), which is a marker for mesenchymal cells. There are still many issues to be discussed regarding CD14+VIM+ cells.Objectives:To investigate the relationship between CD14+VIM+ cells and the degree of synovitis in rheumatoid arthritis.Methods:Synovial tissues collected from RA patients who underwent joint surgeries were prepared for this study. First, the proportions of CD14+ cells in RA synovial tissue and control were analyzed using flow cytometry and the concentrations of inflammatory cytokines released by CD14+ cells in RA synovial tissue and control were examined by ELISA. Next, the proportions of CD14+VIM+ cells in RA synovial tissue and control were examined immunohistologically and then we analyzed the results using image analysis software. Also, we statistically analyzed the relationship between the proportion of CD14+VIM+ cells, the degree of synovitis, and clinical data.Results:Results of flow cytometry showed that CD14+ cells were frequently observed in RA synovial tissue than control. Cultured CD14+ cells released more inflammatory cytokines than cultured CD14- cells. Also, results of immunohistological staining showed that many CD14+VIM+ cells were observed in RA synovial tissue than in control. The proportion of CD14+VIM+ cells was correlated with Krenn synovitis score. High proportion cases significantly showed high level of CRP and MMP-3.Conclusion:CD14+VIM+ cells might be involved in the mechanism of chronic immunological inflammation in RA and the proportion of these cells might influence the clinical data.References:[1]Ochi T, Yoshikawa H, Toyosaki-Maeda T, Lipsky PE. Mesenchymal stromal cells. Nurse-like cells reside in thesynovial tissue and bone marrow in rheumatoid arthritis. Arthritis Research&Therapy 2007; 9(1): 201.[2]Ochi T, Sawai T, Murakami K, Kamataki A, Uzuki M, Tomita T, et al. Nurse-like cells in rheumatoid arthritis: Formation of survival niches cooperating between the cell types. Mod Rheum 2018; 29: 1-5.[3]Krenn V, Morawietz L, Burmester GR, Kinne RW, Muller-Ladner U, Muller B, Haupl T. Synovitis score: discrimination between chronic low-grade and high-grade synovitis. Histopathology 2006; 49: 358-64.Disclosure of Interests:None declared
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Katagiri K, Ozaki N, Ohmura S, Albertazzi B, Hironaka Y, Inubushi Y, Ishida K, Koenig M, Miyanishi K, Nakamura H, Nishikino M, Okuchi T, Sato T, Seto Y, Shigemori K, Sueda K, Tange Y, Togashi T, Umeda Y, Yabashi M, Yabuuchi T, Kodama R. Liquid Structure of Tantalum under Internal Negative Pressure. Phys Rev Lett 2021; 126:175503. [PMID: 33988455 DOI: 10.1103/physrevlett.126.175503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/09/2021] [Accepted: 03/31/2021] [Indexed: 06/12/2023]
Abstract
In situ femtosecond x-ray diffraction measurements and ab initio molecular dynamics simulations were performed to study the liquid structure of tantalum shock released from several hundred gigapascals (GPa) on the nanosecond timescale. The results show that the internal negative pressure applied to the liquid tantalum reached -5.6 (0.8) GPa, suggesting the existence of a liquid-gas mixing state due to cavitation. This is the first direct evidence to prove the classical nucleation theory which predicts that liquids with high surface tension can support GPa regime tensile stress.
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Affiliation(s)
- K Katagiri
- Graduate School of Engineering, Osaka University, Osaka 565-0871, Japan
- Institute of Laser Engineering, Osaka University, Osaka 565-0871, Japan
| | - N Ozaki
- Graduate School of Engineering, Osaka University, Osaka 565-0871, Japan
- Institute of Laser Engineering, Osaka University, Osaka 565-0871, Japan
| | - S Ohmura
- Research Center for Condensed Matter Physics, Department of Environmental and Civil Engineering, Hiroshima Institute of Technology, Hiroshima 731-5193 Japan
| | - B Albertazzi
- LULI, CNRS, CEA, Ecole Polytechnique, UPMC, Université Paris 06: Sorbonne Universites, Institut Polytechnique de Paris, F-91128 Palaiseau cedex, France
| | - Y Hironaka
- Institute of Laser Engineering, Osaka University, Osaka 565-0871, Japan
- Open and Transdisciplinary Research Initiative, OTRI, Osaka University, Osaka 565-0871, Japan
| | - Y Inubushi
- Japan Synchrotron Radiation Research Institute, Hyogo 679-5198, Japan
- RIKEN SPring-8 Center, Hyogo 679-5148, Japan
| | - K Ishida
- Graduate School of Engineering, Osaka University, Osaka 565-0871, Japan
| | - M Koenig
- Graduate School of Engineering, Osaka University, Osaka 565-0871, Japan
- LULI, CNRS, CEA, Ecole Polytechnique, UPMC, Université Paris 06: Sorbonne Universites, Institut Polytechnique de Paris, F-91128 Palaiseau cedex, France
| | - K Miyanishi
- RIKEN SPring-8 Center, Hyogo 679-5148, Japan
| | - H Nakamura
- Graduate School of Engineering, Osaka University, Osaka 565-0871, Japan
| | - M Nishikino
- Kansai Photon Science Institute, National Institutes for Quantum and Radiological Science and Technology, Kyoto 619-0215, Japan
| | - T Okuchi
- Institute for Integrated Radiation and Nuclear Science, Kyoto University, Osaka 590-0494, Japan
| | - T Sato
- Graduate School of Science, Hiroshima University, Hiroshima 739-8526, Japan
| | - Y Seto
- Graduate School of Science, Kobe University, Hyogo 657-0013, Japan
| | - K Shigemori
- Institute of Laser Engineering, Osaka University, Osaka 565-0871, Japan
| | - K Sueda
- RIKEN SPring-8 Center, Hyogo 679-5148, Japan
| | - Y Tange
- Japan Synchrotron Radiation Research Institute, Hyogo 679-5198, Japan
| | - T Togashi
- Japan Synchrotron Radiation Research Institute, Hyogo 679-5198, Japan
- RIKEN SPring-8 Center, Hyogo 679-5148, Japan
| | - Y Umeda
- Institute for Planetary Materials, Okayama University, Tottori 682-0193, Japan
| | - M Yabashi
- Japan Synchrotron Radiation Research Institute, Hyogo 679-5198, Japan
- RIKEN SPring-8 Center, Hyogo 679-5148, Japan
| | - T Yabuuchi
- Japan Synchrotron Radiation Research Institute, Hyogo 679-5198, Japan
- RIKEN SPring-8 Center, Hyogo 679-5148, Japan
| | - R Kodama
- Graduate School of Engineering, Osaka University, Osaka 565-0871, Japan
- Institute of Laser Engineering, Osaka University, Osaka 565-0871, Japan
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Komatsu H, Ishida K, Matsui Y, Amano S, Hashimoto M, Sasaki A. Treatment strategy for locally advanced breast cancer in our department. Breast 2021. [DOI: 10.1016/s0960-9776(21)00151-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Yaghi S, Mistry E, De Havenon AH, Leon Guerrero C, Nouh A, Liberman AL, Giles JA, Liu A, Nagy M, Kaushal A, Azher A, Mac Grory BC, Fakhri H, Espaillat K, Asad SD, Pasupuleti H, Martin H, Tan JT, Veerasamy M, esenwa C, Cheng N, Moncrieffe K, Moeini-Naghani I, Siddu M, Scher E, Trivedi T, Torres JL, Ishida K, Lord A, Khan M, Keyrouz SG, Furie KL, Henninger N. Abstract P12: Alteplase Reduces Mortality in Patients With Ischemic Stroke and Atrial Fibrillation: Analysis of the IAC Study. Stroke 2021. [DOI: 10.1161/str.52.suppl_1.p12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose:
Multiple studies have established that intravenous thrombolysis with alteplase improves outcome after acute ischemic stroke. However, assessment of thrombolysis’ efficacy in stroke patients with atrial fibrillation (AF) has yielded mixed results. We sought to determine the association of alteplase with mortality, hemorrhagic transformation (HT), infarct volume, and mortality in patients with AF and acute ischemic stroke.
Methods:
We retrospectively analyzed consecutive acute ischemic stroke patients with AF included in the Initiation of Anticoagulation after Cardioembolic stroke (IAC) study, which pooled data from 8 comprehensive stroke centers in the United States. 1889 (90.6%) had available 90-day follow up data and were included. For our primary analysis we used a cohort of 1367/1889 (72.4%) patients who did not undergo mechanical thrombectomy (MT). Secondary analyses were repeated in the patients that underwent MT (n=522). Binary logistic regression was used to determine whether alteplase use was independently associated with risk of HT, final infarct volume, and 90-day mortality, respectively, adjusting for potential confounders.
Results:
In our primary analyses we found that alteplase use was independently associated with an increased risk for HT (adjusted OR 2.14, 95% CI 1.49 - 3.07, p <0.001) but overall reduced risk of 90-day mortality (adjusted OR 0.58, 95% CI 0.39 - 0.87, p = 0.009). Among patients undergoing MT, alteplase use was associated with a trend towards a reduction in 90-day mortality (adjusted OR 0.68 95% CI 0.45 - 1.04, p = 0.077). In the subgroup of patients prescribed DOAC treatment (n = 327; 24 received alteplase), alteplase treatment was associated with a trend towards smaller infarct size (< 10 mL), (adjusted OR 0.40, 95% CI 0.15 - 1.12, p = 0.082) without a significant difference in the odds of 90-day mortality (adjusted OR 0.51, 95% CI 0.12 - 2.13, p = 0.357) or hemorrhagic transformation (adjusted OR 0.27, 95% CI 0.03 - 2.07, p = 0.206).
Conclusion:
Thrombolysis with intravenous alteplase was associated with reduced 90-day mortality in AF patients with acute ischemic stroke not undergoing MT. Further study is required to assess the safety and efficacy of alteplase in AF patients undergoing MT and those on DOACs.
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Affiliation(s)
| | - Eva Mistry
- Vanderbilt Univ Med Cente, Nashville, TN
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Carroll E, Lord A, Lewis A, Ishida K, Zhang C, Torres JL, Czeisler B, Melmed KR. Abstract P458: Systemic Inflammatory Response Syndrome is Associated With Hematoma Expansion in Intracerebral Hemorrhage. Stroke 2021. [DOI: 10.1161/str.52.suppl_1.p458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective:
Systemic inflammatory response syndrome (SIRS) and hematoma expansion are both associated with worse outcomes after intracerebral hemorrhage (ICH), but their relationship remains unclear. We sought to determine the association between SIRS and hematoma expansion after ICH.
Methods:
We performed a retrospective cohort study of patients admitted to our hospital from 2013 to 2020 with primary spontaneous ICH with at least two head CTs within the first 24 hours. Patients were excluded if they had a decompressive craniectomy, intracranial vascular lesions or malignancy, or coagulopathy. Hematoma volume was measured using the ABC/2 method; hematoma expansion was defined as 6mL or 33% growth between the first and second scan. We compared patients with and without SIRS using Pearson’s χ2, students T and Wilcoxon rank sum tests. The relationship between admission SIRS and hematoma expansion was assessed using univariate and multivariate regression analysis.
Results:
Of 187 patients with ICH, 73 (39%; mean age 6617, 40% female) met inclusion criteria. Of those, 38 (52%) had SIRS on admission. Admission systolic blood pressure (SBP) was significantly higher in patients with SIRS compared to those without (169 [IQR 133- 205] vs 152 [125- 179] mm Hg, p= 0.02). There was no difference in mean days to first antibiotic administration (6.3 vs 5.6, p=0.78), admission platelets (227 vs 243, p= 0.38) or initial hematoma volume (23 vs 15, p=0.16). Hematoma expansion occurred in 14 patients, 11 (79%) of whom also had SIRS. A significantly greater percentage of patients with SIRS had mRS 4-6 at discharge (87 vs 67%, p=0.05). SIRS was significantly associated with hematoma expansion (OR 4.35, 95% CI 1.10-17.20, p= 0.04) on univariate analysis. The association remained statistically significant after adjusting for admission SBP, platelets, and initial hematoma volume (OR 4.54, 95% CI 1.01-20.60, p= 0.05).
Conclusion:
Presence of SIRS on admission is associated with hematoma expansion within the first 24 hours. Further research is needed to better understand this association, which may enable us to identify early on and treat those patients at highest risk for decompensation.
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Kvernland A, Kumar A, Yaghi S, Raz E, Frontera J, Lewis A, Czeisler B, Kahn DE, Zhou T, Ishida K, Torres JL, Riina H, Shapiro M, Nossek E, Nelson PK, Tanweer O, Gordon D, Jain R, Dehkharghani S, Henninger N, De Havenon AH, Mac Grory B, Lord A, Melmed KR. Abstract P100: Hemorrhagic Stroke in the Setting of COVID-19 is Associated With Anticoagulation Use. Stroke 2021. [DOI: 10.1161/str.52.suppl_1.p100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
While the thrombotic complications of COVID-19 have been described, there are limited data on its implications in hemorrhagic stroke. The clinical characteristics, underlying stroke mechanism, and outcomes in this group of patients are especially salient as empiric therapeutic anticoagulation becomes increasingly common in the treatment and prevention of thrombotic complications of COVID-19.
Methods:
We conducted a retrospective cohort study of patients with hemorrhagic stroke (both non-traumatic intracerebral hemorrhage and spontaneous non-aneurysmal subarachnoid hemorrhage) who were hospitalized between 3/1/20-5/15/20 at a NYC hospital system, during the coronavirus pandemic. We compared the demographic and clinical characteristics of patients with hemorrhagic stroke and COVID-19 to those without COVID-19 admitted to our hospital between 3/1/20-5/15/20 (contemporary controls) and 3/1/19-5/15/19 (historical controls), using Fischer’s exact test and non-parametric testing. We adjusted for multiple comparisons using the Bonferroni method.
Results:
During the study period, 19 out of 4071 (0.5%) patients who were hospitalized with COVID-19 had hemorrhagic stroke on imaging. Of all COVID-19 with hemorrhagic stroke, only 3 had non-aneurysmal SAH without intraparenchymal hemorrhage. Among hemorrhagic stroke and COVID-19 patients, coagulopathy was the most common etiology (73.7%); empiric anticoagulation was started in 89.5% vs 4.2% of contemporary and 10.0% of historical controls (both with p =<0.001). Compared to contemporary and historical controls, COVID-19 patients had higher initial NIHSS scores, INR, PTT and fibrinogen levels. These patients also had higher rates of in-hospital mortality [84.6% vs. 4.6%, p =<0.001]. Sensitivity analyses excluding patients with strictly subarachnoid hemorrhage yielded similar results.
Conclusion:
We observed an overall low rate of imaging-confirmed hemorrhagic stroke among patients hospitalized with COVID-19. Most hemorrhages in COVID-19 patients occurred in the setting of therapeutic anticoagulation and were associated with increased mortality. Further studies are needed to evaluate the safety and efficacy of therapeutic anticoagulation in COVID-19 patients.
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Esenwa C, Cheng N, Antoniello D, Kirchoff-Torres KF, Labovitz DL, Liberman AL, Mabie P, Soetanto A, Lord A, Ishida K, Torres JL, Snyder T, Frontera J, Yaghi S. Abstract P90: Clinical Features of Patients With Cryptogenic Stroke and Covid-19. Stroke 2021. [DOI: 10.1161/str.52.suppl_1.p90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
While coronavirus disease 2019 (COVID-19) has been associated with acute ischemic stroke (AIS), the causal relationship has yet to be elucidated. Factors that likely confer increased stroke risk are COVID-19-associated coagulopathy and hyperinflammatory response. Studying clinical features of patients with otherwise undetermined cause of AIS could help better define COVID-19-associated stroke.
Methods:
We performed a multicenter cross-sectional study of consecutive patients presenting with AIS and COVID-19 to one of two large healthcare systems in New York City during the local COVID-19 surge from March 1, 2020 to May 31, 2020. In-hospital stroke cases were excluded. We compared demographic and clinical features of patients with COVID-19 and a cryptogenic AIS subtype to patients with COVID-19 and a determined subtype. Baseline characteristics and clinical variables were compared using chi-squared and Fisher exact tests.
Results:
A total of 62 patients with AIS and COVID-19 at the time of hospital arrival were identified. Of these, 30 were classified as having a cryptogenic subtype (80% after complete diagnotics evaluation), and 32 had an identifiable stroke mechanism. Patients with cryptogenic AIS were significantly younger (p=0.011) and less likely to have co-morbid hypertension (p=0.019), coronary artery disease (p=0.024), heart failure (p=0.039), atrial fibrillation (<0.0001), and prior stroke or TIA (p=0.033) compared to those with defined mechanisms. Further, d-dimer, but not C-reactive protein, was significantly higher in patients with cryptogenic stroke compared to those with defined causes (p=0.009).
Conclusion:
Patients with AIS in the setting of COVID-19 and no other determined stroke mechanism were younger, less likely to have classic risk factors, and had higher d-dimer levels when compared to those with a determined mechanism. Further study of COVID-19-associated hypercoagulability as a mechanism of stroke is warranted.
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Yang D, Cutting SM, Raz E, Torres JL, Mac Grory BC, Scher E, Pirooz S, De Havenon AH, Ishida K, Furie KL, Gutierrez J, Elkind MS, Yaghi S. Abstract P674: Markers of Atherosclerotic Disease but Not Small Vessel Disease Predict Neurologic Deterioration in Acute Lacunar Strokes. Stroke 2021. [DOI: 10.1161/str.52.suppl_1.p674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Neurologic deterioration (ND) occurs in a quarter of acute lacunar infarct patients and may lead to severe disability. The underlying pathophysiology of ND in these patients is not clearly understood. We sought to identify risk factors and clinical characteristics associated with ND.
Methods:
This retrospective study included consecutive patients admitted to NYU Langone Medical Center and Brown University for lacunar-type strokes from 2017-2019. Lacunar infarct was defined as subcortical infarct <1.5cm on CT or <2cm on diffusion-weighted imaging without significant stenosis (>50%) in the parent vessel and no cardioembolic source. Available non-invasive imaging (CTA or MRA) was reviewed by a neuroradiologist or vascular neurologist to determine the presence or absence of stenosis (<50%) or luminal irregularity without stenosis in the stem artery segment at the location of the perforator corresponding to the infarct. Fazekas score was determined from available MRI T2 images. We defined ND as those with any neurologic deterioration during their hospitalization referable to lacunar stroke and not related to a medical or non-cerebrovascular neurological complication. We compared clinical and radiographic characteristics of those with and without ND.
Results:
Among 242 lacunar stroke patients (mean age 68.9±12.2 years, 43.8% women, 61.2% white, 12.8% black, and 13.2% Hispanic), we identified 46 (19%) with ND. There were no demographic differences between those with and without ND. Those with ND were more likely to have systemic atherosclerotic disease (34.8% vs 19.9%, p=0.049) and higher low-density lipoprotein (111 vs 100 mg/dL, p=0.034). Those with ND had less white matter disease on MRI (lower Fazekas score) and were less likely to have chronic lacunes than those without ND. We did not find any association between radiographic subclinical perforator atherosclerotic disease and ND (odds ratio [95% confidence interval]: 1.83 [0.81-4.14], p=0.147).
Conclusions:
In this multi-ethnic population, patients with neurologic deterioration following an acute lacunar stroke were more likely to have markers of atherosclerotic disease and less likely to have imaging findings suggestive of chronic small vessel disease.
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Affiliation(s)
- Dixon Yang
- Neurology, New York Univ Grossman Sch of Medicine, New York, NY
| | | | - Eytan Raz
- Radiology, New York Univ Grossman Sch of Medicine, New York, NY
| | - Jose L Torres
- Neurology, New York Univ Grossman Sch of Medicine, New York, NY
| | | | - Erica Scher
- Neurology, New York Univ Grossman Sch of Medicine, New York, NY
| | - Sahnaz Pirooz
- Neurology, New York Univ Grossman Sch of Medicine, New York, NY
| | | | - Koto Ishida
- Neurology, New York Univ Grossman Sch of Medicine, New York, NY
| | | | | | | | - Shadi Yaghi
- Neurology, New York Univ Grossman Sch of Medicine, New York, NY
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Yang D, Cutting SM, Raz E, Torres JL, Mac Grory BC, Scher E, Pirooz S, De Havenon AH, Ishida K, Furie KL, Gutierrez J, Elkind MS, Yaghi S. Abstract P661: Atheromatous Disease of the Parent Artery is Common in Patients With Lacunar Infarcts. Stroke 2021. [DOI: 10.1161/str.52.suppl_1.p661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Perforator disease caused by parent artery atheromatous disease is one of the mechanisms implicated in the pathogenesis of lacunar infarcts, but there is limited data on its prevalence. We sought to determine the prevalence of parent vessel atheromatous disease in patients with lacunar infarcts.
Methods:
This is a retrospective study of consecutive patients with lacunar strokes admitted to NYU Langone Medical Center and Brown University from 2017-2019. Lacunar infarct was defined as subcortical infarct <1.5cm on CT or <2cm on diffusion-weighted imaging without significant stenosis (>50%) in the parent vessel and no cardioembolic source. Non-invasive imaging (CTA or MRA) was reviewed by a neuroradiologist or a vascular neurologist to determine the presence or absence of stenosis (< 50%) or luminal irregularity without stenosis in the stem artery segment at the location of the perforator corresponding to the infarct. Patients were divided into two groups: luminal irregularity/stenosis vs. none. We compared clinical and radiographic characteristics and rates of neurological deterioration between the two groups.
Results:
Among 208 patients with lacunar infarcts (mean age 68.9±11.9 years, 40.9% women, 61.1% White, 13.9% Black, and 12.5% Hispanic), 42 (20.2%) had luminal stenosis and 90 (43.3%) had luminal irregularity without stenosis. Baseline characteristics and prevalence of risk factors were similar between the two groups. Patients with luminal irregularity/stenosis had longer median infarct diameter (10.6 mm vs 8.7 mm, p=0.007). Other imaging variables such as the presence of prior lacunar infarcts and white matter disease burden assessed by Fazekas Score were not significantly different between the two groups. The rate of any neurological deterioration after admission was similar between the two groups (22.7% vs. 15.8%, p=0.283).
Conclusion:
In this multi-ethnic population, nearly two-thirds of patients with a lacunar infarct were found to have luminal irregularity or stenosis in the parent artery corresponding to the infarct, implying a potential atherosclerotic mechanism. Future studies are needed using advanced imaging of the stem artery to define plaque characteristics which may help determine the underlying mechanism.
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Affiliation(s)
- Dixon Yang
- Neurology, New York Univ Grossman Sch of Medicine, New York, NY
| | | | - Eytan Raz
- Radiology, New York Univ Grossman Sch of Medicine, New York, NY
| | - Jose L Torres
- Neurology, New York Univ Grossman Sch of Medicine, New York, NY
| | | | - Erica Scher
- Neurology, New York Univ Grossman Sch of Medicine, New York, NY
| | - Sahnaz Pirooz
- Neurology, New York Univ Grossman Sch of Medicine, New York, NY
| | | | - Koto Ishida
- Neurology, New York Univ Grossman Sch of Medicine, New York, NY
| | | | | | | | - Shadi Yaghi
- Neurology, New York Univ Grossman Sch of Medicine, New York, NY
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Zhou E, Lord A, Boehme AK, Henninger N, De Havenon AH, Vahidy FS, Ishida K, Torres JL, Mistry E, Mac Grory BC, Sheth KN, Gurol E, Furie KL, Elkind MS, Yaghi S. Abstract P649: Extracranial Hemorrhage in the Setting of Gastrointestinal Or Genitourinary Cancer is Associated With Increased Risk of Ischemic Stroke in Patients With Atrial Fibrillation. Stroke 2021. [DOI: 10.1161/str.52.suppl_1.p649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose:
Anticoagulation therapy reduces the risk for ischemic stroke in atrial fibrillation (AF) but also predisposes patients to hemorrhagic complications. Patients with GI or GU cancer and AF are at higher risk of bleeding complications with anticoagulation therapy. There is limited knowledge on the risk of first-ever ischemic stroke in AF patients after extracranial hemorrhage (ECH) in patients with gastrointestinal or genitourinary (GI/GU) cancer.
Methods:
We conducted a retrospective study using the California State Inpatient Database (SID) including all non-federal hospital admissions in California from 2005-2011. The exposure variable was hospitalization with a diagnosis of ECH with a previous diagnosis of AF. The outcome variable was a subsequent hospitalization with acute ischemic stroke. We excluded patients with stroke prior to or at the time of ECH diagnosis. We calculated adjusted hazard ratios (HRs) for ischemic stroke during follow up and at 6-month intervals using Cox regression models adjusted for pertinent demographics and co-morbidities and stratifying patients with ECH based on the presence/absence of a GI/GU cancer.
Results:
We identified 764,257 AF patients (mean age 75 years, 49% women) without a documented history of stroke. Of these, 98,647 (13%) had an ECH-associated hospitalization, and 22,748 patients (3%) developed an ischemic stroke during a mean follow up. Compared to non-ECH patients, patients with ECH in the setting of a GI/GU cancer had a significantly higher risk of incident ischemic stroke (adjusted HR 1.40, 95% CI 1.20-1.64).Whereas there was only a modest increase in ischemic stroke risk in those without GI/GU cancer (adjusted HR 1.09 95% CI 1.05-1.13).
Conclusion:
AF patients hospitalized with ECH in the setting of GI/GU cancer have a particularly high risk of incident ischemic stroke. Particular consideration should be given to the optimal balance between the benefits and risks of anticoagulation therapy and the use of non-anticoagulant alternatives such as left atrial appendage closure in this vulnerable population.
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Affiliation(s)
- Eric Zhou
- NYU Grossman Sch of Medicine, New York, NY
| | | | | | | | | | | | | | | | - Eva Mistry
- Vanderbilt Univ Med Cente, Nashville, TN
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Bauman K, Agarwal S, Yaghi S, Lewis A, Lord A, Ishida K, Zhang C, Czeisler B, Torres JL, Melmed KR. Abstract P449: The Impact of Race and Social Determinants of Health on Imaging Biomarkers in Intracerebral Hemorrhage. Stroke 2021. [DOI: 10.1161/str.52.suppl_1.p449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
The association between race and white matter hyperintensities (WMH) and cerebral microbleeds in patients with intracerebral hemorrhage (ICH) is controversial. We examined the relationship between race and social determinants of health with WMH and microbleeds in ICH.
Methods:
We performed a retrospective study of patients at a tertiary care hospital between 2013 and 2020 who presented with ICH and underwent MRI of the brain. MRIs were evaluated for the presence of microbleeds and WMH severity (defined by the Fazekas scale; severe WMH defined as Fazekas 3). We assessed for an association of sex, race, ethnicity, employment status, median household income by zip code, education level, and insurance status with the severity of WMH or presence of microbleeds.
Results:
We identified 105 patients (median age 65.5 (IQR 53-76); 51% females; 13.2% Black) with ICH who had an MRI of the brain. Median ICH score was 1 [IQR 0-2] and median hematoma size was 15.9 ml (SD 19.7). High school graduation was the highest education level in 13.2%, and 57.5% had private insurance. Median income by zip code was $87,667 (IQR $65,900-$117,923). Severe WMH was observed in 19.8% and 52.8% of patients had microbleeds. There was no significant difference in sex, insurance status or median income for patients with or without severe WMH nor those with or without microbleeds. Severe WMH was more common among older patients (p=0.001), Black patients (p=0.03), patients with hypertension (p=0.03), and those with lower levels of education (p=0.03). In multivariable analyses, Black race was associated with severe WMH when adjusting for age and history of hypertension (OR 6.13 95% CI 1.14-25.98, p=0.01) but the effect size attenuated and the association disappears when adding education level to the model (OR 3.38 95% CI 0.48-23.76, p = 0.2). Age and history of hypertension were associated with presence of microbleeds (p<0.01 for both), but there was no association between presence of microbleeds and Black race or education level.
Conclusion:
Although Black race was associated with severe WMH, this association did not remain after adjusting for level of education. Our findings suggest that social determinants of health can modify the association between race and imaging biomarkers of ICH.
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Kvernland A, Prahbakaran S, Khatri P, De Havenon AH, Yeatts SD, Scher E, Torres JL, Ishida K, Frontera J, Lord A, Liebeskind DS, Yaghi S. Abstract P605: Border-Zone Infarcts Predict Early Recurrence in Patients With Large Artery Atherosclerotic Subtype Despite Medical Treatment. Stroke 2021. [DOI: 10.1161/str.52.suppl_1.p605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective:
We aim to investigate infarct patterns and 90-day recurrence in patients with symptomatic intracranial atherosclerotic disease.
Background:
Large artery atherosclerosis subtype carries a high risk of early recurrent stroke despite medical management. Predictors of recurrence remain poorly understood. We hypothesized that border-zone infarcts are associated with a higher risk of recurrence.
Design/Methods:
We included consecutive patients admitted to NYU Langone Health (Manhattan and Brooklyn campuses) over 32-months with a diagnosis of acute ischemic stroke secondary to symptomatic intracranial or tandem atherosclerosis. Patients with purely extracranial stenosis were excluded. The primary predictor was infarct pattern (border-zone vs. non-border-zone infarction), defined in accordance to previous studies. We used univariate and multivariable cox-regression models to determine associations between infarct pattern and recurrent cerebrovascular events (RCVE) at 90-days.
Results:
Ninety-nine patients met the inclusion criteria; 95 were intracranial and 4 were tandem lesions. The mean age was 70 years, 58.6% were men, 15.1% Black and 16.1% Asian. The median symptom onset to arrival time was 1 day, nearly 74.7% of patients were treated with dual antiplatelet therapy and 99% were treated with high intensity statin. Within 90 days of follow up, 19.2% (19/99) had RCVE. In univariate analyses, the only factor associated with RCVE was border-zone infarct pattern when compared to non-border-zone infarct pattern (30.2% vs. 10.7%, p=0.02). In cox regression models, after adjusting for age and sex, border-zone infarct pattern was associated with increased risk of RCVE (adjusted HR 3.21 95% CI 1.21-8.51, p=0.019). Sensitivity analyses excluding patients with tandem lesions (n = 4) did not meaningfully change our findings (adjusted HR 3.04 95% CI 1.11-8.31, p=0.031).
Conclusions:
In real world post-SAMMPRIS medically treated patients with ICAD, infarct pattern was predictive of 90-day RCVE. Border-zone infarcts are likely a surrogate marker of impaired distal blood flow, highlighting the importance of targeting stroke mechanisms and developing alternative treatment strategies for this high-risk cohort.
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Affiliation(s)
- Navdeep Sangha
- Department of Vascular Neurology, Kaiser Permanente, Los Angeles Medical Center , Los Angeles, CA
| | - Koto Ishida
- Department of Neurology, NYU Langone Health, New York, NY
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Frontera JA, Sabadia S, Lalchan R, Fang T, Flusty B, Millar-Vernetti P, Snyder T, Berger S, Yang D, Granger A, Morgan N, Patel P, Gutman J, Melmed K, Agarwal S, Bokhari M, Andino A, Valdes E, Omari M, Kvernland A, Lillemoe K, Chou SHY, McNett M, Helbok R, Mainali S, Fink EL, Robertson C, Schober M, Suarez JI, Ziai W, Menon D, Friedman D, Friedman D, Holmes M, Huang J, Thawani S, Howard J, Abou-Fayssal N, Krieger P, Lewis A, Lord AS, Zhou T, Kahn DE, Czeisler BM, Torres J, Yaghi S, Ishida K, Scher E, de Havenon A, Placantonakis D, Liu M, Wisniewski T, Troxel AB, Balcer L, Galetta S. A Prospective Study of Neurologic Disorders in Hospitalized Patients With COVID-19 in New York City. Neurology 2021; 96:e575-e586. [PMID: 33020166 PMCID: PMC7905791 DOI: 10.1212/wnl.0000000000010979] [Citation(s) in RCA: 187] [Impact Index Per Article: 62.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/14/2020] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To determine the prevalence and associated mortality of well-defined neurologic diagnoses among patients with coronavirus disease 2019 (COVID-19), we prospectively followed hospitalized severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive patients and recorded new neurologic disorders and hospital outcomes. METHODS We conducted a prospective, multicenter, observational study of consecutive hospitalized adults in the New York City metropolitan area with laboratory-confirmed SARS-CoV-2 infection. The prevalence of new neurologic disorders (as diagnosed by a neurologist) was recorded and in-hospital mortality and discharge disposition were compared between patients with COVID-19 with and without neurologic disorders. RESULTS Of 4,491 patients with COVID-19 hospitalized during the study timeframe, 606 (13.5%) developed a new neurologic disorder in a median of 2 days from COVID-19 symptom onset. The most common diagnoses were toxic/metabolic encephalopathy (6.8%), seizure (1.6%), stroke (1.9%), and hypoxic/ischemic injury (1.4%). No patient had meningitis/encephalitis or myelopathy/myelitis referable to SARS-CoV-2 infection and 18/18 CSF specimens were reverse transcriptase PCR negative for SARS-CoV-2. Patients with neurologic disorders were more often older, male, white, hypertensive, diabetic, intubated, and had higher sequential organ failure assessment (SOFA) scores (all p < 0.05). After adjusting for age, sex, SOFA scores, intubation, history, medical complications, medications, and comfort care status, patients with COVID-19 with neurologic disorders had increased risk of in-hospital mortality (hazard ratio [HR] 1.38, 95% confidence interval [CI] 1.17-1.62, p < 0.001) and decreased likelihood of discharge home (HR 0.72, 95% CI 0.63-0.85, p < 0.001). CONCLUSIONS Neurologic disorders were detected in 13.5% of patients with COVID-19 and were associated with increased risk of in-hospital mortality and decreased likelihood of discharge home. Many observed neurologic disorders may be sequelae of severe systemic illness.
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Affiliation(s)
- Jennifer A Frontera
- From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK.
| | - Sakinah Sabadia
- From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK
| | - Rebecca Lalchan
- From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK
| | - Taolin Fang
- From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK
| | - Brent Flusty
- From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK
| | - Patricio Millar-Vernetti
- From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK
| | - Thomas Snyder
- From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK
| | - Stephen Berger
- From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK
| | - Dixon Yang
- From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK
| | - Andre Granger
- From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK
| | - Nicole Morgan
- From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK
| | - Palak Patel
- From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK
| | - Josef Gutman
- From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK
| | - Kara Melmed
- From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK
| | - Shashank Agarwal
- From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK
| | - Matthew Bokhari
- From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK
| | - Andres Andino
- From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK
| | - Eduard Valdes
- From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK
| | - Mirza Omari
- From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK
| | - Alexandra Kvernland
- From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK
| | - Kaitlyn Lillemoe
- From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK
| | - Sherry H-Y Chou
- From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK
| | - Molly McNett
- From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK
| | - Raimund Helbok
- From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK
| | - Shraddha Mainali
- From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK
| | - Ericka L Fink
- From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK
| | - Courtney Robertson
- From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK
| | - Michelle Schober
- From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK
| | - Jose I Suarez
- From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK
| | - Wendy Ziai
- From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK
| | - David Menon
- From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK
| | - Daniel Friedman
- From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK
| | - David Friedman
- From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK
| | - Manisha Holmes
- From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK
| | - Joshua Huang
- From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK
| | - Sujata Thawani
- From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK
| | - Jonathan Howard
- From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK
| | - Nada Abou-Fayssal
- From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK
| | - Penina Krieger
- From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK
| | - Ariane Lewis
- From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK
| | - Aaron S Lord
- From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK
| | - Ting Zhou
- From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK
| | - D Ethan Kahn
- From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK
| | - Barry M Czeisler
- From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK
| | - Jose Torres
- From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK
| | - Shadi Yaghi
- From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK
| | - Koto Ishida
- From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK
| | - Erica Scher
- From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK
| | - Adam de Havenon
- From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK
| | - Dimitris Placantonakis
- From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK
| | - Mengling Liu
- From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK
| | - Thomas Wisniewski
- From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK
| | - Andrea B Troxel
- From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK
| | - Laura Balcer
- From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK
| | - Steven Galetta
- From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK
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Abstract
BACKGROUND Recent studies have noted concern for increased thromboembolic events in the setting of Coronavirus Disease 2019 (COVID-19). Cerebral venous sinus thrombosis (CVST) is a form of thromboembolism that has been observed as a neuro-ophthalmologic complication of COVID-19. METHODS Review of the scientific literature. RESULTS In this article, we report an overview of CVST epidemiology, clinical presentation, diagnostics, disease pathophysiology, and management in the setting of COVID-19. CONCLUSION CVST is an uncommon thromboembolic event with variable phenotypes and multiple etiologies. Neurologic complications can be severe, including significant visual deficits and death. Current observations suggest that the risk of CVST may be profoundly impacted by this novel COVID-19 pandemic, thus prompting increased attention to disease presentation, pathogenesis, and management.
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Affiliation(s)
- Chaitanya B Medicherla
- Department of Neurology (CM, RAP, SY, KI, JT), New York University Langone Medical Center, New York, New York; and Department of Neurology (AdH), University of Utah School of Medicine, Salt Lake City, Utah
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Ishida K. Reader response: Thrombolysis for acute ischemic stroke in the unwitnessed or extended therapeutic time window. Neurology 2020; 95:844-845. [DOI: 10.1212/wnl.0000000000010871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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44
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Sato Y, Uzui H, Aiki Y, Aoyama D, Yamaguchi J, Nodera M, Shiomi Y, Hasegawa K, Ikeda H, Tama N, Fukuoka Y, Morishita T, Ishida K, Miyazaki S, Tada H. Effects of PCSK9 inhibitor on adverse limb outcomes in patients with critical limb ischemia. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9-I), evolocumab, reduced the risk of cardiovascular event in patients with peripheral artery disease in FOURIER trial. However, the effects of evolocumab on favorable limb outcomes in patients with critical limb ischemia (CLI) is still unclear.
Purpose
The aim of this study was to evaluate the impacts of evolocumab on favorable limb outcomes and lipid profile in patients with CLI.
Methods
This was a single center, prospective observational study. A total of 39 patients with CLI were enrolled between November 2016 to May 2019. The subjects were divided into 2 groups based on evolocumab administration: evolocumab-treated group: E group (mean 69.4±11.7 years, n=14) and evolocumab non-treated group: Non-E group (mean 74.0±8.8 years, n=25). Baseline characteristics were assessed at admission. Lipid profile was evaluated at admission, 1, 3, 6, 12 and 18 months. The primary outcome was defined 18-month amputation-free survival (AFS). The secondary outcomes were defined 18-month overall survival (OS) and wound-free limb salvage. Mean follow-up period was 18±11 months.
Results
The patients in E group had greater reduction in levels of LDL cholesterol and non-HDL cholesterol than those in Non-E group over time. The reduction in MDA-LDL level was maintained at 1, 3, 6, 12 months, respectively. The 18-month AFS rate in the E-group was significantly higher than those in the Non-E group (log-rank p=0.02). The patients receiving evolocumab had a lower hazard regarding AFS (hazard ratio, 0.12; 95% confidence interval, 0.02–0.94; P=0.043) and a higher proportion of wound-free limb salvage at 12 months (E group [92%] vs Non-E group [57%], P=0.034) and 18 months (92% vs 52%, P=0.03). Otherwise, evolocumab administration was not associated with 18-month OS (log-rank p=0.053).
Conclusions
Evolocumab administration may be associated with the favorable outcome of 18-month AFS in the patients with CLI. Additionally, long-term administration of evolocumab over 12 months may improve wound-free limb salvage.
Effects of evolocumab on limb outcomes
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- Y Sato
- University of Fukui, Fukui, Japan
| | - H Uzui
- University of Fukui, Fukui, Japan
| | - Y Aiki
- University of Fukui, Fukui, Japan
| | - D Aoyama
- University of Fukui, Fukui, Japan
| | | | - M Nodera
- University of Fukui, Fukui, Japan
| | - Y Shiomi
- University of Fukui, Fukui, Japan
| | | | - H Ikeda
- University of Fukui, Fukui, Japan
| | - N Tama
- University of Fukui, Fukui, Japan
| | | | | | - K Ishida
- University of Fukui, Fukui, Japan
| | | | - H Tada
- University of Fukui, Fukui, Japan
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45
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Ishida K, Torres J, Yaghi S. Response by Ishida et al Regarding Article, "SARS-CoV-2 and Stroke in a New York Healthcare System". Stroke 2020; 51:e316-e317. [PMID: 33104484 DOI: 10.1161/strokeaha.120.031606] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Koto Ishida
- Department of Neurology, New York University School of Medicine
| | - Jose Torres
- Department of Neurology, New York University School of Medicine
| | - Shadi Yaghi
- Department of Neurology, New York University School of Medicine
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Zhou E, Lord A, Boehme A, Henninger N, de Havenon A, Vahidy F, Ishida K, Torres J, Mistry EA, Mac Grory B, Sheth KN, Gurol ME, Furie K, Elkind MSV, Yaghi S. Risk of Ischemic Stroke in Patients With Atrial Fibrillation After Extracranial Hemorrhage. Stroke 2020; 51:3592-3599. [PMID: 33028172 DOI: 10.1161/strokeaha.120.029959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Anticoagulation therapy not only reduces the risk of ischemic stroke in atrial fibrillation (AF) but also predisposes patients to hemorrhagic complications. There is limited knowledge on the risk of first-ever ischemic stroke in patients with AF after extracranial hemorrhage (ECH). METHODS We conducted a retrospective study using the California State Inpatient Database including all nonfederal hospital admissions in California from 2005 to 2011. The exposure variable was hospitalization with a diagnosis of ECH with a previous diagnosis of AF. The outcome variable was a subsequent hospitalization with acute ischemic stroke. We excluded patients with stroke before or at the time of ECH diagnosis. We calculated adjusted hazard ratios for ischemic stroke during follow-up and at 6-month intervals using Cox regression models adjusted for pertinent demographics and comorbidities. In subgroup analyses, subjects were stratified by primary ECH diagnosis, severity/type of ECH, age, CHA2DS2-VASc score, or the presence/absence of a gastrointestinal or genitourinary cancer. RESULTS We identified 764 257 patients with AF (mean age 75 years, 49% women) without a documented history of stroke. Of these, 98 647 (13%) had an ECH-associated hospitalization, and 22 748 patients (3%) developed an ischemic stroke during the study period. Compared to patients without ECH, subjects with ECH had ≈15% higher rate of ischemic stroke (overall adjusted hazard ratio, 1.15 [95% CI, 1.11-1.19]). The risk appeared to remain elevated for at least 18 months after the index ECH. In subgroup analyses, the risk was highest in subjects with a primary admission diagnosis of ECH, severe ECH, gastrointestinal-type ECH, with gastrointestinal or genitourinary cancer, and age ≥60 years. CONCLUSIONS Patients with AF hospitalized with ECH may have a slightly elevated risk for future ischemic stroke. Particular consideration should be given to the optimal balance between the benefits and risks of anticoagulation therapy and the use of nonanticoagulant alternatives, such as left atrial appendage closure in this vulnerable population.
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Affiliation(s)
- Eric Zhou
- NYU Grossman School of Medicine, New York, NY (E.Z.)
| | - Aaron Lord
- Department of Neurology, NYU Langone Health, New York, NY (A.L., K.I., J.T., S.Y.)
| | - Amelia Boehme
- Department of Neurology, Vagelos College of Physicians and Surgeons (A.B., M.S.V.E.), Columbia University, New York, NY
- Department of Epidemiology, Mailman School of Public Health (A.B., M.S.V.E.), Columbia University, New York, NY
| | - Nils Henninger
- Department of Neurology, University of Massachusetts Medical Center, Worcester (N.H.)
- Department of Psychiatry, University of Massachusetts, Worcester (N.H.)
| | - Adam de Havenon
- Departments of Neurology, University of Utah Medical Center, Salt Lake City (A.d.H.)
| | - Farhaan Vahidy
- Center for Outcomes Research, The Houston Methodist Neurological Institute, TX (F.V.)
| | - Koto Ishida
- Department of Neurology, NYU Langone Health, New York, NY (A.L., K.I., J.T., S.Y.)
| | - Jose Torres
- Department of Neurology, NYU Langone Health, New York, NY (A.L., K.I., J.T., S.Y.)
| | - Eva A Mistry
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN (E.A.M.)
| | - Brian Mac Grory
- Department of Neurology, Brown University, Providence, RI (B.M.G., K.F.)
| | - Kevin N Sheth
- Department of Neurology, Yale University, New Haven, CT (K.N.S.)
| | - M Edip Gurol
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (M.E.G.)
| | - Karen Furie
- Department of Neurology, Brown University, Providence, RI (B.M.G., K.F.)
| | - Mitchell S V Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons (A.B., M.S.V.E.), Columbia University, New York, NY
- Department of Epidemiology, Mailman School of Public Health (A.B., M.S.V.E.), Columbia University, New York, NY
| | - Shadi Yaghi
- Department of Neurology, NYU Langone Health, New York, NY (A.L., K.I., J.T., S.Y.)
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47
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Haynes J, Raz E, Tanweer O, Shapiro M, Esparza R, Zagzag D, Riina HA, Henderson C, Lillemoe K, Zhang C, Rostanski S, Yaghi S, Ishida K, Torres J, Mac Grory B, Nossek E. Endarterectomy for symptomatic internal carotid artery web. J Neurosurg 2020:1-8. [PMID: 32858515 DOI: 10.3171/2020.5.jns201107] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 05/18/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The carotid web (CW) is an underrecognized source of cryptogenic, embolic stroke in patients younger than 55 years of age, with up to 37% of these patients found to have CW on angiography. Currently, there are little data detailing the best treatment practices to reduce the risk of recurrent stroke in these patients. The authors describe their institutional surgical experience with patients treated via carotid endarterectomy (CEA) for a symptomatic internal carotid artery web. METHODS A retrospective, observational cohort study was performed including all patients presenting to the authors' institution with CW. All patients who were screened underwent either carotid artery stenting (CAS) or CEA after presentation with ischemic stroke from January 2019 to February 2020. From this sample, patients with suggestive radiological features and pathologically confirmed CW who underwent CEA were identified. Patient demographics, medical histories, radiological images, surgical results, and clinical outcomes were collected and described using descriptive statistics. RESULTS A total of 45 patients with symptomatic carotid lesions were treated at the authors' institution during the time period. Twenty patients underwent CAS, 1 of them for a CW. Twenty-five patients were treated via CEA, and of these, 6 presented with ischemic strokes ipsilateral to CWs, including 3 patients who presented with recurrent strokes. The mean patient age was 55 ± 12.6 years and 5 of 6 were women. CT angiography or digital subtraction angiography demonstrated the presence of CWs ipsilateral to the stroke in all patients. All patients underwent resection of CWs using CEA. There were no permanent procedural complications and no patients had stroke recurrence following intervention at the latest follow-up (mean 6.1 ± 4 months). One patient developed mild tongue deviation most likely related to retraction, with complete recovery at follow-up. CONCLUSIONS CEA is a safe and feasible treatment for symptomatic carotid webs and should be considered a viable alternative to CAS in this patient population.
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Affiliation(s)
- Joseph Haynes
- 1School of Medicine and Dentistry, University of Rochester, New York
| | - Eytan Raz
- 2Department of Radiology, Section of Neurointerventional Radiology
| | | | - Maksim Shapiro
- 2Department of Radiology, Section of Neurointerventional Radiology
| | | | - David Zagzag
- 4Department of Pathology, Section of Neuropathology, and
| | | | | | - Kaitlyn Lillemoe
- 5Department of Neurology, NYU Langone Health, New York, New York; and
| | - Cen Zhang
- 5Department of Neurology, NYU Langone Health, New York, New York; and
| | - Sara Rostanski
- 5Department of Neurology, NYU Langone Health, New York, New York; and
| | - Shadi Yaghi
- 5Department of Neurology, NYU Langone Health, New York, New York; and
| | - Koto Ishida
- 5Department of Neurology, NYU Langone Health, New York, New York; and
| | - Jose Torres
- 5Department of Neurology, NYU Langone Health, New York, New York; and
| | - Brian Mac Grory
- 6Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
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48
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Agarwal S, Huang J, Scher E, Farkas J, Arcot K, Gordon D, Turkel-Parrella D, Tiwari A, Liff J, Yaghi S, Dehkharghani S, Ishida K, Riina H, Frontera JA. Mechanical Thrombectomy in Nonagenarians: A Propensity Score Matched Analysis. J Stroke Cerebrovasc Dis 2020; 29:104870. [DOI: 10.1016/j.jstrokecerebrovasdis.2020.104870] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 04/02/2020] [Accepted: 04/05/2020] [Indexed: 12/20/2022] Open
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49
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Snyder T, Agarwal S, Huang J, Ishida K, Flusty B, Frontera J, Lord A, Torres J, Zhang C, Rostanski S, Favate A, Lillemoe K, Sanger M, Kim S, Humbert K, Scher E, Dehkharghani S, Raz E, Shapiro M, K Nelson P, Gordon D, Tanweer O, Nossek E, Farkas J, Liff J, Turkel‐Parrella D, Tiwari A, Riina H, Yaghi S. Stroke Treatment Delay Limits Outcome After Mechanical Thrombectomy: Stratification by Arrival Time and ASPECTS. J Neuroimaging 2020; 30:625-630. [DOI: 10.1111/jon.12729] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Thomas Snyder
- Department of Neurology New York Langone Medical Center New York NY
| | - Shashank Agarwal
- Department of Neurology New York Langone Medical Center New York NY
| | - Jeffrey Huang
- Department of Radiology New York Langone Medical Center New York NY
| | - Koto Ishida
- Department of Neurology New York Langone Medical Center New York NY
| | - Brent Flusty
- Department of Neurology New York Langone Medical Center New York NY
| | | | - Aaron Lord
- Department of Neurology New York Langone Medical Center New York NY
| | - Jose Torres
- Department of Neurology New York Langone Medical Center New York NY
| | - Cen Zhang
- Department of Neurology New York Langone Medical Center New York NY
| | - Sara Rostanski
- Department of Neurology New York Langone Medical Center New York NY
| | - Albert Favate
- Department of Neurology New York Langone Medical Center New York NY
| | - Kaitlyn Lillemoe
- Department of Neurology New York Langone Medical Center New York NY
| | - Matthew Sanger
- Department of Neurology New York Langone Medical Center New York NY
| | - Sun Kim
- Department of Neurology New York Langone Medical Center New York NY
| | - Kelley Humbert
- Department of Neurology New York Langone Medical Center New York NY
| | - Erica Scher
- Department of Neurology New York Langone Medical Center New York NY
| | | | - Eytan Raz
- Department of Radiology New York Langone Medical Center New York NY
| | - Maksim Shapiro
- Department of Radiology New York Langone Medical Center New York NY
| | - Peter K Nelson
- Department of Radiology New York Langone Medical Center New York NY
| | - David Gordon
- Department of Neurosurgery New York Langone Medical Center New York NY
| | - Omar Tanweer
- Department of Neurosurgery New York Langone Medical Center New York NY
| | - Erez Nossek
- Department of Neurosurgery New York Langone Medical Center New York NY
| | - Jeffrey Farkas
- Department of Neurology New York Langone Medical Center New York NY
- Department of Radiology New York Langone Medical Center New York NY
| | - Jeremy Liff
- Department of Neurology New York Langone Medical Center New York NY
| | | | - Ambooj Tiwari
- Department of Neurology New York Langone Medical Center New York NY
| | - Howard Riina
- Department of Neurosurgery New York Langone Medical Center New York NY
| | - Shadi Yaghi
- Department of Neurology New York Langone Medical Center New York NY
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50
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Agarwal S, Scher E, Rossan-Raghunath N, Marolia D, Butnar M, Torres J, Zhang C, Kim S, Sanger M, Humbert K, Tanweer O, Shapiro M, Raz E, Nossek E, Nelson PK, Riina HA, de Havenon A, Wachs M, Farkas J, Tiwari A, Arcot K, Parella DT, Liff J, Wu T, Wittman I, Caldwell R, Frontera J, Lord A, Ishida K, Yaghi S. Acute stroke care in a New York City comprehensive stroke center during the COVID-19 pandemic. J Stroke Cerebrovasc Dis 2020; 29:105068. [PMID: 32807471 PMCID: PMC7305900 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105068] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/10/2020] [Accepted: 06/15/2020] [Indexed: 11/30/2022] Open
Abstract
Background and Purpose The coronavirus disease-2019 (COVID-19) pandemic caused unprecedented demand and burden on emergency health care services in New York City. We aim to describe our experience providing acute stroke care at a comprehensive stroke center (CSC) and the impact of the pandemic on the quality of care for patients presenting with acute ischemic stroke (AIS). Methods We retrospectively analyzed data from a quality improvement registry of consecutive AIS patients at New York University Langone Health's CSC between 06/01/2019-05/15/2020. During the early stages of the pandemic, the acute stroke process was modified to incorporate COVID-19 screening, testing, and other precautionary measures. We compared stroke quality metrics including treatment times and discharge outcomes of AIS patients during the pandemic (03/012020-05/152020) compared with a historical pre-pandemic group (6/1/2019-2/29/2020). Results A total of 754 patients (pandemic-120; pre-pandemic-634) were admitted with a principal diagnosis of AIS; 198 (26.3%) received alteplase and/or mechanical thrombectomy. Despite longer median door to head CT times (16 vs 12 minutes; p = 0.05) and a trend towards longer door to groin puncture times (79.5 vs. 71 min, p = 0.06), the time to alteplase administration (36 vs 35 min; p = 0.83), door to reperfusion times (103 vs 97 min, p = 0.18) and defect-free care (95.2% vs 94.7%; p = 0.84) were similar in the pandemic and pre-pandemic groups. Successful recanalization rates (TICI≥2b) were also similar (82.6% vs. 86.7%, p = 0.48). After adjusting for stroke severity, age and a prior history of transient ischemic attack/stroke, pandemic patients had increased discharge mortality (adjusted OR 2.90 95% CI 1.77 – 7.17, p = 0.021) Conclusion Despite unprecedented demands on emergency healthcare services, early multidisciplinary efforts to adapt the acute stroke treatment process resulted in keeping the stroke quality time metrics close to pre-pandemic levels. Future studies will be needed with a larger cohort comparing discharge and long-term outcomes between pre-pandemic and pandemic AIS patients.
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Affiliation(s)
- Shashank Agarwal
- Department of Neurology, New York Langone Health, New York, NY, United States.
| | - Erica Scher
- Department of Neurology, New York Langone Health, New York, NY, United States.
| | | | - Dilshad Marolia
- Department of Neurology, New York Langone Health, New York, NY, United States.
| | - Mariya Butnar
- Department of Neurology, New York Langone Health, New York, NY, United States.
| | - Jose Torres
- Department of Neurology, New York Langone Health, New York, NY, United States.
| | - Cen Zhang
- Department of Neurology, New York Langone Health, New York, NY, United States.
| | - Sun Kim
- Department of Neurology, New York Langone Health, New York, NY, United States.
| | - Matthew Sanger
- Department of Neurology, New York Langone Health, New York, NY, United States.
| | - Kelley Humbert
- Department of Neurology, New York Langone Health, New York, NY, United States.
| | - Omar Tanweer
- Department of Neurosurgery, New York Langone Health, New York, NY, United States.
| | - Maksim Shapiro
- Department of Radiology, New York Langone Health, New York, NY, United States.
| | - Eytan Raz
- Department of Radiology, New York Langone Health, New York, NY, United States.
| | - Erez Nossek
- Department of Neurosurgery, New York Langone Health, New York, NY, United States.
| | - Peter K Nelson
- Department of Radiology, New York Langone Health, New York, NY, United States.
| | - Howard A Riina
- Department of Neurosurgery, New York Langone Health, New York, NY, United States.
| | - Adam de Havenon
- Department of Neurology, University of Utah, Salt Lake City, UT, United States.
| | - Michael Wachs
- Department of Neurology, New York Langone Health, New York, NY, United States.
| | - Jeffrey Farkas
- Department of Neurology, New York Langone Health, New York, NY, United States.
| | - Ambooj Tiwari
- Department of Neurology, New York Langone Health, New York, NY, United States.
| | - Karthikeyan Arcot
- Department of Neurology, New York Langone Health, New York, NY, United States.
| | | | - Jeremy Liff
- Department of Neurology, New York Langone Health, New York, NY, United States.
| | - Tina Wu
- Department of Emergency Medicine, New York Langone Health, New York, NY, United States.
| | - Ian Wittman
- Department of Emergency Medicine, New York Langone Health, New York, NY, United States.
| | - Reed Caldwell
- Department of Emergency Medicine, New York Langone Health, New York, NY, United States.
| | - Jennifer Frontera
- Department of Neurology, New York Langone Health, New York, NY, United States.
| | - Aaron Lord
- Department of Neurology, New York Langone Health, New York, NY, United States.
| | - Koto Ishida
- Department of Neurology, New York Langone Health, New York, NY, United States.
| | - Shadi Yaghi
- Department of Neurology, New York Langone Health, New York, NY, United States.
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