Impact of smoking on one year functional outcomes after thrombectomy for young stroke patients

BACKGROUND

The incidence of stroke in young patients (20-50 years old) has increased in recent decades. Unlike the use of good functional outcomes to evaluate prognosis, excellent functional outcomes are a better indicator of return to work among younger patients. The rate of return to work increases with time after stroke. This study investigated the short term (3 months) and long term (1 year) predictors of excellent functional outcomes in young patients after endovascular thrombectomy (EVT).

METHODS

We included young patients who underwent EVT for acute ischemic stroke (AIS) due to large vessel occlusion within 6 hours after stroke onset between 2015 and 2021. Patients with intracerebral hemorrhage on pretreatment CT were excluded. The associations between clinical, imaging, and procedure variables, and excellent functional outcomes were analyzed using univariate and multivariable logistic regression analyses. An excellent functional outcome was defined as a modified Rankin Scale score of ≤1.

RESULTS

Of the 361 patients with AIS eligible for EVT, 55 young patients (aged 24-50 years) were included. Of these, 36.4% and 41.8% achieved excellent functional outcomes at 3 and 12 months, respectively. Multivariate analysis revealed that smoking was the independent negative predictor of both 3 month (adjusted OR (aOR) 0.232, 95% CI 0.058 to 0.928; p=0.039) and 12 month (aOR 0.180, 95% CI 0.044 to 0.741; p=0.018) excellent functional outcomes.

CONCLUSIONS

Current or former smoking habit was an independent negative predictor of both short term and long term excellent functional outcomes in young adults with AIS.

Mechanical analysis of the improved superelastic Ni-Ti alloy wire using the orthodontic simulator with high-precision sensors

PURPOSE

The authors have been using improved superelastic Nickel-Titanium alloy wire (ISW) to close and align extraction spaces simultaneously, instead of separately using rigid wires for closing extraction spaces and Ni-Ti alloy wires for leveling and aligning. ISW has a low stiffness, which makes it challenging to generate sufficient moments. This study aimed to demonstrate the forces and moments exerted on adjacent brackets using an orthodontic simulator (OSIM) attached to a high-precision 6-axis sensor.

MATERIALS AND METHODS

In experiment 1, a 0.016 × 0.022-inch ISW, stainless steel (SS) wire, and β-titanium wires were ligatured into the two brackets. The 0.018 × 0.025-inch slot self-ligating brackets were bonded to two simulated teeth at the same height, and the experiment was conducted using the high-precision OSIM. The distance between the brackets was 10 mm, the V-bend angles of the installed wires were 10°, 20°, 30°, and 40°, and the apex position was set at the center of the bracket. In experiment 2, 6.0- and 9.0-mm long elastomeric chains were placed on the same brackets as in Experiment 1 to measure forces and moments. The distance between the brackets was increased by 1.0 mm from 6.0 to 15.0 mm. Both experiments were conducted in a 37 °C thermostatic chamber similar to the oral environment.

RESULTS AND DISCUSSION

In experiment 1, we measured moments on both sides for all the wires. As the V-bend angle increased, the absolute values of the moments also increased. With a V-bend angle of 10°, there was a significant (p < 0.05) difference in the moment generated in the left and right brackets among the three wire types. In the ISW, -1.67 ± 0.38 N・mm was generated in the left bracket, while 0.38 ± 0.26 N・mm was generated in the right bracket at 10°. At 20°, -1.77 ± 0.69 N・mm was generated in the left bracket, while 2.37 ± 0.94 N・mm was generated in the right bracket. At 30°, -2.98 ± 0.49 N・mm was generated in the left bracket, while 3.25 ± 0.32 N・mm was generated in the right bracket. Moreover, at 40°, -3.96 ± 0.58 N・mm was generated in the left bracket, while 3.55 ± 0.53 N・mm was generated in the right bracket. Furthermore, in experiment 2, the moments increased in proportion to the increase in distance between the centers of the two brackets. Absolute values of the moments were approximately equal for the left and right brackets. The 6.0-mm elastomeric chain generated a minimum force of -0.09 ± 0.05 N in the left direction when the distance between brackets was 6.0 mm, while a maximum of 1.24 ± 0.3 N when the distance between brackets was 12 mm in the right bracket. In the left bracket, minimum and maximum forces of -0.09 ± 0.07 and 1.3 ± 0.4 N were generated in the right direction, respectively. The 9.0-mm elastomeric chain generated a minimum force of 0.03 ± 0.07 N in the left direction when the distance between brackets was 9.0 mm, while a maximum of 1.3 ± 0.1 N when the distance between brackets was 15 mm in the right bracket. In the left bracket, minimum and maximum forces of 0.05 ± 0.06 and 0.98 ± 0.2 N were generated in the right direction, respectively.

CONCLUSION

Mechanical data of the ISW have been collected in the study, which was previously difficult to perform owing to the low stiffness of the wire. It is suggested that the ISW can provide sufficient moments with the addition of V-bends to close the space by bodily movement.

Predictors of 30-day mortality after endovascular thrombectomy for large vessel occlusion in the elderly

OBJECTIVES

Elderly acute ischemic stroke (AIS) patients (≥80 years) would have dismal clinical outcomes even after successful endovascular revascularization for large vessel occlusion (LVO) in the anterior circulation. We aimed to identify predictors of 30-day mortality after endovascular thrombectomy (EVT) in the elderly.

MATERIALS AND METHODS

We included older patients who underwent EVT for AIS due to LVO within 6 h after stroke onset in the anterior circulation between 2017 and 2019. Patients due to posterior circulation stroke, with intracerebral hemorrhage (ICH) or pre-stroke modified Rankin Scale (mRS) score of 4 and 5 were excluded. The primary outcome was mortality within 30 days of EVT. The association between clinical, imaging, procedural, follow-up imaging and mortality were analyzed. Successful reperfusion was defined as modified Thrombolysis in Cerebral Infarction (mTICI) score of 2b or 3. Possible predictors of 30-day mortality were assessed by univariate and multivariable logistic regression.

RESULTS

Total 238 AIS patients eligible for EVT were identified with 58 patients aged 80 years or more. 48 patients met inclusion criteria. Median age was 86 years (age range, 82-102 years). Successful reperfusion was achieved in 38 (79.2%) patients. The 30-day and 90-day mortality rate were 25% and 33.3%, respectively. The independent predictors of 30-day mortality were collateral scores <3 on mCTA (adjusted OR, 16.571; 95% CI, 1.041-263.868; p = 0.047) and number of passes (adjusted OR, 2.475; 95% CI, 1.047-5.847; p = 0.039).

CONCLUSIONS

Lower collateral scores on mCTA and higher number of passes in thrombectomy were independently predictive of 30-day mortality in the elderly.

[Correlation analysis between lactic, procalcitonin and disease severity in patients with imported malaria from Africa]

Objective: To explore the clinical characteristics, the correlation between lactate, procalcitonin and disease severity of imported malaria from Africa. Methods: The clinical data of 186 patients with imported malaria were collected from January 1, 2018 to April 30, 2021 in the Guangzhou Eighth People's Hospital, Guangzhou Medical University. The general conditions, clinical symptoms, laboratory tests, treatment, and prognosis of the patients were analyzed retrospectively. Receiver operating characteristic (ROC) curves were drawn to evaluate the value of relevant indicators in predicting severe malaria. Results: A total of 186 patients were divided into severe cases (n=48) and non-severe cases (n=138) in this study, of which the mean age was (38.3±10.3) years, 169(90.9%) cases were male, 17(9.1%) cases were female. The main infection species was Plasmodium falciparum, in a total of 166 cases (89.2%). The severe cases were all falciparum malarias. Compared with the non-severe group, the lactic, procalcitonin, white blood cell count and neutrophil count of the severe group were all increased, the differences were all statistically significant (all P<0.01); the percentage of monocytes, red blood cell count, hemoglobin, hematocrit and platelet count were all decreased, the difference were all statistically significant (all P<0.01). The areas under the ROC curves (AUC)(95%CI) of lactate, procalcitonin, red blood cell count, hemoglobin, hematocrit and platelet count for predicting severe malaria was 0.753(0.663-0.844), 0.755(0.670-0.841), 0.782(0.700-0.864), 0.738(0.652-0.823), 0.760(0.676-0.844), 0.778(0.699-0.857), respectively (all P<0.01). When the Youden indexes were at their maximum, the best cut-off value of lactic was 2.29 mmol/L, with sensitivity in predicting of severe malaria was 56.3%, and the specificity was 93.5%; the best cut-off value of procalcitonin was 2.12 μg/L, with sensitivity in predicting of severe malaria was 77.1%, and the specificity was 68.1%. The fatality rate of severe malaria was 4.2% (2/48). Conclusions: Anemia and thrombocytopenia are common indicators for predicting the severity of malaria. Lactic and procalcitonin also have higher predictive value for severe malaria, which could help to identify severe malaria as early as possible, improve the cure rate and reduce the risk of death.

Post-orthodontic recontouring of anterior teeth using composite injection technique with a digital workflow

OBJECTIVE

Restorative treatment of anterior teeth is often required as the final step of orthodontic therapy to optimize the esthetics and function. This case report presents a direct minimally invasive approach for post-orthodontic recontouring of anterior teeth using the composite injection technique with a digital workflow.

CLINICAL CONSIDERATIONS

The extraction of central incisors with short roots was indicated to resolve maxillary anterior crowding. The gained space was closed with lateral incisors, and it was necessary to recontour them and canines to resemble central and lateral incisors, respectively. The restorations were digitally designed, and a transparent silicone index was fabricated from a 3D-printed cast of the digital wax-up. After lateral incisors and canines were bonded with a universal adhesive in the etch-and-rinse mode, a highly filled injectable composite resin was applied into the index. The restorative treatment was preceded by gingivectomy using an Er:YAG laser and home bleaching.

CONCLUSIONS

In cases where more complex recontouring of anterior teeth is necessary, the composite injection technique could be a suitable alternative to indirect restorations, because it is straightforward, cost-effective, and does not require any preparation. The digital workflow simplified and expedited the treatment while contributing to its precision.

CLINICAL SIGNIFICANCE

Post-orthodontic recontouring using direct composite restorations is well accepted by patients due to low cost and non-invasiveness. However, in complicated cases, the free-hand technique is time-consuming and technique-sensitive. The presented composite injection technique with a digital workflow significantly simplifies and expedites the composite placement while predictably enhancing the treatment outcome.

Nonbifurcating Carotid Artery: A Case Report with a Review of Embryogenesis

Patient: Male, 66

Final Diagnosis: Nonbifurcating carotid artery

Symptoms: No symptoms

Medication: —

Clinical Procedure: —

Specialty: Neurology

Development of 6-Axis Orthodontic Force and Moment Sensing Device for Decreasing Accident of Orthodontic Treatment. Annu Int Conf IEEE Eng Med Biol Soc 2018;2018:1797-1800. [PMID: 30440743 DOI: 10.1109/embc.2018.8512648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

The purpose of this study is to develop the sensing device which measures three-axis force and three-axis moment for reducing the number of accident in orthodontic treatment. The device is necessary for adequate quantitative evaluation of orthodontic forces during orthodontics. The developed sensing device is composed of six-axis force sensors, tooth models, and arms for connecting sensors and tooth models. The developed device simulates rows of teeth in orthodontic operation and measures $14 \times 6$ axes force and moment from tooth models simultaneously. The averages of the difference of force and moment to theoretical values in each direction are 1.78 % (0.043 N) and 2.72 % (0.60 Nmm) respectively. The average moment applying couple forces is 17.1 % (0.81 Nmm). Then the device is able to measure more accurately as the value of the moment was larger. Therefore using our proposed device, we can conduct the orthodontic treatment which dentition moves large for attaching the rail of wire to the teeth.

Cognitive MRI-TRUS fusion-targeted prostate biopsy according to PI-RADS classification in patients with prior negative systematic biopsy results

BACKGROUND

The purpose of this study was to evaluate the prostate cancer yield rate of targeted transrectal ultrasound (TRUS)-guided biopsy with cognitive magnetic resonance imaging (MRI) registration without concurrent systematic biopsy in patients with previous negative systematic TRUS-guided biopsy results and persistently elevated prostate-specific antigen (PSA) levels.

METHODS

In this prospective study conducted from August 2013 to January 2015, patients with at least one previous negative systematic TRUS-guided biopsy and persistently high PSA (≥4 ng/mL) levels were referred for multiparametric MRI (mpMRI). Those patients with suspicious findings on mpMRI received a subsequent cognitive MRI-TRUS fusion biopsy. The cancer-detection rate, tumor location, and Gleason score were confirmed, and PSA-related data were compared between cancer-yield and noncancer-yield groups.

RESULTS

In total, 48 patients were included in this study. MRI was designated to be four and five in 17 patients. Fifteen patients received a cognitive fusion-targeted biopsy, and prostate cancers were detected in 10 patients. The cancer-detection rate was 20.8% (10/48), and the positive-predictive value of MRI was 66.7%. No significant differences were observed in the PSA level, PSA velocity, or transitional zone volume between the cancer-yield and noncancer-yield groups; however, the corresponding difference in PSA transitional zone density was significant (p=0.025).

CONCLUSION

Cognitive MRI-TRUS fusion-targeted biopsy without concurrent systematic biopsy can detect significant prostate cancer in patients with previous negative systematic biopsy results and persistently elevated PSA levels. Noncancer-yield patients should undergo active surveillance and further follow-ups.

The Effectiveness of ART Score in Selecting Patients for Transarterial Chemoembolization Retreatment: A Cohort Study in Taiwan

The major issue in selecting patients for transarterial chemoembolization (TACE) lies in determining the optimal number of TACE sessions that may benefit patients before switching to other therapies. This is often a subjective decision not based on any standardized protocol. The ART (Assessment for Retreatment with Transarterial chemoembolization) score was recently developed to determine patients who may benefit from multiple sessions of TACE for treatment of hepatocellular carcinoma. The primary aim of the study was to validate the ART score in a Taiwanese cohort. The secondary aims were to evaluate overall survival and clinical determinants of improved survival in patients treated with multiple TACE sessions. The ART score, clinical characteristics, and outcomes of 82 patients with hepatocellular carcinoma who received multiple TACE sessions at Taipei Veterans General Hospital from September 2007 to July 2013 were analyzed. Among the 82 patients evaluated, 69.5% (n = 57) had an ART score of 0 to 1.5 and 34.1% (n = 25) had a score of ≥2.5. The median overall survival was 23.1 months and the overall mortality rate was 62.2% (n = 51). The ART score was not associated with survival (P = 0.58). Multivariate Cox regression analysis revealed that tumor size >7.2 cm (hazard ratio 4.44, P < 0.001), aspartate transaminase (AST) level above 95 IU/L (hazard ratio 2.18, P = 0.02), AST increase more than 25% (hazard ratio 2.13, P = 0.02), 2nd/1st (pre-TACE) alpha-fetoprotein ratio (hazard ratio 1.40, P = 0.001), and lack of radiological response to TACE (hazard ratio 2.21, P = 0.02) were independent clinical determinants of survival. The ART score was not found to be effective in selecting patients for TACE retreatment in our Taiwanese cohort. Large tumor size, high AST level, high 2nd/1st (pre-TACE) alpha-fetoprotein ratio, AST increase >25%, and lack of radiological response to TACE were independently associated with shorter survival after TACE therapy.

Percutaneous computed tomography-guided cryoablation for renal tumor: Experience in 30 cases

BACKGROUND

Percutaneous cryoablation is a minimally invasive alternative for surgical resection of a renal tumor. We report our experience with applying computed tomography-guided cryoablation in renal tumors, focusing on the technique, safety, and treatment response.

METHODS

We retrospectively reviewed the medical records of patients who received cryoablation from October 2009 to August 2013 for renal tumor diagnosed by imaging studies performed at Taipei Veterans General Hospital, Taipei, Taiwan. Patient comorbidities and tumor morphology, technical success rate, tumor control rate, renal function change, and complications were recorded.

RESULTS

A total of 30 patients (32 tumors) were treated, comprising 30 renal cell carcinomas and two angiomyolipomas. The mean age of the patients was 73.7 years (range, 34-89 years). The patients were referred for percutaneous cryoablation arising from old age, medical comorbidities, or preexisting malignancy. The mean follow-up period was 15.2 months (range, from 32 days to 47.4 months). According to the Clavien-Dindo classification, surgical complications included one Grade III, four Grade II, and two Grade I complications. The mean decrease in hemoglobin was 0.77 g/dL (range, from +1.1 g/dL to -3 g/dL). The mean hospital stay after cryoablation was 2.2 days (range, 1-10 days). Incomplete ablation was noted in two patients and local tumor recurrence in two patients. One of them received repeated cryoablation and achieved successful local control. Of the 22 renal cell carcinoma patients with follow-up period > 6 months, 19 patients achieved successful local tumor control (86.4%). The percentage change of glomerular filtration rate before and 3-6 months after the procedure was +1.9%, which was statistically nonsignificant (p = 0.94).

CONCLUSION

Computed tomography-guided percutaneous cryoablation is a safe and effective technique for treating renal tumors with excellent renal function preservation.

Multi-mJ, 200-fs, cw-pumped, cryogenically cooled, Yb,Na:CaF2 amplifier

Using a novel (to our knowledge) broadband Yb-doped Yb3+,Na+:CaF2 crystal cooled in a closed loop to 130 K we demonstrate a chirped pulse regenerative laser amplifier delivering the energy of up to 3 mJ at a repetition rate of 1 kHz and an average output power of 6 W at 20 kHz. The gain narrowing in the laser crystal is compensated by shaping the amplitude of the seed pulse spectrum. As the result, at the highest amplified pulse energy we obtain a 12 nm FWHM bandwidth supporting a 130 fs pulse duration, assuming ideal compression. Amplified pulses were recompressed from 250 ps to 195 fs with a 1700 lines/mm transmission grating compressor.

Generation of radially polarized beam with a segmented spiral varying retarder

We convert a linearly polarized Gaussian beam into a radially polarized doughnut beam with an eight-segment spirally varying retarder (SVR) at wavelength of 808 nm. The SVR is designed based on the linear birefringence of alpha-barium borate (alpha-BBO) crystal and fabricated using a dry etching process. Radially polarized light of high purity (> 96% at far-field distribution) was generated experimentally using the segmented SVR positioned between two quarter waveplates with orthogonal slow axes. The emergent polarization can be switched between radially and azimuthally polarized cylindrical vector beams with a pair of half-wave plates.

Fast switchable electro-optic radial polarization retarder

A fast and switchable electro-optic radial polarization retarder (EO-RPR) fabricated using the electro-optic ceramic Pb(Mg(1/3)Nb(2/3))O(3)-PbTiO(3) is presented. This EO-RPR is useful for fast and switchable generation of a pure cylindrical vector beam. When used together with a pair of half-wave plates, the EO-RPR can change circularly polarized light into any cylindrical vector beam of interest, such as radially or azimuthally polarized light. Radially and azimuthally polarized light with purities greater than 95% are generated experimentally. The advantages of using EO-RPR include fast response time, low driving voltage, and transparency in a wide spectral range (500 to 7,000 nm).

Simple coherent polarization manipulation scheme for generating high power radially polarized beam

We present a simple novel scheme that converts a Gaussian beam into an approximated radially polarized beam using coherent polarization manipulation together with Poynting walk-off in birefringent crystals. Our scheme alleviates the interferometric stability required by previous schemes that implemented this coherent mode summation using Mach-Zehnder-like interferometers. A symmetrical arrangement of two walk-off crystals with a half-wave plate, allows coherence control even when the laser has short temporal coherence length. We generated 14 watts of radially polarized beam from an Ytterbium fiber laser, only limited by the available fiber laser power.

Mimicking optical activity for generating radially polarized light

We propose a new scheme for generating radially polarized light by mimicking optical activity using linear birefringence. It involves a birefringent spirally varying retarder sandwiched between two orthogonally oriented quarter-wave plates. Using Poincaré sphere representation, we show that the polarization transformation of such a scheme is equivalent to that of a spirally varying optical activity and is capable of generating radially polarized light. We demonstrate the proof-of-concept using y-cut crystalline quartz.

Bidirectional optical bistability in a dual-pumped erbium doped fiber ring laser

We investigate bidirectional optical wave propagations in a dual-pumped erbium doped fiber ring laser without isolator, and observe optical bistability behaviors. Consequently, we propose and construct a NOLM-NALM fiber ring laser to demonstrate and exploit this bidirectional optical bistability phenomenon in optical switching by introducing two tunable variable ratio couplers in the system. Numerical analyses based on the proposed laser structure have also been demonstrated corroborated with the experimental results.